We are indebted to Eaton and colleagues for their analysis of 2003 BRFSS data to find among 18- to 24-year olds that: 33% reported binge drinking; 10% engaged in HIV-related high-risk behavior; 30% smoked cigarettes; 36% did not engage in sufficient physical activity; 78% did not eat sufficient fruits and vegetables; 68% were trying to lose or maintain weight; 30% did not have health care coverage; 58% never had been tested for HIV; 56% never had their blood cholesterol checked; 4% and 6% already were diagnosed with high blood cholesterol and high blood pressure, respectively; 8% reported fair or poor health; and 11% reported limitation of activities from physical or psychological problems. (1)
These data bode poorly for the health of our adolescents and emerging adults, and consequently for the future of our nation. Similar to rapid brain and neuroendrocrine development during perinatal transitions, substantial development in brain biology, physiology, and architecture occur during transitions from pre-adolescence through emerging adulthood. An increase in gonadal and stress response hormones during puberty may influence the structural and functional remodeling of the brain; as may tobacco, alcohol, other drugs, anxiety, depression, and physical and psychological trauma. Sculpting of the maturing brain interactively involves genetic programming, cell function, and the environment. The dorsolateral aspect of the brain's prefrontal cortex (which controls thinking ahead and inhibition of impulsive responses) as well as the ventromedial aspect (which controls the regulation of emotions, weighing risks and rewards, and learning from experience) continue to develop substantially until about age 24. (2-5) Thus, there is increasing biological and sociological evidence that emerging adulthood provides a pivotal development period characterized by Arnett (6) as the age "of self focus, of instability, of feeling in-between, of identity exploration, and of possibilities." During the pivotal developmental periods of youth--i.e., early adolescence (ages 10-14), later adolescence (ages 15-19), and emerging (or young) adulthood (20-24)--we largely become who we will be as adults. Regrettably, the last thorough analysis of the well-being of adolescents was submitted to Congress 16 years ago. (7-10)
We as a society have not built the type of consolidated infrastructure--perhaps similar to the infrastructure built 40 years ago to assure Maternal and Child Health--to assure that adolescents and emerging adults can thrive and grow into healthy and productive individuals who experience high quality lives; especially among those most disenfranchised. During the recent past our nation has built vital, though under-funded, largely independent initiatives to improve the lives of youth. Space provided for this commentary permits only a limited outline of some recent national initiatives. Most, but not all, of these initiatives largely function only within a single discipline to improve the lives of youth; e.g., within in secondary and higher education, public health or medicine, the Agricultural Extension Service, labor, faith-based organizations, juvenile justice, community-based youth-serving organizations, the military, or family services organizations, among others--and only within either public-, not-for-profit, or private-sector agencies.
A few examples of initiatives developed within the federal government include: the Health Resources and Services Administration established an Office of Adolescent Health; (11) and the Centers for Disease Control and Prevention built a Division of Adolescent and School Health. (12) These two agencies, in collaboration with many others, launched the National Initiative to Improve Adolescent Health by 2010, (13-14) which monitors and strives to attain 21 National Health Objectives critical to youth. (15) The National Institutes of Health developed Medline Plus--Teen Health; (16) the Department of Agriculture engages seven million youth in developmental activities; (17) the Juvenile Justice and Deliquency Prevention Act established the Coordinating Council on Juvenile Justice and Delinquency Prevention; (18) the current White House established the Task Force for Disadvantaged Youth, (19) and Helping America's Youth. …