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Board on Children, Youth, and Families; Institute of Medicine; National Research Council. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington (DC): National Academies Press (US); 2013 Sep 27.
Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary.
Show detailsAmy Doherty, who was born legally blind, works in a vision rehabilitation laboratory to test and design devices that help people with vision impairments. She said the transitions from high school to college and from college to the workplace can be difficult for all young adults, but especially for those with disabilities because the loss of previous support systems “can be very challenging [and] isolating.”
Figuring out how to become part of a new community can overcome that isolation. “How can I get support, what community resources are there, [how can I] navigate that challenge?” Social media is a “huge advantage,” she said, because it can connect young adults to many different communities.
Andrea Vessel, a junior at American University in Washington, DC, grew up in a middle-class family in Cincinnati, Ohio. Throughout her youth, she was often the only black student in her classes or social clubs. Such students can feel isolated, she said, and that they have to prove themselves. “I have to succeed at a higher rate, do more to fit in, and be successful.”
Her continuous involvement in 4-H and Girl Scouts and the support of her parents were critical to Vessel's success. Participating in social clubs, even when she was the only black member of those clubs, taught her that “the sky is the limit, there wasn't a glass ceiling. I never thought, ‘I couldn't do this.’” High-quality positive youth development programs can provide “skills that can compensate for things related to finances,” which are especially important for individuals who are “low-income, or others who don't have positive images to look up to.” Consistent access to these types of quality programs “is very important in terms of development into young adulthood.”
Eric Lulow spent time in the foster care system in west Detroit and then lived with relatives until he turned 18, at which point he was homeless. But with the support of his community, he was able to put himself through college and get a degree in social work. He now works in the Child, Adolescent, and Family Branch of the Substance Abuse and Mental Health Services Administration as a public health advisor, overseeing grants to communities to provide mental health services for children, youth, and families.
Self-efficacy is the key to resilience, he said. “For myself, struggling with things like not having a job, not having the same level of education as my peers, not having all this stuff, really makes you question yourself and your own abilities.” Building self-efficacy among populations at risk, and especially those with social, emotional, or behavioral health needs, is essential for young adults to overcome the barriers they face, he said.
Shanae grew up in a single-parent household in Washington, DC, while her father was incarcerated for 10 years. She is only 19 years younger than her mother. She is an intern with Freddie Mac through the Year Up program, which provides urban young adults with skills, experiences, and support to reach their full potential through professional careers and higher education. “The Year Up Program saved my life.” Research on young adults in workforce development programs is important to understand the different perspectives and experiences of nontraditional college students, who are often referred to as the Forgotten Half, “that is me.”
Isha-Charlie McNeely, who grew up in the foster care system, is now a case manager for youth in the system. She was adopted at age 16, and the two women who were her adoptive parents provided her with the permanence and stability that she needed to make the transition to adulthood. She now does peer-to-peer mentoring and coaching with youth who are transitioning from foster care to postsecondary education. “It is really important, when youths are transitioning to adulthood, that they transition with permanent connections and stability.”
Jackie Malasky recently received a master's degree in public health and now works with the American Association of Blood Banks. She did her master's thesis on how men and women use the Internet differently to access sexual health resources online, which revealed to her the potential for technology to improve the health of young adults.
Technologies today do not just provide information, she said. They are a way for young adults to make their voices heard. “Reading newspapers, reading magazines, we can't get [from that] what we want to say. Using Twitter and Facebook, we feel like we have value.”
Jose entered the juvenile justice system when he was 11 years old and is still on probation at age 18. At 14, he was sent to the adult system for committing a serious offense and soon was put in segregation for 30 days for fighting with someone who was older than he was. In segregation, he was in his cell for 23 hours each day and rarely talked with his family. Even when he got out of segregation, “I just sat there, day by day, for 3 years.”
