School-related assets and youth risk behaviors: alcohol consumption and sexual activity

Risk Factors for Early Sexual Intercourse in Adolescence: A Systematic Review of Cohort Studies

This systematic review provides a comprehensive assessment of risk factors related to early sexual intercourse (ESI) among adolescents. We used PRISMA guidelines to identify eligible cohort studies published between January 1999 and December 2020. We searched on three databases: PubMed, Embase and LILACS. Studies were screened for quality and eligibility. Of 2787 identified studies, seven met our inclusion criteria. The studies examined a range of factors, which were organized into four dimensions - individual, family, social and environmental, and sociodemographic. Risk factors with strong associations for ESI were: adolescent and parental substance use, aggression and conduct disorders, family attachment, school achievement, family living situation, and maternal education. Three studies were birth cohorts. This review demonstrates the important roles of substance use, family attachment and academic factors in shaping adolescents' sexual behavior. A strength of this review is its focus on longitudinal studies, enabling exploration of exposures collected before initiation of sexual intercourse.

A Social-Ecological Approach to Understanding Adolescent Sexting Behavior

This study examined the extent to which active and passive sexting behaviors are associated with family-, school-, peer-, and romantic-level variables. Young people (N = 3,322; 49.1% female, 48.3% male, 2.6% other) aged 11 to 15 years old (M = 12.84, SD = 0.89) took part, and all attended mainstream secondary schools in Scotland. Participants completed self-report measures of school connectedness, parental love and support, perceived susceptibility to peer- and romantic-pressure (e.g., to display behaviors just to impress others), and their involvement in active and passive sexting. The importance of both school- and family-level factors was evident, though perceived romantic-pressure had the largest effect. However, neither school- nor family-level variables were moderated by either perceived romantic-pressure or perceived peer-pressure. Efforts to reduce sexting or increase its safety should primarily seek to tackle young people's ability to respond effectively to romantic-pressure. It may also be helpful to develop school connectedness and to help families provide support that is constructive and not intrusive.

Youth Assets and Associations With Adolescent Risk Taking

BACKGROUND

Positive youth development emphasizes that adaptive features of adolescence may contribute to teenage pregnancy prevention.

METHODS

Using data from approximately 1300 seventh-ninth graders, we describe positive youth development assets (external and internal) and their association with sexual risk taking. School-, sex-, and race/ethnicity-stratified logistic or linear models assessed associations between developmental assets and 6 outcomes (continuous attitudes about teenage sex and marriage, abstinence intentions, and nonsexual risk-taking behavior; dichotomous high risk-dating behavior, friends' sexual activity, and prior sexual activity).

RESULTS

Associations between developmental assets and youth sexual behavior differed by school, sex, and race/ethnicity. White female respondents showed the most consistent associations between higher amounts of each of the positive youth development assets and attitudes and behaviors conducive to delaying sexual activity while black youth showed the fewest associations.

CONCLUSION

These results contribute to the positive youth development literature by identifying that relationships between assets and adolescent risk differs by race and sex.

Adverse Childhood Experiences and Teen Sexual Behaviors: The Role of Self-Regulation and School-Related Factors

BACKGROUND

There is limited evidence addressing the impact of adverse childhood experiences (ACEs) on adolescent sexual risk behaviors and pregnancy. In this study, we examined whether individual and cumulative ACEs increased the risk of unhealthy sexual behaviors and adolescent pregnancy. To inform intervention efforts, potential mediating mechanisms focusing on youth developmental assets were examined to explain the association.

METHODS

Analyses included 88,815 (9th and 11th grade) students who completed the Minnesota Student Survey in the spring of 2016.

RESULTS

Adolescents who reported each category of ACEs were more likely to initiate sex, have multiple sex partners, engage in unprotected sex, and be involved in pregnancy. Different youth assets, included self-regulation skills, connectedness to school, not skipping school, and academic performance, were associated with lower likelihood of sexual initiation and sexual risk-taking. They served as important mediators to reduce, though not completely diminish, the adverse effects of ACEs on sexual initiation and adolescent pregnancy.

CONCLUSIONS

The results suggest that the relationship between ACEs and adolescent sexual risk behaviors and pregnancy is strong and graded. Effective school initiatives and intervention efforts should encourage the development of self-regulation and connectedness to school among teens who had been exposed to ACEs.

