Objective: To examine the extent to which pediatricians are adhering to clinical preventive service guidelines that have been developed to assist clinicians in screening adolescents for health risks.

Design: 361 pediatricians, in a managed care organization in California, completed a survey assessing the extent to which they screen for biomedical and sociobehavioral health risks as recommended by guidelines for adolescent preventive services. First, pediatricians indicated their screening practices with adolescents on 41 items reflecting a broad range of recommended services. Second, pediatricians were asked a series of more detailed questions about their practices with adolescent patients in the specific areas of: 1) sexual activity, 2) alcohol use, 3) tobacco use, 4) seatbelt or helmet use.

Results: First, pediatricians delivered a broad range of recommended preventive services to about half of their adolescent patients(49%). Second, on average, they screened and educated adolescents most often for seatbelt and helmet use (58% of patients), next often for tobacco use(48%), less often for alcohol use (43%), and least often about sexual behavior(36%). Third, when screening resulted in a positive patient response, rates of education varied by topic. A much greater percentage of the patients who do not use seatbelts or helmets (77%) and who use tobacco (75%) were educated regarding these behaviors than were adolescent patients who identified themselves as using alcohol (44%) or engaging in sexual behavior (44%). Fourth, those physicians who had more recently graduated from medical school were more likely to deliver preventive services to adolescents, and female physicians were more likely to screen and educate adolescents in the areas of sexual behavior.

Conclusions: This study indicates that although pediatricians within this managed care organization are screening a large percentage of their at-risk adolescent patients in certain areas (e.g., injury), they have low rates of delivery for preventive services in other recommended areas(e.g., sexual behavior). More recent graduation from medical school is related to greater delivery of adolescent preventive services regardless of whether the physician is male or female. Female physicians, however, are more likely to deliver services specifically in the area of sexual behavior.