The prison made no effort to educate him. “The only thing I learned was how to watch my back.” But many juveniles in prison want to be educated, Jose said. He is now working on his General Education Development (GED), even though he “had to learn a lot of this on my own…. Why don't you educate those who want to be educated?”
The voices of these seven young adults were a highlight of a workshop titled “Improving the Health, Safety, and Well-Being of Young Adults,” which was hosted by the Board on Children, Youth, and Families of the Institute of Medicine (IOM) and the National Research Council (NRC). The workshop was held in Washington, DC, on May 7-8, 2013, and sponsored by the Health Resources and Services Administration (HRSA).2,3
Young adults are at a significant and pivotal time of life. They may seek higher education, launch their work lives, develop personal relationships and healthy habits, and pursue other endeavors that help set them on healthy and productive pathways. However, the transition to adulthood also can be a time of increased vulnerability and risk (Brindis, 2013). Young adults may be unemployed and homeless, lack access to health care, suffer from mental health issues or other chronic health conditions, or engage in binge drinking, illicit drug use, or driving under the influence. Young adults are moving out of the services and systems that supported them as children and adolescents, but adult services and systems—for example, the adult health care system, the labor market, and the justice system—may not be well suited to supporting their needs (Berlin et al., 2010).
The workshop brought together—both in person and via webcast— more than 250 researchers, practitioners, policy makers, and young adults for 2 full days of presentations and discussions. The workshop objective was to highlight research on the development, health, safety, and well-being of young adults.4 More specifically, workshop presentations and discussions addressed the following questions:
- What are the developmental characteristics and attributes of this age group and its placement in the life course?
- How well are young adults functioning across relevant sectors, including, for example, health and mental health, education, labor, justice, military, and foster care?
- How do the various sectors that intersect with young adults influence their health and well-being?
According to Richard Bonnie, chair of the planning committee for the workshop, the workshop was designed to provide a “sense of the landscape”—what research exists, what gaps and needs in that research exist, and which issues deserve more intensive study. It also was meant to start a conversation aimed at a larger IOM/NRC effort to guide research, practices, and policies affecting young adults. The ultimate objective, said Bonnie, is “to improve the health, safety, and well-being of young adults through policies, research, systems development, and changes to existing service delivery models.”
MOTIVATIONS FOR THE WORKSHOP
The HRSA Maternal and Child Health Bureau had several reasons for supporting a workshop on the topic of young adult health, safety, and well-being, explained Trina Anglin, director of adolescent health at the Bureau. She noted that young adults warrant particular attention because they have a worse set of health outcomes than do adolescents. For example, their rates of death from motor vehicle crashes, homicide, and suicide are significantly higher than those of adolescents, and they are more likely to use tobacco, consume illicit drugs, binge drink, and contract HIV infection. Anglin also noted that young adults are at highest risk to be arrested, with particular groups, such as males of color, at especially high risk. They also are at high risk of homelessness, especially families headed by a single young adult female. Young adults are the workers least likely to be employed, especially those who have not graduated from high school. They have the lowest levels of access to health care, especially among undocumented immigrants and other disadvantaged groups. These issues are discussed in greater detail throughout this summary.
Despite these risks and vulnerabilities, Anglin noted that young adults are in many ways an overlooked population. Young adults do not have any special safety nets (unlike adolescents), and the transition to adult systems and roles may be difficult. As Anglin said, for example, “the pediatric health care system is not quite ready to give them up, and the adult health care system, quite frankly, is not quite ready to accept many of them, especially those who have very complex issues.”
Recent policy changes have made a difference in the lives of young adults. The Patient Protection and Affordable Care Act (ACA) has mandated that parents' commercial health insurance plans make coverage available until children reach the age of 26, which has significantly increased the percentage of young adults who are insured. However, Anglin said, no federal or state entity has developed a structure that can address the needs of young adults. The workshop represented an initial step, she said, to have federal and state agencies work together to support this population group. “Our aspiration is [to] turn that tide, and for people to start thinking about the needs of young adults, but to be doing it in a proactive, constructive, and supportive way.”
