While generally enjoying good health, adolescents and young adults face a range of physiological, psychological, and developmental changes, including puberty, newly found independence, experimentation, and risky behaviors that shape their health decisions and needs. Youth in the District are disproportionately affected by violence and certain sexually transmitted infections . Because adolescents are in developmental transition, they are particularly sensitive to influences from their social environments . It’s understood that families, peer groups, schools, and neighborhoods can either support or threaten young people’s health and well-being; and societal policies and cues, such as structural racism and media messages, can do the same .
Older adolescents and young adults, including those with chronic health conditions, may face challenges as they transition from the child to the adult health care system, such as changes in their insurance coverage and legal status and decreased attention to their developmental and behavioral needs. Encouraging and protecting the positive development of young people facilitates their adoption of healthy behaviors and helps ensure a healthy and productive adult population.
The DC Healthy People 2020 goals for adolescent health include:
1. Adolescents and young adults are socially, physically, emotionally, and mentally supported by the environments in which they regularly engage (home, school, neighborhood).
2. Adolescents and young adults are successful in school and credentialing programs and ready for a career or higher education.
Nutrition and Physical Activity
Eating a healthy diet and maintaining a healthy body weight are important components of overall wellness and success particularly for young people. In the District, youth reported a decrease in the consumption of soda and other sugary drinks over the past decade, as well as a strong tendency to eat breakfast at least some days of the week. More concerning findings include that DC youth spend more time doing sedentary online activities, a habit that is strongly correlated to reported feelings of sadness and hopelessness. It’s important to note that efforts to promote healthy diet and weight should not only address individual behaviors, but also improve policies and build environments in our schools and communities to support health .
Safety, Violence and Juvenile Justice
Violence is one of the leading causes of death and injuries among young people between the ages of 10 and 24 in the United States. Violence can take different forms, such as fighting, bullying, threats with weapons, and gang-related violence. Recent data reveal that violence or the threat of violence has significant impact on daily life for some young people in the District and even causes some students to miss school regularly .
Research on differential treatment of Black youth reveals that Black boys and girls are perceived as older and more likely to be guilty than their white peers, and that police violence against them is more justified . The combination of racism, sexism, and cultural expectations that end with Black girls receiving harsher school discipline, take shape in interactions with systems outside of schools (such as law enforcement and courts) and uniquely affects Black girls’ entry and outcomes in the juvenile justice system. Research on Black girls shows they are more likely to be seen as hypersexual and are less likely to be seen as victims of violence and trauma. As a result, they are more vulnerable to justice involvement when it stems from unaddressed trauma .
Sexual and Reproductive Health
Sexual behaviors can place adolescents at risk for HIV infection, other sexually transmitted infections (STIs), and unintended pregnancy. According to the Centers for Disease Control and Prevention, youth ages 15-24 make up just over one quarter of the sexually active population, but account for half of the 20 million new sexually transmitted diseases that occur in the United States each year. Many young people engage in sexual risk behaviors that can result in unintended health outcomes. Reducing the risk for HIV, STIs, and unintended pregnancy requires having a strong understanding of the underlying attitudes and behaviors of young people, which the YRBS provides.
Very few states in the US have adopted policies that affirm the rights of young people to obtain abortion care. The District is the most protective of the rights of adolescents in the country with regulations that explicitly establish the right of patients younger than 18 to consent to abortion care without parental involvement [6, 7].
Mental and Emotional Health
The adolescent years mark major physical, social, and psychological milestones for young people. Mental and emotional support are critically important components of youth development during this transitional period of their lives. The prevalence of depression in the US and the District among adolescents and young adults is on the rise, leading to a growing number of young people with untreated depression. Many DC youth experience prolonged depression that interferes with everyday activities, and many report they are not able to find the help they need.
Between 2012-2017 in the District of Columbia, an annual average of about 48.5% of youth aged 12-17 with a major depressive episode received depression care . Furthermore, some are experiencing suicidal ideation and suicide attempts, particularly females of color and LGB youth. There is a great need for culturally appropriate prevention and intervention programs that promote strong mental and emotional health among DC youth.
