Youth risk behavior surveillance--United States, 1993

Patterns of maladaptive exercise behavior from ages 14-24 in a longitudinal cohort

BACKGROUND

Exercise for weight loss and maladaptive exercise (exercise that results in negative consequences or interference with daily life) are common behaviors among youth and are associated with increased risk of disordered eating symptoms. The current study clarifies processes that influence exercise-related risk in adolescence and young adulthood, including the frequency with which young people transition between engaging in exercise for weight loss and experiencing negative consequences of this behavior.

METHOD

Participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) reported on eating disorder cognitions at age 14, and exercise behavior at ages 14, 16, 18, and 24 years old. Analyses examined rates of transition between the categories of 'No Exercise for Weight Loss', 'Exercise for Weight Loss', and 'Maladaptive Exercise' over time, identified overall trends in endorsement of exercise for weight loss and maladaptive exercise, and clarified predictors of these behaviors.

RESULTS

Endorsement of exercise for weight loss and maladaptive exercise increased over time in both males and females. Those in the 'Exercise for Weight Loss' category were more likely than those in the 'No Exercise for Weight Loss Category' to transition to 'Maladaptive Exercise' over time. Body mass index (Age 13) and fear of weight gain (Age 14) were consistent predictors of maladaptive exercise across sex.

CONCLUSIONS

Results support re-framing motivations for exercise in youth away from weight loss at a population level and targeting reductions in fear of weight gain for high-risk individuals.

Relationship between physical activity, screen-related sedentary behaviors and anxiety among adolescents in less developed areas of China

This study aimed to explore the association between physical activity, screen-related sedentary behaviors, and anxiety. The current study used latent profile analysis (LPA) to identify homogenous subtypes of anxiety among adolescents in less-developed areas of China. Data were aggregated from 6 schools in the less-developed areas of China in September 2018. In total, 900 students were evaluated using the 100-item Mental Health Test (MHT) and Youth Risk Behavior Surveillance System (YRBSS) questionnaire. The LPA was conducted to explore the potential classification of anxiety, which makes full use of all the sample data and explore heterogeneous classifications within groups. Logistic regression was used for the multifactor analysis. A P value <.05 was considered statistically significant. The entropy value suggested that the model with 3 latent profile was the best choice. There were 223 adolescents in the severe anxiety group, accounting for 24.78%. Logistics regression analysis of anxiety revealed that the risk of severe anxiety in boys was lower (odds ratio [OR] = 0.317, P < .001) than in girls. Students had a significantly lower probability of suffering from severe anxiety in using cellphones or computers ≤ 2 hours/day than those used cellphones or computers＞2 hours/day (OR = 0.391, P = .004). Decreasing screen-related sedentary behaviors should be a target of community and school-based interventions, because high screen-related sedentary behaviors were associated with higher odds of anxiety among adolescents in less developed area of China.

Mother's and Father's Migrating in China: Differing Relations to Mental Health and Risk Behaviors Among Left-Behind Children

Background

In China, the figure for left-behind children (LBC) of migrants stood at 68. 77 million in 2015. Despite being seen as a whole in the last few decades, LBC today differ broadly in parental migrating status. This study focused on LBC with both parents migrating (BLBC), LBC with only mothers migrating (MLBC), LBC with only fathers migrating (FLBC), and previous LBC with one or both parents migrating (PLBC), separately. We aimed at exploring the extent to which LBC were being affected by each migrant parent on both mental health and risk behaviors.

Methods

Data from 4,832 children were collected by a school-based survey in both rural and urban areas of China's Anhui province. Each participant anonymously completed a self-administered questionnaire containing the sociodemographics, the Strength and Difficulties Questionnaire (SDQ), the items from the Youth Risk Behavior Surveillance System (YRBSS), and Young's Internet Addiction Test for Chinese (YIAT-C). Data were analyzed using one-way ANOVA and the Chi-squared test. Associations were estimated by multiple linear regression and logistic regression analyses adjusted for several confounders.

Results

The results suggested that BLBC (p &lt; 0.001), MLBC (p &lt; 0.05), FLBC (p &lt; 0.01), and PLBC (p &lt; 0.001) significantly scored higher for total difficulties along with emotional symptoms and conduct problems than never left-behind children (NLBC). Besides, BLBC, FLBC, and PLBC further reported a significantly higher rate of smoking (p &lt; 0.001, p &lt; 0.01, and p &lt; 0.001, respectively) and drinking (p &lt; 0.01, p &lt; 0.05, and p &lt; 0.01, respectively) than did NLBC. Also, MLBC appeared higher risks of smoking problems [OR = 2.31, 95% CI (1.45–3.69), p &lt; 0.001] and the internet addiction [OR = 2.15, 95% CI (1.24–3.72), p &lt; 0.01], when compared to NLBC.

Conclusions

The findings provided insight into LBC within the different contexts of parental migrations and contributed to a better understanding of their specific and potentially persistent health risks. Correspondingly, the study highlighted the implications for differentiating LBC to capture the more vulnerable group and tailored interventions to prioritize.