OVERVIEW OF A CHANGING LANDSCAPE AND PROFILE OF YOUNG ADULTS
“Why this population and why now?” asked Claire Brindis, in the opening presentation of the workshop. Brindis is professor of pediatrics and health policy in the Department of Pediatrics, Division of Adolescent Medicine, and the Department of Obstetrics, Gynecology, and Reproductive Health Sciences, at the University of California, San Francisco. She provided a broad introduction to many of the most important issues discussed during the workshop, which subsequent speakers explored in greater depth. In her remarks, she discussed the importance of this time of life and the changing context in which young adults are embarking on their adult lives, both of which indicate the need to pay attention to this age group.
Changing Demographics and Milestones
Between 1990 and 2050, the number of young adults ages 18-24 is projected to increase from 27 million to 34 million (see Figure 1-1), at which point this group will constitute about 13 percent of the U.S. population. The racial and ethnic makeup of this group is becoming much more diverse, with Hispanics and Asians showing particularly large increases and non-Hispanic whites decreasing as a percentage of the population (see Figure 1-2). Young adults of color are now spread much more widely throughout the United States rather than living in concentrated areas, which was common in the past.
FIGURE 1-1
The number of young adults ages 18-24 in the United States is expected to reach 34 million by 2050. SOURCE: U.S. Census Bureau, 2013.
FIGURE 1-2
Racial and ethnic makeup of the United States in 1960–2050. SOURCE: U.S. Census Bureau, 2013.
Traditionally, said Brindis, the transition to adulthood has been marked by five major milestones (Henig, 2010):
- 1.
Completion of education
- 2.
Leaving home
- 3.
Financial independence
- 4.
Marriage
- 5.
Children
In the 1960s, 77 percent of women and 67 percent of men would have accomplished these five milestones during their young adult years. By the year 2000, fewer than half of young women and about one-third of young men had achieved all five. Given that lifespans are now longer than in the past, perhaps young adults will still achieve these milestones later in life, but the concern, said Brindis, is that “they may get off kilter and never accomplish any of these.”
Young adults take many different pathways through their late teen years and 20s. People may quit a job, go back to school, enter the military, go to college, or become a parent. In every generation, young adults need the tools to be meaningfully engaged, caring community members, and productively employed to their full potential, said Brindis. This has not changed. However, she noted, the aging of the baby boomers in the United States means the nation will depend even more on the health, well-being, and productivity of young adults. At the same time, young adults face more challenges today than in the past, especially among members of the most vulnerable and marginalized populations. These challenges were examined through the course of the 2-day workshop.
Health Profile of Young Adults
Habits acquired in adolescence and young adulthood can impact the entire life course, noted Brindis, which is an important motivation for focusing on this age group. For example, behaviors in young adulthood can increase the risk of developing chronic disease later in life, such as addiction from binge drinking and heart disease from smoking, poor diet, and/or inadequate physical activity. Behaviors such as binge drinking and transportation accidents also represent an acute risk during this time period. Finally, the young adult period also marks the peak period for onset of chronic illnesses such as mental health disorders. Brindis asked, “how does health fit into the overall picture of ensuring a very successful transition from adolescence through young adulthood, and from young adulthood to later adulthood?”
Compared with young adults in 16 other high-income countries, U.S. young adults have higher transportation-related mortality among males, higher male mortality from violence, and greater diabetes prevalence (NRC/IOM, 2013). About 20 percent of young people between the ages of 18 and 25 are obese, with the percentage increasing later in life (CDC, 2011b). They have high rates of substance use and mental health disorders, with males overrepresented among the former group and females overrepresented among the latter (SAMHSA, 2010). In 2008, nearly 2 million unmarried women ages 20-29 became pregnant, and 69 percent of these, or 1.3 million, were unplanned, with a higher rate of unplanned pregnancies among the younger women in this cohort (National Campaign to End Teenage and Unplanned Pregnancy, 2012). Among young unmarried women, roughly half of unintended pregnancies ended in abortion.
