Screening tests for teens (ages 13-18)


Adolescents are often thought of as the healthiest age group. For teens, annual “well care” visits don’t involve many laboratory screening tests; rather, the emphasis is on preparing for teen health issues, such as accident and injury prevention, sexual health, and avoiding substance abuse as well as on emphasizing healthy lifestyle choices that can help protect against diseases that occur in adulthood. If the health care provider identifies risk factors, however, appropriate screening tests will be recommended. Additional tests and exams may be appropriate due to menstruation or sexual activity (to screen for anemia and infections, for example).

The menu above links you to articles on the few conditions and diseases for which teens 13 to 18 years old may be screened. All teens should be routinely screened for obesity, but the rest of the tests are selective. That is, your health care provider will suggest a screening test if the teen has an above-average risk for a particular health problem.

For more information on what happens at your teen’s medical exams, see Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Pocket Guide.

For more information on preventive medicine and steps you can take to keep you and your family healthy, read Staying Healthy in an Era of Patient Responsibility.


General Sources

American Academy of Pediatrics. Recommendations for preventive pediatric health care (policy statement). Dec 2007. Pediatrics 120(6);1376. Available on the Internet at http://pediatrics.aappublications.org. Accessed 28 Jan 2008.

Hagan JF, Shaw JS and Duncan PM, eds. Bright Futures Guidelines: Guidelines for Health Supervision of Infants, Children, and Adolescents (3rd ed.). 2008. Elk Grove Village, Ill: American Academy of Pediatrics, pp. 211-218.

Biagioli FE and DeVoe JE. What are appropriate screening tests for adolescents? Oct 2006. J Family Practice 55(10):907-913. Available on the Internet at http://www.jfponline.com. Accessed 18 Jan 2008.

American Academy of Family Physicians. Preventive services for healthy living. Review/update Aug 2007. Available on the Internet at http://familydoctor.org. Accessed 17 Jan 2008.


Cervical Cancer

Most deaths from cancer of the cervix (the lower part of the uterus, or womb) can be avoided by having regular gynecological checkups and Pap smears. This is a slow-growing cancer that can take several years to develop. Most often, cancerous cells are seen in women 40 years of age or older. Routine screening can help identify cervical cancer early on, at a time when it is highly curable. Screening can also find precancerous lesions that can be monitored or removed before cancer ever starts to develop.

The American College of Obstetricians and Gynecologists (ACOG) currently suggest that young women under the age of 21 years do not need to see a gynecologist unless there is a medical need. They recommend the following:

  • Pap smears for women younger than 21 are not recommended because the incidence of cancer in this age group is rare. False positive results may occur due to normal cell changes and are somewhat common. The false positive results may generate unnecessary and costly treatment as well as emotional anxiety.

The American Cancer Society and the U.S. Preventive Services Task Force offer similar recommendations.

Teen risk
Experts say that the following situations increase a teen girl's risk for future cervical problems, including cervical cancer:

Under these conditions, the cells of the cervix are more likely to undergo changes in ways that may lead to cancer or future fertility problems. While a Pap smear may not be required, appropriate testing for STDs and counseling regarding safe sex and contraception should be encouraged.

HPV testing
Screening for the presence of human papilloma virus (HPV DNA test) is not recommended for women younger than age 30 because infections with HPV are relatively common in this age group and often resolve without treatment or complications.


Links
American College of Obstetricians and Gynecologists: "Tool kit for teen care: pap tests" available at http://www.medem.com.

To sign up for a personal Pap test scheduling reminder, click here.


Sources

(December 2009). American College of Obstetricians and Gynecology Practice Bulletin Number 109, Cervical Cytology Screening. PDF available for download at http://journals.lww.com/greenjournal/documents/PB109_Cervical_Cytology_Screening.pdf through http://journals.lww.com. Accessed December 2009.

American Cancer Society. Overview: cervical cancer: What causes cancer of the cervix? Can it be prevented? Revised 4 Nov 2003. Available on the Internet at http://www.cancer.org. Accessed 10 Aug 2004; 2006 revision accessed 8 Feb 2008.

American Cancer Society. DES Exposure: Questions and Answers. Available online at http://www.cancer.org/docroot/CRI/content/CRI_2_6x_DES_Exposure_Questions_and_Answers.asp through http://www.cancer.org. Accessed September 2008.

American College of Obstetricians and Gynecologists. Human papillomaviruses and cancer: questions and answers. 8 Jun 2006. Available on the Internet at http://www.medem.com. Accessed 18 Jan 2008.

