Predictors of adolescents' health-promoting behaviors guided by primary socialization theory

Learning About Sex from Different Sources: Implications for Sexual Attitudes, Sexual Knowledge, and Risky Sexual Behavior Among U.S. College Students

This exploratory cross-sectional study, guided by primary socialization theory, examined relations between four primary socialization agents of sexual learning (i.e., mothers, fathers, friends/peers, and online media) and sexual attitudes, sexual knowledge, and risky sexual behavior. Latent-variable structural equation models were tested using self-report data obtained from 515 emerging adults who had spent at least 6 months attending in-person college classes. Results showed that learning about sex from mothers was associated with more conservative sexual attitudes and lower risky sexual behavior. Sexual learning from friends/peers was linked to liberal sexual attitudes and greater sexual knowledge. Learning from online media was associated with increased sexual knowledge. To account for a shift in sexual learning patterns from before to after entry to college, we created algebraic difference scores for each source of sexual information. Greater reliance on sexual learning from friends/peers in the past 6 months of college relative to before college was associated with liberal sexual attitudes and greater sexual knowledge. Additional analyses revealed different effects of learning about sex from mothers more during college than before college between those living on campus vs. commuters living at home. The discussion emphasizes the different role that each of the primary socialization agents plays for emerging adults' sexual development, including the protective role of mothers against risky sexual behavior, the impact of friends and peers on sexual attitudes and knowledge, and the shifting dynamics of socialization processes during college.

Supporting Positive Parenting and Promoting Healthy Living through Family Cooking Classes

BACKGROUND

The family is an important setting in the promotion of child health. The parent-child relationship affects the social and health development of children, and children's healthy behaviors are associated with positive parenting strategies. The parent-child relationship is bi-directional and the connection between parenting and child health is complex. However, few parenting interventions work with parents and children together, and more knowledge is needed on how to develop and implement interventions promoting healthy parent-child relationships. Focusing on a family cooking class program, this study addresses how community initiatives engaging parents and children together can contribute to integrating parenting support with local health promotion.

METHODS

Participant-driven photo-elicited interviews (nine families), focus group evaluations (nine parents/14 children) and observations during cooking classes (10 classes) were applied to analyze the tools and mechanisms that can support positive parenting.

RESULTS

The study found that visual, practical and sensory learning techniques, applied in a context-sensitive learning environment that ensured guidance, safety and a friendly social atmosphere, contributed to positive parent-child interaction and bonding.

CONCLUSION

The cooking program facilitated parenting practices that support child involvement and autonomy. Thus, the program constituted an effective intervention to strengthen parent-child relationships and positive parenting.

Perceived Parental Monitoring: A Systematic Review of Monitoring Instruments

BACKGROUND AND PURPOSE

The purpose of this systematic review was to evaluate parental monitoring instruments and the theoretical perspectives informing their development.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, seven databases were searched for original studies using a monitoring instrument. The psychometric properties of each identified instrument were assessed using the "COnsensus-based Standards for the selection of health status Measurement INstruments" (COSMIN) methodology.

RESULTS

Of 2,245 articles identified, 72 studies representing six parental monitoring instruments met inclusion criteria. Quality of reporting on psychometric properties varied widely across instruments with only three including content validation studies.

CONCLUSIONS

Findings of this review reveal inattention to the psychometric quality of child self-reported monitoring instruments. Future research must focus on the psychometric quality of instruments used to measure the parent-child relationship.

Associations between Trust of Healthcare Provider and Body Mass Index in Adolescents

Adolescent obesity continues to be a serious concern around the world, placing young people at risk for chronic conditions and early death. Research has shown that social relationships are important in making health behavior changes, such as following health-care recommendations for eating and physical activity. Specifically, the trust of health-care providers has been shown to be important in making health behavior change. Evidence suggests that obese young adults are less trusting of health-care providers than their healthy weight peers, but it is not known if this also applies to obese adolescents. The purpose of this secondary analysis study was to determine relationships between the trust of health-care providers and body mass index percentile in adolescents. Participants were 224 adolescents aged 14-19 years attending a public high school in the Midwestern United States. The Wake Forest Physician Trust scale measured the trust of health-care providers. Height and weight were collected at a school screening; body mass index percentile categories were determined according to age- and sex-adjusted body mass index percentiles. One-way analysis of variance and post hoc Tukey tests showed trust scores varied significantly between body mass index percentile categories of girls. Results suggest it may be necessary for health-care providers to make additional efforts to build trust with obese adolescent girls than with other groups of adolescents.

