Table 2. Ages 11-24 Years

Interventions Considered and Recommended for the Periodic Health Examination  Leading Causes of Death 
 
Motor vehicle/other unintentional injuries 
Homicide 
Suicide 
Malignant neoplasms 
Heart diseases
Interventions for the General Population
SCREENING B. Unintended pregnancy: contraception 
B. Height & weight, BMI  (US) Diet and Exercise
A. Blood pressure [1] (US) B. Limit fat & cholesterol; maintain caloric balance; emphasize grains, fruits, vegetables (US)
B. Papanicolaou (Pap) test [2] (females) (US)  B. Adequate calcium intake (females) (US)
A. Chlamydia screen [3] (females <25 yr) (US) B. Regular physical activity (CAN) [*]
B. Rubella serology or vaccination hx [4] (females >12 yr)  Dental Health
B. Assess for problem drinking; counseling B. Regular visits to dental care provider (US)
B. Screen adults for depression in clinical
practices that have systems in place to assure accurate diagnosis, effective treatment, and followup
A. Floss, brush with fluoride toothpaste daily
COUNSELING
Injury Prevention IMMUNIZATIONS 
B. Lap/shoulder belts  B. Tetanus-diphtheria (Td) boosters (11-16 yr) 
B. Bicycle/motorcycle/ATV helmets [*] A. Hepatitis B [5]
B. Smoke detector[*] B. MMR [6] (US)
A. Noise control and hearing protection (CAN) B. Varicella (11-12 yr)[7] 
B. Counseling on home injury risk factors, poisoning (CAN) B. Rubella [4] (females >12 yr) 
B. Removal/safe storage of firearms (US) A. Influenza vaccination (CAN)
B. Counseling on sun exposure, clothing (CAN)
Substance Use
B. Counseling to prevent tobacco use;  A. counseling on smoking cessation; 
B. referral to validated cessation program (CAN)
CHEMOPROPHYLAXIS
B. Avoid underage drinking & illicit drug use[*] A. Multivitamin with folic acid (females planning/capable of pregnancy) (US)
B. Avoid alcohol/drug use while driving, swimming, boating, etc. [*] (US)
B. Children of Alcoholics Screening Test (CAST) (CAN)
Sexual Behavior
B. STD prevention: abstinence;[*] avoid high risk behavior;[*] condoms/female barrier with spermicide[*]


Interventions for High Risk Populations
POPULATION POTENTIAL INTERVENTIONS 
Cardiovascular risk factors/diabetes
Persons 20 and over with risk factors for coronary heart disease (US) Screen with total cholesterol and HDL
Adults with BMI >=30 (US) Intensive counseling and behavioral interventions to promote sustained weight loss
Infections; vaccinations
Susceptible to varicella, measles, mumps (US) Varicella vaccine ; MMR
High risk or unvaccinated individuals exposed to index case (CAN) Amantadine prophylaxis
Contact of household influenza case (CAN) Neuraminidase inhibitor prophylaxis if initiated within 36-48 hours of onset in index case
High risk sexual behavior RPR/VDRL(US); screen for gonorrhea (female) , HIV  , chlamydia (female) ; hepatitis A vaccine (US) 
Injection or street drug use (US) RPR/VDRL; HIV screen; hepatitis A vaccine ; PPD ; advice to reduce infection risk
Household contacts and skin test converters (CAN) INH prophylaxis
TB contacts; immigrants; low income (US) PPD
Blood transfusion between 1978-1985 (US) HIV screen
Native Americans/Alaska Natives (US) Hepatitis A vaccine ; PPD ; pneumococcal vaccine 
Travelers to developing countries (US) Hepatitis A vaccine 
Certain chronic medical conditions (US) PPD ; pneumococcal vaccine ; influenza vaccine 
Institutionalized persons; health care/lab workers (US) Hepatitis A vaccine ; PPD; influenza vaccine
Other
Sibs of children with CF (CAN) Sweat test; DNA analysis for carrier status
Prior pregnancy with neural tube defect (US) Folic acid 4.0 mg
Inadequate water fluoridation (US) Daily fluoride supplement
Family h/o skin cancer; nevi; fair skin, eyes, hair (US) Avoid excess/midday sun, use protective clothing*
Women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes (US)
Refer for genetic counseling and evaluation for BRCA testing

[1]Periodic BP for persons aged >=18 yr.
[2] If sexually active at present or in the past: q <= 3 yr. If sexual history is unreliable, begin Pap tests at age 18 yr.
[3] If sexually active.
[4] Serologic testing, documented vaccination history, and routine vaccination against rubella (preferably with MMR) are equally acceptable alternatives.
[5] If not previously immunized: current visit, 1 and 6 mo later.
[6] If no previous second dose of MMR.
[7] If susceptible to chickenpox.
[*] The ability of clinician counseling to influence this behavior is unproven.