Written in collaboration with Katherine Warren
"Forever young, I wanna be forever young," said Jay-Z in a contemporary rendition of the classic song "Forever Young." For the Millennial Generation, born between 1980 and 2000, the American teens and 20-somethings who will be the first to come of age in the new millennium and the dream put into words by Bob Dylan seems closer to reality than ever before. According to a Pew Research Center survey, the Millennials in America are confident, upbeat and open to change, despite widespread fears about financial security as a result of the economic recession. Most young people today are confident about the future with nine out of ten believing that they will eventually meet their long-term financial goals, despite having a 37 percent unemployment rate, the highest in three decades for this age group.
Millennials embrace self-expression, both online and in person. Using the unprecedented technological connectedness of this age group, their counterparts abroad have recently ignited revolutions in Tunisia, Egypt and other Middle Eastern nations. They are the most ethnically and racially diverse generation in American history and with an increasingly knowledge-based economy. The Millennials are well on their way to becoming the most educated generation with a full 39.6 percent of Americans aged 18-24 enrolled in college as of 2008. They are also the first generation where more women are receiving undergraduate and graduate degrees as compared to men. Known also as the Multitasking Generation, their various handheld devices appear more like extra appendages than technological gadgets!
Despite their unbounded optimism as the Millennial generation comes of age, they face a number of serious health threats, including high rates of suicide, homicide, motor vehicle accidents, substance use, sexually transmitted infections and dramatically increasing obesity rates. The Millennial generation is the first to see rising rates of early-onset obesity-related diseases. In fact, the proportion of young adults between 18 and 29 years of age who are obese has more than tripled in the past forty years, from 8 percent in 1971-1974 to 24 percent in 2005-2006. Today's young people have also experienced a significant drop in physical activity in school as compared to their parents' generation. Almost two-thirds of young adults do not engage in regular leisure-time physical activity and three-quarters don't report participating in semi-weekly strength training recommended by the federal government. In this age group, 18 percent of young women and 12 percent of young men reported at least one of six serious health conditions in 2004-2006, with a full 4-5 percent reporting overall fair or poor health due to a chronic health condition. Furthermore, the obesity epidemic is rapidly becoming a national security issue, as 27 percent of young adults today are unable to meet the physical requirements to join the military. In fact, the military loses 12,000 young men and women each year before the recruits even finish the first term of enlistment because they are unable to maintain the medical requirements. As a result of the obesity epidemic, this generation may not be as healthy or live as long as their parents.
Mental health is also an important issue for this age group. Between 1999 and 2004, nearly nine percent of 20- to 29-year-olds reported having experienced major depression, generalized anxiety disorder or panic disorder in the past year. In particular, young women are nearly twice as likely (11 percent) to report these symptoms than are young men (6 percent) and low-income adolescents experience more than twice the rate of mental health problems as compared to their higher-income peers. For young people, aged 15-24, suicide is the third leading cause of death after unintentional injuries and homicide. On college campuses, the emotional health of first year college students has declined to the lowest level in a quarter century. Among children and adolescents with symptoms of mental health problems, one study found that only 10 percent had received any specialty mental health evaluation or service in the past year, with significant disparities by ethnicity, income and geography. Considering that half of lifetime diagnosable mental health disorders begin by age 14 and three-fourths by age 24, improved early detection and treatment of these illnesses is a cornerstone of a healthier future for the Millennial generation.
Furthermore, like past generations, today's young adults also have high rates of health damaging and risky behaviors. Despite decades of public health campaigns, alcohol, tobacco and substance use remain high in this generation. Six to eight percent of young men and three to five percent of young women are heavy drinkers. One-fifth of young adults are binge drinkers, consuming 5 or more drinks in a day on at least 12 days in the past year. The use of alcohol by young people involved in fatal motor vehicle crashes has increased slightly since 1999, reported in 23 percent of fatal cases involving drivers aged 16-20 and 41 percent of cases with drivers aged 21-24.
In 2006, nearly 30 percent of young adults currently smoked cigarettes. Though the smoking rate has decreased since 1997 by nearly 20 percent among women in this age group, it has not declined significantly for young men. Additionally, illicit drug use remains high with almost 40 percent of young adults aged 18-20, one-third of those 21-25 and one-quarter of those ages 26-29 reporting illicit drug use in the past year. Though pregnancy rates, abortion and birth rates have decreased for 15- to 24-year-old females since 1990, rates of gonorrhea and Chlamydia have increased in the past five years. Of particular significance, 14.2 percent of all new HIV diagnoses in 2006 were in patients, aged 15-24, an increase since 2002, with the highest rates among blacks in this age group.
Motor vehicle accidents remain the leading cause of death for young adults ages 15-29, followed by homicide and suicide. In fact, seven out of 10 deaths for those aged 10-24 in 2005 were the result of these three killers. Young men made up three-quarters of the 47,000 annual deaths in these categories with significant disparities among racial and ethnic groups. Given the peak of various risk-taking behaviors in this age population, it is not surprising that young adults have the highest rate of injury-related emergency department visits of all age groups. Two-thirds of young adults admit to texting while driving, a fact that highlights the need for further research on the impact of new media on the health of adolescents and young adults. Significant health disparities persist among youth, particularly by race, ethnicity, and gender. Blacks have the highest homicide rates and American Indians/Alaskan Natives continue to have both the highest rates of motor vehicle fatalities and suicide.
