Health Maintenance, 18- to 21-Year-Old


After high school completion, the young adult may be attending college, technical or vocational school, or entering the military or the work force.


The young adult establishes adult relationships and explores sexual identity. Young adults may be living at home or in a college dorm or apartment. Increasing independence is important with young adults. Throughout these years, young adults should assume responsibility of their own health care.


  • Influenza vaccine.

  • All adults should be immunized every year.

  • All adults, including pregnant women and people with hives-only allergy to eggs can receive the inactivated influenza (IIV) vaccine.

  • Adults aged 18–49 years can receive the recombinant influenza (RIV) vaccine. The RIV vaccine does not contain any egg protein.

  • Tetanus, diphtheria, and acellular pertussis (Td, Tdap) vaccine.

  • Pregnant women should receive 1 dose of Tdap vaccine during each pregnancy. The dose should be obtained regardless of the length of time since the last dose. Immunization is preferred during the 27th to 36th week of gestation.

  • An adult who has not previously received Tdap or who does not know his or her vaccine status should receive 1 dose of Tdap. This initial dose should be followed by tetanus and diphtheria toxoids (Td) booster doses every 10 years.

  • Adults with an unknown or incomplete history of completing a 3-dose immunization series with Td-containing vaccines should begin or complete a primary immunization series including a Tdap dose.

  • Adults should receive a Td booster every 10 years.

  • Varicella vaccine.

  • An adult without evidence of immunity to varicella should receive 2 doses or a second dose if he or she has previously received 1 dose.

  • Pregnant females who do not have evidence of immunity should receive the first dose after pregnancy. This first dose should be obtained before leaving the health care facility. The second dose should be obtained 4–8 weeks after the first dose.

  • Human papillomavirus (HPV) vaccine.

  • Females aged 13–26 years who have not received the vaccine previously should obtain the 3-dose series.

  • The vaccine is not recommended for use in pregnant females. However, pregnancy testing is not needed before receiving a dose. If a female is found to be pregnant after receiving a dose, no treatment is needed. In that case, the remaining doses should be delayed until after the pregnancy.

  • Males aged 13–21 years who have not received the vaccine previously should receive the 3-dose series. Males aged 22–26 years may be immunized.

  • Immunization is recommended through the age of 26 years for any male who has sex with males and did not get any or all doses earlier.

  • Immunization is recommended for any person with an immunocompromised condition through the age of 26 years if he or she did not get any or all doses earlier.

  • During the 3-dose series, the second dose should be obtained 4–8 weeks after the first dose. The third dose should be obtained 24 weeks after the first dose and 16 weeks after the second dose.

  • Measles, mumps, and rubella (MMR) vaccine.

  • Adults born in 1957 or later should have 1 or more doses of MMR vaccine unless there is a contraindication to the vaccine or there is laboratory evidence of immunity to each of the three diseases.

  • A routine second dose of MMR vaccine should be obtained at least 28 days after the first dose for students attending postsecondary schools, health care workers, or international travelers.

  • For females of childbearing age, rubella immunity should be determined. If there is no evidence of immunity, females who are not pregnant should be vaccinated. If there is no evidence of immunity, females who are pregnant should delay immunization until after pregnancy.

  • Pneumococcal 13-valent conjugate (PCV13) vaccine.

  • When indicated, a person who is uncertain of his or her immunization history and has no record of immunization should receive the PCV13 vaccine.

  • An adult aged 19 years or older who has certain medical conditions and has not been previously immunized should receive 1 dose of PCV13 vaccine. This PCV13 should be followed with a dose of pneumococcal polysaccharide (PPSV23) vaccine. The PPSV23 vaccine dose should be obtained at least 8 weeks after the dose of PCV13 vaccine.

  • An adult aged 19 years or older who has certain medical conditions and previously received 1 or more doses of PPSV23 vaccine should receive 1 dose of PCV13. The PCV13 vaccine dose should be obtained 1 or more years after the last PPSV23 vaccine dose.

  • Pneumococcal polysaccharide (PPSV23) vaccine.

  • When PCV13 is also indicated, PCV13 should be obtained first.

  • An adult younger than age 65 years who has certain medical conditions should be immunized.

  • Any person who resides in a nursing home or long-term care facility should be immunized.

  • An adult smoker should be immunized.

  • People with an immunocompromised condition and certain other conditions should receive both PCV13 and PPSV23 vaccines.

  • People with human immunodeficiency virus (HIV) infection should be immunized as soon as possible after diagnosis.

  • Immunization during chemotherapy or radiation therapy should be avoided.

  • Routine use of PPSV23 vaccine is not recommended for American Indians, Alaska Natives, or people younger than 65 years unless there are medical conditions that require PPSV23 vaccine.

  • When indicated, people who have unknown immunization and have no record of immunization should receive PPSV23 vaccine.

  • One-time revaccination 5 years after the first dose of PPSV23 is recommended for people aged 19–64 years who have chronic kidney failure, nephrotic syndrome, asplenia, or immunocompromised conditions.

  • Meningococcal vaccine.

  • Adults with asplenia or persistent complement component deficiencies should receive 2 doses of quadrivalent meningococcal conjugate (MenACWY-D) vaccine. The doses should be obtained at least 2 months apart.

  • Microbiologists working with certain meningococcal bacteria, military recruits, people at risk during an outbreak, and people who travel to or live in countries with a high rate of meningitis should be immunized.

  • A first-year college student up through age 21 years who is living in a residence hall should receive a dose if he or she did not receive a dose on or after his or her 16th birthday.

  • Adults who have certain high-risk conditions should receive one or more doses of vaccine.

  • Hepatitis A vaccine.

  • Adults who wish to be protected from this disease, have certain high-risk conditions, work with hepatitis A-infected animals, work in hepatitis A research labs, or travel to or work in countries with a high rate of hepatitis A should be immunized.

  • Adults who were previously unvaccinated and who anticipate close contact with an international adoptee during the first 60 days after arrival in the United States from a country with a high rate of hepatitis A should be immunized.

  • Hepatitis B vaccine.

  • Adults who wish to be protected from this disease, have certain high-risk conditions, may be exposed to blood or other infectious body fluids, are household contacts or sex partners of hepatitis B positive people, are clients or workers in certain care facilities, or travel to or work in countries with a high rate of hepatitis B should be immunized.

  • Haemophilus influenzae type b (Hib) vaccine.

  • A previously unvaccinated person with asplenia or sickle cell disease or having a scheduled splenectomy should receive 1 dose of Hib vaccine.

  • Regardless of previous immunization, a recipient of a hematopoietic stem cell transplant should receive a 3-dose series 6–12 months after his or her successful transplant.

  • Hib vaccine is not recommended for adults with HIV infection.


Annual screening for vision and hearing problems is recommended. Vision should be screened objectively at least once between 18–21 years of age. The young adult may be screened for anemia or tuberculosis. Young adults should have a blood test to check for high cholesterol during this time period. Young adults should be screened for use of alcohol and drugs. If the young adult is sexually active, screening for sexually transmitted infections, pregnancy, or HIV may be performed.


  • Adequate calcium intake is important. Consume 3 servings of low-fat milk and dairy products daily. For those who do not drink milk or consume dairy products, calcium enriched foods, such as juice, bread, or cereal, dark, leafy greens, or canned fish are alternate sources of calcium.

  • Drink plenty of water. Limit fruit juice to 8–12 ounces (240–360 mL) each day. Avoid sugary beverages or sodas.

  • Discourage skipping meals, especially breakfast. Young adults should eat a good variety of vegetables and fruits, as well as lean meats.

  • Avoid foods high in fat, salt, or sugar, such as candy, chips, and cookies.

  • Encourage young adults to participate in meal planning and preparation.

  • Eat meals together as a family whenever possible. Encourage conversation at mealtime.

  • Limit fast food choices and eating out at restaurants.

  • Brush teeth twice a day and floss.

  • Schedule dental exams twice a year.


Regular sleep habits are important.


  • One hour of regular physical activity daily is recommended. Continue to participate in sports.

  • Encourage young adults to develop their own interests and consider community service or volunteerism.

  • Provide guidance to the young adult in making decisions about college and work plans.

  • Make sure that young adults know that they should never be in a situation that makes them uncomfortable, and they should tell partners if they do not want to engage in sexual activity.

  • Talk to the young adult about body image. Eating disorders may be noted at this time. Young adults may also be concerned about being overweight. Monitor the young adult for weight gain or loss.

  • Mood disturbances, depression, anxiety, alcoholism, or attention problems may be noted in young adults. Talk to the caregiver if there are concerns about mental illness.

  • Negotiate limit setting and independent decision making.

  • Encourage the young adult to handle conflict without physical violence.

  • Avoid loud noises which may impair hearing.

  • Limit television and computer time to 2 hours each day. Individuals who engage in excessive sedentary activity are more likely to become overweight.


  • Sexually active young adults need to take precautions against pregnancy and sexually transmitted infections. Talk to young adults about contraception.

  • Provide a tobacco-free and drug-free environment for the young adult. Talk to the young adult about drug, tobacco, and alcohol use among friends or at friend's homes. Make sure the young adult knows that smoking tobacco or marijuana and taking drugs have health consequences and may impact brain development.

  • Teach the young adult about appropriate use of over-the-counter or prescription medicines.

  • Establish guidelines for driving and for riding with friends.

  • Talk to young adults about the risks of drinking and driving or boating. Encourage the young adult to call you if he or she or friends have been drinking or using drugs.

  • Remind young adults to wear seat belts at all times in cars and life vests in boats.

  • Young adults should always wear a properly fitted helmet when they are riding a bicycle.

  • Use caution with all-terrain vehicles (ATVs) or other motorized vehicles.

  • Do not keep handguns in the home. (If you do, the gun and ammunition should be locked separately and out of the young adult's access.)

  • Equip your home with smoke detectors and change the batteries regularly. Make sure all family members know the fire escape plans for your home.

  • Teach young adults not to swim alone and not to dive in shallow water.

  • All individuals should wear sunscreen when out in the sun. This minimizes sunburning.


Young adults should visit their pediatrician or family physician yearly. By young adulthood, health care should be transitioned to a family physician or internal medicine specialist. Sexually active females may want to begin annual physical exams with a gynecologist.