Predictors of Physical Activity in a Predominantly Hispanic Sample of Adolescents

In the United States, the vast majority of Hispanic high school students do not meet physical activity recommendations. This prospective, observational study tested the Theory of Planned Behavior (TPB) to predict physical activity in a convenience sample of 232 high school students from a predominantly Hispanic, rural-fringe, lower-income community in Southwestern United States. Mindfulness was tested as a moderator of the intention-physical activity relationship. Data were collected via self-report questionnaires. Statistical analysis included structural equation modeling (SEM) and moderation analysis. The model explained 60% and 43% of the variance in intention and physical activity, respectively. Attitude (β = 0.49, p < 0.001) and subjective norm (β = 0.44, p < 0.001) predicted intention. Intention (β = 0.58, p < 0.001) and perceived behavioral control (β = 0.13, p < 0.027) predicted physical activity. Mindfulness did not moderate the intention-physical activity relationship. The results support using the TPB to predict physical activity in this population and may inspire ideas for targeted interventions.

The Association between Demographic Characteristics, Lifestyle Health Behaviours, and Quality of Life among Adolescents in Asia Pacific Region

Background: Given the risk of physical and psychosocial health that emerge in adolescents that are continuing into adulthood, identifying and addressing early signs of health-related quality of life (HRQoL) decline provides an opportunity to ensure that young people have a healthier progression through adolescence. Aim: To investigate the association between demographic characteristics, lifestyle health behaviours, and HRQoL of adolescents who live in Asia Pacific region, including Hong Kong in China, Beijing in China, Akashi in Japan, Seoul in South Korea, and Bangkok in Thailand. Methods: A cross-sectional self-reported survey carried out in a sample of 2296 adolescents that were aged 9-16 years (mean= 12.0; standard deviation [SD] = 1.63) was conducted in the five cities of the Asia Pacific region between January and August 2017. Demographic characteristics, adolescent lifestyle behaviours, and HRQoL were measured with demographic questionnaire, Adolescent Lifestyle Questionnaire's (ALQ) seven domains and Paediatric Quality of Life's (PedsQL 4.0) global score, respectively. Mixed multilevel model (MMLM) was used to fit the data. Results: After adjusting the demographic variables, one score increase in ALQ physical participation, nutrition, social support, and identity awareness are associated with an increase in PedsQL global score. On the contrary, one score increase in ALQ health practices is associated with a decrease in the PedsQL global score. The estimated mean of PedsQL global score of South Korea, Beijing, and Japan were better, while the score of Thailand and Hong Kong were poorer. Conclusions: Differentiating the impacts of promoting health behaviours among different countries can help in better understanding the health needs of adolescents in each country, especially in the Asia Pacific region, so that adequate and relevant resources can be allocated to reduce health-risk taking behaviours among this vulnerable group for health-promoting strategies.

Diminished Trust of Healthcare Providers, Risky Lifestyle Behaviors, and Low Use of Health Services: A Descriptive Study of Rural Adolescents

The purpose of our study was to determine the extent to which individual characteristic variables predict trust of healthcare provider (HCP), lifestyle behaviors, and use of health services among adolescents attending public high school in rural Indiana. The sample included 224 individuals surveyed in 9th grade or 12th grade required courses. Trust of HCP and lifestyle behaviors were predicted using hierarchical multiple regression; number of HCP visits and emergency department (ED) visits in the past 12 months were predicted using negative binomial regression. This sample of adolescents living in a rural area reported riskier lifestyle behaviors than another sample of adolescents, lower trust of HCP than adults in general, and fewer HCP and ED visits than adolescents in general. Our study supports the need for school-based health services in rural areas and the opportunity for school nurses to act as care coordinators for marginalized youth.

Supportive Peer Relationships and Mental Health in Adolescence: An Integrative Review

In the United States, nearly one in five adolescents has a diagnosable mental health disorder. Beginning in the teenage years, adolescents become less reliant on their parents for support and begin to turn to their peer group for support; therefore, it is important to understand the role of peers during this developmental time, especially in relation to mental health. The purpose of this project is to review the literature regarding positive peer support and mental health in adolescence. CINAHL, PubMed, and PsycINFO were used to conduct the review. The inclusive years of the search were 2007-2017. A total of 15 studies were included for review. The results were consistent over time and settings, demonstrating the positive role of peer support in adolescences with mental health care needs. Following a synthesis of the literature, gaps in research and implications for practice and further research, are discussed.

