Risky Health Behaviors Research Articles

Social inequality in incidence and mortality of malignant neoplasms of lip, oral cavity and pharynx: Is Costa Rica an international paradox?

Low socioeconomic position (SEP) has been associated with higher incidences and mortality of lip, oral cavity and pharynx (LOP) cancers in the vast majority of countries with available data. The origins of health inequalities in cancer are socioeconomic, although they vary by time and country. Evidence from Low-and Middle-income Countries (LMICs) remains scarce. This study aims to identify and describe socioeconomic inequalities in LOP cancers incidence and mortality in Costa Rica. The hypothesis tested is that people leaving in low-SEP districts in Costa Rica have greater incidence and mortality rates of lip, oral cavity and pharynx cancers. The 10th revision of the InternationalClassification of Diseases (ICD-10) was used to define cancer sites. Data come from a national population-based Cancer Registry with 100% completeness to study incidence. Incidence rate included all new cases of LOP cancer diagnosed from January 1, 2011, and December 31, 2015, for a total of 2798517 individuals, 13832524years of follow-up and 601 LOP cases. Mortality rate was extracted from the National Death Index, including 2739733 individuals, 23950240 person-years of follow-up and 586 LOP cancer deaths, from January 1, 2010, to December 31, 2018. The 2011 Census (with 94% of Costa Rican inhabitants) was used to characterize the urbanicity and wealth of 477 districts. Survival models were performed for both incidence and mortality, allowing to consider existing competitive risks. Cox models were used for incidence, and parametric survival models based on a Gompertz distribution for mortality. The study found that people who lived in the most socioeconomically disadvantaged areas had lower probabilities of developing LOP cancers than people in the richest districts. The same pattern for mortality, however, was not significant. The hypothesis that incidence and mortality of LOP cancers will show a positive social gradient was not confirmed in this study, contradicting the existing literature. This could be explained by the social distribution of risky health behaviours, more frequent in socially advantaged populations.

Health risk behavior of Brazilian university men

The insertion of men in the university environment is a complex and worrying phenomenon permeated by vulnerabilities, which are associated with the adoption of risky behaviors for health. The objective of this study was to evaluate the health behavior of Brazilian university men. A cross-sectional study with 663 men students. The study used a questionnaire on health-related life habits. All the questions were extracted from the Surveillance of Risk and Protection Factors for Chronic Diseases through Telephone Interviews. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals and chi-square tests. The analysis of the joint relationships between nutritional status, physical activity and diet was conducted by the multiple correspondence analysis. Of the 663 students, 67.8% were between 20-29 years of age, 69.2% consumed alcohol, 34.5% did not do physical activity, and 34.2% were overweight. The students who did not engage in physical activity smoked more (p=0.05), consumed less fruit (p<0.01), less salad (p<0.01), and consumed full fat milk (p=0.05). In the physically inactive students, a high prevalence of acquiring diabetes mellitus (p<0.01) and high cholesterol (p<0.01) was observed. University students were found to have unhealthy lifestyles. More public policies aimed at promoting preventive measures at universities are needed to encourage healthier health behaviors

The relationship between internet addiction and risky health behaviors in university students: A cross‐sectional study in Turkey

The study was carried out to determine the relationship between internet addiction and risky health behaviors in university students. The study, which is cross-sectional research, was conducted with 606 university students in the 2019-2020 academic year and used face-to-face interviews. It was determined that 7.15% of the students had internet addiction with limited symptoms. A positive and significant relationship was found between internet addiction and risky health behaviors (p < 0.05). To reduce internet addiction and risky health behaviors, counseling, planning peer education programs, and creating an environment where students can express themselves should be provided. It is also recommended that students develop relationships with their social environment and participate in social activities.

