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From the President: Emerging Issues

 Clinical Preventive Services Young Adults - Opportunities for Title V Programs

By Lauren J. Twietmeyer, MPH
Project Associate, Adolescent and Young Adult Health National Resource Center; Division of Adolescent and Young Adult Medicine - UCSF Benioff Children’s Hospital

By M. Jane Park, MPH
Project Coordinator, Adolescent and Young Adult Health National Resource Center; Division of Adolescent and Young Adult Medicine -  UCSF Benioff Children’s Hospital

What are key health issues among young adults?

By and large, young adults face similar health issues as do adolescents, such as injury, sexual health risks, substance abuse, mental health problems and violence. However, they fare worse than adolescents on most markers of health-related behaviors and outcomes in these areas. Fortunately, as with adolescents, many young adults' health problems are preventable, and we can promote positive health behaviors to them. In addition, early intervention can lessen the impact of some health problems. For example, young adulthood is a key period for the emergence of mental health problems. Early screening, diagnosis and treatment can help young adults manage mental health problems and other chronic diseases.1

 Healthy trends among young adults include decreases in rates of motor vehicle fatality and of drinking and driving. In addition, recent cigarette use among young adults fell from 34 percent to 28 percent between 2010 and 2014.2 However, this means than more than one in four young adults smoked in the past month. In addition, rates of gonorrhea and chlamydia increased between 2010 and 2014.3 Improving young adult outcomes in these areas requires a range of preventive interventions, including clinical preventive services.

Improving Preventive Services for Young Adults: What are the Challenges and Opportunities?

One challenge in delivering preventive services to young adults has been their historically low rates of health insurance coverage and health care utilization, including receipt of preventive care, compared with most other age groups. Barely half (52 percent) of adults ages 18-25 received a preventive care visit in 2013.4

Several provisions in the Patient Protection and Affordable Care Act of 2010 (ACA) have helped to improve access to health insurance, including the requirement that private health plans extend dependent coverage up to age 26 and the establishment of "the marketplace" in each state, which offers financial assistance to low-income individuals.5 Thirty-one states and the District of Columbia adopted the ACA's option to expand Medicaid coverage to cover more low-income adults under 65, including young adults.6

Other ACA provisions aim to increase receipt of preventive services. States that expanded Medicaid, as well as most private health plans, are required to cover certain preventive services with no copayment, including services recommended by the U.S. Preventive Services Task Force (USPSTF), vaccinations recommended by the Centers for Disease Control and Prevention Advisory Committee for Immunization Practices (CDC-ACIP), and women's preventive services developed by the Health Resources and Services Administration (HRSA).5

One challenge at the clinician level is the lack of clinical preventive guidelines tailored to young adults. To address this, Ozer et al. (2012) "carved out" a range of recommendations from several relevant guidelines, including the 2008 Bright Futures guidelines, which include preventive services recommendations specific to ages 18-21. Many of these services are also recommended by the USPSTF, the "gold standard" in evidence-based clinical care.7 Two resources, updated in March 2016, present this information in an easy-to-use format:

  1.  Young Adult Clinical Preventive Screening Guidelines: This toolkit offers a one-page document that summarizes all clinical preventive service recommendations for young adults and a supplemental document with details on screening tests and risk factors.

  2. Evidence-based Clinical Preventive Services for Adolescents and Young Adults: This one-page fact sheet summarizes the evidence base of clinical preventive services for adolescents and young adults, with a special emphasis on recommendations from the USPSTF. 

These were developed by the National Adolescent and Young Adult Health Information Center as part of its work for the Adolescent and Young Adult Health National Resource Center (the "AYAH Center").
 
What Can State Title V programs do to Improve Delivery of Preventive Services?

The AYAH Center, supported by the U.S. Maternal and Child Health Bureau, aims to help states improve the delivery of preventive services for adolescents and young adults through multiple strategies. One strategy is to get youth "to the door" by improving health insurance coverage, health literacy and promoting the value of the preventive visit (or "well-visit"). Young Invincibles, a young adult advocacy organization and AYAH Center partner, has found that few young adults feel confident in their understanding of key health insurance concepts and many do not see preventive care as important. In response, Young Invincibles launched a campaign called #HealthyAdulting to provide resources on obtaining and understanding health insurance coverage, along with a toolkit to connect youth to coverage and preventive services in their communities.

A second strategy focuses "in the clinic" on improving quality of care. State action in this area could involve partnering with provider groups to train clinicians in effective delivery of services and to create clinic quality improvement projects. The young adult resources referenced above can help inform clinicians on evidence-based and consensus recommendations for care. Materials for providers and health care systems to implement Bright Futures could be extended for use with young adults.
We also need to explore models from different professional groups to integrate preventive services in a manner that is most relevant to that specialty group, practice or setting, as well as to the young adult group. In addition, interactive computerized technology has great potential for integration into young adult health care across settings.
 
Where can I find additional information on preventive care for young adults?


Please visit the AYAH Center website for more information. A complete list of resources from this Center is available here.

 

References:

  1. Park M.J., Scott J.T., Adams S.H., Brindis C.D., Irwin C.E. Jr. Adolescent and young adult health in the united states in the past decade: Little improvement and young adults remain worse off than adolescents. J Adolesc Health 2014; 55: 3-16.
  2. Center for Behavioral Health Statistics and Quality (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samsha.gov/data/.
  3. Centers for Disease Control and Prevention. National Center for HIV, STD, and TB Prevention, Division of STD/HIV Prevention. Sexually Transmitted Disease Morbidity for selected 1996-2014 STDs by age, race/ethnicity, and gender. CDC WONDER Online Database. Available at: https://wonder.cdc.gov/std-race-age.html. Accessed Nov. 30, 2016.
  4. Agency for Healthcare Research and Quality. (2013). Medical Expenditure Panel Survey [data file]. Retrieved from https://meps.ahrq.gov/mepsweb/.
  5. English A, Park M.J. Access to health care for young adults: the Affordable Care Act of 2010 is making a difference. Chapel Hill, NC: Center for Adolescent Health & the Law; the San Francisco, CA: National Adolescent and Young Adult Health Information Center, 2012.
  6. The Henry J. Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision, October 2016. Available at http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0.
  7. Ozer E.O., Urquhart J.T., Brindis C.D., Park M.J., Irwin C.E. Jr. Young adult preventive health care guidelines: There but can't be found. Arch Pediatr Adolesc Med 2012; 166(3)240-7.