Teens' health care often a missed opportunity
■ A retooled health care system that includes a focus on adolescents is needed, as are coordination of primary and specialty care.
By Susan J. Landers — Posted Jan. 5, 2009
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Washington -- Most of the 42 million adolescents in the nation are on the road to a healthy adulthood, but risky behaviors and chronic diseases are still taking a toll, according to a report from the National Research Council and the Institute of Medicine.
The report, released Dec. 9, 2008, offers guidance to health care professionals on how to help young people, ages 10 to 19, enjoy a healthier adolescence as well as build a strong foundation for adulthood.
The nation's health, which continues to be plagued by rising obesity and chronic disease, as well as stalled smoking quit rates, can be improved significantly if young people adopt healthier behaviors, said panelists who drafted the report, "Adolescent Health Services: Missing Opportunities."
The authors found many teens are lost to the health care system at a crucial time in their development. This missed opportunity carries major implications for their futures.
"Adolescents are works in progress," said Sarah S. Brown, MPH, chief executive officer for the National Campaign to Prevent Teen and Unplanned Pregnancy and one of the panelists. "They may look full grown, but they are still under construction."
"Adolescence is a time of major transitions and rapid changes," said Charles E. Irwin Jr., MD, director of adolescent medicine at the University of California, San Francisco, School of Medicine, and a report author.
The insights from these panelists, who spoke at a briefing in conjunction with the report's release, parallel a growing recognition by physicians of the need to reach out to teens. The American Medical Association has developed a number of resources aimed at teen health, including Guidelines for Adolescent Preventive Services. The NRC/IOM document details several ways in which teens can be driven off track and illustrates them in an video that portrays the experiences of three teens.
The stories of three teens
Shawn was diagnosed with bipolar disorder at 14. Marcus has asthma and had put off his dreams of playing basketball and football. Natalya turned to crack cocaine in high school after both parents were diagnosed with cancer.
All three are doing well now but they could have been helped much earlier, according to commentary by health care professionals.
Shawn related that the help she received initially consisted of caregivers handing her the medication. "I was overmedicated. I couldn't feel anything except anxiety." She eventually entered a period of severe mania and ended up in the hospital.
According to the report, 10% to 20% of teens are affected by mental health issues every year, compared with an estimated 10% of adults older than 25. These conditions apparently have staying power as half of all adult mental illnesses begin by age 14.
Anxiety disorders are the most common adolescent mental illnesses, the panelists write. This includes phobias, general anxiety, panic disorder, obsessive-compulsive disorder and posttraumatic stress disorder.
Given the few mental health professionals available for the adolescent age group, the problem is particularly intractable, said Dr. Irwin.
For Marcus, asthma treatment traditionally was provided by physicians at his local emergency department where he was rushed via ambulance about 15 times a year. He and his mother were enrolled in a prevention program only after his younger brother died from the disease at age 10.
A four-hour home visit taught Marcus and his family how to monitor his illness, and his disease is now controlled. He plays basketball.
Asthma is a major chronic disease among adolescents in the United States, according to the report. An estimated 20% of teens in high school are affected. In addition, about six teens per 100,000 have chronic asthma that is accompanied by breathing problems and that limits daily activities, the panelists write.
Natalya was introduced to illegal drugs by a friend and "fell in love with crack cocaine." But as a consequence, "I lost my family, my friends and who I was." The need for a supportive adult was crucial to recovery.
In 2006, more than 2 million adolescents ages 12 to 17 were estimated to have abused or been dependent on alcohol or an illicit drug in the past year, notes the report.
Plus, with cigarette smoking still taking a toll on adult health, the fact that more than one in 10 high school seniors said they smoke daily is cause for concern. That figure was released two days after the report as part of the latest "Monitoring the Future Survey" by the National Institute on Drug Abuse.
Other data cited in the NRC/IOM report suggest adolescents quickly become dependent on nicotine, thus paving the way for difficulties in quitting and the greater likelihood of smoking into adulthood.
Panel Chair Robert S. Lawrence, MD, professor of environmental health sciences and health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, urged policymakers to pay attention to such teen problems as they discuss how to restructure U.S. health care delivery.
The report calls for a system of health care that coordinates primary and specialty care and includes opportunities for primary care services to reach adolescents through safety-net settings, such as hospitals, community- and school-based health centers and youth development programs.