Investing in the health and well being of young adults

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Investing in the Health and Well-Being of Young Adults

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Richard J. Bonnie, Clare Stroud, and Heather Breiner, Editors; Committee
on Improving the Health, Safety, and Well-Being of Young Adults; Board on
Children, Youth, and Families; Institute of Medicine; National Research
Council

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Investing in the Health and Well-Being of Young Adults

INVESTING IN
THE HEALTH
AND WELL-BEING
OF YOUNG ADULTS

Committee on Improving the Health, Safety, and
Well-Being of Young Adults
Board on Children, Youth, and Families
Richard J. Bonnie, Clare Stroud, and Heather Breiner, Editors

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

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Sciences and the Health Resources and Services Administration (HHSH25034014T),
the Office of the Assistant Secretary for Planning and Evaluation (HHSP23337004),

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Investing in the Health and Well-Being of Young Adults

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Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

Copyright © National Academy of Sciences. All rights reserved.

Investing in the Health and Well-Being of Young Adults

COMMITTEE ON IMPROVING THE HEALTH, SAFETY,
AND WELL-BEING OF YOUNG ADULTS
RICHARD BONNIE (Chair), Harrison Foundation Professor of Medicine
and Law, University of Virginia School of Law
CLAIRE D. BRINDIS, Director, Philip R. Lee Institute for Health Policy
Studies, University of California, San Francisco
GLADYS CARRIÓN, Commissioner, New York City Administration for
Children’s Services
MARK E. COURTNEY, Professor, School of Social Service
Administration, University of Chicago, Illinois
ROBERT CROSNOE, The Elsie and Stanley E. (Skinny) Adams, Sr.,
Centennial Professor in Liberal Arts, Department of Sociology, The
University of Texas, Austin
MARYANN DAVIS, Research Associate Professor, Systems and
Psychosocial Advances Research Center, Department of Psychiatry,
University of Massachusetts Medical School, Worcester
KATHLEEN MULLAN HARRIS, James E. Haar Distinguished Professor
of Sociology, University of North Carolina at Chapel Hill
HARRY J. HOLZER, Professor, McCourt School of Public Policy,
Georgetown University
CHARLES E. IRWIN, JR., Distinguished Professor of Pediatrics, UCSF
Benioff Children’s Hospital, University of California, San Francisco
BEATRIZ LUNA, Director, Laboratory of Neurocognitive Development,
University of Pittsburgh, Pennsylvania
VELMA McBRIDE MURRY, Professor of Human Development and
Lois Autrey Betts Chair, Department of Human and Organizational
Development, Peabody College, Vanderbilt University, Nashville

ZIZI PAPACHARISSI, Professor and Head, Department of
Communication, University of Illinois, Chicago
JOHN SCHULENBERG, Professor of Psychology and Research
Professor, Institute for Social Research and Center for Human
Growth and Development, University of Michigan, Ann Arbor
MARTIN SEPÚLVEDA, IBM Fellow & Vice President, IBM Research
KASISOMAYAJULA VISWANATH, Professor of Health
Communications, Harvard School of Public Health
LESLIE R. WALKER, Professor and Chief, Adolescent Medicine Division,
Seattle Children’s Hospital and the University of Washington, Seattle

v

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

YOUNG ADULT ADVISORY GROUP
MARCUS BROWN, Chief Executive Officer, Adolesco Services
HERNAN CARVENTE, Research Assistant, Vera Institute of Justice
JENNIFER COLLINS, Student, University of Maryland
AMY DOHERTY, Board President, National Youth Leadership Network
SEMIRA ABDULMALIK KASSAHUN, Former Youth Advisor, Colorado
Department of Public Health and Environment
JACKIE MALASKY, Public Health Professional, Baltimore, Maryland
PAUL RASTRELLI, Community Health Action Team Member, Kaiser
Permanente
ANDREA VESSEL, Student, American University
Consultants

