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 Health Issues Facing Young Adults

park.jane_.jpgBy M. Jane Park, M.P.H.
Project Coordinator, National Adolescent Health Information and Innovation Center
Public Policy Analysis and Education Center for Adolescent and Young Adult Health, University of California, San Francisco
 
Why focus on young adults?
Young adulthood is a critical period in the life course.  Generally, young adulthood is defined as ages 18-24 or 18-25; however, some researchers use 18-29.  During this time, young adults navigate the transition to adult roles, responsibilities and relationships. They make choices that may involve college, employment, military service, as well as marriage and childbearing. These choices have implications for their health and well-being, as well as access to health care services. Most youth navigate these transitions successfully avoiding major problems.1 Vulnerable populations of youth face greater challenges. Many systems, including safety net programs that serve vulnerable youth, change or end at age 18. The MCH field has long recognized the importance of facilitating a healthy transition to adult care for youth with special health care needs. Other vulnerable groups include those who are homeless, exiting the foster care system or involved in the justice system.2

What are young adult health issues?
The health care issues of young adulthood largely mirror those of adolescents. Relative to older age groups, young adults are generally very healthy and rates of chronic disease are low.  As with adolescents the major health issues relate to behaviors – such as substance use, sexual behavior, driving habits, diet and exercise – that influence health in the short and/or long term.3 This is also a critical period to identify and treat mental health issues, as symptoms of 75 percent of all lifetime diagnoses emerge by age 24. 4 Compared to adolescents, for example, young adults have higher rates of substance use, including alcohol, tobacco and marijuana use, and drinking and driving, as well as higher rates of obesity, sexually transmitted infections, motor vehicle crash mortality and homicide.3

What are young adult health care needs?
There has been little focus on young adult health care needs, compared to adolescents, despite the similarities in health care issues for these two populations. Young adults often face an abrupt change in services when they reach the age of 18. Many young adults became uninsured in the transition to adulthood. In fact, before passage of the Affordable Care Act in 2010, young adults had the lowest rate of health insurance of any age group. 5 Young adults also had fewer outpatient visits than any age in the life span, but have higher rates of emergency room visits than all ages except for infants and the elderly.5 Fortunately, rates of health insurance have increased among young adults:  the rate increased from 62 percent in 2010 to 69 percent in 2012.7 This increase is likely due in part to implementation of provisions in the 2010 Affordable Care Act. 8

Where can I get more info and resources?
Young adult health and health care issues are receiving increasing attention in policy, programs, and research. For example, in proposed revisions of the Title V MCH Block Grant guidance, adolescents AND young adults (encompassing youth between the ages of 10 and 25) are identified as one of six key population domains. Several provisions of the Affordable Care Act focus specifically on addressing the traditionally very low rates of insurance among young adults.9 Multiple recent reports offer an overview of young adults, their health care needs and other issues, including the following:

  • The Institute of Medicine held a workshop on young adult health in May 2013. The presentations by experts in the field addressed a range of health and health care issue and are available here. A report based on the workshop is also available for free download here.
  • A July 2014 report from The Interagency Forum on Family and Child Statistics offers a comprehensive overview of young adults, including information on demographics, education, employment and health.
  • A review of trends in adolescent and young adult health, released in July 2014, is available from the Journal of Adolescent Health, free of charge, here.
  • Several reports on young adults and the Affordable Care Act are available here.
  • For clinicians and health care systems, a summary of evidence-based preventive services for young adults is available here.

 

References:

  1. Terzian M, Moore K, & Constance N. (2014). Transitioning to Adulthood: How Do Young Adults Fare and What Characteristics Are Associated with a Lower-Risk Transition? Bethesda, MD: Child Trends, 2014. Available at: http://nahic.ucsf.edu/wp-content/uploads/2014/07/Transitioning-to-Adulthood-How-Do-Young-Adults-Fare-and-What-Characteristics-are-Associated-with-a-Lower-Risk-Transition.pdf
  2. English A, Scott J, Park MJ. Implementing the ACA: How Much Will It Help Vulnerable Adolescents & Young Adults? Chapel Hill, NC: Center for Adolescent Health & the Law; and San Francisco, CA: National Adolescent and Young Adult Health Information Center, 2014. Available at: http://nahic.ucsf.edu/vulnpops
  3. Park MJ, Scott JT, Adams SH, Brindis CD, Irwin CE, Jr. Adolescent and young adult health in the US in the past decade: Little improvement and young adults remain worse off. Journal of Adolescent Health. 2014;55(1):3-16.
  4. Kessler RC, Berglund P, Demler O., et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry, 2005; 62:593-602.
  5. Adams S, Newacheck P, Park MJ, Irwin CE, Jr. Health insurance across vulnerable ages: Patterns and disparities from adolescence to the early 30s. Pediatrics 2007;119(5):e1033-39.
  6. Lau JS, Adams, SH, Boscardin WJ, Irwin CE, Jr.  "Health care utilization and expenditures among young adults prior to the Affordable Care Act 2010."  Presented in the AAP Presidential Plenary & Annual Silverman Lecture at the 2013 Pediatric Academic Societies Annual Meeting.
  7. Public Policy Analysis and Education Center for Adolescent and Young Adult Health. National Health Interview Survey [private data run]. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/nchs/nhis.htm.
  8. Kirzinger WK, Cohen RA, Gindi RM. Trends in insurance coverage and source of private coverage among young adults aged 19–25: United States, 2008–2012. NCHS data brief, no 137. Hyattsville, MD: National Center for Health Statistics. 2013.
  9. English A & Park MJ. (2012). The Supreme Court ACA Decision: What Happens Now for Adolescents and Young Adults? Chapel Hill, NC: Center for Adolescent Health & the Law; and San Francisco, CA: National Adolescent and Young Adult Health Information Center, 2012. Available at: http://nahic.ucsf.edu/download/the-supreme-court-aca-decision-what-happens-now-for-adolescents-and-young-adults/