Prospective relationships between youth assets, negative life events, and binge drinking in a longitudinal cohort of the youth

PURPOSE

The purpose of this study was to investigate whether individual, family, and community assets can 1) protect youth from binge drinking in the face of negative life events and 2) modify the relationship between negative life events and binge drinking.

METHODS

Data from waves 2-5 of the Youth Asset Study were analyzed. Generalized estimating equations were used to assess the relationship between negative life events, assets, and binge drinking. Multiplicative and additive interaction between negative life events and assets was evaluated.

RESULTS

When included in the same model as negative life events, individual, family, and community assets had a graded, protective relationship with binge drinking, with strongest protection for those with the greatest number of assets. For example, youth with 3 [adjusted odds ratio (AOR):0.78, 95% confidence interval (CI): 0.65-0.93], 4 [AOR: 0.60, 95% CI: 0.49-0.73], 5 [AOR: 0.53, 95% CI: 0.41-0.69], and 6 [AOR: 0.42, 95% CI: 0.28-0.63] assets within the community domain had a significantly lower odds of binge drinking than youth with 0-2 community assets. No significant interactions were observed.

CONCLUSIONS

The findings suggest that while youth who are exposed to negative life events are at risk for binge drinking, building assets across individual, family, and community domains can have a protective influence.

School Environment Is Related to Lower Health and Safety Risks Among Sexual Minority Middle and High School Students

PURPOSE

The objective of this study was to examine the relationship between school involvement and connectedness with measures of sexual risk, substance use, and experience of violence among students who had sexual contact with the same sex or with both sexes.

METHODS

A sample of middle school and high school students who participated in a study conducted in a large urban school district were selected based on their reported experience of having initiated sexual activity with same-sex partners. In classroom-based surveys, we assessed self-reported involvement in school-based activities and feelings of school connectedness, as well as self-reported sexual risk, substance use, and experience of violence.

RESULTS

Significant protective associations were found between school involvement and lifetime alcohol and marijuana use, and between school connectedness and ever having been in a fight, feeling safe at school, and drug use other than marijuana (all p < .05).

CONCLUSIONS

Findings suggest that efforts to increase school involvement and connectedness provide a starting point for addressing significant health and safety concerns among students with same-sex sexual activity.

Adolescent Stress Treatment Study: A Cluster Randomized Trial

High school students experience a variety of stressors. Mental health issues are critical to their health. The "Adolescent Stress Treatment (AST) Study: A Cluster Randomized Trial" compared the efficacy of two stress reduction devices, the EnergyPod™ and the SleepWing™. The EnergyPod™ is a device that provides a semiprivate acoustical and visual environment for rest, stress reduction, and sleep. The SleepWing™ is a smaller device offering similar benefits. High school students were offered the opportunity to participate in the AST study when they exhibited signs of agitation. The students completed the Profile of Mood States-Short Form (POMS-SF) pre- and postintervention. Total Mood Disturbance (TMD) was measured from the POMS-SF and significant improvement postintervention (p < .001), regardless of intervention used. POMS-SF subscales were all significantly improved no matter which device was used. All participants in the study dramatically improved their mood after being in either therapeutic device.

Adolescent Risk Screening Instruments for Primary Care: An Integrative Review Utilizing the Donabedian Framework

Adolescent risk-taking behavior choices can affect future health outcomes. The purpose of this integrative literature review is to evaluate adolescent risk screening instruments available to primary care providers in the United States using the Donabedian Framework of structure, process, and outcome. To examine the literature concerning multidimensional adolescent risk screening instruments available in the United States for use in the primary care setting, library searches, ancestry searches, and Internet searches were conducted. Library searches included a systematic search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier, Health Source Nursing Academic Ed, Medline, PsycINFO, the Psychology and Behavioral Sciences Collection, and PubMed databases with CINAHL headings using the following Boolean search terms: "primary care" and screening and pediatric. Criteria for inclusion consisted of studies conducted in the United States that involved broad multidimensional adolescent risk screening instruments for use in the pediatric primary care setting. Instruments that focused solely on one unhealthy behavior were excluded, as were developmental screens and screens not validated or designed for all ages of adolescents. In all 25 manuscripts reviewed, 16 screens met the inclusion criteria and were included in the study. These 16 screens were examined for factors associated with the Donabedian structure-process-outcome model. This review revealed that many screens contain structural issues related to cost and length that inhibit provider implementation in the primary care setting. Process limitations regarding the report method and administration format were also identified. The Pediatric Symptom Checklist was identified as a free, short tool that is valid and reliable.

