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Adolescent Health

Goal

Improve the healthy development, health, safety, and well-being of adolescents and young adults.

Overview

Adolescents (ages 10 to 19) and young adults (ages 20 to 24) make up 21 percent of the population of the United States. The behavioral patterns established during these developmental periods help determine young peoples current health status and their risk for developing chronic diseases in adulthood.

Although adolescence and young adulthood are generally healthy times of life, several important public health and social problems either peak or start during these years. Examples include:

• Homicide
• Suicide
• Motor vehicle crashes, including those caused by drinking and driving
• Substance use and abuse
• Smoking
• Sexually transmitted infections, including human immunodeficiency virus (HIV)
• Teen and unplanned pregnancies
• Homelessness

Because they are in developmental transition, adolescents and young adults are particularly sensitive to environmental—that is, contextual or surrounding—influences. Environmental factors, including family, peer group, school, neighborhood, policies, and societal cues, can either support or challenge young people’s health and well-being. Addressing the positive development of young people facilitates their adoption of healthy behaviors and helps to ensure a healthy and productive future adult population.

Why Is Adolescent Health Important?

Adolescence is a critical transitional period that includes the biological changes of puberty and the need to negotiate key developmental tasks, such as increasing independence and normative experimentation.

There are many examples of effective policies and programs that address adolescent health issues. They include:

• State graduated driver licensing programs
• Teen pregnancy prevention programs
• Violence prevention programs
• Delinquency prevention programs
• Mental health and substance abuse interventions
• HIV prevention interventions

The financial burdens of preventable health problems in adolescence are large and include the long-term costs of chronic diseases that are a result of behaviors begun during adolescence. For example, the annual adult health-related financial burden of cigarette smoking, which usually starts by age 18, is $193 billion.

There are significant disparities in outcomes among racial and ethnic groups. In general, adolescents and young adults who are African American, American Indian, or Hispanic, especially those who are living in poverty, experience worse outcomes in a variety of areas (examples include obesity, teen pregnancy,tooth decay, and educational achievement) compared to adolescents and young adults who are white.

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Understanding Adolescent Health

The leading causes of illness and death among adolescents and young adults are largely preventable.3 Health outcomes for adolescents and young adults are grounded in their social environments and are frequently mediated by their behaviors. Behaviors of young people are influenced at the individual, peer, family, school, community, and societal levels.

As illustrated by the following examples of research findings, health outcomes are linked to multiple environmental factors.

Family

• Adolescents who perceive that they have good communication and are bonded with an adult are less likely to engage in risky behaviors.
• Parents who provide supervision and are involved with their adolescents activities are promoting a safe environment in which to explore opportunities.
• The children of families living in poverty are more likely to have health conditions and poorer health status, as well as less access to and utilization of health care.

School

• Academic success and achievement are strong predictors of overall adult health outcomes. Proficient academic skills are associated with lower rates of risky behaviors and higher rates of healthy behaviors.
• High school graduation leads to lower rates of health problems and risk for incarceration,as well as enhanced financial stability during adulthood.
• The school social environment affects students attendance,academic achievement, and behavior.A safe and healthy school environment promotes student engagement and protects against risky behaviors and dropping out.

Neighborhoods

Adolescents growing up in distressed neighborhoods characterized by concentrated poverty are at risk for a variety of negative outcomes, including poor physical and mental health, delinquency, and risky sexual behavior.

Media Exposure

Adolescents who are exposed to media portrayals of violence, sexual content, smoking, and drinking are at risk for adopting these behaviors.

Emerging Issues in Adolescent Health

Two important issues influence how adolescent health will be approached in the coming decade. First, the adolescent population is becoming more ethnically diverse, with rapid increases in the numbers of Hispanic and Asian American youth. The growing ethnic diversity will require cultural responsiveness to health care needs and sharpened attention to disparate health and academic outcomes, which are correlated with poverty, especially among adolescents from minority racial and ethnic groups.2, 46

The second emerging issue is the increased focus on the use of positive youth development interventions for preventing adolescent health risk behaviors.47, 48 Youth development interventions can be briefly defined as the intentional process of providing all youth with the support, relationships, experiences, resources, and opportunities needed to become successful and competent adults.49 There is growing empirical evidence that well-designed youth development interventions can lead to positive outcomes. Ongoing, rigorous evaluation will determine what works, why it works, and how successful interventions can be applied.49

