What screenings and preventive measures are recommended for a healthy 17‑year‑old male?

Recommended Screening for a 17-Year-Old Male

A healthy 17-year-old male should receive a comprehensive annual preventive visit that includes mandatory confidential time alone with the provider, depression and substance use screening, blood pressure measurement, lipid screening if not previously done, immunization review (Tdap, HPV, MenACWY, influenza), and anticipatory guidance on injury prevention and risky behaviors—these screenings directly address the leading causes of morbidity and mortality in this age group. 1, 2

Visit Structure and Confidentiality Requirements

The visit must include an initial assessment with the parent/guardian present, followed by mandatory private time alone with the adolescent to address sensitive topics. 2, 3 Confidentiality is the most critical element for successful screening, as approximately 58% of high school students report health concerns they wish to keep private from their parents, and fear of disclosure causes adolescents to delay or avoid needed care. 3

• Begin by explaining confidentiality limits at the start of the private portion (exceptions include imminent harm to self or others, abuse, or neglect). 2
• The initial assessment with parents should cover medical history, growth parameters, pubertal development (Tanner staging), current health concerns, and school performance. 2, 3

Mandatory Behavioral and Mental Health Screening

Depression screening must be performed annually starting at age 11 through 21 years, as suicide is a leading cause of death in adolescents. 1, 2, 3 Use validated screening tools during the confidential portion of the visit. 2

Substance use screening is required using the CRAFFT questionnaire to assess for tobacco, alcohol, marijuana, and other drug use, as substance abuse is a leading cause of adolescent morbidity and mortality. 1, 2, 3

Additional psychosocial screening should include:

• Sexual activity, number of partners, contraception use, and history of sexually transmitted infections 2, 3
• Discussion of consent, healthy relationships, and STI/pregnancy prevention 2, 3
• Assessment for eating disorders and body image concerns 2, 3
• Screening for involvement in or victimization from violence or abuse 3
• Evaluation of school performance, learning difficulties, and peer relationships 3

Physical Examination and Vital Signs

Blood pressure must be measured annually using proper technique with an age-appropriate cuff size. 1, 2, 3 If elevated (≥90th percentile), recommend lifestyle interventions and recheck in 6 months. 1, 2

Complete a head-to-toe physical examination including:

• Vital signs and body mass index calculation 2
• Skin examination 2
• Genitourinary examination 2, 3
• Assessment for signs of physical abuse or neglect 2, 3

Laboratory Screening

Lipid panel screening is recommended at ages 9-11 years due to the growing obesity epidemic; if not previously performed, screen now if there is a family history of hyperlipidemia or cardiovascular disease. 1, 3

For sexually active adolescents, perform STI screening (gonorrhea, chlamydia, HIV). 3 HIV screening is specifically recommended for adolescents ages 16-18 years, as one in four new HIV infections occurs in persons 13-24 years old. 1

Immunizations

Review and administer vaccines due per current CDC schedule, including: 1, 2, 4

• Tdap booster (if not previously given at age 11-12) 2, 3, 4
• HPV vaccine series (if not completed)—give a strong recommendation emphasizing cancer prevention and normalize by coadministering with other vaccines 1, 2, 3
• Meningococcal conjugate vaccine (MenACWY) 2, 4
• Annual influenza vaccine 2, 3
• Catch up any missed childhood vaccinations 2, 3

Anticipatory Guidance and Health Promotion

Injury prevention counseling is mandatory, as unintentional injuries are the leading cause of adolescent death. 1, 2, 3 Address:

• Seatbelt use and avoidance of distracted/drunk driving 2, 3
• Helmet use for sports and cycling 2, 3
• Firearm safety 2, 3
• Water safety 1

Physical activity: Recommend at least 60 minutes of moderate to vigorous activity daily, including resistance and flexibility training. 1, 2, 3

Nutrition: Discuss healthy eating patterns, limiting sugar-sweetened beverages, and appropriate portion sizes. 2, 3

Sleep: Assess sleep patterns (8-10 hours recommended for this age) and screen for obstructive sleep apnea if indicated. 2, 3

Additional guidance should include:

• Social media use and online safety 2
• Discouraging tobacco/nicotine use, electronic cigarettes, and vaping 3
• Discussing risks of alcohol use and strategies to minimize harm 3
• For sexually active males, incorporate preconception counseling 3

Critical Pitfalls to Avoid

Do not conduct brief "sports physicals" instead of comprehensive examinations—these lack psychosocial screening and confidentiality, missing opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality. 2, 3 Station-based sports physicals primarily assess orthopedic fitness and fail to address longer-term health risks beyond musculoskeletal readiness. 3

Do not skip the confidential time alone with the adolescent—this results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality. 2, 3 Almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues with their physician when parents are present. 3

Do not defer HPV vaccination—give a strong recommendation and normalize it by coadministering with other vaccines. 2, 3

Do not skip depression screening—it must be performed annually starting at age 11. 2, 3

Do not focus only on physical examination while neglecting behavioral and developmental aspects—this misses the primary health threats to this age group. 2