Claire Brindis, Dr. P.H. University of California, San Francisco

1. Adolescent Health: Promising Directions for the 21st Century Claire Brindis, Dr. P.H. University of California, San Francisco American Public Health Association- Annual Meeting November 10, 2004

2. Adolescents & Young Adults – A Time of Development • Critical period of life, major transition from childhood to adulthood. • Some common behaviors (e.g., alcohol and tobacco use, nutrition, physical activity) which start during adolescence, contribute to leading health problems as adults. • Opportunity to promote positive development and a lifetime of healthy behaviors.

3. Adolescents & Young Adults –Who are They? • By 2020, there will be 42 million young people ages 10-19 in the US, which represents 13% of the total population • Increase from 35 million in 1990 # in thousands US Population, Ages 10-19, 1980-2050

4. Adolescents & Young Adults –Who are They? • Young people are a diverse group – racial/ethnic diversity among youth exceeds that of adult population. Race/Ethnicity of US Population vs. Ages 10-19, 2000

5. Adolescents & Young Adults –Who are They? • The racial/ethnic diversity among young people will increase: • The White, non-Hispanic youth population will decrease by 21% between 2000 and 2040. # in thousands Race/Ethnicity of Adolescents Ages 10-19, 2000 & 2040

6. Underlying Philosophy • Reducing behaviors that jeopardize health and safety and improve health outcomes are important–but not enough. • Fostering healthy youth development is integral to improving adolescent and young adult health. • Critical to create a healthy environment, and not focus exclusively on changing individuals to assure health outcomes.

7. Adopting a Lifespan, Developmental Approach from Middle Childhood to Young Adulthood (Ages 6-24) • A societal commitment is critical for creating a positive environment that supports healthy youth development and promotes healthy behaviors. • The involvement of diverse organizations and institutions is necessary for success.

8. Who Needs to Be Involved? Recognize involvement of all societal sectors influencing health: GovernmentAgencies Parents & Families Employers Adolescents & Young Adults Post-SecondaryInstitutions Schools Media Health Care Providers Faith-basedOrganizations CommunityAgencies

9. Special Challenges • Expanding definition of what constitutes health, including well-being. • By most traditional markers, healthy indicators. • Most significant threats pertain to risky behavior. • Focus on individual health problems, but increased emphasis on positive development and environmental influences on health. • Many health problems are inter-related and have common etiologies –yet our approaches tend to be narrow in focus.

10. Policy and Research Analyses and Direction Across the Lifespan • Recognize special populations and how programs and policies are shaped for each: • Demographically-defined, • Legally-defined (incarcerated, foster care, migrant groups), • Chronic conditions (physical, emotional), • Other populations (unique qualities, such as homeless, pregnant and parenting).

11. Future Directions - Research • Need for population-based research focusing on: • Trends and policies that affect environmental influences and healthy development – from family policies to community-interventions at the individual, family, peer, school, community, media, and policy levels.

12. Future Directions - Research • Collect data on indicators of well-being, ways that societal institutions contribute to health, preventive services, coordinated care. • Research supports young people need to navigate transitions successfully (from childhood into adolescence; adolescence into young adulthood). • Conduct further research of the role of families, youth-serving organizations, faith-based institutions and other community influences on adolescent behaviors to develop more effective prevention interventions.

13. Future Directions - Policy • Transition readiness – what policies, programs, etc. are needed to assure smooth transitions (for example, school readiness)? • Influence of youth development, supportive environment on adolescent risk-taking behaviors. • Need developmental and environmental indicators to supplement the current focus on individual health status.

14. Create a National Agenda for Young People • Identify priorities. • Networks of interest groups. • Data collection to monitor comprehensive health status (resiliency; protective indicators). • Analyze extent to which policies and programs are developed and sustained. • Developmentally appropriate. • Inclusive of special populations within each age group.

15. EXAMPLE:The National Initiative to Improve Adolescent Health by the Year 2010& 2010 Guide

16. What is the National Initiative? • A collaborative effort to improve the health, safety, and well-being of adolescents and young adults (ages 10-24). • Launched in a unique partnership of two federal agencies: Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) & Health Resources and Services Administration’s Maternal and Child Health Bureau’s Office of Adolescent Health (HRSA-MCHB-OAH) and other National Partners.

17. Grounded in Healthy People 2010 • A comprehensive set of national disease prevention and health promotion objectives that measure the nation’s progress over time • Two overarching goals of Healthy People 2010: • Increase quality and years of life • Eliminate health disparities www.healthypeople.gov

18. National Initiative Goals • 21 Critical Health Objectives for Adolescent & Young Adult Health: • Include individual health outcomes (injury, disease & death) as well as related behaviors (e.g., substance abuse, physical activity, safety belt use). • 21 Objectives fall into six general areas: • Mortality, • Unintentional Injury, • Violence, • Mental Health and Substance Abuse, • Reproductive Health, • Chronic Disease Prevention.

19. Goals:Beyond the 21 Objectives • Reduce disparities among adolescents and young adults. • Increase adolescents’ and young adults’ access to quality health care, in areas including: • Comprehensive general health, • Oral health, • Mental health, and • Substance abuse prevention and treatment.

20. Improving the Health of Adolescents and Young Adults • One of the Healthy People 2010“Companion Documents” • Also available: • Healthy Campus 2010: Making It Happen • Healthy People 2010: Reproductive Health • Rural Healthy People 2010: A CompanionDocument for RuralAreas http://www.healthypeople.gov/Implementation/compdocs.htm

21. Purpose • To help guide state and local agencies and organizations in: • Community coalition building • Needs-and-assets assessment • Priority Setting, Program Planning,Implementation, and Evaluation • To build national efforts for improving adolescent health

22. Resources • National Initiative to Improve Adolescent Health by the Year 2010 • http://www.cdc.gov/HealthyYouth/NationalInitiative • http://nahic.ucsf.edu/nationalinitiative • 2010 Guide/Companion Document Order It!http://www.cdc.gov/HealthyYouth/NationalInitiative/order/ Download it! http://nahic.ucsf.edu/2010guide • Partner Resources National Initiative Core Partners Resources and Activities – a searchable database, coming soon on NAHIC web site!