Investing in the Health and Well-Being of Young Adults (2015) / Chapter Skim
Currently Skimming:
6 Public Health
6 Public Health
Pages 199-274
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 199... ...
Efforts to address health inequities will have to account for the transitional experiences of young adults, given that the effects of interventions during this period of life are likely to last for several decades. • 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.
|
From page 200... ...
In fact, Milstein and colleagues (2011) estimate that if protective public health interventions were integrated with coverage and care approaches, in 10 years they could save 90 percent more lives in the United States and in 25 years 140 percent more lives than could be saved through coverage and care approaches without such interventions (Milstein et al., 2011)
|
From page 201... ...
We then turn to the role of public health policies, such as those related to the purchase of alcohol and tobacco, in protecting the health, safety, and well-being of young adults. In the next section, we look at the extent to which state and federal public health programs focus on those issues most salient to young adults, and on how these programs can be improved and better coordinated to best address these issues.
|
From page 202... ...
SOURCE: IOM, 2011. BOX 6-1 10 Essential Public Health Services 1.
|
From page 203... ...
However, as the scope of public health has broadened to include preventing chronic disease, promoting healthy communities, and reducing or even eliminating health disparities, collaborative and facilitative approaches have become predominant. Greater attention is being paid to mobilizing and engaging important stakeholders, including community-based organizations, in promoting public health.
|
From page 204... ...
. Overall, as compared with other age groups, young adults have the highest rate of death and injury from motor vehicles, homicides, mental health problems, sexually transmitted infections (STIs)
|
From page 205... ...
. Although all of the indicators are important for the health, safety, and well-being of young adults, this chapter focuses on an illustrative selection of public health challenges that are related most specifically to the health, safety, and long-term well-being of young adults and that pose substantial public health burdens -- motor vehicle injuries; homicide and nonfatal assaultive injuries; sexual assault and intimate partner violence; mental health disorders and suicide; substance abuse; sexual and reproductive health; and chronic disease prevention, including decreasing obesity, reducing tobacco use, and increasing immunizations.
|
From page 206... ...
Injury and Violence Prevention Reducing Motor Vehicle Injuries • Motor vehicle crashes account for the largest percentage (approximately 20 per 100,000) of unintentional injury fatalities for 18- to 25-year-olds in the United States (Neinstein, 2013)
|
From page 207... ...
. • n a study of undergraduate females, almost 20 percent reported expe I riencing completed sexual assault since entering college (Krebs et al., 2009)
|
From page 208... ...
. • mong young adults aged 18-22, full-time college students have higher A binge drinking rates than non-full-time students (Neinstein, 2013)
|
From page 209... ...
. • mong 18- to 22-year-olds, 21.3 percent of full-time college students A reported smoking cigarettes in the NSDUH, compared with 37.2 percent among those not enrolled in college full time (SAMHSA, 2013)
|
From page 210... ...
. a Intimate partner violence, as defined by the National Crime Victimization Survey, includes rape or sexual assault, robbery, aggravated assault, and simple assault committed by the victim's current or former spouse, boyfriend, or girlfriend (Catalano, 2013)
|
From page 211... ...
. Motor Vehicle Injuries • mong 20- to 24-year-olds, rates of mortality due to motor vehicle crashes A are significantly higher for males (25.8 per 100,000 population)
|
From page 212... ...
. PUBLIC HEALTH INTERVENTIONS FOR YOUNG ADULTS Public health interventions include a broad array of activities, such as informing or educating the targeted population about risks, persuading them to reduce risk, creating incentives or disincentives to encourage them to adopt healthy or safe behaviors, and modifying the environment to reduce exposure to risks or to promote or facilitate safe or healthy behaviors.
|
From page 213... ...
, fol lowed by whites (44 percent) and African Americans (32 percent)
|
From page 214... ...
While these approaches have been used for some time, rigorous research has just begun to explore the mechanisms explaining the outcomes of multilevel interventions. In this section, we summarize the evidence base on public health interventions in selected priority areas to illustrate what is known.
|
From page 215... ...
, yet it is one of the most preventable causes of mortality and disease in the United States. Not surprisingly, public health interventions attempting to dissuade people from initiating tobacco use, as well as promoting cessation among users, have received considerable attention.
|
From page 216... ...
