Adolescent Health Risk Behaviors Research Articles

Health risk behaviors in adolescents and emerging adults with congenital heart disease: psychometric properties of the Health Behavior Scale-Congenital Heart Disease

To optimize long-term outcomes, patients with congenital heart disease (CHD) should adopt health-promoting behaviors. Studies on health behavior in afflicted patients are scarce and comparability of study results is limited. To enlarge the body of evidence, we have developed the Health Behavior Scale-Congenital Heart Disease (HBS-CHD). We examined the psychometric properties of the HBS-CHD by providing evidence for (a) the content validity; (b) validity based on the relationships with other variables; (c) reliability in terms of stability; and (d) responsiveness. Ten experts rated the relevance of the HBS-CHD items. The item content validity index (I-CVI) and the averaged scale content validity index (S-CVI/Ave); the modified multi-rater Kappa and proportion of missing values for each question were calculated. Relationships with other variables were evaluated using six hypotheses that were tested in 429 adolescents with CHD. Stability of the instrument was assessed using Heise's method; and responsiveness was tested by calculating the Guyatt's Responsiveness Index (GRI). Overall, 86.3% of the items had a good to excellent content validity; the S-CVI/Ave (0.81) and multi-rater Kappa (0.78) were adequate. The average proportion of missing values was low (1.2%). Because five out of six hypotheses were confirmed, evidence for the validity of the HBS-CHD based on relationships with other variables was provided. The stability of the instrument could not be confirmed based on our data. The GRI showed good to excellent capacity of the HBS-CHD to detect clinical changes in the health behavior over time. We found that the HBS-CHD is a valid and responsive questionnaire to assess health behaviors in patients with CHD.

Health risk behaviors in urban and rural Guatemalan adolescents

Adolescence is an important stage of life when health behaviors and attitudes are established. The purpose of this research was to assess health risk behaviors among Guatemalan students in both an urban and rural school. Items were adapted from the Global School-based Student Health Survey and were used to measure and compare the prevalence of risk behaviors between these two demographically and culturally distant school-based samples. In general, the prevalence of adolescent health risk behaviors in both schools was lower than other Latin American countries. Many health risk behaviors were associated with location (urban vs. rural settings) and/or gender. Tobacco use, alcohol use, and sexual activity were higher among urban students. Boys were more likely than girls to use alcohol, use tobacco, and be sexually active. In addition, the prevalence of mental health problems was higher among girls and rural students. These findings imply that measures should be taken to design effective and appropriate health strategies for adolescents attending these schools. Health promotion programs in schools and communities should assist the youth in developing positive health behaviors and cultivating healthy lifestyles in an effort to reduce risk behaviors among adolescent populations. Further research is needed to extend our understanding of risk factors of health behavior in these adolescent populations and to identify effective preventative approaches and strategies that specifically cater to the location and culture of the students.

Trajectories of multiple adolescent health risk behaviors in a low-income African American population

Trajectories of multiple adolescent health risk behaviors in a low-income African American population

Using family history and health risk behaviors to determine predictors of depressive symptoms in Central American immigrant mothers

In this study, depressive symptomatology in Central American immigrant mothers with adolescent daughters living in the USA was explored. Using the Center for Epidemiologic Studies Depression Short Scale, the Family History Scale, an Acculturation Scale, and the core section of the Youth Conduct Disorder scale from the National Health and Nutrition Examination Survey, 101 Central American mothers were analyzed to identify predictors of depressive symptoms. Over one-third of the participants had depressive symptoms. There were no significant findings for acculturation as a predictor of depressive symptoms. Predictors that related to depressive symptomatology were a positive family history of depression, marital status (divorced), and having a daughter engaged in health risk behaviors. Clinicians working with mothers from Central America should consider risk of depression, whether there is a family history of depression; and additional stresses, such as the health risk behaviors of adolescents. Unprecedented levels of immigration around the world underscore the importance of meeting the healthcare needs of culturally-diverse groups.