Prospective Associations Between Driven Exercise and Other Eating Disorder Behaviors in Adolescence: A Longitudinal Cohort Study

PURPOSE

Dysfunctional exercise is a common, debilitating symptom across eating disorders (ED). We examined the cross-sectional and longitudinal associations between experiences of exercise and ED behaviors and cognitions in an adolescent, population-based sample.

METHODS

Adolescents (n = 4,054) self-reported whether they exercised to control shape and weight (exercise for weight loss [EWL]), and, if so, whether they exercised even when injured, and whether exercise interfered with life functioning (driven exercise) at age 14 years, allowing delineation of three exercise-based groups: no-EWL, EWL, and driven exercise. Participants also reported ED cognitions at age 14 years along with other ED behaviors (fasting, purging, binge eating) at ages 14 and 16 years. Sex-stratified regression approaches were employed to examine relationships between these exercise categories at age 14 and ED behaviors and cognitions at ages 14 and 16.

RESULTS

Cross-sectionally, those in the driven exercise group, compared to the no-EWL group, consistently reported higher levels of ED cognitions and behaviors, with those in the EWL group also reporting higher levels of some ED cognitions and behaviors relative to the no-EWL group. Those in the EWL and driven exercise groups at age 14 also demonstrated a higher prospective likelihood of fasting (boys and girls) and purging (girls only) at age 16, relative to those in the no-EWL group at age 14.

DISCUSSION

Results inform our understanding of EWL and driven exercise and the developmental timing of ED behaviors in adolescence and point toward the potential utility of targeted prevention for young people who report EWL.

Anxiety disorder symptoms at age 10 predict eating disorder symptoms and diagnoses in adolescence

BACKGROUND

Cross-sectional associations between anxiety disorders and eating disorders (EDs) have been well documented; however, limited research has examined whether symptoms of anxiety disorders are prospectively associated with EDs. Identifying these longitudinal associations can aid in discerning relationships among eating and anxiety disorders and point toward a mechanistic understanding of developmental psychopathology. This study investigated the prospective associations between parent-reported anxiety in mid-childhood (age 10) and child-reported ED behaviors and disorders in adolescence (at ages 14 and 16 years) in a population-based sample.

METHODS

Participants were individuals enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based, prospective study of women and their children; 7,767 children whose parents provided data at age 10 were included in current analyses. An exploratory factor analysis identified latent anxiety factors at age 10, followed by a path analysis that evaluated associations between these factors and eating disorder symptoms and cognitions at age 14.

RESULTS

Parent-reported anxiety symptoms at age 10 yielded 5 factors: obsessive-compulsive disorder (OCD) symptoms related to symmetry and checking (Factor 1); OCD symptoms associated with aversion to dirt and germs (Factor 2); physical anxiety symptoms (Factor 3); worries (Factor 4); and social phobia symptoms (Factor 5). Factors 3 and 4 showed the most consistent, positive associations with a range of ED symptoms at age 14. Factor 3 predicted diagnosis of bulimia nervosa by age 16 (OR = 1.11, p = .007), whereas Factor 4 predicted diagnoses of anorexia nervosa (OR = 1.10, p = .01) and disordered eating by age 16 (OR = 1.08, p = .001).

CONCLUSIONS

Results indicate that symptoms of generalized anxiety in middle childhood may predict adolescent-onset ED symptoms and ED diagnoses.

Do disordered eating behaviours in girls vary by school characteristics? A UK cohort study

Previous research on eating disorders, disordered eating behaviours, and whether their prevalence varies across schools, has produced inconsistent results. Our previous work using Swedish record-linkage data found that rates of diagnosed eating disorders vary between schools, with higher proportions of girls and higher proportions of highly educated parents within a school being associated with greater numbers of diagnosed eating disorders. We aimed to extend these findings to a UK population-based sample and hypothesised that a similar association would be evident when studying disordered eating behaviours. We used data from the Avon Longitudinal Study of Parents and Children to test the hypothesis that prevalence of self- and parent-reported disordered eating behaviours (binge eating, purging, fasting, restrictive eating, and fear of weight gain), and body dissatisfaction cluster by school. We had complete data on body dissatisfaction, school attended, and other possible risk factors for 2146 girls in 263 schools at age 14 and on disordered eating behaviours for 1769 girls in 273 schools at age 16. We used multilevel logistic regression modelling to assess whether prevalence varied between and within schools, and logistic regression to investigate the association between specific school characteristics and prevalence of disordered eating behaviours and body dissatisfaction. At age 14, there was no evidence for body dissatisfaction clustering by school, or for specific school characteristics being associated with body dissatisfaction. At age 16, there was no evidence for clustering, but higher rates of disordered eating behaviours were associated with attending all-girl schools and lower levels with attending schools with higher academic results. We found no evidence for clustering of disordered eating behaviours in individual schools, possibly because of the small cluster sizes. However, we found evidence for higher levels of disordered eating behaviours in 16 years in all-girl schools, and in schools with lower academic performance.

Suicidal ideation and attempts among court-involved, non-incarcerated youth

Over the past decade, suicide remains one of the leading causes of death among adolescents and a public health priority. Court-involved non-incarcerated juvenile justice youth frequently present with risk factors for suicide. Among these court-involved youth, 14% (n=50) endorsed a lifetime history of suicide ideation and attempts. Three main factors were associated with increased risk: prior offense, substance use, and childhood sexual abuse histories. This study highlights the importance of understanding suicidal behavior among non-detained juvenile justice populations. Community-based court involvement provides a rare opportunity to coordinate screening and suicide prevention efforts for youth and their families.