Attitudes, Norms, and the Effect of Social Connectedness on Adolescent Sexual Risk Intention

BACKGROUND

Risky sexual behaviors put adolescents at increased risk of adverse outcomes. Parents, school-based adults, and peers play important roles in influencing these sex intentions.

METHODS

This work explored the influence of parent-child sex communication on adolescent attitudes, perceived norms, and intentions to have sex, including the moderating role of social support from school-based adults, in a sample of 21,731 adolescents in California.

RESULTS

Although increased parent-child sex communication was associated with intentions to have sex, it also exhibited protective effects, increasing abstinence attitudes among youth that led to decreased intention directly and via support from school-based adults.

CONCLUSIONS

Although many factors influencing sexual behaviors are largely intrapersonal, these findings indicate the importance of an ecological approach to reducing adolescent sexual risk behaviors through engagement of parents and increased school connectedness.

Grit: A Potential Protective Factor Against Substance Use and Other Risk Behaviors Among Latino Adolescents

OBJECTIVE

Grit, defined as "working strenuously toward challenges, maintaining effort and interest over years despite failure, adversity, and plateaus in progress," is strongly associated with academic achievement and life success and may also be associated with health outcomes and behaviors. We examined predictors of grit, and the association between grit and health behaviors among at-risk Latino adolescents.

METHODS

We analyzed baseline survey data collected in 2013-2014 from a sample of 1270 9th graders in low-income neighborhoods of Los Angeles. We examined factors associated with grit and whether grit is associated with substance use and delinquent behaviors, controlling for adolescent and parent sociodemographic factors.

RESULTS

In a sample of mostly Latino adolescents (89.5%), compared to those with low grit, those with high grit had significantly lower odds of alcohol use in the last 30 days (odds ratio 0.30, P < .001), marijuana use (odds ratio 0.21, P < .05), and fighting (odds ratio 0.58, P < .05). Involvement in delinquent behavior was also lower (β = -0.71, P < .001). Factors associated with more grit included authoritative parenting style, parental employment, and high self-efficacy scores.

CONCLUSIONS

Grit may be an important candidate protective factor against substance use and other risk behaviors among Latino adolescents.

Preventing alcohol-exposed pregnancy among American-Indian youth

Research has determined that the prevention of alcohol-exposed pregnancies (AEP) must occur pre-conceptually with women, either by reducing alcohol intake in women planning pregnancy or at-risk for becoming pregnant, or by preventing pregnancy in women drinking at risky levels. One such AEP prevention programme with non-pregnant American Indian women is the Oglala Sioux Tribe (OST) CHOICES (Changing High-risk alcohOl use and Increasing Contraception Effectiveness Study) Programme, which shows promise in reducing AEP risk in American Indian women aged 18 or older. A community needs assessment was conducted with key informant interviews and focus groups with an emphasis on how to expand OST CHOICES. To identify interconnected themes, a content analysis methodology was used on the qualitative feedback from the focus groups and interviews. Altogether, key informant interviews were completed with 25 health and social service professionals. Eight focus groups were held with 58 American Indian participants, including adult women of child-bearing age, elder women, and adult men. Several sub-themes regarding the prevention of AEP with youth were identified, expanding the OST CHOICES curriculum into the schools, and the role of family and culture within AEP prevention.

School performance and alcohol-related disorders in early adulthood: a Swedish national cohort study

Background Alcohol misuse is an important global health determinant and a major contributor to health inequalities. We aimed to investigate the association between school performance and alcohol-related disorders in early adulthood in a longitudinal register-based national cohort study.

