Taking the Pulse: Improving the Health, Safety and Well-Being of Young Adults

Claire Brindis, Dr. P.H.Professor of Pediatrics and Health Policy

Director, Philip R. Lee Institute for Health Policy Studies with Charles Irwin, Elizabeth Ozer, Jane Park, Sally Adams, and Jazmyn Scott

Center for Vulnerable PopulationsSeptember 19, 2013

2

Why are we here?• Significant demographic shifts • Increasing body of evidence,

including international comparisons, suggest that needs of this group have been overlooked

• Increasing concerns regarding the impact of the “Odyssey”, Boomerang, Failure to Launch generation….

3

Young Adults – Who are they?Between 1990 and 2060, the number of young adults ages 18-24 is projected to increase from 26 to 35 million; represents 10% of the total population.

4

# in

thou

sand

s

US Census Bureau, 2012.

1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 206020,000

22,000

24,000

26,000

28,000

30,000

32,000

34,000

36,000

38,000

U.S. Population Ages 18-24, Actual & Projected, 1990-2060

Year

White (non-Hispanic) Hispanic Black (non-Hispanic) Asian (non-Hispanic)0

10

20

30

40

50

60

70

80

90

100

85

3.511

0.6

72.4

16.312.6

4.8

47

29

139

1960 2010 2050

Racial and ethnic makeup of the US in 1960s vs. now

5

• Racial/ethnic diversity in the general population will continue to increase; the proportion of Hispanics has risen by 25%; the proportion of Whites has decreased by almost half.

US Census Bureau, 2013.

Population Breakdown (%) by Race/Ethnicity, 1960-2050

Changing Demographics: Growth of Hispanic Population

6

Pew Hispanic Center | US Census Bureau

1980

Changing Demographics: Growth of Hispanic Population

7

1990Pew Hispanic Center | US Census Bureau

Changing Demographics: Growth of Hispanic Population

8

2000Pew Hispanic Center | US Census Bureau

Changing Demographics: Growth of Hispanic Population

9

2010Pew Hispanic Center | US Census Bureau

Why this Population? Why now?– Throughout history and in every generation..

• Young adults need tools to be:–meaningfully engaged, –caring individuals in their communities, and –productively employed to their full potential

in society– Changing age structure (aging population) will

mean our nation will depend even more on young people’s health and well-being.

10

Why this Population? Why now?–Just as they are needed more – there

are more challenges to them being successful – especially true for vulnerable populations: • substance users, • mental health, etc.

11

Life Course Perspective• How does health fit into the overall picture of

ensuring a successful transition from adolescence through young adulthood?

• Young adulthood is a critical period in one’s life; sets the stage for adulthood

• Habits acquired in adolescence and further in young adulthood can impact the life course, particularly risk behaviors

• Behaviors in young adulthood can increase risk of developing chronic disease later in life

– Binge drinking and heart disease• Peak onset of chronic illnesses (i.e., mental health)

12

Changing

13

Contextfor

Young Adulthoo

d

Changing Context• Post-Industrial Society and its impact on

Education• Employment and other Pathways • Marriage and Family Formation• Role of Social Technology

14

Milestones• The contextual change for young adulthood has

resulted in delayed attainment of traditional milestones associated with the transition to becoming adult

• Five major milestones – Completion of School– Leaving Home– Financial Independence– Marriage– Children

15

“What is it about 20-Somethings?” New York Times (2010).

16

Before 1960, over 80% of US jobs = industry and manufacturing

Employment: Post-Industrial Society

17

United States Department of Labor, Bureau of Labor Statistics (2010).

1970 1975 1980 1985 1990 1995 2000 2005 20090

5000

10000

15000

20000

25000

Number of Employees by Major Industry, 1970-2009Thousands of persons; monthly data seasonally adjusted

Agriculture

Manufacturing

Financial Activ-ities

Education and Health

Leisure and Hospitality

18

Economic Mobility

percent of those raised in the bottom of the wealth ladder remain on the bottom two rungs themselves, and 66% of those raised in the top of the wealth ladder remain on the top two rungs.

