Brandon Respress, PhDc, RN, MSN, MPH, CPNP Frances Payne Bolton School of Nursing October 15, 2009

1. Social Determinants of Adolescent Risk Behaviors: An Examination of Depressive Symptoms, Sexual Behaviors, Substance Use, and Suicide Risk Behaviors Brandon Respress, PhDc, RN, MSN, MPH, CPNP Frances Payne Bolton School of Nursing October 15, 2009

2. Acknowledgements • Dissertation Committee: • Chair: Dr. Diana L. Morris, PhD, RN, FAAN • Member: Dr. Faye A. Gary, EdD, RN, FAAN • Member: Dr. Linda C. Lewin, PhD, RN, ARNP-BC • Member: Dr. Shelley A. Francis, DrPH, • Dr. Hossein Yarandi, PhD • Funding Sources: • ANA/SAMHSA Ethnic Minority Program • T32: Childbearing, Childrearing, and Caregiving Research Training Grant, Frances Payne Bolton School of Nursing, Cleveland, OH

3. Acknowledgements • This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. • Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. • Persons interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 27516-2524 (addhealth@unc.edu). • No direct support was received from grant P01-HD31921 for this analysis.

4. Purpose • Examine the relationships among race, mother’s education, household income, poverty status, academic performance, and perceived prejudice and discrimination; and reports of depression, sexual, substance use, and suicide risk behaviors in urban high school adolescents. • Identify differences in socioenvironmental factors predicting likelihood of risk behaviors across race categories

5. Adolescence • Transitional period • Time of profound biological, intellectual, psychological, and economic change • Middle adolescence (ages 14-18) often associated with an increase in health • Lifestyle patterns adopted during this period of change and growth often continued into adulthood.

6. Adolescent Risk Behaviors • 68.6% of high school seniors reported frequent use of alcohol • 49.7% reported binge drinking within the past 2 weeks (Johnston, O’Malley, Bachman, & Schulenberg, 2006). • Up to 20% of high school student reported regular use of marijuana, within the past 30 days (Eaton et al., 2006).

7. Adolescent Risk Behaviors • Nearly half of all newly acquired STD infections have been diagnosed in 15 to 24 year olds (Centers for Disease Control and Prevention (CDC), 2007). • 757,000 pregnancies occurred among women aged 15-19 years (Abma, Martinez, Mosher, & Dawson, 2004). • Adolescent pregnancy rates have declined; however, disproportionate rates of pregnancies occur in more in blacks than whites (Hamilton, Martin, & Ventura, 2006).

8. Adolescent Risk Behaviors • 13% of high school students surveyed formulated a plan to commit suicide during the past year • 8.4% had actually attempted suicide (Eaton et al., 2006). • 28.5% of students nationwide had felt so sad or hopeless almost every day for 2 or more weeks in a row that they stopped doing some usual activities, during the 12 months (Eaton et al., 2008).

9. Consequences of Adolescent Risk Behaviors • Engagement in risky sexual behaviors, drunk driving, physical and psychological impairment, and suicidal ideation • Academic difficulties • Interpersonal problems • Emotional problems such as depression and anxiety • Problems can continue into adulthood (Horgan et al., 2001; Miller et al., 2006).

10. Significance • African and Hispanic Americans have higher rates of substance related morbidity and mortality in adulthood (Gil, Wagner, & Tubman, 2004; James, Kim, & Armijo, 2000; Wallace et al., 2002). • Risky behaviors in adolescents may be related to an imbalance between race, socioeconomic status, age, and gender differences. • Failure to address these determinants creates an increased vulnerability in the overall well-being of adolescents (Merline et al., 2004).

11. LaVeist’s Social Determinants of Heath Model (2005) Theoretical Framework LaVeist’s Conceptual Model of Race (1994)

12. Conceptualization of Risky Behaviors in Urban Adolescents

13. Research Questions • What are the socioenvironmental and behavioral characteristics of adolescents in Wave II of the Add Health Study? • What is the relationship between race and adolescent risky behaviors? • Which combination of socioenvironmental factors [chronological age, gender, grade level, race, SES (mother’s education, household income, poverty status), perceived racism (perceived prejudice, perceived discrimination), and academic performance best predict the odds of engagement in sexual risk behaviors in adolescents?

