Supportive social relationships and adolescent health risk behavior among secondary school students in El Salvador

An increasing number of studies suggest that supportive social relationships in the family and school may exert a protective effect against a number of youth health risk behaviors. This study examines the association between perceived parental social support and perceived social cohesion at school with selected youth risk behavior outcomes (physical fighting, victimization, suicidal ideation, substance use, and sexual intercourse) among 930 female and male public secondary school students studying in the central region of El Salvador. The study questionnaire comprised closed-ended items of parent/school relationships and risk behaviors based on the United States Center for Disease Control and Prevention's Youth Risk Behavior Survey. In regression analyses, female students who perceived low parental social support were significantly more likely to report engaging in all risk behaviors examined, and female students with perceptions of low school social cohesion were more likely to report suicidal ideation, binge drinking, and drug use. Perceptions of parental social support and school social cohesion held fewer but still significant associations across risk behaviors for male students. Male students who reported low parental social support were significantly more likely to report suicidal ideation, drug use and physical fighting, while male students with low perceived school social cohesion were more likely to report physical fighting but less likely to report binge drinking. This study lends support to the importance of supportive social relationships for understanding youth risk behavior and suggests that supportive families and schools may operate differently for female and male students living in El Salvador.     

Increased drug use among old-for-grade and dropout urban adolescents

Introduction: In tracking the epidemic of drug use in our communities, much emphasis has been placed on identifying predictive variables. In this study, we examine the relationship between drug use and school progress among a sample of inner-city adolescents.Methods: A blinded, anonymous questionnaire covering a variety of health risk behaviors was administered to 1,720 adolescent patients who visited our outpatient clinic. Participants were classified as age-appropriate for last school grade completed, older than normal for grade, or as a dropout. A urine specimen was also collected in a blinded, anonymous fashion from each participant, and tested for five common substances of abuse.Results: Nearly 12% of participants tested positive for drugs. Participants who were old for grade were over 40% more likely to be positive for drugs than grade-appropriate respondents, while school dropouts were more than twice as likely to test positive.Conclusions: These results demonstrate that being old-for-grade (OFG) and being a dropout in our population are markers for being at higher risk of substance abuse.     

High-risk behaviors associated with early smoking: results from a 5-year follow-up

Purpose: To compare grade 7 nonsmokers, experimenters, and smokers on the basis of prevalence of other problem behaviors at both grade 7 and grade 12.

Methods: Based on longitudinal self-report data from 4327 California and Oregon students, we used logistic regression to develop weighted estimates of the prevalence of academic difficulties, substance use, and delinquent behavior within the three smoking status groups at grades 7 and 12. Huber variance estimates, which adjust for weighting and clustering of observations, were used to assess the statistical significance of differences across groups.

Results: Compared with nonsmokers, early smokers were at least 3 times more likely by grade 12 to regularly use tobacco and marijuana, use hard drugs, sell drugs, have multiple drug problems, drop out of school, and experience early pregnancy and parenthood. These adolescents were also at higher risk for low academic achievement and behavioral problems at school, stealing and other delinquent behaviors, and use of predatory and relational violence. Early experimenters were at significantly greater risk for these problems as well, although to a lesser extent than smokers. Importantly, the higher risk among experimenters and smokers of experiencing many of these problems was evident as early as grade 7.

Conclusions: Early experimenters and smokers are more likely than nonsmokers to experience various problem behaviors by grade 12, with many of these problems evident as early as grade 7. Results suggest that substance use programs that target multiple problems in addition to smoking may be most effective for these high-risk adolescents.     

