title: SAFE TEENS: facilitators of and barriers to adolescent preventive care discussions.
abstract: OBJECTIVE
  This study's goal was to describe the topics discussed during adolescent preventive care visits and to identify facilitators and barriers of these discussions among physicians in family medicine residency programs.
  
  
  METHODS
  Forty-six family physicians in five residency programs used SAFE TEENS study cards to record data during 321 visits with adolescents ages 11--21 years. The study cards included a checklist of 31 potential topics organized under 10 categories. Closed- and open-ended questions were used to explore facilitators and barriers.
  
  
  RESULTS
  The topics most frequently discussed were under the categories of toxins (tobacco, alcohol, and drugs), environment (school, home, and friends), sexuality, and exercise. Physicians were more likely to conduct preventive care discussions in the clinical context of a physical examination and with a new patient. Parents being present for part of the visit, a reminder system, and the recognition of developmental stage were also significant facilitators. The presence of competing demands was the strongest barrier.
  
  
  CONCLUSIONS
  To increase the number of adolescent preventive care discussions, family medicine educators should stress that visits with established patients and visits for reasons other than a physical examination are also opportunities to provide preventive care. The development of electronic reminder systems would also be useful.
authors.affiliation: Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. oscos@uthscsa.edu
authors.forename: Manuel Angel
authors.initials: MA
authors.lastname: Oscós-Sánchez
authors.forename: Darryl
authors.initials: D
authors.lastname: White
authors.forename: Ellen
authors.initials: E
authors.lastname: Bajorek
authors.forename: Marcia
authors.initials: M
authors.lastname: Dahlman
authors.forename: Theresa
authors.initials: T
authors.lastname: Albright
authors.forename: Juan
authors.initials: J
authors.lastname: Treviño
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Burge
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003142:Communication; D004777:Environment; D015444:Exercise; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000458:organization & administration*; D017010:Reminder Systems; D012737:Sex Factors; D019529:Sexuality; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000517:prevention & control