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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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8

Health Care

Important Points Made by the Speakers

  • Young adults need developmentally based services and systems, which today are rare or nonexistent. (Irwin)
  • Social media can enhance health care delivery, health promotion, and prevention. (Irwin)
  • The Patient Protection and Affordable Care Act (ACA) addresses the health needs of young adults through the broadening of private insurance coverage, expansion of Medicaid, and the provision of essential health benefits, but gaps in health care for young adults will remain. (English)
  • The effects of the ACA need to be closely monitored to inform policy makers and advocates about additional needed steps. (English)
  • Many subgroups of young adults face particular health challenges. To reduce health disparities among young adults, all young adults need better access to health care and the provision of necessary services. (Coyne-Beasley)
  • A culturally competent health care system that provides access to at least annual visits and medical homes for all young adults should include transition care to help young adults navigate the health care system. (Coyne-Beasley)
  • Early prevention is important because trajectories are, to a large extent, established in childhood and adolescence. (Oesterle)
Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×
  • The number of programs that target young adults is limited, many interventions need further development, and there is a need to think about programs that are useful for noncollege populations. (Oesterle)

Young adults often have more difficulty accessing health services than do the members of other groups. They traditionally have the lowest rates of insurance coverage of any group, with the poor and near poor most affected. Preventive services and primary care management are scarce for this group, as they are throughout the health care system. Few health-related guidelines are directed specifically at young adults. In the session on health care issues, one presentation described these problems, while a subsequent talk focused on ways in which the ACA addresses them. This chapter also summarizes a presentation about subgroups of young adults that face particular challenges and a presentation on effective preventive and development-promoting interventions for young adults. (These two presentations were not part of the workshop session on access to health care, but are included here because they are thematically related.)

During the presentations by the young adults, Amy Doherty commented on the difficulty young adults can have accessing the health care system even when they have insurance. The system is complicated, and many young people have never learned how to navigate it, especially when they transition from pediatric to adult care. “How do you go about finding a doctor? How do you plan for what you might need to ask? How do you tell your doctor, ‘Well, maybe this isn’t the best, maybe I really don’t want you to do this test?’” Young adults need to be their own advocates, she said, which may require that they specifically receive self-advocacy training in dealing with the health care system.

Eric Lulow, also a member of the young adult panel, also emphasized the problems that a lack of insurance can cause for young adults, not all of whom are covered by their parents’ policies. “I went without health insurance from 18 to 24, so I know what that is like and how difficult it is to get your needs met when that is the case,” he explained.

HEALTH SERVICES

The major problems of early adulthood are largely preventable, said Charles Irwin, distinguished professor of pediatrics, director of the Division of Adolescent and Young Adult Medicine, and director of Health Policy in the Department of Pediatrics at the University of California, San Francisco (UCSF), School of Medicine and the UCSF Benioff Children’s Hospital.

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

Irwin identified three areas in which young adults especially need health care services:

  1. Preventive services
  2. Sexual health services
  3. Care for chronic conditions

In the preventive services area, Ozer et al. (2012) found evidence-based guidelines directed toward young adults in the following areas:

  • Mental health/depression safety
  • Nutrition/exercise/obesity
  • Iillicit drug use
  • Alcohol/tobacco
  • Reproductive health
  • Infectious diseases/immunizations
  • Domestic violence

They also found consensus statements about safety and illicit drug use. Bright Futures, which many pediatricians use for preventive services during early childhood and adolescence, has some recommendations for 18- to 21-year-olds, and some professional guidelines for specific diseases, such as diabetes or asthma, and specialties, such as obstetrics and gynecology, that apply to young adults (Hagan et al., 2008). In general, however, guidelines for young adults that are developmentally based are rare and nonexistent in some areas, Irwin noted.

