2003). The population of rural adolescents increased from 1990 to 2002 (U.S. Census Bureau, 1992, 2003).

A portion of the adolescent population is disconnected from basic opportunities and supports that provide for their health, well-being, and economic self-sufficiency. These adolescents include those who are homeless, are transitioning from foster care, are recent immigrants to the United States, and are involved in the juvenile justice system.

Of the U.S. population under age 18, 0.5 percent live in group quarters—either institutionalized (e.g., correctional institutions, nursing homes, hospital wards and hospices for the chronically ill, mental [psychiatric] hospitals or wards, juvenile institutions, other institutions) or noninstitutionalized (e.g., college dormitories; military quarters; other noninstitutionalized group quarters, such as group homes and shelter facilities). Correctional and juvenile facilities are the two leading group quarters for both male and female adolescents under age 18 living in institutions. There are twice as many adolescent males as females living in institutions (U.S. Census Bureau, 2000). While this factor is important, it is notable that, according to the National Survey of Child Health, family income and mother’s own health status are more likely to be correlated with adolescent health status than is place of residence (Maternal and Child Health Bureau, 2005a,b).

Data on runaway and homeless adolescents are difficult to capture given this population’s inclination to be invisible or difficult to find. The National Runaway Switchboard collects data on calls to its crisis line. In 2006, it handled 113,916 calls from adolescents aged 12–21, 76 percent of whom were female (National Runaway Switchboard, 2006). These adolescents are frequently in a precarious living situation as a result of their being involved in systems of care such as the foster care or juvenile justice system, or their being recent immigrants to the United States or being disenfranchised socially, as may be the case for LGBT adolescents. They generally lack primary health care and may have increased health problems because of either factors that influenced their being homeless or the increased risk and exposure that result from living on the street (Shapiro, 2006).

How adolescents use their time may also affect their health, both positively and negatively. Adolescents who have a substantial amount of unsupervised time during nonschool hours may be at risk of participating in health-damaging behavior (National Research Council and Institute of Medicine, 2002); there is evidence that these adolescents are more likely to engage in sexual activity, smoke, use alcohol and drugs, and participate in violent and gang-related activities (Zill, Nord, and Loomis, 1995). Moreover, involvement with electronic media leads to increased sedentary time and less active playing (Institute of Medicine, 2005), which may contribute to obesity. Besides work time (4 to 6 hours a day), which includes school-work, household labor, and paid labor, adolescents in the United States



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