Investing in the Health and Well-Being of Young Adults (2015)

Summary¹

Young adulthood—ages approximately 18 to 26—is a critical time in life. What happens during these years has profound and long-lasting implications for young adults’ future employment and career paths and for their economic security, health, and well-being. Young adults are key contributors to the nation’s workforce and military services and, since many are parents, to the healthy development and well-being of the next generation.

In recent decades, the world has changed in ways that place greater demands on young adults and provide less latitude for failure. The disruption and lengthening of established social and economic pathways into adulthood—graduating from high school, entering college or the workforce, taking on civic engagement and national service, leaving home, finding a spouse or partner, and starting a family—have presented more choices and opportunities for some young adults, and more barriers for others. And the transition to adulthood reflects the end of trial periods and the beginning of more consequential actions.

Providing educational, economic, social, and health supports will help young adults assume adult roles, develop marketable skills, and adopt healthy lifelong habits that will benefit them, their children, and the nation. Despite popular attention to some of the special circumstances of young adults, however, they are too rarely treated as a distinct population in policy, program design, and research. Instead, they are often grouped with adolescents or, more often, with all adults.

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¹ This summary does not include references. Citations and detailed supporting evidence for the findings presented in the summary appear in the subsequent report chapters.

STUDY CHARGE

In light of these gaps in attention to the needs of young adults, the Health Resources and Services Administration (HRSA) and the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, the Robert Wood Johnson Foundation, the Annie E. Casey Foundation, and the U.S. Department of Defense (DoD) commissioned the Institute of Medicine (IOM) and the National Research Council (NRC) to review and summarize what is known about the health, safety, and well-being of young adults and to offer recommendations for policy and research. The statement of task for this study is in Chapter 1. To respond to this charge, the IOM and the NRC convened a committee comprising experts in public health, the private sector, health care, behavioral health, social services, human development, psychology, neuroscience, demography, justice and law, sociology, economics, family studies, and media and communication. The committee prepared this report to assist federal, state, and local policy makers and program leaders, as well as employers, nonprofit organizations, and other community partners, in developing and enhancing policies and programs to improve young adults’ health, safety, and well-being. The report also suggests priorities for research to inform policy and programs for young adults.

YOUNG ADULTS IN THE 21ST CENTURY: KEY FINDINGS

Young Adulthood Is a Critical Developmental Period

Young adulthood always has been a critical period of development, bridging adolescence and independent adulthood. It is a time when individuals face significant challenges and are expected to assume new responsibilities and obligations. Success or failure in navigating these paths can set young adults on a course that will strongly affect the trajectories of their adult lives. Earlier periods of the life course (e.g., early childhood) are widely viewed as critical windows of development and occasions for intervention, and young adulthood should also be seen in the same light.

The World Has Changed in Ways That Place Greater Demands on Young Adults

Although the normal course of physiological and biological development of young adults probably has not changed in many generations, the world in which they live has changed greatly. Today’s young adults live in a more global and networked world, marked by increased knowledge and information transfer, heightened risks, fairly low social mobility, and greater

economic inequality. Economic restructuring, advances in information and communication technologies, and changes in the labor market have radically altered the landscape of risk and opportunity in young adulthood. For example, earnings gaps between those with a BA and high school only have roughly doubled since 1980. The demands placed upon young adults are greater, and there is less latitude for failure.

Young Adults Today Follow Less Predictable Pathways Than Those in Previous Generations

Beginning in the 1970s, several well-established patterns of social and economic transition that once defined young adulthood have been altered. In previous generations, the path for most young adults was predictable: graduate from high school, enter college or the workforce, leave home, find a spouse, and start a family. While there were always exceptions, these established milestones provided structure and direction for young adults as they assumed adult responsibilities. Today, those pathways are considerably less predictable, often extended, and sometimes significantly more challenging, as the following examples illustrate:

• The cost of college has grown substantially, and many students have difficulty financing the investment or repaying the debt they incur, yet prospects for well-paying jobs for high school graduates without some postsecondary credential are slim. Although many young adults enter college, dropout rates are high, and degree programs take longer to complete.
• Even for young college graduates, well-compensated entry-level jobs are becoming more difficult to find, especially in the aftermath of the Great Recession that began in late 2007. Many companies do not provide health insurance or other nonsalary economic benefits. Low earnings plague many young workers because they lack skills needed for higher-paying knowledge-based jobs. Increasing numbers of the jobs available to them are part time.
• The estimate of a recent study is that 6.7 million youth and young adults aged 16-24—about 17 percent of the population in this age range—are neither in school nor working. The rates are highest among African Americans and those aged 20-24, almost all of whom have left high school.
• Partnership and parenting patterns have shifted substantially. Educated young adults often live together for many years before marrying and having children, while less-educated young adults often have children outside of marriage before gaining skills and income to support them. In addition, rapidly changing laws on same-sex

• marriage are providing new opportunities for family formation among lesbian, gay, bisexual, and transgender young adults.

• The high cost of living independently has encouraged many young adults to move back into their parents’ home.

Inequality Can Be Magnified During Young Adulthood

The disruption of these established social and economic pathways has presented more choice and opportunity for some young adults and more barriers for others. Marginalized² young adults—such as children of low-income immigrants, those aging out of foster care, those in the justice system, those with disabilities, those who dropped out of school, and those who bear responsibility for raising young children—are much less likely than other young adults to experience a successful transition to adulthood. Compared with their peers, for example, former foster youth are less likely to graduate from high school, have low rates of college attendance, suffer from more mental health problems and often experience poorer health, have a much higher rate of involvement with the criminal justice system, have a higher rate of dependence on public assistance, are more likely to be unemployed, and experience high levels of housing instability and homelessness. They also are less likely to marry or cohabit, but have higher rates of out-of-wedlock parenting and more children.

Despite extensive challenges, some of these young people ultimately fare very well as adults, and their hopes and aspirations are similar to those of young people who have not been marginalized. Meeting the needs of marginalized young adults not only improves their lives and can reduce persistent inequalities due to family background, but also has the potential to help them become fully contributing members of society. Absent deliberate action, however, this period of development is likely to magnify inequality, with lasting effects through adulthood.

Young Adults Are Surprisingly Unhealthy

Young adulthood is a critical period for protecting health, not just during the transitional years but over the life course. Despite some positives, however, the dominant pattern among young adults today is declining

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² The committee’s use of this term is informed by the concept of social exclusion, a concept denoting the economic, social, political, and cultural marginalization experienced by specific groups of people because of social forces such as poverty, discrimination, violence and trauma, disenfranchisement, and dislocation. Commitment to social inclusion is based on the belief that a democratic society benefits when all its members participate fully in community affairs. Viewing marginalized populations from this perspective helps shift the focus from individuals’ difficulties or limitations to how society portrays and treats them.

health, seen most clearly in health behaviors and related health statuses such as the following:

• As adolescents age into their early and mid-20s, they are less likely to eat breakfast, exercise, and get regular physical and dental checkups, and more likely to east fast food, contract sexually transmitted diseases, smoke cigarettes, use marijuana and hard drugs, and binge drink.
• In many areas of risky behavior, young adults show a worse health profile than both adolescents and older adults. For example, compared with adolescents and adults aged 26-34, young adults aged 18-25 are more likely to be injured or die in motor vehicle crashes and to have related hospitalizations and emergency room visits. Thus, young adulthood is when many risky behaviors peak, but it is also the time when involvement in risky behaviors begins to decline.
• Young adulthood is a time of heightened psychological vulnerability and onset of serious mental health disorders, a problem compounded by failure to recognize illness or to seek treatment. Recent data show that almost one-fifth of young adults aged 18-25 had a mental illness in the past year, and 4 percent had a serious mental illness. Yet two-thirds of those with a mental illness and almost half of those with a serious mental illness did not receive treatment.
• The current generation of young adults appears to be at the forefront of the obesity epidemic and is more vulnerable than previous generations to obesity-related health consequences in later years. The National Longitudinal Study of Adolescent Health (Add Health) found that obesity rates more than tripled from adolescence (11 percent in 1995) to young adulthood (37 percent in 2008). More than one in four of those aged 24-32 had hypertension, 69 percent were prehypertensive, 7 percent had diabetes, and 27 percent were prediabetic.
• Prejudice and discrimination can negatively impact the health and well-being of young adults of color, but such factors as high racial/ethnic pride and exposure to both the familial and the dominant cultures can be protective.