, interventions focused specifically on young adults have been somewhat limited. A Cochrane review examined the impact of mass media campaigns on smoking prevention among young people (under age 25)
|
From page 217... ...
The Internet and social media hold considerable promise in promoting cessation. Sims and colleagues (2013)
|
From page 218... ...
. Most public health interventions targeting alcohol use by young adults have focused on college students.
|
From page 219... ...
No differences, however, were seen in actual drinking behavior. Many environmental policy interventions have been effective in decreasing drinking and driving and motor vehicle crashes that involve alcohol among young adults (Hingson, 2010)
|
From page 220... ...
. And a sample of college freshmen who were administered an alternative-reality game during a college health education course significantly increased their physical activity compared with controls, although both groups gained a significant amount of weight over the study period, suggesting that other factors in the college experience were impacting weight changes (Johnston et al., 2012)
|
From page 221... ...
found that participants exposed to a 60-minute DVD addressing motivation, information, and behavioral skills with respect to increasing condom use and decreasing risky sexual practices changed these behaviors more when the topic was prevention of STIs or unplanned pregnancy than when it was HIV prevention. Community-based participatory research was used to create a culturally congruent HIV prevention intervention, AMIGAS (Amigas, Mujeres Latinas, Inform andonos, Gui andonos, y Apoy andonos contra el SIDA [friends, Latina women, informing each other, guiding each other, and supporting each other against AIDS]
|
From page 222... ...
Results suggest that this brief, culturally appropriate prevention program may reduce risky sexual behaviors among high-risk youth from urban communities. An HIV intervention for young African American women at Planned Parenthood in Atlanta, Georgia, used two computer-based 60-minute interactive sessions also modeled after the SiSTA program (DiClemente and Wingood, 1995; Wingood et al., 2011b)
|
From page 223... ...
In sum, many interventions targeting STI or HIV prevention saw success when they focused on topics most relevant to young adults; included culturally competent, tailored materials; and introduced skill components along with this tailored feedback. Human Papillomavirus (HPV)
|
From page 224... ...
A Web-based intervention for college students who were in longer-term relationships advised them on problem solving, communication techniques, and ways to enhance positive relationships, with weekly reminders to employ these skills (Braithwaite and Fincham, 2009)
|
From page 225... ...
I and behavioral health needs in this pe- don't feel comfortable. riod of life has the potential to reduce Why am I going to go lifelong impact, since many fewer new to this person and tell cases occur after age 24 (Kessler et al., them my problems?
|
From page 226... ...
found that only about one-third of young adults with a substance use disorder had ever sought help; those in whom the onset of the disorder occurred at 18 or older were less likely to have sought help than those whose onset occurred earlier. Perceived barriers to young adults' seeking help for behavioral health disorders include stigma and embarrassment, difficulty recognizing symptoms or the need for treatment (i.e., lack of behavioral health literacy)
|
From page 227... ...
Thus, any public health campaign to reduce the stigma of behavioral health conditions and encourage help seeking for these conditions should be informed by research aimed at understanding the impact of stigma and of various types of public service announcements on help-seeking behavior in a wide range of young adults with behavioral health disorders. A further impediment to adequate treatment of behavioral health disorders in young adults is that they are more likely than older adults to drop out of treatment once they have started (Edlund et al., 2002; Hadley et al., 2001; Sinha et al., 2003)
|
From page 228... ...
. Law enforcement and repeated short-term mass media exposure appear to be important components of effective motor vehicle safety campaigns (Elder et al., 2004; Morrison et al., 2003; Salzberg and Moffat, 2004; Williams and Wells, 2004)
|
From page 229... ...
A group of college students that viewed fear-based public service announcements on distracted driving (such as talking on a cell phone, texting, or eating) reported significantly higher intentions to engage in the distracting behaviors after viewing the videos, indicating a boomerang effect (Lennon et al., 2010)
|
From page 230... ...
. In summary, successful campaigns promoting motor vehicle safety have combined mass media messaging with legal enforcement, often engaging social networks to amplify the message and change norms.
|
From page 231... ...
, among other areas. Law enforcement and repeated short-term mass media exposure also appear to be important components of motor vehicle safety campaigns.
|
From page 232... ...
