To know that we know what we know: perceived knowledge and adolescent sexual risk behavior

STUDY OBJECTIVE

To examine the relationship between perceived knowledge about sex and adolescent sexual behaviors.

DESIGN

Secondary analysis of the 2001 Minnesota Student Survey. Bivariate and multivariate relationships between perceived knowledge about sex and sexual behaviors were examined.

SETTING

Minnesota.

PARTICIPANTS

83,481 9(th) and 12(th) grade public school students.

MAIN OUTCOME MEASURES

Students' report of sexual experience and sexual behaviors.

RESULTS

Students with low perceived knowledge were less likely to be sexually experienced (OR=0.22, CI=0.17-0.29, females, OR=0.70, CI=0.59-0.82, males, P=0.00). Among sexually active students, those with low perceived knowledge also had significantly higher odds of engaging in risky sexual behaviors. Sexually experienced females with low perceived knowledge were more likely to report not talking with their partners about STIs (OR=1.83, CI=1.1-3.16, P=0.02), a history of pregnancy (OR=2.87, CI=1.59-5.18, P=0.00), and had higher numbers of male (P=0.03) and female (P=0.00) sexual partners. Sexually experienced males with low perceived knowledge were more likely to report not talking with their partners about pregnancy (OR=1.43, CI=1.11-1.84, P=0.01), pregnancy involvement (OR=2.22, CI=1.65-2.95, P=0.00), inconsistent use of birth control (OR=1.30, CI= 1.01-1.68, P=0.04), inconsistent use of condoms (OR=1.79, CI=1.38-2.32, P=0.00), not using a condom at last intercourse (OR=1.58, CI=1.22-2.04, P=0.00), and had a higher numbers of male (P=0.00) and female (P=0.00) sexual partners.

CONCLUSIONS

Perceived knowledge may be a salient antecedent of adolescent sexual risk behavior. Health care providers and programs should incorporate the construct of perceived knowledge into their assessments of and interventions targeted at adolescents.

Correlates of recent suicide attempts in a triethnic group of adolescents

PURPOSE

To describe recent self-reported suicide attempts in a triethnic group of adolescents, to analyze differences in the correlates of attempts by ethnicity and gender, and to explore theoretical correlates of recent suicide attempts using a resilience framework.

METHODS

Quantitative data were collected from 10,059 students in 7th, 9th, and 11th grades in Connecticut in 1996. Secondary analysis was done to compare respondents of African American, Hispanic Latino, and Caucasian ethnicities. Data were analyzed using bivariate and multivariate procedures. Logistic regression was used to identify the best set of explanatory variables for recent suicide attempts.

RESULTS

The percentage of suicide attempts was significantly higher among Hispanic Latina girls (19.3%) than in any other ethnic-gender group. Significant relationships were found between recent suicide attempts and (a) family history of suicide attempt, (b) friend's history of suicide attempt, (c) history of sexual abuse, (d) history of physical abuse, and (e) environmental stress. The significant set of explanatory variables for recent suicide attempts for the three ethnic groups combined were stress, internalizing and externalizing behaviors, physical and sexual abuse, family and friend attempted suicide, social connectedness, and religious influence.

CONCLUSIONS

Findings support use of a resilience model for suicide attempts among three ethnic groups. The finding of a significantly higher percentage of recent suicide attempts by Hispanic girls compared to girls in other ethnic-gender groups warrants further investigation along with development and testing of culturally sensitive preventive interventions.

Adolescent suicide attempts: risks and protectors

OBJECTIVE

In 1997, suicide was the third leading cause of death among 10- to 19-year-olds in the United States, with the greatest increases in suicide rates in the previous decade experienced by black and other minority youth. The purpose of this study was to identify risk and protective factors for suicide attempts among black, Hispanic, and white male and female adolescents.

METHODS

We used data from the National Longitudinal Study of Adolescent Health, conducted in 1995 and 1996. A nationally representative sample of 13 110 students in grades 7 through 12 completed 2 in-home interviews, an average of 11 months apart. We examined Time 1 factors at the individual, family, and community level that predicted or protected against Time 2 suicide attempts.