Individual- and community-level correlates of cigarette-smoking trajectories from age 13 to 32 in a U.S. population-based sample

BACKGROUND

Characterizing smoking behavior is important for informing etiologic models and targeting prevention efforts. This study explored the effects of both individual- and community-level variables in predicting cigarette use vs. non-use and level of use among adolescents as they transition into adulthood.

METHODS

Data on 14,779 youths (53% female) were drawn from the National Longitudinal Study of Adolescent Health (Add Health); a nationally representative longitudinal cohort. A cohort sequential design allowed for examining trajectories of smoking typologies from age 13 to 32 years. Smoking trajectories were evaluated by using a zero-inflated Poisson (ZIP) latent growth analysis and latent class growth analysis modeling approach.

RESULTS

Significant relationships emerged between both individual- and community-level variables and smoking outcomes. Maternal and peer smoking predicted increases in smoking over development and were associated with a greater likelihood of belonging to any of the four identified smoking groups versus Non-Users. Conduct problems and depressive symptoms during adolescence were related to cigarette use versus non-use. State-level prevalence of adolescent smoking was related to greater cigarette use during adolescence.

CONCLUSIONS

Individual- and community-level variables that distinguish smoking patterns within the population aid in understanding cigarette use versus non-use and the quantity of cigarette use into adulthood. Our findings suggest that efforts to prevent cigarette use would benefit from attention to both parental and peer smoking and individual well-being. Future work is needed to better understand the role of variables in the context of multiple levels (individual and community-level) on smoking trajectories.

Predictors of cigarette smoking behavior among military university students in Taiwan

BACKGROUND

The smoking rate among Taiwanese adolescents remains high. In any age group, smoking behavior can be influenced by personal, social, and familial factors. In adolescents, many factors, including psychological, physical, emotional, and interpersonal relationships, both social and familial, interact to influence smoking behavior. At present, no data are available on smoking behavior in military students in Taiwan. Understanding the factors that influence smoking behavior is a critical element in smoking cessation programs.

PURPOSE

The purpose of this study was to investigate the prevalence and predictors of smoking behaviors among military university students in Taiwan.

METHODS

Using a cross-sectional design, 2,477 students were recruited for this study from seven universities across Taiwan. Structured questionnaires were used to collect data covering demographics, family environment, school environment, cigarette smoking attitudes, self-efficacy, and cigarette smoking behaviors. Both descriptive statistics and logistic regression were for the data analysis. A probability threshold of.05 was considered as statistically significant.

RESULTS

The prevalence of smoking among students in Taiwan has been recently reported as 5.7%. Of this number, 12.8% started smoking after enrollment in school and 33.3% became regular smokers. The main reason for first contact with smoking was curiosity. Avoiding the stress and the difficulties of smoking cessation explained continuing smoking behaviors. Over 80% of smokers attempted to quit but could not decide when to start. Age, peer influence, and self-efficacy were major predictors of student smoking behaviors.

CONCLUSIONS/IMPLICATIONS

Smoking prevalence was not high among these students. However, more than one in four smokers became regular smokers after enrollment at school. Tobacco control and prevention strategies proved to be of vital importance, as peer influence and self-efficacy represented major predictors of smoking behaviors.

Resilience and patterns of health risk behaviors in California adolescents

OBJECTIVES

Assess whether adolescent health risk behaviors cluster, and whether resiliency factors are associated with observed clusters.

METHODS

The cross-sectional population-weighted 2003 California Health Interview Survey was used (N=4010). Four gender-specific clusters were based on smoking, alcohol use, low fruit/vegetables consumption, and physical inactivity. Resiliency factors included parental supervision, parental support, role model presence and adolescent mental health. Conditional regression was used to measure the association of individual health risk behaviors and clusters with resiliency factors.

RESULTS

Health risk behaviors clustered as follows: "Salutary Adherents" (no reported health risk behaviors), "Active Snackers" (physically active, low fruit/vegetable consumers), "Sedentary Snackers" (physically inactive, low fruit/vegetable consumers), and "Risk Takers" (smokers, alcohol users, many also physically inactive and low fruit/vegetable consumers). Greater parental supervision was associated with lower odds of being in unhealthful clusters. Among males, having greater parental support reduced odds of being an "Active Snacker" or "Sedentary Snacker." Among females, role model presence reduced odds of being in unhealthful clusters, while depressiveness increased the odds.

CONCLUSIONS

Health promoting interventions should address multiple health risk behaviors in an integrated fashion. Gender-specific, ethnically-targeted, family-centered strategies that address parenting, particularly parental supervision would be useful. Addressing depressiveness may be especially important for female adolescents.

The psychologic context of pediatric diabetes

During the past few decades, there has been an explosion of behavioral science research on family management of pediatric diabetes. This article distills the major conclusions from that literature, emphasizing how primary care providers can apply these findings in clinical practice.

Dating violence and sexual risk behaviors in a sample of at-risk Israeli youth

OBJECTIVE

This exploratory study examines the reported dating violence and its association with sexual risk behavior among Israeli adolescents, who are at risk for dropping out of school.

