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  1. Taking the Pulse: Improving the Health, Safety and Well-Being of Young Adults Claire Brindis, Dr. P.H. Professor of Pediatrics and Health Policy Director, Philip R. Lee Institute for Health Policy Studies with Charles Irwin, Elizabeth Ozer, Jane Park, Sally Adams, and Jazmyn Scott Center for Vulnerable Populations September 19, 2013

  2. Why are we here? • Significant demographic shifts • Increasing body of evidence, including international comparisons, suggest that needs of this group have been overlooked • Increasing concerns regarding the impact of the “Odyssey”, Boomerang, Failure to Launch generation….

  3. Young Adults – Who are they? Between 1990 and 2060, the number of young adults ages 18-24 is projected to increase from 26 to 35 million; represents 10% of the total population. # in thousands US Census Bureau, 2012.

  4. Racial/ethnic diversity in the general population will continue to increase; the proportion of Hispanics has risen by 25%; the proportion of Whites has decreased by almost half. Racial and ethnic makeup of the US in 1960s vs. now Population Breakdown (%) by Race/Ethnicity, 1960-2050 US Census Bureau, 2013.

  5. Changing Demographics: Growth of Hispanic Population 1980 Pew Hispanic Center | US Census Bureau

  6. Changing Demographics: Growth of Hispanic Population 1990 Pew Hispanic Center | US Census Bureau

  7. Changing Demographics: Growth of Hispanic Population 2000 Pew Hispanic Center | US Census Bureau

  8. Changing Demographics: Growth of Hispanic Population 2010 Pew Hispanic Center | US Census Bureau

  9. Why this Population? Why now? • Throughout history and in every generation.. • Young adults need tools to be: • meaningfully engaged, • caring individuals in their communities, and • productively employed to their full potential in society • Changing age structure (aging population) will mean our nation will depend even more on young people’s health and well-being.

  10. Why this Population? Why now? • Just as they are needed more – there are more challenges to them being successful – especially true for vulnerable populations: • substance users, • mental health, etc.

  11. Life Course Perspective • How does health fit into the overall picture of ensuring a successful transition from adolescence through young adulthood? • Young adulthood is a critical period in one’s life; sets the stage for adulthood • Habits acquired in adolescence and further in young adulthood can impact the life course, particularly risk behaviors • Behaviors in young adulthood can increase risk of developing chronic disease later in life • Binge drinking and heart disease • Peak onset of chronic illnesses (i.e., mental health)

  12. Changing Context for Young Adulthood 13

  13. Changing Context • Post-Industrial Society and its impact on Education • Employment and other Pathways • Marriage and Family Formation • Role of Social Technology

  14. Milestones • The contextual change for young adulthood has resulted in delayed attainment of traditional milestones associated with the transition to becoming adult • Five major milestones • Completion of School • Leaving Home • Financial Independence • Marriage • Children “What is it about 20-Somethings?” New York Times(2010).

  15. Before 1960, over 80% of US jobs = industry and manufacturing

  16. Employment: Post-Industrial Society United States Department of Labor, Bureau of Labor Statistics(2010).

  17. Economic Mobility 66% percent of those raised in the bottom of the wealth ladder remain on the bottom two rungs themselves, and 66% of those raised in the top of the wealth ladder remain on the top two rungs. “Pursuing the American Dream: Economic Mobility Across Generations,” Pew Charitable Trusts (2012).

  18. Changing Context: Education Trends United States Department of Labor, Bureau of Labor Statistics(2013).

  19. Changing Context: School Enrollment Males Females “The Changing Pathways of Hispanic Youths Into Adulthood.” Pew Hispanic Center (2009). Note: Whites include only non-Hispanic whites. Blacks include only non-Hispanic blacks.

  20. Changing Role Of Women

  21. Changing Context: Gender Composition of Work Force Distribution of the US Labor Force by Gender, 1948-2009 Note: Figures reflect annual averages Pew Research Center, 2009.

