The study, which appeared in the September 10 issue of the Journal of the American
Medical Association, was conducted by investigators at several academic and research
institutions throughout the U.S.
Among the study's other early findings: adolescents living in homes where drugs,
tobacco, or alcohol are present are more likely to use those substances; adolescents living in
homes where guns are kept are more likely to be involved in violence; adolescents do better in
school when they feel a sense of connectedness to their school; adolescents who appear older
than their peers are more likely to engage in risky behaviors; and students who work for more
than 20 hours per week are at higher risk for a range of health problems, from depression to
The National Longitudinal Study of Adolescent Health (Add Health) is a survey designed
to measure the effects of family, peer group, school, neighborhood, religious institution, and
community influences on behaviors that promote good health, such as seat belt use, exercise, and
nutrition, as well as on health risks such as tobacco use, sexual activity, sun exposure, and drug
and alcohol use.
Because of the sheer volume of data collected, a complete analysis of the survey is
expected to take a decade or more. Survey findings will be reported periodically, by individual
teams of scientists, as their results become available. The study was undertaken in response to a
mandate by the U.S. Congress in the NIH Revitalization Act of 1993 (Public Law 103-43, Title
X, Subtitle D, Section 1031). Funding was provided by a grant from the National Institute of
Child Health and Human Development (NICHD) and by contributions from 17 other federal
"This survey is not just another report card on the status of adolescent health," said
principal investigator J. Richard Udry, PhD, of the Carolina Population Center of the University
of North Carolina in Chapel Hill.
Dr. Udry added that the current analysis has allowed researchers to identify key factors in
the home and school context that protect adolescents from risky behavior. Future analyses will
look at how and why these factors are important, as well as how they interact with the influence
of peer groups and the community at large.
The Add Health survey was conducted in two phases. In the first phase, roughly 90,000
students from grades 7 through 12 at 145 schools around the U.S. answered brief questionnaires
to provide information about themselves and other aspects of their lives, including their health,
friendships, self esteem, and expectations for the future. In the second phase of the study,
interviews were conducted with roughly 20,000 students and their parents in the students' homes.
A final phase of the study, not yet reported, repeated the home interviews with the students a year
The article appearing in the Journal of the American Medical Association examined a
sample of 12,000 of these at-home interviews. Overall, the survey results show that most
adolescents are doing well. However, the survey findings confirm the results of other surveys
that show that a significant proportion of teens are engaged in risky behaviors. For example, 3.5
percent of all adolescents reported suicide attempts in the past year; 24.9 percent reported being
current smokers; 17.5 percent reported drinking alcohol more than once a month; 11.4 percent
reported that they had smoked marijuana at least once during the previous month; and 16 percent
of 7th and 8th graders and 48.5 percent of 9th to 12th graders said that they had experienced
"The initial results of Add Health provide valuable information about factors that help
adolescents to avoid risky behaviors, and point the way to future analysis of the data," said the
NICHD project officer for the study, Christine Bachrach, PhD, Chief of the Demographic and
Behavioral Sciences Branch.
The major finding of the study so far was that adolescents who reported a
"connectedness" to their parents were the least likely to engage in risky behaviors, said Dr.
Bachrach. These young people felt close to their parents, felt their parents and family members
cared for them, and were satisfied with their family relationships. To a lesser extent, adolescents
were also protected by their parents being present at key times during the day--in the morning,
after school, at dinner, and at bedtime--and by sharing activities with their parents. Adolescents
whose parents had high expectations for their children's school performance also reported fewer
indicators for emotional distress, such as depression or suicide attempts.
The study has also found that the mere presence of drugs, alcohol, or tobacco in the home
increases the likelihood of adolescents using these substances. Similarly, adolescents living in
houses where guns are kept are more likely to be involved in violent behavior, and more likely to
attempt or contemplate suicide.
In addition, the survey shows that a sense of connection to the school also protects young
people from a variety of other risk behaviors. Dr. Bachrach explained that students do better if
they feel that their classmates are not prejudiced, and if they feel that their teachers care about
The survey also found that adolescents who appear physically either older or younger than
their peers are more likely to experience negative health outcomes. Repeating a grade or
appearing older than their classmates predisposed adolescents to depression, suicidal thoughts
and suicide attempts, violence, substance use, and earlier age of sexual activity. In addition, 7th
and 8th graders who felt they looked younger than their peers reported experiencing more
emotional distress than did their peers.
As with other at-risk groups in the study, high parental expectations for school
achievement were protective against some risk behaviors. The study also found that adolescents
who work more than 20 hours a week for pay are at a high risk for such problems as depression,
substance abuse and early sexual activity.
The Adolescent Health Study
The Adolescent Health Survey: Questions and Answers