Development of a youth survey to measure risk behaviors, attitudes and assets: examining multiple influences.

Currently, most surveys assessing adolescent health concerns focus primarily on risk behaviors and negative influences rather than positive influences such as assets. The purpose of this paper is to describe the development and validation of the Adolescent Health Attitude and Behavior Survey (AHABS). This instrument was developed to measure the prevalence of youth health risk behaviors, attitudes towards adolescent sexual behavior and youth assets in a statewide evaluation effort. The questionnaire was completed by 4368 public high school students in Grades 9-12. Content validity was established through an extensive review of literature, a group process and factor analyses. Reliability was established through Cronbach's alpha coefficients. Factor loadings ranged from 0.48 to 0.84 for scales measuring attitudes towards adolescent sexual behavior and alpha coefficients ranged from 0.61 to 0.81. Factor loadings ranged from 0.34 to 0.90 for scales measuring youth assets and alpha coefficients ranged from 0.69 to 0.85. Because of several limitations (e.g. construct validity was not measured), additional development work is needed. Therefore, the AHABS is still in a developing, but promising, state. Additional psychometric work will provide program practitioners and evaluators with a psychometrically sound tool to measure behaviors, attitudes and assets.

Relationship between perceived life satisfaction and adolescents' substance abuse.

PURPOSE: To explore the relationship between perceived global life satisfaction and selected substance use behaviors among 5032 public high school students. METHODS: The 1997 South Carolina Youth Risk Behavior Survey substance abuse and life satisfaction variables were used. An adjusted polychotomous logistic regression analysis utilizing SAS/SUDAAN, revealed a significant race/gender interaction. Subsequent multivariate models were constructed individually for four race/gender groups. Adjusted odds ratios and 95% confidence intervals were calculated to assess the magnitude of risk for selected substance abuse behaviors and their association with reduced global life satisfaction. RESULTS: Cigarette smoking, chewing tobacco, marijuana, cocaine, regular alcohol use, binge drinking, injection drug, and steroid use were significantly (p < .05) associated with reduced life satisfaction for specific race/gender groups (white males; black males; white females; and black females). In addition, age (< or = 13 years) of first alcohol drink, first marijuana use, first cocaine use, and first cigarette smoked were also significantly (p < .05) associated with reduced life satisfaction. CONCLUSION: Longitudinal studies are needed to determine whether dissatisfaction with life is a consequence or determinant of substance abuse behavior for adolescents.

Relationship between life satisfaction and violent behaviors among adolescents.

OBJECTIVE: To explore relationships between life satisfaction and violent behaviors among 5,032 adolescents. METHODS: Adjusted polychotomous logistic regression analyses and multivariate models were used via SUDAAN with the 1997 CDC YRBS. RESULTS: Carrying a weapon; carrying a gun; carrying a weapon at school; physical fighting; physical fighting at school; physical fighting that required physician treatment; drinking and driving; riding with a drinking driver; having property stolen/damaged at school; feeling unsafe while at, going to or returning from school; and being injured/ threatened with a weapon were associated (p=.05) with reduced life satisfaction. CONCLUSION: Measures of life satisfaction as a component of comprehensive assessments of adolescent violence/aggression in field-work, research, and program-evaluation efforts should be considered.

Physical activity behaviors of adolescents in public and private high schools.

OBJECTIVE: To examine physical activity differences between public (PUBHS) and private (PVTHS) high school students (n = 6,627). METHODS: The 1995 SC Youth Risk Behavior Survey was utilized. Chi-square analyses compared PVTHS and PUBHS students. RESULTS: PVTHS school students reported greater involvement in regular exercise programs (p < .001) and participation on school-based sport teams (p < .001). However, PUBHS school students reported greater participation in physical education (p < .001). PUBHS males participated in more community-based sport programs than did PVTHS males (p <.001); however, PVTHS females participated in more community-based sports than PUBHS males did (p < .001). CONCLUSION: Significantly different physical activity behaviors exist between PVTHS and PUBHS students in South Carolina.

Identification of the factors associated with compliance to therapeutic diets in older adults with end stage renal disease.

