Table 1.

Adolescent and Young Adult Programmatic Suggestions for Coronavirus Disease 2019 Prevention and Control

Theme	Adolescent and Young Adult-specific Consideration	Programmatic Suggestion
Adolescence and young adulthood as a distinct developmental period	While evidence shows AYA acquire and transmit SARS-CoV-2, AYA have not been prioritized as a key population in the COVID-19 response.	Consideration of factors unique to AYA in the design, communication, and implementation of COVID-19 control measures is warranted.
	Adolescence and young adulthood is a distinct period of neurobiological development in which changing connectivity between brain regions results in the prioritization of short-term social and emotional reward (eg, group interactions, normative life events), rather than the long-term health consequences of potential COVID-19 infection [S1].	Public health programs and messaging can emphasize the short-term socioemotional benefits of adopting COVID-19 measures for AYA (eg, face masks as a style accessory, social distancing as an opportunity to spend time with one’s family) and the collective nature of the COVID-19 response (eg, “We—AYA, peers, parents, other important influencers in AYA’s lives—are all in this together”).
	COVID-19–related research is primarily focused on adults and vulnerable populations, with limited attention placed on early, middle, late adolescence and young adulthood.	Surveillance and research studies that disaggregate data by age, as well as focus on AYA social, immune, endocrine, epigenetic, and clinical factors that may sustain COVID-19 outbreaks are needed.
Public health messaging	Incomplete uptake of COVID-19 protective behaviors among AYA has been depicted as irresponsible in the media and in public health messaging.	Punitive messaging is counterproductive and does not adequately recognize the conflict of normative AYA identity development and social distancing measures.
	Primary caregivers (ie, parents) are an important influence on adolescent and young adult health behavior [S2, S3].	An emphasis on specific guidance for primary caregivers regarding COVID-19 communication and monitoring can address gaps in extant public health communication designed to shape AYA behavior.
	Public health messaging for AYA is primarily generic and has not provided specific guidance on how AYA can prevent transmission in their day-to- day lives.	Provide specific guidance regarding adolescent and young adult self-monitoring of symptoms, household behaviors (ie, shared bathroom use), and similar actions.
Preventing school/ university transmission	The contribution of regular, in-person school/university education to accelerating and sustaining population-level outbreaks of COVID-19 is insufficiently understood.	Clear, evidence-based, and stakeholder-informed prevalence thresholds and plans for stepwise openings and closures should be developed and communicated by schools and universities [S4].
	Evidence-based best practices for a safe return to in-person instruction are needed.	Evaluation and optimization of recommended mitigation measures in schools/universities are needed (ie, situate students at least 6 feet apart, reduce class sizes, minimize mixing between student class groups, assign permanent seating, use of outdoor spaces for classroom-related activities) [S5, S6].
	Mobility patterns such as cross-country travel of out-of-state university students may reinvigorate SARS-CoV-2 transmission in communities with controlled local epidemics.	Robust quarantine strategies for traveling students represent an essential piece of university COVID-19 mitigation plans. Attendance of in-state universities may reduce travel-related spread of COVID-19.
COVID-19 testing	Adolescence and young adulthood is a period of optimal health in which AYA infected with SARS-CoV-2 may be more likely to experience mild, no, or atypical symptoms, making timely identification and isolation of AYA with COVID-19 a challenge.	High-volume, high-frequency, and symptom-unspecific testing in at-risk AYA populations (eg, schools, universities) can reduce reproductive rates and account for the asymptomatic transmission potential among AYA [S7, S8].
	Frequent and widespread testing of asymptomatic AYA, for example, in school or university settings, may be cost-prohibitive and take up laboratory capacity.	Batch testing is scalable, cost-effective, and should be considered for school/university testing initiatives [S9, S10].
	School and university testing may exclude vulnerable AYA who are often disconnected from educational institutions (eg, criminal justice-involved youth, pregnant or parenting youth, sexual/gender minority youth, youth with mental health issues).	Once available, point-of-care COVID-19 testing should be offered routinely in youth-serving health and social service organizations, particularly in vulnerable communities most heavily affected by COVID-19 [S11, S12].
Preventing family/ household transmission	AYA are more likely than older individuals to co-reside with others (eg, family members, roommates), increasing the risk of household transmission [S13].	Evidence-based and specific guidance to minimize transmission within households and among families, particularly from AYA to parents and other family members, is needed.
	There is limited guidance that addresses the needs of AYA residing in households within low socioeconomic status communities.	Community-involved initiatives to develop culturally appropriate, feasible, effective, and replicable COVID-19 mitigation strategies within socially and economically vulnerable households are warranted [S14–S16].
Vaccines and novel prevention and treatment methods	AYA are a key population for efforts to promote uptake of COVID-19 prevention methods that are currently under development, including vaccines, particularly given that vaccination rates among AYA remain low and have decreased during the COVID-19 pandemic [S17, S18].	AYA participation in ongoing and future COVID-19 trials for vaccines, hyperimmune globulin and convalescent plasma therapy, pre-exposure and post-exposure prophylaxis is important. Behavioral interventions to promote the uptake of a novel COVID-19 vaccine as well as available influenza vaccines need to account for the unique needs of AYA.
	The implications of SARS-CoV-2 infection for vulnerable AYA populations is insufficiently understood.	Vulnerable adolescent and young adult populations that warrant special attention in the development and evaluation of COVID-19 vaccines and novel prevention and treatment modalities include ethnic/racial minority AYA, pregnant youth, young substance users, and immunocompromised youth [S11, S19].
Long-term developmental and socioeconomic consequences	Social distancing recommendations are in conflict with normative AYA social development, contributing to increasing mental health problems among AYA.	To optimize adolescent and young adult social interactions, parents can be encouraged to spend additional time with their adolescent or young adult. Additionally, the seamless continuation of AYA behavioral health service delivery, remote or in person, is essential [S21, S21].
	COVID-19 control measures have disrupted AYA educational trajectories, thereby impacting long-term life trajectories and reducing life opportunities, particularly for socially vulnerable AYA.	Practical strategies to avoid adolescent and young adult disengagement in remote schooling, address technology/language barriers to online schooling, and ensure adequate learning environments at home are warranted.
	In the current recessionary economic climate, opportunities for AYA to enter the workforce are limited.	In the contemplated rollout of workforce-intensive COVID-19 mitigation initiatives, such as contact tracing, community-based testing, and public health messaging, AYA training and professional development programs for key positions such as community health workers, contact tracers, should be considered.
	COVID-19 prevention represents only 1 of many AYA health priorities that are shaping long-term adult health and well-being (eg, sexual and reproductive health, mental health)	Universal access to youth-friendly COVID-19, primary and specialty healthcare, and auxiliary services is imperative for reducing long-standing health disparities in the United States. Existing non-COVID-19 specialty services for AYA represent an opportunity for integration of COVID-19 mitigation strategies.

References cited within this table are provided in the Supplementary Material.

Abbreviations: AYA, adolescents and young adults; COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.