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The Health Status of Young Adults in the United States
M. Jane Park, M.P.H. a,*, Tina Paul Mulye, M.P.H.a, Sally H. Adams,
Ph.D.a, Claire D. Brindis, Dr.P.H.a,b,
and Charles E. Irwin, Jr, M.D.a
Health
status during the young adult years has received little attention compared with adolescence. Although young adults are sometimes grouped with adolescents, the
contextual influences that shape risky behavior, health
outcomes and access to care change during the young adult years.
The critical health
issues of young adulthood mirror those of adolescence, including:
-
reproductive health
-
injury
-
-
-
violence
-
obesity
-
access to health care
Young adults fare worse than adolescents in many areas:
peak in young adulthood.
This article synthesizes
national data to present a health profile of young adults. We examine social indicators, mortality,
morbidity, risky behaviors, and health care access and utilization,
identifying the most significant gender and racial/ethnic
disparities.
We argue for creating a national young adult health
agenda that includes research, programs and policies to
address health issues during this period of the lifespan.
Contextual Framework for Young Adult Health
Two important contextual
influences shape young adult health:
a prolonged transition to adult roles and responsibilities and
the weakening of the safety net that supports adolescents
and younger children.
Legally, 18-year-olds
gain adult privileges, such as consenting to confidential
health care. However, many do not assume adult roles and
responsibilities for several years. Young adulthood involves exploration and steps
toward independence, with varying levels of adult supervision,
roles and responsibilities - making this period unique in
the lifespan.
These factors have
important implications for risky behaviors. Arnett argues
that significant identity exploration takes place during
this period of greater freedom and fewer constraints. He
states that risky behaviors in young
adulthood “can be understood in part . . .
as one reflection of the desire to obtain a wide range
of behavior before settling down” [1].
In the area
of sexual behavior, the prolonged transition
is reflected in the long period between first intercourse and marriage
(10 years for the average male and eight years for the average
female) [2].
Arnett suggests that the context of diminished parental surveillance
and little “normative pressure to enter marriage” during
these years may contribute to risky sexual behaviors
[1].
Young adults take
many paths to adulthood - paths that may involve college,
military service, parenthood, and marriage. It is important
to assess the implications of different paths - each with
its unique set of constraints and role expectations - for
health.
Researchers have
begun to examine the influence of transition to adult responsibilities
on behavior. In the area of substance use, Schulenberg et al suggest that decline in young adults’
substance use is linked to events including marriage, parenthood
and employment [3].
This prolonged
transition results from major social and economic transformations
- including the shift to a postindustrial economy and changes
in women’s roles. These changes have shaped the timing
and sequencing of young
adult transitions - including leaving home, entering or leaving school,
entering the workforce, and forming families [1,4 –7].
Major trends include:
Other trends
include a rise in single motherhood and the number
of young men in prison. In 2002, females aged 20–24
years had the highest non-marital birth rate of any age group
[8]. Incarceration rates are especially high for young
Black males, with 11% of Black males aged 20–24
years in prison in 2004 [7,9].
This period of
transition is accompanied by a significant weakening of
the safety net, as well as supportive institutions, organizations
and networks that serve adolescents. For example, while
nearly all adolescents are enrolled in school (96.4% of youth aged 14 –17 years in 2002), no single institution serves such a large percentage of young adults [10].
Whereas 3/4
of young adults have completed high school and at least some postsecondary
education, 1in 7 are disconnected from activities leading
to financial independence, being neither in school, the
work force, nor the military and having no degree beyond
a high school diploma or GED (ages 18 –24, 2000) [11,12].
Young adults
who do not finish college are at particularly high risk of falling behind economically
[13]. Populations
of adolescents that rely heavily on institutions suffer
disproportionately with the abrupt change in support.
These populations
- such as those in foster care or juvenile justice and those with mental health problems or other special health care
needs - are left to navigate young adulthood with few supports as they
age out of these systems [14].
A large literature
has documented that young adults with disabilities require special services to transition successfully to adult roles and functioning. The sharp decrease in insurance coverage in the late teen years makes it difficult for many in this population to secure these services [15].
