519770 research-article2014
RSH0010.1177/1757913913519770Short ReportShort Report
Short Report Distinct patterns of health engagement among adolescents and young adults in England
Distinct patterns of health engagement among adolescents and young adults in England: implications for health services Authors Dougal S Hargreaves University College Hospital, London, UK David James University Hospital Lewisham, Lewisham High Street, London, SE13 6LH, UK Email: davidrjames@doctors. org.uk Anne-Lise Goddings University College London, London, UK Dominic McVey Word of Mouth Research Ltd, London, UK Russell M. Viner University College Hospital, London, UK
Corresponding author: David James, as above
Keywords adolescent; health engagement; health involvement; young adult
Abstract Aims: To compare levels of health engagement between adolescents, young adults and older adults and to investigate the association between health engagement and key health outcomes at different ages. Methods: Using the Healthy Foundations study (2008), the responses to three previously validated questions on health engagement were analysed by age group; adolescents (12-15 years; N=452), young adults (16-24 years; N=785) and older adults (25-74 years; N=4136). Logistic regression was used to calculate the odds ratio of poor health outcomes among participants with low versus high health engagement. Results: Feeling in control of one’s own health decreased from adolescence (mean score 79.3 (95% CI 77.6,81.0)), through young adulthood (74.6 (73.1,76.1)) into older adulthood (72.2 (71.5,72.9)). In contrast, perceived involvement in health showed a U-shaped trajectory: (adolescents 72.0 (70.2,73.7), young adults 68.6 (67.1,70.1), older adults 73.8(73.1,74.5)), as did perceived importance of health (adolescents 75.0 (73.1,76.9), young adults 62.9 (61.0,64.8), older adults 77.1 (76.4,77.8)). Not feeling involved in health was more strongly associated with poor general health among adolescents (OR 1.81 (1.41,2.32)) than older adults (OR 1.19 (1.11,1.28)). Not feeling in control of health was only associated with poorer general health among young adults (OR 2.33 (1.93,2.83)) and older adults (OR 2.26 (2.10,2.44)). In contrast, lack of control over health was most strongly associated with physical inactivity among adolescents (OR 1.99 (1.49,2.66)) but this was also significant in young adults (OR 1.25 (1.06,1.48)) and older adults (OR 1.11 (1.04,1.19)). Conclusion: Young adults feel less involved in their health and rate health a less important priority than adolescents and older adults. Involvement is more strongly linked to key health behaviours among under 25s than older adults.
Introduction Greater health engagement has been identified as the key to improving population health while controlling healthcare expenditure.1 Adolescence is a critical time for this engagement: lifelong attitudes to health are established, behaviours which account for half of all deaths are acquired2 and clinical outcomes deteriorate for many conditions, including diabetes, epilepsy and renal impairment requiring transplant.2,3 However, little attention has
been paid to trajectories of health engagement during this critical stage in the life course.
Objectives 1. To compare levels of health engagement between adolescents, young adults and older adults. 2. To investigate the association between health engagement and key health outcomes at different ages.
Copyright © Royal Society for Public Health 2014 March 2014 Vol 134 No 2 l Perspectives in Public Health 81 SAGE Publications Downloaded from rsh.sagepub.com at UNIV OF NORTH DAKOTA on May 31, 2015 ISSN 1757-9139 DOI: 10.1177/1757913913519770
Short Report Distinct patterns of health engagement among adolescents and young adults in England
Methods Data were obtained from the English nationally representative Healthy Foundations study (2008). Respondents were grouped into adolescents (12–15 years; N = 452), young adults (16–24 years; N = 785) and older adults (25–74 years; N = 4,136). The overall response rate was 55%. Seven patients were excluded as age, sex and deprivation data were not complete. Details of the sampling methodology, interview protocol and weighting have been published previously.4 Regarding socio-economic status, 46% of participants were drawn from the most deprived decile of households (defined by UK Index of Multiple Deprivation (IMD)), with approximately equal distribution of all other deciles among the remaining 54% of the sample. A 7-point Likert scale was used to record responses to three questions: (1) ‘I’m very involved in my health’; (2) ‘There’s nothing more important than health’ and (3) ‘How much control do you feel you have over living a healthy lifestyle in the coming year?’. The questions relate to three key constructs of health engagement: ‘health consciousness’, ‘health as a value’ and ‘health locus of control’. These are taken from questionnaires that have been validated in previously published studies.5–7 Due to space limitations, the full questionnaires relating to each construct could not be included in the Healthy Foundations survey. Therefore, factor analysis was used to select the individual questions that correlated best with the overall score for each construct.4 Following the previously published analysis of this dataset, responses for each were converted to a score from 0 (strongly disagree/no control) to 100 (strongly agree/complete control). The mean score was calculated, with higher mean score indicating greater health engagement. Likert responses were also collapsed into a binary outcome (strongly agree/agree vs. all other responses) and the proportion agreeing with each statement was calculated by age group. The following four dichotomous health outcomes were used:
Figure 1 Mean scores for three measures of health engagement by age and sex, England 2008
100
Mean score: Perceived control over healthy lifestyle in coming year
90 80 70 60 50 Male
Female 12--15
16--24
25+
Mean score: 'I feel I'm involved in my health' 100 90 80 70 60 50
Male
Female
Age 12--15
16--24
25+
Mean score 'There's nothing more important than good health' 100 90 80 70 60 50 Male
Female
Age 12--15
16--24
25+
Note: Data were weighted to be nationally representative
1. Self-reported poor general health (defined as very bad/bad/neutral vs. good/very good)
82 Perspectives in Public Health l March 2014 Vol 134 No 2 Downloaded from rsh.sagepub.com at UNIV OF NORTH DAKOTA on May 31, 2015
2. Current smoking 3. Physical inactivity (defined as
