Validity and stability of self-reported health among adolescents in a longitudinal, nationally representative survey

Stress, sense of coherence and subjective health in adolescents aged 13-18 years

BACKGROUND

This study investigated the relationships between sex, age, stress and sense of coherence (SOC) and each of self-rated health (SRH) and subjective health complaints (SHCs) in adolescents.

METHODS

The study was based on a cross-sectional sample of 1239 adolescents aged 13-18 years. The participants reported scores on a questionnaire, including 12 items assessing SHC, the 13-item version of the Orientation to Life Questionnaire and the 30-item Adolescent Stress Questionnaire. Data were analysed with descriptive, comparative and hierarchical multiple regression analyses.

RESULTS

Boys scored significantly higher on SRH than girls, whereas girls scored higher on SHCs. In the multivariate model, stress was significantly associated with SHCs, but not with SRH. SOC was significantly positively related to SRH and negatively related to SHC; the associations were significantly stronger for girls than for boys. A significant moderation effect (protective role) of SOC was found on the relation between stress and SHC.

CONCLUSIONS

No causal conclusion was possible, but the findings may be used as a basis for further investigation of the role of stress and SOC in longitudinal studies and intervention studies.

Socioeconomic background and high school completion: Mediation by health and moderation by national context

This study uses longitudinal data from the Norwegian Health Study linked with registry data (n = 13262) and the U.S. National Longitudinal Survey of Youth 1997 (n = 3604) to examine (1) whether adolescent health mediates the well-established relationship between socioeconomic background and successful high school completion, and (2) whether this mediated pathway of influence varies by national context. Adolescents from lower educated and lower income families reported poorer health, which negatively impacted their likelihood of graduating from high school. The partial mediational effect of adolescent health was stronger in the U.S. than in Norway. These results suggest that policies aimed at preventing high school dropout need to address adolescent health, in addition to the unequal opportunities derived from socioeconomic disadvantage.

The effects of minimum wages on the health of working teenagers

This article examines the effect of minimum wage increases on the self-reported health of teenage workers. We use a difference-in-differences estimation strategy and data from the Current Population Survey, and disaggregate the sample by race/ethnicity and gender to uncover the differential effects of changes in the minimum wage on health. We find that white women are more likely to report better health with a minimum wage increase while Hispanic men report worse health.

Smoking status, dental visits and receipt of tobacco counseling in dental office among mobile and trailer home adolescents

BACKGROUND

Mobile and trailer home (MTHs) residents are an understudied group. In this study we determined the cigarette smoking status, dental visits in the past 12 months, and receipt of tobacco counseling in adolescents living in MTHs compared to adolescents living in other types of housing.

METHODS

For this secondary data analysis study, we used data of adolescents aged 10 to 19 years (n = 74,890) from the 2012 Florida Youth Tobacco Survey (FYTS). Weighted multiple logistic regression model was conducted to understand the differences between adolescents living in MTHs compared to those living in other types of housing.

RESULTS

Approximately 6 % of the sample reported living in MTHs. The regression model showed that older (p < 0.0001), female (p = 0.0091), and middle school (p < 0.0001) adolescents were more likely, and those who identified as Asians (p = 0.0006), Black/African Americans (p < 0.0001), and Hispanics (p < 0.0001) were less likely to be living in MTHs compared to their counterparts. Current established smokers (p < 0.0001) and non-established smokers (p < 0.0001) were more likely to report living in MTHs compared to non-smokers. Those reporting to have not visited a dental office (p < 0.0001) were more likely to be living in MTHs. Those who visited a dental office but not received any tobacco counseling (p < 0.0001) were less likely to be living in MTHs compared to their counterparts.

CONCLUSIONS

Current cigarette smokers and those not visiting a dental office were more likely to be MTH adolescents. Adolescents reporting to have received tobacco counseling in a dental office were more likely to be living in MTHs.

An education gradient in health, a health gradient in education, or a confounded gradient in both?

