Recommendation 10: All adolescents should receive health guidance annually to promote avoidance of tobacco, alcohol, and other abusable substances, and anabolic steroids.


GAPS includes recommendations for the screening of biomedical, behavioral, and emotional conditions. Some GAPS recommendations lead to a definitive diagnosis (e.g., cervical culture in females to diagnose gonorrhea). Other recommendations lead to a presumptive diagnosis (e.g., urine test for leukocyte esterase in males to screen for gonorrhea or asking about use of alcohol or other drugs during the past six months to screen for substance use) that must be confirmed with additional assessment. Physicians can use information from the initial screening to decide whether to continue the assessment themselves or to refer the adolescent elsewhere. Health risk behaviors may, in some adolescents, be interrelated and co-occur. Adolescents who are found to engage in one health risk behavior, therefore, should be asked about involvement in others.

Recommendation 11: All adolescents should be screened annually for hypertension according to the protocol developed by the National Heart, Lung, and Blood Institute Second Task Force on Blood Pressure Control in Children.

  • Adolescents with either systolic or diastolic pressures at or above the 90th percentile for gender and age should have blood pressure (BP) measurements repeated at three different times within one month, under similar physical conditions, to confirm baseline values.

  • Adolescents with baseline BP values greater than the 95th percentile for gender and age should have a complete biomedical evaluation to establish treatment options. Adolescents with BP values between the 90th and 95th percentiles should be assessed for obesity and their blood pressure monitored every six months.

Recommendation 12: Selected adolescents should be screened to determine their risk of developing hyperlipidemia and adult coronary heart disease, following the protocol developed by the Expert Panel on Blood Cholesterol Levels in Children and Adolescents.

  • Adolescents whose parents have a serum cholesterol level greater than 240 mg/dl and adolescents who are over 19 years of age should be screened for total blood cholesterol level (nonfasting) at least once.

  • Adolescents with an unknown family history or who have multiple

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