Youth who receive special education services under the Individuals with Disabilities Education Act (IDEA 2004) and especially young adults of transition age, should be involved in planning for life after high school as early as possible and no later than age 16. Transition services should stem from the individual youth’s needs and strengths, ensuring that planning takes into account his or her interests, preferences, and desires for the future.
TAG for Professionals
You can make a difference by taking action to improve adolescent health! Learn more about the recommended action steps and find resources for your professional sector, and then get others to join Adolescent Health: Think, Act, Grow® (TAG) by using the TAG Toolkit (PDF, 31 pages).
Out-of-School Time and Community Program Leaders
Leaders from out-of-school and community programs have identified several potential roles and responsibilities for professionals who wish to support adolescent health and development.
Making a Difference: Out-of-School Time and Community Program Leaders
Out-of-school, summertime, and community programs support multiple aspects of adolescent health and healthy development, including physical health, cognitive development, and socio-emotional health.
Professionals from these groups are encouraged to take action on one or more of the roles and responsibilities identified below that can promote adolescent health.
Benefits of afterschool, summertime, or community programs:
- During afterschool activities, children develop social skills, improve academic performance, and establish strong relationships with adults.1
- Participation in club activities is linked to higher academic performance and self-esteem,2 and participation in sports is linked to higher social competence.2,3,4
- Sports participation is also linked with better health and lower likelihood of obesity.5,6
- Afterschool and community programs provide adolescents with safe, enriching environments to grow and develop skills outside of school and can provide them with a sense of accomplishment.
- They can also provide a safe space for adolescents to congregate.
- Peer-to-peer relationships formed in these out-of-school time settings are as critical to adolescents’ overall health and well-being as the presence of supportive adults and information and resources.
Action Steps and Resources for Out-of-School Time and Community Program Leaders
Help youth connect to supportive adults, positive peers, schools, and the community
Encourage youth to connect with supportive adults such as program leaders, coaches, tutors, or mentors, as well as peers who can also be mentors. Serve as a role model in your actions, behaviors, and speech. Be a resource to adolescents themselves and in other ways, like providing access to space, equipment, or resources to support activities. Arrange opportunities for young people to get involved in the community, such as with older citizens in retirement centers or as volunteers for community projects.
Create a safe, warm, and enriching space
Provide a safe environment, a "safe haven," to engage adolescents in enriching activities and the formation of healthy relationships with one another. Create stability, consistency, and a sense of safety for adolescents through well-trained staff, age-appropriate programs, and safe and secure settings. Teach about healthy relationships and encourage a sense of community among your participants. Support skill-building activities to contribute to adolescents’ overall sense of competence and future accomplishments. Offer unstructured time where adolescents can just be.
Encourage physical activity and good nutrition
Plan group activities that include physical exercise (like hikes, bike rides, and competitive sports) and non-competitive play (like aerobic, muscle and bone-strengthening, and cardio-respiratory fitness activities). Establish policies to encourage healthy snacks or meals (as appropriate or needed) and distribute tips for healthy eating.
Be another set of eyes and provide a listening ear
Keep a lookout for how adolescents are doing in terms of their health and healthy development. But also, be a listening ear. Let adolescents talk things through and then help them think about what they should do or say, or guide them to resources that can help.
Share local resources with youth
Identify health resources in your community and share them with the adolescents in your programs and activities. Encourage and highlight the importance of regular medical and dental care and vaccinations, and make sure teens know about help lines. Provide individual or group learning sessions on health topics. Refer adolescents to programs or services beyond the scope of your activities (for example, mental health professionals or social service providers).
Teach youth about staying healthy and safe
Offer special sessions about health and healthy development. For example, bring in speakers on online safety, texting, suicide prevention, healthy relationships (with peers, adults, and mentors), and gender-specific workshops since adolescent males and females are often working through different issues.
Education professionals or volunteers from local, state, and national organizations are encouraged to take action on one or more of the roles and responsibilities identified below that can promote adolescent health and healthy development.
Making a Difference: Education Professionals
By tradition and design, schools are intended to facilitate children’s academic development. However, the links between health and academic achievement are well established. Schools also address other developmental needs such as students’ social, emotional, and health needs. There are a number of ways that schools support adolescent health, though this varies greatly across schools, cities and towns, and states.