There is a positive gradient associating educational attainment with health, yet the explanation for this gradient is not clear. Does higher education improve health (causation)? Do the healthy become highly educated (selection)? Or do good health and high educational attainment both result from advantages established early in the life course (confounding)? This study evaluates these competing explanations by tracking changes in educational attainment and Self-rated Health (SRH) from age 15 to age 31 in the National Longitudinal Study of Youth, 1997 cohort. Ordinal logistic regression confirms that high-SRH adolescents are more likely to become highly educated. This is partly because adolescent SRH is associated with early advantages including adolescents' academic performance, college plans, and family background (confounding); however, net of these confounders adolescent SRH still predicts adult educational attainment (selection). Fixed-effects longitudinal regression shows that educational attainment has little causal effect on SRH at age 31. Completion of a high school diploma or associate's degree has no effect on SRH, while completion of a bachelor's or graduate degree have effects that, though significant, are quite small (less than 0.1 points on a 5-point scale). While it is possible that educational attainment would have greater effect on health at older ages, at age 31 what we see is a health gradient in education, shaped primarily by selection and confounding rather than by a causal effect of education on health.

Money, Peers and Parents: Social and Economic Aspects of Inequality in Youth Wellbeing

Indicators of social and economic status are important health determinants. However, evidence for the influence of family socioeconomic status in adolescent wellbeing is inconsistent and during this period of development youth may begin to develop their own status positions. This study examined social and economic health inequalities by applying a multidimensional and youth-orientated approach. Using a recent (2010–2011) and representative sample of Swedish 14-year olds (n = 4456, 51 % females), the impact of family socioeconomic status, youth economic resources and peer status on internalizing symptoms and self-rated health were examined. Data was based on population register, sociometric and self-report information. Aspects of family socioeconomic status, youth’s own economy and peer status each showed independent associations, with poorer wellbeing observed with lower status. However, there were equally strong or even stronger effects of peer status and youth’s own economy than family socioeconomic status. Lower household income and occupational status were more predictive of poor self-rated health than of internalizing symptoms. The findings suggest that youth’s own economy and peer status are as important as family socioeconomic status for understanding inequalities in wellbeing. Thus, a focus on youth-orientated conceptualizations of social and economic disadvantage during adolescence is warranted.

Self-Rated Health Across Race, Ethnicity, and Immigration Status for US Adolescents and Young Adults

PURPOSE

Health disparities research seeks to understand and eliminate differences in health based on social status. Self-rated health is often used to document health disparities across racial/ethnic and immigrant groups, yet its validity for such comparative research has not been established. To be useful in disparities research, self-rated health must measure the same construct in all groups, that is, a given level of self-rated health should reflect the same level of mental and physical health in each group. This study asks, Is the relationship between self-rated health and four indicators of health status--body mass index, chronic conditions, functional limitations, and depressive symptoms--similar for adolescents and young adults of different races/ethnicities and immigrant generations?

METHODS

Ordinary least squares regression was used to examine associations of self-rated health with the four indicators of health status both cross-sectionally and longitudinally using four waves of the National Longitudinal Study of Adolescent to Adult Health.

RESULTS

Health indicators explained similar amounts of variance in self-rated health for all racial/ethnic and immigrant generation groups. The cross-sectional association between the health indicators and self-rated health did not vary across groups. The longitudinal association between depressive symptoms and chronic conditions and self-rated health also did not differ across groups. However, an increase in body mass index was associated more negatively with later self-rated health for Asians than for whites or blacks.

CONCLUSIONS

Self-rated health is valid for disparities research in large, population-based surveys of US adolescents and young adults. In many of these surveys self-rated health is the only measure of health.

Trends in self-rated health in European and North-American adolescents from 2002 to 2010 in 32 countries

BACKGROUND

Self-rated health (SRH) in adolescence is known to be associated with health outcomes in later life. We carried out a trend analysis on data coming from three waves of data collected in 32 countries (mostly European) from 2002 to 2010 coming from the Health Behaviour in School-Aged Children surveys.

METHODS

SRH in adolescents was assessed using a Likert scale (excellent, good, fair and poor). Responses were dichotomized into 'excellent' vs. 'rest'. Country, age and gender groups were compared based on the odds ratio of declaring excellent SRH in 2010 with respect to 2002 and 2006.

