Downwards trends in adolescent risk-taking behaviours in New Zealand: Exploring driving forces for change.

Adolescents and risks: Why not change our paradigm?

Prevention interventions with persons living with HIV/AIDS: challenges, progress, and research priorities.

Adolescent involvement with alcohol, drugs, tobacco, sexual relationships, and gang violence begins at increasingly younger ages. Awareness of the dangers and consequences of risk-taking behavior has not had a profound or lasting impact on adolescent behavior, and there appears to be no relation between risk behavior and general knowledge concerning these topics. Using paired anonymous questionnaires, we surveyed 215 seventh-grade students and their parents about their experience with and attitudes toward adolescent risk-taking behaviors. The results of each student questionnaire were compared with results of his or her own parents. The survey instrument contained questions concerning tobacco, alcohol, and drug use, sexual activity, gang membership, general knowledge concerning these topics, and parental guidance given. Data were analyzed using the chi2 test of significance. Parent and student recollection of issues discussed and guidance given differed widely, as did the students' understanding of their parents' guidance. Factors found to have a meaningful impact on the reduction of risk behavior in the adolescent population were (1) students perceiving a satisfactory relationship with their parents, and (2) parents successfully communicating their expectations regarding these behaviors to their children. Parental direction has a powerful effect on the reduction of risk behavior in young adolescents. A limited ability for abstract reasoning during early adolescence requires clear anticipatory guidance by parents and an active effort to maintain communication in the child-parent relationship.

Addressing Common Risk and Protective Factors Can Prevent a Wide Range of Adolescent Risk Behaviors

Background Adolescents’ risk-taking behaviors can have profound impacts on their future health. Few studies have established a relationship between multiple social environmental factors and adolescent risk behaviors. We used structural equation modeling to examine the role of parental monitoring and environmental risks on adolescents’ behavioral intentions and risk behaviors. Methods Data were collected through the baseline survey of a national implementation project among 2205 Grade 6 students in 24 government schools in The Bahamas in 2019. Structural equation modeling examined relations among parental monitoring, environmental risk factors, behavioral intentions, and risk behaviors. Results Students had engaged in various delinquent, substance use, and sexual risks. In the structural equation model, parental monitoring demonstrated direct negative (protective) effects on behavioral intentions and risk behaviors, whereas environmental risk factors had a direct positive effect on adolescent behavioral intentions and risk behaviors. The model had an R2 value of 0.57 for adolescent risk behaviors. Conclusion Parental monitoring and environmental risk factors had strong influences on risk-taking behaviors of early adolescents. Future adolescent health behavior interventions should consider offering additional prevention resources to early adolescents who are exposed to multiple environmental risk factors.

Evidence of the effectiveness of AIDS prevention efforts has been constrained by the use of poor study designs, small sample sizes, short evaluation periods and a lack of control groups [1]. However, ‘These same flaws are common to a surprisingly high percentage of research in all areas of medicine, and are not necessarily more problematic in the AIDS area’[1]. These flaws are evident and have been acknowledged widely in the literature on the effectiveness of needle and syringe programmes (NSPs) [2,3]. In a recent editorial, Amundsen [4] relies on these limitations to question the status of NSPs as a ‘superior tool’ for HIV prevention and suggests that more emphasis be placed on testing and counselling to reduce risk behaviour in injecting drug users (IDUs). However, the evidence base for voluntary testing and counselling (VTC) is relatively weak compared to that supporting NSPs. VTC is most effective in reducing risk behaviours among serodiscordant heterosexual couples and those testing HIV positive [5]. While some studies show reductions in risk behaviour following a positive diagnosis [6], many indicate ongoing risk behaviour [7,8]. At best the effects of VTC are variable, with some [8–10], but not all [11], randomized controlled trials reporting a dose–response relationship, with greater reductions in risk associated with more intensive counselling. Evidence of beneficial effects in particular populations is especially weak [12], and many IDUs continue to engage in risk behaviours despite knowledge of their positive serostatus [13,14]. While some studies indicate that HIV-positive IDUs report less risk behaviour than those not tested or infected [15], a randomized trial [16] and a prospective study [17] found that VTC was not associated with a reduction in injection risk behaviour. To date, no trials have evaluated the impact of testing and counselling on HIV transmission, compared with no testing and counselling. However, prevention research is increasingly shifting its focus towards group and structural interventions that address the social and environmental contexts of risk [18] and the role of social networks and group dynamics [19]. The evidence to date suggests that VTC is clearly necessary, but not sufficient, in preventing the transmission of HIV and other blood-borne pathogens. As in other areas of medicine, evidence of the effectiveness of public health interventions is rarely clear-cut and policy makers have traditionally rejected putting all the eggs into a particular basket in favour of a range of interventions which, in turn, have different costs and varying levels of effectiveness. A recent study which examined the allocation of resources to NSP, methadone maintenance and condom distribution programmes targeting different population groups found that best allocations varied by epidemic scenario. In a setting characterized by 40% HIV seroprevalence among IDUs, allocating approximately 75% of the budget to NSP and 25% to a condom availability programme maximized the number of HIV infections averted. In a lower prevalence setting (5%), the best allocation expended almost all funds on methadone maintenance for HIV-positive IDUs [20]. NSPs are clearly a critical component of an effective harm reduction response. Unfortunately, questioning the efficacy of this vital public health tool on the basis of a lack of gold standard evidence may serve to undermine current attempts to scale up NSPs in settings where they are needed most.

