Protecting Adolescents From Harm

ABSTRACT & COMMENTARY

Synopsis: Adolescents who feel connected to their parents, families, and schools appeared to be protected against every common health risk behavior except a history of pregnancy.

Source: Resnick MD, et al. Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA 1997;278:823-832.

This cross-sectional study of a large national sample from 80 middle and high schools was designed to identify family, school, and personal factors that acted to protect or place youth at risk related to four important arenas of morbidity in adolescent health including emotional health, violence, substance use, and sexuality. The sample (n = 12, 118) was selected from an initial national school survey of more than 90,000 students representative of U.S. youth. Personal interviews at home were conducted with both the adolescent and parent(s). The researchers assessed eight areas of risk: emotional distress; suicidal thoughts and behaviors; violence; use of cigarettes, alcohol, and marijuana; age of sexual debut; and a history of pregnancy. The findings clearly show that adolescents’ perception of closeness to family and feelings of connectedness to their school appear to protect them against threats to their physical and mental well being.

COMMENT BY MARY-ANN B. SHAFER, MD, FAAP

The first installment from this important national study of risk and youth represents the first report of cross-sectional data that supports what many health care providers, teachers, and parents have been stating for years; adolescents who feel an integral part of their society, especially a part of family and school, function better as adolescents and most likely as adults as well. For example, parents’ availability during important times during the day (i.e., before and after school, at dinner, and at bedtime) and parents’ high expectations for their child’s school achievement were related to adolescents feeling less emotionally distressed (e.g., less depressed or fearful). Furthermore, adolescents who felt close and loved by a parent had less emotional distress, fewer suicidal thoughts and suicidal acts, used drugs less frequently, were less involved in violence, and had a later sexual debut. This feeling of being loved and wanted by the family was a much stronger relationship than having more time available with parents. Students who felt connected to their school environment (i.e., their teachers were fair, they felt close to people at school, and they felt part of school) had the same lower risk profile described for students who felt connected with their families and parents. The one arena not protected by family and school connectedness was teen pregnancy.

In contrast, homes where guns were available had higher adolescent suicide rates and acts of violence. Students used cigarettes, marijuana, and alcohol in homes where substances were available to them. Of particular interest to the pediatrician, adolescents who described themselves as appearing "older than most" other students in their grade had problems with emotional distress, suicidal thoughts and behaviors, used more drugs, and began sex at an earlier age compared to teens who had a more normal course of pubertal development for their age. In addition, adolescents who had low self esteem, thought they would have an untimely death, repeated a grade in school, had a lower grade average, and older teens who worked more than 20 hours per week also experienced higher emotional distress.

For the pediatrician, I think there are no surprises here. Adolescents who are loved and feel an important part of a family and school environment feel better about themselves, are at decreased risk for emotional problems, and do not feel it necessary to engage in risky behaviors. The one exception to these findings is teen pregnancy. It must be remembered that pregnancy by itself is not a negative outcome. Only the timing in the teen is the potential problem. Therefore, it should not be surprising that this outcome appears to be influenced by different factors than such intrinsically negative outcomes such as emotional problems and drug use. All these findings lend support to the need to address the recommendations to the primary care clinician in the AAP Bright Futures that outline the need for annual, developmentally appropriate counseling and confidential screening.

For the single parent or grandparent or the family where both parents work, we can assure them that their love and caring for the teen is more important than the exact number of hours they are available at home. We need to encourage the parent to get more involved in the life of the school and their adolescent’s school work. As with our discussions about keeping toxins out of the reach of small children, we need to talk to our parents about their own smoking and alcohol habits and the need to keep those substances out of the home. Finally, we need to directly talk about guns in the home leading to violence and suicide. These are discussions that must take place in the context of the prevention role of the primary care pediatrician. We always felt this was correct—now we have the data.

References

1. Green M, ed. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. Arlington, VA: National Center for Education in Maternal and Child Health; 1994.

2. American Medical Association. Guidelines for Adolescent Preventive Services (GAPS). Chicago: American Medical Association; 1994.