Health behavior in the context of perceived social support in late adolescence

Abstract

The presented study is a part of a grant research project: "Health-enhancing and health-threatening behavior: determinants, models and consequences" (n° 13-19808S). It follows up on the results of foreign research on possible connections between health behavior and the perceived level of social support. The primary aim was to identify the key components of health behavior in the developmental stage of late adolescence, map their relation to perceived social support and to explore if there are also some possible significant gender differences in health behavior or in perceived social support of adolescents which would be projected into their health behavior. The quantitative research design based on one-time questionnaire survey was used to carry out the research. Health behavior was assessed by the Health behavior scale, and the level of social support was assessed by the Close relationships and social support scale. The research file contained 825 adolescents aged 15-19 years (the average age was 16.89 years and the median was 17 years); there was a slight predominance of women (457 − 55.4%) over men (368 − 44.6%). By carrying out factor analysis of Health behavior scale, 4 factors explaining the 35.2% of the overall spread were extracted and they were named as: 1. Healthy eating; 2. Health protection; 3. Positive thinking; and 4. Illness prevention. In most of these factors, statistically significant gender differences were found, which are reflected in the reported health behavior. The results have demonstrated that two of the identified components of health behavior − Positive thinking and Illness prevention − are in a positive manner statistically significantly related to the level of perceived social support. Also differences in perceived social support in the given developmental stage have been mapped, and the highest level of social support has been found in 18-year-old respondents. The results of the study highlight the importance of future research in the area of studying the mechanism of impact that perceived social support has on the reported health behavior and the changes of this relationship in ontogeny.

Keywords: Perceived social supporthealth behavior

Introduction

From historical as well as current perspectives, the scope of view on health differs significantly in individual authors − from definitions of health as mere lack of illness (Brannon & Feist, 2009) to a very broad context of intervening variables by which health is described (Rohleder, 2012; Rosen & Imperato, 2015). Even the definition of health itself has undergone a complicated evolution from a purely biological perception of the notion of health, to the integration of social and later also psychological perspective, and now based on holistic foundation, reflecting the dynamics of health condition development in time (at the level of ontogeny of an individual and the development of changes on the scale between health and illness) as well as systemic approach to health in all its key connections, based on the principles of circular causality. Even individual models of health (pathogenic model, biomedical model, social ecological model, behavioral model, holistic model, etc.) overlap and complement each other in the perception of various authors and their approaches. Current process-oriented definitions of health define it in the bio-psycho-eco-social context as a sufficient competence of a system to cope with pathogenic factors and control them effectively thanks to self-regulatory processes. In the context of current approach to health, Egger (2013) defines it as a sufficient competence of an individual to cope with whatever stressful inconvenience at any level of an incessantly changing system through self-regulation. In this understanding, health is not a result of a mere lack of pathogens and does not even mean a lack of psychological stresses or conflicts, but represents the ability of an individual to sufficiently control the above mentioned factors, and thus it is rather perceived as one´s own power (resilience or self-regulatory power). Health is therefore perceived by current specialists mainly as an unceasingly ongoing dynamic action conditioned by many circumstances, especially by the manner in which an organism manages to adjust to changing demands of the outer and the inner environment. We can therefore understand health not only as the present state but rather as a continual process, which is realized in the context of biological and personal dispositions and social relationships, and it is closely related to many other psychosocial and environmental phenomena. Especially in adolescence, social support has a quite fundamental impact on health behavior, which in the end causally influences health.

Adolescence is the key period for forming, strengthening and developing of desirable habits in the area of health behavior (Becker & Arnold, 2004; Sawyer et al., 2012) when the responsibility for one´s health, demonstrated by following desirable hygiene practices and fundamental principles of desirable health behavior, gets transferred from parents to adolescents. The study of health-enhancing behavior and lifestyle in adolescents from North Indian City draws attention to the fact that some health-enhancing types of behavior (physical exercise and healthy diet), but also those health-damaging ones (smoking and use of alcohol) adopted and adapted in the period of adolescence are often preserved until late adulthood (70% of deaths has its roots in the habits related to health behavior solidified in this crucial developmental stage (Raj, Senjam, & Singh, 2013). As opposed to later life periods, this stage also involves more health-threatening behavior and risky attitudes to one´s own health (Haskell et al., 2007; Lerdal, Celius, & Pedersen, 2013). That is why the importance of influence of social support on an individual´s health raises in this stage of development, since, apart from its indirect influence, it can be also significantly demonstrated by its direct influence during adolescence − e.g. by mutual sharing of values and attitudes to health, or displaying health-enhancing behavior in a suitable referent social group.

