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Gender differences in the association between body piercing and adolescent risk behaviors
February 2002
Methods: Year 1 and 2 in-home datasets of the National Longitudinal Study of Adolescent Health (Add Health) yielded a nationally representative sample of 7th–12th graders. Logistic regression identified the life circumstances and risky behaviors of these young people. Results: Some 17% and 14% of boys and girls respectively expect to be killed by age 21years or not live to age 35 years. This perception markedly varies across social groups including onethird of American Indians, one-quarter of Blacks and Hispanics, one in six Asians and 11% of whites. Those perceiving risk of early death are significantly less likely than counterparts (p ⬍ .001) to feel safe in their neighborhood and school, at least twice as likely to be poor, repeat a grade, report having learning problems, carry weapons, report a history of serious violence perpetration, and suicide attempts. They are significantly more likely to report substance use, poor physical and emotional health, disconnection from school, family and other adults, and less consistent parental involvement at home. For both boys and girls (controlling for age, urbanicity and race/ethnicity), the modeling of Time 1 deathrisk perceptions on Time 2 violence vs. Time 1 violence perpetration on Time 2 deathrisk perceptions, consistently showed a more powerful prediction of attitude based on prior behaviors rather than the other way around. Conclusions: Perceived risk of untimely death is a powerful marker for high-risk status, including personal history, damaging social environments, and involvement in health-jeopardizing behaviors.
ADOLESCENT FIGTHING WHILE UNDER THE INFLUENCE OF ALCOHOL OR DRUGS Cheryl Kodjo, M.D., M.P.H., Peggy Auinger, M.S., and Sheryl Ryan, M.D. Division of Adolescent Medicine, Strong Children’s Research Center, Rochester, NY. Purpose: Fifty to sixty percent of adolescents report lifetime use of alcohol and illicit drugs and 36% have been in a physical fight at least once in the course of a year. Previous studies have demonstrated alcohol and drug use to be correlates of physical fighting among adolescents. However, little is known about the co-occurrence of adolescents being under the influence of alcohol or drugs while engaged in a physical fight. The objectives of this study were to determine: 1) the prevalence of physical fighting while under the influence of alcohol or drugs and 2) the associations between demographic factors, other risk behaviors, and physical fighting while under the influence of substances. Methods: This study was an analysis of The National Longitudinal Study of Adolescent Health (Add Health) 1994 –1995, which is a school-based, nationally representative survey of 6504 7th to 12th graders. The dependent outcome variables of interest were: ’The most recent time you got into a fight, had you been drinking?’ and ’Have you ever gotten into a fight when you had been using drugs?’ These questions were asked only of those adolescents who had had a history of alcohol use and fighting, or drug use. Independent variables included: demographics, repeating a grade, maternal education level, marital status, maternal work outside the home, parental monitoring, easy access to alcohol and drugs in the home, selling drugs, gang fighting, and parent perceived influence of best friend. Univariate and bivariate analyses were
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done using SAS software. Logistic regressions were performed for the two outcome behaviors for the overall sample (p ⱕ .05). Results: Of 6504 adolescents, 32% reported physical fighting in the last year. Thirty-nine percent of 3798 substance users fought, in comparison to 23% of 2646 non-substance users (p ⬍ .001). Eleven percent of 1110 drinkers and fighters, and 11% of 1869 drug users reported being under the influence while fighting. Race, ethnicity, urbanicity, neighborhood poverty, maternal education, work outside the home, parental monitoring, easy access to alcohol, and perceived peer influence were not significantly associated with either outcome in bivariate analyses. Logistic regressions showed: 1) older age, 18 –21 years (OR 6.5), selling drugs (OR 2.5), and gang fighting (OR 2.4) were significantly associated with fighting while under the influence of alcohol (p ⱕ .005), and 2) selling drugs (OR 5.6), gang fighting (OR 3.0), easy access to drugs (OR 2.7), male gender (OR 1.8), and having a single parent (OR 1.7) were significantly associated with fighting while high (p ⱕ .006). Conclusions: These findings confirm that a significant proportion of adolescents who use substances will engage in physical fighting while under the influence. High-risk behaviors such as selling drugs and gang fighting were strongly correlated with the outcome behaviors, just as they were in our previous study regarding weapon carrying while under the influence of substances. Health providers should be mindful that co-occurrent fighting/weapon carrying and substance use may be markers for other more high-risk delinquent behaviors.
GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN BODY PIERCING AND ADOLESCENT RISK BEHAVIORS Timothy A Roberts, M.D., Peggy Auinger, M.S., and Sheryl Ryan, M.D. Division of Adolescent Medicine, Strong Children’s Research Center, University of Rochester School of Medicine, Rochester, NY. Purpose: We determined the prevalence of body piercing in a nationally representative sample of adolescents and evaluated the association between body piercing and a wide range of high-risk behaviors. Methods: Cross-sectional analysis using Wave II of the Add Health Public Use Dataset, a nationally representative, school based sample of 4595 adolescents, age 12–21, surveyed in 1996. The primary variable of interest was body piercing at locations other than the ears. Bivariate analyses evaluated the association between piercing and 1) sociodemographic factors, 2) peer substance use, and 3) five areas of high risk behaviors including sexual intercourse, substance use (problem drinking, smoking and marijuana use), violent behavior, antisocial behavior and school problems (failing grades and truancy). Linear (violence and antisocial scales) and logistic (all others) regression analyses, adjusting for sociodemographic variables and peer substance use, were performed using SUDAAN to describe the independent relationships between piercing and high-risk behaviors. Separate analyses were performed for males and females because of significant gender differences in piercing rates. Results: Females were more likely to report piercing (7.1% vs. 1.6% males) as were older adolescents, adolescents living with only one parent and adolescents with a higher family income (all p values ⬍ .005), but ethnicity, parental education and neighborhood type were not. In bivariate analyses, piercing in males was
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associated with peer substance use, sexual intercourse, problem drinking and truancy (all p values ⬍ .005). Piercing in females was associated with peer substance use and all of the risk behaviors evaluated except school failure and violence (all p values ⬍ .005). In regression analyses, piercing in males was only associated with truancy (OR ⫽ 5.1 [95% CI ⫽ 1.6 –16.1]). For females, piercing was associated with sexual intercourse (2.6 [1.6 – 4.1]), smoking (2.3 [1.4 –3.8]) and truancy (2.4 [1.5–3.8]). Conclusion: Strong gender differences exist in the prevalence of body piercing and the associations with high-risk behavior. Clinically body piercing can serve as a marker for potential problem behavior, particularly in females.
IMPACT OF PARENTS ON ADOLESCENT HEALTH PRACTICES WHO IS AT RISK OF BEING UNINSURED AMONG 19 –24 YEAR OLDS? S. Todd Callahan, M.D., Sion Kim Harris, Ph.D., S. Bryn Austin, Sc.D., and Elizabeth R. Woods, M.D., M.P.H. Children’s Hospital Boston, Harvard Medical School, Boston, MA. Purpose: Recent studies show that young adults are twice as likely to lack health insurance as children or older adults. Uninsured young adults may be more likely to forego medical treatment than their peers with health insurance. Because an increasing number of children under age 19 are insured through SCHIP and other programs, we undertook a study to identify factors associated with being uninsured among 19 –24 year olds and to look at whether lack of insurance was associated with having a health maintenance examination in the last 2 years. Methods: We conducted a secondary analysis of data from the Massachusetts Behavioral Risk Factor Surveillance System for the years 1998 –2000. This annual, random-digit-dial telephone health survey of non-institutionalized adults residing in households is conducted by the Centers for Disease Control and the Massachusetts Department of Public Health. Data are weighted to reflect the probability of selection and differential participation by sex and age. We examined data from respondents ages 19 to 24 years. Multiple logistic regression was used to estimate the odds of being uninsured associated with age, race/ethnicity, household income, high school education, and employment, marital, and student status. The analysis was stratified by gender due to the significant difference in insurance rates for males and females. Final models, controlling for the variables listed above, were constructed using SUDAAN® to take into account the weighting of the data. Results: The total number of 19 –24 year old respondents was 1673. Characteristics of the weighted sample included: 51% female, 83% white, and 15% without health insurance (20% of the males and 10% of the females; p ⬍ .001). For males, the odds of being uninsured were higher among those who were white non-Hispanic (AOR 3.31; 95% CI 1.47, 7.44), and were lower for students (AOR 0.11; 95% CI 0.03, 0.36), high school graduates (AOR 0.41; 95% CI 0.16, 1.05; marginal, p ⫽ .06), and those employed for wages or self-employed (AOR 0.19; 95% CI 0.07, 0.50). Compared to males reporting an annual household income under $15,000, the odds of being uninsured were substantially higher for males who were unsure of their income (AOR 5.73; 95% CI 1.78, 18.5) and substantially lower for males who refused to answer the item (AOR 0.03; 95% CI 0.01, 0.16). For females, the
