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INTRODUCTION

The Centers for Disease Control and World Health Organization define adolescence as the phase of life between childhood and adulthood, usually between the ages of 10 and 19 years. Adolescence is a period of rapid physical, emotional, cognitive, and social development. There is considerable variability in the pace of adolescent development, and chronological age may be a poor indicator of physical, physiologic, and emotional maturity. 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 transition to adulthood often continues through ages 20–24 years (young adulthood). 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 and young adults 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. The most common causes of illness, injury, and death in adolescents are preventable. Environmental factors are critical in challenging or supporting an adolescent’s health. 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 2019, there were 10,258 deaths among adolescents aged 15–19 years, representing a rate of 48.7 per 100,000. Cultural and environmental factors, rather than organic factors, pose the greatest threats to life. The three leading causes of death of adolescents aged 15–19 years in 2019 were unintentional injury (34.6%), suicide (23.4%), and homicide (17.1%). The primary cause of unintentional injury death was motor vehicle crashes (62%), followed by poisoning (20%), which includes prescription drug overdoses. In the United States, the fatal crash rate per mile driven for 16–19 year-olds was nearly three times the rate for drivers ages 20 and older, with the highest risk for death at ages 16–17 years. Since 2000, deaths from opioid overdose have increased by over twofold among 15–24 year-olds. Homicide deaths were predominantly attributable to firearms (93%), and firearms were also a leading mechanism of suicide death (45%).

The mortality rate of adolescents differs by gender, with the rate significantly higher among males aged 15–19 compared to females (73 vs 27 per 100,000, respectively, in 2018). This reflects gender differences in the top three leading causes of death of adolescents. Among adolescent males, suicide was the leading cause of death in 2018 (2149 deaths), followed by motor vehicle crashes (1582 deaths) and homicides (1564 deaths). Among females, motor vehicle crashes was the leading cause of ...

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