American College of Obstetricians and Gynecologists. Tool kit for teen care: pap tests. 2003. Available on the Internet at http://www.medem.com. Accessed 17 Jan 2008.

American College of Obstetricians and Gynecologists. ACOG clarifies recommendations on cervical cancer screening in adolescents (news release). 30 Sep 2004. Available on the Internet at http://www.acog.org/from_home/publications/press_releases/nr09-30-04-1.cfm through http://www.acog.org. Accessed 2004 and 18 Jan 2008.

American College of Obstetricians and Gynecologists. Cervical cancer screening: testing can start later and occur less often under new ACOG recommendations (press release). 31 Jul 2003. Available on the Internet at http://www.acog.org/from_home/publications/press_releases/nr07-31-03-1.cfm through http://www.acog.org. Accessed 15 Jul 2004 and 18 Jan 2008.

American College of Obstetricians and Gynecologists. First ob-gyn visit recommended in early teens (news from ACOG). 10 May 2006. Available on the Internet at http://www.medem.com. Accessed 17 Jan 2008.

American College of Physicians. New pap guidelines reduce screening, but raise concerns about compliance. Apr 2003. Observer. Available on the Internet at http://www.acponline.org. Accessed 15 Jul 2004 and 18 Jan 2008.

American Society for Colposcopy and Cervical Pathology. What women should know about HPV and cervical health. 2003. Available on the Internet at http://www.asccp.org/patient_edu.shtml. Accessed 17 Jan 2008.

Smith RA, Cokkinides V and Eyre HJ, for the American Cancer Society. American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin 53:27-43. Available on the Internet at http://caonline.amcancersoc.org. Accessed 5 Aug 2004 and 18 Jan 2008.

Solomon D, Papillo J, Davey D, on behalf of the Cytopathology Education and Technology Consortium. Statement on HPV DNA Test Utilization. Am J Clin Pathol 2009;131:768-769.

US Centers for Disease Control and Prevention. Basic facts on screening and the Pap test. Oct 2003. PDF available for download at http://www.cdc.gov/cancer/cervical/pdf/cc_basic.pdf through http://www.cdc.gov. Accessed 2 Aug 2004 and 18 Jan 2008.

US Preventive Services Task Force. Screening for cervical cancer. Release date Jan 2003. Available on the Internet at http://www.ahcpr.gov/clinic/uspstf/uspscerv.htm through http://www.ahcpr.gov. Accessed 15 Jul 2004 and 18 Jan 2008.

US Food and Drug Administration. Cervical Cancer Screening. FDA Consumer Magazine.  January-February 2004. Available online at http://www.fda.gov/Fdac/features/2004/104_cancer.html through http://www.fda.gov. Accessed September 2008.


Chlamydia and Gonorrhea

Chlamydia and gonorrhea are the most common bacterial sexually transmitted diseases (STDs) in the United States today, but most infected people have no symptoms. These infections most commonly affect the genitals, but may also cause infections of other mucous membranes, eyes, or joints. Pregnant women may transmit the infections to their newborns. Often progressing silently, these diseases can cause female infertility and other damage. Heterosexual males are not routinely screened, although an infected male can spread these diseases and even re-infect a partner if he does not complete treatment. When diagnosed early, both diseases can be cured by antibiotics.

If you are in your teens or early 20’s and sexually active, you face the greatest risk of infection. Parents may not realize that nearly half of all teens as young as 13 years old have had intercourse at least once. Early sexual activity tends to lead to having more partners, the American Academy of Pediatrics notes, which increases the risk for sexually transmitted diseases such as these. A 2005 CDC study showed that more than one third of sexually active students didn’t use a condom the last time they had sex. Without this protection, they were more vulnerable to these and other diseases.

Chlamydia and gonorrhea are spread by intimate sexual contact and can infect the body through the genitals, anus, or mouth. Risk factors include the following: you are sexually active and less than 25 years old, you are sexually active and of African or Hispanic descent, you have a new male sex partner or have had 2 or more partners during the last year, you use barrier contraception inconsistently, or you have a history of sexually transmitted diseases. Having one of these diseases increases your risk of becoming infected with human immunodeficiency virus (HIV). Many people have chlamydia and gonorrhea infections at the same time.

Adolescent girls
The U.S. Preventive Services Task Force recommends the following:

The American Academy of Pediatrics points out that although annual screening is recommended for all young, sexually active females, you should get tested again after sex with any new partner.

The American College of Preventive Medicine suggests the following for females:

  • Have your health care provider review your risk factors at each routine care appointment so you know if you are presently at risk.
  • Get a chlamydia test once a year if you have any of the risk factors.