And more than one-third of youth aged 18-24 get their news from social media. Ownership of mobile devices, such as mobile phones and tablets, has actually increased news consumption, with people accessing information from multiple platforms (Pew Research Center, 2014)
|
From page 233... ...
found no effects of the use of social media on weight or physical activity levels, citing problems with recruitment, retention, and poorly reported methods among reviewed studies. A systematic review of sexual health interventions among young adults also revealed a lack of evidence for the impact of social media on behavior.
|
From page 234... ...
Based on experiences from other fields and data from current use, it is possible to formulate some hypotheses about the use of social media for public health interventions. We emphasize that these are hypotheses only that warrant more systematic testing in further research.
|
From page 235... ...
Overall, use of social and mobile media appears to hold promise for reaching young adults with public health campaigns. However, the effectiveness of these new technologies in fulfilling this promise has yet to be established.
|
From page 236... ...
However, when the national voting age was set at 18 by the 26th Amendment in 1971, 29 states changed the drinking age to 18, 19, or 20, which led to a dramatic increase in motor vehicle fatalities related to alcohol among 18- to 20-year-olds (Wagenaar and Toomey, 2002)
|
From page 237... ...
The U.S. Task Force on Community Preventive Services recommends implementing and maintaining a minimum drinking age of 21 based on strong evidence for the effectiveness of doing so, which includes a median 16 percent decrease in underage motor vehicle crashes in states that increased the legal drinking age to 21 (Shults et al., 2001)
|
From page 238... ...
However marijuana policy unfolds, the committee assumes that policy makers will take meaningful steps to discourage its use among youth below the age of purchase, which is nearly certain to be at least 21, and that state and federal public health agencies will establish the surveillance systems necessary to monitor patterns of consumption and the effects of policy changes on the public's health. The age of purchase for tobacco products also has come under scrutiny.
|
From page 239... ...
The consequence has been a siloed approach to population health that fails to reflect the fact that the same young adult may be engaged in multiple risk behaviors, such as substance abuse and unprotected sexual activity.
|
From page 240... ...
. Virtually all state public health agencies provide immunizations, conduct infectious disease control and reporting, provide health education, and maintain health statistics (IOM, 2003)
|
From page 241... ...
Furthermore, given the resources available, many young people may not have had the opportunity to access health services -- either because their local jurisdiction does not make services available; because eligibility requirements preclude their access to care; or because they lack information about available resources, such as screening for STIs through public health clinics. States have recognized the importance of integration of services for adolescents, and many state public health agencies have created adolescent topic areas or designated state adolescent health coordinators to help coordinate health programs and policies bearing on the health, safety, and well-being of adolescents (SAHRC, 2012)
|
From page 242... ...
Contractors must select at least one of eight risk areas (motor vehicle safety, juvenile delinquency, substance abuse, dating violence, obesity, mental health issues, HIV/STIs, and access to care) on which to focus their activities.
|
From page 243... ...
Table 6-1 illustrates the broad range of current federal public health programs that affect young adults, although, as discussed below, specific data on how many young adults are being served by these programs are not readily available. This table is not exhaustive, but is intended to provide examples within various categories of public health (e.g., substance abuse, reproductive health)
|
From page 244... ...
One notable exception is incorporated as part of the National State-Based Tobacco Control Program, which aims to prevent adolescents and young adults from initiating tobacco use. It is also likely that some other programs, such as the family
|
From page 245... ...
• he increased number of people eligible for Medicaid under the Patient T Protection and Affordable Care Act and children in foster care being able to maintain Medicaid up to age 26 will likely create an increased demand for TAY services. • nitiatives need to include employment and education as a point of entry I to other mental health services.
|
From page 246... ...
FAMILY PLANNING, MATERNITY, PARENTING Maternal and Child HHS/HRSA Mothers and children FY12 $541 Health Services and their families, FY13 est. $512 Block Grants to especially low-income FY14 est.
|
From page 247... ...
SEXUALLY TRANSMITTED INFECTIONS (STIs) /HIV Ryan White HIV/ HHS/HRSA Universal, all ages FY12 AIDS Program $2,392,178,000 FY13 $2,248,638,000b FY14 na HIV Prevention HHS/Office of the Women FY12 $5 Programs for Secretary FY13 est.
|
From page 248... ...
This initiative resulted in increasing the number of designated smoke-free campuses from 774 to 1,342. The rest of the programs included in the report do not specifically mention young adults, although several federal public health programs (e.g., the Maternal and Child Health Services Block Grant Program, the Ryan White HIV/AIDS Program, Federally Qualified Health Centers)
|
From page 249... ...
