poor health in future years. Others experience physical and mental illnesses, including chronic conditions, during adolescence and into adulthood. At the same time, adolescence is a critical period for developing positive behavioral patterns, healthful habits, and independent decision-making skills that create a strong foundation for healthy lifestyles and behavior over the full life span. Therefore, receiving quality health promotion and disease prevention services, supportive counseling, and chronic care treatment and management, as well as engaging in positive activities and personal skill building, plays a crucial role in nurturing healthy adolescents, as well as in reducing their risk for many adult diseases and injuries. Indeed, according to a joint report by the World Health Organization, United Nations Population Fund, and United Nations Children’s Fund (1995, p. 3), “One of the most important commitments a country can make for future economic, social, and political progress and stability is to address the health and development needs of its adolescents.”

It is of concern, therefore, that adolescents have one of the lowest rates of primary care use of any age group in the United States (Hing, Cherry, and Woodwell, 2006) and one of the highest rates of being under- or uninsured (Agency for Healthcare Research and Quality, 2006; U.S. Census Bureau, 2006b). Moreover, some aspects of adolescent health—such as the escalating rate of adolescent obesity and related illnesses—have become increasingly problematic over time (Institute of Medicine, 2005). In addition, certain groups within the adolescent population characterized by selected circumstances—for instance, those who are in the foster care system; homeless; lesbian, gay, bisexual, or transgender (LGBT)2; or in the juvenile justice system—may be especially prone to participate in risky behavior and lack community, family, or economic support. Consequently they may face special challenges that put them at particular risk for poor health outcomes (D’Augelli, Hershberger, and Pilkington, 1998; Saewyc et al., 1999, 2006; Tonkin, 1994). Being part of a racial or ethnic minority group, being poor, or being in a family that has recently immigrated to the United States may also contribute to decreased access to quality and appropriate health services (Weinick and Krauss, 2000; Wise, 2004).

There is some disagreement as to whether health status is dependent more on health services or on other factors, such as genetics, income, or behavior (Association of Maternal and Child Health Programs and the National Network of State Adolescent Health Coordinators, 2005; Fuchs, 1974, 1991; Garfinkel, Hochschild, and McLanahan, 1996). Nonetheless,


The group referred to as “lesbian, gay, bisexual, and transgender” sometimes also encompasses the term “questioning” and is commonly referred to by the acronym LGBT (or GLBT) or LGBTQ (or GLBTQ). For the purposes of this report, the identifier “lesbian, gay, bisexual, and transgender” or LGBT is used.

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