Role of Race and Ethnicity on Trajectories of Health Risk Behaviors From Adolescence Into Adulthood

Purpose: Research on the development of risk behaviors including smoking, marijuana use, tobacco use, alcohol use, and sexual intercourse has been limited in several ways. Studies often stratify by race or gender and may adopt a single developmental pathway for each category of interest. There is a lack of understanding about the relationship between race / ethnicity and the chance of following a particular developmental trajectory and this information could aid in the tailoring of interventions to improve health outcomes for specific groups. The purpose of this study was to explore whether there are exclusive subgroups discernable within the trajectories of selected health risk behaviors (sexual behaviors, smoking, alcohol use, and marijuana use) by examining deviations from each trajectory. Then, we examined whether race / ethnicity is a predictor of subgroup membership for each risk behavior.

Methods: We examined selected health risk behaviors in a sample of participants from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health) using an accelerated longitudinal design approach. Including those 12-31 years of age, 9,421 participants interviewed at all four waves of data collection were included in the study. We estimated trajectories over time by performing growth mixture modeling for the outcomes sexual intercourse, smoking, marijuana use, tobacco use, and alcohol use. To assess the association between race / ethnicity and trajectory membership we used multinomial logistic regression. Our research questions included 1. Do trajectories of development of risky health behaviors from age 12 to 21 vary by race or ethnicity? 2. Are there multiple classes of trajectories or is one trajectory sufficient? Life Course Theory guided this study. According to this theory, trajectories of health behavior change across the various life stages, and these trajectories may change depending on cultural context and social factors. The study was institutional review board approved.

Results: We identified two trajectories for heavy episodic drinking and three for sexual intercourse, smokeless tobacco use, and number of days drunk. Four trajectories were identified for cigarette smoking and five resulted for marijuana use. When we controlled for gender and compared with Whites, African American and Hispanic adolescents / young adults were less likely to be late starters for the use of tobacco, and for both heavy episodic and excessive drinking. Again, compared to Whites, Hispanic adolescents / young adults were less likely to be late initiators for marijuana use. Finally, compared to Whites, African Americans were less likely to engage in sexual intercourse as teens or young adults.

Conclusion: There are different developmental pathways for health risk behaviors among adolescents and young adults in the United States. As might be expected, some behaviors begin with experimentation in early adolescence whereas other behaviors have their beginnings in later adolescence or even young adulthood. Race / ethnicity is related to trajectory. In most cases, non-Whites were more likely to be members of trajectories involving later or no instigation of risk behaviors. These trajectories could provide important information about when to best intervene for particular subpopulations. Targeting nursing interventions has the potential to improve outcomes for these groups.