Adolescent and Young Adult Health

BACKGROUND Adolescence, the transition period from stance abuse, including tobacco, alcohol and childhood to adulthood, is a time of tremen - illicit drug use; (4) mental health, including dous opportunity and promise as well as depression and suicide; (5) reproductive health, unique risks and health concerns. The health including pregnancy and sexually transmitted and well-being of adolescents are critically disease; and (6) overweight/obesity and physi - affected by their experiences during this devel - cal inactivity (Centers for Disease Control and opmental milestone. The majority of adoles - Prevention [CDC], 2009a). cent health problems are preventable, precipi - Health disparities are present in almost all tated by environmental and behavioral factors adolescent health issues and result from multi - that can mitigate or exacerbate immediate and ple factors, including poverty, educational long-term health consequences (NASW, 2002). inequalities, and inadequate access to health The patterns of behavior adolescents develop care. Other risk factors for poor adolescent during these years often influence their health health outcomes include community norms that and well-being throughout life. condone risky behavior; neighborhood disorga - Improving adolescent health outcomes will nization; family mobility and homelessness; require moving beyond a biological approach, lack of attachment to peers, family, school, and toward a broadened understanding of, and community; family drug use; early and persis - attention to, the multiplicity of factors and tent behavior problems, significant grief and complexity of circumstances affecting adoles - loss, and family violence (CDC, 2010). Certain cent health and well-being. Improvements in subgroups are at heightened risk. Lesbian, gay, health status will require the collective effort of bisexual, and transgender (LGBT) youths expe - individuals and communities, social institu - rience higher rates of suicide, victimization, risk tions, and the different disciplines involved behavior for HIV infection, and substance with adolescents (NASW, 2002). abuse, as compared with their heterosexual peers (Advocates for Youth, 2010). Hispanic teenagers have the lowest rates of health insur - Critical Adolescent Health Issues ance among all. children in the United States, Adolescents are a relatively healthy popula - resulting in reduced access to ongoing medical tion, but many in this age group engage in risky care (Kaiser Family Foundation, Commission behavior; develop unhealthy habits; and expe - on Medicaid and the Uninsured, 2010). Pre- rience physical, mental, and behavioral health vention efforts for adolescents, particularly conditions that can jeopardize their immediate efforts targeting disparities, are critical and are and long-term health (Institute of Medicine directly in the realm of social work practice. [IOM], 2008). Critical adolescent health issues fall into six broad categories: (1) unintentional injury and Violence injury, primarily related to motor vehicle use; Motor vehicle injury is the leading cause of (2) violence, including homicide, assault, bully - mortality among adolescents and young ing and other forms of victimization; (3) sub - adults. Substance use is a significant risk factor

