BMJ 2002;325:524 ( 7 September )

Primary care

Health promotion for adolescents in primary care: randomised controlled trial

Zoe Walker, senior lecturer, ^a Joy Townsend, director, ^a Laura Oakley, research fellow, ^a Chris Donovan, chair of working party on adolescent health, ^b Hilary Smith, general practitioner, ^c Zunia Hurst, general practitioner, ^d Janet Bell, nurse practitioner, ^c Sally Marshall, practice nurse. ^d

^a Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield AL10 9AB, ^b Royal College of General Practitioners Working Party on Adolescent Health, 14 Princes Gate, London SW7 1PU, ^c Maltings Surgery, 8 Victoria Street, St Albans AL1 3JB, ^d Bennetts End Surgery, Gatecroft, Hemel Hempstead HP3 9LY

Correspondence to: J Townsend, Health Promotion Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT joy.townsend{at}lshtm.ac.uk

Objectives: To evaluate the effectiveness of inviting teenagers to general practice consultations to discuss health behaviour concerns and appropriate follow up care.
Design: Randomised controlled trial, with participants randomised to a consultation (intervention) or usual care (control). Questionnaires completed at baseline, 3 months, and 12 months.
Setting: Eight general practices in Hertfordshire, England.
Participants: 1516 teenagers aged 14-15 years.
Intervention: Consultations with practice nurses to discuss health concerns and develop plans for healthier lifestyles.
Main outcome measures: Mental and physical health, "stage of change" for health related behaviour, and use of health services.
Results: At baseline 970 teenagers completed questionnaires; 23% smoked, 35% had been drunk in the previous three months, 64% considered they ate unhealthily, 39% took little exercise, and 36% had possible depression. 41% (304) of teenagers invited attended for a consultation; over one third (112) were offered follow up care. More intervention group teenagers reported positive movement in stage of change for diet and exercise and in at least one of four behaviours (diet, exercise, smoking, drinking alcohol) at 3 months (41% v 31%, P<0.01), but this did not persist at 12 months. There was marginally more positive change in actual behaviour by intervention teenagers at 3 months (16% v 12%, P=0.06). Recognition of possible depression resulted in improved mental health outcomes at 3 and 12 months. 97% of attenders said they would recommend the intervention to a friend.
Conclusions: Change in behaviour was slight but encouraging, and the intervention was well received and relatively cheap.

What is already known on this topic Teenagers have a high prevalence of health damaging behaviour and have expressed a wish to discuss a broad range of health related issues with a health professional Few teenagers receive health promotion advice or information from their general practice teams What this study adds General practice based health promotion consultations are welcomed by teenagers who attend Such consultations provide an effective opportunity to identify and tackle mental and physical health problems and encourage healthy lifestyles The effect on teenagers' actual lifestyles is modest

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