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odds of being uninsured were lower for students (AOR 0.14; 95% CI 0.03, 0.66) and those with a reported household income of ⬎$50,000 (AOR 0.19; 95% CI 0.04, 0.80). Uninsured males were four times more likely to have gone more than two years without a health maintenance exam than males with insurance (p ⬍ .001). This association was not observed for females. Conclusions: 19 –24 year old males were at particular risk of being uninsured and the lack of insurance was associated with inadequate preventive care. Surprisingly, this association was not seen for young adult females. As expected, being a non-student was a predictor of lack of insurance for both males and females. Programs attempting to reduce the rates of uninsured young adults and increase preventive care should target males and non-students. Improving health insurance coverage for young adult males may be associated with improved preventive health care delivery.
CONCORDANCE OF PARENTAL AND ADOLESCENTS’ ATTITUDES ABOUT STD VACCINATION Gregory D. Zimet, Ph.D., Rose M. Mays, Ph.D., R.N., Lynne A. Sturm, Ph.D., and April A. Ravert, M.S. Section of Adolescent Medicine, Indiana University Schools of Medicine & Nursing, Indianapolis, IN. Purpose: To evaluate the acceptability of STD vaccines to parents and their adolescent children and to assess concordance of attitudes between parents and adolescents. Methods: Self-administered questionnaires (SAQ) have been completed by 50 parent and adolescent pairs to date. Parents were 31 to 66 years old, 92% female, and 96% white. Adolescents were 12 to 17 years old and 58% female. Participants were recruited from primary care pediatric settings. Parents and adolescents completed separate SAQs which included 3 items regarding acceptability of gonorrhea, genital herpes, and HIV vaccine, as well as a question regarding whether the parent or adolescent would be the primary one to decide about STD vaccination. For all items, a 5-point response format was used. Due to the skewed distributions of key variables, the non-parametric Spearman rho test was used to evaluate relationships between variables. Results: Parents and adolescents rated all 3 vaccines as quite acceptable. In all cases, the mean values were above 4.0 on the 5-point acceptability scale. Vaccine acceptability by parents and adolescents was not significantly associated with parental age, parental education, or child’s age (all Spearman rhos ⬍.24). 42% of parents reported that they would be the primary decision-makers regarding STD vaccination for their adolescents, whereas only 12% of adolescents saw their parents in this role. Conversely, 36% of adolescents reported that they would be the primary decisionmaker, whereas only 10% of parents saw their adolescents in this role. Parents’ and adolescents’ attitudes about locus of decisionmaking were not significantly correlated (Spearman rho ⫽ .17, p ⫽ .24). Conclusions: In general, these parent-adolescent pairs were positively disposed toward the possibility of vaccination against gonorrhea, genital herpes, and HIV. Parental consent will most likely be required for STD vaccination of adolescents. However, our findings suggest that many adolescents expect to have an active role in the decision-making, which was in contrast to parental beliefs in this regard. As new STD vaccines emerge, immunization programs may need to consider the adolescents’
