Promoting Positive Adolescent Health Behaviors and Outcomes Thriving in the 21st Century (2020) / Chapter Skim
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3 The Current Landscape of Adolescent Risk Behavior
3 The Current Landscape of Adolescent Risk Behavior
Pages 53-100
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From page 53... ...
This chapter first examines the nature of adolescent risk taking. It then turns to the three behaviors that the committee selected for targeted inclusion in this report -- alcohol use, tobacco use, and sexual behaviors -- and their related health outcomes.
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From page 54... ...
Healthy risk taking involves socially acceptable and constructive risk behaviors, and as discussed previously, is considered a necessary and ormative part of adolescence (Duell and Steinberg, 2019)
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. Although it is not one of our three focal behaviors, violence is frequently cited in this report because of its impact on the social environment, particularly for mar ginalized groups, and its interrelatedness with substance use and sexual behavior.
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In this context, social acceptability refers to the views of adults rather than those of other adolescents; although the social acceptability of certain healthy risks may be controversial among adults, social acceptability in adolescence is often more strongly associated with peer culture and contextual influences. The following are examples of healthy risk taking within each of the five dimensions of optimal health: 1.
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. In addition, adolescents at highest risk for negative consequences often engage in multiple unhealthy risk behaviors, such as drug or alcohol use and unprotected sexual intercourse (Wu et al., 2010)
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Strongly related to working memory, response inhibition is the capacity to suppress a behavioral response in favor of one that is more appropriate or goal oriented. Research has found that lower response inhibition in adolescents is related to more unhealthy risk behaviors, including unsafe driving, early cigarette smoking, and alcohol use (Henges and Marczinski, 2012; Mashhoon et al., 2018; Ross et al., 2015)
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Life skills and social competence -- encompassing social-emotional skills related to self-awareness, self-management, social awareness, and communication -- help adolescents make positive choices, maintain healthy relationships, and promote their own well-being. Positive personal traits that are protective against unhealthy risk behaviors include
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Fear of losing the ones" Demands of "Pressure to get into a good college/to get good 89 School grades" "Fear of judgement from others, fear of disappointing Fear/Insecurity 86 others, feeling like you are doing the wrong thing" "I often feel overly stressed and unable to do Stress 85 things at my full capacity" "My anxiety, my struggle with type one diabetes, and Mental Health 84 past situations that have caused me to have ptsd" "Having to work too much and not having enough time Job 60 for everything else" "Time im too young i still have to study and work to Time 57 improve my reputation and my resume" 51 "Not being able to surround myself with people who love Peers/Friends me for me, and toxic friendships" "My dad is overly restrictive, and he makes it hard for me Parents 43 to do much" SOURCE: Generated using data from the MyVoice (2019) report.
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From page 61... ...
. Generally, research suggests that adolescents who live in single-parent families are more likely to engage in unhealthy risk behaviors and fare worse on a wide range of developmental outcomes relative to their counterparts in families with two biological parents (Langton and Berger, 2011)
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suggests that because adolescents are fundamentally motivated to prevent social rejection by their peers, they may engage in unhealthy risk behaviors that have adverse health or disciplinary consequences. Adolescents may therefore seek and engage in behaviors that adults view as unhealthy risks in order to win peer approval, or at the very least to avoid peer rejection (Maslowsky et al., 2019)
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From page 63... ...
Research has found that it reduces the likelihood that adolescents will engage in such unhealthy risk behaviors as alcohol use, tobacco use, and unprotected sexual activity. In addition, parental engagement is associated with better student behavior, higher academic achievement, and enhanced social skills (CDC, 2018a)
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. Beyond improving health services, local, state, and federal governments can take additional measures to discourage unhealthy risk behaviors among adolescents.
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This is a serious limitation when one is examining behavior trends, since research shows that youth who are not in school (e.g., dropped out, incarcerated, homeless) have the highest incidence of risk behaviors and related adverse health outcomes (Edidin et al., 2012; Odgers, Robins, and Russell, 2010; Tolou-Shams et al., 2019)
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From page 66... ...
have been updated or added to reflect changes in behaviors and diverse populations over time. SOURCE: Generated using documentation from the YRBS questionnaires (CDC, 2018c)
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. It is also important to note that the reasons these adolescents are not in school may be related to these risk behaviors.
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From page 68... ...
It is also important to note that while YRBS questions have been added or changed over time to reflect more current behavior trends and populations, some questions, particularly those related to sexual behavior, are still ambiguous and exclusive of diverse populations. For example, the first question in the sexual behavior section asks respondents whether they have ever had "sexual intercourse" without defining this term (CDC, 2018c)
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From page 69... ...
