Skip Navigation
Link to the Home Page of U.S. Teens in Our World

U.S. Teens in Our World

Understanding the Health of U.S. Youth in Comparison to Youth in Other Countries

Table of Contents | Executive Summary | Introduction | Chapter 1 | Chapter 2 | Chapter 3 | Chapter 4 | Chapter 5 | Chapter 6 | What Was Left Out | Summary

CHAPTER THREE: FAMILY AND PEER RELATIONSHIPS


In this chapter:
Family and Peer Relationships | What Didn't We Know | References

FAMILY AND PEER RELATIONSHIPS

Adolescent health and behavior occur within the social context of family and peer relationships. These relationships and their effects are complex; not only do family relationships influence an adolescent's behavior, but they are influenced by the adolescent's behavior as well. A committee of the U.S. National Academy of Sciences stressed the problems of understanding these influences and their effects on health and behavior due to their complexity and their interaction with the family's genetic contributions to the adolescent's health and behavior.1 The complex influence of family begins before birth2 and is carried into the transition to adult independence and pursuit of individual identity. Over the course of development from infancy to adolescence, the family's impact on basic physiologic systems, emotion processing, and social competence has relevance for health.3 As adolescents begin to spend more time with peers, the relative importance of peer group influence over family influence may change.4

Parent-child relationships, family structure, and peer group relationships all affect our ability to modify adolescent health and health behavior. Previous research links family and peer relationships to adolescent health behaviors such as seat belt use,5 smoking,6 sexual behavior,7 alcohol use,8 and violence and aggressive behavior.9 Family support, parenting styles, and the influence of peer pressure have been linked to adolescent health behavior.10 A thorough review of research on effects of the family social environment found two generally 'risky' family characteristics that have adverse physical and mental effects on children and youth: 1) conflict and aggression, and 2) a cold, unsupportive or neglectful home.3 In addition to direct effects on health, such as physical abuse, the impact of the home may be mediated or sustained by disruptions in the child's ability to mount a successful physical and/or behavioral response to stress and to acquire appropriate emotional and behavioral self-regulatory skills.3

While the influence and educational role of the family may decrease as students move toward independence, the family's role throughout early life in shaping the health behavior of adolescents is critical and well documented.2 According to findings from the National Longitudinal Study of Adolescent Health (AddHealth),11 the physical presence of a parent in the home at key times, as well as parental connectedness (e.g. feelings of warmth, love, and caring from parents), and parental expectations are associated with adolescent health behavior. Specifically, high parental expectations were an important predictor of adolescents' not engaging in violence, while the physical presence of a parent in the home reduced the risk of substance use. The study also showed that the home environment shapes negative outcomes. Findings indicate that adolescents with easy access to guns, alcohol, tobacco, and illicit substances have an increased risk of suicide, involvement in interpersonal violence, and substance use.

Changes in family structure over the last three decades, with dramatic increases in divorce rates and parental remarriage, as well as single parenting, have also been shown to affect adolescent health and health behavior.12 Again, longitudinal studies of family composition and stability across the developmental stages of a child are needed to understand causation and associations shown with health and health behaviors at a single time in an adolescent's life. Instability and family disruption prior to divorce may be more influential than eventual separations and divorce. However, family stability, marital disruption and family composition are associated with cognitive, emotional, and behavioral problems in children.13 For example, a study by Moore et al.14 reported that disruption of parents' marriage and living with a single parent are related to early onset of sexual behavior. Similarly, research has also shown that adolescents from one-parent families are more likely to demonstrate increased substance and alcohol use as well as more emotional problems, such as depression and loneliness, compared to those in intact families.15 An AddHealth study of family structure on adolescent risk behaviors found strong associations between single-parent families and smoking or sexual intercourse in grades 7-12 and with alcohol use at grades 7-8.16