Additionally, there are many barriers to accessing health care for young adults, particularly those who rely on public health programs. The current available data shows continuing disparities across demographic groups on almost all health indicators . For Black and Latino youth, health status has decreased on almost every possible health indicator over the past decade.
Effectively addressing the health challenges facing the Millennials will require an integrated approach across multiple sectors. In a generation where 8 out of 10 of its members sleep with their cell phones on or next to their bed, mobilizing social media tools to advance the health of young people will be critical. The New York City Health Department is using Twitter to solicit restaurants' sanitary conditions feedback and advertise the free use of recreation centers during BeFitNYC Week. The National Suicide Prevention Lifeline is now on YouTube. The U.S. Department of Health and Human Services also released the "I'm a Flu Fighter" Facebook app during last year's H1N1 flu epidemic. Increased study of this generation's health trends and needs, as well as developing effective delivery mechanisms for health information, will be important for this age group.
Improving health will also necessitate increasing the Millennial generation's access to health care services and programs that target their unique needs. Young adults are the least likely of any age group to have health insurance, with only 61 percent reporting coverage as compared to 82 percent of those aged 30 and older. In 2004-2006, 17 percent of adults, aged 18-29, reported needing but not receiving medical care, prescription medicines, mental health services or eyeglasses in the past year because they could not afford them. In this time period, 15 percent of young adults reported not receiving dental care in the past year because of the higher out-of-pocket costs often associated with less comprehensive dental insurance. The recently passed health reform legislation, The Patient Protection and Affordable Care Act, includes a provision that will help as many as 1.2 million young people up to the age 26 remain on their parents' health insurance. The law also bans insurance companies from dropping young adults when they get sick or have an accident, as well as eliminates lifetime limits for health insurance plans. The recent health care reforms have begun the changes to shift our health care system from a treatment-based to a prevention-focused paradigm in the years ahead.
Investment in this age group will also require an increased research focus, as well as collecting national surveillance data on the Millennial generation. While the Centers for Disease Control and Prevention (CDC) collects data for age groups, 15-19, 20-24, and 25-29, many other research organizations do not regularly collect data for the specific "young adult" population. Though research is conducted on children, adolescent and adult health issues, statistics are infrequently disaggregated for the young adult group, aged 20-29, a population group that has increasingly more in common with older adolescents and the 20-somethings of their generation than seen previously, due to the shift of many important life events such as marriage, leaving home and having children to later years. Furthermore, there is a dearth of data on special Millennial populations including LGBTs, those living in rural areas and those in nontraditional home settings including the foster care and juvenile justice systems. Greater attention to analyzing data with a focus on youth will allow for public health interventions to be better tailored to the needs of the Millennial generation.
After all, the Millennials mark the beginning of a new era of health challenges and opportunities for the United States. Though the goal is perhaps not to be forever young, it is to be forever healthy. The Millennials have innovative social media tools available at their fingertips that were literally unimaginable to those in their parents' generation. But they also have health problems of epidemic proportions, of both communicable and non-communicable conditions. While Millennials represent 27 percent of the U.S. population, they are 100 percent of our nation's future. That's why these change agents of the 21st century must make their health a priority and why we must invest in them.
****
Rear Admiral Susan Blumenthal, M.D. (ret.) is the Public Health Editor of the Huffington Post. She serves as Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center. She served for more than 20 years in health leadership positions in the Federal government in the Administrations of four U.S. Presidents, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health. Dr. Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide and was the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association. Admiral Blumenthal has been named by the National Library of Medicine, The New York Times and the Medical Herald as one of the most influential women in medicine and by GQ magazine and the Geoffrey Beene Foundation as a 2010 Rock Star of Science.
Katherine Warren, an undergraduate at Harvard University, serves as a Health Policy Fellow at the Center for the Study of the Presidency and Congress.
References:
Pew Research Center. (2010). Millennials: A Portrait of Generation Next. Retrieved from http://pewsocialtrends.org/files/2010/10/millennials-confident-connected-open-to-change.pdf
Pew Research Center. (2010). Millennials: A Portrait of Generation Next. Retrieved from http://pewsocialtrends.org/files/2010/10/millennials-confident-connected-open-to-change.pdf
Pew Research Center. (2010). Millennials: A Portrait of Generation Next. Retrieved 4 Apr. 2011 from http://pewsocialtrends.org/files/2010/10/millennials-confident-connected-open-to-change.pdf
Pew Research Center. (2010). Millennials: A Portrait of Generation Next. Retrieved from http://pewsocialtrends.org/files/2010/10/millennials-confident-connected-open-to-change.pdf
Wallis, C. (2006). genM: The Multitasking Generation. Time Magazine. Retrieved 4 Apr. 2011 from http://www.time.com/time/magazine/article/0,9171,1174696,00.html
Olshansky, S. J. et al. (2005). A Potential Decline in Life Expectancy in the United States in the 21st Century. The New England Journal of Medicine 352:1138-1145. Retrieved 4 Apr. 2011 from http://www.nejm.org/doi/full/10.1056/NEJMsr043743.
