The formation of the USPHS can be traced back to the Act for the Relief of Sick and Disabled Seamen of 1798 authorizing government-operated marine hospitals to care for American merchant seamen (U.S. Department of Health and Human Services, 2011). Although subsequent legislation broadened the scope of USPHS, it is important to note that the majority of seamen in 1798 were adolescents. At that time, sailors generally went to sea as boys, and by the time they were 16 years old they could be rated as seamen, but most left the sea in young adulthood (Lambert, 2011). With respect to adolescent psychology, Lambert noted, “the idea of being single, free of responsibilities and well paid would have made a career at sea obviously alluring” (Lambert, 2011). Thus, the earliest federal public health activity was largely a response to the health care needs of this population of adolescents. As noted in Box 1 the field of public health relevant to adolescents now includes seven essential activities (Centers for Disease Control and Prevention, 2011).

The WHO, established in 1948 as the international public health arm of the United Nations, defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 2011a). Thus, any discussion of adolescent health and adolescent health psychology must move beyond disease and illness to comprehensive well-being. The WHO defines adolescents as youth between 10 and 19 years old, accounting for 20 % of the world population, with 85 % of all adolescents living in developing countries (Global Health Council, 2011). As noted in Box 2, nearly two-thirds of premature deaths and one-third of disease burden in adults can be traced to conditions or behaviors that began in youth. Promoting healthy practices among youth that protect them from health risks is critical to the future of every country’s health and social infrastructure and to the prevention of health problems in adulthood (World Health Organization, 2011b).

In 2002, the UN General Assembly Special Session on Children recognized the need for the “development and implementation of national health policies and programmes for adolescents, including goals and indicators, to promote their physical and mental health” (World Health Organization, 2011b).

Healthy People 1990: Under the leadership of the Surgeon General Julius B. Richmond, Healthy People was established as a blueprint to improve the health of all Americans over a decade. With core concepts now considered axiomatic, it laid out a US national public health policy for the first time. Described as a document “to encourage a second public health revolution,” it reflected the first consensus among key stakeholders to focus on health promotion and disease prevention (CDC, 1989). A 1980 Surgeon General’s companion Report Promoting Health, Preventing Disease: Objectives for the Nation for the first time included an adolescent and young adult outcome—mortality reduction (Public Health Service, 1980). A pediatrician who appreciated the special needs of adolescents, Dr. Richmond, presciently wrote, “achievement of these objectives by 1990 is a shared responsibility, requiring a concerted effort not only by the health community, but also by leaders in education, industry, labor, community organizations and many others” (Public Health Service, 1980).

Healthy People 2000 and 2010: In its second iteration, Healthy People 2000, there was a focus to reduce disparities among populations, such as the higher rates of sexually transmitted infections (STIs) in adolescents and young adults compared to older adults. The third iteration, Healthy People 2010, shifted from reducing to eliminating disparities, especially as they existed within a population, such as the higher rates of STIs among African-American compared to White adolescents in the same age-group. In addition, for the first time, Healthy People 2010 included 21 “critical” national health objectives (CNHOs) across six domains for youth 10–24 years old: (1) mortality, (2) unintentional injury, (3) violence, (4) substance use and mental health, (5) reproductive health, and (6) prevention of chronic disease during adulthood. Following the end of the 2000–2010 decade, the first comprehensive study of the 21 CNHOs in Healthy People 2010 was recently published, with both encouraging and discouraging findings (Jiang, Kolbe, Seo, Kay, & Brindis, 2011; Kreipe, 2011).

Although mortality for 10–24-year-olds in the United States was reduced compared to baseline, disparities in deaths continued to exist, based on sex, age, race, and ethnicity in a consistently troubling pattern, with males exceeding females, older groups exceeding younger groups, and Blacks exceeding both Whites and Hispanics in mortality. With respect to mortality rates, White and Hispanic 10–14-year-olds and females 10–19 years old all met Healthy People 2010 targets, but 20–24-year-old mortality increased from baseline. This disturbing trend emphasizes the importance of focusing on young adults as an often overlooked population (Park, Mulye, Adams, Brindis, & Irwin, 2006).

The “Other” race/ethnic mortality category contains two small subgroups that reflect extremes of mortality rates. American Indian/Alaskan Native youth have the highest same-age mortality rate among all racial/ethnic groups for both males and females, while Asian/Pacific Islanders have the lowest (National Adolescent Health Information Center, 2006). Among American Indian/Alaskan Native youth, death rates due to motor vehicle crashes or to suicide are twofold greater than rates for the next highest group, non-Hispanic Whites (National Adolescent Health Information Center, 2006). On the other hand, as a group Asian/Pacific Islander youth have relatively low rates of substance and alcohol use (National Adolescent Health Information Center, 2006), providing possible insight into alcohol-related MVC death reduction. Researchers have identified cultural factors including an emphasis on family reputation, humility, keeping a low profile, negative community sanctions on excessive drinking and behavior, and the impact of moderate parental drinking practices in the Asian/Pacific Islander population (Williams, 1984/1985). Although such protective influences may be mitigated as families accommodate to and are assimilated into mainstream culture, studying low-risk populations may suggest specific interventions for high-risk populations.