The higher levels of poor health in young adulthood have important consequences for future health, educational attainment, and economic well-being. Rapid technological changes, economic challenges, and a prolonged transition to adulthood appear to be contributing to the health problems of young adults by increasing their stress and sedentary habits while making them less likely to participate in work and family roles that serve as strong

social controls on risk taking. Therefore, these worrisome trends in young adult health can be expected to continue or worsen.

Supporting Young Adults Will Benefit Society

Much of the burden of the restructured economy has been borne by America’s young adults. Young adults are resilient and adaptable, and many make remarkable accomplishments, demonstrating an extraordinary capacity for creative insight and innovation. At the same time, however, too many young adults are struggling to find a path to employment, economic security, and well-being. Healthy, productive, and skilled young adults are critical to the nation’s workforce, global competitiveness, public safety, and national security. However, estimates indicate, for example, that 12 percent of all age-eligible men and 35 percent of all age-eligible women were unable to meet U.S. Army standards for weight-to-height ratio and percent body fat in 2007-2008. Furthermore, the DoD reported that between 2006 and 2011 62,000 individuals who arrived for military training failed their entrance physical because of their weight.

RECOMMENDATIONS FOR ACTION

Three common themes emerged from the committee’s review of public and private policies and programs pertaining to young adults in the areas of education and employment, civic engagement and national service, public health, health care systems, and government programs for marginalized young adults. First, current policies and programs addressing this population too often are fragmented and uncoordinated. Second, these policies and programs often are inadequately focused on the specific developmental needs of this population. And third, the evidence base on interventions, policies, programs, and service designs that are effective for young adults is limited in most areas.

What is needed now is a coordinated effort by the public and private sectors to raise public awareness of the need to improve policies and programs that address the needs of young adults. To meet the unique needs of young adults will require heightened public understanding of the challenges they face and a robust public and private investment in their education and opportunities for employment. Investments in marginalized populations are particularly needed to reduce inequalities during the young adult years and increase the supply of skilled workers to serve the nation’s future needs. Investing in public health and clinical preventive services will also be important because health underlies young adults’ abilities to be successful in education, employment, and social relationships. Efforts to prevent and ameliorate the effects of behavioral health problems, including mood

disorders, stress-related dysfunction, and substance use disorders, are critical as well.

Also key will be engaging young adults themselves—and not just high achievers—in the development of policies and programs that affect them. The powerful influence of young people who have lived in foster care in developing federal and state child welfare policy over the past two decades illustrates the potential of better engaging young adults in policy and program development.

While the need to invest in young adults is clear, the ideal nature of those investments is less so. As a result, the committee has generally avoided making recommendations for large-scale policy change. Instead, the current state of knowledge calls for coordination among federal, state, and local governments and philanthropies in engaging in experimentation to help identify the most effective approaches to improving the prospects of young adults. The most immediate tasks are to improve data and research and to make a concentrated effort to evaluate existing policies and programs at every level so as to achieve greater specificity and improve outcomes for young adults, while exploring new policies and programs. In the few contexts in which the evidence appears sufficient (e.g., education and employment), we have recommended some specific actions.

The committee first offers a cross-cutting recommendation that applies to all policies and programs addressing young adults, whether public or private, in all sectors of society. Subsequent recommendations focus on the key domains of education and employment, civic engagement and national service, public health, health care systems, and government investments in marginalized young adults.

Cross-Cutting Recommendation

Recommendation 9-1³: Federal, state, and local governments and nongovernmental entities that fund programs serving young adults or research affecting the health, safety, or well-being of this population should differentiate young adults from adolescents and older adults whenever permitted by law and programmatically appropriate.

To implement this recommendation, specific actions should be taken to

• modify reporting of data to identify young adults (aged 18-26) as a distinct age group in all reports, evaluations, and open data systems in which they are included;

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³ The committee’s recommendations are numbered according to the chapter of the main text in which they appear.

• enhance new or existing surveys or experimental research focused on either adolescents or adults to advance knowledge regarding the health and well-being of young adults and healthy transitions into young adulthood;
• ensure that services provided to young adults are developmentally and culturally appropriate, recognizing that while adolescent or general adult services may sometimes be appropriate, modifications to existing services or entirely new approaches may be needed;
• engage diverse young adults in designing and implementing programs and services;
• support workforce training for health and human services providers to develop the skills and knowledge needed to work with young adults and their families;
• seek opportunities for coordinating services and, where possible, integrating them to achieve greater effectiveness and efficiency; and
• develop, implement, and evaluate systematic policy and program experiments to help identify the most effective approaches to improving the prospects of young adults.

