Social Determinants of Adolescent Risk Behaviors: An Examination of Depressive Symptoms, Sexual Beha

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Social Determinants of Adolescent Risk Behaviors
An Examination of Depressive Symptoms, Sexual
Behaviors, Substance Use, and Suicide Risk
Behaviors

• Brandon Respress, PhDc, RN, MSN, MPH, CPNP
• Frances Payne Bolton School of Nursing
• October 15, 2009

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Acknowledgements

• Dissertation Committee
• Chair Dr. Diana L. Morris, PhD, RN, FAAN
• Member Dr. Faye A. Gary, EdD, RN, FAAN
• Member Dr. Linda C. Lewin, PhD, RN, ARNP-BC
• Member Dr. Shelley A. Francis, DrPH,
• Dr. Hossein Yarandi, PhD
• Funding Sources
• ANA/SAMHSA Ethnic Minority Program
• T32 Childbearing, Childrearing, and Caregiving
  Research Training Grant, Frances Payne Bolton
  School of Nursing, Cleveland, OH

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Acknowledgements

• This research uses data from Add Health, a
  program project designed by J. Richard Udry,
  Peter S. Bearman, and Kathleen Mullan Harris, and
  funded by a grant P01-HD31921 from the Eunice
  Kennedy Shriver National Institute of Child
  Health and Human Development, with cooperative
  funding from 17 other agencies.
• Special acknowledgment is due Ronald R. Rindfuss
  and Barbara Entwisle for assistance in the
  original design.
• Persons interested in obtaining data files from
  Add Health should contact Add Health, Carolina
  Population Center, 123 W. Franklin Street, Chapel
  Hill, NC 27516-2524 (addhealth_at_unc.edu).
• No direct support was received from grant
  P01-HD31921 for this analysis.

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Purpose

• Examine the relationships among race, mothers
  education, household income, poverty status,
  academic performance, and perceived prejudice and
  discrimination and reports of depression,
  sexual, substance use, and suicide risk behaviors
  in urban high school adolescents.
• Identify differences in socioenvironmental
  factors predicting likelihood of risk behaviors
  across race categories

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Adolescence

• Transitional period
• Time of profound biological, intellectual,
  psychological, and economic change
• Middle adolescence (ages 14-18) often associated
  with an increase in health
• Lifestyle patterns adopted during this period of
  change and growth often continued into adulthood.

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Adolescent Risk Behaviors

• 68.6 of high school seniors reported frequent
  use of alcohol
• 49.7 reported binge drinking within the past 2
  weeks (Johnston, OMalley, Bachman,
  Schulenberg, 2006).
• Up to 20 of high school student reported regular
  use of marijuana, within the past 30 days (Eaton
  et al., 2006).

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Adolescent Risk Behaviors

• Nearly half of all newly acquired STD infections
  have been diagnosed in 15 to 24 year olds
  (Centers for Disease Control and Prevention
  (CDC), 2007).
• 757,000 pregnancies occurred among women aged
  15-19 years (Abma, Martinez, Mosher, Dawson,
  2004).
• Adolescent pregnancy rates have declined
  however, disproportionate rates of pregnancies
  occur in more in blacks than whites (Hamilton,
  Martin, Ventura, 2006).

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Adolescent Risk Behaviors

• 13 of high school students surveyed formulated a
  plan to commit suicide during the past year
• 8.4 had actually attempted suicide (Eaton et
  al., 2006).
• 28.5 of students nationwide had felt so sad or
  hopeless almost every day for 2 or more weeks in
  a row that they stopped doing some usual
  activities, during the 12 months (Eaton et al.,
  2008).

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Consequences of Adolescent Risk Behaviors

• Engagement in risky sexual behaviors, drunk
  driving, physical and psychological impairment,
  and suicidal ideation
• Academic difficulties
• Interpersonal problems
• Emotional problems such as depression and anxiety
• Problems can continue into adulthood (Horgan et
  al., 2001 Miller et al., 2006).

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Significance

• African and Hispanic Americans have higher rates
  of substance related morbidity and mortality in
  adulthood (Gil, Wagner, Tubman, 2004 James,
  Kim, Armijo, 2000 Wallace et al., 2002).
• Risky behaviors in adolescents may be related to
  an imbalance between race, socioeconomic status,
  age, and gender differences.
• Failure to address these determinants creates an
  increased vulnerability in the overall well-being
  of adolescents (Merline et al., 2004).

