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The Family as a Protective Asset in Adolescent Development
Abstract
Adolescents are considered at high risk for engaging in such negative health behaviors as drug and alcohol use, unprotected sexual intercourse, and violence. Conventional wisdom has long upheld the belief that the peer group exerts the strongest influence on adolescent behavior. However, recent research has shown that in fact the family remains a strong factor in moderating teen risk behavior. Holistic nursing acknowledges the crucial relationship between environment and health; the environment is composed of everything that surrounds the individual, which by definition includes the family. The purpose of this article is to examine the evidence supporting the concept of the family as a protective external asset in adolescent development, to explore the way the family helps defend young people from risk, and to review briefly the implications for nursing research, practice, advocacy, and education.
... Adolescents are commonly dependent on family members, hence are influenced by the family environment [19,20]. Therefore, another important aspect that should be considered during adolescence is related to the family environment. ...
... Therefore, adolescents from families less connected may present worse oral health behaviors [22]. Although the 15 to 19 age group has greater autonomy compared to younger children [46], a higher level of family cohesion probably indicates greater family support and attention given to the adolescent's oral health [19,22]. Adolescents who grow up in a cohesive family likely have greater discernment to perceive changes in oral health affecting the self-perceived need for dental treatment, suggesting the importance of valuing family cohesion for the establishment of critical attitudes and oral self-care by adolescents. ...
This study explored the association between family cohesion and self-perceived need for dental treatment among adolescents. A school-based representative cross-sectional study was conducted with 746 students aged 15 to 19 randomly selected from schools in Campina Grande, Brazil. Parents/guardians provided information on sociodemographic data, and students completed questionnaires about the self-perceived need for dental treatment, dental pain, and family cohesion and adaptability (FACES III). Two dentists were trained (kappa >0.80) to diagnosis dental caries using the Nyvad criteria and assess adolescents’ level of functional oral health literacy (BREALD-30). Descriptive analysis was performed, followed by nonadjusted and adjusted robust binary logistic regression for complex samples (α=5%). The prevalence of self-perceived need for dental treatment was 88.6%. The presence of dental caries (OR=2.10; IC 95%: 1.22–3.61), tooth loss (OR=15.81; IC 95%: 2.14–116.56), dental pain in the last six months (OR=1.87; IC 95%: 1.06–3.31), and enmeshed family cohesion type (OR=10.23; IC 95%: 3.96–26.4) remained associated with the self-perceived need for dental treatment in the final model. In conclusion, dental caries, dental pain, tooth loss, and family cohesion influenced the self-perceived need for dental treatment in adolescents.
... Previous reviews of the literature have suggested that both PCC and communication are protective against substance use during adolescence (Kingon & O'Sullivan, 2001;Ryan et al., 2010). There is also evidence that interventions involving parenting sessions, including strengthening relationships and communication, may be effective in reducing and preventing alcohol (Foxcroft & Tsertsvadze, 2011) and tobacco use (Thomas, Baker, Thomas, & Lorenzetti, 2015); there is limited evidence in terms of drug use (Gates, McCambridge, Smith, & Foxcroft, 2009). ...
... As far as we are aware, this is the first integrative review to examine the specific elements of parent-child connectedness and communication in the context of adolescents' alcohol, tobacco and drug use. Previous reviews suggested that good general communication is protective against alcohol use (Ryan et al., 2010); and that high levels of connectedness are protective against all three substances (Kingon & O'Sullivan, 2001). This review adds to the evidence base in two ways: firstly, it encompassed a wider assessment of the literature, examining the three related factors across all substances. ...
Previous reviews have highlighted parent?child connectedness and communication as important protective factors against adolescent substance use. However, these reviews focus on single substances such as alcohol. An integrative review of the literature was conducted to examine which elements of parent?child connectedness and substance-use specific communication are effective across adolescent alcohol, tobacco and drug use. Forty-two English language, peer reviewed articles were reviewed. Open communication occurs within the context of high connectedness between parents and their children. Conversations about health risks are associated with lower levels of substance use while more frequent conversations, those about parents? own use, permissive messages and consequences of use are associated with higher levels of use. There are disparities regarding conversations about use of each substance: alcohol and tobacco are easier topics of conversation while drug use is rarely discussed. Parental alcohol and tobacco use can influence the credibility of their communication with their child. Parents should be encouraged to have open, constructive, credible, two-sided conversations with their adolescents about substance use. Interventions to improve parents? communication skills around substance use, particularly drug use, should include the types of approaches and messages highlighted in this review, and, where possible, these interventions should include all family members.
... Parents can play a powerful role in preventing their children from engaging in antisocial activities. A literature review that investigated family risk and protective factors for adolescent behaviors found that family influence may protect against smoking, substance abuse, unprotected sexual intercourse, violence, poor school attendance and grades, and suicidal ideation and suicide attempt [20]. ...
... Open and honest communication, parent-child bonding, expressing high expectations and disapproval for use of alcohol and other substances, and effective parenting practices have been shown in other studies to be protective as well for healthy adolescent development [2,[20][21][22]. On the other hand, there exist several family-related risk factors that can encourage adolescent drug abuse such as family members' use of alcohol and drugs, poor and inconsistent family management practices, family conflict, and low bonding to the family [2]. ...
In 2000, SAMHSA's National Survey on Drug Use and Health found that 7.1% of Asian American adolescents between the ages 12-17 reported having used alcohol in the past month. In 2006, this percentage increased to 19.7%, representing a 75% increase among this population over six years. The purpose of this cross-sectional study is to understand the relationship between a culturally relevant factor, intergenerational conflict within Asian American families, and risk for initiating and engaging in substance abuse among adolescents. Data will be collected from nearly 200 parent-child dyads formed from Chinese American students in the 6th through 8th grades and their parents at four elementary schools in Chicago's Chinatown. Analyses of questionnaire data will include multi-variate and logistic regression while controlling for demographic variables to determine if intergenerational conflict is a significant predictor for alcohol and tobacco use among adolescents. Parenting style will be included in the statistical models to determine if it moderates the relationship between intergenerational conflict and risk for substance abuse through promoting parent-child bonding among families. Furthermore, data gathered from parent-child dyads will more accurately measure intergenerational conflict than from solely assessing the perceptions of either the parent or child alone. Research is limited on the factors that increase risk for substance abuse among Asian American adolescents. Therefore, this study will enhance knowledge of risk factors that are also culturally specific to this racial/ethnic minority and immigrant group. Findings will help to develop tailored interventions to prevent substance abuse among Asian American adolescents in the future.
... que estão associados aos comportamentos sexuais, tem crescido o interesse em compreender o impacto que a influência familiar e dos pares assume na adopção e manutenção de comportamentos sexuais nos adolescentes (DiClemente, Wingood, Crosby et al., 2001;Kingon & Sullivan, 2001). ...
... Os resultados do estudo parecem demonstrar que a percepção por parte dos adolescentes de uma menor supervisão parental está associada com a participação em mais comportamentos de risco, nomeadamente comportamentos sexuais de risco, incluindo um início precoce da actividade sexual e as relações sexuais desprotegidas (DiClemente, Wingood, Crosby et al., 2001;Rodgers, 1999;Jacobson & Crockett, 2000;French & Dishion, 2003). Na opinião dos jovens o controlo e a supervisão parental (em relação às suas actividades, com quem costumam estar e o desempenho escolar) tende a promover comportamentos sexuais mais saudáveis, nomeadamente menos probabilidade de ter relações sexuais (Jones, Forenhand, Brody, & Armistead, 2003;Huebner & Howell, 2003;Mcneely, Shew, Beuhring, Sieving, Miller, & Blum, 2002;Kingon & Sullivan, 2001). ...
The purpose of this study is to examine the adolescents perceptions of parental and peers influence on theirs sexual behaviours. The study utilised focus groups qualitative methods from a sample of 72 adolescents from secondary schools in Portugal. The themes of focus group are discussed in terms of family and peers protective and risk factors in sexual behaviour. Adolescents identified several family factors, such as parents socio-economic status, family connectedness, parent-child communication, parenting style, and peers factors, such as peer communication, peer norms, and peer pressure, that influence adolescents sexual protective or risk behaviour. The results are consistent with a growing body of literature that highlights the impact of parents and peers in adolescents sexual behaviour. These findings lend support for the design and implementation of family-based approaches to promoting healthy adolescent sexual behaviour and reduce the impact of risky friendships.
... The importance of family meals has garnered considerable attention in recent years. Research has consistently shown a wide range of psychological and physical health benefits associated with frequent family meals (Eisenberg, Olson, Neumark-Sztainer, Story, & Bearinger, 2004;Fulkerson, Neumark-Sztainer, & Story, 2006;Kingon & O'Sullivan, 2001;Neumark-Sztainer, Hannan, Story, Croll, & Perry, 2003). Despite the various merits of family meals, the frequency of family dinners has decreased (Bianchi, Robinson, & Milkie, 2006;Nicklas et al., 2004). ...
... Results indicated that the extent that WTFC affects family dinner frequency varies as a function of individuals' NA such that it is only high-NA individuals who reported fewer family dinners when experiencing WTFC. This suggests that high-NA individuals and their family members might be at an increased risk in terms of nutrition and health considering the profound benefits of family meals on individuals' health and well-being (Eisenberg et al., 2004;Kingon & O'Sullivan, 2001;Larson, Neumark-Sztainer, Hannan, & Story, 2007). With this in mind, it might be helpful to provide tailored organizational programs that take key individual differences into account in order to support employees who are more vulnerable to WTFC. ...
