Social Determinants of Adolescent Risk Behaviors An Examination .ppt

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Social Determinants of Adolescent Risk Behaviors An Examination .ppt Powered By Docstoc
					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
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 Social
LaVeist’s Conceptual                                    Determinants of Heath
Model of Race (1994)                                    Model (2005)
                         Race




                      Physiognomy



                                                        Socioenvironmental                                             Health Status
        Societal                      Cultural/Ethnic                                               Biopsysiological
                                                                                                                        Disparities
                                                           (Contextual)        Individual-Level
                                                                             (Psychosocial and
                                                                                 Behavioral)




                                                        Distal                           Transitional                     Proximal
      External Risk                    Health/Illness
       Exposure                          Behavior




                      Race Differences in
                        Health Status
CONCEPTUALIZATION OF RISKY
BEHAVIORS IN URBAN ADOLESCENTS
                                   Race


                                Physiognomy


                                  Societal



              External Risk                     Health/Illness
               Exposure                           Behavior



           Socioenvironmental
                                              Individual Level
                Context


                              Race Differences in
                               Risky Behaviors
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
                                Individual Level Behaviors
              * Race
      *Socioeconomic Status
                                    *Substance Use
        *Mother's Education
                                        *Alcohol Use
        *Household Income
        *Poverty Status                 * Marijuana Use
      *Perceived Racism              * Sexual Risk
        *Perceived Prejudice        * Suicide Risk
         and Discrimination         *Depressive Symptoms
      *Academic Performance
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%)

         11 : 907 (25.8%)
             th

         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 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 nursing’s
    phenomena of concern (Manhart Barrett, 2002).
QUESTIONS OR COMMENTS?

				
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