Receipt of Anticipatory Guidance Among Youth With and Without Special Health Care Needs

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Professional guidelines recommend that all adolescents receive annual preventive visits including psychosocial and behavioral screening, and anticipatory guidance and counseling for health risk behaviors. Youth with special health care needs (YSHCN) experience many health-related disparities yet little is known about receipt of such counseling this population.


We characterized adolescents’ receipt of recommended healthcare provider-delivered counseling and assessed differences between youth with and without special health care needs.


We used data from a 2016 school-based survey of adolescents ages 16-18 in rural South Central Appalachia Tennessee (n=403). About one-quarter (23%) were categorized as YSHCN. A greater proportion of YSHCN were female (68% vs. 49%), non-Hispanic white (96% vs. 83%), or had seen a doctor or other healthcare provider in the past year (97% vs. 83%) (all p<.05). Adolescents reported on their discussions with a healthcare provider about ten different recommended topics across four areas: weight/physical activity; mental health; substance use; and protective factors (i.e., friends, school). We assessed differences in individual topics discussed by YSHCN status using chi-square analyses and multivariable logistic regression.


Overall, only half (50%) of adolescents reported talking with their healthcare provider about any of the assessed topics. As shown in Figure 1, receipt of counseling varied by YSHCN status with a greater proportion of YSHCN reporting having discussed most of the assessed topics with a healthcare provider compared to other youth. In multivariable models controlling for adolescents’ sex, age, race/ethnicity, SES, use of health services, and quality of a relationship with their healthcare provider, YSHCN had greater odds than other youth of discussing topics related to weight/physical activity (OR=4.08, 95% CI: 2.35-7.07); mental health (OR=2.50, 95%CI: 1.46-4.31); protective factors (OR=2.32, 95% CI: 1.29-4.18); but not substance use (p>.05).


This study provides novel data on receipt of healthcare provider-delivered counseling about important health risk and promotion topics. Findings suggest that YSHCN are more likely than other youth to receive counseling about most topics, even when controlling for their increased receipt of preventive care. However, findings also highlight suboptimal provision of anticipatory guidance to all youth, and point to the need to increase delivery of adolescent preventive servcies.


San Francisco, CA

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