A Picture of Adolescent Health

The adolescent years are critical for teens’ current and future health. Good health enables adolescents to learn and grow. While adolescents are generally healthy, mental health, substance abuse, obesity, and risky sexual behaviors are common problems adolescents come across. These health issues can have long-term effects; however, they are often avoided by having supportive relationships and healthy communities. Here’s how America’s teens measure up.

Physical Health and Nutrition

In 2013, male high school students (57 percent) were much more likely than female high school students (37 percent) to report getting the recommended 60 minutes of physical activity on five or more days in the past week.[1] Overall, just under half of all high school students (47 percent) said they were physically active in a biennial national survey.[1] Regular and continued physical activity promotes overall health and helps people achieve or maintain a healthy weight.[2]

Note: The Youth Risk Behavior Surveillance System (YRBS) defines this measure as: “Physically active at least 60 minutes per day on 5 or more days in the past seven days; doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time.”
Source: 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.

In 2011-12, about one in five adolescents ages 12 to 19 (21 percent) were categorized as obese. About the same percentage of female adolescents (21 percent) and male adolescents (20 percent) were obese. When added together the number of overweight or obese adolescents was more than one in three (35 percent).[3] Being overweight can increase the risk of health problems, such as cardiovascular disease, Type 2 diabetes, high cholesterol, and asthma.

Note: The National Health and Nutrition Examination Survey (NHANES) includes a physical examination where weight and height are measured, which was used to calculate body mass index (BMI). NHANES defines obese as: “In children and adolescents aged 2 to 19 years, obesity was defined as a BMI at or above the 95th percentile of the CDC sex-specific BMI-for-age growth charts from 2000.”
Source: Ogden CL, Carroll MD, Kit BK, Flegal KM (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 311(8), 806-814.

Almost one in three adolescents ages 12-17 (31 percent) had at least one chronic health condition in 2011-12, with 13 percent of adolescents having two or more conditions.[4] Chronic health conditions can interfere with many activities. Teens with chronic conditions can benefit from having information about their condition, including ways to manage symptoms appropriately.[5, 6]

Asthma—the single most common chronic condition among adolescents—affected more than one in five high school students (21 percent) in 2013.[1, 7] It is a leading cause of hospitalization among children under age 15, which can lead to school absences.[8] Males and females are equally likely to have asthma.[1]

Note: The National Survey of Children's Health defines this measure as: “Chronic conditions surveyed include learning disability; ADD or ADHD; depression; anxiety problems; behavioral or conduct problems; autism or other autism spectrum disorder; developmental delay; speech problems; asthma; diabetes; Tourette Syndrome; epilepsy or seizure disorder; hearing problems; vision problems; bone or joint problems; and brain injury or concussion. For each condition, parent respondents were asked whether they have ever been told by a health care professional that the adolescent has the condition, and whether the adolescent currently has the condition.”
Source: The Child and Adolescent Health Measurement Initiative. (2014). National Survey of Children's Health 2011/12. Retrieved April 23, 2014, from http://childhealthdata.org/browse/survey?q=2456&r=1.

For more information, visit the physical health and nutrition section of our website.

Mental Health

A surprisingly high number of students report depression during adolescence.[9] Female high school students (39 percent) were almost twice as likely as male high school students (21 percent) to report depressive symptoms.[1] In 2013, three in 10 high school students (30 percent) reported symptoms of depression in the past year.[1] Of students diagnosed with a major depressive episode, more than six in 10 did not receive treatment.[10] Untreated depression can lead to serious health risks, including suicide. However, effective treatments exist and intervening promptly, before symptoms get more serious, could help.[11]

Note: The YRBS measure of feeling sad or hopeless asks whether students felt so sad or hopeless almost every day for 2 or more weeks in a row that they stopped doing some usual activities. Persistent sadness can be a symptom or precursor of clinical depression, though this is not enough for a clinical diagnosis.
Source: 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.

In 2013, one in nine adolescents ages 12-17 (11 percent) experienced attention deficit hyperactivity disorder (ADHD). Adolescent males were more than twice as likely to be diagnosed with ADHD as adolescent females (16 percent versus seven percent).[12] Untreated ADHD can interfere with family and peer relationships, lead to unintended injury, and negatively affect academic performance.[13]

Note: The National Health Interview Survey defines this measure as:  ‘‘Has a doctor or health professional ever told you that [child’s name] had attention deficit hyperactivity disorder (ADHD) or attention deficit disorder (ADD)?’’
Source: Bloom, B., Jones, L., & Freeman, G. (2013). Summary health statistics for U.S. children: National Health Interview Survey, 2012. Washington, DC: National Center for Health Statistics. Retrieved April 3, 2014, from http://www.cdc.gov/nchs/data/series/sr_10/sr10_258.pdf

For more information, visit the mental health section of our website.