Methods: Year 1 and 2 in-home datasets of the National Longitudinal Study of Adolescent Health (Add Health) yielded a nationally representative sample of 7th–12th graders. Logistic regression identified the life circumstances and risky behaviors of these young people. Results: Some 17% and 14% of boys and girls respectively expect to be killed by age 21years or not live to age 35 years. This perception markedly varies across social groups including onethird of American Indians, one-quarter of Blacks and Hispanics, one in six Asians and 11% of whites. Those perceiving risk of early death are significantly less likely than counterparts (p ⬍ .001) to feel safe in their neighborhood and school, at least twice as likely to be poor, repeat a grade, report having learning problems, carry weapons, report a history of serious violence perpetration, and suicide attempts. They are significantly more likely to report substance use, poor physical and emotional health, disconnection from school, family and other adults, and less consistent parental involvement at home. For both boys and girls (controlling for age, urbanicity and race/ethnicity), the modeling of Time 1 deathrisk perceptions on Time 2 violence vs. Time 1 violence perpetration on Time 2 deathrisk perceptions, consistently showed a more powerful prediction of attitude based on prior behaviors rather than the other way around. Conclusions: Perceived risk of untimely death is a powerful marker for high-risk status, including personal history, damaging social environments, and involvement in health-jeopardizing behaviors.
ADOLESCENT FIGTHING WHILE UNDER THE INFLUENCE OF ALCOHOL OR DRUGS Cheryl Kodjo, M.D., M.P.H., Peggy Auinger, M.S., and Sheryl Ryan, M.D. Division of Adolescent Medicine, Strong Children’s Research Center, Rochester, NY. Purpose: Fifty to sixty percent of adolescents report lifetime use of alcohol and illicit drugs and 36% have been in a physical fight at least once in the course of a year. Previous studies have demonstrated alcohol and drug use to be correlates of physical fighting among adolescents. However, little is known about the co-occurrence of adolescents being under the influence of alcohol or drugs while engaged in a physical fight. The objectives of this study were to determine: 1) the prevalence of physical fighting while under the influence of alcohol or drugs and 2) the associations between demographic factors, other risk behaviors, and physical fighting while under the influence of substances. Methods: This study was an analysis of The National Longitudinal Study of Adolescent Health (Add Health) 1994 –1995, which is a school-based, nationally representative survey of 6504 7th to 12th graders. The dependent outcome variables of interest were: ’The most recent time you got into a fight, had you been drinking?’ and ’Have you ever gotten into a fight when you had been using drugs?’ These questions were asked only of those adolescents who had had a history of alcohol use and fighting, or drug use. Independent variables included: demographics, repeating a grade, maternal education level, marital status, maternal work outside the home, parental monitoring, easy access to alcohol and drugs in the home, selling drugs, gang fighting, and parent perceived influence of best friend. Univariate and bivariate analyses were
RESEARCH PRESENTATIONS
103
done using SAS software. Logistic regressions were performed for the two outcome behaviors for the overall sample (p ⱕ .05). Results: Of 6504 adolescents, 32% reported physical fighting in the last year. Thirty-nine percent of 3798 substance users fought, in comparison to 23% of 2646 non-substance users (p ⬍ .001). Eleven percent of 1110 drinkers and fighters, and 11% of 1869 drug users reported being under the influence while fighting. Race, ethnicity, urbanicity, neighborhood poverty, maternal education, work outside the home, parental monitoring, easy access to alcohol, and perceived peer influence were not significantly associated with either outcome in bivariate analyses. Logistic regressions showed: 1) older age, 18 –21 years (OR 6.5), selling drugs (OR 2.5), and gang fighting (OR 2.4) were significantly associated with fighting while under the influence of alcohol (p ⱕ .005), and 2) selling drugs (OR 5.6), gang fighting (OR 3.0), easy access to drugs (OR 2.7), male gender (OR 1.8), and having a single parent (OR 1.7) were significantly associated with fighting while high (p ⱕ .006). Conclusions: These findings confirm that a significant proportion of adolescents who use substances will engage in physical fighting while under the influence. High-risk behaviors such as selling drugs and gang fighting were strongly correlated with the outcome behaviors, just as they were in our previous study regarding weapon carrying while under the influence of substances. Health providers should be mindful that co-occurrent fighting/weapon carrying and substance use may be markers for other more high-risk delinquent behaviors.
GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN BODY PIERCING AND ADOLESCENT RISK BEHAVIORS Timothy A Roberts, M.D., Peggy Auinger, M.S., and Sheryl Ryan, M.D. Division of Adolescent Medicine, Strong Children’s Research Center, University of Rochester School of Medicine, Rochester, NY. Purpose: We determined the prevalence of body piercing in a nationally representative sample of adolescents and evaluated the association between body piercing and a wide range of high-risk behaviors. Methods: Cross-sectional analysis using Wave II of the Add Health Public Use Dataset, a nationally representative, school based sample of 4595 adolescents, age 12–21, surveyed in 1996. The primary variable of interest was body piercing at locations other than the ears. Bivariate analyses evaluated the association between piercing and 1) sociodemographic factors, 2) peer substance use, and 3) five areas of high risk behaviors including sexual intercourse, substance use (problem drinking, smoking and marijuana use), violent behavior, antisocial behavior and school problems (failing grades and truancy). Linear (violence and antisocial scales) and logistic (all others) regression analyses, adjusting for sociodemographic variables and peer substance use, were performed using SUDAAN to describe the independent relationships between piercing and high-risk behaviors. Separate analyses were performed for males and females because of significant gender differences in piercing rates. Results: Females were more likely to report piercing (7.1% vs. 1.6% males) as were older adolescents, adolescents living with only one parent and adolescents with a higher family income (all p values ⬍ .005), but ethnicity, parental education and neighborhood type were not. In bivariate analyses, piercing in males was
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associated with peer substance use, sexual intercourse, problem drinking and truancy (all p values ⬍ .005). Piercing in females was associated with peer substance use and all of the risk behaviors evaluated except school failure and violence (all p values ⬍ .005). In regression analyses, piercing in males was only associated with truancy (OR ⫽ 5.1 [95% CI ⫽ 1.6 –16.1]). For females, piercing was associated with sexual intercourse (2.6 [1.6 – 4.1]), smoking (2.3 [1.4 –3.8]) and truancy (2.4 [1.5–3.8]). Conclusion: Strong gender differences exist in the prevalence of body piercing and the associations with high-risk behavior. Clinically body piercing can serve as a marker for potential problem behavior, particularly in females.
IMPACT OF PARENTS ON ADOLESCENT HEALTH PRACTICES WHO IS AT RISK OF BEING UNINSURED AMONG 19 –24 YEAR OLDS? S. Todd Callahan, M.D., Sion Kim Harris, Ph.D., S. Bryn Austin, Sc.D., and Elizabeth R. Woods, M.D., M.P.H. Children’s Hospital Boston, Harvard Medical School, Boston, MA. Purpose: Recent studies show that young adults are twice as likely to lack health insurance as children or older adults. Uninsured young adults may be more likely to forego medical treatment than their peers with health insurance. Because an increasing number of children under age 19 are insured through SCHIP and other programs, we undertook a study to identify factors associated with being uninsured among 19 –24 year olds and to look at whether lack of insurance was associated with having a health maintenance examination in the last 2 years. Methods: We conducted a secondary analysis of data from the Massachusetts Behavioral Risk Factor Surveillance System for the years 1998 –2000. This annual, random-digit-dial telephone health survey of non-institutionalized adults residing in households is conducted by the Centers for Disease Control and the Massachusetts Department of Public Health. Data are weighted to reflect the probability of selection and differential participation by sex and age. We examined data from respondents ages 19 to 24 years. Multiple logistic regression was used to estimate the odds of being uninsured associated with age, race/ethnicity, household income, high school education, and employment, marital, and student status. The analysis was stratified by gender due to the significant difference in insurance rates for males and females. Final models, controlling for the variables listed above, were constructed using SUDAAN® to take into