Similarly,
young people in the foster care system, who have a high prevalence of physical and
mental health problems, also face barriers to retaining insurance as they exit
foster care, jeopardizing a healthy transition to adulthood [16].
Methods
This article defines
young adulthood as ages 18 –24 years
and presents data using that age grouping where possible.
Age 18 is commonly the year of high school graduation and
a year during which most young people have begun taking steps to achieve independence. No clear event marks the end of young adulthood.
Most data present age groups ending at age 24 years. People in their late 20s differ from those in their early 20s on many markers of health, as well as social indicators, such as employment status and school enrollment. To create a health profile for young adults, we conducted a comprehensive review of electronic databases,
articles and reports since 2000 that used nationally representative samples.
Internet searches were conducted using PubMed and
other search engines. Various search terms and key words were
used, including “young adult,” “early adult,” “emerging adult,” “age” and outcomes of interest. Some measures
were derived from private analyses of publicly available data (see
Table 1 for data sources).
To select outcomes of interest, we adapted the
21 Critical Objectives for Adolescent and Young Adult
Health [17]. A federally
convened panel of experts selected these objectives from
the 108 Healthy People 2010
objectives that address adolescents
and young adults [18].
These objectives fall into six
general areas, which we used to structure our presentation of the data (Table 2). We also review access to care and service utilization indicators for young adults.
Socio-demographic profile
The 2000 Census counted 27.1 million young adults aged 18 - 24 years. Like adolescents,
the young adult population is
more racially/ethnically diverse than the overall population.
In 2000, White non-Hispanics (NHs) comprised 61.7%
of the young adult population;
-
Hispanics, 17.3%;
-
Black NHs,
13.6%;
-
Asian/Pacific Islander NHs, 4.2%;
-
American Indian/Alaskan
Native NHs, .9%.
13% of young adults were foreign born; this figure ranges from 2.4%
of White NHs and 1.3% of American Indian/Alaskan Native
NHs to 61.2% of Asian/Pacific Islander NHs and 44.8% of Hispanics [12].
In 2003, 1 in 6 (16.5%) young adults aged 18–24 lived in
poverty; rates were higher for young females, especially Blacks (33.1%) and Hispanics (25.3%) [19]. Table 3 provides additional sociodemographic data [12,20,21].
Health Status
Overall health and disability
By traditional measures, young
adults are healthy. Over 96% of 18 - 24 year-olds report being in excellent, very good, or good health, a figure that varies little by gender
or race/ethnicity. Disabilities are relatively rare, with 4.6% reporting any physical, mental, or emotional limitation that affects daily functioning (including self care,
housekeeping, and work)
[22].
Mortality
Young adults aged 18 - 24 have over twice
the mortality rate of adolescents aged 12 - 17 ( Figure 1). As in adolescence, unintentional
injury, homicide and suicide account for 3/4 of all young adult
deaths. The higher rate for young adults is largely attributable
to the male mortality rate, which is 3 times the female rate.
American
Indian / Alaskan Native NH and Black NH males have the highest mortality rates (230.4 and 217.8, respectively), whereas Asian/Pacific Islander females have the lowest rate (31.6
[all mortality rates
per 100,000]).
Homicide
accounts for the high mortality among Black NH young
adults, whereas suicide and motor vehicle accidents account for the high mortality among American Indian/Alaskan
Native NHs (Table 4). Despite persistent disparities, overall trends in young adult mortality are encouraging:
Unintentional injury
Unintentional injury (UI) is the leading
cause of mortality for young adults. The UI mortality rate peaks in the young adult years at 42.0, then decreases until age 70.
Young adult males are 3 times more likely to die from injury than their
female peers ( Table
4). About 70%
of young adults’ UI mortality is due to motor vehicle accidents (MVAs). American Indian/Alaskan Native NH males have
the highest MVA mortality rate. Overall, young adult UI mortality
has decreased in the past 2 decades, from 46.9 in 1990 to 42.0 in 2003 [23].
