Advancing Public Health and Equity through Prevention and Reengagement of Disconnected (Opportunity) Youth

Abstract
APHA has a long-standing commitment to promoting positive youth development and health equity. Building on APHA’s support for these goals, this policy statement proposes a systems-level approach to reducing the number of disconnected youth in the United States. These disconnected youth, referred to here as “opportunity youth,” are defined as young people 16–24 years of age who are not engaged in either school or the workforce. Popularized by organizations such as the Aspen Institute, which works at the forefront of youth disconnection, and Opportunity Youth United, a national coalition of young advocates, the term opportunity youth conveys that disconnected young people seek opportunities to thrive and that there are tremendous societal benefits of reconnection with education and labor systems. This statement calls for policies to (1) establish universal pre-K education to ensure that all children start their educational trajectory on equal footing; (2) promote healthy, equitable discipline and integrate evidence-based prevention and treatment services in K–12 settings; (3) increase access to sexual and reproductive health services and programs; (4) better align secondary, postsecondary, and workforce systems to ensure that every young person has an opportunity for a successful career; (5) enhance data collection to track disconnection across key transition points along the education-to-career trajectory as well as risk and protective factors that drive youth disconnection; and (6) expand opportunity youth engagement in policies to incorporate youth perspectives into each of these calls for action.

Relationship to Existing APHA Policy Statements

• APHA Policy Statement 20189: Achieving Health Equity in the United States
• APHA Policy Statement 201811: Addressing Law Enforcement Violence as a Public Health Issue
• APHA Policy Statement 20179: Reducing Income Inequality to Advance Health
• APHA Policy Statement 20173: Public Health and Early Childhood Education: Support for Universal Preschool in the United States
• APHA Policy Statement 20165: Addressing Social Determinants to Ensure On-Time Graduation
• APHA Policy Statement 20143: Sexuality Education as Part of a Comprehensive Health Education Program in K to 12 Schools
• APHA Policy Statement 20131: Endorsing Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs, Third Edition
• APHA Policy Statement 20101: Public Health and Education: Working Collaboratively Across Sectors to Improve High School Graduation as a Means to Eliminate Health Disparities
• APHA Policy Statement 201013: American Public Health Association Child Health Policy for the United States
• APHA Policy Statement 200914: Building Public Health Infrastructure for Youth Violence Prevention
• APHA Policy Statement 200610: Abstinence and U.S. Abstinence Only Education Policies: Ethical and Human Rights Concerns
• APHA Policy Statement 20049: Promoting Public Health and Education Goals through Coordinated School Health Programs
• APHA Policy Statement 20005: Effective Interventions for Reducing Racial and Ethnic Disparities in Health
• APHA olicy Statement 200027: Encourage Healthy Behavior by Adolescents

Problem Statement
In 2019, nearly 11% of youth in the United States 16–24 years of age were both out of school and out of work.[1] Whereas the term “NEET” (not in education, employment, or training) is often used to characterize disconnected youth in Western Europe, Canada, and Australia, disconnected youth in the United States are most commonly referred to as “opportunity youth.” As noted by Opportunity Youth United, a national movement of young people and allies, the term opportunity youth is meant to convey both that “we are seeking opportunity and we offer the nation an opportunity if it would invest in ways for us to rebuild our communities and our lives.”[2] While methods for defining youth disconnection vary somewhat, youth who are in school, work part time, or serve in the military are not considered disconnected. Lived experiences of disconnection also vary, with some opportunity youth actively trying to enter school or obtain a job and others maintaining disengagement due to personal or family circumstances such as illness or disability.

As a result of their disconnection, opportunity youth face profound short- and long-term negative consequences. Youth who are not in school or employed for at least six months are three times more likely to suffer from depression than youth who are connected to these key supports; they are also one sixth as likely to obtain a high school or college degree, hindering lifetime earnings, heightening reliance on health and income security entitlements, and increasing the risk of premature death from preventable conditions such as high blood pressure, diabetes, and stroke.[3,4] These individual costs are accompanied by a societal economic impact, with estimates ranging from $26.8 billion to $93 billion annually.[5]

Risk for youth disconnection is inequitably distributed across racial and ethnic groups, signaling that White supremacy and structural racism contribute to disconnection. In comparison with disconnection rates of 9% and 6%, respectively, among White and Asian American/Pacific Islander youth, approximately 22% of Native youth, 17% of Black youth, and 12% of Latinx youth were disconnected in 2019, and structural racism—including persistent housing, financial, and labor market discrimination—decreases the salience of protective factors such as higher education for these populations.[6] Nearly one in three opportunity youth live in poverty, a rate twice that of their connected peers; as a result, they are more likely to experience the compounding risk factors that accompany living in areas of concentrated poverty, including lower-quality education, poorer health, limited transportation, increased unsupervised time, and higher rates of violence and resulting trauma.[1] Opportunity youth are also more likely to have a history of court involvement, a mental or physical disability, emergent bilingual status, or significant family obligations and twice as likely to live apart from both parents, an indicator of traumatic childhood experiences.[1]

