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April 1995, Vol 149, No. 4 >
Article | April 1995

Clinical Preventive Services Efficacy and Adolescents' Risky Behaviors FREE

Stephen M. Downs, MD, MS; Jonathan D. Klein, MD, MPH
Arch Pediatr Adolesc Med. 1995;149(4):374-379. doi:10.1001/archpedi.1995.02170160028004.
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Objective/Background:  To analyze the value of studying or implementing office-based clinical preventive services for adolescents. Most adolescent mortality and morbidity is attributable to risky behaviors, yet clinical preventive services to reduce risky behaviors are often challenged because their efficacy has not been demonstrated.

Design:  A cost-effectiveness model of adolescents' risky behaviors that compares standard practice with a program of screening visits for all adolescents and counseling visits for youth identified as high risk. We considered two risky behaviors, alcohol abuse and unsafe sexual activity, and five outcomes.

Main Outcome Measures:  Baseline cost-effectiveness of the program, minimum efficacy at which the program would be cost-effective, and sample sizes required for a trial of the program.

Results:  Assuming that the program is 5% effective at preventing risky behaviors, it would cost $3035 to prevent any one adverse outcome and $471 000 to prevent a death from an automobile crash or from human immunodeficiency virus infection. Assuming society were willing to pay $600 000 to prevent a death (a generally accepted figure), the program would be cost-effective only if it were 5.6% effective at changing behavior. At this efficacy, the program would have a cost per year of life saved comparable to or better than many other accepted medical interventions. However, to demonstrate changes in outcomes at this efficacy would require a clinical trial with between 4000 and 95 million adolescents in each treatment group, depending on the outcome measured.

Conclusions:  Studying the ability of clinical preventive services to prevent outcomes of adolescents' risky behaviors would be impractical. The decision to implement these programs should be made based on current knowledge and beliefs; their efficacy can probably be studied only as part of widespread implementation.(Arch Pediatr Adolesc Med. 1995;149:374-379)

