Adolescent Health and Well-Being – serie

Student wellbeing is foundational to academic success. One recent survey of postsecondary educators found that nearly 80 percent believed emotional wellbeing is a "very" or "extremely" important factor in student success. Studies have found the dropout rates for students with a diagnosed mental health problem range from 43 percent to as high as 86 percent. While dealing with stress is a normal part of life, for some students, stress can adversely affect their physical, emotional, and psychological health, particularly given that adolescence and early adulthood are when most mental illnesses are first manifested. In addition to students who may develop mental health challenges during their time in postsecondary education, many students arrive on campus with a mental health problem or having experienced significant trauma in their lives, which can also negatively affect physical, emotional, and psychological wellbeing.The nation's institutions of higher education are seeing increasing levels of mental illness, substance use and other forms of emotional distress among their students. Some of the problematic trends have been ongoing for decades. Some have been exacerbated by the COVID-19 pandemic and resulting economic consequences. Some are the result of long-festering systemic racism in almost every sphere of American life that are becoming more widely acknowledged throughout society and must, at last, be addressed.Mental Health, Substance Use, and Wellbeing in Higher Education lays out a variety of possible strategies and approaches to meet increasing demand for mental health and substance use services, based on the available evidence on the nature of the issues and what works in various situations. The recommendations of this report will support the delivery of mental health and wellness services by the nation's institutions of higher education.

Mental health and substance use disorders among children, youth, and young adults are major threats to the health and well-being of younger populations which often carryover into adulthood. The costs of treatment for mental health and addictive disorders, which create an enormous burden on the affected individuals, their families, and society, have stimulated increasing interest in prevention practices that can impede the onset or reduce the severity of the disorders. Prevention practices have emerged in a variety of settings, including programs for selected at-risk populations (such as children and youth in the child welfare system), school-based interventions, interventions in primary care settings, and community services designed to address a broad array of mental health needs and populations. Preventing Mental, Emotional, and Behavioral Disorders Among Young People updates a 1994 Institute of Medicine book, Reducing Risks for Mental Disorders, focusing special attention on the research base and program experience with younger populations that have emerged since that time.Researchers, such as those involved in prevention science, mental health, education, substance abuse, juvenile justice, health, child and youth development, as well as policy makers involved in state and local mental health, substance abuse, welfare, education, and justice will depend on this updated information on the status of research and suggested directions for the field of mental health and prevention of disorders.

To better understand the inequalities facing lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth and the promising interventions being used to address these inequalities, the National Academies of Sciences,Engineering, and Medicine's Board on Children, Youth, and Families hosted a virtual public workshop titled Reducing Inequalities Between LGBTQ Adolescents and Cisgender, Heterosexual Adolescents, which convened on August 25-27, 2021. The workshop was developed by a planning committeecomposed of experts from the fields of sociology, medicine, public health, psychology, social work, policy, and direct-service provision. This Proceedings of a Workshop summarizes the presentations and discussions from that workshop.

Adolescence is a distinct, yet transient, period of development between childhood and adulthood characterized by increased experimentation and risk-taking, a tendency to discount long-term consequences, and heightened sensitivity to peers and other social influences. A key function of adolescence is developing an integrated sense of self, including individualization, separation from parents, and personal identity. Experimentation and novelty-seeking behavior, such as alcohol and drug use, unsafe sex, and reckless driving, are thought to serve a number of adaptive functions despite their risks. Research indicates that for most youth, the period of risky experimentation does not extend beyond adolescence, ceasing as identity becomes settled with maturity. Much adolescent involvement in criminal activity is part of the normal developmental process of identity formation and most adolescents will mature out of these tendencies.Evidence of significant changes in brain structure and function during adolescence strongly suggests that these cognitive tendencies characteristic of adolescents are associated with biological immaturity of the brain and with an imbalance among developing brain systems. This imbalance model implies dual systems: one involved in cognitive and behavioral control and one involved in socio-emotional processes. Accordingly adolescents lack mature capacity for self-regulations because the brain system that influences pleasure-seeking and emotional reactivity develops more rapidly than the brain system that supports self-control. This knowledge of adolescent development has underscored important differences between adults and adolescents with direct bearing on the design and operation of the justice system, raising doubts about the core assumptions driving the criminalization of juvenile justice policy in the late decades of the 20th century. It was in this context that the Office of Juvenile Justice and Delinquency Prevention (OJJDP) asked the National Research Council to convene a committee to conduct a study of juvenile justice reform.The goal of Reforming Juvenile Justice: A Developmental Approach was to review recent advances in behavioral and neuroscience research and draw out the implications of this knowledge for juvenile justice reform, to assess the new generation of reform activities occurring in the United States, and to assess the performance of OJJDP in carrying out its statutory mission as well as its potential role in supporting scientifically based reform efforts.