RONA BRIERE, Consultant Editor
VICTORIA FAUST, Doctoral Student, School of Ecology, University of
Wisconsin–Madison
CONSTANCE FLANAGAN, Professor, School of Ecology, University of
Wisconsin–Madison
RACHEL FAULKENBERRY McCLOUD, Doctoral Student, Harvard
School of Public Health
LAUREN MIMS, Doctoral Student, University of Virginia
EVELYN STRAUSS, Consultant Writer
LAUREN TOBIAS, Principal, Maven Messaging and Communications
JOANNA WILLIAMS, Assistant Professor, University of Virginia
Project Staff
CLARE STROUD, Study Director
HEATHER BREINER, Associate Program Officer
DOUGLAS KANOVSKY, Senior Program Assistant
AMANDA PASCAVIS, Senior Program Assistant (July-August 2014)
FAYE HILLMAN, Financial Associate
PAMELLA ATAYI, Administrative Assistant
KIMBER BOGARD, Director, Board on Children, Youth, and Families

vi

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

Reviewers

This report has been reviewed in draft form by individuals chosen

for their diverse perspectives and technical expertise, in accordance with
procedures approved by the National Research Council’s Report Review
Committee. The purpose of this independent review is to provide candid
and critical comments that will assist the institution in making its published
report as sound as possible and to ensure that the report meets institutional
standards for objectivity, evidence, and responsiveness to the study charge.
The review comments and draft manuscript remain confidential to protect
the integrity of the deliberative process. We wish to thank the following
individuals for their review of this report:
ANNE-MARIE BRAGA, Colorado Department of Public Health and
Environment
ELLEN WRIGHT CLAYTON, Vanderbilt University
DONNA FUTTERMAN, Albert Einstein College of Medicine
ADRIANA GALVÁN, University of California, Los Angeles
RENÉE R. JENKINS, Howard University College of Medicine
MEREDITH KLEYKAMP, University of Maryland
ROBERT I. LERMAN, American University and Urban Institute
ELIZABETH LOWER-BASCH, Center for Law and Social Policy
MICHELLE R. MUNSON, New York University
ALICE SHOBE, Building Changes
PATRICK H. TOLAN, University of Virginia
PATIENCE WHITE, Got Transition
vii

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Investing in the Health and Well-Being of Young Adults

viiiREVIEWERS

JOY JOHNSON WILSON, National Conference of State Legislatures
JONATHAN F. ZAFF, America’s Promise Alliance
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the report
before its release. The review of this report was overseen by ANTONIA
M. VILLARRUEL, University of Michigan School of Nursing, and SARA
ROSENBAUM, The George Washington University School of Public
Health and Health Services. Appointed by the National Research Council
and the Institute of Medicine, they were responsible for making certain that
an independent examination of this report was carried out in accordance
with institutional procedures and that all review comments were carefully
considered. Responsibility for the final content of this report rests entirely
with the authoring committee and the institution.

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

Prologue1

Marcus Brown is working toward a business management degree at
Davenport University in Grand Rapids, Michigan. He spent 5 years in the
foster care system before being adopted into a family of 23 children.
Lack of contact with one’s biological family raises significant questions
that many people never encounter, Marcus said. “I have had experiences
where I had to go to the hospital. They say, ‘Tell me about your family.’ I
go, ‘Your guess is as good as mine.’” Boys who grow up without a father
can lack other basic information, too, and Marcus relied on social media
to learn some basic life skills. “I did not know how to tie a tie, so I had to
YouTube that,” he said. “My other parent is the Internet.”

Marcus offered ideas about ways to smooth and improve the transition
from the foster care system into independent life. As adulthood looms and
people are about to age out, “It is like, ‘oh yeah, we want to talk to you
about housing now.’ I say, ‘Should we not have talked about that a year
ago so I could start saving for the deposit?’”
Hernan Carvente will soon graduate from the City University of New
York with a bachelor’s degree in criminal justice. He is a research assistant
at the Vera Institute of Justice, where he works on projects related to juvenile justice and family engagement. Many of Hernan’s insights and sug1  The

vignettes presented here are from eight young adults who served as a young adult advisory group to the committee that prepared this report. They provided written permission to
include their stories, quotes, and names. Their stories are not intended to be representative of
all young adult experiences and views. A description of the group and its work is in Chapter 1.