Outcomes for two other objectives deserve special attention because they worsened over time. Rates for the STI Chlamydia and for overweight/obesity worsened markedly from baseline to 2010 targets. Among 15–24-year-olds, females attending family planning clinics experienced a −125 % deviation from the 2010 target to reduce Chlamydia rates, while females and males at STI clinics had a −34 % and −52 %, respectively, deviation (Jiang et al., 2011). Overweight or obesity in 12–19-year-olds increased by 62 %, representing a −115 % deviation from the 2010 target (Jiang et al., 2011).

In Healthy People 1990, smoking was the major target of health promotion and disease prevention, and obesity was only mentioned in relation to hypertension and cardiovascular disease in adults (Public Health Service, 1980). Gonorrhea was the primary STI; Chlamydia was noted as an agent causing newborn illness and did not become a reportable STI until 1995. Obesity has replaced tobacco as a public health priority for preventable mortality and morbidity among adolescents and young adults (Ogden, Carroll, & Flegal, 2008), and Chlamydia is now the most common STI in 15–24-year-olds, and becoming ever more so (Centers for Disease Control and Prevention, 2010a). Disparities are evident in both of these domains as well: obesity is higher among males than females, and among Blacks and Hispanics than Whites, and increases with age (Eaton et al., 2010).

Healthy People 2020: As a tribute to Dr. Richmond’s visionary leadership, Healthy People, now in its fourth iteration for the years 2010–2020, includes a new goal: “to improve the healthy development, health, safety, and well-being of adolescents and young adults,” (Healthy, 2020a) and two new topic areas: adolescent health and lesbian, gay, bisexual, and transgender health (Healthy, 2020b), each with special relevance to adolescent health. Another feature of Healthy People 2020 with respect to adolescent health psychology is a new focus on identifying, measuring, and tracking health disparities by examining the determinants of health, with a goal of achieving health equity by eliminating disparities and improving the health of all groups. Health disparity exists if, for any reason, a health outcome occurs to a greater or lesser extent between populations of adolescents. Because databases such as those analyzed for the comprehensive study of 2010 outcomes are limited to a narrow range of individual characteristics, such as sex, race, and ethnicity, other potential dimensions of disparity (e.g., sexual identity, disability, socioeconomic status, or geographic location) that may foster or impair an individual’s ability to achieve good health have had limited inclusion in public health policy development. These features are more difficult to measure, but compared to the standard individual demographics may be more responsive to interventions and have an even greater impact on adolescent health psychology.

Thus, a range of personal, social, economic, and environmental factors affect adolescent health status. To that end, Healthy People 2020 encourages the development of objectives that address the relationship between health status and biology, individual behavior, health services, social factors, and policies. An ecological approach—in which adolescents are seen to affect the environment and the environment affects the adolescent—requires a dual focus at both individual and population levels of adolescents (Kreipe, 2011). Because the determinants of health are interactive and dynamic, effective public health interventions must mirror these qualities. For example, the adolescent population is becoming increasingly ethnically diverse, with recent dramatic increases in the numbers of Hispanic and Asian American youth. The adolescent and young adult population is not only more diverse than the adult population, but becoming so more rapidly (National Adolescent Health Information Center, 2008). This is important because family structure both varies by racial/ethnic group (National Adolescent Health Information Center, 2008) and influences health outcomes. Meeting the goal of improving the healthy development, health, safety, and well-being of adolescents in the context of rapidly expanding diversity will require culturally effective public health practices and increased attention to disparate health and academic outcomes known to correlate highly with poverty, especially among adolescents from minority racial and ethnic groups (Healthy, 2020a).

The collaborative entity that has been responsible for overseeing national efforts to address adolescent health deserves mention. The National Initiative to Improve Adolescent Health (NIIAH, www.cdc.gov/HealthyYouth/AdolescentHealth/NationalInitiative) is led by two federal agencies collaborating with a variety of partner organizations and key stakeholders to mobilize activity directed at the adolescent health objectives in Healthy People. NIIAH has a national, state, and community focus and commitment to the health, safety, positive development, and well-being of adolescents, young adults, and their families. To improve health and safety outcomes, NIIAH addresses access to quality health, safety education, and health care, with attention to social determinants of, and the elimination of disparities in, health, safety, and well-being of adolescents and young adults and their families (CDC, 2011). Leaders in adolescent health have noted that emerging data indicate a “clear, sustained, and appropriately-supported national mandate for relevant agencies to collaboratively pursue a new National Initiative to Improve the Health of Adolescents and Young Adults by the Year 2020” (Jiang et al., 2011).