66%

“Pursuing the American Dream: Economic Mobility Across Generations,” Pew Charitable Trusts (2012).

Changing Context: Education Trends

19

19701972

19741976

19781980

19821984

19861988

19901992

19941996

19982000

20022004

20062008

20100

5

10

15

20

25

30

35

40

45

36.1

8.7

38.1

28

11.8

28

14.1

35.3

Percent Distribution of Workforce by Education, 1970-2011

Less than 4 Years HS4 Years HS, No CollegeSome College4 Years College

United States Department of Labor, Bureau of Labor Statistics (2013).

Changing Context: School Enrollment

20

Foreign-born Hispanic

Native-born Hispanic

Hispanic

Black

White

34

46

42

40

49

23

52

40

49

56

Percent Young Adults (16-25) Enrolled in School by Gender, 1970 vs. 2007

20071970

Males

Native-born Hispanic

Foreign-born Hispanic

Hispanic

Black

White

36

27

33

37

40

58

34

49

56

61Females

“The Changing Pathways of Hispanic Youths Into Adulthood.” Pew Hispanic Center (2009). Note: Whites include only non-Hispanic whites. Blacks include only non-Hispanic blacks.

Changing Role Of Women21

Changing Context: Gender Composition of Work Force

22

Distribution of the US Labor Force by Gender, 1948-2009

Note: Figures reflect annual averages

Pew Research Center, 2009.

• In 2012, what percentage of young men ages 25-29 completed college degrees? Women?

a) 16% men, 28% womenb) 30% men, 37% womenc) 36% men, 38% womend) 42% men, 49% women

• In what year did females begin completing college at a higher rate than men?

a) 1986b) 1989c) 1991d) 1995

23

Quiz

20122010

20082006

20042002

20001998

19961994

19921990

19881986

19841982

19801978

19761974

19721970

19681966

19641959

19521947

0

5

10

15

20

25

30

35

40

29.8

5.8

37.2

4.9

Percent College Completion Among Adults ages 25-29 by Gender, 1947-2012

% of 25-29 year olds

MaleFemale

Changing Context: Education

Sources: 1947,and 1952 to 2002 March Current Population Survey, 2003 to 2012 Annual Social and Economic Supplement to the Current Population Survey (noninstitutionalized population, excluding members of the Armed Forces living in barracks); 1950 Census of Population and 1940 Census of Population (resident population).

24

20122010

20082006

20042002

20001998

19961994

19921990

19881986

19841982

19801978

19761974

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

33.7

22.0 22.7

7.9

14.8

5.7

60.861.6

Percent of Adults 25 Years and Over who Have Completed 4 years of College or More by Race and Ethnicity, 1975-2012

WhiteBlackHispanicAsian

Sources: 1947,and 1952 to 2002 March Current Population Survey, 2003 to 2012 Annual Social and Economic Supplement to the Current Population Survey (noninstitutionalized population, excluding members of the Armed Forces living in barracks); 1950 Census of Population and 1940 Census of Population (resident population).

Milestone: College Completion

25

26

20122010

20082006

20042002

20001998

19961994

19921990

19881986

19841982

19801978

19760

10

20

30

40

50

60

70

White Males; 29.9

Black Males; 18.5

Hispanic Males; 12.5

Asian Males, 56.8

White Females; 37.6

Black Females; 26.2

Hispanic Females; 17.4

Asian Females; 62.3

Percent of People 25 Years and Over who Have Completed 4 years of Col-lege or More, by Race and Ethnicity, 1975-2012

Sources: 1947,and 1952 to 2002 March Current Population Survey, 2003 to 2012 Annual Social and Economic Supplement to the Current Population Survey (noninstitutionalized population, excluding members of the Armed Forces living in barracks); 1950 Census of Population and 1940 Census of Population (resident population).

Milestone: College Completion

27

Changing Context: Unemployment Trends

2003 2004 2005 2006 2007 2008 2009 2010 2011 20120%

2%

4%

6%

8%

10%

12%

8%

6%

11%

9%

Unemployment Rate among Young Adults 20-24, 2003-2012

28United States Department of Labor, Bureau of Labor Statistics (2013).

