Adolescent early death perception: links to behavioral and life outcomes in young adulthood.

INTRODUCTION: The purpose of this study was to examine the relationship between changes in adolescent perception of risk for early death over time and behavioral and life outcomes in young adulthood. METHODS: This is a secondary data analysis of 7202 respondents participating in waves 1 (1995), 2 (1996), and 3 (2001-2002) of the in-home interviews from the National Longitudinal Study of Adolescent Health. Linear and logistic regression models were used to determine the predictive ability of adolescent early death perception at waves 1 and 2 on young adult outcomes of health risk, human capital, and prosocial development, and fitness at wave 3. RESULTS: Nearly one in four youth (23%) expressed perceived risk of premature death at some point in time; 6% of youth persisted in this outlook. Perceived risk of premature death during adolescence was linked to poor health and productivity on multiple levels in young adulthood. DISCUSSION: Adolescent perceived risk for premature death portends poor outcomes in young adulthood. Findings support incorporating screening questions on adolescents' mortality beliefs into psychosocial assessments and interviews.

Early death perception in adolescence: identifying factors associated with change from pessimism to optimism about life expectancy.

US teens overestimate risk for early death. The purpose of this study was to identify factors associated with an adolescent's change from early death perception to a belief in living into adulthood. Data are from 9140 adolescents participating in waves 1 (1995) and 2 (1996) of the National Longitudinal Study of Adolescent Health. Logistic regression models were used to determine contexts of healthy and unhealthy change associated with the likelihood of early death perception change. Youth report of increased caring and connection to other adults and increased self-esteem were associated with greater likelihood of moving from pessimism to optimism about life expectancy (P = .003 and P = .038, respectively). Reductions in self-esteem and poorer perception of health were associated with decreased odds of death perception change (P = .017 and P = .011, respectively). Nurturing positive connections with adults and strategies that improve a youth's self-esteem offer 2 opportunities to facilitate adolescent early death perception change.

Individual, interpersonal, and relationship factors predicting hormonal and condom use consistency among adolescent girls.

INTRODUCTION: Few existing studies have considered influences of adolescents' sexual partners on contraceptive consistency. This study examines the influence of personal characteristics, partner characteristics, and relationship factors on consistency of contraceptive use among an ethnically diverse sample of adolescent girls at high risk for pregnancy and sexually transmitted diseases. METHOD: Data are from 110 sexually active 13- to 17-year-old girls participating in a clinic-based intervention study aimed at reducing sexual risk behaviors. Personal characteristics were assessed at baseline (T1), and partner and relationship characteristics were assessed at 12 months (T2). RESULTS: Multivariate analyses revealed that T2 hormonal contraceptive consistency was predicted by T1 hormonal consistency, girls' desire to use birth control, having the same sexual partner at T1 and T2, perceived partner support for birth control, and communication with partner about sexual risk. T2 condom use consistency was negatively predicted by emergency contraceptive use history and perceived partner support for birth control. DISCUSSION: Findings underscore the importance of nurses addressing both personal and relationship factors in their efforts to promote consistent contraceptive use among sexually active adolescent girls.

Adolescent perception of premature risk for death: contributions from individual and environmental contextual factors.

OBJECTIVE: Adolescent perception of premature risk for death is a cause of great concern. This study identified individual and environmental characteristics of youth expressing perception of premature risk for death. METHODS: Data are from Waves 1 (1995) and 3 (2001-2002) of the in-home interviews from the National Longitudinal Study of Adolescent Health. The study sample included 12,103 adolescents and 10,519 parents (Wave 1) and 9130 young adults (Wave 3). Logistic regression models were used to determine contexts for health risk, connection, safety and monitoring, individual/developmental, and caregiver/family characteristics associated with adolescent early death perception. RESULTS: One in 7 youth endorsed perceived risk for early demise. After controlling for demographic factors, adolescent early death perception is a powerful marker for high-risk status, including involvement in self-destructive behaviors (odds ratio [OR] 1.32-13.97, P = .01-P <.001) and physical and psychological distress (OR 8.33-39.37, P < .001). Alternately, models for stronger connection in the primary socializing domains, perceptions of safety, academic achievement, outlets for participation, and better caregiver capacity offered significant protective effect (OR 0.10-0.91, P < .001). In a final multivariate model, unique relationships between adolescent early death perception and health risk behavior and exposure, adult and peer connection, mental health, and parent/family economic security emerged. CONCLUSIONS: Study findings support further research into constructs for premature death perception as a potential mechanism to facilitate intervention with youth who may be at risk for further negative life trajectories, including depressive reactions and extreme reactions to future adverse life events.

From adolescent connections to social capital: predictors of civic engagement in young adulthood.

