What are the USPSTF (United States Preventive Services Task Force) guidelines for routine preventive care in a healthy 14-year-old male?

USPSTF Preventive Care Guidelines for a Healthy 14-Year-Old Male

For a healthy 14-year-old male, the USPSTF recommends screening for depression (when systems are in place for diagnosis and treatment), behavioral counseling for sexually transmitted infections if sexually active, screening for illicit drug use, and tobacco use prevention counseling. 1

Mental Health Screening

• Screen for major depressive disorder (MDD) when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive behavioral or interpersonal), and follow-up. 1
• This is a Grade B recommendation specifically for adolescents aged 12-18 years. 1
• Consider recurrent screening in patients with unexplained somatic symptoms, comorbid psychological conditions (panic disorder, generalized anxiety), substance abuse, or chronic pain. 1

Suicide Risk Assessment

• The USPSTF found insufficient evidence (I statement) to recommend for or against routine screening for suicide risk in adolescents. 1
• However, clinicians should be aware of high-risk patients and ask about suicidal thoughts during routine visits, particularly those with mood disorders, family dysfunction, declining grades, or history of abuse. 1

Substance Use Screening and Counseling

Illicit Drug Use

• Screen for illicit drug use, including nonmedical use of prescription drugs. 1
• Screening should begin as early as age 12 years, as some adolescents may be sexually active and engaging in high-risk behaviors at this age. 1
• The USPSTF is currently updating recommendations on screening for illicit drug use in adolescents aged 12-17 years. 1

Tobacco Use Prevention

• Provide primary care interventions to prevent tobacco use initiation. 1
• Ask about tobacco use and provide tobacco cessation interventions if the patient uses tobacco products. 2
• The USPSTF recommends education or brief counseling interventions to prevent tobacco initiation (B recommendation). 1

Alcohol Use

• Screen and provide behavioral counseling interventions to reduce unhealthy alcohol use. 1
• The USPSTF has recommendations on screening and behavioral counseling for adolescents aged 12-17 years. 1

Sexually Transmitted Infection Screening

• If sexually active, screen for chlamydia and gonorrhea based on risk factors. 1
• Consider screening for HIV and syphilis if at increased risk (multiple partners, unprotected sex, injection drug use, or living in high-prevalence communities). 1
• Age at first sexual encounter varies; providers should consider the possibility of sexual activity in all adolescents when making screening decisions, as persons as young as 12 years may be sexually active. 1
• Screen annually for sexually active adolescents, particularly those in high-risk communities or demographic groups. 1

Immunizations

At age 14, ensure the following vaccinations are up to date: 1

• Tetanus and diphtheria toxoid (Td) booster if not received at ages 11-12 years. 1
• Second dose of measles, mumps, and rubella (MMR) vaccine if not previously administered. 1
• Hepatitis B vaccine series if not previously vaccinated (this is critical before high-risk behaviors begin). 1
• Varicella virus vaccine if indicated (no history of chickenpox or previous vaccination). 1

Screenings NOT Recommended at Age 14

• Do NOT screen for prostate cancer - PSA testing is not appropriate for adolescents and should not begin until at least age 45-50 years with shared decision-making. 2, 3, 4
• Do NOT routinely screen for lipid disorders unless there are specific risk factors such as family history of premature cardiovascular disease, diabetes, hypertension, or obesity (BMI ≥25 kg/m²). 2, 3
• Do NOT routinely screen for diabetes unless the patient is overweight or obese (BMI >25 kg/m²). 2

Important Clinical Considerations

Risk Stratification

• Tailor screening based on individual risk factors, family history, sexual activity status, and community prevalence of infections. 1
• Consult local public health data when available, as STI prevalence varies significantly by geographic region and community. 1
• Race and ethnicity may serve as surrogate markers for underlying social factors that increase STI risk in certain communities. 1

Common Pitfalls to Avoid

• Do not assume adolescents are not sexually active based on age alone - begin conversations about sexual health and risk behaviors early. 1
• Do not delay hepatitis B vaccination - initiate the series before high-risk behaviors begin, as most HBV infections are acquired during adolescence and young adulthood. 1
• Do not screen for depression without having systems in place for appropriate diagnosis, treatment, and follow-up. 1