Methods We followed a register-based national cohort of Swedish citizens born 1973–1984 (N = 948 440) from compulsory school graduation at age 15–16 to 2009. We divided the population into five groups: high school marks (> mean + 1 SD); high average (between mean and mean + 1 SD); low average (between mean and mean − 1 SD); low (< mean – 1SD); and missing. Cox proportional hazard models were used to investigate the relation between school marks at time of graduation and hospital care for alcohol-related disorders in early adulthood.

Results There was a steep gradient in the risk of alcohol-related disorders related to school performance. In comparison with peers in the top category of school marks, students with low marks had adjusted hazard ratios of 8.02 [95% confidence interval (CI) 7.20 to 8.91], low average 3.02 (2.72 to 3.35) and high average 1.55 (1.39 to 1.73). The risk associated with low school marks was stronger in the male population and in the group from high socioeconomic background.

Conclusions The study demonstrated a strong graded relation between low school performance and alcohol-related disorders in young adulthood. School performance should be taken into account when developing prevention programmes/policies targeting alcohol misuse among teenagers and young adults, especially if the aim is to reach high-risk groups.

School bullying, low self-control, and opportunity

The theory of low self-control has been shown to be a valid predictor of a wide variety of criminal and deviant behaviors. However, a limited number of studies were conducted to understand the relationship between low self-control and bullying and the effects of opportunity factors (i.e., parental supervision, association with other bullies, negative school environment, and disciplinary measures used by teachers) on bullying in the context of low self-control theory. The present study, using a sample of nearly 300 youths, examined the effects of low self-control and opportunity factors on various types of bullying behaviors. Results indicated that youths with low self-control were likely to physically and psychologically bully, consistent with the theory's prediction. When opportunity measures were introduced, they were stronger explanations of bullying than low self-control, especially association with other bullies and youth who experienced disciplinary measures by their teacher. Negative school environment was a significant predictor of psychological bullying but not for physical bullying. Theoretical and policy implications are discussed.

Do men need empowering too? A systematic review of entrepreneurial education and microenterprise development on health disparities among inner-city black male youth

Economic strengthening through entrepreneurial and microenterprise development has been shown to mitigate poverty-based health disparities in developing countries. Yet, little is known regarding the impact of similar approaches on disadvantaged U.S. populations, particularly inner-city African-American male youth disproportionately affected by poverty, unemployment, and adverse health outcomes. A systematic literature review was conducted to guide programming and research in this area. Eligible studies were those published in English from 2003 to 2014 which evaluated an entrepreneurial and microenterprise initiative targeting inner-city youth, aged 15 to 24, and which did not exclude male participants. Peer-reviewed publications were identified from two electronic bibliographic databases. A manual search was conducted among web-based gray literature and registered trials not yet published. Among the 26 papers retrieved for review, six met the inclusion criteria and were retained for analysis. None of the 16 registered microenterprise trials were being conducted among disadvantaged populations in the U.S. The available literature suggests that entrepreneurial and microenterprise programs can positively impact youth's economic and psychosocial functioning and result in healthier decision-making. Young black men specifically benefited from increased autonomy, engagement, and risk avoidance. However, such programs are vastly underutilized among U.S. minority youth, and the current evidence is insufficiently descriptive or rigorous to draw definitive conclusions. Many programs described challenges in securing adequate resources, recruiting minority male youth, and sustaining community buy-in. There is an urgent need to increase implementation and evaluation efforts, using innovative and rigorous designs, to improve the low status of greater numbers of African-American male youth.

The influence of assets and environmental factors on gender differences in adolescent drug use

For adolescents, illicit drug use remains a significant public health problem. This study explored prospectively the differential effects of 17 youth assets and 5 environmental factors on drug use in adolescent males and females (Youth Asset Study - a 5-wave longitudinal study of 1117 youth/parent pairs). Baseline analyses included 1093 youth (53% female). Mean age was 14.3 years (SD = 1.6) and the youth were 40% Non-Hispanic White, 28% Hispanic, 24% Non-Hispanic Black, and 9% Non-Hispanic other. Analyses revealed that 16 assets for males and 15 for females as well as the total asset score were prospectively associated with no drug use. No environmental factors were prospectively associated with any drug use for males, and for a subset of females, only Neighborhood Support was significant. This study confirms and extends previous work regarding youth drug use by recognizing the importance of the protective effect of assets for both males and females.

