Important Points Made by the Speaker
- The combination of risky behaviors, a low awareness of risk, and limited access to health care and insurance poses threats to the health of young adults. (Neinstein)
- Prevention and early intervention for health problems that often have an onset in young adulthood, such as high blood pressure, provides an opportunity to prevent significant longer-term health problems. (Neinstein)
Young adults are often considered to be America’s healthiest age group, but their actual health status is more complicated. The health challenges they face may affect their long-term future. Children with chronic diseases are more often surviving to adulthood. Prominent health disparities affect underrepresented racial and ethnic groups. Physical health encompasses a wide range of issues, and is impacted by emotional health, a person’s developmental stage, community health, and health promotion and prevention. Many of these issues pose special challenges to young adults.
For many health problems, young adults are at higher risk than 12- to 17-year-olds or 26- to 34-year-olds. Young adults also tend to have the lowest awareness of risk and the least access to health care and insurance. “You throw those three things together, and that is a problem, i.e., a ‘perfect storm,’” said Larry Neinstein, professor of pediatrics and medicine at
the University of Southern California Keck School of Medicine. The information in this section is from his recent paper, “The New Adolescents: An Analysis of Health Conditions, Behaviors, Risks, and Access to Services Among Emerging Young Adults” (Neinstein, 2013b). The paper extends beyond physical health issues. This chapter, however, focuses primarily on those concerns that may be considered to fall under the category of physical health; safety and health-related behaviors are the focus of Chapter 4, mental health is the focus of Chapter 6, and the health system is the focus of Chapter 8.
Neinstein listed the leading causes of mortality for 12- to 17-year-olds and for 18- to 25-year-olds (see Table 5-1), with the latter group having more than 2.5 times more deaths. The leading causes of death among 18- to 25-year-olds are unintentional injury (primarily motor vehicle accidents), homicide, and suicide (Neinstein, 2013b). Common morbidities include mental conditions, eating disorders, chronic diseases, substance abuse, back pain, allergies, sinus infections, strep throat, asthma, ear infections, carpal tunnel, fractures, high blood pressure, high cholesterol, chronic fatigue,
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12-17 | 18-25 | |||
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Rank | Cause of Death | Cause of Death | ||
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1 | Unintentional injuries | 11.9 | Unintentional injuries | 39.1 |
2 | Homicide | 4 | Homicide | 14.5 |
3 | Suicide | 3.8 | Suicide | 12 |
4 | Malignant neoplasms | 2.7 | Malignant neoplasms | 4.4 |
5 | Heart disease | 1.1 | Heart disease | 3.2 |
6 | Congenital anomalies | 0.9 | Congenital anomalies | 1.1 |
7 | Cerebrovascular | 0.3 | Diabetes mellitus | 0.6 |
8 | Chronic lower respiratory disease | 0.3 | HIV | 0.6 |
9 | Influenza and pneumonia | 0.3 | Influenza and pneumonia | 0.6 |
10 | Benign neoplasms | 0.2 | Cerebrovascular | 0.5 |
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NOTE: This table was created using data from Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, Underlying Causes of Death 1999-2008, on CDC WONDER Online Database, released 2011. These data are periodically updated by the CDC and posted to its website, http://wonder.cdc.gov.
SOURCE: Neinstein, 2013b.
warts, sexually transmitted infections, and many other conditions that can develop during young adulthood.
More than 10 percent of young adults ages 18-24 are disabled due to a physical, mental, or emotional condition (Neinstein, 2013b). The prevalence of being obese or overweight also increases from adolescence to young adulthood, said Neinstein. Young adults ages 18-25 eat an average of only about two fruits and vegetables per day, compared with the recommendation of five. They do better in meeting recommended physical activity guidelines, but about 40 percent still do not meet the recommendation (Neinstein, 2013a).
Diagnoses of diabetes rose from less than 1 percent for 18- to 25-year-olds to 2 percent for 26- to 34-year-olds (Neinstein, 2013a). Others have laboratory results that point toward diabetes but are undiagnosed. About 6 percent of 20- to 24-year-olds have high cholesterol, a number that jumps to 16 percent for 25- to 44-year-olds (Neinstein, 2013a). The prevalence of hypertension also increases across the young adult years, pointing to opportunities to intervene in young adults to prevent later health problems.
The incidence rates of certain malignancies are increased in young adults compared with those of other age-groups, said Neinstein. Cancer is the fourth leading cause of death among young adults ages 18-25, following unintentional injury, homicide, and suicide (Neinstein, 2013b). The most common forms of cancer among individuals ages 18-25 include lymphoma, leukemia, melanoma of the skin, and brain (NCI, 2012; Neinstein, 2013a). The National Institutes of Health and National Cancer Institute published recommendations that apply to adolescent young adults diagnosed with cancer, including identifying unique characteristics among this age group, improving awareness and prevention, ensuring excellence in service delivery, and supporting the patients (NCI, 2012).
Many different sets of guidelines recommend screening of young adults in areas such as immunizations, substance use, reproductive health, mental health, exercise and nutrition, and safety and violence. But the guidelines are “all over the map” and need to be coordinated, said Neinstein. Challenges and opportunities in the provision of health care for young adults, including the impact of the Patient Protection and Affordable Care Act, are examined in Chapter 8.
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