Health-compromising behaviors among Vietnamese adolescents: the role of education and extracurricular activities

PURPOSE: To examine the prevalence of unhealthy behaviors among a cohort of Vietnamese adolescents in California; to examine the relationship between these behaviors and school-related variables (school performance, educational risk behaviors, higher-education aspirations, and participation in extracurricular activities); and to assess the differences that may exist between males and females with regard to these factors. METHODS: We conducted telephone interviews with 783 Vietnamese adolescents, aged 12-17 years, recruited through telephone listings from four California counties where large Vietnamese populations reside: San Francisco, Santa Clara, Los Angeles, and Orange. Of the 783 completed interviews, 60.8% were conducted in English and 39.2% in Vietnamese. The main outcome measure is a health risk behavior scale that includes adolescents' reports of ever smoking a cigarette, sedentary vs. active lifestyle, consumption of fruits and vegetables, consumption of foods high in fat, ever drinking alcohol, and ever engaging in sexual behavior. Multiple regression analyses were employed to estimate the association among the demographic variables, acculturation, school performance, aspirations, extracurricular activities, and the overall health risk. RESULTS: Females were significantly more sedentary than males. Over one-quarter (29%) of the females reported not having participated in vigorous physical activity on 3 or more days per week, compared with just 18% of the males. Most adolescents reported they had never tried cigarettes (84%), never used alcohol (77%), and never had sex (97%). Males were more likely than females to report a higher frequency of experimentation with smoking and drinking. Overall, school performance and participation in extracurricular activities were significantly related to the health risk behavior scale. Adolescents who demonstrated at least one educational risk (ever skipped school or ever sent out of the classroom) were more likely to engage in other risky behaviors. Also, older and more acculturated adolescents were at increased risk of engaging in health-compromising behaviors. Analysis by gender revealed that the variables age, educational risk, and chance of attending college were all related to health risk behavior for both males and females. Among the boys, those who reported achieving an average grade of B or better had a decreased risk of engaging in health-compromising behaviors; however, neither extracurricular activities nor acculturation was related to health-compromising behaviors in boys. Among the girls, the reverse was true: lack of participation in extracurricular activities was related to health-compromising behaviors, whereas grades were not a significant risk factor. CONCLUSIONS: Among sampled Vietnamese adolescents in California, health risk behaviors are common and inversely related to some school performance indicators. Using these indicators to identify high-risk groups could allow targeted educational programs or interventions for the mitigation of health-compromising behaviors.     

Risk Behaviors and Emotional Well-Being in Youth With Chronic Health Conditions

Using a cross-sectional comparison group design, 4, 746 ethnically diverse middle and high school students from 31 public schools in a metropolitan area were surveyed about their health, emotional factors (self-esteem, depressive symptoms, and suicidality), and behaviors (tobacco, alcohol, and drug use). Based on regression analyses that adjusted for gender, race, school level, and socioeconomic status, adolescents with chronic health conditions were significantly more likely to report depressive symptoms and low self-esteem than adolescents without chronic health conditions; they were almost twice as likely to have considered suicide and over 3 1/2 times more likely to have attempted suicide. They also reported greater use of cigarettes, marijuana, and illicit drugs. Given the extent of behavioral and emotional problems among adolescents with chronic health conditions, appropriate referrals and mental health services for these adolescents are warranted.     

The role of repeat victimization in adolescent delinquent behaviors and recidivism.

PURPOSE: To report prevalence of adolescent victimization and delinquency recidivism as well as to assess the association between repeat victimization and delinquency recidivism in a large, population-based sample of high school seniors. METHODS: A nationally representative sample of the Monitoring the Future Project (about 17,000 high school seniors from 1996 to 1999) was analyzed as a pooled sample. The analysis was based on self-reported measures of ten different types of delinquent behaviors including violent and property offenses. Other measures included in the analysis are victimization and information about sociodemographic (e.g,. geographic region, parental education, number of parents in the home) and lifestyle (e.g., grade from average, truancy, work experience, religious commitment) characteristics. Pairwise and multivariate methods were used to examine the risk association between repeat victimization and delinquency recidivism. RESULTS: From 1996 to 1999, a downward trend was observed for most types of delinquent behaviors: recidivism among seniors except for hitting instructors/supervisors, damaging school property, and car theft. For the same study period, the prevalence of victimization recidivism was also on the decline except for injury with a weapon and physical threats. Repeat victimization was found to be significantly associated with delinquency recidivism. Other risk factors more frequently associated with delinquency recidivism included gender, race, drug use, poor school performance, truancy, risk-seeking, and conflicts with parents. CONCLUSIONS: The present study showed a significant association between repeat victimization and delinquent recidivism; it identified characteristics of adolescent at risk of repetitive delinquent behaviors, which could be used for planning intervention strategies.     

