Michael Resnick

Adolescence and the social determinants of health

The health of adolescents is strongly affected by social factors at personal, family, community, and national levels. Nations present young people with structures of opportunity as they grow up. Since health and health behaviours correspond strongly from adolescence into adult life, the way that these social determinants affect adolescent health are crucial to the health of the whole population and the economic development of nations. During adolescence, developmental effects related to puberty and brain development lead to new sets of behaviours and capacities that enable transitions in family, peer, and educational domains, and in health behaviours. These transitions modify childhood trajectories towards health and wellbeing and are modified by economic and social factors within countries, leading to inequalities. We review existing data on the effects of social determinants on health in adolescence, and present findings from country-level ecological analyses on the health of young people aged 10-24 years. The strongest determinants of adolescent health worldwide are structural factors such as national wealth, income inequality, and access to education. Furthermore, safe and supportive families, safe and supportive schools, together with positive and supportive peers are crucial to helping young people develop to their full potential and attain the best health in the transition to adulthood. Improving adolescent health worldwide requires improving young peoples daily life with families and peers and in schools, addressing risk and protective factors in the social environment at a population level, and focusing on factors that are protective across various health outcomes. The most effective interventions are probably structural changes to improve access to education and employment for young people and to reduce the risk of transport-related injury.

Ethnic differences in psychosocial and health behavior correlates of dieting, purging, and binge eating in a population-based sample of adolescent females

OBJECTIVEnTo examine ethnic differences in factors associated with disordered eating behaviors.nnnMETHODnData were collected from 17,159 adolescent females who completed a school-based health survey conducted in 1987.nnnRESULTSnIn all ethnic groups, dieting was associated in bivariate analyses with weight dissatisfaction, perceived overweight, and low body pride. Purging was associated with weight dissatisfaction, perceived overweight, low body pride, greater suicide risk, and greater alcohol use. Binge eating was associated with weight dissatisfaction, perceived overweight, low body pride, lower family connectedness, greater peer acceptance concerns, and emotional stress.nnnDISCUSSIONnBody dissatisfaction and perceived overweight are consistent correlates of dieting and binge eating in adolescent females of diverse ethnic groups. Ethnic subculture does not appear to protect against the broader sociocultural factors that foster body dissatisfaction among adolescent females. Implications for understanding sociocultural influences on dieting, obesity, and eating disorders are discussed.

Risk and direct protective factors for youth violence: results from the national longitudinal study of adolescent health

BACKGROUNDnThe majority of studies on youth violence have focused on factors that increase the risk for youth violence.nnnPURPOSEnTo assess whether determinants of violence operate as risk factors, direct protective factors, or both during adolescence and young adulthood.nnnMETHODSnData from participants in the National Longitudinal Study of Adolescent Health, aged 13 years at Wave 1, were analyzed. Individual, family, school, peer, and community factors during adolescence (Wave 1 [1995]; age 13 years) were examined as predictors of violence involvement during adolescence (Wave 2 [1996]; age 14 years) and in young adulthood (Wave 3 [2001-2002]; ages 18-20 years).nnnRESULTSnTwelve percent of participants aged 14 years and 8% of participants aged 18-20 years reported serious violence involvement during the past 12 months. Bivariate analyses revealed risk and direct protective factors for violence at both time points. Risk for violence at age 14 years was increased by earlier attention-deficit hyperactivity disorder (ADHD) symptoms, low school connectedness, low grade-point average, and high peer delinquency. Direct protective factors for youth violence at age 14 years included low ADHD symptoms, low emotional distress, high educational aspirations, and high grade-point averages. Bivariate analyses showed a lower risk of violence among youth aged 18-20 years who reported low peer delinquency at age 13 years. Multiple logistic regression analyses predicting violence involvement showed direct protective effects for low ADHD symptoms and low emotional distress at age 14 years, and a direct protective effect for low peer delinquency at ages 18-20 years, after controlling for demographic characteristics.nnnCONCLUSIONSnFindings suggest that violence involvement remains difficult to predict but indicate the importance of assessing both risk and direct protective factors for understanding violent behavior.

The appropriateness of health services for adolescents: Youths' opinions and attitudes

Minnesota high school students were surveyed about their attitudes, beliefs, and opinions about health, illness, and medical care. Data were obtained from small group discussions conducted by the adolescents themselves in schools and agencies throughout the state. This paper reports their views toward adolescent medical services. Teenagers emphasized the idea of service appropriateness as central to promoting service utilization. Key to the concept of appropriateness were the components of staff, cost and confidentiality. Each of these dimensions is examined from the view of youth as to implications for increased appropriateness of services for both utilization and improved health. Findings are discussed in terms of differences in problem definition between the adolescent and professional, and their implications for medical care in conventional and alternative settings.

Physician attitudes toward confidentiality of treatment for adolescents: Findings from the Upper Midwest Regional Physicians Survey

The provision of confidential medical services to adolescents is an enduring health policy issue in the United States, and the focus of policy statements by several professional medical organizations. Physician attitudes toward confidential service provision to teenagers were examined in the Upper Midwest Regional Physician Survey, a representative sample of community-based pediatricians and family physicians. Overall, three-quarters of participants favored confidential service provision for youths. Multivariate analysis revealed that the most salient reasons for favoring confidentiality were perception of unique needs among adolescents, year of licensure, high self-assessed competency in addressing sexual concerns of adolescence, adequacy of training in interpersonal and sexual issues, frequency of addressing interpersonal issues, and lower self-assessed adequacy of training in traditional medical problems of youths. Implications for state and federal legislation are discussed.

Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents

PURPOSEnTo describe and differentiate the usual sources of health care, patterns of utilization of services, and reasons for foregone health care among Hispanic adolescents by place of birth (U.S. mainland versus Puerto Rico or other country) and gender.nnnMETHODSnAll subjects who identified themselves as Hispanic (n = 717) in a larger survey of 10,059 students in 7th (n = 3,596), 9th (n = 3,691), and llth (n = 2,772) grades in the state of Connecticut in 1996 were included in this secondary analysis. Data were analyzed using Pearson product-moment coefficients, Chi-squares, and logistic regression.nnnRESULTSnThe majority of usual sources of medical care services were community clinics or private doctors offices. Subjects born in Puerto Rico or countries other than the United States were more likely to use a doctors office. About 5% reported no usual source of care. Over 25% reported not going to a doctor or other health care provider when they thought they should (foregone care). There were significant gender differences in reasons given for foregone care. Feeling connected to others was a significant predictor of having had a physical examination and negatively associated with foregone care for girls. For boys, connectedness and use of alcohol were negative predictors of foregone care.nnnCONCLUSIONSnThe majority of Hispanic youth in this sample report having a usual source of medical care and the source differs by place of birth. Adolescents who do not report high levels of connectedness are more likely to have foregone care. The most frequent explanation given for not having sought care was that subjects thought the problem would go away. Socialization about how to access and use health care services, as well as what to expect, is needed by Hispanic adolescents who may be at risk.

am I qualified? How do I know? a Qualitative Study of Sexuality educators' Training experiences

Abstract Background: National Health Education Standards in the U. S. focus on key concepts and skills around health issues, including sexuality. However, little is known about the extent to which classroom teachers are trained to deliver sexuality education. Purpose: The purpose is to explore pre-service training experiences and needs of sexuality educators in Minnesota. Methods: Seven focus groups were conducted with a diverse sample of 41 sexuality educators, and qualitative analysis was used to detect themes across groups. Results: Results indicate a wide variety of pre-service teaching experience, ranging from no instruction to extensive training. Teachers had numerous suggestions for ways their training could have better prepared them to teach sexuality education, such as ways of working with culturally diverse students. Teachers described many ways in which they were unprepared in their first year of teaching sexuality education. Discussion: Training programs to prepare sexuality educators are not adequately preparing teachers for their multifaceted role. Findings point to the need to train sexuality educators differently than teachers for other subjects. Translation to Health Education Practice: Findings indicate that pre-service training programs should greatly expand their offerings, tighten requirements and hone methodologies in sexuality education to meet the needs of todays teachers and students.

Beyond the Call of Duty: A Qualitative Study of Teachers' Additional Responsibilities Related to Sexuality Education.

Seven focus groups were conducted with sexuality educators in Minnesota to explore ways that teaching sexuality education differs from teaching other health education content and to determine if additional supports or resources are needed for sexuality educators. Teachers described many specific additional responsibilities or concerns related to sexuality education, including a) interacting with parents, b) interacting with administration, c) addressing students’ personal concerns, d) managing sensitive information in the classroom, and e) developing and updating lesson plans. Findings suggest that Minnesota teachers often go above and beyond their usual responsibilities to provide quality sexuality education for their students, both in and out of the classroom.

Policies, principals and parents: multilevel challenges and supports in teaching sexuality education

A teachers capacity to provide sexuality education may be hampered or enhanced by a number of factors. A social–ecological framework can be used to understand these influences, and the present study assesses interpersonal, organisational/institutional and community/policy level influences on teaching sexuality education. Seven focus groups were conducted in 2009 with 41 sexuality education teachers in Minnesota; discussion focused on challenges and the supports teachers experienced. At the interpersonal level, teachers reported both positive and negative interactions with parents, regarding parents as highly influential on school administrators and policy. Teachers reported many organisational level challenges, including their administrators, district policy, and structural factors such as time, financial resources, and diversity in the student body. At the community level, participants overwhelmingly felt that policy changes could be very beneficial to sexuality education in Minnesota, and believed that this support could come from all levels. Findings suggest numerous intervention points to reduce challenges and strengthen supports for teachers, and indicate that a multi-level approach is needed to increase teachers ability to deliver sexuality education that meets their students needs and is less onerous for the educator.

Developmental and Personalogical Correlates of Adolescent Sexual Behavior and Outcome

An extensive literature has developed which explores the sociological and psychological characteristics of sexually active adolescents. A more recent to sexual decision making provides a useful research paradigm for approaching issues of adolescent sexual behavior and outcomes. In a study of 206 adolescent females in St. Paul and Minneapolis, developmental and personalogical characteristics were examined for four groups: successful contraceptors, aborters, mothers, and pregnant teens. Aborters were characterized by their highly developed future time perspective and modern sex role orientation. Mothers had the least developed future time perspective and sense of personal efficacy, and the most traditional sex role orientation. They also tended to be highly anxious, passive, dependent, and prone toward denial as a cognitive style. Successful contraceptors were best described by their complex cognition and ego development, although contrary to expectation, did not evidence a more well developed future time perspective or modern sex role orientation than did aborters. Pregnant teens had the least distinguishing characteristics of all groups. Implications for future comparative group analyses are discussed including both the sociological and developmental assessment of sexual decision making and its consequences for youth.