Reproductive Health

Teens who delay first sex are more likely to use contraception and have fewer sexual partners,[14] lowering their risk of teen pregnancy and sexually transmitted diseases.[15] In 2013, almost half of high school students (47 percent) reported they had sexual intercourse (46 percent of females and 48 percent of males).[1]

Note: The YRBS defines this measure as "ever had sexual intercourse."
Source: 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.

For more information, see the reproductive health section of our website.

Substance Abuse

Tobacco use

Tobacco use is one of the leading causes of preventable death and disease. Most smokers begin smoking in adolescence.[16]

In 2013, about one in 13 adolescents ages 12-17 (8 percent) reported having used one or more tobacco products, including cigarettes, chewing tobacco, snuff, cigars, and pipe tobacco during the past month.[27] In 2014, almost one in 15 high school seniors (7 percent) identified as being a daily smoker, and almost one in seven (14 percent) had smoked at least once in the previous month.[18] In 2014, more teenagers smoked electronic cigarettes (or e-cigarettes) than smoked tobacco cigarettes.[18]

In 2013, more than one in three high school students (35 percent) reported drinking alcohol in the past month (34 percent for males and 35 percent for females).[1] Binge drinking is the most common form of alcohol abuse among adolescents, although any consumption may be harmful.[19, 20]

Note: YRBS defines this measure as: “Had at least one drink of alcohol on at least one day 30 days prior to taking the survey.”
Source: 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.

In 2013, the majority of 8th to 12th grade students reported that they were substance free (they didn’t use tobacco, alcohol, or illicit drugs in the past month). Students in the 8th grade (86 percent) were more likely to be substance free than 10th grade students (66 percent) and 12th grade students (52 percent).[21] Use of tobacco, alcohol, and drugs is associated with numerous adverse health outcomes.[22]

Source: Child Trends’ original analysis of Monitoring the Future survey data, 2013.

For more information, visit the substance abuse section of our website.

Educational Attainment

Good health promotes education and education promotes good health. Healthy students are generally better learners than their peers who lack healthy behaviors.[23] In addition, youth who perform better in school and complete more education are healthier over the course of their adult lives. They engage in fewer risky behaviors such as smoking and binge drinking and participate in healthier behaviors such as exercise, which helps them to live longer.[24] Some of the long-term relationship between education and health is due to the potential for increased employment and earnings that more education can provide.[24]

In 2013 in the United States, only about one in three 8th grade students (35 percent) were at the proficient or advanced level in math (male and female proficiency levels were similar).[25] In comparison, about one in four 12th grade students (26 percent) were proficient in math in 2013. Male 12th grade students (28 percent) were more likely to be proficient in math than were female 12th grade students (24 percent).[25]

Note: The National Assessment of Education Progress defines this measure as “Proficient is defined as solid academic performance for each grade assessed. Students reaching this level have demonstrated competency over challenging subject matter, including knowledge of the subject matter, application of such knowledge to real-world situations, and analytical skills appropriate to the subject matter.”
Source: U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistisc. National Assessment of Educational Progress Mathematics Assessments (NAEP), 2013, 2011, 2009, 2007, 2005, and 2003 Mathematics Assessments. Retrieved May 7, 2014, at http://nces.ed.gov/nationsreportcard/naepdata/.

In 2011, among both 8th grade and 12th grade students, more than one in four students (27 percent) were at the proficient or advanced writing level. In both grade levels, female students were more likely to be proficient in writing than were male students.[26]

Note: The National Assessment of Education Progress defines this measure as: “Proficient is defined as solid academic performance for each grade assessed. Students reaching this level have demonstrated competency over challenging subject matter, including subject-matter knowledge, application of such knowledge to real-world situations, and analytical skills appropriate to the subject matter.”
Source: U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics, National Assessment of Educational Progress (NAEP), 2011 Writing Assessment. Retrieved May 7, 2014, from http://nces.ed.gov/nationsreportcard/naepdata/dataset.aspx.

For more information, visit the positive youth development section of the Adolescent Health Library.

