When Intention Precedes Action: Does Adolescent SelfRated Risk Evaluation Predict Deleterious Decisi

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When Intention Precedes Action Does Adolescent
Self-Rated Risk Evaluation Predict Deleterious
Decision Making?

• By
• Lynn A. Agre, MPH
• Ph.D. Candidate, Rutgers University,
• School of Social Work
• American Public Health Association
• November, 2006

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Introduction

• The premise for this query into adolescent
  self-rated risk as a cofactor in determining the
  likelihood to engage health risk behaviors, such
  as substance use and earlier sexual behavior,
  arises out of the self-rated health literature, a
  five-point Likert scale demonstrated to be a
  strong predictor for mortality among adults
  (Idler and Benjamini, 1997).
• The self-rated risk scale used in the Young Adult
  portion of the National Longitudinal Survey on
  Youth in the 1998, 2000 and 2002 waves evaluates
  how discerning adolescents are in their
  planfullness and proclivity toward sensation
  seeking.

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Research Questions

• It is postulated that those adolescents who
  identify as more risk prone versus risk adverse
  are more likely to engage in alcohol and drug
  use, in addition to sexual behavior, particularly
  in early adolescence.
• Further, it is also hypothesized that youth who
  originate from households of mothers with higher
  educational attainment, as a proxy for social
  support, will be less likely to engage in health
  risk behaviors, such as substance use and early
  onset of sexual behavior (Rosenbaum and Kandel
  1990).

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Influence of Social Support on Prosocial Behavior

• Social support can be included under the general
  rubric of social environmental factors as an
  essential component in buffering certain patterns
  of behavior and how these affect adolescent
  health risk decision making.
• The process of social support is contingent upon
  the participation of another person in a
  reciprocal relationship where some benefit is
  exchanged between the person experiencing the
  illness episode or crisis and the other who is
  not.
• House (1981) defines four different types of
  social support emotional, appraisal,
  informational and instrumental.

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Influence of Maternal Education as Appraisal and
Informational Support

• Emotional support refers to emotional concern,
  love and empathy received from those in the
  domain.
• Appraisal support entails deriving information
  relevant to self-evaluation.
• Informational support pertains to seeking
  knowledge about the situation.
• Instrumental support involves help with daily
  activities.
• Maternal support in this context is measured as
  social support, since maternal education has been
  demonstrated to delay the initiation of health
  risk behaviors in adolescence (Mensch and Kandel,
  1992).

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Theoretical Framework

• The framework selected for assessing the multiple
  interacting environments is the Bronfenbrenner
  ecological approach (1979), comprised of the
  individual, family, and extra-familial level
  (Small and Luster, 1994) contained in the
  ecosystem (Ginther, Haveman, and Wolfe, 2000).
• In this study, the effect on health risk behavior
  is based upon an adolescents self-rated
  perception of risk in conjunction with the
  influence of multiple environments.
• Bronfenbrenners ecological paradigm considers
  role expectations of the individual in different
  environments in contrast to the internal-external
  locus of control model simply viewing impulse
  control as total reliance on inhibition of self
  (Rotter, 1966).

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Internal-External Locus of Control (Rotter, 1966)

• The internal-external locus of control model does
  not take into account how multiple environments
  and the influence of the behavioral exchange
  within those environments can temper the
  individuals capacity to engage in behavior
  detrimental to physical and mental well-being.
• Therefore, the Bronfenbrenner model views the
  individual as both the decision maker and the
  operator, neither placing the blame on the self,
  nor viewing another as blameworthy.
• Rather, the change in behavior is dependent upon
  the fluid process of one environment influencing
  another.
• Thus, various forms of social support in these
  different contexts of the ecosystem, i.e.micro-,
  meso- and exo-systemsact as buffers when
  disruptions occur in each of these domains.

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Model Presaged Intention Predicts Outcome

• The predictor variables included in the analysis
  are maternal age, maternal education, adolescent
  age, gender and race.
• The psychosocial indexes encompass (1) the
  seven-item short form of the CESD (Derogatis,
  1977) on which respondents indicate on a
  four-point scale how often they have experienced
  symptoms of depression during the past week (2)
  the self-mastery scale consisting of select
  measures originally developed by Rosenberg and
  Pearlin (1978) (3) self-esteem scale as a
  composite of ten variables about perception of
  control over life problems and capacity to solve
  these problems and (4) parenting scale assessing
  the adolescents perception of how well parents
  agree on household rules.
• The individual measures for each potential scale
  have been summed to create one single variable.

