Young adulthood, spanning approximately ages 18 to 26,1 is a transitional period during the life course when young people are traditionally expected to become financially independent, to establish romantic relationships and become parents, and to assume responsible roles as productive and engaged members of the community. From a developmental point of view, young adulthood is characterized by a period of normal and predictable biological and psychological maturation, but the specific social roles and tasks expected of each cohort of young adults are determined by the characteristics of the particular society at a particular time in history. In contemporary American society, young adulthood is marked by great heterogeneity of transitional experiences, with considerable variability in the timing, sequencing, and content of social roles and tasks.
The social expectations associated with young adulthood in the United States have changed markedly in recent decades. Many people do not view or treat young people aged 18-26 as adults, perhaps because their life experiences do not match traditional views of adulthood as a time of being both independent and responsible for others (Settersten and Ray, 2010). Indeed, national surveys reveal that only a bare majority of Americans label people in their early 20s as adults, even though large majorities did so in the past (Taylor et al., 2012). As they move from adolescence into adulthood, therefore, young adults do not seem to be either adolescents or adults, but
1 The ages of 18 and 26 are arbitrary markers of the boundaries of both the developmental process and the social transitions that define young adulthood. Moving the markers to 16 and 30 would encompass a wider range of individual variation.
a little of both. The uncertainty of this “in-between” period and the ways in which it flows out of early life trajectories and shapes future life trajectories make it a time of both individual risk and opportunity, and a time when societal inequalities may be reproduced or reduced. As a result, social and institutional supports that may help young people navigate these uncertain years toward more certain futures assume particular importance (Arnett, 2004; Furstenberg, 2010; Roisman et al., 2004).
A systematic approach to understanding and responding to the unique circumstances and needs of today’s young adults can help pave the way to a more productive and equitable tomorrow for young adults in particular and U.S. society at large. Unfortunately, despite popular attention to the special circumstances of young adults,2 they are rarely treated as a distinct subpopulation in research and policy. Instead, they are often grouped with adolescents or, more often, with all adults. As the “in-between” subpopulation, they are getting lost in the shuffle.
Recognizing this paucity of attention to young adulthood as a distinct period of life in policy and research, the Health Resources and Services Administration 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 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. To respond to this charge, the IOM and the NRC appointed the Committee on Improving the Health, Safety, and Well-Being of Young Adults, drawn from both the public and private sectors, with expertise in public health, health care, behavioral health, social services, human development, psychology, neuroscience, demography, justice and law, sociology, economics, family studies, and media and communication. The committee’s full statement of task is in Box 1-1, and biosketches of the committee members are in Appendix D.
The committee’s work is well situated in a rich intellectual and scientific tradition focused on understanding and studying the development of trajectories over the life course, as described below. In addition, several recent federal initiatives reflect a nascent effort to focus research and policy
