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Adolescents accurately characterize the preventive care they receive

According to a study supported in part by the Agency for Health Care Policy and Research (HS08192) and the Centers for Disease Control and Prevention, adolescents are tuned into preventive health care. They are aware of and can describe the preventive services they receive. Adolescent care often includes confidential discussions between teenagers and their clinicians about sensitive issues, including sexuality, reproductive health, substance use, mental health, and abuse. These confidential encounters may not be accurately reflected in either parent reports or medical charts. Also, physicians tend to overestimate their delivery of preventive services, explains Jonathan D. Klein., M.D., M.P.H., of the University of Rochester Medical Center.

Dr. Klein and his colleagues recruited 400 adolescents (14 to 21 years of age) from 15 community-based primary care practices in one New York county and audiotaped their visits with physicians. A total of 354 adolescents were surveyed by phone either 2 to 4 weeks or 5 to 7 months after their visit to assess their recollection of the preventive health care they received. The researchers coded the audiotapes to assess delivery of 33 specific preventive services and compared the tapes and chart documentation of services with adolescent recall of the services.

Preventive screening and counseling during these visits ranged from 2 percent for discussing anabolic steroids to 86 percent for discussing sex. Adolescents' recall of the care they received was quite good, with the 2-to-4-week group recalling slightly more than the 5-to-7-month group. Both groups recalled with moderate to high sensitivity 24 of the 33 preventive screening and counseling items, including discussions of weight, diet, body image, exercise, seatbelt use, bike helmet use, cigarettes/smoking, smokeless tobacco, alcohol, drugs, steroids, sex, sexual orientation, birth control, condoms, AIDS, sexually transmitted diseases, school, family, future plans, emotions, suicidal thoughts, and abuse.

See "Developing quality measures for adolescent care: Validity of adolescents' self-reported receipt of preventive services," by Dr. Klein, Caryn A. Graff, M.P.H., John S. Santelli, M.D., M.P.H., and others, in the April 1999 Health Services Research 34(1), pp. 391-404.

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