Dimensions of risk behaviors among American Indian youth

OBJECTIVE

To explore the covariation of risk behaviors in a national sample of American Indian reservation-based youth using listwise principal components factor analysis and to determine how these risk behaviors may vary by age and sex.

DESIGN

Analysis of data from the National Indian Adolescent Health Survey, a validated anonymous self-report questionnaire of 162 items addressing various health domains.

SETTING

The survey was administered nationally in more than 200 reservation-based schools.

PARTICIPANTS

Thirteen thousand nine hundred twenty-three reservation-based American Indian or Alaska Native students in grade 7 through 12 representing more than 50 tribes. The listwise factor analysis sample included 7687 respondents with complete data.

MAIN OUTCOME MEASURES

Item loading and factor correlations by age and sex for 30 risk behaviors across various health domains.

RESULTS

Three risk behavior factors were fairly stable across sex and age: (1) the use of alcohol, tobacco, and other drugs; (2) risky sexual behavior, and (3) suicidal behaviors. Correlations between these and other factors suggested different strengths of relationships by sex and age. Other factors, including violence, truancy, and delinquency, showed differences in item loading on factors and correlations between factors. The use of tobacco, alcohol, and other drugs was most frequently associated with other risk behavior factors, and suicidal behaviors showed the next highest frequency of intercorrelations.

CONCLUSIONS

There are sex and age differences in the covariation of risk behaviors, and suicidal behaviors should be further investigated to determine of our findings are unique to American Indian youth. Health interventions that focus categorically on 1 risk dimension should also emphasize substance use prevention and intervention. To prevent substance abuse among American Indian youth, research efforts need to focus on effective strategies for coping with social and psychological stressors.

The relationship between suicide risk and sexual orientation: results of a population-based study

OBJECTIVES

This study examined the relationship between sexual orientation and suicide risk in a population-based sample of adolescents.

METHODS

Participants were selected from a cross-sectional, statewide survey of junior and senior public high school students. All males (n = 212) and females (n = 182) who described themselves as bisexual/homosexual were compared with 336 gender-matched heterosexual respondents on three outcome measures: suicidal ideation, intent, and self-reported attempts. Logistic regression analyses were used to examine the association between sexual orientation and outcome measures with adjustment for demographic characteristics.

RESULTS

Suicide attempts were reported by 28. 1 % of bisexual/homosexual males, 20.5% of bisexual/homosexual females, 14.5% of heterosexual females, and 4.2% of heterosexual males. For males, but not females, bisexual/homosexual orientation was associated with suicidal intent (odds ratio [OR] = 3.61 95% confidence interval [CI = 1.40, 9.36) and attempts (OR=7.10; 95% CI=3.05, 16.53).

CONCLUSIONS

There is evidence of a strong association between suicide risk and bisexuality or homosexuality in males.

Protecting against hopelessness and suicidality in sexually abused American Indian adolescents

PURPOSE

The purpose of this study was to identify factors protective against the adverse health correlates of sexual abuse in reservation-based American Indian and Alaskan Native adolescents.

METHODS

Data were taken from the National American Indian Adolescent Health Survey administered in 1988-1990 to 13,923 youths. Included in this analysis were 991 females and 166 males who reported a history of sexual abuse. Chi-square analysis was used to identify significant protective factors in sexually abused youths who did not report suicidality or hopelessness. Discriminant function analysis was used to determine which factors distinguished this group from those who experienced adverse health correlates.

RESULTS

Separate multivariate analyses for boys and girls demonstrated that for girls, family attention, positive feelings toward school, parental expectations, and caring exhibited by family, adults, and tribal leaders were associated with absence of suicidality and hopelessness. For suicidality in boys, significant protective factors were enjoyment of school, involvement in traditional activities, strong academic performance, and caring exhibited by family, adults, school people, and tribal leaders. No significant protective factors against hopelessness were identified for boys.

CONCLUSIONS

To minimize hopelessness and suicidal involvement among youth who have been sexually abused, strategies should be planned, implemented, and evaluated that support family caring and connectedness, strengthen school attachment and performance, and improve tribal connectedness.

The validity of self-reported condom use among adolescents

BACKGROUND

Research and public health interventions designed to reduce the risk of sexually transmitted diseases (STDs) often are based on self-reported condom use. Yet, validation of self-reported condom use, in particular with adolescents, has rarely been described in the literature.

