Chapter 8: Adolescents, Young Adults, And Adults

- adolescents and young adults (10-24 years) and adults (25-64 years of age) - viewing age group profiles allows public health workers to detect the causes of disease, injury , and death for specific priority population and to propose interventions to reduce those causes - life between the ages of 10 and 64 are some of the most productive - increasing number of adolescent and young adults are relying some life choices and taking longer to become independent - enjoy the best health of their lives

- those people who fall into 10 to 24 year old range - represent the future of our nation - adolescence and young adulthood can be divided into two subgroups

- generally regarded as the period of life from puberty to maturity - not an easy stage because it is a period of transition from childhood to adulthood - time when children psychologically move from areas of relative comfort and emotional security to places and situations that are more complex and often much more challenging - hormonal changes, physical maturation and opportunities to engage in risky behaviors - The combined period of adolescence and adulthood is critical in health because this is the period in one's life that many health-related beliefs, attitudes, and behaviors are adopted and challenged. - During this stage, young people have increased freedoms and access to health compromising substances and experiences as well as health enhancing experiences. - Lifestyles are established and shaped which leads to long term influences on health

- face physical emotional and educational changes - adults can complete their physical growth and maturity, and experiences those situations and opportunities that was mentioned above - stage is considered to be the most difficult because couple the demands of personal changes with the demands of society

Concept that health status and environmental exposures in the early part of one's life will impact their adult health status. Helps to explain how every stage of a person's life impacts the individual's long term health

number of young people, their living arrangement, their employment status, and their access to health care are the four variables most important to communities health

- 2010 US Census; 10 to 24 years old made up over a fifth of the US population. - In the future, the proportion of adolescents and young adults will decrease but the number of adolescents will continue to increase. - 54% of adolescents were non-Hispanic whites in 2050 the percentage will drop to 40%

- Percentage of children younger than the age of 18 living in a single parent family has been on the rise ever since 1965. Rose sharply in 1970 (increase rates of divorce) and slowly in 1990. In 2012, more than a quarter of all children lived in single parent families. Often live with mothers than fathers - Black (55) and Hispanic (31) were more likely to live in single parent home than whites (21). - Children living in single parent families are more likely to experiences economic disadvantages as well as negative impacts on emotional cognitive and social well being.

- 1960-1980, when there were increases in participation of young women in the labor force, the proportion of all adolescents and young adults in the labor force remained constant. However, the past decade this age group is beginning to see some permanent changes in the labor force participation (16-19 years old males) because if increased school attendance and enrollment in high school, college, and summer school. - Youth labor force composed of 16-24 year olds makes up 13% of the overall labor force - Unemployment rates of this age group is separated by race and ethnicity. Black adolescents and young adults are more likely to be unemployed. White adolescents and young adults have the lowest proportion of unemployment. - Health insurance and health care access is connected to employment status. In 2013, 75% of young adults ages 18 to 25 had health insurance coverage compared to 92% children age 6 to 18 - Young adults have less access to health care and tend to use emergency room for care more than adolescents.

adolescents and young adults will have increased access to health insurance and health care. More info on 208.

Four major areas that stand out: mortality, morbidity from specific infectious disease, health behavior and lifestyle, and protective factors. A person's behavior and overall lifestyle are heavily impacted by factors both within and outside his or her control.

- Due to the obesity epidemic, today's youth may have a shorter life expectancy than their parents. The death rate of adolescents and young adults have significantly declined. - Between 1950 and 2013 the death rate of adolescents and young adults ages 15-24 declined 50% and for the mortality of early adolescents (10-13). Decline in death rates can be attributed to advances in medicine and injury and disease prevention and behavior change among this age group. - adolescents and young adults males have a higher mortality rate than adolescents and young adults females - Mortality rates for males and females were highest among blacks and AI/AN. Lowest mortality rates of both women and men were Asians - Leading causes of death for young adolescents (5-14) are unintentional injuries, neoplasms (cancer), and suicide. - Physical threat to older adolescents and young adults ages 15-24 stems from their behavior and their environment rather than disease. - For young people three fourths of all mortality can be attributed to three causes-- unintentional injuries (many motor crashes 41%), homicide (17%) and suicide (15%). Mortality from unintentional injuries in this age group declined during the last half of the 20th century (since 1990 the mortally rates for deaths declined by 55%) - Unintentional injuries are the leading causes of death in adolescents and young adults ages 10-24 and alcohol is a contributing factor for deaths by vehicles - White males have higher rates of death in motor vehicles than do blacks. Motor vehicle related death rates of whites and Native American males are the highest for this age group. The mortality rates for white and black women combined are lower than those of males from either of those races. - Suicide rates almost doubled over the past 50 years. Suicide is the second leading cause of death in adolescents and young adults between 15 and 24. Rates are higher in Native Americans males (but decreased 1/3 over the past 50 years). Only represents a fraction of all suicides contemplated. From the YRBSS, it said that about one in seven 9th to 12th graders in the US thought about attempting suicide (17%) while 8% attempted. - Homicide rates are a concern among black males because their rates are four times higher the Hispanic males and more than 10 times higher than other populations at this age group. Homicide rates are reduced when SES factors are taken in account.