- Currently, most school systems offer adolescents health education classes.
- In most schools, adolescents can participate in physical activities, including physical education.
- Many schools have a school nurse and a counselor.
- Health training requirements for school teachers, nurses, and other staff also vary widely from school to school within and across states.
- Many schools provide food at reduced or no cost to students who qualify through school meal programs. For some children, this is their primary place for nourishment.
- Some schools sponsor healthy eating initiatives.
- Finally, the physical environment and layout of the school can greatly affect adolescents' health (for example, the presence of environmental toxins in a school, proper ventilation for fresh air, or whether the school has areas for physical activity).
Action Steps and Resources for Education Professionals
Create a supportive and safe school climate
Develop an inclusive, caring, secure, and welcoming climate for adolescents and their families. Make certain that every student, regardless of race, ethnicity, gender, disability, or sexual orientation, feels safe and is supported. Provide adolescents with opportunities to participate in school leadership and honor youth voices and opinions. Foster a positive physical and psycho-social atmosphere and incorporate it into discipline and classroom management policies. Ensure that all school staff members have information about community health resources and student referral procedures, as well as legal reporting responsibilities and confidentiality laws, regulations, and policies.
Strengthen or increase health curricula and activities that support healthy development
Build students’ knowledge, skills, and positive approaches toward health and infuse positive, healthy development into all aspects of the curriculum. Include lessons that teach the benefits of avoiding risky health behaviors and fostering lifelong healthy habits. Teach problem-solving, critical thinking, communication, and collaboration. Offer courses in music, visual and performing arts, technology, foreign languages, and other subjects that can build healthy connections between students and their school. Offer physical exercise activities during and after school that can be enjoyed into adulthood and create partnerships with community-based nonprofits and volunteer groups to support them. Provide healthy options in school meal programs and vending machines.7
Support social and emotional development
Provide all school staff with training on the rapid and profound social and emotional development of adolescents. Teach students how to develop and maintain healthy relationships with both peers and adults, which will help minimize bullying and other harmful interactions. Establish procedures that encourage safe reports of bullying and ensure policies are in place to handle these issues. Teach conflict-resolution and anger management skills, which help mitigate behavioral challenges and manage classrooms in positive ways.8
Be a resource on health to students and their families
Inform students of health resources available through the school. Encourage parent involvement and promote regular communication between school and home. Share information with families through newsletters, emails, school websites, and parent meetings on topics such as developmental milestones for adolescents, how to encourage healthy behaviors, and how to help their children avoid risky behaviors.
Implement annual health and safety assessments and coordinate with community efforts
Conduct annual assessments to identify strengths and weaknesses of health and safety policies. Develop an improvement plan and collaborate with teachers, parents, students, public health agencies, and the community to promote health-enhancing behaviors that mitigate risk and maximize protective factors.9
Ensure schools are environmentally healthy settings for learning
Regularly monitor the school’s environmental health to ensure it is free from toxins and other potential hazards, that it is clean, and that the building and classrooms are safe and in good repair. Provide clean and safe water for drinking and washing, minimize unnecessary noise, and be certain indoor and outdoor areas are well-lit. Test air quality for carbon dioxide and dampness and use green cleaning products.10
Use open spaces to promote physical activity
In addition to PE classes, utilize gyms and outdoor spaces such as fields, tracks, and paved areas to encourage physical activity, especially during breaks, lunchtime, and before or after school. Mark paved areas to encourage a variety of games, provide outdoor basketball hoops, and erect appropriate playground structures (especially for younger adolescents). Support community organizations in using the facilities for youth and family programs during evenings, weekends, and school breaks.
Leaders from faith-based organizations are encouraged to take action on one or more of the roles and responsibilities identified below that can promote adolescent health.
Making a Difference: Faith-based Leaders
Many adults in faith-based organizations are already supporting the health and healthy development of adolescents, including their spiritual development, either directly in their community, or through service and outreach beyond the place of worship. Many offer a range of services to youth and families regardless of religious beliefs.
In addition to activities and services that are religious in nature, many faith-based organizations provide social and healthcare to people regardless of denomination and direct services to youth and families.