In addition, disconnected youth are more than 20 times as likely to live in institutionalized group quarters, including psychiatric and correctional facilities, and disconnected teens who are married and mothering are at increased risk for domestic violence, poor birth outcomes, and postpartum depression.[1,7] Youth who use substances are at increased risk of disconnection from school and work and, in the reverse, youth who have educational problems or are unemployed are more likely to use substances, especially if they experienced childhood poverty and low socioeconomic status.[8] LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning) youth — who are more than twice as likely as their cisgender and straight peers to be victims of targeted bullying on school grounds—are also at increased risk of disconnection, with more than one in five transgender students reporting having left a school because of mistreatment.[9,10]

Although significant progress was achieved over the last decade in reducing the youth disconnection rate from 14.7% to 10.7%, the COVID-19 pandemic and associated economic crises are expected to reverse this trend, increasing disconnection and further widening racial disparities.[1]

Evidence-Based Strategies to Address the Problem
Research demonstrates that prioritizing opportunity youth and youth at risk of disconnection strengthens the health, well-being, and socioeconomic stability of our nation.[11] This proposal outlines strategies that must be included as part of a youth-informed federal policy agenda targeting the myriad and intersecting systems that touch the lives of these youth. It is imperative that such cross-sector strategies are pursued and employed in combination, as a piecemeal approach does not address the “whole child,” and that youth voices are incorporated into every element of implementation. Importantly, the strategies outlined in this proposal are designed to not only mobilize and reconnect opportunity youth but also support the healthy development of all children.

Universal pre-K: High-quality pre-K education, defined as programs aligned with the National Institute of Early Education Research’s 10 quality benchmarks, provides 3- and 4-year-olds with the social, emotional, and academic foundations needed to lead healthy and prosperous lives. Children who participate in pre-K are less likely to repeat a grade and are more prepared for school.[12,13] In addition, pre-K attendees are more likely to be physically active, have access to nutritious meals, receive health screenings, and stay up to date with immunizations and dental care.[14] These academic and health benefits pay off, with evidence showing that quality early childhood education significantly increases the likelihood of graduating from high school and college, reduces teen pregnancy and crime, and leads to overall better health.[15] High school graduation alone is associated with a longer life span (up to nine years), along with lessened reliance on government services.[16–18]

A high school diploma is necessary for most jobs and secondary training, but opportunity youth are nine times more likely than their peers to have dropped out of high school.[1] While the causes of dropout vary, many factors—both in and out of school—can be addressed by working upstream through high-quality pre-K. Without universal pre-K access, students enter kindergarten with varying levels of social and academic development that create an educational achievement gap that becomes more difficult and costly to close as children advance through upper grades. While universal pre-K is estimated to cost up to $26 billion each year, the earlier that educators and health professionals can intervene to address risk factors for dropout and subsequent youth disconnection, the lower the health, social, and financial costs to both the individual and the community. In fact, for every dollar spent on pre-K, there is an estimated $7 to $10 return on investment, with the potential for federal budget savings to outpace government spending two to one within 35 years.[19]

Equitable discipline and evidence-based prevention and treatment services in schools: School disciplinary actions such as suspensions, expulsions, and referrals to law enforcement are intended to maintain classroom order and protect students from harming themselves and others. However, these approaches—collectively referred to as exclusionary school discipline—have proven ineffective at achieving these goals, instead creating unintended negative consequences such as the failure to acknowledge that “bad behaviors” are often symptoms of a child’s trauma exposure or mental health struggles. In addition, exclusionary practices disproportionately target youth of color, particularly Black males, as well as LGBTQ+ students and students with disabilities—populations that are overrepresented in national opportunity youth data.[20] Research shows that a majority of exclusionary instances occur in response to minor infractions that pose no threat to students and staff, and each subsequent instance increases the odds that students will fall behind academically, drop out of school, and become involved in the juvenile legal system. As a result, schools utilizing exclusionary practices fail to address behavior in a constructive and productive way and instead place youth at greater risk for school and work disconnection, social isolation, and long-term health disparities. 

By contrast, multi-tiered evidence-based prevention models—including social-emotional learning programs, positive behavioral interventions and support, cognitive behavioral skills, mindfulness practices, and restorative justice approaches—support youth achievement and health equity by increasing connectedness and accountability, promoting social and emotional growth, and decreasing youth involvement in the juvenile legal system.[21–24] Whereas exclusionary policies physically restrict access to the academic setting and its associated supports, school-based prevention programs—coupled with on-site mental health professionals—strengthen youth skills and assets, such as emotion regulation capacities, to reduce and prevent mental health problems, promote resilience, and improve retention.[25] Regardless of whether such programs are delivered universally to all students or in a more targeted fashion to students with risk factors or emerging symptoms, the availability of on-site mental health professionals in all schools is critical for the implementation of tiered prevention models. To better support existing opportunity youth, multi-tiered evidence-based prevention models should also be offered in reengagement centers serving youth who have already disconnected, and expanded diversion programs linking youth to mental health and substance use treatment rather than the juvenile legal system for minor infractions have the potential to prevent future disconnection while also ensuring that vulnerable adolescents receive critical mental health care.[26]