PURPOSE: This study examined the ability of adolescent connection in family and community contexts to promote an aspect of healthy youth development and transition into adulthood, civic engagement. METHODS: Data are from Wave 1 (1995) and Wave 3 (2001-2002) of the in-home interviews from the National Longitudinal Study of Adolescent Health. The sample for this study included 9130 young adults aged 18-26 years. Linear and logistic regression models were used to measure the influence of connection in family and community contexts (Wave 1) on outcomes of civic engagement in young adulthood (Wave 3). RESULTS: Stronger connection in all family and community contexts during adolescence predicted greater likelihood of voting, community volunteer service, involvement in social action/solidarity groups, education groups, and/or conservation groups, and endorsement of civic trust in young adulthood. Select connections in family and community contexts were also significant predictors of political voice/involvement and blood product donation. In a final multivariate model, frequency of shared activities with parent(s) and school connection during adolescence emerged as unique predictors of young adult civic engagement. CONCLUSIONS: Connections in family and community contexts during adolescence promote healthy youth development through facilitation of multiple aspects of civic engagement in young adulthood. The importance of these connections in fostering youth capacity to bond to a broader community construct is discussed.

Protective factors in the lives of bisexual adolescents in North America.

OBJECTIVES: We compared protective factors among bisexual adolescents with those of heterosexual, mostly heterosexual, and gay or lesbian adolescents. METHODS: We analyzed 6 school-based surveys in Minnesota and British Columbia. Sexual orientation was measured by gender of sexual partners, attraction, or self-labeling. Protective factors included family connectedness, school connectedness, and religious involvement. General linear models, conducted separately by gender and adjusted for age, tested differences between orientation groups. RESULTS: Bisexual adolescents reported significantly less family and school connectedness than did heterosexual and mostly heterosexual adolescents and higher or similar levels of religious involvement. In surveys that measured orientation by self-labeling or attraction, levels of protective factors were generally higher among bisexual than among gay and lesbian respondents. Adolescents with sexual partners of both genders reported levels of protective factors lower than or similar to those of adolescents with same-gender partners. CONCLUSIONS: Bisexual adolescents had lower levels of most protective factors than did heterosexual adolescents, which may help explain their higher prevalence of risky behavior. Social connectedness should be monitored by including questions about protective factors in youth health surveys.

Associations between health screening questions and sexual risk behaviors in adolescent female clinic patients: identifying a brief question format to yield critical information.

This study examines the ability of brief screening questions to identify adolescent girls at high risk for sexually transmitted infections and teen pregnancy. Participants included 103 sexually active 13-year-old to 17-year-old girls recruited from adolescent clinics who (1) were identified as at risk for negative sexual health outcomes through responses to an 8-item Health Screening Survey, and (2) returned to clinic within 2 weeks to complete a self-report survey about sexual risk behaviors and contraceptive use. Analyses examined relationships between girls' total screening scores, individual screening survey items, and 5 self-reported sexual risk behaviors. Higher screening scores correlated with lower levels of refusing unprotected sex and less consistent condom use (P < .05 and P < .01, respectively). High-risk responses to 2 screening items were associated with all 5 sexual risk behaviors. Findings suggest useful questions in routine clinical screening of sexually active adolescent girls to identify those at high levels of sexual risk.

Protecting urban American Indian young people from suicide.

OBJECTIVE: To examine the likelihood of a past suicide attempt for urban American Indian boys and girls, given salient risk and protective factors. METHODS: Survey data from 569 urban American Indian, ages 9-15, in-school youths. Logistic regression determined probabilities of past suicide attempts. RESULTS: For girls, suicidal histories were associated with substance use (risk) and positive mood (protective); probabilities ranged from 6.0% to 57.0%. For boys, probabilities for models with violence perpetration (risk), parent prosocial behavior norms (protective), and positive mood (protective) ranged from 1.0% to 38.0%. CONCLUSIONS: Highlights the value of assessing both risk and protective factors for suicidal vulnerability and prioritizing prevention strategies.

Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British Columbia.

Over the past decade, several large-scale school-based studies of adolescents in Canada and the U.S. have documented health disparities for lesbian, gay and bisexual teens compared to their heterosexual peers, such as higher rates of suicide attempts, homelessness, and substance use. Many of these disparities have been linked to "enacted stigma," or the higher rates of harassment, discrimination, and sexual or physical violence that sexual minority youth experience at home, at school, and in the community. An unexpected health disparity for lesbia n, gay and bisexual youth is their significantly higher risk of teen pregnancy involvement (between two and seven times the rate of their heterosexual peers), especially in light of declining trends in teen pregnancy across North America since the early 1990s. What is behind this higher risk? Is it getting better or worse? Using the province-wide cluster-stratified British Columbia Adolescent Health Surveys from 1992, 1998, and 2003, this paper explores the trends in pregnancy involvement, related sexual behaviours, and exposure to forms of enacted stigma that may help explain this particular health disparity for gay, lesbian and bisexual youth in Canada.