Action Steps and Resources for Faith-based Leaders
Connect adolescents to adults
Provide adolescents with opportunities to meet and connect with members of the community, such as religious leaders, older adults, or peer leaders who can serve as role models or mentors. Offer activities, whether in worship, community service, outreach, music, or other programs, to help them connect with adults in the community and find role models or mentors.
Provide opportunities for adolescents to connect with peers in a safe environment
Help adolescents establish a network of friendships that can be relied upon in moments of crisis by providing opportunities for them to connect with peers through regular meetings, shared activities, and social media. Offer safe spaces for adolescents to gather, and share your space with out-of-school time programs and other activities.
Provide service opportunities
Help youth grow in compassion and develop a sense of community responsibility to ease others’ suffering by providing opportunities for youth to serve others.
Support the role of families in healthy adolescent development
Share ideas for strengthening families. Consider encouraging families to create special customs, such as weekly family nights. Provide seasonal events for families to attend, and/or family mission or service opportunities.
Connect young people to health information and resources
Identify and share existing community resources with young people. Offer programs on various aspects of adolescent health, such as physical activity, nutrition, new media use, or preventive healthcare. Provide brochures or host special presentations from local health clinics. Share health-related messages by Twitter, Facebook, or texts.
Encourage healthy habits
Offer some activities that have a physical exercise component. Engage youth in making the community “greener” and healthier. Provide healthy food choices at fellowship times.
Support adolescents’ spiritual growth
Convey beliefs and values, recognize milestones through religious rites, and help adolescents connect within their religious community and to the larger world around them.
Offer youth services or refer youth and their families to meet immediate needs
As appropriate, offer direct services to youth and their families, such as healthcare, mental health, foster care, refugee resettlement support, and education. Make referrals to community resources to help adolescents and their families meet pressing needs for food, shelter, mental health or other health, and social supports.
Facilitate opportunities for youth skills training, internships, and employment
Provide leadership opportunities and training courses to build adolescents’ skills. Facilitate internships or entry-level jobs. Offer employment opportunities directly or reach out to businesses.
Healthcare professionals are on the front line of improving adolescent health and development. See below for additional ways to promote adolescent health.
Making a Difference: Healthcare Professionals
The majority of American children enter adolescence and continue through in good health, but adolescents benefit from healthcare tailored to this unique developmental period. Healthcare professionals are encouraged to adopt one or more of the roles below to enhance the delivery of healthcare services to adolescents.
- Preventive healthcare services during adolescence can help protect them into adulthood. Unfortunately, less than half of all children and adolescents receive the recommended number of preventive care visits and many do not receive all the screening and counseling services and immunizations recommended for adolescents.11
- Positive health behaviors, such as exercising regularly and eating nutritious meals, are often established during this period as well.
- The recent trend to establish patient-centered medical homes shows some promise for improving overall quality of patient health and producing better experiences.12 This should be tested with adolescents.
Action Steps and Resources for Healthcare Professionals
Make healthcare offices friendly and welcoming
Consider adolescents when selecting décor, furniture, and reading materials. Provide take-home information in smaller formats that can be tucked in wallets or purses discreetly, and offer information in private settings. Set office hours to accommodate busy school schedules. Bring services to schools whenever feasible. Train all staff, including clerical and paraprofessionals, in how to welcome and interact with adolescents.
Ask hard questions and use risk screening tools
Ask adolescents about sensitive topics, such as weight, sexual orientation or behavior, mental health, behavioral risks, and violence or victimization. Use risk screening tools. Integrate tools and confidentiality policies into healthcare practices to improve patient care. Establish practice-wide policies to create time alone with teenage patients, and inform parents in writing and on your website that this is your routine practice.
Make preventive services a priority
Ensure adolescents receive recommended clinical preventive services, including immunizations, screening, and counseling about behaviors that will support their health.
Maintain referral sources for youth with chronic conditions, special needs, and behavioral health issues
Know who in your community can help with mental health, substance use, eating disorders, and other challenges. Make referrals to available services in the community and establish and implement follow-up procedures to see if the patient obtained the services and how he or she is doing.
Improve and update training on adolescent health
Use this training to reflect the latest knowledge on adolescent development, risks and protective factors, and confidentiality laws. Ensure that staff receives training and incorporates this knowledge into practice.