Developing a children\u2019s health risk behaviour prevention program targeting grade 4\u20137 learners in the western cape, South Africa: a study protocol

BackgroundHealth risk behaviour among South African youth is a significant public health concern. Despite a societal mind shift to educating the public on the prevention of health risk behaviour, behavioural change is not progressing at the rate needed to influence health risk behaviour positively. The project aims to explore behavioural trends and willingness to engage in risky behaviour among senior primary school children. Secondly, to design a health risk behaviour prevention program which adequately equips senior primary school children with the necessary life skills to alter risk behaviour engagement.MethodsThe study will make use of an intervention mapping framework and a sequential, explanatory mixed methods design. Stratified random probability sampling will be used to select three primary schools in the region. Nonprobability purposive sampling will be used to select the stakeholders participating in the focus group sessions. Data collection consists of five phases with the results of each stage informing the structure and application of the next. Phase 1 - baseline data collection (needs analysis) using the child health risk behaviour survey. Phase 2 - focus group interviews. Phase 3 - a systematic review of the literature for result analysis triangulation. Phase 4 – the development of the child risk behaviour prevention program based on the outcomes of phases 1,2 and 3. Phase 5 - implementation of the program. Descriptive statistics will be used to analyse the quantitative data. Chi-square, ANOVA and multiple regression analyses will be used to predict health risk behaviour engagement. Thematic analysis will be used to analyse qualitative data.DiscussionTo our knowledge, this is the first study that would attempt to establish a health risk behaviour prevention program in youth and young people in South Africa. Overwhelming evidence exists that adolescents engage in risky health behaviour which may potentially negatively impact their lives. This study provides an opportunity to address a gap in the current strategy by developing a prevention program for young people which could later be supported by further booster programs through their adolescents. This project would serve as a baseline prevention program that could assist in the reduction of risky health behaviour among various communities.

Healthy Behaviors Associated with Changes in Mental and Physical Strength in Urban African American and White Adults.

Over time, adherence to healthy behaviors may improve physical and mental strength which is essential for successful aging. A plausible mechanism is the reduction of inflammation. Research on the association of risky health behaviors on change in strength with age is limited. This study examined changes in the inflammatory potential of the diet, smoking, illicit drug use with changes in strength in a racially and socioeconomically diverse adult sample from the Healthy Aging in Neighborhoods of Diversity Across the Life Span study. The dietary inflammatory index (DII) was calculated from 35 food components derived from multiple 24-h dietary recalls. Strength was evaluated by handgrip strength (HGS), SF-12 PCS and SF-12 MCS (physical and mental component scores). Repeated measures analyses were used to examine associations. At baseline, mean age was 48.4 ± 0.25 years, 56% of the sample were women, and 58% African American. Significant 4-way interactions were found between age, race, socioeconomic status, and DII for women, on change in HGS (p < 0.05) and in SF-12 PCS (p < 0.05) and for men, in change in SF-12 PCS (p < 0.05). Improvements in SF-12 MCS were associated with all three health behaviors as main effects. This study provided evidence that changes towards improving healthy behaviors, diet with anti-inflammatory potential, not smoking cigarettes and not using illicit drugs, were associated with improved strength. Health professionals, especially registered dietitians and health coaches, should create lifestyle interventions to reduce inflammation targeting change in more than one risky health behavior.

The association of sexual orientation with cancer screening and diagnosis.

