When an adolescent or young adult comes for a health maintenance visit, how comfortable are you talking about important yet sensitive topics with your patients? Do you talk about what the AAP’s Bright Futures recommends? Do you select a few of the topics to discuss because you worry a teen may find it just as uncomfortable as you do, and you don’t want to hamper your ability to gain the trust of that teen by over-asking overly sensitive questions? Santelli et al. (10.1542/peds.2018-1403) decided to see what teens remember discussing with you in a health maintenance visit. They analyzed data from a national online survey of more than 1500 respondents with a good response rate (65%) who were asked about 11 specific and somewhat sensitive topics suggested by national guidelines like the AAP’s Bright Futures, assuming they had been seen at least once before and in the past two years by their primary care provider. The authors then tried to assess factors that contribute more specifically to (1) use of tobacco, (2) alcohol and drugs, (3) sexually transmitted infections and HIV, and (4) the number of sensitive topics discussed.
It will come as no surprise that less than half of the respondents had ten or more topics discussed during a visit, and when it came to factors that helped a particularly sensitive topic be discussed (e.g. smoking, alcohol, drugs), the factors were similar for all of those sensitive areas. What are those helpful factors? They included a pre-talk about confidentiality, sufficient private time without the parent present, and use of a checklist or screening questionnaire to make sure all areas were discussed. There are many other factors identified that may be better for open discussion of any one of these risk behaviors, but hopefully you’ll take a safe risk and read this study to learn more. If you want to glean more about the sensitive risk-taking behaviors of your teen patients (while not forgetting to focus as well on what they do well and their resiliencies), then give this study your attention and hopefully incorporate any of the predictive factors identified into your visits with adolescents. You and your teen patients will be glad you did.
