Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter September 11, 2015

Is HEADS in our heads? Health risk behavior is not routinely discussed with young people with chronic conditions

  • Kirsten A. Boisen EMAIL logo , Pernille Grarup Hertz , Charlotte Blix and Grete Teilmann

Abstract

Background:

Outpatient clinic visits are a window of opportunity to address health risk behaviors and promote a healthier lifestyle among young people. The HEADS (Home, Education, Eating, Activities, Drugs [i.e. substance use including tobacco, alcohol, and illegal drugs], Sexuality [including contraception], Safety, Self-harm) interview is a feasible way of exploring health risk behaviors and resilience.

Objective:

The purpose of this study was to evaluate how often HEADS topics were addressed according to young patients and staff in pediatric and adult outpatient clinics.

Methods:

We conducted a questionnaire survey among young patients and health care professionals at a tertiary university hospital. Young patients reported on their cumulative experience and staff reported on their usual practice.

Results:

A total of 290 young patients aged 12–22 years (78% having a chronic condition) and 97 health care professionals participated. We found only small reported differences between staff and young patients regarding whether home, education, and activity were addressed. However, staff reported twice the rate of addressing smoking, alcohol, illegal drugs, sexuality, and contraception compared to young patients. Young patients reported that smoking, alcohol, illegal drugs, sexuality, and contraception were addressed significantly more at adult clinics in comparison to pediatric clinics. After controlling for age, gender and duration of illness, according to young patients, adjusted odds ratios for addressing smoking at adult vs. pediatric clinics was 2.47 (95% confidence interval [CI]: 1.26–4.83), alcohol 2.84 (95% CI:1.45–5.57), illegal drugs 4.20 (95% CI:1.69–10.44), sexuality 3.54 (95% CI: 1.67–7.50), contraception 3.68 (95% CI:1.61–8.41), and any of the above 2.95 (95% CI: 1.47–5.91).

Conclusion:

According to young patients, smoking, alcohol, illegal drugs, sexuality, and contraception were not routinely addressed at a tertiary hospital, and especially at paediatric clinics, these issues were seldom addressed.


Corresponding author: Kirsten A. Boisen, Center of Adolescent Medicine, 4101, Rigshospitalet, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark, Phone: +45 35 45 44 33, Fax: +45 35 45 65 43, E-mail:

Acknowledgments

We are very grateful to our youth panel members who tested and revised the questions. We also want to thank Torsten Munch-Hansen from Public Health and Quality Improvement in Aarhus for his revision of the questionnaires and statistician Andreas Kryger, Nordsjaellands Hospital for statistical supervision. We thank all young patients and staff members at Copenhagen University Hospital Rigshospitalet for their invaluable help in replying to the questionnaires.

  1. Conflict of interest: All authors declare no conflicts of interest.

References

1. Christie D, Viner R. Adolescent development. Br Med J 2005;330:301–4.10.1136/bmj.330.7486.301Search in Google Scholar PubMed PubMed Central

2. Steinberg L. A Social neuroscience perspective on adolescent risk-taking. Dev Rev DR 2008;28:78–106.10.1016/j.dr.2007.08.002Search in Google Scholar PubMed PubMed Central

3. Suris JC, Michaud PA, Akre C, Sawyer SM. Health risk behaviors in adolescents with chronic conditions. Pediatrics 2008;122:e1113–8.10.1542/peds.2008-1479Search in Google Scholar PubMed

4. Hublet A, De BD, Boyce W, Godeau E, Schmid H, et al. Smoking in young people with asthma. J Public Health 2007;29:343–9.10.1093/pubmed/fdm047Search in Google Scholar PubMed

5. Goldenring JM, Rosen DS. Getting into adolescent heads: an essential update. Contemp Pediatr 2004;21:64–90.Search in Google Scholar

6. Ambresin AE, Bennett K, Patton GC, Sanci LA, Sawyer SM. Assessment of youth-friendly health care: a systematic review of indicators drawn from young people’s perspectives. J Adolesc Health 2013;52:670–81.10.1016/j.jadohealth.2012.12.014Search in Google Scholar PubMed

7. Solberg LI, Nordin JD, Bryant TL, Kristensen AH, Maloney SK. Clinical preventive services for adolescents. Am J Prev Med 2009;37:445–54.10.1016/j.amepre.2009.06.017Search in Google Scholar PubMed

8. Viner RM. Do adolescent inpatient wards make a difference? Findings from a national young patient survey. Pediatrics 2007;120:749–55.10.1542/peds.2006-3293Search in Google Scholar PubMed

