Challenges in Adolescent Health Care Workshop Report (2007) / Chapter Skim
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2 Overview of Adolescent Health Issues
2 Overview of Adolescent Health Issues
Pages 6-23
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From page 6... ...
Students in grades 9 through 12 are covered in the National Youth Risk Behavior Survey, for example, while the Healthy People 2010 health objectives address 10- to 19-year-olds, with some attention to 20- to 24-year-olds, and the Healthy People in Every Stage of Life Program defines adolescents as 12- to 19-year-olds.1 Other research programs related to adolescents at the National Institutes of Health and the Agency for Healthcare Research and Quality offer no definition. In the face of this confusion, Robert Blum (The Johns Hopkins University)
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From page 7... ...
ADOLESCENT HEALTH STATUS 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.
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From page 8... ...
Predominant risk factors include motor vehicle crashes and firearm-related injuries. Older ado lescents are at higher risk than younger adolescents of mortal ity caused by motor vehicle crashes and firearm-related injuries.
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From page 9... ...
From MacKay's perspective, the broad category of mental health and risk behaviors provides an important key to adolescent health that must be considered along with medically related measures of health. A significant proportion of adolescents' health problems relate to sexual activity;
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From page 10... ...
Indicators for many of these behaviors have shown some improvement. For example, the rate of frequent smoking3 dipped below 10 percent in 2005; the rate of frequent alcohol use has edged down slightly since 1991, to approximately 25 percent; and the rate of current marijuana use has also slipped down to 20 percent, after a substantial increase in the 1990s.4 Despite these modest improvements, however, risky behaviors are still among the biggest issues in adolescents' health, and the rates are still high enough to be significant public health concerns.
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From page 11... ...
CURRENT STATE OF CARE With this picture of adolescent health in place, the focus of the research workshop shifted to an examination of the ways in which care is provided for this group. Statistical Overview Jonathan Klein presented a statistical overview of the care adolescents are currently receiving.
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From page 12... ...
He cited statelevel data indicating that only about half of the encounters with providers create the opportunity for adolescents to have private or confidential visits or to ask about any critical risk behaviors (Shenkman, Youngblade, and Nackashi, 2003)
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From page 13... ...
2-2 mental health conditions and the transition to adult care are also insufficient, in Homer's view. Adolescents are less likely to receive appropriate treatment to control asthma, for example, than younger children or adults (and all Medicaid recipients are less likely to than patients covered by commercial health plans)
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From page 14... ...
Nearly 40 percent received no counseling on diet, weight, or exercise, and 41 percent received no counseling on depression, mental health, or relationships. Adolescents also say they lack opportunities for private and confidential visits with practitioners to discuss these subjects -- just 25 percent in this study had a confidential visit related to risky behaviors.
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From page 15... ...
Looking just at work that addressed programs that both delivered traditional health care (rather than categorical services, such as STD screening or family planning, exclusively) and served adolescents, she found relatively few studies.
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From page 16... ...
Adolescents need care that bridges the space between pediatrics and adult internal medicine and that addresses the nonmedical factors that affect their health.8 Adolescents, especially those with chronic or ongoing health problems, are not likely to receive guidance about making the transition to adult care and are not receiving care that adequately addresses behavioral issues. He acknowledged that although the benefits of this kind of guidance have received little research attention, they have been empirically demonstrated for certain health categories, such as STDs, HIV, and family planning care (Ozer et al., 2005)
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From page 17... ...
Catalano traced the association of both risk and protective factors with a variety of the behaviors and circumstances that have a significant impact on health for good or ill: alcohol or illicit drug use, mental and BOX 2-1 Risk Factors for Adolescent Behavior Problems Community Risk Factors • Availability of drugs • Availability of firearms • ommunity laws and norms favorable toward drug use�� firearms�� and crime C • Media portrayals of violence • Transitions and mobility • Low neighborhood attachment and community disorganization • Extreme economic deprivation Family Risk Factors • Family history of problem behavior • Family management problems • Family conflict • avorable parental attitudes toward and involvement in the problem behavior F School Risk Factors • Academic failure beginning in late elementary school • Lack of commitment to school Individual/Peer Risk Factors • Early and persistent antisocial behavior • Rebelliousness • Friends who engage in the problem behavior • Early initiation of the problem behavior • Constitutional factors SOURCE: Presentation by Richard Catalano�� January 22�� 2007.
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From page 18... ...
The latter include • Prenatal and infancy programs • Early childhood education • Parent training • After-school recreation • Mentoring with contingent reinforcement • Adolescent employment with education • Organizational change in schools • Classroom organization, management, and instructional strategies • School behavior management strategies • Classroom curricula designed to promote social competence • Community and school policies In addition to programs and interventions for adolescents, several programs that make use of strategies that have been evaluated and have demonstrated effectiveness for parent training include • Guiding Good Choices® (Spoth, Redmond, and Shin, 1998) • Adolescent Transitions Program (Andrews, Soberman, and Dish ion, 1995; Dishion and Andrews, 1995)
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From page 19... ...
The cost to individuals, families, and communities of inadequate and inappropriate care may be difficult to measure, but without a doubt the economic cost is high. Considering only the direct and long-term social costs associated with six of the most common health issues adolescents experience (pregnancy, sexually transmitted diseases, motor vehicle injuries, alcohol and drug problems, other unintentional injuries, and mental health problems)
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From page 20... ...
Brindis offered a list of protective factors similar to the one offered by Catalano, including caring relationships, high expectations, and opportunities to participate and contribute, as well as traits that make adolescents resilient, including social competence, problem-solving skills, autonomy and a positive sense of self, and a sense of purpose and anticipation of a positive future. Brindis sees training for providers who treat adolescents as the best way to create a broad-based prevention strategy for adolescent care that builds on protective factors and targets risk factors.
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From page 21... ...
. An overlapping concept is the chronic care model, which focuses on proactive, planned care that makes use of information technology to improve coordination between primary and specialty care and helps patients manage their own 9It should be noted that the three primary care disciplines -- pediatrics, family medicine, and internal medicine -- do mandate the inclusion of adolescent health as part of basic residency training, although only pediatrics mandates in-depth coverage or clinical experiences.
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From page 22... ...
Vulnerable groups, such as homeless and incarcerated adolescents, adolescents in foster care, and immigrant adolescents, are especially likely to lack coverage, even when they are eligible, because they tend to lack supports, are frequently unemployed, and do not have an ongoing connection to responsible adults. Brindis cited data indicating specific weaknesses in insurance coverage.
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From page 23... ...
Insurance companies cannot shoulder this burden alone, Blum argued; a public-sector commitment is needed to take on an issue of this magnitude. English described options that have been proposed, such as MediKids,10 which would have expanded publicly funded coverage to age 23, as well as local initiatives that are filling some gaps.
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