A sense of connectedness in adolescence predicts positive outcomes in adulthood

Steiner, R. J., Sheremenko, J., Lesesne, C., Dittus, P. J., Sieving, R. E., & Ethier, K. A. (2019). Adolescent Connectedness and Adult Health Outcomes. Pediatrics. DOI: https://doi.org/10.1542/peds.2018-3766

Summarized by Harry Bayly

• Using Ad Health data on 14,800 adolescents, this study examined if adolescents who felt connected within their family and their school community would demonstrate more healthy behaviors as they grew up and reached adulthood.
• School connectedness in adolescence had independent protective associations for emotional distress, suicidal ideation, physical violence victimization and perpetration, multiple sex partners, STI diagnosis, prescription drug misuse, and other illicit drug use in adulthood.
• Family connectedness had independent protective associations for emotional distress, all violence indicators examined, including intimate partner violence, multiple sex partners, STI diagnosis, and both substance use indicators.
• Instilling a sense of connectedness with one’s school and family in adolescence may predict these long-term outcomes.

Introduction (Reprinted from the Abstract)

Because little is known about long-term effects of adolescent protective factors abstract across multiple health domains, we examined associations between adolescent connectedness and multiple health-related outcomes in adulthood. We used weighted data from Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 14,800). Linear and logistic models were used to examine associations between family and school connectedness in adolescence and self-reported health risk behaviors and experiences in adulthood, including emotional distress, suicidal thoughts and attempts, physical violence victimization and perpetration, intimate partner physical and sexual violence victimization, multiple sex partners, condom use, sexually transmitted infection (STI) diagnosis, prescription drug misuse, and other illicit drug use. In multivariable analyses, school connectedness in adolescence had independent protective associations in adulthood, reducing emotional distress and odds of suicidal ideation, physical violence victimization and perpetration, multiple sex partners, STI diagnosis, prescription drug misuse, and other illicit drug use. Similarly, family connectedness had protective effects for emotional distress, all violence indicators, including intimate partner violence, multiple sex partners, STI diagnosis, and both substance use indicators. Compared to individuals with low scores for each type of connectedness, having high levels of both school and family connectedness was associated with 48% to 66% lower odds of health risk behaviors and experiences in adulthood, depending on the outcome. Family and school connectedness may have long-lasting protective effects across multiple health outcomes related to mental health, violence, sexual behavior, and substance use. Increasing both family and school connectedness during adolescence has the potential to promote overall health in adulthood.

Implications (Reprinted from the Discussion)

Long-term consequences of health risks in adolescence are well documented.1–3 However, the influence of adolescent behaviors and experiences on health trajectories into adulthood is not limited to risk and subsequent adverse impact. Our study suggests that family and school connectedness during adolescence may have long-lasting protective effects across a range of adult health outcomes related to mental health, violence, sexual behavior, and substance use. Specifically, school connectedness in adolescence had independent protective associations for emotional distress, suicidal ideation, physical violence victimization and perpetration, multiple sex partners, STI diagnosis, prescription drug misuse, and other illicit drug use. Similarly, family connectedness had independent protective associations for emotional distress, all violence indicators examined, including intimate partner violence, multiple sex partners, STI diagnosis, and both substance use indicators. Suicide attempt and condom nonuse were the only 2 outcomes not protectively associated with family and/or school connectedness in multivariable analyses. We also found that both connectedness constructs are associated with increased likelihood of graduating from college, a key indicator of life opportunity.

Limitations of this study should be considered. We examine self-reported health outcomes, and there may be underreporting due to social desirability biases. A specific measurement concern is that condom use in the past 12 months is an imprecise indicator, which may account for the lack of significant multivariable associations with this outcome. Additionally, the prevalence of suicide attempts was low, potentially precluding detection of significant differences. In using Wave IV, we have missing data because of study attrition, but baseline differences between those retained and lost to follow-up were minimal. Additionally, we did not control for all potential confounding factors given some were unmeasured and others were strongly correlated with baseline outcomes, such that inclusion of these variables would have likely created multicollinearity. The data, particularly Wave I, are older, although given our research question, this is of minimal concern because we would expect connectedness to function similarly today. Finally, although the data are nationally representative, the school-based sampling limits generalizability.

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