Young adults are at a significant and pivotal time of life. They may seek higher education, launch their work lives, develop personal relationships and healthy habits, and pursue other endeavors that help set them on healthy and productive pathways. However, the transition to adulthood also can be a time of increased vulnerability and risk. Young adults may be unemployed and homeless, lack access to health care, suffer from mental health issues or other chronic health conditions, or engage in binge drinking, illicit drug use, or driving under the influence. Young adults are moving out of the services and systems that supported them as children and adolescents, but adult services and systems--for example, the adult health care system, the labor market, and the justice system--may not be well suited to supporting their needs. Improving the Health, Safety, and Well-Being of Young Adults is the summary of a workshop hosted by the Board on Children, Youth, and Families of the Institute of Medicine (IOM) and the National Research Council (NRC) in May, 2013.More than 250 researchers, practitioners, policy makers, and young adults presented and discussed research on the development, health, safety, and well-being of young adults. This report focuses on the developmental characteristics and attributes of this age group and its placement in the life course; how well young adults function across relevant sectors, including, for example, health and mental health, education, labor, justice, military, and foster care; and how the various sectors that intersect with young adults influence their health and well-being. Improving the Health, Safety, and Well-Being of Young Adults provides an overview of existing research and identifies research gaps and issues that deserve more intensive study. It also is meant to start a conversation aimed at a larger IOM/NRC effort to guide research, practices, and policies affecting young adults.

Identifying and Addressing the Needs of Adolescents and Young Adults with Cancer is the summary of a workshop convened by the Institute of Medicine's National Cancer Policy Forum in July 2013 to facilitate discussion about gaps and challenges in caring for adolescent and young adult cancer patients and potential strategies and actions to improve the quality of their care. The workshop featured invited presentations from clinicians and other advocates working to improve the care and outcomes for the adolescent and young adult population with cancer. Cancer is the leading disease-related cause of death in adolescents and young adults. Each year nearly 70,000 people between the ages of 15 and 39 are diagnosed with cancer, approximately 8 times more than children under age 15. This population faces a variety of unique short- and long-term health and psychosocial issues, such as difficulty reentering school, the workforce, or the dating scene; problems with infertility; cardiac, pulmonary, or other treatment repercussions; and secondary malignancies.Survivors are also at increased risk for psychiatric conditions such as anxiety, depression, substance abuse, and suicide and may have difficulty acquiring health insurance and paying for needed care. Identifying and Addressing the Needs of Adolescents and Young Adults with Cancer discusses a variety of topics important to adolescent and young adult patients with cancer, including the ways in which cancers affecting this group differ from cancers in other age groups and what that implies about the best treatments for these cancer patients. This report identifies gaps and challenges in providing optimal care to adolescent and young adult patients with cancer and to discuss potential strategies and actions to address them.

