Protective Factors in Individuals, Families, and Schools

? National Resilience Resource Center, University of Minnesota, Minneapolis and the Center for the Application of Prevention Technologies, 2001.
Center for the Application
of Prevention Technologies
Resilience Research for Prevention Programs
Protective Factors in Individuals, Families,
and Schools: National Longitudinal Study on
Adolescent Health Findings
By:
Bonnie Benard and
Kathy Marshall
National Resilience
Resource Center
University of Minnesota
College of Continuing Education
National Resilience Resource Center
humility
strength beauty
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National Resilience Resource Center ?
Initial results from the largest, most comprehensive survey of adolescents to
date provide powerful research support for resilience-based prevention as a
means of developing better youth outcomes. The National Longitudinal Study
on Adolescent Health (Add Health) was funded by the National Institute of Child
Health and Human Development and 17 other federal agencies.
According to the researchers, While these findings are confirmatory of other studies,
they are also unique because they represent the first time certain protective factors
have been shown to apply across the major risk domains (Resnick, et al.1997,
p.?830). The study collects data on health-related behaviors including diet, physical
activity, health-service use, morbidity, injury, violence, sexual behavior, contraception,
sexually transmitted infections, pregnancy, suicidal intentions/thoughts, substance
use/abuse, and runaway history.
Add Health is a school-based study of adolescents in grades 7-12. The study is
designed to explore the causes of healthy and unhealthy behaviors in youth, and
especially considers what protective influence families, friends, schools, and communities
have in the lives of adolescents.
This massive study has an impressive roster of researchers. J. Richard Udry is the
principal investigator of the Add Health study coordinating a team of adolescenthealth
researchers: Karl Bauman and Kathleen Mullan Harris, of the University of
North Carolina; Peter Bearman, of Columbia University; John Billy and William
Grady, of Battelle; Robert Blum and Michael Resnick, of the University of Minnesota;
James Jaccard, of the University at Albany-SUNY; and David Rowe, of the University
of Arizona.
In this analysis of what promises to be a decade of study, investigators from the University
of Minnesota (UM) Medical School s Division of General Pediatrics and the
UM Adolescent Health Program, in collaboration with the University of North
Carolina s Population Center, have identified risk and protective factors. Factors are
examined at the individual, family, and school levels as they relate to four domains of
adolescent health: emotional health, violence, substance use (cigarettes, alcohol,
and marijuana), and sexuality.
The early analysis of the study establishes the
power of family and school social contexts to influence
adolescent behavior. Specifically, we
find consistent evidence that perceived caring
and connectedness to others is important in understanding
the health of young people today
(Resnick et al., p. 830).
The ongoing study was organized in two phases.
In the first phase, started in the 1994-95 school
year, 90,118 students at 134 schools (80 high
schools and selected feeder middle schools)
around the United States completed brief questionnaires
about their lives. School survey data
about existing school health services, policies,
environments, and characteristics was collected
from 130 school administrators in the first year.
In the first phase of the study, in-home interviews
were conducted among a random sample of the
students, including one parent of each of those
students. [The second phase of completed work,
not yet reported, includes additional interviews
with students, parents, and school administrators.
Neighborhood and community data are being
collected and will be analyzed in the future.]
In this initial analysis, researchers are reporting
data from interviews with the students (12,118
total) and 1994-95 school administrators. The
parent interview data and the longitudinal data
will be published separately. As reported in the
September 1997 JAMA, eight areas were assessed:
student emotional distress; suicidal
thoughts and behaviors; violence; use of cigarettes;
use of alcohol; use of marijuana; age of
sexual debut; and pregnancy history.
Findings
Family Context
For each of the four domains of adolescent
health examined (emotional, violence, substance
use, and sexuality), Add Health researchers
found that parents do, indeed, matter! For all
health-risk behaviors, across all socioeconomic
levels, family structures, and races and
ethnicities, When teens feel connected to their
families and when parents are involved in their
Family Context Variables
Parent and family connectedness:
Highest degree of closeness, caring, and
satisfaction with parental relationship,
whether resident or nonresident mother or
father; feeling understood, loved, wanted,
and paid attention to by family members.
Parental/adolescent activities: Number
of different activities engaged in with
resident and/or nonresident parent or parents
in the past four weeks.
Parental presence: Parent present
before school, after school, dinner, bedtime.
Household access to substances
and guns: Ease of access to drugs or
guns at home.