RESULTS

Perceived parent and family connectedness was protective against suicide attempts for black, Hispanic, and white girls and boys, with odds ratios ranging from 0.06 to 0.32. For girls, emotional well-being was also protective for all of the racial/ethnic groups studied, while a high grade point average was an additional protective factor for all of the boys. Cross-cutting risk factors included previous suicide attempt, violence victimization, violence perpetration, alcohol use, marijuana use, and school problems. Additionally, somatic symptoms, friend suicide attempt or completion, other illicit drug use, and a history of mental health treatment predicted suicide attempts among black, Hispanic, and white females. Weapon-carrying at school and same-sex romantic attraction were predictive for all groups of boys. Calculating the estimated probabilities of attempting suicide for adolescents with increasing numbers of risk and protective factors revealed that the presence of 3 protective factors reduced the risk of a suicide attempt by 70% to 85% for each of the gender and racial/ethnic groups, including those with and without identified risk factors.

CONCLUSIONS

In these national samples of black, Hispanic, and white youth, unique and cross-cutting factors derived from a resiliency framework predicted or protected against attempting suicide. In addition to risk reduction, promotion of protective factors may offer an effective approach to primary as well as secondary prevention of adolescent suicidal behavior.

Pregnancy feelings among adolescents awaiting pregnancy test results

OBJECTIVE

The authors surveyed adolescent girls about their feelings regarding pregnancy.

METHODS

A survey was administered to 117 13- to 18-year-olds who obtained pregnancy tests at nine clinics in Minneapolis and St. Paul, Minnesota, in 1998. The survey included four measures of pregnancy feelings. The authors used bivariate and multivariate logistic regression analyses to examine the associations of these measures with engagement with school, future expectations, social and environmental characteristics, and perceived partner desire for pregnancy.

RESULTS

The four measures of pregnancy feelings were highly correlated (P = 0.0001). Participants reported a range of positive, negative, and ambivalent feelings on all measures. Perceived partner desire for pregnancy, limited future expectations, and lack of school engagement were significantly associated with positive pregnancy feelings for the four measures.

CONCLUSIONS

Successful adolescent pregnancy prevention interventions may include the involvement of partners and key adults as well as strategies to enhance the educational or employment aspirations of girls and adolescents.

Social, educational, and psychological correlates of weight status in adolescents

OBJECTIVES

The purpose of this research was to examine the social, educational, and psychological correlates of weight status in an adolescent population. It was hypothesized that obese adolescents would differ on psychological, social, and educational variables compared with their non-overweight peers.

RESEARCH METHODS AND PROCEDURES

In this cross-sectional study, a population-based sample of 4742 male and 5201 female public school students in the 7th, 9th, and 11th grades responded anonymously to a classroom administered questionnaire. Body mass index was calculated from self-reported height and weight and categorized into four classes of weight status: underweight (<15th percentile), average weight (15th to 85th percentile), overweight (>85th to 95th percentile), and obese (>95th percentile). The questionnaire also included questions about social experiences, psychological well-being, educational experiences, and future goals. Associations of weight status with social, psychological, and educational variables and future goals were explored.

RESULTS

After adjustment for grade level, race, and parental socioeconomic status, obese girls, when compared with their average weight counterparts, were 1.63 (95% confidence interval [CI]: 1.16, 2.30) times less likely to hang out with friends in the last week, 1.49 (95% CI: 1.12, 1.98) times more likely to report serious emotional problems in the last year, 1.79 (95% CI: 1.20, 2.65) times more likely to report hopelessness, and 1.73 (95% CI: 1.21, 1.98) times more likely to report a suicide attempt in the last year. Obese girls were also 1.51 (95% CI: 1.09, 2.10) times more likely to report being held back a grade and 2.09 (95% CI: 1.35, 3.24) times more likely to consider themselves poor students compared with average weight girls. Compared with their average weight counterparts, obese boys were 1.91 (95% CI: 1.43, 2.54) times less likely to hang out with friends in the last week, 1.34 (95% CI: 1.06, 1.70) times more likely to feel that their friends do not care about them, 1.38 (95% CI: 1.08, 1.76) times more likely to report having serious problems in the last year, 1.46 (95% CI: 1.05, 0.03) times more likely to consider themselves poor students, and 2.18 (95% CI: 1.45, 3.30) times more likely to expect to quit school. Compared with average weight boys, underweight boys were 1.67 (95% CI: 1.30, 2.13) times more likely to report hanging out with friends in the last week, 1.22 (95% CI: 1.01, 1.49) times more likely to report disliking school, and 1.40 (95% CI: 1.06, 1.86) times more likely to consider themselves poor students.