Problem statement

The study is a part of an extensive grant project "Health-enhancing and health-threatening behavior: determinants, models and consequences", whose primary research aims cover the following areas: Optimism model and its relation to health behavior; Health-enhancing and health-threatening behavior model; Neuropsychological markers of health-enhancing behavior and neuropsychological markers as indicators of health-threatening behavior; and Age as a mediator of key influences projected into health behavior. The last research topic included cross-selectional research, which helped to describe and compare health behaviors and mapped its fundamental intrapersonal and interpersonal influences from adolescence to old age, highlighting the identification of main health-enhancing behavior predictors for individual stages of ontogeny. In accordance with the current psychological approaches to health, which find it important to link individual aspects of health and see it as a whole (Coleman, Hendry, & Kloep, 2007), the presented study maps the level of perceived social support in late adolescence and its impact on health behavior.

Purpose of the study

The study therefore explores possible connections between health behavior and the perceived level of social support in late adolescence, since, as well as other authors, we regard this developmental stage not only as crucial but also critical in creating, developing and solidifying habits in health behavior (Blatný et al., 2006; Bonino, Sawyer et al., 2012). Adolescents are especially sensitive to external incentives, and environmental factors like family, school, peers or social institutions can either support or undermine their approach to health. Moreover, in adolescence, strong friendships are created and the influence of peers and close friends and gradually also partners becomes more and more important (Helsen, Vollebergh, & Meeus, 2000). The presented study is based on conclusions of Umberson, Crosnoe & Reczek (2010), who claim that social support positively influences health of individuals and is an integral part of their healthy lifestyle not only during adolescence but also during their whole lives.

Research methods

With regard to the aim of the research and the formulated hypotheses, the quantitative research design was used, and it was carried out in the form of cross-selectional research with the use of one-time questionnaire survey. It was a correlation and partly also comparative study, which was searching for the connections between health behavior and the level of perceived social support in the developmental stage of late adolescence. The methods used were based on subjective statements of respondents about their behavior (see further). The research team administered the questionnaire battery in selected schools using the paper-pencil method, and it took one lesson (45 minutes) to fill in the questionnaire, which was entirely anonymous. For ethical reasons, only those students who provided informed agreement to participate in the study (signed by their parents) took part in the research. The respondents had the right to withdraw from the research study and after the data had been analyzed, school leaders and individual classes participating in the research were informed about the results by educational advisors.

Findings

The demographic data was processed with the help of descriptive statistics. The respondents who took part in the research were students of grammar schools (18.7%), high schools (40.9%) and the last years of elementary schools (10.3%). The information about the type of studies was not filled in by 248 (30.1%) respondents. As regards their place of residence, the respondents mostly stated a village − in 394 cases (47.8%) and then 232 (28.1%) of them stated that they live in a small town up to 20 thousand inhabitants, 105 of the respondents (12.7%) stated that they live in a relatively big town up to 100 thousand inhabitants, 43 (5.2%) in a big town up to 500 thousand inhabitants, and only 4 (0.5%) stated their place of residence was a city which has more than 1 million inhabitants (The information about the place of residence was not provided by 8 respondents.) . In the results presented below, the respondents do not differ in either type of school or the reported place of residence.

Differences in levels of perceived social support in late adolescence

When mapping possible differences in levels of perceived social support in the developmental stage of late adolescence, we focused on the classes of 15-year-old (N=139), 16-year-old (N=189), 17-year-old (N=220), 18-year-old (N=174) and 19-year-old (N=103) adolescents. We determined the existence of differences between these classes with the help of Chi-squared test. By adding the scores of variables in individual respondents on the Close relationships and social support scale, we gained the total score of social support for each respondent. Subsequently, we used the Compute Variable function to create three groups and further worked with perceived social support divided into three variables: Low level of social support (score 3-11 points); Medium level of perceived social support (score 12-20 points); and High level of perceived social support (score 21-29 points). It turned out that the difference in levels of social support between individual classes is statistically significant (χ2=24.77; df=12; p<0.05) and that individuals who were 18 years old showed the highest level of social support.