Failure to wear a seat belt and driving while
alcohol or drug -impaired put all drivers at greater risk of fatal MVAs. In 2002, 70.2% of 18 - 24 year olds reported that
they always use seat belts, up from 57.7% in 1995. This figure increases
to 75.1% for 25 - 29 year olds and continues to increase throughout the lifespan [24].
Alcohol plays a larger role in MVA fatalities in young adulthood
than any other age:
-
in 2003, nearly a 1/3 (32.2%)
of fatal MVAs among 21- 24 year-olds involved an alcohol impaired driver, compared with 18.8% among 16 - 20-year-olds.
This rate decreases to 26.6% for 25 - 34-year
olds and continues to decrease throughout the lifespan [25].
In 2003, 1 in 4 (25.3%) young adults
aged 18 - 25 drove under the influence of alcohol and 1 in 7 (14.1%)
drove under the influence of any illicit drug in the past year [26].
For every fatal MVA among young
adults aged 21 - 24, there are 82 nonfatal MVAs (2003
data) [23]. The nonfatal MVA rate
(per 100,000) for this age group
was 1884 (1873 males
vs. 1894 females). This rate was second only to that of 16 - 20-year-olds
(2352) and was much higher than that of adults aged 25 - 34 (1361) [27].
Violence
As in many countries, most perpetrators and victims
of violence in the United States are adolescent and young adult
males [28].
Homicide rates peak in young adulthood at 16.1 and then
decline throughout the lifespan.
In
2003, over 4/5 of young adult
homicides involved firearms (82.5%),
a figure that has stayed relatively stable over the past decade. Male young adults are about 6 times more likely to die from homicide than same-age
females (Table 4), with the rate for Black NH males (111.0) being extremely high.
Between
1990 and 2003, young adult homicide rates declined (from 22.2 to 16.1), especially among Black
NH males (163.8 to 111.0) [23]. Homicide offending rates
also peak in young adulthood and are highest among Black
males. These rates have decreased considerably over the past decade [29].
Violent crime data show a similar pattern. Among
young adults (aged 20–24 years) in 2003, 43.5 per 1000 were victims of violent crimes, which include homicide, rape / sexual assault, robbery
and assault [30]. Although lower than
the rate for 16 - 19-year-olds (53.1), this figure was much higher than the rate for adults
aged 25 - 34 (26.5) [31].
In 2002, young adults
aged 18 - 29 perpetrated more than 1/3 (35.4%) of violent crime offenses. Violent crime victimization rates
are higher among young adult males than same-age females.
American Indians and Whites have the highest victimization rates [30,32].
Between
1993 and 2003, the victimization rate for young adults
decreased by 1/2 (91.6
to 43.5) [31].
In contrast to other areas of violence, females
are more likely to be victims of sexual assault than males. The rate (per 1000) for females peaks at ages 16 –19 (10.4 in 2002).
It then decreases for young adults (5.4) and throughout
the lifespan. The rate of sexual assault, including rape, is 13.5 times higher among females
than males (5.4 vs. .4, ages 20 –24) and is highest among Whites [30].
Substance use
Substance use and abuse have a substantial societal impact, with research showing links to other risky behaviors,
mental health problems, suicide, motor vehicle accidents, violent crime, and major health problems, including cancer and heart disease [33,34].
Substance use peaks in the young adult
years and is especially high among males [26].
Generally, American Indians/Alaskan Natives and Whites report the highest levels of substance use and Blacks report the lowest [26]. After a dramatic drop in the use of all substances during the 1980s, trends in
substance use since the early 1990s vary by substance and age group within young adulthood [35].
Tobacco
Tobacco use is the leading actual cause of death
for all ages, because of its link to cancer, cardiovascular disease and respiratory disease [36,37]. Cigarette smoking peaks in young adulthood.
According
to the 2003 National Survey on Drug Use and Health (NSDUH), young adults (ages 18 - 25 years)
report a rate of recent (i.e., past month) smoking that is 3.3 times the rate for adolescents (ages 12–17) and 1.6 times the rate for adults ages 26 and older (40.2% vs. 12.2%
and 24.7%, respectively) [26].
