Young Adults Should Be Seen as Distinct Patient Group

Troy Brown, RN

October 30, 2014

Young adults aged 18 to 26 years hover between adolescence and full adulthood, with brains that are still maturing, and they should be considered a separate subpopulation for policy and research purposes, according to a new report from the Institute of Medicine and the National Research Council.

The report calls for an improved understanding and response to the circumstances and needs of today's young adults.

This period of maturation and change sets young adults apart from adolescents and older adults, both biologically and psychologically. Many retain adolescent qualities such as favoring short-term rewards and being vulnerable to peer approval. Unlike adolescents, however, they are developing improved impulse control and giving more thought to hard problems before choosing a course of action, the researchers write.

This period of development for those in young adulthood is critical, and successes or failures during this time can profoundly affect the direction their lives take. Today's young adults find it harder to achieve independence than their predecessors did, take longer to reach full adulthood, and are less healthy. The report highlights the need for better understanding of the needs of young adults and the issues they face.

"Early childhood is widely viewed as a critical window of development, and young adulthood should also be seen in the same light," Richard J. Bonnie, committee chair, Harrison Foundation Professor of Medicine and Law, and director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia in Charlottesville, said in a news release. "Adolescents do not suddenly stop developing when they turn 18; their brains are still maturing. Also, during this critical period, young adults face great challenges that provide less latitude for failure. Essentially, young adults who are not keeping up will have a harder time catching up."

Long and Winding Road to Independence

Previous generations have experienced a more straightforward path to adulthood and independence, and society's expectations of them were clearer. Today, however, young adults face more risk and less opportunity. College is far more costly, and those who can afford to attend college are often left with burdensome college debt that follows them for years.

"Even for young college graduates, well-compensated entry-level jobs are becoming more difficult to find, especially in the aftermath of the Great Recession that began in late 2007. Many companies do not provide health insurance or other nonsalary economic benefits," the authors write in the report. "Low earnings plague many young workers because they lack skills needed for higher-paying knowledge-based jobs. Increasing numbers of the jobs available to them are part-time."

Many young adults continue to live with their parents or move back to their parents' home after college. The report estimates that 17% of young adults do not attend school or work, and many have stopped looking for employment altogether because jobs for those with high school or less education pay lower wages and offer fewer benefits. The gap between what an individual with a bachelor's degree earns compared with that of a person with a high school diploma is about twice what it was in 1980.

Inequalities Further Magnified for Marginalized Young Adults

These inequalities are further magnified for marginalized young adults, such as those born to low-income immigrants, those with disabilities, those who have dropped out of school, those with children to support, or those who are aging out of foster care. These young adults find it much harder to successfully make the transition to adulthood.

"Meeting the needs of marginalized young adults not only improves their lives and can reduce persistent inequalities due to family background, but also has the potential to help them become fully contributing members of society," the authors explain in the report. "Absent deliberate action, however, this period of development is likely to magnify inequality, with lasting effects through adulthood."

Fewer Healthy Behaviors, More Risk-Taking

The health of young adults is particularly alarming. Older adolescents and young adults "are less likely to eat breakfast, exercise, and get regular physical and dental checkups, and more likely to eat fast food, contract sexually transmitted diseases, smoke cigarettes, use marijuana and other drugs, and binge drink," the authors write in the report.

Young adults also display more risky behavior than both adolescents and older adults, and they are more likely to be injured or killed in motor vehicle crashes and to be hospitalized or treated in emergency departments as a result. "[Y]oung adulthood is when many risk behaviors peak, but it is also the time when involvement in risky behaviors begins to decline," the authors write.

Young adults need more educational, economic, social, and health supports. This is especially important for those who experience the greatest struggles. The committee believes that the public and private sectors need to upgrade policies and programs concerned with the needs of young adults. It recommends raising high school and postsecondary institution completion rates and making sure the skills and credentials attained will result in well-paid jobs.

The health and well-being of young adults is particularly important because working-age adults will be called on to care for increasing numbers of retiring elders. The authors estimate that by 2050, the ratio of working-age adults will increase to approximately 4 elders per 10 workers.

"The future well-being of the nation rests on the investments made in all young adults today — particularly those whose background and characteristics put them at risk of experiencing the greatest struggles," the authors conclude.

"Providing more of the educational, economic, social, and health supports they need will help ensure equal opportunity, erase disparities, and enable more young adults to successfully embrace adult roles as healthy workers, parents, and citizens."

The US Department of Health and Human Services' Health Resources and Services Administration and Office of the Assistant Secretary for Planning and Evaluation, Robert Wood Johnson Foundation, Annie E. Casey Foundation, and US Department of Defense sponsored the study.

"Investing in the Health and Well-Being of Young Adults." National Academy of Sciences. Full text


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