The Effects of Connectedness on Health-Promoting and Health-Compromising Behaviors in Adolescents: Evidence from a Statewide Survey

Using a social ecological perspective, we examined the effects of connectedness in multiple domains on health-promoting and health-compromising behaviors among Asian American (AA), Pacific Islander (PI), and Caucasian/White American (WA) adolescents in California. After adjusting for age, gender, and socioeconomic status, the following consistent results emerged across the three ethnic groups: (a) community connectedness increased the odds of physical activity; (b) internal, family, and school connectedness decreased, whereas friend connectedness increased, the odds of substance use; and (c) internal and family connectedness decreased the odds of violent behavior. We also found specific ethnic variations pertaining to the effects of connectedness. Friend connectedness increased the odds of violent behavior for AAs and WAs, but not for PIs. Meanwhile, community connectedness increased the odds of substance use and violent behavior for AAs and PIs, but decreased the odds of these behaviors for WAs. Findings for healthy dietary behavior were inconsistent across ethnic groups and connectedness domains. Our overall findings suggest that the effects of connectedness were more salient for health-compromising behaviors than for health-promoting behaviors. Health prevention and intervention efforts in adolescents could target the role of their connectedness to their multiple social domains.     

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.     

Correlates of Inadequate Consumption of Dairy Products among Adolescents

The objective of this study was to identify the sociodemographic, personal, psychosocial, and behavioral correlates of low consumption of dairy products among adolescents. A comprehensive, school-based health behavior survey was administered to 36,284 public school students in grades 7 through 12 in Minnesota. Students self-reported consumption of dairy products and items addressing various dimensions of health. The risk factors for low consumption of dairy foods included being female, nonwhite, and of low socioeconomic status. The psychosocial factors associated with low intake included low weight satisfaction, school grades less than or equal to C, and low family connectedness. Dieting was strongly associated with low consumption of dairy foods, and modest consistent associations were also found with other health-compromising behaviors such as binge eating and substance abuse. Interventions aimed at increased consumption of calcium-rich foods among youth need to address high-risk groups and should include both education and environmental components as part of a comprehensive school-based program. Future research should examine differences in intake patterns of calcium-rich foods and health implications of lower intakes among different ethnic groups.     

Familial correlates of extreme weight control behaviors among adolescents

OBJECTIVE: To identify familial factors associated with extreme weight control among adolescents. METHOD: Analysis of a comprehensive 1996 health survey of Connecticut students. Familial factors among extreme dieters who deliberately vomited, took diet pills, laxatives, or diuretics were compared with youth reporting none of these behaviors, using logistic regression controlling for age and body mass index. RESULTS: Nearly 7% of adolescents reported engaging in extreme weight control behaviors. Boys' risk factors included high parental supervision/monitoring and sexual abuse history. Protective factors included high parental expectations, maternal presence, and connectedness with friends and other adults. The only significant risk factor for girls was sexual abuse history. Protective factors included family connectedness, positive family communication, parental supervision/monitoring, and maternal presence. CONCLUSIONS: Extreme dieting appears to be less an expression of body composition than of psychosocial issues. That connectedness to family, other adults, and friends is protective further demonstrates interrelationships of extreme weight control behaviors with family/social issues.     

Health risk behaviors and associated risk and protective factors among Brazilian adolescents in Santos, Brazil.

OBJECTIVE: To describe the prevalence of health risk behaviors and identify risk and protective factors that are associated with several health risk behaviors (cigarette smoking, drug use, onset of sexual intercourse before age 15, pregnancy, gun-carrying, suicidal ideation, and suicide attempts) among adolescents in Brazil, as well as to explore gender differences. METHODS: We estimated prevalence rates, evaluated bivariate associations, and explored multivariate analyses using logistic regression on data from a 1997 survey of adolescent health among 2059 eighth- and 10(th)-grade students in Santos, Brazil. RESULTS: Youth in Santos, Brazil report high rates of gun-carrying, suicidal thoughts and attempts, sexual intercourse, and pregnancy. Factors associated with diminished involvement for nearly all health risk behaviors, for both boys and girls, included having good family relationships, and feeling liked by friends and teachers. Factors associated with increases in nearly all health risk behaviors were: gun-carrying and gun availability in the home, drug use, and sexual abuse. CONCLUSIONS: Factors that are associated with a wide range of health risk behaviors among adolescents in Brazil appear to parallel those found in industrialized countries: access to guns, substance use, and sexual abuse. Likewise, connectedness to family, school, and peers is consistently the protective factor associated with diminished risky behaviors.     