It is important to note that this recommendation is not intended to imply the creation of an extensive set of new programs targeted only at young adults. Such an approach would have the potential to create new silos and similar concerns about discontinuities and lack of coordination as are found currently across programs for children/adolescents and adults. Rather, the intent is to increase focus on how policies and programs are currently working for young adults. We recommend the adaptation or creation of new policies, programs, and practices only when the evidence indicates that young adults’ specific needs are not being met, with an emphasis on first attempting to modify existing efforts to better suit young adults. Further, we emphasize the importance of considering the transitions into and out of young adulthood to avoid inadvertently creating new discontinuities.

Relationships

Findings from recent two-generation programs, which invest simultaneously in young children and their parents, are promising and could be monitored closely, with successful programs being expanded to new sites. Such programs show potential for enhancing the outcomes experienced by young adults, and it is important that the programs value the parents as individuals in addition to the vital role they play in relation to the children.

Recommendation 3-1: In funding the implementation and evaluation of two-generation programs, philanthropic funders and federal government agencies should actively monitor the outcomes of the young parent participants in addition to early childhood outcomes. Doing so would be valuable for programs that target primarily health and well-being (such as home visiting programs), as well as those that target primarily human capital development.

Education and Employment

Enhancing the opportunities and the success of young adults will require (1) raising completion rates in high school and among those who enroll in postsecondary institutions, and (2) ensuring that the skills and credentials attained are ones the labor market actually rewards. To accomplish these goals will require better integrating institutions of secondary and higher education with workforce agencies and ensuring that both are more responsive to labor market needs than is the case today. In addition, more research is needed on what works for young adults who are neither working nor in education and those with disabilities and chronic health conditions.

Recommendation 4-1: State governments, with support from the U.S. Department of Education, should experiment with and evaluate a range of interventions designed to improve graduation rates at high schools and colleges, as well as the rates at which high school dropouts receive their General Educational Development (GED) credential and enroll in college or job training. These experiments should be primarily attempts to scale up interventions that have already been rigorously evaluated and generated positive impacts, such as (1) GED preparation or accelerated developmental education programs in college that integrate training (or at least labor market information) with remediation, (2) financial assistance that is more closely tied to individual performance as well as family income, (3) the provision of more information about college quality to high school students, and (4) mandated academic and career counseling for college students.

To encourage experimentation and evaluation of these interventions, the committee recommends the following specific actions:

• The U.S. Department of Education should continue to provide competitive grants for states that implement such interventions state- or county-wide and rigorously evaluate them, as it has done recently through its High School Graduation Initiative.

• The U.S. Department of Education should provide technical assistance for any states that undertake such interventions.
• State governments should encourage local school systems and the 2- and 4-year colleges in their state to implement such interventions, including by providing resources and assistance, and should rigorously evaluate them.
• State and local school systems should particularly experiment with and evaluate programs designed to reduce the enormous disparities in high school and college completion that now exist by race, family income, and geographic location (urban versus rural).
• State governments should promote the adoption by colleges of health and social supports that appear to encourage academic success among young adult enrollees.

Recommendation 4-2: State governments, with support from the U.S. Departments of Education and Labor, should implement and evaluate education and workforce development approaches that are more closely tied to high-demand economic sectors. These approaches should include sectoral models and partnerships (e.g., among employers, community colleges, and intermediaries), career pathways, high-quality career and technical education in high school, apprenticeships, and other forms of work-based learning.

To facilitate the implementation of these education and workforce development approaches, the committee recommends the following specific actions:

• The U.S. Departments of Education and Labor should provide competitive grants—perhaps modeled on the Race to the Top program for K-12 education, which had large impacts on state policy and practice—for states that implement such interventions at a medium or large scale and rigorously evaluate them.
• The U.S. Departments of Education and Labor should provide technical assistance for any states that undertake such interventions.
• State governments should encourage local colleges and workforce boards to implement such interventions, including by providing resources and assistance, and should rigorously evaluate them.

To improve the education and employment outcomes of young adults and also the efficiency of resources spent on higher education and workforce development, it will be necessary to improve both the information available to students and workers and the incentives for education institutions to improve the outcomes they generate.