2 See the 2010 New York Times Magazine cover asking, “What Is It About Twentysomethings?”
Statement of Task
An ad hoc committee will conduct a study and prepare a report on the state of the science and policies pertinent to the life course of young adults (approximately 18-26 years old), as well as their transitions from adolescence (starting at about age 16) and to full adulthood (up to about age 30). The study will constitute Phase 2 of a three-part effort, following the completion in Phase 1 of the workshop titled “Improving the Health, Safety, and Well-Being of Young Adults, a Hidden Population.” The study committee will review the available literature on young adults in the context of their health and development, building on the workshop as appropriate; the committee will also consider systems and institutions that provide pathways from adolescence into adulthood; and policies that impact young adult health and well-being. The following topics are of interest:
- The demographic profile of young adults today and historical shifts over time
- Neurobiological development of young adults
- Health behaviors, including substance abuse, and relationship to later outcomes
- Health and well-being of vulnerable populations
- Health and well-being of first-, second-, and third-generation immigrants
- Well-being of young adults in public systems and institutions (e.g., military, justice, welfare, college/university)
- Application of public health practices, and access to and use of health services
- Shifting roles and responsibilities within the family unit
- Labor force, economic, and civic engagement
- Policies that foster young adult health and well-being
- How young adults receive information and make decisions
Based on currently available evidence, the report will include—but will not necessarily be limited to—consideration of the above topics. Among these topics, the report may provide particular attention to policy and program areas that have the greatest potential for impacting young adults’ lives. The report will provide recommendations for policies, programs, research, systems development, and service delivery that can facilitate the health, safety, and well-being of all young adults and inform policy makers and other stakeholders. The report will also inform institutions serving young adults. Recommendations will be primarily geared toward federal departments and their agencies (e.g., U.S. Department of Health and Human Services and such agencies as the Health Resources and Services Administration/Maternal and Child Health Bureau; National Institutes of Health; Centers for Disease Control and Prevention; Agency for Healthcare Research and Quality; Substance Abuse and Mental Health Services Administration; U.S. Department of Defense; U.S. Department of Labor; U.S. Department of Justice) as well as state agencies. As appropriate, the report may also provide recommendations aimed at legislatures, local governments, and nongovernmental entities. The report will also identify areas for further research to answer questions raised during the study process. Phase 3 will be planned to cover the dissemination/communication of the reports resulting from Phases 1 and 2.
Selected Federal Initiatives on Young Adults
My Brother’s Keeper. This initiative of President Obama is intended to address persistent employment and education gaps for boys and young men of color, which continue throughout their lives, and to encourage action and partnerships to this end across multiple sectors, including government, business, nonprofit, philanthropic, faith, and community partners (My Brother’s Keeper Task Force, 2014; Obama, 2014).
Young Adult Indicator Data. The Federal Interagency Forum on Child and Family Statistics released a special issue report on young adult data indicators in July 2014. This report provides data from nationally representative, federally sponsored surveys on young adults aged 18-24 in the following key areas: education; economic circumstances; family formation; civic, social, and personal behavior; and health and safety (Federal Interagency Forum on Child and Family Statistics, 2014).
Healthy People 2020 Adolescent and Young Adult Indicators. Healthy People establishes health goals and objectives, which are revised every 10 years to reflect changes in the health challenges facing the nation. Healthy People 2020 addresses adolescents and young adults in greater depth than in previous decades by identifying 41 indicators for adolescent and young adult health (HHS, 2012). These include outcome and system-level indicators in seven areas: health care, healthy development, injury and violence prevention, mental health, substance abuse, sexual health, and prevention of chronic diseases of adulthood.
The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Grants to Improve Mental Health Services for Young People. In September 2014, the U.S. Department of Health and Human Services announced $99 million in grants for an expanded set of mental health initiatives, with a particular focus on children and young people (HHS, 2014a). This effort is a component of President Obama’s Now Is the Time plan, which is focused on reducing gun violence (The White House, 2013). The fiscal year 2015 budget provides SAMHSA with $130 million to use for mental health treatment for students, which is estimated to impact 750,000 young people (HHS, 2014b). Two of these SAMHSA initiatives are particularly relevant to young adults. First, working with the Health Resources and Services Administration, SAMHSA will provide $35 million toward training mental health professionals to serve students and young adults. Second, SAMHSA will award $20 million in grants in the Healthy Transitions program, which will support young adults aged 16-25—and their families—at high risk for mental illness, substance abuse, and suicide (SAMHSA, 2014).
The above are examples of initiatives that include a major focus on young adults. Other government initiatives focus on preparing adolescents for the transition to adulthood. An example of such an initiative is Promoting Readiness of Minors in Supplemental Security Income (PROMISE), a major interagency initiative to help youth with disabilities transition successfully to adult self-sufficiency (U.S. Department of Education, 2014).
development on the distinct capacities, vulnerabilities, and needs of young adults (see Box 1-2). This report is intended to build on these efforts, with a particular focus on the health and well-being of young adults.
