We gratefully acknowledge grant support from NIMH & NICHD (#’s 2R01HD058305 & ...

Paper Symposium:

Toward a Differentiated Perspective on the Meaning of Adolescent Peer Relations for

Adult Functioning in the Long-term

Friends and Health Across Time: Cumulative Long-term Links of Adolescent Social

Functioning to Adult Physical Health

Joe AllenElenda Hessel

Emily Loeb

University of Virginia

We gratefully acknowledge grant support from NIMH & NICHD (#’s 2R01HD058305 & R01-MH58066).

Copies of related papers are available at:WWW.TEENRESEARCH.ORG

Collaborators:Maryfrances Porter, Ph.D.Kathleen McElhaney, Ph.D.Joseph TanSamantha MagaroLauren Elreda, Ph.D.

Farah Williams, Ph.D.Chris Hafen, Ph.D.Megan SchadLauren EverhartRachel Narr

Christy McFarland, Ph.D.Emily Marston, Ph.D.Erin Miga, Ph.D.Amanda Hare, Ph.D.

Social Relationships and Physical Health

Surprisingly Powerful Links

Social isolation linked to:• Early Mortality• Effects Comparable to Physical

Risk Factors

Social Relationships and Physical Health

Hypothesized Mechanisms • Health Behavior• Poor Physical Health as Creating

Social Isolation• Stress/Allostatic Load

Social Relationships and Physical Health

Hypothesized Mechanisms • Humans as Pack Animals

• Needing Social Contact to Thrive

Overarching Question

Can we identify social relationship characteristics in adolescence that predict long-term health outcomes

into adulthood?

Assessing Global Adult Health

Age 25 – Simple 5-item Self-Report Scale (Medical Outcomes Study Short-form Health Survey, DeSalvo , 2006)

Cronbach’s α =.83

Assessing Global Adult HealthAge 25 Links from Prior Literature

Global Health Assessment

Objective Markers of Illness

Early Mortality

Future Illness

Sample 184 Adolescents (followed from age 13 to 27), their Parents,

Best Friends, Other Friends, Romantic Partners

Intensive Interviews and Observations with all parties (Total N over first 15 years ~ 3400).

Equal numbers of Males and Females

Socio-economically Diverse (Median Family Income= $40- $60K)

31% African American; 69% European American

Very Low Attrition (98% participation rate in current phase)

Can We Prospectively Identify Adolescent Relationship Qualities

That Will Predict Their Health as Adults?

Plan of Attack:

Start With Intuitive Long-term Predictorse.g., Social Acceptance/ Social Anxiety

Data on an Unexpected, but Remarkably Robust Set of PredictorsThe (Not So) Rugged Individualist

Putting it all Together

Peer AcceptanceAge 14

Combination of Three Peer-report Measures:

Close Friend Attachment to Target Teen:• Inventory of Parent and Peer Attachment (Armsden & Greenberg, 1987)

Overall Friendship Quality with Target Teen:• Friendship Quality Questionnaire (Parker & Asher, 1993)

Social Acceptance of Target Teen:• Rated by Close Friend• Modified Adolescent Self-Perception Profile, Close Friendship Competence

Scale (Harter, 1988)

Global Health.21**

Early Social Acceptance Predicting Future Global Health

Age 14 Age 25

Social Acceptance

Global Health.27**

Early Social Acceptance Predicting Future Global Health

Age 14 Age 25

Peer-ratings of social acceptance of target teen predict target teen’s future health.

-.10

-.22**

Family Income

Gender

Social Acceptance

Adult Covariates:

Body Mass Index

Adolescent Covariates: -.12

Social Anxiety (Age 19-20)

Social Anxiety Scale for Adolescents (LaGreca, 1998)

• 22-item self-report scale• Cronbach’s α =.93• Collected at both age 19 and age 20, with the average score across the two

ages used.

-.24**

Late-Adolescent Social Anxiety Predicting Future Global Health

Age 19-20 Age 25

Social Anxiety

Global Health

-.27**

Late-Adolescent Social Anxiety Predicting Future Global Health

Age 19-20 Age 25

Social Anxiety

Global Health

Social anxiety predicts POORER future health.

-.02

-.17*

Family Income

Gender

Adult Covariates:

Body Mass Index

Adolescent Covariates: -.17*

The Risky Status of The Rugged Individualist

Links of dominance to poor heart health (Smith et al., 2007, 2012)

Cross-cultural comparisons

??