DISCUSSION

Associations of weight status with social relationships, school experiences, psychological well-being, and some future aspirations were observed. Among girls, the pattern of observations indicates that obese girls reported more adverse social, educational, and psychological correlates. Obese as well as underweight boys also reported some adverse social and educational correlates. These findings contribute to an understanding of how adolescent experiences vary by weight status and suggest social and psychological risks associated with not meeting weight and body shape ideals embedded in the larger culture.

Development of adolescent self-report measures from the National Longitudinal Study of Adolescent Health

PURPOSE

To present a set of multi-item indicators and associated reliability estimates derived from early research with survey data from adolescents participating in the National Longitudinal Study of Adolescent Health (Add Health).

METHODS

Add Health provides information on the health and health-related behaviors of a nationally representative sample of U.S. adolescents, as well as on individual-level and contextual factors that either promote young peoples' health or increase their health risk. Specifically, the 135-page in-home adolescent survey instrument includes multiple items intended to measure individual-level and social-environmental constructs relevant to adolescent health and well-being. This article details the development of a set of multi-item scales and indices from Add Health in-home adolescent survey data. These steps include identification of inconsistent responders, use of a split-halves approach to measurement validation, and use of a deductive approach in the development of scales and item composites.

RESULTS

Estimates of internal consistency reliability suggest that many of the multi-item measures have acceptable levels of internal consistency across grade, gender, and race/ethnic groups included in this nationally representative sample of adolescents. In addition, moderate to high bivariate correlations between selected measures provide initial evidence of underlying latent constructs.

CONCLUSIONS

This article provides adolescent health researchers with a set of methodologic procedures and measures developed in early research on the Add Health core adolescent data set.

The effects of race/ethnicity, income, and family structure on adolescent risk behaviors

OBJECTIVES

The study examined the unique and combined contributions of race/ethnicity, income, and family structure to adolescent cigarette smoking, alcohol use, involvement with violence, suicidal thoughts or attempts, and sexual intercourse.

METHODS

Analyses were based on the National Longitudinal Study of Adolescent Health. A nationally representative sample of 7th to 12th graders participated in in-home interviews, as did a resident parent for 85.6% of the adolescent subjects. The final sample included 10,803 White, Black, and Hispanic 7th to 12th graders.

RESULTS

White adolescents were more likely to smoke cigarettes, drink alcohol, and attempt suicide in the younger years than were Black and Hispanic youths. Black youths were more likely to have had sexual intercourse; both Black and Hispanic youths were more likely than White teens to engage in violence. Controlling for gender, race/ethnicity, income, and family structure together explained no more than 10% of the variance in each of the 5 risk behaviors among younger adolescents and no more than 7% among older youths.

CONCLUSIONS

Findings suggest that when taken together, race/ethnicity, income, and family structure provide only limited understanding of adolescent risk behaviors.

Disordered eating among adolescents: associations with sexual/physical abuse and other familial/psychosocial factors

OBJECTIVE

To examine associations between disordered eating behaviors and a range of familial/psychosocial factors, including sexual and physical abuse experiences, among adolescent girls and boys.

METHOD

A statewide representative sample of 9,943 students in Grades 7, 9, and 11 in Connecticut completed a comprehensive survey on adolescent health within their schools. The present analysis focused on measures of disordered eating, sexual and physical abuse, familial factors, peer support, and depressive symptoms.

RESULTS

Youth at increased risk for disordered eating included those who perceived family communication, parental caring, and parental expectations as low and those who reported sexual or physical abuse experiences. After adjusting for differences in familial/psychosocial factors, associations between abuse experiences and disordered eating were weakened. However, youth who reported sexual abuse were still at increased risk for disordered eating, even after adjusting for physical abuse, sociodemographics, and familial/psychosocial factors (girls: odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.51, 2.64; boys: OR = 4.88, 95% CI = 2.94, 8.10). Youth reporting physical abuse were also at increased risk for disordered eating after adjusting for sexual abuse, sociodemographics, and familial/psychosocial factors (girls: OR = 2. 00, 95% CI = 1.52, 2.62; boys: OR = 1.95, 95% CI = 1.26, 3.04).

DISCUSSION

The findings suggest that strong familial relationships may decrease the risk for disordered eating among youth reporting abuse experiences, but both sexual and physical abuse are strong independent risk factors for disordered eating among both adolescent girls and boys.

