The Changing Face of America's Adolescents

More than 12 percent of people in the United States—almost 42 million—are between the ages of 10 and 19.[1] These adolescents are increasingly diverse and reflect the changing racial/ethnic, socioeconomic, and geographic structure of the U.S. population.

As young people develop their identities and habits, these diverse characteristics are connected to their health outcomes and access to services. If adults who work with youth understand the demographic characteristics and diversity of adolescents, they can do a better job of planning and delivering health services to this population.

Number of Adolescents

Today, adolescents make up 13.2 percent of the population. As the U.S. population ages, adolescents will represent a smaller proportion of the total. By 2050, estimates show that adolescents will make up 11.2 percent of the population. While adolescents are predicted to represent a smaller portion of the total population, estimates show that the number of adolescents in the population will continue to grow, reaching almost 45 million in 2050.

Adolescents will represent a decreasing percentage of the U.S. population

The number of adolescents will continue to grow

Source: 2014 Current Population Survey Estimate and the 2012 National Population Projections Middle Series

Age and Gender

There are important developmental, physical, and behavioral differences between younger (10-14) and older (15-19) adolescents. For instance, older youth are more likely to engage in unsafe behaviors—including drug use and risky sexual activity—than are younger teens.[2,3]

There are also differences between male and female adolescents in risky health behaviors. For example, male adolescents are more likely to use tobacco, alcohol, and other drugs while female adolescents are more likely to be physically inactive and to engage in unhealthy eating behaviors (such as intentionally vomiting and skipping meals), which often leads to eating disorders to control their weight and body composition.[2]

Differences by age and gender also show up in how adolescents use health services. For example, as they get older, male adolescents are less likely to see a doctor than female adolescents.[4] Professional guidelines recommend that providers spend some time alone with adolescent patients during health visits. This one-on-one time helps build a relationship with a health professional, encourages adolescents to share health information, and improves adolescents’ ability to manage their health care.[5]

49 percent of adolescents are female and 51 percent are male.Adolescents are evenly split between younger (ages 10-14) and older (15-19) adolescents.

Source: Table 3 of Current Population Survey. Projections of the population by sex and selected age groups for the United States: 2015 to 2060.

Race and Ethnicity

Differences by race/ethnicity in access to health care, health-related behaviors, and health outcomes are widely known.[2] Members of racial and ethnic minority groups, in general, have less access to health care, experience more serious health conditions, and have higher mortality rates than whites.[6-8] In part, these disparities reflect higher poverty rates among racial and ethnic minorities, which are also linked to poorer health.[9, 10] Health professionals can improve the delivery of services to minority youth by incorporating culturally informed practices.[11-14]

The proportion of adolescents who are racial and ethnic minorities is expected to rise in the future. More than half of U.S. adolescents (54 percent) were white in 2014, but by 2050 that proportion is projected to drop to 40 percent as Hispanic and multiracial teens, in particular, come to represent a larger share of the population. Health equity among the diverse adolescent population will be difficult to achieve if racial and ethnic disparities are not addressed.

Adolescents will become increasingly diverse in race & ethnicity.

Hispanics/Latinos can be of any race. As listed all race categories, except for Hispanic and multiracial, exclude Hispanics/Latinos. AIAN stands for American Indian Alaska Native. HPI stands for Hawaiian or Other Pacific Islander.
Source: Current Population Survey: Projected Population by Single Year of Age, Sex, Race, and Hispanic Origin for the United States: 2014 to 2060.

Socioeconomic Status

Poverty is a reality for many adolescents in the United States. In 2014, almost one in five adolescents (18 percent) were living in families with incomes below the federal poverty line (defined as an income of $23,850 or less for a family of four with two children in 2014). Poverty rates were especially high for children growing up in a single-parent family.[15]

Growing up in poverty can have negative health implications for adolescents. Compared to adolescents in higher income families, adolescents in lower income families have worse academic outcomes. These adolescents are also more likely to suffer from behavioral or emotional problems and engage in unhealthy behaviors, such as smoking and early initiation of sexual activity.[16-20]

In general, low-income adolescents have also been more likely to be uninsured.[21] However, the Patient Protection and Affordable Care Act of 2010 has expanded health insurance coverage in recent years. As a result, more than nine in 10 adolescents ages 10 to 19 (91 percent) now have health insurance.[1] Still, almost two million adolescents between the ages of 12 and 17 lacked health insurance in 2014.[1]