Affiliation with friends who engage in risk behaviors has been shown to be a strong predictor of an adolescent's own behavior.10 For instance, alcohol use by friends is substantially associated with adolescents' own alcohol use.8 Likewise, friends' cigarette smoking and use of hard drugs is related to an adolescent's own smoking and drug use.17 The causal relationship between friends' risk behavior and adolescents' own behavior is important to consider in examining adolescent health behavior. Adolescents may choose friends who engage in similar types of behavior, or they may be influenced by the behavior of friends.19

Research from the longitudinal AddHealth study addresses the multifaceted nature of friendship networks as they impact on the relationship between peer delinquency and an adolescent's own delinquent involvement.20 The density of the peer network and an adolescent's own centrality and popularity in the network may modify the effect of peer relations. Some evidence also suggests that friends' positive, healthy, "pro-social" behaviors may reduce their likelihood of engaging in risky behavior themselves. For example, adolescents' affiliation with "pro-social" peers has been shown to be associated with abstinence from alcohol use, delayed initiation of sexual activity, and protection against violent behavior among youths.21,22,23

The HBSC study examined the association of students' health-related behaviors among all countries with the strength of their relationships and the lines of communication with their parents and their peers.24 HBSC researchers focused on adolescent relationships with family and peers because the quality of communication and social skills are essential contributors to hygiene, nutrition, and physical activity, all of which are related to the risk of health impairments later in life. As noted above, both the physical and mental health of an adolescent, including communication factors, are probably a function of both the family environment and dynamics.3

The analysis measured the strength of parental communication difficulties with the following attributes: difficulty talking to elder siblings, difficulties talking to friends, difficulties making friends, having a low number of close friends, time spent with friends after school, and feeling less happy, less healthy, lonely more often, helpless more often, smoking more often, drinking alcohol more often, and having more experience of drunkenness. The analysis also examined changes with age.

Factors Associated with Difficulties in Talking to Parents

Young People who report
difficulties in talking to their parents:

11-year-olds

13-year-olds

15-year-olds

Statistical method

Boys

Girls

Boys

Girls

Boys

Girls

Have more difficulties talking to elder siblings

***

***

***

***

***

***

Pearson Correlation

Have more difficulties talking to
friends

**

**

**

**

**

**

Pearson Correlation

Have more difficulties making
friends

**

**

**

*

*

*

Pearson Correlation

Have a low number of close friends
 

**

***

**

**

**

**

x2

Spend more time with friends
after school

**

**

**

*

**

*

x2

Feel less happy
 

**

***

**

***

**

***

Student s t

Feel less healthy
 

*

**

*

*

*

*

Student s t

Feel lonely more often

*

**

**

**

*

**

Pearson Correlation

Feel helpless more often

*

**

**

**

*

**

Pearson Correlation

Smoke more often
 

*

**

**

***

*

*

x2

Drink alcohol more often
 

**

**

**

***

**

***

x2

Have more experience of
drunkenness

**

***

**

**

**

**

Student s t

 

Strength of association

None = *

Medium = **

Strong = ***

Compared to students with easy parental communications, young people who report difficulties in talking to their parents are more likely to experience similar difficulties with elder siblings, possibly indicating poor family communication in general. Students who do not report difficulties in talking to their parents find it easier to make friends, particularly among 11- and 13-year-old girls. Those who report difficulties talking with parents spend more time with friends after school. This association decreases with age and is not present for 13- and 15-year-old girls. Young people who spend more time with friends find it easier to make new friends, have more friends, and find it easier to talk to friends. However, spending more time with friends after school is also associated with smoking, drinking, and more experience with drunkenness.

For 11-year-old girls, difficulties talking with parents is associated with feeling less healthy. This association is not found for older girls or for boys at any age. Feeling lonely is associated with poor family communication mainly for girls. Negative moods such as feeling helpless or lonely were moderately associated with difficult parental communication for girls of all ages and 13-year-old boys. Interactions of poor family communication, negative moods, and the influence of the peer group are strongly associated with use of tobacco and alcohol. Strong direct associations are seen between smoking and difficulties talking to parents for girls.