6506 Background: Data on heterogeneity in cancer screening and diagnosis rates among sexual minorities (SMs) is lacking. Recent studies have shown SMs are more likely to engage in risky health behavior and have decreased healthcare utilization compared to heterosexual counterparts. However, few studies have examined how sexual orientation (SO) impacts cancer screening and prevalence. We therefore investigated whether SO affects prevalent gender-specific cancer screening and prevalence, including prostate (PCa), breast (BC), and cervical cancer (CC). Methods: This was a cross-sectional survey-based US study, including men and women aged 18+ from the Health Information National Trends Survey (HINTS) database (part of the National Cancer Institute’s division of cancer control and population sciences) between 2017-2019. The primary endpoint was individual-reported PCa, BC, and CC screening and prevalence rates among heterosexual and SM men and women. Multivariable logistic regression analyses assessed association of various covariates with undergoing screening and diagnosis of these cancers. Results: Overall, 4,441 (95.18%) men and 6,333 (96.75%) women reported a SO of heterosexual whereas 167 (3.6%) and 58 (1.2%) men and 105 (1.6%) and 108 (1.6%) women reported a SO of gay and bisexual, respectively. Mean age was higher in the heterosexual group compared to the gay and bisexual groups in both men (57.7 [±16.0] vs. 52.4 [±14.5] and 51.9 [±18.0] years, p = &lt; 0.001) and women (56.2 [±16.7] vs. 49.0 [±17.1] and 40.0 [±14.8] years, p = &lt; 0.001). Homosexuals and bisexuals were less likely to be screened for PCa (30.53% and 27.58% vs 41.27%, p = &lt; 0.001), BC (63.81% and 45.37% vs 80.74%, p = &lt; 0.001), and CC (90.48% and 86.11% vs 95.36%, p = &lt; 0.001) than their heterosexual counterparts. While rates of PCa and BC diagnoses were similar across SO, more homosexual and bisexual women were diagnosed with CC compared to their heterosexual counterparts (4.76% and 3.70% vs 1.85%, p = 0.039). Multivariable logistic regression models showed that SMs were less likely to be screened for cancer with ORs of 0.61 (95% CI 0.39-0.95, p = 0.030) for PCa, 0.52 (95% CI 0.30-0.92, p = 0.025) for BC, and 0.21 (95% CI 0.09-0.46, p = &lt; 0.001) for CC. Although multivariable models did not show that SMs were more likely to be diagnosed with PC, BC, or CC, SMs were more likely to be diagnosed with any cancer with ORs of 1.64 (95% CI 1.06-2.54, p = 0.026) in women only and 1.50 (95% CI 1.11-2.03, p = 0.009) in men and women combined. Conclusions: These data suggest that in addition to other established and known specific socio-economic risk factors, SMs may be less likely to undergo screening of prevalent malignancies such as PCa, BC, and CC. This provides more evidence of ongoing healthcare inequality, urging our healthcare system to invest more in cancer screening of this vulnerable population.

Waterpipe smoking among university students: Prevalence and association with mental health, risky health behaviors and psychosocial factors

Waterpipe smoking among university students: Prevalence and association with mental health, risky health behaviors and psychosocial factors

Gender stigma awareness is associated with adolescent risky health behaviors.

ObjectivesAlthough racial stigma in school is associated with adolescent risky health behaviors, there are no studies investigating how gender stigma relates to adolescent risky health behaviors among low-income, minority youth. We sought to determine whether gender stigma awareness is associated with adolescent risky health behaviors (delinquency, fighting, and substance use) and whether this association is mediated by school disengagement (low perceived teacher support, low school engagement, cutting classes, and breaking school rules) among low-income, minority students.MethodsWe analyzed cross-sectional survey data, collected from 2017 to 2019, from 412 high school students. Multi-level logistic regressions tested whether gender stigma awareness was associated with delinquency, fighting, and substance use, controlling for covariates, baseline behaviors, and clustering within schools. Mediation analyses tested whether school disengagement (low school engagement, perceived teacher support, cutting class, and breaking school rules) mediated these associations. Secondary analyses explored whether associations differed for male versus female, high-performing versus low-performing, and Latinx versus non-Latinx students.ResultsIn this predominantly Latinx (83%) sample, gender stigma awareness was associated with delinquency (AOR = 1.48, P< 0.001) and fighting (AOR = 1.15, P< 0.001). School engagement, perceived teacher support, breaking school rules, and cutting classes mediated 42.7% of the association between gender stigma awareness and delinquency and 65.42% of the association between gender stigma awareness and fighting. Gender stigma awareness was also associated with substance use for low-performing (AOR = 1.68, P = 0.003) and non-Latinx adolescents (AOR = 3.80, P = 0.03). School disengagement did not mediate the association between gender stigma awareness and substance use for non-Latinx students but mediated 50% of this association for low-performing students.ConclusionsGender stigma awareness is associated with adolescent risky health behaviors. A decreased sense of acceptance in the school community and increased school misbehavior may mediate these associations. School environments that value and accept all students may better support adolescent health.