RESULTS

The trend for European adolescents indicates an improvement over the last decade, although, in the majority of countries, a higher proportion of adolescents rate their health as excellent during the period 2002-06 with respect to the second half of the decade (2006-10).Girls were found to constantly rate their health as poorer, compared to their male peers, in all countries. Age has also a very stable trend towards a decreasing rating of health with increasing age.

CONCLUSION

Decreased rating of health in the period 2006-10 may be a signal of the socio-economic difficulties of Europe in the last part of this decade.

Age at smoking initiation and self-rated health among second grade high school boys and girls in Scania, Sweden, a cross-sectional study

BACKGROUND

Smoking is usually initiated early in life and most adult regular smokers have started smoking before 18 years of age. A younger age at smoking initiation is associated with risk taking behaviours and worse health outcomes regarding psychological and somatic conditions, suggested to be caused by exposure during critical developmental periods. The present study aims to investigate self-rated health among second grade high school boys and girls related to age at smoking initiation (<14 years of age and ≥ 14 years of age) among current and former smokers, compared to never smokers.

METHODS

Data was derived from the Scania public health survey among children and adolescents in 2012. The study was cross-sectional with retrospective information about first time cigarette smoking experiences among 3245 boys and 3434 girls in second grade of high school. Self-rated health was assessed with the question "How do you rate your general health". Associations of age at smoking initiation, current smoking status and poor self-rated health were investigated with logistic regression models.

RESULTS

Crude odds ratios of poor self-rated health were increased for all smoking groups compared to never smokers. Former smoking boys and currently smoking girls with early smoking initiation had the highest odds ratios of poor self-rated health, with odds ratios (OR) 2.4 (95 % confidence interval (CI): 1.5-3.7) and OR 2.9 (95 % CI: 2.3-3.6), respectively. After adjustments for sociodemographic factors, health-related behaviours, psychosocial factors, weight and functional disabilities, the results were attenuated, but remained statistically significant regarding former and current smoking boys with early smoking initiation, OR 2.0 (95 % CI: 1.1-3.7) and OR 1.7 (95 % CI: 1.1-2.4) and for current smoking girls with early and later smoking initiation, OR 2.1 (95 % CI: 1.5-2.8) and OR 1.5 (95 % CI: 1.1-2.0).

CONCLUSION

Boys and girls in second grade of high school with early smoking initiation reported poorer self-rated health than later initiators and never smokers. Poorer self-rated health persisted also after smoking cessation among early initiating boys. Further studies are needed to understand the adverse health effects associated with timing of smoking initiation.

Trends in prevalence of overweight and obesity: are Portuguese adolescents still increasing weight?

OBJECTIVE

To report the prevalence and trends of the BMI of Portuguese adolescents in 2002, 2006 and 2010.

METHODS

4138 boys and 4472 girls self-reported weight, height, physical activity, perception of health and life satisfaction.

RESULTS

For adolescents aged 11-13 years, the prevalence of overweight/obesity decreased from 23.5 % in 2002 to 20.7 % in 2010, using IOTF cutoff points, and decreased from 32.4 to 28.4 % between 2002 and 2010 using WHO cutoff points. For adolescents aged 15-17 years, the prevalence increased from 13.9 to 16.8 % between 2002 and 2010 using IOTF cutoff, and increased from 14.8 % in 2002 to 18.2 % in 2010 when using WHO cutoff points. Although the prevalence decreased among younger adolescents and increased among older ones, the differences were not significant. Physical activity in the last 7 days (p < 0.05), better life satisfaction (p < 0.05) and perception of health (p < 0.001) predicted lower body mass index z score.

CONCLUSIONS

Overall, there have been no significant changes in overweight and obesity prevalence in Portuguese adolescents from 2002 to 2010. However, the prevalence remains high and therefore it is important to continue surveillance.

