Neighborhood context and youth cardiovascular health behaviors

OBJECTIVES: This study sought to determine the relationships between race/ethnicity, socioeconomic status (SES), and cardiovascular health behaviors among youths and whether neighborhood characteristics are associated with such behaviors independently of individual characteristics. METHODS: Linear models determined the effects of individual and neighborhood characteristics (SES, social disorganization, racial/ethnic minority concentration, urbanization) on dietary habits, physical activity, and smoking among 8165 youths aged 12 to 21 years. RESULTS: Low SES was associated with poorer dietary habits, less physical activity, and higher odds of smoking. After adjustment for SES, Black race was associated with poorer dietary habits and lower odds of smoking. Hispanic ethnicity was associated with healthier dietary habits, lower levels of physical activity, and lower odds of smoking than non-Hispanic ethnicity. Low neighborhood SES and high neighborhood social disorganization were independently associated with poorer dietary habits, while high neighborhood Hispanic concentration and urbanicity were associated with healthier dietary habits. Neighborhood characteristics were not associated with physical activity or smoking. CONCLUSIONS: Changes in neighborhood social structures and policies that reduce social inequalities may enhance cardiovascular health behaviors.     

自杀行为暴露与青少年非自杀性自伤关系的纵向研究

目的 青少年群体中,非自杀性自伤（non-suicidal self-injury,NSSI）行为较为普遍且受多种因素影响。本研究旨在探究中国青少年自杀行为暴露与其自身NSSI之间的关系。方法 研究对象来自山东省青少年行为与健康队列研究。选取参与了2015年基线调查和2016年第一次随访调查,并且基线调查中不存在NSSI行为史的5 154名学生为研究对象。研究内容通过自填式问卷收集,包括基本人口学信息、社会心理学信息、终生及过去一年NSSI情况、自杀行为暴露史等。采用多因素logistic回归模型分析基线自杀行为暴露与一年后NSSI间的关系。结果 5 154名研究对象的基线年龄为（14.49±1.48）岁,女性占48.5%。9.0%的青少年报告曾暴露于自杀行为,其中6.0%暴露于自杀未遂,4.9%暴露于自杀死亡,7.3%暴露于朋友/熟人的自杀行为,3.1%暴露于亲属的自杀行为。自杀行为暴露组的过去一年NSSI发生率高于非暴露组,差异有统计学意义（P<0.05）。多因素logistic回归分析显示,与非暴露组相比,暴露于自杀死亡（OR=1.91,95% CI：1.22~3.01）和暴露于亲属自杀行为（OR=1.79,95% CI：1.02~3.12）与NSSI风险增加有关。结论 暴露于自杀死亡或亲属自杀行为可能会增加青少年NSSI行为风险。自杀事件发生后,针对高危人群进行心理疏导和健康教育可促进青少年身心健康、预防自我伤害。     

广州市青少年性相关行为发生情况分析

目的 了解广州市青少年性相关行为现况,为制定干预措施提供科学依据.方法 采用“中国青少年健康相关行为调查问卷”,对分层整群随机抽取的广州市66所大中学校11939名学生进行问卷调查.结果 15.22％的中学生看过色情书籍和音像制品,农村(16.46％)高于城市(14.44％)；男生(25.07％)高于女生(6.23％)；职中生最高(25.41％),普通中学(13.93％)高于重点中学(10.71％),差异均有统计学意义(P值均＜0.01).在看过色情书籍、音像制品的学生中,曾发生性行为率高达22.35％.在高中、职中学生中,35.82％曾单独约会异性朋友,34.95％有亲密行为,7.26％曾经发生过性行为,2.10％学生有被迫性行为,73.97％从学校接受过有关艾滋病知识教育,63.44％知道艾滋病病原体是病毒,31.76％对艾滋病感染者持正确态度.8.87％大学生有过性行为,使用安全套的比例占68.52％.结论 广州市青少年性相关行为频发但预防教育不足,要加强对青少年性观念及行为的正确引导.     

