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Background In 2010, as part of the 75th Anniversary celebration of the Maternal and Child Health Bureau (MCHB), a concept paper Rethinking MCH: The Life Course Model as an Organizing [...], The Life Course Perspective (LCP), or Model, is now a guiding framework in Maternal and Child Health (MCH) activities, including training, supported by the Health Resources and Services Administration's Maternal and Child Health Bureau. As generally applied, the LCP tends to focus on pre- through post-natal stages, infancy and early childhood, with less attention paid to adolescents as either the "maternal" or "child" elements of MCH discourse. Adolescence is a distinct developmental period with unique opportunities for the development of health, competence and capacity and not merely a transitional phase between childhood and adulthood. Adequately addressing adolescents' emergent and ongoing health needs requires well-trained and specialized professionals who recognize the unique role of this developmental period in the LCP. Keywords Life course * Adolescent health * Adolescent development * Maternal and child health training programs

Teenagers may be more likely to reveal sensitive information to their doctor if the doctor promises to keep all the information confidential. Researchers played an audiotape of a typical office visit to 562 high school students. Some of the tapes included a physician ensuring unconditional confidentiality, others a physician ensuring conditional confidentiality and others a physician who doesn't mention confidentiality. Teenagers who heard a message of confidentiality were more likely to say they would disclose sensitive information to such a doctor. Unconditional confidentiality would lead them to return to such a doctor., Context. -- Adolescents' concerns about privacy in clinical settings decrease their willingness to seek health care for sensitive problems and may inhibit their communication with physicians. Objective. -- To investigate the influence of physicians' assurances of confidentiality on adolescents' willingness to disclose information and seek future health care. Design. -- Randomized controlled trial. Setting. -- Three suburban public high schools in California. Participants. -- The 562 participating adolescents represented 92% of students in mandatory classes. Intervention. -- After random assignment to 1 of 3 groups, the adolescents listened to a standardized audiotape depiction of an office visit during which they heard a physician who assured unconditional confidentiality, a physician who assured conditional confidentiality, or a physician who did not mention confidentiality. Main Outcome Measures. -- Adolescents' willingness to disclose general information, willingness to disclose information about sensitive topics, intended honesty, and likelihood of return visits to the physician depicted in the scenario were assessed by anonymous written questionnaire. Results. -- Assurances of confidentiality increased the number of adolescents willing to disclose sensitive information about sexuality, substance use, and mental health from 39% (68/175) to 46.5% (178/383) ([Beta] = .10, P = .02) and increased the number willing to seek future health care from 53% (93/175) to 67% (259/386) ([Beta] = .17, P [is less than] .001). When comparing the unconditional with the conditional groups, assurances of unconditional confidentiality increased the number of adolescents willing to return for a future visit by 10 percentage points, from 62% (122/196) to 72% (137/190) ([Beta] = .14, P = .001). Conclusions. -- Adolescents are more willing to communicate with and seek health care from physicians who assure confidentiality. Further investigation is needed to identify a confidentiality assurance statement that explains the legal and ethical limitations of confidentiality without decreasing adolescents' likelihood of seeking future health care for routine and nonreportable sensitive health concerns. JAMA. 1997;278:1029-1034

Objectives. This study determined how often primary care physicians ask adolescents about smoking. Methods. We surveyed a stratified random sample of community-based, board-certified California physicians, using a mailed questionnaire. Results. Overall, physicians (n = 343; 77% response rate) screened younger adolescents for regular smoking during 71.4% (95% confidence interval [CI] = 67.9, 74.9) of routine physical exams and older adolescents during 84.8% (95% Cl = 82.3, 87.4) of such visits. For acute-care visits, the screening rates were 24.4% (95% Cl = 20.6, 28. 1) for younger and 40.2% (95% Cl = 36.4, 44.0) for older adolescents. Physicians asked 18.2% (95% Cl = 15.2, 21.3) of younger and 35.6% (95% Cl = 32.0, 39.1) of older adolescents about experimental smoking. Screening varied by specialty. Conclusions. These data imply that physicians are missing opportunities to screen adolescents for smoking. (Am J Public Health. 1997;87: 1341-1345)

Many adolescents and their families fail to keep their medical appointments, thereby negatively affecting the efficiency of the medical care and practice. In a prospective observational study conducted in a medical clinic, 166 randomly selected lower-middle and middle class adolescents were asked about their beliefs regarding their follow-up appointment and the constructs of the Health Belief Model. Forty-eight percent of the adolescents did not keep their appointments. A strong correlation was shown between social class and appointment-keeping. Neither parental involvement nor age had any effect on whether the adolescent kept his or her follow-up appointment. Such a failure is a barrier to care, so the reasons for missed appointments should be ascertained, and clinicians should work with adolescents to help them understand the adverse consequences of their failure to keep appointments., Study objectives. To identify the sociodemographic and Health Belief Model predictors of follow-up appointment-keeping behavior. Design. Prospective observational study. Settings. General adolescent medical clinic. Patients and measurements. Sequential sample of 166 adolescents (aged 12 to 20 years, mean = 15.9 years) enrolled in the clinic. The population was 75% female; the racial-ethnic distribution of the sample was 37.9% black, 29.8% white, 11.2% Asian, 14.3% Hispanic, and 6.8% "other" background. Subjects' social class was primarily lower-middle (60.5%) and middle class (28.6%). A subsample was randomly assigned to be interviewed about their beliefs concerning their follow-up appointment and the constructs of the Health Belief Model. Results. Forty-eight percent of the total sample failed to keep their follow-up appointment. There was a significant positive correlation between social class and appointment keeping (F = 5.07; df = 5,110; P = .026). Neither race-ethnicity nor who made the appointment were found to be associated with follow-up appointment-keeping. The only construct of the Health Belief Model found to be significantly associated with appointment keeping was the number of potential negative outcomes resulting from noncompliance perceived by the subject (F = 6.85; df = 1,74; P = .011). Conclusions. Clinicians must work with adolescents to improve their understanding of the potential negative outcomes associated with noncompliance to improve appointment-keeping behavior. Pediatrics 1993;92:20-23; adolescent, appointinent-keeping, health care.

This study examined the health concerns and behaviors of 563 adolescents (aged 11 through 14) from a variety of social, racial, and ethnic backgrounds. Behaviors associated with adolescent morbidity and mortality were examined, including sexual behavior, substance use, and injury-related behaviors. Although young adolescents are often viewed as unlikely participants in these risk behaviors, the results of this study suggest that greater attention should be paid to this younger group and their health-risk behaviors. A majority of the sample had tried alcohol and tobacco, and almost a third had used marijuana. Twenty-one percent were sexually active. Prevalence rates varied by social class, race-ethnicity, gender, and age. More than 75% of the sample had visited a physician during the prior year, suggesting an important role physicians may serve as sources of information and positive role models for these young adolescents. The results suggest that we stop viewing young adolescents as naive children and begin to view them as observers of and participants in a changing social environment that has important implications for their current and future health status. Without a realistic appraisal of the young adolescent, we can expect to have little overall effect on the status of adolescent health in the United States. Pediatrics 1992;89:422-428; early adolescence, risk-taking behavior, sexual behavior, substance use, health behaviors.

Characteristics of disordered eating are common in adolescents. These characteristics, which include restrained eating, binge eating, fear of fatness, purging, and distortion of body image, are associated with obesity and […]