The Changing Face of America's Adolescents
Adolescents are increasingly diverse and reflect the changing racial/ethnic, socioeconomic, and geographic structure of the U.S. population. 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.
Today, there are almost 42 million adolescents between the ages of 10 and 19 in the United States, and adolescents make up 12.9 percent of the population.1 As the U.S. population ages, adolescents will represent a smaller proportion of the total. By 2050, estimates show that adolescents will make up 11.3 percent of the population.1 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 44 million in 2050.1
Source: U.S. Census Bureau. (2017). Projected 5-year age groups and sex composition: Main projections series for the United States, 2017-2060. Washington, DC: U.S. Census Bureau, Population Division. Retrieved from https://www2.census.gov/programs-surveys/popproj/tables/2017/2017-summary-tables/np2017-t3.xlsx
Differences by race/ethnicity in access to health care, health-related behaviors, and health outcomes are well documented. Members of racial and ethnic minority groups, in general, have less access to healthcare, receive worse healthcare, experience more serious health conditions, and have higher mortality rates than whites.2-4 Use Healthy People’s Health Disparities widget to browse health disparities linked to social, economic, and environmental factors. In part, these disparities reflect higher poverty rates among racial and ethnic minorities, which also are linked to poorer health.5,6 Health professionals can improve the delivery of services to minority youth by incorporating culturally informed practices.7-11 The proportion of adolescents who are racial and ethnic minorities is expected to rise in the future. More than half of U.S. adolescents (53 percent) were white in 2016, but by 2050 that proportion is projected to drop to about 40 percent as Hispanic and multiracial teens, in particular, come to represent a larger share of the population.1 Health equity among the diverse adolescent population will be difficult to achieve if racial and ethnic disparities are not addressed.
Notes: 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: U.S. Census Bureau. (2017). Projected population by single year of age, sex, race, and Hispanic Origin for the United States: 2016 to 2060 [Data set]. Retrieved from https://www2.census.gov/programs-surveys/popproj/datasets/2017/2017-popproj/np2017_d1.csv
Poverty is a reality for many adolescents in the United States. In 2017, almost one in six adolescents (16 percent) were living in families with incomes below the federal poverty line (defined as an income of $24,600 or less for a family of four in 2017), and more than one in three adolescents (36 percent) were living in low-income families (defined as less than twice the federal poverty line).12 Poverty rates were especially high for single-parent families.13
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.14 These adolescents are also more likely to suffer from behavioral or emotional problems and engage in unhealthy behaviors, such as eating unhealthy diets, physical inactivity, smoking, and early initiation of sexual activity.15-18
Notes: Data are not available for youth in foster care or those under the age of 15 living with non-relatives. Federal poverty line is defined as $24,600 for a family of four.
Source: U.S. Census Bureau. (2018). Current Population Survey, Annual Social and Economic Supplement, 2018 [Data set]. Retrieved from http://www.census.gov/cps/data/cpstablecreator.html
The area where adolescents live affects their health behaviors and the availability of health services. Most adolescents in the United States live in or just outside an urban area.19 Although adolescents in urban areas may be exposed to higher levels of violent crime,20 they are more likely than their rural counterparts to have access to playgrounds, community or recreation centers, and parks.21
More than five million adolescents live in rural areas.19 Rural adolescents are more likely to live in low-income households than adolescents in urban areas.21 While children living in urban and rural areas are equally likely to have health insurance,21 rural youth face barriers to accessing health services due to a shortage of providers and transportation challenges.22 Moreover, mental health services are notably limited in rural areas.23 Youth in rural areas, compared to youth in urban areas, are more likely to be overweight or obese and to live with someone who smokes.21 Youth in rural areas also have higher suicide rates and are more likely to misuse opioids.24,25 However, rural youth (particularly those in small rural areas) are more likely than other youth to live in supportive communities and share a meal with their family every day of the week.21
Note: Nearly six million adolescents (5,722,442) live in an unidentified or unknown Census area.
Source: U.S. Census Bureau. (2018). Current Population Survey, Annual Social and Economic Supplement, 2018 [Data set]. Retrieved using IPUMS’ SDA 3.5 from https://sda.cps.ipums.org/cgi-bin/sdaweb/hsda?harcsda+all_march_samples
1 U.S. Census Bureau. (2017). Projected 5-year age groups and sex composition: Main projections series for the United States, 2017-2060. Washington, DC: U.S. Census Bureau, Population Division. Retrieved from https://www2.census.gov/programs-surveys/popproj/tables/2017/2017-summary-tables/np2017-t3.xlsx
2 Agency for Healthcare Research and Quality. (2017). 2017 National healthcare quality and disparities report. Rockville, MD: U.S. Department of Health and Human Services. Retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2017nhqdr.pdf
3 Centers for Disease Control and Prevention. (2018). NVSS report: Deaths: Final data for 2016 (No. 5). Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf
4 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.