METHODOLOGY

A convenience sample of 105 at-risk youth (51 boys and 54 girls) completed self-administered anonymous, questionnaires in small same-gender groups. The questionnaire included a Hebrew version of the Conflict in Adolescent Dating Relationships Inventory, a valid scale developed in the US especially for adolescents, the Hebrew version of the Conflict Tactics Scale and the Self-Efficacy to Refuse Sexual Behavior Scale.

RESULTS

We found high rates of perpetration of verbal-emotional abuse for both girls and boys. Rates of reported victimization by physical abuse were higher among boys but that by sexual abuse were higher among girls. We found a moderate inverse association between victimization by dating violence and practicing safe sex among girls. There was a similar but much stronger association for boys who were victims of dating violence.

CONCLUSIONS

The high rates of various types of dating violence in Israel, at least among at-risk adolescents, should raise concern and motivate designing and implementing specific prevention interventions. The high reported rates of victimization from dating violence among boys are somewhat surprising and call for special attention and more indepth studies.

Hi5+: systematic development of a family intervention to increase fruit and vegetable intake

This article describes the development of a peer-led home-based intervention to increase fruit and vegetable (FV) intake and family interaction among fourth graders and their families. Hi5+ intervention content and delivery strategies were developed using two complementary processes: cognitive mapping (CM), a consumer-based approach to identifying salient issues, and intervention mapping (IM), a comprehensive planning model. Step 1 involved creating plans to guide the design, implementation, and evaluation of Hi5+. We delineated our performance objectives and then prioritized those determinants we felt were most salient and changeable. Step 2 involved selecting and utilizing cognitive and behavioral theory constructs to develop intervention methods and strategies. Step 3 involved designing and pilot testing the instructional materials and other intervention components. Step 4 entailed developing plans for program adoption and implementation, while the final step (Step 5) involved creating a comprehensive evaluation plan. Implications of this multistep approach to intervention development are discussed.

Youth Resilience Framework for reducing health-risk behaviors in adolescents

Adolescents engage in risky behaviors that compromise their health. Leading causes of morbidity and mortality are associated with a few preventable health-risk behaviors initiated in childhood and early adolescence. Interventions that enhance protective factors in childhood are needed to offset these vulnerabilities and thus promote the health of adolescents. The Youth Resilience Framework is presented that addresses individual and sociocultural risk factors and protective resources that can influence health outcomes throughout adolescence. This framework incorporates a developmental approach to address precursors and health-risk behaviors that may be amenable to early health-promoting interventions.

Impact of television viewing patterns on fruit and vegetable consumption among adolescents

BACKGROUND

National data indicate that children and youth do not meet Healthy People 2010 objectives for fruit and vegetable intake. Television viewing is hypothesized as a contributing factor because of its documented role in encouraging consumption of highly advertised foods that may lead to the replacement of fruits and vegetables.

METHODS

A sample of 548 ethnically diverse students (average age: 11.7 +/- 0.8 years) from public schools in 4 Massachusetts communities were studied prospectively over a 19-month period from October 1995 to May 1997. We examined the associations between baseline and change in hours of television and video viewing per day (the predictor variables) and change in energy-adjusted intake of fruits and vegetables by using linear regression analyses to control for potentially confounding variables and the clustering of observations within schools.

FINDINGS

For each additional hour of television viewed per day, fruit and vegetable servings per day decreased (-0.14) after adjustment for anthropometric, demographic, dietary variables (including baseline percent energy from fat, sit-down dinner frequency, and baseline energy-adjusted fruit and vegetable intake), and physical activity. Baseline hours of television viewed per day was also independently associated with change in fruit and vegetable servings (-0.16).

CONCLUSIONS

Television viewing is inversely associated with intake of fruit and vegetables among adolescents. These associations may be a result of the replacement of fruits and vegetables in youths' diets by foods highly advertised on television.

Predictors of reported consumption of low-nutrient-density foods in a 24-h recall by 8–16 year old US children and adolescents

The purpose of this study was to develop an explanatory model to predict the number of low-nutrient-density (LND) foods reported in a 24-h recall by US children and adolescents using data from the third National Health and Nutrition Examination Survey. The reported number of LND foods was estimated from 24-h dietary recall data for 8-16 year old respondents (n=4137; 2024 males and 2113 females). The LND foods included--baked and dairy desserts, sweeteners, salty snacks, visible/discretionary fat, and miscellaneous. The predictive ability of socio-demographic, family, weight/dieting related, life-style or food consumption related subject characteristics was determined using multiple linear regression analyses. The strongest independent negative predictor of the reported number of LND foods was the amount of nutrient-dense foods from the five major food groups. In addition, number of eating occasions reported was a significant independent positive predictor, and the weekly frequency of consuming a complete school lunch was a significant independent negative predictor of the reported number of LND foods. These models explained approximately 55% of the variance in LND food reporting in both males and females. Socio-demographic, family, body weight, or lifestyle characteristics contributed little to predicting the number of LND foods reported in a 24-h recall.

Eating patterns and obesity in children. The Bogalusa Heart Study

BACKGROUND

Childhood obesity is a growing public health problem. This study examined the association between eating patterns and overweight status in children who participated in the Bogalusa Heart Study.