Perceived knowledge and training needs in adolescent pregnancy prevention: results from a multidisciplinary survey

OBJECTIVES

To examine health care professionals' knowledge and interest in training in adolescent pregnancy prevention and whether an association exists between perceived knowledge and interest in training.

DESIGN

A cross-sectional mailed survey.

PARTICIPANTS

Random, stratified sample design that identified 800 psychologists, 800 social workers, 1,000 nurses, and 400 pediatricians from national professional membership lists. Response rate to the mailed survey was 51%. After removing respondents who did not currently work with adolescents, 1,242 surveys (41%) were available for analyses.

MAIN OUTCOME MEASURES

Descriptive analyses were conducted on self-report data concerning perceived knowledge and interest in training about adolescent pregnancy prevention separately for each of the 4 disciplines. Within disciplines, perceived knowledge and interest in training were correlated for each of 3 content areas (ie, sex education and contraceptive counseling, adolescent pregnancy, and counseling after a negative pregnancy test) and for a summary measure of the content areas.

RESULTS

Less than half of the nursing, pediatrics, psychology, and social work professionals reported high perceived knowledge in the 3 content areas. Psychologists and social workers reported the lowest perceived knowledge. However, with the exception of psychologists, more than two thirds of the other respondents reported moderate or high interest in training in the 3 content areas. Interest in training was not strongly correlated with perceived knowledge within any discipline.

CONCLUSIONS

The need to integrate psychosocial components into adolescent health care is a core assumption in the field, yet these data indicate that psychologists and social workers perceive low levels of knowledge and interest in training. These disciplines may benefit from more targeted professional training about their role in preventing adolescent pregnancy.

Protective correlates of stages in adolescent substance use: a Swiss National Study

OBJECTIVE

To identify factors potentially protective against involvement with additional illicit drugs among adolescent users of marijuana.

DESIGN AND METHODS

A cross-sectional, secondary analysis of a national data set of Swiss adolescents was performed. The original survey was conducted in 1992-1993 (N= 9268). Stages of substance use were conceptualized as lifetime use of marijuana of three or more times and as use of marijuana and other illicit drugs (opiates, inhalants, cocaine, hallucinogens, or stimulants) more than twice in the past month. Behavioral characteristics associated with level of drug use were examined. Based on the resilience literature, factors potentially protective against progression of drug use were examined in their bivariate relationships and analyzed in a multiple regression model.

RESULTS

Almost one quarter of the surveyed adolescents were classified as past or current marijuana users. One in 20 of these adolescents also used other illicit drugs. Prevalence of risk-related behaviors (e.g., antisocial behavior, accidents, suicide attempts) was elevated for marijuana users compared to nonusers and even more elevated for users of marijuana with other illicit drugs. In a multivariate logistic regression model, communicating well with a parent was significantly associated with not having progressed to use of illicit drugs other than marijuana [for males, odds ratio (OR) = 0.72, confidence interval (CI) = 0.55, 0.92; for females, OR = 0.60, CI = 0.39, 0.93]. Other significant protective correlates for boys were academic achievement (OR = 0.66, CI = 0.47, 0.92), type of education: school versus apprenticeship (OR = 0.42, CI = 0.21, 0.87), confiding in a family member (OR = 0.49, CI = 0.28, 0.85), and regular participation in a sports club (OR = 0.39, CI = 0.22, 0.77).

CONCLUSION

Within this national sample of Swiss adolescents, a cross-sectional analysis identified the quality of relationships within the family and factors related to school associated with lack of progression of illicit substance use. However, longitudinal studies will be necessary to confirm these associations and to allow for designing interventions targeting the enhancement of protective factors among young people already at risk for serious substance use.

Protective factors, resiliency and healthy youth development

The last decade has been characterized by an increasing focus on the question: "What works to promote and protect the health and well-being of adolescents?" This question is raised in multiple arenas, from pregnancy prevention to substance use and violence prevention, as well as for broad populations of young people. An accumulating body of evidence underscores the effectiveness of a dual strategy of enhancing protective factors and promoting healthy youth development while seeking to reduce risk factors in the lives of youth. Building upon research frameworks of the 1970s and 1980s that emphasized the concepts of resiliency, risk, vulnerability, and protective factors, this research provides insights into best practices when the weight of evidence is sufficiently developed, as well as ideas about "best bets" when strategies show particular promise. Critical to the ongoing advancement of adolescent health is a powerful, evidence-based response to the argument that "nothing can be done" for high-risk youth. This perspective must be superseded by practitioners, researchers, and advocates who demonstrate, at multiple points of intervention, that the dual approach of risk reduction and enhancement of protective factors constitutes an effective strategy for adolescent health promotion.