Family suicide or attempts: Suicidal
attempts and/or completions by any family
member in the past 12 months.
Parental disapproval of sex: Parental
disapproval of adolescent s having intercourse
now.
Parental disapproval of contraception:
Parental disapproval of adolescent s
using contraception now.
Parental school expectations:
Mother s or father s expectations for high
school and college completion.
SOURCE: Blum & Rinehart (1997), p. 16.
children s lives, teens are protected (Blum and
Rinehart, 1997, p. 15). A second major overall
family protective factor was parental expectations
regarding school achievement. Higher expectations
for completing high school and college were
associated with lower levels of health-risk behaviors.
In the case of suicidal thoughts and behaviors,
only parent-family connectedness was
protective.
2
Family context variables affect alcohol, tobacco, and
other drug use as follows:
Parent and family connectedness: Much attention has
been placed on the physical presence of a parent in the
home at key times as reducing the risk for substance use.
That, however, researchers note, is consistently less significant
than parental connectedness (feelings of warmth,
love and caring from parents) (Resnick et al., 1997,
p.?830).
Parental/adolescent activities: This variable was protective
against cigarette use for students in grades 9-12 (and
for teen pregnancy).
Parental presence: This served as protection against
9th-12th graders use of cigarettes, alcohol and marijuana
and 7th-8th graders use of marijuana as well as for emotional
distress at all grade levels and violence in high
school. There does not seem to be a magical time of the
day when parental presence is especially critical. Rather,
it is having access to a parent and perhaps parental supervision
in general that matters most (Blum and
Rinehart, 1997, p. 19).
Parental school expectations: This variable was protective
in 9th-12th graders use of cigarettes.
Family suicide or attempts: This served as a risk factor
for cigarette use at all grade levels and for alcohol use in
high school as well as for emotional distress, suicide attempt,
early sexual debut, and violence.
Household access to substances and guns: Access to
substances in the home was a risk factor for use of the
three substances at all grade levels. Access to guns in
the home was a risk factor for violence in high school.
The researchers conclude: For each aspect of health
that Add Health researchers examined, the home environment
proved important. Teens sense of connectedness
to parents and family, parental presence in the
home, shared activities, parents expectations for their
teens, and the presence of guns, cigarettes, alcohol, and
drugs in the home all are associated, either positively or
negatively, with one or more facets of adolescent health
and behavior (Blum & Rinehart, 1997, p. 20).
School Context
School Environment Variables
School connectedness: From the student s
perspective, teachers treat students fairly; teens feel
close to people at school, and get along with teachers
and students.
Student prejudice: From the student s perspective,
extent to which students at teen s school are
prejudiced.
Attendance: The student s average daily attendance.
Parent-teacher organization: Percent of parents
involved with a parent-teacher organization (as
identified from paid dues).
Dropout rate: Estimated dropout rate high vs.
low.
School types: Comprehensive public, magnet,
parochial, technical, other.
Teacher education: Percent of teachers with
master s degrees.
College: Proportion of students who are collegebound.
School policies: School policies governing violence,
cigarette use, and drugs.
SOURCE: Blum & Rinehart (1997), p. 21.
Overall, the Add Health research team found just one
school variable to be consistently associated with better
health and healthier behaviors including use of cigarettes,
alcohol, and marijuana among the students: a
feeling of connectedness to school. What seems to matter
most for adolescent health is that schools foster an
atmosphere in which students feel fairly treated, close to
others, and a part of the school (Blum & Rinehart, 1997,
p. 24). Similarly, just one school variable was identified as
a risk factor: student prejudice. This was associated with
both emotional distress and suicide attempt.
While much emphasis is placed on school policies governing
adolescent behaviors, such policies appear in the
3
present analysis to have limited associations with
the student behaviors under study. It is, once
again, school connectedness, influenced in
good measure by perceived caring from teachers
and high expectations for student performance
(Resnick et al., 1997, p.?831), that makes the
critical difference. In a 1997 interview in The
Washington Post, Blum said that of all the school
context measures, Only one of those whether
students felt close to their teachers made a difference
in helping teenagers avoid unhealthy behavior.
Overriding classroom size, rules, all those
structural things, the human element of the
teacher making a human connection with kids is
the bottom line.
Individual Context
According to the Add Health team, A number
of individual characteristics emerged as salient
correlates of risky behaviors [including
substance use] across a variety of domains in
this analysis (Resnick et al., 1997, p. 831).