ADOLESCENT AND YOUNG ADULT HEALTH 3 for motor vehicle crashes involving teenagers. substance use Policies such as graduated driver’s licenses are In the United States in 2008, almost one-third becoming more common and seek to have of adolescents ages 12 to 17 drank alcohol in the impact on this issue. past year, around one-fifth used an illicit drug, High school students have reported de - and almost one-sixth smoked cigarettes (U.S. creased levels of violent behavior since the Department of Health and Human Services, 1990s (Mulye et al., 2009), but troubling trends Substance Abuse and Mental Health Services remain. The adolescent homicide rate decreased Administration, Office of Applied Studies, throughout the 1990s, but has since leveled off. 2009). Tobacco use, including cigarette smok - Black, male non-Hispanics are disproportion - ing, cigar smoking, and smokeless tobacco use, ately affected by homicide, both as victims and remains the leading preventable cause of death offenders. In addition, dating violence is an in the United States. Nearly 90 percent of all emerging issue for adolescents, with one in adult smokers begin while in their teens, or ear - four adolescents reporting verbal, physical, lier, and two-thirds become regular, daily smok - emotional, or sexual abuse from a dating part - ers before they reach the age of 19 (Campaign ner each year (CDC, 2011a). Bullying, both for Tobacco-Free Kids, 2011). Alcohol use and physical and virtual (“cyber-bullying”), has be - binge drinking among adolescents remain come a pervasive public health problem, with major public health concerns. Illicit drug use, as LGBT and special needs teenagers at particular well as prescription and over-the-counter drug risk. Prevention of violence and bullying among abuse, is also a continued threat to adolescent adolescents requires a balanced effort that health and well-being. addresses the complex underlying factors and builds on the assets of youths, families, and Pregnancy and reproductive Health Since the early 1990s, the teenage pregnancy communities (CDC, 2011b). and birth rates have declined by approxi - mately one-third. The teenage birth rate is now at a record low, as is the national teenage preg - mental Health nancy rate. However, three in 10 girls in the Mental health issues often appear first in United States still become pregnant at least this age group. It is estimated that one in five once by age 20, resulting in well over 400,000 adolescents experience “significant emotional births to teenage mothers each year. Rates of distress” and one in 10 faces “more serious teenage pregnancy and parenthood in the emotional impairment” (Mulye et al., 2009). United States remain far higher than those in Recognizing, diagnosing, and treating adoles - other fully developed countries. As in other cents with mental health issues is important adolescent health indicators, disparities exist: given that symptoms of nearly half of all life - At least 50 percent of Hispanic and African time diagnosable problems appear by age 14 American teenage girls will become pregnant (Kessler et al., 2005). Left untreated, depression before the age of 20. Only 19 percent of non- and other adolescent mental health concerns Hispanic white teenage girls under 20 will can lead to negative consequences, including become pregnant. Research has demonstrated violence and bullying, increased school that lowering the rate of teenage pregnancy dropout rates, and suicide (NASW, 2003). helps reduce poverty and improve educational Suicide is the third leading cause of death achievement, workforce competitiveness, child for adolescents. The rate of suicide decreased welfare, and other critical social issues for both throughout the 1990s, but leveled off at 7.0 in parents and children (National Campaign to 1999. In 2007, the rate was 6.9 per 100,000 Prevent Teen and Unplanned Pregnancy, 2011). teenagers ages 15 to 19 (National Institute of Many young people in the United States Mental Health, 2010). Recognizing risk and engage in sexual risk behaviors that, in addi - protective factors is essential when developing tion to pregnancy, can result in HIV/AIDS or adolescent suicide prevention and intervention other sexually transmitted diseases (STDs). In efforts (NASW, 2009). 2009, 46 percent of high school students had

