1. Paper Symposium: Toward a Differentiated Perspective on the Meaning of Adolescent Peer Relations for Adult Functioning in the Long-term

2. Friends and Health Across Time: Cumulative Long-term Links of Adolescent Social Functioning to Adult Physical Health Joe Allen Elenda Hessel Emily Loeb University of Virginia We gratefully acknowledge grant support from NIMH & NICHD (#’s 2R01HD058305 & R01-MH58066). Copies of related papers are available at: WWW.TEENRESEARCH.ORG Collaborators: Maryfrances Porter, Ph.D. Kathleen McElhaney, Ph.D. Joseph Tan Samantha Magaro Lauren Elreda, Ph.D. Farah Williams, Ph.D. Chris Hafen, Ph.D. Megan Schad Lauren Everhart Rachel Narr Christy McFarland, Ph.D. Emily Marston, Ph.D. Erin Miga, Ph.D. Amanda Hare, Ph.D.

3. Social Relationships and Physical Health Surprisingly Powerful Links Social isolation linked to: Early Mortality Effects Comparable to Physical Risk Factors

4. Social Relationships and Physical Health Hypothesized Mechanisms Health Behavior Poor Physical Health as Creating Social Isolation Stress/Allostatic Load

5. Social Relationships and Physical Health Hypothesized Mechanisms Humans as Pack Animals Needing Social Contact to Thrive

6. Overarching Question Can we identify social relationship characteristics in adolescence that predict long-term health outcomes into adulthood?

7. Assessing Global Adult Health Age 25 – Simple 5-item Self-Report Scale Age 25 – Simple 5-item Self-Report Scale (Medical Outcomes Study Short-form Health Survey, DeSalvo, 2006) Cronbach’s =.83 Cronbach’s α =.83

8. Assessing Global Adult Health Age 25 Links from Prior Literature Global Health Assessment Objective Markers of Illness Early Mortality Future Illness

9. Sample 184 Adolescents (followed from age 13 to 27), their Parents, Best Friends, Other Friends, Romantic Partners 184 Adolescents (followed from age 13 to 27), their Parents, Best Friends, Other Friends, Romantic Partners Intensive Interviews and Observations with all parties (Total N over first 15 years ~ 3400). Intensive Interviews and Observations with all parties (Total N over first 15 years ~ 3400). Equal numbers of Males and Females Equal numbers of Males and Females Socio-economically Diverse (Median Family Income= $40- $60K) Socio-economically Diverse (Median Family Income= $40- $60K) 31% African American; 69% European American 31% African American; 69% European American Very Low Attrition (98% participation rate in current phase) Very Low Attrition (98% participation rate in current phase)

10. Can We Prospectively Identify Adolescent Relationship Qualities That Will Predict Their Health as Adults? Plan of Attack: Start With Intuitive Long-term Predictors e.g., Social Acceptance/ Social Anxiety Data on an Unexpected, but Remarkably Robust Set of Predictors The (Not So) Rugged Individualist Putting it all Together

11. Peer Acceptance Age 14 Combination of Three Peer-report Measures: Close Friend Attachment to Target Teen: Close Friend Attachment to Target Teen: Inventory of Parent and Peer Attachment (Armsden & Greenberg, 1987) Inventory of Parent and Peer Attachment (Armsden & Greenberg, 1987) Overall Friendship Quality with Target Teen: Overall Friendship Quality with Target Teen: Friendship Quality Questionnaire (Parker & Asher, 1993) Friendship Quality Questionnaire (Parker & Asher, 1993) Social Acceptance of Target Teen: Social Acceptance of Target Teen: Rated by Close Friend Rated by Close Friend Modified Adolescent Self-Perception Profile, Close Friendship Competence Scale (Harter, 1988) Modified Adolescent Self-Perception Profile, Close Friendship Competence Scale (Harter, 1988)

12. Global Health.21** Early Social Acceptance Predicting Future Global Health Age 14 Age 25 Social Acceptance

13. Global Health.27** Early Social Acceptance Predicting Future Global Health Age 14 Age 25 Peer-ratings of social acceptance of target teen predict target teen’s future health. -.10 -.22** Family Income Gender Social Acceptance Adult Covariates: Body Mass Index Adolescent Covariates: -.12

14. Social Anxiety (Age 19-20) Social Anxiety Scale for Adolescents (LaGreca, 1998) Social Anxiety Scale for Adolescents (LaGreca, 1998) 22-item self-report scale 22-item self-report scale Cronbach’s =.93 Cronbach’s α =.93 Collected at both age 19 and age 20, with the average score across the two ages used. Collected at both age 19 and age 20, with the average score across the two ages used.

