Identifying and Intervening in the Health Lifestyles of African American Preadolescents and Their Parents Público
Robbins, Carolyn (2016)
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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