PolicyLab

Editor’s Note: PolicyLab welcomes 2025 with Dr. Shelby Davies as the new faculty lead for the Adolescent Health and Well-being research portfolio. She brings her community-engaged and clinical focus on adolescent and young adult health to the portfolio, with expertise both in providing care to youth experiencing homelessness and health care disparities, particularly inequities in menstrual health care. She joins Radha Pennotti in portfolio leadership.  

Adolescence, marked by rapid growth and development (physical, cognitive, psychological and emotional), is a critically important life stage. It is not just a period of storm and stress, but a time of discovery, enjoyment, learning and growth. Health and well-being experienced during this period have a lasting impact, shaping an individual's overall health into adulthood. 

Alongside members of PolicyLab’s Adolescent Health and Well-Being portfolio, we are identifying opportunities to protect and enhance young people’s health in the changing political context to help inform our collaborative work and priorities.  

In this post, we’re sharing relevant data and elevating several opportunities to support adolescents’ access to health care that they may need. 

Checking in on the health and well-being of adolescents 

Adolescents worldwide face unique health challenges, including a disproportionate burden of HIV, pregnancy complications, mental health disorders and risk of injury-related death. In many ways, adolescent and young adult health has improved over the last several years, but there remain opportunities to build on these improvements. For a snapshot of adolescent health, we looked to a national survey of adolescents and found the following points particularly salient.  

Different groups of adolescents have unique experiences, and we looked specifically at female and LGBTQ+ adolescents in these data:  

Adolescent mental health continues to be concerning.  

Nearly 4 in 10 adolescents experience feelings of sadness or hopelessness. While this is a high proportion of youth, it represents fewer youth than in 2021. Other indicators, such as considering or attempting suicide and experiencing poor mental health, did not worsen or improve. 

Overall, however, female and LGBTQ+ youth reported more signs of poor mental health than their male and cisgender and heterosexual peers in 2023. 

Adolescents’ use of substances is trending downwards.  

The percentage of youth who drank alcohol in the last 30 days decreased from 35% in 2013 to 22% in 2023. Youth using illicit drugs also decreased in the same period. Those reporting current use of marijuana or ever misusing an opioid prescription remained unchanged in the last two years.  

• Female and LGBTQ+ youth were more likely to report current use of alcohol, marijuana or misuse of prescription opioids.  

Fewer youth are having sex.  

However, they are also less likely to use condoms, get tested for HIV or sexually transmitted infections (STIs)—all protective sexual behaviors. Incidence rates of STIs among youth and young adults remain high.  

Protecting the health and well-being of adolescents through access to health care 

Recent PolicyLab research shows that youth benefit from supportive adults, and other data endorse the supportive roles of community and health care providers as teens mature, build deeper relationships and take age-appropriate risks. Adolescents and young adults have unique disparities in health care access, including coverage of comprehensive benefits, consent and confidentiality.  

In this current context, here are several policy opportunities to enhance adolescent’s access to health care, and areas to protect in order to ensure the health of diverse populations of adolescents.

Preserving youth’s access to confidential care  

Many states permit youth to consent to reproductive health care. At the federal level, Title X provides comprehensive family planning and related preventive health services. PolicyLab research demonstrated that a 2019 change to the Title X program, known as the gag rule, resulted in more than 1.8 million youth losing access to this confidential care. The change was reversed in 2021, but service levels did not recover in the year following, underscoring the lasting effects of the federal policy change.  

Ensuring coverage of preventive services by commercial and public payors  

While the Biden administration’s proposed rule to enhance coverage of preventive services, including insurance coverage for over-the-counter contraception, did not advance, the rule development process illuminated opportunities to remove barriers to access, such as cost sharing, patient and provider awareness of coverage, exemption processes, and protecting confidentiality. State public policy can ensure coverage of preventive services, which will benefit adolescents as discussed in this PolicyLab blog. 

Protecting LGBTQ+ youth 

Under the Biden administration, we saw federal efforts to extend nondiscrimination protections on the basis of sexual orientation and gender identity in health care policy strive to ensure that health care settings are safe and supportive to LGBTQ+ individuals. State and local policy can also protect and support health care access for LGBTQ+ people. Amidst these supportive policies, it’s important to note that anti-LGBTQ+ policies, in addition to limiting protections, negatively impact the mental health of youth.  

Dedicating substance use prevention and treatment funds to reach youth 

States and communities are actively making decisions about how to use opioid settlement funds. A portion of these funds may be dedicated to prevention, as well as treatment initiation and retention efforts that aim to reach youth. In allocating these funds, it’s critical to select evidence-based activities, and emerging work from PolicyLab is exploring opportunities to enhance treatment retention among adolescents and young adults in Philadelphia.  

Keeping a pulse on how youth are doing  

Population level data on youth health and well-being serve as signals for community response and investments in our youth. Datasets that cover self-reported behaviors and feelings, like the Youth Risk Behavior Survey, issue specific ones like Youth Mental Health Tracker, or state level data like PA Youth Survey identify bright spots and opportunities to better support youth. Sustaining data collection and dissemination is critical as leaders across sectors, health care, education, and public health, use these data regularly. 

We can do more to protect and support adolescents' health and well-being.  

Among our many projects, our team members are currently engaged in work that aims to address co-occurring issues of substance use and high risk of HIV, evaluate a digital health intervention that connects teens to PrEP resources in the emergency department, and support youth with sickle cell disease with their transition to adult care.  

True to PolicyLab’s model, we will continue to explore policy-relevant research questions, seek input from community organizations, translate relevant findings, and disseminate this information within our community and beyond.  

We welcome partnership in this work and the opportunity to share more about our findings.  

*At the time of writing, all links to U.S. government websites were active though access and content may be modified to comply with President Trump’s Executive Orders.