Positive Peer Association Among Black American Youth and the Roles of Ethnic Identity and Gender

The study examined whether peer association, a subtype of peer influence that involves the indirect modeling of behaviors, can promote positive development among Black American adolescents living in high-risk neighborhoods. Data were collected during a three-year longitudinal study from a sample of 316 Black American adolescents (M = 11.65 years). As positive peer association increased over time, youth experienced an increase in self-esteem, school connectedness, paternal and maternal closeness, and a decrease in supportive beliefs about aggression. Additionally, lower ethnic identity appeared to account for why some youth experienced a sharper increase in maternal and paternal closeness as positive peer association increased. Future interventions should consider harnessing the ability of prosocial peers to foster healthy development.

Implications of Peer Pressure for Adolescent Nursing Research: A Concept Analysis Approach

The influence of peers is widely held as a significant factor in child and adolescent development. As health care providers seek ways to improve the health of children and adolescents, peer pressure must be examined. This article analyzes peer pressure and its relationship to the health of children and adolescents. Defining attributes of peer pressure are discussed, including incomplete identity formation, the presence of a peer influence, and a need for approval. Antecedents and consequences of peer pressure are also explored. Methods of measuring peer pressure are discussed, along with implications for health care research in the pediatric population.

What could keep young people away from alcohol and cigarettes? Findings from the UK Household Longitudinal Study

Background

Adolescents are vulnerable to risky behaviours that are likely to co-occur. We examined whether happiness, awareness of alcohol- or smoking-related harm or the size of friendship networks would be longitudinally associated with young people’s risky behaviours.

Methods

We used available cases (N=1,729) from adolescents aged between 10 and 15 who participated in waves 2 and 3 of the UK Longitudinal Household Study that has annually collected population representative data from 40,000 UK households. The outcome variable was patterns of cigarette and alcohol use among adolescents (1= persistent non-use; 2= ex-use; 3= initiation; 4= persistent use) that we derived by tabulating current alcohol or cigarette use at waves 2 and 3. Explanatory variables were scores on participants’ perception of overall happiness, awareness of harm due to alcohol and cigarette use, and supportive friendship network size, collected at wave 2. Covariates were participants’ sex, age, base level of self-reported health status, reported religious affiliation, and household social position. All estimates were corrected for the complex survey design and non-response. Multinomial logistic regression was used to test assumed associations by taking persistent cigarette and alcohol use as the reference category.

Results

Findings showed higher happiness scores were longitudinally associated with adolescents’ persistent non-use (RRR=1.06, 95% CI=1.01-1.13). Awareness of alcohol or cigarette use-related harm was longitudinally associated with persistent non-use (RRR=1.24, 95% CI 1.15-1.35) as well as initiation of alcohol or cigarette use (RRR=1.21, 95% CI=1.11-1.32).

Conclusion

Joint interventions to promote happiness and harm awareness could help young adolescents from engaging with drinking alcohol or smoking cigarettes.

Characteristics of influential peers in the eyes of secondary school students: a mixed method study

Aim It is the aim of this study to explore the characteristics of influential peers identified by schoolmates, and the mechanism by which they exert their influence on their peers.

BACKGROUND

Adolescent crowds are a salient influence on the health-risk behaviors of peers, contributing to adolescent substance use such as drinking alcohol, smoking cigarettes, and taking drugs.

METHODS

A mixed method study. Three schools granted us access to students and those who had been nominated as influential by their peers. The students were asked to nominate and indicated the characteristics of peers whom they considered influential in a quantitative study. Those peers whom they considered influential were invited to take part in focus group interviews. A total of six focus group interviews were conducted, comprised of two groups from each school, with an average of seven participants in each group. Findings Students considered caring and friendliness (91.0%), being a buddy (88.5%), and entertaining/humor (86.8%) as the top three characteristics of influential peers. The interviews revealed that the students believed that they are influential because of their cheerfulness and humor, considerateness, ability to communicate, popularity and sociability, sincerity and trustworthiness, and because they possess the characteristics of a leader. They also believed that their power to influence came about through their helpfulness, accommodation, and the closeness of their relationships. Their influence was manifested in both positive and negative ways on the academic pursuits and health-risk behaviors of their peers. In order to engage at-risk students in health promotion programs, it is important to identify their influential peers, and to understand how adolescent friends may help one another to resist behaviors that pose a risk to their health.

