Supporting Young Adults to Rise to the Challenge of COVID-19

To the Editors:

“If I get corona, I get corona. At the end of the day I'm not going to let it stop me from partying,” declared Brady Sluder, a college student celebrating spring break in Miami. My social media feed has exploded with chastisements of young adults who are ignoring public health advice advocating for social distancing. In particular, I hear these concerns from my retired parents and older neighbors, who worry that their own health will be sacrificed because of the recklessness of young adults. As a physician specializing in adolescent and young adult medicine, I believe that young people are actually in the best position to weather this period of distant socializing because of their fluency with technology as core to their social networking and engagement. However, some young adults may not be listening to public health advice because we are not effectively communicating in ways that resonate with them.

Although the legal age of adulthood in the United States is 18, brain and cognitive development continues from adolescence through the late 20s [1]. Young adults are still developing the ability to set long-term goals and delay gratification. While teenagers get a bad rap, young adults actually engage in more risk behaviors than teenagers. For instance, young adults have higher rates of substance use and sexually transmitted infections than adolescents [2]. Missing a much-anticipated spring break trip with friends may seem worse than catching a virus.

Laws and regulations due to COVID-19 challenge young adults' newfound independence and autonomy. Young adulthood is traditionally marked by less time spent with parents and more time spent with peers and romantic partners [3]. Owing to social distancing, young adults may be separated from their peers and romantic partners. College students have returned home unexpectedly, after a period of living independently in dorms, and thus feel that they have regressed. COVID-19 has cancelled young people's sports seasons, arts performances, and graduations.

Though young adults are generally assumed to be healthy, they have worse physical and mental health outcomes, attend fewer medical checkups, and are more likely to be uninsured than adolescents [2]. Initial reports of COVID-19 focused on its impact on the elderly; however, the Centers for Disease Control reports that 29% of cases in the United States are aged 20–44 years [4]. Young adults may be a key population to turn the tide of transmission. We should support them to adhere to new public health guidance to prevent the spread of COVID-19.

Principles that adolescent and young adult physicians use to foster healthful behavior changes in young people include the following:

• 1.Respect. Any communication or advice to young people should address their desire for status and respect, rather than threatening them [5]. For instance, rather than chastising young adults, consider asking how we can support them as we work together to adhere to these new rules. Acknowledge that social distancing rules may be challenging for everyone. Young adults may also respond to stories or posts from peers who share creative alternatives to cope with social distancing.
• 2.Motivation. Motivational interviewing is commonly used with young adults, particularly in dealing with addiction or mental illness [6]. This technique engages with the young person to explore their own motivations for change. In the setting of the COVID-19 pandemic, this could be a grandparent, family member, or friend who might become seriously ill if they were to contract the novel coronavirus. The young person is allowed to analyze the potential risks and benefits that are associated with their behaviors, thus supporting them to make their own informed choices [6].
• 3.Privacy. Give young adults some privacy while home. Physicians now caring for young people via telehealth face challenges with providing confidential services when family members are in close proximity. If possible, allowing a young person some private time at home to talk with friends or romantic partners may prevent them from having to physically leave the home to get private time. Parents might allow their young adults more leeway to keep in touch with their friends and peers virtually so they do not have to meet in person.
• 4.Strengths. Young adults have many strengths, and leveraging these may be a win-win for all involved. Young adults are experts at distant socializing through social media and virtual communications. For instance, they can help families to keep connected virtually and troubleshoot technical issues as families work from home. Young adults can also assist with essential groceries for their families and older neighbors. Similarly, undergraduate and medical students have organized fundraisers and drives for personal protective equipment collection to support local hospitals.

We should respect young adults and leverage their strengths rather than chastise them. By supporting them to rise to the challenge of COVID-19, we are also promoting their final stage of development into adulthood.

Mr. Sluder recently posted an apology on Instagram, writing, “I would like to sincerely apologize for the insensitive comment I made in regards to COVID-19 while on spring break.…Like many others, I have elderly people who I adore more than anything in the world and other family members who are at risk, and I understand how concerning this disease is for us all. Our generation may feel invincible, like I did when I commented, but we have a responsibility to listen and follow the recommendations in our communities.”