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A longitudinal multi-level analysis of health disparities among adolescents

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Healthy People 2010 includes objectives related both to adolescent health and to reducing health disparities. This R21 will examine health disparities over time in demographically defined sub-groups of youth by conducting secondary analyses of the 5 waves of longitudinal data from the Youth Asset Study (YAS). This study's purpose is to examine associations among youth assets, environmental factors, and adolescent risky behaviors across youth sub-groups over a 4 year period. Adolescent health disparities have been shown for race/ethnicity and socioeconomic status (SES). Tracking these objectives over time across youth sub-groups is important to assess health disparities and monitor progress of the Healthy People 2010 goals. It is also imperative to determine factors that may be related to these disparities including individual factors such as youth assets as well as environmental factors. We propose to use existing data from the YAS (funded by the Centers for Disease Control and Prevention, (CDC) Division of Reproductive Health), a 4 year/5 wave longitudinal prospective study that involves youth aged 12-17 years at wave 1 and their parents The study examines associations among neighborhood and family factors, youth assets, and youth risk behaviors. The CDC has funded data collection and data analysis related to sexual risk behaviors. The CDC supports our submission for additional funding for analysis of other outcomes. Data collected includes: 17 assets (e.g. Relationship with Mother, Religiosity, Peer Role Models), youth race/ethnicity, extensive parent reported socioeconomic status (SES) data, and risky behaviors including non-use of seatbelts, riding with drivers who have been drinking alcohol, binge drinking of alcoholic beverages, tobacco use, physical fighting, and weapon carrying. The following specific hypotheses will be examined: 1) Disparities in the proportion of youth participating in risky behaviors will change over time and this change will be different for each race/ethnicity and impacted by SES. 2) The impact of youth assets in the disparate relationship between risky behavior and time will vary by race/ethnicity and SES. 3) Environmental factors (waves 1 &2) and assets (wave 3) will be associated with risk behavior disparities (waves 4 &5) differently across race/ethnic groups and impacted by SES. 4) Youth assets (wave 3) will moderate the influence of environmental factors (waves 1 &2) on behavioral disparities differently across race/ethnic and SES groups. Separate analyses for each of the six risky behaviors will be conducted. To test these hypotheses multi-level longitudinal mixed effect models, marginal models, and structural equation modeling will be utilized. Health disparities related to racial/ethnic groups while controlling for SES will initially be examined by analyzing interactions and then may be further examined by stratifying the data based on race/ethnicity. This information will help explain the role of youth assets and the environment as they relate to youth health disparities for six risky behaviors specifically related to race/ethnicity and SES. Results will help guide interventions developed to eliminate youth health disparities. PUBLIC HEALTH RELEVANCE: The study will contribute to public health in the general area of youth development theory and specifically to our understanding of how youth assets and environmental factors may decrease health disparities related to race/ethnicity and socioeconomic status across six risky behaviors in adolescents. Practitioners can use the study results to guide interventions specifically planned at reducing or eliminating youth health disparities related to race/ethnicity and socioeconomic status.

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