Recommendation 4-3: State governments should experiment with and evaluate providing performance-based subsidies to their public colleges and universities, with performance being measured by credits earned, time to degree, and graduation rates. Weight also should be given to the subsequent labor market employment and earnings of graduates. States should ensure as well that college students have access to up-to-date labor market information and career counseling based on that information.

To facilitate state governments’ implementation of these education and workforce development incentives, the committee recommends the following specific actions:

• The U.S. Departments of Education and Labor should provide competitive grants for states’ use of performance-based subsidies for public colleges and universities. These grants should be targeted at states that implement such incentives state-wide and rigorously evaluate them.
• The U.S. Departments of Education and Labor should provide technical assistance for any states that undertake such incentives.
• States should give substantial weight to performance measures for specifically disadvantaged populations to help ensure that colleges meet performance requirements by applying improved practices to populations similar to those they have been serving, rather than by raising admission requirements to exclude more-disadvantaged students.

Civic Engagement and National Service

Civic engagement and national service, including military service, can contribute to optimal development during the transition to adulthood by providing new and alternative opportunities to contribute to society in meaningful ways, to form one’s identity, and to explore the larger world. For some, national service is a logical next step after college; for those who do not go on to college, it can be a path to social incorporation and to skill and network building. If national service is to serve this function for marginalized young adults, however, it must provide at least some of the scaffolds (mentoring, counseling, education and training, guided practice in leadership and teamwork) that are built into curricular and co-curricular college life. To this end, sponsors of such programs need to focus on the development of the participants as well as community impact when evaluating program success. Unfortunately, the Corporation for National and Community Service recently shifted its evaluation priorities to focus primar-

ily on community impact rather than on participants’ development. This policy should be modified.

Recommendation 5-1: The Corporation for National and Community Service, the U.S. Department of Labor, and other entities that fund service programs should expand and improve opportunities for service for all young adults. They also should emphasize member development (in addition to community impact) in program evaluations, including the short- and long-term effects of service on participants’ health and well-being.

Public Health

Because young adults confront more challenges to health and safety than is commonly assumed, and given the desirability of nurturing lifelong healthy habits, public health programs and clinical preventive services for young adults should be a high priority. Mobile digital media and social networking have the potential to play a pivotal role as vehicles for public health interventions, and research on the effectiveness of these technologies is a high priority.

Community interventions focused on binge drinking and alcohol-impaired driving, as well as tobacco control, demonstrate the effectiveness of multipronged and reinforcing community interventions that target and are tailored to individual behavior as well as the social environment and legal context. Such interventions require concerted and sustained implementation and a clear commitment to documenting outcomes for different groups of young adults (e.g., rural versus urban, by educational status). Very few state or local public health programs, however, have attempted to coordinate or integrate programs for young adults, although such initiatives have been undertaken in a handful of states. Several recent federal initiatives also represent a nascent effort to promote and support policies and practices reflecting an integrated understanding of young adulthood. Under the new Adolescent and Young Adult Health Program funded by HRSA, states and localities will be encouraged to expand services beyond adolescents.

Recommendation 6-1: State and local public health departments should establish an office to coordinate programs and services bearing on the health, safety, and well-being of young adults. If a separate office is not established for young adults, these responsibilities should be assigned to the adolescent health coordinator.

This initiative would promote the development of state- and community-level partnerships to advance coordination and integration through collab-

orative activities that promote the health, safety, and well-being of young adults.

In addition, to strengthen the collective ability to address the needs of young adults, the committee makes the following recommendation:

Recommendation 6-2: Each community should establish a multistakeholder private-public coalition on “Healthy Transitions to Adulthood,” with the goal of promoting the education, health, safety, and well-being of all young adults. State or local public health agencies should take the lead in convening these coalitions. The coalitions should include young adults; colleges and universities; providers of career and technical education; employers; youth organizations; nonprofit organizations; medical specialties providing primary care to young adults; and other community organizations serving, supporting, or investing in young adults. These initiatives should mobilize public and private engagement and support; set priorities; formulate strategies for reaching all groups of young adults who need services and support; and design, implement, and evaluate prevention activities and programs. Initiatives should also incorporate the valuable input of young adults in shaping their scope and activities to ensure that there is traction among those initiatives aimed at improving their health, safety, and well-being.