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Theoretical Framework

• LaVeists Social Determinants of Heath Model
  (2005)

• LaVeists Conceptual Model of Race (1994)

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Conceptualization of Risky Behaviors in Urban
Adolescents
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Research Questions

• What are the socioenvironmental and behavioral
  characteristics of adolescents in Wave II of the
  Add Health Study?
• What is the relationship between race and
  adolescent risky behaviors?
• Which combination of socioenvironmental factors
  chronological age, gender, grade level, race,
  SES (mothers education, household income,
  poverty status), perceived racism (perceived
  prejudice, perceived discrimination), and
  academic performance best predict the odds of
  engagement in sexual risk behaviors in
  adolescents?

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Research Questions

• Which combination of socioenvironmental factors
  best predict substance use alcohol and marijuana
  use in adolescents?
• Which combination of socioenvironmental factors
  best predict the odds of suicidal risk behaviors
  in adolescents?
• Which combination of socioenvironmental factors
  best predict depressive symptoms in adolescents?

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Research Model
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Methods Secondary Study

• Setting In-Home Interviews conducted during Wave
  II of the Add Health Study, Public Use Data Set
• Sample
• High school students grades 9-12
• One-half of the core, chosen at random, and
  one-half of the over-sample of African-American
  adolescents with a parent who has a college
  degree
• Oversamples of Blacks from well-educated
  families, Chinese, Cubans, and Puerto Rican
  backgrounds, individuals with physical
  disabilities, and genetically related (twins)
  siblings

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Results Characteristics

• Sample
• Total n 3, 599
• 2,818 were White
• 514 were Black
• 134 were Other
• 51.8 are female
• Average age16
• Grade Level
• 9th 885 (25.2)
• 10th 881 (25.1)
• 11th 907 (25.8)
• 12th 836 (23.8)

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Results Demographics

• Mothers level of Education 74 had an HS
  education
• 40.4 of Blacks and 66.4 of other minorities
  had less than a HS education compared to 8.3 of
  Whites
• 339 White mothers had reported having a college
  education or higher compared to a total of 23
  Blacks and Other racial minorities
• Household Income 31,105
• Blacks 21,821
• Whites 32,903
• Others 28,344
• Level of poverty
• Low 21 of Blacks and compared to 64 of Whites
  
• High 62 of Blacks compared to 12 of Whites
  living in high impoverished states

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Results socioenvironmental factors

• Grade Point Average 2.87
• Blacks 2.61
• Whites 2.92
• Others 2.90
• Perceived racism 6.37
• Blacks 6.11
• Whites 6.71
• Others 6.29

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Results Risk Behaviors

• Sexual Risk Behaviors
• 44 of all participants have had sexual
  intercourse
• 58.7 of Blacks
• 34.8 of Others
• 43.3 of Whites
• 138 females reported at least 1 pregnancy
• 68 (n 95) were White females

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Results Risk Behaviors

• Substance Use
• Alcohol Use 44.2 of all participants reported
  drinking
• Other minorities reported 9 drinks on average,
  compared to 6 drinks for Whites, and 4 drinks for
  Blacks
• Binge Drinking 46.6 had at least one binge
  drinking episode during the past year
• Whites and other minorities reported binge
  drinking between 3-12 times
• Blacks reported binge drinking once or twice
• Marijuana Use overall 23.6 of all participants
  reported trying marijuana
• All reported using marijuana between 5 and 7 days
  during the past month

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Results Risk Behaviors

• Suicide Risk Behaviors
• Overall 10.6 (n 373) had suicidal thoughts
• 3.9 (n 139) of all adolescents had one suicide
  attempt
• Depressive Symptoms
• Mild to moderate depressive symptoms
• Blacks 11.26
• Whites 10.65
• Others 12.64

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Implications

• Improving the understanding of relationships
  between race and moms education and adolescent
  risk behaviors
• Understanding racial differences is risk
  behaviors
• Developing culturally relevant interventions that
  target at-risk adolescents, including urban Black
  youths
• Identifying and clarifying adverse health
  consequences related to overt and covert racism
  that adolescents confront in their daily lives

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Implications

• Policy Implications
• Development of school health programs and
  policies
• Implementation of programs and policies for
  high-risk youth
• Nurses have a social mandate to develop,
  disseminate, and use knowledge based on nursings
  phenomena of concern (Manhart Barrett, 2002).

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Questions or comments?