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For policymakers, adolescence presents an invaluable opportunity to ensure that all young people can access the high-quality services and supports they need to improve their odds of becoming successful, healthy, productive adults. At an historic moment when the provisions and breadth of health care reform are under vigorous debate, it is important to take stock of how well the states are currently meeting the health and development needs of all adolescents, and particularly disadvantaged youth. This report presents information from NCCP's Improving the Odds for Adolescents project about state policy choices that affect the health and well-being of adolescents.

Adolescence is an important period of physical, social, psychological, and cognitive growth. No longer children and not yet adults, adolescents make significant choices about their health and develop attitudes and health behaviors that continue into adulthood. Substance use disorders among adolescents can impede the attainment of important developmental milestones, including the development of autonomy, the formation of intimate interpersonal relationships, and general integration into adult society. Similarly, the use of alcohol and illicit substances by youth often leads to adverse health outcomes. Because heightened peer influence and a tendency towards risk taking are normal developmental changes in adolescence, experimentation with substances during this period is common. However, using drugs and alcohol at a young age increases the risk of dependency and addiction, and early onset of drinking increases the likelihood of alcohol-related injuries, motor vehicle crash involvement, unprotected intercourse, and interpersonal violence. The more risk an adolescent is exposed to, the more likely it is he or she will abuse substances. Some risk factors, such as peer influence, may be more powerful during adolescence, and likewise some protective factors, such as a strong sense of school belonging and a meaningful positive adult presence, can have a greater positive impact during this period. An important goal of substance abuse prevention is to reduce risk and increase protective factors in the lives of all adolescents, and particularly among disadvantaged youth.

Recent research shows that the human brain continues to develop throughout adolescence, with the pre-frontal cortex ““ the section of the brain responsible for executive function and complex reasoning ““ not fully developing until the mid-twenties. Because adolescents' brains are not fully matured, their decision-making and thought processes differ from those of adults. For example, it is developmentally normative for adolescents to take greater risks and show greater susceptibility to peer influences than adults. These otherwise normal differences can contribute to behaviors that lead to involvement with the juvenile justice system. Beyond developmental influences, additional risk factors associated with youth ending up in the juvenile justice system are cognitive deficits, low school involvement, living in poverty, or being runaway or homeless. Just over two million youth under the age of 18 were arrested in 2008. Of these two million, about 95 percent had not been accused of violent crimes, such as murder, rape, or aggravated assault. In 2010, of the nearly 100,000 youth under the age of 18 who were serving time in a juvenile residential placement facility, 26 percent had been convicted of property crimes only, such as burglary, arson, or theft. For nonviolent youth involved in the juvenile justice system, incarceration in traditional residential placement facilities often does more harm than good. These large residential facilities are ineffective at providing the services and rehabilitation these youth need, and this lack of capacity contributes to high recidivism rates (rearrest within one year of release). Reliance on these residential placement facilities is an inefficient use of taxpayer money, not only with regard to the funds needed to keep youth in these facilities, but also the future lower wages and lost productivity that often follows for these youth. Reform efforts must place a greater focus on improving access to mental health services for all youth, better serving the needs of youth who are involved in the juvenile justice system, and creating effective alternatives to traditional residential placement facilities. Proper treatment and rehabilitative services can help many youth currently in the juvenile system become healthy and productive members of society.

Adolescent obesity in the United States has many important implications for both the health and well-being of the individual and society. Specific negative impacts of obesity on health include increased susceptibility to a host of diseases, chronic health disorders, psychological disorders, and premature death, which in turn add billions of dollars in health care costs each year. Excess medical costs due to overweight adolescents are estimated at more than $14 billion per year. Furthermore, adolescent obesity affects our nation's ability to protect itself; more than a quarter of 17- to 24-year-olds are not fit to enroll in the military due to their weight. Adolescence is a crucial period for establishing healthy behaviors. Many of the habits formed during this developmental stage will last well into adulthood. Although obesity is a complex problem not yet fully understood by researchers, by addressing the known factors that contribute to obesity in adolescence, policymakers can help ensure a healthy and productive adulthood for our nation's youth. Obesity and poor nutrition — combined with mental health disorders and emotional problems, violence and unintentional injury, substance use, and reproductive health problems — form part of a complex web of potential challenges to adolescents' healthy emotional and physical development.

The reproductive and sexual health needs of adolescents differ from those of adults. During adolescence, the body undergoes significant developmental changes, most notably puberty, the bodily changes of sexual maturation, and the formation of sexual identity. Achieving reproductive and sexual health requires more than preventing unwanted pregnancy and sexually transmitted infections, it includes developing the ability to form and maintain meaningful relationships with others and with one's own body. Psychological, social, educational, environmental, and economic factors, among others, all play a role. In addition, adolescents are more likely to engage in risk-taking behaviors than either younger children or adults. These significant factors underline the importance of meeting the reproductive and sexual health needs of this age group. Reproductive and sexual health — combined with mental health disorders and emotional problems, violence and unintentional injury, substance use, and poor nutrition — form part of a complex web of potential challenges to adolescents' healthy emotional and physical development.

The purpose of this report is to highlight a growing segment of the population who are arriving at young adulthood disconnected from the main pathways leading to economic independence. Arriving at young adulthood in a state of disconnection can have consequences for both young adults and the larger society. Young adults who have low educational attainment or who are out of school or unemployed for extended periods of time may be more likely to engage in delinquent behavior, turn to illegal activities as a source of income, and be incarcerated. The consequences of disconnection may also result in long-term penalties, such as underemployment and lower earnings over the life course. Young adults disconnected for three or more years are about 14 times more likely to be poor and earn about two and one half times less in earnings and are about two to three times less likely to be employed full-time than young adults who had never been disconnected. Disconnectedness experienced during young adulthood may also have serious health consequences. Research shows that different components of disconnectedness, such as having less than high school education or being unemployed is associated with suboptimal health and mental health outcomes. Furthermore, disconnected young adults are more likely to rely on some form of public assistance. Thus, the costs of disconnection to government can include increased transfer payments and social support expenses as well as a decrease in tax revenues from their lack of participation in the labor market. In short, this population deserves our attention given the long-term consequences being disconnected can pose for a successful transition to adulthood.

Overall rates of injury and death increase dramatically from childhood to late adolescence. Due to developmental and social factors, such as time spent without adult supervision and increasing independence, adolescents are more likely to engage in risk-taking behaviors than either younger children or adults. Biology also plays a role. The maturation of brain networks responsible for self-regulation often does not occur until late adolescence, making adolescents more likely to engage in risk-taking behaviors. These are just a few of the factors that contribute to greater risk of injury or violence in this age group. Violence and unintentional injury are two of the interrelated areas of vulnerability that adolescents may encounter. Combined with problems related to mental health, sexual and reproductive health, substance use, and nutrition and obesity, violence and unintentional injury form part of a complex web of potential challenges to adolescents' health.

Adolescence is a critical period for mental, social, and emotional wellbeing and development. During adolescence, the brain undergoes significant developmental changes, establishing neural pathways and behavior patterns that will last into adulthood. Because their brains are still developing, adolescents are particularly receptive to the positive influences of youth development strategies, social and emotional learning, and behavioral modeling. But adolescents' developing brains, coupled with hormonal changes, make them more prone to depression and more likely to engage in risky and thrill-seeking behaviors than either younger children or adults. These and other factors underline the importance of meeting the mental, social, and emotional health needs of this age group. Mental health and social and emotional wellbeing — combined with sexual and reproductive health, violence and unintentional injury, substance use, and nutrition and obesity — form part of a complex web of potential challenges to adolescents' healthy emotional and physical development.