Proximal Social Determinants of Adolescent Health: Findings from the Fragile Families and Child Wellbeing Study

Background/Purpose: During the past two decades, attention has increasingly been drawn to the powerful consequences of social determinants of health (SDH). Despite a vastly accumulating body of literature, adolescents are often neglected as a population in the SDH literature. They are frequently aggregated with either younger children or with young adults. Yet, adolescence is a period in the life cycle characterized by unique social determinants. Research has identified several proximal social determinants of adolescent health in addition to common structural determinants that are universal across the life span (e.g., wealth, education, gender, and ethnic/racial inequalities). However, few studies have examined proximal social determinants, such as the impact of peer relationships, family support, school climate, and neighborhood environment, simultaneously on the national scale. Using data from the Fragile Families and Child Wellbeing Study, we examined the effects of proximal social determinants of health, including family support, social relations, and neighborhood environment, on self-rated physical health among 14- and 15-years-old adolescents.

Methods: The Fragile Families Study is an ongoing, longitudinal, birth cohort study of children born in large cities in 1998-2000. The sample includes adolescents in both married and unmarried families, with an over-representation from unmarried families. We drew on data from the 15^th year follow-up. The analytic sample consists of 2441 adolescents residing with either one or both of their biological parents. Self-rated health was measured by asking “in general, how is your health?” with responses ranging from “poor” to “excellent.” Family support was measured by adolescent-reported relationship quality with father and mother. Social relational factors were measured by adolescent-reported bullying and adolescent-perceived school connectedness. Neighborhood environment was measured by the neighborhood efficacy scale (which accounts for neighborhood cohesion and support). Covariates included demographic variables (gender, race), socioeconomic status (family income), and physical health conditions (number of diagnosed physical health conditions over the past 12 months). Hierarchical ordinal logistic regression models were estimated to examine the relationship between each set of social determinants and adolescent self-rated health.

Results: After controlling for covariates, greater levels of family support, namely relationship with mother (OR=1.47, p<.001) and father (OR=1.15, p<.001), were significantly associated with a higher likelihood of reporting better self-rated health. Higher quality social relations, lower exposure to bullying (OR=.90, p<.001) and greater school connectedness (OR=1.05, p<.001), were significantly associated with better self-rated health. Finally, community efficacy had a significantly positive association with better self-rated health (OR=1.03, p<.001).

Implications: Our study reveals important information on proximal social determinants unique to adolescent self-rated health, namely relationship with parents, vulnerability to aggression by other adolescents, and school connectedness. Furthermore, community environment also plays an important role. The findings suggest further research to unravel how the effects of these factors on health are interrelated with other outcomes, such as mental health, social competence, school performance, as physical health has important implications for adolescent development and life chances during their subsequent transition to adulthood.