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INTRODUCTION

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According to the World Health Organization (WHO), there are about 1.2 billion adolescents ages 10 to 19 years worldwide, of whom more than 40 million live in the United States, based on the 2012 Census data. This population is growing in numbers as well as in racial-ethnic and socioeconomic status diversity, which presents unique challenges, such as inconsistent access to care and adverse effects related to poverty, unstable housing, and homelessness. These variables factor in to morbidity among adolescents and young adults, presenting opportunities through policies and programs to improve public health and health economics outcomes in youth. Measurements such as disability-adjusted life years (DALYs), which is the sum of years lived with disability (YLD) and years of life lost (YLL), are used in the field of public health to gain a better understanding of the burden of disease. These measures are particularly important when assessing morbidity in adolescents, since many chronic diseases of adulthood have their origin during the teen years.

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ADVERSE CHILDHOOD EXPERIENCES

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Across the life course, adverse childhood experiences (ACEs) have been shown to impact adult morbidity. ACEs include abuse (psychological maltreatment, physical, or sexual), neglect, and household dysfunction (witnessing domestic violence; living with parents/adults who suffered from mental illness, alcohol abuse, or substance abuse; or loss of a parent, separated/divorced parents, or having an incarcerated household member). In addition to the aforementioned ACEs, other events such as bullying, neighborhood violence, and death of peers and family impact the health and well-being of youth. In the United States, more than 90% of 14-year-olds have experienced at least 1 ACE; those most affected are the poor, those with lower educational attainment, and racial-ethnic minorities. Adolescents with a greater number of and more recent ACEs have poorer health outcomes. Impaired health begins in early adolescence and progresses into adulthood. In fact, ACEs perpetuate chronic toxic stress, altering brain structure and metabolic responses, and increasing lifespan incidence of myocardial infarction, cerebrovascular disease, and stroke, in addition to other illness (eg, asthma).

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LEADING CAUSES OF MORBIDITY

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Risk Factors

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Childhood and adolescent ACEs are linked to adolescent risky behaviors and increasing morbidity. Risky health behaviors, rather than infectious or chronic diseases, are the leading causes of morbidity among adolescents. ACEs increase the prevalence of risky behaviors and the onset of somatic complaints and poor health. Most morbidity results from 3 risky behaviors initiated in early to middle adolescence: substance use, sexual activity, and motor/recreational vehicle use. Many risk behaviors interrelate; for example, substance use plays a major role in motor vehicle crashes. The WHO recognizes alcohol use as the second leading cause of YLD among males ages 15 to 19 years old. For example, 21.9% of 9th through 12th graders rode with someone who was under the influence of alcohol, 10% drove while drinking, and 41.5% drove while texting or emailing. Use of substances is associated ...

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