Tenth Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services

The U.S. Preventive Services Task Force (USPSTF) has released its “10th Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services.”

In 2020, the USPSTF continued to fulfill its mission of improving the health of all Americans by making evidence-based recommendations about clinical preventive services such as screening tests, counseling about healthy behaviors, and preventive medications. These recommendations help clinicians and their patients make informed health care decisions.

In this annual report, the USPSTF calls attention to high-priority research gaps from its recommendations related to child and adolescent health and health inequities, including mental and behavioral health, substance use, and obesity. Research into these complex health issues will help clinicians meaningfully assist patients and their families in preventing them and reducing health inequities.

Read the executive summary below or access the full report here.

Executive Summary

The U.S. Preventive Services Task Force (USPSTF or Task Force) is an independent, volunteer panel of national experts in prevention, primary care, and evidence-based medicine. The Task Force makes evidence-based recommendations about clinical preventive services to improve the health of all Americans. The Task Force comprehensively assesses the potential benefits and harms of services to prevent disease in people without signs or symptoms, including screening tests, behavioral counseling, and preventive medications.

Each year, Congress charges the USPSTF to provide a report that identifies gaps in the scientific evidence base and recommends areas for future research. In some cases, clinical preventive services have been well studied, but there are important evidence gaps that prevent the USPSTF from making recommendations for specific populations and age groups. The Task Force recognizes disparities persist in healthcare based on age, race and ethnicity, sexual orientation, and social risk factors. Greater inclusion of diverse populations in research will help the USPSTF issue recommendations that improve the quality of preventive care, which will hopefully lead to improved access to and use of these preventive services, reduced disparities in healthcare, and increased health equity.

In this 10th Annual Report to Congress, which covers 2019 to 2020, the Task Force calls for more research in areas where evidence is lacking, including evidence for underrepresented populations and age groups.

Where More Research Is Needed Related to Child and Adolescent Health and Health Inequities

In this report, the USPSTF calls attention to high-priority research gaps from its recommendations related to child and adolescent health and health inequities, including mental and behavioral health, substance use, and obesity. Although there are many child and adolescent health topics with important research gaps, such as autism and speech and language delay, the USPSTF chose to focus this report specifically on those pertaining to mental and behavioral health, substance use, and obesity. Research into these complex health issues will help clinicians meaningfully assist patients and their families in preventing them and reducing health inequities.

Specifically, more research is needed to:

Mental and Behavioral Health in Children and Adolescents

  1. Depression in Children and Adolescents: Screening
    • Evaluate screening for major depressive disorder in children age 11 years or younger
    • Evaluate combined treatments, and complementary and alternative approaches
    • Assess the effect of having other health conditions along with depression
  2. Suicide Risk in Adolescents, Adults, and Older Adults: Screening
    • Evaluate screening and interventions for suicide risk, including:
      • Understanding how to better help people with suicide intentions before they act
      • Whether screening and interventions might be effective in individuals at average or high risk, so we can understand whether tailored therapies are more effective in these populations
    • Identify ways to link clinical and community resources

Substance Use in Children and Adolescents

  1. Prevention and Cessation of Tobacco Use in Children and Adolescents: Primary Care Interventions
    • Evaluate interventions to stop use of tobacco, including studies that:
      • Examine whether interventions help youth quit for the longer term (6 months or longer)
      • Provide details on components of behavioral counseling interventions
    • Determine which interventions are effective in preventing the initiation of use and promote cessation of:
      • E-cigarettes in youth
      • Other types of tobacco
    • Evaluate interventions tailored to populations with higher tobacco use rates
  2. Illicit Drug Use in Children, Adolescents, and Young Adults: Primary Care–Based Interventions
    • Evaluate interventions to prevent drug use, including studies that:
      • Examine prevention of marijuana use
      • Examine and report the harms of interventions
      • Examine health, social, and legal outcomes
      • Focus on children younger than age 10 years as well as young adults (ages 18–25 years)
      • Examine technology approaches to prevention, family-based approaches, and clinician training
  3. Unhealthy Drug Use: Screening
    • Evaluate screening (by asking questions about unhealthy drug use) and interventions for unhealthy drug use in adolescents

Obesity in Children and Adolescents

  1. Obesity in Children and Adolescents: Screening
    • Evaluate behavioral interventions in underrepresented populations and younger children
    • Evaluate benefits and harms, especially in studies that:
      • Are larger and have more children as participants
      • Examine longer-term effects of treatment
      • Examine direct effects of screening  Examine benefits and harms of weight loss medications
      • Provide details on components of behavioral counseling interventions

Future research in these areas can help fill these gaps and may result in important new recommendations that will help to improve the health of all Americans, including underrepresented populations. The USPSTF hopes that identifying evidence gaps and highlighting them as research priorities will inspire public and private researchers to collaborate and target their efforts to generate new knowledge, address important health issues, and reduce health inequities.