29

CollegeMotherhood

Dropout

Work

Military

Incarceration

Other

Trajectories

Changing Context and other Trajectories: Military

30

Foreign Born Hispanic

Native-Born Hispanic

Black Non Hispanic

White Non Hispanic

0 2 4 6 8 10 12

6.00

7

2.00

2.00

3

5

5

4

1

4

8

4

1

2

9

11

Percent Young Adult (20-25) Males in the Military by Race, 1970-2007

1970198019902007

“The Changing Pathways of Hispanic Youths Into Adulthood.” Pew Hispanic Center (2009).

Changing Context and other Trajectories: Incarceration

31

Foreign Born Hispanic

Native-Born Hispanic

Black Non Hispanic

White Non Hispanic

0 1 2 3 4 5 6 7 8 9 10

2.00

2

5.00

2.00

1

2

5

1

2

4

8

1

2

5

9

2

Percent Young Adult (20-25) Males Incarcerated by Race, 1970-2007

1970198019902007

“The Changing Pathways of Hispanic Youths Into Adulthood.” Pew Hispanic Center (2009).

32

Quiz• What % of young adults ages 25-29 say they

live at home or moved back in temporarily with their parents because of the economy?a. 20%b. 30%c. 40%d. 50%

33

Milestones: Living at Home

34“The Boomerang Generation: Feeling OK About Living with Mom and Dad.” Pew Research Center (2012).

18-24

25-29

30-34

All Young Adults

53%

41%

7%

39%

% young adults saying they live with parents now or moved back in with parents temporarily because of economy

Youngest Adults Staying Closer to Home

Milestones: Financial Independence

35

18-24

25-29

30-34

All Young Adults

47%

60%

44%

32%

% young adults saying their financial situation is linked to their parents’ financial situation “a great deal” or “some”

Financial Ties Vary with Age

“The Boomerang Generation: Feeling OK About Living with Mom and Dad.” Pew Research Center (2012).

36

Milestones: Marriage and Family

Formation

Milestones: Marriage by Education Level

37“Knot Yet.” National Campaign to Prevent Teen and Unplanned Pregnancy (2013).

Percentage of 25-29 year old Women Who have Never Married, By Education, 1990-2010

Source: Decennial Census Public Use Microdata Samples, 1990-2000; American Community Survey Public Use Microdata Samples, 2010

Milestones: Marriage by Race

38

“The Decline of Marriage and Rise of New Families.” Pew Research Center (2010).

Share of Never Married, by Race and Ethnicity,

1960-2008 (%)

Note: Ages 18 and older. Hispanics are of any race. Whites and Blacks

Include only non-Hispanics.

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 20100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

4.80%

63.10%

39

Milestones: Marriage, Childbearing

Percentage of All Births to Women Ages 20-24 that were to Unmarried Women ages 20-24, 1970-2011

“Births to Unmarried Women.” Children Trends Data Bank (2012).

1970 1975 1980 1985 1990 1995 2000 2005 2010 20110%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

5.70%

29.10%

37.60%

72.30%

0.2326

0.534

0.073

0.17222.40%

66.20%

White, NHBack, NHHispanicAsianAmerican Indian

40

Milestones: Marriage, ChildbearingPercentage of All Births that were to Unmarried Women

by Race and Hispanic Origin, 1970-2011

“Births to Unmarried Women.” Children Trends Data Bank (2012).

Health Issues of Young Adults

41

Health Issues of Young Adulthood

• The major health problems of early adulthood are largely preventable.

• Many problems are linked to behaviors and conditions with related outcomes.

• Few young adults have serious impairment that interferes with daily functioning, BUT

• Those with chronic conditions, including mental health disorders, must learn to manage these conditions with increasing interdependence.

