South Carolina Young Adults Count
A comprehensive report on the lives of South Carolinians ages 18 to 29
A comprehensive report on the lives of South Carolinians ages 18 to 29
Good health is critical for both general well-being and productive work performance. Persons with poor
health are restricted in a variety of adult roles - as spouses and parents, as employees, and as community contributors. Good health is shaped partly by genetic factors but also depends on responsible lifestyle behaviors, positive environmental conditions, and effective healthcare.
Too many young adults die in the prime of their lives. In 1997, 238 persons ages 15-19, 300 ages 20-24, 356 ages 25-29, and 488 ages 30-34 died in South Carolina. Over the age span of 18-29, roughly 1% of young adults die.
Causes of Deaths in 1997
| 15-19 | 20-24 | 25-29/B> | 30-34 | |
|---|---|---|---|---|
| Motor Vehicle Traffic Accidents | 44% | 32% | 28% | 18% |
| Other Accidents | 11% | 13% | 8% | 10% |
| Homicide and Legal Intervention | 13% | 16% | 12% | 12% |
| Suicide | 8% | 14% | 12% | 8% |
| Heart Disease | 5% | 4% | 5% | 8% |
| Cancer | 5% | 7% | 7% | 8% |
| HIV | 0% | 2% | 9% | 14% |
| All other | 15% | 13% | 19% | 22% |
| Total | 100% | 100% | 100% | 100% |
Source: Department of Health and Environmental Control, Division of Biostatistics.
During ages 15-34, 77% of male deaths but only 54% of female deaths were the result of potentially preventable and often behaviorally-driven causes such as motor vehicle accidents, homicide, suicide, other accidents, and HIV. The remaining deaths resulted from less preventable causes such as cancer, heart disease, and other health conditions.
Youth and young adults are often less experienced and less careful in avoiding and managing risks. As a result, many are injured, frequently unnecessarily. During 1997, hospitals in S.C. served 77,626 young adults ages 18–29 for injuries, either inpatient or in the emergency room. About 90% of these injuries were unintentional, while the remainder resulted from assaults and suicide attempts. One-quarter of injuries involved motor vehicles, one-sixth resulted from being struck by objects, one-tenth from falls, and one-tenth from being cut or pierced, usually unintentionally.
During young adulthood, most individual chronic conditions tend to be low in prevalence or not very severe in impact on the persons affected. However, when all chronic conditions are considered in total, significant numbers of young adults are seriously impacted by one or more severe conditions. Some of the more serious conditions harm few young adults but later grow in prevalence with age as the result of inadequate medical care, environmental factors, and lifestyle behaviors, which typically start in childhood and the young adult years. The most prevalent chronic conditions during ages 18–44 are (in rates per 100 persons): orthopedic impairments and deformities of back, shoulders, hips, legs, arms, and feet (16.2); chronic sinusitis (15.7); hay fever (12.1); migraines (5.7) and other non-tension headaches (5.8); high blood pressure (5.2); hearing impairments (5.1); arthritis (5.0); chronic bronchitis (4.5); and asthma (4.1). Of these, orthopedic impairments, arthritis, asthma, migraines, and high blood pressure are associated with activity restriction or bed disability.
Other chronic conditions that have serious effects on persons when they grow older are identifiable in only a small percentage of young adults, though they have critical origins early in life. These conditions include heart disease, cerebrovascular disease (stroke), emphysema, diabetes, and intervertebral disc disorders. They are mentioned in conjunction with young adulthood because health behaviors, environmental conditions, and timing of early healthcare can make a significant difference in the prevention or reduction of these diseases. Smoking plays a powerful role in stroke, emphysema, and diabetes. Diet and exercise affect all but emphysema. The prevalence of these disorders, in conditions per 100 persons ages 18-44, is 3.7 for heart disease, 0.1 for cerebrovascular disease, 0.1 for emphysema, 1.2 for diabetes, and 1.9 for disc disorders. In addition, cancer is a major cause of death and suffering in later years. Under 2% of persons develop cancer before age 40, but during the young adult years the causes of cancer develop increasing strength in terms of poor diet, smoking, chemicals, and other environmental factors. (See also Appendix A.)
It has been estimated that 12-20% of children and youth at some time experience emotional and behavioral disorders. In young adulthood the estimated occurrence of mental illness during ages 18-24 is one in six persons in any month. For adults generally, one-year prevalence has been found to be approximately 30%. Lifetime prevalence rates, the percentage of the population experiencing mental illness at some point across their lives, have been estimated from population surveys to be in the range of 44-48%. Prevalence of mental illness occurring any time during the course of the young adult years is lower but at least 20-25%.