References

1U.S. Census Bureau. 2008 population estimates: National characteristics, national sex, age, race and Hispanic origin. Washington: 2008. Available from:http://www.census.gov/popest/national/asrh/NC-EST2008-asrh.html

2National Research Council and Institute of Medicine. Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention, and Healthy Development. Adolescent health services: Missing opportunities. Lawrence RS, Gootman JA, Sim LJ, editors. Washington: National Academies Press, 2009. Available from:http://books.nap.edu/openbook.php?record_id=12063&page=1 

3Mulye TP, Park MJ, Nelson CD, et al. Trends in adolescent and young adult health in the United States. J Adolesc Health. 2009;45(1):8-24. Available from: http://download.journals.elsevierhealth.com/pdfs/journals/1054-139X/PIIS1054139X09001244.pdf 

4National Research Council, Panel on High-Risk Youth, Commission on Behavioral and Social Sciences and Education. Losing generations: Adolescents in high-risk settings. Washington: National Academies Press; 1993. Available from: http://www.nap.edu/openbook.php?record_id=2113&page=1 

5McNeely C, Blanchard J. The teen years explained: A guide to healthy adolescent development. Baltimore: Johns Hopkins Bloomberg School of Public Health, Center for Adolescent Health; 2009. Available from: http://www.jhsph.edu/adolescenthealth 

6Halfon N, Hochstein M. Life course health development: An integrated framework for developing health, policy and research. Milbank Q. 2002;80(3):433-79. Available from: http://www.milbank.org/quarterly/8003feat.html 

7National Research Council, Institute of Medicine, and Transportation Research Board; Committee for a Workshop on Contributions from the Behavioral and Social Sciences in Reducing and Preventing Teen Motor Crashes. Preventing teen motor crashes: Contributions from the behavioral and social sciences, workshop report. Washington: National Academies Press; 2007. Available from:http://www.nap.edu/openbook.php?record_id=11814&page=1 

8Department of Health and Human Services (HHS), Office of Public Health and Science, Office of Adolescent Health. Overview of the teen pregnancy prevention research evidence review. Washington: HHS; 2010. Available from:http://www.hhs.gov/ash/oah/prevention/research/index.html

9National Campaign to Prevent Teen and Unplanned Pregnancy. Effective program research [Internet]. Washington: National Campaign to Prevent Teen and Unplanned Pregnancy; 2010. Available from: http://www.thenationalcampaign.org/resources/effective_programs.aspx 

10Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control [Internet]. Best practices of youth violence prevention: A sourcebook for community action. Atlanta: CDC; 2002. Available from:http://www.cdc.gov/violenceprevention/pub/YV_bestpractices.html

11Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. STRYVE: Striving to reduce youth violence everywhere [homepage on the Internet]. Atlanta: CDC. Available from: http://www.safeyouth.gov 

12University of Colorado, Institute of Behavioral Science, Center for the Study and Prevention of Violence. Blueprints for violence prevention [homepage on the Internet]. Boulder, CO: University of Colorado; 1996–2010. Available from:http://www.colorado.edu/cspv/blueprints/index.html 

13Centers for Disease Control and Prevention. The effectiveness of universal school-based programs for the prevention of violent and aggressive behavior: A report on recommendations of the Task Force on Community Preventive Services. MMWR. 2007;56(RR-7):1-12. Available from: http://www.cdc.gov/mmwr/PDF/rr/rr5607.pdf

14Interagency Working Group on Youth Programs. Evidence-based program directory [Internet]. Washington: Interagency Working Group on Youth Programs; 2008. Available from: http://www.findyouthinfo.gov/ProgramSearch.aspx 

15Substance Abuse and Mental Health Services Administration (SAMHSA). National registry of evidence-based programs and practices [homepage on the Internet]. Rockville, MD: SAMHSA; 2010. Available from: http://www.nrepp.samhsa.gov/

16National Research Council and Institute of Medicine, Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Preventing mental, emotional and behavioral disorders among young people—Progress and possibilities. OConnell ME, Boat T, Warner KE, editors. Washington: National Academies Press; 2009. Available from: http://books.nap.edu/catalog.php?record_id=12480 