In the area of chronic conditions, according to the 2011 National Health Interview Survey, about 15 percent of young women had limitations in their daily functioning, whereas about 12 percent of males reported limitations. Asthma, obesity, and hypertension are the leading causes of limitations, with heart conditions and diseases, diabetes, cancer, and ulcers making smaller contributions (CDC, 2011b). In addition, as noted by earlier speakers, mental health and substance use disorders are major contributors to limitations in daily functioning for young adults, said Irwin.

Several professional organizations have developed recommendations covering the transition from pediatric to young adult care for those with chronic conditions. However, according to the National Survey of Children with Special Health Care Needs, only 39 percent of families report that their children ages 15 to 17 receive the necessary services to transition to adult health care, work, and independence (CDC, 2010). Developmentally based services and systems are rare, Irwin said. A recommendation Irwin made to address this deficiency is that future clinicians should have a discipline-specific young adult rotation, so they know how caring for a 41-year-old is

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

different than caring for a 21-year-old. In addition, young adults should be taught what to expect when they enter into a system of care.

Only about 5 percent of all adolescents ages 10-17 have no usual source of health care, but 31 percent of males and 20 percent of females ages 18-25 do not (Irwin, 2013). Males ages 20-29 use ambulatory care an average of only 1.1 times per year, while females average 2.3 visits per year (Fortuna et al., 2009). Few young adults come in for preventive health care—just 0.1 annual visits by males and 0.4 visits by females. Young adults are the age group least likely to use any health care services, said Irwin. However, they are just as likely or more likely than other groups below age 65 to use emergency departments.

Average health care expenditures on young adults ages 18-25 are about $2,000 per year, which is about the same as for adolescents, but less than for older groups (Irwin, 2013). About 17 percent of their costs were out of pocket, which is similar to the percentage for other adults and adolescents. However, even this amount can place a significant challenge on those who do not have assistance from family members.

Insurance status has a major effect on the health care of young adults, with those who are uninsured less likely to fill a prescription, skip a test or treatment, or forgo specialist care (see Figure 8-1). In addition, among

images

FIGURE 8-1 Young adults who were uninsured at some point in the past year or are currently uninsured are less likely to have access to health services than young adults who are continuously insured.
SOURCE: Collins et al., 2012.

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

those with mental health or substance use problems, many did not receive treatment, especially among vulnerable populations (Irwin, 2013).

Young adults and their parents are not prepared for the changes in health care systems following adolescence, said Irwin. (An exception, he said, is the Children and Youth with Special Health Care Needs program, which has guidelines to help manage this transition.) In addition, the diversity of trajectories through the young adult years complicates health care for this group. While some groups may have sources of care—such as those in college, the military, or prison—others do not—such as those who are homeless, are leaving foster care or the justice system, or have chronic conditions. Furthermore, “carve-out” arrangements—in both public and private insurance—separate the mental health and physical health delivery systems, which impedes referral or care coordination and often precludes reimbursement for primary care clinicians. The poor coverage of mental health services in private insurance plans also can cap the number of visits or cause high copays, said Irwin.

On the positive front, more than two-thirds of primary care physicians reported use of electronic medical records in 2012 (Schoen, 2012), which provides an opportunity to improve communication with young adults because many of them are avid users of electronic technologies.

IMPACT OF THE AFFORDABLE CARE ACT

Abigail English, director of the Center for Adolescent Health & the Law, also pointed out that young adults are insured at lower rates than are children or adolescents. In 2011, only two-thirds of young adults had continuous coverage, compared with about 90 percent of adolescents (English and Park, 2012). Only about half of young adults were covered by private insurance, with an additional 15 percent having public coverage, primarily through Medicaid (English and Park, 2012).

A major component of ACA was its expansion of insurance coverage. As of 2010, young adults could remain on their parents’ insurance plans until they reach the age of 26. This provision added about 3 million young people to insurance rolls between September 2010 and December 2011, which has been “a big advance for that age group,” said English. (However, as was pointed out during the discussion session, the decline in the numbers of uninsured young adults has stalled more recently.) In addition, the act provides for the creation of health insurance exchanges and subsidies starting in 2014; requires that individuals be covered by insurance or be subject to financial penalties; and sought to expand public health insurance, largely through the expansion of Medicaid (English, 2013).

