Adolescents' Receipt of Care in a Medical Home: Results From a National Survey.

PURPOSE: Despite long-term emphasis on the medical home for children, little research focuses on adolescents. This study examines adolescent past-year attainment of medical home, its components, and subgroup differences among demographic and mental/physical health condition categories. METHODS: Utilizing the 2020-21 National Survey of Children's Health (NSCH), ages 10-17 (N = 42,930), we determined medical home attainment and its 5 components and subgroup differences utilizing multivariable logistic regression: sex; race/ethnicity; income; caregiver education; insurance; language spoken at home; region; and health conditions: physical, mental, both, or none. RESULTS: Forty-five percent had a medical home with lower rates among those who were as follows: not White non-Hispanic; lower income; uninsured; in non-English-speaking households; adolescents whose caregivers lacked a college degree; and adolescents with mental health conditions (p range = .01-<.0001). Differences for medical home components were similar. DISCUSSION: Given low medical home rates, ongoing differences and high mental illness rates, efforts are needed to improve adolescent medical home access.

Young Adult Anxiety or Depressive Symptoms and Mental Health Service Utilization During the COVID-19 Pandemic.

PURPOSE: Young adult anxiety/depression (mental health) symptoms have increased from prior to the COVID-19 pandemic. This study assessed young adult (aged 18-25 years) anxiety/depressive symptoms, mental health care utilization (prescription drug use, counseling, and/or either), and unmet counseling/therapy needs utilizing the national Household Pulse Survey data from June to July 2021. METHODS: Young adult (n = 2,809) rates and subgroup differences in mental health symptoms (Generalized Anxiety Disorder-2 and/or Patient Health Questionnaire-2) were assessed, as were mental health care utilization and unmet counseling/therapy needs. RESULTS: In total, 48% of young adults had mental health symptoms. Among those, 39% received treatment and 36% reported unmet mental health counseling/therapy needs. DISCUSSION: These findings highlight young adults' ongoing mental health needs and low services receipt. Interventions and further research to reduce barriers to seeking and utilizing mental health care and to increase the capacity of providers to deliver culturally appropriate mental health care are needed.

Adolescent Technology-use Rules and Sleep in a Large Representative Sample.

PURPOSE: This study investigated the prevalence of technology-use rules, typical sleep habits, and associations between rules and sleep using the representative 2017-2018 California Health Interview Survey adolescent sample. METHODS: Adolescents aged 12-17 years completed the California Health Interview Survey, including queries of (1) rules at home regarding times to turn off or put away electronics and (2) school-night bedtime and rise time. Rates of rules and associations between rules and sleep were investigated using descriptive statistics and bivariate and multivariable analyses. RESULTS: Seventy-two percent reported technology-use rules. Rates were comparable across subgroups. Rules and sleep were not significantly associated after adjusting for covariates. Reported time in bed fell below National Sleep Foundation guidelines for 38% of participants. CONCLUSIONS: Most adolescents reported technology-use rules at home. Associations between rules and bedtime were mixed, suggesting that further exploration of contextual and developmental factors is needed. Many reported inadequate sleep duration, supporting sleep as a key topic in adolescent health.

Young Adult Perspectives on COVID-19 Vaccinations.

PURPOSE: Young adults have the highest cumulative incidence of COVID-19 infection in the country. Using March 2021 Household Pulse Survey data, an ongoing, cross-sectional nationally representative survey, we examined U.S. young adult intention to accept COVID-19 vaccines. METHODS: Young adult (ages 18-25 years) Household Pulse Survey participants were queried on intention to receive a COVID-19 vaccine and related perspectives (N = 5,082). RESULTS: Most unvaccinated respondents (76%) indicated an intention to become vaccinated. The most frequently cited reasons for potentially rejecting vaccination included desire to wait and see if the vaccine is safe (56%); concerns over side effects (53%); and believing others are in greater need of the vaccine (44%). CONCLUSIONS: With 24% of young adults hesitant to accept a COVID-19 vaccine, public health interventions should target reasons for hesitancy, address concerns about safety and side effects, and underscore the importance of vaccinations for this population.

Medical Vulnerability of Young Adults to Severe COVID-19 Illness-Data From the National Health Interview Survey.