ix

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

xPROLOGUE
gestions are based on his experiences with various government institutions
and programs. Beginning at age 15, he served 4 years at a secure juvenile
detention facility. “My family was broken, so the gang became my family,”
he said. “The only system that could hold onto me was the criminal justice
system, unfortunately.”
Hernan highlighted the importance of problem-solving skills. “In public schools, I never experienced any structured lesson on how to deal with
conflicts,” he said. “With my troubled background, I had no ways to deal
with issues impacting me at home, which led to issues with peers at school.”
He sees family-centered initiatives as a priority. Rather than telling parents

that “you did no good,” so “we are going to take care of your child,”
Hernan suggested that government programs “give the responsibility back
to the people who brought that child into the world by offering them the
appropriate resources.” He also emphasized the value of communication
among agencies. “When a young person goes into the foster care system
and ends up in the criminal justice system, it is hell to get the data that was
in the foster care system,” said Hernan. Yet that information is essential
to “understand what the young person went through” and provide the
services he or she needs. “The systems fall apart when we don’t have that
collaboration.”
Jennifer Collins entered foster care for the first time at age 7. As a teen,
she struggled with mental health issues. Now pursuing a bachelor’s degree
in family science at the University of Maryland at College Park, she credits numerous “tireless advocates”—her social worker, foster mother, and
adoptive mother—with helping her get the help she needed to persevere
and succeed.
Jennifer spoke about the difficulties she faced while trying to navigate the Medicaid system, particularly when she was dealing with serious
emotional challenges. “The most frustrating thing is just getting on the
phone with someone,” she said. “It usually took a drastic event, like me
attempting to off myself, to access care. The only way you could get into
the mental health system, as I recall, was the police had to take you there
after you tried to take your own life.” Jennifer raised other issues that are
commonly misunderstood, such as abuse. “I don’t think a lot of people
realize that abuse may start at any point—and many people discount abuse
of older kids,” she said. “I was stuck in a situation for three years until I
could get someone to listen. If I had been younger, someone would have
done something sooner.”
Jennifer pointed out that low Medicaid reimbursement rates lead to
high turnover in the system and a lack of experienced professionals—a
problem that has particularly grave ramifications in the area of mental
health. When a person starts working with a new psychologist, “you are

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

PROLOGUE

xi

not starting where you dropped off before,” she said. “You are starting all
the way back at square one.”
Amy Doherty graduated from Mount Holyoke College in South Hadley,
Massachusetts, and conducts research in a vision rehabilitation lab. She was
born legally blind and currently serves as board president for the National
Youth Leadership Network, a group that works to break down isolation
and build community among young people with disabilities.
Amy discussed the many challenges young adults face as they grow toward independence. “One of the things that I noticed in transitioning from
high school to college was that you lose a lot of your support system,” she
said. The people who previously had played that role are no longer “right
there with you.” She talked about the importance of helping young adults
access health care, which has been difficult for her, even with private insurance, and she also pointed out that young people typically do not learn
financial management skills. That crucial topic “is missing from education,”
she said, “but it could be incorporated in lots of ways.”
Semira AbdulMalik Kassahun came to the United States at age 3. Her
English fluency grew, and she soon was translating for her parents at doctor
appointments and teacher conferences to “make everything go smoothly . . .
which is a typical scenario for U.S. immigrant families.” Semira is the first
person in her family to graduate college and is now pursuing a master’s degree in public health, focusing on maternal and child health, at The George
Washington University in Washington, DC.

“Growing up, you sometimes have to take charge,” she said. “My
parents always supported me by saying, ‘Keep going,’ but due to language
and education barriers I needed to take the initiative of finding guidance
and role models who I could ask about college and higher education.” She
now feels “proud and happy” to serve a similar role for young people in
her community. In addition, she is reaching out to individuals beyond her
cultural circle to raise awareness about issues that matter to her, such as
religion. “I’m a Muslim and I follow Islam,” she said. “There’s a lot of
work I’ve tried to do to fight misconceptions about Islam.” Semira stressed
the value of connections with older people to whom young adults can direct
personal and professional questions. “Relationships are like fuel,” she said,
“helping young people move forward in their lives.”
Jackie Malasky majored in public health and anthropology at New York
University. She then earned a master’s degree in education at The George
Washington University, where she concentrated on maternal and child
health. Jackie did her master’s thesis on how men and women use the Inter-

