Racial and Ethnic Disparities in Adolescent Health

1. 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

2. There is extensive data comparing adolescent risk behaviors among various ethnic groups

3. Poverty Rates by Ethnicity In 1992, 21.9% of all Youth Lived in Poverty Percentage *Single Parent

4. Homicide Rates

5. Sexual Debut Among 15-19 Year Old Females Percentage Hispanic African American White

6. Cigarette Smoking by Race Percentage

7. Add-Health Study—Current 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?

8. 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) N=15,243 Core In-school survey & school rosters Special Teen N=12,105 (79.5%) Parent N=10,471 (86.5%) Wave 1 (1994-5) Wave 2 (1996) Teen

9. Sample Description

10. Family Variables • Income (Parent Report) • < $20,000 • $21,000 - $40,000 • > $40,000

11. Ethnicity/Race(Adolescent Report) • White (Non-Hispanic) • Hispanic (all races) • African American/Black (Non-Hispanic) • Multiple Races: primary ethnic identity

12. Family Structure(Adolescent Report) • Two resident parent (biologic, recombined, adoptive) • Single resident parent (biologic, adoptive)

13. Adolescent Risk Behaviors • Cigarette Smoking: A 7-category composite variable from never smoked to smoked >1 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.

14. 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.

15. Findings: Intercorrelation of Family Structure and Income Income Over $40,000 Among Single Parent Families Percent

16. Findings: Intercorrelation of Family Structure and Income Income Under $20,000 Among Single Parent Families Percent

17. High Risk Behavior: Income & Grade a p<.05 b p<.01 c p<.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 (n=8,486).

18. High Risk Behavior: Ethnicity & Grade ap<.05 bp<.01 cp<.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 (n=8,486).

19. High Risk Behavior: Ethnicity & Income ap<.05 bp<.01 cp<.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.

20. High Risk Behavior: Ethnicity & Income ap<.05 bp<.01 cp<.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.

21. High Risk Behavior: Ethnicity & Income ap<.05 bp<.01 cp<.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.

22. Cigarette Smoking

23. 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.

24. Alcohol Use

25. 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.

26. Violence Perpetration

27. 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.

28. Suicide Attempt

29. 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.

30. Sexual Debut

31. 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.

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

33. Which are the factors that matter most across ethnic groups?

34. Cigarette Smoking and Alcohol Use

35. Cigarette Smoking and Alcohol Use

36. Violence, Suicide Risk, Sexual Debut

37. Violence, Suicide Risk, Sexual Debut

38. Violence, Suicide Risk, Sexual Debut