42

Global burden of disease in young people aged 10-24 years: a systematic analysis

Gore et al, Lancet 2011

43

10-14 years 15-19 years 20-24 years

1 Depressive disorder Depressive disorder Depressive disorder

2 Lower RTI Schizophrenia Road Traffic Accidents

3 Road Traffic Accidents Road Traffic Accidents Violence

4 Asthma Bipolar disorder HIV/AIDS

5 Refractive errors Alcohol use Schizophrenia

6 Iron deficiency anaemia Violence Bipolar disorder

7 Falls Self-inflicted injuries Tuberculosis

8 Migraine Panic disorder Self-inflicted injury

9 Drowning Asthma Alcohol use

10 Diarrhoeal diseases HIV/AIDS Abortion

Specific Behaviors & Negative Health Outcomes

• Substance Use: Habituation, Trauma, Violence• Sexual Activity: STI’s & Pregnancy• Injury Related Behavior: Trauma & Disability• Eating Behaviors: Eating Disorders, Obesity &

Chronic Physical & Mental Health Disorders • Mental Health Disorders: Disability

45

CHRONIC CONDITIONS

46

Male Female0%

5%

10%

15%

20%

25%

30%

35%

40%

12%15%

National Health Interview Survey, 2011

Young Adults (18-25) reporting any Functional Limitation from any Condition, by Gender, 2011

Hypertension Asthma An Ulcer Cancer Diabetes Heart Condition/Disease

Obese (BMI>=30)0%

4%

8%

12%

16%

20%

5%

16%

2%1% 1%

2%

20%

Prevalence of Chronic Con-ditions among Young Adults

(18-25), 2011

47National Health Interview Survey, 2011

Serious Psycholog-ical Distress %

Major Depressive Episode %

Alcohol Abuse/Dependence %

Drug Abuse/Dependence %

0%

5%

10%

15%

20%

25%

14%

5%

20%

9%

22%

12% 12%

6%

Past-Year Mental Health and Substance Use Disorders Young Adults (18-25) by Gender, 2010

MaleFemale

48National Survey on Drug Use and Health, 2010

How do young adults use health care services?

–Where do they go?–What do they get?

49

50

Differences between Adolescent and Young Adult Health Care

Adolescents Young Adults• Identified health care provider -

pediatricians. No identified health care

provider.

• Financial system in place. No financial system in place.

• Organizational structure for care exists.

No identified organizational structure for care.

• Not high users of non-traditional sources of care.

High users of non-traditional sources of care.

• Minors under age 18; parents play major role.

Rights and responsibilities change after age 18.

Transitions from Pediatric to Young Adult Care

• Professional Recommendations from the American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians– Developmentally appropriate – Coordination of responsibilities – Planned transition– Consistent and uninterrupted chronic care

management

52Clinical Report – Supporting Health Care Transition from Adolescence to Adulthood in the Medical Home. AAP, AAFP, ACP (2011).

Transitions to Adulthood

• In 2009-2010, only 39% of youth (ages 15-17) received services necessary to make appropriate transitions to adult health care, work and independence.

53National Survey of Children with Special Health Care Needs, 2010

How Can Services Help?• As they transition through young adulthood - they

are beginning to: • Assume responsibility for their care, • Learn to navigate the health care system.

• Developmentally-based health care may help:• Reduce mortality and morbidity -- including incidence of

chronic illnesses -- by decreasing health-damaging behaviors, enable recognition of emerging conditions & promoting healthy behavior.

• Improve management of chronic conditions/special needs.

54

Health Care Services Needed by Young Adults

Preventive Services• Oral Health Care• Substance Use• Nutrition/Exercise• Safety and Violence• Immunizations

Sexual Health Services• Screening and

counseling• Birth control• STI treatment and

management

Care for Chronic Conditions• Mental health issues

are critical at this age• Those that occur prior

to or with peak onset during early adulthood

55

Preventive Services for Young Adults

• No single source of guidelines for young adults –not developmentally based• Bright Futures, 3rd ed.** is widely recognized as the

professional standard for care for adolescents and younger children: • Includes specific recommendations for ages 11-14, 15-

17 & 18-21• Professional guidelines are generally specific to

disease/condition (e.g., diabetes, asthma) or specialty (e.g., Ob-gyn)

56

** Bright Futures in published by the American Academy of Pediatrics, which collaborated with professional organizations from multiple disciplines to create the 3rd Edition.