OBJECTIVE: To identify theory based factors pertinent to compliance with therapeutic diets. DESIGN: A paper and pencil survey was read to volunteer hemodialysis patients in outpatient dialysis clinics. SUBJECTS: A convenience sample of 276 hemodialysis patients aged 50 years and older who agreed to be interviewed during treatment. STATISTICAL ANALYSIS: Descriptive statistics were used to report responses to all survey questions. The Fisher exact test was used to test associations between the dependent variable, dietary compliance, and independent variables, which included knowledge, perceived severity of illness, attitudes toward compliance, environmental factors, perceived barriers, self-efficacy, and perceived health benefits. Principal Components Analysis determined final scale items. Logistic regression was used to develop a model of independent variables profiling the compliant patient. RESULTS: Subjects were more likely to be compliant if they indicated favorable attitudes toward compliance (P =.0076), a supportive environment (P =.0107), and knowledge about their diet (P =.0014). A logistic regression model of compliance indicated that subjects who followed their special diets were more likely to have higher knowledge (odds ratio [OR] = 1.092, 95% CI = 1.006, 1.186), perceived fewer barriers (OR = 1.094, 95% CI = 0.841, 1.226), being white race (OR = 0.710, 95% CI = 0.399, 1.263), and having gout (OR = 9.349, 95% CI = 1.139, 76.714). APPLICATION: Health professionals should apply these findings in providing dietary education focused on improving not just knowledge, but attitudes and family support. Nutrition education and health promotion applications geared to non-white populations could be particularly important as tools to improve dietary compliance.

Severe dating violence and quality of life among south carolina high school students.

BACKGROUND: Little research has addressed the impact of dating violence and forced-sex victimization and perpetration on adolescent well-being. In this cross-sectional study, we provide (1) estimates of severe dating violence (SDV) by victimization and perpetration status, (2) estimates of lifetime forced-sex victimization and perpetration, (3) demographic and health behaviors correlated with SDV, and (4) associations between SDV and forced sex and well-being as assessed by (1) health-related quality of life (H-R QOL) and (2) life satisfaction measures. METHODS: We used a stratified cluster sample of 5414 public high school students, grades 9 through 12, who responded to the 1997 self-administered South Carolina Youth Risk Behavior Survey. RESULTS: Nearly 12% of adolescents self-reported SDV as a victim (7.6%) or a perpetrator (7.7%), and SDV rates (victimization/perpetration combined) are higher in girls (14.4%) than boys (9.1%). Race, aggressive behaviors, substance use, and sexual risk-taking are correlates of SDV. Among young women, SDV victimization, not perpetration, was associated with recent poor H-R QOL and suicide ideation or attempts, but not lower life-satisfaction scores. Among young men, SDV perpetration, not victimization, was strongly associated with poor H-R QOL and suicide attempts, and lower scores for all domains of life satisfaction. CONCLUSIONS: This research provides evidence that SDV and forced sex are associated with poor H-R QOL, low life-satisfaction scores, and adverse health behaviors in adolescent female victims and male perpetrators. Screening for dating violence is needed to identify and intervene early to reduce the impact of dating violence.

The structure of self-reported aggression, drug use, and delinquent behaviors during early adolescence.

Examined the structure of self-report scales designed to assess the frequency of adolescent problem behaviors. Urban (n = 988) and rural (n = 1,895) middle school students completed the Problem Behavior Frequency Scale (Farrell, Danish, & Howard, 1992a) and measures of other relevant constructs. Confirmatory factor analyses supported a model that included specific factors related to aggression, drug use, and delinquent behaviors, and a higher order problem behavior factor. Findings did not support a distinction between physical and nonphysical aggression. Results were generally consistent across settings (i.e., urban vs. rural) and gender. Other relevant constructs, including peer pressure for drug use and attitudes favoring aggression, had both specific associations with relevant first-order factors and more general associations with the second-order factor. These findings support the construction of separate scales assessing specific domains of problem behaviors in studies of adolescents' problem behaviors.

Formative evaluation results from the Mariner Project: a coordinated school health pilot program.