Outdoor physical activity and its relation with self-reported health in Japanese children: results from the Toyama birth cohort study

BACKGROUND

Few studies have examined trends in engagement in outdoor physical activity as children grow and whether changes in physical activity at different ages affect children's health. This study determined the preference for and frequency of physical activity among Japanese children from ages 6 to 12 years and investigated the effect of physical activity and of change in physical activity on children's self-reported health.

METHODS

Data were from the prospective, longitudinal Toyama Birth Cohort Study, a total of 5238 children were followed at their age of 12 years. Preference for and frequency of outdoor physical activity were from the self-administered questionnaire. Self-reported health was from the Japanese version of Dartmouth Primary Care Co-operative project charts.

RESULTS

Reporting liking and participating in outdoor physical activity at both ages 6 and 12 years were associated with higher likelihood of good self-reported health (Odds ratio 1.24 [95% CI: 1.03-1.50] for liking activity and OR = 1.27[1.08, 1.50] for participating in activity) compared with those who did not like or participate in this at only one or at neither age, after adjustment for lifestyle factors and body pain. The adjusted OR was 1.23 (95% CI: 0.97-1.56) for girls whose preference for liking outdoor physical activity was not changed at both ages compared with those whose preference changed. The OR was 1.47 (95% CI: 1.14-1.89) for boys who persisted in participating in the outdoor physical activity than those who did not persist.

CONCLUSIONS

There is an association between a persistent expression of liking outdoor physical activity and self- reported health.

The use of parental occupation in adolescent health surveys. An application of ISCO-based measures of occupational status

BACKGROUND

Recent research has emphasised that the challenge in researching socioeconomic differences in adolescent health cross-nationally lies in providing valid and comparable measures of socioeconomic position (SEP) across regions. This study aims to examine measures of occupational status derived from the International Standard Classification of Occupations (ISCO), alongside commonly used affluence measures in association with adolescent self-rated health (SRH).

METHODS

Data were from the 2005/2006 'Health Behaviour in School-aged Children study' (HBSC); 27 649 individuals aged 11, 13 and 15 years from Germany, Macedonia, Norway, Turkey, Wales and Scotland. Three occupational scales were compared: the International Socioeconomic Index of Occupational Status (ISEI), the Standard International Occupational Prestige Scale (SIOPS) and the Erikson-Goldthorpe-Portocarero class categories (EGP). Correlation analyses compared these occupational scales with the family affluence scale (FAS) and a family well-off measure, while logistic regression assessed the association between occupational scales and poor SRH. Multiple imputation techniques investigated possible bias arising from parental occupation missingness.

RESULTS

Moderate correlations existed between occupational scales and FAS and family well-off. Socioeconomic inequalities in poor SRH were found for ISEI, SIOPS and EGP in all regions, independent of FAS and family well-off. Models of imputed data sets did not alter the results. The relationship between SEP and SRH was therefore not biased by high levels of missing values for ISCO.

CONCLUSIONS

ISCO-based indicators of occupational status in cross-national self-administered adolescent health surveys were found to be robust measures of SEP in adolescence. These measure different aspects of SEP independent of FAS and family well-off.

Factors for Hospitalization in a Medically Complex Population of Pediatric Home Care Patients

Research has identified demographic, clinical, and technological characteristics that are associated with recurrent pediatric hospital admissions. However, research focusing on risk factors for hospitalization among pediatric home care patients is lacking. The purpose of this study was to identify characteristics associated with 60-day hospitalization among pediatric home care patients. To address this objective, we used information collected from pediatric home care patients, age 6 months to 17 years, who were served by a large not-for-profit home care agency in New York City between 2008 and 2012 ( N = 6,187). Results showed that 5.4% of patients in our study population were hospitalized. Specific characteristics that were significantly associated with hospitalization are described in detail.

Comparing self and maternal reports of adolescents' general health status: do self and proxy reports differ in their relationships with covariates?

PURPOSE

Given that mothers often-but do not always-report children's health status in surveys, it is essential to gain an understanding of whether the relationship between children's general health status and relevant covariates depends on who reports children's general health status.