The health exchanges will offer platinum, gold, silver, and bronze insurance plans, along with catastrophic plans for young adults up to age 30. To

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

encourage people to enroll for insurance through the exchanges, subsidies are available both for cost sharing and for premium tax credits—up to 250 percent of poverty for cost-sharing assistance or 400 percent of poverty for premium tax credits. However, as English observed, the benefits, costs, and other details of health plans can vary greatly by state.

Prior to ACA, Medicaid was required to cover children and pregnant women at income levels up to at least 133 percent of the federal poverty level, and adolescents up to at least 100 percent, but the income eligibility levels for single adults, including young adults, were very low in the vast majority of states. ACA increases the income eligibility level for adolescents, requires the states to at least maintain their past efforts in Medicaid, and provides for expansion of Medicaid starting in 2014; originally it was a requirement, but it became an option subsequent to the Supreme Court’s ACA decision in 2012 (English and Park, 2012). However, many states have stated that they do not plan to expand Medicaid, and even if Medicaid is expanded, some groups will continue to be left out, including undocumented immigrants, and legal immigrants who have been in the United States less than 5 years. Former foster youth must be covered by Medicaid in all states up to age 26, in parallel with private insurance.

ACA requires that plans offered through the exchanges cover 10 essential health benefits, several of which are important for young adults:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance abuse disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

These benefits also must be available in the Medicaid expansion states for the newly eligible populations.

Some prominent services are left out of this list, English noted. Oral and vision care is covered only for the pediatric population, not for young adults. Preventive services must be covered without cost sharing in private health plans, but only if they are obtained through in-network providers.

Some sexual and reproductive health services must be covered without cost sharing as preventive services, but this coverage has limitations. Screening is covered, but that may not cover follow-up diagnosis and treatment.

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

Maternity care is covered, but abortion coverage has significant limitations. All methods approved by the Food and Drug Administration for contraception are supposed to be covered, but health insurers are excluding coverage of some brands within a method. Religious exemptions and accommodations for religious institutions will continue to be controversial, said English.

The provisions of ACA pose other challenges to young adults, English observed, though many questions remain about exactly how the law will affect young adults specifically. The individual mandate is enforceable by financial penalties except if a person’s income is below the income tax filing threshold, which is currently between $9,000 and $10,000 a year. However, the penalties are less than the cost of the premium, even factoring in subsidies. Because many young adults are already reluctant to purchase health insurance coverage, their compliance with the mandate remains uncertain, which may affect the costs of premiums for others. National enrollment levels among young adults will need to be monitored carefully, English said.

At the time of the workshop, 25 states had indicated that they were planning to expand Medicaid, while the remainder were demonstrating a reluctance to do so.1 In addition, some of the states that are not planning to expand Medicaid include ones that have very low income eligibility levels for young adults. The expansion is critical for young adults, said English, because they lag behind adolescents and other adults in public health insurance coverage.

Also, young adults who are below 100 percent of the federal poverty level will not be eligible for subsidies to purchase private insurance in the exchanges. If they are in a state that does not expand Medicaid and has a Medicaid eligibility level below the federal poverty level, those between this level and the federal poverty level will fall through the cracks.

ACA requires states to engage in outreach to vulnerable populations, including “unaccompanied homeless youth, children with special health care needs, pregnant women, racial and ethnic minorities, rural populations, and individuals with HIV/AIDS”2 to help them enroll in Medicaid and the Children’s Health Insurance Program (CHIP). However, some groups still will be at risk of not getting the health insurance coverage they need or of being able to access needed health care services. In general, outreach is needed so that young people know where to go for care, who will accept their insurance, and what they can expect from providers. “This is

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1 Current information on how many states are planning to expand Medicaid is available at http://kff.org/health-reform/state-indicator/state-decisions-for-creating-health-insurance-exchanges-and-expanding-medicaid.