In the past decade, a number of state, local, and tribal jurisdictions have begun to take significant steps to overhaul their juvenile justice systems - for example, reducing the use of juvenile detention and out-of-home placement, bringing greater attention to racial and ethnic disparities, looking for ways to engage affected families in the process, and raising the age at which juvenile court jurisdiction ends. These changes are the result of heightening awareness of the ineffectiveness of punitive practices and accumulating knowledge about adolescent development. Momentum for reform is growing. However, many more state, local, and tribal jurisdictions need assistance, and practitioners in the juvenile justice field are looking for guidance from the federal government, particularly from the Office of Juvenile Justice and Delinquency Prevention (OJJDP) in the Department of Justice. Implementing Juvenile Justice Reform identifies and prioritizes strategies and policies to effectively facilitate reform of the juvenile justice system and develop an implementation plan for OJJDP.Based on the 2013 report Reforming Juvenile Justice, this report is designed to provide specific guidance to OJJDP regarding the steps that it should take, both internally and externally, to facilitate juvenile justice reform grounded in knowledge about adolescent development. The report identifies seven hallmarks of a developmental approach to juvenile justice to guide system reform: accountability without criminalization, alternatives to justice system involvement, individualized response based on needs and risks, confinement only when necessary for public safety, genuine commitment to fairness, sensitivity to disparate treatment, and family engagement. Implementing Juvenile Justice Reform outlines how these hallmarks should be incorporated into policies and practices within OJJDP, as well as in actions extended to state, local, and tribal jurisdictions to achieve the goals of the juvenile justice system through a developmentally informed approach. This report sets forth a detailed and prioritized strategic plan for the federal government to support and facilitate developmentally oriented juvenile justice reform.The pivotal component of the plan is to strengthen the role, capacity, and commitment of OJJDP, the lead federal agency in the field. By carrying out the recommendations of Implementing Juvenile Justice Reform, the federal government will both reaffirm and advance the promise of the Juvenile Justice and Delinquency Prevention Act.

Young adulthood - ages approximately 18 to 26 - is a critical period of development with long-lasting implications for a person's 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 of the next generation. Although 'millennials' have received attention in the popular media in recent years, young adults are too rarely treated as a distinct population in policy, programs, and research. Instead, they are often grouped with adolescents or, more often, with all adults. Currently, the nation is experiencing economic restructuring, widening inequality, a rapidly rising ratio of older adults, and an increasingly diverse population. The possible transformative effects of these features make focus on young adults especially important. A systematic approach to understanding and responding to the unique circumstances and needs of today's young adults can help to pave the way to a more productive and equitable tomorrow for young adults in particular and our society at large.Investing in The Health and Well-Being of Young Adults describes what is meant by the term young adulthood, who young adults are, what they are doing, and what they need. This study recommends actions that nonprofit programs and federal, state, and local agencies can take to help young adults make a successful transition from adolescence to adulthood. According to this report, young adults should be considered as a separate group from adolescents and older adults. Investing in The Health and Well-Being of Young Adults makes the case that increased efforts to improve high school and college graduate rates and education and workforce development systems that are more closely tied to high-demand economic sectors will help this age group achieve greater opportunity and success. The report also discusses the health status of young adults and makes recommendations to develop evidence-based practices for young adults for medical and behavioral health, including preventions. What happens during the young adult years has profound implications for the rest of the life course, and the stability and progress of society at large depends on how any cohort of young adults fares as a whole.Investing in The Health and Well-Being of Young Adults will provide a roadmap to improving outcomes for this age group as they transition from adolescence to adulthood.

Millions of Americans use e-cigarettes. Despite their popularity, little is known about their health effects. Some suggest that e-cigarettes likely confer lower risk compared to combustible tobacco cigarettes, because they do not expose users to toxicants produced through combustion. Proponents of e-cigarette use also tout the potential benefits of e-cigarettes as devices that could help combustible tobacco cigarette smokers to quit and thereby reduce tobacco-related health risks. Others are concerned about the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals who have never used tobacco products such as youth and young adults. Given their relatively recent introduction, there has been little time for a scientific body of evidence to develop on the health effects of e-cigarettes.Public Health Consequences of E-Cigarettes reviews and critically assesses the state of the emerging evidence about e-cigarettes and health. This report makes recommendations for the improvement of this research and highlights gaps that are a priority for future research.

