What are the current United States Preventive Services Task Force (USPSTF) screening guidelines for a generally healthy 14‑year‑old male?

USPSTF Preventive Screening Guidelines for a 14-Year-Old Male

For a healthy 14-year-old male, the USPSTF recommends screening for depression (when appropriate systems are in place), substance use counseling, tobacco prevention education, and ensuring immunizations are current—but does NOT recommend routine screening for most adult conditions like cardiovascular disease, diabetes, or cancer at this age. 1

Mental Health Screening

• Screen for major depressive disorder using a validated tool when your practice has systems in place for accurate diagnosis, psychotherapy referral, and follow-up (Grade B recommendation). 1
• Prioritize screening if the patient presents with unexplained somatic complaints, chronic pain, substance abuse, or comorbid psychological conditions. 1
• While the USPSTF found insufficient evidence for routine suicide risk screening, you should directly ask about suicidal ideation during visits, especially in high-risk patients. 1

Common Pitfall

Do not screen for depression if you lack established pathways for diagnosis and treatment—screening without follow-up systems causes harm. 1

Substance Use Prevention and Screening

• Screen for illicit drug use including nonmedical use of prescription drugs, as this age marks the typical initiation period. 1
• Ask about tobacco use at every visit and provide brief counseling interventions to prevent initiation (Grade B recommendation). 1
• Screen for alcohol use and provide behavioral counseling to reduce unhealthy drinking patterns. 1
• Males aged 14 are at the beginning of a trajectory where health risk behaviors steadily increase through adolescence into the early 20s. 2

Sexual Health Screening

• If sexually active, screen annually for chlamydia and gonorrhea based on risk factors. 1
• Consider HIV and syphilis screening if the patient has increased risk factors (multiple partners, high-prevalence community, men who have sex with men). 1

Common Pitfall

Do not assume a 14-year-old is not sexually active based on age alone—early adolescent females are more likely to be sexually active than commonly recognized, and males rapidly increase sexual activity through mid-adolescence. 2

Immunization Verification

Confirm the following vaccines are up to date: 1

• Tetanus-diphtheria (Td) booster
• Second dose of MMR (measles, mumps, rubella)
• Hepatitis B series completion
• Varicella vaccine if no prior immunity
• HPV vaccine series (typically started at age 11-12, but can be initiated through age 26)
• Meningococcal conjugate vaccine (MenACWY)

Obesity Screening

• Calculate BMI and screen for obesity, though recognize that BMI may underestimate adiposity in adolescents—up to 23% of obese adolescents may be misclassified as normal weight by BMI alone. 3
• If BMI ≥95th percentile for age and sex, refer to intensive multicomponent behavioral interventions. 4

What NOT to Screen

The provided evidence focuses on adult screening guidelines (prostate cancer, cardiovascular disease, diabetes) that are not applicable to a 14-year-old male: 5, 6

• No PSA screening—prostate cancer screening begins at age 50 for average-risk men, age 45 for high-risk populations
• No routine lipid screening—cardiovascular screening begins at age 35 for at-risk males
• No diabetes screening—unless the patient is overweight/obese (BMI >25 kg/m²)
• No aspirin for primary prevention

Counseling and Anticipatory Guidance

Address the following topics during the visit, as coverage rates are suboptimal (15-76% in routine care): 7

• Safety: Seatbelt and helmet use (discussed in only ~50% of visits)
• Violence prevention (discussed in only 15% of visits)
• Exercise and nutrition (discussed in ~76% of visits)
• Sexual health education if age-appropriate

Males aged 14 are entering a critical period where risk behaviors increase substantially, making this an optimal time for prevention-focused counseling. 2