METHODS

Baseline data were obtained from 540 adolescents, 13-21 years of age, enrolled in a 1-year longitudinal study of health beliefs, sexual behaviors, and STD acquisition. Of the 445 participants reporting to be sexually active, 404 (90.8%) agreed to a complete physical examination, including a genital examination, with STD screening after completing the self-administered written questionnaire. Participants' written self-report of condom use was compared to histories obtained by clinicians and laboratory diagnosis of acute STDs to assess validity of written self-report.

RESULTS

Complete data were available for 321 females and 77 males of whom 52 females and 5 males had laboratory evidence of 63 infections. Although three individuals who had STDs reported to be consistent users of condoms, a significant association (P < 0.05) was found between those who reported more frequent condom use with the last two partners and the absence of STDs.

CONCLUSION

In this group of adolescents, self-report of condom use with the last two partners was associated with the absence of an acute STD. This finding suggests that self-reported condom use is a valid indicator of risk for STDs, with implication for those working with adolescents clinically and in research contexts.

Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health

CONTEXT

The main threats to adolescents' health are the risk behaviors they choose. How their social context shapes their behaviors is poorly understood.

OBJECTIVE

To identify risk and protective factors at the family, school, and individual levels as they relate to 4 domains of adolescent health and morbidity: emotional health, violence, substance use, and sexuality.

DESIGN

Cross-sectional analysis of interview data from the National Longitudinal Study of Adolescent Health.

PARTICIPANTS

A total of 12118 adolescents in grades 7 through 12 drawn from an initial national school survey of 90118 adolescents from 80 high schools plus their feeder middle schools.

SETTING

The interview was completed in the subject's home.

MAIN OUTCOME MEASURES

Eight areas were assessed: emotional distress; suicidal thoughts and behaviors; violence; use of 3 substances (cigarettes, alcohol, marijuana); and 2 types of sexual behaviors (age of sexual debut and pregnancy history). Independent variables included measures of family context, school context, and individual characteristics.

RESULTS

Parent-family connectedness and perceived school connectedness were protective against every health risk behavior measure except history of pregnancy. Conversely, ease of access to guns at home was associated with suicidality (grades 9-12: P<.001) and violence (grades 7-8: P<.001; grades 9-12: P<.001). Access to substances in the home was associated with use of cigarettes (P<.001), alcohol (P<.001), and marijuana (P<.001) among all students. Working 20 or more hours a week was associated with emotional distress of high school students (P<.01), cigarette use (P<.001), alcohol use (P<.001), and marijuana use (P<.001). Appearing "older than most" in class was associated with emotional distress and suicidal thoughts and behaviors among high school students (P<.001); it was also associated with substance use and an earlier age of sexual debut among both junior and senior high students. Repeating a grade in school was associated with emotional distress among students in junior high (P<.001) and high school (P<.01) and with tobacco use among junior high students (P<.001). On the other hand, parental expectations regarding school achievement were associated with lower levels of health risk behaviors; parental disapproval of early sexual debut was associated with a later age of onset of intercourse (P<.001).

CONCLUSIONS

Family and school contexts as well as individual characteristics are associated with health and risky behaviors in adolescents. The results should assist health and social service providers, educators, and others in taking the first steps to diminish risk factors and enhance protective factors for our young people.

Adolescent vegetarians. A behavioral profile of a school-based population in Minnesota

OBJECTIVE

To compare a population-based sample of vegetarian and nonvegetarian adolescents regarding food intake patterns, disordered eating, and a range of other non-food-related health-compromising and health-promoting behaviors.

DESIGN

A cross-sectional school-based survey.

SETTING

Public schools within nonurban areas of Minnesota.

PARTICIPANTS

Adolescents (n = 107) aged 12 to 20 years who reported on the Minnesota Adolescent Health Survey that they follow a vegetarian diet and a comparison group of nonvegetarian youth (n = 214) matched for sex, age, and ethnicity. The percentage of self-identified vegetarians in the study population was relatively low (0.6%); most of the vegetarians were female (81%).

MAIN OUTCOME MEASURES

Food intake patterns, disordered eating (frequent dieting, binge eating, self-induced vomiting, and laxative use), health-compromising behaviors (tobacco, alcohol, and marijuana use and suicide attempts), and health-promoting behaviors (seat belt use, physical activity, and brushing teeth regularly).