- Suffers significantly from a number of communicable disease: sexually transmitted diseases (STDs) or known as sexually transmitted infections (STIs). Young people 15 to 24 acquiring half of all new STDs. At higher risk of acquiring STDs for a combo of behavioral biological and cultural reasons. Can be cured through antibiotics. Effects can last a lifetime. - Hep, HIV, HPV can be treated but never cured. HPV is the precursor to cervical cancer and the effects of chlamydia and can lead to infertility. HIV is the precursors to getting AIDS. - Chlamydia os the most common curable STD among the age group. 1 in 20 sexually active female ages 14 to 19 are estimated to get chlamydia. - 26% of all new HIV infections in the US in 2012 were found in 13 to 24 year olds. 60% were founded in blacks/AA. Majority youth ages 13 to 24 with HIV in 2012 were not aware they were infected. 15-42 year olds represent 25% of the sexually experienced population and get half of all new STDs. - Cases: chlamydia, gonorrhea, syphilis, TB, AIDS, and measles

- Susceptible to developing behaviors like abuse of alcohol and other drugs,, fighting, and weapon carrying. - CDC started the YRBSS to track selected health behaviors among young people. Has a national school based survey (state territorial tribal district). Conducted biennially during number of years among 9th to 12th graders. Started in 1990. - Proved to be helpful at both the state and local levels. Number of states and local communities have place programs and policies to reduce risk behaviors in youth. - Behaviors that contribute to unintentional death, violence, tobacco use, alcohol and there drugs, sexual behaviors, PA and sedentary lifestyle, and overweight

- Five different behaviors that relate to unintentional injuries: seat belt use, bicycle helmet use, motorcycle helmet use, riding in a vehicle with a driver who been drinking alcohol, and driving after drinking. - Since 1991, numbers of students engaging in these risk behaviors have declined. - 2015 one fifth of students nation wide had ridden with a driver who had alcohol and 10% said that drove while under the influence. 41.4% had texted or emailed while driving

- carrying a weapon, engaging in a physical fight, engaging in dating violence, having been forced to have sexual intercourse, engaging in school-related violence including bullying, suicide ideation, and suicide attempts - one in five students (20.2%) had been bullied and 14.8% of students reported being electronically bullied. - Males are more likely to get in fight or carry a weapon. Females are more likely to suicide ideation and attempts and being forced to have intercourse

- represents one of the most wide spread and high risk health behaviors for this group - About one tenth of high school students were current smokers (declined since 1995 with 34.8%). A decrease of people who smoked on 20 or more days. - Whites students (12.4) were more likely to report cigarette use than were Hispanics (9.2) and black (6.5%). Develop dependency before the age of 18. - use of smokeless tobacco and cigars - 2015 smokeless tobacco use was 7.3% in high school students which is a decrease in 1995. Cigar use decrease since 1997. Using electronic vapor products has increased in 2015 to 24.1% compared to 1.5% in 2011.

Spit tobacco, includes oral snuff, loose leaf chewing tobacco, plug chewing tobacco, and nasal snuff.

Called that companies to make a payment of 206 billion to the Staes over 25 years in 2000 and to finance antismoking programs in exchange the states will drop their health care lawsuits. Tobacco companies agreed to spend 1.7 billion to study youth and smoking and to finance antismoking advertising and access restrictions on marketing practices that appeal to children

2009 - granted the US FDA the authority to regulate the manufacture, distribution, sale, labeling, advertising, and promotion of tobacco products to protect public health

- One sixth of students surveyed for the YRBSS in 2015 indicated that they drank alcohol for the first time prior to the age of 13. - Alcohol use and abuse continue to be major problems for adolescents, particularly among high school drop outs. - Use of marijuana and other illicit drugs. 5.2% used cocaine, 7% used inhalants, 5% used ecstasy, 3% use meth and 3.5% steroids. Nearly one-sixth (16.8%)have taken prescription drugs with out a prescription.

