The Social Context of Health Risks and Resilience Among U.S. Adolescents

Abstract

Adolescence is a critical developmental stage where the health behaviors and choices that adolescents make have the potential to affect their long-term health and well-being (Centers for Disease Control and Prevention, 2014). This dissertation contributes three distinct studies on the contextual influences that shape adolescents' health behaviors. The first study, "The Role of Psychosocial Conditions on Sexually Transmitted Infection (STI) Risk among U.S. Young Adults," grounded in life course and syndemics theory, utilized logistic regressions to examine the role of co-occurring psychosocial conditions (childhood sexual abuse and physical abuse; depression and illicit drug use in adolescence) on STI infection (chlamydia and trichomoniasis) and sexual risk behaviors among U.S. young adults. Multiple co-occurring psychosocial conditions had an additive effect on sexual risk behaviors but no effect was observed on STIs. The second study, "Sexually Transmitted Infections and Neighborhood Poverty: The Role of Individual Resilience and Social Connectedness," utilized resilience and ecological systems theory, and logistic regressions to test if individual resilience and social connectedness (maternal, peer, and school) moderate the association between concentrated neighborhood poverty and STIs (chlamydia and trichomoniasis) among U.S. young adults. The study's main finding is that youth who reported more school connectedness and lived in high concentrated poverty in adolescence were less likely to test positive for chlamydia but were more likely to test positive for trichomoniasis. Utilizing a similar framework, "Sleeping in a Digital World: The Role of Excessive Media Use on Sleep Inadequacy Among U.S. Adolescents," examined family and neighborhood determinants that shape adolescent sleep behaviors. Grounded in the ecological systems theory and social learning theory, logistic regressions, stratified by age (aged 10-12 vs. 13-17), were used to examine the associations between excessive media use and sleep inadequacy. The study found that among older adolescents, sleep inadequacy was associated with excessive computer use. Older adolescents who watched television excessively and had media present in the bedroom were more likely to be sleep inadequate. Together, these three studies shed light on the different contextual environments in which adolescents experience health risks and resilience and will help to inform interventions that promote adolescent health and well-being.