PURPOSE: COVID-19 morbidity and mortality reports in the U.S. have not included findings specific to young adults. The Centers for Disease Control and Prevention provides a list of conditions and associated behaviors, including smoking, conferring vulnerability to severe COVID-19 illness regardless of age. This study examines young adults' medical vulnerability to severe COVID-19 illness, focusing on smoking-related behavior. METHODS: A young adult subsample (aged 18-25 years) was developed from the National Health Interview Survey, a nationally representative data set, pooling years 2016-2018. The medical vulnerability measure (yes vs. no) was developed, guided by the Centers for Disease Control and Prevention medical indicators. The estimates of medical vulnerability were developed for the full sample, the nonsmoking sample, and the individual risk indicators. Logistic regressions were conducted to examine differences by sex, race/ethnicity, income, and insurance. RESULTS: Medical vulnerability was 32% for the full sample and half that (16%) for the nonsmoking sample. Patterns and significance of some subgroup differences differed between the full and the nonsmoking sample. Male vulnerability was (33%) higher than female (30%; 95% CI: .7-.9) in the full sample, but lower in nonsmokers: male (14%) versus female (19%; 95% CI: 1.2-1.7). The white subgroup had higher vulnerability than Hispanic and Asian subgroups in both samples-full sample: white (31%) versus Hispanic (24%; 95% CI: .6-.9) and Asian (18%; 95% CI: .4-.5); nonsmokers: white (17%) versus Hispanic (13%; 95% CI: .06-.9) and Asian (10%; 95% CI: .3-.8). CONCLUSIONS: Notably, lower young adult medical vulnerability within nonsmokers versus the full sample underscores the importance of smoking prevention and mitigation.

Young Adult Preventive Healthcare: Changes in Receipt of Care Pre- to Post-Affordable Care Act.

PURPOSE: Young adults have unique health and health care needs. Although morbidity and mortality stem largely from preventable factors, they lack a structured set of preventive care guidelines. The Affordable Care Act (ACA), enacted in 2010, increased young adult insurance coverage, prohibited copayments for preventive visits among privately insured and for many preventive services. The objectives were to evaluate pre- to post-ACA changes in young adults' past-year well visits and, among those using a past-year health care visit, the receipt of preventive services. METHODS: We used pooled Medical Expenditure Panel Survey data, comparing pre-ACA (2007-2009, N = 10,294) to post-ACA (2014-2016, N = 10,567) young adults aged 18-25 years. Bivariable and multivariable stratified logistic regression, adjusting for sociodemographic covariates, were conducted to determine differences in well visits and in preventive services among past-year health care utilizers: blood pressure and cholesterol checks, influenza immunization, and all three received. RESULTS: Past-year well visits increased from pre-ACA (28%) to post-ACA (32%), p < .001. Increases were noted for most demographic subgroups with greatest increases among males, Asian, and highest income subgroups. Larger pre- to post-ACA increases were found for most of the preventive services, p < .05, including the receipt of all three services (7% vs. 16%), p < .001, among past-year health care utilizers. CONCLUSION: Following ACA implementation, young adults experienced modest increases in well visit rates and larger increases in most preventive services received. Overall rates of both remain low. Building on these improvements requires concerted efforts that account for young adults' unique combination of health care issues and challenges in navigating an adult health care system.

Increasing Delivery of Preventive Services to Adolescents and Young Adults: Does the Preventive Visit Help?

PURPOSE: Despite decades of emphasizing the delivery of adolescent preventive care visits and evidence that many preventive services reduce risk, little evidence links preventive visits to increased preventive service delivery. This study examined whether a preventive healthcare visit versus any nonpreventive healthcare visit was associated with higher rates of adolescent and young adult preventive services. METHODS: Analyzed Medical Expenditure Panel Survey data (2013-2015) to determine whether those with a preventive versus nonpreventive healthcare visit had higher rates of past-year preventive services receipt; adolescents (N = 8,474, ages 10-17) and young adults (N = 5,732, ages 18-25). Bivariable and multivariable analyses adjusting for personal/sociodemographic covariates tested for differences in preventive services rates between preventive versus nonpreventive care groups. Adolescent services were blood pressure, height and weight measured, and all three measured; and guidance given regarding healthy eating, physical activity, seatbelts and helmets, secondhand smoke, dental care, all six topics received, and time alone with provider. Young adult services were blood pressure and cholesterol checked, received influenza immunization, and all three services received. RESULTS: All preventive services rates were significantly higher in those attending preventive visits versus those with nonpreventive visits. Adolescent services increase ranged from 7% to 19% and young adults increase from 9% to 14% (all bivariable and multivariable analyses, p < .001). However, most rates were low overall. CONCLUSIONS: Higher rates of preventive services associated with preventive visits support its clinical care value. However, low preventive services rates overall highlight necessary increased efforts to promote preventive care and improve the provider delivery of prevention for both age groups.

