Study calls for preventive health guidelines for young adults
■ Healthy People 2010 created several national objectives to improve the health of this population, including reducing mortality and alcohol- and drug-related injuries.
Young adulthood is a time when rates of mental health problems, substance use and sexually transmitted diseases often peak. But there are no clinical preventive guidelines to help physicians and young adults deal with these and other health issues, a study says.
Part of the problem is that the unique health needs of young adults have long been unaddressed, said S. Todd Callahan, MD, MPH, a pediatrician and specialist in adolescent and young adult health at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn.
“We’re learning that young adults have health risks that are different from adolescents and older adults, and young adults access health care differently than other patient populations,” he said.
Data also show that young adulthood is the ideal time to improve one’s health and prevent the development of chronic health conditions, said Elizabeth M. Ozer, PhD, an associate professor of pediatrics in the Division of Adolescent Medicine at the University of California, San Francisco.
A study in the March Archives of Pediatrics and Adolescent Medicine calls for evidence-based preventive care guidelines that address the health needs of patients age 18 to mid-20s. Ozer is lead author of the study. Dr. Callahan wrote an editorial on the report that appeared in the same Archives issue.
Until such guidelines are issued, Ozer encourages primary care physicians to follow preventive care recommendations, such as those by the U.S. Preventive Services Task Force, that cover young adults in broad categories, including the 18-and-older group.
“It’s really important for primary care providers to focus on the unique health needs of young adults when they have a patient in their office. Even it it’s a very brief discussion,” Ozer said.
Preventing health issues
Compared with adolescents, young adults have three times the suicide rate, nearly three times the incidence of HIV and higher rates of smoking, binge drinking and illicit drug use, said a Sept. 15, 2009, Annals of Internal Medicine study.
Healthy People 2010 established several national objectives to improve the health of this population, including reducing mortality, alcohol- and drug-related injuries and motor vehicle crashes.
Researchers for the Archives study searched online for young adult preventive care guidelines that address the Healthy People 2010 objectives. They searched websites of federal agencies and health care organizations, including the American Medical Association.
Researchers found no specific guidelines for young adults 18 to 26 years old. They confirmed their findings with the Agency for Healthcare Research and Quality’s guidelines database.
But the Archives report notes that this age group is included in many broad preventive health care recommendations for adolescents and adults that are issued by various medical organizations. For example, the AMA recommends that physicians perform an eye exam on patients between ages 20 and 29.
Young adulthood is a unique period because it often is the first time that a person is living alone or away from home and is responsible for his or her health, said Michael Houston, MD, a psychiatrist in Washington, D.C.
The late teen and early adult years also are when serious mental illnesses, such as bipolar disorder and schizophrenia, typically appear, he said. Complicating matters, many young adults do not have a primary care physician, because they are too old to be seen by their pediatrician and can no longer visit their college or university health clinic, he added.
“The responsibility is on physicians to engage young adults in their health care,” said Dr. Houston, associate professor of psychiatry and pediatrics at the George Washington University School of Medicine and Health Sciences.
He recommends that physicians talk to all patients in that age group about preventive health and safety issues, which can include drinking and driving, bullying and gun safety.
But due to a lack of clear guidance on preventive care for this age group, such conversations often do not happen, he said.
Preventive counseling occurred at only 31% of young adult visits to an office-based physician between 1996 and 2006, according to the 2009 Annals study. Thirty-three percent of all primary care visits included prevention counseling.
“Young adults are a group [that physicians] need to focus on,” Ozer said. “With health reform [expanding insurance coverage], we’re going to have more young adults coming into the clinic and giving doctors an unprecedented opportunity to influence the health” of this population.