Young adults’
cigarette use is higher among males than females and among
American Indian/Alaskan Native NHs (Table 4) [38]. Among all young adults,
college graduates have a lower prevalence of cigarette use than those with less than a high school degree (28.7% vs. 49.2%) [26].
Data
from the Monitoring the Future study (MTF), which reports higher substance use rates than NSDUH [26],
show a steep rise in cigarette smoking among young adults
in the 1990s. Rates have declined since the late 1990s for 19 - 22-year-olds, but not 23 - 24-year-olds [35].
Alcohol
Recent binge drinking and heavy alcohol use peak in young adulthood.
According to the 2003 NSDUH, young adults aged 18 - 25 report a slightly higher rate of recent binge drinking than adults aged 26 - 29 (41.9% vs. 37.8%, respectively) and a much higher rate than adolescents
aged 12 - 17 (10.7%) ( Table 4) [26].
Among
young adults, more males report binge drinking than females,
and rates are highest for White NHs (58.2% males and 38.8% females), American Indian/Alaskan Native NHs (47.8% and 34.8%) and Hispanics (46.6% and 23.7%)
[38].
Heavy alcohol use follows a similar pattern. Young adults have a slightly
higher rate than adults aged 26–29 (14.9% vs. 11.5%) and a rate over 5 times that of adolescents (2.6%). Males have twice the rate of females.
Among young adult males, rates are highest among White NHs (26.2%), [26] American Indian/Alaskan Natives NHs (18.2%),
and Hispanics (14.1%) [38].
According
to MTF, college students binge drink more than young adults not in college (41.7% vs. 33.7%). By contrast, those not in school report higher rates of daily
drinking than their peers in school (5.8% vs. 3.7%, respectively).
Binge
drinking in the past two weeks rose during the 1990s and decreased slightly for 19 - 22-year
olds, but not 23 - 24-year-olds [35].
Illicit drugs
Recent illicit drug use also peaks during young adulthood:
- in 2003, 20.3% of young adults aged 18 - 25 reported recent illicit drug use, compared with 11.2% of adolescents aged 12 - 17 and 13.4% of adults aged 26–29 [26].
Young adult males report recent illicit drug use more than females (Table 4).
American Indian/Alaskan
Native NH young adults
report the highest rates of illicit drug use (34.0% males and 28.9% females) and marijuana use (32.4% and 22.4%, respectively) [38]. Recent
marijuana use has increased for young adults since the
early 1990s:
- the rate for 19
- 20-year-olds increased from 13.2% in 1991 to 23.1% in 1999, and decreased slightly to
22.5% in 2003 [35].
Substance dependence / abuse and treatment
Rates of dependence on or abuse of any illicit
drug or alcohol are highest in young adulthood (ages 18–25
years) and are higher for males ( Table 4)
[39]. Among males, rates of
substance dependence/abuse are highest for White NHs and American Indian/Alaskan Native
NHs (14.1% and 13.1%, respectively) [38].
Dependence/abuse
rates decline for both males and females after age 25 [39]. Among young adults who report substance abuse / dependence, few (2.8%) have received any
treatment addressing abuse or associated conditions the past year.
NSDUH data indicate great unmet need for substance abuse treatment: 21.5% of young adults needed treatment for an illicit drug or alcohol problem in the past
year, but only 7.1% received treatment specifically for abuse or related conditions [26].
Suicide and mental health
Young adults aged 18 - 24 years have triple the
suicide rate of adolescents aged 12 - 17. Young adult males have
6 times the suicide rate of females ( Table
4). Among young adults, rates are highest for male
American Indian/Alaskan Native NHs (43.9) and White NHs (23.1).
Overall,
the young adult suicide rate decreased from 14.8 in 1990 to 11.5 in 2003 [23].