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Scale Construction

• The higher the score on each of the indexes the
  better the mastery, the self-esteem and the
  quality of parenting as perceived by the
  adolescent.
• In contrast, however, the higher the score on the
  short form of the CESD, the worse the depressive
  symptoms according to the adolescent.
• The neighborhood index evaluates the quality of
  the neighborhood environment from the
  respondents point of view, using the dichotomous
  yes/no format.
• Finally, the risk behavior scale contains six
  reverse-coded items where a higher score means
  greater willingness to engage in risk behavior
  i.e. (i) often does things without thinking
  (ii) planning takes the fun out of things (iii)
  uses self-control to keep out of trouble (iv)
  enjoys taking risks (v) enjoys new/exciting
  experiences and (vi) feels life without danger
  is dull.

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Bivariate Methods

• Methods for testing group distinction between
  high and low risk takers, include t-tests to
  examine mean differences between the
  sociodemographic control measures and the
  psychosocial scales, all of which are
  significant.
• Mantel-Haenszel Chi-Square is also employed to
  test for independence between psychosocial well
  being states and high and low risk propensity,
  and a variety of health behaviors including age
  at first alcohol, tobacco and marijuana use and
  age at initiation of sexual behavior.
• This analysis of association between two binary
  variables is applied to ascertain if proportion
  of one group is different from another.
• The low and high risk groups are statistically
  distinct from each other at the .05 significance
  level on all the psychosocial scales and
  detrimental health behavior variables.

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Multivariate Results

• In the multivariate model, higher adolescents
  scores on the self-rated risk index are
  significantly correlated with other psychosocial
  well-being measures such as greater depressive
  symptoms, lower self-esteem, but a higher sense
  of mastery.
• The regression analysis demonstrates that alcohol
  and drug use affects adolescents likelihood to
  rate herself/himself as risk prone and increase
  the likelihood of initiation of sexual
  intercourse at a younger age.
• Male adolescents are more likely to engage in
  risk behavior at an earlier age than females,
  particularly African American males.
• Neighborhood quality does not increase likelihood
  of an adolescent to perceive herself/himself as
  risk prone but does increase the initiation of
  sexual activity at a younger age.

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Discussion

• Adolescents who report more depressive symptoms
  also perceives themselves as higher risk takers.
• Risk is studied as a matrix of concomitant
  exposure to adverse social conditions, the
  youths judgment of that milieu and her/his
  internalization of his response and sensitivities
  to those environs.(Link and Phelan, 1997).
• Self-assessment of risk during adolescence could
  emerge as a potential predictor in determining
  later-life health trajectories.

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Regression Analysis - Dependent Variable Age
when first had sex 1998
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Regression Analysis - Dependent Variable Age
when first had sex 1998 (Continued)
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Regression Analysis - Dependent Variable Risk
Scale 1998
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Regression Analysis - Dependent Variable
RISK2_1998 (Continued)
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Regression Analysis -Dependent Variable of
people had sex with in last 12 months 1998
(Continued)
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- Regression Analysis -Dependent Variable of
people had sex with in last 12 months 1998
(Continued)
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- Regression Analysis -Dependent Variable On
Average how often R drank in the past 12 months.
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- Regression Analysis -Dependent Variable On
Average how often R drank in the past 12 months
(Continued)
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- Regression Analysis -Dependent Variable Age
when first began to drink alcohol once a month or
more 1998
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- Regression Analysis -Dependent Variable Age
when first began to drink alcohol once a month or
more 1998 (Continued)
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- Regression Analysis -Dependent Variable How
often in past 30 days smoked cigarettes? 1998
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- Regression Analysis -Dependent Variable How
often in past 30 days smoked cigarettes?
(Continued)
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- Regression Analysis -Dependent Variable Age
of respondent when first used marijuana? 1998
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- Regression Analysis -Dependent Variable Age
of respondent when first used marijuana? (Cont.)
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Behavior Health Risk Decision Making