immigrated to the United States; lesbian, gay, bisexual, or transgender; or in the juvenile justice system—and examined the relationship of these characteristics to health status and health services.

In defining health, the committee considered services provided by physicians, nurses, nurse practitioners, psychologists, social workers, dentists, and other health care providers. Health services were defined to include routine checkups; health maintenance or well care visits; school and sports physicals; psychiatric and substance abuse counseling; reproductive health services; dental care; and medical care for injury or illness, including chronic conditions. The committee also considered risky behavior and its implications for adolescent health and health services.

Study Frameworks

The committee was guided by two basic frameworks in its data collection, review of the evidence, and deliberations on various dimensions of adolescent health status and health services. The first focuses on behavioral and contextual characteristics that influence how adolescents interact with the health system, and the second on the objectives of adolescent health services. Neither framework alone is sufficient to explain significant variations in adolescent health outcomes; rather, they complement each other and, in tandem, provide a more complete picture of the features of the health system that should be improved in order to provide adolescents high-quality care and thus help to improve their health status.

Framework 1:
Behavioral and Contextual Characteristics

Certain sets of behavioral and contextual characteristics, listed below, matter for adolescents in the ways they approach and interact with health care services, providers, and settings. When these characteristics are addressed in the design of health services for adolescents, these services can offer high-quality care that is particularly attuned to the needs of this age group. These characteristics helped frame the chapters of this report and, where relevant and supported by the evidence, are reflected in the committee’s recommendations.

  • Development matters. Adolescence is a period of significant and dramatic change spanning the physical, biological, social, and psychological transitions from childhood to young adulthood. This dynamic state influences both the health of young people and the health services they require (Chapter 1).

  • Timing matters. Adolescence is a critical time for health promotion. Many health problems and much of the risky behavior that under-

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