- Adolescents in the US continue to experience high rates of unintended pregnancies and STDs and including HIV infections. More than one third of all high school students (41.2%) have engaged in sexual intercourse. Ranged from 20.7 for 9th grade girls and 59.0% for high school senior boys. - More likely for black and hispanics students to engaged in sexual intercourse than whites. - Teenage brith rates decline 9% from 2013 to 2014. More than 249,000 teen girls in the US between the ages of 15 and 19 becoming pregnant each year. Most pregnancies are unintended. - Teenage mothers are less likely than women age 20 to receive prenatal care and more likely to smoke, have a preterm baby, and have a baby who has a low birth rate. - Educational economic and psychosocial risks for father and mother.

- Lack of PA by young people is a concern. - In 2015, nearly half 48.6% students had not been physical active for at least 60 minutes per day on 5 or more days during the 7 days prior the survey. Males were more likely than females to due PA (57.8% compared to 39.1%). Nationally 14.3% students didn't do PA. - 25% of students watched TV for at lest 3 hours per day and 42% of students used the computer for something other than homework for at least 3 hours.

Can develop type 2 diabetes and other health issues. In 2015, about one quarter of high school students were obese (13.9) or overweight (16.8) while 31.5% described them as slightly or very overweight. Half of the students wanted to lose weight.

- Data sources regarding the health behaviors of college students are National College Health Assessment and Monitoring the Future. - The NCHA started in 2000 and is a national nonprofit research effort organized by the American College Health Association. Examines a wide range of health behaviors of college students. - Monitoring the Future is conducted by the University of Michigan Institute for Social Research (1975) has been funded by the National Institute of Drug Abuse. Examines drug behaviors and related attitudes of broad participant age range (with, tenth, twelfth graders to adults through age 55)

- Use of alcohol, by the injured individual or people with whim the individual is with at the time of injury, is the common cause of unitnifnal injuries among adolescents and young adults, ESPECIALLY college students. - Often associated with motor vehicle accidents but not always - Unintentional injuries have been the leading causes of death for young adults throughout the past 50 years.

- Sexual assault is prevalent among college students. - Female college students reported significantly more sexual abusive experiences in the past school year, without consent. Included sexual touching, verbal threats, attempted penetration, or sexual penetration. About 10.9% of females and 6.1% of males reported being involved in an emotionally abusive relationship.m - Alcohol is a contributing factor in may of these episodes.

- The more education a person has the less likely they are going to use tobacco. - 2015, the prevalent smoking for college students was 5% vs 16% for age-mates not enrolled full time college. - The use of tobacco by college students have been steadily declining until the early 1990s, was inconsistent during the 1990s and had a decline in the 2000s - the development of e-cigarettes has had an impact on tobacco use particularly among males who are not enrolled in college

- In 2014, alcohol was the drug of choice on college campuses. 63.1% reported consuming alcohol. Illicit drug use is lower than in 1980. - Alcohol trends: the number of people consuming one or more drinks in the past 30 days has had a stable decline the past 10 years, 79.4% college students tried alcohol. - Binge drinking is a concern. National College Health Association reported that 37.4% of males and 27.4% females binge drank at least one occasion during the 2 weeks prior to the survey. - Excessive alcohol leads to fatal and nonfatal injuries, alcohol poisoning, STDs and unintended pregnancy, and forms of violence

consuming five or more drinks in a row

- unintended pregnancies and infections with STDs through practice of unprotected sexual activity. - 54% of gonorrhea cases and 2/3 of chlamydia cases occur among person under 25 years of age - 2/3 (64%) of college students used condoms that last time they had intercourse and 34.9 relied on the withdrawal method.

Individual or environmental characteristics, conditions, or behaviors that reduce the effects of stressful life events. These factors also increase the ability to avoid risks or hazards, and promote social and emotional competence to thrive in life and the future. Factor that increases an individual's ability to avoid risks or hazards, and promoted social and emotional competence to thrive in all aspects of life. ex. School connectedness and engagement. ex. community service = engage in fewer problem behaviors in later adolescent and have a stronger connection to their community, self-esteem, future earning, SES status

The belief by students that adults and peers in the school care about their learning as well as about them as individuals. Has shown to decrease the likelihood of substance use, school absenteeism, violence, unintentional injuries, and early sexual initiation.

