Educational expectations and adolescent health behaviour: an evolutionary approach

Do behavioral drivers matter for healthcare decision-making during crises? A study of low-income women in El Salvador during the COVID-19 pandemic

Understanding health-seeking behaviors and their drivers is key for governments to manage health policies. A growing body of research explores the role of cognitive biases and heuristics in health and care-seeking behaviors, but little is known about how a context of heightened anxiety and uncertainty might influence these behavioral drivers. This study analyzes the association between four behavioral predictors-internal locus of control, impatience, optimism bias, and aspirations-and healthcare decisions among low-income women in El Salvador, controlling for other factors. We find positive associations between internal locus of control and preventive health behaviors during the COVID-19 pandemic. For instance, a one standard deviation increase in locus of control is associated with a 10% increase in an index measuring the use of masks, distancing, hand washing, and vaccination. Locus of control was also associated with women's use of preventive health services (one standard deviation improves the likelihood of having a hypertension test in the last six months by 5.8 percentage points). In a sub-sample of mothers, we find significant relationships between the four behavioral drivers and the decisions the mothers make for their children. However, we find these associations are less robust compared to the decisions they make for themselves. Some associations were stronger during the pandemic, suggesting that feelings of uncertainty and stress could amplify behavioral drivers' influence on health-related behaviors. This novel finding is relevant for designing policy responses for future shocks. JEL CODES: I12, D10, D91, I30.

A tale of tails: Nonlinear effects of ability rank on adolescent psychological well-being

Previous literature has documented the effect of cognitive ability on adolescent psychological well-being. This study extends this line of research by revealing the nonlinear effect of a student's ability rank within the peer group on adolescent depression. Using a nationally representative longitudinal survey of U.S. adolescents, we leverage a quasi-experimental research design to show that controlling for absolute ability, students with lower ability ranks are more likely to develop depressive symptoms. Moreover, this effect is nonlinear and more pronounced at the top and bottom of the ability distribution. We further examine two mediation mechanisms: social comparison and social relations. Results show that social comparison partly mediate the ability rank effect on depression at the top and bottom of the ability distribution; social relations, particularly care from teachers, partly mediate the rank effect at the top of the ability distribution. Findings may help design targeted initiatives to address adolescent depression.

Peers' parental education and cardiovascular disease risk in adulthood: The mediating role of health-related behaviors

RATIONALE

Although there is a growing body of empirical evidence on the relationship between peers' parental education and adolescents' educational outcomes, little is known about whether exposure to highly educated peers' parents is associated with improved physical health in adulthood.

OBJECTIVE

This study investigated the relationship between the education level of peers' parents (Wave I) and the risk of developing cardiovascular disease (CVD) in adulthood (Wave IV). Moreover, we considered a set of health-related behaviors (Wave II) as the underlying mechanisms linking peers' parental education to later-life physical health such as substance use (smoking, binge drinking, and marijuana use) and other lifestyle behaviors (physical activity, sedentary behavior, and unhealthy dietary habits).

METHODS

Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), spanning respondents' adolescence to adulthood, were used. To address the endogenous school selection problem and account for the unobserved school-level confounders, this study exploited quasi-experimental within-school/across-cohort variation in peer composition. To formally test for mediation, Sobel tests were conducted.

RESULTS

The results of this study revealed that independent of own parents' education levels, exposure to higher levels of peers' parental education is associated with a lower CVD risk score in adulthood. For a one-standard-deviation increase in peers' parental education-that is, about a 0.98-year increase in grademates' parental educational attainment, a CVD risk in adulthood increased by about 6.2%. Our mediation analyses showed that part of this association is explained by a decrease in substance use (27% for smoking, 10% for binge drinking, and 11% for marijuana use). In contrast, none of the other lifestyle behaviors evaluated significantly mediated the association.

CONCLUSION

The study's findings suggest that the role of peers' parents should not be overlooked when developing health-promoting interventions for adolescents. Policymakers and practitioners may wish to increase opportunities for students to benefit from health-related social learning from their peers' highly educated parents.

The great decline in adolescent risk behaviours: Unitary trend, separate trends, or cascade?