Weight-related behaviors among non-overweight adolescents: results from the Korean national survey from 2005 to 2007

This study aimed to assess the prevalence of overweight misperception, unhealthy diet practices, and factors associated with these weight-related behaviors among Korean adolescents. The subjects were a nationally representative sample of non-overweight students (52,515 in 2005, 64,084 in 2006, and 67,113 in 2007) in middle and high schools who completed the Korea Youth Risk Behavior Web-Based Survey. The prevalence of weight-related behaviors and factors associated with these behaviors were assessed using a complex sampling design. Of non-overweight students, 14.9% of boys and 22.2% of girls reported their weight as overweight/obese. Dieting within the last year was reported by 19.8% of boys and 41.8% of girls. Of those who attempted dieting, 17.1% of boys and 24.6% of girls indicated practicing at least one unhealthy diet behavior within the last month. Overweight misperceptions were independently associated with diet attempts and unhealthy diets after adjustment for weight status, and demographic, social, and psychological factors. Additionally, these weight-related behaviors were also associated with psychosocial factors such as low school achievement, sadness, suicidal ideation, increased stress perception, and cigarette or alcohol use. In conclusion, the high prevalence of inappropriate weight-related behaviors suggests a need for comprehensive approaches to improve weight-related behaviors in non-overweight Korean adolescents.     

Risky adolescent sexual behaviors and reproductive health in young adulthood

CONTEXT: Little research links adolescent risk behaviors to reproductive health outcomes beyond adolescence, although young adults—men and women in their early 20s— bear a disproportionate burden of STDs and unintended childbearing. METHODS: To assess whether individuals who engaged in risk behaviors during adolescence had increased risk of negative reproductive health outcomes in young adulthood, data from Waves 1–4 of the National Longitudinal Study of Adolescent Health on 5,798 sexually active respondents were analyzed. Logistic and multinomial logistic regressions examined associations between risk behaviors (cumulatively and individually) and each of three outcomes. RESULTS: Four in 10 youth reported at least three risk factors during adolescence. Women who were exposed to an increasing number of risks had an elevated likelihood of having had multiple sex partners in the last year, rather than none (relative risk ratio, 1.3); having had an STD (odds ratio, 1.1); and having had an intended or unintended birth, as opposed to no birth (relative risk ratio, 1.1 for each). Inconsistent contraceptive use and having had multiple partners, a nonmonogamous partner or a nonromantic partner were associated with reporting multiple partners in the last year; inconsistent use, sexual debut after age 16 and not discussing contraception with a partner were associated with having any birth. CONCLUSIONS: Teenagers’ sexual behaviors have both short‐term and long‐term consequences, and interventions that focus on multiple domains of risk may be the most effective in helping to promote broad reproductive health among young adults.     

Body weight satisfaction among New Zealand adolescents: findings from a national survey

Body dissatisfaction has been extensively studied but, recently, the importance of body satisfaction and its attributing factors has received significant recognition. Also, there is an increasing awareness of the need for research examining body dissatisfaction and satisfaction in youth other than North American females. Thus, the current research examined the prevalence of, and the individual, social, and familial factors associated with, body-weight satisfaction among New Zealand male and female adolescents (n=9107). Data were analysed from Youth '07, a nationally representative survey of New Zealand secondary school students. Overall, half of students were happy with their weight, with significantly more males than females reporting body-weight satisfaction. Students happiest with their weight were most likely to report healthy and supportive social and family environments, as well as higher levels of well-being. These findings are consistent with a growing body of research that suggests creating positive peer and family environments may lead to better developmental outcomes, such as body satisfaction, and also higher levels of well-being.     

贵州兴义农村在校儿童性与生殖健康知识及行为调查

目的 了解贵州省兴义市农村在校儿童性与生殖健康知识知晓情况、发生性行为及其影响因素,为改善农村在校儿童性与生殖健康状况提供依据。方法 2015年3-4月采用整群抽样方法对兴义市小学五、六年级和初中一、二年级548名农村在校儿童进行调查,采用单因素及多因素logistic回归分析知识知晓及发生性行为的影响因素。结果 调查的548名儿童中,有297人（54.2%）知晓性与生殖健康知识;多因素logistic回归分析显示,男生（OR_调整=1.454,95% CI=1.027~2.058）、经常与父母交流沟通（OR_调整=1.460,95% CI=1.003~2.125）、经常与老师交流沟通（OR_调整=1.608,95% CI=1.129~2.289）、在校学习过性教育课程（OR_调整=2.035,95% CI=1.418~2.919）是知晓性与生殖健康知识的影响因素。5.8%（32/548）的农村在校儿童发生过性行为,多因素分析显示,经常与父母交流沟通（OR_调整=0.267,95% CI=0.128~0.558）和在校学习过性教育课程（OR_调整=0.447,95% CI=0.216~0.925）是减少儿童过早性行为的保护因素。结论 农村在校儿童性与生殖健康知识待完善,应注意加强学校及家庭教育,营造良好网络环境,促进农村儿童健康成长。     

Family context of mental health risk in Tsunami-exposed adolescents: findings from a pilot study in Sri Lanka