Access to comprehensive sex education and reproductive care for all youth: Until the introduction of the Personal Responsibility Education Program and Teen Pregnancy Prevention Program in 2010, abstinence-only programming was the only form of sex education in the United States to receive federal funding.[27] Today, abstinence-only education remains the most prevalent form of sex education across the country despite evidence of its failure to delay sex or reduce risky behaviors.[28] In 2017, a total of 194,377 babies were born to youth 15–19 years of age.[29] The major consequences of unplanned teen pregnancy are linked to the social determinants of health, with teen mothers half as likely to receive their high school diploma by the age of 22 years as their peers who do not give birth during adolescence and the children of teen mothers more likely to experience health problems, school dropout, incarceration, unemployment, and teen parenthood.[30,31] The federal government’s continued investment in abstinence-only education is a disservice to youth and comes at a high cost to society of approximately $9.4 billion annually.[32] In addition, an abstinence-only focus—coupled with the lack of any federal mandate surrounding the provision of sex education—has allowed several states to implement programs that not only exclude information about LGBTQ+ sexual and reproductive health but actively promote hostility toward LGBTQ+ youth through the framing of “alternate sexual lifestyles” as unnatural, offensive, and even criminal. In these states, LGBTQ+ students receive less support from educators and their peers and are less able to access relevant school health services.[33] Physical and emotional abuse against LGBTQ+ students also contributes to a higher risk of teen pregnancy among lesbian and bisexual youth and disproportionate dropout rates among LGBTQ+ youth more broadly.[33,34] 

Youth need access to complete, accurate information about abstinence, condoms, and contraception to prevent unintended pregnancies, form healthy relationships, and protect themselves from sexually transmitted infections. Such information can be found in high-quality, evidenced-based sex education—often termed “comprehensive sex education”—that is medically accurate, age appropriate, inclusive, and broad, covering issues related to the physical, biological, emotional, and social aspects of sexuality. Instead, Congress has spent more than $2 billion on abstinence-only programming since 1982.[35] Reputable groups such as the National Academy of Medicine have condemned this allocation of funds as poor fiscal and public health policy given the lack of evidence demonstrating the effectiveness of abstinence-only education.[36] To act on lessons learned from comprehensive sex education, youth also need access to comprehensive sexual and reproductive health care. Revitalization of the Title X program, which disproportionately serves Black, Latinx, LGBTQ+, and low-income individuals, would increase access for opportunity youth given the shared characteristics between populations facing significant barriers to health care and those at risk for disconnection.[37]

Policies, systems, and structures that support youth transitions: The high proportion of young people in the United States who become disconnected is due in large part to a lack of integration across key systems—including secondary education, postsecondary education, and the workforce—that makes it difficult for youth to smoothly transition between systems and successfully achieve their ambitions. Moreover, few youth affected by trauma have access to adequate mental health services, another key barrier to successful transitions in educational and occupational settings, and many youth lack basic resources including housing, transportation, and food.[38] Such resources and supports are particularly scarce for parenting youth and youth who transition out of foster care or the juvenile legal system. Ensuring alignment of systems, particularly those related to education and employment, is imperative for keeping youth connected to school and work. Race must be addressed explicitly as part of this alignment by prioritizing the needs of Black, Latinx, and Native youth and actively removing structural barriers to participation.[39] If this effort is implemented successfully, every young person in the United States should receive a high school degree or equivalent, have a range of postsecondary options promoting labor market success, and have an opportunity for quality career training, national service, or employment.[40] The following federal initiatives are particularly well suited to the needs of opportunity youth and those at risk for future disconnection:

• The Workforce Innovation and Opportunity Act, which supports youth reengagement through job readiness programs (e.g., Job Corps, Youth Build) that provide training and education, and the Carl D. Perkins Career and Technical Education Act, which provides funds to states to create connections among high schools, higher education, and employers.[41] Although both programs support youth in transition, particularly low-income youth, they do not receive sufficient federal funding in part because of nondefense discretionary program limits set by the 2011 Budget Control Act.
• Dual enrollment and early college high school programs, authorized by the Every Student Succeeds Act (ESSA), which allow students to earn college credit in high school with the financial support of local school districts. While 82% of U.S. public schools offer dual enrollment, 45% fail to cover the cost for low-income students, creating barriers for those who stand to benefit most from programs aimed at reducing the financial burden of higher education.[42,43]
• The Federal Pell Grant Program, which provides low- and moderate-income students with direct assistance for postsecondary studies—both occupational and academic — based on their financial need.[44,45] Financial burden is one of the primary barriers opportunity youth face in the pursuit of postsecondary training and education, and financial support can provide youth with the momentum to stay engaged and transition to new opportunities.[46] Unfortunately, the maximum value of the Pell Grant has declined significantly relative to the cost of college and program eligibility has failed to keep up with changing demands of the workforce, with the grants continuing to fund only two- and four-year postsecondary programs at the exclusion of high-quality job training programs that can place participants in high-paying jobs with a low debt burden.[47,48]
• Federal registered apprenticeships, which can bridge the gap between education and employment by providing training in specific skill sets needed for current and future job openings. However, only 250,000 youth enrolled in registered apprenticeships in 2019, as compared with the more than 2 million youth who enrolled in community colleges nationwide.[49] One factor related to poor enrollment is a disconnect between apprenticeship programs and the higher education system, which leaves participants with highly developed technical skills but not the associate or bachelor’s degree necessary to advance in their field.[45]

