• there is a family history of premature heart disease, obesity, hypertension, or diabetes mellitus;

  • they express concern about their weight;

  • they have elevated serum cholesterol levels or blood pressure.

If this assessment is negative, these adolescents should be provided general dietary and exercise counseling and should be monitored annually.

Recommendation 14: All adolescents should be asked annually about their use of tobacco products, including cigarettes and smokeless tobacco.

  • Adolescents who use tobacco products should be assessed further to determine their patterns of use.

  • A cessation plan should be provided for adolescents who use tobacco products.

Recommendation 15: All adolescents should be asked annually about their use of alcohol and other abusable substances and about their use of over-the-counter or prescription drugs for nonmedical purposes, including anabolic steroids.

  • Adolescents who report any use of alcohol or other drugs or inappropriate use of medicines during the past year should be assessed further regarding family history; circumstances surrounding use; amount and frequency of use; attitudes and motivation about use; use of drugs; and the adequacy of physical, psychosocial, and school functioning.

  • Adolescents whose substance use endangers their health should receive counseling and mental health treatment, as appropriate.

  • Adolescents who use anabolic steroids should be counseled to stop.

  • The use of urine toxicology for the routine screening of adolescents is not recommended.

  • Adolescents who use alcohol and other drugs should also be asked about their sexual behavior and their use of birth control products.

Recommendation 16: All adolescents should be asked annually about involvement in sexual behaviors that may result in unintended pregnancy and STDs, including HIV infection.

  • Sexually active adolescents should be asked about their use and motivation to use condoms and contraceptive methods, their sexual orientation, the number of sexual partners they have had in the past six

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