AAP Recommendations for Male Adolescent, Young Adult Health

Laurie Barclay, MD

August 12, 2013

Pediatricians have the opportunity to improve the health of their adolescent male patients, according to a review published online August 12 in Pediatrics. The authors highlight objectives and practices for chronic illness, mortality, unintentional injury and violence, mental health and substance use, and reproductive and sexual health in young men.

"Adolescent and young adult male health receives little attention, despite the potential for positive effects on adult quality and length of life and reduction of health disparities and social inequalities," write David L. Bell, MD, MPH, from the Department of Pediatrics and the Department of Population and Family Health, Columbia University Medical Center, New York City, and colleagues. "Pediatric providers, as the medical home for adolescents, are well positioned to address young men's health needs."

The authors reviewed available literature on young men's health and summarized best clinical practices to meet the Centers for Disease Control and Prevention Healthy 2020 objectives for adolescents and young adults. While offering recommendations for overall care of males in this age group, the review especially focuses on gender-specific issues in reproductive and sexual health.

Specific Recommendations

  • Male youth and their parents should be involved in their own care, as their specific strengths allow.

  • Clinicians should offer time and a safe space for confidential conversations about sensitive topics, approaching these in respectful 2-way conversations rather than a lecture format, and using motivational interviewing–based techniques.

  • Chronic disease interventions should include screening for tobacco use, obesity (using body mass index for age), diabetes (for adolescent males who are overweight and have 2 risk factors), and hyperlipidemia.

  • Clinicians should recommend smoking cessation and healthy lifestyles.

  • To reduce mortality, violence, and unintentional injuries, clinicians should screen for weapon ownership, interpersonal violence and domestic violence, and suicide.

  • Clinicians should counsel teenagers and parents about driving safety, including seat belt use, risks of having passengers in the car, and night driving, and they should know whether their state has a graduated licensing program.

  • Clinicians should screen for depression, suicide, and substance use (particularly alcohol, marijuana, and steroids) and treat and/or refer for treatment as indicated.

  • Clinicians should screen for and counsel regarding sexual activity, including promoting abstinence for those aged 17 years or younger and discuss healthy relationships and safer sexual behaviors, using gender-neutral language and not assuming heterosexuality.

  • Clinicians should discuss and appropriately screen for sexually transmitted infections on the basis of sexual behavior according to Centers for Disease Control and Prevention guidelines, not according to sexual orientation or identity.

  • Primary prevention efforts for males should include hepatitis A and B and human papilloma virus vaccinations.

  • Clinicians should promote condom use and dual contraception and educate males about emergency contraception.

  • Clinicians who feel uncomfortable providing high-quality care to sexual minorities or transgender youth should refer the youth to a clinician able to provide such care.

  • Clinicians should be prepared to address concerns about the timing, approach, and potential repercussions to "coming out" and should support the parents as well as the adolescent.

  • Clinicians should assess or refer for assessment gender-nonconforming youth. Intervention may include the possibility of transitioning to the desired gender.

Neurophysiological Issues

In an accompanying commentary, Elizabeth R. McAnarney, MD, from the Department of Pediatrics, University of Rochester School of Medicine and Dentistry in New York, discusses the conceptual and practical complexity of issues related to male reproductive health.

"Adolescence is the stage of development marking the transition between childhood and adulthood when rapid biological, cognitive, and behavioral changes occur," Dr. McAnarney writes. "Genes, the brain, and the environment largely govern the ultimate expression of growth and maturity."

Despite recent progress in this field, including better understanding of the neurophysiological and endocrinological changes underlying puberty, much is still unknown about the effect of biopsychosocial and environmental influences on health and disease in the young man.

"Neurocognitively, the limbic system (the accelerator) is activated before the prefrontal cortex (the brake) that controls judgment and impulses," Dr. McAnarney writes. "Thus, adolescents, biologically capable of being sexually active in the presence of adolescent sexual impulses and risk-taking behaviors may have untimely pregnancies and/or contract sexually transmitted illnesses."

"The conditions reviewed in this timely piece provide opportunities to review the interplay of biology and behavior during adolescence," she writes.

The authors and Dr. McAnarney have disclosed no relevant financial relationships.

Pediatrics. Published online August 12, 2013. Article abstract

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