Adolescent Substance Use in the Context of the Family: A Qualitative Study of Young People's Views on Parent-Child Attachments, Parenting Style and Parental Substance Use

BACKGROUND

Adolescent substance use can place youth at risk of a range of poor outcomes. Few studies have attempted to explore in-depth young people's perceptions of how familial processes and dynamics influence adolescent substance use.

OBJECTIVES

This article aimed to explore risk and protective factors for youth substance use within the context of the family with a view to informing family based interventions.

METHODS

Nine focus groups supplemented with participatory techniques were facilitated with a purposive sample of sixty-two young people (age 13-17 years) from post-primary schools across Northern Ireland. The data were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Three themes emerged from the data: (1) parent-child attachments, (2) parenting style, and (3) parental and sibling substance misuse. Parent-child attachment was identified as an important factor in protecting adolescents from substance use in addition to effective parenting particularly an authoritative style supplemented with parental monitoring and strong parent-child communication to encourage child disclosure. Family substance use was considered to impact on children's substance use if exposed at an early age and the harms associated with parental substance misuse were discussed in detail. Both parent and child gender differences were cross-cutting themes.

CONCLUSION

Parenting programmes (tailored to mothers and fathers) may benefit young people via components on authoritative styles, parental monitoring, communication, nurturing attachments and parent-child conflict. Youth living with more complex issues, e.g., parental substance misuse, may benefit from programmes delivered beyond the family environment, e.g., school based settings.

Suicide Ideation and Life Events in a Sample of Rural Adolescents

Adolescents experience both developmental and situational periods of transition along with myriad stressful life events when they enter and exit high school. These life events may be associated with thinking of, planning, and attempting suicide. Yet despite the development of prevention programs to treat at-risk individuals, suicide rates among adolescents have remained relatively high. Recent research suggests that suicidal ideation is associated with stressful life events and the use of maladaptive coping mechanisms, but studies have been limited to cross-sectional designs and clinical samples. We conducted a longitudinal study of 1345 rural adolescents (50.7% Hispanic) attending public schools in central Texas. The purpose of this analysis was to determine changes in suicide ideation rates over time and to test hypotheses about the life events and coping mechanisms associated with suicide ideation. Gender and race/ethnic differences in suicide were also explored. Rates of reported suicide ideation declined significantly from the first to the last year of high school (p=.015). Statistically significant relationships were found between suicide ideation, several types of life events, and maladaptive coping strategies. Gender and racial/ethnic differences were also found. Taken together, these findings suggest new approaches to developing and testing interventions that can assist specific populations of adolescents to learn how to cope with their life events in productive and health-promoting ways.

A Systematic Review of Consent Procedures, Participation Rates, and Main Findings of Health-Related Research in Alternative High Schools From 2010 to 2015

There is a well-established link between educational attainment and health. Alternative high schools (AHSs) serve students who are at risk for school dropout. Health-related research conducted in AHSs has been sparse. Achieving high participation rates is critical to producing generalizable results and can be challenging in research with adolescents for reasons such as using active consent. These challenges become greater when working with vulnerable populations of adolescents. In this systematic review, we examined health-related studies conducted in AHSs between 2010 and 2015. Results indicated that (1) health-related research in AHSs has increased over the past 5 years, (2) AHS students continue to experience significant disparities, (3) active consent is commonly used with AHS students, (4) 42% of studies reported participation rates or provided enough information to calculate participation rates, and (5) school nurses are missing from health-related research conducted in AHSs. Implications for future research and school nursing are discussed.

Gender and Ethnic Differences in Health-Promoting Behaviors of Rural Adolescents

Although much is known about health-risk behaviors of adolescents, less is known about their health-promoting behaviors. The purpose of this analysis was to compare health-promoting behaviors in adolescents in Grades 9–12 by gender and ethnicity and explore how these behaviors changed over time. Data were collected from 878 rural adolescents (47.5% Hispanic; mean age at baseline 14.7 years). Males from all ethnic groups scored significantly higher than all females on physical activity; non-Hispanic Black males and females scored significantly higher than other ethnic groups on safety behaviors. Hispanic and non-Hispanic White females scored higher than males in these ethnic groups on stress management. Nutrition, physical activity, and safety behaviors decreased significantly for most participants from Grade 9 to 12 whereas stress management remained relatively stable. Findings are similar to those from nationally representative samples that analyzed cross-sectional data and have implications for school nursing interventions to improve health-promoting behaviors in rural adolescents.