Association Between Adolescent Preventive Care and the Role of the Affordable Care Act.

Importance: Despite decades of adolescent preventive well visit and services promotion (Guidelines for Adolescent Preventive Services and Bright Futures), rates are below recommended levels and little is known of the effect of the Patient Protection and Affordable Care Act (ACA) implementation on these care rates. Objectives: To use Medical Expenditure Panel Survey data to determine (1) whether adolescent well visit rates increased from the pre-ACA period to post-ACA period, and (2) whether caregivers' reports of past-year preventive services delivery increased from the pre- to post-ACA period among adolescents with any past-year health care visit. Design, Setting, and Participants: Secondary data analysis of 2007-2009 (before ACA implementation) and 2012-2014 (after ACA implementation) Medical Expenditure Panel Survey data on the differences in well visits and preventive services. Data were collected through computer-assisted personal interviews of caregivers of a nationally representative sample of a noninstitutionalized US population (n = 25 695 10- to 17-year-old adolescents). Main Outcomes and Measures: For objective 1, pre- to post-ACA period differences in past-year well visits: (1) stratified bivariable logistic regressions identifying subgroup rate differences and (2) multivariable analyses controlling for demographic factors. For objective 2, pre- to post-ACA period differences in caregiver reports of preventive services receipt, including time alone with clinician: (1) bivariable (year differences) and (2) multivariable logistic regressions controlling for demographic variables. Results: A total of 6279 (50.9%) and 6730 (50.8%) participating adolescents in the pre- and post-ACA period data were male, respectively. Under objective 1, we found that well-visit rates increased from 41% to 48% post-ACA implementation (odds ratio, 1.3; 95% CI, 1.2-1.5); minority and low-income groups had the greatest increases. Under objective 2, we found that among those with any past-year visit, most preventive services rates (8 of 9) increased post-ACA implementation (range, 2%-9%, absolute), with little or no change when controlling for demographic variables. Time alone with clinicians increased 1%, significant only when covariates were controlled (adjusted odds ratio, 1.2; 95% CI, 1.0-1.3). Conclusions and Relevance: Despite modest to moderate increases, with greatest gains for underserved youth, adolescent preventive care rates remain low, highlighting the need for increased efforts to bring adolescents into well care and improve clinician delivery of preventive care within their practices.

Improving Receipt and Preventive Care Delivery for Adolescents and Young Adults: Initial Lessons from Top-Performing States.

Purpose Provisions of the Patient Protection and Affordable Care Act (ACA) of 2010 hold promise for improving access to and receipt of preventive services for adolescents and young adults (AYAs). The Title V Block Grant transformation also includes a focus on improving adolescent preventive care. This brief report describes and discusses an inquiry of promising strategies for improving access and preventive care delivery identified in selected high-performing states. Methods Two data sources were used to identify top-performing states in insurance enrollment and preventive care delivery: National Survey of Children's Health for adolescents (ages 12-17 years) and Behavioral Risk Factors Surveillance System for young adults (ages 18-25 years). Interviews were conducted with key stakeholders to identify promising strategies related to increasing AYAs' insurance enrollment and receipt of preventive services. Results Seven top-performing states were selected: California, Colorado, Illinois, Iowa, Oregon, Vermont, and Texas; 27 stakeholders completed interviews. Four strategies were identified regarding insurance enrollment: use of partnerships; special populations outreach; leveraging laws and resources; and youth engagement. Four strategies were identified regarding quality preventive care: expand provider capacity to serve AYAs; adopt medical home policies; establish quality improvement projects; and enhance consumer awareness of well-visit. States focused more on adolescents than young adults and on increasing health insurance enrollment than the provision of preventive services. Conclusions This commentary identifies strategies and recommends areas for future action, as Title V programs and their partners focus on improving healthcare for AYAs as ACA implementation and the Title V transformation continues.

Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go?

We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act's provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology-such as gaming platforms, mobile phone applications, and wearable devices-suggests opportunities to expand clinicians' reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care.

Adolescent and Young Adult Preventive Care: Comparing National Survey Rates.

INTRODUCTION: The Affordable Care Act's preventive healthcare provisions have the potential to increase adolescents' and young adults' receipt of recommended preventive services. Assessing whether this potential is realized requires valid monitoring data in several areas, including receipt of an annual preventive visit. The purpose of this study is to describe and compare preventive visit rates across national surveys for adolescents and young adults. METHODS: This study, conducted in 2014: (1) identified national surveys with past-year preventive visit measures; (2) compared survey features, including mode of administration, respondent, response rate, demographic profile (univariate analysis), preventive visit measure wording, and method of construction; and (3) compared preventive visit rates, including rates among sociodemographic subgroups (bivariate analyses). RESULTS: Four 2011 surveys were identified: National Health Interview Survey, National Survey of Children's Health (2011-2012), and Medical Expenditure Panel Survey (MEPS) for adolescents, and MEPS and Behavioral Risk Factor Surveillance System for young adults. Surveys varied by most assessed features; demographic profiles were similar. Preventive visit rates varied significantly across adolescents (43%-81%) and young adults (26%-58%). The largest differences in visit rates were in comparisons of subjective assessments to a more detailed assessment coded from specific records of visits kept by respondents. Sociodemographic differences in visit rates were consistent across surveys. CONCLUSIONS: Further research is needed to assess reasons for the different estimates of preventive visits across national surveys. Those who monitor trends in receipt of recommended care for adolescents and young adults should take survey differences into account. Monitoring content of care is also needed.

Improvement in preventive care of young adults after the affordable care act: the affordable care act is helping.

IMPORTANCE: The 2010 Affordable Care Act (ACA) included expansion of insurance coverage for young adults and improved access to preventive care. OBJECTIVE: To examine the ACA's initial effects on young adults' receipt of preventive care. DESIGN, SETTING, AND PARTICIPANTS: Secondary data analysis using a pre-post design that compared health care use by young adults (aged 18 to 25 years) from 2009 and 2011 Medical Expenditure Panel Surveys. Data were collected through computer-assisted personal interviews of a nationally representative sample of the noninstitutionalized US population. MAIN OUTCOMES AND MEASURES: Differences by year in rates of receiving a routine examination in the past year, blood pressure screening, cholesterol screening, influenza vaccination, and annual dental visit. Three logistic regression models were developed to (1) compare pre-ACA (2009) and post-ACA (2011) rates of receiving preventive care and (2) determine if post-ACA increases in insurance coverage accounted for changes in preventive care rates. Model 1 was a bivariate model to determine differences in preventive care rates by year; model 2, a multivariable model adding insurance status (full-year private, full-year public, partial-year uninsured, and full-year uninsured) to determine whether insurance accounted for survey year differences; and model 3, a multivariable model adding covariates (usual source of care and sociodemographic variables) to determine whether they further accounted for differences by survey year or insurance status. RESULTS: After ACA, young adults had significantly higher rates of receiving a routine examination (47.8% vs. 44.1%; P < .05), blood pressure screening (68.3% vs. 65.2%; P < .05), cholesterol screening (29.1% vs. 24.3%; P < .001), and annual dental visit (60.9% vs. 55.2%; P < .001) but not an influenza vaccination (22.1% vs. 21.5%; P = .70). Full-year private insurance coverage increased (50.1% vs. 43.4%; P < .001), and rates of lacking insurance decreased (partial-year uninsured, 18.4% vs. 20.7%; P = .03; and full-year uninsured, 22.2% vs. 27.1%; P < .001). Full-year public insurance rates remained stable (9.4% vs. 8.8%; P = .53). Insurance status fully accounted for the pre- and post-ACA differences in routine examination and blood pressure screening and partially accounted for year differences for cholesterol screening and annual dental visits. Covariate adjustment did not affect year differences. CONCLUSIONS AND RELEVANCE: The ACA provisions appear to increase insurance coverage and receipt of preventive services among young adults. Further studies are needed to replicate these findings as other ACA provisions are implemented.

Adolescent and young adult health in the United States in the past decade: little improvement and young adults remain worse off than adolescents.