Facilitate smooth transitions from adolescent to adult healthcare settings
Assist adolescent patients with transitions and ensure continuity and quality of care. If an adolescent with special needs or a chronic condition is transitioning to a different healthcare setting, make referrals to providers who can meet those needs. Encourage youth and parents to plan for medical coverage during the transition to adulthood.
Be a leader in building partnerships in the community with others who serve youth
Promote adolescent health by taking a lead role in coordinating care across systems, including health, education, social services, and other community partners. Identify and engage unlikely allies and organizations such as older adults and retiree groups to partner with to improve adolescent health. Get involved in community efforts related to adolescent health such as facilitating greater access to health and sex education information, programs that strengthen families and build youth skills, and school health centers.
Public Health Professionals
Public health professionals are encouraged to take action on one of the roles identified below to further improve adolescent health in our communities.
Making a Difference: Public Health Professionals
State and local public health agencies play a central role in laying a strong foundation for healthy lifestyles. Disease prevention and health promotion for adolescents should begin with a focus on healthy development.
In general, public health activities involve preventing disease, promoting wellness, and monitoring disease prevalence at the local, state, and national levels. Public health agencies are a trusted voice in the face of epidemics, food outbreaks, and disasters. Increased prioritization and leadership by public health officials on adolescent health and preventive services has the potential for significant impact. One of the great contributions of public health programs is their ability to address racial/ethnic health disparities and tackle service delivery challenges, especially for vulnerable populations. Public health programs often provide services of “last resort,” which are crucial in overcoming barriers to care in underserved populations and addressing unmet needs.
Public health professionals conduct a range of activities to improve the health of children and adolescents, including:
- Providing vaccination programs for school-age children to prevent the spread of disease
- Launching education campaigns to decrease smoking and other behaviors with long-term adverse health consequences
- Supporting healthy school nutrition programs and other activities that promote healthy lifestyles
Action Steps and Resources for Public Health Professionals
Provide leadership for developing community-wide approaches to promoting adolescent health
Partner with community organizations, schools, faith-based organizations, businesses, healthcare providers, local foundations, parents, grandparents, and teens to identify priorities for advancing adolescent health in the community, such as holding activities in parks and creating safe spaces for adolescents to gather and hang out. Leverage grant-making opportunities, training, and cross-sector programming to raise awareness across settings and increase attention to improving adolescent health.
Conduct or provide data for community health assessments
Use assessments to identify and describe adolescent health needs, including measuring and tracking adolescent health outcomes. Assessments of local needs may have been completed in response to grant requirements, community-based initiatives, or by tax-exempt hospitals. Make sure adolescent health needs are included when assessments are conducted or updated. Use and refer to state and local health departments, which routinely collect and maintain data and have benchmarks for adolescent health trends. Utilize national objectives, such as Healthy People 2020,13 and data on adolescent health that are readily available to inform local assessments and plans.
Focus on risk-reduction activities for adolescents
Risk-reduction activities include approaches for smoking cessation, addressing substance abuse, mitigating sexual risks, treating mental health problems, identifying diabetes precursors, and reducing obesity. Ensure adolescents, parents, and those working with adolescents understand risky behaviors and the benefits of early and brief interventions. Identify resources that can help reduce risky behaviors, and refer as appropriate. Use evidence-based approaches when available and evaluate innovations to help grow the evidence base.
Train staff on working with adolescents using the latest knowledge about what is effective
Provide training on cultural competency, trauma-informed care, working with vulnerable populations, positive youth development, and what’s appropriate for younger versus older adolescents. Encourage staff and others working with adolescents to use positive youth development strategies that support adolescents in their day-to-day lives. Specifically consider the needs of vulnerable adolescent populations, such as those living in poverty, who are homeless, or who are LGBT.
Promote a positive, strengths-based view of adolescents
Participate in public awareness campaigns. Join ongoing community efforts to encourage and support better adolescent health outcomes. Look for ways to promote adolescent successes to foster more positive views of adolescents in society.
Help young people take responsibility for their own health and promoting healthy communities
Encourage and teach older adolescents how to navigate the healthcare system. Involve adolescents of all ages in creating and monitoring community programs and activities for adolescents. Support youth engagement and leadership development, which have the potential for creating career pathways into health. Work with youth to ensure that strategies and services meet their needs and are youth-friendly. Pilot ideas and campaigns intended for youth with youth themselves to make sure the materials and concepts resonate.