Data collection on disconnection pathways and predictors: Opportunity youth are a difficult population to identify and assess. Standard tracking systems often miss them as a result of their disconnected status and heterogeneous contexts, including foster care or juvenile legal system settings. Furthermore, no set of common measures or indicators exists, with some groups having defined opportunity youth as spanning 16–19 years old and others specifying the age range as 16–24 years.[1,50] The American Community Survey (ACS), administered annually by the U.S. Census Bureau, is the most comprehensive annual source of information on school enrollment and employment status.[51] Measure of America uses the ACS to calculate the annual rate of youth disconnection nationally, as well as by state, congressional district, and metropolitan area scales. Due to data limitations, however, individual youth cannot be tracked over time, and data are lacking on key subgroups such as LGBTQ+ youth.[1]

Public health advocates, educators, medical professionals, nonprofits, and policymakers would be better able to make data-informed decisions—preferably in partnership — if key questions about the characteristics and needs of opportunity youth could be answered more accurately, comprehensively, and quickly. Policies should be enacted to establish a national database or tracking system that measures the education and employment status of young people annually. Disconnection is most likely to occur during transitions from high school to postsecondary education or the workforce; as such, capturing disconnection rates at specific points along the education-to-career trajectory is key for understanding disconnection across these transitions. Identifying the extent to which various subgroups are disconnected can provide additional insights about disparities and help shape intervention strategies. Some groups, such as LGTBQ+ youth, are currently not captured in the ACS; expanding the ACS to include questions about gender identity and sexual orientation would provide critical information. Longitudinal studies that track factors associated with disconnection over time—as well as youth movement in and out of disconnection—are also important for understanding when and how to intervene.[51]

Opportunity youth engagement — young people as partners: To further develop a policy agenda that is successful at reducing youth disconnection, youth perspectives must be meaningfully incorporated.[52] Young people can provide important insights into the strategies proposed above, including their feasibility and acceptability. Young people can also serve as ambassadors in their communities to disseminate policy information or gather input to inform policy development. Engagement of opportunity youth and youth at risk for disconnection is important for decisions that affect their well-being, and their involvement has the potential to provide youth with not only leadership and employment opportunities but also key relationships with caring adults that are critical to success in school, work, and beyond.[53]

Opposing Arguments/Evidence
Universal pre-K: Arguments against universal pre-K typically emphasize financial concerns, with at least one study estimating the annual cost at $26 billion. However, that same study revealed that within 35 years, the financial benefits of universal pre-K would more than double program costs, returning $8.90 for every dollar invested.[54] Despite current investments in publicly funded options, access to pre-K in the United States is primarily limited to those who can afford it, with caregivers outspending the government in this sector by approximately $6 billion in 2017.[55] Most low-income families are unable to provide this essential start for their children, and both Head Start and state-level programs supported by the Child Care and Development Fund fall short of closing the gap. Across all publicly funded programs in the 2018–2019 academic year, only 17% and 44% of 3- and 4-year-olds, respectively, were enrolled in pre-K programs.[56] Furthermore, Black and Latinx children are often shut out of the highest quality programs, with statewide enrollment rates as low as 4% and 1%, respectively, during the 2017–2018 school year.[57]

Equitable discipline and evidence-based prevention and treatment services in schools: U.S. public schools are complex settings that manage multiple academic and administrative demands, often with limited funds. Disciplinary practices and prevention and treatment services are frequently implemented in a piecemeal manner—with multiple programs delivered to a single grade and inconsistent attention to coherent implementation across K–12—and without sufficient training and supervision.[58] As a result, many question the effectiveness of nonexclusionary practices. However, with adequate funding and resources, as well as consistent support from leadership and coherent implementation across grades, nonexclusionary practices have the potential to improve school climates, promote positive youth coping and conflict resolution skills, and reduce the number of students with emotional, behavioral, and academic problems who require intensive interventions. A tiered prevention model is ideal, as it promotes universal skill building for all students and offers additional forms of support, such as group psychosocial interventions, for students with emerging mental health symptoms as well as mental health and substance use treatment services for students with more serious psychological issues.[59]

Sex education: There are a number of opposing viewpoints to comprehensive sex education, including competing priorities of school districts, disapproval of topic areas, and lack of understanding about what constitutes a “comprehensive” approach.[60] However, public opinion polls consistently show that the American public, regardless of political view, is in favor of both sex education in schools and high-quality, evidence-based teen pregnancy prevention programs.[61] While three decades of research indicate that comprehensive sex education programming plays a vital role in the sexual health and well-being of young people, the federal government annually spends $110 million on abstinence-only programs; thus, concerns about costs of expanded programming can be addressed by reallocating funds from abstinence-only programs to the implementation of national standards in all U.S. schools.[62] 

Youth transitions: Because the recommendations presented to strengthen support for youth at critical transitions are varied, so too is the scope of opposing arguments. In the case of workforce development programs, which include federal apprenticeships, many view youth as a homogenous population and fail to recognize the systemic oppression faced by youth of color. To improve workforce development programs, racism and equity need to be directly addressed. Education and workforce systems, which rarely collaborate with each other, also need to be better aligned.[63] With regard to Pell Grants, some argue that schools will simply increase tuition to capture additional federal funding, negating any benefit to students, but past research does not provide strong support for this argument; instead, increases to programs such as Pell help lessen the gap between what students can afford and what schools can offer in institutional financial aid, making it more likely that schools can fully meet the needs of students from low-income backgrounds.[64] In terms of college readiness programs such as those funded by ESSA, opponents have raised concerns regarding the quality of coursework offered, arguing that participants will not be adequately prepared for college; however, a 2018 report from the University of Texas System showed that students who enrolled with credits earned through dual enrollment outperformed their peers with respect to retention, grades, and both on-time and early graduation rates, findings consistent with similar evaluations.[65]

Data collection: While proposed changes to the American Community Survey are minor, any changes in data collection and analysis carry a cost. Assuming opponents of survey expansion would cite financial concerns, proponents can note the potential return on investment of reconnecting opportunity youth. As noted earlier, the annual economic impact of youth disconnection is estimated at up to $93 billion after accounting for lost wages, tax revenue, and health and income security entitlements such as Medicaid, Temporary Assistance for Needy Families, and the Supplemental Nutrition Assistance Program.[4] With a clearer understanding of who opportunity youth are and what led them to disconnection, public health professionals will be better positioned to create policies and programs tailored for this heterogeneous population to improve reconnection and retention rates.

Opportunity youth engagement: Young people are often denied decision-making involvement because they are viewed as too young and inexperienced. In particular, perspectives of youth of color and youth living in poverty—who are at particular risk for becoming disconnected—have historically been marginalized.[53] Because these young people generally have not had opportunities to influence policymakers or to gain leadership, advocacy, and policy training, their talents may not be appreciated. It is critical, however, that public health practitioners provide these opportunities to young people both because their lived experiences and perspectives are instrumental for informing effective strategies and because their involvement provides them with valuable professional training and experience.

Action Steps

1. The health and social benefits of universal pre-K make it essential for safeguarding the well-being of all U.S. children and preventing youth disconnection. APHA calls on Congress to fund universal pre-K for all 3- and 4-year-old children, as well as high-quality training and livable wages for all early childhood educators.
2. Policies that shift school discipline toward more healthy, equitable outcomes will improve the overall well-being of students and prevent disconnection. APHA calls on the Departments of Education and Justice to reinstate and update the 2014 School Discipline Guidance Package to Enhance School Climate and Improve School Discipline Policies/Practices to ensure that it incorporates evidence-supported, culturally appropriate prevention programs and practices across grades K–12. In addition, the Department of Education should amend ESSA to ensure that state and local jurisdictions receiving federal funding demonstrate a commitment to prevention programming, social-emotional learning, and restorative justice principles as aligned with the reinstated school discipline guidance and that all schools, reengagement centers, and job training programs have on-site mental and behavioral health professionals who can provide screening and assessment, prevention and intervention programming, and referrals for additional treatment as needed.
3. Congress should prohibit funding for any grants or programs related to exclusionary school discipline or school resource officers and fund a school and community discipline data management program jointly authorizing the Department of Education Office of Safe and Supportive Students and the Department of Justice Office of Juvenile Justice and Delinquency Prevention to collaboratively monitor and evaluate school discipline data.
4. For the health and socioeconomic success of youth and society more broadly, federal agencies should solely fund evidence-based, inclusive, and comprehensive sexual and reproductive education and services. The White House should establish a national commission for advancing school health services convened by the Department of Education and the Teen Pregnancy Prevention Program of the Department of Health and Human Services’ Office of Population Affairs to outline federal guidance for sexual health care provision in schools and build the capacity of state and local officials to increase access to school health services.
5. Congress should increase the maximum Pell Grant award to $12,000 and amend the legislation to annually adjust Pell Grants for inflation, expand eligibility to include short-term credentials and workforce programming offered by institutions of higher education, classify Pell Grant funding as mandatory spending in the federal budget, and provide additional grant “seed funding” for high school students to attend public community colleges at no cost, thereby increasing postsecondary accessibility for low-income students and students of color.
6. Congress fully fund the Every Student Succeeds Act, the Workforce Innovation and Opportunity Act, and the Carl D. Perkins Career and Technical Education Act to ensure that youth — especially those from the most marginalized backgrounds — have access to proven programs aimed at the transition from education to career.
7. Congress should amend the Higher Education Act to establish a new category of “student-apprentice” and a special type of postsecondary academic degree that includes the core features of apprenticeship and ensure that associated tuition and fees are eligible expenses under the Federal Work-Study Program; ensure that all pre-apprenticeships link directly to registered apprenticeships that pay living wages, provide benefits, and are structured to support career advancement; incentivize pre-apprenticeship development in partnership with registered apprenticeships that commit to equitable practices and demonstrate results; create direct entry agreements for pre-apprenticeship graduates to enter a two- or four-year institution; and create an apprenticeship institute in each state — funded similarly to public land-grant institutions and backed by a federal apprenticeship loan for employers — to serve as an intermediary link among employers, educators, and apprentices.
8. The U.S. Census Bureau and the Office of Management and Budget should expand the American Community Survey to include additional questions on disconnection during key transitional periods as well as questions on gender and sexual identity to provide additional data on the characteristics of opportunity youth.
9. The Centers for Disease Control and Prevention and the Departments of Labor and Education should prioritize and fund longitudinal studies following young people to better measure factors related to disconnection.
10. Policies that provide funding and guidelines for the development of youth advisory boards will facilitate the engagement of youth in decisions that affect their own opportunities and well-being. Thus, APHA calls on the White House to establish a federal youth advisory board under the joint sponsorship of the Departments of Education and Labor to advise on developing and implementing a policy agenda aimed at reducing youth disconnection, fund corresponding state and local boards to adapt national recommendations to local contexts, and foster linkages across national, state, and local government agencies and nongovernmental organizations to provide needed services and support.

References
1. Lewis K. A decade undone: 2021 update. Available at: https://measureofamerica.org/youth-disconnection-2021. Accessed August 13, 2021.
2. Opportunity Youth United. About us. Available at: https://oyunited.org/about-us. Accessed August 13, 2021.
3. Bynner J, Parsons S. Social exclusion and the transition from school to work: the case of young people not in education, employment, or training (NEET). J Vocational Behav. 2002;60(2):289–309. 
4. Lansford JE, Dodge KA, Pettit GS, Bates JE. A public health perspective on school dropout and adult outcomes: a prospective study of risk and protective factors from age 5 to 27 years. J Adolesc Health. 2016;58(6):652–658.
5. Aspen Institute Forum for Community Solutions. Who are opportunity youth? Available at: https://www.aspencommunitysolutions.org/who-are-opportunity-youth/. Accessed August 13, 2021.
6. Borowczyk-Martins D, Bradley J, Tarasonis L. Racial discrimination in the U.S. labor market: employment and wage differentials by skill. Labour Econ. 2014;49:106–127. 
7. Agrawal A, Ickovics J, Lewis JB, Magriples U, Kershaw TS. Postpartum intimate partner violence and health risks among young mothers in the United States: a prospective study. Matern Child Health J. 2014;18(8):1985–1992. 
8. Gubbels J, van der Put CE, Assink M. Risk factors for school absenteeism and dropout: a meta-analytic review. J Youth Adolesc. 2019;48(9):1637–1667. 
9. Gower AL, Rider GN, McMorris BJ, Eisenberg ME. Bullying victimization among LGBTQ youth: current and future directions. Curr Sex Health Rep. 2018;10(4):246–254. 
10. Kosciw JG, Greytak EA, Zongrone AD, Clark CM, Truong NL. The 2017 National School Climate Survey. Available at: https://www.glsen.org/sites/default/files/2019-10/GLSEN-2017-National-School-Climate-Survey-NSCS-Full-Report.pdf. Accessed August 13, 2021.
11. Mendelson, T, Mmari K, Blum, R, Catalano R, Brindis C. Opportunity youth: insights and opportunities for a public health approach. Public Health Rep. 2018;133(suppl):54S–64S. 
12. National Institute for Early Education Research. Benchmarks for high-quality pre-K checklist. Available at: https://nieer.org/wp-content/uploads/2019/12/BENCHMARKS-CHECK-LIST-PDF.pdf. Accessed August 13, 2021.
13. Community Preventive Services Task Force. Promoting health equity through education programs and policies: comprehensive, center-based programs for children of low-income families to foster early childhood development. Available at: https://www.thecommunityguide.org/sites/default/files/assets/HealthEquity-Early-Childhood-Development.pdf. Accessed August 13, 2021.
14. Friedman-Krauss A, Barnett WS. Early childhood education: pathways to better health. Available at: https://www.thecommunityguide.org/sites/default/files/assets/HealthEquity-Early-Childhood-Development.pdf. Accessed August 13, 2021.
15. McCoy DC, Yoshikawa H, Ziol-Guest KM, et al. Impacts of early childhood education on medium- and long-term educational outcomes. Educ Researcher. 2017;46(8):474–487. 
16. Health, United States, 2011: With Special Feature on Socioeconomic Status and Health. Hyattsville, MD: National Center for Health Statistics; 2012.
17. Muennig P. Health returns to education interventions. Available at: http://www.centerforeducationalequity.org/events-page/equity-symposia/2005-the-social-costs-of-inadequate-education/papers/75_Muennig_Executive-Summary.pdf. Accessed August 13, 2021.
18. Belfield, CR, Hickox, I. The economic effects of high school non-completion and disconnected youth. Available at: http://azmayors.org/wp-content/uploads/2018/04/Arizona-Mayors-Education-Dashboards-Spring-2018.pdf. Accessed August 13, 2021.
19. Heckman J. Invest in early childhood development: reduce deficits, strengthen the economy. Available at: https://heckmanequation.org/www/assets/2013/07/F_HeckmanDeficitPieceCUSTOM-Generic_052714-3-1.pdf. Accessed August 13, 2021.
20. U.S. Government Accountability Office. Discipline disparities for Black students, boys, and students with disabilities. Available at: https://www.gao.gov/assets/700/690828.pdf. Accessed August 13, 2021.
21. González T, Sattler H, Buth AJ. New directions in whole‐school restorative justice implementation. Conflict Resolution Q. 2018;36:1–14. 
22. González T, Epstein R. Increasing school connectedness for girls: restorative justice as a health equity resource. Available at: https://www.law.georgetown.edu/poverty-inequality-center/wp-content/uploads/sites/14/2020/03/Restorative-Justice-as-a-Health-Equity-Resource.pdf. Accessed August 13, 2021.
23. Losen D, Hodson C, Keith MA, Morrison K, Belway S. Are we closing the school discipline gap? Available at: https://www.civilrightsproject.ucla.edu/resources/projects/center-for-civil-rights-remedies/school-to-prison-folder/federal-reports/are-we-closing-the-school-discipline-gap/AreWeClosingTheSchoolDisciplineGap_FINAL221.pdf. Accessed August 13, 2021.
24. Gregory A, Evans KR. The starts and stumbles of restorative justice in education: where do we go from here? Available at: http://nepc.colorado.edu/publication/restorative-justice. Accessed August 13, 2021.
25. Dray J, Bowman J, Campbell E, et al. Systematic review of universal resilience-focused interventions targeting child and adolescent mental health in the school setting. J Am Acad Child Adolesc Psychiatry. 2017;56(10):813–824. 
26. Wylie LE, Rufino KA. The impact of victimization and mental health symptoms on recidivism for early system-involved juvenile offenders. Law Hum Behav. 2018;42(6):558–569. 
27. Kaiser Family Foundation. Abstinence education programs: definition, funding, and impact on teen sexual behavior. Available at: https://www.kff.org/womens-health-policy/fact-sheet/abstinence-education-programs-definition-funding-and-impact-on-teen-sexual-behavior/. Accessed August 13, 2021.
28. Santelli JS, Kantor LM, Grilo SA, et al. Abstinence-only-until-marriage: an updated review of U.S. policies and programs and their impact. J Adolesc Heal. 2017;61(3):273–280. 
29. Centers for Disease Control and Prevention. Reproductive health: teen pregnancy. Available at: https://www.cdc.gov/teenpregnancy/about/index.htm. Accessed August 13, 2021.
30. Kalmuss DS, Namerow PB. Subsequent childbearing among teenage mothers: the determinants of closely spaced second birth. Fam Plann Perspect. 1994;26(4):149–153. 
31. Hoffman SD. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy. Washington, DC: Urban Institute Press; 2008. 
32. Centers for Disease Control and Prevention. Winnable battles: teen pregnancy. Available at: https://www.cdc.gov/winnablebattles/report/teenPregnancy.html. Accessed August 13, 2021.
33. GLSEN. Laws that prohibit the “promotion of homosexuality”: impacts and implications. Available at: https://www.glsen.org/sites/default/files/2019-10/GLSEN-Research-Laws-that-Prohibit-Promotion-of-Homosexuality-Implications.pdf. Accessed July 27, 2021. 
34. Charlton BM, Roberts AL, Rosario M, et al. Teen pregnancy risk factors among young women of diverse sexual orientations. Pediatrics. 2018;141(4):e20172278. 
35. SIECUS. Dedicated federal abstinence-only-until-marriage programs: funding by fiscal year (FY), 1982–2019. Available at: siecus.org/wp-content/uploads/2018/10/AOUM-Funding-Table-FY19-Oct-2018-FINAL.pdf. Accessed July 27, 2021.
36. Ruiz MS, Gable AR, Kaplan EH, Soto MA, Fineberg HV, Trussell J, eds. No Time To Lose: Getting More from HIV Prevention. Washington, DC: National Academies Press; 2001.
37. Office of the Federal Register, National Archives and Records Administration. Ensuring access to equitable, affordable, client-centered, quality family planning services. Available at: https://www.govinfo.gov/app/details/FR-2021-04-15/2021-07762. Accessed July 27, 2021.
38. Finkelhor D, Turner H, LaSelva D. Receipt of behavioral health services among US children and youth with adverse childhood experiences or mental health symptoms. JAMA Netw Open. 2021;4(3):e211435. 
39. Bird K, Parton B, White T. Building back better: a national plan for youth employment. Available at: https://www.newamerica.org/education-policy/briefs/building-back-better-a-national-plan-for-youth-employment/. Accessed August 13, 2021.
40. Tatum L, Dutta-Gupta I, Hampton C, Li H, Edelman P. The youth opportunity guarantee: a framework for success. Available at: http://www.georgetownpoverty.org/wp-content/uploads/2019/04/Youth-Opportunity-Guarantee-20190411.pdf. Accessed July 27, 2021.
41. U.S. Department of Education. Carl D. Perkins Career and Technical Education Act of 2006: Reauthorization of Perkins. Available at: https://www2.ed.gov/policy/sectech/leg/perkins/index.html. Accessed July 27, 2021.
42. Karp MM, Calcagno JC, Hughes KL, Jeong DW, Bailey TR. The postsecondary achievement of participants in dual enrollment: an analysis of student outcomes in two states. Available at: https://ccrc.tc.columbia.edu/media/k2/attachments/dual-enrollment-student-outcomes.pdf. Accessed July 27, 2021.
43. Zinth JD. Increasing student access and success in dual enrollment programs: 13 model state-level policy components. Available at: https://www.ecs.org/clearinghouse/01/10/91/11091.pdf. Accessed July 27, 2021.
44. Bass JC. The Higher Education Act of 1965. Available at: https://www.newamerica.org/education-policy/reports/higher-education-act-1965/recommendations/#registered-apprenticeships-and-workforce-development. Accessed July 27, 2021.
45. Urban Institute. Understanding college affordability: how students, institutions, and the public pay for higher education. Available at: http://collegeaffordability.urban.org/financial-aid/federal/#/pell_grants. Accessed July 27, 2021.
46. Piff J. Changing systems for opportunity youth: six common barriers. Available at: https://aspencommunitysolutions.org/changing-systems-for-opportunity-youth-six-common-barriers/. Accessed July 27, 2021. 
47. National College Attainment Network. Strengthen Pell Grants. Available at: https://www.ncan.org/page/Pell. Accessed July 29, 2021.
48. Brown K. Putting Pell Grants to work for working students: how modernizing our federal higher education policy can improve outcomes for students and employers in today’s economy. Available at: https://www.nationalskillscoalition.org/wp-content/uploads/2020/12/Putting-Pell-Grants-to-work-for-working-students-1.pdf. Accessed August 13, 2021.
49. U.S. Department of Labor. Registered apprenticeship national results fiscal year 2019. Available at: https://www.dol.gov/agencies/eta/apprenticeship/about/statistics. Accessed July 27, 2021.
50. Child Trends. Disconnected youth. Available at: https://www.childtrends.org/?indicators=youth-neither-enrolled-in-school-nor-working. Accessed July 27, 2021.
51. Equal Measure. Equity counts: tracking opportunity youth outcomes. Available at: https://aspencommunitysolutions.org/wp-content/uploads/2019/10/EquityCounts_OYF-Measures-Brief_EqM_FINAL_Oct19.pdf. Accessed July 27, 2021.
52. Miles M, Nemoy Y, Martin N. Advancing youth voice and changing the narrative about opportunity. Available at: https://aspencommunitysolutions.org/wp-content/uploads/2021/03/Advancing-Youth-Voice-Final-March2021.pdf. Accessed August 13, 2021.
53. Sprague Martinez L, Richards-Schuster K, Teixeira S, Augsberger A. The power of prevention and youth voice: a strategy for social work to ensure youths’ healthy development. Soc Work. 2018;63(2):135–143. 
54. Lynch R, Vaghul K. The benefits and costs of investing in early childhood education: the fiscal, economic, and societal gains of a universal prekindergarten program in the United States, 2016–2050. Available at: https://equitablegrowth.org/research-paper/the-benefits-and-costs-of-investing-in-early-childhood-education/?longform=true. Accessed July 27, 2021.
55. Gould E, Blair H. Who’s paying now? The explicit and implicit costs of the current early care and education system. Available at: https://www.epi.org/publication/whos-paying-now-costs-of-the-current-ece-system/. Accessed July 27, 2021. 
56. National Center for Education Statistics. Enrollment of 3-, 4-, and 5-year-old children in preprimary programs, by age of child, level of program, control of program, and attendance status: selected years, 1970 through 2018. Available at: https://nces.ed.gov/programs/digest/d19/tables/dt19_202.10.asp. Accessed July 27, 2021.
57. Gillispie C. Young learners, missed opportunities: ensuring that Black and Latino children have access to high-quality state-funded preschool. Available at: https://edtrust.org/resource/young-learners-missed-opportunities/. Accessed July 27, 2021. 
58. Mahoney JL, Weissberg RP, Greenberg MT, et al. Systemic social and emotional learning: promoting educational success for all preschool to high school students. Am Psychol. 2020 [Epub ahead of print]. 
59. Finning K, Ukoumunne OC, Ford T, et al. The association between child and adolescent depression and poor attendance at school: a systematic review and meta-analysis. J Affect Disord. 2019;245:928–938. 
60. Miedema E, Le Mat MLJ, Hague F. But is it comprehensive? Unpacking the ‘comprehensive’ in comprehensive sexuality education. Health Educ J. 2020;79(7):747–762. 
61. Survey Says. Birth control support. Available at: https://powertodecide.org/sites/default/files/resources/primary-download/survey_says_january_2017_birth_control_support.pdf. Accessed July 27, 2021.
62. Guttmacher Institute. Federally funded sex education: strengthening and expanding evidence-based programs. Available at: https://www.guttmacher.org/fact-sheet/sex-education. Accessed July 27, 2021.
63. Lam L. A design for workforce equity. Available at: https://www.americanprogress.org/issues/economy/reports/2019/10/16/475875/design-workforce-equity. Accessed July 27, 2021.
64. Archibald RB, Feldman DH. Federal financial aid policy and college behavior. Available at: https://www.acenet.edu/Documents/Paper-Archibald-Feldman-Federal-Financial-Aid-Policy.pdf. Accessed July 27, 2021. 
65. Troutman DR, Hendrix-Soto A, Creusere M, Mayer E. The University of Texas System Dual Credit Study: dual credit and success in college. Available at: https://data.utsystem.edu/sites/default/files/upload/UTSystem-DualCreditStudy.pdf. Accessed July 27, 2021.