The following charts show how U.S. students compare to students from other countries in measures related to family and peer relations with data from the HBSC study. These charts measure current social resources and behavior, a product of life experience and the students' own choices, such as becoming more independent of their parents. Family structure (who lives in the household) and previous instability in living arrangements are also strong precursors to family communication.12,13,14,15,16

Data for both genders are combined since there were no significant differences. The U.S. ranks just after Greenland and Denmark in the low proportion of students living with both parents (62 percent). The U.S. had the highest proportion of students living with single parents (23 percent), and ranks fourth for living with step-parents (13 percent). The proportion of students living with both parents in the U.S. decreased slightly from 67 percent at age 11 and 65 percent at age 13 with most of the change accounted for by increases in the proportion living in step-families.

Graph: "With Whom Do You Live?"[d]

About one-third of U.S. 15-year-old students had difficulty talking to their mothers, an increase from about one-fifth among 11 year olds.1 While ranking in the top three countries for difficulties (at all ages),1 the U.S. was only slightly higher than average. Across countries, 28 percent of 15-year-olds on average reported difficulties talking to their mothers, ranging from 16 to 36 percent. Few countries showed a marked gender difference and most showed that older students reported more problems than younger students.

Fifty-three percent of U.S. girls and 42 percent of boys reported difficulty communicating with their fathers. The U.S. ranking compared to other countries deteriorated with age.1

  Graph: "How Easy Is It For You To Talk To Your Mother About Things That Really Bother You?"[d]   Graph: "How Easy Is It For You To Talk To Your Father About Things That Really Bother You?"[d]

In all countries, more students reported difficulties talking to their fathers than their mothers at each age. Girls experienced these difficulties with greater frequency than boys and difficulties were more prevalent among older students. The U.S. ranked fifth among all countries in proportion of students saying it was easy for them to make new friends (85 percent), with no significant differences between genders or strong differences across ages.1 The U.S. ranking improved with age relative to other countries. However, differences among countries are small, with approximately three-quarters of all students finding making new friends easy.

About one-third of U.S. students report spending time with friends after school 4-5 days per week. The U.S. ranks within the lowest third of countries for percent of students reporting that much time, with ranges from 30 percent of boys in Denmark to 68 percent in Greenland; 18 percent of girls in Denmark to 51 percent in Greenland. In all countries, almost all students report spending time with friends after school at least once a week, with boys generally reporting more time spent with friends.

Graph: "How Often Do You Spend Time With Friends Right After School?"[d]

What Didn't We Know?

As the National Academy of Sciences Report on the interplay of biological, behavioral, and societal influences emphasized, family and peer relationships are complex.1 Without longitudinal and genetic studies, the causal effects from family and peer relations remain difficult to trace. The limited family and peer relations factors measured by the HBSC are only indicators of complex societal, family, and individual interactions. Part of the family context are the intergenerational and genetic influences working within the larger social and physical environment. Each student both influences and is influenced by the social network in which he or she lives.

The social factors of family structure, family communication, ease in making friends, and time spent with friends are highlighted in this report because U.S. students differ from other countries in these areas. The larger international report did not address other aspects either.24 They serve only to raise questions about how they may be part of the interplay between the biological and societal influences on student health and health behaviors.

Other research was reviewed for similarities to what we learned from the HBSC study about the association of difficulty with parental communication with other psychosocial risk factors and risk behaviors. The in-depth research review by Repetti and others on effects of risky families on the mental and physical health of children addresses vulnerabilities, including genetic factors, that could lead to such problems.3 Risky families are characterized by conflict and aggression and by relationships that are cold, unsupportive, and neglectful. Some of the research addressed communication patterns, which certainly may be a factor in families' impact on children's development of basic physiological systems, ability to handle emotions, and social competence. Another review of research on family strengths emphasizes the need to define what works for families managing multiple stresses in daily life, again including good communication in addition to positive parental mental health, household routines, sufficient quality time together, involvement, monitoring, and supervision.25 This article stresses that the role of culture, including ethnic differences, affects family processes and relationships in ways that we don't currently understand or assess well.

