MCHB EPI Atlanta Conference
 
December 5 - 7, 2006

You've Got to Accentuate the Positive:

Research on Protective Factors for Child Well-Being

CLAIRE BRINDIS: Thank you, Michael. And I also want to say on behalf of the panel that we really appreciate all of the work that Michael did to bring us together in this way. I am delighted to be here with you in Atlanta. I spent four years of my life here and this is where my first child was conceived. So I always feel that the sense of connectivity I feel with the city is reflected in Seth’s outcome. When he was about 10 years old, this wonderful set of cookies came out, Mother’s Cookies and they were shaped like dinosaurs, like one of Chris’ slides, and when he was done with his bath he said, “Mom, can I have some of those cookies?” And I said, “You know, I hate to tell you this but your mom ate the whole box of cookies” and he said, “Mom, how could you do that? Why didn’t you just say, no?” And I said to him, I said, “You know, I don’t use drugs. I don’t use very much alcohol. But when it comes to cookies, this is a weakness.” So I went out and bought another box of cookies and showed him moderation.

So today’s panel is really looking at those positive indicators. And what I want to do is build on what Chris started off by sharing with you some of the research that clearly points out why it’s so important to start looking at these issues of positive indicators and their relationships to risk-taking behaviors among young people. I’ll be focusing a lot on parenting, and on community connectivity, and also perceptions by young people of those communities around them and how that impacts their own behavior.

If you think about a structural framework for this, we really look at the fact that if we’re going to have resilient, healthy adults; what are kinds of external assets such as caring relationships, high expectations, and frankly, opportunities to participate and contribute. So really looking at the community context as much as individual factors, and the relationships between the individual factors and the communities in which our young people are being raised.

All of the youth in our lives and ourselves, through a developmental lens, need a sense of love, belonging, respect, mastery, safety, challenge, power, and meaning. And these aspects of developmental milestones are true no matter whether you’re a recent immigrant to this country or whether you have been here for several generations, whether you’re a rural or urban, whether you’re Samoan, African-American, Latino, etcetera. And many of these assets really are shaped by some of these internal assets, which really deal with the issue of social confidence, problem solving, the sense of self and autonomy, and the sense of purpose and future. So it’s really behooves us in the field of public health and maternal and child health to be thinking about how our data helps to shape programs that try to engage young people in these kinds of ways because these kinds of antecedents really contribute to improved health, social, and academic outcomes.

Let me start off with parental connectiveness. I don’t know how you feel about your parents. My parents were very special to me and I think that you need to be thinking about parents as I go through these next slides. Because clearly one of the most important tasks of being a good parent is giving the child that sense of being loved, accepted, and cared about by the parent. In fact, youth who do not experience parental love have been shown to have much more hostility and aggression, much more dependency, and clearly less self-esteem and less sense of adequacy, as well as emotional instability. The ABC’s of parenting really reflect the role of advocating on behalf of the young person, behavioral control, which I’ll talk a little bit more next, as well as that sense of connectivity. And, I must indicate to you that that isn’t something that just happens in the zero to three or zero to five; it’s a life course issue.

My husband who’s a cardiologist recently saw a patient who is in his early 90s, and Ralph asked him how he was doing and he said, “Oh, you know, I’m doing pretty well but I’m a little worried about how my son is going to turn out.” And Ralph thought, “Well, maybe, you know, we’re living in California, maybe this was a new trophy wife. I remind him that he’s got his trophy wife already and he said, “My son.” He said, “How old is your son?” He said, “He’s 63.” So the role of parenting does not end and the role of advocacy on behalf of your child does not end. Because clearly while you’re--the child is younger, the mentoring and the monitoring often is around schoolwork and issues of participating in the life of the child includes having opportunities to participate in the school environment. And we know that children are at disadvantage when their parents don’t feel comfortable about coming to the school and participating in the life of that youngster. That parent is really the champion and they have to seek resources for the child as well as supporting the child in the face of another parent’s opposition, although I have to say sometimes when I see the news and I see some of the over-anxious parents on the soccer field, I worry a little bit about how much opposition and what kind of role modeling we’re showing our young people. And clearly, parents are important in terms of modeling civic engagement. What is good behavioral control? Clearly, we want to have parents who know how to monitor their--the behavior of their children, who establish clear lines of behavior and the consequences for the infractions of those rules, knowing your child’s friends and friend’s parents as well as conveying clear expectations. So parental monitor, monitoring is really around attending to and tracking a child’s whereabouts, activities and adaptations. And we know, from a variety of research that that monitoring really helps decrease the risk of drug and alcohol use, decreases sexual activity, increases or delays the onset of sexual activity and onset of the resulting of a pregnancy, decrease of depression, school problems, as well as victimization and delinquency and helps to delay or decrease the issues of peer influence.

Robert Blum was kind enough to share some of the research with me about the Add Health data that he’s looked at Wave I, Wave II and Wave III. And by looking at what happens in early adolescence, at age 12 to 14, around issues of family closeness and parental behavior, he also looked at how that relates to the initiation of health compromising behaviors and how that leads to poor health and health related outcomes in the ages of 18 to 21.