17Centers for Disease Control and Prevention (CDC), National Center for HIV, STD, and TB Prevention, HIV/AIDS Prevention Research Synthesis Project. Compendium of HIV prevention interventions with evidence of effectiveness. Atlanta: 2001. Available from:http://www.cdc.gov/hiv/resources/reports/hiv_compendium/pdf/HIVcompendium.pdf

18National HIV/AIDS Strategy. Washington: The White House; 2010. Available from: http://aids.gov/federal-resources/policies/national-hiv-aids-strategy/nhas.pdf

19Schoenborn CA, Vickerie JL, Barnes PM. Cigarette smoking behavior of adults: United States, 1997–98. Advance Data from Vital and Health Statistics, Number 331; 2003 Feb 7. Hyattsville, MD: National Center for Health Statistics. Available from:http://www.cdc.gov/nchs/data/ad/ad331.pdf

20SAMHSA, Office of Applied Studies. Results from the 2007 National Survey on Drug Use and Health: National findings (NSDUH Series H-34, DHHS Publication No. SMA 08-4343), Rockville, MD: Substance Abuse and Mental Health Administration; 2008. Chapter 5: Initiation of Substance Use. Available from: http://www.oas.samhsa.gov/nsduh/2k7nsduh/2k7results.cfm

21Adhikari B, Kahende J, Malarcher A, et al. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004. MMWR. 2008;57(45):1226-8. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm

22Ogden, CL, Carroll MD, Curtin, LR, et al. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA. 2010;303(93):242-9. Available from: http://jama.ama-assn.org/cgi/reprint/303/3/242 

23Robert Wood Johnson Foundation (RWJF), Leadership for Healthy Communities. Overweight and obesity among American Indian and Alaska Native youths [fact sheet]. Princeton, NJ: RWJF; 2010. Available from: http://www.rwjf.org/files/research/20100512lhcamerindian.pdf 

24Centers for Disease Control and Prevention (CDC), Division of Reproductive Health. Preventing teen pregnancy 2010-2015. Atlanta: CDC; 2010. Available from: http://www.cdc.gov/TeenPregnancy/PDF/TeenPregnancy_AAG.pdf

25Centers for Disease Control and Prevention (CDC), Division of Oral Health. Disparities in oral health. Atlanta: CDC; 2009. Available from:http://www.cdc.gov/oralhealth/oral_health_disparities.htm

26Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Dis. 2007;4(4):1-11. Available from:http://www.cdc.gov/pcd/issues/2007/oct/pdf/07_0063.pdf

27Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. JAMA. 1997;278(10):823-32. Available from: http://jama.ama-assn.org/cgi/reprint/278/10/823 

28Aufseeser D, Jekielek S, Brown B. The family environment and adolescent well-being: Exposure to positive and negative family influences. Washington: Child Trends; and San Francisco: National Adolescent Health Information Center, University of California, San Francisco; 2006. Available from: http://www.childtrends.org/Files/Child_Trends-2006_06_01_FR_FamilyEnvironmen.pdf 

29Larson K, Halfon, N. Family income gradients in the health and health care access of US children. Matern Child Health J. 2010;14(3):332-42. Available from: http://www.springerlink.com/content/g1g387152516738r/fulltext.pdf 

30Marin P, Brown B. The school environment and adolescent well-being: Beyond academics. [Research Brief]. Washington, DC: Child Trends; 2008 (publication #2008-26). Available from: http://www.childtrends.org/Files/Child_Trends-2008_11_14_RB_SchoolEnviron.pdf 

31SAMHSA Office of Applied Studies. The NSDUH Report: Youth activities, substance use, and family income. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2007. Available from: http://oas.samhsa.gov/2k7/youthActs/youthActs.htm

32Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Healthy youth! Student health and academic achievement. Atlanta: CDC; 2010. Available from:http://www.cdc.gov/HealthyYouth/health_and_academics/index.htm#2

33Wong MD, Shapiro MF, Boscardin W, et al. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002;347(20):1585-92. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJMsa012979 

34Muennig P, Woolf SH. Health and economic benefits of reducing the number of students per classroom in US primary schools. Am J Public Health. 2007;97(11):2020-7. Available from: http://ajph.aphapublications.org/cgi/reprint/97/11/2020 