REFERENCES

1 +
US Office of Technology Assessment. Adolescent Health, I: Summary and Policy Options . Washington, DC: US Office of Technology Assessment; (April) 1991;. Publication OTA-H-468.
2 +
Logsdon C, Lazaro C, Meier R.  The feasibility of behavioral risk reduction in primary medical care . Am J Prev Med . 1989;;5:249-256.
3 +
Prevention of Mental Disorders, Alcohol and Other Drug Use in Children and Adolescents . Rockville, Md: US Dept of Health and Human Services; 1989;. OSAP Prevention Monograph ADM 90-1646.
4 +
Kottke T, Battista R, DeFries G, Brekke M.  Attributes of successful smoking cessation interventions in medical practice . JAMA . 1989;;256:2882-2889.
5 +
Lindsay S, Wilson D, Best J, et al.  A randomized trial of physician training for smoking cessation . Am J Health Promotion . 1989;;3:11-18.
6 +
Johnston LD, O'Malley TM, Bachman JG. Drug Use Among American High School Seniors, College Students, and Young Adults, 1975-1990 . Rockville, Md: National Institute on Drug Abuse; 1991; 1. US Dept of Health and Human Services publication ADM-91-1813.
7 +
Weinstein MC, Fineberg HV. Clinical Decision Analysis . Philadelphia, Pa: WB Saunders Co; 1980;:168-183.
8 +
Anda RF, Remington PL, Dodson DL, DeGuire PJ, Foreman MR, Gunn RA.  Patterns of self-reported drinking and driving in Michigan . Am J Prev Med . 1987;;3:271-275.
9 +
American School Health Association, Association for the Advancement of Health Education, Society for Public Health Education. The National Adolescent Student Health Survey . Oakland, Calif: Third Party Publishing; 1989;.
10 +
Centers for Disease Control and Prevention.  Sexual behavior among high school students, United States, 1990 . MMWR Morb Mortal Wkly Rep . 1992;;40:885-887.
11 +
Dryfoos JG. Adolescents at Risk: Prevalence and Prevention . New York, NY: Oxford University Press; 1990;.
12 +
Millstein SG, Irwin CE, Alder NE, Cohn LD, Kegeles SM, Dolcini MM.  Healthrisk behavior and health concerns among young adolescents . Pediatrics . 1992;; 89:422-428.
13 +
Osgood DW, Wilson JK. Covariation Among Adolescent Problem Behaviors: Background Paper for the US Congress Office of Technology Assessment . Washington, DC: Office of Technology Assessment; 1991;. NTIS No. PB91 -145 377/AS.
14 +
Elster AB, Kuznets NJ. Guidelines for Adolescent Preventive Services . Baltimore, Md: Williams & Wilkins; 1993;.
15 +
Paulson JA.  Injuries: the leading cause of mortality and morbidity in adolescent . Adolesc Med State Art Rev . 1990;;1:97-112.
16 +
National Safety Council. Adolescent Facts . Chicago, Ill: National Safety Council; 1988;.
17 +
US Dept of Commerce, Bureau of the Census. US Population Estimates, by Age, Sex, Race and Hispanic Origin, 1989: Current Population Reports . Washington, DC: Bureau of Census; 1990;.
18 +
Sox HC, Blatt MA, Higgins MC, Martin KI. Medical Decision Making . Stoneham, Mass: Butterworth Publishers; 1988;:67-101.
19 +
Fletcher RH, Fletcher SW. Wagner EH. Clinical Epidemiology . 2nd ed. Baltimore, Md: Williams & Wilkins; 1988;:195-198.
20 +
Gans JE, Blyth DA, Elster AB, Gaveras LL. America's Adolescents: How Healthy Are They? Chicago, III: American Medical Association; 1990;.
21 +
St. Louis ME, Conway GA, Hayman CR, Miller C, Petersen LR, Dondero TJ.  Human immunodeficiency virus infection in disadvantaged adolescents . JAMA . 1991;;266:2387-2391.
22 +
Wendell DA, Onorato IM, McCray E, Allen DM, Sweeney PA.  Youth at risk: sex, drugs, and human immunodeficiency virus . AJDC . 1992;;146:76-81.
23 +
Hayes CD, ed. Risking the Future: Adolescent Sexuality, Pregnancy, and Childbearing . Washington, DC: National Academy Press; 1987;.
24 +
Washington AE, Katz P.  Cost of and payment source for pelvic inflammatory disease . JAMA . 1991;;266:2565-2569.
25 +
Hellinger FJ.  Forecasting the medical costs of the HIV epidemic: 1991-1994 . Inquiry . 1991;;28:213-225.
26 +
Rice DP, Hodgeson TA, Kopstein AN.  The economic costs of illness: a replication and update . Health Care Financing Rev . 1985;;7:61-80.
27 +
Hulley SB, Cummings SR, eds. Designing Clinical Research . Baltimore, Md: Williams & Wilkins; 1988;:216-217.
28 +
Sinclair JC, Torrence GW. Boyle MH, Horwood SP, Saigal S, Sackett DL.  Evaluation of neonatal-intensive-care programs . N Engl J Med . 1981;;305:489-494.
29 +
Boyle MH, Torrence GW, Sinclair JC. Horwood SP.  Economic evaluation of neonatal intensive care of very-low-birth-weight infants . N Engl J Med . 1983;; 308:1330-1337.
30 +
Goel V, Deber RB, Detsky AS.  Nonionic contrast media: economic analysis and health policy development . Can Med Assoc J . 1989;;140:389-395.
31 +
Welch GH, Larson EB.  Cost effectiveness of bone marrow transplantation in acute nonlymphocytic leukemia . N Engl J Med . 1989;:321:807-812.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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References

