adolescents report nontraditional sites, such as school-based health centers, hospital emergency departments, or family planning centers, as their usual source of care (about 1 percent in each category).

As adolescent males grow older, their annual visits to health care providers decline significantly. The sharpest decrease occurs at age 18, a time when many adolescents age out of insurance, both public and private. Older adolescent females show much less of a decline in annual health care visits.

MISSED OPPORTUNITIES FOR PREVENTION AND HEALTH PROMOTION AMONG ADOLESCENTS

As reviewed in Chapter 2, more than 70 percent of all deaths among adolescents aged 10–19 can be attributed to three causes: unintentional injuries (including motor vehicle crashes), homicides, and suicide (National Center for Injury Prevention and Control, 2007). Furthermore, unhealthful habits and risky behaviors that are initiated in adolescence extend into adulthood and contribute directly to poor health conditions and significant morbidity and mortality in the short and long terms (Kolbe, Kann, and Collins, 1993). In one national survey, for example, 78 percent of adolescents had not eaten five or more servings of fruits and vegetables a day during the week preceding the survey, 33 percent had not participated in a sufficient amount of physical activity, and 14 percent were overweight. Moreover, 22 percent of high school students had smoked cigarettes in the month preceding the survey (Grunbaum et al., 2004). There is a need, then, for adolescent health services focused on prevention and health promotion.

Current Status of Prevention and Health Promotion Services for Adolescents

Standardized screening instruments, structured tools, and professional guidelines are available to address risky adolescent behaviors, as is discussed in more detail in Chapter 4. Despite the availability of these resources, studies have shown that practitioners fail to provide the recommended screening, counseling, and health education services. Health personnel frequently rely on adolescents or their parents to initiate discussions of health concerns that may involve the use of alcohol, tobacco, or other substances; risky sexual practices; or other problematic behaviors. The frequent practice in some domains, such as mental health, is simply to ask whether there are any general areas of concern during annual health maintenance visits or routine physical examinations or to use specific trigger questions around a particular topic (Olson et al., 2001). This lack of communication about high-risk issues may be especially problematic for adolescents who are



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