An analysis of the 21 Critical Health Objectives for ages 10–24, a subset of the Centers for Disease Control and Prevention’s Healthy People 2010, highlights how little progress has been made in the overall health status of adolescents since the year 2000. Of the 21 objectives—which encompass a broad range of concerns, from reducing deaths, reducing suicides, and increasing mental health treatment to increasing seat belt use, reducing binge drinking, and reducing weapon carrying—the only ones that have shown improvement for adolescents since 2000 are behaviors leading to unintentional injury, pregnancy, and tobacco use. Negative trends include increased mortality due to motor vehicle crashes related to alcohol, increased obesity/overweight, and decreased physical activity.

Certain groups of adolescents have particularly high rates of comorbidity, defined as the simultaneous occurrence of two or more diseases, health conditions, or risky behaviors. These adolescents are particularly vulnerable to poor health. Moreover, specific groups of adolescents—such as those who are poor; in the foster care system; homeless; in families that have recently immigrated to the United States; lesbian, gay, bisexual, or transgender; or in the juvenile justice system—may have higher rates of chronic health problems and may engage in more risky behavior when compared with the overall adolescent population. These adolescents may have especially complex health issues that often are not addressed by the health services and settings they use. Furthermore, members of racial and ethnic minorities are becoming a larger portion of the overall U.S. adolescent population. And because minority racial or ethnic status is closely linked to poverty and a lack of access to quality health services, the number of adolescents experiencing significant disparities in access to quality health services can be expected to increase as well.

Overall Conclusion 2: Many current models of health services for adolescents exist. There is insufficient evidence to indicate that any one particular approach to health services for adolescents achieves significantly better results than others.

Evidence shows that while private office-based primary care services are available to most adolescents, those services depend significantly on fee-based reimbursement and are not always accessible, acceptable, appropriate, or effective for many adolescents, particularly those who are uninsured or underinsured. Such young people often have difficulty gaining access to mainstream primary care services; require additional support in order to connect with health care providers; and may rely extensively on such “safety-net” settings as hospital-, community- and school-based health centers for their primary care. For example, adolescents are in the age group



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