Social Services Professionals
Social service professionals are encouraged to take action on one or more of these roles below.
Making a Difference: Social Services Professionals
Each year, our nation’s social service networks provide assistance to millions of adolescents and their families, including at-risk youth, such as those living in poverty, from racial or ethnic minorities, who are homeless, who are living in foster care, or who are interacting with the juvenile justice system. Social service professionals are encouraged to take action on one or more of the roles below to further improve the health and healthy development of adolescents with whom they work.
Some youth in the United States live in communities and with families well-equipped to provide for their health and healthy development; however, some youth live in less supportive environments. Public and private agencies help sustain the health, safety, and healthy development of adolescents through a wide range of services, including:
- Physical and mental healthcare
- Food and nutrition assistance
Some programs assist adolescents in low-income families with meeting basic needs. Others help adolescents and their families during circumstances involving abuse and neglect, youth violence, or public safety issues.
At-risk adolescents may interact with social services through a number of different entry points. For example, they may receive services from a public agency, such as the child welfare or juvenile justice systems, or they may get assistance from community programs or religious institutions delivering social services. The range of professionals and volunteers providing services and supports to at-risk youth come from multiple disciplines, including social work, counseling, healthcare, law, and law enforcement.
Action Steps and Resources for Social Services Professionals
Encourage positive connections between youth and supportive adults
Help youth reach out to adults who can serve as mentors or informal counselors, such as teachers, coaches, religious leaders, relatives, family friends, or older adults in the community. Foster the development of healthy relationships with peers, adults, and mentors. Make referrals to mentoring programs. Encourage youth to participate in extracurricular activities. Support educational and work opportunities for young people.
Ensure services and programs are welcoming and developmentally appropriate
Make sure services and programs are welcoming to adolescents, including youth with disabilities and chronic health conditions. Use a youth-friendly approach that recognizes that teens’ need for guidance can be at odds with their growing desire for independence and autonomy.
Encourage adolescents to learn about their health and to connect with trusted healthcare professionals, including mental health providers
As appropriate for their age, provide adolescents with information to help them begin to manage their medical and dental care and prepare for the transition to adult services. Teach them how to advocate for themselves. Point to resources that will help them navigate the healthcare system, including many new online resources and teen-friendly apps that help youth manage their own care, especially relating to chronic health conditions, disabilities, or mental health needs. Ensure youth are fully assessed for their needs and referred to those who can help. Also, establish follow-up procedures to see whether the youth obtained the services and how he or she is doing.
Provide opportunities for youth to offer input and build leadership skills into program design and activities
Involve adolescents in designing and reviewing program materials to confirm that language and materials work. Establish a youth advisory panel to solicit input on policies or programs. Encourage older youth to be mentors to younger adolescents. Reach out to youth who may not participate without encouragement.
Join with others in your community to improve and coordinate service delivery
Work with providers, health professionals, education and community leaders, and others to coordinate the provision of services to adolescents, particularly for those involved in multiple systems of care, such as child welfare, juvenile justice, and behavioral health. When possible, try to deliver services in places where young people already spend time, such as schools, malls, home, afterschool or summer programs, or in faith-based organizations. Catalog existing services and programs in the community and address gaps by expanding the reach of current programs or assisting in implementing new ones.
Stay abreast of the latest research and implement best practices
Contact national resource and technical assistance centers for information and training. Learn about the latest research and best practices, and train staff to provide developmentally appropriate services. Implement multi-pronged strategies to support youth in overcoming trauma and challenges. Drop programs that research has shown do not work.
Workforce Development Professionals
Professionals who help prepare and train youth for the workforce, and those that employ them, can play a key role in promoting adolescent health today and facilitating young people’s transition to adulthood as healthy, productive employees.
Making a Difference: Workforce Development Professionals
Work can be an important part of healthy adolescence and yield multiple benefits for youth and society in general.
In addition to economic benefits and job-related skills, work experiences provide teens with opportunities to engage in key developmental tasks, such as decision-making, building social skills, and taking on new levels of responsibility. Working during high school has benefits now and into the future; it’s associated with lower likelihood of dropping out of school, higher employment rates, and better wages in adulthood.