The current health care system for young adults falls short in several respects, said Brindis, though, as noted above, ACA offers hope for improvement through greater insurance coverage and improved access to services. The health care financing system is difficult to navigate and leaves many out. The system's incentives reward acute care over preventive services and chronic disease management. Providers trained in and comfortable serving adolescents and young adults are in short supply, especially in mental health. Little consensus exists on the health care needs of young adults.
Changing Context: Education and Employment
Before 1960, more than 80 percent of U.S. jobs were in industry and manufacturing. Today, service jobs in education, health, financial activities, and leisure and hospitality are much more common than manufacturing jobs. The traditional pathway to adulthood for young adults with only a high school degree—employment in a well-paying manufacturing job—has largely disappeared.
More jobs today are performed by people with higher education levels than in the past. Reflecting these changing demands, the percentage of adults ages 25-29 who have completed college has risen to 30 percent for men and 37 percent for women (Brindis, 2013). (The college completion rate of women of this age surpassed that of men in 1991—when both were at about 23 percent—and has been rising since then.) The workforce is now almost half women, compared with slightly more than one-quarter of the workforce in 1950.
High school and college enrollments have increased over time among most students of color. As a result, the percentage of U.S. adults ages 25 and over who have completed 4 or more years of college has risen steadily among these groups (Fry, 2009). However, great disparities among racial and ethnic groups and between genders still exist.
At the same time, economic mobility has become more limited in the United States. Two-thirds of those raised in the bottom of the wealth ladder remain on the bottom two rungs, and a comparable percentage of those raised in the top of the wealth ladder remain on the top two rungs (Pew Charitable Trusts, 2012).
Changing Context: Family Structure
The percentage of all births to women ages 20-24 that were to unmarried women rose from 4.8 percent in 1960 to 63.1 percent in 2010 (Child Trends Data Bank, 2012), with striking increases among all racial and ethnic groups. However, the increase has been especially dramatic among less educated women.
The percentage of 25- to 29-year-old women who have never married has risen from about 30 percent in 1990 to more than 50 percent today, with increases among women at all educational levels. However, the percentage is higher for black and Hispanic women than for white women (Pew Research Center, 2010).
More than 22 million young adults now live at home, compared with 18 million a decade ago, which has earned the current cohort of young adults the somewhat disparaging name of the “boomerang” or “failure to launch” generation. About 40 percent of young adults ages 25-29 say they live at home with their parents because of the economy (Parker, 2012b).
Changing Context: The Role of Social Technology
All age groups in the United States have increased their use of the Internet over the past 10 years, but teens and young adults are at especially high levels—about 95 percent, said Brindis. A large proportion rely on Facebook, Twitter, Instagram, Pinterest, Tumblr, and other social networking sites, with 83 percent reporting some use of social networking (Duggan and Brenner, 2013). Young adults have “a tremendous interest in using social media for communication, for self-definition, [and for] a sense of community,” she said.
Implications
Demographic changes will continue to play a critical role in the status of young adults. For example, as Latinos close the education gap with other groups, they will have increased opportunities, though this will be true more for females than males. Age, gender, race and ethnicity, opportunities for education, employment, and health care all interact, said Brindis, and impact the pathways taken by young adults.
Some young adults face what can seem to be a “limitless number of pathways,” according to Brindis. “The road not taken can sometimes feel overwhelming. As a result, a lot of young people are frozen in their ability to make decisions about moving forward.” At the same time, members of underrepresented racial and ethnic groups and low-income populations may have life options that are narrower in scope than for members of other groups. Educational and employment options may need to be established that enable youth to get on and get off various trajectories as they seek more advanced education and training.