Adolescent health in the Caribbean: risk and protective factors

OBJECTIVES: This study sought to identify, among youths, factors associated with characteristics such as poor health status, substance use, and suicide risk and to explore the extent to which the risk and protective factors identified cut across health-compromising behaviors. METHODS: A survey was administered to representative samples of young people from 9 Caribbean countries. RESULTS: Physical/sexual abuse and having a friend or relative who had attempted suicide were associated with an increased prevalence of health-compromising behaviors. Connectedness with parents and school and attendance at religious services were associated with fewer health risk behaviors. CONCLUSIONS: When the identified risk and protective factors were compared with those seen among young people in the United States, similarities as well as important differences were found.     

Similarity of risk and protective behaviors among African-American pre- and early adolescent members of naturally occurring friendship groups.

To determine whether self-reported risk and protective behaviors, expectations, and attitudes are more similar among African-American early adolescents within a community-based friendship group than across groups, a cross-sectional study was conducted among 382 African-American youth 9 through 15 years of age forming 76 community-based groups of 3 through 10 same-gender friends. Each member of the friendship group reported his/her own past involvement in nine risk behaviors (sexual intercourse, substance abuse, drug-trafficking, and other delinquent activities) and two protective behaviors (high academic performance and regular church attendance) and their expectations and feelings regarding several of these behaviors. Intraclass correlation coefficients were calculated overall and by gender and age. Members were generally more similar within friendship groups than across groups with regard to several risk behaviors and expectations including sexual intercourse and drug-trafficking. Particularly striking was the similarity among members of "junior" friendship groups (e.g., median age of youth < 11 years) of both risk and protective behaviors and expectations. The finding of enhanced similarity of risk behaviors and expectations among members within groups suggests that intervention delivery through community-based friendship groups may be a useful approach for risk prevention efforts targeting pre-adolescent African-American youth living in low-income settings.     

Adolescent substance use and sexual risk-taking behavior.

PURPOSE: To examine the relationship of adolescent substance use and dependence to sexual risk-taking behavior in late adolescence and young adulthood. METHODS: We prospectively examined self-reported sexual behaviors and substance involvement questionnaires in a sample of youth in substance abuse treatment programs and a comparison sample of sociodemographically similar community youths without histories of substance use disorders recruited from media ads. Assessments of sexual behaviors and substance involvement (78% white, 51% female) were collected at 2, 4, and 6 years after initial assessments, as they transitioned from middle adolescence to young adulthood (from age 15.5 to age 21.5 years, on average).The two samples were compared using Chi-square, analysis of variance, and multivariate analysis of variance approaches. Continuous indicators of high-risk sexual behaviors and substance involvement were analyzed with multiple regression. RESULTS: Earlier age of onset to sexual activity, more sexual partners, less consistent use of condoms, more sexually transmitted diseases (STDs), and greater prevalence of human immunodeficiency virus testing were reported by youth in the clinical treatment sample relative to sociodemographically comparable nonabusing community youth. High rates of STDs were found among females, and more substance-abusing females reported pregnancies than community females. Substance involvement continued to be associated with high-risk sexual behavior throughout the transition into young adulthood. CONCLUSIONS: Youth identified with substance problems are more likely to engage in risky sexual behaviors during adolescence and to continue risky sexual behaviors to the extent that substance problems persist. Risk reduction education should be included with adolescent substance abuse treatment.     

