What health screenings are recommended for an 18-year-old?

Health Screenings for 18-Year-Olds

Screen all 18-year-olds for hypertension (blood pressure), and assess for depression, substance use, and sexual health risks as part of routine preventive care. 1

Cardiovascular Screening

Blood Pressure

• Universal screening for hypertension is strongly recommended starting at age 18 with a Grade A recommendation from the USPSTF. 1
• Hypertension screening prevents premature death, myocardial infarction, renal insufficiency, and stroke. 1
• Screen every 2 years if blood pressure is <120/80 mm Hg, and annually if systolic BP is 120-139 mm Hg or diastolic BP is 80-89 mm Hg. 1

Lipid Screening

• Dyslipidemia screening is not routinely recommended at age 18 based on the available evidence. 1
• The American Academy of Pediatrics recommends cholesterol screening at ages 9-11 years for obesity-related concerns, but does not extend universal screening to 18-year-olds without specific risk factors. 1

Mental Health and Behavioral Screening

Depression and Suicide Risk

• Screen annually for depression starting at age 11 and continuing through age 21. 1
• This addresses suicide as a leading cause of death in adolescents and young adults. 1
• The American Academy of Pediatrics recommends global and domain-specific mental health screening, with depression and suicide risk screening after age 12. 2

Substance Use

• Use the CRAFFT screening questionnaire (Car, Relax, Alone, Forget, Friends, Trouble) to assess alcohol and drug use in adolescents and young adults. 1
• This structured approach improves detection rates compared to unstructured questioning. 3

Anxiety

• Anxiety screening should begin after age 8 and continue through young adulthood. 2

Sexual Health Screening

HIV and STI Screening

• Screen for HIV infection at ages 16-18 years, as one in four new HIV infections occurs in persons aged 13-24 years, with 60% unaware of their infection. 1
• Sexually transmitted infection screening should be performed based on sexual activity and risk assessment. 1

Cervical Cancer Screening

• Do not screen for cervical dysplasia until age 21, regardless of sexual activity. 1
• This represents a shift from previous recommendations that started screening earlier. 1

Vision Screening

• At age 18, transition to risk-based vision assessment rather than routine screening. 1
• Evidence shows fewer new vision problems develop in low-risk young adults. 1
• Universal visual acuity screening is not necessary at this age unless risk factors are present. 1

Anemia Screening

• Routine hematocrit or hemoglobin screening is not recommended at age 18 unless specific risk factors are present (heavy menstrual bleeding, restrictive diets, chronic disease). 1
• Universal anemia screening is recommended at 12 months of age, with risk-based screening at 15 and 30 months. 1

Common Pitfalls

• Avoid over-screening for conditions without evidence-based recommendations at this age (e.g., routine lipid panels in low-risk individuals, cervical cancer screening before age 21). 1
• Do not rely on passive questioning for behavioral health risks—use validated screening tools like CRAFFT for substance use. 1
• Male patients and those without a usual source of care receive significantly fewer preventive services; actively address these disparities. 4
• Private practice settings historically screen less comprehensively for psychosocial and behavioral risks compared to dedicated adolescent clinics; implement systematic screening protocols. 5