9. Center for Patient Experience and Evaluation. Available at: http://patientoplevelser.dk/center-patient-experience-and-evaluation. Accessed on May 9, 2015.Search in Google Scholar

10. Sterling SA, Kline-Simon AH, Wibbelsman CJ, Wong AO, Weisner CM. Screening for adolescent alcohol and drug use in pediatric health-care settings: predictors and implications for practice and policy. Addict Sci Clin Pr 2012;7:13.10.1186/1940-0640-7-13Search in Google Scholar PubMed PubMed Central

11. McDonagh JE, Minnaar G, Kelly K, O’Connor D, Shaw KL. Unmet education and training needs in adolescent health of health professionals in a UK children’s hospital. Acta Paediatr 2006;95:715–9.10.1080/08035250500449858Search in Google Scholar PubMed

12. Klein JD, Graff CA, Santelli JS, Hedberg VA, Allan MJ, et al. Developing quality measures for adolescent care: validity of adolescents’ self-reported receipt of preventive services. Health Serv Res 1999;34:391–404.Search in Google Scholar

13. Brown JD, Wissow LS. Discussion of sensitive health topics with youth during primary care visits: relationship to youth perceptions of care. J Adolesc Health 2009;44:48–54.10.1016/j.jadohealth.2008.06.018Search in Google Scholar PubMed PubMed Central

14. Due P, Krolner R, Rasmussen M, Andersen A, Trab DM, et al. Pathways and mechanisms in adolescence contribute to adult health inequalities. Scand J Public Health 2011;39:62–78.10.1177/1403494810395989Search in Google Scholar

15. Tyc VL, Throckmorton-Belzer L. Smoking rates and the state of smoking interventions for children and adolescents with chronic illness. Pediatrics 2006;118:e471–87.10.1542/peds.2004-2413Search in Google Scholar

16. Britto MT, Garrett JM, Dugliss MA, Daeschner CW, Johnson CA, et al. Risky behavior in teens with cystic fibrosis or sickle cell disease: a multicenter study. Pediatrics 1998;101:250–6.10.1542/peds.101.2.250Search in Google Scholar

17. Britto MT, Rosenthal SL, Taylor J, Passo MH. Improving rheumatologists’ screening for alcohol use and sexual activity. Arch Pediatr Adolesc Med 2000;154:478–83.10.1001/archpedi.154.5.478Search in Google Scholar

18. Hollen PJ, Hobbie WL, Donnangelo SF, Shannon S, Erickson J. Substance use risk behaviors and decision-making skills among cancer-surviving adolescents. J Pediatr Oncol Nurs 2007;24:264–73.10.1177/1043454207304910Search in Google Scholar

19. Michaud PA, Suris JC, Viner R. The adolescent with a chronic condition. Part II: healthcare provision. Arch Dis Child 2004;89:943–9.10.1136/adc.2003.045377Search in Google Scholar

20. Wilson H, Bostock N, Phillip N, Shannon P, Payne D, et al. Opportunistic adolescent health screening of surgical inpatients. Arch Child 2012;97:919–21.10.1136/archdischild-2012-301835Search in Google Scholar

21. Suris JC, Akre C, Rutishauser C. How adult specialists deal with the principles of a successful transition. J Adolesc Health 2009;45:551–5.10.1016/j.jadohealth.2009.05.011Search in Google Scholar

22. Yeo MS, Bond LM, Sawyer SM. Health risk screening in adolescents: room for improvement in a tertiary inpatient setting. Med J Aust 2005;183:427–9.10.5694/j.1326-5377.2005.tb07110.xSearch in Google Scholar

23. Klein JD, Wilson KM. Delivering quality care: adolescents’ discussion of health risks with their providers. J Adolesc Health 2002;30:190–5.10.1016/S1054-139X(01)00342-1Search in Google Scholar

24. Robertson LP, McDonagh JE, Southwood TR, Shaw KL. Growing up and moving on. A multicentre UK audit of the transfer of adolescents with juvenile idiopathic arthritis from paediatric to adult centred care. Ann Rheum Dis 2006;65:74–80.10.1136/ard.2004.032292Search in Google Scholar

25. Middleman AB, Binns HJ, DuRant RH. Factors affecting pediatric residents’ intentions to screen for high risk behaviors. J Adolesc Health 1995;17:106–12.10.1016/1054-139X(94)00187-JSearch in Google Scholar

26. Van Amstel LL, Lafleur DL, Blake K. Raising our HEADSS: adolescent psychosocial documentation in the emergency department. Acad Emerg Med 2004;11:648–55.10.1197/j.aem.2003.12.022Search in Google Scholar