A Comparison of Weight-Related Behaviors Among High School Students Who Are Homeless and Non-Homeless

BACKGROUND: Previous research has shown that youth who are homeless engage in high-risk behaviors. However, there has been little information published on nutritional and physical activity behaviors in this population, and studies comparing homeless youth in school with their non-homeless peers are scarce. This study compares weight-related risk behaviors of public high school students in Massachusetts based on homeless status.
METHODS: We obtained data from 3264 9th through 12th grade students who participated in the 2005 Massachusetts Youth Risk Behavior Survey. Multivariable logistic regression, controlling for gender, grade, race/ethnicity, and sexual orientation, was performed to assess the relationship between homeless status as defined by the McKinney-Vento Homeless Assistance Act and weight-related indicators. Analyses were weighted and adjusted for the multistage complex sampling design.
RESULTS: Of this sample, 4.2% reported being homeless (n = 152). Higher prevalence of homelessness was found among males, racial/ethnic minorities, sexual minorities, and students who were not in a traditional grade level. The distribution of body mass index was similar among students who were homeless and non-homeless (underweight 4.0 and 3.0%, and overweight 27.1 and 27.1%, respectively). Homeless students were more likely than non-homeless students to report disordered weight-control behaviors including fasting (aOR 2.5, 95% CI 1.4–4.5) and diet pill use (aOR 3.3, 95% CI 1.6–6.9).
CONCLUSIONS: More than 4% of public high school students in Massachusetts meet the federal definition of homelessness. These students are at high risk for disordered weight-control behaviors. Policy decisions at the school, state, and federal levels should make a concerted effort to target these students with social services and nutritional interventions.     

Health care utilization and risk behaviors among HIV positive minority drug users

This study compared health care utilization and HIV-related risk behaviors between HIV-infected African American (n=123) and Hispanic (n=97) drug users recruited in New York City. African Americans were more likely to use crack, while Hispanics were more likely to use heroin and speedball. African Americans were more likely than Hispanics to report having traded sex for drugs or money. The two groups did not significantly differ in HIV care utilization (e.g., taking HIV medications). In multiple logistic regression analyses, for African Americans, taking HIV medications was significantly related to enrollment in HIV clinics and non-use of crack, while for Hispanics, being married and attending HIV support groups were significant factors. Drug treatment enrollment was significantly related to non-use of crack and injection drug use among African Americans, and a trend (p=.07) was found between injection drug use and drug treatment enrollment among Hispanics. The findings indicate the continuing need for harm reduction programs for HIV positive drug using populations. Programs for these populations should also take into account the different risk behaviors among different racial/ethnic groups, in order to tailor culturally sensitive programs for HIV care and intervention.     

广州市中学生性行为现况研究

目的了解广州市中学生性行为的现状,为制定青少年性健康教育政策和采取干预措施提供科学依据。方法采用分层整群抽样方法分别抽取广州市8所中学约6 420名学生进行无记名问卷调查。结果有3.4%的学生曾经发生过性行为。男生的危险性行为的发生高于女生,初中生的危险性行为的发生高于高中生。性行为与吸烟、饮酒、自杀、吸毒等健康危险行为的发生均有关联性（P〈0.001）。结论应重视青少年过早性行为的发生,并及早干预,减少其他危险行为的发生以促进青少年身心健康。     

