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  1. 1. THE RELATIONSHIP ANDSELF-ESTEEM AND HEALTH-RELATED RISK BEHAVIORS AMONG ADOLESCENTS IN BAGUIO CITY ___________ In partial fulfillment Of the requirements In the course INTRODUCTION TO NURSING RESEARCH __________ Submitted to The Faculty of the School of Nursing Saint Louis University Submitted by: Names August 2011INTRODUCTION adolescence ↓ Changes in adolescents ↓ Among the changes- Self-estem (reasons)- Males vs females, race/ethnicity ↓
  2. 2. Other than self-esteem- engage with health-related risk behaviors-common health-related risk behaviors- statistics CDC, race or gender ↓ GAP ↓ Summary Adolescence is a period of rapid and transformative physical, psychological,sociocultural, and cognitive development. The physical changes of puberty — including growthand maturation of multiple organ systems such as the reproductive organs and brain — lay abiological foundation for the other developmental changes.Erik Erikson’s psychosocial theorystates that adolescence is the period of development during which an individual makes thetransition from childhood to adulthood, usually between 12-18 years old (Potter and Perry,2006). Stanley Hall views adolescence as the “Storm and Stress” period (John W. Santrock,1997). During this period, the adolescent brain is rewired, with resulting maturation of cognitiveabilities in early adolescence. When these new cognitive abilities are combined with lifeexperiences, we often observe development of social judgment, including judgment about riskand safety. Adolescence is also marked by critical transformation in the relationship of a youngperson to the world, as the social circles of peers and the adult worlds of work, pleasure, andsocial responsibility become more central and the family circle becomes somewhat lessprominent — at least temporarily. Adolescents must learn to deal with an expanding socialuniverse and must develop the social skills to find friendship, romance, employment, and socialstanding within multiple social spheres. Finally, a critical task of adolescence is theestablishment of a stable sense of identity and the development of autonomy or agency. Thisdevelopment of identity often occurs only after a period of exploration, of trial and error in socialroles and social behaviors. Although most adolescents navigate the often turbulent course fromchildhood to adulthood to become healthy adults and productive citizens, many fail to do so(Adolescents at risk: A Generation in Jeopardy, Crosby Adolescence is the agewhereaccording to the Intrapsychic theory (also called psychodynamic) focuses on an individual’sunconscious processes. Feelings, needs, conflicts and drives are considered to be motivators ofbehavior, learning and development. Sigmund Freud and Erik Erikson are two major
  3. 3. Intraphysictheorist, it is the time where adolescents are given this perspective, its not hard torecognize that self-esteem plays a big part in the developing adolescent. It is important tounderstand that not all theorists believe adolescence is characterized as a time of storm andstress. It certainly may have its ups and downs, but much of this is a normal reaction to all of thephysical, emotional and social changes taking place. Latent growth curve analyses indicatedthat self-esteem increases during adolescence and continues to increase more slowly in youngadulthood. Women and men did not differ in their self-esteem trajectories. In adolescence,Hispanics had lower self-esteem than Blacks and Whites, but the self-esteem of Hispanicssubsequently increased more strongly, so that at age 30 Blacks and Hispanics had higher self-esteem than Whites. At each age, emotionally stable, extraverted, and conscientious individualsexperienced higher self-esteem than emotionally unstable, introverted, and less conscientiousindividuals. Moreover, at each age, high sense of mastery, low risk taking, and better healthpredicted higher self-esteem (PubMed; Self-esteem development from age 14-30 years: Alongitudinal study; 2011) .Self-esteem issues are important throughout the teen years. Self esteem is the one important factor required by anybody to succeed in life. It is a wellproven concept that if you can build self esteem at your adolescent period it will last all throughyour life. Adolescence is one period in which boys and girls faces with many problems andissues. It is necessary that adolescent self esteem to be at top to face the problems faced withadolescent period because if not, this will lead to uncertain things that will definitely affect theinteraction of adolescents to their environment (Adolescent Self-esteem, Todd Koenig). Webster defines self-esteem as "an objective respect for or favorable impression ofoneself, an inordinately or exaggeratedly favorable impression of oneself." This simply meanshow you feel about yourself. Dr. Nathaniel Branden said, "Self-esteem is the experience ofbeing competent to cope with the basic challenges of life and of being worthy ofhappiness".(Branden, N., 1994, The Six Pillars of Self-Esteem, New York: Bantam Books.) Too many fall prey to social and behavior morbidities and mortality, and many fail toachieve their full potential as workers, parents, and individuals. Many suffer substantial short -term impairment and disability, and for many this impairment extends into adulthood. Many ofthese failures of adolescent development are the result of preventable health risk behaviors.Adolescence is marked by increasing involvement in health risk behaviors. Between the ages oftwelve and twenty - five, we observe the initiation of myriad health risk behaviors, includingalcohol and drug use, smoking, sexual behaviors, delinquency, and behaviors leading tointentional and unintentional injuries — all of which can adversely influence health in the short