If pregnant
The U.S. Preventive Services Task Force recommends the following:

  • If you are pregnant and 25 years old or younger, you should be tested for chlamydial infection.
  • If you are pregnant and at increased risk, you should be tested for gonorrhea.

Adolescent boys
A health care provider should routinely assess your risk if you engage in sexual activity or have had sexual contact. You need prevention information, even if you are only considering sexual activities, and to know what STD tests, if any, would be appropriate. Without symptoms, heterosexual males are usually not screened, even though they may obtain and spread these infections. Screening for STDs is, however, considered for adolescent boys and young men in correctional facilities and those seen in adolescent and STD clinics. The U.S. Centers for Disease Control and Prevention recommends that males who have sex with males be screened at least once a year for chlamydia and gonorrhea as well as syphilis and HIV, with screening at 3- to 6-month intervals appropriate if he or a partner has risk factors such as multiple or anonymous partners or illicit drug use.

Talk to your health care provider
Some health care providers fail to discuss sexual health issues at all, especially with young patients. This leaves the health risks unchecked. If your health care provider does not bring up sexual health topics, you can simply ask for a test or a risk assessment. You can also use confidential services to obtain testing or counseling.

Although it is possible to have an STD without knowing it, you should always seek medical attention from your health care provider if you have any of the following signs or symptoms:

  • Painful urination (often a burning sensation)
  • Vaginal discharge in women
  • Pain during sexual intercourse
  • Pain in the lower abdomen
  • Irregular periods in women
  • A discharge from the penis in men
  • Trouble getting pregnant
  • Pain in the testicles in men

Re-infection is common

  • Re-infection is common, especially among teens. If you are treated for these diseases, know when you should be re-tested (usually, after about 3 months, but no later than 1 year).

Links

American College of Obstetricians and Gynecologists: Tool Kit for Teen Care: Sexually Transmitted Diseases.

STIs: Learn How to Protect Yourself


Sources

American Academy of Pediatrics. Contraception and adolescents (policy statement). Nov 2007. Pediatrics 120(5):1135-1148. Available on the Internet at http://aappolicy.aappublications.org. Accessed 28 Jan 2008.

American Academy of Family Physicians. Chlamydia. July 2008. Available on the Internet at http://familydoctor.org/online/famdocen/home/common/sexinfections/sti/204.html through http://familydoctor.org. Accessed 8 Sept 2008.

American College of Obstetricians and Gynecologists. Tool kit for teen care: sexually transmitted diseases. 2003. Available on the Internet at http://www.medem.com. Accessed 17 Jan 2008.

American Social Health Association. Gonorrhea (fact sheet). Available on the Internet at http://www.ashastd.org. Accessed 18 Jan 2008.

Berg AO, for the US Preventive Services Task Force. Screening for chlamydial infection: recommendations and rationale. Apr 2001. Am J Prev Med 20(3 Suppl):90-94. Available on the Internet at http://www.guideline.gov. Accessed 19 Jul 2004; revision of 17 Jul 2007 accessed 17 Jan 2008.

Hagan JF, Shaw JS and Duncan PM, eds. Bright Futures Guidelines: Guidelines for Health Supervision of Infants, Children, and Adolescents. 2008. Elk Grove Village, Ill: American Academy of Pediatrics, pp. 169, 173.

Hollblad-Fadiman K and Goldman SM, for the American College of Preventive Medicine. Screening for chlamydia trachomatis (practice policy statement). Apr 2003. Am J Prev Med 24(3):287-292. Available on the Internet at http://www.guideline.gov. Accessed 19 Jul 2004 and 18 Jan 2008.

US Centers for Disease Control and Prevention. Chlamydia fact sheet. Last modified 20 Dec 2007. Available on the Internet at http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm through http://www.cdc.gov. Accessed 19 Jul 2004 and 23 Jan 2008.

US Centers for Disease Control and Prevention. Prevent STDS among MSM. Available on the Internet at http://www.cdc.gov/ncidod/diseases/hepatitis/msm through http://www.cdc.gov. Accessed 23 Jan 2008.

US Centers for Disease Control and Prevention. Questions and answers for the general public: revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings. Last modified 22 Jan 2007. Available on the Internet at http://www.cdc.gov/hiv/topics/testing/resources/qa/qa_general-public.htm through http://www.cdc.gov. Accessed 28 Jan 2008.

US Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. 4 Aug 2006. MMWR 55(RR11). Available on the Internet at http://www.cdc.gov/std/treatment. Accessed 23 Jan 2008.