Peer Ratings of Target Teen as a Follower Report by Best Friend at age 14 :

• 5-items• Examples:

Some teens do things just because other kids do them Some teens usually do whatever their friends tell them to do Some teens get a lot of ideas about what to wear, what to do, and how to

act from their friends

• Cronbach’s α =.68

Peer-ratings of Teen as a Follower Predicting Future Health

Peer-ratings of Teen as a Follower Predict BETTER Health in Adulthood

Global Health

Age 14 Age 25

Family Income

Gender

Teen is a Follower

Adult Covariates:

Body Mass Index

Adolescent Covariates:

.22**

-.05

-.15*

-.17

Leadership Self-Ratings Self-report at age 14

• 5-items• Examples:

How much do you see yourself as being similar to teens who: Set an example for other kids to follow Are copied by other kids Often tell their friends what to do

Self-reported Leadership Predicting Future Global Health

Age 25

Leadership is related to POORER Health in Adulthood.

Global Health

Age 14 Age 25

-.04

-.17*

Family Income

Gender

Leadership

Adult Covariates:

Body Mass Index

Adolescent Covariates: -.14

-.28***

Target Teen is Easily Influenced by Peers(Age 16)

Report by Best Friend at age 16:• 7-items

• Overall, how much do you actually think you influence: Who Target Teen Hangs out With How Target Teen Treats Other People Target Teen to Drink (or Not toDrink) Target Teen to Follow Parents’ Rules Target Teen to go farther (or not ) sexually

• Cronbach’s α =.71

.25**

Peer-ratings of Teen as Easily Influenced Predicting Future Health

Age 16

Easily Influenced Teens at 16 have BETTER Health in Adulthood

Easily Influenced by

PeersGlobal Health

Age 25

Family Income

Gender

Adult Covariates:

Body Mass Index

Adolescent Covariates:

-.09

-.21*

-.17

Teen is Assertive (Peer-Ratings) (Age 17)

Report by Best Friend at age 17 :• 5-items• Examples: How Good is Target Teen at:

Getting people to go along with what he/she wants Taking charge Sticking up for him/herself Getting someone to agree with his/her point of view Deciding what should be done

• Cronbach’s α =.90

-.29***

Peer-ratings of Teen Assertiveness Predicting Future Health

Age 17 Age 25

Assertive Teens at 17 have POORER Health in Adulthood

Assertiveness Global Health

-.16

-.12

Family Income

Gender

Adult Covariates:

Body Mass Index

Adolescent Covariates: -.20*

Teen Values Self-Direction (Age 19)

Adapted from Parenting Values Measure • (Schaefer, 1985; Kohn, 1977)• 6-items• Examples: I should…

Be able to think for myself Obey parents, bosses or teachers (reverse-scored)

• Cronbach’s α =.53

-.31***

Peer-ratings of Teen Valuing of Self-direction Predicting Future Health

Age 19 Age 25

Self-directed Teens at 19 have POORER Health in Adulthood

Self-directedness

Global Health

-.09

-.17

Family Income

Gender

Adult Covariates:

Body Mass Index

Adolescent Covariates: -.24**

Putting It All TogetherComposite Measure of “Rugged Individualism”

Combination of Three Peer-report Measures:• Teen as Follower (age 14; reverse-scored)

• Teen Influenced by Peers (Age 16; reverse-scored)

• Teen Assertiveness (Age 17)

• Standardized and summed together.

Global Health-.36***

Self-ratings of Individualism Composite Predicting Future Health

Age 14-17 Age 25

Rugged Individualism

Composite

Individualism Composite Accounts for 13.9% of Incremental Variance in Health Outcomes

Family Income

Gender

Adult Covariates:

Body Mass Index

Adolescent Covariates:

-.05

-.23***

-.15

Global Health

Comprehensive Model of Adolescent Social Relationships Predicting Future Health

Age 14-17 Age 25

3 Social Predictors Account for 29.6% of Incremental Variance in Health After Covariates

.19*

Family Income

Gender

Rugged IndividualismComposite

Adult Covariates:

Body Mass Index

Adol. Covariates:

Concurrent Depressive Symptoms (BDI)

Social Acceptance

Social Anxiety

Age 14 Age 20

-.21**

-.03

-.22**-.14

-.19*

-.29***.10

.02

Conclusions Adolescent Social Relationships and Future Health

Peer Relationships and Peer Pressure really may be ‘life and death’ issues for teens.

Copies of related papers are available at:

www.TeenResearch.org

Conclusions The Death of the Rugged Individualist?

• (or at least his/her poor health)?

Evidence from other observational research on dominance/independence

• Tim Smith and Marital Relationships

• Robert Sapolsky and Primate Dominance Hierarchies

Evidence from other cultures

• East to West

Copies of related papers are available at:

www.TeenResearch.org

Limitations

Correlational not Causal

Did not have baseline health assessments

Still Need to Understand Possible Mediating and Moderating Mechanisms!

HPA Axis Cardiovascular Reactivity Immune Functioning Health/Risk Behaviors Etc.

Copies of related papers are available at:

www.TeenResearch.org

Conclusions Implications:

• Recognizing the adolescent bind

• Well-child visits and predictors of future health

• Interventions to enhance peer relationships

Copies of related papers are available at:

www.TeenResearch.org

Thinking different is great…but it has its costs.