account the weighting of the data. Results: The total number of 19 –24 year old respondents was 1673. Characteristics of the weighted sample included: 51% female, 83% white, and 15% without health insurance (20% of the males and 10% of the females; p ⬍ .001). For males, the odds of being uninsured were higher among those who were white non-Hispanic (AOR 3.31; 95% CI 1.47, 7.44), and were lower for students (AOR 0.11; 95% CI 0.03, 0.36), high school graduates (AOR 0.41; 95% CI 0.16, 1.05; marginal, p ⫽ .06), and those employed for wages or self-employed (AOR 0.19; 95% CI 0.07, 0.50). Compared to males reporting an annual household income under $15,000, the odds of being uninsured were substantially higher for males who were unsure of their income (AOR 5.73; 95% CI 1.78, 18.5) and substantially lower for males who refused to answer the item (AOR 0.03; 95% CI 0.01, 0.16). For females, the
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odds of being uninsured were lower for students (AOR 0.14; 95% CI 0.03, 0.66) and those with a reported household income of ⬎$50,000 (AOR 0.19; 95% CI 0.04, 0.80). Uninsured males were four times more likely to have gone more than two years without a health maintenance exam than males with insurance (p ⬍ .001). This association was not observed for females. Conclusions: 19 –24 year old males were at particular risk of being uninsured and the lack of insurance was associated with inadequate preventive care. Surprisingly, this association was not seen for young adult females. As expected, being a non-student was a predictor of lack of insurance for both males and females. Programs attempting to reduce the rates of uninsured young adults and increase preventive care should target males and non-students. Improving health insurance coverage for young adult males may be associated with improved preventive health care delivery.
CONCORDANCE OF PARENTAL AND ADOLESCENTS’ ATTITUDES ABOUT STD VACCINATION Gregory D. Zimet, Ph.D., Rose M. Mays, Ph.D., R.N., Lynne A. Sturm, Ph.D., and April A. Ravert, M.S. Section of Adolescent Medicine, Indiana University Schools of Medicine & Nursing, Indianapolis, IN. Purpose: To evaluate the acceptability of STD vaccines to parents and their adolescent children and to assess concordance of attitudes between parents and adolescents. Methods: Self-administered questionnaires (SAQ) have been completed by 50 parent and adolescent pairs to date. Parents were 31 to 66 years old, 92% female, and 96% white. Adolescents were 12 to 17 years old and 58% female. Participants were recruited from primary care pediatric settings. Parents and adolescents completed separate SAQs which included 3 items regarding acceptability of gonorrhea, genital herpes, and HIV vaccine, as well as a question regarding whether the parent or adolescent would be the primary one to decide about STD vaccination. For all items, a 5-point response format was used. Due to the skewed distributions of key variables, the non-parametric Spearman rho test was used to evaluate relationships between variables. Results: Parents and adolescents rated all 3 vaccines as quite acceptable. In all cases, the mean values were above 4.0 on the 5-point acceptability scale. Vaccine acceptability by parents and adolescents was not significantly associated with parental age, parental education, or child’s age (all Spearman rhos ⬍.24). 42% of parents reported that they would be the primary decision-makers regarding STD vaccination for their adolescents, whereas only 12% of adolescents saw their parents in this role. Conversely, 36% of adolescents reported that they would be the primary decisionmaker, whereas only 10% of parents saw their adolescents in this role. Parents’ and adolescents’ attitudes about locus of decisionmaking were not significantly correlated (Spearman rho ⫽ .17, p ⫽ .24). Conclusions: In general, these parent-adolescent pairs were positively disposed toward the possibility of vaccination against gonorrhea, genital herpes, and HIV. Parental consent will most likely be required for STD vaccination of adolescents. However, our findings suggest that many adolescents expect to have an active role in the decision-making, which was in contrast to parental beliefs in this regard. As new STD vaccines emerge, immunization programs may need to consider the adolescents’