Black-White racial health disparities in inflammation and physical health: Cumulative stress, social isolation, and health behaviors

Black Americans have vastly increased odds and earlier onsets of stress- and age-related disease compared to White Americans. However, what contributes to these racial health disparities remains poorly understood. Using a sample of 1577 older adults (32.7% Black; ages 55–65 at baseline), we examined whether stress, health behaviors, social isolation, and inflammation are associated with racial disparities in self-reported physical health. A latent cumulative stress factor and unique stress-domain specific factors were modeled by applying bifactor confirmatory analysis to assessments across the lifespan (i.e., childhood maltreatment, trauma exposure, discrimination, stressful life events, and indices of socioeconomic status). Physical health, health behavior, and social isolation were assessed using self-report. Interleukin-6 (IL-6) and C-reactive protein (CRP) were assayed from morning fasting serum samples; a z-scored inflammation index was formed across these 2 cytokines. A parallel serial mediational model tested whether race (i.e., Black/White) is indirectly associated with health through the following 3 independent pathways: (1) cumulative stress to preventative health behaviors (e.g., healthy eating) to inflammation, (2) cumulative stress to risky health behaviors (e.g., substance use) to inflammation; and (3) cumulative stress to social isolation to inflammation. There were significant indirect effects between race and self-reported physical health through cumulative stress, preventative health behaviors, and inflammation (B = −0.02, 95% CI: −0.05, −0.01). Specifically, Black Americans were exposed to greater cumulative stress, which was associated with reduced engagement in preventative health behaviors, which was, in turn, associated with greater inflammation and reduced physical health. A unique SES factor also indirectly linked race to physical health through preventative health behaviors. Cumulative stress exposure and unique aspects of socioeconomic status are indirectly associated with Black-White racial health disparities through behavioral (i.e., preventative health behavior) and biological (i.e., inflammation) factors. Culturally responsive evidence-based interventions that enhance engagement in preventative health behaviors are needed to directly confront health disparities. Ultimately, large scale anti-racist public policies that reduce cumulative stress burden (e.g., a living wage, universal healthcare) may best attenuate racial health disparities.

The Affordable Care Act's young adult mandate was associated with a reduction in pain prevalence.

Pain is a major health problem among U.S. young adults. The passage of the Affordable Care Act's young adult mandate in 2010 allowed individuals to remain on their parents' health insurance until age 26. Although studies have documented the positive effects of this mandate on various health outcomes, less is known about its association with self-reported pain among young adults. Using the 2002 to 2018 National Health Interview Survey (N = 48,053) and a difference-in-differences approach, we compared the probabilities of reporting pain at 5 sites (low back, joint, neck, headache/migraine, and facial/jaw) and the number of pain sites between mandate eligible (ages 20-25) and ineligible (ages 26-30) adults before and after the mandate. In fully adjusted models, the mandate was associated with a decline of 2 percentage points in the probability of reporting pain at any site (marginal effect, -0.02; 95% confidence interval [CI], -0.05 to -0.002; weighted sample proportion, 0.37) and in the number of pain sites (coefficient, -0.07; 95% CI, -0.11 to -0.01; weighted sample average, 0.62). These results were primarily driven by the association between the mandate and the probability of reporting low back pain (marginal effect, -0.03; 95% CI, -0.05 to -0.01; weighted sample proportion, 0.20). Additional analyses revealed that the mandate was associated with improvements in access to care and reductions in risk factors for pain-including chronic conditions and risky health behaviors. To the extent that the results are generalizable to other health insurance programs, removing financial barriers to medical care may help reduce pain prevalence.

Associations Among Health Behaviors and Psychosocial Outcomes in Adolescent and Young Adult Cancer Survivors.