2 Patient Protection and Affordable Care Act, Public Law 111-148, 42 U.S.C. § 2201(b) (amending 42 U.S.C. § 1397aa).

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

where social media strategies … become extremely useful, since this is a population that can be reached that way.”

ACA requires the states to have streamlined application procedures, and an application that was originally 21 pages has been reduced to 3 for single adults who are not applying for family coverage. “We have to see how that will work, but it should be an improvement over some of the extensive applications that young people have had to contend with in the past,” said English.

Privacy concerns can be pressing for young adults. For example, when young adults remain on their parents’ insurance plans, the billing and insurance claims process can significantly jeopardize confidentiality for that age group (English et al., 2012).

Many of the effects of ACA will depend on the details of its implementation, English said. These effects should be examined closely to inform policy makers about changes that are needed and to inform advocates about what additional steps are needed to meet the legislation’s promise.

YOUNG ADULTS FACING PARTICULAR ISSUES

Many groups of young adults face particular health challenges, said Tamera Coyne-Beasley, professor in the Departments of Pediatrics and Internal Medicine at the University of North Carolina, Chapel Hill, including

  • Young adults who have been in the juvenile justice system
  • Immigrants
  • Members of the military
  • Young adults with special health care needs
  • Rural young adults
  • Young adults who have been in the foster care system
  • LGBTQ (lesbian, gay, bisexual, transgender, and queer/questioning) young adults
  • Homeless young adults
  • Young adults with chronic diseases
  • Young adults who are unemployed
  • Young adults in poverty
  • Young adults of color

In her talk, Coyne-Beasley focused on the final seven groups in this list (in bold), as other groups were the focus of other sessions. She first described particular concerns and risks associated with these groups. She then discussed changes to the health system that would help reduce health disparities and improve health care for all young adults.

Health disparities among young adults arise in many ways, including

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

differential access to care, differences in the quality of care received within the health care system, differences in life opportunities, and exposures to racism, discrimination, and stress that undermine health status (IOM, 2002). Furthermore, many of the challenges these groups face are multifactorial: A young adult may have graduated out of foster care; be unemployed, poverty stricken, and homeless; and have a chronic disease. Coyne-Beasley focused on three of these factors: race, poverty, and employment.

Race is one of the most frequently measured social determinants of health, despite the difficulty in many cases of defining a person’s race. It is considered a “marker” for certain health problems, but of course race or ethnicity per se does not cause a particular health problem or status. Rather, such factors as income, education, access to care, and stress are related to poor health outcomes. Nevertheless, these factors also can be associated with race and with perceptions of race. As Coyne-Beasley noted in the discussion session, for example, the health outcomes of fair-skinned Latinos and blacks may be worse than whites due to unequal treatment (IOM, 2002).

Poverty is a particularly influential social determinant of health. In 2011, more than one in four young adults ages 18-24 lived in poverty (Kids Count Data Center, 2013), up from one in six in 2003 (Park et al., 2006). Furthermore, youth of color are more likely to be economically deprived. About 26 percent of American Indians live in poverty, as do about 24 percent of African Americans, about 23 percent of Hispanics, and about 11 percent of Asian Americans and Pacific Islanders, compared with just 8 percent of whites (NASW, 2001).

Poverty is closely related to employment. Unemployed young adults report higher levels of risky drinking and lack of physical activity in their leisure time, though employed individuals have higher levels of smoking, higher french fry consumption, and low fruit and vegetable consumption (Caban-Martinez et al., 2011). Indeed, no broad group of young adults eats well, Coyne-Beasley noted.

Drawing on data from Park and colleagues (2006), Coyne-Beasley described how many health indicators for young adults vary by racial and ethnic group. For example, American Indians and Alaskan Natives have the highest rates of motor vehicle fatalities. Homicides are more common among blacks, and suicides are more common among whites. American Indians and Alaskan Natives report the highest levels of cigarette use, illicit drug use, and drug dependence, while binge drinking and heavy alcohol use are more common among white males. Young adults score worse on all of these indicators than do adolescents.