35Muennig P. The economic value of health gains associated with education interventions. [Paper prepared for the Equity Symposium on "The Social Costs of Inadequate Education" at Teachers College, October 24–25]. New York: Columbia University; 2005. Available from:http://www.schoolfunding.info/news/policy/Muennig%20-%20Health%20and%20Education.pdf 

36Lochner L. Education policy and crime. Working Paper 15894. Cambridge, MA: National Bureau of Economic Research; 2010. Available from: http://economics.uwo.ca/faculty/lochner/papers/educationpolicycrime_mar10.pdf  or http://www.nber.org/papers/w15894 

37Sum A, Khatiwada I, McLaughlin J. The consequences of dropping out of high school: Joblessness and jailing for high school dropouts and the high cost for taxpayers. Boston: Center for Labor Market Studies, Northeastern University; 2009. Available from:http://www.americaspromise.org/~/media/Files/Resources/Consequences_of_Dropping_Out_of_High_School.ashx 

38Centers for Disease Control and Prevention. Youth risk behavior surveillance—United States, 2009. Surveillance summaries, June 4, 2010. MMWR. 59(SS-5):8. Available from: http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf

39Sellstrom E, Bremberg S. Is there a "school effect" on pupil outcomes? A review of multilevel studies. J Epidemiol Community Health. 2006;60(2):149-55. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2566146/pdf/149.pdf

40Blum RW, McNeely C, Nonnemaker J. Vulnerability, risk and protection. In: Adolescent risk and vulnerability: Concepts and measures. Fischhoff B, Nightingale EO, Iannotta JG, editors. Board on Children, Youth and Families, National Research Council and Institute of Medicine. Washington: The National Academies Press; 2001. Available from: http://www.nap.edu/catalog.php?record_id=10209 

41Bontempo DE, DAugelli AR. Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths health risk behavior. J Adolesc Health. 2002;30(5):364-74. Available from: http://download.journals.elsevierhealth.com/pdfs/journals/1054-139X/PIIS1054139X01004153.pdf 

42Henderson M, Ecob R, Wight D, et al. What explains between-school differences in rates of smoking? BMC Public Health. 2008;8:218. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442834/pdf/1471-2458-8-218.pdf or http://www.biomedcentral.com/1471-2458/8/218 

43Aveyard P, Markham WA, Lancashire E, et al. The influence of school culture on smoking among pupils [abstract]. Soc Sci Med. 2004;58(9):1767-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14990377

44Leventhal T, Brooks-Gunn J. Diversity in developmental trajectories across adolescence: Neighborhood influences. Chapter 15 in Handbook of Adolescent Psychology (pp 451-86), 2nd ed. Lerner RM, Steinberg L, editors. Hoboken, NJ: John Wiley & Sons, Inc.; 2004.

45Roberts DF, Henriksen L, Foehr UG. Adolescents and media. Chapter 16 in Handbook of Adolescent Psychology (pp 487-521), 2nd ed. Lerner RM, Steinberg L, editors. Hoboken, NJ: John Wiley & Sons, Inc.; 2004.

46Ozer EM, Park MJ, Paul T, et al. Americas adolescents: Are they healthy? San Francisco: University of California-SF, National Adolescent Health Information Center; 2003. Available from: http://staff.imsa.edu/wellness/AA_2003.pdf 

47Birkhead GS, Riser MH, Mesler K, et al. Youth development is a public health approach. J Public Health Manag Pract. 2006;12(suppl 6):S1-S3. Available from: http://journals.lww.com/jphmp/Fulltext/2006/11001/Youth_Development_Is_a_Public_Health_Approach.1.aspx 

48Centers for Disease Control and Prevention. Positive youth development promoting adolescent sexual and reproductive health: A review of observational and intervention research. J Adolesc Health. 2010 Mar;46(3 suppl). Available from: http://jahonline.org/issues/contents?issue_key=S1054-139X(10)X0003-9 

49Bernat DH, Resnick MD. Healthy youth development: Science and strategies. J Public Health Manag Pract. 2006;12(suppl 6):S10-S16. Available from: http://journals.lww.com/jphmp/Fulltext/2006/11001/Healthy_Youth_Development__Science_and_Strategies.4.aspx 

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