School Disconnectedness: Identifying Adolescents at Risk in Ontario, Canada

Background:  There is strong theoretical and empirical support for school connectedness as an important element of healthy youth development. The primary objective of this study was to replicate previous research identifying factors differentiating youth who do not feel connected to their schools in a sample of adolescents in Ontario, Canada. A secondary objective was to extend this work by assessing whether physical activity was an additional health behavior that differentiated youth who feel connected to their schools from those who do not.
Methods:  Data for this study were based on questionnaires from 2243 grade 7 to grade 12 students derived from the 2001 cycle of the Ontario Student Drug Use Survey. Logistic regression analysis was used to examine associations between physical activity, other health risk factors, and school disconnectedness.
Results:  The odds of feeling disconnected from their schools were substantially greater for female students who perceived their health or academic performance to be poor, engaged in no vigorous physical activity, reported 3 or more physician visits during the past year, and had low extracurricular involvement. None of the sociodemographic factors or substance use measures was significantly associated with school disconnectedness for any students.
Conclusions:  Our results highlight sex differences in how school disconnectedness is related to health-compromising behaviors such as physical inactivity. Further research is required to examine how boys and girls perceive, interpret, and internalize the school climate. Increasing school connectedness should be a consideration for academic administrators and health-promotion advocates.     

Family connectedness and sexual risk-taking among urban youth attending alternative high schools

CONTEXT : Youth in alternative high schools engage in risky sexual behavior at higher rates than do their peers in regular schools, placing themselves at an increased risk of sexually transmitted disease and unintended pregnancy. Family connectedness is associated with reduced adolescent sexual risk-taking, although this association has not been tested among alternative school youth.
METHODS : A sample of 976 urban, predominantly minority alternative high school students in Houston, Texas, were surveyed in 2000-2002. Survey data were analyzed using logistic regression to determine whether family connectedness is related to sexual risk-taking .
RESULTS : Overall, 68% of students reported ever having had sex. Of sexually experienced students, 74% reported having had sex in the past three months and 29% reported ever having been involved in a pregnancy. The higher students scored on a scale of perceived family connectedness, the less likely they were to report ever having had sex, recently having had unprotected sex and having been involved in a pregnancy (odds ratio, 0.97 per unit increase for each outcome). Among females, higher perceived family connectedness was associated with reduced odds of ever having had sex or having initiated sex prior to age 13 (0.96 for each); males who perceived higher family connectedness had reduced odds of having been involved in a pregnancy (0.93) .
CONCLUSIONS : Family connectedness may be a protective factor related to sexual risk-taking, even among high-risk youth. Including activities that acknowledge the influence of family relationships and facilitate positive parent-child relationships may increase the efficacy of programs for reducing sexual risk-taking among alternative school youth.     

Depressive symptoms and adolescent eating and health behaviors: a multifaceted view in a population-based sample

BACKGROUND: Previous research has shown significant associations between depression and substance use and eating disordered behaviors. However, no research to date has described associations between depressive symptoms and nutritional intake or physical activity among adolescents in a nonclinical, population-based sample. METHODS: Classroom surveys were completed by 4,734 ethnically diverse, middle- and high school students. Based on their depressive symptom scores, males and females were categorized with low-, moderate-, or high-depressive symptom status. Linear models were used to examine eating and health behavior variables by depressive symptom groups. RESULTS: Depressive symptoms were positively associated with health-compromising attitudes such as perceived barriers to healthy eating and weight concerns, and health-compromising behaviors such as unhealthy weight-control behaviors and substance use, including caffeine. Depressive symptoms were negatively associated with health-promoting behaviors such as eating breakfast, lunch, and dinner. However, most associations between depressive symptoms and dietary micronutrients were not statistically significant. Health-promoting moderate-to-vigorous physical activity was negatively associated with depressive symptoms among males. CONCLUSIONS: Adolescents who report depressive symptoms are at risk for other health-compromising attitudes and behaviors and are also less likely to engage in health-promoting behaviors. Depressive symptoms may be an underlying trait in the expression of health behaviors among adolescents.     

School attendance,health-risk behaviors,and self-esteem in adolescents applying for working papers.

