What essential history questions should be asked during a preventive physical examination of an 18‑year‑old male?

Essential History Questions for an 18-Year-Old Male Physical Exam

For an 18-year-old male preventive visit, prioritize questions about substance use, sexual health, mental health screening, safety concerns, and family cardiovascular history, as these directly impact morbidity and mortality in this age group. 1

Substance Use Assessment

• Ask directly about tobacco, alcohol, marijuana, cocaine, methamphetamine, and other recreational drugs including specific questions about frequency and quantity of use 2
• For any substance use identified, inquire about patterns of use, contexts where substances are used, and any concerns about dependence 1
• Screen for vaping and e-cigarette use, which is highly prevalent in this age group 3

Sexual Health and Risk Behavior

• Obtain a comprehensive sexual history in an open, nonjudgmental manner asking about current and past sexual practices, number of partners, and types of sexual activity 2
• Ask specifically about condom use consistency and contraceptive practices 2
• Inquire about history of sexually transmitted infections and most recent STI screening 2
• Screen for sexual violence or assault history with direct questions like "Have you ever experienced unwanted or forced sexual contact?" 2
• Ask about use of dating apps or meeting partners online, which represents a high-risk situation 2

Mental Health and Trauma Screening

• Screen for depression and anxiety by asking about persistent sadness, loss of interest in activities, excessive worry, and changes in sleep or appetite 1
• Ask directly: "Has anything scary or concerning happened to you since your last visit?" to screen for trauma exposure 2
• Inquire about suicidal thoughts or self-harm behaviors with questions like "Have you ever thought about hurting yourself or ending your life?" 2
• Assess for symptoms of PTSD including nightmares, flashbacks, or avoidance behaviors if trauma history is disclosed 2

Safety and Risk-Taking Behaviors

• Ask about high-risk situations including attending parties with unknown people, walking alone at night, or accepting drinks from strangers 2
• Inquire about helmet use during biking or other activities, and consistent seatbelt use 1
• Screen for exposure to violence by asking "Do you feel safe at home, school, and in your relationships?" 2, 1
• Ask about access to firearms in the home and gun safety practices 1
• Assess screen time habits, internet safety, and social media use 1

Family Medical History

• Obtain detailed family history of cardiovascular disease, specifically asking about myocardial infarction in first-degree male relatives before age 55 2
• Ask about family history of hypertension, diabetes mellitus, and hyperlipidemia 2
• Screen for family history of psychiatric disorders including depression, anxiety, bipolar disorder, and substance use disorders 1
• Inquire about family history of cancer, particularly testicular cancer and colon cancer 4, 5

Social Context and Support Systems

• Ask about living situation: "Who do you live with? Have there been any recent changes in your family structure?" 1
• Inquire about educational status, employment, and future plans 2
• Assess social support by asking about friendships, peer relationships, and who they turn to when stressed 1
• Screen for housing stability and food security 2

Developmental and Functional Assessment

• Ask about academic or work performance, ability to concentrate, and completion of tasks 1
• Inquire about sleep patterns including duration, quality, and any difficulties falling or staying asleep 3
• Assess nutrition by asking about typical daily food intake, meal patterns, and any concerns about weight 3
• Ask about physical activity levels and participation in sports or exercise 1

Confidentiality Framework

• At the beginning of the visit, explain confidentiality parameters to both the patient and any accompanying parent, stating what information will remain private and what must be disclosed (imminent danger to self or others, abuse) 1
• See the adolescent alone for at least part of the interview to allow discussion of sensitive topics including sexual activity, substance use, and mental health 1

Common Pitfalls to Avoid

• Do not skip substance use screening assuming young adults will volunteer this information—direct questioning is essential 2
• Avoid judgmental language or facial expressions when discussing sexual history, as this will shut down honest communication 2
• Do not overlook family cardiovascular history, as this is critical for risk stratification in young males who may develop early heart disease 2
• Never conduct the entire interview with parents present, as adolescents will not disclose sensitive information about sexual activity, substance use, or mental health concerns 1