Despite the abundant benefits that have been associated with family meals, families report that they share fewer meals together than in the past. Although parents’ work (e.g., work hours) is recognized as a barrier to family meals, the role of the individual in determining family meal frequency has received relatively little attention. With this in mind, this study investigated two important person factors that may aggravate or attenuate the negative relationship between work- to-family conflict (WTFC) and family dinner frequency using survey data from employed parents (n206). Specifically, parents’ negative affectivity (NA) and family meal atmosphere were examined as moderators. As hypothesized, the relationship between WTFC and family dinner frequency was stronger for high- NA individuals than for low-NA individuals. However, no support was found for the moderating role of family meal atmosphere. Findings suggest that WTFC may be more deleterious for high-NA individuals due to their tendency to strongly react to stressors and highlight the necessity to consider both situational and individual factors in understanding work-family experiences.
... Consistent with previous studies, we found that inferior family atmosphere increased the risk of adolescents' internet addiction [60,61]. As one of the earliest and most intimate growing environments [62], family atmosphere profoundly affects adolescents' mental health [63]. According to the compensatory internet use theory [13], adolescents exposed to long-term familial stress and conflict are likely to use the internet to meet their unmet needs (e.g., satisfaction and pleasure [64,65]). ...
Objectives: Family atmosphere is a significant predictor of internet addiction in adolescents. Based on the vulnerability model of emotion and the compensatory internet use theory, this study examined whether self-esteem and negative emotions (anxiety, depression) mediated the relationship between family atmosphere and internet addiction in parallel and sequence. Methods: A total of 3,065 Chinese middle school and high school students (1,524 females, mean age = 13.63 years, SD = 4.24) participated. They provided self-reported data on demographic variables, family atmosphere, self-esteem, anxiety, depression, and internet addiction through the Scale of Systemic Family Dynamic, Self-Esteem Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Internet Addiction Test, respectively. We employed Hayes PROCESS macro for the SPSS program to scrutinize the suggested mediation model. Results: It revealed that self-esteem, anxiety, and depression mediated the relationship between family atmosphere and internet addiction in parallel and sequence. The pathway of family atmosphere-self-esteem-internet addiction played a more important role than others. Conclusion: The present study confirmed the mediating role of self-esteem and negative emotions between family atmosphere and internet addiction, providing intervention studies with important targeting factors.
... Three family domain risk and protective factors emerged within the top six most predictive. It is well documented that adolescent development is enhanced through families that provide support, positive communication, family boundaries, cohesion, parents who are involved in school, and establish high expectations [43]. Family communication, especially among male adolescents, has previously been identified as a significant predictor of suicidal thoughts [44]. ...
Introduction
Addressing the problem of suicidal thoughts and behavior (STB) in adolescents requires understanding the associated risk factors. While previous research has identified individual risk and protective factors associated with many adolescent social morbidities, modern machine learning approaches can help identify risk and protective factors that interact (group) to provide predictive power for STB. This study aims to develop a prediction algorithm for STB among adolescents using the risk and protective factor framework and social determinants of health.
Methods
The sample population consisted of more than 179,000 high school students living in Utah and participating in the Communities That Care (CTC) Youth Survey from 2011-2017. The dataset includes responses to 300+ questions from the CTC and 8000+ demographic factors from the American Census Survey for a total of 1.2 billion values. Machine learning techniques were employed to extract the survey questions that were best able to predict answers indicative of STB, using recent work in interpretable machine learning.
Results
Analysis showed strong predictive power, with the ability to predict individuals with STB with 91% accuracy. After extracting the top ten questions that most affected model predictions, questions fell into four main categories: familial life, drug consumption, demographics, and peer acceptance at school.
Conclusions
Modern machine learning approaches provide new methods for understanding the interaction between root causes and outcomes, such as STB. The model developed in this study showed significant improvement in predictive accuracy compared to previous research. Results indicate that certain risk and protective factors, such as adolescents being threatened or harassed through digital media or bullied at school, and exposure or involvement in serious arguments and yelling at home are the leading predictors of STB and can help narrow and reaffirm priority prevention programming and areas of focused policymaking.
... A more cohesive family environment contributes to protection from risky behaviours in adolescence. 28 A previous study also found better oral health behaviours among adolescents who reported a higher level of family cohesion. 13 Thus, higher levels of cohesion could indicate greater attention on the part of parents/guardians regarding the oral health of their children in the form of greater supervision and seeking dental services. ...
Background
The prevalence of dental caries is high in adolescents worldwide, and a large percentage have never been to a dentist or have not had regular dental appointments.
Aim
To evaluate the influence of oral health literacy and sociodemographic, clinical, and family factors on dental visits among early adolescents.
Design
A cross‐sectional study was conducted with 740 12‐year‐old students in Campina Grande, Brazil. Students answered about their level of oral health literacy (BREALD‐30), levels of family adaptability and cohesion (FACES III), and visits to the dentist some time in life. Dental caries experience was evaluated using Nyvad criteria. Robust Poisson regression for complex samples was performed.
Results
A higher level of oral health literacy (PR = 1.01; 95% CI: 1.01 to 1.03), high social class (PR = 1.28; 95% CI: 1.09 to 1.50), higher mother’s schooling (PR = 1.58; 95% CI: 1.37 to 1.83), family cohesion classified as enmeshed (PR = 1.55; 95% CI: 1.19 to 2.02) and connected (PR = 1.22; 95% CI: 1.02 to 1.44), and the absence of toothache (PR = 1.18; 95% CI: 1.01 to 1.38) remained associated with having visited a dentist.
Conclusions
Oral health literacy and sociodemographic, family, and clinical factors were predictors of having visited a dentist among early adolescents.
... The perceived high level of social support reflected that the adolescents realized that they still have families and friends that they can rely on. A research carried out by Kingon & O'Sullivan (2001) has proved that family is a protective factor. Contradictory, utmost level of perceived social support is still insufficient for them to refrain themselves from engaging in offences. ...
... Families that provide a supportive, encouraging environment reduce the likelihood that their children will become engaged in antisocial behaviors such as truancy and violence (Dekovic et al. 2003). During the adolescent's development, the family can be a protective factor, moderating risky adolescent behaviors (Kingon and O'Sullivan 2001;Stoltz et al. 2013). Protection provided by family cohesion may not be maintained throughout adolescence since family cohesion levels decrease as adolescents develop (Baer 2002), however, decreased parental support is associated with an increase in depressive symptoms in early adolescence (Newman et al. 2007) and a decrease in alcohol use among adolescent males (Bray et al. 2001) and young adults (Stevens-Watkins and Rostosky 2010). ...
Previous research has demonstrated the effect of family cohesion on adolescent outcomes. However, little attention has been given to the effect of adolescence on the family environment. Family systems theory suggests that as adolescents develop, their development will impact the family environment. The current study examined the impact of adolescent development on family cohesion. Specifically, 4 years of data from the Mobile Youth Survey, a study of adolescents living in low-income neighborhoods in Mobile, Alabama, were analyzed. Survey participants were between the ages 13 and 16 and 97 % of them were Black American. Adolescent development was measured using three dimensions-identity style, self-worth, and hopelessness. Family cohesion was measured along two dimensions: maternal and paternal warmth. Adolescent gender was used as a covariate. The longitudinal models revealed that parents responded differently to identity styles and to levels of self-worth depending upon the adolescent's gender. Our study provides evidence that family cohesion, a key predictor of adolescent behaviors, changes in response to adolescent development.
... 6 Healthy family environments, including family connectedness (ie, feelings of love, warmth, and caring from parents) have been found to be protective against poor mental health or psychosocial outcomes, and the role of the family has long been studied as an important contribution to adolescent well-being. [7][8][9] Interestingly, there is evidence that young males might respond differently than females do to family environments and dynamics. [10][11][12][13] A simple, nonintrusive intervention that could easily be applied to increase healthy family environments is engaging in family meals. ...
To conduct a systematic review of the effects of frequent family meals on psychosocial outcomes in children and adolescents, and to examine whether there are differences in outcomes between males and females.
Studies were identified through a search of MEDLINE (1948 to fifth week of June 2011) and PsycINFO (1806 to first week of July 2011) using the Ovid interface. The MeSH terms and key words used both alone and in combination were family, meal, food intake, nutrition, diets, body weight, adolescent attitudes, eating behaviour, feeding behaviour, and eating disorders. Bibliographies of papers deemed relevant were also reviewed.
The original search yielded 1783 articles. To be included in the analysis, studies had to meet the following criteria: have been published in a peer-reviewed journal in English; involve children or adolescents; discuss the role of family meals on the psychosocial outcomes (eg, substance use, disordered eating, depression) of children or adolescents; and have an adequate study design, including appropriate statistical methods for analyzing outcome data. Fourteen papers met inclusion criteria. Two independent reviewers studied and analyzed the papers.
Overall, results show that frequent family meals are inversely associated with disordered eating, alcohol and substance use, violent behaviour, and feelings of depression or thoughts of suicide in adolescents. There is a positive relationship between frequent family meals and increased self-esteem and school success. Studies show substantial differences in outcomes for male and female children and adolescents, with females having more positive results.
This systematic review provides further support that frequent family meals should be endorsed. All health care practitioners should educate families on the benefits of having regular meals together as a family.
Copyright© the College of Family Physicians of Canada.
... Families that provide a supportive, encouraging environment reduce the likelihood that their children will become engaged in antisocial behaviors such as truancy and violence (Dekovic et al. 2003). During the adolescent's development, the family can be a protective factor, moderating risky adolescent behaviors (Kingon and O'Sullivan 2001;Stoltz et al. 2013). Protection provided by family cohesion may not be maintained throughout adolescence since family cohesion levels decrease as adolescents develop (Baer 2002), however, decreased parental support is associated with an increase in depressive symptoms in early adolescence (Newman et al. 2007) and a decrease in alcohol use among adolescent males (Bray et al. 2001) and young adults (Stevens-Watkins and Rostosky 2010). ...