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events occurring before age 18 years. Data on ACEs among adolescents in the United States have primarily been collected through parent report and have not included important violence-related ACEs, including physical, sexual, and emotional abuse. This report presents the first national prevalence of self-reported ACEs among U.S. high school students aged <18 years, estimates associations between ACEs and 16 health conditions and risk behaviors, and calculates population-attributable fractions of ACEs with these conditions and behaviors using cross-sectional, nationally representative 2023 Youth Risk Behavior Survey data. Exposures were lifetime prevalence of individual (emotional, physical, and sexual abuse; physical neglect; witnessed intimate partner violence; household substance use; household poor mental health; and incarcerated or detained parent or guardian) ACEs and cumulative ACEs count (zero, one, two or three, or four or more). Health conditions and risk behaviors included violence risk factors, substance use, sexual behaviors, weight and weight perceptions, mental health, and suicidal thoughts and behaviors. Bivariate analyses assessed associations between individual and cumulative ACEs and demographics. Adjusted prevalence ratios assessed associations between cumulative ACEs and health conditions and risk behaviors, accounting for demographics. Population-attributable fractions were calculated to determine the potential reduction in health conditions and risk behaviors associated with preventing ACEs. ACEs were common, with approximately three in four students (76.1%) experiencing one or more ACEs and approximately one in five students (18.5%) experiencing four or more ACEs. The most common ACEs were emotional abuse (61.5%), physical abuse (31.8%), and household poor mental health (28.4%). Students who identified as female; American Indian or Alaska Native; multiracial; or gay or lesbian, bisexual, questioning, or who describe their sexual identity in some other way experienced the highest number of ACEs. Population-attributable fractions associated with experiencing ACEs were highest for suicide attempts (89.4%), seriously considering attempting suicide (85.4%), and prescription opioid misuse (84.3%). ACEs are prevalent among students and contribute substantially to numerous health conditions and risk behaviors in adolescence. Policymakers and public health professionals can use these findings to understand the potential public health impact of ACEs prevention to reduce adolescent suicidal behaviors, substance use, sexual risk behaviors, and other negative health conditions and risk behaviors and to understand current effects of ACEs among U.S. high school students.

ObjectivesThe authors aimed to examine whether changes in health risk behaviour rates alter the relationships between behaviours during adolescence, by comparing clustering of risk behaviours at different time points.DesignComparison of...

Adolescent risk behaviors and religion: Findings from a national study

BackgroundInterventions aimed at preventing risky behaviour in adolescence and young adulthood have largely focused on single risk behaviours and a limited number of underlying predictors. Interventions that take a broader...