Purpose: Adolescents and young adults (AYA) experience challenges both during and after their cancer treatment. Health behaviors are important contributors to health, yet little research examines health behaviors in AYA cancer survivors. We examined frequencies of health behaviors and associations between health behaviors, psychosocial, and clinical factors in AYA cancer survivors. Methods: Participants were survivors of AYA cancer (n = 60; 38.3% male; mean age = 25.3 years [standard deviation, SD = 4.6]; mean years since therapy completion = 9.0 [SD = 4.2]) from the Alberta Children's Hospital (ACH). Survivors were 13-21 years old at the time of diagnosis. Measures included demographic and clinical data, and the ACH Long-Term Survivor's Questionnaire. Health behaviors were compared with a control group (n = 600) using data from the 2017 Canadian Community Health Survey. Frequencies, conditional logistic regression, and logistic regression analyses were conducted. Results: Compared with controls, survivors reported engaging in physical activity (91.5% vs. 87.5%; odds ratio [OR] = 0.87, 95% confidence interval [CI] = 0.34-2.24; p = 0.77), smoking tobacco (15.3% vs. 19.7%; OR = 1.85, 95% CI = 0.89-3.85; p = 0.10), and street drug use (27.6% vs. 36.5%; OR = 1.60, 95% CI = 0.88-2.91; p = 0.12) at the same rate. Survivors reported binge drinking significantly less (61.0% vs. 76.6%; OR = 0.53, 95% CI = 0.30-0.92; p = 0.024) than controls. Logistic regression analyses revealed a significant model predicting binge drinking [χ2(5, 58) = 23.17, p < 0.001] with greater time off treatment, fear of another health condition, and higher mean body mass index emerging as significant predictors. Conclusion: AYA cancer survivors engage in risky health behaviors at rates similar to their peers. Further research is needed to understand factors mediating survivors' decision to participate in risky health behaviors.

Medicaid expansion and the mental health of college students.

Reported mental health problems have risen dramatically among US college students over time, as has treatment for these problems. We examine the effect of state-level Medicaid expansion following the 2014 implementation of the Affordable Care Act on the diagnosis of mental health conditions, psychotropic prescription drug use, and the mental health status of a national sample of college students. We find that students from disadvantaged backgrounds are more likely to report being on public insurance after 2014 in expansion states relative to non-expansion states, while more advantaged students do not see this increase. Both diagnosis of common mental health conditions and psychotropic drug use increase following expansion for disadvantaged students relative to advantaged ones, which translates into an elimination of the pre-expansion gap in these outcomes by family background in expansion states. However, in contrast to some recent work on Medicaid expansion and mental health, we do not find that these changes are associated with improvements in self-reported mental health status. We also do not find that Medicaid expansion has affected risky health behaviors or academic outcomes.

Do Financial Literacy and Financial Education Influence Smoking Behavior in the United States?

Smoking is still a serious economic, health, and social problem despite various efforts to curb its prevalence. We examined the influence of financial literacy and financial education on the smoking behavior in the United States in terms of the use of rational decision-making abilities to reduce irrational behavior. We hypothesized that financial literacy and financial education, as proxies for rational decision making, would reduce the likelihood of smoking. We used data from the Preference Parameters Study (PPS) of Osaka University conducted in the United States in 2010 and applied probit regression models to test our hypothesis on a sample of 3831 individuals. We found that financially literate people are less likely to be smokers, though we found no clear role of financial education in reducing the likelihood of smoking. Further, respondents’ gender, age, unemployment status, and risky health behaviors such as drinking and gambling, have a significantly positive association with smoking, while marital status, university degree, family size, household income, household assets, physical exercise, and level of happiness have a significantly negative association. Our findings suggest that financial literacy, as an instrument encouraging rational decision making, could be a tool to help reduce smoking in the United States.

The association between sexual orientation and screening of prevalent gender-specific cancers.