This study determined the extent to which a coordinated school health program (CSHP) infrastructure was in place and functioning adequately within a two- to three-year developmental period in South Carolina. The Mariner Project's eight-component model was implemented in three middle schools and their four feeder elementary schools in three communities. Evaluation criteria for the Mariner Project reflect rigorous, minimum adequacy performance standards, and were based on national standards for school health practice and research and objective judgments of project performance. Eleven critical performance elements were developed, and a modified indexing procedure was utilized for project evaluation efforts. Results suggest that a combination of four critical performance elements, 1) Administrative Support/Buy-In, 2)Coordination of the Eight-Component Personnel School-Based Health Promotion Team, 3) Program Champion/Liaison/Facilitator, and 4) Staff Wellness Coordinator, served as the foundation for adequate or less-than-adequate performance for each school among the remaining critical elements, and subsequently for the overall Mariner Project.

Relationship between number of sexual intercourse partners and selected health risk behaviors among public high school adolescents.

PURPOSE: To examine the relationship between number of sexual partners and selected health risk behaviors in a statewide sample of public high school students. METHODS: The Centers for Disease Control and Prevention Youth Risk Behavior Survey was used to secure usable sexual risk-taking, substance use, and violence/aggression data from 3805 respondents. Because simple polychotomous logistic regression analysis revealed a significant Race x Gender interaction, subsequent multivariate models were constructed separately for each race-gender group. Odds ratios and 95% confidence intervals was calculated from polychotomous logistic regression models for number of sexual intercourse partners and their potential risk behavior correlates. RESULTS: An increased number of sexual intercourse partners were correlated with a cluster of risk behaviors that place adolescents at risk for unintended pregnancy, human immunodeficiency virus/acquired immunodeficiency syndrome, and other sexually transmitted infections. For Black females, alcohol, tobacco, marijuana use, and dating violence behaviors were the strongest predictors of an increased number of sexual partners; white females had similar predictors with the addition of physical fighting. For white males, alcohol, tobacco, marijuana use, physical fighting, carrying weapons, and dating violence were the strongest predictors of an increased number of sexual intercourse partners. Black males had similar predictors with the addition of binge alcohol use. CONCLUSION: Prevention of adolescent sexual and other health risk behaviors calls for creative approaches in school and community settings and will require long-term intervention strategies focused on adolescent behavior changes and environmental modifications.

PIP: This study examines the relationship between a number of sexual partners and selected health risk behaviors among public high school students. 56 schools took part in the study with approximately 125 participants from each school. A total of 3805 respondents (52% female, 48% males) were included in the final analysis that consisted of 1506 Black students and 2299 White students. The findings showed that a significant number of public high school students are engaging in sexual intercourse. Black males had the highest percentage (88%) engaging in sexual intercourse, followed by Black females (70%), White males (61%), and White females (52%). Furthermore, an increased number of sexual intercourse partners were correlated with certain risk behaviors that place adolescents at risk for unintended pregnancy, HIV/AIDS, and other sexually transmitted infections. The strongest predictors of an increased number or sexual partners for White females were alcohol, tobacco, marijuana use, and dating violence; Black females had similar predictors with the addition of physical fighting. For White males, alcohol, tobacco, marijuana use, physical fighting, carrying weapons, and dating violence were the strongest predictors of an increased number of sex partners. Black males have similar predictors with the addition of binge alcohol use. These findings suggest the need for a comprehensive prevention program that focuses on adolescent behavior changes and environmental modifications.

Association between employment and substance abuse behaviors among public high school adolescents.

PURPOSE: To examine the relationship between adolescents' after-school and weekend employment and substance abuse behaviors in a cross-sectional sample of public high school students in South Carolina. METHODS: The Centers for Disease Control and Prevention Youth Risk Behavior Survey (YRBS) was used to secure usable data from 4800 subjects. Logistic regression adjusting for age and using SUDAAN were performed. Odds ratios and 95% confidence intervals were calculated from the regression analyses. RESULTS: Thirty percent of white males, 29% of white females, and 20% of black males and females worked at a job for pay during the academic year. For white males employment, ranging from 11 to 15 h and 26 to > or =31 h was associated with cigarette smoking, working from 11 to > or =31 h was associated with alcohol use, working > or =31 h was associated with binge drinking, working from 26 to > or =31 h was associated with marijuana use, and working from 26 to 30 h was associated with cocaine use. For white females, working from 16 to 20 h was associated with alcohol use, working from 21 to 30 h was associated with binge drinking, and working from 26 to 30 h was associated with marijuana and cocaine use. CONCLUSION: Youth who work above 15 h/week at a job for pay during high school appear to have an increased risk for substance abuse and its consequences.

