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African Americans are at greater risk for morbidities and subsequent premature mortality than whites, despite efforts to reduce disease burden (Arias, Anderson, Kung, Murphy, & Kochanek, 2003). African-American women have the highest rates of obesity and overweight than any other group (OMH, 2012). Overweight is associated with heart disease, cancer and stroke, which are three leading causes of death among African American adults (CDC, 2013). Similarly, African-American adolescent girls have higher rates of obesity than adolescent girls of any other racial group in the United States (Ogden, Carroll, Kit & Flegal, 2014). Among African-American adolescents ages 10-19, approximately 58% of diabetes diagnoses are of the Type 2 variety (often associated with overweight), compared to 14.9% for Caucasian adolescents (Nwobu & Johnson, 2007).
Disparities in morbidity and mortality outcomes could be partially attributed to fewer health promoting behaviors (HPB) among African Americans during adolescence. In addition, adolescents’ desire for independence affects their decision making and they may take more risks that could affect their health and quality of life (Fahs et al., 1999; Tymula et al., 2012). Health beliefs, behaviors, and habits are most commonly formed during adolescence and well established by adulthood (Halfon & Hochstein, 2002; Mulye et al., 2009). Health knowledge and health promoting behaviors during adolescence impact subsequent health outcomes in adulthood.
Healthy decision making requires that adolescents have the necessary knowledge to make informed decisions (Reyna & Farley, 2006). Research suggests that adolescents who are better educated are more likely to engage in risk control and preventative behaviors. For example, Cutler and Llures-Muney (2009) found that increased education was positively associated with automobile and household safety practices while negatively associated with smoking initiation. Less education and younger age were associated with increased health risk behaviors among adolescents. According to Sales and colleagues, younger African-American girls had less knowledge about sexually transmitted diseases, lower sex refusal efficacy, and less confidence in the correct use of condoms, despite being more likely to have discussion about sex with their parents than older adolescents (2012), and thus may be at increased risk for pregnancy, HIV and other sexually transmitted diseases.
African American adolescent health behaviors and outcomes differ by sex. In 2012, the leading cause of death and disability among African American girls ages 15-19 was unintentional injuries while homicide was the leading cause among African American adolescent boys (CDC, 2013). In addition, African American adolescent boys and girls differed little on consumption of fruits and vegetables, but differed greatly in terms of their physical activity. Seventy-one percent of African American adolescent girls were physically inactive at least 60 minutes per day 5 days a week compared to 46.7% of adolescent males (CDC, 2013).
Examining gender specific health knowledge and health promoting behaviors among African American adolescents may be central in understanding persistent morbidity and mortality disparities among African Americans as a whole, and among girls specifically. Therefore, this study sought to examine HPB and health knowledge among a sample of African American middle school age girls in the southeastern United States. The following questions were assessed: 1. How often do these girls engage in HPBs such as physical activity and car safety? 2. What is the description of their health knowledge? 3. How do these girls compare to African American high school girls on knowledge and behaviors?
Methods:
Health behaviors including physical activity and seat belt usage were assessed among 104 African American middle school girls in the southeast US; demographic information was obtained from their mothers. Similar behaviors were examined among African American high school girls in grades 11 and 12 from the 2013 Youth Risk Behavior Surveillance Survey (add ref here). A 10-item health knowledge assessment scored as correct or incorrect, administered to the middle school age girls, included questions about smoking, diet, and stress.
Results:
Of the 75 African American middle school girls who reported riding a bike or skateboard, 85% stated they rarely or never wore a helmet. Ten percent of all 104 middle school girls reported rarely or never wearing a seat belt when riding in a car compared to 6% and 7% of girls in 11th and 12th grade, respectively. Almost half of the middle school girls (48%) reported being physically active for at least 60 minutes per day on 5 or more of the last 7 days compared to 27% of 12th grade girls. Nine percent of the middle school girls reported no days of exercise in the last 7 of at least 60 minutes per day. Only 5 middle school girls got all 10 knowledge questions correct. The individual questions with lowest percent correct were: washing your hands with soap and water for twenty seconds is as effective in killing germs as washing your hands with water or using an alcohol based sanitizer (false; 22%), and bad body odors always come from poor hygiene (false; 26%). Seventy-eight percent of mothers of the middle school girls had health insurance compared to 99% of their daughters. About three-fourths (77%) of mothers got most of their health care from a private doctor compared to 85% of their middle school daughters. Approximately 93% of mothers of the middle school girls reported their daughter having a routine physical exam in the past year.
Conclusion:
Health behaviors begin early in life and whether or not a person knows about and practices HPBs can have long-term implications. Understanding the knowledge that African American girls have about ways to promote health, and the HPBs they practice is important in order to inform intervention design to address inequities in health and health differences among the sexes.