US Preventive Services Task Force. Guide to Clinical Preventive Services, 2007: Infectious Diseases. Available on the Internet at http://www.ahrq.gov/clinic/pocketgd07/gcp2b.htm through http://www.ahrq.gov. Accessed 17 Jan 2008.

US Preventive Services Task Force. Screening for chlamydial infection (recommendation statement). 17 Jul 2007. Ann Intern Med 17;147(2):128-34. Available on the Internet at http://www.guideline.gov. Accessed 23 Jan 2008.


High cholesterol

Beginning in childhood, the waxy substance called cholesterol and other fatty substances known as lipids begin to build up in the arteries. Slowly, over many years, these build-ups harden into plaques that narrow the passageway. During adulthood, plaque buildup and resulting health problems occur not only in the arteries supplying blood to the heart muscle but in arteries throughout the body (a problem known as atherosclerosis). For both men and women in the United States, the number one cause of death is heart disease, and the amount of cholesterol in the blood greatly affects a person’s chances of suffering from it. Physical activity and healthy eating in childhood and adolescence—appropriately limiting unhealthy cholesterol, saturated fat, and trans fat—may protect against heart disease in adulthood.

For those under 20 years of age and at low risk, cholesterol testing is usually not ordered routinely. However, when a youth is at risk, a blood test to measure cholesterol levels may provide useful information.

Risk Factors

  • Family History: Cholesterol testing may be most appropriate for youths with a family history of high cholesterol or heart disease, particularly that occurring before age 55 in men or 65 in women. If the family history is not known, a cholesterol test is recommended, particularly if other risk factors are present.
  • Personal Health: Cholesterol testing is also recommended for youths judged to be at higher risk because:
    • they are overweight
    • they consume excessive amounts of saturated fats and cholesterol
    • they have diabetes or hypertension (high blood pressure)
    • they smoke.

When overweight or obese
Cholesterol testing is advised for overweight youths, when the individual’s body mass index (BMI) is at or above the 85th percentile. The BMI should be calculated at least once a year by the youth’s health care provider. For an obese youth (one whose BMI is at or above the 95th percentile), laboratory tests to measure cholesterol levels may be recommended every 2 years.

High-risk children should have their first cholesterol test before 10 years of age, according to the American Academy of Pediatrics, which recommends the fasting lipid profile. If the results are not worrisome, the fasting test should be given again in three to five years. The youth’s age and stage of puberty as well as ethnicity and gender must be considered as well. 


Links
National Heart, Lung, and Blood Institute: What is high blood cholesterol?
Keep Kids Healthy: Cholesterol Screening
KidsHealth: Cholesterol and Your Child
The Children’s Hospital Boston: Cholesterol, LDL, HLD & Triglycerides


Sources

Barlow SE and the Expert Committee. Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Dec 2007 (suppl). Pediatrics 120:S164-S192. Available on the Internet at http://pediatrics/aappublications.org. Accessed 10 Jan 2008.

Nemours Foundation. Cholesterol and your child. Reviewed Jan 2005. Available on the Internet at http://www.kidshealth.org/parent/food/general/cholesterol.html through http://www.kidshealth.org. Accessed 9 Jan 2008.

Haney EM, et al. 1 Jul 2007. Screening and treatment for lipid disorders in children and adolescents: systematic evidence review for the US Preventive Services Task Force. Pediatrics 120(1):e189-e214. Available on the Internet at http://pediatrics.aappublications.org. Accessed 9 Jan 2008.

Kavey RE, et al. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. 25 Mar 2003. Circulation 107(11):1562-6. Available on the Internet at http://circ.ahajournals.org. Accessed 9 Jan 2008.

US Preventive Services Task Force. Screening for lipid disorders in children (topic page). Jul 2007. Available on the Internet from the Agency for Healthcare Research and Quality at http://www.ahrq.gov/clinic/uspstf/uspschlip.htm through http://www.ahrq.gov. Accessed 10 Jan 2008.

Daniels, SR, Greer FR, and the Committee on Nutrition. Jul 2008. Lipid screening and cardiovascular health in childhood (clinical report). Pediatrics 122:198-208.

McCrindle, BW, et al. Apr 10 2007. Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association. Circulation 115:1948-67.

American Academy of Family Physicians. Summary of policy recommendations for periodic health examinations. 2003 Aug. Superceded in 2007 by the Summary of recommendations for clinical preventive services (rev 6.4). Available on the Internet, from the National Guideline Clearinghouse at http://www.guideline.gov.