Previous research has demonstrated the effect of family cohesion on adolescent outcomes. However, little attention has been given to the effect of adolescence on the family environment. Family systems theory suggests that as adolescents develop, their development will impact the family environment. The current study examined the impact of adolescent development on family cohesion. Specifically, 4 years of data from the Mobile Youth Survey, a study of adolescents living in low-income neighborhoods in Mobile, Alabama, were analyzed. Survey participants were between the ages 13 and 16 and 97 % of them were Black American. Adolescent development was measured using three dimensions—identity style, self-worth, and hopelessness. Family cohesion was measured along two dimensions: maternal and paternal warmth. Adolescent gender was used as a covariate. The longitudinal models revealed that parents responded differently to identity styles and to levels of self-worth depending upon the adolescent’s gender. Our study provides evidence that family cohesion, a key predictor of adolescent behaviors, changes in response to adolescent development.
... This finding is consistent with those of earlier studies that also found an association between greater levels of maternal warmth and lower levels of delinquent behavior (Church, Tomek et al., 2012). Other evidence has suggested family serves as a protective factor against adolescents engaging in risky behaviors, including violence (Kingon & O'Sullivan, 2001). Paternal warmth seemed to have little effect on initial gang involvement among males, yet high paternal warmth significantly decreased the amount of initial gang involvement among females. ...
Using linear growth modeling and data from the Mobile Youth Survey—a 14-year multiple cohort study of adolescents living in low-income neighborhoods in Mobile, Alabama—we investigate the roles of peer influence, family cohesion, and self-worth on gang involvement. The study finds that peer influence, family cohesion, and self-worth have an effect on initial gang involvement, but only family cohesion and gender have any influence on gang involvement across time. Males are more likely to be gang involved than females. Greater family cohesion reduced gang activity across time. This research suggests that family-based interventions and efforts to promote positive peer relationships might decrease the likelihood of gang involvement.
... One family factor that has been included in numerous studies exploring risk and protection among adolescents is family bonding. For example, research shows that adolescents who live in families whose members are not strongly bonded tend to engage in higher levels of unprotected sex (Miller, Benson, & Galbraith, 2001), gang membership (Florian-Lacy, Jefferson, & Fleming, 2002), attempted suicide (O'Donnell, O'Donnell, Wardlaw, & Stueve, 2004;Pages, Arvers, Hassler, & Choquet, 2004), and substance use (Jung, 1995;Kingon & O'Sullivan, 2001;Vega & Gil, 1998). Feeling connected to family consistently protects youth from the development of health risk behaviors such as accidental injury, tobacco and other substance use, sexual activity (Resnick et al., 1997). ...
The purpose of this study was to explore longitudinal relationships between parent derogation and family bonding in a sample of African American and non-Hispanic White males during middle school. While statistically controlling race, regression analyses indicated that parent derogation levels reported in sixth, seventh and eighth grades were statistically highly significant predictors of eighth grade family bonding. However, sixth grade parent derogation was not as strong a predictor as seventh grade parent derogation, and seventh grade was not as strong a predictor as eighth grade parent derogation. These results suggest that improving parent-child communication patterns at any point during middle school could reduce the development of problem behaviors in high school and young adulthood.
... Early sexual onset in such a setting is often blamed on peer pressure, coercion and sudden " freedom " from parental scrutiny. Some studies have shown positive influence of parental supervision in various settings and their provision of protection from unhealthy behaviors by youths [16,17]. Majority of the students were single and this setting typifies one that will present students as youths without " borders " . ...
This study was conducted to assess the level and association of demographic factors on risky sexual behaviors and pattern of condom use among students of a Nigerian university. Final and penultimate year students in University of Nigeria were recruited and purposively sampled. Using a well structured and pre-validated questionnaire, questions on HIV awareness, sexual experiences and condom use were asked and responses collected. Data obtained were analyzed using descriptive statistics and analysis of variance. Exactly 524 students (mean age, 24 years; mean sexual debut age 19 years) participated. More females than male students had bisexual or homosexual partners (4.8% vs. 0.7%, p < 0.01); did not use a condom in the most recent sex (48.3% vs. 22.9%, p < 0.01) and in the last twelve months (31.5% vs. 11.7%, p < 0.05); had been forced for sex (23.2% vs. 18.7%, p < 0.05). More male students did not know their status (37.1% vs. 25.7%, p < 0.05); had oral and anal sex (41.3% vs. 27.3%, p < 0.01). As regards age at first sex, students who debuted earlier (≤ 19 years) performed oral/anal sex (53.6% vs. 40.1%, p < 0.05), did not use a condom during that first sex (70.1% vs. 45.4%, p < 0.01) and have had more than five sexual partners since then (38.5% vs. 10.1%, p < 0.01). This study showed that being male was associated with poor awareness of the virus and risky sexual behaviors and being female was associated with poor/inconsistent condom use. Also having started sex at an early age and being single was linked with risky behaviors. Such behaviors could be cautiously put in check by re-introducing HIV/AIDS prevention awareness strategies in universities.
... Regular family meals may serve as a proxy for parental involvement in a child's life and family connectedness in general ). Family connection is consistently associated with reduced risks for emotional distress, substance use, violence involvement, unhealthy weight control, and sexual behaviors (Borowsky, Ireland, and Resnick 2001;Eisenberg et al. 2004;Kingon and O'Sullivan 2001;Resnick et al. 1997). ...
This study, drawing on approximately 1,100 males from the National Longitudinal Study of Adolescent Health, demonstrates the importance of genetics, and genetic-environmental interactions, for understanding adolescent delinquency and violence. Our analyses show that three genetic polymorphisms - specifically, the 30-bp promoter-region variable number tandem repeat (VNTR) in MAOA, the 40-bp VNTR in DAT1, and the Taq1 polymorphism in DRD2 - are significant predictors of serious and violent delinquency when added to a social-control model of delinquency. Importantly, findings also show that the genetic effects of DRD2 and MAOA are conditional and interact with family processes, school processes, and friendship networks. These results, which are among the first that link molecular genetic variants to delinquency, significantly expand our understanding of delinquent and violent behavior, and they highlight the need to simultaneously consider their social and genetic origins.
... Cross-sectional (51,59) and longitudinal (48,60) studies have found significant associations between family meals and various measures of psychosocial well-being similar to those found in Project EAT. The statistical adjustment for family connectedness in Project EAT is noteworthy, in that it reduces the likelihood that the observed associations are due more generally to positive family functioning, which has been associated with numerous adolescent health behaviours (61,62) as well as family meal frequency. Thus, findings suggest that family meals are associated with positive psychosocial outcomes above and beyond the benefits of family meals for overall family functioning. ...
The purpose of the present paper is to provide an integrated overview of the research methodology and key findings from a decade of research on family meals as part of Project EAT (Eating Among Teens), a large, population-based study of adolescents.
Focus groups conducted with 141 middle-school and high-school adolescents suggested the importance of family meals in influencing adolescents' food choices. These findings led to the inclusion of questions on family meals in the Project EAT-I survey, completed by 4746 middle-school and high-school students, and in the Project EAT-II longitudinal survey, completed by 2516 of the original participants five years later. A subset of 902 parents also participated in telephone interviews as part of Project EAT-I.
Findings indicate that many adolescents and parents view family meals in a positive light, but there is great diversity in the context and frequency of family meal patterns in the homes of adolescents. Findings further suggest that family meals may have benefits in terms of dietary intake, disordered eating behaviours, substance use and psychosocial health.
Findings from Project EAT, in conjunction with other research studies on family meals, suggest the importance of working with families to increase the frequency and improve the quality of family meals. Further research is needed in order to elucidate the pathways that underpin the relationships between family meals and health outcomes. Suggestions for a future research agenda based on what was learned from Project EAT are provided.
... Recent reviews have stressed the importance of the family environment for adolescent substance use, not just as a main effect (Weinberg, Rahdert, Colliver, & Glantz, 1998) but also for moderating peer influence (Kingon & O'Sullivan, 2001). Over the last 30 years, various family-based risk factors for adolescent substance use have been identified, such as family structure, substance using family members, and family atmosphere (Denton & Kampfe, 1994;Kuntsche & Kuendig, 2006;Vakalahi, 2001). ...
This study explored the links between having older siblings who get drunk, satisfaction with the parent-adolescent relationship, parental monitoring, and adolescents' risky drinking. Regression models were conducted based on a national representative sample of 3725 8th to 10th graders in Switzerland (mean age 15.0, SD = .93) who indicated having older siblings. Results showed that both parental factors and older siblings' drinking behaviour shape younger siblings' frequency of risky drinking. Parental monitoring showed a linear dose-response relationship, and siblings' influence had an additive effect. There was a non-linear interaction effect between parent-adolescent relationship and older sibling's drunkenness. The findings suggest that, apart from avoiding an increasingly unsatisfactory relationship with their children, parental monitoring appears to be important in preventing risky drinking by their younger children, even if the older sibling drinks in such a way. However, a satisfying relationship with parents does not seem to be sufficient to counterbalance older siblings' influence.
... Parental supervision has been documented to be protective from other unhealthy behaviours among adolescents in diverse settings (Desrichard, Roché, & Bègue, 2007;Frojd, Kaltiala-Heino & Rimpela, 2007;Harris et al., 2007). Kingon and O'Sullivan (2001) have reported how the family could offer a protective function against unhealthy behaviours among adolescents. ...