METHODS

Using data from the first wave of the National Longitudinal Study of Youth 1997 cohort (N = 6,466), a nationally representative sample of adolescents in the United States ages 12 to 17 in 1997, the study first examined the concordance between self and maternal reports of adolescents' general health status. Then, self and maternal reports of adolescents' general health status were each regressed on health-relevant covariates, and tests of differences in coefficients across the models were estimated.

RESULTS

Self and maternal reports of adolescents' general health status are moderately concordant. Furthermore, the associations of adolescents' general health status with adolescent BMI and the adolescent being female significantly differ across reporters, such that the negative relationships are even more negative with self compared to maternal reports of adolescents' general health status. The associations of adolescents' general health status with the measures of adolescents' health limitations, maternal self-rated health, and certain sociodemographic covariates differ across reporters, such that each has a greater relationship with maternal compared to self-reports of adolescents' general health status.

CONCLUSION

The results are important for interpreting research on the causes and consequences of child and adolescent health, as results across studies may not be comparable if the reporter is not the same.

Does academic achievement during childhood and adolescence benefit later health?

PURPOSE

Educational disparities in health persist after adjustment for income and occupation, suggesting that other purely cognitive and psychosocial mechanisms may be involved. Unlike occupation- or income-mediated effects, effects of cognitive and psychosocial gains-as reflected in academic achievement-may be apparent even before schooling is completed.

METHODS

We used data spanning 10 years on a national U.S. cohort of 2546 children aged 3-14 years at baseline to estimate the effects of academic achievement, measured by standardized tests of cognitive achievement, on future health. We used marginal structural models to address potential mutual influence of achievement and health on each other over time.

RESULTS

One SD higher academic achievement 1997-2002 was associated with a lower prevalence of poorer health status in 2007 in girls (prevalence ratio = 0.87 [(95% confidence interval) 0.78-0.97]) but not in boys (prevalence ratio = 0.96 [0.86-1.08]). Higher achievement was also weakly associated with lower body mass index and less psychological distress among girls only.

CONCLUSIONS

Academic achievement may benefit future health but a number of questions remain unanswered, including reasons for the gender differences and how academic achievement-related health disparities may progress over the life course and interact with other social determinants of health.

The interplay between child and maternal health: reciprocal relationships and cumulative disadvantage during childhood and adolescence

While many studies use parental socioeconomic status and health to predict children's health, this study examines the interplay over time between child and maternal health across childhood and adolescence. Using data from women in the National Longitudinal Study of Youth 1979 cohort and their children (N = 2,225), autoregressive cross-lagged models demonstrate a reciprocal relationship between child activity limitations and maternal health limitations in direct effects of child activity limitations on maternal health limitations two years later and vice versa-net of a range of health-relevant time-varying and time-invariant covariates. Furthermore, there are indirect effects of child activity limitations on subsequent maternal health limitations and indirect effects of maternal health limitations on subsequent child activity limitations via intervening health statuses. This study examines how the interplay between child and maternal health unfolds over time and describes how these interdependent statuses jointly experience health disadvantages.

Teasing apart the effects of cognition, stress, and depression on health

OBJECTIVE

To test whether cognitive vulnerability could explain the link between depression and poor health.

METHODS

A 4-week longitudinal design was used to examine health problems (eg, diabetes), health behaviors (eg, smoking), depressive symptoms, cognitive vulnerability, and life stress in a sample of 154 undergraduates.

RESULTS

Contrary to hypotheses, depressive symptoms, but not cognitive vulnerability, were associated with health problems. However, as predicted, cognitive vulnerability was a better predictor of prospective changes in specific health behaviors than were depressive symptoms. Unexpectedly, life stress was the best predictor of prospective changes in specific health behaviors.

CONCLUSIONS

These results are among the first to show that the factors associated with health problems are different than those associated with specific health behaviors.

Educational Attainment and Self-Rated Health Status among Single Mothers in Rural Alabama

Using previous data from a random sample of 300 single mothers from rural Alabama, multiple regression analysis indicated that food insecurity and employment status had a modest effect on self-rated health status, while educational attainment and income had the greatest effect. These variables explained 29% of the variance in health status. Social and economic policies that affect educational attainment and income distribution may have important consequences for health status in these rural areas.