Adolescence and young adulthood are unique developmental periods that present opportunities and challenges for improving health. Health at this age can affect health throughout the lifespan. This review has two aims: (1) to examine trends in key indicators in outcomes, behaviors, and health care over the past decade for U.S. adolescents and young adults; and (2) to compare U.S. adolescents and young adults on these indicators. The review also assesses sociodemographic differences in trends and current indicators. Guided by our aims, previous reviews, and national priorities, the present review identified 21 sources of nationally representative data to examine trends in 53 areas and comparisons of adolescents and young adults in 42 areas. Most health and health care indicators have changed little over the past decade. Encouraging exceptions were found for adolescents and young adults in unintentional injury, assault, and tobacco use, and, for adolescents, in sexual/reproductive health. Trends in violence and chronic disease and related behaviors were mixed. Review of current indicators demonstrates that young adulthood continues to entail greater risk and worse outcomes than adolescence. Young adults fared worse on about two-thirds of the indicators examined. Differences among sociodemographic subgroups persisted for both trends and current indicators.

Medical home for adolescents: low attainment rates for those with mental health problems and other vulnerable groups.

BACKGROUND: The importance of the medical home for children has been demonstrated but has not been examined comprehensively for adolescents. Adolescence is a unique period of physical, cognitive, and psychosocial changes when many mental disorders first emerge; thus, receiving care within a medical home could improve well-being. This study examines rates of medical home attainment and its components for adolescents and subgroups, including those with mental health conditions. METHODS: Utilizing the 2007 National Survey of Children's Health, we determined the following for adolescents aged 10 to 17 years (n = 45 897): 1) rates of medical home attainment and its 5 components (usual source of care, having a personal doctor, and receiving needed referrals, effective care coordination, and family-centered care); and 2) subgroup differences; gender, race/ethnicity, income, insurance, region, language spoken at home, respondent education, and the presence of mental health conditions. RESULTS: Fifty-four percent of adolescents had a past-year medical home. Rates were lower for minority youth compared to whites; lower-income and uninsured youth; those in households that are non-English speaking in which the respondent did not have some college; and those with mental health as opposed to physical health conditions (all P < .01). Patterns of disparities in the medical home components were similar, and rates were lowest for effective care coordination and family-centered care components. CONCLUSIONS: Nearly half of adolescents lacked a medical home in the past year. Even lower rates for subgroups highlight the need to increase access to comprehensive quality health care. Efforts to improve effective care coordination and family-centered care could result in higher quality of care for all children and adolescents, and specifically for disadvantaged adolescents and those with mental health conditions.

Young adult preventive health care guidelines: there but can't be found.

OBJECTIVES: To (1) identify adolescent and adult clinical preventive services guidelines relevant to the young adult age group; (2) review, compare, and synthesize these guidelines, with emphasis on the extent to which professional guidelines are consistent with evidence-based guidelines developed by the US Preventive Services Task Force; and (3) recommend the next steps in the establishment and integration of preventive care guidelines for young adults. DESIGN: Nonexperimental: an Internet search was conducted to identify relevant preventive care guidelines for the young adult group. SETTING: The search included federal agencies and professional organizations that focus on health areas linked to the care of young adults or that provide health care to adolescents and young adults. PARTICIPANTS: National organizations, federal agencies, health professional associations, and medical societies. MAIN OUTCOME MEASURES: Preventive services guidelines for adolescents and adults that intersect with the age range of 18 to 26 years. RESULTS: When the ages of 18 to 26 years are carved out of established professional guidelines across specialty groups, there is a broad number of recommendations, with many supported by sufficient evidence to receive a US Preventive Services Task Force grade of A or B that can inform the care of young adults. CONCLUSIONS: We recommend the establishment of young adult preventive health guidelines that reflect the current evidence-based recommendations that overlap with the young adult age group; we suggest clinician and health care system supports to facilitate the delivery of preventive services to young adults; and we emphasize prioritizing research in prevention areas in which sufficient evidence does not exist.

Health care services and the transition to young adulthood: challenges and opportunities.