In many high-income countries, the proportion of adolescents who smoke, drink, or engage in other risk behaviours has declined markedly over the past 25 years. We illustrate this behavioural shift by collating and presenting previously published data (1990-2019) on smoking, alcohol use, cannabis use, early sexual initiation and juvenile crime in Australia, England, the Netherlands, New Zealand, and the USA, also providing European averages where comparable data are available. Then we explore empirical evidence for and against hypothesised causes of these declines. Specifically, we explore whether the declines across risk behaviours can be considered 1) a 'unitary trend' caused by common underlying drivers; 2) separate trends with behaviour-specific causes; or 3) the result of a 'cascade' effect, with declines in one risk behaviour causing declines in others. We find the unitary trend hypothesis has theoretical and empirical support, and there is international evidence that decreasing unstructured face-to-face time with friends is a common underlying driver. Additionally, evidence suggests that behaviour-specific factors have played a role in the decline of tobacco smoking (e.g. decreasing adolescent approval of smoking, increasing strength of tobacco control policies) and drinking (e.g. more restrictive parental rules and attitudes toward adolescent drinking, decreasing ease of access to alcohol). Finally, declining tobacco and alcohol use may have suppressed adolescent cannabis use (and perhaps other risk behaviours), but evidence for such a cascade is equivocal. We conclude that the causal factors behind the great decline in adolescent risk behaviours are multiple. While broad contextual changes appear to have reduced the opportunities for risk behaviours in general, behaviour-specific factors have also played an important role in smoking and drinking declines, and 'knock-on' effect from these behavioural domains to others are possible. Many hypothesised explanations remain to be tested empirically.

Psychological distress, oral health behaviour and related factors among adolescents: Finnish School Health Promotion Study

BACKGROUND

Psychological distress may affect health behaviour. We examined how psychological distress, social phobia (SP) and anxiety associated with tooth brushing among Finnish adolescents with respect to gender, school grade, parents' education, family structure, smoking and perceived general health.

METHODS

This study is part of the Finnish national School Health Promotion Study (SHP). The study population comprised a representative sample of Finnish 15-year-olds (N = 45,877). Mini-Social Phobia Inventory (Mini-SPIN) and generalized anxiety disorder (GAD) served to assess SP and anxiety. A questionnaire enquired about the respondents' oral health habits (tooth brushing, smoking), background factors (age, gender, family structure and parents' education) and perceived general health. Chi-squared tests and logistic regression analyses served in the statistical analyses.

RESULTS

About two-thirds of the girls (66.7%) and less than half of the boys (40.1%) followed the international recommendation of tooth brushing twice daily. Girls reported possible problems with SP and GAD more often than boys did. Those reporting possible problems with SP or moderate or severe anxiety brushed their teeth at least twice daily less often than did those reporting no possible problems with SP and those with no, slight or mild anxiety. Logistic regression analyses showed that male gender (OR = 3.2; 95% CI 3.1-3.4), parents' basic education (OR = 1.5; 95% CI 1.4-1.5), and adolescents' perception of their current state of health as moderate, fairly or very poor (OR = 1.8; 95% CI 1.5-2.0) associated with not brushing teeth twice daily. Gender-specific logistic regression analyses showed that boys who smoked (OR = 1.7; 95% CI 1.6-1.8) were less likely than non-smokers to brush their teeth twice daily.

CONCLUSION

Adolescents with psychological distress, such as possible SP or possible general anxiety, had less favourable oral health behaviour. Psychological distress indicates a greater risk for oral health problems already in adolescence.

Highlighting the Role of Cognitive and Brain Reserve in the Substance use Disorder Field

BACKGROUND

Cognitive reserve (CR) refers to the ability of an individual to cope with brain pathology remaining free of cognitive symptoms. This protective factor has been related to compensatory and more efficient brain mechanisms involved in resisting brain damage. For its part, Brain reserve (BR) refers to individual differences in the structural properties of the brain which could also make us more resilient to suffer from neurodegenerative and mental diseases.

OBJECTIVE

This review summarizes how this construct, mainly mediated by educational level, occupational attainment, physical and mental activity, as well as successful social relationships, has gained scientific attention in the last years with regard to diseases, such as neurodegenerative diseases, stroke or traumatic brain injury. Nevertheless, although CR has been studied in a large number of disorders, few researches have addressed the role of this concept in drug addiction.

METHODS

We provide a selective overview of recent literature about the role of CR and BR in preventing substance use onset. Likewise, we will also discuss how variables involved in CR (healthy leisure, social support or job-related activities, among others) could be trained and included as complementary activities of substance use disorder treatments.

RESULTS

Evidence about this topic suggests a preventive role of CR and BR on drug use onset and when drug addiction is established, these factors led to less severe addiction-related problems, as well as better treatment outcomes.