Preventive Services for Young Adults

USPSTF Consensus Mental Health/Depression SafetyNutrition/Exercise/Obesity Illicit drug UseAlcohol/TobaccoReproductive HealthInfectious Disease/ImmunizationsDomestic Violence

57Ozer et al., 2012

Where Young Adults Access CareAny Health Care Utilization 72%

Office-Based Visits 55%

Hospital Outpatient Visits 7%

ER Visits 15%

Inpatient Hospitalizations 6%

Prescription Medications 48%

Dental Visits 34%

58National Health Interview Survey, 2011

No Usual Source of Health Care by Age and Gender, 2011

Adolescents (10-17) Young Adults (18-25)0%

5%

10%

15%

20%

25%

30%

35%

4%

31%

5%

20%

Males Females

59National Health Interview Survey, 2011

Per-Capita Annual Ambulatory Care Utilization 2000-2006, by Gender and Age

15-19 20-29 30-390

0.5

1

1.5

2

2.5

3

3.5

2.13

2.31

2.95

1.65

1.1

1.73 FemaleMale

Adapted from “Ambulatory Care Among Young Adults in the US”, Fortuna, et al, 200960

Per-Capita Annual Health Care Visits Among Young Adults, by Gender, 2000-2006

Acute Chronic Preventive0

0.2

0.4

0.6

0.8

1

0.5

0.37

0.1

0.9

0.6

0.4MaleFemale

Adapted from “Ambulatory Care Among Young Adults in the US”, Fortuna, et al, 2009

61

Overall Health Care Service Utilization by Age Group, 2009

Age 0-11 Age 12-17 Age 18-25 Age 26-44 Age 45-64 Age 65+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

88%83%

72%78%

89%97%

% h

ad u

tiliza

tion

Medical Expenditures Survey, 2009

Office-Based Service Utilization by Age Group, 2009

Age 0-11 Age 12-17 Age 18-25 Age 26-44 Age 45-64 Age 65+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

77%

68%

55%

65%

79%

91%

% h

ad u

tiliza

tion

Medical Expenditures Survey, 2009

ER Utilization by Age Group, 2009

Age 0-11 Age 12-17 Age 18-25 Age 26-44 Age 45-64 Age 65+0%

5%

10%

15%

20%

25%

30%

15%

12%

15%

12% 12%

17%

% h

ad u

tiliza

tion

Medical Expenditures Survey, 2009

Average Healthcare Expenditures by Age, 2009

65Medical Expenditures Survey, 2009

Children (0-11) Adolescents (12-17)

Young Adults (18-25)

Adult (26-44)0%

10%20%30%40%50%60%70%80%90%

100%

$1,506 $1,905 $1,935 $2,783

$195 $384 $336 $456

Average Healthcare Expenditures Average Out of Pocket Expenditures

13%

20%

17% 16%

Utilization Summary• Young adults receive care from

a variety of sources. • Many young adults lack a usual

source of health care.• Females generally use care

more than males.• Young adults have low

utilization rates for most services, but especially high use of ER.

66

67

What don’t they get?

Young Adults (19-29) Experiencing Past-Year Access Problems Due to Cost, 2011

68

0102030405060

16 16 1913

3040 43

3635

48 5040

Insured all year Insured now, time uninsured in past yearUninsured now

The Commonwealth Fund, 2011

Unmet Needs: Mental Health

69

Serious Psychological Stress

Major Depressive Episode

Alcohol Abuse/Dependence

Drug Abuse/Dependence

0 10 20 30 40 50 60

36

55.2

5.8

8.4

23

36.4

7

12.6

Past Year Treatment for Mental Health and Substance Abuse/Dependence Problems among Young Adults (18-25)