- Community health is influenced by 4 factors: physical factors, community organizing, individuals behavior, and social and cultural factors. Social and cultural factors and community organizing need attention when dealing with health problems of adolescents and young adults - Many health problems pregnant from the social and cultural environments in which people have been raised and lived in. And culture and social norms. - ex. Biggest heath problems facing adolescents and young adults in the US is alcohol use. Alcohol contributes to all leading causes of mortality and morbidity. Community need to change their culture. - Culture and social norms do not change quickly. - Needs to be community wide to sustain over long period. Community organizing effort is needed. - Alcohol prevention efforts needs to be a comprehensive school health education effort and should include components outside the classroom. Prevention programs need to focus on changing norms, interaction among peers, social skills training and developmental and cultural appropriateness. - adolescents and young adults are the healthiest segments of the US. Health problems need to be address at the community level for adolescents and young adults.

the involvement of all stakeholders in a community, not just those who are associated with health-related professions

institutionalizing the change in the culture

- Those 25 to 64 represent slightly more than half of the US population. Segment is expected to remain stable in the next couple of decades but in proportion this segment will become smaller. - Health profile is characterized with mortality from chronic disease stemming from poor health behaviors impacted by health-detracting environments and the health behaviors, events, and exposures experienced during earlier years of life.

- Life expectancy at birth between 75 and 80 years most Americans are expected to live beyond their 65th birthday. In the 1950 and 60s death for this age group was from preventable conditions associate with unhealthy behaviors and lifestyles. Public health and medical communities have recognized how the environment, social, and cultural factors shape an individuals' behavior. - Many adults have quit smoking, and more have been exercising regularly and eating healthier diets. - Lifestyle improvements and success in public health (built environment and advances in medicine)resulted in decline in death rates for adults. - Adult years were divided in two subgroups: 25 to 44 years and 45 to 65 years - 2013 the death rate for age 25 to 34 was 106.1 per 100,000 and for age 35 to 44 172.0 per 100,000 - Leading cause of death in 2013 were unintentional injuries, neoplasms, heart disease, and suicide. - Six leading causes of death are the same but different in rank order by race and ethnicity. For 35-44 year olds, heart disease is the leading cause of death for blacks. Unintentional injuries is the leading cause of deaths for whites and Hispanics. Diabetes is the leading cause of death for white and blacks. HIV is the leading cause of death for blacks. - 2013 the death rate 45 to 54 was 406.1 per 100,000 more than twice that of 35 to 44 age group. Death rate of 55 to 64 age group was more than two times greater than 45 to 54 age group. Majority of deaths were the results of noncommunicable health problems (cancer, heart disease, unintentional injuries, liver disease, chronic lower respiratory disease- emphysema, asthma, and bronchitis- and diabetes) - Cancer and heart dies are the first and second cause of death for all three groups (white black hispanic).

- Since 1983 the number one cause of death in the adult age group for those people ages 45 to 54 and 55 to 64 has been cancer. Cancer rtes for both age groups have decreased since 1950. - Four types of cancer account for these large numbers: prostate, lung, and colorectal for men; for women it is breast, lung, and colorectal. - The leading cause of cancer deaths and the most preventable type of cancer for men and women is lung cancer. Attributed to smoking. - Colorectal cancer: risk factors include obesity, physical inactivity, a diet high in red or processed meats, smoking, and moderate to high alcohol consumption - Breast cancer (it was surpassed by lung cancer in 1980) was the leading cancer deaths in women. Number of cases of breast cancer is more than twice that of lung cancer. Screenings for breast cancer > survival rates are much higher than for lung cancer. Breast cancer rates can be reduced if women older than 39 Yeats coupled with screening recommendations.

- Greatest changes in cause-specific mortality rates in adults - Age adjusted mortally rates from diseases of heart dropped from 588.8 per 100,000 to 169.8 in 2013. Death from strokes dropped. Dropped about 71% and 80%. - Changes are the results of public health efforts and changes in the environment. - The reduction of deaths from heart disease has resulted in cancer becoming the leading cause of deaths in adults 45 to 64 years of age.

- Risk factors associated with the leading causes of morbidity and mortality in American adults are associated with health behaviors the tare influenced by an individual's environment and other social determinants of health (income food education) - Need environmental support system. - Prevalence of smoking among adults has declined and the incidence of drinking and driving. - National Center for Health Statistics (NCHS) collects self-reported behavior risks data on adults. Data are collected via the Behavioral Risk Factor Surveillance System (BRFSS). The limitation is that the data is collected and usually reported on all adults older than 18 years of age (not broken down in specific age groups).