The impact of a required college health and physical education course on the health status of alumni.

The impact of a required college health and physical education course on selected health knowledge, attitudes, and behaviors of alumni was evaluated. The design was a cross-sectional study (mail out/mail back survey) using a stratified random sample of 2,000 college alumni. The overall response rate was 50%. Results were analyzed by college of graduation (college with a required health/physical education course versus no required course). Alumni who took the course were more likely to know their blood pressure, blood cholesterol, and recommended dietary fat intake than the comparison group were. They also reported that the course positively influenced their attitudes toward exercise, eating, and smoking They were more likely to engage in aerobic exercise and less likely to smoke; and they had lower intakes of dietary fat, cholesterol, and sodium. The results suggested that a required college course enhanced selected health-related knowledge, attitudes, and behaviors of alumni.

Black-white differences in body size perceptions and weight management practices among adolescent females.

OBJECTIVE: This study compares body size perceptions and weight management practices of black and white adolescent females. DESIGN: Subjects were selected through a statewide, three-stage sampling procedure designed to provide a sample statistically representative of high school students in South Carolina. SUBJECTS: Participants included black (n = 1824) and white (n = 2256) females, 14-18 years of age, enrolled in South Carolina public high schools. METHODS: Respondents were asked to assess their perceived body size as overweight, underweight, or about right. Self-reported weight management practices included dieting (reducing caloric intake), exercise, and other methods (including diet pills and vomiting). Chisquare analysis was used to assess the differences in body size perception and weight management behaviors. Polychotomous logistic regression was performed to examine association while controlling for socioeconomic status. RESULTS: Forty-one percent of the white adolescents and 29% of the black adolescents perceive themselves as overweight (p < 0.005). In the week prior to the survey, 28% of the white adolescents and 13% of the black adolescents reported dieting 34% of the while versus 23% of the black adolescents reported exercising to lose weight; and 45% of the white and 16% of the black students reported both dieting and exercising. Polychotomous logistic regression analysis showed that white adolescent girls were almost twice as likely to perceive themselves as overweight as black adolescent girls. The white students had 6.04 [95% confidence interval (CI), 1.77, 20.67] times the odds of using pills and vomiting and 3.76 (95% CI, 2.99, 4.72) times the odds of engaging in dieting and exercising as methods of weight management compared to the black students. CONCLUSIONS: These findings suggest that white adolescents are more likely to perceive themselves as overweight than black adolescents and are more likely to engage in unhealthy weight management practices than black adolescents.

Comparison of selected health risk behaviors between adolescents in public and private high schools in South Carolina.

This study examined differences in selected health risk behaviors among 5,517 students attending public high schools (PUBHS) and 1,089 students attending private high schools (PVTHS) in South Carolina. The 1995 CDC Youth Risk Behavior Survey was used to collect self-report information on adolescent risk behaviors. Chi-square analyses were performed for comparing public and private students on selected risk behaviors. Both PUBHS and PVTHS students reported substantial involvement in most of the risk-taking behaviors examined. PUBHS students, in general, were more likely to report higher prevalence rates than PVTHS students for most of the selected health risk behaviors. However, PVTHS students reported even higher prevalence rates than PUBHS students for alcohol use, driving after drinking, and binge drinking; smoking cigarettes (past 30 days); chewing tobacco (males only); marijuana use during the past 30 days (females only); and use of alcohol or other drugs before last act of sexual intercourse. Results suggest attendance at a private high school is not a panacea for protection against adolescent risk behaviors, and that all high school students could benefit from a coordinated school health program.

One-year evaluation results from CableQuit: a community cable television smoking cessation pilot program.

