M. Jane Park

Trends in Adolescent and Young Adult Health in the United States

This review presents a national health profile of adolescents and young adults (ages 10-24). The data presented include trends on demographics, mortality, health-related behaviors, and healthcare access and utilization, as well as the most significant gender and racial/ethnic disparities. Although the data show some improvement, many concerns remain. Encouraging trends-such as decreases in rates of homicide, suicide, and some measures of reproductive health-appear to be leveling off or, in some cases, reversing (e.g., birth and gonorrhea rates). Large disparities, particularly by race/ethnicity and gender, persist in many areas. Access to quality healthcare services remains a challenge, especially during young adulthood. Policy and research recommendations to improve health during these critical periods in the lifespan are outlined.

Disparities in adolescent health and health care: does socioeconomic status matter?

DATA COLLECTION/EXTRACTION METHODS National household survey. DATA SOURCES/STUDY SETTING We analyzed data on 12,434 adolescents (10 through 18 years old) included in the 1999 and 2000 editions of the National Health Interview Survey. STUDY DESIGN We assessed the presence of income gradients using four income groups. Outcome variables included health status, health insurance coverage, access to and satisfaction with care, utilization, and unmet health needs. PRINCIPAL FINDINGS After adjustment for confounding variables using multivariate analysis, statistically significant disparities were found between poor adolescents and their counterparts in middle- and higher-income families for three of four health status measures, six of eight measures of access to and satisfaction with care, and for six of nine indicators of access to and use of medical care, dental care, and mental health care. CONCLUSION Our analyses indicate adolescents in low-income families remain at a disadvantage despite expansions of the Medicaid program and the comparatively new State Childrens Health Insurance Program (SCHIP). Additional efforts are needed to ensure eligible adolescents are enrolled in these programs. Nonfinancial barriers to care must also be addressed to reduce inequities.

To Tweet, or Not to Tweet: Gender Differences and Potential Positive and Negative Health Outcomes of Adolescents’ Social Internet Use

Adolescents and young adults are avid Internet users. Online social media, such as social networking sites (e.g., Facebook, MySpace), blogs, status updating sites (e.g., Twitter) and chat rooms, have become integral parts of adolescents’ and young adults’ lives. Adolescents are even beginning to enter the world of online dating with several websites dedicated to “teenage online dating.” This paper reviews recent peer-reviewed literature and national data on 1) adolescents use of online social media, 2) gender differences in online social media and 3) potential positive and negative health outcomes from adolescents’ online social media use. We also examine parental monitoring of adolescents’ online activities. Given that parental supervision is a key protective factor against adolescent risk-taking behavior, it is reasonable to hypothesize that unmonitored Internet use may place adolescents’ at significant risk, such as cyberbullying, unwanted exposure to pornography, and potentially revealing personal information to sexual predators.

Adolescent and Young Adult Health in the United States in the Past Decade: Little Improvement and Young Adults Remain Worse Off Than Adolescents

Adolescence and young adulthood are unique developmental periods that present opportunities and challenges for improving health. Health at this age can affect health throughout the lifespan. This review has two aims: (1) to examine trends in key indicators in outcomes, behaviors, and health care over the past decade for U.S. adolescents and young adults; and (2) to compare U.S. adolescents and young adults on these indicators. The review also assesses sociodemographic differences in trends and current indicators. Guided by our aims, previous reviews, and national priorities, the present review identified 21 sources of nationally representative data to examine trends in 53 areas and comparisons of adolescents and young adults in 42 areas. Most health and health care indicators have changed little over the past decade. Encouraging exceptions were found for adolescents and young adults in unintentional injury, assault, and tobacco use, and, for adolescents, in sexual/reproductive health. Trends in violence and chronic disease and related behaviors were mixed. Review of current indicators demonstrates that young adulthood continues to entail greater risk and worse outcomes than adolescence. Young adults fared worse on about two-thirds of the indicators examined. Differences among sociodemographic subgroups persisted for both trends and current indicators.

Young adult preventive health care guidelines: there but can't be found.

OBJECTIVES To (1) identify adolescent and adult clinical preventive services guidelines relevant to the young adult age group; (2) review, compare, and synthesize these guidelines, with emphasis on the extent to which professional guidelines are consistent with evidence-based guidelines developed by the US Preventive Services Task Force; and (3) recommend the next steps in the establishment and integration of preventive care guidelines for young adults. DESIGN Nonexperimental: an Internet search was conducted to identify relevant preventive care guidelines for the young adult group. SETTING The search included federal agencies and professional organizations that focus on health areas linked to the care of young adults or that provide health care to adolescents and young adults. PARTICIPANTS National organizations, federal agencies, health professional associations, and medical societies. MAIN OUTCOME MEASURES Preventive services guidelines for adolescents and adults that intersect with the age range of 18 to 26 years. RESULTS When the ages of 18 to 26 years are carved out of established professional guidelines across specialty groups, there is a broad number of recommendations, with many supported by sufficient evidence to receive a US Preventive Services Task Force grade of A or B that can inform the care of young adults. CONCLUSIONS We recommend the establishment of young adult preventive health guidelines that reflect the current evidence-based recommendations that overlap with the young adult age group; we suggest clinician and health care system supports to facilitate the delivery of preventive services to young adults; and we emphasize prioritizing research in prevention areas in which sufficient evidence does not exist.

