1. CONTROL ID: 2705488
TITLE: Adolescent Health Risks and Motivation to Change
ROLE TYPE: Abstract
CURRENT CATEGORY: General Pediatrics
CURRENT SUBCATEGORY: Prevention, Public Health & Healthy Behavior
KEYWORDS: motivation , counseling, health risk behaviors.
AUTHORS (FIRST NAME, LAST NAME): Ardis Olson
1
, Kellen Von Nostrand
2
INSTITUTIONS (ALL):
1. Pediatrics, Geisel Dartmouth School of Medicine, Lebanon, NH, United States.
2. Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.
TITLE: Adolescent Health Risks and Motivation to Change
Background: Adolescence is a time where both engaging in risky alcohol/drug behaviors and not adopting healthy
eating/exercise behaviors are important for health. Adapting the counseling approach to the teen's motivational status
is key to successful counseling. Little information is available on readiness to change and perceptions of importance
(Imp) and confidence (Conf) regarding change at the well visit.
Objective: To describe youth readiness for change and motivational factors important in motivational counseling
Design/Methods: DartScreen, an iPad based electronic screening of youth health risk behaviors, is an ongoing
process in 14 pediatric and family medicine practices in rural New England. HIPPA de-limited screener data that
included health risk and motivational factors reported to the clinician was collected on 6759 teens ages 13-21 at their
annual visit over 5 years. For youth with health risks (ETOH/ Marijuana (MJ) use or inadequate exercise/unhealthy
eating) motivational factors Imp and Conf status was determined for level of readiness to change ( Yes/ Unsure).
Results: Risk behaviors varied by age. Overall 15.3% reported drinking in the past year, and 3.9%/ 4.1% used
Tobacco/ Marijuana in the past month. 22.1%/ 27.9% currently had an inadequate exercise/poor diet risk. Table 1
shows that among those with a risk, interest in changing ETOH was the low and MJ nearly as low, but the tobacco
users were more interested in change. Interest in changing obesity related health risks were much higher.
For those responding Yes for Interest in Change the motivational factors of importance and confidence were
compared. Those with high importance and high confidence are at the motivational stage to plan action steps. Table 2
shows that even among teens ready to change only 40-66% were likely to be ready for actions. Data on motivations
of those unsure of change will also be presented
Conclusion(s): Lack of readiness to change is very common with alcohol and marijuana use. Youth using tobacco
show stronger readiness to change. For obesity related health risks half the youth indicated interest in change.
Clinicians need to include assessment the motivational factors of importance and confidence. The different patterns of
importance and confidence indicate how motivational counseling should be customized. Assuming all who are
interested in change are ready for planning specific actions may contribute to the lack of successful counseling
outcomes in youth.
TABLE:
Table 1. Readiness to Change Risk Behaviors
. Level of Interest
Risk Behavior Yes Unsure No
Alcohol (n=1037) 51 (4.9%) 120 (23.9%) 866 (83.5%)
Tobacco ( n=264) 90 (34.1%) 63 (23.9%) 111 (42%)
Marijuana ( n=274) 31 (11.3%) 46 (16.8%) 197 (71.9%)
Inadequate Exercise 740 (49.5%) 368 (24.6%) 387 (25.9%)

2. (n=1495)
Poor Diet ( n=1888) 936 ( 49.6%) 436 (23.1%) 516 (27.3%)
Table 2. Motivational Status, Importance by Confidence
. Low Confidence High Confidence
Alcohol Use
n=50
Low Importance 10% 20%
High Importance 4% 66%
Tobacco Use
n=90
Low Importance 15.6% 27.8%
High Importance 16.7% 40%
Marijuana Use
n=29
Low Importance 13.7% 6.9%
High Importance 17.2% 62.1%
Inadequate Exerice
n=738
Low Importance 21.7% 15.9%
High Importance 20.6% 41.9%
Poor Diet
n=933
Low Importance 16.8% 14.9%
High Importance 16.4% 51.9%
Low Importance 1-6, High Importance 7-10 Low Confidence 1-6, High Confidence 7-10
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Content Type Expertise: Clinical Care Updates, Health Services/Clinical Outcomes Research, Population
Health/Global/Social determinants of Health
APA SIG Comm Region: None of These
Sabbath Conflict: No Conflict
First Author Trainee?: No, Not a Trainee
AWARDS: