The coronavirus outbreak has pushed millions of Americans, especially young adults, to move in with family members. The share of 18- to 29-year-olds living with their parents has become a majority since U.S. coronavirus cases began spreading early this year, surpassing the previous peak during the Great Depression era.
In July, 52% of young adults resided with one or both of their parents, up from 47% in February, according to a new Pew Research Center analysis of monthly Census Bureau data. The number living with parents grew to 26.6 million, an increase of 2.6 million from February. The number and share of young adults living with their parents grew across the board for all major racial and ethnic groups, men and women, and metropolitan and rural residents, as well as in all four main census regions. Growth was sharpest for the youngest adults (ages 18 to 24) and for White young adults.
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The COVID-19 outbreak has affected data collection efforts by the U.S. government in its surveys, especially limiting in-person data collection. This resulted in a 15.3 percentage point decrease in the response rate for the CPS in July 2020. It is possible that some measures of employment and enrollment and its demographic composition are affected by these changes in data collection.
The total number of young adults living with parents would have been even higher had we included those living with the parents of their spouse or partner. Among 18- to 29-year-olds, 1.3%, or 680,000 people, did so in July 2020, according to the CPS; this group has remained relatively stable over the past decade. We omitted this group to be consistent with the historical decennial census data.
The share of young adults living with their parents is higher than in any previous measurement (based on current surveys and decennial censuses). Before 2020, the highest measured value was in the 1940 census at the end of the Great Depression, when 48% of young adults lived with their parents. The peak may have been higher during the worst of the Great Depression in the 1930s, but there is no data for that period.
These new living arrangements may have an impact not just on young adults and their families, but on the U.S. economy overall, reflecting the importance of the housing market to overall economic growth. Even before the outbreak, the growth in new households trailed population growth, in part because people were moving in with others. Slower household growth could mean less demand for housing and household goods. There also may be a decline in the number of renters and homeowners, and in overall housing activity. Between February and July 2020, the number of households headed by an 18- to 29-year-old declined by 1.9 million, or 12%. The total went from 15.8 million to 13.9 million.
The pattern is consistent with employment losses since February. The youngest adults have been more likely than other age groups to lose their jobs or take a pay cut. The share of 16- to 24-year-olds who are neither enrolled in school nor employed more than doubled from February (11%) to June (28%) due to the pandemic and consequent economic downturn.
It is worth noting that in these Current Population Survey numbers, unmarried students who reside in on-campus college dorms are counted as living in their family home, so any increase in young adults living with parents this year would not be due to the pandemic-related closure of college dorms in the spring.
In past decades, White young adults have been less likely than their Asian, Black and Hispanic counterparts to live with their parents. That gap has narrowed since February as the number of White young adults living with their mothers and/or fathers grew more than for other racial and ethnic groups.
Young men are more likely than young women to live with their parents, and both groups experienced increases in the number and share residing with mom, dad or both parents since the beginning of the coronavirus outbreak. Similarly, a higher share of young adults in metropolitan areas compared with rural ones live with their parents now, but the number in both areas grew from February to July.
By region, the number and share of young adults living with parents grew throughout the country. Growth was sharpest in the South, where the total rose by more than a million and the share increased by 7 percentage points, from 46% to 52%. But the Northeast retained its status as the region where the highest share of young adults live with parents (57%).
I once received a sign-out on a patient from the emergency department for a well-appearing young child who was admitted for a urinary tract infection. Normally, a simple urinary tract infection does not warrant a hospital admission, so I asked further questions. The emergency room attending added that the patient received a prescription for oral antibiotics at an earlier emergency room visit, but the parents did not pick up the medication. Passively, the attending mentioned that the parent's "noncompliance" necessitated the admission.
This statement bothered me. The label of noncompliance presupposed an intentional choice on the part of the family to ignore medical advice. After speaking at length with the family, they revealed that transportation issues and the father's work schedule prevented them from picking up the medication. The interaction reminded me about the need to practice with cultural competence, and, further, how implicit bias can surreptitiously insert itself in our daily interactions.
Cultural competency is defined as acquiring the knowledge and skills necessary to address the needs and vulnerabilities of different populations in order to provide access and care. Born out of the social psychology movement of the 1980s, it was quickly adapted to healthcare with two books by the Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare and Who Will Keep the Public Healthy?.
Later development of cultural competency courses worked to sensitize healthcare providers to the conditions faced by the underserved and most affected by health inequalities, namely ethnic and racial minorities.
Culture is not solely defined through a racial or ethnic context. Health advocacy consultant Karen Fletcher defines culture as "people acting from a similar set of ideas and beliefs about how the world works." She contends that viewing cultural competency through the narrow lens of race or ethnicity focuses too much on differences, thus potentially widening the divide between the "traditional beliefs" of the minority and the more "conventional or mainstream beliefs" of the majority.
Furthermore, as these beliefs are tallied and attributed to groups, the danger of stereotyping presents itself. As effective as cultural competency has been in increasing awareness of the needs of others, more is needed to avoid widening the cultural gap.
Coined more than 20 years ago by Melanie Tervalon, MD, MPH, and Jann Murray-Garcia MD, MPH, cultural humility is defined as "a lifelong process of self-reflection and self-critique." Rather than starting with a goal of understanding others, the individual is tasked with first understanding themselves, their beliefs, and their biases. Culture in this sense is not limited to ethnic or racial scopes. For example, a practice of cultural humility encourages me to explore how I relate to others as a medical doctor, a father, or as an Asian cisgender male. Each of these identities affects how I relate to others as well as how others relate to me.
An awareness of our lack of knowledge about others' beliefs and values, coupled with a recognition of our assumptions, prejudices, and the power imbalances that may be present (such as the physician-patient relationship)
The relationships fostered by cultural humility mean that cultural competency is no longer a binary goal of mastering knowledge about particular groups. Instead, it is about striving to understand the dynamic process of culture and how it can influence both ourselves and others.
Patient-centered care is one of the six domains of quality healthcare defined by the Institute of Medicine. Adopting a more culturally humble and competent approach enriches not only our professional lives but also our personal lives.
The remainder of my patient's hospital stay was uneventful but yielded additional details of her home life. I learned that her father worked a construction job that made it difficult for him to leave work. I learned about other young family members in the household that prevented her mother from leaving to fetch the medicine. The family also struggled with language and transportation barriers daily. In addition, I learned how I took for granted the ease with which I can obtain whatever my family needs. This was not a simple story of being "noncompliant" by choice; this was a story of being unable to comply for lack of one. It is a stark reminder that with regard to cultural competence and humility, my journey has only just begun.
Assistant Professor of Pediatrics, Pediatric Hospitalist, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
Disclosure: Giancarlo Toledanes, DO, has disclosed no relevant financial relationships.
Talk to some of the folks who lived through the bombing of 62nd and Osage Avenue in West Philadelphia 30 years ago, and you'll notice that they refer to the MOVE bombing simply by its full date. May 13, 1985.
That's how Perry Moody refers to it, too. His house is on the north side of Pine Street. On that day three decades ago, he was evacuated from the block but watched from nearby as the houses on the other side of the street were swallowed up by flames.
Ramona Africa refers to it that way, too. She was inside the targeted house at 6221 Osage while it was battered by police bullets and deluge guns and, eventually, brought down by a makeshift bomb dropped from a police helicopter. Ramona Africa managed to escape the burning building. Her compatriots in MOVE, the radical organization to which she belonged and that had been engaged in a standoff with the City of Philadelphia, were not so fortunate. 152ee80cbc
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