Adolescence is a developmental stage during which profound physical, intellectual, emotional, psychological, and sexual change occurs. Adolescence corresponds to the preteen and teenage years, the middle and high school years, and the years during which puberty and maturation occur, but a specific age range is not defined. Exploration and establishment of health behaviors—both risky and protective— also occur during adolescence. Combined with teens’ overall state of good health, adolescence is thus also an ideal time to influence the development of healthy behaviors, including overall health behaviors, sexual behaviors, substance use, and health care-seeking behaviors. Focusing on public health action that influences teens’ health behaviors provides the opportunity to improve immediate health (e.g., reduce STDs and teen pregnancy) and prepare teens to better protect themselves during young adulthood when many will face increased risks (e.g., when HIV incidence peaks).
Teens are a healthy population overall, but they experience certain important preventable causes of mortality and morbidity. Injuries and violence are the leading causes of death among teens, but chronic diseases (e.g., asthma and diabetes) are frequent causes of morbidity, school absenteeism, and health care usage. Sexually Transmitted Diseases (STDs) also occur frequently among sexually active teens and young adults with approximately 10 million new STD infections every year among people age 15-24. Teen pregnancy rates have declined consistently during the past 25 years, reflecting successful public health interventions that encourage delayed sexual initiation and contraception use; however, prevalence of teens giving birth remains high in the United States (US).
Risk behaviors in all categories have steadily improved since behavioral surveillance among middle and high school students was initiated in 1991. However, prevalence of certain behaviors still remains high and contributes to ongoing risk for each successive cohort of teens. Regarding HIV, STD, and pregnancy risk, sexual risk behaviors and substance use behaviors are of greatest relevance. Stable rates of sexual experience (47%) and current sexual activity (34%) during the past decade reflect adolescence as the period of sexual development. Rates of risky sexual behaviors (e.g., >4 lifetime partners, 15%; sexual initiation before age 13 years, 5.6%; failure to use condoms, 41%; and low rates of long acting reversible contraception use, 1.6%) reflect ongoing risk for HIV, STDs, and pregnancy among teens. Although injecting drugs remains low for teens overall (<2%), among sexual minority youth, rates of injecting drugs are up to seven times higher. Additionally, alcohol, marijuana, and some prescription drugs (e.g., opiates) might increase risky sexual behavior, and rates remain high among teens (47%, 27%, and 18% respectively). Certain substance use also might serve as a gateway to injecting drug use behavior later, with an associated risk for HIV and hepatitis.
The majority of teens are enrolled in school, thus making both school-based programs ideal for disease prevention and health promotion purposes. School health education, physical education, provision of safe and healthy physical and social environments, and provision of or linkage to health services all contribute to disease prevention and health promotion efforts and have a direct impact on teens’ health. Schools serve as a key link to parents and other community health and social services and are an integral part of the community with links to crucial community-based health, educational, and social services.