Promoting Health Intervention Strategies from Social and Behavioral Research (2000) / Chapter Skim
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Paper Contribution E: Preadolescent and Adolescent Influences on Health
Paper Contribution E: Preadolescent and Adolescent Influences on Health
Pages 217-253
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From page 217... ...
Adolescence is also examined within context, so that adolescence is seen as a dynamic developmental process that is influenced by proximal and distal social environments. The manifestation of this developmental process can be seen in adolescents' behaviors, behaviors that cause considerable concern in American society.
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Thus, some boys might never exhibit aggressive behavior in a social environment without provocation. Similarly, Udry (1988)
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The lack of rational and abstract thinking abilities leaves adolescents particularly vulnerable to messages from the social environment that portray some behaviors, such as smoking, drinking, and sexual behavior, as potentially functional and rewarding (Perry, 1999a) , even though the longer-term consequences may be dire for them.
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Yet, as the examples above indicate, even biological changes interact with social environmental factors to influence adolescent behavior. Still, from within specific cultures and subcultures come the answers to the question, What are adolescents supposed to achieve during this developmental stage?
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This suggests that focusing attention on early conduct problems and competencies in childhood should be beneficial for academic and job achievements, as well as reducing conduct problems, in adolescence (Moffitt, 1993, Masten et al., 1995~. Additionally, this study strongly underlines the need to examine early precursors to some adolescent behaviors as an avenue to early prevention and intervention.
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From page 222... ...
Although these are being reviewed separately, there is significant covariation among these health behaviors, making some adolescents at increased risk for a range of shortterm and long-term health problems (Jessor and Jessor, 1977, U.S. DHHS, 1994, Lytle et al., 1995~.
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From page 224... ...
Sexual Behavior Sexual behavior also has its debut in adolescence, with two out of three adolescents reporting having had sexual intercourse prior to high school graduation (CDC, 1998~. This sexual activity incurs the risk of pregnancy and infectious diseases, which have significant social, economic, and physical health ramifications (Ozer et al., 1998~.
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Eating Behaviors and Physical Activity In comparison with drug use, violence, and sexual behavior, eating and exercise may seem like relatively benign behavioral areas for adolescents. Yet eating behaviors significantly affect growth during adolescence (Story, 1992)
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However, females were not more likely to be overweight than males, except among African Americans (Troiano and Flegal, 1998~. In the 1997 Youth Risk Behavior Survey, 27% of high school students reported they were overweight (CDC, 1998~.
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In one study, American Indian females were more likely to engage in unhealthy weight loss practices than whites, while Asians were less likely (Neumark-Sztainer et al., 1996) Despite some evidence that African American females are heavier than Hispanic and white females, they are more likely to be satisfied with their weight and body image, and have a lower prevalence of eating disorders (Resnicow et al., 1997~.
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From page 228... ...
Thus, the focus in etiology is on the social environment, rather than the adolescents themselves, because it is within the social context that behavior change can take place and interventions appear to be most efficacious. The Etiology of Health Behaviors in Adolescence The reasons American adolescents engage in health-compromising behaviors have been the focus of several academic and popular books, as well as hundreds of journal articles, over the past several years (DiClemente et al., 1996, Schulenberg et al., 1997, Jessor, 1998, Brownlee, 1999, Hine, 1999, Vida, 1999~.
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The factors also need to be amenable to intervention: they should be able to be promoted, changed, reduced, or eliminated through social, educational, political, and/or public health efforts. A common thread in the recent etiological research, which parallels the trend in intervention development, is increased attention to the social environment and social context of adolescents.
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As an example of the influence of social capital at the community level, we assessed social environmental factors related to young adolescents' alcohol use as part of a 20-community prevention trial, Project Northland (Perry et al., 1996~. It was interesting to us that there was such a large amount of variability in alcohol use among eighth grade students among the 20 communities, since they appeared very homogeneous small rural and mostly white communities in northeastern Minnesota.
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Poverty exerts its influence as an environmental and social factor in many aspects of young people's health behavior. Poor, urban youth are exposed to high rates of community violence that influence subsequent aggressive and violent behaviors and depression (Farrell and Bruce, 1997, Gorman-Smith and Tolan, 1998~.
