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That’s What Friends Are For: Adolescent Peer Social Status, Health-Related Quality of Life and Healthcare Costs

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Abstract

Background

Social connections at all stages of life are essential for physical and mental well-being. Of particular importance are social relationships during adolescence that shape adult health behaviors and health outcomes.

Objective

The aim of this study was to estimate the association between adolescent peer status in school and later-life quality-adjusted life-years (QALYs) and healthcare costs.

Methods

This study used social network and health outcomes data from Wave I (ages 12–18 years) and Wave III (ages 18–24 years) of the US National Longitudinal Study of Adolescent Health (n = 10,578) to compare QALYs and healthcare costs (in 2012 US$) by adolescent peer status in US schools. Generalized linear models controlled for school fixed effects, individual and family characteristics, and US census block neighborhood effects. Non-parametric bootstrapping accounted for residual skewness in QALYs and healthcare costs. Net monetary benefit (NMB) was calculated by converting adjusted 5-year QALYs into US$ values and subtracting 5-year healthcare costs. NMB was then compared across quintiles of adolescent peer status in school at Wave I.

Results

Results obtained from non-parametric bootstrapping indicate that adolescents with higher peer status in school experience significantly better health and lower healthcare costs over the next 5 years. At US$50,000 per QALY, adolescents with 8 or more friends achieved NMB of US$214,300 (95 % CI 212,800–215,800) over a 5-year span, in comparison to adolescents with 0–1 friends, who attained US$209,900 (95 % CI 207,900–211,700) NMB. This difference translates into approximately US$4,440 (95 % CI 2,036–6,825) per socially disengaged adolescent in additional health costs and/or reduced QALYs over 5 years.

Conclusion

The study calls for randomized controlled trials targeting adolescent peer group structures in schools as a means to promote better health and lower healthcare costs in adulthood.

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Acknowledgments

The authors would like to thank Benjamin Craig, Mindy Smith, and John Mullahy for their valuable comments and suggestions. This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due to Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth). No direct support was received from grant P01-HD31921 for this analysis.

Author contributions

Marlon Mundt designed the study, conducted the statistical analyses, and took the lead on writing the manuscript. Larissa Zakletskaia contributed to study design, interpretation of results, and made substantive contributions to the writing and revision of the manuscript. Marlon Mundt acts as guarantor of the content.

Conflicts of interest

Marlon Mundt was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism, NIAAA 1K01 AA018410-01, to conduct this analysis. The authors declare no conflicts of interest.

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  1. Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct., Madison, WI, 53715, USA

    Marlon P. Mundt & Larissa I. Zakletskaia

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  1. Marlon P. Mundt
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Correspondence to Marlon P. Mundt.

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Mundt, M.P., Zakletskaia, L.I. That’s What Friends Are For: Adolescent Peer Social Status, Health-Related Quality of Life and Healthcare Costs. Appl Health Econ Health Policy 12, 191–201 (2014). https://doi.org/10.1007/s40258-014-0084-y

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