The Intellectual and Scientific Context
This report builds on the work of an influential sequence of research networks funded by the John D. and Catherine T. MacArthur Foundation over several decades, including initiatives on successful aging, midlife, and adolescent development. The Network on Transitions to Adulthood brought together a diverse group of scholars from 2000 to 2009 to examine the changing nature of early adulthood (MacArthur, 2014). Major program areas were education, labor economics, marriage and relationships, changing attitudes and norms, and various populations of young adults. This fruitful initiative resulted in many books, briefs, and articles (e.g., Carr and Kefalas, 2009; Danziger and Rouse, 2007; Osgood et al., 2005; Settersten and Ray, 2010; Settersten et al., 2005; Waters et al., 2011). The present report extends the MacArthur network’s extensive body of work by incorporating a focus on health and well-being, connecting the study of young adulthood to recent advances in developmental neuroscience, incorporating research published since the network finished its work, and offering concrete policy and program recommendations.
The Policy Context
The importance of focusing policy attention on young adults has become increasingly evident. An aim of this report is to consolidate information on these efforts and encourage similar initiatives by other federal agencies.
This report represents the second phase of a three-phase project. The first phase was a large public workshop held in May 2013 to highlight research on the development, health, safety, and well-being of young adults. A published summary of the workshop presentations and discussions is available (IOM and NRC, 2013). The second phase was the consensus study that produced this report and is described in more detail below. The third phase will be extensive communication and dissemination activities.
The committee’s work on this report was accomplished over a 12-month period that started in October 2013. The committee held four meetings between December 2013 and June 2014 that included both closed-session deliberations and open-session information-gathering dialogues with subject
matter experts and stakeholders. During the first meeting, the committee received its charge from sponsors and held an information-gathering session to gain an overview of selected federal policies and programs relevant to the health, safety, and well-being of young adults. The second meeting included a 1-day workshop focused primarily on state policies and programs that impact young adults’ health, safety, and well-being. That workshop also included a session on social media and information technology. The third meeting included a brief information-gathering session that explored the experience of young adults in the justice system. The agendas for these public sessions are available in Appendix A. The May 2013 workshop and its published summary, mentioned above, also were an important source of information for the committee (IOM and NRC, 2013).
In addition to the above information-gathering sessions, the committee examined the relevant peer-reviewed literature and available information on state and federal policies and programs; gathered information through personal contacts; and commissioned a paper on civic engagement, volunteerism, and national service programs and their impact on young adults’ well-being. This paper provided extensive material for Chapter 5 of this report and is included in full on the project website.3
A young adult advisory group also informed the committee’s work. This group of eight young adults met with the committee twice in person and several times by conference call to provide input and feedback on the topics the committee was examining. A brief vignette about each member appears in the prologue to this report, and the members are quoted throughout the report. The group’s members were identified through organizations that work with young adults and through individual recommendations, and several had spoken at the May 2013 public workshop. Collectively, they brought diverse perspectives and experiences to this study, but their stories and views are not intended to be representative of all young adults. The group’s members provided written permission to include their stories, quotes, and names.
This section explains the use of key terms in this report and provides some brief comments about how the committee approached its task. Chapter 2 offers a broader introduction to the report, including background information and key findings and their implications for policy and programs.
Key Terms and Definitions
This report defines young adults as individuals aged approximately 18-26 and focuses primarily on this age range. Recognizing the continuity of human development and the fact that some individuals will take on typical “young adult” tasks at slightly younger and slightly older ages, the report also considers the transitions from adolescence (starting at about age 16) into full adulthood (up to about age 30). There are no definitive reasons to select these specific cut-off points, and it will sometimes make sense to adjust the age period to take account of unique considerations in a particular policy context. However, in an effort to promote consistency in data analysis across domains of research and policy, the committee arrived at the age range 18-26 after considerable deliberation. The choice of 18 as the lower bound of young adulthood is conventional from a societal point of view—it is the “age of majority,” the point at which individuals are legally considered adults not only in this country but in many other countries around the world as well. The choice of 26 as the upper bound is less clear. From biological and societal perspectives, no compelling evidence supports 26 versus 24, 25, 27, or 28. The committee’s selection of 26 rests primarily on societal considerations. Based on the evidence reviewed in Chapter 2, 26 (up to the 27th birthday) denotes a point at which a large portion of young adults have completed some of the transitions typically associated with adulthood and are settling into adult status in society. Many current data sources use 24 as the upper bound,4 which appears to underestimate the duration of this transitional period for most young adults. Further, it is noteworthy that the 26th birthday is the age used in the Patient Protection and Affordable Care Act to mark the point at which young adults are no longer covered under a parent’s health insurance policy—the most prominent policy to date to recognize the special needs of young adults during this transitional period.