And how do you operationalize these concepts of family closeness? And here are some of the ways that Add Health does. My family cares for me. My family understands me. I have fun with my family. My family pays attention to me. When you look at parental behavior control, some of the indicators are: the parent decides the amount of TV, child watches or what time the child comes home on a weekend, parent decides what types of TV programs the child watches and the time that parent--the child goes to bed, and also decisions around nutrition and peer, who they hang-out with. And I must say that the research indicates that if a child has a television set in their bedroom as an indicator that that often contributes to a decrease in this level of parental behavior control.

School dropout has clearly been linked to the issue both for males and females and this slide I show the relationship between parental behavior control and parent-family closeness and how that contributes in Wave II to the incidence of skipping school and eventually to school dropout. And same pattern occurs for females.

I want to talk a little bit about the sense of adult supervision and whether teenagers feel the sense of parental presence. The good news, I think, is that the majority of teenagers, in fact, report and this is based upon California health interview survey, that they--their parents really know where they are and have some type of adult presence in after school hours. However, among the 20 percent or so who don’t have any adult presence, they are much more likely to engage in risky behaviors including sexual activity, alcohol use and marijuana use. Now most of you have seen the article by Resnik that was published in JAMA, which was the first article that really looked at the impact of--or the review of the National Longitudinal Study on Adolescent Health.

And there the results clearly show strong association between adolescent connectivity to meaningful adults in schools and the prevention of every risk. So students who feel connected to schools are less likely to use substances and here, the blue line as alcohol, yellow are cigarettes, and teal is marijuana. If the adolescent feels very connected to school they experience less emotional distress so that adolescents who feel not at all connected have much greater instance of emotional distress. And this data, I think has really helped to launch a movement around the need for smaller schools within larger high schools. There’s also a sense of less violence and deviant behavior, the more connected you feel to schools and less likelihood of pregnancy.

Now I wanted to highlight a little bit of California data, and I want to share this first slide first because the rest are very dependent on this pattern and I thought this was extremely important in terms of the number of students who scored high in external assets around caring relationships, high expectations, and meaningful participation. The first bar is the seventh grade, the second is ninth, 11th, and then the last is non-traditional school. And the numbers here are not as important as the pattern that I want to share with you, which is--look at the impact as our young people get older and how the sense of connectivity to caring relationships, high expectations, and meaningful participation, decreases significantly as adolescence go from the seventh grade to the 11th grade. And again, there is a bias in this data because these are the adolescents who are actually still attending school. And so this data we’ve used in California as part of our Adolescent Health Strategic Plan to really point out the importance of continuing to support adolescents throughout all of their high school years.

This slide shows the number of adolescents who feel decreasingly connected to their home, going from the seventh grade where about three-fourths of them feel that they have caring relationships, going down to less than half as they’re in the 11th grade. And students attending non-traditional schools, alternative schools, even have less sense of connectivity.

This is also a slide showing the results or data of adult--excuse me, teen connectivity to the community, and here again teenagers are being raised in communities where they don’t feel that they have caring relationships, or high expectations, or meaningful participation. So the adolescent’s perceptions of parental monitoring really does contribute to a decrease in their risk behaviors and we also have to be aware of how that varies by gender. With males feeling that parents were more likely to know about their alcohol and smoking and they perceive that their parents would know much less about their sexual behavior and females reporting that parents were equally likely to know about sexual experience or alcohol use but most likely to know about tobacco use.

And finally in this data, it’s important to point out that the younger the adolescent, again, clearly the more connectivity and more awareness by the parents of their behaviors as opposed to older teens.

I apologize about this slide in terms of being small. I’ve broken it up that I made an error. In terms of implications for your own work as you’re thinking about positive indicators and our panel here have put together a one-page, which each of you should have with our recommendations of some of the best indicators to consider, as well as some additional resources. But clearly we are advocating for the use of or incorporation of positive indicators within your existing data collection systems to gather data. And some examples include Vermont where they’ve modified the Youth Risk Behavior Survey by adding asset-based questions, if it used administrative data and supplements from The Search Institute. In Maine, there are 24 positive indicators from multiple data sources. In California, we have our California household interview survey, which has a module on positive indicators. In New York, there is a lot of activity around youth development indicators. In Iowa, there is a youth development results framework which extends their early childhood initiative. And this is what you couldn’t read, this is just taken from what the state of Vermont has been doing, which is adding questions pertaining to how many youth report parental involvement in their schools, how many they feel—who feel that they decide on what goes on in their schools, whether they have useful roles, whether they’re actually engaged in volunteering, whether they feel that they are growing up in homes with high levels of love and support, as well as seniors who have strong plans for their future in terms of educational or vocational training and employment and finally, adolescents who feel valued by their community. And again, these are challenging areas of indicators to have an impact from a programmatic perspective, but there are ways that this data can be used to really create more effective interventions on behalf of young people. Thank you very much.