Forty percent of the U.S. population is anticipated to be affected by the Centers for Disease Control and Prevention’s Community Transformation Grant (CTG) program. The measurable performance goals of the CTG program are to reduce the following by 5 percent within 5 years: death and disability due to tobacco, the rate of obesity through nutrition and physical activity interventions, and death/disability due to heart disease and stroke. This program presents a good opportunity to address some of the issues that are important for young adults.

Recommendation 6-3: Recipients of Community Transformation Grants—including state and local government agencies, tribes and territories, and nonprofit organizations—should incorporate specific targets for young adults in their plans to reach the 5-year measurable performance goals in the areas of reducing death and disability due to tobacco use and reducing the rate of obesity through nutrition and physical activity interventions.

Health Care Systems

The majority of young adults’ health problems are preventable. However, efforts to provide preventive care to young adults are complicated by

(1) the lack of a consolidated package of preventive medical, behavioral, and oral health guidelines focused specifically on the young adult population; (2) the fact that navigating the health care system during the transition from pediatric to adult providers is confusing and difficult, especially for those with behavioral health problems or a chronic condition; and (3) the limited availability of behavioral health interventions developed specifically for young adults, the early stages of development of those interventions for young adults that do exist, and the limited availability of interventions with demonstrated efficacy specifically in this population.

Recommendation 7-1: Health care delivery systems and provider organizations serving young adults (e.g., medical homes, accountable care organizations)—with input from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS)—should improve the transition process for young adults moving from pediatric to adult medical and behavioral health care.

To implement this recommendation, the committee recommends the following specific actions:

• AHRQ should develop quality performance metrics on the transition-of-care process to ensure continuity of care for young adults making this transition.
• CMS should encourage greater attention to this transition within the innovation models that it solicits and funds, such as those from the Center for Medicare & Medicaid Innovation.
• Health care delivery systems and provider organizations serving young adults should develop a coordinated pediatric-to-adult transition-of-care process within their organizations.
• Pediatric-to-adult transition-of-care performance metrics should be incorporated into quality measurement and reporting frameworks by the National Committee for Quality Assurance, the National Quality Forum, and other quality measurement entities for all health care delivery models serving young adults, such as medical homes, accountable care organizations, and integrated delivery systems.
• The Office of the National Coordinator for Health Information Technology should ensure that meaningful use criteria enable the capture of relevant data elements for reporting on the pediatric-to-adult transition-of-care process.
• CMS, health insurers, and purchasing entities such as employer coalitions should incorporate young adult transition-of-care met-

• rics into pay-for-performance initiatives, contracting, and other provider assessments.

• The Maternal and Child Health Bureau in the Health Resources and Services Administration should expand its work on transition-of-care metrics for youth with special health care needs to include all youth and young adults, incorporate such metrics in Title V program requirements, and support related capacity development and training in states.

Recommendation 7-2: The U.S. Preventive Services Task Force should develop a consolidated set of standardized evidence-based recommendations for clinical preventive services such as screenings, counseling services, and preventive medications specifically for young adults aged 18-26. Behavioral and oral health should be included in these recommendations.

Federal, state, and local government entities that fund or provide physical or behavioral health services—including the U.S. Department of Health and Human Services (through the Substance Abuse and Mental Health Services Administration, HRSA, AHRQ, CMS, and the Indian Health Service), DoD, the U.S. Department of Veterans Affairs, and corresponding state and local agencies, in partnership with commercial insurers and employer-sponsored health plans, should be involved in improving preventive care for young adults.

Recommendation 7-3: Federal, state, and local governments, commercial insurers, employer-sponsored health plans, and medical and behavioral health systems should adopt the clinical preventive services recommended by the U.S. Preventive Services Task Force, include the delivery of those services in quality performance metrics used for pay-for-performance and other health care provider assessments, and require public reporting of compliance.

Recommendation 7-4: The National Institutes of Health should support research aimed at developing a set of evidence-based practices for medical and behavioral health care, including prevention, for young adults. This research should build on the existing and established evidence-based practices (EBPs) for populations that are older (i.e., adults in general) or younger (i.e., adolescents) to

• identify those EBPs that hold promise for being effective in this age group and test them for efficacy;

• identify EBPs that are likely to be effective with modification for this age group and test the efficacy of the modified versions; and
• identify behavioral and medical health care needs that are unlikely to be addressed by existing or modified EBPs and conduct research to develop and establish new EBPs for young adults in these areas.