Sex differences in associations of school connectedness with adolescent sexual risk-taking in Nova Scotia, Canada

BACKGROUND

Associations of lower school connectedness have been seen with adolescent sexual risk behaviors, but little is known about gender differences with respect to these relationships. Understanding any such differences could contribute to better supporting the school environment to promote youth sexual health.

METHODS

We used provincially representative cross-sectional data from 1415 sexually active students in grades 10 to 12 in Nova Scotia, Canada, to determine whether lower school connectedness was associated with students' sexual risk behaviors using multivariate logistic regression, stratifying by sex.

RESULTS

In boys, lower connectedness was associated with three risk behaviors, having  ≥ 2 partners in the previous year (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01-1.13), no condom use at last intercourse (OR 1.06; 95% CI 1.01-1.12), and having unplanned intercourse due to substance use (OR 1.09; 95% CI 1.03-1.15). No such associations were seen in girls.

CONCLUSIONS

These results demonstrate that gender differences may exist for associations of school connectedness and sexual risk behaviors; connectedness may be more important for boys than for girls in this area of adolescent health. Educators should consider gender differences when designing interventions to maximize youth sexual health through school-based interventions. Further research on school connectedness and risk-taking should examine genders separately.

Sexual behavior among Brazilian adolescents, National Adolescent School-based Health Survey (PeNSE 2012)

OBJECTIVE: This study describes the sexual behavior among students who participated in the National Adolescent School-based Health Survey (PeNSE) 2012 and investigates whether social inequalities, the use of psychoactive substances and the dissemination of information on sexual and reproductive health in school are associated with differences in behavior. METHODOLOGY: The response variable was the sexual behavior described in three categories (never had sexual intercourse, had protected sexual intercourse, had unprotected sexual intercourse). The explanatory variables were grouped into socio- demographic characteristics, substance use and information on sexual and reproductive health in school. Variables associated with the conduct and unprotected sex were identified through multinomial logistic regression, using "never had sexual intercourse" as a reference. RESULTS: Over nearly a quarter of the adolescents have had sexual intercourse in life, being more frequent among boys. About 25% did not use a condom in the last intercourse. Low maternal education and work increased the chance of risky sexual behavior. Any chance of protected and unprotected sex increased with the number of psychoactive substances used. Among those who don't receive guidance on the prevention of pregnancy in school, the chance to have sexual intercourse increased, with the largest magnitude for unprotected sex (OR = 1.41 and OR = 1.87 ). CONCLUSION: The information on preventing pregnancy and STD/AIDS need to be disseminated before the 9th grade. Social inequalities negatively affect risky sexual behavior. Substance use is strongly associated with unprotected sex. Information on the prevention of pregnancy and STD/AIDS need to be disseminated early.

School connectedness and susceptibility to smoking among adolescents in Canada

INTRODUCTION

Smoking susceptibility in early adolescence is strongly predictive of subsequent smoking behavior in youth. As such, smoking susceptibility represents a key modifiable factor in reducing the onset of smoking in young people. A growing literature has documented a number of factors that influence susceptibility to smoking; however, there is limited amount of research examining associations of susceptibility to smoking and school connectedness. The current study examines whether school connectedness has an independent protective effect on smoking susceptibility among younger adolescents.

METHODS

A nationally representative sample of 12,894 Canadian students in grades 6-8 (11-14 years old), surveyed as part of the 2010-2011 Youth Smoking Survey, was analyzed. Multilevel logistic regression models examined unadjusted and adjusted associations between school connectedness and smoking susceptibility. The impacts of other covariates on smoking susceptibility were also explored.

RESULTS

Approximately 29% of never-smokers students in grades 6-8 in Canada were susceptible to future smoking. Logistic regression analysis, controlling for standard covariates, found that school connectedness had strong protective effects on smoking susceptibility (odds ratio [OR] 0.91, 95% CI 0.89-0.94).

CONCLUSIONS

The finding that school connectedness is protective of smoking susceptibility, together with previous research, provides further evidence that improving school conditions that promote school connectedness could reduce risky behavior in adolescents. While prevention efforts should be directed at youth of all ages, particular attention must be paid to younger adolescents in the formative period of 11-14 years of age.