198 Background: Data on heterogeneity in cancer screening and diagnosis rates among sexual minorities (SMs) is lacking. Recent studies have shown SMs are more likely to engage in risky health behavior and have decreased healthcare utilization. However, few studies have examined how sexual orientation impacts cancer screening and prevalence. We therefore investigated whether sexual orientation affects prevalent gender-specific cancer including prostate (PCa), breast (BC), and cervical cancer (CC). Methods: This was a cross-sectional survey-based US study, including men and women aged 18+ from the Health Information National Trends Survey (HINTS) database (part of the National Cancer Institute’s division of cancer control and population sciences) between 2017-2019. The primary endpoint was individual-reported PCa, BC, and CC screening and prevalence rates among heterosexuals and homosexuals/bisexuals. Multivariable logistic regression analyses assessed association of various covariates with undergoing screening and diagnosis of these cancers. Results: Overall, 4,441 and 6,333 heterosexual men and women, respectively, were compared to 225 and 213 homosexual/bisexual men and women, respectively. Homosexuals/bisexuals were younger and less likely to be screened for PCa (34.7% vs 41.3%, p=0.013), BC (54.5% vs 80.7%, p=&lt;0.001), and CC (88.3% vs 95.4%, p=&lt;0.001). While rates of PCa and BC diagnosis were similar, more than twice as many homosexual/bisexual women were diagnosed with CC (4.2% vs 1.9%, p=0.023). Multivariable logistic regression models (Table) showed homosexuals/bisexuals were less likely to be screened for cancer with ORs of 0.61 (95% CI 0.39-0.95) for PCa, 0.52 (95% CI 0.30-0.92) for BC, and 0.21 (95% CI 0.09-0.46) for CC. Homosexuals/bisexuals were more likely to be diagnosed with any cancer with ORs of 1.64 (95% CI 1.06-2.54) in women only and 1.50 (95% CI 1.11-2.03) in men and women combined. Conclusions: Homosexuals/bisexuals in the US may be less likely to undergo screening of gender-specific prevalent malignancies, including PCa, BC, and CC. The implementation of cancer screening among SMs should be improved. [Table: see text]

Differences in health status, health behaviour and healthcare utilisation between Immigrant and native homeless people in Spain: An exploratory study

Few studies have examined the differences between immigrant and native-born homeless populations. Our aim was to conduct an exploratory study to examine the differences in health status, health behaviour and healthcare utilisation in a sample of Spanish immigrant and native homeless people. Study was conducted in eight different temporary accommodations in the Valencia region in August 2018. Overall, 86 participants were included in the analysis who answered questionnaires concerning socio-demographic characteristics, immigration status, health status and behaviour, healthcare utilisation and experienced discrimination in healthcare and health literacy. In total, 76.7% were men with a mean age of 41.91 (14.17) years, with 60.4% having immigration background with an average of 4.8 (4.2) years since arrival in Spain. No differences were found in the subjective health status, however, native homeless participants reported significantly higher prevalence of heart disease (87.5% vs. 12.5%), hypertension (84.6% vs. 15.4%), psychological illness (63.6% vs. 36.4%) and were also more often smokers (73.5% vs. 28.8%), reported smoking more cigarettes per day (12.0 vs. 7.4) and were more often illegal drug users (17.6% vs. 2.0%). Immigrant participants were significantly more often not insured, reported more problems in healthcare access and had lower rates of visits to general practitioners and less hospital admissions. Differences were also observed in social status with the native homeless more often reporting receiving income, and living in less crowded accommodations. Our results show a variety of issues that the immigrant homeless population in Spain is confronted with that also prevents adequate social inclusion and achieving good health. However, the immigrant population engaged less often in risky health behaviour. More, and continuous, monitoring of social, mental and physical health of the homeless population is necessary. Public health interventions aiming at health promotion in the immigrant homeless populations need to focus on increasing overall social integration.

Leisure time activities and biomarkers of chronic stress: The mediating roles of alcohol consumption and smoking.

Previous research found an association between leisure time activities such as arts and cultural activities and self-reported health over the life course-a measure prone to response bias. This study tested the relationship between arts and cultural activities and allostatic load, a biomarker of chronic stress, and examined risky health behaviors, including alcohol consumption and smoking, as possible mediators. The sample consists of 8948 adults from the second wave of the United Kingdom Household Longitudinal Study, which is representative of the British population. The cross-sectional association between arts and cultural activities and allostatic load was tested with negative binomial models, and the mediation roles of alcohol consumption and smoking in the association was tested with the Karlson-Holm-Breen (KHB) decomposition method. Frequent participation in arts, frequent attendance of cultural events, visits to museums or galleries, and visits to historical sites have negative associations with allostatic load. The associations are mediated by lower frequency of alcohol drinking and smoking. Cultural capital may promote health by reducing the frequency of health risk behaviors such as drinking alcohol and smoking. Future research and public health policies should consider whether cultural capital acts as a social determinant of health to promote healthy leisure activities over the life course.

