1. ADOLESCENT TO YOUNG ADULT

2. TASKS OF ADOLESCENCE SELF ESTEEM FRIENDSHIPS INDEPENDENCE VALUES GOALS

3. TRANSITIONING FOR “SICK” ADOLESCENTS Parent Oriented to Patient Oriented Nurturing to Empowering Vision of the Future Specialty AND Primary Care (Parents may feel “Left Out”)

4. TRANSITIONING FOR “WELL” ADOLESCENTS Age - “Rules of the Practice” Age - May feel “Out of Place” Different Insurance Need Health Supervision Visit for: –College –Sports –Job

5. INTERVIEWING H Home E Education/Employment A Activities/Acquaintances D Drugs S Sexuality S Suicide/Depression

6. PHYSICAL EXAM/ SCREENING Breast/Testicular Exam STD Screening PAP test Cholesterol ?Hgb, UA

7. IMMUNIZATIONS 3 Hep B 2 MMR 2 Varicella 1 dT (Influenza, Pneumococcal, Hep A)

8. HIGH RISK BEHAVIORS INJURIES SEXUAL BEHAVIORS TOBACCO USE ALCOHOL/DRUG USE DIETARY PATTERNS PHYSICAL ACTIVITY

9. WHY RISKY BEHAVIORS? Jessor’s Model Group Socialization Theory Biopsychosocial Model “Intractable to simple explanation”

10. INJURIES UNINTENTIONAL/HOMICIDE/SUICIDE 70% of deaths for 15-24 y/o –use of alcohol/drugs –failure to use safety devices –access to firearms

11. INJURIES: VT YOUTH Use seatbelt when driving: 81% Drove under the influence: 24% Carried weapon to school: 19%

12. SEXUAL BEHAVIORS MORTALITY (HIV, cervical ca, hep B) HIV = 19% of deaths for 25-44 y/o MORBIDITY (STD’s, infertility, ectopic pregnancies)

13. SEXUAL BEHAVIORS: VT YOUTH Ever had sex: 63% Used condom: 54% Used alcohol/drugs: 28% Multiple partners: 19%

14. TOBACCO USE Leading cause of preventable death 80% start before 18

15. TOBACCO USE: VT YOUTH Ever smoked: 77% Smoked past month: 43% Ever tried to quit: 34% Chewing tobacco: 9%

16. ALCOHOL/DRUGS MORTALITY: 100,000 deaths/yr MORBIDITY: violence, injury, child/spousal abuse, HIV/AIDS, adolescent pregnancy, school failure, car crashes, low work productivity, homelessness

17. ALCOHOL/DRUGS: VT YOUTH Alcohol in past month: 65% Binged in past month: 44% Tried marijuana: 61% Marijuana in past month: 39% Ever used inhalants: 22% Ever used cocaine: 12%

18. DIETARY PATTERNS MORTALITY: cancers, cardiovascular disease, diabetes MORBIDITY: obesity, eating disorders –14% children –12% adolescents

19. DIETARY PATTERNS: VT YOUTH Think they are overweight: 38% Trying to lose weight: 60% Vomited/took laxative: 10% Took pills: 8%

20. PHYSICAL ACTIVITY Together with diet = 20-60% of fatal cancers

21. PHYSICAL ACTIVITY: VT YOUTH Daily phys ed: 14% School sports team: 51%

22. WHAT PROTECTS ADOLESCENTS FROM RISKS? CONNECTIONS RESILIENCY

23. WHAT CAN YOU DO? ACT AS A CHANGE AGENT!

24. 6 STAGES OF CHANGE PRE-CONTEMPLATIVE CONTEMPLATIVE DETERMINATIION ACTION MAINTENANCE RELAPSE

25. CAGE QUESTIONS Have you ever felt the need to CUT DOWN on your drinking? Have you ever felt ANNOYED by criticism about your drinking? Have you ever felt GUILTY about something you did while drinking? Have you ever taken a morning EYE-OPENER?

26. REMEMBER... Ask about one behavior at each encounter Encourage one change step Don’t nag!