RESULTS

Vegetarian adolescents were twice as likely to consume fruits and vegetables (P < .001), one third as likely to consume sweets (P < .001), and one fourth as likely to eat salty snack foods (P < .001) more than once a day compared with nonvegetarians. Vegetarians were almost twice as likely to report frequent dieting (P < .001), 4 times as likely to report intentional vomiting (P < .001), and 8 times as likely to report laxative use (P < .001) than nonvegetarians. Overall, associations with other health-compromising and health-promoting behaviors were not apparent.

CONCLUSIONS

A vegetarian diet may be beneficial because of increased fruit and vegetable consumption and decreased consumption of foods high in fat, salt, and sugar. However, adolescents following a vegetarian diet need to be screened for adequate food intake and potential disordered eating behaviors.

The relationship between socioeconomic status and eating-disordered behaviors in a community sample of adolescent girls

OBJECTIVE

Although previous research has demonstrated a relationship between socioeconomic status (SES) and weight, the research has not been consistent regarding the relationship between SES and eating disorders. This analysis was designed to examine this relationship in a large community sample of adolescent girls (Grades 7 to 12).

METHOD

Items were selected from a comprehensive self-report health survey completed by 17,571 adolescent girls. The relationships between SES and dieting behaviors and attitudes were examined using chi-square tests and analysis of variance (ANOVA) to control for body mass index.

RESULTS

Although there was a significant positive relationship between SES and some of the unhealthy dieting behaviors, there was no relationship between self-report of clinically significant eating-disordered behaviors (e.g., vomiting twice a week or more) and SES in this community sample.

DISCUSSION

This study suggests that while there may be a significant relationship between SES and dieting or other behaviors associated with eating disorders, this relationship does not apply to diagnostically significant behaviors. SES may be associated with differences in dieting or eating behaviors; however, among those young women who meet psychiatric criteria for an eating disorder, SES does not appear to be a significant factor.

Does scoliosis have a psychological impact and does gender make a difference?

STUDY DESIGN

A population-based case-control study, we identified adolescents with and without scoliosis in Minnesota who were 12 through 18 years of age. Matched control subjects were randomly selected from school children who did not have scoliosis or any other condition. Information on scoliosis was obtained by a self-administered questionnaire, the Adolescent Health Survey. Collected on more than 75,000 school age adolescents, with established validity and reliability, a secondary analysis of adolescents with scoliosis was performed as compared with a normative peer group.

OBJECTIVE

To describe and characterize the psychosocial impact of scoliosis on the areas of peer relations, body image, and health-compromising behavior, such as suicidal thought and alcohol consumption.

SUMMARY OF BACKGROUND DATA

The impact of adolescent idiopathic scoliosis has not been assessed using generic health status measures appropriate for adolescents. Previous studies have concentrated on the health status of adults by measuring work status, marriage status, and other adult measures. The purpose of this study was to study the health status of patients with adolescent idiopathic scoliosis, using the Adolescent Health Survey, a generic health status measure with established validity and reliability.

METHODS

Body image, peer relations, social and high-risk behavior, and comparative health were assessed to determine if scoliosis was an independent risk factor and to determine if scoliosis was associated with these psychosocial issues.

RESULTS

Six hundred eighty-five cases of scoliosis were identified from the 34,706 adolescents. The prevalence was 1.97%. Of the 685 adolescents with scoliosis and their control subjects, the adjusted odds ratio for having suicidal thought among adolescent with scoliosis, compared to adolescents without scoliosis, was 1.40 (P value of 0.04) after adjustment for race, gender, socioeconomic status, and age. The adjusted odds ratio for having feelings about poor body development among adolescents with scoliosis was 1.82 (P value 0.001) compared with adolescents without scoliosis after adjustment for race, gender, socioeconomic status, and age. Scoliosis was an independent risk factor for suicidal thought, worry and concern over body development, and peer interactions after adjustment.

CONCLUSION

Scoliosis is a significant risk factor for psychosocial issues and health-compromising behavior. Gender differences exist in male and female adolescents with scoliosis.

Covariations of eating behaviors with other health-related behaviors among adolescents

PURPOSE

The study objectives are: (1) to examine and compare patterns of covariation of a wide range of health behaviors among adolescent boys and girls; (2) to determine whether eating behaviors are part of a larger construct of health-related behaviors and to identify the behaviors with which they share underlying similarities; and (3) to determine whether youth engaging in other health-compromising behaviors are at risk for unhealthy eating.