Adolescent sexuality is an important public health issue, as it affects risk to contract HIV and other sexually transmitted infections. The assessment of prevalence of sexual intercourse among adolescents is of public health significance, as it may guide policies and programmes aimed at reducing the transmission of sexually transmitted infections among this age group. This cross-sectional study using standardised methodology was conducted to assess the prevalence and correlates of sexual intercourse among Namibian school-going adolescents in 2004. Overall the prevalence of sexual intercourse was 33.2% (44.0% males and 24.8% females). Variables positively associated with the outcome in multivariate analysis were male gender (OR=2.39; 95% CI (1.81, 3.17)), cigarette smoking (OR=1.67; 95% CI (1.07, 2.63)), alcohol drinking (OR=1.63; 95% CI (1.18, 2.26)), and drug use (OR=9.82; 95% CI (6.28, 15.36). Parental supervision was negatively associated with sexual intercourse in the last 12 months (OR=0.73; 95% CI (0.56, 0.94)). Efforts to control unhealthy lifestyles (smoking, alcohol and illicit drug use) may impact on adolescents' sexual activity.
... A review of research over the past 10 years revealed that among etiological variables the family environment is particularly important for adolescent substance use (Weinberg et al., 1998). Another review stresses that despite the overwhelming research on peer influence the family remains a strong factor in moderating adolescent substance use (Kingon and O'sullivan, 2001 ) and, at least for initiation to drinking, parental influence is more important than peer behavior (Jung, 1995). Over the last 30 years, various family-based risk factors for adolescent substance use have been identified, such as family structure, substance using family members, and family atmosphere (Denton and Kampfe, 1994; Vakalahi, 2001). ...
The aim of the present study was to determine if family structure, perception of excessive drinking in the family, and family bonding hold a graduated importance in predicting adolescent alcohol use and their association with peers who drink excessively. Three nested linear structural models were calculated separately for frequent and excessive drinking, based on a sample of 3,127 eighth and ninth graders in Switzerland (mean age 15.3, SD 0.8) surveyed in spring 2002 in the context of the "Health Behavior in School-Aged Children (HBSC)" study. The results confirm that the perception of excessive drinking in the family is more closely related to both frequent and excessive drinking than family structure, and family bonding is more closely related than drinking perception. Adjusting for both socio-demographic variables and the association with peers who drink excessively only slightly changed the results. To predict an association with the latter, family structure was more important than the perception of drinking, but family bonding remained the predominant predictor. The results stress the graduated importance of family-related risk factors: by listening to their children's worries, by spending their free time with them, and by providing help when needed, parents might have the possibility to actively minimize the risk of frequent and excessive drinking regardless of whether they are frequent excessive drinkers or live without a partner.
Protective factors shield young offenders from adversity and stressors, thereby increasing their resilience and reducing their emotional and behavioural problems (EBPs). This chapter investigates a set of external and internal protective factors by examining how they changed over time with EBPs within the EPYC’s sample of young offenders in Singapore. The analyses identified three family-related factors, including family functioning, parental attachment, and home assets, to be effective external protective factors. For internal protective factors, cooperation and communication, and self-efficacy, were identified as two effective buffers. When youths experienced an increase in these factors, their EBPs tended to decrease over time. These findings recommend a strong focus on the family environment in policy making and rehabilitation programmes. Programmes that aim to nurture specific personal competencies could also help to increase resilience for young offenders.
The study aimed to explore the development trend of positive mental health and the interaction between adolescents’ perceived family support and positive mental health. A 3-year longitudinal survey of perceived family support and positive mental health (resilience and self-efficacy) for four waves was conducted with 564 junior high school students (297 girls, mean age = 11.12 ± 0.38 years at baseline). The Latent Growth Curve Modeling indicated that adolescents’ resilience and general self-efficacy showed a curve upward trend, which increased first and then decreased. The development rate decreased each year. The cross-lagged panel model and a random intercept cross-lagged panel model concluded that perceived family support was strongly associated with positive mental health of junior high school students. Family support was important for developing positive mental health in early adolescence. Therefore, attention and interventions targeting positive mental health changes in early adolescence are particularly effective. And, it is important to encourage parents of adolescents to continue to provide support and guidance.
In this preregistered study, we studied the extent to which family functioning and family regularity compensated for (compensatory model of resilience, Garmezy et al., Child Development 55:97–111, 1984) and buffered against (risk-protective factor model of resilience, Fergus and Zimmerman, Annual Review of Public Health 26:399–419, 2005) the influence of cumulative risks (CRs) on young children’s internalizing and externalizing problems. We conducted path analyses on multi-informant, longitudinal data from 3159 families enrolled in the Generation R Study, a large prospective birth cohort in the Netherlands. Children self-reported on internalizing and externalizing problems at age six. Mothers and fathers reported on 48 CRs between birth and child age five. Mothers reported on family regularity items at child ages two and four, and on family functioning at child age four. CR was positively associated with girls’ and boys’ internalizing problems, and with boys’ externalizing problems. We did not find support for a compensatory or buffering role of family functioning on the association between CR and children’s internalizing or externalizing problems. Our findings suggest that the use of a CR index may be beneficial for identifying children who are at higher risk for developing internalizing and externalizing problems in the early school years, as well as for planning treatment and intervention. Keywords: Cumulative risk, Internalizing problems, Externalizing problems, Family functioning, Family regularity, Early childhood.
Introduction:
Sexual minority girls (SMGs) may be at high risk for substance use partially due to anti-gay discrimination. Low levels of parent-child communication and parental knowledge may contribute to this risk. This study seeks to identify parent-child communication and parental knowledge trajectories, determine the likelihood of SMGs following these trajectories, and describe the relationships between these trajectories, sexual orientation, and substance use.
Methods:
This is a secondary data analysis of the Pittsburgh Girls Study (N = 2450), a longitudinal study on the changes in behaviors among girls throughout childhood. We generated group trajectory models of parentchild communication and parental knowledge starting from age 12 to age 17 years. We then tested the likelihood of SMGs belonging to these group trajectories and the association between group trajectory membership and substance use at age 18 years.
Results:
SMGs were more likely than were heterosexual girls to follow the infrequent decreasing parent-child communication trajectory and the slowly decreasing parental knowledge trajectory and were more likely than were heterosexual girls to engage in substance use at age 18 years. Parent-child communication and parental knowledge trajectories were statistically significant mediators between sexual orientation and substance use.
Conclusion:
Frequency of parent-child communication and levels of parental knowledge may be determinants of substance use among SMGs. These results have implications for developing substance use prevention programs among sexual minority youth targeting parent-child relationships.
The purpose of this paper is to describe unique culturally-based factors that may increase the vulnerability of Asian American adolescents to engage in alcohol use and abuse and the role of parent-child bonding as a protective factor. In particular, this paper addresses the interactions among acculturation, alcohol use, and parent-child bonding and the challenges Asian American families face in strengthening parent-child bonds. We begin by examining likely causes for alienation that occur as a result of immigration to the United States. We then present the cultural context of Asian American families that can also serve to create distance between parent and child, including the contrasting cultural orientations of individualism and collectivism, Asian traditional values, differences in Eastern and Western parenting styles, and intergenerational cultural dissonance. Next, we present a review of the research that has examined acculturation as a risk factor for alcohol use and abuse among Asian American adolescents, with special attention to the mediating role of parent-child bonding. Finally, we conclude with recommendations for future research on the risk and protective factors for adolescent substance abuse, as well as other risky health behaviors among the growing population of Asian Americans in the United States.
Homeless youth represent a vulnerable and understudied population. Little research has prospectively identified factors that may place youth at risk for experiencing homelessness. The current study utilizes data from the National Longitudinal Survey of Youth-97 (NLSY-97) to examine predictors of experiencing homelessness as a young adult (before age 25). The NLSY-97 includes a nationally representative sample of 8,984 youth. Data were first collected from these youth when they were between the ages of 12 to 18 years. The current study examined whether individual and family risk factors reported during adolescence predict homelessness by the age of 25. The findings showed that multiple runaway episodes, non-traditional family structure, lower educational attainment, and parental work limitations due to health increased the risk of homelessness. A permissive parenting style and being Hispanic protected against homelessness. This study offers unique insight into risk and protective factors for youth homelessness, and has important clinical implications.
El 19,6% de los colombianos son adolescentes; esto exige una adecuada preparación médica para atender los problemas de salud de esta población. En Colombia, la mortalidad por causas externas es elevada para este grupo, pero estas causas de muerte son las principales en adolescentes a nivel mundial. El sentido de invulnerabilidad y las conductas exploratorias favorecen el consumo de sustancias tóxicas (alcohol, 65%, y tabaco, 35,8%), la precocidad sexual (embarazo, 21%) y la falta de autocontrol. La violencia, los accidentes, el suicidio y las alteraciones de la salud sexual tienen gran repercusión en la vida de jóvenes y familias. Ante la falta de instrumentos de la medición de riesgo y la débil influencia de las intervenciones en los problemas mencionados, el actuar médico con perspectiva de riesgo resulta fundamental. La prevención con el fortalecimiento de los factores protectores (familia, espiritualidad, deporte) cuenta con suficiente evidencia, pero requiere el desarrollo de habilidades y destrezas que no son parte de los procesos regulares de formación médica y tampoco de la práctica profesional rutinaria en Colombia.
Homeless youth represent a vulnerable and understudied population. Little research has prospectively identified factors that may place youth at risk for experiencing homelessness. The current study utilizes data from the National Longitudinal Survey of Youth-97 (NLSY-97) to examine predictors of experiencing homelessness as a young adult (before age 25). The NLSY-97 includes a nationally representative sample of 8984 youth. Data were first collected from these youth when they were between the ages of 12 and 18 years. The current study examined whether individual and family risk factors reported during adolescence predict homelessness by the age of 25. The findings showed that multiple runaway episodes, nontraditional family structure, lower educational attainment, and parental work limitations due to health increased the risk of homelessness. A permissive parenting style and being Hispanic protected against homelessness. This study offers unique insight into risk and protective factors for youth homelessness and has important clinical implications.
