Racial and Ethnic Disparities in Adolescent Health

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Racial and Ethnic Disparities in Adolescent Health

• Robert Wm. Blum, M.D., M.P.H., Ph.D.
• Professor and Director
• Division of General Pediatrics Adolescent
  Health
• University of Minnesota
• Prepared for
• 16th Annual UIC MCH Leadership Conference
• Translating Research into MCH Public Health
  Practice
• April 28, 2003

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There is extensive data comparing adolescent risk
behaviors among various ethnic groups
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Poverty Rates by Ethnicity

• In 1992, 21.9 of all Youth Lived in Poverty

Percentage
Single Parent
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Homicide Rates
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Sexual Debut Among 15-19 Year Old Females
Percentage
Hispanic
African American
White

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Cigarette Smoking by Race
Percentage
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Summary

• Prevalence differences in adolescent behaviors
  among races has lead to the conclusion that race
  (or its associated cultures) are important
  explanations of those differences.

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Add-Health StudyCurrent Analyses

• To what extent does race/ethnicity explain
  differences in adolescent risk behaviors?
• To what extent is race confounded by income
  and/or family structure?
• How much can adolescent risk behaviors be
  explained by ethnicity, income and family
  structure together?

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Add-Health Sample Design
129 Schools (79) 90,118 (75.6)
In-School Sample (1994)
Saturation High income African American
Twins Disability
In-Home Samples (1995)
N15,243
Core In-school survey school rosters
Special
Teen N12,105 (79.5)
Parent N10,471 (86.5)
Wave 1 (1994-5)
Wave 2 (1996)
Teen
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Sample Description
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Family Variables

• Income (Parent Report)
• lt 20,000
• 21,000 - 40,000
• gt 40,000

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Ethnicity/Race(Adolescent Report)

• White (Non-Hispanic)
• Hispanic (all races)
• African American/Black (Non-Hispanic)
• Multiple Races primary ethnic identity

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Family Structure(Adolescent Report)

• Two resident parent (biologic,
  recombined, adoptive)
• Single resident parent (biologic, adoptive)

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Adolescent Risk Behaviors

• Cigarette Smoking A 7-category composite
  variable from never smoked to smoked gt1 pack/day
  in the past 30 days.
• Alcohol Use An 8-category variable from
  never/almost never used to daily/almost daily use
  alcohol in the past year.
• Suicidality A 5-category scale from seriously
  thought about committing suicide to attempted 1,
  2, or more times in the past year.

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Adolescent Risk Behaviors

• Violence An 8-item scale from a physical
  fight, a group fight, injured someone, threatened
  someone with a weapon in a fight, to shot or
  stabbed someone in the past year.
• Sexual Debut Ever had intercourse.

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Findings Intercorrelation of Family Structure
and Income
Income Over 40,000 Among Single Parent Families
Percent
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Findings Intercorrelation of Family Structure
and Income
Income Under 20,000 Among Single Parent Families
Percent
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High Risk Behavior Income Grade
a plt.05 b plt.01 c plt.001 X2 (2df) Test for
difference among three groups on dichotomized
risk behavior variables. Note Calculated on
subsample of youth in three ethnic groups who
have resident parents and information on
household income (n8,486).
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High Risk Behavior Ethnicity Grade
aplt.05 bplt.01 cplt.001 X2 (2df) Test for
difference among three groups on dichotomized
risk behavior variables Note Calculated on
subsample of youth in three ethnic groups who
have resident parents and information on
household income (n8,486).
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High Risk Behavior Ethnicity Income
aplt.05 bplt.01 cplt.001 X2 (2df) Test for
difference among three groups on dichotomized
risk behavior variables. Low 20,000
household income Moderate 21,000-40,000
household income High 40,000 household
income.
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High Risk Behavior Ethnicity Income
aplt.05 bplt.01 cplt.001 X2 (2df) Test for
difference among three groups on dichotomized
risk behavior variables. Low 20,000
household income Moderate 21,000-40,000
household income High 40,000 household
income.
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High Risk Behavior Ethnicity Income
aplt.05 bplt.01 cplt.001 X2 (2df) Test for
difference among three groups on dichotomized
risk behavior variables. Low 20,000
household income Moderate 21,000-40,000
household income High 40,000 household
income.
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Cigarette Smoking
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Cigarette Smoking

• When taken together race, incomeand family
  structure explain 2 of variance (R2.020) for
  younger teens and 6.1 for high school students.
  Gender does not contribute explanatory power.

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Alcohol Use
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Alcohol Use

• Race, income and family structure
• explain 1 of variance for younger adolescent
  drinking behavior and 2.5 for older teens.
  Gender is non-contributory for older adolescents.

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Violence Perpetration
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Violence Perpetration

• Most of the variance (4.6 for younger teens
  and 5.0 for older) is explained by gender. Race,
  income and family structure together account for
  an additional 3.5 and 3.9 of variance in
  violence perpetration, respectively, for younger
  and older teens.

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Suicide Attempt
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Suicide Attempt

• Gender explains less than 1 of variance for
  younger teens and only 1.3 for older
  adolescents. Race, income and family structure
  when taken together add no explanatory power to
  understanding suicide attempts.

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Sexual Debut
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Sexual Debut

• While an R2 statistic cannot be calculated
  using logistic regression, using an improvement
  in X2 fit, it is estimated that race, income and
  family structure explain an estimated 8.5 of
  variance among younger teens and 3.5 for older
  adolescents.

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Summary

• When taken together, race, income and family
  structure explain between 0.7 and 8.5 of the
  variance in the adolescent risk behaviors.

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Which are the factors that matter most across
ethnic groups?
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Cigarette Smoking and Alcohol Use
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Cigarette Smoking and Alcohol Use
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Violence, Suicide Risk, Sexual Debut
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Violence, Suicide Risk, Sexual Debut
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Violence, Suicide Risk, Sexual Debut