METHODS

Data were analyzed from the Minnesota Adolescent Health Survey, a classroom-administered questionnaire, completed by 36,284 adolescents, in grades 7-12 from 1986-87.

RESULTS

Among boys, factor analysis revealed five factors: (1) risk-taking behaviors, (2) school-related behaviors, (3) "quietly" disturbed behaviors (e.g., frequent dieting, self-induced vomiting, suicide attempts), (4) health-promoting behaviors; and (5) exercise. Eating behaviors loaded on the construct of health-promoting behaviors with brushing teeth and seat belt use. Among girls, four similar factors emerged; however, exercise loaded on the construct of health-promoting behaviors. Therefore, eating behaviors loaded with brushing teeth, seat belt use, and exercise among girls. Logistic regression analyses, controlling for sociodemographic and personal variables, revealed that boys and girls engaging in health-promoting behaviors were less likely to have unhealthy eating behaviors, while those engaging in quietly disturbed behaviors, risk-taking behaviors, and problematic school behaviors were more likely to have unhealthy eating behaviors.

CONCLUSIONS

Eating behaviors appear to be part of a health-promoting behavioral construct and should not be viewed in isolation from other behaviors. Although eating behaviors do not appear to be part of the "problem behavior syndrome," youth engaging in a wide range of health-compromising behaviors are at risk for unhealthy eating; emphasizing the need to target high-risk youth with health promotion programs.

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.

Psychosocial concerns and health-compromising behaviors among overweight and nonoverweight adolescents

OBJECTIVE

To compare weight-specific and global psychosocial concerns and health-compromising behaviors among overweight and nonoverweight youth across gender and ethnicity.

METHODS

A cross-sectional school-based survey of 31,122 adolescents in grades 7 to 12. Based on self-reported heights and weights, respondents were categorized as nonoverweight (body mass index (BMI) < 85th percentile), moderately overweight (85th percentile < BMI < 95th percentile), or severely overweight (BMI > 95th percentile).

RESULTS

Global psychosocial concerns, such as emotional well-being, suicidal ideation, future job concerns, and peer concerns, did not differ greatly between nonoverweight, moderately overweight, and severely overweight adolescents. Substance abuse behaviors were equally or less prevalent among the overweight group. Overweight girls were significantly less likely to consume alcohol, whereas overweight boys were at lower risk for marijuana use. In contrast, overweight youth were more likely to perceive their health as only fair or poor and were more likely to express weight-specific concerns and engage in behaviors such as chronic dieting and binge eating than nonoverweight youth. Overweight American Indian girls perceived their physical health more positively than nonoverweight American Indian girls. Strong associations were found between overweight status and chronic dieting among African American boys and girls.

CONCLUSIONS

Nutritional counseling and educational programs need to address the weight-specific concerns and behaviors of overweight adolescents. However, assumptions regarding global psychosocial concerns and health-compromising behaviors among overweight adolescents of different genders and ethnicities should be avoided. These broad issues need to be explored in more depth at both the research and intervention levels.

Psychosocial and behavioral correlates of dieting and purging in Native American adolescents

OBJECTIVE

This study examined the relationship of psychosocial factors and health behaviors to frequent dieting and purging behaviors in Native American adolescent boys and girls.

DESIGN

School-based health survey.

SETTING AND PARTICIPANTS

A total sample of 13 454 Native American youth in grades 7 through 12 living on or near reservations from eight Indian Health Service areas completed a self-report, school-based health questionnaire.

RESULTS

Almost half (48.3%) of the girls and one third (30.5%) of the boys had dieted in the past year. More than one fourth (28%) of the girls and 21% of the boys reported purging behavior of some type. Dieting frequency and purging status were associated with negative psychosocial factors and health risk behaviors. Dieting frequency in girls was associated with weight dissatisfaction, concerns about being overweight, high emotional stress, binge eating, alcohol use, tobacco use, suicide ideation and attempts, delinquent behaviors, and physical and sexual abuse. Purging status was positively and independently associated with negative psychosocial and health behavior risk factors. There were fewer significant relationships in boys.

CONCLUSIONS

Findings from this study suggest that dieting and purging are associated with similar psychosocial factors and health-compromising behaviors in Native American and white youth. Implications for future research and prevention programs are discussed.

