Understanding Well-Visit Attendance From Adolescence to Young Adulthood: Trends, Patterns, and Implications

Maintaining regular medical check-ups is essential for promoting long-term health, particularly for adolescents and young adults (AYAs) who are navigating critical developmental transitions. Despite clear recommendations from the American Academy of Pediatrics for annual well-visit attendance through age 21, many young people do not consistently engage in preventive care. Recent research sheds light on longitudinal patterns of well-visit attendance, revealing who remains engaged and what factors influence continuity of care.

What Are Well-Visits and Why They Matter

Well-visits, sometimes called routine health check-ups, are scheduled appointments with a primary care provider to assess overall health, provide preventive care, and identify emerging physical or mental health concerns. For AYAs, these visits serve as an opportunity to discuss nutrition, physical activity, sexual health, mental health, substance use, and other health behaviors that can shape future outcomes. Preventive care during adolescence can reduce risk behaviors, detect early health issues, and provide guidance as youth transition into adulthood.

Declining Well-Visit Attendance in Young Adults

National statistics show that well-visit attendance decreases as adolescents move into young adulthood. Cross-sectional surveys report attendance rates of 43 to 81 percent for adolescents but only 26 to 58 percent for young adults. Many of these studies, however, rely on single-time-point data, which limits understanding of how engagement changes over time. To address this gap, researchers conducted a longitudinal study tracking over 2,700 young people from ages 15 to 23 to identify patterns in well-visit attendance and explore the factors influencing these trajectories.

Patterns of Engagement in Preventive Care

Using advanced statistical methods called Latent Class Growth Analysis, researchers identified distinct well-visit attendance patterns for both males and females. Three key trajectories emerged:

For males:

1. Engaged: Two-thirds of males maintained consistent attendance over time, though there was a slight decline from age 15 to 23.
2. Engaged with Decline: About 18 percent started with high attendance but experienced steep decreases by early adulthood.
3. Persistently Disengaged: Around 17 percent had consistently low attendance throughout adolescence and young adulthood.

For females:

1. Engaged: Two-thirds of females remained engaged in well-visits, showing only a modest decline over time.
2. Engaged with Decline: Nearly 19 percent started highly engaged but gradually reduced attendance by young adulthood.
3. Gradually Reengaged: Approximately 13 percent began with low attendance in mid-adolescence but steadily increased engagement over time.

These findings indicate that while most adolescents stay connected to preventive care, a significant minority exhibit patterns of decline or delayed reengagement.

Factors Influencing Well-Visit Attendance

The study identified several factors associated with the likelihood of remaining engaged in well-visits:

Health Needs

Health status strongly influenced attendance patterns. Males with chronic illnesses or disabilities were more likely to remain engaged, likely due to ongoing care needs such as medication management and referrals. For females, depressive symptoms were linked to lower engagement, highlighting how mental health challenges can affect preventive care use. Overall, adolescents and young adults with better general health were more likely to consistently attend well-visits.

Social Determinants

Socioeconomic factors also played a role. Health insurance coverage was strongly associated with higher engagement, as was family affluence. Interestingly, other indicators of social stability, such as the number of parents at home or parent education, showed inconsistent associations, suggesting that access to care may depend more on structural supports than family composition alone.

Background Characteristics

Race, ethnicity, and geographic location were also related to engagement patterns. Males from minority racial or ethnic groups were sometimes more likely to maintain attendance, while regional differences in the United States influenced trajectories for both sexes. Being born in the United States and speaking English at home were associated with higher engagement, underscoring the barriers immigrant youth may face in accessing care.

Gender Differences

Overall, females were more likely than males to maintain consistent well-visit attendance. Some females also demonstrated reengagement after periods of low attendance, potentially reflecting increased health care utilization for sexual and reproductive health needs, including gynecological care, contraception, and screenings for sexually transmitted infections. Males, in contrast, were more likely to experience persistent disengagement, highlighting the need for targeted strategies to maintain preventive care in young men.

