Identifying and Intervening in the Health Lifestyles of African American Preadolescents and Their Parents Open Access

Robbins, Carolyn (2016)

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Persistent health disparities in the African American community are a central concern for medical sociologists and public health officials. Previous research has shown that overarching health lifestyles unite health behaviors, so intervening in health lifestyles may be an effective way to reduce health disparities, particularly early in the life course. This study uses data on African American preadolescents and their parents to identify health lifestyles, understand the mechanisms influencing the intergenerational transmission of health lifestyles, and assess the efficacy of intervening in health lifestyles. This dissertation also offers a bidimensional alternative to Cockerham's Health Lifestyles Theory, which interprets health behaviors in light of Bourdieu's habitus. I conducted latent class analysis and latent transition analysis on data from Parents Matter!, a set of three longitudinal parent-based HIV prevention interventions targeting 9-12-year-old African Americans in the Southeast (N = 1,105 dyads at baseline). Logistic regression, multinomial logistic regression, ANOVA, and pairwise comparisons were also used for supplementary analyses. Four distinct health lifestyles emerged for both preadolescents and their parents that ranged across four health domains: nutrition, physical activity, sexual behaviors/attitudes, delinquency (children), and stress (adults). Children's health lifestyles operated on health-promoting and health-compromising dimensions, although this distinction was not as clear for parents. No single variable was associated with membership in every lifestyle, but perceived norms and socioeconomic status were often significant. Baseline health lifestyles impacted preadolescents' health trajectories over the course of three years, and parents' health lifestyles were more stable than children's. Associations existed between preadolescent and parent health lifestyles. Parent-child relationship characteristics were associated with child and parent health lifestyles and may have facilitated any intergenerational transmission of health lifestyles. The interventions were linked with improvements in health behaviors across all four domains, as well as with certain health lifestyles. There was some evidence of the interventions influencing health lifestyles by interacting with aspects of the parent-child relationship. These results provide support for a habitus--based, multi-dimensional approach to interventions that may be effective at promoting positive health lifestyles and ultimately help to reduce health disparities in the African American community.

Table of Contents

Chapter 1: Introduction. 1

Chapter 2: Health Disparities and Health Behaviors over the Life Course. 7

Viewing Health Disparities from a Life Course Perspective. 7

How Health Behaviors Cluster into Health Lifestyles Over the Life Course. 11

How the Life Course Impacts Health Behaviors and Health Lifestyles. 12

Childhood. 12

Preadolescence and Adolescence. 13

Adulthood. 17

SNAP (Smoking, Nutrition, Alcohol, and Physical Activity) Behaviors. 19

SA (Smoking and Alcohol) and Sexual Behaviors. 23

SNAP (Smoking, Nutrition, Alcohol, and Physical Activity) and Sexual Behaviors. 26

Bidimensional Health Lifestyles. 30

Chapter 3: Theorizing Health Lifestyles. 34

Problem Behavior Theory. 34

Prioritizing the Social Environment. 38

Health Lifestyles Theory. 40

Historical Background of Health Lifestyles Theory. 40

Empirical Evidence of the Habitus. 44

Health Lifestyles Theory Diagram. 47

A Bidimensional Model of Health Lifestyles. 51

Implications of a Bidimensional Model of Health Lifestyles. 59

Considerations for the Operationalization of Health Lifestyles. 61

Chapter 4: Intervening in Health Lifestyles. 68

Public Health Intervention Strategies. 68

Social Relationships and Health. 72

Peers. 73

Parents. 75

Parent-Based Interventions. 79

Parent-Based Interventions in Practice. 81

Chapter 5: Methods. 87

Data. 88

Measures. 96

Operationalizing Health Lifestyles. 97

Sexual Health Behavior Outcomes. 104

Covariates. 105

Statistical Analysis. 108

Topic 1: Reconsidering Health Lifestyles. 111

Topic 2: Understanding the Development and Transmission of Health Lifestyles. 113

Topic 3: Intervening in Health Lifestyles. 116

Chapter 6: Results--Reconsidering Health Lifestyles. 119

Descriptive Statistics. 119

Retention Analysis. 131

Question 1. 134

Question 2. 149

Question 3. 156

Discussion. 173

Chapter 7: Results--Understanding the Development and Transmission of Health Lifestyles. 176

Question 4. 176

Question 5. 185

Question 6. 195

Discussion. 207

Chapter 8: Results--Intervening in Health Lifestyles. 211

Question 7. 211

Question 8. 227

Question 9. 240

Discussion. 248

Chapter 9: Conclusion. 250

Limitations. 252

Impact for Sociology. 255

Impact for Public Health. 256

Avenues for Future Research. 257

Connecting Sociology and Public Health. 258

Appendix. 260

Works Cited. 345

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