METHODS

A single 24-hour dietary recall was collected on a cross-sectional sample of 1562 children aged 10 years (65% Euro-American [EA], 35% African American [AA]) over a 21-year period. Overweight was defined as body mass index greater than the 85th percentile using Centers for Disease Control and Prevention reference standards. Multivariate logistic regression was used to investigate the association between eating patterns and overweight.

RESULTS

Consumption of sweetened beverages (58% soft drinks, 20% fruit flavor drinks, 19% tea, and 3% coffee) (p<0.001); sweets (desserts, candy, and sweetened beverages) (p<0.001); meats (mixed meats, poultry, seafood, eggs, pork, and beef) (p<0.051); and total consumption of low-quality foods (p<0.01) were positively associated with overweight status. Total amount of food consumed, specifically from snacks, was positively associated with overweight status (p<0.05). There was a lack of congruency in the types of eating patterns associated with overweight status across four ethnic-gender groups. The percent variance explained from the eating pattern-overweight models was very small. The interaction of ethnicity and gender was significantly associated with overweight status (p<0.001). The odds of being overweight for EA males were 1.2 times higher than for AA females.

CONCLUSIONS

These results demonstrate that numerous eating patterns were associated with overweight status, yet the odds of being overweight were very small. Additional studies are needed to confirm these findings in a longitudinal sample having multiple days of assessment.

The utility of Cox's Interaction Model to direct the assessment and prevention of adolescent aggression

The current study of violence prevention is hampered by a lack of consensus on the definition of violence. There is, however, some agreement about the behavioral cues that may predict violent behavior such as aggression. Although it has been shown that individual-level variables (e.g., race, gender, and ethnicity) are correlated with aggressive behavior, it is clear that they alone are not explanatory of aggressive behavior. This article demonstrates how the Interaction Model of Client Health Behavior is an important health behavior framework for the assessment of aggression in adolescents, offering insight into the contextual nature of adolescent aggression. Victimization and witnessing of violence, frequently identified to be precursors of adolescent aggression in current epidemiologic studies, are examined within this framework. On the basis of the interactional nature of the phenomenon, necessary components for successful prevention programs are suggested. Finally, future research implications calling for a well-designed study that integrates individual and contextual variables with the use of this theory-driven explanatory framework are proposed.

Sexual Risk Taking in Adolescence: The Role of Self-Regulation and Attraction to Risk

Precursors of adolescent sexual risk taking were examined in a multiethnic sample consisting of 443 children (51% girls) of National Longitudinal Survey of Youth participants. Respondents were 12-13 years old in 1994 and 16-17 in 1998. Controlling for demographic and contextual factors, self-regulation--but not risk proneness--was significantly (modestly) associated with overall sexual risk taking 4 years later. Analyses of individual sexual behaviors indicated that self-regulation may affect choices made after becoming sexually active (e.g., number of partners) rather than the initiation of sexual activity. Measures of parent and peer influence had independent effects on sexual risk taking but did not moderate the effects of self-regulation and risk proneness. Findings add to the growing literature on implications of self-regulation for individual development.

Association of self-perceived body weight status with dietary reporting by U.S. teens

OBJECTIVE

Children's self perception of body weight and the medical definition of obesity show poor correlation. This study examined the independent associations of body mass index (BMI) and self-perceived weight status (considered self over-, under-, or right weight) with food reporting, nutrient intake estimates, and biomarkers of dietary exposure.

RESEARCH METHODS AND PROCEDURES

Dietary (one 24-hour recall), anthropometric, and biochemical data were from the third National Health and Nutrition Examination Survey (1269 boys and 1385 girls, ages 12 to 18 years). Sex-specific multiple regression analyses were used to determine the association of BMI and self-perceived body weight status with reported intakes of energy, macronutrients, low-nutrient-dense foods, micronutrients, and serum concentrations of selected vitamins and carotenoids.

RESULTS

Reported intakes of energy, macronutrients, number of eating occasions, percentage of energy from low-nutrient-dense foods, likelihood of meeting the standard of intake of micronutrients, and biomarkers were not different among boys and girls who perceived themselves as overweight relative to those who perceived themselves at the right weight (p > 0.05). In boys, BMI was a negative predictor of percentage of energy from low-nutrient-dense foods (p = 0.004) and intake of ascorbic acid (p = 0.04). BMI was inversely related to serum concentrations of most carotenoids (p < or = 0.002).

DISCUSSION

Perceiving oneself as overweight was not associated with reporting of low-nutrient-dense foods, macronutrients, micronutrients, and biomarker status; BMI, however, was a significant predictor of several outcomes.