In South Carolina, 10% of young adults responded to the Behavioral Risk Factor Surveillance System (BRFSS) that their emotional and mental health was not good for five or more days in the past month. The Epidemiologic Catchment Area (ECA) study found one year prevalence rates of 18-29 year olds in the United States at 1.2% for schizophrenia, 4.2% for major depression, 0.9% for mania, 9.9% for phobia, 0.8% for panic, 2.2% for obsessive compulsive disorder, and 2.3% for anti-social personality. The Comorbidity Survey found one year prevalence in all age groups to be lower at 0.3% for schizophrenia and other non-affective psychosis, but higher at 10.3% for major depressive episodes, 1.3% for manic episodes, 7.9% for social phobia, and 2.3% for panic disorder.
What matters most is serious mental illness requiring treatment to enable persons to function effectively in daily living, work, and personal relationships. The National Advisory Mental Health Council estimated that during a one year period 2.8% of persons over 18 have severe mental health disorders, including schizophrenia, manic depressive illness, major depression, panic disorder, and obsessive compulsive disorders. These estimates help to emphasize that relatively few young adults (perhaps 3%) are severely disabled by their mental illness during any particular year. In S.C. this would amount to roughly 20,000 young adults ages 18-29. The Comorbidity Survey found that in any year, 90% of severe disorders are occurring among the 14% of all persons who over their lifetimes experience three or more disorders. The principal investigator of the Comorbidity Survey, Ron Kessler, has emphasized that "the major burden of psychiatric disorder is concentrated in a group of highly comorbid people who constitute about one-sixth of the population."
Many types of impairments create the functional limitations and disabilities which can restrict work and daily living activities when necessary social and environmental supports are lacking. The prevalence of disabilities among 18-34 year olds is 10-13% for having any disability, but only 3-5% for severe disabilities. Furthermore, only 2-4% of 16-44 year olds are prevented from working by their disabilities. The primary conditions associated with inability to work and need for assistance with activities of daily living are asthma, mental retardation, mental disorders, heart disease, osteoarthrosis, disc disorders, and physical impairments of the back, neck, shoulder, and lower extremities. Less prevalent conditions causing serious work and daily living limitations are blindness, cerebral palsy, diabetes, multiple sclerosis, epilepsy, emphysema, arthritis, cancers, and hearing impairments. The prevalence of severe disabilities and inability to work is twice as high among African-Americans as among Whites.
Since young adults deliver the majority of births, their health behaviors and medical care during pregnancy are critically important. One percent of pregnancies that progress past the 20th week, or to at least 350 grams, terminate through fetal deaths in South Carolina. Another 1% of births end with infant mortality during the first year of life. Over 9% of babies are born with low birthweight (below 5.5 pounds), including almost 2% born with very low birthweight (below 3.3 pounds). Approximately 2-3% of babies are born with significant disabilities. The most prevalent birth defects affect the heart and circulation, muscles and skeleton, and genital and urinary tract. The more severe problems like spina bifida, Down syndrome, and fetal alcohol syndrome usually occur in only 0.1% of babies for each condition.
Other disabilities of speech, learning, retardation, and emotion are identified later in childhood or in adolescence. These developmental disabilities are the result of genetics, environmental factors such as chemicals, unintended and unwanted births, inappropriate maternal health behaviors, and maternal health problems including diabetes, hypertension, STDs, and anemia. Avoidable maternal behaviors that harm fetal development include substance use, smoking, stress, poor eating and nutritional habits, and extremes of weight and exercise, as well as failure to obtain adequate prenatal care.
Sexually Transmitted Disease rates in S.C. are among the highest in the nation. During the 1990s, under 1% of young adults annually contracted gonorrhea. In addition, 4% or more of 20-24 year olds are estimated to be infected with chlamydia, a bacterial infection which is often non-symptomatic and can cause pelvic inflammatory disease, infertility, and ectopic tubal pregnancy. The actual rate of chlamydia may be much higher, as indicated by the 15% of recruits from the South who were found at Fort Jackson to be infected. One in six Whites and two in six African-Americans ages 20-29 are estimated to have herpes. Human papillomavirus (HPV) may infect a hundred thousand or more young adults in S.C. HPV is linked to cervical cancer and genital warts. The high prevalence of viral STDs reflects both careless, multi-partner sexual activities of teens and young adults and the lack of possible treatment to keep viral STD cases from spreading and cumulating in prevalence.