One in five public school students is from an immigrant-headed household. We used Youth Risk Behavior Survey data from one state and four large urban school districts to examine whether length of time living in the US was associated with health risk behaviors. Logistic regression models, using weighted data, controlled for sex, race/ethnicity, and grade. Compared to US natives, not having always lived in the US was correlated with lower risk for some behaviors (e.g., current marijuana use and alcohol use) among high school students, but higher risk for other behaviors (e.g., attempted suicide, physical inactivity). Many findings were inconsistent across the study sites. Interventions that specifically target recently-arrived school-aged youth to prevent behaviors that put health and safety at risk, may result in the best outcomes for immigrant youth. Care should be taken to understand the specific health risks present in different immigrant communities.
Associating with substance using peers is generally considered as one of the most important predictors of adolescent substance use. However, peer association does not affect all adolescents in the same way. To better understand when and under what conditions peer association is most linked with adolescent substance use (SU), this review focuses on the factors that may operate as moderators of this association. The review highlighted several potential moderators reflecting adolescents' individual characteristics (e.g., pubertal status, genes and personality), peer and parental factors (e.g., nature of relationships and parental monitoring), and contextual factors (e.g., peer, school and neighborhood context). As peer association is a broad concept, important methodological aspects were also addressed in order to illustrate how they can potentially bias interpretation. Taking these into account, we suggest that, while the effects of some moderators are clear (e.g., parental monitoring and sensation seeking), others are less straightforward (e.g., neighborhood) and need to be further examined. This review also provides recommendations for addressing different methodological concerns in the study of moderators, including: the use of longitudinal and experimental studies and the use of mediated moderation. These will be key for developing theory and effective prevention.
This longitudinal study tested the direction of associations between family meals and alcohol and tobacco consumption during early adolescence. We examined family meal frequency, family connectedness, alcohol (binge drinking, drunkenness), and tobacco consumption (past year, daily frequency) in 671 adolescents (51% women; mean age, Wave 1 = 14.05 years). Structural equation modeling (SEM) was employed to estimate the associations between meal frequency and increases in alcohol and tobacco consumption, and alcohol and tobacco consumption on increases in meal frequency over a year, while adjusting for family connectedness, social class, and age. Family meals were associated with reductions in alcohol and tobacco consumption in girls but not boys. Alcohol consumption was also associated with reductions in the frequency of meals among girls, but not boys. Results supported the assertion that family meals protect some girls from substance abuse but suggest meals may have little impact on existing users.
The purpose of this longitudinal study was to determine if there were changes in familism scores among a sample of African American and non-Hispanic White youths as they progressed through middle school, and if changes differed by race. Results indicated that African American subjects reported higher levels of familism than their non-Hispanic White peers throughout middle school, reaching statistical significance in both seventh and eighth grades. However, scores for both groups decreased slightly between the sixth and ninth grades. The proportion of youth reporting low familism did not differ significantly by race in either the sixth or seventh grade. However, it approached significance in the eighth grade.
Objective:
To examine the association between frequency of family dinners (FFD) and selected problem behaviors for adolescents after adjusting for family connectedness, parental awareness, other family activities, and other potentially confounding factors.
Methods:
Data are drawn from the National Longitudinal Survey of Youth, 1997. The primary variable of interest is self-reported FFD in a typical week. Problem behaviors studied are substance-use, physical violence, property-destruction, stealing, running away from home, andgang membership. Multivariate logistic models are estimated for each behaviors. Linear regression models are estimated for behavior-frequency for the sub-samples engaging in them. Analysis is done separately by gender.
Results:
FFD is negatively associated with substance-use and running away for females; drinking, physical violence, property-destruction, stealing and running away for males.
Conclusion:
Family meals are negatively associated to certain problem behaviors for adolescents even after controlling rigorously for potentially confounding factors. Thus, programs that promote family meals are beneficial.
Peer violence perpetration and victimization are the most common types of violence among youth. This study determined the associations among violent attitudes toward peers, involvement in peer violence perpetration, and experience with peer violence victimization among boys and girls in a high-risk, urban community. Analyses were based on data from the 2004 Youth Violence Survey, which was administered to over 80% of public school students in grades 7, 9, 11, and 12 (N = 4,131) in a disadvantaged, urban, school district in the USA. Logistic regression analyses were conducted to test the associations between attitudes in support of violence and involvement in violent behaviors. Results show that among youth, attitudes supporting boys hitting boys significantly increased the odds of peer violence perpetration after controlling for potential confounders (adjusted odds ratio [AOR], 1.35; 95% confidence interval [CI] = 1.07, 1.72). However, stratified analyses for boys and girls show that attitudes supporting boys hitting boys increased the odds of peer violence perpetration for girls only after controlling for potential confounders (AOR, 1.49; 95% CI = 1.05, 2.13). The findings demonstrate that there are important differences between boys and girls in terms of their associations with violent attitudes and involvement in actual violent behaviors. However, additional research is needed to determine how attitude modifications can be incorporated into youth violence prevention programs.
To examine 5-year longitudinal associations between family meal patterns and subsequent substance use in adolescents.
A total of 806 Minnesota adolescents were surveyed in public schools in 1998-1999 (mean age, 12.8 years) and again by mail in 2003-2004 (mean age, 17.2 years) as part of a longitudinal population-based study. Logistic regression was used to estimate the odds of tobacco, alcohol, and marijuana use at follow-up for adolescents reporting regular family meals at baseline compared with those without regular family meals, adjusting for family connectedness and prior substance use.
Family meal frequency at baseline was associated with significantly lower odds of cigarette smoking, alcohol use, and marijuana use at follow-up among female adolescents, even after adjusting for baseline substance use and additional covariates. Family meals were not associated with use of any substance at follow-up for male adolescents after adjusting for baseline use.
Results from this study suggest that regular family meals in adolescence may have a long-term protective association with the development of substance use over 5 years among females. Parents should be encouraged to establish a pattern of regular family meals, as this activity may have long lasting benefits.
Despite evidence that frequent family meals are associated with low levels of substance use during adolescence, prior studies have not examined the role of how adolescents perceive mealtimes. We examined family meal frequency, family connectedness, perceived priority, atmosphere and structure of mealtimes as predictors of alcohol and tobacco consumption, using data from 550 adolescents (50% boys; age range 11-16). Frequent family meals were significantly associated with a lower likelihood of alcohol and tobacco use. However, this association was explained by adolescents' perception of the atmosphere at mealtimes. These findings suggest adolescents' perception of the mealtime environment contributes to family meals' protective effect.
There is a need to involve sexual partners when addressing sexual behavior of high-risk adolescent women. This study explored men's perceptions of their role in sexual relationships with adolescent women with a history of sexually transmitted infection (STI) and abuse. The AIDS risk reduction model was used to assess sexual risk behaviors of these men for development of cognitive behavioral risk reduction interventions for themselves and partner. Qualitative interviews were conducted with African and Mexican American men (n = 14; ages 18 to 21 years), recruited via adolescent women enrolled in a control-randomized trial of behavioral interventions for reduction of unintended pregnancy, abuse, substance use, and STI. Participants varied in their perceptions of personal susceptibility to STI or HIV, access to informational resources regarding sexual behavior, and level of adult support for safer sexual behavior. These men shared perceptions of inadequate sexual health preparation, including education concerning risk, ultimately contributing to adverse outcomes of sexual behavior.
To compare the prevalence and characteristics of bullying between two towns in Bosnia and Herzegovina-Stolac, which was exposed to firearm conflict during the 1992-1995 war in Bosnia and Herzegovina, and Posusje, which was outside of the active combat zone.
In this cross-sectional study, we included 484 primary school pupils attending 4th-8th grade of elementary school, 217 (44.8%) of them from Stolac and 267 (55.2%) from Posusje. The pupils were interviewed using a standardized questionnaire on the experience of bullying.
Every sixth pupil (16.4%) experienced at least one form of bullying almost every day, while 34 (7.0%) pupils constantly bullied other children. Sixth-eighth graders were more often bullies than 4th-5th graders (P=0.044). Girls were most often victims was of bullying, while boys were most often bullies (P=0.036). The expected difference in bullying between the two towns was not observed, except for older pupils in Posusje, who were more violent than their peers in Stolac (P=0.044). Among the analyzed variables of sex, age, town, and school achievement, only male sex was significant predictor of bullying (P=0.010), increasing the relative risk by 3.005 times.
Bullying among primary school pupils did not differ between areas that experienced war activities in 1992-1995. Our results could be useful in the introduction of specific prevention measures against bullying in postwar situation.
In nursing, critical thinking is particularly important because of its potential impact on patient care. With the rapid changes in health care and the influx of new technology, nurses must be able to use critical thinking to make decisions that provide optimal patient care. The rapid, dynamic changes occurring in the health care setting have dictated a stronger, more comprehensive, holistic way of arriving at decisions than the traditional nursing process. This more comprehensive, holistic approach is called critical thinking. Nurses must be able to engage in critical thinking to handle the onslaught of continuous procedural and technological changes. Critical thinking has become such a key component in learning that the National League for Nursing requires that graduates be able to demonstrate critical thinking. This article is a concept analysis of critical thinking using the Walker and Avant model.
The nursing faculty at the State University of West Georgia views individuals as an integration of body-mind-spirit. Our program's commitment complements efforts to teach students to honor the body, mind, and spirit of patients. Within this framework, faculty recognize that factors other than nursing knowledge impact students' ability to pass NCLEX-RN. An intervention program was designed that incorporated these factors. "Preparation for Licensure" was implemented as a holistic nursing course to intervene with students' learning and testing needs. The purpose was to increase self-awareness, promote a positive attitude toward passing the NCLEX-RN, and provide specific strategies for test taking and stress reduction. Posttest raw scores and percent correct on the Mosby Assess Test were significantly higher (p < .05) than pretest scores. Qualitative analysis of journal data exploring the students' experience of participating in the course revealed three themes: Perfectionism, Self-Worth, and Consequences and Meaning of Failure.
