Children's Health

Physicians who feel confident in delivering preventive services to adolescents are more likely to screen them for risky behaviors

The majority of adolescent morbidity and mortality can be attributed to preventable causes, including risky behaviors such as use of alcohol and drugs and failure to use seatbelts and helmets. When pediatricians and nurse-practitioners feel confident in screening adolescents for these risky behaviors, they are more likely to conduct such screening, according to a study that was supported in part by the Agency for Healthcare Research and Quality (HS11095) and conducted by researchers at the University of California, San Francisco, and Kaiser Permanente, Northern California.

The researchers found that providers' confidence in their ability to deliver preventive services was correlated with provider-reported screening in the five areas studied: tobacco use, alcohol use, sexual behavior, seat belt use, and helmet use. In addition to provider self-report, the researchers also collected independent data through adolescent report. Provider confidence was significantly related to adolescent reports of being screened during well visits for sexual activity, alcohol use, and tobacco use but not for seat belt or helmet use.

The researchers asked 66 pediatricians and nurse practitioners working in three pediatric clinics within a managed care organization to complete surveys assessing their confidence in screening adolescent patients in the five areas. They compared the clinicians' responses to provider-reported screening and screening reported by 323 adolescent patients (aged 14 to 16 years). Adolescent reports were for a single visit, while providers reported on the percentage of adolescents screened in each area during the preceding month.

Self-reported provider screening rates ranged from a low of 57 percent for helmet use to a high of 85 percent for tobacco use, whereas adolescent reports of screening rates ranged from a low of 28 percent for helmet use to a high of 65 percent for screening for tobacco use. These findings underscore the importance of increasing clinicians' perceptions of competence to screen adolescents for high-risk behaviors during outpatient, well-care visits.

See "Provider self-efficacy and the screening of adolescents for risky health behaviors," by Elizabeth M. Ozer, Ph.D., Sally H. Adams, Ph.D., Linda Rieder Gardner, M.P.H., and others, in the Journal of Adolescent Health 35, pp. 101-107, 2004.

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