  22. Quiz • In 2012, what percentage of young men ages 25-29 completed college degrees? Women? • 16% men, 28% women • 30% men, 37% women • 36% men, 38% women • 42% men, 49% women • In what year did females begin completing college at a higher rate than men? • 1986 • 1989 • 1991 • 1995

  23. Changing Context: Education Sources: 1947,and 1952 to 2002 March Current Population Survey, 2003 to 2012 Annual Social and Economic Supplement to the Current Population Survey (noninstitutionalized population, excluding members of the Armed Forces living in barracks); 1950 Census of Population and 1940 Census of Population (resident population).

  24. Milestone: College Completion Sources: 1947,and 1952 to 2002 March Current Population Survey, 2003 to 2012 Annual Social and Economic Supplement to the Current Population Survey (noninstitutionalized population, excluding members of the Armed Forces living in barracks); 1950 Census of Population and 1940 Census of Population (resident population).

  25. Milestone: College Completion Sources: 1947,and 1952 to 2002 March Current Population Survey, 2003 to 2012 Annual Social and Economic Supplement to the Current Population Survey (noninstitutionalized population, excluding members of the Armed Forces living in barracks); 1950 Census of Population and 1940 Census of Population (resident population).

  26. Changing Context: Unemployment Trends United States Department of Labor, Bureau of Labor Statistics(2013).

  27. Motherhood College Work Dropout Incarceration Military Other Trajectories

  28. Changing Context and other Trajectories: Military “The Changing Pathways of Hispanic Youths Into Adulthood.” Pew Hispanic Center (2009).

  29. Changing Context and other Trajectories: Incarceration “The Changing Pathways of Hispanic Youths Into Adulthood.” Pew Hispanic Center (2009).

  30. Quiz • What % of young adults ages 25-29 say they live at home or moved back in temporarily with their parents because of the economy? • 20% • 30% • 40% • 50%

  31. Milestones: Living at Home Youngest Adults Staying Closer to Home “The Boomerang Generation: Feeling OK About Living with Mom and Dad.” Pew Research Center (2012).

  32. Milestones: Financial Independence Financial Ties Vary with Age “The Boomerang Generation: Feeling OK About Living with Mom and Dad.” Pew Research Center (2012).

  33. Milestones: Marriage and Family Formation

  34. Milestones: Marriage by Education Level Percentage of 25-29 year old Women Who have Never Married, By Education, 1990-2010 Source: Decennial Census Public Use Microdata Samples, 1990-2000; American Community Survey Public Use Microdata Samples, 2010 “Knot Yet.” National Campaign to Prevent Teen and Unplanned Pregnancy (2013).

  35. Milestones: Marriage by Race Share of Never Married, by Race and Ethnicity, 1960-2008 (%) Note: Ages 18 and older. Hispanics are of any race. Whites and Blacks Include only non-Hispanics. “The Decline of Marriage and Rise of New Families.” Pew Research Center (2010).

  36. Milestones: Marriage, Childbearing Percentage of All Births to Women Ages 20-24 that were to Unmarried Women ages 20-24, 1970-2011 “Births to Unmarried Women.” Children Trends Data Bank (2012).

  37. Milestones: Marriage, Childbearing Percentage of All Births that were to Unmarried Women by Race and Hispanic Origin, 1970-2011 “Births to Unmarried Women.” Children Trends Data Bank (2012).

  38. Health Issues of Young Adults

  39. Health Issues of Young Adulthood • The major health problems of early adulthood are largely preventable. • Many problems are linked to behaviors and conditions with related outcomes. • Few young adults have serious impairment that interferes with daily functioning, BUT • Those with chronic conditions, including mental health disorders, must learn to manage these conditions with increasing interdependence.

  40. Global burden of disease in young people aged 10-24 years: a systematic analysis Gore et al, Lancet 2011

  41. Specific Behaviors & Negative Health Outcomes • Substance Use: Habituation, Trauma, Violence • Sexual Activity:STI’s & Pregnancy • Injury Related Behavior:Trauma & Disability • Eating Behaviors:Eating Disorders, Obesity & Chronic Physical & Mental Health Disorders • Mental Health Disorders: Disability

  42. Chronic Conditions

  43. Young Adults (18-25) reporting any Functional Limitation from any Condition, by Gender, 2011 National Health Interview Survey, 2011

  44. National Health Interview Survey, 2011

  45. National Survey on Drug Use and Health, 2010

  46. How do young adults use health care services? • Where do they go? • What do they get?