1 +
US Office of Technology Assessment. Adolescent Health, I: Summary and Policy Options . Washington, DC: US Office of Technology Assessment; (April) 1991;. Publication OTA-H-468.
2 +
Logsdon C, Lazaro C, Meier R.  The feasibility of behavioral risk reduction in primary medical care . Am J Prev Med . 1989;;5:249-256.
3 +
Prevention of Mental Disorders, Alcohol and Other Drug Use in Children and Adolescents . Rockville, Md: US Dept of Health and Human Services; 1989;. OSAP Prevention Monograph ADM 90-1646.
4 +
Kottke T, Battista R, DeFries G, Brekke M.  Attributes of successful smoking cessation interventions in medical practice . JAMA . 1989;;256:2882-2889.
5 +
Lindsay S, Wilson D, Best J, et al.  A randomized trial of physician training for smoking cessation . Am J Health Promotion . 1989;;3:11-18.
6 +
Johnston LD, O'Malley TM, Bachman JG. Drug Use Among American High School Seniors, College Students, and Young Adults, 1975-1990 . Rockville, Md: National Institute on Drug Abuse; 1991; 1. US Dept of Health and Human Services publication ADM-91-1813.
7 +
Weinstein MC, Fineberg HV. Clinical Decision Analysis . Philadelphia, Pa: WB Saunders Co; 1980;:168-183.
8 +
Anda RF, Remington PL, Dodson DL, DeGuire PJ, Foreman MR, Gunn RA.  Patterns of self-reported drinking and driving in Michigan . Am J Prev Med . 1987;;3:271-275.
9 +
American School Health Association, Association for the Advancement of Health Education, Society for Public Health Education. The National Adolescent Student Health Survey . Oakland, Calif: Third Party Publishing; 1989;.
10 +
Centers for Disease Control and Prevention.  Sexual behavior among high school students, United States, 1990 . MMWR Morb Mortal Wkly Rep . 1992;;40:885-887.
11 +
Dryfoos JG. Adolescents at Risk: Prevalence and Prevention . New York, NY: Oxford University Press; 1990;.
12 +
Millstein SG, Irwin CE, Alder NE, Cohn LD, Kegeles SM, Dolcini MM.  Healthrisk behavior and health concerns among young adolescents . Pediatrics . 1992;; 89:422-428.
13 +
Osgood DW, Wilson JK. Covariation Among Adolescent Problem Behaviors: Background Paper for the US Congress Office of Technology Assessment . Washington, DC: Office of Technology Assessment; 1991;. NTIS No. PB91 -145 377/AS.
14 +
Elster AB, Kuznets NJ. Guidelines for Adolescent Preventive Services . Baltimore, Md: Williams & Wilkins; 1993;.
15 +
Paulson JA.  Injuries: the leading cause of mortality and morbidity in adolescent . Adolesc Med State Art Rev . 1990;;1:97-112.
16 +
National Safety Council. Adolescent Facts . Chicago, Ill: National Safety Council; 1988;.
17 +
US Dept of Commerce, Bureau of the Census. US Population Estimates, by Age, Sex, Race and Hispanic Origin, 1989: Current Population Reports . Washington, DC: Bureau of Census; 1990;.
18 +
Sox HC, Blatt MA, Higgins MC, Martin KI. Medical Decision Making . Stoneham, Mass: Butterworth Publishers; 1988;:67-101.
19 +
Fletcher RH, Fletcher SW. Wagner EH. Clinical Epidemiology . 2nd ed. Baltimore, Md: Williams & Wilkins; 1988;:195-198.
20 +
Gans JE, Blyth DA, Elster AB, Gaveras LL. America's Adolescents: How Healthy Are They? Chicago, III: American Medical Association; 1990;.
21 +
St. Louis ME, Conway GA, Hayman CR, Miller C, Petersen LR, Dondero TJ.  Human immunodeficiency virus infection in disadvantaged adolescents . JAMA . 1991;;266:2387-2391.
22 +
Wendell DA, Onorato IM, McCray E, Allen DM, Sweeney PA.  Youth at risk: sex, drugs, and human immunodeficiency virus . AJDC . 1992;;146:76-81.
23 +
Hayes CD, ed. Risking the Future: Adolescent Sexuality, Pregnancy, and Childbearing . Washington, DC: National Academy Press; 1987;.
24 +
Washington AE, Katz P.  Cost of and payment source for pelvic inflammatory disease . JAMA . 1991;;266:2565-2569.
25 +
Hellinger FJ.  Forecasting the medical costs of the HIV epidemic: 1991-1994 . Inquiry . 1991;;28:213-225.
26 +
Rice DP, Hodgeson TA, Kopstein AN.  The economic costs of illness: a replication and update . Health Care Financing Rev . 1985;;7:61-80.
27 +
Hulley SB, Cummings SR, eds. Designing Clinical Research . Baltimore, Md: Williams & Wilkins; 1988;:216-217.
28 +
Sinclair JC, Torrence GW. Boyle MH, Horwood SP, Saigal S, Sackett DL.  Evaluation of neonatal-intensive-care programs . N Engl J Med . 1981;;305:489-494.
29 +
Boyle MH, Torrence GW, Sinclair JC. Horwood SP.  Economic evaluation of neonatal intensive care of very-low-birth-weight infants . N Engl J Med . 1983;; 308:1330-1337.
30 +
Goel V, Deber RB, Detsky AS.  Nonionic contrast media: economic analysis and health policy development . Can Med Assoc J . 1989;;140:389-395.
31 +
Welch GH, Larson EB.  Cost effectiveness of bone marrow transplantation in acute nonlymphocytic leukemia . N Engl J Med . 1989;:321:807-812.

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