This report was produced under a contract from the Office of the Assistant Secretary for Planning and Evaluation (ASPE),
"Co-Occurrence of Youth Risky Behavior," Contract No. HHS-100-95-0021.
This research is based in part on data from the Add Health project, a program designed by J. Richard Udry (PI) and Peter Bearman, and funded by grant P01-HD31921 from the National Institute of Child Health and Human Development to the Carolina Population Center, University of North Carolina at Chapel Hill, with cooperative funding participation by the National Cancer Institute; the National Institute of Alcohol Abuse and Alcoholism; the National Institute on Deafness and Other Communication Disorders; the National Institute on Drug Abuse; the National Institute of General Medical Sciences; the National Institute of Mental Health; the National Institute of Nursing Research; the Office of AIDS Research, NIH; the Office of Behavior and Social Science Research, NIH; the Office of the Director, NIH; the Office of Research on Women's Health, NIH; the Office of Population Affairs, DHHS; the National Center for Health Statistics, Centers for Disease Control and Prevention, DHHS; the Office of Minority Health, DHHS; the Office of the Assistant Secretary for Planning and Evaluation, DHHS; and the National Science Foundation. Persons interested in obtaining data files from The National Longitudinal Study of Adolescent Health should contact Jo Jones, Carolina Population Center, 123 West Franklin Street, Chapel Hill, NC, 27516-3997 (email: jo_jones@unc.edu). The National Survey of Adolescent Males was funded with the support of the National Institute of Child Health and Human Development, with additional support from the Office of Population Affairs, the National Institute of Mental Health and the Centers for Disease Control and Prevention.
The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors, and should not be attributed to The Urban Institute, its trustees, or its funders.
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Many teenagers participate in risk behaviors that threaten their current and future health. Substance use, violence, and unprotected sexual intercourse are responsible for much of the mortality and morbidity experienced in adolescence and early adulthood.1 While older adults are vulnerable to illnesses such as heart disease, cancer, and diabetes, adolescents are threatened by homicide, suicide, car accidents, and AIDS - ailments that are behavioral and, therefore, preventable.2
There is growing recognition that teens who engage in risk behaviors often participate in multiple types of behaviors, referred to as clustering or co-occurrence.3 Evidence suggests that adolescent risk behaviors share common underlying causes as well as having unique influences; individual, biological, family, school, and neighborhood factors all influence the types of risks teens take.4 In addition to monitoring adolescent participation in specific behaviors, it is important to focus on the co-occurrence of risk-taking among teens.
In this chapter, we present a portrait of multiple risk-taking among teens. Using recent data from the National Longitudinal Study of Adolescent Health (Add Health) and the 1995 National Survey of Adolescent Males (NSAM) [see box 1], we describe the degree to which teens engage in multiple health risk behaviors and contrast it with the extent to which teens participate in positive behaviors such as spending time with parents and being involved in extra-curricular activities. Describing participation in these behaviors is an important part of understanding teens' exposure to health risks and monitoring efforts to reduce those risks.
How Are Health Risk Behaviors Measured?
Health risk behaviors may threaten the well-being of teens and may prevent them from becoming fully functioning members of society.
Using recent data from students in grades 7 through 12 from the Add Health survey, we explore the extent to which middle and high school students engage regularly in multiple health risk behaviors. Drawing from common approaches used in prior research, we define health risk behaviors as volitional involvement in established patterns of behavior that threaten the well-being of teens and limit their potential for achieving responsible adulthood.5 (These are also commonly referred to as problem behaviors).6 We distinguish risk-taking behaviors from risk outcomes-the consequences of the behavior. For example, unprotected sexual intercourse is a risk behavior and is included in this analysis, while teenage pregnancy is a risk outcome and is not examined here.
Table 1 identifies the 10 health risk behaviors examined in this study: regular tobacco use, regular alcohol use, regular binge drinking, recent marijuana use, recent use of illicit drugs other than marijuana, physical fighting, carrying a weapon at school, suicidal thoughts, non-fatal suicide attempt,7 and unprotected sexual intercourse. Although these 10 behaviors are not an exhaustive list of adolescent health risk, they reflect key areas of risk-taking. Conclusions from this study do not necessarily extend to other types of health risk behaviors. Other studies have explored additional types of risk taking such as dangerous driving, eating disorders, and criminal activity.8
Notes from this section of the report
1. Sells, C.W. and Blum, R.W. 1996. "Morbidity and Mortality Among U.S. Adolescents: An Overview of Data and Trends." American Journal of Public Health 86: 513-519.
2. U.S. Preventive Services Task Force. 1996. Guide to Clinical Preventive Services (2nd ed.). Alexandria, VA: International Medical Publishing; Ozer, E.M., Brindis, C.D., Millstein, S.G., Knopf, D.K., and Irwin, C.E. 1998. America's Adolescents: Are They Healthy? San Francisco, CA: National Adolescent Health Information Center, University of California, San Francisco.
3. There is also concern about adolescents' participation in more than one risk behavior at a single point in time, such as drinking immediately prior to sexual intercourse. (See, for example, Halpern-Felsher, B.L., Millstein, S.G., and Ellen, J.M. 1996. "Relationship of Alcohol Use and Risky Sexual Behavior: A Review and Analysis of Findings." Society for Adolescent Medicine 19: 331-336.)
4. Donovan, J.E., and Jessor, R. 1985. "Structure of Problem Behavior in Adolescence and Young Adulthood." Journal of Counseling and Clinical Psychology 53: 890-904; Irwin, C.E., Jr., and Millstein, S.G. 1986. "Biophysical Correlates of Risk-Taking Behaviors During Adolescence." Journal of Adolescent Health Care 7: 82S-96S; Kandel, D. 1988. "Issues of Sequencing of Adolescent Drug Use and Other Problem Behaviors." Drugs and Society 3: 55-76; Elliot, D.S., and Morse, B.J. 1989. "Delinquency and Drug Use as Risk Factors in Teenage Sexual Activity." Youth and Society 21: 21-60.
5. Resnick, G., and Burt, M.R. 1996. "Youth at Risk: Definitions and Implications for Service Delivery." American Journal of Orthopsychiatry 66(2): 172-188; Elliott, D.S. 1993. "Health-Enhancing and Health-Compromising Lifestyles." In Promoting the Health of Adolescents. Millstein, S.G., Petersen, A.C., and Nightingale, E.O., eds. New York, NY: Oxford University Press.
6. Jessor, R., and Jessor, S. 1977. Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth. New York: Academic Press.
7. A non-fatal suicide attempt is defined as a health risk behavior, not a risk outcome, because it is a strong predictor of a later completed suicide and this is a substantial threat to adolescent health. See Spirito, A., Brown, J., Overholser, J., and Fritz, G. 1989. "Attempted Suicide in Adolescence: A Review and Critique of the Literature" Clinical Psychology Review 9: 335-363.
8. Kolbe, L.J., Kann, L., and Collins, J.L. 1993. "Overview of the Youth Risk Behavior Surveillance System." Public Health Report 108 (supp. 1): 2-10; Ponton, L.E. 1996. "Disordered Eating." In Handbook of Adolescent Health Risk Behavior. New York and London: Plenum Press; Osgood, D.W., O'Malley, P.M., Bachman, J.G., and Johnston, L.D. 1988. "The Generality of Deviance in Late Adolescence and Early Adulthood." American Sociological Review 53: 81-93.
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