To determine the association between frequency of family meals and multiple indicators of adolescent health and well-being (tobacco, alcohol, and marijuana use; academic performance; self-esteem; depressive symptoms; and suicide involvement) after controlling for family connectedness.
Data come from a 1998-1999 school-based survey of 4746 adolescents from ethnically and socioeconomically diverse communities in the Minneapolis/St Paul, Minn, metropolitan area. Logistic regression, controlling for family connectedness and sociodemographic variables, was used to identify relationships between family meals and adolescent health behaviors.
Approximately one quarter (26.8%) of respondents ate 7 or more family meals in the past week, and approximately one quarter (23.1%) ate family meals 2 times or less. Frequency of family meals was inversely associated with tobacco, alcohol, and marijuana use; low grade point average; depressive symptoms; and suicide involvement after controlling for family connectedness (odds ratios, 0.76-0.93).
Findings suggest that eating family meals may enhance the health and well-being of adolescents. Public education on the benefits of family mealtime is recommended.
Health-risk behaviors and associated adverse health outcomes in homeless adolescents are well documented. Strengths of these youth that contribute to their health and well-being are seldom acknowledged. The purpose of this secondary analysis of qualitative data was to identify strengths that protect homeless youth. Two types of strengths emerged: resources and self-improvement. Resources served as the foundation for survival whereas self-improvement served as a process that enabled youth to consider a more healthy future. By recognizing the many strengths of homeless youth, nurses may develop community-based programs to help this population reenter society.
To determine whether the frequency of family meals in childhood is associated with positive health outcomes in adolescence through the mediating links of increased family cohesion and positive coping skills.
Data were obtained from the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS), a 10-year longitudinal study of 2,379 black and white girls assessed annually from ages 9-19. The mediational analysis framework of H. C. Kraemer and colleagues (2001) was used to test the hypothesis that the frequency of family meals in childhood (Study Years 1 and 3) would be related to health outcomes (Study Year 10) through the mediating links of family cohesion and coping skills (Study Years 7/8), after adjusting for baseline (Year 1) demographics as well as previous levels of the outcome variables (Years 5/6).
Several measures of adolescent health variables were included as outcome measures. These included the Perceived Stress Scale, three Eating Disorders Inventory subscales (drive for thinness, body dissatisfaction, and bulimia), number of days of alcohol and tobacco consumption, and engaging in extreme weight control behaviors (e.g., self-induced vomiting).
More frequent family meals in the first 3 study years predicted greater family cohesion and problem- and emotion-focused coping in Years 7 and 8. Family cohesion mediated family meals and risk of smoking in Year 10. Problem-focused coping mediated family meals and both stress and disordered eating-related attitudes and behaviors in Year 10.
Eating together as a family during childhood may have multiple benefits in later years.
A problem-focused paradigm tends to dominate theory, research, and practice and has been traditionally used to plan, organize, and implement prevention policies, programs, and practices. An emerging paradigm focuses on conceptualizing core elements of human development to enhance health and well-being. This article describes the research instrument that has provided the primary source of data for the developmental assets framework, Search Institute Profiles of Student Life: Attitudes and Behaviors, a self-report survey designed for 6th- to 12th-grade youth. The article also describes the research tradition informing the developmental assets framework, a discussion of how measurement and reporting was approached given its use in applied settings, and an analysis of the utility of the developmental assets in predicting adolescent risk behaviors.
With a sample of 116, the authors asked how characteristics of the family, rated by adolescents, predicted health risk behavior at young adulthood 6 years later and whether adolescent and young adult personal and emotional functioning mediated these relationships. The authors also explored the consistency of relationships among these variables across 4 types of families: balanced, traditional, disconnected, and emotionally strained. The family variables significantly predicted young adult health risk behavior over time and functioning at adolescence and young adulthood did not serve as a mediator. The family model operated well in 3 of the 4 family contexts; it failed to operate among offspring from disconnected families. Characteristics of the family affect the display of health risk behavior when offspring come from families that have well-defined and coherent family structures. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this paper we examine the degree to which family cohesion buffers the effects of fathers' problem drinking at Time 1 (T1) on adolescent distress, deviance, and heavy drinking at Time 2 (T2), one year later. Data from a representative sample of 658 families were used to test the hypotheses. Mothers, fathers (if present), and adolescent children were interviewed in the home. Fathers who were present completed self-report scales measuring problem drinking. When fathers were not available, mothers' reports on fathers' drinking were used to measure fathers' problem drinking. Results from regression analysis indicate that after controlling for the effects of race, SES, age, gender, and family structure: (1) the more cohesion in the family and the fever stressful events, the less distress, deviance, and heavy drinking shown by adolescents; (2) the fathers' problem drinking affects adolescent distress and deviance when cohesion is low; but as cohesion increases, the effects of the fathers' drinking are reduced. The findings support the hypothesis that cohesion in families buffers the effects of fathers' problem drinking on adolescents.
Past research suggests that adolescent children of alcoholics (COAs) are at heightened risk for alcohol and drug use. However, not all COAs use substances during adolescence. The current study investigated whether five factors (self-awareness, perceived control, family organization, behavioral coping and cognitive coping) buffer COA risk for substance use initiation during adolescence.
A community sample of 454 COA and matched control families was recruited to participate in a 3-year longitudinal study, involving annual computer-assisted interviews with adolescents and their parents. Subjects were selected for the current study if they had complete data at all three assessment periods and showed either abstinence throughout the study or substance use initiation after the first wave of assessment. A subsample of 267 (127 COAs, 147 controls; 147 male) of the original participants was included in the current analyses.
Logistic regress on analyses found some support for the buffering hypothesis in that COAs with greater perceived control or extreme (very low or high) levels of cognitive coping were less likely to initiate substance use than their peers. Main effects suggested that adolescents reporting high family organization and either very low or very high levels of behavioral coping were less likely to initiate substance use over the course of the study.
These findings suggest that highly organized families and behavioral coping efforts may deter substance use initiation. Moreover, perceived control over one's environment and cognitive coping may buffer adolescents from the risk associated with parent alcoholism for substance use.
Using self-report questionnaire data from high school students (N = 253), the relation between adolescents' perceptions of family characteristics and adolescent substance use patterns were examined. Results indicated that adolescents' perception of maternal substance use, family hardiness, and age of the adolescent were significant predictors of adolescent substance use. Implications are presented.
The main threats to adolescents' health are the risk behaviors they choose. How their social context shapes their behaviors is poorly understood.
To identify risk and protective factors at the family, school, and individual levels as they relate to 4 domains of adolescent health and morbidity: emotional health, violence, substance use, and sexuality.
Cross-sectional analysis of interview data from the National Longitudinal Study of Adolescent Health.
A total of 12118 adolescents in grades 7 through 12 drawn from an initial national school survey of 90118 adolescents from 80 high schools plus their feeder middle schools.
The interview was completed in the subject's home.
Eight areas were assessed: emotional distress; suicidal thoughts and behaviors; violence; use of 3 substances (cigarettes, alcohol, marijuana); and 2 types of sexual behaviors (age of sexual debut and pregnancy history). Independent variables included measures of family context, school context, and individual characteristics.
Parent-family connectedness and perceived school connectedness were protective against every health risk behavior measure except history of pregnancy. Conversely, ease of access to guns at home was associated with suicidality (grades 9-12: P<.001) and violence (grades 7-8: P<.001; grades 9-12: P<.001). Access to substances in the home was associated with use of cigarettes (P<.001), alcohol (P<.001), and marijuana (P<.001) among all students. Working 20 or more hours a week was associated with emotional distress of high school students (P<.01), cigarette use (P<.001), alcohol use (P<.001), and marijuana use (P<.001). Appearing "older than most" in class was associated with emotional distress and suicidal thoughts and behaviors among high school students (P<.001); it was also associated with substance use and an earlier age of sexual debut among both junior and senior high students. Repeating a grade in school was associated with emotional distress among students in junior high (P<.001) and high school (P<.01) and with tobacco use among junior high students (P<.001). On the other hand, parental expectations regarding school achievement were associated with lower levels of health risk behaviors; parental disapproval of early sexual debut was associated with a later age of onset of intercourse (P<.001).
Family and school contexts as well as individual characteristics are associated with health and risky behaviors in adolescents. The results should assist health and social service providers, educators, and others in taking the first steps to diminish risk factors and enhance protective factors for our young people.
Utilized a pattern‐based approach to discover the different constellations of perceived social transactions separately for family and peer systems and explored the risk and protective functions of these microsystem profiles for both depression and antisocial behavior among a sample of ethnically and racially diverse urban adolescents living in poverty. Measures of perceived social support, involvement and hassles with family and peers, as well as perceived social acceptance and peers' values were entered into two sets of iterative cluster analyses to identify distinct profiles of family and peer transactions. From each of the perceived family and peer transactional analyses, six replicated profiles emerged. Several of the profiles were consistent with expectations from prior literature such as Enmeshing families and Rejecting peer networks, while others were novel and intriguing such as Entangling peers. Family profiles were consistent in their risk and protective associations for both depression and antisocial behavior, while the peer profiles varied in their effects for each developmental outcome. For example, the Rejecting peer profile placed adolescents at increased risk for depression but protected them from antisocial behavior. Implications for future research and preventive intervention are discussed.