15. -.24** Late-Adolescent Social Anxiety Predicting Future Global Health Age 19-20 Age 25 Social Anxiety Global Health

16. -.27** Late-Adolescent Social Anxiety Predicting Future Global Health Age 19-20 Age 25 Social Anxiety Global Health Social anxiety predicts POORER future health. -.02 -.17* Family Income Gender Adult Covariates: Body Mass Index Adolescent Covariates: -.17*

17. The Risky Status of The Rugged Individualist Links of dominance to poor heart health (Smith et al., 2007, 2012) Links of dominance to poor heart health (Smith et al., 2007, 2012) Cross-cultural comparisons Cross-cultural comparisons ??

18. Peer Ratings of Target Teen as a Follower Report by Best Friend at age 14 : Report by Best Friend at age 14 : 5-items 5-items Examples: Examples: Some teens do things just because other kids do them Some teens do things just because other kids do them Some teens usually do whatever their friends tell them to do Some teens usually do whatever their friends tell them to do Some teens get a lot of ideas about what to wear, what to do, and how to act from their friends Some teens get a lot of ideas about what to wear, what to do, and how to act from their friends Cronbach’s =.68 Cronbach’s α =.68

19. Peer-ratings of Teen as a Follower Predicting Future Health Peer-ratings of Teen as a Follower Predict BETTER Health in Adulthood Global Health Age 14 Age 25 Family Income Gender Teen is a Follower Adult Covariates: Body Mass Index Adolescent Covariates:.22** -.05 -.15* -.17

20. Leadership Self-Ratings Self-report at age 14 Self-report at age 14 5-items 5-items Examples: Examples: How much do you see yourself as being similar to teens who: How much do you see yourself as being similar to teens who: Set an example for other kids to follow Set an example for other kids to follow Are copied by other kids Are copied by other kids Often tell their friends what to do Often tell their friends what to do

21. Self-reported Leadership Predicting Future Global Health Age 25 Leadership is related to POORER Health in Adulthood. Global Health Age 14 Age 25 -.04 -.17* Family Income Gender Leadership Adult Covariates: Body Mass Index Adolescent Covariates: -.14 -.28***

22. Target Teen is Easily Influenced by Peers (Age 16) Report by Best Friend at age 16: Report by Best Friend at age 16: 7-items 7-items Overall, how much do you actually think you influence: Overall, how much do you actually think you influence: Who Target Teen Hangs out With Who Target Teen Hangs out With How Target Teen Treats Other People How Target Teen Treats Other People Target Teen to Drink (or Not toDrink) Target Teen to Drink (or Not toDrink) Target Teen to Follow Parents’ Rules Target Teen to Follow Parents’ Rules Target Teen to go farther (or not ) sexually Target Teen to go farther (or not ) sexually Cronbach’s =.71 Cronbach’s α =.71

23. .25** Peer-ratings of Teen as Easily Influenced Predicting Future Health Age 16 Easily Influenced Teens at 16 have BETTER Health in Adulthood Easily Influenced by Peers Global Health Age 25 Family Income Gender Adult Covariates: Body Mass Index Adolescent Covariates: -.09 -.21* -.17

24. Teen is Assertive (Peer-Ratings) (Age 17) Report by Best Friend at age 17 : Report by Best Friend at age 17 : 5-items 5-items Examples: How Good is Target Teen at: Examples: How Good is Target Teen at: Getting people to go along with what he/she wants Getting people to go along with what he/she wants Taking charge Taking charge Sticking up for him/herself Sticking up for him/herself Getting someone to agree with his/her point of view Getting someone to agree with his/her point of view Deciding what should be done Deciding what should be done Cronbach’s =.90 Cronbach’s α =.90