Since health-risk behaviors are often encountered in clusters among adolescents, it was hypothesized that adolescents with poor school attendance would be associated with more health-risk behaviors (e.g., substance use, violence) than those who attend school regularly. This study assessed the relationship between poor school attendance and health-risk behaviors, and described health-risk behaviors and self-esteem among adolescents seeking employment. In this cross-sectional study, school attendance (poor vs. regular attendance) was related to health-risk behaviors by asking 122 subjects seen at a New York City Working Papers Clinic to complete both a 72-item questionnaire about their health-risk behaviors and the 58-item Coopersmith Self-Esteem School Form Inventory. Chi-square and Fisher''s Exact Tests were performed. The poor and regular attenders of school differed significantly in only 5 out of 44 items pertaining to health-risk behaviors. Self-esteem measures for the two groups did not differ from one another or from national norms. In this sample, depression "in general" (global) and "at home," but not "at school," were associated significantly with suicidal thoughts/attempts and serious past life events (e.g. family conflict, sexual abuse). There were no significant associations between depression or self-esteem and illicit substance or alcohol use. We found few associations between poor school attendance and health-risk behaviors in this sample of employment-seeking adolescents. The poor and regular attenders of school were similar in most aspects of their health-risk behaviors and self-esteem.     

Adverse Childhood Experiences and Suicidal Behaviors Among Youth: The Buffering Influence of Family Communication and School Connectedness

PurposeThe main objectives of this study were to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of adverse childhood experiences (ACEs; direct protective effect) and (2) whether family communication or school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect) on the multiplicative and additive scales.MethodsData were obtained from a western state's 2019 Youth Risk Behavior Survey that included 5,341 middle school and 4,980 high school participants. Generalized linear models were used to estimate whether family communication and school connectedness offered direct protection against suicidal behaviors or buffered the association between ACEs and suicidal behaviors using adjusted prevalence ratios and corresponding 95% confidence intervals.ResultsFamily communication and school connectedness offered direct protection against suicidal behaviors in the presence of ACEs (a 1-unit higher score was associated with a 32%–42% lower prevalence of suicidal behaviors for middle school youth and a 27%–39% lower prevalence of suicidal behaviors for high school youth). There was evidence that family communication and school connectedness buffered the association between ACEs and suicidal behaviors on the multiplicative scale.ConclusionsThe findings provide support for the development and implementation of interventions that build family communication and school connectedness to reduce suicidal behaviors. Furthermore, screening for trauma and suicidal behaviors is warranted.     

Condom use: slippage, breakage, and steps for proper use among adolescents in alternative school settings

BACKGROUND : School‐based human immunodeficiency virus (HIV)/sexually transmitted infection (STI), and pregnancy prevention programs often focus on consistent and correct condom use. Research on adolescents' experience using condoms, including condom slippage/breakage, is limited. This exploratory study examines proper condom use and the occurrence of condom slippage/breakage among alternative school youth. METHODS : Data are from an HIV/STI prevention trial for youth in continuation school settings (N = 776). Analyses included separate hierarchical logistic regression analyses to explore the relationship between potential correlates and each outcome variable. RESULTS : Students' use of steps for proper condom use varied—73.8% put on the condom before sexual contact, 71.1% squeezed air from the tip, and 92.0% unrolled the condom fully. Notably, 28.5% reported condom slippage/breakage. Results from the regression analyses showed that 4 sets of variables (demographic, substance use, sexual risk behaviors, and condom psychosocial factors) were associated with putting on a condom before sexual contact; none of the variable sets were associated with the other 2 condom steps measured. For slippage/breakage, the demographic and sexual risk behaviors were significant correlates; steps for proper condom use approached statistical significance (p = .058). CONCLUSIONS : This study extends the limited research on how adolescents use condoms, and highlights important targets for prevention interventions.     

Reconceptualizing adolescent sexual behavior: beyond did they or didn't they?

CONTEXT: Adolescent sexual behavior is typically studied as a dichotomy: Adolescents have had sex or they have not. Broadening this view would lead to a greater understanding of teenagers' sexual behavior. METHODS: Interview data from 907 high school students in Alabama, New York and Puerto Rico were used to examine the relationships between sexual experience and a variety of social, psychological and behavioral variables. Four groups of teenagers are compared: those who did not anticipate initiating sex in the next year (delayers), those who anticipated initiating sex in the next year (anticipators), those who had had one sexual partner (singles) and those who had had two or more partners (multiples). RESULTS: Compared with delayers, anticipators reported more alcohol use and marijuana use; poorer psychological health; riskier peer behaviors; and looser ties to family school and church. Similarly, multiples reported more alcohol and marijuana use, riskier peer behaviors and looser ties to family and school than singles. Risk behaviors, peer behaviors, family variables, and school and church involvement showed a linear trend across the four categories of sexual behavior. CONCLUSIONS: The traditional sex-no sex dichotomy obscures differences among sexually inexperienced teenagers and among adolescents who have had sex. Prevention efforts must be tailored to the specific needs of teenagers with differing sexual experiences and expectations, and must address the social and psychological context in which sexual experiences occur.     