CableQuit was a 6-week, community cable television smoking cessation program, with 13 30-min "live" sessions, each followed by a 30-min "live" telephone call-in support segment. Telecasts were hosted by a public health educator with postdoctoral training in smoking cessation. Five smokers from Austin, Texas, were selected to participate "live" in the studio, while registrants followed step by step at home. A time-series design was utilized to evaluate program effectiveness. Baseline and follow-up data were gathered via mail as well as saliva samples, subsequently tested for cotinine analysis of smoking status. Participants were followed-up at 6 weeks, 6 months, and 12 months. Nonsmokers at 1 year had significantly greater levels of self-efficacy (p < .004) and significantly lower levels of depression (p < .03) than smokers. A 1-year quit rate of 17% exceeded those of previous televised programs (5-15%). Utilization of combined face-to-face smoking cessation techniques with mass media warrants further research.

Black and white adolescent females' perceptions of ideal body size.

A stratified, random sample of 344 White and Black adolescent females participated in a survey of ideal body size beliefs, which included responses to a questionnaire and a series of nine female and male body size drawings. Using SES and race as independent variables and BMI (kg/m2) as a covariate. Black females preferred a significantly heavier ideal female body size than Whites. They also perceived their parents and both male and female friends would select as ideal a significantly heavier female body size than White subjects. Black subjects' body size preferences were significantly more influenced by family members than were White subjects, who were significantly more influenced by their peer group. These findings suggest a greater social approval of increasing weight and body size for Black adolescent females, a desire for a smaller size by White adolescent females, and cultural differences in the influencing factors that help to communicate these body size preferences.

Patterns of tobacco and alcohol use among sedentary, exercising, nonathletic, and athletic youth.

Through a statewide random design, 7,846 9th to 12th grade students in 81 South Carolina public schools were selected to complete the Youth Risk Behavior Survey. Mantel-Haenszel Chi-Square, general linear models, and logistic regression were used to examine the relation between the independent variables of race, gender, and physical activity status with the dependent variables of tobacco and alcohol use while controlling for race, gender, and participation in physical education classes. The six physical activity levels ranged from sedentary nonathletes to athletes participating on two or more sports teams. Highly active athletes drank more frequently than did low-activity nonathletes (p = .002) and sedentary nonathletes (p = .006), and they were more likely to binge drink (p = .004). Athletic groups were less likely to smoke than were the nonathletic groups (p < .0001) with "sedentary nonathletes" the heaviest smokers of all groups. Athletes were more likely to use smokeless tobacco (p < .0001) than nonathletes although this difference disappeared when controlling for gender and race. This research supports other findings about prevalence of smokeless tobacco use among athletic youth. In addition, it reveals that athletic youth are at an increased risk of alcohol use and binge drinking. Possible factors such as the risk-taking tendencies of team sport athletes should be investigated.

Relationship between physical activity level and cigarette, smokeless tobacco, and marijuana use among public high school adolescents.

This study analyzed the association between physical activity level and cigarette, smokeless tobacco, and marijuana use among a selected group of public high school students from South Carolina (N = 4,800). The 1993 CDC Youth Risk Behavior Survey was used to collect self-report information on physical activity, substance use, and other risk-taking behaviors. Multiple logistic regression analysis for weighted data (SUDAAN) was used for data analysis. Adjusted analysis showed significant associations (p < .05) among White males for use of cigarettes, smokeless tobacco, and marijuana, where higher levels of physical activity were inversely associated to use of these substances. Results from the study substantiate the importance of physical activity for adolescents, and demonstrate the need for future research to clarify the causal relationship between physical activity and substance use behaviors.

Correlates of aggressive and violent behaviors among public high school adolescents.

PURPOSE: This study analyzed the types and predictors of violent behaviors reported by 4,137 South Carolina adolescents, grades nine through twelve. METHODS: The 70 item self-report Youth Risk Behavior Survey developed and piloted by the Centers for Disease Control and Prevention was utilized in 57 of the state's public high schools. A series of logistic regression analyses were performed for each race/gender group to explore the relation of the demographic and potential risk variables to fighting and carrying weapons. RESULTS: Results indicate that 38 percent of males and 11 percent of females reported carrying a weapon. Eleven percent of males and five percent of females reported fights resulting in an injury. The strongest predictors of fighting were binge drinking and sexual activity for males, any alcohol use and illegal drug use for white females, and sexual activity for black females. For carrying a weapon, the strongest predictors included alcohol use and sexual activity in all but white females, and illegal drug use among whites, but not blacks. CONCLUSION: Prevention of adolescent violence calls for creative approaches in school and community settings and will require long-term intervention strategies, focused on adolescent behavior change and environmental modifications.