4 SOCIAL WORK SPEAKS ever had sexual intercourse, and 14 percent of nant teenagers). Legal immigrant teenagers and high school students had had four or more sex their families face stiff enrollment barriers to partners during their life (CDC, 2009b). Use of these programs. The result is a perpetuation of alcohol and other drugs increases the likeli - heath disparities between immigrant teenagers hood of risky behaviors, such as unprotected and their nonimmigrant peers. sex (CDC, 2011a). chronic disease ISSUE STATEMENT Adolescents are engaging in more behaviors Health indicators have shown promising that put them at risk for chronic health condi - trends for adolescents. Rates of risky behaviors tions. Rates of adolescent obesity are rising, overall have dropped since the early 1990s. caused in large part by the poor nutritional However, over the past five years, there has choices young people often make as they been a leveling off of these developments. In become increasingly autonomous. Another sig - addition, adolescents in different ethnic, racial, nificant cause of obesity is lack of physical and other population groups are dispropor - exercise, related to sedentary activities, such as tionately represented in some of the most trou - video and computer games, and fewer physi - bling adolescent health statistics. Unfortunately, cal education options in schools. Heart disease research and policy initiatives to address ado - and diabetes are among the most common con - lescent health issues continue to rely on a sequences of these lifestyle choices. Education “deficit model,” with minimal or no grounding for wellness and other preventive strategies in prevention, youth development, or self- would go a long way in lowering the incidence efficacy or responsibility. of preventable cases of these diseases, while at Addressing the aspects of disease and public the same time improving quality of life and health challenges that are preventable can pro - saving on health care costs. vide substantial quality of life and economic benefits. The challenge, however, is that for Health insurance coverage many adolescents, health services are not Insurance coverage is also an area of concern accessible, acceptable, appropriate, effective, or for this population. Medicaid and the Children’s equitable (IOM, 2008). Health Insurance Program (CHIP) have been Adolescent health issues are largely pre - important sources of health insurance cover - ventable and can be addressed through behav - age for adolescents. States are required to ior modification or through the social environ - pro vide income-eligible adolescents with ment. Adolescents are strongly influenced by Medicaid and CHIP coverage until they turn family, schools, peers, and the community. 19. States have the option to extend Medicaid Preventive measures should be developed that coverage to age 21. However, once children age enhance family and community involvement, out of Medicaid or CHIP eligibility, they are age-appropriate education, and school and typically subject to the much more limited peer support, to improve adolescent health. Medicaid eligibility criteria for adults. Young adults who lose Medicaid or CHIP coverage are in danger of becoming uninsured and los - POLICY STATEMENT ing access to their health providers and the NASW seeks to make adolescent health a medical treatments they may need. High national, state, and local policy priority by unemployment among older teenagers leaves strengthening adolescent health service deliv - many particularly vulnerable to becoming ery systems, with an emphasis on developing uninsured (Kaiser Family Foundation, 2010). programs that Immigrant teenagers (both documented and undocumented) are the group of children least - Ⅲ include a continuum of evidence-based likely to have insurance coverage. Un documented prevention, early intervention, and treatment teenagers in almost all cases are ineligible for approaches to meet the unique physical and Medicaid and CHIP (with the exception of preg - behavioral health needs of adolescents.

ADOLESCENT AND YOUNG ADULT HEALTH 5 Ⅲ promote access to mental and physical Ⅲ federal and state policy changes that sup - health evaluation and treatment in an age- port nutrition and regular physical activity for appropriate manner. adolescents in schools and communities. Ⅲ provide medical homes (a primary, ongo - Ⅲ access to affordable and effective family ing source of medical care) for all adolescents, planning services for adolescents, through especially those with special health care needs. preservation of teenage pregnancy prevention funding streams and increased funding for Ⅲ offer team-based, integrated, multidiscipli - Title X programs. nary care. Ⅲ provide easy accessibility, such as school- based and community-based adolescent health REFERENCES clinics that are available to all adolescents regardless of insurance coverage, ability to pay, Advocates for Youth. (2010). Gay, lesbian, or other factors. bisex ual, transgender, and questioning (GLBTQ) youth: A population in need of Ⅲ respect the confidentiality and self-deter - understanding and support. Retrieved from mination needs of adolescents and are pro - http://www.advocatesforyouth.org/stor vided in a culturally appropriate manner. age/advfy/documents/glbtq_youth%2020 Ⅲ offer specialized training to staff on work - 10.pdf ing with vulnerable populations, including Campaign for Tobacco-Free Kids. (2011). LGBT teenagers, and homeless and undocu - Smoking and kids . Retrieved from http:// mented youths. www.tobaccofreekids.org/research/fact sheets/pdf/0001.pdf NASW advocates Centers for Disease Control and Prevention. Ⅲ full implementation of the Affordable Care (2009a). The national Youth Risk Behavior Act of 2010, including expansion of Medicaid Survey. Retrieved from http://www.cdc coverage to all individuals age 19 and over. .gov/healthyyouth/yrbs/pdf/us_overvie w _yrbs.pdf Ⅲ state expansion of Medicaid eligibility up Centers for Disease Control and Prevention. to age 21. (2009b). Understanding teen dating vio - Ⅲ state adoption of comprehensive Graduated lence [Fact sheet]. Retrieved from http:// Driver License (GDL) laws, and federal finan - www.cdc.gov/chooserespect/pdfs/Teen cial incentives for state enactment of compre - DatingViolence2009-a.pdf hensive GDL legislation. Centers for Disease Control and Prevention. (2010, June 4). Youth risk behavior surveil - Ⅲ implementation of comprehensive tobacco- lance— United States, 2009. Morbidity and free campus policies and increased tobacco Mortality Weekly Report. Retrieved from taxes, to prevent and reduce tobacco use and http://www.cdc.gov/mmwr/pdf/ss/ss addiction in young people. 5905.pdf Ⅲ routine inclusion of sexual orientation and Centers for Disease Control and Prevention. gender identity measures in all relevant national, (2011a). Sexual risk behavior: HIV, STD, & state, and local health and research surveys that teen pregnancy prevention . Retrieved from cover adolescents, to increase our understanding http://www.cdc.gov/healthyyouth/sex ual of the health care needs of LGBT youths. behaviors/index.htm Centers for Disease Control and Prevention. Ⅲ increased federal funding for health care (2011b). Why prevention must be a priority. workforce training in research-based approaches Retrieved from http://www.safeyouth to adolescent health care. .gov/Pages/Prevention_Priority.aspx#a2 Ⅲ implementation of strong gun laws and poli - Institute of Medicine. (2008). Adolescent health cies, to prevent adolescents from accessing guns services: Missing opportunities . Washington, and protect communities from gun violence. DC: National Academy of Sciences.