Objectives:
To compare the self-reported risk-taking behaviors, health status, and access to care issues of 2 samples of shelter-based homeless youth who had previously been street youth (youth on streets or doubling-up with friends or lovers) and systems youth (youth involved in foster care) and to examine information on the etiology of homelessness, including parent or family of origin risk factors for both samples.Design:
The study population consisted of 109 shelter-based homeless youth: 41 street youth and 68 systems youth. A chart audit was completed on all youth, noting documentation of past health problems, reasons for shelter placement, and parental risk factors. Adolescents from both samples completed a health history questionnaire followed by a physical examination. Differences between the 2 samples for behaviors and disease diagnoses were examined using χ2 and 2-tailed t tests.Results:
The street youth exhibited greater risk-taking behaviors and suffered from poorer health status and access to care than did systems youth. The main differences were in substance using and high-risk sexual behaviors. The street youth were more likely to report previous exposure to violence and having been victims of forced sex. Self-reported risk behaviors, including sexual activity and substance abuse were corroborated by more objective information on these items from medical record information. The street youth were more likely to be medically uninsured, to have used an emergency department in the past year, and to have used an emergency department for their last care.Conclusions:
There are important variations in health needs between samples of homeless youth, often overlooked in health planning for this population. Knowledge of parent or family of origin risk factors and causes of homelessness provides important contextual information for understanding the risk behaviors and health states of homeless youth.Arch Pediatr Adolesc Med. 1997;151:817-823
Objective
To review the latest studies on risk and protective factors for the development of substance abuse and the effectiveness of prevention interventions for the pediatric population.
Data Sources
Multiple bibliographic databases, including MEDLINE and ERIC, were used to develop a comprehensive review of the literature on substance abuse prevention during the last 10 years. Selected indexing terms included substance abuse prevention, risk factors, and protective factors . Research monographs from the National Institute on Drug Abuse and the Center for Substance Abuse Prevention were used, along with information from authors of prevention curricula.
Study Selection
Study populations included children from birth through adolescence who were enrolled in controlled, prospective, and/or longitudinal studies of either protective or risk factors for the development of substance abuse or response to substance abuse prevention programs. Studies of adult patients that investigated predisposing risk factors for substance abuse (eg, genetic implications) were also used. Care was taken to ensure studies included children from diverse racial and social backgrounds.
Data Extraction
Information was abstracted and summarized from peer-reviewed publications. Controlled random-designed studies were used to determine prevention program efficacy.
Data Synthesis
Main results of the review are summarized in a qualitative format.
Conclusions
Factors that contribute to the emergence of substance abuse in the pediatric population are multifactorial. Behavioral, emotional, and environmental factors that place children at risk for the development of substance abuse may be remediated through prevention and intervention programs that use research-based, comprehensive, culturally relevant, social resistance skills training and normative education in an active school-based learning format.
Context
American Indians and Alaska Natives have the highest suicide rates of all ethnic groups in the United States, and suicide is the second leading cause of death for American Indian and Alaska Native youth.
Objective
To identify risk and protective factors associated with suicide attempts among native male and female adolescents.
Design
The 1990 National American Indian Adolescent Health Survey.
Setting
Schools of reservation communities in 8 Indian Health Service areas.
Participants
Eleven thousand six hundred sixty-six 7th-through 12th-grade American Indian and Alaska native youth.
Main Outcome Measures
Responses were compared among adolescents with and without a self-reported history of attempted suicide. Independent variables included measures of community, family, and individual characteristics. Separate analyses were conducted for boys and girls.
Results
Ever attempting suicide was reported by 21.8% of girls and 11.8% of boys. By logistic regression done on boys and girls separately, suicide attempts were associated with friends or family members attempting or completing suicide; somatic symptoms; physical or sexual abuse; health concerns; using alcohol, marijuana, or other drugs; a history of being in a special education class; treatment for emotional problems; gang involvement; and gun availability. For male and female youth, discussing problems with friends or family, emotional health, and connectedness to family were protective against suicide attempts. The estimated probability of attempting suicide increased dramatically as the number of risk factors to which an adolescent was exposed increased; however, increasing protective factors was more effective at reducing the probability of a suicide attempt than was decreasing risk factors.
Conclusions
A history of attempted suicide was associated with several risk and protective factors. In addition to targeting youth at increased risk, preventive efforts should include promotion of protective factors in the lives of all youth in this population.
This study uses lifespan and ecological frameworks to investigate the factors associated with early adolescent sexual activity. Data from a longitudinal study of urban teenagers of color address three issues: (1) the prevalence and pattern of sexual activity among boys and girls ages 15 and younger, (2) the link between early sexual activity and high-risk sexual behavior, and (3) the life contexts linked with early sexual activity. Results from 803 African American and Hispanic adolescents suggest a high prevalence of early sexual activity, which is associated with higher rates of childbearing and risky sexual behavior than sexual activity initiated in later adolescence. Somewhat different factors are associated with early sexual activity for boys and girls, although family composition, parent attachment, and substance use are important for both genders. Implications for intervention are discussed.
Differences among three outcome groups of late adolescents identified as at risk for major depression were investigated. Adolescents with major depression, with other psychiatric diagnoses, and with no diagnoses differed in major areas of functioning and well-being, with the most difficulties shown by those with depression. The phenomenon of resilience was examined among the at-risk adolescents with no diagnosis, revealing that family cohesion and social support are associated with resilience. Implications for social work practice and research include the need to focus on promoting family strengths.
Purpose:
To examine parental influences on two transitions in the adolescent smoking uptake process: from never having smoked to experimentation and from experimentation to established smoking.
Methods:
Using data from the longitudinal Teenage Attitudes and Practices Survey of 1989-1993, we related perceived parental concern about their adolescents' future smoking, parental smoking status, problem-solving communication between parent and adolescent, demographics, and other factors at baseline to experimentation by follow-up among those who had never puffed on a cigarette (n = 4149). We also related these factors at baseline to reaching a lifetime level of smoking of at least 100 cigarettes by follow up among those who had experimented but smoked < 100 cigarettes (n = 2684) in univariate and multivariate analyses.
Results:
Among never-smokers, baseline susceptibility to smoking and having male best friends who smoke predicted experimentation in the next 4 years. Among experimenters, susceptibility to smoking, having male or female best friends who smoked, and lack of parental concern about future smoking distinguished those who progressed to established smoking by follow-up. Furthermore, communicating with parents first about serious problems was protective against progression from experimentation to established smoking.
Conclusion:
Interventions aimed at reducing adolescent smoking should encourage cessation for parents who smoke and help parents communicate strong anti-smoking norms to children and adolescents and maintain strong lines of communication with them.
This study examined the suicidal involvement, disordered eating behaviors, sexual risk taking, delinquent behaviors, substance use and school performance of male teenagers with a reported history of sexual abuse. With the exception of school performance, this group had higher rates of adverse correlates in these areas than the comparison group without a history of abuse. Among index group members, protective factors against adverse correlates included a higher maternal education, emotional well-being and perceived caring from parents. Risk factors that increased the likelihood of adverse correlates included perceived substance use in school and family stresses.
The purpose of this study was to identify determinants of violent and nonviolent behavior among a group of vulnerable inner-city youths. Students attending schools known to be at high risk for violence (n =521) were administered an anonymous questionnaire. Logistic regression analysis predicted violent behavior from youths who are exposed to violence, are gang members, have family or friends who are gang members, and have peer support. Nonviolent behavior was predicted from youths who have adult social support, view religion as important, are younger, and are female. This sstudy supports the role of certain factors in mitigating violent behavior among vulnerable youths
(C) Williams & Wilkins 1997. All Rights Reserved.
Violence has reached epidemic proportions in the United States, with African American males residing in urban areas bearing the brunt of this epidemic. The violence permeating our society emanates from a variety of societal ills, including poverty, racism, substance abuse and exposure to violence. Traditionally, methods of research on adolescent violence have focused on an identification of associated risk factors. The majority of African American adolescents living in communities with widespread and chronic violence grow up to be law-abiding citizens. The reason for this may be due to resiliency within these adolescents. Resiliency has been defined as the ability to experience adverse circumstances and successfully overcome them. Resiliency is enhanced through three mechanisms identified as protective factors: individual characteristics/traits; familial traits; and extrafamilial relationships. The risks faced may be altered, and even ameliorated, through the presence of these protective factors. The purpose of this paper is to identify protective factors within the family that foster resiliency. Protective factors within the family may be categorized as having three broad characteristics: caring and support, high expectations, and encouragement of participation and involvement for the adolescent.
Adolescent delinquency is an ever-increasing societal concern. Certain health problems are concentrated in the delinquent population. Families of delinquent youths often fail to reinforce self-care. Therefore health care providers need to focus on ways to teach delinquent adolescents to care for themselves. This article reviews delinquency and characteristics of juvenile delinquents and their families. A model is presented to guide health care providers to assess delinquent adolescents' abilities to care for themselves and to teach them strategies for self-care.
Resilience is relevant to nurses because of its implications for health. Research on the resilience of children and adolescents has proliferated over the past five years. However, the specific processes underlying resilience and outcome variables require further study. Furthermore, few intervention studies have been conducted. This article describes resilience and factors that influence resilience of children, examines the relationship between resilience and health, identifies interventions that foster children's resilience and health, reviews research focusing on children's resilience, and suggests the relevance of resilience to nursing of children.
This study identified social, cognitive, and behavioral factors associated with how adolescents seek health care for sexually transmitted diseases.
Data for male and female adolescents (n = 208) attending a clinic specializing in sexually transmitted diseases were examined.
Symptomatic female adolescents required greater time to obtain care than asymptomatic female adolescents or symptomatic male adolescents. Factors affecting duration of care seeking interval included perception of barriers to care, lower self-efficacy for response to a sexually transmitted disease, greater perceived seriousness of sexually transmitted diseases, previous history of sexually transmitted diseases, and stigma.
Improved secondary sexually transmitted disease prevention efforts among adolescents require reductions in barriers to care and improved symptom recognition by adolescents.