Psychosocial correlates of health compromising behaviors among adolescents

The objective of the present study was to examine psychosocial correlates of diverse health-compromising behaviors among adolescents of different ages. The study population included 123,132 adolescents in sixth, ninth and 12th grades. Psychosocial correlates of substance abuse, delinquency, suicide risk, sexual activity and unhealthy weight loss behaviors were examined. Risk-taking disposition was significantly associated with nearly every behavior across age and gender groups. Other consistent correlates included sexual abuse and family connectedness. Correlates of health-compromising behaviors tended to be consistent across age groups. However, stronger associations were noted between sexual abuse and substance use for younger adolescents, and risk-taking disposition and school achievement were stronger correlates for older youth. The results suggest the presence of both common and unique etiological factors for different health-compromising behaviors among youth. The results emphasize the importance of focusing on positive 'risk-taking' experiences for youth in prevention programs; being sensitive to possible sexual abuse experiences among both female and male adolescents in health-care consultations; integrating strategies for improved family connectedness into health promotion efforts; and making school relevant for all adolescents.

Cognitive and behavioral predictors of sexually transmitted disease risk behavior among sexually active adolescents

OBJECTIVE

To identify important cognitive and behavioral predictors of sexually transmitted disease (STD) risk behavior among a sexually active adolescent cohort.

DESIGN

One-year longitudinal study of health beliefs, sexual behaviors, and STD acquisition among 549 adolescents, 14 to 21 years of age.

SETTING

School- and community-based health clinics in a large metropolitan area.

PARTICIPANTS

Data from 410 sexually active adolescents completing surveys at baseline and 1-year follow-up.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

Sexually transmitted disease risk behavior--a composite measure of condom use consistency with most recent sexual partner(s), number of vaginal sex partners, and frequency of intercourse with most recent sexual partner(s).

RESULTS

For girls (n = 335), a model including baseline STD risk behavior, condom use self-efficacy, oral contraceptive use, communication with sexual partners about STD prevention, and alcohol use in connection with sexual activity explained 21.1% of the variance in STD risk behavior at 1-year follow-up. For boys (n = 75), the strongest predictors of STD risk behavior at follow-up included baseline STD risk behavior, perceived susceptibility to STD, condom use self-efficacy, negative outcome expectations associated with condom use, and perceived barriers to STD prevention.

CONCLUSIONS

Efforts targeting reduction in STD risk behavior must begin before the onset of somewhat stable patterns of sexual risk behavior. Among adolescents who are sexually active, interventions should include components that increase condom use self-efficacy, build skills to communicate with sexual partners about STD prevention, and address behaviors associated with STD risk behavior including oral contraceptive use.

Gender-specific outcomes for sexually abused adolescents

This study examined the gender differences in outcomes related to school performance, suicidal involvement, disordered eating behaviors, sexual risk taking, substance use, and delinquent behaviors of male (n = 370) and female teenagers (n = 2,681) who self-reported a history of sexual abuse. It was found that female adolescents, by and large, engaged in internalizing behaviors and males in externalizing behaviors. Male adolescents were found to be at higher risk than females in poor school performance, delinquent activities, and sexual risk taking. Female adolescents, on the other hand, showed higher risk for suicidal ideation and behavior as well as disordered eating. Females showed more frequent use of alcohol. However, male adolescents exhibited more extreme use of alcohol and more frequent and extreme use of marijuana. Among index female adolescents, protective factors against adverse correlates included a higher emotional attachment to family, being religious or spiritual, presence of both parents at home, and a perception of overall health. Factors that augmented adverse correlates for them included a stressful school environment due to perceived high levels of substance use in and around school, worry of sexual abuse, maternal alcohol consumption, and physical abuse. For male adolescents, maternal education and parental concern appeared to be protective factors.

Don't ask, they won't tell: the quality of adolescent health screening in five practice settings

OBJECTIVES

This study examined the extent to which comprehensive, age-appropriate adolescent health screening is undertaken in the clinical setting and whether the extent of such screening varies by setting.

METHODS

Charts of adolescents 13 to 17 years old (n = 788) were randomly selected from five practice settings in Minneapolis, Minn. Each was assessed for the number of biomedical and sociobehavioral health risks screened.