6 SOCIAL WORK SPEAKS Kaiser Family Foundation, Commission on National Association of Social Workers. (2009). Medicaid and the Uninsured. (2010). Aging The NASW Shift Project: Suicide prevention out of Medicaid: What is the risk of becoming for adolescent girls. Retrieved from http:// uninsured? (Publication No: 8057). Wash - www.socialworkers.org/practice/adoles ington, DC: Author. cent_health/shift/default.asp Kessler, R. C., Berglund, P., Demler, O., Jin, R., National Campaign to Prevent Teen and Merikangas, K. R., & Walters, E. (2005). Unplanned Pregnancy. (2011). 2011 Federal Lifetime prevalence and age-of-onset dis - policy agenda. Retrieved from http://www tributions of DSM-IV disorders in the .thenationalcampaign.org/resources/pdf/ National Co-morbidity Survey replica - Briefly_2011_PolicyAgenda.pdf tion. Archives of General Psychology, 62, National Institute of Mental Health. (2010). 593– 602. Suicide in the U.S.: Statistics and prevention Mulye, T. P., Park, M. J., Nelson, C. D., Adams, [Fact sheet]. Retrieved from http://www. S. H., Irwin, C. E., Jr., & Brindis, C. D. nimh.nih.gov/health/publications/sui (2009). Trends in adolescent and young cide-in-the-us-statistics-and-prevention/ adult health in the United States. Journal of index.shtml#children Adolescent Health, 45, 8– 24. U.S. Department of Health and Human National Association of Social Workers. (2002). Services, Substance Abuse and Mental Partners in program planning in adolescent Health Services Administration, Office of health . Washington, DC: Author. Applied Studies. (2009). Results from the National Association of Social Workers. (2003). 2008 National Survey on Drug Use and Practice update: The impact of poverty on Health: National findings (HHS Publication adolescent health. Adolescent Health, 3 (2). No. SMA 09-4434, NSDUH Series H-36). Retrieved from http://www.socialworkers Retrieved from http://oas.samhsa.gov/ .org/practice/adolescent_health/ah0503.pdf nsduh/2k8nsduh/2k8Results.cfm

nasW members with Primary responsibility for revision of this Policy

First Draft Revision: Policy Panelists:

Heather A. McCabe (IN) Betty Morningstar (MA) Aline Goodman (NYS) Steve Burton (WV) George Baboila (MN) Deb Hanson (ND) Lisa Bates (OR)

Policy statement approved by the NASW Delegate Assembly, August 2011. This statement supersedes the policy statement on Adolescent Health approved by the Delegate Assembly in August 2002. For further information, contact the National Association of Social Workers, 750 First Street, NE, Suite 700, Washington, DC 20002-4241. Telephone: 202-408-8600; e-mail: [email protected]

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