Implications for Policy and Practice

These findings have several practical implications for improving preventive care engagement among adolescents and young adults:

1. Early Intervention: Identifying youth at risk for declining well-visit attendance during mid-adolescence could allow healthcare providers to implement preventive strategies, including outreach and education.
2. Targeted Programs for Males: Given that a subset of males remains persistently disengaged, interventions tailored to young men, possibly including school-based health programs or community health worker outreach, could help increase preventive care utilization.
3. Mental Health Support: Females with depressive symptoms were less likely to remain engaged, suggesting the importance of integrating mental health screening and support within primary care settings.
4. Equitable Access: Ensuring health insurance coverage and addressing socioeconomic barriers is critical for sustaining engagement in preventive care. Policies that expand access to affordable insurance and provide transportation support or flexible scheduling could improve attendance rates.
5. Youth-Centered Care Models: Incorporating adolescent perspectives into care, providing patient-centered communication, and tailoring visit content to meet specific health needs can enhance the perceived value of well-visits, particularly for youth who are otherwise healthy.

Understanding the Critical Transition to Adulthood

The transition from adolescence to young adulthood is a vulnerable period for engagement in preventive care. Late adolescence is when youth begin assuming responsibility for their own health, making independent decisions about attending appointments. Declines in well-visit attendance often occur before age 18, suggesting that interventions during early to mid-adolescence may be especially effective in preventing disengagement.

The findings also highlight the importance of considering both social and health-related factors. While socioeconomic stability can facilitate access, it does not automatically guarantee regular attendance. Structural barriers such as lack of transportation, conflicting work or school schedules, and limited clinic hours may prevent adolescents and young adults from maintaining engagement even when they have health insurance or family support.

Strategies to Improve Well-Visit Attendance

Healthcare systems can take several steps to improve preventive care engagement for adolescents and young adults:

• School-Based Health Programs: Providing well-visits in schools can reduce barriers related to transportation and scheduling, reaching youth who might otherwise disengage.
• Community Outreach: Community health workers and local programs can educate families and youth on the importance of preventive care and provide support for accessing services.
• Technology Solutions: Appointment reminders through text messaging or apps can increase attendance, particularly for adolescents who rely on digital communication.
• Flexible Scheduling: Offering evening and weekend appointments accommodates school and work commitments, making it easier for youth to attend.
• Integrated Mental Health Services: Incorporating mental health support within primary care can address barriers to engagement for youth experiencing depression or anxiety.

Future Research Directions

While this study provides important insights, several areas warrant further exploration:

• Perceived Value of Care: Understanding how adolescents and young adults perceive the usefulness of well-visits may clarify why some disengage despite having access to services.
• State-Level and Policy Effects: Geographic variations suggest that state policies, Medicaid coverage, and provider availability may influence engagement. Future research should investigate these structural determinants.
• Transition to Adult Care: Examining how youth navigate the shift from pediatric to adult providers could inform strategies to maintain continuous preventive care.
• Longitudinal Mental Health Patterns: Further studies could explore how changes in mental health across adolescence affect attendance over time, including use of alternative care settings.

Conclusion

Well-visit attendance is a critical component of preventive health care for adolescents and young adults. While most youth maintain engagement, a significant minority experience declining attendance, with patterns differing by sex, health needs, and social factors. Males are more likely to experience persistent disengagement, while some females show gradual reengagement. Health insurance, family affluence, and general health status increase the likelihood of maintaining well-visit attendance, whereas depressive symptoms and structural barriers can impede it.

Targeted interventions that account for health needs, social determinants, and developmental transitions are essential to support continuous engagement in preventive care. Policymakers, healthcare providers, and community organizations can leverage these findings to design programs that encourage consistent well-visits, improving long-term health outcomes for young people during this critical period of growth and development.

Source: Akande, M., Van Eck, K., Wu, X., Matson, P. A., Ozer, E. M., & Marcell, A. V. (2025). Well-Visit Attendance From Mid-Adolescence to Young Adulthood: Who Remains Engaged? Journal of Adolescent Health.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. For guidance on preventive care and well-visits, consult a qualified healthcare provider.