*Not including youth in foster care or those under the age of 15 living with non-relatives
Source: U.S. Census Bureau. (2014). Current Population Survey, Annual Social and Economic Supplement, 2014. Retrieved February 4, 2015, from http://www.census.gov/cps/data/cpstablecreator.html

Geographic Location

Where adolescents live affects the number and types of services that they can access and their health behaviors. Most adolescents in the United States live in or just outside an urban area. Adolescents in urban areas, particularly those who live in poverty, may be exposed to higher levels of certain environmental toxins, violent crime, and may live in neighborhoods with limited options to purchase healthy food.[22,23] However, urban children are more likely than rural children to have access to community or recreation centers and parks or playgrounds.[24]

More than six million adolescents live in a rural area. Rural adolescents are more likely to be poor than adolescents in urban areas. They also face barriers to accessing health services due to a shortage of providers and transportation challenges.[25-28] Moreover, mental health services are notably limited in rural areas.[29] Youth in rural areas, compared to youth in urban areas, are more likely to be overweight or obese, to spend more time watching television or videos, and to live with someone who smokes.[29] Nevertheless, rural children (particularly those in small rural areas) are more likely than other children to share a meal with their family every day of the week and attend religious services at least weekly—both of which are linked to more positive health outcomes.[29]

18.3 million adolescents live in a suburban area, 11.0 million live in an urban area, and 6.1 million live in a rural/non-metropolitan area.

Note: Nearly six million adolescents (6,013,724) live in a“not identified” Census area.
Source: U.S. Census Bureau. (2014). Current Population Survey, Annual Social and Economic Supplement, 2014. Retrieved February 4, 2015, from http://www.census.gov/cps/data/cpstablecreator.html