CONCLUSION

CR and BR are variables not taken yet into account in drug addiction. However, they could give us a valuable information about people at risk, as well as patient's prognosis.

Adolescent alcohol use and parental and adolescent socioeconomic position in six European cities

Background

Many risk behaviours in adolescence are socially patterned. However, it is unclear to what extent socioeconomic position (SEP) influences adolescent drinking in various parts of Europe. We examined how alcohol consumption is associated with parental SEP and adolescents’ own SEP among students aged 14–17 years.

Methods

Cross-sectional data were collected in the 2013 SILNE study. Participants were 8705 students aged 14–17 years from 6 European cities. The dependent variable was weekly binge drinking. Main independent variables were parental SEP (parental education level and family affluence) and adolescents’ own SEP (student weekly income and academic achievement). Multilevel Poisson regression models with robust variance and random intercept were fitted to estimate the association between adolescent drinking and SEP.

Results

Prevalence of weekly binge drinking was 4.2% (95%CI = 3.8–4.6). Weekly binge drinking was not associated with parental education or family affluence. However, weekly binge drinking was less prevalent in adolescents with high academic achievement than those with low achievement (PR = 0.34; 95%CI = 0.14–0.87), and more prevalent in adolescents with >€50 weekly income compared to those with ≤€5/week (PR = 3.14; 95%CI = 2.23–4.42). These associations were found to vary according to country, but not according to gender or age group.

Conclusions

Across the six European cities, adolescent drinking was associated with adolescents’ own SEP, but not with parental SEP. Socio-economic inequalities in adolescent drinking seem to stem from adolescents’ own situation rather than that of their family.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4635-7) contains supplementary material, which is available to authorized users.

Marijuana and Alcohol Use as Predictors of Academic Achievement: A Longitudinal Analysis Among Youth in the COMPASS Study

BACKGROUND

We tested the effect of initiating marijuana and alcohol use at varying frequencies on academic indices.

METHODS

In a sample of 26,475 grade 9-12 students with at least 2 years of linked longitudinal data from year 1 (Y1: 2012-2013), year 2 (Y2: 2013-2014), and year 3 (Y3: 2014-2015) of the COMPASS study, separate multinomial generalized estimating equations models tested the likelihood of responses to measures of academic goals, engagement, preparedness, and performance when shifting from never using alcohol or marijuana at baseline to using them at varying frequencies at follow -up.

RESULTS

Students who began using alcohol or marijuana were less likely to attend class regularly, complete their homework, achieve high marks, and value good grades, relative to their abstaining peers. Changing from abstaining to rare/sporadic-to-weekly drinking or rare/sporadic marijuana use predicted aspirations to continue to all levels of higher education, and initiating weekly marijuana use increased the likelihood of college ambitions, while more regular marijuana use reduced the likelihood of wanting to pursue graduate/professional degrees, over high school.

CONCLUSIONS

The importance of delaying or preventing substance use is evident in associations with student performance and engagement. The influence on academic goals varied by substance and frequency of initiated use.

Energy drink consumption, health complaints and late bedtime among young adolescents

OBJECTIVES

Energy drinks contain large amounts of caffeine. Their effects on adolescent well-being are poorly known. We examined the relationship of energy drink consumption with health complaints and late bedtime among 13-year-olds.

METHODS

A classroom survey was conducted on all 7th graders in the Helsinki metropolitan region, Finland (73 % responded; n = 9446). Logistic regression analysis and structural equation modeling (SEM) were used.

RESULTS

The prevalence of health complaints increased as energy drink consumption increased from non-consumers to several times/day. Late bedtime (≥11 PM) increased correspondingly. Those consuming energy drinks several times/day exhibited increased odds of experiencing daily health complaints compared with non-consumers: headache OR (adjusted) = 4.6 (2.8-7.7), sleeping problems OR = 3.6 (2.2-5.8), irritation OR = 4.1 (2.7-6.1), tiredness/fatigue OR = 3.7 (2.4-5.7), and late bedtime OR = 7.8 (5.7-10.9). In SEM, energy drink consumption had a direct effect on health complaints and late bedtime and an indirect effect on health complaints via late bedtime.

CONCLUSIONS

Energy drinks, late bedtime, and health complaints form a behavior pattern that is worth considering in schools, home and clinical settings when adolescents complain about headaches, problems with sleeping and corresponding symptoms.