A survey involving an ethnically diverse and nationally representative sample of 14,000 young people found diet, inactivity, obesity, health-care access, substance use and reproductive health to worsen with age. Only self-perceptions of personal health, including mental health, and exposure to violence improved with age.
The study, funded by the National Institute of Child Health and Human Development, appears in the January issue of the Archives of Pediatrics and Adolescent Medicine.
The declines in health indicators spanned both sexes and all racial and ethnic groups. The study compared the health of whites, blacks, Asians, Hispanics and American Indians. All groups showed significant declines in health from adolescence into young adulthood.
The report used a unique source of data, the National Longitudinal Study of Adolescent Health (Add Health), which follows a national sample of more than 14,000 adolescents through their transition into young adulthood. Most previous studies of health disparities have used data collected at a single time point.
"This is the first longitudinal study to track the developmental trends in health disparities among a national cohort of young people with new findings showing a general decline in health during the transition to adulthood," said the lead author Dr. Kathleen Mullan Harris, Gillian T. Cell distinguished professor of sociology at UNC, a fellow at the Carolina Population Center and director of the Add Health study.
UNC has been the home base for Add Health since its initiation in 1994 with federal funding.
Add Health survey participants were recruited from high schools and middle schools nationwide. They were first interviewed from 1994 to 1995, when they ranged in age from 12 to 19 years, and again, in 2001 and 2002, when they were between 19 and 26 years old. They responded to questions on diet, inactivity, obesity, tobacco use, substance use, binge drinking, violence, reproductive health, mental health and access to health care.
According to the report, as adolescents become young adults, an increasing proportion have no current health insurance, do not receive health care when they need it and do not receive regular dental or physical examinations.
"The transition to adulthood is a time when people begin to solidify their health practices and, therefore, an important time for health improvement efforts," said study co-author Dr. Penny Gordon-Larsen, assistant professor of nutrition (a department housed jointly in UNC's schools of public health and medicine) and a fellow at the Carolina Population Center.
"We need a major investment in preventive health efforts for this age group, especially in those areas that our study found were important, such as greater access to health insurance, healthy food options, exercise facilities and reduced exposure to substances of abuse."
For most of the health indicators that worsened over time, racial and ethnic disparities also increased, although no one single ethnic group stood out as consistently disadvantaged. For example, smoking and binge drinking increased significantly for all groups, with increasing disparity between racial groups over time, with the greatest disadvantage found among whites. Diagnosis of sexually transmitted infections (STIs) increased significantly for all groups, with increasing racial and ethnic disparity over time and the greatest disadvantage among blacks.
In general, the study showed great variability in the levels and trends of racial and ethnic disparity across a large array of health indicators. "That means that there are no simple, across-the-board solutions for addressing health disparities," Harris said. "Instead, solutions must be sensitive to the different patterns of health risk that emerge across population groups as adolescents enter young adulthood."
In addition to Harris and Gordon-Larsen, other authors are Kim Chantala, research associate at the Carolina Population Center; and Dr. J. Richard Udry, Kenan professor in the College of Arts and Sciences' department of sociology and in the School of Public Health's department of maternal and child health and a fellow within the Carolina Population Center.
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