with Problem, by Gender, 2011% who received treatment

Male Female

National Survey on Drug Use and Health, 2010

Preventive Services Received by Young Adults (18-25) by Gender,

2011

% BP Check % Fasting Blood Sugar

Talked about Diet

Talked about smoking if

smoker

Flu Shot0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

60%

11% 12%

31%

13%

81%

23% 22%

51%

25%

MaleFemale

70National Health Interview Survey, 2011

Percentage of Visits During Which Preventive Counseling

was Provided to Young Adults, 1996 to 2006

All Specialties Primary Care Ob/Gyn

Any 30.6% 32.7% 33.6%

Injury 2.4% 3.1% 0.8%

Smoking 3.1% 4.2% 3.1%

Exercise 8.2% 9.4% 8.2%

Weight reduction 3.0% 3.8% 3.4%

Mental health 4.1% 4.2% 1.3%

STD/HIV 2.7% 2.6% 7.1%

Diet 10.0% 12.4% 12.4%

Adapted from “Ambulatory Care Among Young Adults in the US”, Fortuna, et al, 200971

Unmet Needs Summary

• Insurance matters!• Unmet needs are high, especially in regards to

mental health• Receipt & content of preventive screening is

very low

72

Shortcomings of the Health Care System for

Youth• The current system falls short in many respects:

• The financing system is difficult to navigate and leaves many out.

• System rewards acute care over preventive services and chronic disease management.

• Shortage of providers trained in and comfortable serving adolescents, especially in mental health.

• Little consensus/focus on health care needs for young adults.

73NRC/IOM, 2008; Park et al., 2006

Shortcomings of the Health Care System: Financing

• The financing system is difficult to navigate and leaves many out.

• System enables acute care over preventive services and chronic disease management.

• Little preparation for change in system: young adults and families not prepared to navigate this change and enable young adults to take charge of their health care.

74NRC/IOM, 2008; Park et al., 2006

Abrupt change at 18 - Content• Health care system (and other systems) changes

abruptly at age 18, not developmentally based; • Change in legal status: can legally consent to own

care.• Loss of eligibility for public insurance and parents’

insurance (this is getting better).• Limited models for transition to adult health care

(Youth with Special Health Care Needs - consensus it is somewhat of an important exception).

75

Limited Understanding of Young Adult Perspective

• Little consensus/focus on health care needs for young adults and what young adults want.

• Young adulthood characterized by varied trajectories/settings/levels of parental involvement/support; • Challenging to address needs of young adults in all those

different settings/situations.• Few populations have organizational structure for care

(e.g., military, prison, college health).

76

Several groups of youth are especially vulnerable in this transition

• Populations include youth who• Do not graduate from high school• Are homeless• Are leaving foster care• Are in the justice system• Have chronic conditions/special health care

needs, including mental health disorders

77

Challenges in ProvidingMental Health Services

• “Carve-out” arrangements – in both public and private insurance – that separate mental health and physical health delivery systems.• Impedes referral or care coordination

• Often precludes reimbursement for primary care clinicians

• Poor coverage of mental health services in private plans• Capped number of visits

• High co-pays

78

NSCH-2007; NRC/IOM, 2009

Systemic Issues Summary • No organized system focusing on young adults.• Young adults have traditionally had the lowest

rates of insurance – poor and near poor most affected.

• But even if we fix that huge problem, there are other issues affecting access.

• Focus on acute care, rather than prevention and primary care management.

• System is not developmentally based.• EMR & Social Media are opportunities.

79

How Can The Affordable Care Act (ACA) Help?

• No exclusions for pre-existing conditions & individual insurance mandate.

• Major expansions of private insurance.• Major expansion of public coverage

(Medicaid) will be decided on a state-by-state basis.

• Improved access to services, through:• Essential health benefit packages.• No-cost sharing for certain preventive

health services.80

Summary• Several risky behaviors & health conditions peak during young

adulthood.

• Low utilization rates with ER & Acute Care being more common

• High out-of-pocket costs

• Unmet needs high for preventive care, mental health and substance use services & transition care for youth with special health care needs

• Smoothing transitions from pediatric care to young adult care, especially for those who have special health care needs

• No organized system of care

81

82

Implications• Demographics:

– Apart from gender and race/ethnic disparities, recognize great variability among and across special groups in different geographic parts of the country.

– Greater proportion of Latinos/as continuing their education may slowly close an opportunity gap, but will primarily benefit females.

83

84

Implications• Pipeline Choices:

– “Interacting synergies” between age, gender, race/ethnicity, opportunities for education, employment, and other health care and well-being needs of this population.