Berg AO, for the US Preventive Services Task Force. Screening for lipid disorders: recommendations and rationale. Apr 2001. Am J Prev Med 20(3S):73-76.

American Academy of Family Physicians. Heart disease: assessing your risk. Available on the Internet through http://familydoctor.org. Accessed 19 Jul 2004 and 19 Jan 2008.


Human Immunodeficiency Virus (HIV)

Parents may not recognize that nearly half of all teens as young as 13 years old have had intercourse at least once. Early sexual activity tends to lead to having more partners, the American Academy of Pediatrics notes, which increases the risk for sexually transmitted diseases such as this one. A 2005 CDC study showed that more than one third of sexually active students didn’t use a condom the last time they had sex, which means they were more vulnerable to these types of infections.

Many young adults and adolescents feel invincible. These feelings help explain why some engage in risky behavior and delay getting tested for human immunodeficiency virus (HIV), notes the National Institutes of Health. Health care providers even report that many young people, if they learn they are HIV-positive, take several months to accept the diagnosis and return for treatment. Because young people are most likely at a relatively early stage of infection, though, they are ideal candidates for early interventions. HIV screening tests help them protect their health.

Universal testing for HIV has become routine health care in the United States. HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a deadly disease that is most often sexually transmitted. At least 90 to 95 percent of individuals who are infected with HIV will, within 3 months of exposure, develop enough antibodies to have a positive HIV antibody test; over 99 percent of HIV-infected individuals will have a positive test within 6 months. If a pregnant woman is infected with HIV, the virus can be passed to and infect her fetus.

The U.S. Centers for Disease Control and Prevention (CDC) recommends screening for this infection as follows:

  • Everyone 13 to 64 years old should have an HIV screening test at least once.
  • Pregnant women should have at least one HIV test.

The CDC recommends getting tested each year if you’ve engaged in an activity that can spread an HIV infection.

Know your risk
Any of the following put you at risk and are a reason to have an HIV screening test soon, even if you have no symptoms of an infection, the U.S. Preventive Services Task Force and the American Academy of Family Physicians strongly suggest:

Sexual contacts of concern:

  • If you’ve had unprotected sex with 2 or more people
  • If you’re a male who, since 1975, has had sexual contact with another male
  • If you or a partner exchanged sex for money or drugs
  • If someone with whom you’ve had sex was HIV-infected, bisexual, or an injection drug user
  • If you’re being treated for a sexually transmitted disease

Other issues of concern:

  • If you use or used injection drugs (are likely to have shared unsterilized needles)
  • If between 1978 and 1985 you had a blood transfusion

How often you are tested should depend on your activities and sexual contacts. For example, during a long-term, truly monogamous sexual relationship, you may want just one test. However, if you or your partner have had sexual contact with more than one person in recent months, your risk of infection is greater. If you or a person with whom you’ve had sexual contact (even unwanted sexual contact) engaged in some risky behavior, you have even more reason to be tested.

Talk to your health care provider
Don’t be surprised if a health care provider, in any care setting, asks you, your teen, or your partner to consent to an HIV screening test, in keeping with CDC recommendations. Routine HIV testing (which you can decline or “opt out” of) prevents feelings of embarrassment or shame from becoming obstacles to crucial health care. This universal, nonjudgmental approach protects those who hesitate or never get to discuss sexual health issues with a health care provider. Those infected find out sooner; they can then get treatment when it works best and take steps to protect the health of sex partners and even their unborn children.

Some health care providers may be more selective about screening for HIV and other STDs. Instead of routinely offering all patients such tests, they may, as time and circumstances allow, assess your risk and then decide whether to suggest a screening test(s). Unfortunately, some may not discuss sexual health issues at all, especially with younger patients. This leaves the health risks unchecked. If your health care provider does not bring up sexual health topics, you can simply ask for a test or a risk assessment. You can also use confidential services to obtain testing or counseling. 


Resources/Links

For confidential information, you can call the STDs and HIV/AIDS hotline of the CDC: 800-232-4636.
National Library of Medicine: online, narrated tutorial on STDs
Mayo Clinic: STD testing - What to know before your appointment


Sources

Biagioli FE and DeVoe JE. What are appropriate screening tests for adolescents? Oct 2006. J Family Practice 55(10):907-913. Available on the Internet through http://www.jfponline.com. Accessed 18 Jan 2008.

Branson BM, et al, for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. 22 Sep 2006. MMWR 55(RR14):1-17. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm. Accessed 28 Jan 2008.