Suicide attempts among American Indian and Alaska Native youth: risk and protective factors

CONTEXT

American Indians and Alaska Natives have the highest suicide rates of all ethnic groups in the United States, and suicide is the second leading cause of death for American Indian and Alaska Native youth.

OBJECTIVE

To identify risk and protective factors associated with suicide attempts among native male and female adolescents.

DESIGN

The 1990 National American Indian Adolescent Health Survey.

SETTING

Schools of reservation communities in 8 Indian Health Service areas.

PARTICIPANTS

Eleven thousand six hundred sixty-six 7th- through 12th-grade American Indian and Alaska native youth.

MAIN OUTCOME MEASURES

Responses were compared among adolescents with and without a self-reported history of attempted suicide. Independent variables included measures of community, family, and individual characteristics. Separate analyses were conducted for boys and girls.

RESULTS

Ever attempting suicide was reported by 21.8% of girls and 11.8% of boys. By logistic regression done on boys and girls separately, suicide attempts were associated with friends or family members attempting or completing suicide; somatic symptoms; physical or sexual abuse; health concerns; using alcohol, marijuana, or other drugs; a history of being in a special education class; treatment for emotional problems; gang involvement; and gun availability. For male and female youth, discussing problems with friends or family, emotional health, and connectedness to family were protective against suicide attempts. The estimated probability of attempting suicide increased dramatically as the number of risk factors to which an adolescent was exposed increased; however, increasing protective factors was more effective at reducing the probability of a suicide attempt than was decreasing risk factors.

CONCLUSIONS

A history of attempted suicide was associated with several risk and protective factors. In addition to targeting youth at increased risk, preventive efforts should include promotion of protective factors in the lives of all youth in this population.

Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference?

CONTEXT

Although a limited amount of research has retrospectively explored the childhood and adolescent heterosexual experiences of lesbians, little is known about the prevalence of heterosexual behavior and related risk factors or about pregnancy histories among lesbian and bisexual teenagers.

METHODS

A secondary analysis was conducted using responses from a subsample of 3,816 students who completed the 1987 Minnesota Adolescent Health Survey. Behaviors, risk factors and pregnancy histories were compared among adolescents who identified themselves as lesbian or bisexual, as unsure of their sexual orientation and as heterosexual.

RESULTS

Overall, bisexual or lesbian respondents were about as likely as heterosexual women ever to have had intercourse (33% and 29%, respectively), but they had a significantly higher prevalence of pregnancy (12%) and physical or sexual abuse (19-22%) than heterosexual or unsure adolescents. Among sexually experienced respondents, bisexual or lesbian and heterosexual women reported greater use of ineffective contraceptives (12-15% of those who used a method) than unsure adolescents (9%); bisexual or lesbian respondents were the most likely to have frequent intercourse (22%, compared with 15-17% of the other groups). In the sample overall, among those who were sexually experienced and among those who had ever been pregnant, bisexual or lesbian women were the most likely to have engaged in prostitution during the previous year.

CONCLUSIONS

Providers of reproductive health care and family planning services should not assume that pregnant teenagers are heterosexual or that adolescents who say they are bisexual, lesbian or unsure of their sexual orientation are not in need of family planning counseling. Further research should explore the interactions between adolescent sexual identity development and sexual risk behaviors.

Correlates of physical and emotional health among Native American adolescents

PURPOSE

To examine the risk and protective factors among Native American youth that are correlated with both physical and emotional health.

METHODS

The study was based upon the National American Indian Adolescent Health Survey (n = 13,454), conducted using students self-categorized into a ranked variable of physical health ("poor," "fair," "good," or "excellent") and a continuous variable of emotional health based upon a nine-item unidimensional scale (overall Cronbach's alpha of .74). Twenty-nine variables derived from resilience theory encompassing both risk and protective factors were selected. Associations with physical and emotional health were examined using linear regression analysis.

RESULTS

Identified protective factors explained approximately 30% of variance for emotional health, with family caring explaining nearly 15% of variance for both genders. The most significant associations for emotional health for females were family caring, body pride, feelings about school, and worries or concerns particularly about violence. For males, most significant protective factors included family caring, body pride, parental expectations, and type of sexual attraction. For physical health, the identified variables explained only 16% of variance for both genders. Body pride was the most significant association, explaining 10% of variance.

