Mega Doctor News
By Johns Hopkins Medical Center
It’s common that as kids get to high school and transition to adulthood, they begin to skip yearly wellness visits with a pediatrician or other primary care provider. And, as expected, skipping those checkups can have serious health consequences, including missed early markers of diseases and disorders that come with growing older and are treatable with early interventions.
A new study led by Johns Hopkins Children’s Center researchers using data on adolescents and young adults (AYAs) ages 15 to 23 has added to evidence that as kids get to high school and transition to adulthood, many begin to skip yearly wellness visits with a pediatrician or other primary care provider.
The findings, they say, should advance efforts by parents, pediatricians and other primary care providers to encourage annual wellness visits, as recommended by the American Academy of Pediatrics. Findings from this study, funded by the Health Resources and Services Administration Maternal and Child Health Bureau, were published Dec. 19 in the Journal of Adolescent Health.
Children’s Center researchers say AYAs face a critical period of vulnerability during the transition to adulthood, when serious relationships begin, new jobs start and environments shift.
“These life changes can have physical and mental health impacts. Attending yearly wellness visits is an opportunity to screen and provide care for risky or dangerous behavior, including drug use,” says Johns Hopkins Children’s Center pediatrician and adolescent medicine specialist Arik V. Marcell, M.D., M.P.H.
The new study, led by Marcell and Children’s Center fellow Morayo Akande, Ph.D., M.P.H., analyzed data for both male and female AYAs gathered from the NEXT Generation Health Study funded in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. That study was designed to study health outcomes by following the same AYAs for seven years, starting from ages ranging from 15 to 23. As part of the current study, Johns Hopkins researchers tracked how often the AYAs got yearly checkups and what factors contributed to them continuing or not continuing to go.
For the new study, the researchers grouped males as either engaged, engaged with decline or persistently disengaged from going to checkups during the seven-year period. Females were grouped as either engaged, engaged with decline or gradually reengaged.
Results showed that a majority of both sexes were found to be engaged, meaning they received a yearly wellness visit. However, more than 30% of males and nearly 20% of females became disengaged as they got older. Marcell says this is very concerning since these young people will have fewer opportunities to get preventive care, especially during a period when engaging in riskier behaviors begins or escalates, including behaviors related to drug use and sexual activity.
Researchers identified a couple possible reasons for the decline in primary care visits. For example, when children go away to college, parents no longer make their appointments for them. Additionally, adolescents are more inclined to see only specialized physicians for specific complaints — such as when a girl begins seeing a gynecologist. These specialists may be mistakenly perceived by AYAs as a replacement for primary care.
The study also found that about 13% of girls and young women “gradually reengaged,” meaning that during the seven years of tracking, they tended to go back to a primary care doctor. Marcell says that girls and young women have more health-related concerns and “touchpoints” that may lead them to make a wellness appointment — including changes in menstrual cycles, the need for birth control, or concerns about pregnancy — than do boys and young men.
Additionally, the study found that boys and young men with chronic health problems were more likely to stay engaged with their wellness visits. However, females with mental health symptoms were less likely to be engaged.
The current study adds to evidence found in a previous study led by Marcell and colleagues, which showed that from middle childhood (age 5) to late adolescence (age 17), about half of children had wellness visits. However, half of boys’ wellness visits dropped off after they turned 5 — when vaccines are required for school entry — and at far higher rates than girls’ wellness visit patterns. Also, among boys whose wellness visits dropped off, one-third continued to be disconnected from preventive care through age 17, versus less than 10% of girls over the same timeframe.
Marcell recommends that all parents and AYAs need to understand the value of the annual preventive care wellness visit, and that parents teach their children how to make a primary care checkup appointment. He says attention to health care is a learned behavior, and it’s never too early to begin those conversations and to practice those skills.
Based on the findings in the study, Marcell also believes more research and longitudinal data, such as those collected in the NEXT data set, can help primary care providers better understand who is and isn’t being seen, and focus some attention on reaching out to AYAs.
Other authors in this study include Kathryn Van Eck, Xingyun Wu, Elianna Perrin, Lingxin Hao and Pamela Matson with Johns Hopkins and Elizabeth Ozer with the University of California, San Francisco.
The study was funded by the U.S. Health Resources & Services Administration Maternal and Child Health Bureau (R42MC49146 and U8DMC45901). The original NEXT study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HHSN275201200001I), the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.
No authors declared conflicts of interest under Johns Hopkins University School of Medicine policies.
Information source: Johns Hopkins Medical Center
