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Adolescents and Healthy Lifestyle Choices
Research conducted by: Ka He, Ellen Kramer, Robert F. Houser, Virginia R. Chomitz, and Karen A. Hacker
Case study prepared by: Robert F. Houser, Alyssa Koomas, and Georgette Baghdady
Overview
Teen pregnancy, sexually transmitted disease, drug abuse, and suicide are some of the behaviorally-mediated negative health outcomes that can occur during adolescence. Identifying the characteristics of adolescents who are able to make healthy lifestyle choices is imperative toward understanding positive health behaviors in this age group. This information could be used to develop targeted interventions that support at-risk adolescents in making healthy lifestyle choices, and hopefully prevent such negative outcomes.
This study collected survey data from 1487 high school students in an urban Massachusetts community. The survey assessed health-related behaviors, stressful events, demographics, familial characteristics, perceptions of peer and parental support, and academic performance. In collaboration with community stakeholders and parents, the researchers selected six health-related behaviors and developed two sets of criteria to define positive health behaviors. One set used “strict” definitions, namely, not drinking alcohol in the last 30 days, no attempted suicide in the past 12 months, and no experience at all with tobacco, hard illegal drugs, marijuana, and sexual partners. The second set used “broad” definitions that allowed for mild use and safe experimentation (except for suicidal behavior). Students who adhered to all six health-related behaviors according to the “strict” definitions formed one subgroup for analysis, and those who reported behaviors in accordance with the “broad” definitions formed another subgroup. These two lifestyle subgroups were analyzed separately in relation to the personal and social-environmental factors assessed by the survey.
Questions to Answer
What personal and social-environmental characteristics are associated with adolescents who practice healthy lifestyle behaviors according to the “strict” definitions? How much more likely are adolescents with these characteristics to be practicing healthy behaviors than adolescents without these characteristics?
Design Issues
The results of this study may not be applicable to adolescents in non-urban schools, as the sample was drawn from a diverse, urban school. As well, the definitions that make up positive health behaviors may vary by region and social group. Adolescents self-reported their health-related behaviors and other information via the survey. Missing responses may have caused bias in the results.
Descriptions of Variables
| Variable |
Description |
| Healthy behaviors based on the “strict” definitions |
Whether or not the adolescent practices all 6 health-related behaviors according to the “strict” definitions |
| Immigration status |
Whether the adolescent was born in the US or is an immigrant |
| Stress score |
An index from 0 to 14 assessing 14 possible stressful events in the adolescent’s life, such as failing grades, moving, death in the family, divorce in the family, abuse, and violence |
| Stress index |
Whether the adolescent’s stress score is at or above the median stress score of 2, or below |
| Academic performance |
The adolescent’s average academic letter grade (A, B, C, D, F) |
| References |
He, K., Kramer, E., Houser, R. F., Chomitz, V. R., Hacker, K. A. (2004). Defining and understanding healthy lifestyles choices for adolescents. Journal of Adolescent Health, 35, 26-33. |
Links 1 in 3 Teens Text While Driving
2011 Youth Risk Behavior Surveillance Survey
| Exercises |
Please read the original publication before performing the exercises. Table 2 in the article shows how various personal and social-environmental characteristics are related to making healthy lifestyle choices. For the contingency tables below, please refer to Table 2 for cell frequencies.
- In Table 2, which of the personal and social-environmental factors are nominal variables and which are ordinal variables?
- Complete the 2 X 2 contingency table below by filling in the cell frequencies. This table examines the relationship between immigration status (“immigrant” versus “born in the US”) and whether or not adolescents practice all 6 healthy behaviors based on the “strict” definitions.
Immigration status |
Practices all 6 healthy behaviors (strictly defined) |
Does not practice all 6 healthy behaviors (strictly defined) |
Total |
Immigrant
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Born in the US
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Total
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- What percentage of immigrant adolescents were practicing all 6 healthy behaviors according to the “strict” definitions? What percentage of US-born adolescents were practicing all 6 healthy behaviors according to the “strict” definitions?
- Perform a Pearson Chi Square test to determine whether there is a statistically significant relationship (p<0.05) between immigration status and practicing healthy behaviors. Interpret your findings in a sentence that reports the relevant percentages and Chi Square and p values.
- Calculate an odds ratio that expresses how much more likely immigrant adolescents were to be practicing healthy behaviors than US-born adolescents. Interpret your findings.
- What are some of the possible explanations for the relationship that you found between immigration status and practicing healthy behaviors?
- Construct a 2 X 2 contingency table that examines the relationship between stress index (“< median score” versus “≥ median score”) and whether or not adolescents practice all 6 healthy behaviors based on the “strict” definitions.
- Of the adolescents who scored below the median stress score, what percentage were practicing all 6 healthy behaviors according to the “strict” definitions? Of the adolescents who scored at or above the median stress score, what percentage were practicing all 6 healthy behaviors according to the “strict” definitions?
- Perform a Pearson Chi Square test to determine whether there is a statistically significant relationship (p<0.05) between stress and practicing healthy behaviors. Interpret your findings in a sentence that reports the relevant percentages and Chi Square and p values.
- Calculate an odds ratio that expresses how much more likely adolescents with stress scores below the median were to be practicing healthy behaviors than adolescents with stress scores at or above the median. Interpret your findings.
- What are some of the possible explanations for the relationship that you found between stress and practicing healthy behaviors?
- Complete the 3 X 2 contingency table below by filling in the cell frequencies. This table examines the relationship between academic performance and whether or not adolescents practice all 6 healthy behaviors based on the “strict” definitions.
Academic performance (average letter grade) |
Practices all 6 healthy behaviors (strictly defined) |
Does not practice all 6 healthy behaviors (strictly defined) |
Total |
A
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B
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C or lower
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Total
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- What percentage of A students were practicing all 6 healthy behaviors according to the “strict” definitions? What percentage of B students were practicing all 6 healthy behaviors according to the “strict” definitions? What percentage of students with grades of C or lower were practicing all 6 healthy behaviors according to the “strict” definitions?
- Perform a Pearson Chi Square test using the 3 X 2 contingency table. Is there a statistically significant relationship (p<0.05) between academic performance and practicing healthy behaviors? What can and can’t you conclude?
- To determine which pairs of letter grades are statistically significantly different in relation to practicing healthy behaviors, perform three separate 2 X 2 Pearson Chi Square tests comparing (1) A students versus B students, (2) B students versus students with grades of C or lower, and (3) A students versus students with grades of C or lower. Interpret your findings in sentences that report the relevant percentages and Chi Square and p values.
- Calculate an odds ratio that expresses how much more likely A students were to be practicing healthy behaviors than B students. Interpret your findings.
- What are some of the possible explanations for the relationship that you found between academic performance and practicing healthy behaviors?
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