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

xiiPROLOGUE
net differently to access sexual health resources online. She currently works
as an HIV program evaluator.
Technology—especially social media—is changing how young adults
mature and establish themselves in the world. “We are developing our selfidentity by using two-way media,” she said, but often “people post without
really thinking about what it means or what it says about them.” Jackie
is especially interested in using entertainment to educate young adults. She
also would like to see that they are trained to recognize and assist with mental health problems in their communities. “Our friends may be depressed,”

she said, but “we are not psychologists. How can I have the tools I need to
really provide resources?”
Paul Rastrelli has always been interested in health, perhaps because
both of his parents work in that field. In high school, he was already making significant contributions to his community’s welfare. For instance, he
spearheaded an antibullying campaign. Paul was a member of Kaiser’s
Community Health Action Team (CHAT), which is creating classroom
resources that help students learn about comprehensive health. He commuted 2.5 hours to attend CHAT meetings, “but it was totally worth it,”
he said. He is now studying mechanical engineering at the University of
Colorado Boulder.
Through his work with CHAT and other enterprises, Rastrelli
encountered—and was captivated by—the concept of human-centered design. “When you are designing a product or an experience, you design
around the eventual end user and really get their input,” he said. He talked
about the importance of following one’s enthusiasm—and how social status
can interfere with that endeavor. “Regardless of who you are, you contribute the most to the world when you feel you are doing something you are
passionate about,” he said.
Andrea Vessel grew up in a middle-class household with both of her
parents. She often was racially isolated—the only black person in predominantly white communities—and felt pressured to “represent my culture,”
she said. As she advanced through school and noticed that fewer people
“looked like me,” she wanted “to prove myself.” Because of her involvement in 4‑H and Girl Scouts, she said, “I never thought, ‘I couldn’t do this’
or ‘people around me may not be doing this and I can’t do it either.’ I saw
myself as being able to achieve.” Now studying justice and law at American
University in Washington, DC, she also serves as a youth trustee on the
National 4-H Council Board of Trustees.
Andrea spoke about mistrust among young adults that can interfere
with public health campaigns. “For example,” she said, “when people say

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

PROLOGUE

xiii

marijuana is bad, we think they are full of it. It’s just some way to get us
to not do drugs.” Providing information about drugs rather than telling
young adults what to think, Andrea suggested, might help empower them
to make wise choices.

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

Preface

Young adulthood (spanning the ages of approximately 18-26) is a significant and pivotal time of life. During this time, young women and men
typically complete their education, start working, develop relationships,
and pursue other endeavors that help set them on the path to a healthy
and productive adult life. Older adults, myself included, who have the opportunity to work on a daily basis with successive generations of young
adults, often marvel at the energy, talent, creativity, and hopefulness they
bring to their classrooms and workplaces and to their relationships with
each other and their elders. Almost every new insight I have had in recent
memory emerged from my interactions with the young adults I see every

day. It is therefore all the more troubling that many young adults in our
country are having difficulty accomplishing these transitions, particularly
in the aftermath of the Great Recession and in the face of escalating costs
of higher education. The dizzying pace of change in modern life also has
confounded the traditional pathways to marriage, parenting, and other
hallmarks of independent adulthood. Any conversation with today’s young
adults is likely to evoke observations about the stresses and uncertainties
they confront.
The needs of young adults, and the challenges they face, do not receive
a great deal of systematic attention in policy and research. Accordingly, the
Health Resources and Services Administration asked the Institute of Medicine (IOM) to convene a committee to examine, analyze, and synthesize
information and knowledge on the health, safety, and well-being of young
adults. The IOM appointed a planning committee to design, organize, and
conduct a workshop to review the current state of knowledge in this area.
xv

