Original article
Self-rated health among U.S. adolescents

An earlier version of this article was presented at the 2004 annual meetings of the Population Association of America, Boston, Massachusetts.
https://doi.org/10.1016/j.jadohealth.2005.01.006Get rights and content

Abstract

Purpose

This article investigates the meaning of subjective health assessments for younger respondents by examining the temporal stability of self-rated health (SRH) among adolescents. Two competing understandings of SRH are tested: SRH as a spontaneous health assessment or as an enduring self-concept.

Methods

Using data from two waves of the National Longitudinal Study of Adolescent Health (n = 13,511), an intra-class correlation coefficient and a weighted Kappa estimate are calculated to assess the test-retest reliability for SRH. Self-rated health (T2) is then modeled as a function of SRH (T1), physical health (T1), and mental health (T1), and changes in physical and mental health (T2–T1).

Results

SRH is found to be moderately stable over repeated observations (K = .40; ρ = .55) among adolescents. Findings from multivariate analyses suggest that SRH (T2) is largely determined by SRH (T1) and less so by changes in physical or psychological health status (T2-T1).

Conclusions

SRH among adolescents is in part a spontaneous health assessment but it is best understood as an enduring self-concept.

Section snippets

The perception of health among adolescents

In a recent article, Bailis and colleagues [9] describe two distinct understandings of SRH. When asked to assess his or her overall health status, an individual may take stock of relatively immediate physical cues such as energy levels, the presence or absence of pain, or recent changes in health status (improvements or declines). In this case, SRH can be understood as a spontaneous assessment of overall health that is intimately related to current health status. Alternatively, changes in

Data and measures

All data used in these analyses come from Waves I and II of the National Longitudinal Study of Adolescent Health (Add Health). Add Health is a school-based study of youth originally in grades 7 through 12 [21]. All high schools that included an 11th grade (and their respective feeder schools) with an enrollment of at least 30 students were included in the population of schools. These schools were then stratified by region (Northeast, Midwest, South, West), urbanicity (urban, suburban, rural),

Results

Table 1 presents a cross-tabulation of SRH responses across the two interviews. An examination of the main diagonal of this simple matrix reveals that more than one-half (7018 of 13,551) of adolescents interviewed reported consistent SRH. An additional 40% reported either 1 point better (n = 2799) or 1 point worse (n = 2545). However, roughly 9% of adolescents reported SRH levels that differed by at least two values. For example, 209 of the 913 (nearly one in four) adolescents who reported

Discussion and conclusion

Using a large, nationally representative sample of adolescents interviewed at two points in time (roughly 1 year apart) this article finds that self-rated health reported by adolescent respondents is moderately stable. And, whereas SRH among adults is characterized as both an enduring self-concept and a spontaneous health assessment [9], SRH among adolescents, particularly among younger adolescents, appears to be more appropriately characterized as an enduring self-concept.

These findings speak

Acknowledgments

This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from seventeen other agencies. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, Carolina

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