- Best single behavioral change Americans can make to reduce morbidity and mortality is to stop smoking. - Cigarette smoking causes one out of five deaths in the US each year and it is an important risk factor for cancer, heart disease and stroke.In 2014 nearly one sixth (17%) of this age 18 and older smoked. This is 40 million Americans. - Proportion of Americans who smoke has drooped considerably since 1965, when 40% of all Americans smoked. Consequences on individual health remains. Smoking rates are higher among AI/AN, people with fewer education, and lower income. - Three other risk factors that contribute to disease and death in adults are the: lack of exercise, poor nutrition, and drinking too much alcohol. Few are exercising on a regular basis. In 2011, more than half (52%) of US adults did not meet recommendations for aerobic exercise or physical activity. Recommendations encourage adults to engage in 2 hours and 30 minutes a week of moderate intensity aerobic PA and engage in muscle strengthening activities 2 or more days a week. - Poor dietary habits are associated with Type 2 diabetes, hypertension, heart disease, certain cancers, and micronutrient deficiencies. In 2011, more than one-third (38%) of adults reported eating fruit less than once per day and one-quarter (23%) ate veggies less than one day. - Poor diet and poor PA leads to obesity. More than one-third (34.9%) of US adults are obese with rate higher among middle age adults, 40 to 59 years old (39.5%), compared to those younger (30.3%) and over (35.4%). Obesity in the US is an epidemic. BMI is a way to measure obesity, Maintain weight is a combination of healthy eating and exercise. Person's environment, including society and other life circumstances, impacts his or her ability to engage in these behaviors. - Alcohol consumption places adults at greater health risk. In 2014, 57% of adult Americans reported consuming alcohol in the previous month and about one-quarter (24.7%) of people ages 18 or older reported bing drinking. - Men are twice as likely as women to report binge drinking and heavy alcohol use. Greater risks for developing dependence on alcohol and for developing alcohol related health problems as cirrhosis, alcoholism, and alcohol psychosis. - Alcohol increases the rates of homicide, suicide, family violence, and unintentional injuries (vehicle, boats, and falls)

cardiovascular workload measured by heart rate

the ratio weight (in kilograms) to height (in meters squared) BMI of 30 or more indicates an individual is obese.

- Ex. screenings for hypertensions, diabetes, high blood cholesterol, and cancer. - Blood pressure falls in the range of healthy. For adults (20 and over) BP should be less than 120/80 mm Hg (more than one blood pressure reading) - Hypertensive crisis exists when a person's systolic pressure is equal or greater than 140 mm of mercury and/or diastolic pressure is equal or greater than 110 mm Hg for extended periods of time. - Hypertension is found in one in three adults in the US and only half of this people have their condition under control > making it a risk factor for cardiovascular disease. - Hypertension is a highly modifiable risk factor: combo of diet modification, physical exercise, and weight management. And medications if need be. - Ways to reduce morbidity and mortality hypertension can be mass screenings - Diabetes - Cholesterol - Dietary factors are associated with 4 of the 10 leading causes of death. Disproportionate consumption of foods high in fat and added sugars, often at the expense of food in complex carbs and dietary fiber. Limiting sugars, sat fats, and sodium will help reduce a person's risk of diabetes, hypertension, heart disease, and stroke. - Cancer should be screened. Neoplasms are the leading cause of death in 45 to 65 year olds. American Cancer Society recommends a number of screenings for various groups

systolic pressure equal to or grater than 140 mm of mercury (Hg) and/or diastolic pressure equal to or grater than 90 mm Hg for extended periods of time

It results from failure of the pancreas to make or use sufficient amount of insulin. Without insulin food cannot be properly used by the body. Diabetes can be controlled through a combo of diet, exercise, medications, and insulin injections. Diabetes is one of the leading causes of death for adults especially adults age 45 to 64. Half of all Hispanic men and women and black women predicated to develop the disease. 29 million Americans or 9.3% of the US population are estimated to have diagnosed or undiagnosed diabetes with 1.7 million new cases diagnosed each year. Percentage of adults with diagnosed diabetes has nearly quadrupled over the past 30 years.

- Soft fat like substance that is need to build cell membranes. 75% of cholesterol produced by the liver and other cells in the body and 25% coming from foods. - Elevated cholesterol levels in the blood can put people at greater risk for heart disease and stroke. Person's cholesterol level is affected by health conditions like diabetes, lifestyle, age, and family history. We can reduce our risk by engaging in healthy lifestyle behaviors. - Less than 200 mg/dL in middle age show a low risk for coronary heart disease. People with a high total blood cholesterol have twice the risk for heart disease as people with ideal levels.

high levels of cholesterol in the blood can control through screening and treatment

- For most individuals between 25 and 64 are some of the healthiest of their lifetime. - Health status impacted by current and previous health behaviors (and SES like poverty and education) and personal influences on their health throughout their life. - Policy, systems, and environmental change strategies.