5 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.
6 Lau, M., Lin, H., & Flores, G. (2012). Racial/ethnic disparities in health and health care among U.S. adolescents. Health Services Research, 47(5). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513617/
7 Goodkind, J. R., Ross-Toledo, K., John, S., Hall, J. L., Ross, L., Freeland, L., … Lee, C. (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. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041509/
8 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.
9 Alegria, M., Vallas, M., & Pumariega, A. J.. (2010). Racial and ethnic disparities in pediatric mental health. Child and Adolescent Psychiatric Clinics of North America, 19(4): 759–774. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011932/
10 Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: A systematic scoping review. BMC Health Services Research, 18, 232. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879833/pdf/12913_2018_Article_3001.pdf
11 Cheng, T. L., Emmanuel, M. A., Levy, D. J., & Jenkins, R. R. (2013). Child health disparities: What can a clinician do? Pediatrics 136(5), 961-968. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621792/pdf/peds.2014-4126.pdf
12 U.S. Census Bureau. (2018). Current Population Survey, Annual Social and Economic Supplement, 2018 [Data set]. Retrieved from http://www.census.gov/cps/data/cpstablecreator.html
13 Fontenot, K., Semega, J., & Kollar, M. (2018). Current population reports: Income and poverty in the United States: 2017 (No. P60-263). Washington, DC: U.S. Government Printing Office. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-263.pdf
14 National Center for Education Statistics. (2017). Public high school 4-year adjusted cohort graduation rate (ACGR), by race/ethnicity and selected demographic characteristics for the United States, the 50 states, and the District of Columbia: School year 2015-16 [Data set]. Retrieved from https://nces.ed.gov/ccd/tables/ACGR_RE_and_characteristics_2015-16.asp
15 Costello, E. J., Compton, S. N., Keeler, G., et al. (2003). Relationships between poverty and psychopathology: A natural experiment. Journal of the American Medical Association, 290(15), 2023-2029. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/197482
16 Pampel, F. C., Kreueger, P. M., & Denney, J. T. (2010). Socioeconomic disparities in health behaviors. Annual Review of Sociology, 36, 349–370. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169799/
17 Centers for Disease Control and Prevention. (2019). Youth and Tobacco Use. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm
18 Kirby, D. (2002). Antecedents of adolescent initiation of sex, contraceptive use, and pregnancy. American Journal of Health and Behavior, 26(6), 473–485.
19 U.S. Census Bureau. (2018). Current Population Survey, Annual Social and Economic Supplement, 2018 [Data set]. Retrieved using IPUMS’ SDA 3.5 from https://sda.cps.ipums.org/cgi-bin/sdaweb/hsda?harcsda+all_march_samples
20 Office for Victims of Crime. (2017). 2017 NCVRW resource guide: Urban and rural victimization fact sheet. Washington, DC: Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. Retrieved from https://ovc.ncjrs.gov/ncvrw2017/images/en_artwork/Fact_Sheets/2017NCVRW_UrbanRural_508.pdf
21 U.S. Department of Health and Human Services. (2015). The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation, 2011-2012. Rockville, Maryland: U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Retrieved from https://mchb.hrsa.gov/nsch/2011-12/rural-health/index.html
22 Ferdinand, A. O., Johnson, L., Speights, J. S. B., Taite, S. M., Myers, K., Speights, A., & Bellamy. G. (2015). Access to quality health services in rural areas – primary care: A literature review. In Bolin, J. N., Bellamy, G., Ferdinand, A. O., Kash, B. A., & Helduser, J. W. (Eds.), Texas A&M Health Science Center School of Public Health, Southwest Rural Health Research Center. College Station, Texas. Retrieved from https://srhrc.tamhsc.edu/docs/rhp2020-volume-1.pdf
23 Ferdinand, A. O., Madkins, J., McMaughan, D., & Schulze, A. (2015). Mental health and mental disorders: A rural challenge. In Bolin, J. N., Bellamy, G., Ferdinand, A. O., Kash, B. A., & Helduser, J. W. (Eds.), Texas A&M Health Science Center School of Public Health, Southwest Rural Health Research Center. College Station, Texas. Retrieved from https://srhrc.tamhsc.edu/docs/rhp2020-volume-1.pdf
24 Fontanella, C. A., Hiance-Steelesmith, D. L., Phillips G. S., Bridge, J. A., Lester, N., Sweeney, H. A., & Campo, J. V. (2015). Widening rural-urban disparities in youth suicides, United States, 1996-2010. JAMA Pediatrics 169(5), 466-473. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4551430/
25 Monnat, S. M., & Rigg, K. K. (2015). Examining rural/urban differences in prescription opioid misuse among US adolescents. The Journal of Rural Health, 32(2), 204-218. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779738/
Content last reviewed on October 3, 2019