CONCLUSIONS

Connection to family remains a consistently powerful factor in the lives of these youth. Other associations including body pride and parental expectations may help in the exploration and buffering of emotional health among American Indian youth.

Sociodemographic and personal characteristics of adolescents engaged in weight loss and weight/muscle gain behaviors: who is doing what?

BACKGROUND

Prevalence rates of behaviors aimed at weight loss and weight/muscle gain among adolescents were examined across sociodemographic and personal anthropometric variables to provide insight into these behaviors and identify high-risk subgroups.

METHODS

A statewide representative sample of 7th, 9th, and 11th grade public school students from Connecticut completed a classroom-administered survey on adolescent health in 1995-1996. The study sample in the present analysis included 9,118 adolescents.

RESULTS

The most frequently reported weight control behavior was exercise followed by dieting. Disordered eating (vomiting, diet pills, laxatives, or diuretics) over the previous week was reported by 7.4% of the girls and 3.1% of the boys. Steroids were used by 0.5% of the girls and 2.3% of the boys. Girls in the highest BMI category were at greatest risk for disordered eating behaviors while boys in the lowest BMI category were at greatest risk for steroid use. African American and Hispanic girls were less likely than Caucasians to diet and exercise, but were more likely to report behaviors aimed at weight gain. Relatively high rates of disordered eating behaviors were reported by African American and Hispanic boys. Older girls reported slightly more dieting and disordered eating and less exercise than younger girls. Youth from low socioeconomic backgrounds were at greater risk for disordered eating than youth from high socioeconomic backgrounds.

CONCLUSIONS

The findings suggest a need to widen our scope of thinking with regard to who is concerned with their body shape/size and at risk for engaging in potentially dangerous behaviors aimed at either weight loss or muscle gain.

Lessons learned about adolescent nutrition from the Minnesota Adolescent Health Survey

In 1986-1987, more than 30,000 adolescents completed the Minnesota Adolescent Health Survey, a comprehensive assessment of adolescent health status, health behaviors, and psychosocial factors. Although the survey included relatively few items on nutrition-related issues, a wealth of knowledge about adolescent nutrition was gained. Lessons learned from a decade of subsequent analyses of data collected in the survey and implications for working with youth are summarized in this article. Major concerns identified included high prevalence rates of inadequate intake of fruits, vegetables, and dairy products; unhealthful weight-control practices; and overweight status. For example, inadequate fruit intake was reported by 28% of the adolescents and inadequate vegetable intake was reported by 36%. Among female adolescents, 12% reported chronic dieting, 30% reported binge eating, 12% reported self-induced vomiting, and 2% reported using diuretics or laxatives. Some of the risk factors for inadequate food intake patterns or unhealthful weight-control practices included low socioeconomic status, minority status, chronic illness, poor school achievement, low family connectedness, weight dissatisfaction, overweight, homosexual orientation among male adolescents, and use of health-compromising behaviors. To improve adolescent eating behaviors, the results suggest a need for innovative outreach strategies that include educational and environmental approaches. Dietitians play a key role in developing interventions and promoting research in the field of adolescent nutrition.

Sexual orientation, sexual behaviors, and pregnancy among American Indian adolescents

PURPOSE

A recent study found a disproportionate number of pregnancies among Euro-American lesbian and bisexual adolescents compared to heterosexual peers. American Indian adolescents have reported higher prevalence of gay/lesbian/bisexual orientations than Euro-Americans; do they also report higher prevalence of pregnancy?

METHODS

The study assessed prevalence of teen pregnancy and related factors by sexual orientation among sexually experienced, reservation-based American Indian adolescent males (n = 2056) and females (n = 1693) who participated in a national school-based survey in 1991. Self-reported orientation was classified as heterosexual, gay/lesbian/bisexual, and "unsure" of orientation.

RESULTS

Gay/bisexual males were more likely than other males to report early heterosexual intercourse (<14 years), more consistent contraception, and a higher prevalence of abuse and running away (p < 0.05 to p < 0.0001). Likewise, lesbian/bisexual females were more likely to report early onset of heterosexual intercourse, more frequent intercourse, and running away. Sexual or physical abuse did not vary by orientation for females. Prevalence of pregnancy also did not vary by orientation (males, 18.6% gay/bisexual vs. 10.4% "unsure" vs. 11.8% heterosexual; females, 25.0% lesbian/bisexual vs. 22.1% "unsure" vs. 21.9% heterosexual). For lesbian/bisexual females, no variables were significantly associated with pregnancy history; for "unsure" females, pregnancy was associated with contraceptive frequency and early onset of heterosexual activity. For heterosexual females, age, intercourse frequency, and physical abuse were associated. For gay/bisexual males, intercourse frequency, ineffective contraception, and physical abuse were associated with involvement in a pregnancy; for "unsure" and heterosexual males, most items except ineffective contraception were related to pregnancy involvement history.

