Adolescent connectedness associated with lower emotional distress and risk behaviors in adulthood

1. Higher self-reported school and family connectedness in adolescence was associated with lower emotional distress and lower odds of risk behaviors and experiences in adulthood.

2. Adult risk for suicidal ideation, sexually transmitted infection (STI) diagnosis, prescription drug misuse, and intimate partner physical violence were all lower among individuals with high levels of school and family connectedness in adolescence.

Evidence Rating Level: 2 (Good)

Study Rundown: The relationship between adverse experiences in adolescence and risk for adult mental and physical health outcomes is well-studied, but less is known about protective factors in adolescence. While previous studies have examined the protective effects of connectedness in adolescence, most have had short follow-up periods. In this retrospective cohort study, researchers used nationally representative survey and questionnaire data to measure self-reported school and family connectedness in adolescence, and self-reported health risk behaviors and experiences in adulthood more than 10 years later. Higher school connectedness in adolescence was associated with lower emotional distress and lower odds of nearly all risk behaviors and experiences examined in adulthood, including risk for suicidal ideation, STI diagnosis, and prescription drug misuse. Similar protective associations were found for family connectedness.

These findings are limited by self-reported health outcomes, which may be underreported. Furthermore, the study may be underpowered to detect significant differences in suicide attempts because the prevalence was low. Nonetheless, the study is strengthened by its large, nationally representative sample and long follow-up period. For physicians, these findings highlight the importance of identifying and intervening on adolescents who feel unconnected with their school and their family.

Click to read the study, published in Pediatrics

Relevant reading: Adolescence and the Social Determinants of Health

In-Depth [retrospective cohort]: Researchers used data from the National Longitudinal Study of Adolescent to Adult Health to identify 14 800 subjects interviewed in grades 7 to 12 in 1994-1995, and again at age 24 to 32 in 2008. Surveys and interviews measured self-reported school and family connectedness, self-reported health risk behaviors, and sociodemographic characteristics. Multivariable analyses were used to model associations between adolescent connectedness and health outcomes in adulthood.

Higher school connectedness in adolescence was associated with lower emotional distress in adulthood, as well as lower odds for most other risk behaviors and experiences, including suicidal ideation (adjusted odds ratio [aOR] = 0.97; 95% confidence interval [CI] 0.95-1.00), STI diagnosis (aOR = 0.98; 95%CI 0.96-1.00), and prescription drug misuse (aOR = 0.97; 95%CI 0.96-0.99). Similar protective associations were found for family connectedness, including lower odds for intimate partner physical violence (aOR = 0.98; 95%CI 0.96-1.00), STI diagnosis (aOR = 0.96; 95%CI 0.94-0.98), and prescription drug misuse (aOR = 0.94; 95%CI 0.92-0.97). Individuals with high levels of both school and family connectedness had 48% to 66% lower odds of health risk behaviors and experiences in adulthood compared with individuals with low levels of connectedness.

Image: PD

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