Seventy-three percent of pregnancies among black women ages 20-29 are unintended, compared with 70 percent among whites and 59 percent among Hispanics (Kaye et al., 2009). Among young adults ages 18-29 who

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

do not intend to get pregnant, only about two-thirds said it was very likely that they will use contraception in their next act of sexual intercourse (Kaye et al., 2009). Twenty-six percent of Hispanics ages 18-29 (31 percent of men and 21 percent of women) either strongly agreed or somewhat agreed that using birth control is morally wrong, compared with 11 percent of non-Hispanic whites and 8 percent of blacks, with the percentage gradually lowering as people get older. More than 40 percent of blacks and Hispanics strongly or somewhat agree with the following three statements:

  1. The government and public health institutions use people of color and the poor as guinea pigs to try out new birth control methods.
  2. The government is trying to limit underrepresented racial and ethnic groups by encouraging the use of birth control.
  3. Drug companies don’t care if birth control is safe—they just want people to use it so they can make money (Kaye et al., 2009).

Given the history of government support for sterilization techniques used disproportionately with minorities, such beliefs are not surprising, Coyne-Beasley said.

“Youth in the foster care system are more likely to suffer poor health and have a greater likelihood of chronic conditions and mental health disorders” (NASW, 2001). In addition, children of color make up a majority of youths represented in the foster care population—approximately 42 percent are African American and 36 percent are Hispanic (Child Welfare League of America, 2001; Clark, 2001). Among young adults leaving foster care, a quarter suffer from posttraumatic stress disorder, and most are at high risk of losing Medicaid or other forms of insurance coverage when they age out.

Among the LGBTQ community, less than 50 percent report having at least one adult family member to whom they can turn for help (Ryan et al., 2009). LGBTQ young adults ages 21-25 who report “family rejection were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse” (Reardon et al., 2009). In addition, LGBTQ youth are disproportionately represented among homeless populations. Nationally, 44 percent of homeless LGBTQ youth are black and 26 percent are Hispanic (HRSA, 2001). This disparity is even greater among transgender homeless youth (62 percent black and 20 percent Hispanic), said Coyne-Beasley.

Homeless young adults are more likely to engage in high-risk behaviors such as unprotected sex with multiple partners, drug use, and exposure to and participation in violence, said Coyne-Beasley. In addition, they have many barriers to accessing health care, such as a lack of insurance, difficulty

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

navigating the health system, no address or means of contact, and attitudes of health staff.

During the discussion session, Coyne-Beasley also briefly discussed young adults in rural areas. Some things taken for granted in urban areas, such as cell phone and Internet access, are more limited in rural areas, which can require that interventions be adapted for the technologies available. Inhabitants of rural areas also can have somewhat different attitudes toward such issues as community and privacy, said Coyne-Beasley. A useful guideline is to engage all communities as much as possible in the design of research and interventions, she said.

To improve the safety and well-being of young adults, their psychosocial needs and social supports should be assessed so that they can be better connected to a trusted adult or community. They also need help with tobacco cessation and obesity prevention. They need better access to health care, including screening for diseases, for mental health issues, and for risk behaviors, and the provision of necessary services. Coyne-Beasley focused specifically on vaccinations because of their potential to reduce health disparities. No other therapeutic devices or medication have been able to eradicate disease in the United States the way vaccines have. Examples include smallpox and polio. Vaccines offer many opportunities to greatly reduce the incidence of such cancers as those in the cervix, anus, and vulva. However, disparities exist in vaccine uptake.

A culturally competent health care system that provides access to at least annual visits and medical homes for all young adults must include transition care to help young adults navigate the health care system, Coyne-Beasley said. It also must engage more multidisciplinary providers, family and community members, and young adults in prevention.3 Also, more research is needed on community engagement, the life course, and resiliency and protective factors. “A majority of young adults make it fine, even those with particular challenges. What is it that they have?” Answering this question would require longitudinal data from adolescence and earlier in a person’s life, but such an effort could be extremely useful. Finally, evidence-and policy-based interventions and systems are needed to address the social determinants of health, including policies to dismantle racism, sexism, classism, and other “isms,” Coyne-Beasley said.

