Many teenagers enter adulthood with significant risk factors for cardiovascular disease, and the transition from adolescence to adulthood is a key time to address these risk factors and reduce the risk of developing future cardiovascular disease, according to a new American Heart Association scientific statement published today in the Journal of the American Heart Association.
According to the scientific statement, “Cardiovascular Health in the Transition from Adolescence to Emerging Adulthood,” emerging adulthood is the period between age 18 and the mid- to late-twenties, when the brain and decision-making ability are still maturing to adult levels. Greater independence and many changes in life circumstances are occurring simultaneously during this time.
“Emerging adulthood is a time of significant planning, often centered around career development and forming close personal relationships. This pivotal phase is also an ideal time to establish health practices that support lifelong heart health,” said Chair of the scientific statement writing group Jewel Scott, Ph.D., R.N., FNP-C, an assistant professor of biobehavioral health and nursing science in the College of Nursing at the University of South Carolina in Columbia, South Carolina.
The scientific statement reviews many of the individual and social challenges to protecting heart health in emerging adults, and it identifies types of interventions that may help.
Transitions in health care and lifestyle changes
In childhood and adolescence, there are typically standard occasions to see health care professionals, such as scheduled vaccinations and school or sports check-ups. These visits provide an opportunity to measure weight and blood pressure and check cholesterol and blood sugar levels. They can also open the door to a discussion about maintaining heart health and addressing any concerns before a risk factor is apparent.
“In the transition from high school to young adulthood, the built-in checkpoints fall off, and young adults may not reengage with care until after they’ve developed a heart disease risk factor,” said Scott.
Life’s Essential 8, the American Heart Association’s key measures for improving and maintaining cardiovascular health, include several health behaviors (such as eating a healthy diet and getting enough physical activity) that may worsen in emerging adulthood. This period of life usually brings greater responsibilities along with a loss of structures that were in place during adolescence. Becoming more sedentary is common, as is gaining weight.
“Lots of youth who were very active in high school become less active once the recreational sport or team sport they loved goes away. How to cook is not often taught in high school these days, and we know that people who have more cooking skills are more likely to prepare food at home — and meals at home tend to have less sodium and to be more balanced than meals at fast food or sit-down restaurants,” said Scott.
Responsibilities related to school, work, commuting and parenting may also make it difficult for young adults to get sufficient sleep, another important factor for optimal heart health.
While, historically, young people often started smoking tobacco in middle school and high school, the percentage of people who started using tobacco between 18 and 23 years of age doubled between 2002 to 2018, with electronic cigarettes as the most frequently used product. The authors emphasize that more research is needed to learn about the long-term cardiovascular effects of vaping.
Barriers to health care access
The ability to pay for health care may also become a challenge during the transition from adolescence to adulthood. Emerging adults make up the largest group of the 27 million uninsured adults in the United States. In some states without expanded Medicaid access, individuals can lose their Medicaid coverage when they turn 19. If their parents are insured through the Affordable Care Act, emerging adults age out of coverage after age 26.
While college health services can be important in providing care, 40% of all college students attend two-year community colleges. These students are less likely to have access to health care, which is often not available at community colleges. Young adults pursuing a trade pathway or apprenticeship are also less likely to have health insurance coverage.
To improve health care access for emerging adults, the statement suggests supporting policies that expand insurance access across the lifespan and eliminate gaps in coverage. However, the statement points out that barriers to obtaining health care go beyond insurance status, since health care utilization is less than 40% among insured emerging adults. Barriers may include a lack of knowledge of health care services, past negative experiences with care or other issues, such as long wait times and poorly coordinated care.