US Preventive Services Task Force. Guide to Clinical Preventive Services, 2007. Available on the Internet at http://www.ahrq.gov/clinic/pocketgd07. Accessed 28 Jan 2008.

Hagan JF, Shaw JS and Duncan PM, eds. Bright Futures Guidelines: Guidelines for Health Supervision of Infants, Children, and Adolescents. 2008. Elk Grove Village, Ill: American Academy of Pediatrics. Pp. 169, 173.

US Centers for Disease Control and Prevention. Questions and answers for the general public: revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings. Last modified 22 Jan 2007. Available on the Internet at http://www.cdc.gov/hiv/topics/testing/resources/qa/qa_general-public.htm through http://www.cdc.gov. Accessed 28 Jan 2008.


Obesity

About 17 percent of children and adolescents in the United States are overweight. This serious health problem extends from preschoolers to teens. Problems associated with overweight and obesity include Type 2 diabetes, sleep apnea, social and psychological problems, high cholesterol, and elevated blood pressure. Excess weight can also interfere with proper growth of leg and hip bones, creating both immediate and lifelong problems. Children who continue to be overweight into adulthood and overweight children who become obese as adults are at greater risk for other serious health problems as well, including heart disease, stroke, and some cancers.

At least once a year, a health care provider should assess the teen’s weight. This recommendation comes from a federally convened “expert committee” that represents 15 national health care organizations. The teen’s height, weight, age, and gender are considered in determining the teen’s desirable body mass index (BMI).

  • Overweight: An overweight youth (one whose BMI is between the 85th percentile and the 94th percentile) faces additional health risks.
  • Obese: An obese youth (at or above the 95th percentile or a BMI of greater than or equal to 30 kg/m2, whichever is lower) faces even more serious health risks.

At each well visit, the following should be discussed: the teen’s dietary patterns, levels of physical activity, and sedentary behaviors. The family’s history of obesity, type 2 diabetes, and high blood pressure are important considerations as are a number of other physical measurements the health care provider can take. The goal is to prevent and address the problems of overweight and obesity through identification and early interventions, such as diet and exercise to achieve a healthy weight and BMI.

The health care provider will discuss the health risks and the changes the teen and family should make. If the teen is overweigt or obese, lab tests for glucose to identify Type 2 diabetes and cholesterol to identify lipid abnormalities may be measured and used to monitor the effectiveness of lifestyle changes in reversing these conditions.  

Children’s body mass calculations need to be related to their growth charts. A visit to a health care provider will provide you with the most reliable information, but the calculator at the following web site helps you see if your teen is at risk of being overweight: http://apps.nccd.cdc.gov/dnpabmi/calculator.aspx. This CDC website uses slightly different terminology than used above.


 Sources

American Academy of Pediatrics, Committee on Nutrition. Prevention of pediatric overweight and obesity (policy statement). 2 Aug 2003 (reaffirmed 1 Feb 2007). Pediatrics 112(2):424-430. Available on the Internet at http://aappolicy.aappublications.org. Accessed 23 Jul 2004 and 7 Jan 2008.

Barlow SE and the Expert Committee. Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Dec 2007 (suppl). Pediatrics 120:S164-S192. Available on the Internet at http://pediatrics/aappublications.org. Accessed 10 Jan 2008.

Krebs NF, et al. Assessment of child and adolescent overweight and obesity. Dec 2007. Pediatrics 120:S193-228. Available on the Internet at http://pediatrics.aappublications.org. Accessed 28 Jan 2008.

The Obesity Society. Childhood overweight. Available on the Internet at http://naaso.org/information/childhood_overweight.asp through http://naaso.org. Accessed 7 Jan 2008.

US Centers for Disease Control and Prevention. BMI calculator for child and teen. Reviewed 30 Jul 2007, updated 8 Jan 2008. Available on the Internet at http://apps.nccd.cdc.gov/dnpabmi/calculator.aspx through http://apps.nccd.cdc.gov. Accessed 8 Jan 2008.

US Centers for Disease Control and Prevention. Childhood overweight. Last reviewed 18 Apr 2007. Available on the Internet at http://www.cdc.gov/HealthyYouth/overweight/index.htm through http://www.cdc.gov. Accessed 8 Jan 2008.

US Centers for Disease Control and Prevention. Overweight and obesity: frequently asked questions. Available on the Internet at http://www.cdc.gov/nccdphp/dnpa/obesity/faq.htm#children through http://www.cdc.gov. Accessed 8 Jan 2008.

