SOCIAL DETERMINANTS OF ADOLESCENT RISK BEHAVIORS: AN EXAMINATION OF DEPRESSIVE SYMPTOMS, SEXUAL BEHAVIORS, SUBSTANCE USE, AND SUICIDE RISK BEHAVIORSBrandon Respress, PhDc, RN, MSN, MPH, CPNP

Frances Payne Bolton School of Nursing

October 15, 2009

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

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@unc.edu).

No direct support was received from grant P01-HD31921 for this analysis.

PURPOSE Examine the relationships among race,

mother’s 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

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.

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, O’Malley, Bachman, & Schulenberg, 2006).

Up to 20% of high school student reported regular use of marijuana, within the past 30 days (Eaton et al., 2006).

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).

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).

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).

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).

THEORETICAL FRAMEWORK

LaVeist’s Conceptual Model of Race (1994)

LaVeist’s Social Determinants of Heath Model (2005)

Race

Physiognomy

Societal Cultural/Ethnic

Race Differences inHealth Status

External RiskExposure

Health/IllnessBehavior

Individual-Level(Psychosocial and

Behavioral)

BiopsysiologicalHealth StatusDisparities

Socioenvironmental(Contextual)

Distal Transitional Proximal

CONCEPTUALIZATION OF RISKY BEHAVIORS IN URBAN ADOLESCENTS

Race

Physiognomy

Societal

Race Differences inRisky Behaviors

External RiskExposure

Health/IllnessBehavior

SocioenvironmentalContext

Individual Level

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 (mother’s 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?

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?

RESEARCH MODEL

Socioenvironmental Context

* Race*Socioeconomic Status *Mother's Education *Household Income *Poverty Status*Perceived Racism *Perceived Prejudice and Discrimination*Academic Performance

Individual Level Behaviors

*Substance Use *Alcohol Use

* Marijuana Use

* Sexual Risk * Suicide Risk *Depressive Symptoms

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

RESULTS: CHARACTERISTICS

Sample: Total: n = 3, 599

2,818 were White 514 were Black 134 were “Other”

51.8% are female Average age:16 Grade Level:

9th: 885 (25.2%) 10th: 881 (25.1%) 11th: 907 (25.8%) 12th: 836 (23.8%)

RESULTS: DEMOGRAPHICS Mother’s 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 mother’s 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

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

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

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

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

IMPLICATIONS

Improving the understanding of relationships between race and mom’s 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

IMPLICATIONS

Policy ImplicationsDevelopment of school health

programs and policiesImplementation of programs and

policies for high-risk youthNurses have a social mandate to

develop, disseminate, and use knowledge based on nursing’s phenomena of concern (Manhart Barrett, 2002).

QUESTIONS OR COMMENTS?