Selected anti-health behaviors of junior high school students diagnosed with allergic disease

Introduction. A health risk behavior is characteristic of the period of adolescence, both in healthy adolescents as well as in those with a chronic disease, including allergy. It is associated with looking for their own identity and autonomy, as well as ways to cope with difficulties and stress. Aim. Identification of some anti-healthy behaviors of ju-nior high school students diagnosed with allergic disease. Material and methods. The study included a group of 100 junior high school students with diagnosed allergic disease in one of the public schools in Lublin, in 2008. The control group (100 persons) were adolescents from the same school, but without allergies. The research tool was authors’ questionnaire. For the comparison of both groups the statistical program SPSS 14.0 PL was used with the numbers, percentage calculations, and chi squared test of conformity and chi squared test of independence. Results. The attempts of smoking are confirmed by 38.3% of young people with allergy, and up to 61.3% of boys and 58.2% of girls in the control group. Pressure from peers when trying smoking was an important motivating factor to take these risky health behaviors in all patients with allergy, whereas in healthy young people it concerned 68.1% of boys and 78.0% girls. Similarly, alcohol consumption significantly more often was reported in the control group (87.2% in boys) than in adolescents with allergy (38.1% in girls). Conclusions. The pressure of peers has a significant impact on the occurrence of anti-health behavior in adolescents with allergic disease. Attempts to health risk behaviors in adolescents with allergies were more frequent in girls than in boys. Anti-health behavior strongly dominated in the control group, but its presence in adolescents with allergic disease may be a greater health risk than in the group of healthy adolescents.

Mediation of Late Adolescent Health‐Risk Behaviors and Gender Influences

This study explored how multiple bioecological constructs operate to explain health-risk behaviors in late adolescence and to test for moderator effects of gender. This was a descriptive, cross-sectional study with a convenience sample of 437 predominately Caucasian late adolescents with an average age of 19 years who lived in Northern California. Parental Attachment, Shyness, Loneliness, Law Abidance, and Youth Risk Behaviors were measured with self-report tools and analyzed using structural equation modeling. Confirmatory factor analysis indicated that the data fit the model well. Analysis of group differences revealed that gender moderated the relationships among the measured variables; thus, data were analyzed in independent gender-based models. Structural modeling demonstrated good model fit for each gender. Shyness and parental attachment each were associated with loneliness. Loneliness was associated with smoking. Loneliness linked the relationship between shyness, parental attachment, and smoking. Parental attachment was associated with law abidance. Law abidance was associated with sexual behaviors for female adolescents only. This study provides valuable insights for public health nurses as it pertains to late adolescent health-risk behaviors. Nurses should use screening tools and techniques to ensure appropriate referrals and interventions to meet the needs of at-risk adolescents.

Explaining educational differences in adolescent substance use and early sexual debut: The role of parents and peers

Previous studies from a wide variety of European countries have demonstrated that low educated adolescents engage more frequently in health risk behaviors compared to high educated adolescents. The present study investigates the mediating roles of parental knowledge and time spent with peers in this relationship. Data were retrieved from a nationally representative sample of 12- to 16-year old Dutch adolescents (N=5422). Risk behaviors were measured by adolescents’ report of daily smoking, binge drinking and cannabis use in the previous month, and sexual debut before age 17. Low educated adolescents indicated that their parents had less knowledge on their whereabouts and reported spending more time with peers than high educated adolescents. Both factors mediated the relationship with health risk behaviors. These results hint to parenting practices and adolescent peer relations as points of reference for prevention and intervention work aiming to reduce educational inequalities in adolescent health risk behaviors.

The Relationship Between Sexual Behavior and Nonsexual Risk Behaviors Among Unmarried Youth in Three Asian Cities

Health risk behaviors in adolescents and youth, such as smoking, alcohol, drug use, violence, suicide, and unprotected sexual behavior, are issues of major public health concern. Addressing the relationship between sexual behavior and nonsexual risk behaviors will make a significant contribution to the design of effective intervention programs for this population of adolescents and unmarried youth. This cross-sectional study was conducted in three Asian cities with a common heritage of Confucian values: Hanoi, Shanghai, and Taipei. Data were collected in 2006 from 17,016 youth aged 15-24 years residing in both urban and rural districts of the three settings. The relationships between sexual behavior and seven nonsexual risk behaviors among unmarried adolescents were examined using χ(2) tests, logistic regression models, Cox regression models, and cluster analysis. Sexual behavior was associated with seven nonsexual risk behaviors, especially with smoking, drinking, drug use, and running away from home. In terms of the age at initiation of risk behaviors, smoking and drinking were usually initiated before sexual intercourse. Sexual behavior and nonsexual risk behaviors co-occurred in the high-risk group in all three cities. Youth having the highest risk of sexual behavior were more likely to have the highest risk of nearly all nonsexual risk behaviors, with the exception of fighting in Hanoi and gambling in Shanghai and Taipei. Sexual behavior among unmarried youth is correlated with nonsexual risk behaviors but with different patterns across the three settings. Interventions aimed at reducing unprotected sex generally focus only on the sexual behavior; however, considering the correlations found here between sexual and nonsexual risk behaviors, they should target multiple risk behaviors.