Alcohol, Tobacco and Drugs
Alcohol and drug use increases the risk of injuries, violence, HIV infection, depression, and other health problems among young people and continues to be a public health concern around the country. While alcohol and illegal drug use is down overall from ten years ago in DC, certain groups of DC youth appear to be more at risk. LGB youth were disproportionately represented among youth who used alcohol, tobacco and drugs in 2017 . Understanding the behaviors of these groups is critical to developing effective prevention and intervention programs for DC youth. Although drug use and addiction can happen at any time during a person’s life, drug use typically starts in adolescence, a period when the first signs of mental illness commonly appear. Co-morbid disorders can also be seen among youth. During the transition to young adulthood (ages 18 to 25 years), people with co-morbid disorders need coordinated support to help them navigate potentially stressful changes in education, work, and relationships .
Vaping, or smoking e-cigarettes, is receiving renewed attention amid recent illnesses and deaths that were linked to vaping. DC law already prohibits the sale of vaping products to anyone under the age of 21, but lawmakers introduced two bills in September 2019 that would ban flavored e-cigarettes and require a prescription to purchase other electronic smoking products. 
Assets & Resources
Promising Practices & Policies:
• AH-I Offer comprehensive early childhood development programs for low income families.
• AH-II Implement the Whole School, Whole Community, Whole Child approach to achieve comprehensive, integrated, and collaborative school health services.
• AH-III Implement restorative justice practices before youth are involved with the criminal justice system.
• Attendance interventions for chronically absent students provide support and resources to address individual factors that contribute to absences such as low self-esteem, school anxiety, social skills, medical conditions, familial factors such as poverty, parental support; and school factors such as teacher/student relationships and bullying.
• Lead abatement programs can improve health outcomes for children and adolescents by reducing developmental disorders, attention deficit hyperactivity disorder-related behaviors (ADHD), anemia, hypertension, and kidney and brain damage.
• Addressing bullying in school wellness policies can demonstrate strong support for full inclusion in healthy eating and physical activity opportunities by including anti-bullying measures that affirm positive, supportive, safe and inclusive school environments.
• Addressing segregation by income, race, and ethnicity as rigorous evidence shows that neighborhoods matter in shaping life chances. Yet economic and racial segregation means that children of different races and incomes often grow up in neighborhoods with vastly different sets of resources and opportunities.
Citations & Additional Data Resources
1. DC Healthy People 2020. Adolescent Health. 2016
2. Healthy People 2020. Adolescent Health. 2019
3. DC YRBS 2017
4. Georgetown Law Center on Poverty and Inequality. Girlhood Interrupted: The Erasure of Black Girls’ Childhood. 2017
5. Rights4Girls and Georgetown Juvenile Justice Initiative. Beyond the Walls: A Look at Girls in D.C.’s Juvenile Justice System. 2018
6. Guttmacher Institute. Ensuring Access to Abortion at the State Level: Selected Examples and Lessons. 2019
7. DC Regulations. Minor’s Health Consent. Regulation No. 74-22 (August 30, 1974), 21 DCR 477 (September 16, 1974), 6H DCRR § 2 (1982); as amended by § 2 of the Minors Health Consent Regulation, effective November 17, 1981 (D.C. Law 4-52; 28 DCR 4348 (October 9, 1981)); as amended by § 5 of the Preventive Health Services Amendments Act of 1985, effective February 21, 1986 (D.C. Law 6-83; 32 DCR 7276, 7282 (December 13, 1985)).
8. SAMHSA. Behavioral Health Barometer, District of Columbia, Volume 5. 2017.
9. NIH. Common Comorbidities with Substance Use Disorders. 2018
10. DCist. The DC Council Will Consider Two Bills to Crack Down on Vaping. 2019
Photo by Mignon Hemsley on Unsplash