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INTRODUCTION

Adolescence is a period of rapid physical, emotional, cognitive, and social development. Generally, adolescence begins at age 11–12 years and ends between ages 18 and 21. Most teenagers complete puberty by age 16–18 years; in Western society, however, for educational and cultural reasons, the adolescent period is prolonged to allow for further psychosocial development before the individual assumes adult status. The developmental passage from childhood to adulthood includes the following steps: (1) completing puberty and somatic growth; (2) developing socially, emotionally, and cognitively, and moving from concrete to abstract thinking; (3) establishing an independent identity and separating from the family; and (4) preparing for a career or vocation.

EPIDEMIOLOGY

Adolescents (ages 10–19) and young adults (ages 20–24) make up 21% of the population of the United States. Adolescence is typically a healthy time of life but several important public health and social problems can greatly affect morbidity and mortality during these years. Environmental factors are critical in challenging or supporting an adolescent’s health. The positive development of young people facilitates their adoption of healthy behaviors. The behavioral patterns established during the developmental periods of adolescence help determine young people’s current health status and their risk for developing chronic diseases in adulthood.

MORTALITY DATA

In 2017, there were 10,812 deaths among adolescents aged 15–19 years, representing a rate of 51.2 per 100,000. Cultural and environmental rather than organic factors pose the greatest threats to life. The three leading causes of death in adolescents aged 15–19 years were unintentional injury (38.5%), suicide (20.2%), and homicide (15.6%) (Figure 4–1). The primary cause of unintentional injury death was motor vehicle crashes (52%), followed by poisoning (36%), which includes prescription drug overdoses. Since 2000, deaths from opioid overdose have increased by over twofold among 15–24 year olds. Homicide deaths were predominantly attributable to firearms (88%), and firearms were also a leading mechanism of suicide death (47%). The mortality rate of adolescent males aged 15–19 was more than twice that of females (71.4 vs 30 per 100,000, respectively), largely due to higher rates of unintentional injury, homicide, and suicide death among males.

Figure 4–1.

Leading causes of death (ages 15–19 years in 2017). (Reproduced with permission from Heron M. Deaths: Leading causes for 2017. National Vital Statistics Reports; vol 68 no 6. Hyattsville, MD: National Center for Health Statistics. 2019.)

The rate of adolescent mortality has declined significantly since 2000. This decline may be largely attributable to decreases in unintentional injury. Motor vehicle crashes, the leading cause of death among teenagers in the United States, account for more than one-quarter of deaths in this age group. Death rates from motor vehicle accidents have decreased from 26.9/100,000 in 2000 to 16.6/100,000 in 2016.

The most concerning aspect about recent mortality data is ...

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