Many surveys of adolescent behavior are dependent on self-reported data. We sought to assess the accuracy of adolescent self-report of sexually transmitted diseases (STDs) and pregnancies.
We randomly selected 149 (118 females, 31 males) adolescents to participate in this accuracy study. Follow-up questionnaires were administered to the 126 patients (99 females, 27 males) who returned after enrollment. Patients were asked about STDs and pregnancies during the follow-up period which ranged from 6 months to 1 year. All patient charts were reviewed to validate post-testing history.
Return visits were made by 126 patients (84%). Fifty-one (40%) denied having had an STD at all during the follow-up period but were found to have had at least one STD. Another 11 (9%) admitted having had an STD but had multiple STDs in excess of what they reported. Only 46% of the patients provided accurate information on the follow-up questionnaire. Of the 99 girls who returned for follow-up, the inaccurate patients (10%) consisted of 9 who reported no visits for a pregnancy but had a pregnancy documented in their charts and 1 who underreported her number of pregnancies. Reliability analysis of the accuracy of STD and pregnancy self-report for our patients showed kappas ranging from 0.185 to 0.413 (slight and fair to moderate, respectively). Pearson correlation coefficients were 0.3107 and 0.4364 for STD and pregnancy, respectively.
Our patients' histories of visits for STDs and pregnancies are often not substantiated by review of their medical records. The reason for the inaccuracies in self-report of sexual behaviors is unclear. Further research in this area should be done. Physicians must confirm patient history concerning sexual practices through appropriate record review and medical evaluation.
To examine the relationship of reported condom use to specific sociodemographics, psychosocial variables, and perceptions of and motivations for condom use as conceptualized by the Health Belief Model.
This study performed a cross-sectional survey of 557 adolescents enrolled in a hospital-based pregnancy prevention program in an urban community hospital (Harlem Hospital). Multiple logistic regression analysis examined the combined relationship of the significant psychosocial variables to consistent condom use.
Males were less likely than females to report teen-parent conflict and depression and more likely to report support for birth control, participation in community activities, and favorable attitudes toward delaying parenthood. Consistent with the Health Belief Model adjusting for age, the strongest predictors of consistent condom use were partner preference for condoms, perceived benefit of avoidance of pregnancy, male gender, and support for birth control (usually by a parent).
The data on this urban, predominantly African-American sample of adolescents suggest the importance of the influences on specific motivations to use protection--that is, the wish to avoid pregnancy, human immunodeficiency virus/acquired immunodeficiency syndrome, and sexually transmitted diseases, although the mechanisms are still unclear. In addition, gender and the modifying effects of parental and partner support of the use of protection strongly influence the reported use of condoms by adolescents. These factors (in addition to psychosocial factors such as depression) may be important in planning interventions to increase condom use by sexually active teens.
The purpose of this study was to examine the associations among delinquency/aggressiveness and alcohol or drug use, sexual risk behaviors, and other scales from the Problem-Oriented Screening Instrument for Teenagers (POSIT).
A total of 173 15- to 18-year-olds attending adolescent medicine clinic completed a 183-item questionnaire. The questionnaire contained the POSIT, the CAGE questions, a 22-item alcohol and drug screen (AOD), and a human immunodeficiency virus and sexual risk behavior screen. The dependent variable was the Aggressive Behavior/Delinquency (ABD) scale from the POSIT.
There were no gender or racial differences in the ABD scale (p > 0.05). The ABD scale was significantly (p < or = 0.001) associated with the POSIT AOD scale (r = 0.46), the 22-item AOD drug screen (r = 0.57), the CAGE questions (r = 0.39), the sexual risk behavior scale (r = 0.39), and the POSIT physical health (r = 0.34), mental health (r = 0.51), family relations status (r = 0.37), peer relations (r = 0.57), educational status (r = 0.44), social skills (r = 0.31), and leisure/recreation (r = 0.16) scales. Multiple regression analysis indicated that the AOD screen and problems in the area of peer relations, family relations, and mental health accounted for 47.7% of the variation in the ABD scale (p < or = 0.00001).
These findings suggest that adolescents who engage in more aggressive and delinquent behaviors are more likely to use alcohol and other drugs, engage in sexual risk behaviors, report problems with peer and family relationships, and report more mental health symptoms.
The purpose of this study was to identify factors protective against the adverse health correlates of sexual abuse in reservation-based American Indian and Alaskan Native adolescents.
Data were taken from the National American Indian Adolescent Health Survey administered in 1988-1990 to 13,923 youths. Included in this analysis were 991 females and 166 males who reported a history of sexual abuse. Chi-square analysis was used to identify significant protective factors in sexually abused youths who did not report suicidality or hopelessness. Discriminant function analysis was used to determine which factors distinguished this group from those who experienced adverse health correlates.
Separate multivariate analyses for boys and girls demonstrated that for girls, family attention, positive feelings toward school, parental expectations, and caring exhibited by family, adults, and tribal leaders were associated with absence of suicidality and hopelessness. For suicidality in boys, significant protective factors were enjoyment of school, involvement in traditional activities, strong academic performance, and caring exhibited by family, adults, school people, and tribal leaders. No significant protective factors against hopelessness were identified for boys.
To minimize hopelessness and suicidal involvement among youth who have been sexually abused, strategies should be planned, implemented, and evaluated that support family caring and connectedness, strengthen school attachment and performance, and improve tribal connectedness.
Social support, widely studied as a variable that positively affects the adaptation of adolescents, is often less present in the lives of youths at risk of school failure. This study explores the social support of at-risk students, including who provides each of eight types of support, and the effects of particular types of social support on school performance outcomes. Results of analyses of data from students enrolled in Communities in Schools programs, indicate that parents and adult caretakers are major sources of social support for both middle and high school at-risk students. Analyses of school outcomes data indicate that particular types of social support are associated with different desirable school outcomes. The article presents implications for social work practice and the development of intervention strategies to enhance students' school performance and behavior.
To review the latest studies on risk and protective factors for the development of substance abuse and the effectiveness of prevention interventions for the pediatric population.
Multiple bibliographic databases, including MEDLINE and ERIC, were used to develop a comprehensive review of the literature on substance abuse prevention during the last 10 years. Selected indexing terms included substance abuse prevention, risk factors, and protective factors. Research monographs from the National Institute on Drug Abuse and the Center for Substance Abuse Prevention were used, along with information from authors of prevention curricula.
Study populations included children from birth through adolescence who were enrolled in controlled, prospective, and/or longitudinal studies of either protective or risk factors for the development of substance abuse or response to substance abuse prevention programs. Studies of adult patients that investigated predisposing risk factors for substance abuse (eg, genetic implications) were also used. Care was taken to ensure studies included children from diverse racial and social backgrounds.
Information was abstracted and summarized from peer-reviewed publications. Controlled random-designed studies were used to determine prevention program efficacy.
Main results of the review are summarized in a qualitative format.
Factors that contribute to the emergence of substance abuse in the pediatric population are multifactorial. Behavioral, emotional, and environmental factors that place children at risk for the development of substance abuse may be remediated through prevention and intervention programs that use research-based, comprehensive, culturally relevant, social resistance skills training and normative education in an active school-based learning format.
A part of a larger study of the health behaviors of adolescent women, this investigation examined health-promoting behaviors and the influence of cognitive, social, and environmental factors on these health-promoting behaviors of rural adolescent women. The sample consisted of 128 rural African-American and white adolescent women. Forty-four percent of the variance in health-promoting behavior of this sample was explained by five variables: self-image, problem solving, mother's education, employment status, and family structure. Self-image was the most salient predictor of health-promoting behavior, explaining 33% of the variance.
Mainstream health care for homeless youth is often fragmented or unavailable.
To evaluate the use of complementary and alternative medicine (CAM) by homeless youth who use our free clinic.
Self-administered cross-sectional survey.
Subjects included homeless youth between the ages of 14 and 21 years receiving care at the 45th Street Clinic Youth Program in Seattle, Wash, between January 29,1998, and March 5, 1998. The self-administered survey included items on demographics, health issues, use frequency of different therapists or therapies, referral sources, and perceived effectiveness of treatment.
The response rate by patients was 96.3% (157/163) with an average respondent age of 18.5 years (range, 14-21 years). Complementary and alternative medicine was used by 70.1% of the subjects. Referrals most often came from friends (52.7%). The most common reason for using CAM was because it was "natural" (43.9%). Most of those who used alternative therapies (87.3%) believed they had been helped "some" or "a lot." Given a choice of providers to visit when they were ill, 51.7% would seek care from a physician, 36.9% from a CAM provider, and 11.4% would treat themselves.
Care with CAM is frequently used and accepted by homeless youth. Cost-effectiveness and contributions to overall health care require additional evaluation. Integrating CAM into allopathic health centers may serve as an incentive to entice youth into mainstream health care.
Utilized a pattern-based approach to discover the different constellations of perceived social transactions separately for family and peer systems and explored the risk and protective functions of these microsystem profiles for both depression and antisocial behavior among a sample of ethnically and racially diverse urban adolescents living in poverty. Measures of perceived social support, involvement and hassles with family and peers, as well as perceived social acceptance and peers' values were entered into two sets of iterative cluster analyses to identify distinct profiles of family and peer transactions. From each of the perceived family and peer transactional analyses, six replicated profiles emerged. Several of the profiles were consistent with expectations from prior literature such as Enmeshing families and Rejecting peer networks, while others were novel and intriguing such as Entangling peers. Family profiles were consistent in their risk and protective associations for both depression and antisocial behavior, while the peer profiles varied in their effects for each developmental outcome. For example, the Rejecting peer profile placed adolescents at increased risk for depression but protected them from antisocial behavior. Implications for future research and preventive intervention are discussed.
- American Academy of Pediatrics