CONCLUSIONS

Although prevalence of pregnancy is similar, findings show group differences in associated risk factors by sexual orientation. Interventions to reduce pregnancy among American Indian adolescents should include assessment of sexual orientation and behavioral risk factors.

Demographics of sexual orientation among American-Indian adolescents

Self-report of sexual orientation and sexual behavior was compared for 12,978 reservation-based American-Indian and 11,356 rural Anglo-American adolescents. Findings included a significantly higher prevalence of homosexual, bisexual, and unsure responses among American Indians. However, a larger nonresponse rate for American-Indian adolescents raises questions about the cultural relevance of the survey method, and underscores the need for development of more culturally sensitive research tools and methods.

Disordered eating among adolescents with chronic illness and disability: the role of family and other social factors

OBJECTIVES

To compare prevalence rates of weight-control behaviors among adolescents with and without chronic illness and to explore the role of familial and other social factors on associations between disordered eating and chronic illness.

DESIGN AND SETTING

Survey conducted in public schools in Connecticut.

PARTICIPANTS

A representative statewide population-based sample of 9343 7th-, 9th-, and 11th-grade public school students, of whom 1021 reported a chronic illness.

MAIN OUTCOME MEASURES

Disordered eating (vomiting, diet pills, and laxatives), dieting, and exercise for weight control; chronic illness status; family structure, family communication, parental caring, parental monitoring, parental expectations, peer support, and sexual and physical abuse.

RESULTS

Adolescents with chronic illness were at greater risk for disordered eating than youth without chronic illness, after controlling for sociodemographic variables (girls: odds ratio, 1.59 [95% confidence interval, 1.19-2.14]; boys: odds ratio, 2.22 [95% confidence interval, 1.49-3.32]). Adolescents with chronic illness were less likely to come from 2-parent families; reported lower levels of family communication, parental caring, and parental expectations; and reported more sexual and physical abuse than youth without chronic illness. Male adolescents with chronic illness were more likely to report low peer support and low parental monitoring. Most of these familial-social factors were also associated with an increased prevalence of disordered eating. After familial-social factors were controlled for, however, associations between disordered eating and chronic illness remained statistically significant.

CONCLUSIONS

Adolescents with chronic illness are at greater risk for disordered eating behaviors than youth without chronic illness. Factors other than the familial-social factors assessed in this study may be contributing to this increased risk. In the clinical setting, youth with chronic illness need to be screened for disordered eating and familial and other social concerns.

Gender differences in health and risk behaviors among bisexual and homosexual adolescents

OBJECTIVE

This study explored gender differences in the health and risk behaviors of 394 self-identified bisexual and homosexual adolescents who participated in an anonymous, school-based survey.

METHODS

Respondents included 182 girls and 212 boys; girls were significantly younger than boys (p < 0.001), so respondents were further grouped as younger (< or =14 years) and older (> or =15 years) for analysis. Chi-square was used to test for gender differences in health perceptions and risk behaviors. Items included general health perceptions and health care access, body image and disordered eating behaviors, sexual behaviors, alcohol use, and emotional health measures including mood, life satisfaction, and suicidal ideation and attempts.

RESULTS

Both younger and older girls were significantly more likely than their male age mates to report a history of sexual abuse, dissatisfaction with weight, a negative body image, more frequent dieting, and an earlier age at onset of sexual intercourse. Both younger and older boys were significantly more likely than girls to have a positive body image, to rate themselves as healthier than peers, to report no regular source of health care, to be sexually experienced, and to drink alcohol more often and in greater quantity; a significantly greater proportion of older boys than older girls reported alcohol use before school (19.0% vs. 3.9%; p < 0.05). No significant gender differences were found for measures of emotional health, including suicidal ideation and attempts; however, nearly 1 of 3 older boys and girls reported at least one suicide attempt.

