odologically rigorous surveys; and systematically miss school dropouts and youth not at school that day or in alternative placement settings. Publicly available data are reported every 2 years. Under conditions of complete implementation and ideal circumstances, representative classroom data could be obtained from states concerning these high-risk behaviors among high school students. This survey also assesses exercise and positive health behaviors. However, due to the modest levels of funding and lack of centralized control of assessment and sampling procedures, the survey relies on each state to conduct and follow-up the data collection procedures. This produces great unevenness in actual survey execution.

Several other recurring national surveys offer highly relevant information in very specific, targeted areas. For example, the Substance Abuse and Mental Health Services Administration’s National Household Survey on Drug Use and Health (NHSDUH) assesses information relevant to the prevalence, patterns, and consequences of drug and alcohol use among individuals age 12 and older, as well as family environment and parenting practices or perceptions that might influence substance use practices among youth. The Monitoring The Future study (funded by the National Institute on Drug Abuse, conducted by the Institute for Social Research at the University of Michigan) assesses substance use, other behaviors, attitudes, and values of 50,000 U.S. secondary school students, college students, and young adults; periodic follow-up questionnaires are mailed to a sample of each graduating class for several years after study entrance.

Another source of behavioral data on younger children is the National Labor Survey on Youth, which continues to follow the children of women in the original cohort. This survey includes the child Behavior Problems Index, but the early rounds of the survey primarily include children born to young mothers.

Data regarding youth behavior and its implications for health are sometimes available from investigator-initiated surveys. For example, the National Longitudinal Survey of Adolescent Health (ADD-Health) began in 1994–1995 with a sample of 7th- through 12th-grade schools. Interviews were attempted with the more than 100,000 students attending these schools, with three follow-up personal interviews conducted with a random one-fifth of these students. Health-related behaviors have been relatively well measured in each survey wave through questionnaire responses.

Absent from current efforts to measure children’s behavioral influences is consideration of their attitudes, beliefs, expectations, and cultural factors that shape decisions to seek health care or engage in health promotion or illness prevention activities. For example, “local” instruments have been developed by researchers exploring in a cross-sectional and prospective fashion the relative roles of parents’ and peers’ perceptions and risk involvement on risk and protective behaviors among adolescents (Stanton, Li, Galbraith et al., 2000; Cottrell, Li, Harris et al., 2003). As noted in Chapter 3, substantial evidence indicates that these factors exert major influences on youths’ health behaviors and subsequent health, whether related to their health behavior choices, tobacco/alcohol/



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