Students working more than 20 hours per week
were associated with higher levels of emotional
distress, substance use, and earlier age of
sexual debut. Low grade-point average and
grade retention were related to emotional distress,
substance use, involvement in violence,
and earlier onset of sexual intercourse. Consistently,
it appears that those who are academically
at risk are at high risk in other ways as
well (Resnick et al., 1997, p. 831).
Other risk factors for substance use include:
appearing older than peers (associated with
more frequent use of all substances across all
grade levels); same-sex attraction (correlated
with more frequent alcohol and marijuana use in
older teens); and anticipating an early death (associated
with all substance use in grades 7-8 as
well as marijuana use in grades 9-12).
Individual protective factors appearing across
most domains included religious identity, selfesteem,
and higher grade-point average.
Specifically, for substance use, For both
younger and older youth, personal importance
placed on religion and prayer is associated with
decreased frequency of cigarette smoking and
drinking...and with less frequent marijuana use
in older teens and correlated with delayed
sexual activity (Blum and Rinehart, 1997, p. 28).
High levels of self-esteem are also associated
with lower levels of use of cigarette and marijuana
use by older adolescents, and less alcohol
use among all teens. (Resnick et al., 1997,
p.?829).
Individual
Characteristics
Self-esteem: Extent to which adolescent
agrees to having good qualities, a lot to be
proud of, likes self, feels loved and wanted.
Religious identity: Whether adolescent
affiliates with a religion and, if so, frequency
of prayer and perception as religious.
Same-sex attraction: Ever had samesex
romantic attraction.
Perceived risk of untimely death:
Perceived chances of dying before age 35.
Work: Worked 20-plus hours per week for
pay during the school year.
Physical appearance: Appears older/
younger than most age peers.
Repeated grade: Ever repeated one or
more grades.
Grade-point average: Available grades
in English, math, history/social studies and
science in the most recent reporting period.
SOURCE: Blum & Rinehart (1997), p. 26.
4
Lessons Learned
The Add Health study calls for resilience-based
prevention. As the largest survey of adolescent
health ever done, it bears out what the classic
Kauai longitudinal resilience study first documented.
Caring relationships, high expectations,
and opportunities for participation have tremendous
protective and connective powers to influence
youth (and human) development (Werner
& Smith, 1992; Benard, 1991).
Families, schools, and any organizations
serving youth must make the
development and maintenance of
strong relationships the top priority in
their work.
According to Resnick, Youth need as many anchoring
points as possible. They must have in
their repertoire experiences with competent, caring,
prosocial adults (personal communication,
November 30, 1998). Educators who tap student
resilience with genuine rapport and deep listening
while seeing the innate resilience and health
of the student can be highly effective (Mills,
1997).
Naturally occurring healthy relationships with
parents, neighbors, teachers, and peers are critical
in a young person s life. Youth-serving institutions
can increase both the quality and quantity
of relationships, using relationship-based strategies
such as peer helping, cross-age tutoring,
mentoring, volunteers in the classroom, cooperative
learning, and community service learning.
Prevention and education reform
efforts must focus on environmental
change?on creating healthy, inviting
climates and systems?versus ?fixing?
youth.
As one of the Add Health researchers writes,
The construct of resilience is closely linked with
prevention and is system centered (Blum,
1998, p. 372). This means changing systems at
the most fundamental levels of beliefs and relationships,
and providing opportunities for participation
that ultimately serve as the connective
tissue for healthy youth development. Efforts,
thus, must begin by helping the adults in the system
to realize their own health so they can be
these competent and caring anchoring points
for youth. (Marshall, 1998).
Efforts to change systems must also focus on
providing youth the opportunities to master and
apply skills. Resiliency researchers Werner &
Smith (1992) and Add Health researchers demonstrate
that these experiences are critical to
healthy development. According to Resnick, The
building blocks of youth development are twofold.
First, youth need opportunities to develop
competence in anything poetry, music, handson
skills, it doesn t matter. Second, they need
opportunities to use and apply that skill in service
to others. This is how we sparkle! (Personal
communication, November 30, 1998.) Resnick
continues, These must be available in all youthserving
institutions.
Furthermore, according to Resnick, these are the
opportunities that help youth view themselves as
spiritual people. It is important that they experience
that sense of wonder, awe, and mystery,
experiences that ultimately connect them to life.