Cigarette Smoking as a Predictor of Alcohol and Other Drug Use by Children and Adolescents: Evidence of the "Gateway Drug Effect"

ABSTRACT: Data from a statewide survey, conducted by the Indiana Prevention Resource Center, of 20,629 Indiana students in grades 5–12 were analyzed to determine the extent to which cigarette smoking predicted use of alcohol and other drugs and acted as a so-called "gateway drug." A three-stage purposive/quota cluster sampling strategy yielded a representative sample of Indiana students, stratified by grade. Cross-tabulated data revealed a strong, dose-dependent relationship between smoking behavior and binge drinking, as well as use of alcohol and illicit drugs. Daily pack-a-day smokers were three times more likely to drink alcohol, seven times more likely to use smokeless tobacco, and 10–30 times more likely to use illicit drugs than nonsmokers. A stepwise multiple regression analyzed the role that the student's perceptions of the risk of using drugs and of peer approval/disapproval of the student's drug use, gender, grade in school, and ethnic background played in predicting alcohol and other drug use.     

Effectiveness of HIV Interventions Among Women Drug Users

SUMMARY

A prospective cohort study was conducted among chronic injecting and crack cocaine drug using women. The hypothesis tested was that participation in a standard-plus-innovative intervention was more likely to produce behavior change than participation in a standard intervention. Standardized intervention protocols and corresponding instruments were designed. Data were collected on drug and sex risk behaviors at baseline and six-month follow-up intervals. The level of behavioral change in two intervention arms—standard and a standard-plus-innovative intervention—was measured by composite sex risk and drug risk scores using the generalized estimating equation approach. The results show that on four risk measures the enhanced intervention was significantly associated with positive change in both drug use and sexual behavior: less frequent drug use, less drug use during sex, and more frequent condom use during particular frequencies for specific types of sexual activities. Public health interventions are effective when targeting specific risk behaviors through interventions tailored to prevent HIV and reduce risk behaviors among specific cultural and gender groups.     

Sexual Risk Behaviors Among Teens at an Urban Emergency Department: Relationship With Violent Behaviors and Substance Use

PurposeData regarding sexual risk behaviors among adolescent patients presenting to urban emergency departments (EDs) are lacking. This article describes rates and correlates of sexual risk behaviors among adolescents screened in an urban ED.MethodsDuring a period of 1-year, a total of 1,576 patients aged 14–18 years, self-administered a computerized survey (57.6% female, 59.3% African American).ResultsAmong sexually active adolescents (60%), 12% reported four or more partners; of those, 45.3% reported using a condom all the time and 14.7% reported using substances before sex. Regression analyses examined correlates of sexual risk behaviors on the basis of demographics, violence, and substance use. Males and younger teens were more likely to report condom use than females and older teens. Participants with poor grades were more likely to have had sex and used substances before sex, and were less likely to report condom use. Participants reporting dating violence were more likely to have had sex and less likely to have used condoms, whereas participants reporting peer violence and weapon carriage were more likely to report substance use before sex. Binge drinking and marijuana use were associated with all sex risk behaviors.ConclusionsThe visit to an urban ED may provide an opportunity to deliver interventions to address sexual risk behaviors among adolescents.     

Correlates of gambling among eighth-grade boys and girls

BACKGROUND: This study examined the correlates of gambling behavior among eighth‐grade students. METHODS: Children (n = 15,865) enrolled in publicly funded schools in Oregon completed the 2008 Oregon Healthy Teens survey. Multivariate logistic regression analyses assessed the combined and independent associations between risk and protective factors with active gambling among male and female youth separately. RESULTS: Approximately 17% of eighth‐grade girls and 33% of eighth‐grade boys had gambled during the past 3 months. Most health risk behaviors were positively associated with gambling. However, gambling was also positively associated with frequent physical activity participation and, among boys, eating 5 daily servings of fruits and vegetables. Logistic regression analyses identified significant differences among risk and protective factors between active gamblers and non‐gamblers. Regardless of gender, relative to active gamblers, non‐gamblers were more likely to hold strong personal health beliefs, be uninvolved in antisocial behavior, exhibit good safety behaviors, and not have experienced a mouth injury while playing sports during the past year. Female gamblers were more likely to be active tobacco users, to speak a language other than English at home, and engage in more than 2 hours a day of screen time than non‐gamblers. Male gamblers were more likely to be physically active, Hispanic, use alcohol, and perceive lower levels of social control in their neighborhoods than non‐gamblers. CONCLUSIONS: Gambling may be a topic that is appropriate for inclusion in school programs targeting health risk reduction among eighth‐grade students.     