Disparities in women's health across a generation: a mother-daughter comparison

BACKGROUND

The U.S. Centers for Disease Control and Prevention has set national goals to eliminate health disparities by race, sex, and socioeconomic status. Progress in meeting these goals has been mixed. This paper provides a different view on the evolving health of U.S. women by examining a sample of daughters and their mothers.

METHODS

The aim was to determine if the health risk profiles of daughters (born 1975-1992) were different from their mothers (born 1957-1964) measured when both were between the ages of 17 and 24 years. The U.S.-based National Longitudinal Survey of Youth 1979 and associated Children and Young Adult Surveys were used. The sample was 2411 non-Hispanic white and African American girls born to 1701 mothers. Outcomes were height, weight, body mass index (BMI), age of menarche, and self-reported health.

RESULTS

In both races, daughters were taller but entered adulthood at greater risk for the development of chronic illness than their mothers. Racial differences were greater in the daughters' generation than in the mothers'. Whites in both generations experienced educational differences in health based upon the mother's educational level, with fewer years of maternal education associated with poorer health. African Americans of both generations experienced differences by maternal education in self-reported health. However, when African American daughters were compared with their mothers, daughters born to college educated women gained more weight and had higher BMI and earlier menarche than did daughters born to high school dropouts.

CONCLUSION

Health deterioration across generations in both races suggests that much work is needed to meet Healthy People 2020 goals of health equity.

Physical activity and self-reported health status among adolescents: a cross-sectional population-based study

OBJECTIVES

Little is known about the dose-response relationship between physical activity and health benefits among young people. Our objective was to analyse the association between the frequency of undertaking moderate-to-vigorous physical activity (MVPA) and the self-reported health status of the adolescent population.

DESIGN

Cross-sectional study.

SETTING

All regions of Spain.

PARTICIPANTS

Students aged 11-18 years participating in the Spanish Health Behaviour in School-aged Children survey 2006. A total of 375 schools and 21 188 students were selected.

MAIN OUTCOMES

The frequency of undertaking MVPA was measured by a questionnaire, with the following four health indicators: self-rated health, health complaints, satisfaction with life and health-related quality of life. Linear and logistic regression models were used to analyse the association, adjusting for potential confounding variables and the modelling of the dose-response relationship.

RESULTS

As the frequency of MVPA increased, the association with health benefits was stronger. A linear trend (p<0.05) was found for self-rated health and health complaints in males and females and for satisfaction with life among females; for health-related quality of life this relationship was quadratic for both sexes (p<0.05). For self-reported health and health complaints, the effect was found to be of greater magnitude in males than in females and, in all scales, the benefits were observed from the lowest frequencies of MVPA, especially in males.

CONCLUSIONS

A protective effect of MVPA was found in both sexes for the four health indicators studied, and this activity had a gradient effect. Among males, health benefits were detected from very low levels of physical activity and the magnitude of the relationship was greater than that for females.

A modified obesity proneness model predicts adolescent weight concerns and inability to self-regulate eating

BACKGROUND

The prevalence of obesity among high school students has risen in recent decades. Many high school students report trying to lose weight and some engage in disordered eating to do so. The obesity proneness model suggests that parents may influence their offspring's development of disordered eating. This study examined the viability of a modified obesity proneness model in a high school population.

METHODS

Cross-sectional survey data from a random cluster sample of 1533 students in grades 9-12 from a Florida school district were analyzed using structural equation modeling. Variables included adolescents' weight concerns; inability to self-regulate eating; and perceptions about maternal comments about adolescents' weight, restrictive feeding practices, and maternal weight-related concern and values.

RESULTS

All the model's originally proposed relationships were statistically significant, for example perceived maternal weight comments were associated with adolescents' weight concerns (β = 0.64; p < .0001), and perceived maternal restrictive feeding practices were associated with adolescents' inability to self-regulate eating (β = 0.22; p < .001).