Cultural Adaptation of the Strengthening Families Program 10–14 to Italian Families

The family context has proven to be a useful target in which to apply prevention efforts aimed at child and adolescent health risk behaviors. There are currently a variety of cultural adaptation models that serve to guide the international adaptation of intervention programs. The cultural adaptation process and program reception of the Strengthening Families Program 10–14 (SFP 10–14) was described in this article. The implementation context is one in which strong family bonds and high family communication are the norm. We described our cultural adaptation process comparing our efforts to the recommended stages of the main current cultural adaptation models. We pilot tested and implemented the adapted version of our program with a total of 35 families in the city of Turin Italy. This study showed that the SFP 10–14 may indeed be quite suitable for Italian families given the particularities of Italian society regarding strong family bonds and extended social networks. We described the language translation, cultural adaptation process for program materials, staff training, onsite supervision, and the process evaluation feedback that were undertaken as part of the adaptation efforts. The field of prevention could greatly benefit from the identification of tools and techniques that are applicable to populations with diverse social and cultural backgrounds. The family is extremely important for Italians and represents a rich context in which prevention efforts could be addressed.

Social‐Psychological Theories and Adolescent Health Risk Behavior

AbstractThis paper reviews several psychosocial theories that have been applied to the study of adolescent health behavior. Some of these theories have existed for several decades and, though not originally intended for this purpose, have proven quite useful in predicting and explaining many different types of health‐relevant behaviors. During the last 10–15 years, however, there has been a significant increase in the application of social psychological theories to the examination of what is increasingly being seen as a social‐psychological phenomenon: health risk behavior among adolescents. This interest has been prompted, in part, by an appreciation of the value of dual‐processing principles in explaining these behaviors, and, in particular, a recognition that much adolescent health risk behavior: a) is not always planful or premeditated, and b) involves both heuristic and analytic processing. The paper includes discussion of how dual‐processing principles and social‐psychological theories can inform intervention efforts.

What is the role of adolescent body mass index and physical activity on adult health risk behaviors?

Introduction: A high prevalence of modifiable risk factors exists among adolescents that may lead to increased levels of morbidity and mortality in adulthood. This study sought to determine whether higher levels of physical activity (PA) and/or having a healthy body weight in adolescence influences future health risk behaviors (HRB) in young adulthood. Methods: Complete data were gathered for 536 participants from a prospective study and a follow-up survey conducted 10 years apart. At both time points, the questionnaires included information about HRB, PA, and health status. Results: Males who engaged in HRB during adolescence were more likely to continue these same risk behaviors during adulthood. Using multivariate models, only HRB in adolescence predicted HRB in adulthood for drinking, binge drinking and smoking among males, and for binge drinking and smoking among females. Conclusions: It appears that for males, once a health-risk behavior is initiated, it will likely continue into young adulthood, regardless of the presence of other healthy behaviors such as the proper maintenance of body weight and higher levels of PA. Similarly for females, binge drinking and smoking in adolescence is predictive of the same behavior in adulthood.

Associations of Muscular Fitness With Psychological Positive Health, Health Complaints, and Health Risk Behaviors in Spanish Children and Adolescents

We examined the association of muscular fitness with psychological positive health, health complaints, and health risk behaviors in 690 (n = 322 girls) Spanish children and adolescents (6-17.9 years old). Lower body muscular strength was assessed with the standing long jump test, and upper-body muscular strength was assessed with the throw basketball test. A muscular fitness index was computed by means of standardized measures of both tests. Psychosocial positive health, health complaints, and health risk behaviors were self-reported using the items of the Health Behavior in School-aged Children questionnaire. Psychological positive health indicators included the following: perceived health status, life satisfaction, quality of family relationships, quality of peer relationships, and academic performance. We computed a health complaints index from 8 registered symptoms: headache, stomach ache, backache, feeling low, irritability or bad temper, feeling nervous, difficulties getting to sleep, and feeling dizzy. The health risk behavior indicators studied included tobacco use, alcohol use, and getting drunk. Children and adolescents with low muscular fitness (below the mean) had a higher odds ratio (OR) of reporting fair (vs. excellent) perceived health status, low life satisfaction (vs. very happy), low quality of family relationships (vs. very good), and low academic performance (vs. very good). Likewise, children and adolescents having low muscular fitness had a significantly higher OR of reporting smoking tobacco sometimes (vs. never), drinking alcohol sometimes (vs. never), and getting drunk sometimes (vs. never). The results of this study suggest a link between muscular fitness and psychological positive health and health risk behavior indicators in children and adolescents.