RESULTS

In no practice setting was there screening to the level recommended. The two teen clinics screened more extensively for behavioral, psychosocial, substance use and sexual behavior risks than the community family practice setting, which, in turn, screened more extensively than either the private family practice or private pediatric practice settings, which did not differ from each other. Age differences and gender accounted for only small amounts of variance in total number of health risks screened, whereas differences among practice settings accounted for a larger amount.

CONCLUSIONS

Results suggest substantive deficiencies in private practice settings' implementation of preventive care screening protocols for adolescents.

Patterns of health-compromising behaviors among Minnesota adolescents: sociodemographic variations

OBJECTIVES

This study compared prevalence rates of health-compromising behaviors among boys and girls from different ethnic backgrounds in early, middle, and late adolescence and compared co-occurrences of such behaviors across gender and ethnic groups.

METHODS

The study population included 123 132 adolescents in grades 6, 9, and 12. Adolescents completed a classroom-administered statewide survey focusing on high-risk behaviors, including unhealthy weight loss, substance abuse, suicide risk, delinquency, and sexual activity.

RESULTS

Prevalence rates of most health-compromising behaviors differed by gender, increased with age, and tended to be highest among American Indian youth and lowest among Asian Americans. Strong associations were found between substance abuse and delinquency across all ethnic groups. Substance abuse and delinquency were associated with suicide risk across most ethnic groups. Covariations with sexual activity and unhealthy weight loss behaviors showed more ethnic variation.

CONCLUSIONS

Prevention interventions should take into account the tendency for health-compromising behaviors to co-occur and should be sensitive to demographic and socioeconomic differences in behavior patterns.

Psychosocial predictors of binge eating and purging behaviors among adolescents with and without diabetes mellitus

PURPOSE

This study aims to compare dieting, binge eating, and purging behaviors, and to examine predictors of binge eating and purging behaviors among adolescents with and without Diabetes Mellitus (DM).

METHODS

The index group included 310 adolescents who reported that they had DM on a statewide population survey of 36,284 adolescents in grades 7-12 in Minnesota. The comparison group included a random sample matched for socioeconomic status (SES), of 850 adolescents without chronic illness. Disordered eating behaviors assessed in the present study included binge eating, vomiting, laxative use, and diuretic use. Potential predictor variables assessed included weight loss behaviors, body image, sexual abuse, sexual attractions, emotional well-being, family connectedness, poor school performance, age, race, Body Mass Index (BMI), and SES.

RESULTS

Binge eating and purging were significantly more prevalent among adolescents with DM than among the comparison group. Different risk profiles were found for adolescents with and without DM and for males and females. Predictors of binge eating and purging among females with DM included weight dissatisfaction, bisexual/homosexual attractions, and younger age. Predictors among males with DM included bisexual/homosexual attractions, younger age, sexual abuse, and an interaction between sexual abuse and emotional well-being.

CONCLUSIONS

Adolescents with DM should be screened for unhealthy weight control practices and eating disorders. If disordered eating is present, clinicians need to be sensitive to the variety of factors possibly associated with these behaviors among different individuals.

Correlates of inadequate fruit and vegetable consumption among adolescents

BACKGROUND

The present study aims to determine the prevalence of inadequate fruit and vegetable consumption among adolescents and to determine sociodemographic, personal, psychosocial, and behavioral correlates of inadequate consumption.

METHODS

Data presented in this study were taken from the Minnesota Adolescent Health Survey, a classroom-administered questionnaire, which was completed by 36,284 adolescents in grades 7-12. Chi-square analyses and multivariate logistic regressions controlling for socioeconomic status, ethnicity, age, gender, and BMI were done.

RESULTS

Inadequate consumption of fruits and vegetables was common among the study population. Less than daily consumption of fruits and vegetables was reported by approximately 40% of adolescents from low socioeconomic backgrounds. Ethnic differences in eating patterns were also apparent in that American Indians were at highest risk for inadequate fruit consumption and African Americans were at greatest risk for inadequate vegetable consumption. Psychosocial correlates of inadequate intake included low family connectedness, weight dissatisfaction, and poor academic achievement. Frequent dieting was associated with inadequate fruit consumption but not with vegetable consumption. Health-compromising behaviors such as binge eating, substance abuse, and past suicide attempts were correlated with inadequate intake.

