PROTECTING ADOLESCENTS FROM HARM - FINDINGS FROM THE NATIONAL LONGITUDINAL-STUDY ON ADOLESCENT HEALTH

Context.-The main threats to adolescents' health are the risk behavior s they choose, How their social context shapes their behaviors is poor ly understood. Objective.-To identify risk and protective factors at t he family, school, and individual levels as they relate to 4 domains o f adolescent health and morbidity: emotional health, violence, substan ce use, and sexuality. Design.-Cross-sectional analysis of interview d ata from the National Longitudinal Study of Adolescent Health. Partici pants.-A total of 12 118 adolescents in grades 7 through 12 drawn from an initial national school survey of 90 118 adolescents from 80 high schools plus their feeder middle schools. Setting.-The interview was c ompleted in the subject's home. Main Outcome Measures.-Eight areas wer e assessed: emotional distress; suicidal thoughts and behaviors; viole nce; use of 3 substances (cigarettes, alcohol, marijuana); and 2 types of sexual behaviors (age of sexual debut and pregnancy history), Inde pendent variables included measures of family context, school context, and individual characteristics. Results.-Parent-family connectedness and perceived school connectedness were protective against every healt h risk behavior measure except history of pregnancy, Conversely, ease of access to guns at home was associated with suicidality (grades 9-12 : P<.001) and violence (grades 7-8: P<.001; grades 9-12: P<.001). Acce ss to substances in the home was associated with use of cigarettes (P< .001), alcohol (P<.001), and marijuana (P<.001) among all students. Wo rking 20 or more hours a week was associated with emotional distress o f high school students (P<.01), cigarette use (P<.001), alcohol use (P <.001), and marijuana use (P<.001). Appearing ''older than most'' in c lass was associated with emotional distress and suicidal thoughts and behaviors among high school students (P<.001); it was also associated with substance use and an earlier age of sexual debut among both junio r and senior high students, Repeating a grade in school was associated with emotional distress among students in junior high (P<.001) and hi gh school (P<.01) and with tobacco use among junior high students (P<. 001). On the other hand, parental expectations regarding school achiev ement were associated with lower levels of health risk behaviors; pare ntal disapproval of early sexual debut was associated with a later age of onset of intercourse (P<.001). Conclusions.-Family and school cont exts as well as individual characteristics are associated with health and risky behaviors in adolescents. The results should assist health a nd social service providers, educators, and others in taking the first steps to diminish risk factors and enhance protective factors for our young people.