Findings from the AddHealth study show that the physical presence of a parent in the home at key times reduces some risks, particularly for substance abuse,11 and another AddHealth study indicates that no more than 10 percent of the variance explaining student smoking, drinking, suicide thoughts or attempts, involvement in violence, and sexual intercourse could be accounted for by family structure, race/ethnicity, and income together.16 Across these studies, parental connectedness (feelings of warmth, love, and caring from parents) remains the most important factor.

Provisional analysis by KM Harris, et al, of AddHealth data related to family structure and context addresses variation in parenting behaviors and parent-child relationships and their effect on substance use, delinquency, violence, and sexual activity. They find that family processes mediate the effects of family structure for all four outcomes, especially the effects of living in single-father and surrogate-parent families. Accounting for family structure, family context and other factors, family processes that involve joint decision making, close and satisfying parent-child relations, and shared time in activities and meals promote the health development of youth and protect adolescents from engaging in risky behavior. They also find evidence that parental control of youth behavior is more effective when parents and youth share close emotional bonds. Other provisional work suggests that the quantity of fathers' involvement is linked to parents' socioeconomic status and quality of father-child bond is related to the type of father figure in the home.

Since the U.S. has the highest proportion of students living with single parents and is among the highest ranked for students living with step-parents, we need to understand more about the effects of family structure on health, well-being, fitness, and family and peer relationships. The social and ethnic diversity of U.S. students and families adds complexity to the dynamics of family structure given such issues as immigration, acculturation, language, and mobility. One important question raised by this study is whether students in single or step-families are more or less likely to have communication difficulties than students living with both parents, and whether other factors, such as the gender of the student, his or her race and ethnicity, or the family's economic status influence the effect of family structure on adolescents' health and behavioral outcomes.

The population of children in immigrant families has grown by almost 50 percent during the 1990's.26 Children in immigrant families are more likely than the native-born to be poor, live in crowded housing, to lack a usual source of health care, and to be in fair or poor health.27 Yu, et al, used the HBSC data to assess the well-being of U.S. adolescents whose primary language spoken at home was other than English, a measure of acculturation.28 This study found that, compared to those who usually speak English at home, adolescents who usually speak another language at home face greater risks for poor health factors, psychosocial and school risk factors, and less parent support. Regardless of race or ethnicity. In this analysis, students with a primary language other than English at home are more likely to have difficulty making new friends, not feel accepted by other students, not feel as though they belong at school, and have difficulty talking to either parent about things that bothered them. They feel that their parents are less supportive and less willing to help with school problems or talk with teachers.

Family structure and the diversity of our population adds to the complexity of our questions about family communication, relationships, and peer relations as they affect health, well-being, and fitness. These family and peer relations obviously exert influence on the school environment as well.

REFERENCES

* Note: If you used a link in the text to reach these footnotes, please use the "Back" button on your browser to return to the text you were reading.

  1. National Academy of Sciences Committee on Health and Behavior. Health and Behavior: The interplay of biological, behavior, and societal influences. Washington, DC: National Academy Press, 2001;pages 19-29. (Available at http://nap.edu.)
  2. National Research Council and Institute of Medicine. From Neurons to Neighborhoods: The science of early childhood development. Committee on Integrating the Science of Early Childhood Development. JP Shonkoff and DA Phillips, Eds. Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press, 2000;pages 1-69.
  3. Repetti RL, Taylor SE, Seeman, TE. Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin 2002;128:330-366.
  4. National Research Council and Institute of Medicine. Risks and opportunities: Synthesis of studies on adolescence. Forum on Adolescence. MD Kipke, Ed. Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press, 1999;pages 6-17.
  5. Riccio-Howe LA. Health values, locus of control, and cues to action as predictors of adolescent safety belt use. Journal of Adolescent Health 1991;12:256-262.
  6. Bailey SL, Hubbard RL. Developmental variation in the context of marijuana initiation among adolescents. Journal of Health and Social Behavior 1990;31:58-70.
  7. Turner RA, Irwin CE, Tschann JM, Millstein SG. Autonomy, relatedness, and the initiation of health risk behaviors in early adolescence. Health Psychology 1993;12(3):200-208.
  8. Hawkins JD, Catalno RF, Miller JY. Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood. Psychological Bulletin 1992;112:64-105.
  9. Prinstein MJ, Boergers J, Spirito A. Adolescents and their friends' health-risk behavior: Factors that alter or add to peer influence. Journal of Pediatric Psychology 2001;26(5):287-298.
  10. Spear HJ, Kulbok PA. Adolescent health behaviors and related factors: A review. Public Health Nursing 2001;18(2):82-93.
  11. Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. JAMA 1997;278:823-832.
  12. Amato PR, Keith B. Parental divorce and the well-being of children: A meta-analysis. Psychological Bulletin 1991;110:26-46.
  13. Garnefshi N, Diekstra RF. Adolescents from one parent, stepparent and intact families: Emotional problems and suicide attempts. Journal of Adolescence 1997;20:201-208.
  14. Moore KA, Miller BC, Sugland BW, Morrison DR, Glei DA, Blumenthal C. Beginning too soon: Adolescent sexual behavior, pregnancy and parenthood. A review of research and interventions [On-line]. (Available at http://aspe.hhs.gov/hsp/cyp/xsteesex.htm.)
  15. Astone N, McLanahan S. Family structure, parenting practices and high school completion. American Sociology Review 1991;56:309-320.