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Perhaps the relationship between the tobacco industry and adolescents is best summarized by an R.J. Reynolds researcher who wrote: "Realistically, if our company is to survive and prosper, over the long term, we must get our share of the youth market" (Teague, 1973~.
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provides important quantification of the ways families influence adolescent behavior. Adolescents were found to be less at risk for emotional distress, violence, and drug use if they perceived themselves as connected to their parents: that is, they experienced feelings of warmth, love, and caring from their parents.
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Likewise, adolescents who received support from their parents to be more autonomous were less likely to initiate sexual intercourse, those who were more emotionally attached to their parents were less likely to engage in fighting and drug use (Turner et al., 1993~. Finally, adolescents who perceived that their parents knew their friends, where they went at night, how they spent their money, what they did with their free time, and where they were most afternoons, were less likely to begin to use drugs (Steinberg et al., 1994~.
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Disengagement from school may also lead to more intensive involvement in the workplace (Steinberg and Avenevoli, 1998) , with its own implications for health behaviors.
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This section reviews examples of prevention-intervention research on how changes in the social environment or social context of adolescents were made. These recent intervention experiences provide models for how more general adolescent health behavior change might be approached, even when the intervention addresses only a particular behavior.
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What is notable about recent adolescent health behavior intervention research is that the interventions tend to be multicomponent, with changes in several social contexts, multiyear, theory driven, and evaluated using sophisticated research designs and analysis methodologies. Thus, intervention research is where the answer to, How?
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This was part of the larger Florida Tobacco Pilot Program, which had as one of its main goals to empower youth to lead community involvement against tobacco (Holtz, 1999~. The advertising campaign focused on the tobacco industry, with teens demanding more honesty from the industry, including tobacco distributors, retailers, advertising agencies, and media associated with the industry.
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Changing Community NormsThe Tobacco Policy Options Program Obtaining community involvement and changing community norms are critical to providing a social environment that supports the healthy development of adolescents (Hansen and Graham, 1991, Glanz et al., 1995, Perry et al., 2000~. The short-term effects of school-based programs, for example, may be the result of behavior change that is inconsistent with the larger community norms, so that healthy behavior is not supported and reinforced after the program is completed.
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From page 240... ...
Promoting Positive Peer Involvement Project Northland Project Northland was a randomized community trial to reduce the onset and prevalence of alcohol use among young adolescents in 24 school districts and surrounding communities (Perry et al., 1993~. The three-year intervention program consisted of classroom-based curricula in sixth through eighth grades, parental education and involvement activities, peer leadership opportunities, and community-wide task force activities.
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Thus, in changing the social context for adolescents, we need to consider their roles and leadership in their own educational and social endeavors. More comprehensive reviews of recent interventions around each of the adolescent health behaviors have been undertaken by the Centers for Disease Control and Prevention and others (Drug Strategies, 1996, 1998, Catalano et al., 1999, Perry, l999b, U.S.
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There is much more that we know about the etiology of adolescent behavior than what we have been able to translate into effective intervention strategies. Thus, one opportunity that exists is to fund welldesigned, large-scale, longitudinal intervention research that includes careful delineation and assessment of process, mediating, and outcome variables.
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Third, the types of competencies, skills, or opportunities for adolescents that might influence their behavior need to be more fully explored and expanded and included in intervention research, and might include self-management, communication, academic planning, character building, community organizing, and even spiritual skills. For example, in Project Northland, students' self-evaluation of their own wisdom (including harmony and warmth, intelligence, and spirituality scales)
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Health Education and Behavior, 24, 640-651.
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(1988~. Social capital in the creation of human capital.
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(1995~. Social capital and successful development among at-risk youth.
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(1999~. Preventing adolescent health-risk behaviors by strengthening protection during childhood.
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(1998~. Social capital, income inequality, and firearm violent crime.
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(1995~. Covariance of adolescent health behaviors: The Class of 1989 Study.
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(2000~. Project Northland high school interventions: Community action to reduce adolescent alcohol use.
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(1998~. Children who prosper in unfavorable environments: The relationship to social capital.
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(1993~. Autonomy, relatedness, and the initiation of health risk behaviors in early adolescence.
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(1995~. A home-based prevention program for sixth grade alcohol use: Results from Project Northland.
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