IMPROVING THE HEALTH, SAFETY, AND WELL-BEING OF

YOUNG ADULTS

Workshop Summary

Clare Stroud, Tara Mainero, and Steve Olson, Rapporteurs
Board on Children, Youth, and Families

INSTITUTE OF MEDICINE AND
NATIONAL RESEARCH COUNCIL
                                    OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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IMPROVING THE HEALTH, SAFETY, AND WELL-BEING OF YOUNG ADULTS Workshop Summary Clare Stroud, Tara Mainero, and Steve Olson, Rapporteurs Board on Children, Youth, and Families

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THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was ap- proved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by Contract HHSH25034014T between the National Academy of Sciences and the U.S. Department of Health and Human Services. The views presented in this publication do not necessarily reflect the views of the orga- nizations or agencies that provided support for the activity. International Standard Book Number-13:  978-0-309-28562-9 International Standard Book Number-10:  0-309-28562-3 Additional copies of this workshop summary are available for sale from the Na- tional Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent ad- opted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine) and NRC (National Research Coun- cil). 2013. Improving the health, safety, and well-being of young adults: Workshop summary. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE ON IMPROVING THE HEALTH, SAFETY, AND WELL-BEING OF YOUNG ADULTS1 RICHARD BONNIE (Chair), Harrison Foundation Professor of Medicine and Law, University of Virginia School of Law, Charlottesville WILLIAM ADELMAN, Adolescent Medicine Consultant to the Army Surgeon General, U.S. Army, Maryland CLAIRE BRINDIS, Director, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco ROBERT CROSNOE, The Elsie and Stanley E. (Skinny) Adams, Sr., Centennial Professor in Liberal Arts, Department of Sociology, University of Texas, Austin MARK COURTNEY, Professor, School of Social Service Administration, University of Chicago, Illinois MARYANN DAVIS, Research Associate Professor, University of Massachusetts Medical School, Department of Psychiatry, Worcester BEATRIZ LUNA, Director, Laboratory of Neurocognitive Development, University of Pittsburgh, Pennsylvania VELMA McBRIDE MURRY, Professor of Human Development & Betts Chair, Department of Human and Organizational Development, Peabody College of Vanderbilt University, Nashville ZIZI PAPACHARISSI, Professor and Head, Department of Communication, University of Illinois, Chicago JOHN SCHULENBERG, Professor of Psychology and Research Professor, Institute for Social Research and Center for Human Growth and Development, University of Michigan, Ann Arbor LAURENCE STEINBERG, Laura H. Carnell Professor of Psychology, Department of Psychology, Temple University, Philadelphia, Pennsylvania LESLIE WALKER, Professor and Chief, Adolescent Medicine Division, Seattle Children’s Hospital, Washington Project Staff CLARE STROUD, Project Director TARA MAINERO, Research Associate DOUGLAS KANOVSKY, Senior Program Assistant 1  Institute of Medicine and National Research Council planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The re- sponsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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Board on Children, Youth, and Families Staff KIMBER BOGARD, Director FAYE HILLMAN, Financial Associate PAMELLA ATAYI, Administrative Associate vi

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Reviewers This workshop summary has been reviewed in draft form by individu- als chosen for their diverse perspectives and technical expertise, in accor- dance with procedures approved by the National Reserch Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Amelia M. Arria, University of Maryland Tamera Coyne-Beasley, University of North Carolina Charles E. Irwin, Jr., University of California, San Francisco Robin J. Mermelstein, University of Illinois at Chicago Carola Suárez-Orozco, University of California, Los Angeles Patrick H. Tolan, University of Virginia Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Elena O. Nightingale, Institute of Medicine. Appointed by vii

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viii REVIEWERS the Institute of Medicine, she was responsible for making certain that an independent examination of this workshop summary was carried out in ac- cordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.

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Contents PART I: INTRODUCTION, DEVELOPMENT, AND CONTEXT 1 INTRODUCTION 3 Motivations for the Workshop, 6 Overview of a Changing Landscape and Profile of Young Adults, 7 Organization of the Workshop Summary, 12 2 NEUROBIOLOGICAL, PSYCHOLOGICAL, AND SOCIAL DEVELOPMENT 15 Neurobiological Development, 16 Psychological Development, 17 Social Development, 19 3 THE ECONOMIC, CULTURAL, AND SOCIAL LANDSCAPE 23 The Economic Landscape, 23 Culture, Ethnicity, and Race, 27 The Use of Technology and Social Media, 29 PART II: HEALTH AND SAFETY OF YOUNG ADULTS 4 SAFETY- AND HEALTH-RELATED BEHAVIORS 35 Violence and Victimization, 35 Unintended Pregnancy, HIV Infection, and Other Sexually Transmitted Infections, 38 Substance Use, 40 ix

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x CONTENTS 5 PHYSICAL HEALTH 45 6 MENTAL HEALTH 49 Mental Health in Young Adults, 50 Epidemiology of Mental Health Disorders in Young Adulthood, 52 Schizophrenia and Other Psychotic Disorders, 55 PART III: THE SYSTEMS AND INSTITUTIONS THAT AFFECT YOUNG ADULTS 7 FAMILIES, SOCIAL NETWORKS, AND THE MEDIA 61 Parenting, 62 Social Networks and Social Media, 63 Marketing and Media, 65 8 HEALTH CARE 69 Health Services, 70 Impact of the Affordable Care Act, 73 Young Adults Facing Particular Issues, 76 Effective Interventions and Programs Targeting Young Adults, 80 9 EDUCATION AND EMPLOYMENT 83 Schooling and Health, 84 Health and Safety of Young Adults in Higher Education Settings, 86 10 THE MILITARY 89 Military Service Among Young Adults, 90 Psychological Effects of the Long War, 91 11  FOSTER CARE, WELFARE SERVICES, AND SERVICES FOR HOMELESS YOUNG ADULTS 95 Services for Homeless Young Adults, 96 Young Adults Who Have Been in the Foster Care System, 97 Welfare Services, 100 12 THE JUSTICE SYSTEM 103 Trajectories Through the Juvenile and Adult Justice Systems, 104 Health and Safety in the Justice System, 106

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CONTENTS xi PART IV: THEMES AND FUTURE RESEARCH 13 THEMES OF THE WORKSHOP 111 Diversity of Young Adults’ Lives in a Changing World, 111 Continuing Development of Young Adults, 112 Opportunities for and Risks to the Health and Safety of Young Adults, 112 Enhancing Young Adults’ Health, Safety, and Well-Being Through Systems and Institutions, 113 14 FUTURE RESEARCH AND OTHER OPPORTUNITIES 115 Understanding the Varied Experiences and Trajectories of Young Adults, 116 Resilience, Protective Factors, and Well-Being, 117 Mental Health Care, Mental Health Interventions, and Substance Abuse, 117 Health Care, 118 Families, Parents, and Relationships, 118 Communications, Media, and Decision Making, 119 Young Adults’ Health, Safety, and Well-Being Within Systems and Organizations, 119 Research Methods and Approaches, 120 APPENDIXES A REFERENCES 125 B AGENDA 135 C REGISTERED WORKSHOP ATTENDEES 143 D BACKGROUND PAPER: PATHWAYS TO YOUNG ADULTHOOD AND PREVENTIVE INTERVENTIONS TARGETING YOUNG ADULTS 147 E  BACKGROUND PAPER: PARENTING DURING THE TRANSITIONS TO ADULTHOOD 177

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