 


Tuberculosis

According to the Centers for Disease Control and prevention (CDC), there were 13,293 reported cases of tuberculosis in 2007, a decline by 4.2% compared to 2006.  Overall, the TB incidence rate has decreased from 7.3%, as seen in the 1990s, to 3.8% during the first seven years of this decade.  However, this rate of decline appears to be slowing, and the ultimate goal of eliminating TB in the US is still elusive. Slightly more than one per cent (1.1%) of those patients with TB has multidrug-resistant tuberculosis (MDR TB).  In 2008, the World Health Organization (WHO) reported that MDR TB was at the highest rate ever.

While tuberculosis is still relatively rare in this country, it is a large health issue among at-risk groups. The rate is almost ten times higher in foreign-born persons living in the US as opposed to US-born individuals. Among those TB-positive patients in 2007 who were also tested for HIV, 11.3% were HIV-positive.  HIV is now recognized as a key risk factor in the progression from latent to full TB infection; thus the CDC has recommended HIV testing for all TB patients.

Current guidelines call for targeted screening among such groups. Teens who are part of or have been exposed to those who fall into high risk groups should also be considered for screening.

The infection may be detected via a tuberculin skin test and/or a blood test. The CDC note that more data are needed on the blood test’s effectiveness in children and those with HIV or acquired immunodeficiency syndrome (AIDS).

  • Although the CDC discourages routine screening of low-risk populations, students are often required to be tested before the first day of school.
  • Most health care workers are routinely tested for possible exposure.
  • Persons who have had contact with an individual who has suspected or confirmed TB and persons with or at risk for HIV infection are the CDC’s highest screening priority.

If an adolescent has been exposed to a high-risk adult, he or she should be tested. The American Academy of Family Physicians’ high-risk category includes the following:

  • Those with close contact to a person with known or suspected TB
  • Health care workers
  • Immigrants from countries with a high rate of this disease (generally, less industrialized, developing nations)
  • People with HIV
  • Alcoholics
  • Users of injection drugs or other illicit substances
  • Residents of long-term care facilities (such as nursing homes, mental health facilities, prisons, AIDS care facilities, and homeless shelters)
  • Those considered medically underserved, from a low-income environment

Links
CDC: Fact sheet on TB
University of Iowa’s Virtual Children’s Hospital web site


Sources

US Centers for Disease Control and Prevention. QuantiFERON-TB Gold Test (fact sheet). Last modified 16 Nov 2007. Available on the Internet at http://www.cdc.gov/tb/pubs/tbfactsheets/QFT.htm through http://www.cdc.gov. Accessed 6 Dec 2007.

US Centers for Disease Control and Prevention. Trends in Tuberculosis – United States, 2007. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm through http://www.cdc.gov.

New Jersey Medical School and National Tuberculosis Center, University of Medicine and Dentistry of New Jersey. History of TB: the recent TB epidemic. 26 Feb 2001. Available on the Internet at http://www.umdnj.edu/globaltb/tbhistory.htm through http://www.umdnj.edu. Accessed 26 Jul 2004 and 6 Dec 2007.

D’Alessandro D and Huth L. Children’s Virtual Hospital and The University of Iowa. Pediatrics common questions, quick answers: TB (tuberculosis). Last revised Apr 2002. Available on the Internet at http://lib.cpums.edu.cn/jiepou/tupu/atlas/www.vh.org/pediatric/patient/pediatrics/cqqa/tb.html through http://lib.cpums.edu.cn. Accessed 26 Jul 2004 and 6 Dec 2007.

Screening for tuberculosis and tuberculosis infection in high-risk populations: recommendations of the advisory council for the elimination of tuberculosis. 8 Sep 1995. MMWR 44(RR11);18-34. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/00038873.htm through http://www.cdc.gov. Accessed 21 Jul 2004 and 28 Jan 2008.

US Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection (American Thoracic Society/CDC statement). 9 Jun 2000. MMWR 49(RR06);1-54. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4906a1.htm through http://www.cdc.gov. Accessed 21 Jul 2004 and 6 Dec 2007.

University of Iowa Health Care. Tuberculosis. Last modified 19 Oct 2006. Available on the Internet at http://
www.uihealthcare.com/topics/infectiousdiseases/infe4731.html through http://
www.uihealthcare.com. Last accessed 6 Dec 2007.

Tuberculosis. In: Caring for Your Baby and Young Child: Birth to Age 5. 1999. Bantam. Excerpt on the Internet at http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ1BN54FDC&sub_cat=573 through http://www.medem.com. Accessed 26 Jul 2004 and 6 Dec 2007.