Mulye, T.P.; Park, M.J.; Nelson, C.D.; Adams, S.H.; Irwin, C.E.; Brindis, C.D. (2009). "Trends in Adolescent and Young Adult Health in the United States." Journal of Adolescent Health 45:8-24.
U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
Mission: Readiness (2010). Too Fat to Fight: Retired Military Leaders Want Junk Food Out of America's Schools. Washington, DC: Mission Readiness. Retrieved Apr. 7, 2011 from
U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
National Adolescent Health Information Center (2007). 2004 & 2005 National Health Interview Survey. Retrieved Apr. 6, 2011 from http://www.cdc.gov/nchs/nhis.htm
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (2010). Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved Apr. 4, 2011 from http://cdn.missionreadiness.org/MR_Too_Fat_to_Fight-1.pdfwww.cdc.gov/ncipc/wisqars
Pryor, J.H., Hurtado, S., DeAngelo, L., Palucki Blake, L., & Tran, S. (2010). The American freshman:
National norms fall 2010. Los Angeles: Higher Education Research Institute, UCLA. Retrieved Apr. 4, 2011 from http://www.heri.ucla.edu/PDFs/pubs/briefs/HERI_ResearchBrief_Norms2010.pdf
Kataoka, S.H., Zhang, L., & Wells, K.B. (2002). Unmet need for mental health care among U.S. Children: Variation by ethnicity and insurance status. American Journal of Psychiatry 159(9): 1548-1555.
Kessler, R.C., Berglund, P., Demler, O., et al. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry 62:593-602.
U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
National Highway Traffic Safety Administration. Traffic safety facts 1999: a compilation of motor vehicle crash data from the fatality analysis reporting system and the general estimates system. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/809100.PDF. Accessed March 18, 2009.
Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System [youth online database]. Available at: http://apps.nccd.cdc.gov/yrbss. Accessed March 18, 2009.
U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
Mulye, T.P.; Park, M.J.; Nelson, C.D.; Adams, S.H.; Irwin, C.E.; Brindis, C.D. (2009). "Trends in Adolescent and Young Adult Health in the United States." Journal of Adolescent Health 45:8-24.U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
Mulye, T.P.; Park, M.J.; Nelson, C.D.; Adams, S.H.; Irwin, C.E.; Brindis, C.D. (2009). "Trends in Adolescent and Young Adult Health in the United States." Journal of Adolescent Health 45:8-24.
National Center for Health Statistics (2010). "Table 7. Deaths and death rates for the 10 leading causes of death in specified age groups: United States, preliminary 2009." National Vital Statisticsc Reports 59(4). Retrieved Apr. 6, 2011 from http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_04.pdf
National Center for Injury Prevention and Control. WISQARS: Leading Causes of Death, Fatal and Non-Fatal Injury Reports. Retrieved from http://www.cdc.gov/ncipc/wisqars.
U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
Pew Research Center. (2010). Millennials: A Portrait of Generation Next. Retrieved from http://pewsocialtrends.org/files/2010/10/millennials-confident-connected-open-to-change.pdf
Mulye, T.P.; Park, M.J.; Nelson, C.D.; Adams, S.H.; Irwin, C.E.; Brindis, C.D. (2009). "Trends in Adolescent and Young Adult Health in the United States." Journal of Adolescent Health 45:8-24.
Mulye, T.P.; Park, M.J.; Nelson, C.D.; Adams, S.H.; Irwin, C.E.; Brindis, C.D. (2009). "Trends in Adolescent and Young Adult Health in the United States." Journal of Adolescent Health 45:8-24.
U.S. Department of Health and Human Services. (2008). Health, United States, 2008, with Special Feature on the Health of Young Adults (DHHS Publication No. 2009-1232). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
Dental, Oral and Craniofacial Data Research Center. Oral health U.S., 2002. Bethesda, MD. Available from: http://drc.hhs.gov/report/inside_cover.htm.
Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey. Center for Financing, Access, and Cost Trends. Dental services expenditures table 2. 2003. Available from: http://www.meps.ahrq.gov/mepsweb/data_stats/ summ_tables/hc/state_expend/2003/table2.htm.
Democratic Leader Nancy Pelosi (2011). How the Affordable Care Act Benefits Young Adults. Democratic Leader News Room. Retrieved Apr. 11, 2011 from http://www.democraticleader.gov/news/reports?id=0519
Knopf, D.K., Park, M.J., Brindis, C.D. et al. (2007). What gets measured gets done: assessing data availability for adolescent populations. Maternal and Child Health Journal 11:335-45.
U.S. Census Bureau (2010). Age and Sex, 2005-2009 American Community Survey 5-Year Estimates. American Community Survey. Retrieved Apr. 11, 2011 from http://factfinder.census.gov/servlet/STTable?_bm=y&-geo_id=01000US&-qr_name=ACS_2009_5YR_G00_S0101&-ds_name=ACS_2009_5YR_G00_