Footnotes

1
U.S. Census Bureau. (2014). Current Population Survey, annual social and economic supplement, 2014. Retrieved January 21, 2016, from http://www.census.gov/cps/data/cpstablecreator.html.
2
Centers for Disease Control and Prevention. (2014). Youth risk behavior surveillance — United States, 2013. Morbidity and Mortality Weekly Report, 63(4). Retrieved January 21, 2016, from http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf.
3
Johnston, L. D., O'Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the Future national results on drug use: 1975–2014: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan. Retrieved January 21, 2016, from http://www.monitoringthefuture.org//pubs/monographs/mtf-overview2014.pdf.
4
Ziv, A., Boulet, J. R., & Slap, G. B. (1999). Utilization of physician offices by adolescents in the United States. Pediatrics, 104(1), 35–42. Retrieved January 21, 2016, from http://pediatrics.aappublications.org/content/104/1/35.abstract.
5
American Academy of Pediatrics. Adolescence: 11 to 21 years. Retrieved January 21, 2016, from http://brightfutures.aap.org/pdfs/Guidelines_PDF/18-Adolescence.pdf.
6
Agency for Healthcare Research and Quality. (2012). Disparities in healthcare quality among racial and ethnic groups: Selected findings from the 2011 National Healthcare Quality and Disparities Reports. Rockville, MD: U.S. Department of Health and Human Services. Retrieved January 21, 2016, from http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr11/minority.pdf.
7
Murphy, S. L., Xu, J., & Kochanek, K. D. (2013). Deaths: Final data for 2010. National Vital Statistics Reports, 61(4). Retrieved January 21, 2016, from http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_09.pdf.
8
Office of Minority Health. (2014). Asian American and Pacific Islander Heritage Month 2014 "I am beyond". Retrieved January 21, 2016, from http://omhhehealthequitymatters.blogspot.com/2014/05/asian-american-and-pacific-islander.html.
9
Dubay, L., & Lebrun. (2012). Health, behavior, and health care disparities: Disentangling the effects of income and race in the United States. International Journal of Health Services, 42(4), 607–625.
10
Lau, M., Lin, H., & Flores, G. (2012). Racial/ethnic disparities in health and health care among U.S. adolescents. Health Services Research, 47(5).
11
Richardson, A., Allen, J. A., Xiao, H., & Vallone, D. (2012). Effects of race/ethnicity and socioeconomic status on health information-seeking, confidence, and trust. Journal of Health Care for the Poor and Underserved, 23(4), 1477–1493.
12
Goodkind, J. R., Ross-Toledo, K., John, S., Hall, J. L., Ross, L., Freeland, L., et al. (2010). Promoting healing and restoring trust: Policy recommendations for improving behavioral health for American Indian/Alaska Native adolescents. American Journal of Community Psychology, 46, 386–394.
13
Imel, Z. E., Baldwin, S., Atkins, D. C., Owen, J., Baardseth, T., & Wampold, B. E. (2011). Racial/ethnic disparities in therapist effectiveness: A conceptualization and initial study of cultural competence. Journal of Counseling Psychology, 58(3), 290–298.
14
Alegria, Margarita, Melissa Vallas, & Andres J. Pumariega. (2010). Racial and ethnic disparities in pediatric mental health. Child and Adolescent Psychiatric Clinics of North America, 19(4): 759–774.
15
Blackwell, D. L. (2010). Family structure and children's health in the United States: Findings from the National Health Interview Survey, 2001-2007. Washington, DC: National Center For Health Statistics. Retrieved January 21, 2016, from http://www.cdc.gov/nchs/data/series/sr_10/sr10_246.pdf.
16
Schreier, H., & Chen, E. (2010). Health Disparities in Adolescence. In A. Steptoe (Ed.), Handbook of Behavioral Medicine (pp. 571–583). New York, NY: Springer.
17
Howell, E. (2004). Access to children’s mental health services under Medicaid and SCHIP. Washington, DC: The Urban Institute. Retrieved January 21, 2016, from http://www.urban.org/UploadedPDF/311053_B-60.pdf.
18
Pampel, F. C., Kreueger, P. M., & Denney, J. T. (2010). Socioeconomic disparities in health behaviors. Annual Review of Sociology, 36, 349–370.
19
Hiscock, R., Bauld, L., Amos, A., Fidler, J.A., & Munafo, M. (2012). Socioeconomic status and smoking: a review. Annals of the New York Academy of Sciences, 1248,107–123.
20
Kirby, D. (2002). Antecedents of adolescent initiation of sex, contraceptive use, and pregnancy. American Journal of Health and Behavior, 26(6), 473–485.
21
Berdahl, T.A., Friedman, B.S., McCormick, M.C., & Simpson, S. (2013). Annual report on health care for children and youth in the United States: Trends in racial/ethnic, income, and insurance disparities over time, 2002–2009. Academic Pediatrics, 13(3), 191–203.
22
Evans, G. W. (2006). Child development and the physical environment. Annual Review of Psychology, 57, 423–451.
23
Woolf, S. H., & Braveman, P. (2011). Where health disparities begin: The role of social and economic determinants — and why current policies may make matters worse. Health Affairs, 30(10), 1–8.
24
U.S. Department of Health and Human Services. (2011). The health and well-being of children in rural areas: A portrait of the nation, 2007. Rockville, MD: U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.Retrieved January 21, 2016, from http://mchb.hrsa.gov/nsch/07rural/moreinfo/pdf/nsch07rural.pdf.
25
National Rural Health Association. Rural health issues: Implications for Rural Healthy People 2020. Retrieved January 21, 2016, from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwi-tfHA0P_JAhWGRSYKHY25DpAQFggiMAA&url=http%3A%2F%2Fwww.ruralhealthweb.org%2Fdownload.cfm%3Fdownloadfile%3D37F1DE3E-3048-651A-FEA203DE7ED16E47&usg=AFQjCNEjaoodVVnUDaw196mb7kOZJb21Og&sig2=i4CJ4XMQQdQZT-XkfZSLJA&cad=rja.
26
Byck, G. R., Walton, S. M., & Cooksey, J. A. (2008). Access to dental care services for Medicaid children: Variations by urban/rural categories in Illinois. The Journal of Rural Health, 18(4), 512–520.
27
DeVoe, J., Krois, L., & Stenger, R. (2009). Do children in rural areas still have different access to healthcare? Results from a statewide survey of Oregon's food stamp population. The Journal of Rural Health, 25(1).
28
Zimmer-Gembeck, M. J., Alexander, T., & Nystrom, R. J. (1997). Adolescents report their need for and use of health care services. Journal of Adolescent Health, 21, 388–399.
29
Gamm, L. D., Hutchison, L. L., Dabney, B. J., & Doresey, A. M. (Eds.). (2003). Rural Healthy People 2010: A companion document to Healthy People 2010 (Vol. 1).
Last updated: August 16, 2016