Food and Drug Administration; HHS = U.S. Department of Health and Human Services; HRSA = Health Resources and Services Administration; na = not available; NHTSA = National Highway Traffic Safety Administration; SAMHSA = Substance Abuse and Mental Health Services Administration.
|
From page 250... ...
This matching results in more than $6 billion available annually for maternal and child health programs at the state and local levels (HRSA, 2014d)
|
From page 251... ...
However, it represents only a small component of public health systems' response to the needs of this population. Where necessary, new data collection efforts, disaggregated by these age groupings and other identifiers, are warranted to support improvements in public health programs and
|
From page 252... ...
. CTG grants fund evidence-based programs that address major causes of chronic disease, such as heart disease, diabetes, and cancer, in communities, and promote tobacco-free living, physical activity, healthy eating, services to prevent and control high blood pressure and high cholesterol, social and emotional wellness, and healthy and safe environments (Hennrikus, 2013)
|
From page 253... ...
• The use of mobile digital media and social networking to imple ment interventions shows considerable promise, although evidence for the effectiveness of this approach remains to be developed. • The notable success of some multilevel public health campaigns targeting older adolescents and young adults provides a solid foun dation for developing and fielding innovative community initiatives that combine health messages with environmental interventions addressing cross-cutting health and safety challenges for young adults.
|
From page 254... ...
To advance this transformation, the committee makes the following recommendation: 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.
|
From page 255... ...
Recommendation 6-2: Each community should establish a multistake holder 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.
|
From page 256... ...
Some states may choose to build on the efforts they have devoted to adolescents, extending the purview of those efforts to recognize the importance of the transition into adulthood. The intent is not to dilute existing efforts to improve adolescent health, but to recognize the importance of the young adult years within the life course and the necessity of investing in this particular age group as well.
|
From page 257... ...
Department of Veterans Affairs are engaged in ensuring that federal programs and facilities meet the Dietary Guidelines for Americans.16 Key Areas for Research Given existing gaps in the current public health infrastructure for young adults, research is needed in several key areas to inform public health policies and programs: • The effectiveness of multilevel interventions in achieving health outcomes, including how to connect with difficult-to-reach young adults. More research is needed to understand the impact of mul tilevel interventions, including public health campaigns and initia tives, on prevention and the amelioration of risk factors among young adults.
|
From page 258... ...
But despite the promise of media for connecting young adults with both health information and re sources in their communities, more research is needed to determine how best to integrate this platform into health interventions. Those conducting such research will need to use high-quality research methods and large samples, understand what other resources may be needed to supplement social media content, and determine how behavior change may be sustained over time.
|
From page 259... ...
2013. Brothers leading healthy lives: Outcomes from the pilot testing of a culturally and contextually congruent HIV prevention intervention for black male college students.
|
From page 260... ...
2012. Social media delivered sexual health intervention: A cluster randomized controlled trial.
|
From page 261... ...
American Journal of Preventive Medicine 21(4)
|
From page 262... ...
2004. Effectiveness of mass media campaigns for reducing drinking and driving and alco hol-involved crashes: A systematic review.
|
From page 263... ...
2009. Effect of nutrition intervention using a general nutrition course for promoting fruit and vegetable consumption among college students.
|
From page 264... ...
2012. The structure and organization of local and state public health agencies in the U.S.: A systematic review.
|
From page 265... ...
2014. The impact of health education transmitted via social media or text messaging on adolescent and young adult risky sexual behavior: A systematic review of the literature.
|
From page 266... ...
Are health behavior change interventions that use online social networks effective? A systematic review.
|
From page 267... ...
2013. Using Face book and text messaging to deliver a weight loss program to college students.
|
From page 268... ...
Accident Analysis & Prevention 53:89-99. NNSAHC (National Network of State Adolescent Health Coordinators)
|
From page 269... ...
young adults. American Journal of Public Health 104(8)
|
From page 270... ...
2014. State adolescent health coordinators & contacts.
|
From page 271... ...
young adults: A systematic review. American Journal of Preventive Medicine 39(6)
|
From page 272... ...
2014. Social media interventions for diet and exercise behaviours: A systematic review and meta-analysis of randomised controlled trials.
|
From page 273... ...
delivered by driver education instructors. Journal of Adolescent Health 53(1)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.