Elsevier

Social Science & Medicine

Volume 193, November 2017, Pages 23-32
Social Science & Medicine

Health lifestyles across the transition to adulthood: Implications for health

https://doi.org/10.1016/j.socscimed.2017.09.041Get rights and content

Highlights

  • Health lifestyles among adolescents, early adults, and young adults were diverse.

  • Few individuals fell into the most behaviorally healthy groupings.

  • People with less healthy lifestyles exhibited poorer health in young adulthood.

Abstract

Research has long established the importance of individual health behaviors such as cigarette smoking for adult morbidity and mortality. However, we know little about how health behaviors cluster into health lifestyles among adolescents and young adults in the United States, or in turn, how such health lifestyles are associated with young adult health outcomes. This study establishes health lifestyles as distinct group phenomena at three developmental time points in a single cohort: late adolescence (ages 15–17), early adulthood (ages 20–24), and young adulthood (ages 26–31). We then identify the associations between these health lifestyles and young adult health outcomes. We use the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of U.S. adolescents followed into adulthood, and latent class analysis and regression models. We uncover diverse health lifestyles among adolescents, early adults, and young adults; however, few individuals engaged in a consistently salubrious lifestyle at any developmental stage. People with less healthy lifestyles also tended to exhibit poorer health in young adulthood. Our results showed that young adult health lifestyles were significantly associated with young adult cardiovascular risk. Moreover, health lifestyles in each of the three developmental stages were associated with young adult self-rated health, and accounting for lifestyles in later stages explained some of these associations. Overall, this study suggests a portrait of problematic health lifestyles among a nationally representative cohort of young Americans, with associated patterns of relatively poor physical health among those with poor health lifestyles.

Introduction

Research has long established the importance of health behaviors for longevity (Rogers et al., 2000). In addition, smoking, poor nutrition and inadequate exercise, and excessive drinking all contribute to the less healthy profile of U.S. adults compared to adults living in similarly wealthy countries (Danaei et al., 2009; NRC and IOM, 2013). However, this important research establishing the health consequences of health behaviors has tended to focus on single behaviors or combinations of two or three behaviors (e.g. Danaei et al., 2009). We therefore know little about complex groupings of health behaviors, even though sociological research has long identified health behaviors as components of broader lifestyles that develop over time in social contexts (Cockerham, 2005). To fill this gap, this study contextualizes individual health behaviors within a package of broader health lifestyles and examines these health lifestyles across the transition to adulthood, a developmental stage that is particularly salient for health behaviors. This study seeks to answer two questions. First, what do health lifestyles look like during three specific developmental stages across the transition to adulthood? Second, what are the associations between health lifestyles in these three developmental stages and young adult health outcomes? Answering these questions can inform theoretical understandings of the development and implications of health lifestyles in this sensitive and important life phase.

Health behaviors are not isolated phenomena but comprise routines and habits that make up a lifestyle (Bourdieu, 1984). Theory has highlighted the potential importance of health lifestyles in understanding how and why there are patterns to behaviors that promote or endanger health (Cockerham, 2005), and a substantial body of literature demonstrates that health behaviors cluster together within individuals (Chou, 2008, De Vries et al., 2008, Dodd et al., 2010, Leech et al., 2014). However, most of these studies examine a limited number of behaviors that affect public health most strongly: substance use, physical activity, and nutrition. Yet, there are a wide variety of other important health behaviors, such as health care use, sleep habits, and safety practices. Recently, researchers have begun to tie the theoretical literature on health lifestyles to empirical examinations of clusters of a wide range of behaviors (Cockerham et al., 2017, Mize, 2017, Mollborn et al., 2014, Saint Onge and Krueger, 2017, Skalamera and Hummer, 2016). This nascent literature suggests that U.S. children, adolescents, and adults exhibit coherent patterns of behavior, consistent with their conceptualization as health lifestyles. To our knowledge, though, only one study has examined health lifestyles as they develop from adolescence to young adulthood, but this study limited behaviors to smoking, drinking, obesity, and physical activity (Daw et al., 2017). Thus, to our knowledge, we are the first study to examine health lifestyles as they unfold across the transition to adulthood while considering a broad range of behaviors in which individuals engage. This expansive approach to health lifestyles could reveal that individuals generally fall along a spectrum of positive or negative behaviors, in which case additive or scale approaches to health behaviors would be appropriate for future research. Or, the results could reveal substantively complex combinations of behaviors that would provide evidence for more research into the contexts shaping such mixtures.