Type 2 Diabetes

Type 2 diabetes, the sixth leading cause of death in Americans, has become a concern for children and adolescents. About 177,000 young people under 20 years of age have diabetes. Developing the disease early in life means the individual will most likely suffer many more of the damaging blood sugar spikes. This increases the risk of serious health problems earlier in adulthood, such as heart disease, kidney failure, blindness, and foot amputations due to nerve damage.

Overweight, obesity, and physical inactivity are all contributing factors, and they too have become national health problems. As public health experts work to educate Americans on what to do to avoid this disease and its serious complications, parents and teens should be aware that eating habits and activity choices can be changed to lower an individual’s risk of developing diabetes and of suffering the complications from the disease as their lives progress.

An overweight youth with just 2 other known risk factors faces a substantial risk of having or developing type 2 diabetes, warns the American Diabetes Association. The following risk factors are important to monitor:

The American Diabetes Association makes the following screening recommendation:

  • An overweight youth who has 2 or more other risk factors should be screened every 2 years for diabetes, starting at 10 years of age or the onset of puberty.

A fasting plasma glucose (FPG) test or a 2-hour oral glucose tolerance test (OGTT) can be used to screen for diabetes (see Glucose test).


Links
Information to help parents and teens learn how to lower the chances of developing diabetes is available from the Joslin Diabetes Center and the American Diabetes Association.


Sources

American Diabetes Association. Standards of medical care in diabetes—2008 (position statement). Jan 2008. Diabetes Care 31:S12-S54. Available on the Internet at http://care.diabetesjournals.org. Accessed 18 Feb 2008.

Gahagan S, Silverstein J. Committee on Native American Child Health and Section on Endocrinology. Prevention and treatment of type 2 diabetes mellitus in children, with special emphasis on American Indian and Alaska native children. Oct 2003. Pediatrics 112(4):e328-e328. Available on the Internet at http://pediatrics.aappublications.org. Accessed 8 Jan 2008.

Information on diabetes in children and young people: resources on children and adolescents. National Diabetes Education Program, National Institutes of Health. Available on the Internet at http://www.ndep.nih.gov/diabetes/youth/youth.htm through http://www.ndep.nih.gov. Accessed 8 Jan 2008.

Overview of Diabetes in Children and Adolescents. 
A Fact Sheet From the National Diabetes Education Program. 
Available on the Internet at http://ndep.nih.gov/diabetes/youth/youth_FS.htm through http://www.ndep.nih.gov.

US Centers for Disease Control and Prevention. National diabetes fact sheet 2005: national estimates on diabetes. Last reviewed 7 Jul 2007. Available on the Internet at http://www.cdc.gov/diabetes/pubs/estimates05.htm through http://www.cdc.gov. Accessed 8 Jan 2008.

Santa Barbara Regional Health Authority. Type 2 diabetes: reduce your child’s risk now. In: In Your Health (newsletter). Summer 2006. Available on the Internet at http://www.sbrha.org. Accessed 8 Jan 2008. 

National Diabetes Information Clearinghouse, National Institutes of Health. Am I at risk for type 2 diabetes? (NIH pub. 04-4805). Apr 2004. Available on the Internet at http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/index.htm through http://diabetes.niddk.nih.gov. Accessed 19 Jul 2004 and 8 Jan 2008.

American Diabetes Association. Type 2 diabetes in children and adolescents. Mar 2000. Diabetes Care 23(3):381. Available on the Internet at http://care.diabetesjournals.org. Accessed 11 Mar 2008.

US Centers for Disease Control and Prevention. CDC issues statements on diabetes issues: lifetime risk for diabetes mellitus in the United States. (Original source: Naryan KMB, et al. Lifetime risk for diabetes mellitus in the United States. Oct 2003. JAMA 8;290(14):1884-1890.) Available on the Internet at http://www.cdc.gov/diabetes/news/docs/lifetime.htm through http://www.cdc.gov. Accessed 30 Aug 2004 and 9 Jan 2008.

Grassi Y. Type 2 diabetes: reduce your child’s risk now. Bronson for Parents (newsletter). Winter 2003. The Children’s Hospital at Bronson, Kalamazoo, Michigan. Available on the Internet at http://www.bronsonhealth.com. Accessed 31 Aug 2004.

National Diabetes Education Program, National Institutes of Health. Resources on children and adolescents. Available on the Internet at http://www.ndep.nih.gov/diabetes/youth/youth.htm through http://www.ndep.nih.gov. Accessed 30 Aug 2004 and 8 Jan 2008.