Published online February 1, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. e307-e313 (doi:10.1542/10.1542/peds.2007-0881)
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ARTICLE

Why Do Adolescents Say They Are Less Healthy Than Their Parents Think They Are? The Importance of Mental Health Varies by Social Class in a Nationally Representative Sample

Sara B. Johnson, PhD, MPHa and Constance Wang, PhDb

a Center for Health and Community, University of California, San Francisco, California
b Department of Epidemiology, University of California, Berkeley, California

OBJECTIVE. We sought to (1) confirm the discrepancy between parent-reported and youth-reported adolescent health in a nationally representative sample, (2) compare the predictors of parent-reported and adolescent self-reported health, and (3) determine whether the discrepancy between the 2 ratings differed by sociodemographic characteristics, particularly income.

METHODS. Data were from the 2001–2002 National Health and Nutrition Examination Survey. A total of 1157 adolescents aged 12 to 15 years, representative of 16227827 US youth, were included. Youth and their parents reported on the youth's health status along with other indicators of health and illness and sociodemographic characteristics. To examine predictors of self-rated and parent-rated adolescent health (excellent to poor), bivariate analyses were conducted, followed by multiple linear regression adjusted for relevant covariates. All of the analyses were stratified by income (standardized poverty income index: ≤1 vs >1).

RESULTS. Parents and youth differed in subjective judgments regarding the child's health, even when these differences were not supported by other health indicators (days of school missed because of illness or injury or days of poor mental or physical health). Poor adolescents reported worse self-rated health than higher-income youth, and their parents did also. In income-stratified multiple regression models, higher-income adolescents' and their parents' ratings were predicted by indicators of physical health. In contrast, poor youth and parent ratings were better predicted by mental health care use. Poor youth with a mental health visit in the last year reported better health, but their parents saw these mental health visits as an indication of poor health.

CONCLUSIONS. The findings suggest that social class differences in subjective ratings of adolescents' health are related to the differential ways that youth and parents determine what constitutes health and are not simply a reflection of objective health status.

Key Words: adolescent • self-rated health • proxy measures • mental health • income

Abbreviations: SRH—self-rated health • NHANES—National Health and Nutrition Examination Survey • PRH—parent-rated health • PIR—poverty/income ratio

Accepted Jun 19, 2007.


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