The examination of health lifestyles across the transition to adulthood is particularly important. First, these developmental stages are characterized by substantial changes in the prevalence and patterns of health behaviors. Behaviors like smoking, alcohol use, drug use, and sexual activity become increasingly common during adolescence (Kwan et al., 2012, Pampel et al., 2014). Other important developmental changes occur as well, such as an increased need for sleep (Hirshkowitz et al., 2015). Second, the transition to adulthood is a particularly important time for establishing one's identity, patterns of health-related behavior, and trajectories of adult health (Harris, 2010).

The first aim of this paper is therefore to identify prevalent health lifestyles as distinct group phenomena during the transition to adulthood among a nationally representative cohort. We examine health lifestyles within three developmental stages: late adolescence (ages 15–17), early young adulthood (ages 20–24), and late young adulthood (ages 26–31).

Research has established that adult health behaviors are important for adult mortality and morbidity (Danaei et al., 2009, National Research Council and Institute of Medicine (NRC and IOM), 2013, Rogers et al., 2000), but the relationship between health lifestyles and young adult health is less clear. First, it is unknown whether health lifestyles during these developmental stages are consequential for young adult health. It could be that the behaviors that comprise temporally limited lifestyles do not have lasting effects. Alternatively, even experimental or brief bouts of unhealthy actions could have consequences into adulthood. If health lifestyles are associated with young adult health as suggested by the latter, this relationship could operate in two ways. Health risk behaviors at critical periods in the life course can result in exposures that leave an imprint on health, years later or concurrently. Or health lifestyles may be part an overall trajectory of exposures which affect health (“pathway”) (Goosby et al., 2016, Montez and Hayward, 2011). Thus, our second aim is to identify associations between health lifestyles at three different life course stages and young adult health outcomes, while distinguishing whether any associations are best described by an imprint or pathway model.

If results indicate that one developmental stage is most strongly associated with young adult health, and such associations are independent of other stages of health lifestyles, an “imprint effect” would be supported. If, in contrast, health lifestyles from multiple stages are associated with young adult health and associations are attenuated or accounted for when considering health lifestyles of other stages, a “pathway” model would be supported. Life course literature suggests that different life phases all matter for health, and that they sometimes operate through “imprint” processes and sometimes “pathway” processes depending on the phenomenon being studied (Berkman, 2009, Montez and Hayward, 2011). Thus, identifying the specific pattern of the health lifestyle-health relationship can shed light on the production of health as it unfolds across the life course. Importantly, we also control for confounding influences such as race/ethnicity, gender, family background socioeconomic status (SES), and adolescent health (self-rated health and weight status), all of which may influence both health lifestyle membership and young adult health.

The examination of young adult health is important not only in and of itself, but also because it helps researchers and policymakers understand what future health risks and trajectories may look like (Harris, 2010). Most health conditions are more prevalent in middle and older adulthood compared with young adulthood, but the consequences of unhealthy practices sometimes appear in younger adulthood (Harris, 2010). We focus on two measures of health that are important and appropriate for young adults: cardiovascular risk and global self-rated health. Today's young adults have exceedingly high rates of cardiovascular risk, including high body mass index (BMI), diabetes, and glucose levels (Clark et al., 2014), and U.S. young adults ages 20–34 demonstrate higher rates of obesity and diabetes than their peers in similarly wealthy countries (NRC and IOM, 2013). Self-rated health comprehensively captures a host of physical and mental conditions and capabilities across life stages (Jylhä, 2009).

Section snippets

Data

We used the National Longitudinal Study of Adolescent to Adult Health (Add Health). This dataset was well suited for this study because it provided detail on a range of behaviors across several stages of the early life course and collected information on health outcomes in young adulthood. The first wave of Add Health surveyed 20,745 adolescents ages 11–19 in 1994–1995. We did not use Wave II because only a subsample of individuals was re-interviewed. A second follow-up (Wave III) was conducted

Aim #1: health lifestyles at each wave

Results from the latent class analyses for the three waves provide evidence that health lifestyles are an important and meaningful construct that differs across life stages. The results demonstrate that while some individuals in each life stage engage in a lifestyle that can be described as consistently positive or negative, most individuals have a lifestyle that is characterized by a mix of salubrious and insalubrious behaviors. But perhaps most important for future health outcomes among this

Discussion

Despite the well-established importance of health behaviors for older adult morbidity and mortality, we know little about how health behaviors cluster into health lifestyles across the transition to adulthood or the health implications of these clusters. This study had two distinct aims. First, we identified health lifestyles in a U.S.-representative longitudinal cohort at three development stages: late adolescence, early adulthood, and young adulthood. Second, we assessed the relationships

Acknowledgements

This research is based on work supported by a grant from the National Science Foundation (SES 1423524). This research was also supported by the National Institutes of Health under Ruth L. Kirschstein National Research Service Award (F32 HD 085599) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. We are grateful to the Carolina Population Center (P2C HD050924) and the University of Colorado Population Center (grant P2CHD066613) for general support. The

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