Sex: Many young adults are engaging in sex with multiple partners, sometimes concurrently but often sequentially in a revolving door of romances. During the 1990s, 68-74% of 16 and 17 year olds and 76-84% of high school students age 18 or older said that they had already initiated sexual intercourse. Of high school seniors, 41% of males and 39% of females said that they had previously engaged in intercourse with 3 or more persons; 27% of males and 22% of females said they had had intercourse with 5 or more persons. In S.C. on the BRFSS, 8% of 18-29 year olds felt that they were at medium or high risk of HIV, but there is no data for the number with multiple partners. The National Health and Social Life Survey found that, among 18-24 year olds in the past year, 42% had a new sex partner, 30% had a partner for under two months, 21% had a one-time sex partner, and 11% had sex with a casual date or pickup. Single persons not cohabiting were far more likely to engage in higher risk sex with new partners and with short-term or one-time partners. The risk of infection with STDs increases rapidly as the number of sex partners increases.
Alcohol: Drinking is the most widespread form of risk-taking by young adults. In South Carolina among 18-24 year olds during any month, 48% drink and 20% binge drink. Each month 15-20% more males than females both drink and binge drink. Whites are much more likely to drink than African-Americans. Single persons are more likely to drink heavily than are married couples and much more likely than parents with children. Half of illegal drug users and one-quarter of cigarette smokers binge drink, as compared with only 10-12% of young adults who abstain from cigarettes and drugs. Binge drinking is a widespread recreational pursuit of carefree youth and young adults who participate in the "party culture". Others engage in solitary drinking because of depression or loneliness, or overindulge habitually with one or more drinking partners. Most eventually grow out of binge drinking and the party scene once the responsibilities of marriage, children, and work become dominant in their lives.
Unfortunately, recreational drinking evolves into alcoholism for almost a quarter of men and 5% of women at some point in their lives. At any point in time among young adults nationally, over 7% of White males, 4% of Black males, and 2% of women ages 18-29 are alcoholics, according to a major survey. Therefore, binge drinking leads to periods of alcoholism for as much as one in four males, many of whom go through episodes of recovery and renewed alcohol abuse.
Drug Use: Recreational drug use is also part of the party culture. By high school, many youth are drug users. According to the 1997 South Carolina Youth Risk Behavior Survey Report (YRBS), 37% of male and 24% of female 16 and 17 year olds in South Carolina used marijuana monthly. A different survey by DAODAS in 1995 showed that 24% of 12th graders had used drugs in the past month:
1995 Monthly Drug Use by 12th Graders in S.C.
| Total | White Male | White Female | African American & Other Male | African American & Other Female |
|---|---|---|---|---|
| 24% | 31% | 28% | 25% | 11% |
Source: S.C. Department of Alcohol and Other Drug Abuse Services.
The 1995 DAODAS survey reported monthly use among 10th and 12th graders respectively as: 20% for marijuana, 3% for hallucinogens, 4% for inhalants, 1% for heroin/opiates, and 1.6% for cocaine/crack. Comparable data for young adults in S.C. is not available, but the national Monitoring the Future Survey has shown a decline in monthly use from 24% of 18 year olds to 13% of 31–32 year olds. The same survey reports monthly use of any illegal drugs other than marijuana declining from 10% at age 18 to 4% at ages 31–32. Most drug users do not become dependent on or addicted to drugs. Based on national surveys, rough estimates of drug dependence among 18–29 year olds in S.C. would be 1% per month, 2–3% per year, and 8% or less during a lifetime.
Smoking: During ages 16 and 17, 41% of youth smoke monthly: 45% of boys and 38% of girls, according to the YRBS. The 1995 DAODAS survey showed 35% of 12th graders smoking each month:
1995 Monthly Smoking by 12th Graders in S.C.
| Total | White Male | White Female | African American & Other Male | African American & Other Female |
|---|---|---|---|---|
| 35% | 49% | 26% | 47% | 12% |
Source: S.C. Department of Alcohol and Other Drug Abuse Services.
A 1996 DAODAS adult survey found monthly smoking by 27% of 18-24 year olds, 22% of 25-34 year olds, and 31% of 35-44 year olds. The reduction in smokers from the high rates during the teen years is partly because of maturing judgment about the dangers of smoking and partly the reflection of a downward trend in smoking during the 1980s and early 1990s. The monthly smoking rates of 18-34 year olds were:
1995 Monthly Smoking by 18-34 Year Olds in S.C.
| Total | White Male | White Female | African American & Other Male | African American & Other Female | |
|---|---|---|---|---|---|
| 18-24 year olds | 27% | 33% | 25% | 31% | 17% |
| 25-34 year olds | 22% | 27% | 21% | 26% | 14% |
Source: S.C. Department of Alcohol and Other Drug Abuse Services.