Healthy Relationships

Dating violence

Intimate partner violence is associated not only with physical injury, but also with emotional and behavioral problems.[27-29]

In 2013, one in 10 high school students who had dated in the 12 months before the survey (10 percent) reported that they were hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend.[1] Female high school students (13 percent) were more likely than male high school students (7 percent) to experience dating violence in the past year.[1] This number may be a conservative estimate because dating violence incidents are often not reported.[30]

Bullying is associated with a number of serious health issues, including substance abuse and emotional problems, and even with suicide.[31, 32]

In 2013, one in five high school students (20 percent) reported being bullied at school.[1] Female high school students (24 percent) were more likely to report being bullied at school in the past 12 months than male high school students (16 percent).[1]

Note: YRBS defines this measure as: “Bullying is when one or more students tease, threaten, spread rumors about, hit, shove, or hurt another student over and over again. It is not bullying when two students of about the same strength or power argue or fight or tease each other in a friendly way.”
Source: 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.

The actual or perceived safety of neighborhoods can influence health directly or indirectly. If safety concerns restrict opportunities to get physical exercise, for example, adolescents’ health can suffer.[33]

In 2011-12, nearly nine out of 10 parents of adolescents ages 12-17 felt that their child was usually or always safe in their neighborhood.[4] However, 12 percent of parents of adolescents reported that their child was never or only sometimes safe in their neighborhood. 

Source: The Child and Adolescent Health Measurement Initiative. (2014). National Survey of Children's Health 2011/12. Retrieved April 23, 2014, from http://childhealthdata.org/browse/survey?q=2456&r=1.

Supportive neighborhoods—where people look out for each other’s well-being, and families can rely on neighbors’ help—contribute to social and emotional health.[34] In 2011-12, most parents of adolescents ages 12-17 (84 percent) agreed that their neighborhood was supportive, but almost one in six (16 percent) disagreed that their neighborhood was supportive.[4]

Note: NSCH defines this measure as: “Supportive neighborhood information is reported by parents and is based on the statements: people in my neighborhood help each other out; we watch out for each other's children in this neighborhood; there are people I can count on in this neighborhood; if my child were outside playing and got hurt or scared, there are adults nearby who I trust to help my child. Parents were asked whether they strongly agree, somewhat agree, somewhat disagree, or strongly disagree with each statement. Choosing a ‘disagree’ option on more than one statement removes someone from living in a supportive neighborhood.”
Source: The Child and Adolescent Health Measurement Initiative. (2014). National Survey of Children's Health 2011/12. Retrieved April 23, 2014, from http://childhealthdata.org/browse/survey?q=2456&r=1.

For more information, visit the healthy relationships section of our website.