Substance abuse among sexually abused adolescents and their families

The concurrence of substance abuse and history of sexual abuse among adolescents has prompted this study of substance abuse patterns among families of adolescents who report incest or extrafamilial sexual abuse. A total of 3,179 ninth-grade students in a rural midwestern state completed a survey that included questions about individual and family substance abuse. Adolescents who had been sexually abused were more likely to report substance abuse for themselves as well as for members of their immediate families. They were also more likely to report that they used substances because of family problems, school problems, and because they were sad, lonely, or angry. Adolescents reporting a parent with an alcohol or a drug problem were more likely to use cigarettes, marijuana, alcohol, or “speed.” Adolescents experiencing extrafamilial abuse reported more alcohol abuse and more alcohol-related problems than those who experienced incest. There were similar reports of parental and familial alcohol and drug problems among those experiencing incest and those experiencing extrafamilial abuse. Those with drug-abusing parents, however, were most likely to report some kind of sexual abuse history.     

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

BACKGROUND: Two risk behaviors, alcohol consumption and early initiation of sexual intercourse (ISI), can have devastating consequences for youth. The purpose of this study was to determine the association of school connectedness and school‐related behaviors (eg, academic performance, skipping school, getting into trouble at school) with these 2 risk behaviors. METHODS: The Youth Asset Survey (YAS) was administered to 1117 youth/parent pairs in their homes using Computer‐Assisted Personal/Self‐Interviewing (CAPI/CASI). The YAS measures 17 youth assets and risk behaviors including alcohol consumption and sexual activity. RESULTS: The mean age of the sample was 14.3 years; 53% were female; and 70% were from 2‐parent homes. Five school‐related behaviors were positively associated with no ISI. Four school‐related behaviors were positively associated with reporting no alcohol consumption in the past 30 days, including the School Connectedness asset (only among 12‐ to 13‐year‐olds), not skipping school (only among non‐Hispanic Caucasians), staying out of trouble, and paying attention. CONCLUSIONS: School is very much a part of the lives of youth and therefore the relationship they have with their school experience is important and may influence their involvement in risk behaviors. Feeling connected to school is a positive asset that can protect youth from such risky behaviors as sexual initiation and alcohol consumption.     

Differences in behavior,psychological factors,and environmental factors associated with participation in school sports and other activities in adolescence

This study examined whether participation in school team sports, exclusively or in combination with other extracurricular activities, is associated with higher levels of psychosocial functioning and healthy behavior than participation in other extracurricular activities alone or nonparticipation. The study sample includes 50,168 ninth grade public school students who completed an anonymous, voluntary statewide survey in 2001. Students were classified into four groups based on their participation in sports and other activities (such as clubs, volunteer work, band, choir, or music lessons): neither, both, other activities only, and sports only. Odds ratios for the group involved in both types of activities were significantly higher than those for all the other groups for all healthy behaviors and measures of connectedness, and significantly lower for all but one of the unhealthy behaviors. Students involved in sports, alone or in combination with other activities, had significantly higher odds than the other two groups for exercise, milk consumption, and healthy self-image, and significantly lower odds for emotional distress, suicidal behavior, family substance abuse, and physical and sexual abuse victimization. Students involved in other activities, alone or in combination with sports, had significantly higher odds than the other two groups for doing homework and significantly lower odds for alcohol consumption, marijuana use, and vandalism. The finding that abuse victims appeared to avoid sports but not other group activities raises concern and merits further research. Considering the potential benefits of participation in sports and other activities, more research is needed to identify and overcome barriers or deterrents, particularly for youth from low-income families.     

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. J Am Diet Assoc. 1998;98:1449–1456.