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Investing in the Health and Well-Being of Young Adults

xviPREFACE
The workshop was held on May 7-8, 2013, and a summary of the presentations was published in September 2013.1 The Committee on Improving the
Health, Safety, and Well-Being of Young Adults was then formed to conduct a consensus study and develop a set of recommendations for policies,
programs, practices, systems development, service delivery, and research
to address the needs of young adults and guide policy makers and other
stakeholders in meeting those needs. (See Chapter 1 for the committee’s full
statement of task.) This report is the product of that study.
The central aim of this report is to draw attention to young adulthood
as a distinct and important period in the life course of young people who

are growing up in modern society. From a developmental standpoint, young
adults are different, biologically and psychologically, from both adolescents
and older adults in ways that affect their decision making, health, and behavior. From a social point of view, many of today’s young adults confront
major challenges in making a successful transition to adult roles in a rapidly
changing and stressful world. Policy makers and service providers need to
understand these differences in designing and implementing policies and
programs to help young people accomplish these transitions successfully.
It is also important for public and private agencies monitoring the
health, safety, and well-being of young adults to collect, classify, and maintain data in a way that permits researchers to analyze the status, behavior,
and well-being of young adults, as well as their correlates and causes and
the outcomes of interventions designed to improve them. Many of the
report’s recommendations focus on advancing understanding of young
adulthood and the effects of policies and programs focused on this critical period of life. While the committee’s recommendations include specific
substantive changes in current policies and programs where the evidence
is sufficiently compelling to warrant action, we were generally content to
sketch our policy prescriptions with broad strokes, pointing the way for
others to conduct more specialized investigations.
I would like to express my sincere appreciation to each member of
the committee and the talented IOM staff for their extraordinary commitment to this important project. The health, safety, and well-being of young
adults are of immense interest to us all as parents, colleagues, scientists,
and members of the body politic. I am particularly grateful to our young
adult advisory group for their uniquely insightful contributions to the committee’s work.
Richard Bonnie, Chair
Committee on Improving the Health, Safety, and
Well-Being of Young Adults
1  The

full text of the summary is available online via www.iom.edu/youngadults.

Copyright © National Academy of Sciences. All rights reserved.

Investing in the Health and Well-Being of Young Adults

Acknowledgments

The committee would like to express its sincere gratitude to everyone
who assisted in the development of this report. This work would not have
been possible with the support of our sponsors—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. We thank them for generously providing
information and responding to our questions.
Shortly after the study was initiated, a young adult advisory group
was formed to give the committee opportunities for ongoing dialogue with
young adults during the research phase of the study and the preparation of
this report. We are grateful to the following individuals for their thoughtful
comments throughout the study process: Marcus Brown, Hernan Carvente,
Jennifer Collins, Amy Doherty, Semira AbdulMalik Kassahun, Jackie
Malasky, Paul Rastrelli, and Andrea Vessel. Their efforts proved invaluable to the committee.
The committee would also like to acknowledge several consultants
who contributed to this study: Constance Flanagan and Victoria Faust
(University of Wisconsin–Madison) for their synthesis of research on civic
engagement among young adults and service programs in which many
young adults participate; Rachel Faulkenberry McCloud, a doctoral candidate in the Department of Social and Behavioral Sciences at the Harvard
School of Public Health, for her assistance with the committee’s review of
the literature on public health interventions; Joanna Williams and Lauren
Mims (University of Virginia) for their assistance in reviewing the literature
xvii

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

xviiiACKNOWLEDGMENTS
on diversity; Sandra Graham at the University of California, Los Angeles,
Graduate School of Education and Information Studies for her technical
review; Evelyn Strauss for her assistance with writing and her advice on
incorporating young adult voices throughout the report; and Lauren Tobias
of Maven Messaging for her advice on presenting the evidence in a compelling manner. The committee is also grateful to Rona Briere and Alisa
Decatur of Briere Associates, Inc., for their assistance in editing the report.
Many individuals volunteered significant time and effort to address and
educate the committee during our information-gathering meetings (see Appendix A for the names of these speakers). In addition, Rebecca Gudeman
of the National Center for Youth Law provided valuable information about
confidentiality issues in young adult health. These contributions informed
our deliberations and enhanced the quality of this report.
The committee also expresses its deep appreciation for the opportunity to work with the talented and dedicated members of the staff of the
Institute of Medicine and the National Research Council on this important
project. We are grateful for the ongoing contributions of Kimber Bogard,
director of the Board on Children, Youth, and Families. The assistance of
associate program officer Heather Breiner and senior program assistant
Douglas Kanovsky were indispensable. Finally, special praise is due to study
director Clare Stroud, whose impeccable planning, superb judgment, and
faithful support made serving on (and especially chairing) this committee
a genuine pleasure.

