Around the same time that clinicians were evaluating the primary health care needs of adults, clinicians who practice adolescent medicine (with backgrounds in pediatrics, internal medicine, family medicine, gynecology, nursing, psychology, nutrition, and other professions) recognized that the guidelines for adult and pediatric health services did not always fit the needs and health risks of adolescence. Neither the ACOG Guidelines for Primary Preventive Care nor the USPSTF recommendations is sufficiently comprehensive or focused on this age group, although both documents include many important aspects of adolescent health care (10,13). The American Medical Association, with the assistance of a national scientific advisory board, developed the Guidelines for Adolescent Preventive Services (GAPS) in response to this perceived need for recommendations for delivering comprehensive adolescent preventive services (13,14,26).
Obstetricians-gynecologists typically see adolescents in crisis to provide care for unintended pregnancies or STDs, including pelvic inﬂammatory disease. The urgency for preventing these crises is evident. The GAPS report extends the framework of services provided to adolescents. The impetus for developing GAPS was the belief that a fundamental change in the delivery of adolescent health services was necessary. This concept is strongly supported by the Society for Adolescent Medicine, the American Academy of Pediatrics, and the American Academy of Family Physicians (27). Gynecologists could easily provide most, if not all, of the recommended services. The American College of Obstetricians and Gynecologists developed a “Tool Kit” on primary and preventive health care for female adolescents in recognition of the needs of this population, and recommended that the “first visit to the obstetrician-gynecologist for health guidance, screening, and the provision of preventive health care services should take place between the ages of 13 years and 15 years” (28,29). Subsequent annual visits are recommended by ACOG to provide preventive guidance and services including contraception and STD treatment as required. The guidelines and recommendations for adolescent health care address the delivery of health care, focus on the use of health guidance to promote the health and well-being of adolescents and their families, promote the use of screening to identify conditions that occur relatively frequently in adolescents and cause significant suffering either during adolescence or later in life, and provide guidelines for immunizations for the primary prevention of specific infectious diseases. Considerable barriers exist to adolescents’ accessing these services, including barriers inherent in the US health care system and legal barriers (30).