27. Zack J, Jacobs CP, Keenan PM, Harney K, Woods ER, et al. Perspectives of patients with cystic fibrosis on preventive counseling and transition to adult care. Pediatr Pulmonol 2003;36:376–83.10.1002/ppul.10342Search in Google Scholar PubMed

28. Ma J, Wang Y, Stafford RS. US adolescents receive suboptimal preventive counseling during ambulatory care. J Adolesc Health 2005;36:441.10.1016/j.jadohealth.2004.08.024Search in Google Scholar PubMed

29. Duncan P, Frankowski B, Carey P, Kallock E, Delaney T, et al. Improvement in adolescent screening and counseling rates for risk behaviors and developmental tasks. Pediatrics 2012;130:e1345–51.10.1542/peds.2011-2356Search in Google Scholar PubMed

30. Lau JS, Adams SH, Irwin CE, Ozer EM. Receipt of preventive health services in young adults. J Adolesc Health 2013;52:42–9.10.1016/j.jadohealth.2012.04.017Search in Google Scholar PubMed PubMed Central

31. Hill LL, Hovell M, Blumberg E, Kelley N, Baird S, et al. Gaps between adolescent risk behaviors and disclosure during outpatient visits. Int J Fam 2013;2013:718568.10.1155/2013/718568Search in Google Scholar PubMed PubMed Central

32. Van HS, Harris SK, Brooks T, Carey P, Kossack R, et al. The «Six T’s»: barriers to screening teens for substance abuse in primary care. J Adolesc Health 2007;40:456–61.10.1016/j.jadohealth.2006.12.007Search in Google Scholar PubMed

33. Ozer EM, Adams SH, Lustig JL, Millstein SG, Camfield K, et al. Can it be done? implementing adolescent clinical preventive services. Health Serv Res 2001;36:150–65.Search in Google Scholar

34. Ozer EM, Adams SH, Lustig JL, Gee S, Garber AK, et al. Increasing the screening and counseling of adolescents for risky health behaviors: a primary care intervention. Pediatrics 2005;115:960–8.10.1542/peds.2004-0520Search in Google Scholar PubMed

35. Ozer EM, Adams SH, Gardner LR, Mailloux DE, Wibbelsman CJ, et al. Provider self-efficacy and the screening of adolescents for risky health behaviors. J Adolesc Health 2004;35:101–7.10.1016/S1054-139X(03)00536-6Search in Google Scholar

36. Lustig JL, Ozer EM, Adams SH, Wibbelsman CJ, Fuster CD, et al. Improving the delivery of adolescent clinical preventive services through skills-based training. Pediatrics 2001;107:1100–7.10.1542/peds.107.5.1100Search in Google Scholar PubMed

37. Sanci LA, Coffey CM, Veit FC, Carr-Gregg M, Patton GC, et al. Evaluation of the effectiveness of an educational intervention for general practitioners in adolescent health care: randomised controlled trial. Br Med J 2000;320:224–30.10.1136/bmj.320.7229.224Search in Google Scholar PubMed PubMed Central

38. Sanci L, Coffey C, Patton G, Bowes G. Sustainability of change with quality general practitioner education in adolescent health: a 5-year follow-up. Med Educ 2005;39:557–60.10.1111/j.1365-2929.2005.02172.xSearch in Google Scholar PubMed

39. Oscos-Sanchez MA, White D, Bajorek E, Dahlman M, Albright T, et al. SAFE TEENS: facilitators of and barriers to adolescent preventive care discussions. Fam Med 2008; 40:125–31.Search in Google Scholar

40. Danish Health and Medicines Authority. [Guideline on confidentiality] Sundhedsstyrelsens vejledning om sundhedspersoners tavshedspligt – dialog og samarbejde med patienters pårørende, nr. 9494 af 04/07/2002. Jul 4, 2002. Available at: https://sundhedsstyrelsen.dk/da/udgivelser/2002/vejledning-om-sundhedspersoners-tavshedspligt-dialog-og-samarbejde-med-patienters-paaroerende.Search in Google Scholar

41. Britto MT, Tivorsak TL, Slap GB. Adolescents’ needs for health care privacy. Pediatrics 2010;126:e1469–76.10.1542/peds.2010-0389Search in Google Scholar PubMed

Received: 2015-2-19
Accepted: 2015-7-2
Published Online: 2015-9-11
Published in Print: 2016-11-1

©2016 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 1.3.2024 from https://www.degruyter.com/document/doi/10.1515/ijamh-2015-0015/html
Scroll to top button