Footnotes

1
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.
2
Daniels, S. R., Arnett, D. K., Eckel, R. H., Gidding, S. S., Hayman, L. L., Kumanyika, S., et al. (2005). Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation, 111(15), 1999-2012.
3
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association, 311(8), 806-814.
4
The Child and Adolescent Health Measurement Initiative. (2014). National Survey of Children's Health 2011/12. Retrieved January 21, 2016, from http://childhealthdata.org/browse/survey?q=2456&r=1.
5
Michaud, P. A., Suris, J. C., & Viner, R. (2007). The adolescent with a chronic condition: Epidemiology, developmental issues and health care provision. Washington, DC: World Health Organization. Retrieved January 21, 2016, from http://whqlibdoc.who.int/publications/2007/9789241595704_eng.pdf.
6
Sawyer, S. M., Drew, S., Yeo, M. S., & Britto, M. T. (2007). Adolescents with a chronic condition: Challenges living, challenges treating. The Lancet, 369, 1481-1489.
7
Centers for Disease Control and Prevention. (2013). Asthma and schools. Retrieved January 21, 2016, from http://www.cdc.gov/healthyyouth/asthma/index.htm
8
Akinbami, L. J., Moorman, J. E., & Lui, X. (2011). Asthma prevalence, health care use, and mortality: United States, 2005-2009. Hyattsville, MD: National Center for Health Statistics. Retrieved January 21, 2016, from http://www.cdc.gov/healthyschools/asthma/index.htm.
9
Knopf, D. K., Park, J., & Mulye, T. P. (2008). The mental health of adolescents: A national profile, 2008. Retrieved January 21, 2016, from http://nahic.ucsf.edu/downloads/MentalHealthBrief.pdf.
10
Substance Abuse & Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Mental health detailed tables. Table 2.6B. Retrieved January 21, 2016, from http://www.samhsa.gov/data/sites/default/files/2013MHDetTabs/NSDUH-MHDetTabs2013.htm#tab2.6B.
11
Bhatia, S. K., & Bhatia, S. C. (2007). Childhood and adolescent depression. American Family Physician, 75(1), 73-80.
12
Bloom, B., Jones, L., & Freeman, G. (2013). Summary health statistics for U.S. children: National Health Interview Survey, 2012. Washington, DC: National Center for Health Statistics. Retrieved January 21, 2016, from http://www.cdc.gov/nchs/data/series/sr_10/sr10_258.pdf.
13
Centers for Disease Control and Prevention. (2014). Attention-Deficit / Hyperactivity Disorder (ADHD). Retrieved January 21, 2016, from http://www.cdc.gov/ncbddd/adhd/facts.html.
14
Martinez, G., & Abma, J.C. (2015). Sexual activity, contraceptive use, and childbearing of teenagers aged 15-19 in the United States. National Center for Health Statistics. Vital and Health Statistics, 209. Retrieved January 21, 2016, from http://www.cdc.gov/nchs/data/databriefs/db209.pdf.
15
Goesling, B., Colman, S., Trenholm, C., Terzian, M., & Moore, K. A. (2014). Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: A systematic review. Journal of Adolescent Health, 54(5), 499-507.
16
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, MI: Institute for Social Research, The University of Michigan. Retrieved January 21, 2016, from http://www.monitoringthefuture.org//pubs/monographs/mtf-overview2014.pdf.
17
Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of national findings. Retrieved January 21, 2016, from http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.htm.
18
Miech, R. A., Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2014). E-cigarettes surpass tobacco cigarettes among teens. Ann Arbor, MI: University of Michigan. Retrieved January 21, 2016, from http://www.monitoringthefuture.org//pressreleases/14drugpr_complete.pdf.
19
Centers for Disease Control and Prevention. (2012). Fact sheets: Underage drinking. Retrieved January 21, 2016, from http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm.
20
U.S. Department of Health and Human Services. (2007). The Surgeon General's call to action to prevent and reduce underage drinking. U.S. Department of Health and Human Services, Office of the Surgeon General. Retrieved January 21, 2016, from http://www.ncbi.nlm.nih.gov/books/NBK44360/.
21
Cooper, P. M. (2015). Child Trends’ original analysis of Monitoring the Future survey data, 2013.
22
Ellickson, P. L., Tucker, J. S., & Klein, D. J. (2003). Ten-year prospective study of public health problems associated with early drinking. Pediatrics, 111(5), 949-955.
23
National Center for Chronic Disease Prevention and Health Promotion. (2014). Health and academic achievement. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved January 21, 2016, from http://www.cdc.gov/healthyyouth/health_and_academics/pdf/health-academic-achievement.pdf.
24
Telfair, J., & Shelton, T. L. (2012). Educational attainment as a social determinant of health. North Carolina Medical Journal, 73(5), 358-365.
25
U.S. Department of Education Institute of Education Sciences National Center for Education Statistics. (2014). National Assessment of Educational Progress mathematics assessments (NAEP), 2013, 2011, 2009, 2007, 2005, and 2003 mathematics assessments. Retrieved May 7, 2014, from http://nces.ed.gov/nationsreportcard/naepdata/
26
U.S. Department of Education Institute of Education Sciences National Center for Education Statistics. National Assessment of Educational Progress (NAEP), 2011 Writing Assessments. Retrieved January 21, 2016, from http://nces.ed.gov/nationsreportcard/naepdata/dataset.aspx.
27
Zwicker, T. J. (2002). The imperative of developing teen dating violence prevention and intervention programs in secondary schools. Southern California Review of Law and Women's Studies, 12, 131-157.
28
Silverman, J. G., Raj, A., & Clements, K. (2004). Dating violence and associated sexual risk and pregnancy among adolescent girls in the United States. Pediatrics, 114(2), 220-225.
29
Ackard, D. M., Eisenberg, M. E., & Neumark-Sztainer, D. (2007). Long-term impact of adolescent dating violence on the behavioral and psychological health of male and female youth. The Journal of Pediatrics, 151(5), 476-481.
30
Ackard, D. M., & Neumark-Sztainer, D. (2002). Date violence and date rape among adolescents: associations with disordered eating behaviors and psychological health. Child Abuse and Neglect, 26(5), 455-473.
31
Nansel, T. R., Overpeck, M., Scheidt, P., Pilla, R. S., Ruan, J., & Simmons-Morton, B. (2001). Bullying behaviors among U.S. youth: prevalence and association with psychosocial adjustment. Journal of the American Medical Association, 285(16), 2094-2100.
32
U.S. Department of Health & Human Services. Effects of bullying. Retrieved January 21, 2016, from http://www.stopbullying.gov/at-risk/effects/.
33
Beets, M. W., & Foley, J. T. (2008). Association of father involvement and neighborhood quality with kindergartners' physical activity: a mulitlevel structural equation model. American Journal of Health Promotion, 22(3), 195-203.
34
Sampson, R. J., Morenoff, J. D., & Gannon-Rawley, T. (2002). Assessing "neighborhood effects": Social processes and new directions in research. Annual Review of Sociology, 29(1), 443-478.
Last updated: October 28, 2016