CONCLUSIONS

The results stress the need for intervention programs aimed at increased consumption of fruits and vegetables among adolescents. While programs need to reach all adolescents, approaches need to be suitable to those at highest risk for inadequate consumption, in particular those from low socioeconomic backgrounds.

Sexual behavior of adolescents with chronic disease and disability

PURPOSE

This study aimed to assess sexual behaviors, sexual orientation, pregnancy, and abuse history among adolescents with and without chronic conditions.

METHODS

Analyses were based on a statewide survey of 36,284 young people in the 7th through 12th grades for analytic purposes; subsets were defined using a specialized cohort design including adolescents with visible and nonvisible conditions plus controls. Principle outcome measures included self report of ever having sexual intercourse, age of sexual debut, reasons for not having intercourse, ever causing or having a pregnancy, ever having a sexually transmitted disease (STD), contraceptive use and reasons for their nonuse, history of sexual abuse, and sexual orientation.

RESULTS

No differences were evident between adolescents with and without chronic conditions in the proportion ever having intercourse, age of sexual debut, pregnancy involvement, patterns of contraceptive use, or sexual orientation. No differences were evident among girls or boys with visible compared with invisible conditions. A significantly greater proportion of girls and boys with invisible conditions than controls reported a history of sexual abuse. More index boys than controls reported ever having an STD, whereas more girls with visible conditions than controls reported this.

CONCLUSIONS

Adolescents with chronic conditions are at least as sexually involved as their peers, and significantly more likely to have been sexually abused. Visibility of chronic conditions does not appear to affect the sexual behaviors of adolescents. The need for comprehensive sexuality education in this population is high, and discussion of sexuality, contraception and abuse must be part of standard psychosocial assessment and anticipatory guidance for all teenagers, including those with chronic conditions.

Sexual orientation and prevalence of body dissatisfaction and eating disordered behaviors: a population-based study of adolescents

OBJECTIVE

The hypothesis that homosexual orientation would be associated with higher rates of body dissatisfaction, dieting, and eating disordered behaviors in males, but lower rates in females, relative to those of heterosexual orientation, was examined.

METHODS

A population-based sample of 36,320 students in Grades 7 through 12 completed a health behavior survey that included questions on sexual orientation, body satisfaction, and weight control behaviors. A subset of heterosexual males (N = 212) and females (N = 182) were selected for comparison with the adolescents who self-identified as homosexual (N = 81 males and N = 38 females) or bisexual (N = 131 males and N = 144 females).

RESULTS

Homosexual males were more likely to report a poor body image (27.8% vs. 12.0%), frequent dieting (8.9% vs. 5.5%), binge eating (25.0% vs. 10.6%), or purging behaviors (e.g., vomiting: 11.7% vs. 4.4%) compared with heterosexual males. Homosexual females were more likely than heterosexual females to report a positive body image (42.1% vs. 20.5%). However, they were not less likely to report frequent dieting (20.8% vs. 23.7%), binge eating (25.0% vs. 31.8%), or purging behaviors (e.g. vomiting: 19.4% vs. 12.1%).

DISCUSSION

These results support the hypothesis that homosexual orientation is associated with greater body dissatisfaction and problem eating behaviors in males, but less body dissatisfaction in females. The possible role of sociocultural influences or gender identification on these relationships is discussed.

Body dissatisfaction and unhealthy weight-control practices among adolescents with and without chronic illness: a population-based study

OBJECTIVE

To compare body dissatisfaction and unhealthy weight-loss practices among adolescents with and without chronic illness.

DESIGN

Survey.

PARTICIPANTS

The sample consisted of 2149 adolescent boys and girls with diabetes, asthma, attention deficit disorder, physical disabilities, or seizure disorders; and a comparison group of 1381 adolescents without chronic illness.

MAIN OUTCOME MEASURES

Body concerns, binge eating, frequent dieting, vomiting, and laxative or diuretic use among adolescents.

RESULTS

Adolescents with chronic illness reported higher body dissatisfaction and engaged in more high-risk weight-loss practices than adolescents without chronic illness. This trend was consistent across the different conditions and was not limited to those with a nutrition-related condition such as diabetes. The trend remained after conducting logistic regression and controlling for age, race, socioeconomic status, and body mass index.

CONCLUSIONS

Adolescents with chronic illness are at high risk for engaging in unhealthy weight-loss practices and should be screened and targeted for prevention and treatment.