The young adult
years represent a critical period for identifying problems, as 3/4
of all lifetime cases of diagnosable mental disorders begin by age 24. According to the 2002 National Co-Morbidity Survey, 52.4% of 18 - 29-year-olds have experienced a mental disorder at some point in their lives, with depression (15.4%) and alcohol abuse (14.3%) being the most common [40].
The
2003 NSDUH indicates that 1 in 7 young adults aged 18 - 25 years reports having a serious mental illness (SMI) at some time in the past year (Table 4)
[26]. SMI rates are higher
for females than males, and are highest among Whites and Asians [38]. SMI is more prevalent among those who have
less than a high school degree or are unemployed.
1/3 (35.2%) of young
adults with SMI received mental health treatment or counseling in the past year [26].
Reproductive health
Most young adults
aged 18–24 are sexually experienced (80.3% males and 82.1% females). Among males,
this figure is higher for Black NHs (87.8%) and Hispanics (87.7%) than White NHs (78.4%).
Among females this figure is highest among Black NHs (86.7%), followed by Hispanics (82.5%) and White NHs (81.5%).
Although most sexually active young adults use contraception, large numbers do not.
Among young adult
males who are single and not co-habitating or who have had more than one partner in the
past year, 7.3% used withdrawal or no method at most recent
intercourse; among same-age females, this figure was 7.9% [20].
More
males than females report having more than one partner in the last year (33.5% vs. 24.3%,
respectively), a behavior linked to sexually transmitted infections (STIs) [20,41].
STIs can have serious consequences, including pelvic
inflammatory disease, infertility, urethritis, epididymitis, and cardiovascular and organ damage [42].
The prevalence of many STIs, including chlamydia and gonorrhea, peaks in young adulthood.
Large
disparities exist by race/ethnicity, with Blacks, especially Black females, disproportionately
affected. Chlamydia is the most commonly reported STI among
young adults aged 20–24. Females have nearly 4 times
the rate of males, with the rate for Black NH females (7847.8, 2004 data) being especially
high.
Gonorrhea
is somewhat less prevalent and the gender disparity is much smaller
(Table 4). The gonorrhea rate for young
adult Black NH females (2565.4) is also very high [43]. The number of new HIV/AIDS cases in 2002 was about 3 times higher
for young adults (aged 20–24, 2459 cases) than adolescents
(aged 13–19, 854 cases).
Black
males were most affected, comprising 32.2% of all new HIV/AIDS cases among young adults [44]. Although gonorrhea rates for young adults have decreased dramatically over the past decade (1131.2 in 1990 vs.
497.8 in 2004) [43,45], several factors make
it difficult to assess trends for other STIs.
The
large increase in chlamydia - from 882.4 in 1996 to 1660.4 in 2004 - may be partly attributable to more sensitive tests and greater testing [42,43,46]. The number of new AIDS cases changed very
little between 1990 and 2002 (1637 vs. 1574, respectively) [44,47].
Overweight / obesity and physical activity
Overweight/obesity is the second leading actual
cause of death for all ages. Poor diet and physical inactivity contribute to overweight/obesity and are associated with cancer, cardiovascular disease and
diabetes [36,48,49].
As
with the general population, the prevalence of overweight / obesity among young adults has increased significantly in the past four decades. The average
body mass index (BMI) of young adult males (ages 20–29) increased from 24.3 in 1960
- 1962 to 26.6 in 1999–2002; for same-age females these figures are 22.2 to 26.8 [50].
Obesity affects 1 in 6 young adults (ages 24–26), with males and females having similar rates (16.8% vs. 17.2%) [51].
In 2004, nearly 4/5 (79.7%) of young adults aged
18–24 reported participating in any physical activity during the past month. Higher rates of physical activity are reported by White NH males (88.3%), White NH females (83.9%), and Black NH males (81.7%).
Lower rates
are reported by Hispanic males (68.5%), Black NH females (66.2%), and Hispanic females (60.0%) [52].
Health access and utilization
Young adults have the lowest insurance rate of
any age group 0 - 64 years [53]. In the transition to young adulthood, young people
become ineligible for their parents’ health coverage and the public insurance that
covers adolescents.