To refer to the age group immediately younger than young adults, the committee uses the terms adolescents and youth in the disciplinary contexts in which these terms are typically used. For example, adolescent is more common in health fields, while youth is commonly used in economics and can sometimes encompass both older adolescents and young adults (e.g., ages 16-24). Just as we have described for young adults, a variety of different age ranges also are used for adolescents (for an overview, see NRC and IOM ). To differentiate adolescents from young adults for the
4 For example, the data sources used in the Healthy People 2020 core indicators for adolescent and young adult health use the following age ranges for young adults: 18-24, 18-21, 22-24, 20-24, and 21-24 (HHS, 2012).
purposes of this report, we consider age 17 to be the upper boundary of adolescence. We use the term children to refer to the youngest individuals.
Health and Well-Being
The report takes a broad view of the health and well-being of young adults, applying the World Health Organization’s definition of health as a resource for active living encompassing social, physical, and mental well-being (WHO, 2006). Being healthy in this sense requires access to comprehensive, quality, and affordable medical care. But it also necessitates the use of system-level approaches to create and sustain the conditions needed for health and well-being, including strong families, supportive social networks, educational attainment, and productive employment.
The term health care is used broadly in this report to include both physical and behavioral health. Physical health is a general term encompassing the human body’s capacity to meet life’s demands. It includes the promotion of overall physical fitness and the prevention and treatment of diseases and medical conditions that impair the normal functions of the body, including dental, medical, and developmental functions. The term behavioral health is a general term encompassing the promotion of emotional health; the prevention of mental and substance use disorders; and treatments and services for substance abuse, addiction, and mental and substance use disorders (SAMHSA, 2011). When one of these two areas of health care is specifically being discussed, the particular term is used; otherwise the term health care applies to both physical and behavioral health.
Young Adults Who Are Marginalized, Disadvantaged, and Disconnected
Studies and official policy documents pertaining to young adults use different terms to refer to those who face the most challenging obstacles in making a successful transition to independent adulthood. The committee has chosen to use marginalized young adults as the primary term in referring to this population, while reserving two other terms for contexts in which their use is standard in the pertinent discipline.
Marginalized young adults are young adults who exhibit characteristics that put them at risk for poor outcomes during young adulthood. Examples of young adults who may be marginalized are those living in poverty, children of low-income immigrants, those aging out of foster care, those in the justice system, those with disabilities, those who have dropped out of school, and those who bear responsibility for raising young children. Our
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 (Daly and Silver, 2008; Mathiesen et al., 2008; Sen, 2000). 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. An emphasis on social inclusion calls for the identification of policies that exclude certain groups from full participation in society and the development of policies that enhance opportunities for full participation. We believe social exclusion is a useful lens through which to view how policies contribute to or ameliorate the relatively poor outcomes experienced by the groups of young people on which we focus here.
While marginalized young adults is the primary term used in this report, two other terms with related but distinct meanings are used in the context of young adults’ educational attainment and employment. Disadvantaged young adults refers to young adults who come from families with lower incomes and/or educational attainment, while young adults who are disconnected are those without parental responsibilities who are neither enrolled in education nor employed.5
A Lens on Young Adults
The primary lens of this report is on young adults themselves, and of course this is an important focus, particularly in areas in which morbidity, mortality, and well-being indicators show worse outcomes for this age group relative to younger and older groups or long-term impacts throughout adulthood. However, the research presented in the report also makes clear that young adults’ well-being has a critical impact on society at large, in both the short and long terms. Since many young adults are parents of young children, the report also highlights that investing in young adults has potential benefits for their young children, and therefore can complement existing efforts to support the health, safety, and well-being of the youngest members of society.
