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

Robbins, Carolyn (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/df65v805z?locale=en
Published

Abstract

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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