decrease their opportunities for a successful transition through adolescence to adulthood.

Minority adolescents, those in low-income families, and those who live in rural areas experience particular disparities in health status and therefore face additional challenges in accessing needed health services:

• The racial and ethnic makeup of adolescents in the United States is becoming more diverse (see Chapter 1). By 2050, it is estimated that more than 53 percent of adolescents aged 10–19 will be members of racial or ethnic minority groups (U.S. Census Bureau, 2007).

• Adolescents who are in low-income families (income below $19,971 for a family of four in 2005) make up 16 percent of the adolescent population aged 10–17, while an additional 20 percent of adolescents live in near-poor families (income up to $37,619 for a family of four) (MacKay and Duran, 2007).

• Of U.S. adolescents aged 12–17, 19 percent, or 4.6 million, live in rural areas (nonmetropolitan counties including no city with a population of greater than 10,000) (Fields, 2003). The population of rural adolescents increased from 1990 to 2002 (U.S. Census Bureau, 1992, 2003).

When available, information on the disparities in health status (i.e., mortality, morbidity, and health-related behavior) experienced by these specific groups of adolescents is presented throughout this chapter. It should be noted, however, that while some data exist on the health of low-income adolescents, these data are limited given that many of these adolescents are uninsured and not receiving consistent health services whereby their health status can be tracked. Additionally, it is often difficult to separate the effects of race and ethnicity from those of socioeconomic status. Without better data on these most vulnerable adolescents, understanding their specific health needs is problematic.

In 2005, there were 3.3 million complaints to child protection agencies alleging child abuse and neglect (child maltreatment), involving 6 million