14. Research Questions • Which combination of socioenvironmental factors best predict substance use [alcohol and marijuana use] in adolescents? • Which combination of socioenvironmental factors best predict the odds of suicidal risk behaviors in adolescents? • Which combination of socioenvironmental factors best predict depressive symptoms in adolescents?

15. Socioenvironmental Context Individual Level Behaviors * Race *Socioeconomic Status *Mother's Education *Household Income *Poverty Status *Perceived Racism *Perceived Prejudice and Discrimination *Academic Performance *Substance Use *Alcohol Use * Marijuana Use * Sexual Risk * Suicide Risk *Depressive Symptoms Research Model

16. Methods: Secondary Study • Setting: In-Home Interviews conducted during Wave II of the Add Health Study, Public Use Data Set • Sample: • High school students grades 9-12 • One-half of the core, chosen at random, and one-half of the over-sample of African-American adolescents with a parent who has a college degree • Oversamples of: Blacks from well-educated families, Chinese, Cubans, and Puerto Rican backgrounds, individuals with physical disabilities, and genetically related (twins) siblings

17. Results: Characteristics • Sample: • Total: n = 3, 599 • 2,818 were White • 514 were Black • 134 were “Other” • 51.8% are female • Average age:16 • Grade Level: • 9th: 885 (25.2%) • 10th: 881 (25.1%) • 11th: 907 (25.8%) • 12th: 836 (23.8%)

18. Results: Demographics • Mother’s level of Education: 74% had an HS education • 40.4% of Blacks and 66.4% of other minorities had less than a HS education compared to 8.3% of Whites • 339 White mother’s had reported having a college education or higher compared to a total of 23 Blacks and Other racial minorities • Household Income: $31,105 • Blacks: $21,821 • Whites: $32,903 • Others: $28,344 • Level of poverty • Low: 21% of Blacks and compared to 64% of Whites; • High: 62% of Blacks compared to 12% of Whites living in high impoverished states

19. Results: socioenvironmental factors • Grade Point Average: 2.87 • Blacks: 2.61 • Whites: 2.92 • Others: 2.90 • Perceived racism: 6.37 • Blacks: 6.11 • Whites: 6.71 • Others: 6.29

20. Results: Risk Behaviors • Sexual Risk Behaviors • 44% of all participants have had sexual intercourse • 58.7% of Blacks • 34.8% of Others • 43.3% of Whites • 138 females reported at least 1 pregnancy • 68% (n = 95) were White females

21. Results: Risk Behaviors • Substance Use • Alcohol Use: 44.2% of all participants reported drinking • Other minorities reported 9 drinks on average, compared to 6 drinks for Whites, and 4 drinks for Blacks • Binge Drinking: 46.6% had at least one binge drinking episode during the past year • Whites and other minorities reported binge drinking between 3-12 times • Blacks reported binge drinking once or twice • Marijuana Use: overall 23.6% of all participants reported trying marijuana • All reported using marijuana between 5 and 7 days during the past month

22. Results: Risk Behaviors • Suicide Risk Behaviors • Overall 10.6% (n = 373) had suicidal thoughts • 3.9% (n = 139) of all adolescents had one suicide attempt • Depressive Symptoms • Mild to moderate depressive symptoms • Blacks: 11.26 • Whites: 10.65 • Others: 12.64

23. Implications • Improving the understanding of relationships between race and mom’s education and adolescent risk behaviors • Understanding racial differences is risk behaviors • Developing culturally relevant interventions that target at-risk adolescents, including urban Black youths • Identifying and clarifying adverse health consequences related to overt and covert racism that adolescents confront in their daily lives

24. Implications • Policy Implications • Development of school health programs and policies • Implementation of programs and policies for high-risk youth • Nurses have a social mandate to develop, disseminate, and use knowledge based on nursing’s phenomena of concern (Manhart Barrett, 2002).

25. Questions or comments?