The Role of Connectedness in the Lives of

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The Role of Connectedness in the Lives of Youth Robert Wm. Blum, MD, MPH,

The Role of Connectedness in the Lives of Youth Robert Wm. Blum, MD, MPH, Ph. D. William H. Gates Sr. Professor and Chair Johns Hopkins University Bloomberg School of Public Health Department of Population and Family Health Sciences

Protective Factors in the Lives of Youth: crosssectional analyses

Protective Factors in the Lives of Youth: crosssectional analyses

National Longitudinal Study of Adolescent Helath Add Health Findings Parent-teen connectedness and school connectedness

National Longitudinal Study of Adolescent Helath Add Health Findings Parent-teen connectedness and school connectedness were each independently associated with less involvement with every health risk behavior studied.

The association between parent connectedness and adolescent health risk behaviors: 9 -12 th graders

The association between parent connectedness and adolescent health risk behaviors: 9 -12 th graders Suicidality Violence Cigarette use Alcohol use Age of first sex** Parental -. 24*** Connectedness -. 13*** -. 14*** Parental presence -. 07*** -. 06*** -. 13*** -. 06*** Parental -. 08*** -. 07*** -. 05* -expectations for school (parameter estimates, * = level of significance; **Odds Ratio) . 85 -- --

School Connectedness and Substance Use Level of Substance Use (SD Units) Students who feel

School Connectedness and Substance Use Level of Substance Use (SD Units) Students who feel connected to school are less likely to use substances Frequency of Use: Levels of connectedness

School Connectedness and Emotional Distress Level of Emotional Distress (SD Units) Students who feel

School Connectedness and Emotional Distress Level of Emotional Distress (SD Units) Students who feel connected to school experience less emotional distress Levels of connectedness

School Connectedness and Violent or Deviant Behavior Level of Violence or Deviant Behavior (SD

School Connectedness and Violent or Deviant Behavior Level of Violence or Deviant Behavior (SD Units) Students who feel connected to school engage In less violent or deviant behavior Levels of connectedness

School Connectedness and Pregnancy Percent ever Pregnant Students who feel connected to school are

School Connectedness and Pregnancy Percent ever Pregnant Students who feel connected to school are less likely to become pregnant Levels of connectedness

Analysis # 2: The Relationship between School Connectedness and Adolescent Health Risk Behaviors: longitudinal

Analysis # 2: The Relationship between School Connectedness and Adolescent Health Risk Behaviors: longitudinal analyses

Initiated Cigarette Use Predicted Percent of cigarette smoking at time 2 among those who

Initiated Cigarette Use Predicted Percent of cigarette smoking at time 2 among those who at time 1 did not smoke as a function of Teacher Support Multinomial logit models adjusted for social belonging, race/ethnicity, income, gender, family structure, emotional distress, relationship with parents, hx of peer suicide, hx of family suicide

Initiated Getting Drunk Predicted Percent Three Levels of Teacher Support 13. 4 11. 3

Initiated Getting Drunk Predicted Percent Three Levels of Teacher Support 13. 4 11. 3 9. 5 6. 2 4. 5 3. 2 Multinomial logit models adjusted for social belonging, race/ethnicity, income, gender, family structure, emotional distress, relationship with parents, hx of peer suicide, hx of family suicide

Initiated Marijuana Use Predicted Percent at Three Levels of Teacher Support 8. 3 6.

Initiated Marijuana Use Predicted Percent at Three Levels of Teacher Support 8. 3 6. 3 4. 7 4. 4 3. 4 2. 6 Multinomial logit models adjusted for social belonging, race/ethnicity, income, gender, family structure, emotional distress, relationship with parents, hx of peer suicide, hx of family suicide

Seriously Considered or Attempted Suicide Predicted Percent at Three Levels of Teacher Support 5.

Seriously Considered or Attempted Suicide Predicted Percent at Three Levels of Teacher Support 5. 5 5. 0 4. 5 2. 2 1. 7 1. 3 Multinomial logit models adjusted for social belonging, race/ethnicity, income, gender, family structure, emotional distress, relationship with parents, hx of peer suicide, hx of family suicide

Initiated Sexual Intercourse Predicted Percent at Three Levels of Teacher Support 12. 2 11.

Initiated Sexual Intercourse Predicted Percent at Three Levels of Teacher Support 12. 2 11. 0 9. 8 Multinomial logit models adjusted for social belonging, race/ethnicity, income, gender, family structure, emotional distress, relationship with parents, hx of peer suicide, hx of family suicide

Initiated Violence Predicted Percent at Three Levels of Teacher Support 7. 5 6. 0

Initiated Violence Predicted Percent at Three Levels of Teacher Support 7. 5 6. 0 4. 7 Multinomial logit models adjusted for social belonging, race/ethnicity, income, gender, family structure, emotional distress, relationship with parents, hx of peer suicide, hx of family suicide

Analyses #3: The International Evidence

Analyses #3: The International Evidence

Family factors associated with pregnancy: Ecuador Pregnant Non. Pregnant p value Mothers education (primary

Family factors associated with pregnancy: Ecuador Pregnant Non. Pregnant p value Mothers education (primary school only) 63. 8 39. 8 p <. 01 Fathers education (primary school only) 67. 5 38. 2 p =. 002 Low family cohesion 12. 8 2. 3 p <. 01 Youth participates in family decision making 36. 9 56. 8 p =. 004 (Guijarro, Blum et al 1999)

Positive Family Relations: Brazil Males Females n % P N % p Smoking 79

Positive Family Relations: Brazil Males Females n % P N % p Smoking 79 9. 8 . 001 127 12. 8 . 001 Drug use 64 7. 9 . 001 44 4. 4 . 001 Age at 1 st sex <15 yo 300 38. 4 . 01 110 11. 2 . 001 Pregnancy 13 1. 9 . 05 27 3. 0 . 01 Suicidal thoughts 164 20. 3 . 001 270 20. 3 . 001 Suicide attempt 54 6. 6 . 01 75 7. 5 . 001 (Anteghini, Blum et al 2001)

Positive Relationship with Teachers: Caribbean Males Females n % p N % p Smoking

Positive Relationship with Teachers: Caribbean Males Females n % p N % p Smoking - - - Drug use 37 7. 0 . 001 - - - Age at 1 st sex <15 yo 186 36. 4 . 05 4. 2 4. 6 . 05 Pregnancy 8 1. 8 . 01 - - - Suicidal thoughts 112 21. 2 . 01 276 3. 0 . 01 Suicide attempt 35 6. 6 . 05 88 9. 5 . 05

The Protective Role of School Connectedness Among Caribbean Youth Risk Behavior Males Females Low*

The Protective Role of School Connectedness Among Caribbean Youth Risk Behavior Males Females Low* High* Sexual debut 79. 0 49. 2 84. 8 19. 6 Violence 68. 1 39. 9 71. 9 11. 6 Regular alcohol use 62. 1 8. 6 78. 7 2. 1 Smoke cigarettes 51. 3 9. 1 66. 6 9. 8 * Net of any other protective factors and holding risk factors constant

Parent/Family Connectedness as a Moderator of Health Risk Behaviors Among Caribbean Youth Age Category

Parent/Family Connectedness as a Moderator of Health Risk Behaviors Among Caribbean Youth Age Category Sexual debut Depression/ suicidality Violence perpetration Rage 10 -12 13 -15 16 -18 0. 62 0. 76 - 0. 37 0. 42 0. 32 0. 69 0. 83 - 0. 44 0. 48 0. 51