This study investigated associations among adolescents' self-esteem in 6 domains (peers, school, family, sports/athletics, body image and global self-worth) and risk behaviours related to substance use, bullying, suicidality and sexuality. A multistage stratified sampling strategy was used to select a representative sample of 939 English-, Afrikaans- and Xhosa-speaking students in Grades 8 and 11 at public high schools in Cape Town, South Africa. Participants completed the multidimensional Self-Esteem Questionnaire (SEQ; DuBois, Felner, Brand, Phillips, & Lease, 1996) and a self-report questionnaire containing items about demographic characteristics and participation in a range of risk behaviours. It included questions about their use of tobacco, alcohol, cannabis, solvents and other substances, bullying, suicidal ideation and attempts, and risky sexual behaviour. Data was analysed using a series of logistic regression models, with the estimation of model parameters being done through generalised estimation equations. Scores on each self-esteem scale were significantly associated with at least one risk behaviour in male and female adolescents after controlling for the sampling strategy, grade and race. However, specific self-esteem domains were differentially related to particular risk behaviours. After taking the correlations between the self-esteem scales into account, low self-esteem in the family and school contexts and high self-esteem in the peer domain were significantly independently associated with multiple risk behaviours in adolescents of both sexes. Low body-image self-esteem and global self-worth were also uniquely associated with risk behaviours in girls, but not in boys. Overall, the findings suggest that interventions that aim to protect adolescents from engaging in risk behaviours by increasing their self-esteem are likely to be most effective and cost-efficient if they are aimed at the family and school domains.

Background: This study investigated associations among adolescents’ self‐esteem in 6 domains (peers, school, family, sports/athletics, body image and global self‐worth) and risk behaviours related to substance use, bullying, suicidality and sexuality. Method: A multistage stratified sampling strategy was used to select a representative sample of 939 English‐, Afrikaans‐ and Xhosa‐speaking students in Grades 8 and 11 at public high schools in Cape Town, South Africa. Participants completed the multidimensional Self‐Esteem Questionnaire (SEQ; ) and a self‐report questionnaire containing items about demographic characteristics and participation in a range of risk behaviours. It included questions about their use of tobacco, alcohol, cannabis, solvents and other substances, bullying, suicidal ideation and attempts, and risky sexual behaviour. Data was analysed using a series of logistic regression models, with the estimation of model parameters being done through generalised estimation equations. Results: Scores on each self‐esteem scale were significantly associated with at least one risk behaviour in male and female adolescents after controlling for the sampling strategy, grade and race. However, specific self‐esteem domains were differentially related to particular risk behaviours. After taking the correlations between the self‐esteem scales into account, low self‐esteem in the family and school contexts and high self‐esteem in the peer domain were significantly independently associated with multiple risk behaviours in adolescents of both sexes. Low body‐image self‐esteem and global self‐worth were also uniquely associated with risk behaviours in girls, but not in boys. Conclusions: Overall, the findings suggest that interventions that aim to protect adolescents from engaging in risk behaviours by increasing their self‐esteem are likely to be most effective and cost‐efficient if they are aimed at the family and school domains.

Engagement in risk behaviours may pose a significant threat to health if involvement spans multiple behaviours. The asset model suggests that contextual aspects of young people's lives, such as factors related to family, school and community, serve as a protective function against health risk behaviours. A risk-taking index was created from the English health behaviour in school-aged children study on 15 years olds, substance use and sexual activity. Using a multinomial regression, potential asset variables relating to school, family, peers, community and family affluence were tested for their association with levels of risk behaviours. Sense of neighbourhood belonging, strong school belonging and parental involvement in decision-making about leisure time were related to lower engagement in health risk behaviours. A weaker sense of family belonging was associated with increased risk behaviours if connectedness with teachers was also low. Factors related to school and community played a greater role in adolescent participation in health-related risk behaviours than family-related factors, including family affluence. Feelings of safety and belonging in the out-of-home settings of adolescents were positively associated with reduced risk behaviours, and indicate the importance of the wider community alongside parents and school as protective assets for health.

Knowing the risk: relationships between risk behaviour and health knowledge

Knowing the risk: relationships between risk behaviour and health knowledge.