Original article
Does Delivering Preventive Services in Primary Care Reduce Adolescent Risky Behavior?

https://doi.org/10.1016/j.jadohealth.2011.02.011Get rights and content

Abstract

Purpose

To determine whether the delivery of preventive services changes adolescent behavior. This exploratory study examined the trajectory of risk behavior among adolescents receiving care in three pediatric clinics, in which a preventive services intervention was delivered during well visits.

Methods

The intervention consisted of screening and brief counseling from a provider, followed by a health educator visit. At age 14 (year 1), 904 adolescents had a risk assessment and intervention, followed by a risk assessment 1 year later at age 15 (year 2). Outcomes were changes in adolescent behavior related to seat belt and helmet use; tobacco, alcohol, and drug use; and sexual behavior. Analysis involved age-related comparisons between the intervention and several cross-sectional comparison samples from the age of 14–15 years.

Results

The change in helmet use in the intervention sample was 100% higher (p < .05), and the change in seat belt use among males was 50% higher (p = .14); the change in smoking among males was 54% lower (p < .10), in alcohol use was no different, and in drug use was 10% higher (not significant [NS]); and the change in rate of sexual intercourse was 18% and 22% lower than cohort comparison samples (NS).

Conclusions

The intervention had the strongest effect in the area of helmet use, shows promise for increasing seat belt use and reducing smoking among male adolescents, and indicates a nonsignificant trend toward delaying the onset of sexual activity. Participation in the intervention seemed to have no effect on the rates of experimentation with alcohol and drugs between the ages of 14 and 15 years.

Section snippets

Methods

All procedures were approved by the university and the managed care organization internal review boards.

Results

Descriptive statistics for the intervention and comparison samples are presented in Table 1. Although there are some differences in the percentage of adolescents in each race/ethnic group across the samples, the patterns of proportions are, for the most part, similar between samples. In three of four of the data sets, about half the respondents were white adolescents, whereas the Pediatric Comparison Safety sample was more evenly divided between white (30%), Hispanic (26%), black (20%), and

Discussion

This is the first study to integrate a broad range of clinical services into primary care practice and then follow adolescent patients longitudinally to assess the behavior of adolescents receiving clinical preventive services. The intervention—involving screening and brief counseling from a primary care clinician, followed by reinforcement and goal setting with a health educator—had mixed outcomes across the range of risk areas.

The intervention had the strongest effect in the area of helmet

Acknowledgments

The authors thank John Santelli, M.D., M.P.H., our former project officer at the CDC, for his support and guidance; Arthur Elster, M.D., Patricia Levenberg, Ph.D., and Missy Fleming, Ph.D., at the AMA for their collaboration in the early phases of this research program; project officer Gary Nelson, Ph.D., at the California Wellness Foundation; Robert Bonar, M.D., and Daniel Fuster, M.D., for their collaboration on the training; Carol Bandura Cowley for assistance with the health educator

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