Data from 2002 - 2003 show that 37.7% of males and 30.7% of females aged 18 - 24 years were uninsured at any point during the past year ( Figure 2) [22]. These figures are larger than
previously published measures, which assessed insurance at the time of the interview, rather
at any point in the previous year [54].
The
gender disparity may be due in part to Medicaid coverage of poor families, which are disproportionately
headed by young single women with children [55]. Risk of being uninsured is greater among certain groups of young adults, including the poor, Hispanics, those with low educational attainment, and non-students [54].
Low insurance rates affect young adults’
access to and utilization of health care services. Compared with their insured peers, uninsured young adults are more likely to report foregoing needed care; not filling a prescription because of cost; not having
spoken to a health professional in the past 12 months; and having no usual source of care.
Young adult males are
more likely than females to report no contact with a health professional (35.1% vs. 12.8%)
and no usual source of care (36.3% vs. 19.9%). Males and females report similar rates of
foregoing care (11.1% vs. 12.6%). Among young adult males,
62% of the uninsured had no usual source of health care, compared
with 24% of the privately insured.
Among females, 26%
of the uninsured reported having delayed or missed medical care due to cost, compared with
only 8% of those privately insured [56].
Young adults report high use of emergency room
care. In 2002, 8.5% of young adults (aged 18–24)
had two or more emergency department (ED) visits in the past year, a figure second only to 9.0% for ages 75 [57]. In 2002, trauma related disorders
accounted for the highest number of young adults’ (aged 18–24) ED visits, with more males than females reporting
such a visit (933,000 vs. 664,000) in 2002 [58].
With over 4/5 of young
adult women sexually active and over 2.2 million pregnancies among women aged 20–24 years (2000 data), reproductive health services are critical
for young women [59]. Reproductive health services dominate health care utilization: data for females aged 18–24 in 2002 show
that live birth accounts for the highest number of hospitalizations (865,000); contraception
and female genital disorders account for the highest number of prescription medicines prescribed (2.1 million); birth, contraception and female
genital disorders also dominate outpatient visits [58].
In 2002, 75.7% of young adult females aged 20–24 received at least one medical service
related to reproductive health in the past year [60]. Outside of reproductive health issues, similar conditions account for male and female health care utilization.
Conditions
accounting for the largest number of young adults’
use of health care services (including office visits, hospitalizations, ED visits and prescription medicine) are, in order:
In 2004, 72.3% of 18 - 24-year-olds reported having visited the dentist or dental clinic
in the past year. Among adults, only 25–34- and 65-year-olds are less likely to have had a dental visit in the past year
(67.6% and 66.1%, respectively) [24].
Young adults with disabilities
Access to care is especially important for the
increasing numbers of children with disabilities who survive into adulthood [61,62]. Lack of insurance has greater consequences for these young adults, because of their greater health needs.
According to 2002–2003 data, 60% of uninsured
young adults aged 19–29
years with a disability delayed care due to costs, compared with 14.7% of their peers with
insurance and 19.4% of uninsured young adults without
a disability.
Similarly, 41.4% could not afford to fill a prescription,
compared with 12.3% of their peers with insurance and 14.5%
of uninsured young adults without a disability [63].
Discussion
These data show that
young adult health issues merit attention. Mortality rates more than double between
adolescence and young adulthood.
The prevalence of many health problems - including homicide, motor vehicle injuries, substance abuse, and STIs - peaks during the early 20s.
In addition, large disparities persist. Young men,
particularly Whites and American Indian/Alaskan Natives, have higher rates of substance abuse; American Indian/Alaskan Native males have higher suicide rates; young Black men are disproportionately
affected by homicide; and young Black women experience
higher STI rates.
Compounding these problems
is a spike in uninsurance during young adulthood, a problem
most pronounced among certain groups, including those who are low-income, Hispanic or not
in school.
On the positive side, trends in many areas are encouraging, such as declines in the major causes of death. Available data on young adult health are limited in many ways. Although a few surveys regularly
monitor some indicators of health and well-being, there is no comprehensive monitoring system parallel to the Youth Risk Behavior Surveillance System, for
example, administered by the Centers for Disease Control and Prevention [64].
