in the discussion of insurance coverage in Chapter 5 since the available evidence tends to distinguish between issues related to those aged 10–18 and those aged 19–24. Since the committee’s definition includes those aged 19, data on insurance eligibility and coverage for the full older age range are included to demonstrate the major transitions and striking shortcomings in access to health services that occur as adolescents grow older.

The committee’s decision to focus on ages 10–19 was difficult and problematic. The lack of attention to the health and health service needs of older adolescents or emerging adults is a major concern that lies beyond the scope of this report, but one that the committee believes deserves careful attention in its own right in future studies.

Selected Adolescent Subpopulations

The range of subpopulations of adolescents in the United States results in broad variation among adolescents and their health status. The health and development and health service needs of adolescents vary by gender, race and ethnicity, social and economic environment, information and skills, and access to health services, as well as other factors. When possible, the committee considered a variety of population variables and their relationship to adolescent health status and health services. In addition, the committee considered the specific issues and needs of adolescents in various circumstances, such as those who are in the foster care system, are homeless, are in families that have recently immigrated to the United States, identify themselves as LGBT, or are in the juvenile justice system. Data on the number of adolescents who fall into these subpopulations are sparse, and in many cases there is overlap among groups. Where possible, however, the committee attempted to quantify the numbers of adolescents in these specific groups.

Finally, it is important to note that, while there is recognition in the literature and among experts that certain groups of adolescents have differing needs, risks, and resources related to health, there is no agreement on the specific subpopulations within the adolescent population (Knopf et al., 2007). As will be discussed further in subsequent chapters, this lack of agreement creates challenges in addressing the unique health and health service needs of selected subpopulations and tailoring service delivery accordingly. As well, much of the evidence on health status and health objectives for specific adolescent subpopulations is based on limited data and likely represents an underestimation of the challenges involved (Knopf et al., 2007).

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