Far from acceptable: youth-reported risk behaviour screening by primary care physicians

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Adolescence and early adulthood are periods of experimentation during which health detrimental behaviours might be acquired.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This study’s purpose is to evaluate physicians’ likelihood of addressing health risk behaviours with youths depending on the youths’ wishes, risk behaviours and personal characteristics.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Data were drawn from the third wave (2017–18) of the GenerationFRee longitudinal study carried out on a sample of 1970 youths aged 17–26 in Switzerland. Analysed risk behaviours were: eating disorders, substance use, emotional wellbeing, problematic Internet use and gambling. Bivariate and multivariate analyses were performed, results are presented as adjusted odds ratios (aORs).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Physicians discussed most risk behaviours with less than half of the youths. The odds of addressing risk behaviours were seldom raised when the risk behaviour was present, or when the youth wished to discuss it. Emotional wellbeing was addressed with half as many males as females (aOR 0.47), and drugs were found to be addressed more frequently with youths reporting a low family socio-economic status (aOR 6.18). When a risk behaviour is addressed it is mostly alongside an extended screening.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>This study confirmed the low levels of health risk behaviours screening, regardless of the youths’ wish to discuss the topic with their physician. Despite the low levels, physicians do tend to screen systematically, especially when discussing substance use. There is a need to improve physicians training in risk behaviour screening and counselling in order to increase this practice.</jats:p> </jats:sec>

Adolescents’ self-reported health status, behaviours and health issues addressed during routine school doctor consultations in Switzerland: an observational study

“…However, in our study, the health issues discussed depended heavily on the school doctor, suggesting that the discussion was not always patient-centred. This is consistent with the findings of a recent Swiss study of young adults (aged 17-26 years), which showed that the likelihood of risk behaviours being addressed by primary care physicians was largely independent of the risk factors and wishes of the youth [26]. Moreover, consistent with previous studies [37], the most frequently addressed health topics were "exercise, nutrition and health protection" and "stimulants and addictive substances".…”

“…Our inferential results are also well in line with the literature: the association of both lower socioeconomic status [24][25][26] and female gender [6,24,27,28] with unfavourable self-reported health status is well documented. For instance, the HBSC survey found that adolescents from less wealthy families and female adolescents reported lower levels of life satisfaction and health [18,24].…”

An Electronic Teen Questionnaire, the eTeenQ, for Risk Behavior Screening During Adolescent Well Visits in an Integrated Health System: Development and Pilot Implementation

“…Many primary care practices rely on paper adolescent screening tools. However, these tools are often not completed by patients and results of the paper screening are inconsistently recorded in the electronic health record (EHR), making it difficult to monitor individual or population-level risk behaviors over time [ 7 ]. Electronic data capture for adolescent risk behavior screening has several potential advantages over paper screening and is generally preferred by adolescents [ 8-10 ], including those engaging in high-risk behaviors [ 9 11 ].…”

Adolescent behavioural risk screening in primary care: physician’s point of view

“…Previous studies, based both in Switzerland and in the United States, 10 , 11 have shown that although adolescents regularly consult their primary care provider (PCP), they are not routinely screened for psychosocial risk behaviours such as alcohol or drug consumption, eating issues, or suicidal behaviours. 12 , 13 Barriers to behavioural risk screening have previously been established to be insufficient financial compensation, insufficient consulting time, or lack of resources and this is independent of the health system examined. 14 , 15 …”