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Guidelines for Adolescent Preventive Services (GAPS)

In order to set guidelines for care of adolescents, the American Medical Association's Department of Adolescent Health has issued a series of Guidelines for Adolescent Preventive Services (GAPS). For adolescents, the primary health risks are more social in origin than medical. Advising physicians to be aware of these risks, and to promote healthier lifestyles can have dramatic effects on the child's future. Interventions aimed at adolescents have been shown to decrease premature adult mortality rates. GAPS identifies such behavior patterns, helping physicians identify at risk adolescents and provides them with information about changing unhealthy behaviors.

GAPS consists of 24 recommendations that encompass health care delivery, health guidance, screening and immunizations. These recommendations are:

Recommendation 1
From ages 11 to 21 all adolescents should have an annual routine health visit.

Recommendation 2
Preventive service should be age and developmentally appropriate, and should be sensitive to individual and sociocultural differences.

Recommendation 3
Physicians should establish office policies regarding confidential care for adolescents and the way parents will be involved in that care. These policies should be made clear to adolescents and their parents.

Recommendation 4
Parents or other adult caregivers of adolescents should receive health guidance at least once during early adolescence, once during middle adolescence and, preferably, once during late adolescence.

Recommendation 5
All adolescents should receive health guidance annually to promote better understanding of their physical growth, their psychosocial and psychosexual development, and the importance of becoming actively involved in decisions regarding their health care.

Recommendation 6
All adolescents should receive health guidance annually to promote the reduction of injuries.

Recommendation 7
All adolescents should receive health guidance annually about dietary habits, including the benefits of a healthy diet and ways to achieve a healthy diet and safe weight management.

Recommendation 8
All adolescents should receive health guidance annually about the benefits of exercise and should be encouraged to engage in safe exercise on a regular basis.

Recommendation 9
All adolescents should receive health guidance annually regarding responsible sexual behaviors, including abstinence. Latex condoms to prevent sexually transmitted diseases (including HIV infection) and appropriate methods of birth control should be made available with instructions on ways to use them effectively.

Recommendation 10
All adolescents should receive health guidance annually to promote avoidance of tobacco, alcohol and other abusable substances, and anabolic steroids.

Recommendation 11
All adolescents should be screened annually for hypertension according to the protocol developed by the National Heart, Lung, and Blood Institute's Second Task Force on Blood Pressure Control in Children.

Recommendation 12
Selected adolescents should be screened to determine their risk of developing hyperlipidemia and adult coronary heart disease, following the protocol developed by the Expert Panel on Blood Cholesterol Levels in Children and Adolescents.

Recommendation 13
All adolescents should be screened annually for eating disorders and obesity by determining weight and stature, and asking about body image and dieting patterns.

Recommendation 14
All adolescents should be asked annually about their use of tobacco products, including cigarettes and smokeless tobacco.

Recommendation 15
All adolescents should be asked annually about their use of alcohol and other abusable substances, and about their use of over-the-counter or prescription drugs, including anabolic steroids, for nonmedical purposes.

Recommendation 16
All adolescents should be asked annually about involvement in sexual behaviors that may result in unintended pregnancy and STDs, including HIV infection.

Recommendation 17
Sexually active adolescents should be screened for STDs.

Recommendation 18
Adolescents at risk for HIV infection should be offered confidential HIV screening with the ELISA and a confirmatory test.

Recommendation 19
Female adolescents who are sexually active and women 18 or older should be screened annually for cervical cancer by use of a Papanicolaou test.

Recommendation 20
All adolescents should be asked annually about behaviors or emotions that indicate recurrent or severe depression or risk of suicide.

Recommendation 21
All adolescents should be asked annually about a history of emotional, physical or sexual abuse.

Recommendation 22
All adolescents should be asked annually about learning or school problems.

Recommendation 23
Adolescents should receive a tuberculin skin test if they have been exposed to active tuberculosis, have lived in a homeless shelter, have been incarcerated, have lived in or come from an area with a high prevalence of tuberculosis, or currently work in a health care setting.

Recommendation 24
All adolescents should receive prophylactic immunizations according to the guidelines established by the federally convened Advisory Committee on Immunization Practices.

The table and information above is reprinted with permission of the American Academy of Family Physicians.