Does Prior Adolescent Behavior Increase the Likelihood of Receiving Physician Advice? Prospective Findings from a Nationally-Representative Cohort

While policy statements by the American Academy of Pediatrics recommend that pediatricians advise patients who engage in risk and unhealthy behaviors, the extent to which this occurs is unknown.  This study examines the likelihood of adolescents receiving physician advice according to alcohol use, smoking, dietary intake and physical activity.

Data come from three waves (W1-W3) of the NEXT Generation Study, a nationally-representative cohort of U.S participants enrolled in 10^thgrade (2009-10). Participants who reported seeing a physician within the prior 12 months and had been asked if they had engaged in specific risk/health behaviors were included in these analyses (W1 N=2042, W2 N=1912, W3 N=1871). Participants were asked about receiving physician advice about associated risks (yes/no) or changing their behavior (yes/no) specific to alcohol use, smoking, diet, and exercise. Risk behaviors included any self-reported 30-day binge drinking (>4 drinks for boys, ≥5 for girls in one occasion or not), and smoking (yes/no). Health behaviors included 7-day eating at a fast food restaurant (>1 day/week v. ≤1day/week), consuming fruits and soda (>1 time/day v. ≤1 time/day) and vigorous physical activity (VPA, >1 hour/week v. ≤1 hour/week). Logistic regression was used to examine the association of adolescents' previous wave behavior on physician advice, controlling for design variables, previous wave physician advice and BMI (for diet and VPA), sex, race/ethnicity, and family affluence.

Compared to those who did not engage in risk behaviors, participants who engaged in risk behaviors at W1 were more likely to report physician risk advice at W2 for smoking (odds ratio [OR] =2.03, p=0.01), physician reduction advice for binge drinking (OR=1.68, p=0.04) and smoking (OR=2.28, p=0.003). Compared to their respective referent groups, participants were more likely to report receiving diet-specific change advice at W2 if they ate more fast food (OR=1.55, p=0.02), low fruits (OR=1.52, p=0.02) and drank soda more (OR=2.23, p=0.001) at W1. Participants who engaged in ≤1 hour/week of VPA were more likely to receive increase advice (OR=1.74, p=0.03). In the W2-W3 models, the pattern of results was very similar for risk behaviors (risk advice: binge drinking OR=1.61, p=0.04, smoking OR=2.71, p=0.003; reduction advice: smoking OR=3.01, p=0.002), dietary intake (risk advice: fruit intake OR=1.71, p=0.02, reduction advice soda intake: OR=1.78, p=0.001) and VPA (increase advice: OR=1.48, p=0.02).

Findings suggest that physicians may be responsive to certain risk and health behaviors in U.S teens. Encouraging physicians to ask about adolescent risk behaviors may increase the likelihood of adolescents receiving health-promoting advice about risks and behavior change.