Correlates and consequences of early initiation of sexual intercourse.

This cross-sectional analysis of the 1991 CDC Youth Risk Behavior Survey explored factors associated with an early age at first sexual intercourse. Almost 18% of White males, 49% of Black males, 5% of White females and 12% of Black females were sexually active before age 13. Carrying a weapon to school, fighting, and early (< age 13) experimentation with cigarettes and alcohol were associated with early initiation of sexual activity for all four race and gender groupings. Those initiating sexual activity early had greater numbers of partners but were 50% less likely to use condoms regularly and were two-seven times more likely to have been pregnant or caused a pregnancy. Females who initiated sexual activity early were more likely to have had a sexually transmitted disease (STD). Interventions to postpone sexual activity need to be tailored to the ethnic and gender differences observed in these analyses. Interventions must begin before age 13 and should be comprehensive school-based efforts.

PIP: The 1991 CDC Youth Risk Behavior Survey is a statewide survey of 1509 White male, 1234 Black male, 1479 White female, and 1256 Black female public school students in grades 9-12 conducted February-May 1991 in South Carolina. Survey data were used in the study of factors associated with experiencing first sexual intercourse at younger than age 13. Students younger than 14 years old were excluded from the analysis. 17.8% of White males, 49.2% of Black males, 5.1% of White females, and 11.9% of Black females had had sexual intercourse before age 13. 38% of White males, 12% of Black males, 47% of White females, and 27% of Black females were virgins at the time of the interview. Controlling for race, males were 6.8 times more likely than females to have had first sexual intercourse when younger than 13. Fighting, experimenting with cigarettes and alcohol younger than age 13, and carrying a weapon to school were associated for all race and gender groupings with the early initiation of sexual intercourse. 54.8% of White males, however, compared to 39.3% of Black males brought weapons to school, 51.1% of White males compared to 47.0% of Black males got into a fight at school, 11.6% of White males compared to 5.3% of Black males smoked before age 13, and 39.0% of White males compared to 30.6% of Black males drank alcohol before age 13. Respondents who initiated sexual intercourse before age 13 had greater numbers of partners, but were 50% less likely to use condoms regularly and were two-seven times more likely to have been pregnant or caused a pregnancy. Females who initiated sexual activity early were more likely to have had a sexually transmitted disease. The authors recommend that the ethnic and gender differences observed in this study be considered when designing interventions to postpone sexual activity. Interventions must begin before age 13 and should be both comprehensive and school-based.

Black and white females' perceptions of ideal body size and social norms.

Different cultural norms and standards for appropriate female body size might contribute to the disparity in obesity rates between black and white adult females (46.0% and 24.6% respectively). The purpose of this study was to measure adolescents' perceptions of ideal size and social norms regarding female body size as well as adolescents' perceptions of significant others' evaluation and expectations of the adolescents' body size. Subjects included 437 adolescent girls (247 white and 190 black) aged 13 to 19 (x = 14.9, SD = .979) from six randomly selected public schools. The subjects, heights and weights were measured. Responses to a body image questionnaire and a series of nine female body drawings (arranged ordinally, 1 to 9, from thinnest to heaviest) were analyzed using the General Linear Model and Logistic Regression. The female body size considered ideal by black females was significantly larger than the size selected as ideal by white females (x = 3.47 and x = 3.13 respectively, p < 0.001). Black females were two times more likely than white females to describe themselves as thinner than other girls their age (O.R. = 2.01, 95% C.I. 1.34, 3.01) and seven times as likely to say that they were not overweight (O.R. = 7.08, 95% C.I. 3.72, 13.45). White females wanted to be a smaller size than they currently were and felt encouraged by significant others to lose weight or reduce their size. Black females did not indicate as great a desire as whites to be smaller and they tended to feel that their size was considered satisfactory by significant others. Only subjects from the low SES group perceived that significant others wanted them to gain weight. The differences between black and white subjects' beliefs and perceptions about body size norms may explain, in part, why heavier body weights persist in some cultural groups.