CONCLUSION

Some points of intervention should be subjected to empirical study. These interventions should give mothers guidance about appropriate feeding practices and discourage mothers from making weight-related comments to their offspring. Together, as 1 component of a multilevel intervention, these behaviors may help prevent disordered eating and obesity.

Psychosocial functioning and self-rated health in Japanese school-aged children: A cross-sectional study

Emotional and behavioral disorders in children are school-health concerns; however, Japanese screening tools for such disorders are not yet available. We examined the association between psychosocial functioning as measured by the Pediatric Symptom Checklist (PSC) and self-rated health within school settings. A cross-sectional study was conducted for 2513 fifth and eighth graders from all of the primary and secondary schools in Shunan City, Japan. The Japanese PSC had high internal consistency (Cronbach's α = 0.90) and a factor structure similar to that of the English PSC. When the cut-off values were set to ≥ 28 and ≥ 17, 4-9% and 20-39% of our respondents, respectively, reported high PSC scores. A multiple ordinal logistic regression analysis showed that the odds ratio of a positive PSC score (≥ 28) for poorer self-rated health among ratings of "very good," "good," "fair," and "poor" was 3.5 (95% confidence interval = 2.6-4.8). There was a clear association between psychosocial dysfunction identified by a PSC score ≥ 28 and poor self-rated health. We offer directions for further research on appropriate PSC cut-off values with Japanese samples.

The health status of youth in Puerto Rico

BACKGROUND

Few population-based studies have assessed health outcomes and health care access and use among youth in the US Commonwealth of Puerto Rico.

METHODS

Data are from an island population-based sample of 337 youth, 10 to 17 years old, who participated in the Asthma, Depression, and Anxiety in Puerto Rican Youth Study. In-person interviews with youth and caregivers assessed self-rated physical and mental health, weight status, diagnosed health conditions, and health care access and use.

RESULTS

Island Puerto Rican youth report slightly worse physical and mental health than mainland youth. Puerto Rican youth have high rates of asthma, headaches, and stomachaches. Also, 6 in 10 island youth use public health insurance, and 1 in 3 regularly receive care at the emergency department.

CONCLUSIONS

Island Puerto Rican youth are at a health disadvantage compared with mainland youth. Public health research is needed to fully understand and combat health challenges among Puerto Rican youth.

Household income and spiritual well-being but not body mass index as determinants of poor self-rated health among African American adolescents

Very little is known about predictors of subjective health status among African American adolescents. This study was designed to determine whether selected anthropometric, psychological, lifestyle behavioral, and structural variables predicted poor self-rated general health in a cross-sectional nonclinical sample of 310 female African American adolescents, 14-18 years old. The odds of reporting poor self-rated health were 2-3 times greater for African American teens from lower socioeconomic households when compared to teens residing in higher socioeconomic households and for those reporting infrequent participation in activities that promote spiritual well-being compared to those who participate more frequently in activities that enhance spiritual health. Findings indicate that socioeconomic level and engagement in behaviors that enhance healthy spirituality appear to be the most salient predictors of self-rated health. In addition to biodiversity considerations that influence perceptions of health status, culturally focused interventions should integrate variables shown to influence self-rated health among African American teens. These inclusions may inform a more integrated understanding of health, health outcomes, and health disparities in this vulnerable population.

Multiple forms of perceived discrimination and health among adolescents and young adults

Research on perceived discrimination has overwhelmingly focused on one form of discrimination, especially race discrimination, in isolation from other forms. The present article uses data from the Black Youth Culture Survey, a nationally representative, racially and ethnically diverse sample of 1,052 adolescents and young adults to investigate the prevalence, distribution, and mental and physical health consequences of multiple forms of perceived discrimination. The findings suggest that disadvantaged groups, especially multiply disadvantaged youth, face greater exposure to multiple forms of discrimination than their more privileged counterparts. The experience of multiple forms of discrimination is associated with worse mental and physical health above the effect of only one form and contributes to the relationship between multiple disadvantaged statuses and health. These findings suggest that past research may misspecify the discrimination-health relationship and fails to account for the disproportionate exposure to discrimination faced by multiply disadvantaged individuals.