Professionals who employ or prepare and train youth for the workforce are not only helping young people now with additional income and job skills; they are also improving their employment and career prospects in the future. This has positive implications for individual youth, families, and society at large.
These professionals are encouraged to adopt one or more of the roles below to enhance efforts to promote adolescent health.
Action Steps and Resources for Workforce Development Professionals
Incorporate positive youth development into professional development training
Promote staff development that fosters holistic, strengths-based approaches to serving youth. Use training curricula and approaches that help adult professionals understand adolescent development and identify opportunities to foster resilience and promote healthy development. An increased awareness of the unique stages of adolescent development will help staff better facilitate learning opportunities, promote meaningful youth engagement, and effectively teach the skills youth need to succeed in work, including academic, social-emotional, and practical life skills.
Identify services to meet the unique needs of opportunity youth
Educate local workforce boards about the unique needs and barriers to work for opportunity youth, especially youth who are homeless, parenting, low-income, LGBTQ, disabled, in foster care, or no longer in school. Support community-based organizations in providing housing, health care, trauma-informed services, and other assistance to these youth. Obtain input from teens on how to improve services and supports to be more teen-friendly and effective. When possible, bring the services to young people instead of asking them to come to you to get what they need.
Work with vocational rehabilitation partners
Strengthen pre-employment transition services for youth with disabilities. Assist educators with incorporating health and employment planning into Individualized Evaluation Plan (IEP) meetings for high school students with disabilities. Provide information about support services and job training opportunities to school districts so they can help all students, including students with IEPs, plan for their lives after graduation.
Facilitate mentoring opportunities
Connect young people to quality mentoring programs that acknowledge the individual differences among adolescents, including socio-economic status, race, gender, sexual orientation, and disability. Supportive, healthy relationships are critically important to positive youth development.
Identify and improve transportation options
Work with community partners to let local officials know how important transportation is to young people’s success at work. Encourage local governments to improve transportation options and urge employers to consider subsidizing transportation for young workers after school so students can get to their part-time jobs safely and on time.
Promote financial literacy for youth and their families
Support local organizations, including high schools and community colleges, that provide financial literacy training. Teach youth about financial literacy, which includes help with setting up a bank account, interpreting a pay stub, creating and staying on a budget, and understanding credit and debit cards. Partner with local banks and make sure youth know how to bank their earnings and understand interest. Help youth understand credit reports and how to build their credit.
Engage employers in the community
Speak to employers about the many benefits of youth employment. Engage youth in outreach to employers to communicate how much they want to be employed. Share examples of employers that offer on-site and other supports that help youth be successful at work, such as transportation, child care, and health services. Encourage local workforce boards to create youth councils so young people can participate in a meaningful way.
1 Gartland, D., Bond, L., Olsson, C.A., Buzwell, S., & Sawyer, S.M. (2011). Development of a multi-dimensional measure of resilience in adolescents: The Adolescent Resilience Questionnaire. BMC Medical Research Methodology, 11. Retrieved from http://www.biomedcentral.com/1471-2288/11/134/
2 Fletcher, A.C., Nickerson, P., & Wright, K.L. (2003). Structured leisure activities in middle childhood: Links to well-being. Journal of Community Psychology, 31(6), 641-659.
3 Schaefer, D.R., Simpkins, S.D., Vest, A.E., & Price, C.D. (2011). The contribution of extracurricular activities to adolescent friendships: New insights through social network analysis. Developmental Psychology, 47(4), 1141-1152. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134619/pdf/nihms-294155.pdf (PDF, 22 pages)
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9 Centers for Disease Control and Prevention. (2012). School Health Index: A Self-Assessment and Planning Guide 2014. Middle school/high school version. Atlanta, Georgia: Author. Retrieved from https://www.cdc.gov/healthyschools/shi/pdf/middle-high-total-2014.pdf (PDF, 200 pages)
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12 Peikes, D., Zutshi, A., Genevro, J., Smith, K., Parchman, M., & Meyers, D. (2012). Final report: Early evidence on the patient-centered medical home. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from https://pcmh.ahrq.gov/sites/default/files/attachments/Early%20Evidence%20on%20the%20PCMH%202%2028%2012.pdf (PDF, 50 pages).
13 Healthy People 2020. Adolescent health. Washington, DC: U.S. Department of Health and Human Services. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/Adolescent-Health
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