Establishing Priorities for Student-Athletes: Balancing Academics and Sports

The overachievement of African American male student-athletes in becoming 65% of the National Football League (NFL) and 78% of the National Basketball Association (NBA) does not offset the underachievement in graduation rates from college and admission to professional schools to earn doctorate degrees. Whereas the NFL and NBA selected 224 and 60 student-athletes respectively in the 2011 drafts, U.S. medical schools admitted 19,230 students in 2011 and African American males comprised only 2.3% (445) of the total. In addition, the NFL and NBA employed 1,696 and 450 professional athletes, respectively; however, the Bureau of Labor Statistics projects an increase in the number of U.S. physicians from 661,400 in 2008 to 805,000 in 2018. Imbalances between athletic skill building and academic skill building demonstrated by some African American male student-athletes should be considered an adolescent health risk behavior requiring intervention to affect changes in attitudes, knowledge, and skills.

An Introduction to Item Response Theory for Health Behavior Researchers

To introduce item response theory (IRT) to health behavior researchers by contrasting it with classical test theory and providing an example of IRT in health behavior. Demonstrate IRT by fitting the 2PL model to substance-use survey data from the Adolescent Health Risk Behavior questionnaire (n=1343 adolescents). An IRT 2PL model can produce viable substance use scores that differentiate different levels of substance use, resulting in improved precision and specificity at the respondent level. IRT is a viable option for health researchers who want to produce high-quality scores for unidimensional constructs. The results from our example-although not flawless-demonstrate the feasibility of IRT in health behavior research.

Perceived Weight Status Effect on Adolescent Health-Risk Behaviors: Findings from 2007 and 2009 Rhode Island Youth Risk Behavioral Survey

The goal of this study is to systematically examine the associations between perceived weight status and selected health-risk behaviors among Rhode Island adolescents. We utilized the biennial 2007 and 2009 Rhode Island representative Youth Risk Behavior Survey data. The combined statewide sample contained 5,423 randomly selected public high school students. Perceived weight status was classified into very underweight, slightly underweight, about the right weight, slightly overweight, and very overweight according to the question “How do you describe your weight?” Adolescent’s body mass index (BMI) was calculated from self-reported height and weight. BMI percentile was categorized as extremely underweight, underweight, normal, overweight, and obese. Multivariable logistic regression models were used to analyze perceived weight status associated with six categories of priority health-risk factors. Perceived very underweight and very overweight were statistically significantly associated with 17 out of 22 health-risk behaviors. The relationships can be expressed as a “U”-shaped curve in terms of odds ratios in adolescents. There were no such similar consistent patterns between BMI percentile categories and health-risk behaviors. Perceived weight status, rather than BMI percentile categories, has an important influence on health-risk behaviors. Our results may assist health programs to intervene with high-risk students by changing their cognitive behaviors.

Associação entre comportamentos de risco à saúde de pais e adolescentes em escolares de zona rural de um município do Sul do Brasil

This article aimed to assess the association between health risk behaviors in parents and adolescents in a rural area. The sample included 377 schoolchildren 10 to 18 years of age and 338 parents. The following variables were analyzed: level of leisure-time and commuting physical activity, inadequate eating habits, overweight/obesity, smoking, and alcohol consumption. Prevalence rates for smoking and alcohol consumption by adolescents in the previous 30 days were 6.7% and 27%, respectively. Forty-five percent of adolescents failed to reach the target physical activity score. Adherence to steps to healthy eating was low. Physical activity in adolescents was positively associated with that of parents, and adolescent drinking was associated with maternal alcohol consumption. There was no significant association for other behaviors. In the analysis stratified by gender, level of physical exercise in female adolescents was associated with that of fathers. Parental health risk behaviors were associated with the behaviors in the adolescent children in this rural area.

