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Article Excerpt
COMPREHENSIVE THEORETICAL MODELS of adolescent problem behavior propose risk and promotive factors at multiple levels of the social environment, including the family, peer, school, and neighborhood contexts. (1-3) In addition, growing attention is focused on promoting positive youth development, encouraging health-promoting behavior, and investing in resources for youth. (4-7) Thus, a holistic and comprehensive approach to optimizing adolescent development requires an understanding of factors related to both reducing problem behavior and increasing positive, competent youth behavior.
Research related to optimal youth development has begun to delineate critical dimensions of important social contexts. (8-11) For example, some researchers propose 3 basic experiences (ie, connection, regulation, and autonomy) to define youth's main associations with their environment that can be measured across multiple settings. (8,12,13) Others have articulated similar concepts and expanded the number of dimensions to include characteristics, such as adequate nutrition, health, and shelter; physical and psychological safety; adequate and appropriate supervision and motivation; supportive relationships; support for efficacy and opportunities for skill building; and integration of family, school, and community efforts. (10,11)
Empirical research generally substantiates these concepts, For example, multiple aspects of parenting including warmth, discipline, modeling of healthy behavior, monitoring, and supervision have been related to both positive and negative developmental outcomes. (14-17) Other research has shown positive outcomes for youth positively connected to school (14) and negative outcomes from associating with delinquent peers. (18-20) More distally, research has shown that community investments in youth (through structural resources, appropriate mechanisms of control, and connectedness) are related to lower levels of risky behavior in the community and greater opportunity for health-promoting behavior and positive youth development. (4,5,21-23)
Together, this work provides evidence that resources at multiple levels are important for both reducing negative behavior and promoting positive, healthy development. However, 3 concerns remain. First, much of the previous research focuses on single contexts, rather than understanding how factors in multiple contexts coexist to promote and detract from ideal outcomes (15,24); and, of those studies that include multiple contexts, few simultaneously include both risk and promotive factors in them. (1,7,9,14) Second, many studies include either positive or negative dimensions of adolescent development but not both, especially when considered from a multilevel contextual framework. Third, again with exceptions, much of this work has been conducted with smaller, nonrepresentative samples.
We use the 2003 National Survey of Children's Health (NSCH) to assess the simultaneous impact of family, school, and community risk and promotive factors on several commonly studied positive (social competence, (25,26) self-esteem, (27,28) health-promoting behavior (29)) and negative (externalizing and internalizing behavior, (30) academic problems (31)) developmental outcomes. Sociodemographic characteristics were included as controls in the models on the basis of numerous studies that document associations between these markers and behavioral outcomes. (15) Multiple indicators of positive (eg, closeness, safety) and negative (eg, aggression, negative influence) dimensions of family, school, and community contexts were included on the basis of previous research. (1,7,11-15)
We hypothesized that, controlling for sociodemographics, negative contextual factors would be associated with negative behavioral outcomes and inversely related to positive outcomes; contextual promotive factors would be associated with positive outcomes and inversely related to negative outcomes; and when entered simultaneously in the model, both family, school, and community contexts would be significantly associated with the outcomes.
METHODS
The survey design of the 2003 NSCH is described briefly in the article by Kogan and Newacheck (32) in this issue; more in-depth information can be found elsewhere. (33) Human subjects review was not required for this study.
Study Sample
Surveys were identified for 42 305 adolescents between the ages of 11 and 17 years (weighted mean: 13.94 years; SE: 0.017 years); 51% were girls. As rated by parents (0 = poor to 4 = excellent), adolescents were relatively healthy (mean: 3.38; SE: 0.008); however, 21% met screening criteria that identified a special health care need. (34) Nineteen percent were black, 81% were white or other, and 15% were Hispanic. The highest level of education in the household was more than high school for 62% of families. Most families (56%) had incomes between 100% and 400% of the federal poverty level (FPL), with 16% below 100% FPL and 28% above 400% FPL. Fifty-three percent of the adolescents lived in 2-parent households (Table 1).
Missing Data
Several composite variables were created from subsets of individual survey items. In some cases, some items within a composite were missing. When at least half of the items within that subset had valid responses, the missing items were estimated as the average of the valid responses. The greatest amounts of missing data were for poverty level (~20% of cases). Poverty level was imputed from state, highest household education, total number of children in household, and total number of adults in household, using hot-decking techniques to maximize use of that variable...
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