Extended educational and training requirements may affect the progression toward marriage and family formation. In addition, social policies related to training programs (e.g., following service in the military), continued advances in long-distance learning, and increased paternal leave may continue to influence gender roles, which in turn may have an impact on family formation.
A lack of economic opportunities, in spite of educational achievements, will likely continue to impact traditional milestones such as living independently from parents, which may delay marriage or childbearing even more. Given the economic disparities facing major segments of the young adult population, educational and employment opportunities for the underserved, particularly males representing diverse ethnic groups, need to be prioritized, Brindis said.
ORGANIZATION OF THE WORKSHOP SUMMARY
This document is intended to summarize the presentations and discussions that took place at the workshop. In general, speakers' responses to questions posed during the discussion sessions are integrated into the summaries of their talks.
The workshop summary is divided into 4 broad parts and 14 chapters. The remainder of Part I examines the development and context for young adults in greater detail. Chapter 2 describes the presentations of three speakers on the neurobiological, psychological, and social development of young adults. Chapter 3 looks at the economic, cultural, and social landscape within which young adults live, which differs in important ways from the landscapes experienced by earlier generations.
Part II contains three chapters based on the presentations given the first day of the workshop, which together create a mosaic of research results on the health and safety of young adults, drawn from a wide range of disciplines. Chapter 4 considers safety- and health-related behaviors among young adults and their contributions to poor health outcomes. Chapters 5 and 6 describe physical health issues and mental health issues, respectively. The chapters in Part II also include comments from the young adults who, in the day's final session, offered reflections on earlier presentations.
Part III contains another six chapters based on the second day's presentations, which together present a more integrated picture of the societal influences, institutions, and service systems that affect young adults. Chapter 7 considers the influence of families, social networks, and media, including the marketing to which young adults are exposed when they use social networks and the media. Chapter 8 looks at the health care system, examines whether the ACA can overcome the difficulties young adults often have in accessing that system, provides an overview of programs targeted at young adults for which there is evidence of effectiveness, and examines particular concerns for vulnerable groups of young adults. Chapter 9 discusses the pathways through education to employment, not only for those who go to college, but for the “forgotten half”—young adults who have just a high school education or have attended some college, but have not earned a 4-year degree. The military is the subject of Chapter 10; young adults who go into the military face many of the same challenges as other young adults, but their lives also differ from those of their peers in many ways. Chapter 11 examines the foster care system, welfare services, and services for homeless young adults, which serve partly overlapping and partly separate populations. Finally, Chapter 12 looks at both the juvenile and adult justice systems, including the health of prisoners and detainees. As in Part II, the concluding reflections of a panel of young adults appear throughout Part III.
Part IV provides an overview of the major themes and individual suggestions from the workshop. Specifically, Chapter 13 provides the major themes and Chapter 14 is a compilation of individual participants' suggestions for future research and other opportunities.
Footnotes
- 1
The planning committee's role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine or the National Research Council, and they should not be construed as reflecting any group consensus.
- 2
The young adult speakers at the workshop were identified through organizations that work with young adults and through individual recommendations. Written permission to include their stories, views, and names as they appear was obtained from the young adult speakers. Their stories are not intended to be representative of all young adult experiences and views.
- 3
Videos of the workshop presentations and discussions, slides, and other materials are avail able at http://iom
.edu/Activities /Children/ImprovingYoungAdultHealth/2013-MAY-07.aspx. - 4
Workshop participants did not try to specify an exact age range for the term “young adult.” Various datasets cover different age ranges, and the issues facing someone just out of high school can differ substantially from those facing people in their mid- to late 20s. However, the end of high school, at about age 18 for those who graduate, is often considered the beginning of young adulthood, with the transition away from young adulthood occurring sometime around age 26.
- Introduction - Improving the Health, Safety, and Well-Being of Young AdultsIntroduction - Improving the Health, Safety, and Well-Being of Young Adults
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