Healthy mental, emotional, and behavioral (MEB) development is a critical foundation for a productive adulthood. Much is known about strategies to support families and communities in strengthening the MEB development of children and youth, by promoting healthy development and also by preventing and mitigating disorder, so that young people reach adulthood ready to thrive and contribute to society. Over the last decade, a growing body of research has significantly strengthened understanding of healthy MEB development and the factors that influence it, as well as how it can be fostered. Yet, the United States has not taken full advantage of this growing knowledge base. Ten years later, the nation still is not effectively mitigating risks for poor MEB health outcomes; these risks remain prevalent, and available data show no significant reductions in their prevalence.Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda examines the gap between current research and achievable national goals for the next ten years. This report identifies the complexities of childhood influences and highlights the need for a tailored approach when implementing new policies and practices. This report provides a framework for a cohesive, multidisciplinary national approach to improving MEB health.

The strengths and abilities children develop from infancy through adolescence are crucial for their physical, emotional, and cognitive growth, which in turn help them to achieve success in school and to become responsible, economically self-sufficient, and healthy adults. Capable, responsible, and healthy adults are clearly the foundation of a well-functioning and prosperous society, yet America's future is not as secure as it could be because millions of American children live in families with incomes below the poverty line. A wealth of evidence suggests that a lack of adequate economic resources for families with children compromises these children's ability to grow and achieve adult success, hurting them and the broader society.A Roadmap to Reducing Child Poverty reviews the research on linkages between child poverty and child well-being, and analyzes the poverty-reducing effects of major assistance programs directed at children and families. This report also provides policy and program recommendations for reducing the number of children living in poverty in the United States by half within 10 years.

Adolescence is a critical growth period in which youth develop essential skills that prepare them for adulthood. Prevention and intervention programs are designed to meet the needs of adolescents who require additional support and promote healthy behaviors and outcomes. To ensure the success of these efforts, it is essential that they include reliably identifiable techniques, strategies, or practices that have been proven effective.Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century identifies key program factors that can improve health outcomes related to adolescent behavior and provides evidence-based recommendations toward effective implementation of federal programming initiatives. This study explores normative adolescent development, the current landscape of adolescent risk behavior, core components of effective programs focused on optimal health, and recommendations for research, programs, and policies.

Adolescence is a dynamic time for both brain development and social pressures, making it a critical period to understand mental, emotional, and behavioral health, yet it is often overlooked in terms of policies and service interventions, which makes many young people feel unheard when communicating their own challenges.To explore best practices in providing and supporting adolescent health services and key messaging and communication strategies related to the mental, emotional, and behavioral health of adolescents, the National Academies of Sciences, Engineering, and Medicine's Forum for Children's Well-Being held a workshop on May 5, 2020. The workshop featured a panel of youth representatives who shared their own experiences related to mental, emotional, and behavioral health. This publication summarizes the presentation and discussion of the workshop.

Adolescence is a crucial period of life for the prevention of substance use disorders. Research has shown that early intervention can significantly reduce rates of substance use disorder in adulthood. To learn more about effective family-focused interventions in primary care settings for preventing substance use disorder, the National Academies of Sciences, Engineering, and Medicine hosted a workshop on May 5-6, 2022. The proceedings from that workshop explores existing efforts to incorporate family-focused interventions into state health care policies. It also examines barriers to implementing such interventions as well as lessons learned from successful efforts to scale up these interventions.

The COVID-19 pandemic has had an unprecedented impact on the lives of children and their families, who have faced innumerable challenges such as illness and death; school closures; social isolation; financial hardship; food insecurity; deleterious mental health effects; and difficulties accessing health care. In almost every outcome related to social, emotional, behavioral, educational, mental, physical, and economic health and well-being, families identifying as Black, Latino, and Native American, and those with low incomes, have disproportionately borne the brunt of the negative effects of the pandemic.The effects of the COVID-19 pandemic on children and families will be felt for years to come. While these long-term effects are unknown, they are likely to have particularly significant implications for children and families from racially and ethnically minoritized communities and with low incomes.Addressing the Long-Term Effects of the COVID-19 Pandemic on Children and Families identifies social, emotional, behavioral, educational, mental, physical, and economic effects of the COVID-19 pandemic and looks at strategies for addressing the challenges and obstacles that the pandemic introduced for children and families in marginalized communities. This report provides recommendations for programs, supports, and interventions to counteract the negative effects of the pandemic on child and family well-being and offers a path forward to recover from the harms of the pandemic, address inequities, and prepare for the future.