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3 For additional information about the psychology of immigration, including the importance of culturally sensitive, systemic care, see APA (2012).

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

EFFECTIVE INTERVENTIONS AND PROGRAMS TARGETING YOUNG ADULTS

Sabrina Oesterle, research associate professor in the School of Social Work at the University of Washington, discussed her review of existing programs targeted specifically at young adults to identify those that have been tested and demonstrated to be effective. This presentation is summarized only briefly here because the full results of her research appear in a background paper that was developed for the workshop, which can be found in Appendix D. Drawing on eight established inventories of tested-effective programs and policies, she identified 26 programs in these five topic areas:

  1. Substance use (14)
  1. Sexually transmitted infection/HIV prevention, risky sexual behavior (5)
  2. Educational and vocational skills (3)
  3. Suicide prevention and mental health (2)
  4. Crime and antisocial behavior (2)

These five categories make sense, Oesterle observed, in that they correspond with areas of heightened vulnerability for young adults. She added, however, that a prominent missing category is parenting for young adults, who are most likely to have preschool-aged children. Several more broadly based parenting programs for children of this age have strong evidence and could be readily applied to young adults.

Overall, the number of programs that target young adults is still limited, and many interventions need further development. Programs also tend to be focused more on college students, even though rates of some problems, such as substance use, are higher among noncollege populations. “Let’s not forget the noncollege population,” said Oesterle. “That is one theme that has come out very strongly in my research.”

Programs that help young adults make major transitions also are scarce, such as programs on relationship skills or managing finances. Young adults themselves recognize the need for more programs to help them develop life skills. Universal preventive programming could help all young adults avoid problems, while a closer matching of programs to young adult health risks and subpopulations could target those groups at greatest risk. As an example, Oesterle mentioned programs focused on obesity for young adults.

More research on turning points and on the potential to intervene in young adulthood would enable the design of more effective programs, said Oesterle. In addition, tested-effective programs directed toward all adults could be applied specifically to young adult populations in well-designed studies, such as randomized trials. Finally, as was noted during the discus-

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

sion period, existing research could be reanalyzed to derive the effects of programs specifically on young adults.

Once effective programs have been identified, widespread dissemination with high-quality implementation is critical. Applying and adapting successful programs could bring widespread public health impacts, Oesterle concluded.

Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
×

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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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Suggested Citation:"8 Health Care." Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18340.
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Young adults are at a significant and pivotal time of life. They may seek higher education, launch their work lives, develop personal relationships and healthy habits, and pursue other endeavors that help set them on healthy and productive pathways. However, the transition to adulthood also can be a time of increased vulnerability and risk. Young adults may be unemployed and homeless, lack access to health care, suffer from mental health issues or other chronic health conditions, or engage in binge drinking, illicit drug use, or driving under the influence. Young adults are moving out of the services and systems that supported them as children and adolescents, but adult services and systems—for example, the adult health care system, the labor market, and the justice system—may not be well suited to supporting their needs.

Improving the Health, Safety, and Well-Being of Young Adults is the summary of a workshop hosted by the Board on Children, Youth, and Families of the Institute of Medicine (IOM) and the National Research Council (NRC) in May, 2013. More than 250 researchers, practitioners, policy makers, and young adults presented and discussed research on the development, health, safety, and well-being of young adults. This report focuses on the developmental characteristics and attributes of this age group and its placement in the life course; how well young adults function across relevant sectors, including, for example, health and mental health, education, labor, justice, military, and foster care; and how the various sectors that intersect with young adults influence their health and well-being. Improving the Health, Safety, and Well-Being of Young Adults provides an overview of existing research and identifies research gaps and issues that deserve more intensive study. It also is meant to start a conversation aimed at a larger IOM/NRC effort to guide research, practices, and policies affecting young adults.

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