Gradients in risk for youth injury associated with multiple-risk behaviours: a study of 11,329 Canadian adolescents

This study used the Canadian version of the World Health Organization-Health Behaviour in School-Aged Children (WHO-HBSC) Survey to examine the role of multiple risk behaviours and other social factors in the etiology of medically attended youth injury. 11,329 Canadians aged 11-15 years completed the 1997-1998 WHO-HBSC, of which 4152 (36.7%) reported at least one medically attended injury. Multiple logistic regression analyses failed to identify an expected association between lower socio-economic status and risk for injury. Strong gradients in risk for injury were observed according to the numbers of multiple risk behaviours reported. Youth reporting the largest number (7) of risk behaviours experienced injury rates that were 4.11 times (95% CI: 3.04-5.55) higher than those reporting no high risk behaviours (adjusted odds ratios for 0-7 reported behaviours: 1.00, 1.13, 1.49, 1.79, 2.28, 2.54, 2.62, 4.11; p(trend) < 0.001). Similar gradients in risk were observed within subgroups of young people defined by grade, sex, and socio-economic level, and within restricted analyses of various injury types (recreational, sports, home, school injuries). The gradients were especially pronounced for severe injury types and among those reporting multiple injuries. The analyses suggest that multiple risk behaviours may play an important role in the social etiology of youth injury, but these same analyses provide little evidence for a socio-economic risk gradient. The findings in turn have implications for preventive interventions.

Sources of information on the health effects of environmental tobacco smoke among African-American children and adolescents

PURPOSE

To determine the common sources of information regarding the effects of smoking on health and their relationship to knowledge, attitudes, and preventative efforts regarding exposure to environmental tobacco smoke (ETS) among urban African-American children and adolescents.

METHODS

All students who were enrolled in Grades 5-12 in an urban public school district located in the greater metropolitan area of Detroit, Michigan were surveyed using a structured, written questionnaire that assessed sources of information on the health effects of smoking, as well as knowledge, attitudes, and preventive efforts with respect to exposure to ETS. The primary analytic procedures utilized in the study were correlation analysis and analysis of variance.

RESULTS

The African-American students surveyed in this study received information regarding the health effects of smoking from many sources, most notably television, family, and teachers. Second, students who received information on the effects of smoking on health from family and external sources (teacher, parent's friend, and religious leader) had higher overall knowledge, attitude, and preventive efforts scores than students who received information from other sources (friends, electronic media, and printed media). Finally, family influence was greater when parents were not smokers, and influenced elementary students more than middle school or high school students.

CONCLUSIONS

The active involvement of teachers, religious leaders, parents, and other influential adults should be elicited in tobacco education and prevention efforts to maximize their effectiveness.

Adolescent cigarette smoking and health risk behavior

During the past 30 years, tobacco use among adolescents has substantially increased, resulting in major health problems associated with tobacco consumption. The purpose of this study was to identify adolescent smoking behaviors and to determine the relationship among smoking, specific demographic variables, and health risk behaviors. The sample consisted of 93 self-selecting adolescents. An ex post facto design was used for this study and data were analyzed by using nonparametric statistics. Findings included a statistically significant relationship between lifetime cigarette use and ethnicity. Statistically significant relationships were also found among current cigarette use and ethnicity, alcohol use, marijuana use, suicidal thoughts, and age at first sexual intercourse. Nurses and other providers must recognize that cigarette smoking may indicate other risk behaviors common among adolescents.

Health status and risk behavior of adolescents in the north of Madrid, Spain

PURPOSE

To study the health status and risk behavior in an adolescent population of Madrid, Spain.

METHODS

An anonymous self-administered questionnaire was completed by 2831 pupils aged 14-20 years from urban, suburban, and rural populations in the north of Madrid. A large number of questions were from the Minnesota Adolescent Health Survey questionnaire, which included sociodemographics, health status, drug use, sexual practices, suicidal thoughts, emotional problems, and injury risk. Student's t-test, analysis of variance, and Chi-square statistics are used for analyzing associations between the different variables.

RESULTS

A majority (80%) of students thought they are in good or very good health (better for males than females); 18.3% had had intercourse, the average age of the first intercourse was 15.4 years +/- 1.68 SD for males and 16.1 years +/- 1.46 SD for females. Most (73%) had used some kind of contraception. Eighty-five percent had tried alcohol, and regular use (frequently or every day) was as high as 24%. Males drank more than females (28% vs. 20%); 58.2% of the population drink only during weekends, the percentage increasing with age. Seventy percent of the sample had smoked at least once; 34. 5% reported regular tobacco use and this increased with age. Males smoked less than females (27% vs. 42%); 3.2% smoked more than 20 cigarettes/day. The consumption of illegal drugs was very low (20% had tasted cannabis and use by males was higher). Cocaine, heroin, etc. were used by less than 5%.

CONCLUSION

In general, our adolescents are in good health with most problems being preventable. Sexual activity was lower than in other European and American countries. The consumption of tobacco and alcohol started early and in general was high. Our study confirms the relationship among different health-compromising behaviors. There is a need to implement health promotion and preventive programs for adolescents.

Questioning the psycho-socio-cultural factors that contribute to the cases of suicide attempts: an investigation

Suicide attempts can be described to include all actions taken by an individual to end their life as a result of acute desperation. In parallel with the changes in the make-up of human societies both globally and in this country in recent years, suicide attempts are receiving attention in ever increasing proportions. The current study is aimed at investigating the psycho-socio-cultural factors that contribute to the known cases of suicide attempts. The study included 116 cases admitted to the Emergency Internal Medicine and Surgery Units of the University of Istanbul, Faculty of Medicine Hospital between 1 December 1998 and 31 May 1999. In only 47 cases, a 30-point questionnaire was used in several face-to-face interviews with the patients following the preparation of a clinical case study. In establishing the socio-demographic, socio-cultural and socio-economic attributes of each individual case, a range of contributing effective factors is questioned. Including the specific reasons for each suicide attempt, the emotional state of the individual prior to the suicide attempt, the type of suicide action chosen and reasons for this selection, immediate family structure, personal psychiatric antecedent, substance abuse. The results of our investigations are compared with the existing literature in a multi-faceted discussion.