A third lesson: Prevention practitioners
can successfully use the Add
Health and other studies to promote
resilience-based prevention efforts.
Premier researchers like Resnick and Blum have
begun to declare, Risk-reduction approaches,
whether targeted at delinquency, drugs, or pregnancy,
do not appear to work (Blum, 1998, p.
373). Because of their studies, signs of a sea
change in prevention from risk-focused deficit
models to asset-focused strengths models are
beginning to appear among policymakers. For
example, former Secretary of Education Richard
Riley charged educators with making sure that
every child in America in a school has a positive
and caring relationship with at least one adult
(Hoff, 1998, p. 12). Finally, we are talking the resilience
talk; our challenge is to now walk the resilience
walk.
5
Think
About
It
!
The Add Health study clearly underscores the
importance of connectedness and caring relationships.
How can adults be assisted in
their efforts to create caring connections with
youth? Caring relationships and the ability to
encourage high expectations and meaningful
opportunities for youth participation are natural
by-products of an adult who is himself or
herself healthy. Where can systems and organizations
turn to enhance the health of the
helper the key adults the Add Health study
impact young people s lives?
NATIONAL
RESILIENCE
RESOURCE CENTER
The National Resilience
Resource Center (NRRC)
is located at the University
of Minnesota. Executive
Director Kathy Marshall
and associate for program
development Bonnie
Benard guide long-term
systems change initiatives
in selected school and
community sites. Resilience
research-based systems
change training and
technical assistance services
are available on a
fee-for-service basis. For
service related requests
write National Resilience
Resource Center, University
of Minnesota, College
of Continuing Education,
202A Wesbrook Hall,
77 Pleasant Street SE,
Minneapolis, MN 55455 or
contact NRRC@cce.
umn.edu. The NRRC logo
was created by John B.
No Runner.
To enhance the application
of prevention technologies,
NRRC and the Central
Center for the Application
of Prevention Technologies
have collaborated
in disseminating this
information.
References
Benard, B. (1991, August). Fostering Resiliency in Kids: Protective Factors in the Family,
School and Community. Portland, OR Northwest Regional Educational Laboratory.
Blum, R. (1998). Healthy youth development as a model for youth health promotion: A
review. Journal of Adolescent Health, 22, 368-375.
Blum, R. & Rinehart, P. (1997). Reducing the Risk: Connections That Make a Difference
in the Lives of Youth. Minneapolis: University of Minnesota, Division of General Pediatrics,
Adolescent Health.
Hoff, D. (1998, June 17). Feds plot anti-violence strategies; student coping skills emphasized.
Education Week, p.12.
Marshall, K. (1998). Reculturing systems with resilience/health realization. Promoting
Positive and Healthy Behaviors in Children: Fourteenth Annual Rosalynn Carter Symposium
on Mental Health Policy. Atlanta, GA: The Carter Center. pp. 48-58.
Mills, R. (1997). Tapping innate resilience in today s classrooms. Research/Practice,
Spring, pp.15-27.
National Institute of Child Health and Human Development. (1997, September 9) NIH
Backgrounder: The Adolescent Health Study. Bethesda, MD: National Institutes of Health.
Resnick, M.; Bearman, P.; Blum, R.; Bauman, K.; Harris, K.; Jones, J.; Tabor, J.;
Beuhring, T.; Sieving, R.; Shew, M.; Ireland, M.; Bearinger, L.; and Udry, R. (1997). Protecting
adolescents from harm: Findings from the National Longitudinal Study on Adolescent
Health. Journal of the American Medical Association, 278, 823-832.
Love conquers what ails teens, study finds. (1997, September 10). The Washingon Post,
p. A-1.
Werner, E. and Smith, R. (1992). Overcoming the Odds: High Risk Children from Birth to
Adulthood. Ithaca, NY: Cornell University Press.
The Add Health findings have been presented to such key audiences as the United States
Congress, WHO/UNICEF, Society for Adolescent Medicine, Consortium of Social Science
Associations, International Conference of Adolescent Health, American Public Health Association,
National Association of State Boards of Education, and more. For a detailed listing of
presentations and publications, go to cpc.unc.edu/projects/addhealth/files/pubs/present.pdf.
For a detailed description of the Add Health project, go to www.cpc.unc.edu/projects/
addhealth/sitemap.html. Individual researchers e-mail addresses are provided; copies of
selected publications may be requested.