persist into the early twenties. The average age of the onset of puberty has declined over the last century, occurring by age 10 for many children, while neuroscience has established that cognitive development is not complete until the early twenties. At the same time, as the world has become more complex, the social concept of adolescence is extending into what was once considered adulthood, and young people are assuming adult roles and responsibilities later. Such changes have challenged researchers and practitioners to sustain a coherent conceptual picture of adolescence.

To highlight the need, Blum took note of two contrasting models of care: one focused on children, and the other on adults. In a pediatric approach to medicine, the parent is the responsible agent and the focus is on nurturing the patient in a family context. In an adult-centered approach, the patient is the responsible agent; the provider offers information with which the patient makes decisions, and the focus is on the individual, not the family.2 The treatment of adolescents does not fit either model well, and their needs change as they progress through this stage. Despite the complexity of this stage of life, the significant developmental and cognitive changes it encompasses, and the important implications of adolescent health and behavior patterns for adult health status, adolescence is the subject of less research than any other age group, Jonathan Klein (University of Rochester Medical Center) pointed out. Perhaps as a result, while some practitioners specialize in caring for adolescents, their numbers are few—less than 1 percent of primary care physicians who may see adolescents are board-certified specialists in adolescent medicine, according to data from the American Board of Medical Specialties supplied by Klein.


Regardless of the boundaries of adolescence, however, a variety of health issues affect this group, according to MacKay, who provided an overview of trends in adolescent health. The good news is that mortality rates for adolescents ages 15 through 19, both from injury and from all other causes, declined between 1980 and 2004, according to the CDC’s National Vital Statistics System. Currently, the rate of death from all causes for this age group is approximately 65 per 100,000. Nevertheless, adolescence is a much more dangerous phase of life than childhood. Despite the improved mortality rates, three major threats to adolescents’


A third model of care is offered by family medicine, in which the family—including children, adolescents, and adults—is the focus of care for a family physician or family nurse practitioner.

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