Enhancing Adolescent Health Counseling; Healthy Teens PDA Screening. Ardis L. Olson, MD Cecelia Gaffney, Med Zsolt Nagakaldi, PhD* Department of Pediatrics & Community and Family Medicine Dartmouth Medical School *Oklahoma Health Sciences University CECH primary care research Network
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Ardis L. Olson, MD
Cecelia Gaffney, Med
Zsolt Nagakaldi, PhD*
Department of Pediatrics
& Community and Family Medicine
Dartmouth Medical School
*Oklahoma Health Sciences University
CECH primary care research Network
JD Klein et al., J Adol Health 25;120-130 & 30:190-195
Better ways to motivate teens to make changes to improve their health
Does not address key issues like anxiety, alcohol, strengths
His doctor had cared for him for years
He found him a shy kid with no problems
who was hard to get talking.
Sad thoughts, no recent fun, no friends or
adults he felt he could talk with, guns in the home, didn’t feel his parents really listened to him, school performance worse than last year. Concerned about problems in his family. Binge drinking and CRAFFT positive. Otherwise screener topics negative.
The provider knew it was important to talk with John alone. With review of his PDA answers and John opened up and talked about personal and family problems. He acknowledged recent increased drinking at parties and drinking alone recently.
* Olson, AL, Gaffney, CA, Hedberg,VA, Gladstone, GR. Use of inexpensive technology to enhance adolescent health behavior and screening approach, Archives of Child and Adolescent Medicine, 163(2):172-177, 2009.
**Olson, AL, Gaffney, CA, Lee, PW, Starr P. Changing adolescent health behaviors; The Healthy Teens Counseling Approach, American Journal of Preventive Medicine, 35(5S):S359-S364, 2008
Outcomes Assessed with post health visit exit surveys
More teens felt their discussion was confidential
More teens felt their provider listened very carefully to them during the visit
More teens were very satisfied overall with the visit
Comparison of the topics teens reported discussed prior to PDA use and after showed
An increase in the proportion who discussed:
Prior PDA use
Fruit/vegetable intake 42% 61% p <.05
Tobacco Use 40% 57% p .07
Alcohol Use 38% 54% p <.05
No significant change in proportion who discussed ;
Television viewing 32% 37%
Exercise 64% 67%
Milk product intake 45% 52%
Drug use 38% 50%
Mood issues 40% 42%
60 teens with usual care prior to PDAs vs. 91 teens with PPA use
Prior PDA use
Fruit/vegetable intake (n=80) 32% 58% p <.05
Milk product intake ( n=74) 44% 70% p <.05
Exercise (n=99) 40% 57% p .08
No significant change;
Tobacco Use (n=74) 63% 70%
Alcohol Use (n=73) 60% 61%
Mood issues (n=62) 38% 53%
Drug use (n=59) 61% 67%
TV viewing (n=53) 32% 37%
*Among teens with topic discussed the proportion who responded discussion was
very helpful vs somewhat/ not helpful
*92 teens with usual care vs.136 teens with PPA use
During exercise have you ever been dizzy or passed out?
Have you ever been unconscious or had a concussion?
Have any of your family members or relatives died of a heart
problem or sudden death before age 50?
If No, then asked-
Do you ever eat in secret?
Do you spend a lot of time thinking about ways to be thinner?
Do you do things to lose or control your weight (skip meals, try not to eat, vomit, take pills, etc)
CRAFFT: adolescent alcohol/substance abuse
C. Have you ever been in a carwhere the driver (including yourself) has been using drugs or alcohol?
R. Do you ever use alcohol/drugs to relax, feel better about yourself or fit in?
A. Do you ever use alcohol/drugs while you are by yourself, alone?
F. Do your family or friends ever tell you that you should cut down on your drinking or drug use?
F. Do you ever forgetthings you did while using alcohol or drugs
T. Have you gotten into trouble while you were using alcohol or drugs?
Over the past 2 weeks, how often have you been bothered by any of the following problems:
Feeling down, depressed or hopeless
Not being able to stop or control worrying
If answer yes, then asked:
Ages: 11- 14 yrs 15-19 yrs
N= 1066 N= 921
“I thought I knew my kids, but I really
didn’t. I learned”
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