At the end of the workshop, planning committee chair Richard Bonnie and Patrick Tolan, director of Youth-Nex (the Center to Promote Effective Youth Development) at the University of Virginia, provided an overview of important topics discussed at the workshop. In this chapter, the rapporteurs have drawn on their presentations and on the summary of the workshop to identify the workshop’s major themes. The final chapter of this summary contains a compilation of individual suggestions made by speakers for future research, policy development, and changes to systems and organizations.
DIVERSITY OF YOUNG ADULTS’ LIVES IN A CHANGING WORLD
Young adults traditionally have been expected to achieve an education, employment, financial independence, marriage, and children. Today the achievement of those milestones is much more variable. The young adult years are more fluid and flexible than in the past. In addition, young adults do not have a single age of majority or rite of passage. Rather, they undergo a variety of transitions to adult roles and enhanced autonomy. Young people can drive at 16, vote at 18, drink at 21, and stay on their parents’ insurance until reaching the age of 26.
Young adults take many different paths through these years, although evidence reveals certain patterns in the paths taken. They develop differently, face different circumstances and opportunities, and make different choices. Also, major differences exist among subgroups of young adults.
Race and ethnicity, social class, immigrant status, family background, and many other factors affect their options and experiences.
The social landscape of life has changed markedly in recent years. More young adults are going to college, more are living at home with their parents, and more are members of underrepresented racial and ethnic groups. In addition, rapid changes in technology both facilitate self-expression and provide opportunities to support health and social services. Today, information is not so much passed from elders to youth as it is transferred horizontally among young adults. This “horizontaling,” as Tolan called it, is premised on the idea that the information someone needs to know exists somewhere—it just needs to be accessed.
The nature of work has changed dramatically. High unemployment rates, especially among disadvantaged groups, have put a premium on education and have worsened the prospects of those with just a high school or some college education—a group referred to during the workshop as the “forgotten half.” Social class distinctions are sharpening, and discrepancies in opportunities and resources are growing. Social mobility and income inequality are increasing in the United States, and these trends are affecting the lives of young adults.
CONTINUING DEVELOPMENT OF YOUNG ADULTS
Brain development is continuing in young adults, but this development is not a simple extrapolation of what occurs in adolescence. Executive function, impulse control, planning, and related aspects of psychological functioning continue to mature. Young adults also face particular challenges, and the plasticity of the brain allows it to respond to those challenges. Young adults show a decline in risk taking over the course of the young adult years.
During this time period, young adults are working to achieve self-regulation, responsibility, connection, and identity. Although achieving independence is often discussed, interdependence, connection to others, and successful transitions to new roles are critical.
OPPORTUNITIES FOR AND RISKS TO THE HEALTH AND SAFETY OF YOUNG ADULTS
The young adult years may provide an opportunity to make healthy rather than unhealthy behaviors into habits. This is a time when health habits with long-term implications are being set, and also a time when many chronic diseases are first evident.
Young adulthood is also a time of heightened risk for dangerous substance use, unintentional injuries, violence, unintended pregnancy, sexually transmitted infections, and suicide. Much research and attention have fo-
cused on these risks; perhaps less attention has been paid to opportunities to develop healthy habits and promote positive development.
Mental health is a particular concern for this age group because this is the time when symptoms of major chronic mental illness often first emerge, although some research suggests that there are prodromal signs and some childhood symptoms of these adult-onset disorders evident earlier (e.g., adolescence and late childhood).
Many health risks disproportionately affect particular groups, including young adults of color and young adults who are poor, unemployed, and/or homeless.
Summarizing the findings on young adult health and safety concerns, Tolan said, “This is a clear, critical, immediate health crisis that we should be focusing on.” He pointed out, however, that most young adults are doing fairly well. Even young adults with one or more problems may be doing well in other areas. They should not be pathologized because of the challenges they face. But they are living in a changing world, which requires that young people and the institutions that serve them be flexible and adaptable. They need to figure out how to lead a good life, not the right life (i.e., efficiently and completely accomplishing the many life tasks traditionally expected for this age).
ENHANCING YOUNG ADULTS’ HEALTH, SAFETY, AND WELL-BEING THROUGH SYSTEMS AND INSTITUTIONS
Supports, interventions, and systems and organizations designed with young adults in mind could help young adults to develop the skills and capabilities they need to manage their health, build skills, and avoid problems. But much remains to be learned about how societal systems and institutions can best promote young adults’ safety, health, and well-being.
Young adults often have more difficulty accessing health services than do the members of other age groups because of low insurance rates, the medical system’s focus on acute care, and a lack of guidelines and providers directed specifically at this age group. Young adults and their parents also are not well prepared for the transition from adolescent to adult health care. The Patient Protection and Affordable Care Act (ACA) has been designed to simplify and expand enrollment in insurance plans and the provision of services and information to young adults, but implementation of the act will vary from state to state and some groups may not be well served.
Although young adults are disproportionately affected by mental health conditions, the services they access are often fragmented and uncoordinated. Young adults may not be served well by either “child” or “adult” interventions. Increased coordination, the development of approaches appropriate for this age group, and enhanced training for professionals may help improve mental health care for young adults.
Young adults have new ways of using media for self-management, connection, and health, and the use of media extends across social groups. New media also have enhanced the marketing of products that can be harmful to young adults, including alcohol and tobacco products. Harnessing media and technology to promote healthy behaviors and provide information seems promising.
Educational attainment can have a strong effect on the health and well-being of young adults, but the quality of the schooling that adolescents and young adults receive is highly variable. In high schools, many groups tend to be overlooked, including underrepresented racial and ethnic groups, undocumented immigrants, and lesbian, gay, bisexual, transgender, and queer/questioning youth, and the resulting lack of preparation can cause problems for these students in college. High school dropouts and students who take on large amounts of debt in failed efforts to earn 2- or 4-year degrees can be placed in especially dire circumstances.
Colleges provide an opportunity for interventions and counseling of young adults. Screening programs can identify students who need services and are not accessing them on their own. Skills-based interventions, motivational interviewing, and personalized feedback can help reduce problems with alcohol and illegal drugs in college. Increasing mental health awareness among students can facilitate crisis interventions for young adults. These efforts may be helpful for students at a broad range of educational institutions, not just 4-year residential colleges.
Young adults in the military are fully employed and have access to comprehensive medical benefits for themselves and their families, yet they also face challenges that other young adults do not, including the physical and psychological consequences of being in combat. Mitigating strategies can reduce stress-related conditions and suicides. In addition, the broader military health care system is moving toward an emphasis on patient-centered care oriented around medical homes.
The foster care, welfare, and homelessness systems all influence the lives of young adults, but little research has been done to compare the effectiveness of different interventions for this age group. Young adults aging out of the foster care system are at risk of poor outcomes, including homelessness. Also, young adults are not eligible for many of the social services provided to others in the United States, though these services could help them gain the skills and supports they need for success in the workplace.
Finally, many young adults either have been or are involved with the justice system. The juvenile justice system has become more systematic in identifying juveniles with mental health disorders and diverting them into alternate trajectories, but the adult justice system does little more than warehouse offenders until release.