Using survey data from 325 Tsunami-exposed adolescents and mothers from two villages in southern Sri Lanka, this pilot study investigated influences of Tsunami exposure and subsequent psychosocial losses on adolescent depressive and post-traumatic stress disorder (PTSD) symptoms. Findings generally support the study hypotheses: disaster exposure (for example experiences of property destruction and deaths of close others) contributes to depressive and PTSD symptoms in adolescents. Findings also show that psychosocial losses associated with Tsunami exposure, such as prolonged displacement, social losses, family losses, and mental health impairment among mothers, contribute to depressive and PTSD symptoms in adolescents. Results suggest that the influence of Tsunami exposure on adolescent mental health operates partially through Tsunami-related psychosocial losses. As expected, positive mother-child relationships provide a compensatory influence on both depressive and PTSD symptoms of adolescents. In addition, high levels of depressive symptoms among mothers increases the detrimental influence of other Tsunami-related psychosocial losses on adolescent mental health. These preliminary findings suggest ways to improve ongoing recovery and reconstruction programs and assist in formulating new programs for families exposed to both the Tsunami and other natural disasters. More importantly, findings from this pilot study emphasize the urgent need for larger systematic studies focusing on mental health following disaster exposure.     

Natural mentoring relationships and adolescent health: evidence from a national study

OBJECTIVES: We used nationally representative data to examine the impact of natural (or informal) mentoring relationships on health-related outcomes among older adolescents and young adults. METHODS: We examined outcomes from Wave III of the National Longitudinal Study of Adolescent Health as a function of whether or not respondents reported a mentoring relationship. Logistic regression was used with control for demographic variables, previous level of functioning, and individual and environmental risk. RESULTS: Respondents who reported a mentoring relationship were more likely to exhibit favorable outcomes relating to education/work (completing high school, college attendance, working >/= 10 hours a week), reduced problem behavior (gang membership, hurting others in physical fights, risk taking), psychological well-being (heightened self-esteem, life satisfaction), and health (physical activity level, birth control use). However, effects of exposure to individual and environmental risk factors generally were larger in magnitude than protective effects associated with mentoring. CONCLUSIONS: These findings suggest a broad and multifaceted impact of mentoring relationships on adolescent health. However, mentoring relationships alone are not enough to meet the needs of at-risk youths and therefore should be incorporated into more comprehensive interventions.     

Religious participation and risky health behaviors among adolescents

Previous studies have shown that adolescent religious participation is negatively associated with risky health behaviors such as cigarette smoking, alcohol consumption, and illicit drug use. One explanation for these findings is that religion directly reduces risky behaviors because churches provide youths with moral guidance or with strong social networks that reinforce social norms. An alternative explanation is that both religious participation and risky health behaviors are driven by some common unobserved individual trait. We use data from the National Longitudinal Study of Adolescent Health and implement an instrumental variables approach to identify the effect of religious participation on smoking, binge drinking, and marijuana use. Following Gruber (2005), we use a county-level measure of religious market density as an instrument. We find that religious market density has a strong positive association with adolescent religious participation, but not with secular measures of social capital. Upon accounting for unobserved heterogeneity, we find that religious participation continues to have a significant negative effect on illicit drug use. On the contrary, the estimated effects of attendance in instrumental variables models of binge drinking and smoking are statistically imprecise.     

Risky sexual behaviors among Malay adolescents: a comparison with Chinese adolescents in Singapore

Objective: Malays, with majority of the individuals being Muslim, form the largest ethnic group in Southeast Asia. This region is experiencing a rising incidence of HIV infections. Due to circumcision and prohibition of sex outside marriage, being Muslim was argued to be a protective factor against sexually transmitted infections (STI) and Human Immunodeficiency Virus (HIV). However, Malay adolescents were found to be more likely to contract chlamydia and gonorrhea than non-Malay adolescents in Singapore.

Design: Using a cross-sectional survey, we examined and compared safer sex knowledge, attitudes and self-efficacy, and sexual behaviors of 248 sexually active Malay adolescents with 384 Chinese adolescents aged 16–19 years in Singapore. Poisson regression, adjusted for socio-demographic characteristics, was used for modeling each dependent variable. Adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were obtained.

