What preventive care and medications are recommended for a 20-year-old?

Recommended Preventive Care for a 20-Year-Old

For a 20-year-old, comprehensive preventive care should include annual well visits with confidential screening for behavioral and physical health risks, appropriate immunizations, and targeted health education focusing on reproductive health, mental health, and substance use prevention.

Core Preventive Services

Annual Well Visit

• Annual preventive health visits are recommended for all individuals between 11-21 years of age 1
• Should include confidential screening for behavioral, emotional, and medical risks 1
• Should be conducted in a medical home that provides coordinated care 1

Screening Assessments

• Mental Health:

  • Annual screening for depression for ages 11-21 1
  • Use of CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) questionnaire for alcohol and drug use assessment 1
  • Suicide risk assessment (particularly important as suicide is a leading cause of death in this age group) 1

• Sexual/Reproductive Health:

  • Confidential counseling about sexual development, sexuality, and responsible decision-making 1
  • Screening for sexually transmitted infections (STIs) for sexually active individuals 1
  • HIV screening recommended for adolescents 16-18 years of age 1
  • Emergency contraception should be covered by insurance with minimal or no copayments 1, 2

• Physical Health:

  • Blood pressure measurement at regular healthcare visits 1, 3
  • Risk assessment for traditional cardiovascular risk factors every 4-6 years starting at age 20 1
  • Vision screening based on risk assessment 1

Immunizations

• Annual influenza vaccine 3
• Catch-up on any missed childhood vaccinations
• Tdap/Td (tetanus, diphtheria, pertussis) if not previously received 3
• COVID-19 vaccination as per current recommendations 3

Health Education and Counseling

Preventive counseling should focus on:

1. Healthy Lifestyle:

   • Promotion of healthy eating and physical activity 1
   • Sleep hygiene education 3
   • Weight management 3

2. Risk Avoidance:

   • Tobacco, alcohol, and substance use prevention 1
   • Safe driving practices (seat belts, avoiding drunk driving) 1
   • Violence prevention 1
   • Injury prevention (protective helmets, weapons avoidance) 1

3. Reproductive Health:

   • Contraception options and STI prevention 1
   • Access to confidential reproductive health services 1

Implementation Considerations

Confidentiality

• Confidentiality is critical for adolescents and young adults seeking healthcare 1
• 58% of high school students report health concerns they want to keep private from parents 1
• Insurance plans should develop policies that protect confidentiality while allowing access to services 1

Access to Care

• Affordability is essential - public and private insurance must provide preventive services 1
• Offering after-hours care increases accessibility for young adults 1
• Reduced or eliminated copayments for preventive services improve utilization 1

Clinical Pitfalls to Avoid

1. Replacing comprehensive care with limited exams: Sports physicals should not replace comprehensive well visits 1
2. Neglecting confidentiality: Failure to ensure confidentiality may prevent young adults from seeking necessary care 1
3. Missing screening opportunities: Use urgent care visits as opportunities to provide preventive services 1
4. Overlooking mental health: Depression and substance use screening are essential but often missed components 1
5. Underestimating cardiovascular risk assessment: Even at age 20, periodic assessment of risk factors is important 1

Evidence Quality and Gaps

Current evidence shows that young adults have higher risks of mental illness, substance use, STIs, and risk-taking behavior 4, yet they often receive only half of recommended preventive services 5. Implementation of comprehensive preventive guidelines has been shown to increase receipt of services and improve access to care 6.

While the Affordable Care Act has modestly increased well visit rates and preventive service utilization among young adults, overall rates remain low 7, highlighting the need for continued emphasis on preventive care in this population.

The estimated cost of clinical preventive services per adolescent per year is approximately $130 in a fee-for-service system 8, which is significantly less than the estimated $859 per adolescent per year spent on treating preventable conditions 8.

By implementing comprehensive preventive care for 20-year-olds, we can address health risks early and potentially reduce long-term morbidity and mortality.