A Midcourse Review of the Healthy People 2010: 21 Critical Health Objectives for Adolescents and Young Adults

As part of Healthy People 2010, a national consensus panel identified 21 Healthy People 2010 objectives as critical to adolescent and young adult health. These objectives span six areas: mortality, unintentional injury, violence, mental health and substance use, reproductive health, and the prevention of chronic disease during adulthood. Progress on these objectives was reviewed as part of the Healthy People 2010 Midcourse Review. The review found little or no improvement on most objectives. Expert recommendations call for broad, population-based efforts to improve adolescent health. However, changes in health policy are largely issue-based and occur incrementally.

Health insurance across vulnerable ages: patterns and disparities from adolescence to the early 30s.

OBJECTIVE. Young adults have the lowest rate of insurance coverage of any age group. Little is known about insurance patterns from adolescence through the early 30s. The objective of this study was to assess patterns and disparities in health insurance from adolescence through the early 30s. DESIGN. We analyzed data from the 2002 and 2003 National Health Interview Survey (ages 13–32; N = 48827). We examined public and private insurance coverage and conducted logistic regression to evaluate racial/ethnic and income disparities in coverage. Outcomes were insurance coverage at ages 13 to 32. RESULTS. Insurance patterns follow a U-shaped curve across the age categories. Rates are highest at ages 13 to 14, lowest at ages 23 to 24, and then increase gradually. Private rate patterns are similar; however, public coverage decreases across ages. In bivariate analyses, black and Hispanic groups had lower coverage rates than the white group, and the low- and middle-income groups had lower rates than the high-income group. After adjustment for confounding variables, all disparities remained significant except for differences between the black and white groups. CONCLUSIONS. After age 18, all groups are vulnerable to lack of insurance. Rate increases beyond age 25 to 26 years are attributable to increases in private coverage, whereas decreases in public coverage account for the lack of a full recovery to the higher rates seen in adolescence. The safety net of public programs that cover adolescents disappears in young adulthood, leaving young adults vulnerable, a problem that persists into the 30s for those who are in poverty and those who are of Hispanic origin.

Who Gets Confidential Care? Disparities in a National Sample of Adolescents

Using the 2001-2004 Medical Expenditures Panel Survey, we examined rates of past-year adolescent time alone with a clinician by visit type, and among youths with a preventive visit, examined age, gender, and race/ethnicity differences. Youths with a preventive visit have higher rates of time alone; rates for these youths increase with age, are higher for males (42%) versus females (37%), and are lowest among Hispanics. Time alone rates are low, especially for younger females and Hispanic youths. Special efforts are needed to increase time alone in these populations.

Medical Home for Adolescents: Low Attainment Rates for Those With Mental Health Problems and Other Vulnerable Groups

BACKGROUND The importance of the medical home for children has been demonstrated but has not been examined comprehensively for adolescents. Adolescence is a unique period of physical, cognitive, and psychosocial changes when many mental disorders first emerge; thus, receiving care within a medical home could improve well-being. This study examines rates of medical home attainment and its components for adolescents and subgroups, including those with mental health conditions. METHODS Utilizing the 2007 National Survey of Childrens Health, we determined the following for adolescents aged 10 to 17 years (n = 45 897): 1) rates of medical home attainment and its 5 components (usual source of care, having a personal doctor, and receiving needed referrals, effective care coordination, and family-centered care); and 2) subgroup differences; gender, race/ethnicity, income, insurance, region, language spoken at home, respondent education, and the presence of mental health conditions. RESULTS Fifty-four percent of adolescents had a past-year medical home. Rates were lower for minority youth compared to whites; lower-income and uninsured youth; those in households that are non-English speaking in which the respondent did not have some college; and those with mental health as opposed to physical health conditions (all P < .01). Patterns of disparities in the medical home components were similar, and rates were lowest for effective care coordination and family-centered care components. CONCLUSIONS Nearly half of adolescents lacked a medical home in the past year. Even lower rates for subgroups highlight the need to increase access to comprehensive quality health care. Efforts to improve effective care coordination and family-centered care could result in higher quality of care for all children and adolescents, and specifically for disadvantaged adolescents and those with mental health conditions.

Prevalence and Treatment of Mental Health and Substance Use Problems in the Early Emerging Adult Years in the United States Findings From the 2010 National Survey on Drug Use and Health

Onset of most mental disorders occurs by the mid-20s, yet studies of mental health (MH) status are limited for younger adults (YAs) aged 18–25. The objectives were to determine YAs’ rates of MH and substance use (SU) disorders, treatment, and sociodemographic disparities. To determine relative vulnerability and unmet need, overall rates were compared between ages 18–25 and 26–34. Using the 2010 National Survey on Drug Use and Health (n = 25,216), we estimated past-year serious psychological distress, major depressive episode, alcohol and drug abuse/dependence, and treatment for both age groups and examined YA subgroup differences (gender, race/ethnicity, income, education, and insurance). YAs had higher prevalence of MH and SU disorders, but lower treatment rates than older adults. YA females had higher MH but lower SU disorder rates than males. Other sociodemographic disparities were noted. Efforts to improve YAs’ MH status are necessary to foster a successful transition to adulthood.