Use rates decrease with education and income: from 45% of high school dropouts to 15% of college graduates and from 35% of persons with less than $10,000 income to 17% of persons with over $60,000.
Weight And Nutrition: Already during high school, youth are worried about their weight. Among 12th graders, 22% of boys and 34% of girls said that they were slightly or very overweight. Consequently 24% of boys and 55% of girls in their senior year were trying to lose weight, and 16% of boys and 38% of girls said they had actually dieted in the past month. Moreover, 5% said they had vomited or taken laxatives, and 8% used diet pills to lose weight. Many of these high school seniors had poor eating habits. During an average day 48% ate hamburgers and hot dogs, 63% french fries and potato chips, and 56% cookies, cake, pie, or doughnuts, while 20% ate salad, 47% vegetables, and 50% fruit.
The BRFSS found that only 24% of young adults in S.C. ate the recommended five fruits and vegetables daily. The National Health and Nutrition Examination Survey physically evaluated young adults and found one-fourth of 20–34 year olds to be overweight. On the BRFSS, 22% of 18–29 year olds in S.C. were overweight, based on their Body Mass Index calculating weight for height. The BRFSS showed that 28% of young adults were trying to lose weight: 20% of males and 35% of females.
Exercise: Among older youth in their final years of high school, many are physically active; however, substantial numbers are not. Girls are less likely than boys to engage in vigorous activity but are equally likely to participate in light exercise. In the 12th grade, 22% of both boys and girls walked or bicycled for 30 minutes or more during three or more days per week; and 35% of senior boys and 31% of senior girls did stretching exercises three or more times per week. However, three or more times per week 58% of boys, compared with 32% of girls, played sports or exercised hard for at least 20 minutes that made them sweat or breathe hard. Overall, roughly one-third of boys and almost two-thirds of girls in the 12th grade are rather inactive in exercise and sports. The BRFSS found that 54% of young adults in S.C. are relatively sedentary: 59% of Whites and 50% of African-Americans.
Violence: Fighting and other violence among boys tend to decrease during high school. While 50% of 9th grade boys reported being in a fight, this declines to 32% of seniors. For girls, fighting drops from 39% to 19% between the 9th and 12th grades. In any year of high school, 5–6% of boys and 2% of girls are injured in fights seriously enough to require treatment by a doctor or a nurse. Self-inflicted violence through actual suicide attempts is reported by 6–9% of high school boys and, among girls, by 18% in the 9th grade, declining to 7% in the 12th grade. These suicide attempts result in 3% of boys and 4% of girls requiring medical attention, with the rate increasing with age for boys and decreasing for girls. Youth also carry weapons: 37% of boys and 12% of girls monthly in grades 9–12 carried a weapon; 17% of high school boys said they carried a gun in any month but only 2–3% of girls. Comparable data is not available for young adults.
Healthcare Utilization: Use of health services by young adults is restrained primarily by the good health of the majority of these younger persons but also by their lack of health insurance and limited relationships with health providers. In 1994–95, 21% of young adults in S.C. ages 19 to 34 and probably 25–30% in their early twenties had no health insurance, a rate higher than for any other age group.
Unfortunately, many young adults do suffer from diseases, chronic conditions, and disabilities that require medical attention. In South Carolina, 86% of 18–29 year olds say that they have had a checkup in the last two years, but there is no data about their overall utilization of ambulatory care. Data from the National Health Interview Survey has shown that persons ages 15–44 average 5 physician contacts per year: 3.7 for men and 6.2 for women. The additional visits by women are primarily for reproductive and prenatal healthcare. Men with good to excellent health average 3 visits, while those in fair to poor health average 12 to 15. Women in good to excellent health average 5 to 6 visits, while women in fair to poor health average 15, except for higher income women in fair to poor health, who average 23 visits. Among young adults 18–29 years old in S.C., it is the 8% who say their health is generally fair or poor who have the greatest need for healthcare.
During 1997, hospitals served 1.4 male admissions and 7.3 female admissions per 100 persons ages 18–29 in S.C. Pregnancy and childbirth are responsible for the gender difference in hospital visits and account for the predominant share (64%) of inpatient hospitalizations of young adults. Roughly 2.8% of young adults are hospitalized annually for reasons other than pregnancy and childbirth. The other major causes are digestive (intestinal bleeding, food poisoning, dysentery), musculoskeletal (back, leg, ankle, neck, knee injuries), mental illness, respiratory (pneumonia, bronchitis), female reproductive (uterine infections and surgery, often caused by STDs), kidney (stones and infections), and nervous system (seizures, headaches, head injury) diseases and disorders.