  4. 4. and long term. For example, alcohol and drug use are the proximate causes of unintentionalinjuries during adolescence; they also can lead to adult addiction and social and healthimpairment. Sexual behaviors often result in unplanned pregnancy and sexually transmitteddiseases, including HIV infection. Self-esteem of adolescents play an important role in theirengagement to health related risk behaviors such as physical harm, dietary behavior, physicalinactivity, sexual behavior, substance abuse (Charalampous, Ford, and Skinner; 1976;Donnelly, 2000) which the Youth Risk Behavior Surveillance System (YRBSS) haveenumerated. Adolescents may engage in these health-related risk behaviors and may react on itnegatively or positively.There is a belief among many in the field of health promotion and healtheducation that ahigh self-esteem is somehow protective against involvement in the so-called health riskbehaviours. The assumed protectiveeffect of self-esteem is derived from a deficit or susceptibility model of adolescentbehaviour (McGee & Williams, 2000; Moore, Laflin& Weis, 1996) Some researches that were conducted outside the country revealed that there is asignificant difference among male and female adolescents when it comes to engaging in thosehealth-related risk behaviors whether they have a high or low self-esteem. In terms of sexualbehavior, self-esteem plays an apparent role in the sexual behaviors among adolescents,according to a study by researchers at the Indiana University School of Medicine published inthe April 2002 issue of Pediatrics. Self-esteem had opposite effects on female adolescents andmale adolescents. Female adolescents with high self-esteem were less likely to engage in earlysexual activity, while male adolescents with high self-esteem were more likely to report beingsexually active. In terms of physical harm, Johnson (1977) concludedthat juvenile delinquency prevention programs often fail because they arebased on incorrect assumptions about the sources of delinquency and overlookthe crucial roles of school failure and low self-esteem among adolescents either male or female.Kelley (1978) reported a direct correlation between delinquency and lowself-esteem. He found evidence of a link between increased self-esteem and areduction of delinquent behavior. He found that as programs were implementedto raise the level of self-esteem, the incidence of delinquent behavior wasreduced. Those with low self-esteem seem to rely more on group or collectiveself-esteem than those with high personal self-esteem. Thus, some
  5. 5. individuals seek gang membership to compensate for feelings of lowself-esteem (Review of Self-esteem Research, Robert W. Reasoner). In terms of substance abuse, low self-esteem can be one of the main indicators whyadolescents engage in using illegal drugs, drinking alcohol and the like. Moreover femaleadolescents are less likely to engage in substance abuse than male adolescents (Women andChildren Treatment, 2010). In the book Alcoholism: A False Stigma: LowSelf-Esteem the True Disease, (1996) Candito reports, "Those who haveidentified themselves as "recovered alcoholics" indicate that low self esteemis the most significant problem in their lives. Low self-esteem is the trueproblem and the true disease not because it will lead to alcoholism but also to other substanceabuse like marijuana, smoking and others. In terms of dietary behaviors, Dr. Yellowlees (1996)states that low self-esteem seems to operate as a predisposing andcontributory factor in the development of eatingdisorders. In some cases, evidence for thisrelationship is so strong that it is even thought by some researchers thatchronic low self-esteem is a necessary prerequisite for disordered eating. However more of thefemale adolescents were being affected by their low self-esteem than the males. In terms of physical inactivity, female and male adolescents who have a high self-esteem are the ones who likely committed physical inactivity. Female and male adolescentswho have a low self-esteem are the ones engaging in physical activity such as exercise in orderto boost their low self-esteem (PubMed.Gov, 2009). Since these researches were conducted outside the country, we would also liketo have a research about this in order to see if the results do vary here in the Philippines andthus this factors affect the prevalence of committing certain attitudes that is why we come upwith this research entitled Self-esteem and Health-Related Risk Behaviors among Adolescentsin Baguio City. In our research, Self-esteem is referred to as the overall evaluation or appraisal of one’sown worth. Health-related risk behaviors are the actions, attitudes and perceptions that maycontribute to one’s engagement in activities which are hazardous or dangerous to their own
  6. 6. health. One of this is physical harm which is referred to as the intention or to cause damage toself, others or property. Substance abuse is the maladaptive use(abuse) of tobacco, alcohol andother drugs. Sexual behavior is the maladaptive sexual patterns or behaviors of adolescentssuch as unsafe or premarital sex. Dietary behaviors are the dietary habits that are notconsidered to be healthy. Physical inactivity is the behavior such as lack of exercise.The research aims to understand the relationship of self-esteem and health risk behaviors.Specifically, it seeks to answer the following questions: 1. What is the relationship between self-esteem and health-related risk behaviors of adolescents? 2. What is the relationship betweenself-esteem and health-related risk behaviors among adolescents whenthese behaviors are classified according to: a. Physical harm b. Substance abuse c. Sexual behaviors d. Dietary Behaviors e. Physical inactivity 3. Is there a significant association between the relationship of self-esteem and health- related risk behavior when grouped according to: a. Gender b. EthnicityMETHODOLOGY The study will utilize a correlational quantitative design. Give a short description inrelations to your study. (Poilt and Beck, 20?). The total population of adolescents in Baguio Cityis 1,000,000 excluding those who are not enrolled. Adolescents who are out of school will not beconsidered because the researchers were not able to know their exact number. The samplesize of 385 was determined by the formula for standard proportions. The study will be conducted in Baguio City… {REASONS} To answer the research questions, the researchers will utilize a questionnaire to gatherdata. The questionnaire is composed of 3 parts. The first part comprises of a letter addressed tothe respondent. The letter explains the title of the study, the purpose of the study and ethical
  7. 7. considerations that shall be observed in the conduct of the study. The second part determinesthe participants’ demographic data. The third part of the questionnaire consists of _ items todetermine the level of self-esteem and the level of health-related risk behaviors. The tool thatwill be used in the study was adapted from Rosenberg’s Global Self-Esteem Inventory andYRBSS ________. To assure validity of the tool, Expert- Content Validity Index CVI! {} {Data Gathering Procedure}