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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



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.


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.


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.


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).


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:


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.


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

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