A
key challenge in data collection is the lack of a single institution that serves the majority of young adults, parallel to schools for adolescents. A persistent problem is the inconsistent age grouping for young adults.
Despite the high prevalence of many
health problems during young adulthood, data sources often
group young adults with older adults. When data are presented
for young adults, basic demographic breakdowns are seldom
available, despite the disparities noted above. Assessing socioeconomic status is particularly challenging; with many young adults in school, income is a problematic measure.
Data are lacking in specific health areas. Given the prevalence of overweight / obesity, greater information on nutrition, physical activity and
sedentary behavior is needed. Monitoring data on mental health, a problem that clearly affects
this population, are fairly limited for young adults,
as are data on oral health.
Specific data on access to care for different types
of students (e.g., full-time vs. part-time, 4-year college vs. 2 - year college) would help identify gaps in access. Special populations warrant additional focus, including
the unemployed, those with disabilities, or those transitioning out of foster care, as well as young adults in different settings, such as the incarcerated or those in the military.
Summary and Implications
A national health research and policy agenda for young adults needs further
development. Although many health problems of young adulthood could be addressed through preventive interventions
and greater access to care, this age group has largely been neglected by researchers, policymakers
and professional organizations, in contrast to support for adolescents.
Whereas child and adolescent health advocates have been largely successful in promoting policies to offset declines in private insurance,
the lack of parallel effort for young adults leaves them
with the lowest insurance rate of any age group.
Similarly, professional health organizations have
developed numerous clinical guidelines to promote healthy development and prevent risky behaviors for children and adolescents. However, similar guidelines do not exist for young adults, who face similar health problems as adolescents.
Perhaps the most glaring problem is that young adults lack a common entry point into the health care system. Although
college health services play a valuable role in serving many young
adults during the school year, those not in school are not served by this system.
Compared with adolescence, few research or policy
initiatives have focused on young adulthood. Where national
young adult health recommendations exist, they generally
are part of efforts that primarily address adolescents. For example,
of the 21 Critical Objectives that provided a framework for this article, only five include
young adults in the Healthy People 2010 measure (Table
5) [17].
A
few national consensus reports that focus primarily on adolescents offer information and recommendations related to young adults, including reports on underage drinking [65] and youth development [66]. Although there is substantial literature on effective prevention programs for adolescents
[67], very little exists for young
adults [68].
A few initiatives do primarily address young adults. These include: the Commonwealth Fund’s focus on insurance
and the MacArthur Foundation’s Network on Transitions to Adulthood and Public Policy, which examines young adults’ risky behaviors and other social trends [69,70].
The
well-being of non-college-bound youth, including risky behaviors, has been examined in the Forgotten Half and
the Forgotten Half Revisited [13,71]. The American College Health Association provides national leadership in college health, with research, monitoring, advocacy
and professional education [72].
Young adults with disabilities have been the focus of national attention since Surgeon General Koop convened a conference on the issue in 1989, through Healthy People 2010, which includes objectives specific to this population [61,62,73–75]. A few states have addressed young adult
health [76,77].
Bills before Congress would expand
private and public insurance coverage for young adults
[78]. Some states require all students to be covered by their college [53]. Some cities and counties are addressing young adults’
lack of insurance as well [79].
These and other initiatives form a base on which
to build a national health agenda for young adults. As
with adolescents, advancing a young adult health agenda
will require collaborative efforts of different sectors, such as colleges, the military, and employers, as well as health professionals.
More longitudinal research - for example, studies
that identify risk and protective factors for risky behaviors among young adults in different settings - can shape effective policies and programs. Data collection systems can provide demographic breakdowns
to improve monitoring of populations at greatest risk [7].
This article highlights key health issues for the young adult population and identifies gaps in research, monitoring
and programmatic efforts. Based on our review, we conclude that young adulthood is an important, unique period
of the lifespan and recommend the development of a national young
adult health agenda to address the needs of this population.
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