Copyright © National Academy of Sciences. All rights reserved.

Investing in the Health and Well-Being of Young Adults

Contents

SUMMARY1
Study Charge, 2
Young Adults in the 21st Century: Key Findings, 2
Recommendations for Action, 6
Conclusion, 18
1INTRODUCTION
Study Charge, 20
Context for This Study, 20
Methods, 23
Study Approach, 24
Organization of the Report, 31
References, 32

19

2 YOUNG ADULTS IN THE 21ST CENTURY
Basic Patterns of Development, 35
Historical Patterns of Social Roles and Activities, 42
Social/Economic Changes and the Refashioning of
Young Adulthood, 49
The Health of Young Adults, 52
Diversity and the Effects of Bias and Discrimination on
Young Adults’ Health and Well‑Being, 57
Key Findings and Implications, 59
Principles to Guide Action, 64

35

xix

Copyright © National Academy of Sciences. All rights reserved.


Investing in the Health and Well-Being of Young Adults

xxCONTENTS



Conclusion, 66
References, 67

3RELATIONSHIPS
Social Relationships, 80
Romantic Relationships and Union Formation, 82
The Transition to Parenthood, 87
Intergenerational Relationships, 98
Conclusions and Recommendation, 107
References, 111

77

4

EDUCATION AND EMPLOYMENT
Employment Outcomes of Young Adults, 127
Educational Patterns and Outcomes of Young Adults, 134
Health and Social Causes and Consequences, 143
Education and Employment Policy for Young Adults, 150
Conclusions and Recommendations, 158
References, 163

123

5






CIVIC ENGAGEMENT AND NATIONAL SERVICE
Overview of Civic Engagement and National Service, 173
National Service Programs for Young Adults, 177
Military Service, 187
Conclusions and Recommendations, 192
References, 194

171

6









PUBLIC HEALTH
Overview of Public Health Perspectives and Activities, 201
Priority Public Health Issues for Young Adults, 203
Public Health Interventions for Young Adults, 212
Social Media and the Health of Young Adults, 232
Protective Public Policies for Young Adults, 235
Improving and Coordinating Public Health Programs, 239
Conclusions and Recommendations, 253
References, 259

199

7

THE HEALTH CARE SYSTEM
Current Use of Health Care by Young Adults, 280
Transitions, 282
Preventive Care for Young Adults, 295
Behavioral Health Interventions for Young Adults, 304
Health Care Coverage for Young Adults, 304
Systems Issues Related to Young Adults, 313

275

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Investing in the Health and Well-Being of Young Adults

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CONTENTS




Conclusions and Recommendations, 323
References, 330

8GOVERNMENT INVESTMENTS IN MARGINALIZED
YOUNG ADULTS
347
Young Adults Aging Out of Foster Care, 351
Young Adults in the Justice System, 356

Homeless Young Adults, 366
Young Parents, 371
Young Unauthorized Immigrants, 378
Characteristics Common to Marginalized Young Adults and the
Programs That Serve Them, 380
The Evidence Base for Assisting Marginalized Young Adults, 383
Conclusions and Recommendations, 384
References, 392
9 NEXT STEPS
Overall Conclusions About Policies and Programs That Serve
Young Adults, 401
A Plan for Moving Forward, 405
Cross-Cutting Recommendation, 407
Organization of Domain-Specific Recommendations by
Responsible Entities, 408
Research Needs, 412
Concluding Remarks, 413
APPENDIXES

A OPEN SESSION AGENDAS
BDIVERSITY AND THE EFFECTS OF BIAS AND
DISCRIMINATION ON YOUNG ADULTS’ HEALTH
AND WELL-BEING
C YOUTH-FOCUSED NATIONAL SERVICE PROGRAMS
D BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS

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401

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Investing in the Health and Well-Being of Young Adults

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Investing in the Health and Well-Being of Young Adults

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.
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.

1

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Investing in the Health and Well-Being of Young Adults

2

INVESTING IN THE HEALTH AND WELL-BEING OF YOUNG ADULTS

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

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