A coordinated school health program approach to adolescent obesity

Obesity has become one of this country's most significant nutritional diseases. The prevalence of childhood and adolescent obesity has steadily increased over the past 20 years. The risk of developing health problems increases as the obese child becomes an obese adolescent and adult. The 1997 Youth Risk Behavior Survey reports adolescents participate in behaviors that put them at risk for obesity. The recognition of these unhealthy behaviors among our youth has led to the need for early intervention. The Coordinated School Health Program is a mechanism to address adolescent obesity at the school-age level. This program includes an organized set of policies, procedures, and activities intended to protect and promote the health and well-being of students and staff. The eight components of a Coordinated School Health Program (CSHP) include school health services, a healthy school environment, comprehensive school health education, counseling and guidance, physical education, food service, worksite health promotion, and the integration of school and community. This paper describes integration of prevention and treatment strategies for adolescent obesity for each of the eight components of a CSHP.

Substance use in high school students in New South Wales, Australia, in relation to language spoken at home

PURPOSE

To examine for the first time adolescent substance use by ethnicity, given the high proportion of migrants from non-English-speaking countries in New South Wales, (NSW), Australia.

METHODS

Data from four surveys of NSW secondary school students in 1983, 1986, 1989, and 1992 were used for this analysis. The prevalence of substance use by whether English was spoken at home was stratified by sex and age using data from the most recent survey year. Adjusted odds ratios and 95% confidence intervals were produced by simultaneous logistic regression, adjusting for sex, age group, and the interaction term of sex and age for each of these substances, and for each survey year separately. Data from 1989 and 1992 were pooled together to examine rates of substance use by ethnic subgroups which reflect migration patterns.

RESULTS

The prevalence of smoking and alcohol and illicit drug use was consistently lower among NSW adolescents speaking a language other than English at home, compared with those speaking English at home in all survey years. Only the prevalence of solvent sniffing was higher among younger adolescents speaking a language other than English at home. Students from Southeast Asia showed consistently lower rates of usage of all substances compared to all other groups.

CONCLUSIONS

There may be different opportunities for the prevention of adolescent substance use among native English speakers to be gained from non-English-speaking cultures.

School-related violence among high school students in the United States, 1993-1995

Using logistic regression to calculate odds ratios and confidence intervals, this secondary analysis determined statistically significant predictors and prevalence rates for high school students in the United States who carried a weapon, were threatened or injured with a weapon, or were involved in physical fighting on school property from 1993-1995. Geographic region, grade in school, race/ethnicity, and gender were the independent variables. Data regarding school-related violence among adolescents were collected in 1993 and 1995 using the Youth Risk Behavior Survey developed and implemented by the Centers for Disease Control and Prevention. Results indicated gender, race, and grade in school were predictors of school-related violence for students in grades 9-12 from 1993 to 1995. Males were involved in violent acts more often than females. Minority students, especially Hispanics and Blacks, and students in lower grades at school participate in and are victims of violence more often than other students.

Integrative research review of risk behaviors among adolescents in rural, suburban, and urban areas

PURPOSE

The purpose of this integrative review was to describe the state of the science regarding adolescent risk behaviors, with particular emphasis on comparisons among rural, urban, and suburban populations.

METHOD

The review was done at two levels, moving from the major national survey studies which included data collected in the late 1980s up to 1993, to more focused topical areas including studies with data collection and publication between 1990 and 1996 within each identified category of adolescent health issues. A total of 137 published works across several disciplines were reviewed. Suggestions for clinical practice were drawn from the significant research findings. In addition, risk behaviors were compared to national baseline data and objectives.

RESULTS

The level of research in this topic area was primarily descriptive. Currently, only a small portion of the national objectives for decreasing adolescent risk behaviors have been met. Successful intervention programs, although few in number, usually included not only topical education but also adolescent interaction with peers and support systems to raise awareness and change behaviors.

CONCLUSIONS

The risk behaviors for the adolescent population as a whole have been well described. Education alone is not sufficient to change behaviors. Objective outcomes must be identified and health care providers need to use research findings in their practice with adolescents. It is time to intervene with developmentally and culturally appropriate strategies. There was a large gap in the literature regarding risk behaviors and protective factors for rural adolescents. The few studies that included subjects from rural settings indicated that the view that rural adolescents are engaged in fewer or less severe risk behaviors is misleading.