. Trends in current alcohol use, defined as any use in the past 30 days, are similar with 4 Five to 11 questions are added to the standard, national YRBS questionnaire each cycle, and these items generally cover topics that are not covered by the priority health-risk behavior categories (e.g., sun protection)
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15.5% Drank alcohol before age 13 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 FIGURE 3-2 Adolescent alcohol use has declined since 1991. SOURCE: Generated using Youth Risk Behavior Survey data (CDC, 2019b)
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SOURCE: Generated using Youth Risk Behavior Survey data (CDC, 2019b)
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. Substantial research has identified and examined the acute health effects of binge drinking, which include alcohol poisoning, alcohol-related blackouts and injury, car crashes and fatalities, physical and sexual assault, unprotected sexual behavior, and problems at school or work (Hingson and White, 2014; Siqueira and Smith, 2015)
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Department of Transportation were not disaggregated by biological sex or race/ethnicity. SOURCE: Generated using data from Young Driver Safety Fact Sheets (U.S.
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. Use of tobacco products typically begins during adolescence, with nearly 9 of 10 cigarette smokers trying their first cigarette by age 18 (HHS, 2014)
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SOURCE: Generated using Youth Risk Behavior Survey data (CDC, 2019b)
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In general, research shows that the main factors accounting for why adolescents are more susceptible than other groups to initiating use of tobacco products are flavors; marketing; social pressures; and the belief that alternative tobacco products, such as e-cigarettes, are not harmful (Ambrose et al., 2014; Amrock, Lee, and Weitzman, 2016; ooperC et al., 2016; Gorukanti et al., 2017; Harrell et al., 2017; Hebert et al.,
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the significant heterogeneity of this group limits the conclusions that can be drawn. SOURCE: Generated using National Youth Tobacco Survey data, as presented by Gentzke et al.
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From page 78... ...
Manufacturers and retailers of tobacco products market aggressively to youth through the Internet, social media, television, radio, event sponsorship, celebrity placement, and strategic positioning in convenience stores (Cobb, Brookover, and Cobb, 2015; de Andrade, Hastings, and Angus, 2013; Grana and Ling, 2014)
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From page 79... ...
. Sexual Behavior in Adolescence Trends First sexual intercourse, or sexual debut, is an important milestone in sexual and human development.
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SOURCE: Generated using Youth Risk Behavior Survey data (CDC, 2019b)
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SOURCE: Generated using Youth Risk Behavior Survey data (CDC, 2019b)
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has remained unchanged. SOURCE: Generated using Youth Risk Behavior Survey data (CDC, 2019b)
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SOURCES: Generated using pregnancy data from the National Survey of Family Growth, as analyzed by Kost, Maddow-Zimet, and Arpaia (2017) and birth surveillance data from the Centers for Disease Control and Prevention (2018d)
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Adolescents also need access to youth-friendly contraceptive and reproductive health services. Community efforts to address the social and economic factors associated with teenage pregnancy can play a major role as well in tackling racial/ethnic and geographic disparities in teen birth rates (CDC, 2019f; Kearney and Levine, 2012)
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From page 85... ...
As a part of their sexual development, adolescents typically form intimate partnerships, affirm gender identities, identify sexual orientations, situate sexuality in the context of their religious beliefs, and incorporate cultural attitudes toward sexuality into their own value systems, all of which help them prepare for adult roles and relationships (Diamond and Savin-Williams, 2009; Everett, 2019; NASEM, 2019; Suleiman et al, 2017; Tulloch and Kaufman, 2013)
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. SOURCE: Generated using sexually transmitted disease surveillance data from the Centers for Disease Control and Prevention (2019g, 2019h)
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. While unhealthy risk behaviors can occur within a sexual context, having sex is not necessarily unhealthy or problematic, even in adolescence.
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, many of whom are more likely to engage or have engaged in unhealthy risk behaviors. CONCLUSION 3-3: The sexual behavior items included in the Youth Risk Behavior Survey are neither specific nor comprehensive enough to (1)
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It is therefore just as important to support healthy sexual development as it is to prevent the negative health outcomes associated with sexual behavior (e.g., unintended pregnancy, sexually transmitted infections) during adolescence.
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. Methodology of the Youth Risk Behavior Surveillance System -- 2013.
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. A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors.
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Journal of Adolescent Health, 54(5 Suppl)
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. Youth risk behavior surveillance -- United States, 2017.
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. Does the Centers for Disease Control and Prevention's Youth Risk Behavior Survey underreport risky sexual behavior?
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Report commissioned by the Committee on Applying Lessons of Optimal Adolescent Health to Improve Behav ioral Outcomes for Youth. Available: https://www.nap.edu/resource/25552/Youth%20 Perspectives%20on%20Being%20Healthy%20and%20Thriving.pdf.
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. Adolescent risk taking, impulsivity, and brain development: Implications for prevention.
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. Youth-adult connectedness: A key protective factor for adolescent health.
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. Adolescent Health: Think, Act, Grow® Playbook.
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From page 99... ...
. A parallel process growth mixture model of conduct problems and substance use with risky sexual behavior.
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