5 A report by Belfield and colleagues (2012) coined the term opportunity youth to describe young people, disconnected from all major institutions, who present an opportunity for society to devise new ways to reengage them. Although this term conveys an important point about the promise associated with better supporting these young adults, we have elected to use marginalized to emphasize society’s role in the circumstances of these young adults, as described above in the Key Terms and Definitions section.
Program Selection and Data Limitations
A challenge entailed in preparing this report was the overwhelming number and range of state and federal policies and programs that are potentially relevant to young adults and, at the same time, a paucity of data specific to young adults within these programs.
Young adults are eligible for inclusion in a majority of federal programs aimed at adults in such domains as labor, education, justice, health, and social services, with the exception of programs that target solely adults of retirement age and older. Young adults, particularly those aged 18 to 21, also are included in many programs and systems for children and adolescents. Only a couple of federal programs exclusively target young adults. Therefore, the committee had to consider both youth- and adult-targeted programs, as well as transitions between the two, which occur at different ages depending on the system and state. There are also a large number of specialty programs that target specific populations and outcomes, as illustrated particularly in Chapter 8, which examines government programs for marginalized young adults. In selecting programs for particular attention within the report, the committee focused primarily on those that serve a large number of young adults and those that are most relevant to the critical tasks of young adulthood, such as completing education, finding and keeping a job, obtaining health care coverage, and learning to navigate the adult health system.
Despite the abundance of programs that potentially impact young adults, specific information on young adults is frequently missing because they often are combined with adolescents in youth-focused programs and with older adults in adult-focused programs. In many cases, it was difficult to ascertain the number of young adults within the population served, and evaluation efforts typically did not assess effectiveness specifically for young adults. As described further in Chapter 2, there are developmental reasons why programs that show effectiveness across adults generally may not necessarily be effective for young adults, and vice versa.
Scope and Focus of the Report
The committee faced several challenges in determining how to carry out a charge that was so broad in scope (see Box 1-1). First, the charge called for reviewing the “the state of the science . . . pertinent to the life course of young adults.” A wide-angle lens was required to synthesize knowledge and draw general conclusions about the health and well-being of the whole population of young adults. We have attempted to accomplish this in Chapter 2, which provides a broad overview of the complex transition from adolescence to young adulthood. At the same time, the charge invited
specific recommendations for action in those “policy and program areas with the greatest potential” to affect the lives of young adults. To this end, we exercised our collective judgment in selecting several areas to explore in depth in the remainder of the report.
Topics Explored in Depth
The committee chose to concentrate on five policy-relevant domains. The programs and policies most central to the study charge are those relating to health (Chapters 6 and 7) and education and employment (Chapter 4). In addition, we chose to focus on policies and programs designed to serve populations of young adults perceived to be in need of help beyond what is available from their families and communities (Chapter 8). We also examined the relationships that are created during young adulthood, as well as the continuing relationships with parents, and considered policy and program implications of findings in this domain (Chapter 3). Finally, we chose to focus on civic engagement and national service because of the many government programs in this area and the salience of these activities to young adulthood (Chapter 5).
Many other policy areas also merit attention, including parental support obligations, correctional programs for young adult offenders, and services and supports available to unauthorized immigrants. While these topics are mentioned in the report, the committee was not well constituted to delve deeply into family policy, criminal justice administration, or immigration policy. Another area we chose not to address in depth is the highly specialized body of law, policies, and programs pertaining to young adults with severe developmental disabilities. While these individuals and their families confront transitions related to legal classifications and services during the age period of interest (18-26), those transitions differ substantially, in developmental and social terms, from those that lie at the center of this report for young adults who have opportunities for a successful transition to independent adulthood.