Smoking is associated with poor self-rated health among adolescents in Hong Kong

INTRODUCTION

To investigate the association between smoking and self-rated health (SRH) among adolescents in Hong Kong.

METHODS

Form 1 (U.S. Grade 7) to 5 students (N = 36,225) from 85 randomly selected secondary schools were surveyed using anonymous, self-administered questionnaires to collect information about smoking, SRH, secondhand smoke exposure, drinking, illicit drug use, physical activities, medical services use, health complaints, and sociodemographic characteristics. Logistic regression yielded adjusted odds ratios (AORs) for poor SRH due to smoking in boys and girls.

RESULTS

Compared with never-smoking, smoking experimentation, ex-smoking, and current smoking were associated with AORs (95% CI) for poor SRH of 1.22 (1.07-1.40), 1.43 (1.12-1.83), and 1.31 (1.13-1.53), p for trend <.001, in boys and 1.26 (1.10-1.39), 1.42 (1.08-1.85), and 1.75 (1.53-2.00, p for trend <.001, in girls. The AOR of poor SRH for current smoking was higher in girls than boys, p for interaction <.001. Current and experimental smoking but not ex-smoking were significantly associated with poor SRH among healthy students who had no health complaints or recent medical consultations. Increasing cigarette consumption, years of smoking, and smoking urge were also significantly associated with poor SRH.

CONCLUSIONS

Smoking was associated with poor SRH among Chinese adolescents, especially girls. This finding is useful for discouraging smoking initiation and motivating quitting in adolescent smokers.

Discordance in national estimates of hypertension among young adults

BACKGROUND

In the United States, where coronary heart disease (CHD) is the leading cause of mortality, CHD risk assessment is a priority and accurate blood pressure (BP) measurement is essential.

METHODS

Hypertension estimates in the National Longitudinal Study of Adolescent Health (Add Health), Wave IV (2008)-a nationally representative field study of 15,701 participants aged 24-32-was referenced against NHANES (2007-2008) participants of the same age. We examined discordances in hypertension, and estimated the accuracy and reliability of blood pressure in the Add Health study.

RESULTS

Hypertension rates (BP: ≥ 140/90 mm Hg) were higher in Add Health compared with NHANES (19% vs. 4%), but self-reported history was similar (11% vs. 9%) among adults aged 24-32. Survey weights and adjustments for differences in participant characteristics, examination time, use of antihypertensive medications, and consumption of food/caffeine/cigarettes before blood pressure measurement had little effect on between-study differences in hypertension estimates. Among Add Health participants interviewed and examined twice (full and abbreviated interviews), blood pressure was similar, as was blood pressure at the in-home and in-clinic examinations conducted by NHANES III (1988-1994). In Add Health, there was minimal digit preference in blood pressure measurements; mean bias never exceeded 2 mm Hg; and reliability (estimated as intraclass correlation coefficients) was 0.81 and 0.68 for systolic and diastolic BPs, respectively.

CONCLUSIONS

The proportion of young adults in NHANES reporting a history of hypertension was twice that with measured hypertension, whereas the reverse was found in Add Health. Between-survey differences were not explained by digit preference, low validity, or reliability of Add Health blood pressure data, or by salient differences in participant selection, measurement context, or interview content. The prevalence of hypertension among Add Health Wave IV participants suggests an unexpectedly high risk of cardiovascular disease among US young adults and warrants further scrutiny.

Health and the structure of adolescent social networks

Much research has explored the role of social networks in promoting health through the provision of social support. However, little work has examined how social networks themselves may be structured by health. This article investigates the link between individuals' health and the characteristics of their social network positions. We first develop theoretical predictions for how health may influence the structure of adolescent networks. We then test these predictions using longitudinal analysis of the National Longitudinal Study of Adolescent Health (Add Health). We find important relationships between the health status of adolescents and the characteristics of the social network positions within which they are embedded. Overall we find that adolescents in poor health form smaller local networks and occupy less central global positions than their healthy peers. These results also have implications for social network research, expanding the scope of factors responsible for the network positions individuals occupy.