Changes in the socio-demographic patterning of late adolescent health risk behaviours during the 1990s: analysis of two West of Scotland cohort studies

BackgroundSubstance use and sexual risk behaviour affect young people's current and future health and wellbeing in many high-income countries. Our understanding of time-trends in adolescent health-risk behaviour is largely based on routinely collected survey data in school-aged adolescents (aged 15 years or less). Less is known about changes in these behaviours among older adolescents.MethodsWe compared two cohorts from the same geographical area (West of Scotland), surveyed in 1990 and 2003, to: describe time-trends in measures of smoking, drinking, illicit drug use, early sexual initiation, number of opposite sex sexual partners and experience of pregnancy at age 18-19 years, both overall and stratified by gender and socioeconomic status (SES); and examine the effect of time-trends on the patterning of behaviours by gender and SES. Our analyses adjust for slight between-cohort age differences since age was positively associated with illicit drug use and pregnancy.ResultsRates of drinking, illicit drug use, early sexual initiation and experience of greater numbers of sexual partners all increased significantly between 1990 and 2003, especially among females, leading to attenuation and, for early sexual initiation, elimination, of gender differences. Most rates increased to a similar extent regardless of SES. However, rates of current smoking decreased only among those from higher SES groups. In addition, increases in 'cannabis-only' were greater among higher SES groups while use of illicit drugs other than cannabis increased more in lower SES groups.ConclusionMarked increases in female substance use and sexual risk behaviours have implications for the long-term health and wellbeing of young women. More effective preventive measures are needed to reduce risk behaviour uptake throughout adolescence and into early adulthood. Public health strategies should reflect both the widespread prevalence of risk behaviour in young people as well as the particular vulnerability to certain risk behaviours among those from lower SES groups.

High Peer Popularity Longitudinally Predicts Adolescent Health Risk Behavior, or Does It?: An Examination of Linear and Quadratic Associations

In contrast to prior work, recent theory suggests that high, not low, levels of adolescent peer popularity may be associated with health risk behavior. This study examined (a) whether popularity may be uniquely associated with cigarette use, marijuana use, and sexual risk behavior, beyond the predictive effects of aggression; (b) whether the longitudinal association between popularity and health risk behavior may be curvilinear; and (c) gender moderation. A total of 336 adolescents, initially in 10-11th grades, reported cigarette use, marijuana use, and number of sexual intercourse partners at two time points 18 months apart. Sociometric peer nominations were used to examine popularity and aggression. Longitudinal quadratic effects and gender moderation suggest that both high and low levels of popularity predict some, but not all, health risk behaviors. New theoretical models can be useful for understanding the complex manner in which health risk behaviors may be reinforced within the peer context.

Adolescent Health-Risk Sexual Behaviors: Effects of a Drug Abuse Intervention

Adolescents who abuse substances are more likely to engage in health-risking sexual behavior (HRSB) and are at particularly high risk for HIV/AIDS. Thus, substance abuse treatment presents a prime opportunity to target HIV-risk behaviors. The present study evaluated a one-session HIV-risk intervention embedded in a controlled clinical trial for drug-abusing adolescents. The trial was conducted in New Mexico and Oregon with Hispanic and Anglo adolescents. Youths were randomly assigned to individual cognitive behavior therapy (CBT) or to an integrated behavioral and family therapy (IBFT) condition, involving individual and family sessions. The HIV-specific intervention was not associated with change. IBFT and CBT were both efficacious in reducing HIV-risk behaviors from intake to the 18-month follow-up for high-risk adolescents. For low-risk adolescents, CBT (versus IBFT) was more efficacious in suppressing HRSB. These data suggest that drug abuse treatments can have both preventative and intervention effects for adolescents, depending on their relative HIV-risk.

Early adolescent health risk behaviors, conflict resolution strategies, and school climate

Drawing upon an ethnically and socio-economically diverse sample of 323 7th grade students from twelve urban schools within one school district, this mixed method study examined early adolescents' self-reported health risk behaviors as related to their conflict resolution strategies and their school's conflict resolution climate. Survey data suggested that early adolescents who reported using more cooperative and fewer aggressive conflict resolution strategies also reported to engage in fewer personal health risk behaviors. Reported engagement in fewer behavioral risks also was associated with attending schools with more supportive “conflict resolution climates.” Serial small group interviews in selected schools indicated that conflict resolution climate quality was associated with how well teachers were perceived to respond to students' conflicts and how they managed teacher–student conflicts. In addition, many students in less supportive climates exhibited cynical attitudes regarding the viability of the conflict resolution strategies promoted by schools and prevention programs.