Health risk behaviors of Texas students attending dropout prevention/recovery schools in 1997

This study determined prevalence of health risk behaviors of 9th through 12th grade students attending dropout prevention/recovery alternative schools in Texas in 1997. Participants were 470 youth whose health risk behaviors were assessed using the Youth Risk Behavior Survey in an anonymous, self-administered format. Behaviors measured included frequency of weapon-carrying and fighting, suicide-related behaviors, substance use, and sexual behaviors. A substantial percentage of alternative school students reported participating in behaviors that placed them at acute or chronic health risk. Differences in the prevalence of risk behaviors were noted by gender, racial/ethnic, and age subgroups. In addition, alternative school students frequently engaged in multiple risk behaviors. These findings suggest a need for comprehensive school-based health education/intervention programs to reduce the prevalence of risk behaviors in populations of alternative school students.

Social context, perceived norms and drinking behavior in young people

An anonymous questionnaire was administered to 1,283 middle school/high school students and 930 college students. The students responded to instruments assessing social context of drinking, perceived norms of drinking, alcohol use intensity, and frequencies of impaired driving (DWI) and riding with an impaired driver (RWID). Canonical correlation analyses revealed that in middle school/high school students, there are discernable patterns of association between social context, perceived norm and alcohol abuse measures. Drinking intensity for self was closely related to several social context variables and perceptions of close friends' drinking intensity, whereas RWID and DWI frequencies for self were most strongly associated with different perceived norm variables. Among college students, findings from a canonical analysis showed that both social context and perceived norm variables were related to drinking intensity, though there were not multiple patterns of association among subsets of variables. Overall, the findings indicate that alcohol consumption has linkages to both social context and perceived norms. In contrast, DWI and RWID are closely related only to normative influences.

An investigation of adolescents' substance use behaviors, depressed affect, and suicidal behaviors

Data from a four-wave panel design of 975 adolescents were used to study inter-relationships among suicidal behaviors, depressive symptoms, and substance use behaviors. Persistently high levels of problem drinking and depressive symptoms were associated with higher levels of suicidal thoughts and attempts. Higher levels of depressive symptoms and greater cigarette and illicit drug use distinguished suicidal ideators from attempters. Adolescents attempting suicide reported lower levels of family social support, a greater use of substances to cope with stressors, and a higher density of substance-using peers. Implications of the findings for preventive interventions with high-risk teens are discussed.

Psychosocial concerns and weight control behaviors among overweight and nonoverweight Native American adolescents

OBJECTIVE

To compare the psychosocial and weight-related concerns and weight control, eating, and exercise behaviors of overweight and nonoverweight Native American adolescents living on or near reservations.

STUDY DESIGN

A cross-sectional survey assessed psychosocial, health, and weight-specific concerns; disordered eating; and health-promoting behaviors.

STUDY POPULATION

The study population included 11,868 Native American youth in grades 7 through 12.

STATISTICAL ANALYSES PERFORMED

Analyses of variance and chi 2 tests were used to examine associations between weight status and psychosocial and weight-related concerns and behaviors. Stratified analyses were done by gender and by gender and age.

RESULTS

Self-reported weights and heights indicated that 25% of the study population was overweight. Overweight youth were twice as likely to report health concerns as nonoverweight youth. Although a high percentage of nonoverweight youth expressed body- or weight-related concerns and reported engaging in disordered eating behaviors, prevalence rates for these concerns were significantly higher among overweight youth. Overweight youth were also somewhat less likely to engage in health-promoting behaviors. In contrast, differences in global psychosocial concerns were minimal.

APPLICATIONS

Overweight Native American youth were concerned about their weight, but did not appear to have major psychosocial concerns associated with being overweight. Interventions aimed at obesity prevention and overall health promotion are essential, given the high prevalence of obesity and of psychosocial and weight-related concerns and behaviors among the study population as a whole. The challenge is to develop culturally appropriate interventions aimed at the promotion of healthful weight control behaviors that will not lead to negative psychosocial consequences.

Adolescent females' attitudes, subjective norms, perceived behavioral control, and intentions to use latex condoms

Guided by I. Ajzen's (1991) theory of planned behavior, the authors of this descriptive correlational study explored adolescent females' attitudes, subjective norms (social pressure), perceived behavioral control, and intentions with regard to latex condom use. An elicitation study was initially conducted (n = 16) to ascertain salient beliefs related to condom use. These beliefs were then used to develop a questionnaire administered during the main study to 60 sexually active adolescent females attending a sexually transmitted disease clinic. Global attitudes, subjective norms, and perceived behavioral control predicted 50% of the variance of intentions to use condoms. Perceived behavioral control contributed the highest proportion of variance in the equation for both global and belief-based measures in stepwise regression analyses. Implications for community health practice, research, and theory are reported.

New Jersey college students' high-risk behavior: will we meet the health objectives for the year 2000?

The US Centers for Disease Control and Prevention developed the Youth Risk Behavior Survey to measure the health risk behavior of the nation's high school students and to measure progress toward meeting the national health objectives for the year 2000. The survey was adapted for college students and pilot tested in spring 1993 in 18 4-year public and private colleges in New Jersey. In this article, the authors summarize results from this survey regarding unmarried respondents' risk behavior, including sexual behavior, use of alcohol, drugs, and tobacco, and behaviors that may lead to intentional and unintentional injuries. These findings, when compared with the relevant national health objectives, suggest that New Jersey college students will meet the health objectives regarding tobacco and cocaine use but will not meet national targets set for condom and birth control use, alcohol and marijuana use, and seatbelt and bicycle helmet use.