The role of stress and absence: How household member incarceration is associated with risky sexual health behaviors.

Sexual health is a critical indicator of wellbeing with consequences for population health. However, little is known about whether and how household member incarceration affects the sexual health behaviors of young adults. This study seeks to assess the association between household member incarceration and sexual health behaviors and provides an initial test of mechanisms. Drawing upon data from the NLSY97, this study estimates the association between household member incarceration and sexual health behaviors using linear probability models, and then re-estimates these associations using two alternative comparison groups; 1) youth who experienced other forms of stress, and 2) youth who experienced other forms of family absence. Results indicate that household incarceration is positively associated with a higher risk of reporting sexual intercourse with an intravenous drug user net of individual and family characteristics and is negatively associated with condom use net of individual but not family characteristics. The results also show that the associations between household member incarceration and sexual health behaviors may be attributable, at least in part, to the well documented stress associated with incarceration. Yet, the results provide little evidence that absence is a pathway linking household member incarceration to risky sexual health behaviors. It is possible that household member incarceration is linked to deleterious outcomes for youth through different mechanisms than parental incarceration given the differing roles of parents versus other adults in the home. Future research should explore the pathways linking household member incarceration to health risks for youth and consider household member incarceration as a unique family stressor.

Relative age for grade and adolescent risky health behavior

This paper uses Danish register data to examine the effect of relative age for grade on women’s risky health behavior. I exploit an administrative rule that creates a discontinuous jump in relative age for grade for children born around January 1. Being young-for-grade leads to a higher probability of an abortion and alcohol poisoning in adolescence and earlier births, cohabitation and contraceptive use. The results show how relative age for grade is a determinant of adolescent women’s risky sex and heavy drinking. For men, being young-for-grade have no effect on alcohol poisonings, fatherhood and cohabitation.

Biased health perceptions and risky health behaviors—Theory and evidence

This paper investigates the role of biased health perceptions as a potential driving force of risky health behaviors. We define absolute and relative health perception biases, illustrate their measurement in surveys and provide evidence on their relevance. Next, we decompose the theoretical effect into its extensive and intensive margin: When the extensive margin dominates, people (wrongly) believe they are healthy enough to “afford” unhealthy behavior. Finally, using three population surveys, we provide robust empirical evidence that respondents who overestimate their health are less likely to exercise and sleep enough, but more likely to eat unhealthily and drink alcohol daily.

Mental Health and Abortions Among Young Women: Time-Varying Unobserved Heterogeneity, Health Behaviors, and Risky Decisions

In this paper, we provide causal evidence on abortions and risky health behaviors as determinants of mental health development among young women. Using administrative in- and outpatient records from Sweden, we apply a novel grouped fixed-effects estimator proposed by Bonhomme and Manresa (2015) to allow for time-varying unobserved heterogeneity. We show that the positive association obtained from standard estimators shrinks to zero once we control for grouped time-varying unobserved heterogeneity. We estimate the group-specific profiles of unobserved heterogeneity, which reflect differences in unobserved risk to be diagnosed with a mental health condition. We then analyze mental health development and risky health behaviors other than unwanted pregnancies across groups. Our results suggest that these are determined by the same type of unobserved heterogeneity, which we attribute to the same unobserved process of decision-making. We develop and estimate a theoretical model of risky choices and mental health, in which mental health disparity across groups is generated by different degrees of self-control problems. Our findings imply that mental health concerns cannot be used to justify restrictive abortion policies. Moreover, potential self-control problems should be targeted as early as possible to combat future mental health consequences.