Suicidal ideation and attempts in North American school-based surveys: are bisexual youth at increasing risk?

This study explored the prevalence, disparity, and cohort trends in suicidality among bisexual teens vs. heterosexual and gay/lesbian peers in 9 population-based high school surveys in Canada and the U.S. Multivariate logistic regressions were used to calculate age-adjusted odds ratios separately by gender; 95% confidence intervals tested cohort trends where surveys were repeated over multiple years. Results showed remarkable consistency: bisexual youth reported higher odds of recent suicidal ideation and attempts vs. heterosexual peers, with increasing odds in most surveys over the past decade. Results compared to gay and lesbian peers were mixed, with varying gender differences in prevalence and disparity trends in the different regions.

Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada.

Some studies suggest lesbian, gay, and bisexual (LGB) teens are at higher risk than peers for violence at home, in school, and in the community. That can bring them into the child welfare system or services for runaway and homeless teens. This study compared self-reported experiences of sexual and physical abuse based on sexual orientation and gender in seven population-based surveys of youth. The authors used c2 and age-adjusted odds of abuse to compare bisexual to heterosexual, mostly heterosexual, and gay and lesbian students. They also provide case studies to illustrate the experiences of such youth.

Violence perpetration among urban american Indian youth: can protection offset risk?

OBJECTIVE: To predict the likelihood of violence perpetration given various combinations of the most statistically salient risk and protective factors related to violence perpetration. DESIGN: Urban Indian Youth Health Survey, conducted from October 9, 1995, to March 30, 1998, consisting of 200 forced-choice items exploring values, cultural identity, relationships, decision-making skills, and health and well-being. SETTING: Urban schools and an after-school youth development program at an urban American Indian center. PARTICIPANTS: Five hundred sixty-nine urban American Indian youth enrolled in grades 3 through 12. MAIN OUTCOME MEASURES: Violence perpetration dichotomized in 2 ways: (1) level of violence perpetration (ie, hitting someone 1-2 times in the past year vs picking fights, hitting repeatedly, participating in group fights, or shooting or stabbing someone in the past year) and (2) having shot and/or stabbed someone during the past year. RESULTS: In the final multivariate models with age as a covariate, most protective against violence perpetration were connections to school (odds ratio [OR], 0.17), positive affect (OR, 0.29), and peer prosocial behavior norms against violence (OR, 0.35). School connectedness (OR, 0.01) and positive affect (OR, 0.46) were also protective against shooting and/or stabbing someone, as was parental prosocial behavior norms against violence (OR, 0.23). The strongest risk factors for violence perpetration were substance use (OR, 2.60) and suicidal thoughts/behaviors (OR, 2.71); for shooting and/or stabbing, it was substance use (OR, 5.26). The likelihood of violence perpetration increased markedly (from 10% to 85%) as the exposure to risk factors increased and protective factors decreased. For shooting or stabbing someone, the probabilities ranged from 3% (0 risks and 3 protective factors) to 64% (1 risk and 0 protective factors). CONCLUSION: The dramatic reduction in the likelihood of violence involvement when risk was offset with protective factors in the probability profiles suggests the utility of a dual strategy of reducing risk while boosting protection.

Measuring sexual orientation in adolescent health surveys: evaluation of eight school-based surveys.

PURPOSE: To examine the performance of various items measuring sexual orientation within 8 school-based adolescent health surveys in the United States and Canada from 1986 through 1999. METHODS: Analyses examined nonresponse and unsure responses to sexual orientation items compared with other survey items, demographic differences in responses, tests for response set bias, and congruence of responses to multiple orientation items; analytical methods included frequencies, contingency tables with Chi-square, and ANOVA with least significant differences (LSD)post hoc tests; all analyses were conducted separately by gender. RESULTS: In all surveys, nonresponse rates for orientation questions were similar to other sexual questions, but not higher; younger students, immigrants, and students with learning disabilities were more likely to skip items or select "unsure." Sexual behavior items had the lowest nonresponse, but fewer than half of all students reported sexual behavior, limiting its usefulness for indicating orientation. Item placement in the survey, wording, and response set bias all appeared to influence nonresponse and unsure rates. CONCLUSIONS: Specific recommendations include standardizing wording across future surveys, and pilot testing items with diverse ages and ethnic groups of teens before use. All three dimensions of orientation should be assessed where possible; when limited to single items, sexual attraction may be the best choice. Specific wording suggestions are offered for future surveys.