Attempted suicide and associated health risk behaviors among Native American high school students

Suicide represents the second-leading cause of death among American Indian/Alaska Native (AI/AN) youth aged 15-24 years. Data from the 2001 Bureau of Indian Affairs (BIA) Youth Risk Behavior Survey were used to examine the association between attempted suicide among high school students and unintentional injury and violence behaviors, sexual risk behaviors, tobacco use, and alcohol and other drug use. The study included students in BIA-funded high schools with 10 or more students enrolled in grades 9-12. Overall, 16% of BIA high school students attempted suicide one or more times in the 12 months preceding the survey. Females and males who attempted suicide were more likely than females and males who did not attempt suicide to engage in every risk behavior analyzed: unintentional injury and violence behaviors, sexual risk behaviors, tobacco use, and alcohol and other drug use. These data enable educators, school health professionals, and others who work with this population to better identify American Indian youth at risk for attempting suicide by recognizing the number and variety of health risk behaviors associated with attempted suicide.     

Drug use and illnesses among eighth grade students in rural schools

We examined the relationship between drug use by young adolescents and two indicators of illness, frequency of illness and numbers of days absent from school owing to illness. Data were from a general health survey of all eighth grade students enrolled in public schools in two rural Maryland counties. A total of 745 students completed a self-administered questionnaire during school hours in January 1984. Information was obtained on a variety of sociodemographic characteristics and on the students' use of tobacco, alcohol, and marijuana. Correlational analyses were used to examine the relationships among cigarette smoking, beer or wine drinking, whiskey or hard liquor drinking, and marijuana use. Logistic regression was used to model the effects of drug use behaviors on the likelihood of being absent from school 3 or more days, adjusting for the student's age, sex, race, parents' education, illness frequency, and concerns about learning problems in school. We found substantial covariation among the use of cigarettes, alcohol, and marijuana. After adjusting for the background variables of illness, frequency, and learning problems, we found that students who are frequent cigarette smokers experienced a 2.6 risk of school absenteeism. Other drug use behaviors were not associated significantly with increased risk of missing school. Findings are discussed within the context of health-related consequences of drug use.     

HIV-Related Behaviors and Perceptions Among Adults in 25 States: 1997 Behavioral Risk Factor Surveillance System

OBJECTIVES: To assess the level of HIV-related risk behavior among the general US adult population, we analyzed data from the first sexual behavior questions available for states to use with the Behavioral Risk Factor Surveillance System. METHODS: The Behavioral Risk Factor Surveillance System is a state-specific, population-based, random telephone survey. In 1997, 25 states collected sexual behavior data. Annual prevalence estimates for selected behaviors were calculated and examined by sociodemographic characteristics. The correlation between actual and perceived HIV risk also was determined. RESULTS: Most (77.1%) of the respondents reported just 1 sexual partner in the past year; 26.0% reported using a condom at last intercourse. Males, persons who were younger, and Blacks were more likely to report 2 or more partners but also more likely to report using a condom at last intercourse. Only 4.1% of the respondents reported a risk factor for HIV infection; 7.7% reported that they were at medium or high risk for HIV. Actual and perceived HIV risk were positively associated. CONCLUSIONS: Most US adults do not engage in HIV-related risk behavior; those that do are more likely to report protective behavior.