Thus, adolescent health psychology and public health activities intersect at both the individual and the population level. Readers are referred to the chapters in this book by Clements-Nolle (epidemiology), DiClemente (determinants of health-related behaviors), Leany (brain development), Dmitrieva (socioeconomical influences), and Coleman (processes of risk and resilience) for a more in-depth discussion of factors that must be appreciated to develop effective public health interventions with respect to adolescent health psychology.

A federal monograph on adolescent health services emphasizes that adolescent patterns of behavior determine young people’s health status both in the present and the future (National Research Council and Institute of Medicine, 2009a). Contemporary public health and social problems in America that either start or peak between 10 and 24 years of age include (1) homicide, especially among urban minority youth; (2) suicide, especially among suburban or rural youth; (3) motor vehicle crashes, including those caused by drinking and driving; (4) substance use and abuse; (5) smoking; (6) STIs, including human immunodeficiency virus (HIV), with the highest risk group being adolescent and young adult males who have sex with males; (7) teenage unplanned pregnancies; and (8) homelessness (Healthy, 2020a). Although these health threats are largely preventable, adolescents are in a developmental transition (no longer children but not yet adults) and sensitive to environmental influences (Mulye et al., 2009). As previously noted regarding the ecological nature of adolescent heath, disease, and illness, environmental factors, including family, peer group, school, neighborhood, policies, and societal cues, can either support or challenge young people’s health and well-being (National Research Council, 1993).

As documented throughout this book, adolescence is a critical life-course phase, with a variety of developmental tasks that must be successfully negotiated for an individual to transition to healthy adulthood (Kreipe, 2008). Also, many conditions linked to multiple environmental risks, as well as protective factors, covary with each other. Thus, adolescents who have good communication and connection with an adult are less likely to engage in risky behaviors (Resnick et al., 1997). Likewise, risky behavior is less likely in adolescents whose parents monitor their activities and provide safe opportunities for development (Aufseeser, Jekielek, & Brown, 2006). On the other hand, adolescents who live in poverty have poorer health and less access to health care (Larson & Halfon, 2010). With respect to school, academic skills are associated with higher rates of healthy behavior (Centers for Disease Control and Prevention, 2010b); high school graduation lowers the risk of health problems (Muennig & Woolf, 2007), incarceration, and financial instability (Sum, Khatiwada, & McLaughlin, 2009). Neighborhoods provide an important ecological context in adolescent health, with youth from areas with concentrated poverty being at particular risk for mental health problems, delinquency, and unhealthy sexual behaviors (Leventhal & Brooks-Gunn, 2004). An environmental factor of increasing concern, due to our lack of complete understanding regarding its potential for good or harm, is the media, with an increased risk of adolescents who are exposed to media violence, sexual content, smoking, and drinking alcohol engaging in them (Roberts, Henriksen, & Foehr, 2004).

There are numerous examples of public health interventions targeting adolescents with specific health problems, each with a slightly different approach.

Graduated Driver Licensing and Tobacco Reduction Programs: Legislative approaches such as state-graduated driver licensing programs are highly effective (D’Angelo, Halpern-Felsher, & Abraham, 2010), while those limiting the sale of tobacco products are probably not as effective as media campaigns, such as “Reality Check” or the “Truth Campaign,” to reduce youth tobacco use by emphasizing that the tobacco industry manipulates adolescents to become addicted to nicotine with devious marketing and advertising strategies (American Legacy Foundation, 2011). See also the chapter in this book by Brook, Pahl, Brook, and Brown (smoking).

Adolescent Pregnancy Prevention Programs: Despite an overall decrease in US teen pregnancy rates over the past two decades, the rates continue to far exceed those in other developed countries. In 2010, the federal government established the Office of Adolescent Health within the Department of Health and Human Services, which is funding a broad, long-term research effort related to evidence-based teen pregnancy prevention programs across the country. This initiative supports replication of extant evidence-based programs as well as the study of promising programs to establish a firm scientific foundation of evidence of effectiveness in the real world. A thorough scientific review of interventions with an evidence-base of effectiveness is available at the Office of Adolescent Health website devoted to this topic (Department of Health and Human Services, 2010). Also see the chapter by Aruda (pregnancy) in this book for more information.