Distinct patterns of health engagement in adolescents and young adults: implications for health services

Abstract

BackgroundIn 2002, the Wanless report argued that increased health engagement is essential for population health to improve and for health systems to be affordable. Little attention has been paid to trajectories of health engagement in youth, despite WHO evidence that two-thirds of premature mortality is caused by behaviours and habits acquired during this period. We aimed to describe variation in health engagement between adolescents, young adults, and older adults and to investigate the association between health engagement and key public health outcomes at different ages. MethodsData were analysed from the nationally representative UK Healthy Foundations study (2008), separating adolescents (12–15 years; n=452), young adults (16–24 years; n=785), and older adults (25–74 years; n=4136). Responses to three health engagement questions were analysed: “I'm very involved in my health”, “I'm in control of my health”, and “There's nothing more important than health”. Responses were scored from 0 (strongly disagree) to 100 (strongly agree) and the mean score for each question was calculated. Health outcomes were self-reported poor general health, smoking, physical inactivity, and being overweight (each using standard, age-appropriate definitions). Logistic regression was used to calculate the odds ratio (OR) of poor health outcomes with low health engagement, adjusting for sex and deprivation. FindingsFeeling in control of one's own health decreased from adolescence (mean score 79·3, 95% CI 77·6–81·0) through young adulthood (74·6, 73·1–76·1) and older adulthood (72·2, 71·5–72·9). By contrast, perceived involvement showed a U-shaped trajectory (adolescents 72·0, 70·2–73·7; young adults 68·6, 67·1–70·1; older adults 73·8, 73·1–74·5), as did perceived importance of health (adolescents 75·0, 73·1–76·9; young adults 62·9, 61·0–64·8; older adults 77·1, 76·4–77·8). Not feeling involved in health was more strongly associated with poor general health in adolescents (OR 1·81, 1·41–2·32) and young adults (2·04, 1·70–2·45) than older adults (1·19, 1·11–1·28). A stronger link was also seen with physical inactivity in adolescents (1·56, 1·17–2·08) than older adults (1·08, 1·01–1·15), but there was a less significant link with smoking in adolescents (1·39, 0·99–1·92) than young adults (1·41, 1·20–1·67) and older adults (1·33, 1·23–1·43). Not feeling in control of health was associated with poor general health in young adults (2·33, 1·93–2·83) and older adults (2·26, 2·10–2·44). By contrast, lack of control over health was most strongly associated with physical inactivity in adolescents (1·99, 1·49–2·66), but continued to be significant in young adults (1·25, 1·06–1·48) and older adults (1·11, 1·04–1·19). InterpretationYoung adults have distinct patterns of health engagement, feeling less involved and rating health a less important priority than younger and older respondents. Lack of involvement in health was more strongly linked to poor health outcomes in both adolescents and young adults, consistent with findings from social psychology and neuroscience that show distinct social cognition processes from puberty until the mid-20s. Improved understanding of these patterns could lead to more effective health promotion services for young people and higher quality care for those with long-term medical disorders during the transition from paediatric to adult services. FundingNone.