RSH0010.1177/1757913913519770Short ReportShort Report
Short Report Distinct patterns of health engagement among adolescents and young adults in England
Distinct patterns of health engagement among adolescents and young adults in England: implications for health services Authors Dougal S Hargreaves University College Hospital, London, UK David James University Hospital Lewisham, Lewisham High Street, London, SE13 6LH, UK Email: davidrjames@doctors. org.uk Anne-Lise Goddings University College London, London, UK Dominic McVey Word of Mouth Research Ltd, London, UK Russell M. Viner University College Hospital, London, UK
Corresponding author: David James, as above
Keywords adolescent; health engagement; health involvement; young adult
Abstract Aims: To compare levels of health engagement between adolescents, young adults and older adults and to investigate the association between health engagement and key health outcomes at different ages. Methods: Using the Healthy Foundations study (2008), the responses to three previously validated questions on health engagement were analysed by age group; adolescents (12-15 years; N=452), young adults (16-24 years; N=785) and older adults (25-74 years; N=4136). Logistic regression was used to calculate the odds ratio of poor health outcomes among participants with low versus high health engagement. Results: Feeling in control of one’s own health decreased from adolescence (mean score 79.3 (95% CI 77.6,81.0)), through young adulthood (74.6 (73.1,76.1)) into older adulthood (72.2 (71.5,72.9)). In contrast, perceived involvement in health showed a U-shaped trajectory: (adolescents 72.0 (70.2,73.7), young adults 68.6 (67.1,70.1), older adults 73.8(73.1,74.5)), as did perceived importance of health (adolescents 75.0 (73.1,76.9), young adults 62.9 (61.0,64.8), older adults 77.1 (76.4,77.8)). Not feeling involved in health was more strongly associated with poor general health among adolescents (OR 1.81 (1.41,2.32)) than older adults (OR 1.19 (1.11,1.28)). Not feeling in control of health was only associated with poorer general health among young adults (OR 2.33 (1.93,2.83)) and older adults (OR 2.26 (2.10,2.44)). In contrast, lack of control over health was most strongly associated with physical inactivity among adolescents (OR 1.99 (1.49,2.66)) but this was also significant in young adults (OR 1.25 (1.06,1.48)) and older adults (OR 1.11 (1.04,1.19)). Conclusion: Young adults feel less involved in their health and rate health a less important priority than adolescents and older adults. Involvement is more strongly linked to key health behaviours among under 25s than older adults.
Introduction Greater health engagement has been identified as the key to improving population health while controlling healthcare expenditure.1 Adolescence is a critical time for this engagement: lifelong attitudes to health are established, behaviours which account for half of all deaths are acquired2 and clinical outcomes deteriorate for many conditions, including diabetes, epilepsy and renal impairment requiring transplant.2,3 However, little attention has
been paid to trajectories of health engagement during this critical stage in the life course.
Objectives 1. To compare levels of health engagement between adolescents, young adults and older adults. 2. To investigate the association between health engagement and key health outcomes at different ages.
Copyright © Royal Society for Public Health 2014 March 2014 Vol 134 No 2 l Perspectives in Public Health 81 SAGE Publications Downloaded from rsh.sagepub.com at UNIV OF NORTH DAKOTA on May 31, 2015 ISSN 1757-9139 DOI: 10.1177/1757913913519770
Short Report Distinct patterns of health engagement among adolescents and young adults in England
Methods Data were obtained from the English nationally representative Healthy Foundations study (2008). Respondents were grouped into adolescents (12–15 years; N = 452), young adults (16–24 years; N = 785) and older adults (25–74 years; N = 4,136). The overall response rate was 55%. Seven patients were excluded as age, sex and deprivation data were not complete. Details of the sampling methodology, interview protocol and weighting have been published previously.4 Regarding socio-economic status, 46% of participants were drawn from the most deprived decile of households (defined by UK Index of Multiple Deprivation (IMD)), with approximately equal distribution of all other deciles among the remaining 54% of the sample. A 7-point Likert scale was used to record responses to three questions: (1) ‘I’m very involved in my health’; (2) ‘There’s nothing more important than health’ and (3) ‘How much control do you feel you have over living a healthy lifestyle in the coming year?’. The questions relate to three key constructs of health engagement: ‘health consciousness’, ‘health as a value’ and ‘health locus of control’. These are taken from questionnaires that have been validated in previously published studies.5–7 Due to space limitations, the full questionnaires relating to each construct could not be included in the Healthy Foundations survey. Therefore, factor analysis was used to select the individual questions that correlated best with the overall score for each construct.4 Following the previously published analysis of this dataset, responses for each were converted to a score from 0 (strongly disagree/no control) to 100 (strongly agree/complete control). The mean score was calculated, with higher mean score indicating greater health engagement. Likert responses were also collapsed into a binary outcome (strongly agree/agree vs. all other responses) and the proportion agreeing with each statement was calculated by age group. The following four dichotomous health outcomes were used:
Figure 1 Mean scores for three measures of health engagement by age and sex, England 2008
100
Mean score: Perceived control over healthy lifestyle in coming year
90 80 70 60 50 Male
Female 12--15
16--24
25+
Mean score: 'I feel I'm involved in my health' 100 90 80 70 60 50
Male
Female
Age 12--15
16--24
25+
Mean score 'There's nothing more important than good health' 100 90 80 70 60 50 Male
Female
Age 12--15
16--24
25+
Note: Data were weighted to be nationally representative
1. Self-reported poor general health (defined as very bad/bad/neutral vs. good/very good)
82 Perspectives in Public Health l March 2014 Vol 134 No 2 Downloaded from rsh.sagepub.com at UNIV OF NORTH DAKOTA on May 31, 2015
2. Current smoking 3. Physical inactivity (defined as