Perceived social support in late adolescence

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Conclusions

By carrying out factor analysis of the Health behavior scale, 4 factors, explaining 35.2 % of the overall spread, were extracted, and named as: 1. Healthy eating; 2. Health protection; 3. Positive thinking; and 4. Illness prevention. These factors correspond with individual components of health behavior, as they are described by many authors (Steptoe & Wardle, 2004; Brannon, Feist & Updegraff, 2014). Statistically significant gender differences, which are reflected in the reported health behavior, were found in most of these factors. Adolescent women, for example, care more about healthy diet than men. This result is in agreement with the results of the study by McCabe and Ricciardelli (2001), who postulate that girls watch their diet more and avoid unhealthy food due to the current cult of beauty, which puts more pressure on them than on boys (see also Ata et al. 2007). A statistically significant difference between male and female sex also turned out to be in the Health protection factor. Women are more focused on health protection, which is reflected in their use of safety equipment when doing sport or using means of transport, adjusting their daily regime to their current health condition and protecting themselves against sunshine. This result is in accordance with conclusions of other authors, who ascribe women greater conscientiousness in their attitude to health, which is reflected in their health behavior (Ghanbarzadeh & Mohamadi, 2012; Mathur, Stigler, Erickson, Perry, & Forster, 2014). The last statistically significant gender difference in health behavior appeared in the Positive thinking factor. In this case, the result shows that men, as opposed to women, keep themselves in good mood and spend their time in the company of their close friends. Bothmerová a Fridlund (2005) in this context state that adolescent girls are much more often stressed and face more mental stress than adolescent boys. It is therefore possible that this fact prevents them from keeping themselves in a good mood and positively disposed. There was no significant gender difference in the Illness prevention factor in the reported health behavior, which is displayed as, for example, regular building of resistance to cold, keeping one´s diet balanced, regular relaxation and mental hygiene, etc. Therefore, no differences have been found between respondents, which is probably caused by the attitude of both sexes to preventive health measures following from the given developmental stage, when most of them feel in very good physical condition and do not feel the need to care about prevention, which requires a considerable amount of self-regulation, since these activities need to be performed regularly and long-term (Harris & Jenkins, 2006; Steptoe, Wright, Kunz-Ebrecht, & Iliffe, 2006).

The presented results further lead us to the conclusion that perceived social support influences certain aspect of health behavior in adolescents. A statistically significant positive relationship was confirmed in respondents between perceived social support and some components of health behavior, namely, Positive thinking (including a positive attitude to oneself, relaxation, spending time with friends and keeping oneself in a good mood) and Illness prevention (partially including also mental hygiene and building up resistance to cold) − even though in this case the relationship was weaker. In this context, Kahneman & Krueger (2006) claim that people are happier if they perceive social support from their surroundings, which is in its consequence reflected in their attitudes to and expectations about health as well as in their health behavior. In the Healthy eating factor, no statistically significant relationship was found, which corresponds with the conclusions of Fitzgerald et al. (2013), who states that peer support causes a more frequent consumption of unhealthy food, specifically fast food and sweets. Considering that the compared Healthy eating factor mostly consisted of questions about consumption of fried meals, sweetened lemonades and eating in fast food restaurants, it is possible that individuals who scored high (i.e. they avoided such unhealthy food and drinks) had a lower social support. Also the relationship between social support and the Protection of health factor was statistically insignificant. Similarly, no statistically significant gender differences have been found in the level of social support, but it is possible that this result was influenced by unidirectionally oriented questions on the Close relationships and social support scale. We also found out that there are differences in perceived social support in the context of the given developmental period − the highest level of social support was demonstrated by 18-year-old respondents. It is possible that at this breakthrough age, which is in the Czech republic considered the beginning of maturity, respondents gain social support not only from their parents and friends but also from their romantic partners, since interest in intimate relationships and searching for a suitable partner increases, and the age of first sexual experience is, on average, at this particular age (Wellings et al., 2001; Weiss & Zvěřina, 2009). Moreover, we should not forget that the age of 18 years is also the borderline for alcohol consumption and entrance to nightclubs where there are many opportunities to start new relationships.

The presented results prove the validity of researching mutual relationships between social support and health behavior, including relevant mechanisms of the given effect and developmental trends, and they can be incorporated into relevant intervention programs.

Acknowledgments

The study is a part of an extensive research project "Health-enhancing and health-threatening behavior: determinants, models and consequences", which started under the patronage of Grant Agency of the Czech Republic (no. 13-19808S).

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