    Blum RW, Beuhring T, Shew ML, et al. The effects of race/ethnicity, income, and family structure on adolescent risk behaviors. American Journal of Public Health 2000;90:1879-1884.
  16. Lynskey MT, Fergusson DM, Horwood LJ. The origins of the correlations between tobacco, alcohol, and cannabis use during adolescence. Journal of Child Psychology and Psychiatry and Allied Disciplines 1998;39:995-1005.
  17. Kandel DB. Homophily, selection, and socialization in adolescent friendships. American Journal of Sociology 1978;84:427-436.
  18. Keenan K, Loeber, et al. The influence of deviant peers on the development of boys' disruptive and delinquent behavior: A temporal analysis. Development and Psychopathology 1995; 7:715-726.
  19. Haynie DL. Delinquent peers revisited: Does network structure matter? American Journal of Sociology 2001;106:1013-57.
  20. Spoth R, Redmond C, Hockaday C, Yoo S. Protective factors and young adolescent tendency to abstain from alcohol use: A model using two waves of intervention study data. American Journal of Community Psychology 1996;24:749-770.
  21. Bearman P, Brückner H, Brown BB, Theobald W, Philliber S. Peer Potential: Making the most of how teens influence each other. Washington DC: National Campaign to Prevent Teen Pregnancy, 1999.
  22. Group for the Advancement of Psychiatry. Violent behavior in children and youth: Preventive intervention from a psychiatric perspective. Journal of the American Academy of Child and Adolescent Psychiatry 1999;38:235-241.
  23. Currie C, et al. (ed.) Health and Health Behaviour among Young People. WHO Policy Series: Health Policy for Children and Adolescents, Issue 1. (Available at http://www.hbsc.org)
  24. Moore KA, Chalk R, Scarpa J, Vandivere S. Family strengths: Often overlooked but real. Washington, DC: Child Trends Research Brief, 2002.
  25. Hernandez DJ, Charney E, eds. From Generation to Generation: The health and well-being of children in immigrant families. Washington, DC: National Academy Press, 1998.
  26. Capps R. Hardship among Children of Immigrants: Findings from the 1999 National Survey of American's Families. New Federalism: National Survey of America's Families, Series B, No. B-29. Washington, DC: The Urban Institute, 2001.
  27. Yu SM, Huang ZJ, Schwalberg RH, Overpeck M, Kogan MD. Acculturation and the health and well-being of U.S. immigrant adolescents. J Adolescent Health (in press).

* Note: If you used a link in the text to reach these footnotes, please use the "Back" button on your browser to return to the text you were reading.

 

Table of Contents | Executive Summary | Introduction | Chapter 1 | Chapter 2 | Chapter 3 | Chapter 4 | Chapter 5 | Chapter 6 | What Was Left Out | Summary

Top of Page