– The sense of “limitless number of pathways” represents a challenge, particularly for under-represented minority youth, whose life options may be more narrow in scope, as well as for middle-and upper-class young adults.

– Pipeline education and employment options may need to be established to enable youth at different points in the “runway” to “get on and off,” as they seek more advanced education and training.

Implications• Education and Training:

– The extended educational training requirements bumps the progression towards marriage and family formation; gender may have different impacts upon choices young adults select.

– Social policies related to training programs (for example, post-military), advanced long-distance learning, and paternal leave may continue to impact gender roles, in turn, further impacting family formation.

85

Implications• Economics

– The lack of economic opportunities, in spite of educational achievements, will likely continue to impact traditional milestones—including living independently from parents, delaying childbearing, and delaying marriage even more.

– Options for policymakers may be limited, unless focused upon employment opportunities for the under-served, particularly males representing diverse ethnic groups.

86

Next steps:• Understanding what young adults want and their decision-

making related to health care• Advocating for the adoption of developmentally-based services &

systems for young adults – WILL HAVE TO BE BUILT!

• Clinical Training – discipline-specific young adult rotation, how is caring for a 41 year-old different than a 21 year-old?

• Medical, nursing, psychology, social work

• Improving services for vulnerable young adults, including those with mental health and substance abuse disorders.

• Smoothing transitions from pediatric care to young adult care, especially for those who have special health care needs

• Use electronic & social media to enhance delivery system, health promotion & prevention

87

Thank YouSally AdamsTrina Anglin

Charles IrwinElizabeth Ozer

Jane ParkJazmyn Scott

Funder: Maternal and Child Health Bureau, Health Services and Resources Administration, USDHHS

(cooperative agreements: U45MC 00002 & U45MC 00023)

88

References• US Census Bureau (2012). 2012 National Population Projections: Summary Tables. • US Department of Commerce, Economics and Statistics . Administration; US Census Bureau

(2010). “Over of Race and Hispanic Origin: 2010.” Washington, DC: US Census Bureau. Retrieved from: http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

• Passel, Jeffrey, D’Vera Cohn (2008). “US Population Projections: 2005-2050.” Washington, DC: Pew Hispanic Center.

• Pew Research Hispanic Center (2012). “Latinos by Geography.” Washington, DC: Power Research Center. Retrieved from: http://www.pewhispanic.org/2012/03/16/latinos-by-geography/

• National Research Council, Institute of Medicine (2013). US Health in International Perspective: Shorter Lives, Poorer Health.” Washington, DC: National Academies.

• National Center for Injury Prevention and Control, Centers for Disease Control (2013). WISQARS Database.

• National Survey on Drug Use and Health, 2010. • National Campaign to Prevent Teen and Unplanned Pregnancy (2012). Fast Facts: Unplanned

Pregnancy, Sexual Activity, and Contraception among Unmarried Young Adults. Retrieved from: http://www.thenationalcampaign.org/resources/pdf/FastFacts_UPSexualActivityContraception.pdf

References• National Health Interview Survey (2011).• United States Department of Labor, Bureau of Labor Statistics (2010). 2010 Economic

Report of the President, Appendix B. Retrieved from: http://www.whitehouse.gov/sites/default/files/microsites/economic-report-president-appendix-b.pdf

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• Pew Research Center (2013). “Teens and Technology 2013.” Washington, DC: Pew Research Center. Retrieved from: http://www.pewinternet.org/~/media//Files/Reports/2013/PIP_TeensandTechnology2013.pdf

• Pew Research Center (2012). “The Demographics of Social Media Users – 2012.” Washington, DC: Pew Research Center. Retrieved from: http://www.pewinternet.org/~/media//Files/Reports/2013/PIP_SocialMediaUsers.pdf

• Henig, Robin M. (2010). “Why are so many people in their 20’s so long to grow up?”

References• Pew Hispanic Center (2009). “The Changing Pathways of Hispanic Youths Into Adulthood.”

Washington, DC: Pew Research Center. Retrieved from: http://www.pewhispanic.org/files/reports/114.pdf

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