CONCLUSIONS

Gender is a substantive source of variation in health and risk behaviors among bisexual and homosexual adolescents. Health care providers should incorporate gender-specific approaches to health promotion and risk reduction with young people who self-identify as gay, lesbian, or bisexual.

Environmental stressors and emotional status of adolescents who have been in special education classes

OBJECTIVE

To identify environmental and psychosocial factors associated with receiving special education services.

DESIGN

The 1992 Minnesota Student Survey, an anonymous, self-report survey.

SETTING

Minnesota public schools.

PARTICIPANTS

A total of 121848 adolescents in the 6th, 9th, and 12th grades.

MAIN OUTCOME MEASURES

Emotional status and potential environmental risk factors including family structure, family substance use problems, family violence, and sexual abuse were compared between adolescents reporting a history of having been in classes for learning problems and a grade- and race-matched comparison group of adolescents who had never been in classes for learning problems. Comparisons were conducted separately for male and female respondents.

RESULTS

Compared with adolescents who had never been in classes for learning problems, a significantly greater proportion of male and female students who had been in special education classes lived in single-parent and nontraditional households, indicated that a family member had an alcohol or other drug problem, had witnessed or experienced physical abuse, and reported a history of sexual abuse and poor emotional health. Most of these associations remained significant when simultaneously controlling for the other factors in logistic regression. Significant factors showed modest odds ratios in the multivariate analyses (<1.6), except for the emotional status variable. Students with a history of receiving special education services had from 6 to 14 times the odds of reporting poor emotional health. This association was strongest among the youngest adolescents.

CONCLUSION

Several environmental stressors and psychosocial factors, most notably poor emotional health, are associated with a history of special class placement for learning problems.

Dimensions of risk behaviors among American Indian youth

OBJECTIVE

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Protecting against hopelessness and suicidality in sexually abused American Indian adolescents

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The validity of self-reported condom use among adolescents

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

CONTEXT

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS

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

SETTING

The interview was completed in the subject's home.

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

DESIGN

A cross-sectional school-based survey.

SETTING

Public schools within nonurban areas of Minnesota.

PARTICIPANTS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

METHOD

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

RESULTS

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

DISCUSSION

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

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

STUDY DESIGN

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

OBJECTIVE

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

SUMMARY OF BACKGROUND DATA

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Psychosocial concerns and weight control behaviors among overweight and nonoverweight Native American adolescents

OBJECTIVE

To compare the psychosocial and weight-related concerns and weight control, eating, and exercise behaviors of overweight and nonoverweight Native American adolescents living on or near reservations.

STUDY DESIGN

A cross-sectional survey assessed psychosocial, health, and weight-specific concerns; disordered eating; and health-promoting behaviors.

STUDY POPULATION

The study population included 11,868 Native American youth in grades 7 through 12.

STATISTICAL ANALYSES PERFORMED

Analyses of variance and chi 2 tests were used to examine associations between weight status and psychosocial and weight-related concerns and behaviors. Stratified analyses were done by gender and by gender and age.

RESULTS

Self-reported weights and heights indicated that 25% of the study population was overweight. Overweight youth were twice as likely to report health concerns as nonoverweight youth. Although a high percentage of nonoverweight youth expressed body- or weight-related concerns and reported engaging in disordered eating behaviors, prevalence rates for these concerns were significantly higher among overweight youth. Overweight youth were also somewhat less likely to engage in health-promoting behaviors. In contrast, differences in global psychosocial concerns were minimal.

APPLICATIONS

Overweight Native American youth were concerned about their weight, but did not appear to have major psychosocial concerns associated with being overweight. Interventions aimed at obesity prevention and overall health promotion are essential, given the high prevalence of obesity and of psychosocial and weight-related concerns and behaviors among the study population as a whole. The challenge is to develop culturally appropriate interventions aimed at the promotion of healthful weight control behaviors that will not lead to negative psychosocial consequences.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

DESIGN

School-based health survey.

SETTING AND PARTICIPANTS

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

RESULTS

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

CONCLUSIONS

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

Psychosocial correlates of health compromising behaviors among adolescents

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

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

OBJECTIVE

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

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

RESULTS

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

CONCLUSIONS

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

Gender-specific outcomes for sexually abused adolescents

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Correlates of inadequate fruit and vegetable consumption among adolescents

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Sexual behavior of adolescents with chronic disease and disability

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

DISCUSSION

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

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

OBJECTIVE

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

DESIGN

Survey.

PARTICIPANTS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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