A Portrait of Adolescent Health
By Susan M. Persons
The promise of a picture of United States adolescent health as rich in depth and color as an oil painting was unveiled at a recent NIH Seminar Series lecture organized by the behavioral and social sciences research coordinating committee. Dr. J. Richard Udry, principal investigator of the National Institute of Child Health and Human Development study, "Add Health," addressed a standing-room-only audience at NIH as he described the design and preliminary findings of the first national longitudinal study of adolescent health.
The main premise of the study is that social context -- such as relationships with families, friends, and peers -- influences the health-related behaviors of young people, and that understanding that context is essential to guide efforts to modify health behaviors. What is unique about this study is the multitude of perspectives it provides from which to understand the health-related behavior of adolescents, and the effects of family, peers, school, neighborhood, religious institution, and community on those behaviors.
Udry, professor of maternal and child health and of sociology at the University of North Carolina at Chapel Hill, and his colleagues chose a state-of-the-art survey as the medium to assess the health status of adolescents. The survey was conducted in two phases. In the first phase, approximately 90,000 students from grades 7 through 12 at 145 U.S. schools answered brief questionnaires to provide information about themselves and other aspects of their lives, including their health, friendships, self esteem, and expectations for the future. In the second phase, 90-minute laptop computer-administered interviews were conducted in the homes of 20,000 students and their parents drawn from the larger sample. One year later, these same students were interviewed a second time in their homes. Also interviewed were school administrators to provide comprehensive information on the school environment, and other independent sources to provide a strong data set of health-related aspects of the local neighborhood and community.
Because of the richness of the data in this study, it can best be described as a work-in-progress. "Although the first results from analysis of the data were published in JAMA on Sept. 10, 1997, we believe that the diversity and versatility of the data will allow a mosaic to emerge over time that will continue to inform parents, school and health professionals, as well as policy makers," Udry said. "We strongly encourage scientists to mine the resources of this study to augment or develop their own analyses."
In the meantime, preliminary analyses from the Add Health study offer surprising and in some cases, counterintuitive findings. For example, most parents hope that their own health practices will have a positive influence on their children. Parents who choose not to smoke may believe that they are, by their good example, affecting their child's behavior not to smoke. However, data from the study show that, whether or not parents smoke, adolescents' decision to smoke is most influenced by their peers.
Adults who fondly remember "being true to their school" may find some Add Health data troubling. "The study has found that a student's level of allegiance to a school is greatest either when the student body is all Black or all white. It is least when the student body is half white and half Black," according to Udry. "School size also has an influence -- small schools elicit greater allegiance than moderate and large schools."
The study also offers some unsettling findings on obesity in the U.S. "There is a relationship among obesity, race and ethnicity, and the number of generations a family has been in the U.S.," said Udry. "Obesity levels vary by race and ethnicity, with Native Americans having the highest overall percentage. Obesity is drastically lower for the first generation Americans of all ethnicities and races. Unfortunately, by the second generation, members of all ethnic and racial groups begin to approach the U.S. general population obesity level," reported Udry. For more information about the study, visit: http://www.cpc.unc.edu/addhealth.
The next lecture sponsored by the Office of Behavioral and Social Sciences Research will feature Dr. Margaret Chesney from the University of California, San Francisco, addressing "Women's Health Care, Research and Policy" on Thursday, Feb. 26, in Wilson Hall, Bldg. 1, 10 to 11 a.m.
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