Challenges and Limitations

The committee was challenged by the limited data and existing scientific literature in a number of key areas. There are no comprehensive national indicators of the health status of adolescents that place particular emphasis on behavioral and developmental health. Specifically, information is lacking by selected population characteristics (e.g., income, racial and ethnic status, geographic location) and other circumstances (e.g., LGBT, in the foster care system) that would provide longitudinal trends and enable comparison of the health behaviors of selected adolescent populations as they grow. Health services for adolescents are delivered in myriad settings and through varied institutional structures, and data on and evaluation of services are limited, thus making comprehensive assessment of the quality of service delivery, as well as comparison of different settings and services, a further challenge. Information on issues related to the adolescent health workforce, such as competency requirements for health professionals who work with adolescents, is also difficult to obtain. Finally, while there may be costs associated with the recommendations presented in this report, the committee did not address these economic implications. Such an analysis was beyond the scope of the study charge and the committee’s expertise. A future topic for research, therefore, is whether implementing the committee’s recommendations would require additional resources or could be financed through reallocation of current investments.

Study Scope

The committee was charged broadly with an examination of adolescent health and health services. However, the charge did not specify what ages fall within the period of adolescence and what “health” should encompass. Therefore, one of the committee’s early tasks was to reach consensus on how to define these terms in reviewing the literature.

Defining Adolescence

The period of adolescence is influenced by social, cultural, economic, and physical elements, and the boundaries of this life phase are not precise. As a period in the life span, adolescence is a fairly new concept, recognized first at the beginning of the twentieth century. Psychologist G. Stanley Hall wrote a two-volume book in 1904 in which he described the nature of teens and argued that their specific developmental period required particular types of supports. The concept of adolescence became increasingly popular throughout the twentieth century as society changed its perspective on children. The view of children shifted from their being simply members of



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