Results: On multivariate analysis, Malay adolescents were more likely to report marginally unfavorable attitude towards condom use (aPR 1.21 CI 1.00–1.48) and significantly lower confidence in using condoms correctly (aPR 1.24 CI 1.05–1.47) than Chinese adolescents. They were also more likely to report significantly younger first sex age (aPR 0.98 CI 0.96–1.00), never use of condoms for vaginal sex (aPR 1.32 CI 1.16–1.49) and anal sex (aPR 1.75 CI 1.11–2.76) and non-use of contraceptives at last sex (aPR 1.30 CI 1.17–1.45) than Chinese respondents. Malay males were less likely to buy sex (aPR 0.56 CI 0.37–0.85), but they reported higher likelihood of inconsistent condom use with female sex workers (aPR 2.24 CI 1.30–3.87).

Conclusion: Malay ethnicity was associated with unfavorable condom use attitude and lower self-efficacy in using condoms, which was consistent with risky sexual behaviors such as non-use of condoms. Future research should use mixed methods to explore and identify cultural influences to these behaviors.     

Longitudinal patterns and predictors of multiple health risk behaviors among adolescents: The TRAILS study

BackgroundMost studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants.PurposeTo examine the prevalence, longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents.MethodsEight health risk behaviors (no regular consumption of fruit, vegetables or breakfast, overweight or obesity, physical inactivity, smoking, alcohol use and cannabis use) were assessed in a prospective population study (second and third wave). Participants were assessed in three waves between ages 10 and 17 (2001–2008; n = 2230). Multiple linear regression was used to assess the influence of gender, self-control, parental health risk behaviors, parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors (analysis: 2013–2014).ResultsRates of > 5 health risk behaviors were high: 3.6% at age 13.5 and 10.2% at age 16. Smoking at age 13.5 was frequently associated with health risk behaviors at age 16. No regular consumption of fruit, vegetables and breakfast, overweight or obesity, physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up. Significant predictors of the development of multiple health risk behaviors were adolescents' levels of self-control, socioeconomic status and maternal smoking.ConclusionsMultiple health risk behaviors are common among adolescents. Individual and social factors predict changes in multiple health risk behaviors, showing that prevention targeting multiple risk behaviors is needed. Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes.     

Unemployed youth and health: findings from the pilot phase of a longitudinal study

Contemporary research perspectives on the impact of unemployment on health and well-being among young people have tended to focus on a rather narrow range of outcomes, typically those in the mental health domain. The impetus for the proposed longitudinal study, the main dimensions of which are described in this paper, reflects the need for a more comprehensive profiling of the health needs and experiences of young people if effective interventions tailored to their short and long term health needs are to be developed. The proposed study includes variables from a wide range of domains and adopts an interdisciplinary perspective. The feasibility of the approach, both in terms of establishing appropriately stratified samples and determining the acceptability and utility of the measures proposed has been examined during an extensive pilot phase. Findings from the database established during this phase are presented. These focus on multi-dimensional comparisons of health and well-being between employed and unemployed young people, the impact of socio-economic status of origin on cardiovascular and other indicators, and the correlates of health and well-being among the unemployed. The results point to the potential complexity of the influences on health status and behaviour and the need to develop comprehensive models of this for research and intervention purposes.     

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.     

Exploring sexual behaviors and health communication among older women

Older women around the globe are generally depicted as asexual beings, which may impact patient-provider discussions about sex. We examined data on 703 aging women in the United States to compare factors associated with women perceiving sex as important and women discussing sex with their physicians since turning 50. While 65.1% of participants perceived sex to be important, only 23.8% discussed sex with their providers since turning 50. Factors related to discussing sex included age, education, having a chronic condition, and consuming alcohol. Provider training and tools about sexual health communication could help launch those discussions about sex and increase advocacy for older women's sexual health.     

Covariance of adolescent health behaviors: the Class of 1989 study

The purpose of this paper is to add to the growing body of knowledgeregarding the clustering or covariation of health behaviorsin adolescents. Patterns of smoking, healthy eating and activitylevels were examined through a self-report survey using serialcross-sectional samples of students over 7 years (sixth to 12thgrade). The students represented were participants in the Classof 89 study, a component of the Minnesota Heart Health Program.Comparisons are made between males and females as well as byreference and intervention communities. Bi-variate and multivariateresults suggest that not only do associations exist betweenhealth behaviors, but the associations strengthen over time.After the eighth grade, students reporting lower activity patternsas well as those making fewer healthy food choices also exhibita higher weekly smoking prevalence. The multivariate analysespoint to a risk profile where smoking, poor food choices andlower activity patterns cluster. The results point to the importanceof early health education in order to foster the developmentof a positive health profile prior to consolidation of unhealthfulbehaviors. Comprehensive school-based health education is alsorecommended as a way to promote the importance and developmentof a healthy lifestyle across multiple behaviors.