OBJECTIVE: The aim of this study was to examine the potential role of the health care system in the successful transition to young adulthood for all adolescents, with emphasis on adolescents with special health care needs (ASHCN), and to evaluate the system's status in filling that role. METHOD: Research and conceptual frameworks addressing successful transitions and functioning were reviewed. A framework describing a role for health care services in the transition was presented. The health care system's status in promoting healthy transitions was evaluated, including National Survey of Children with Special Health Care Needs 2005-2006 analyses of key outcomes for ASHCN. RESULTS: Although most national efforts to define skills needed for the transition have focused on career/vocational skills, a few frameworks integrate broader issues such as health, psychosocial development, and civic engagement. Adolescent transitional issues have generally received little attention; however, these have been articulated for ASHCN. Nevertheless, only 2 in 5 ASHCN receive transitional care, and ASHCN fare poorly on other core outcomes. ASHCN with mental health conditions fare worse on outcomes than those with physical health conditions. Our framework for healthy transitions includes the following: 1) adolescents can access a comprehensive health care system, 2) preventable problems are avoided, and 3) chronic problems are managed. The present health care system falls short of accomplishing these. CONCLUSIONS: Health care services can potentially play a role in facilitating a healthy transition to young adulthood; however, many gaps exist. Although the health care reform act addresses some gaps, efforts that integrate adolescents' developmental needs and address mental health issues are needed.

Who gets confidential care? Disparities in a national sample of adolescents.

Using the 2001-2004 Medical Expenditures Panel Survey, we examined rates of past-year adolescent time alone with a clinician by visit type, and among youths with a preventive visit, examined age, gender, and race/ethnicity differences. Youths with a preventive visit have higher rates of time alone; rates for these youths increase with age, are higher for males (42%) versus females (37%), and are lowest among Hispanics. Time alone rates are low, especially for younger females and Hispanic youths. Special efforts are needed to increase time alone in these populations.

To tweet, or not to tweet: gender differences and potential positive and negative health outcomes of adolescents' social internet use.

Adolescents and young adults are avid Internet users. Online social media, such as social networking sites (e.g., Facebook, MySpace), blogs, status updating sites (e.g., Twitter) and chat rooms, have become integral parts of adolescents' and young adults' lives. Adolescents are even beginning to enter the world of online dating with several websites dedicated to "teenage online dating." This paper reviews recent peer-reviewed literature and national data on 1) adolescents use of online social media, 2) gender differences in online social media and 3) potential positive and negative health outcomes from adolescents' online social media use. We also examine parental monitoring of adolescents' online activities. Given that parental supervision is a key protective factor against adolescent risk-taking behavior, it is reasonable to hypothesize that unmonitored Internet use may place adolescents' at significant risk, such as cyberbullying, unwanted exposure to pornography, and potentially revealing personal information to sexual predators.

Helping young men thrive: positive youth development and men's health.

Positive youth development (PYD) is a strong and growing field that complements the traditional problem-focused view of youth, and describes and promotes the healthy development and positive outcomes of young people. The PYD perspective can be applied in clinical and community intervention settings. Frameworks such as the "Five Cs" and the Search Institute's developmental assets model have guided researchers and practitioners in better understanding the process of PYD and the effectiveness of community interventions to promote PYD. The PYD literature lacks a coherent guiding framework to describe gender differences in positive development, which in turn could guide community and clinical interventions designed to help young men thrive.

Marijuana: use among young males and health outcomes.

Marijuana is the most commonly used illicit drug by adolescents and young adults, with more males than females reporting marijuana use. The adolescent and young adult years represent a critical period for interventions to prevent marijuana use and abuse. This article reviews relevant literature, including trends in young males' marijuana use and health effects of marijuana use. By most measures, there has been little net change in marijuana use among 12th graders and young adults since the 1990s. Despite males' greater use, little research has examined gender differences in areas such as metabolism of marijuana and long-term impact of marijuana use. In many areas, including dental health, fertility, and respiratory function, research is either sparse or has yielded conflicting results. Similarly, research on marijuana's carcinogenic effects has yielded conflicting results; however, a small but consistent literature indicates that marijuana use is linked to cancers unique to males. A stronger literature has identified an association between marijuana use and psychiatric problems. Clinical and program interventions for adolescents have potential to prevent marijuana use, as well as screen for and treat marijuana abuse. Improved research is needed, such as research with greater consistency in defining levels of use and greater emphasis on gender differences. Such research would help clinical and program interventions focus on those most at risk for adverse outcomes.