Another challenge the committee faced was finding the right approach for conveying, in a single, integrated report, the diverse experiences, pathways, and trajectories of the heterogeneous population of young adults. The same challenge would confront a committee charged with characterizing the “current status” of “children” or “adolescents” in the United States. Any such developmentally oriented inquiry will reveal wide differences in health and well-being among the individuals in the focal population, divergent trajectories as they age, and variations in the need for interventions to
improve and shift these trajectories. In such a mixed picture, how does the observer develop an integrative narrative? Does one focus on vulnerabilities and risks or on strengths and resilience?
Choice of tone and emphasis was a constant theme in the committee’s deliberations from the outset of the study. Inevitably, a policy-oriented discussion of the health, safety, and well-being of any population will tend to focus on the left end of the distribution (on young adults with greater needs) and on the potential value of interventions, rather than on those who are more successful and who do not require interventions to keep them on track. However, this tendency to focus on the negative was frequently counteracted by reminders that the period of young adulthood is also a time when even the most disadvantaged young people demonstrate resilience and when many young people make remarkable accomplishments, demonstrating an extraordinary capacity for creative insight and innovation. That being said, this report does tend to focus on those areas in which opportunities for healthy productive futures are now being squandered and in which support and protection are most needed to help young adults live healthy and productive lives and contribute to the well-being of their families and communities.
Haves and Have-Nots
Chapter 2 provides a broad overview of the diverse pathways into adulthood taken by recent cohorts of young adults, ranging from those who progress through these transition years with strong financial and emotional support from parents to those who have no connections with parents and little financial support for education, workforce entry, and the creation of strong social relationships. One of the committee’s concerns is that the demands of education, workforce entry, and parenting faced by young adults today tend to magnify the effects of preexisting inequality. Thus, from a policy standpoint, the report naturally emphasizes the need to provide the resources and supports that will enable the least advantaged young adults to accomplish successful transitions to independent and productive lives as adults. The transcendent goal is preserving opportunity for all young adults.
Racial and Ethnic Disparities
Every domain of public policy in the United States is bedeviled by disparities in outcomes associated with race and ethnicity and by the challenges of eliminating these disparities. In the context of this report, the committee describes disparities in educational achievement, employment, health and health care outcomes, and participation in social service programs. However, further focused efforts are needed to provide in-depth analyses of
the causes and consequences of disparities in each of these policy domains and to develop detailed policies to address them among young adults. A related topic of direct relevance to the committee’s charge is the impact of experiencing prejudice and discrimination on the health and well-being of young adults. This topic is addressed briefly in Chapter 2 in the context of observations about the increasing diversity of American life and the prospects for eliminating prejudice and discrimination based on race and ethnicity. Appendix B explores this topic in somewhat greater detail, but the committee is convinced that it warrants a comprehensive review on its own.
The recommendations offered in this report focus primarily on federal and state agencies, as the study charge specifies; the committee was also authorized to direct recommendations to local governments and nongovernmental entities, including private employers. Our main aim in this report is to set the stage for informed policy making. At present, evidence in most areas is insufficient to permit firm recommendations. 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 recommend specific actions. In other areas, we recommend some preliminary strategies designed to promote coordination across currently fragmented program areas and to identify those areas that might be ripe for experimentation and innovation.
The remainder of this report examines young adults’ health, safety, and well-being within various domains. Chapter 2 provides a broad overview of the transitional challenges and opportunities of young adulthood. It summarizes developmental changes occurring during this period and examines the broader social and economic structures that impact young adults’ health, safety, and well-being. The chapter concludes with key findings from this review of development and trends and their implications for policies and programs. Chapter 3 considers young adults’ relationships with their parents, friends, and romantic partners. Chapter 4 focuses on young adults’ education and employment; the discussion includes consideration of the bidirectional relationship between education/employment and health/well-being. Chapter 5 looks at young adults’ civic engagement and participation in national service, including both national service programs and the military. Chapter 6 examines public health priorities, interventions, and
programs for young adults, while Chapter 7 focuses on young adults within the health care system, including consideration of behavioral health. Chapter 8 addresses marginalized young adults and examines the government programs designed to support them. Finally, Chapter 9 provides a summary of the committee’s suggested approach for enhancing young adults’ health, safety, and well-being, including recommendations for policies and programs, as well as priorities for research.
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