In developing methodologies for implementing this recommendation, it will be important to take into account socioeconomic position and racial, ethnic, and geographic disparities and differences, as well as differences according to immigrant and refugee status, across the full spectrum of the social, behavioral, and health indicators under discussion.

Government Investments in Marginalized Populations

Although young adults from marginalized populations are a heterogeneous group, they share a number of characteristics and experiences, such as living in poverty and behavioral health problems. Similarly, there is considerable overlap in the populations reached by the many programs that serve marginalized young adults. However, the lack of a comprehensive view of these populations limits the development of policies and programs intended to reduce their marginalization.

Recommendation 8-1: Federal and state government agencies—including the U.S. Departments of Health and Human Services, Labor, Justice, Housing and Urban Development, and Education and the corresponding state agencies—should incorporate a greater focus on marginalized young adults in ongoing and new population-based cross-sectional and longitudinal studies of young adults.

To implement this recommendation, the committee recommends the following specific actions:

• In conducting ongoing studies and developing new studies, agencies should actively involve planning and advisory groups comprising researchers and program managers familiar with the various marginalized populations, as well as representatives from these populations who have experienced such life events. Doing so would help ensure that study designs, including sampling and recruitment strategies and survey items, will better capture the experiences of these populations.
• Agencies should consider oversampling of marginalized populations to better distinguish their experiences from those of other young adults.

Recommendation 8-2: Federal and state governments should continue encouraging programs that serve marginalized populations to make better use of administrative data for describing the overlap of populations across service systems and young adults’ trajectories into and out of these systems, and for evaluating policies and programs affecting young adults.

To implement this recommendation, the committee recommends the following specific actions:

• Federal agencies operating programs that affect young adults should aggressively implement the recent Office of Management and Budget “Guidance for Providing and Using Administrative Data for Statistical Purposes.”
• Federal agencies serving young adults—including the U.S. Departments of Health and Human Services, Labor, Justice, Housing and Urban Development, and Education—and philanthropic funders should fund demonstration projects at the state level to support states in integrating program administrative data to better understand marginalized young adults and evaluate programs serving them.
• State government agencies serving marginalized young adults should expand on existing state and local efforts to integrate and use administrative data to better understand and serve these young adults.

Fragmented programs have narrow and idiosyncratic eligibility criteria that hinder young adults from obtaining the help they need, often create lapses in help when it is provided, and too often are stigmatizing. Major entitlement programs intended to help marginalized populations provide limited support for young adults, and discretionary programs targeting these populations often fall far short of meeting demonstrable needs. Collective accountability for improving the overall health and well-being of marginalized young adults is hampered by the multiple distinct, and often fragmented and uncoordinated, outputs and outcomes associated with the plethora of programs.

Recommendation 8-3: Congress and the Executive Branch should amend federal laws and regulations to allow for more flexible and efficient eligibility determination and service provision across marginalized young adult populations.

Recommendation 8-4: Congress and the Executive Branch at the federal level and state legislatures and governors at the state level should amend laws and regulations to create accountability for achieving improvement on a limited set of key outcomes for marginalized young adults (e.g., employment, education, housing stability, safety, health, connections to responsible adults, and effective parenting).

Recommendation 8-5: In funding evaluations of programs for marginalized young adults, the federal government and philanthropic funders should emphasize evaluation of programs aimed at improving outcomes across multiple marginalized populations while remaining sensitive to differences across subpopulations.

CONCLUSION

Focusing on the health and well-being of the current cohort of young adults (those becoming adults in the first third of the 21st century) is especially important because of the powerful (and perhaps transformative) economic and social forces now at work—the restructuring of the economy, widening inequality, a rapidly increasing “elder dependency ratio” (i.e., the ratio of the population aged 65 and older to the working-age population), a substantial increase in immigration, and the increasing diversity of the U.S. population. The future well-being of the nation rests on the investments made in all young adults today—particularly those whose background and characteristics put them at risk of experiencing the greatest struggles. Providing more of the educational, economic, social, and health supports they need will help ensure equal opportunity, erase disparities, and enable more young adults to successfully embrace adult roles as healthy workers, parents, and citizens.