25. -.29*** Peer-ratings of Teen Assertiveness Predicting Future Health Age 17Age 25 Assertive Teens at 17 have POORER Health in Adulthood Assertiveness Global Health -.16 -.12 Family Income Gender Adult Covariates: Body Mass Index Adolescent Covariates: -.20*

26. Teen Values Self-Direction (Age 19) Adapted from Parenting Values Measure Adapted from Parenting Values Measure (Schaefer, 1985; Kohn, 1977) (Schaefer, 1985; Kohn, 1977) 6-items 6-items Examples: I should… Examples: I should… Be able to think for myself Be able to think for myself Obey parents, bosses or teachers (reverse-scored) Obey parents, bosses or teachers (reverse-scored) Cronbach’s =.53 Cronbach’s α =.53

27. -.31*** Peer-ratings of Teen Valuing of Self- direction Predicting Future Health Age 19Age 25 Self-directed Teens at 19 have POORER Health in Adulthood Self- directedness Global Health -.09 -.17 Family Income Gender Adult Covariates: Body Mass Index Adolescent Covariates: -.24**

28. Putting It All Together Composite Measure of “Rugged Individualism” Combination of Three Peer-report Measures: Teen as Follower (age 14; reverse-scored) Teen as Follower (age 14; reverse-scored) Teen Influenced by Peers (Age 16; reverse-scored) Teen Influenced by Peers (Age 16; reverse-scored) Teen Assertiveness (Age 17) Teen Assertiveness (Age 17) Standardized and summed together. Standardized and summed together.

29. Global Health -.36*** Self-ratings of Individualism Composite Predicting Future Health Age 14-17Age 25 Rugged Individualism Composite Individualism Composite Accounts for 13.9% of Incremental Variance in Health Outcomes Family Income Gender Adult Covariates: Body Mass Index Adolescent Covariates: -.05 -.23*** -.15

30. Global Health Comprehensive Model of Adolescent Social Relationships Predicting Future Health Age 14-17Age 25 3 Social Predictors Account for 29.6% of Incremental Variance in Health After Covariates.19* Family Income Gender Rugged Individualism Composite Adult Covariates: Body Mass Index Adol. Covariates: Concurrent Depressive Symptoms (BDI) Social Acceptance Social Anxiety Age 14Age 20 -.21** -.03 -.22** -.14 -.19* -.29***.10.02

31. Conclusions Adolescent Social Relationships and Future Health Adolescent Social Relationships and Future Health Peer Relationships and Peer Pressure really may be ‘life and death’ issues for teens. Peer Relationships and Peer Pressure really may be ‘life and death’ issues for teens. Copies of related papers are available at: www.TeenResearch.org

32. Conclusions The Death of the Rugged Individualist? The Death of the Rugged Individualist? (or at least his/her poor health)? (or at least his/her poor health)? Evidence from other observational research on dominance/independence Evidence from other observational research on dominance/independence Tim Smith and Marital Relationships Tim Smith and Marital Relationships Robert Sapolsky and Primate Dominance Hierarchies Robert Sapolsky and Primate Dominance Hierarchies Evidence from other cultures Evidence from other cultures East to West East to West Copies of related papers are available at: www.TeenResearch.org

33. Limitations Correlational not Causal Correlational not Causal Did not have baseline health assessments Did not have baseline health assessments Still Need to Understand Possible Mediating and Moderating Mechanisms! Still Need to Understand Possible Mediating and Moderating Mechanisms! HPA Axis HPA Axis Cardiovascular Reactivity Cardiovascular Reactivity Immune Functioning Immune Functioning Health/Risk Behaviors Health/Risk Behaviors Etc. Etc. Copies of related papers are available at: www.TeenResearch.org

34. Conclusions Implications: Implications: Recognizing the adolescent bind Recognizing the adolescent bind Well-child visits and predictors of future health Well-child visits and predictors of future health Interventions to enhance peer relationships Interventions to enhance peer relationships Copies of related papers are available at: www.TeenResearch.org

36. Thinking different is great…but it has its costs.