Date of Award

5-2007

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Nursing

Research Advisor

Mona N. Wicks, R. N., Ph. D.

Committee

Jerome Blakemore, Ph. D. Melissa S. Faulkner, R. N., D. S. N. Margaret T. Hartig, A.P.R.N., Ph. D. Judy C. Martin, A.P.R.N., Ph. D. Muriel C. Rice, A. P. R. N., Ph. D.

Abstract

Area of Investigation: Cardiovascular (CV) diseases are the leading cause of death among Black American adult males. Health behaviors that contribute to CV disease are probably learned during adolescence yet few researchers have studied the factors that influence health promotion behaviors in adolescent Black American males. This study described the health barriers, health perceptions (health self-efficacy and health status), and CV risk factors reported by and the influence of these variables on health promotion behaviors of a sample of Black American adolescent males without known CV disease.

Methods and Procedures: A descriptive correlation study design was used to explore the associations among self-reported health barriers, self-efficacy, perceived health status, CV risk factors, and health promotion behaviors in 92 adolescent Black American males 13 to 18 years of age. Participants were recruited from two sites in Tennessee and Louisiana, respectively. Health barriers were assessed by asking adolescents “What are the 3 major things in your life that will keep you from making lifestyle changes for the sake of your health?” Health self-efficacy was examined using a 12-item survey, Self- Efficacy Scale, which measured perception of one’s ability to attend to and promote personal health. Perceived health-status was assessed using the 25-item Self-Rated Abilities for Health Practices Scale. A 40-item Adolescent Health Promotion Scale assessed health promotion behaviors. Modifiable and non-modifiable risk factors were examined using the 49-itemYouth Risk Behavior Survey. Modifiable risk factors included blood pressure measurement, height and weight (to assess body mass index or BMI), fasting blood glucose and total cholesterol levels. Non-modifiable risk factors including gender, age, and family medical history were examined using health screening and demographic questionnaires. Descriptive statistics were used to summarize sample characteristics. The a priori alpha level for the study was p≤.05. Spearman Rho’s correlation coefficients estimated study variable associations as many of the study variable distributions were non-normal. Stepwise multiple regression analysis with backward elimination was used to estimate the amount of variance in health promotion behavior scores explained by self-efficacy, perceived health, and CV risk factors. This analysis was limited to adolescents from Louisiana as these participants were significantly younger, more apt to be free lunch participants, and many had experienced Hurricane Katrina in the months prior to data collection. Candidate variables for the regression analysis were those that were significantly associated with the health promotion behaviors at a significance level of p≤0.20.

Findings: Study adolescents reported four categories of perceived health barriers: diet (32%), environment (39%), finances (4%), and other (17%). Perceived health status and self-efficacy levels were moderately high, while reported health promoting behaviors indicated a moderate level of participation. Results of CV risk factors indicated that 8.5% (n=6) were hyperglycemic and 11.42% (n=8) were hypoglycemia. Borderline for high total cholesterol levels occurred in 23% (n=16) of the sample. More than 50% of the sample (n=49) had systolic blood pressures of 120 mm/Hg or more, while diastolic blood pressures of 80 mm/Hg or greater were assessed in 32% (n=30) adolescents. Body mass index results indicated that 21% (n=17) were at risk for being overweight and 13% (n=12) were overweight. Reported tobacco use included 34% who reported having tried smoking. Physical activity participation levels reported included 16.48% (n=15) that engaged in 20 minutes of daily physical activity 7 days a week. Sedentary activity that included television watching 5 or more hours per day was reported by 42% (n=42). Results of the Spearman Rho correlation coefficient indicated a moderate positive association between perceived health status and self-efficacy (r= 0.5608; p=< .0001). Approximately 2.7% of the adjusted variance in health promotion behavior in the sample was explained by self-efficacy, perceived health status, and fasting glucose levels, suggesting that the study framework did not adequately explain health promotion behavior for the study sample. As the study independent variables were not significantly associated with health promotion behaviors, clinicians must consider other variables, such as family and community factors that may influence the health promotion practices of this population. Significant proportions of adolescents in this study had one-time blood pressure values suggestive of pre-hypertension, many were over weight or at risk for overweight, several had one-time hyperglycemic blood glucose levels, and 19.56% of adolescents reported clinically significant inactivity although 59.34% reported participating in team sports. These results are of concern as many participating adolescents had a significant family history of CV disease. Future studies are needed to gain insights about the factors that predict health promotion behaviors in this population. Until this information becomes available clinicians must continue to assess the health practices and behaviors of adolescents and their families and encourage the inclusion of health promotion practices in daily life.

DOI

10.21007/etd.cghs.2007.0065

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