The effects of self-esteem and academic
performance on youth decision-making:
An examination of sexual debut and illegal substance use
Stephanie B. Wheeler, MPH
University of North Carolina at Chapel Hill
Cecil G Sheps Center for Health Services Research
Background
 Early sexual intercourse related to:
 STDs
 Unwanted pregnancy
 Depression, anxiety, eating disorders
 Illegal use of controlled substances in youth related to:






Substance dependency
Motor vehicle accidents
Injury from violence
Criminal activity
Mental health problems
High school drop-out
 Determinants of risky behaviors among young people
largely remain unknown
Background
 Self-esteem, perceived intelligence, and academic
performance may play roles in decision-making
 Self-esteem
 “Acting out” to help fill a void
 Confidence and self-efficacy required to say “no”
 Feeling invincible, immune to risk, living on the cutting edge
 Academic achievement
 Better knowledge about risks
 Heightened self-efficacy as result of higher perceived
intelligence
 Having a positive outlook for one’s academic future
Conceptual Framework

Social Competency/Individual Deficiency theory
(Norman and Turner, 1993)

High risk behavior in young people associated with:






Low self-esteem
Inability to solve problems
Difficulties with communication
Inappropriate values
Attempts to seek peer approval
Self-esteem may be determined in part or mediated
by personal, familial, and environmental factors
SOCIETY
Race/ethnicity
COMMUNITY
Gender
COMPETENT
Age
Religion
Values
PERCEIVED
SELF-WORTH
(SELF-ESTEEM)
Relationships
Achievements
Self-efficacy
Communication Skills
DEFICIENT
RISKY
BEHAVIOR
Research Questions
 Does higher self-esteem at baseline
 Reduce the likelihood of sexual debut?
 Reduce the likelihood of illegal substance use?
 Does higher academic performance at baseline
 Reduce the likelihood of sexual debut?
 Reduce the likelihood of illegal substance use?
Methods
 Retrospective, secondary analysis
 National Longitudinal Study of Adolescent Health
(aka Add Health, public version)
 Population
 American youth enrolled in the 7th through 12th grades in
52 middle schools and 80 high schools
 Sampled originally in 1994-1995 academic years (baseline)
 Followed up in 1996 (wave II) and 2002-2003 (wave III)
 Adolescent in-home survey data only
 Waves I-III contain data from approximately 6500
individuals ages 11-26
Methods
 Face-to-face interviews and computer-assisted
personal interview devices
 Exclusion criteria for current study:
 Individuals not available for sampling in all three waves
 Individuals who reported having had sex at baseline
(sexual debut models only)
 Stratified multivariate logistic regression (by gender)
 Controlling for known confounders
Key Variables
 Dependent Variables
 Sexual debut
 Illegal substance use
 Drug use
 Underage alcohol use
 Underage cigarette smoking
 Independent Variables
 Academic performance
 Self-esteem
 Ascending scale of 10 Likert-scaled survey items
 Range: 14-44 (median score: 33)
Self Esteem Measurement
Questions related to personal confidence and satisfaction with life:
- “I have a lot of good qualities”
- “I have a lot to be proud of”
- “I like myself just the way I am”
- “I feel I am doing everything just about right”
- “I feel socially accepted”
- “I feel I am just as good as other people”
- “I enjoy life”
Perceived intelligence relative to peers:
- “Compared with other people your age, how intelligent are you?”
Overall satisfaction with weight/size:
- “How do you think of yourself in terms of weight?”
- “Are you trying to lose weight, gain weight, or stay the same?”
Results: Descriptive Statistics at Wave 1
Variable
% or Mean
SD or Range
Sex by Wave I
33%
.47
Drug use in Wave I
26%
.44
Underage alcohol use in Wave I
52%
.50
Self esteem in Wave I
32.7
15-42
A student (>/=3.5 GPA) in Wave I
43%
.50
B student (>/=2.5-3.5 GPA) in Wave I
37%
.48
C or lower (< 2.5 GPA) in Wave I
20%
.38
PVT standardized test score Wave I
100.5
10-137
Age in Wave I
15.6
11-21
Race – White
64%
.48
Race – Black
21%
.41
Race – Other
15%
.35
Selected Results:
Adjusted Odds Ratios for Sexual Debut
Females OR
Males OR
Wave II
Wave II
“A” student (defined as >=3.5 GPA)
0.49**
0.63+
“B” student (defined as >=2.5, <3.5 GPA)
0.81
0.72
Self-esteem
0.98
1.01
Age14
2.29*
1.17
Age15
3.75**
1.23
Age16
5.51**
2.25*
Age17
6.16**
3.06**
Age Over17
6.65**
4.68**
Race African American
1.31
2.12**
Influence of religion
0.90*
0.90*
Having taken abstinence pledge
0.68*
0.65
Ever in romantic relationship
2.33**
2.17**
Lives with one parent
1.668*
1.490
Observations
1255
974
+ significant at 10%; * significant at 5%; ** significant at 1%
Selected Results:
Adjusted Odds Ratios for Illegal Drug Use
Females OR
Males OR
Females OR
Males OR
Wave II
Wave II
Wave III
Wave III
“A” student (defined as >=3.5 GPA)
0.61**
0.89
0.92
1.01
“B” student (defined as >=2.5, <3.5 GPA)
0.57**
0.88
1.07
0.86
Self-esteem
0.96**
0.98
0.99
0.99
Prior use of substances in Wave I
11.38**
10.10**
3.44**
3.09**
Age14
1.01
2.29*
0.80
0.89
Age15
1.39
1.65
0.84
0.70+
Age16
0.81
2.06*
0.71+
0.60*
Age17
0.88
2.00*
0.48**
0.48**
Age Over17
0.73
2.52*
0.42**
0.40**
Race African American
0.72
2.02**
0.91
0.85
Race Other
1.24
1.56*
0.93
1.08
Influence of religion
0.90**
0.92*
0.95*
0.93**
Ever in romantic relationship
1.44**
1.42*
1.09
1.28*
Lives in urban area
1.41*
1.11
1.18+
0.98
Observations
1825
1517
2245
1850
+ significant at 10%; * significant at 5%; ** significant at 1%
Summary and Discussion
 Academic performance related to sexual debut and illegal
substance use, but effect varies by gender and over time
 How to interpret significance of academic performance
 No strong/consistent effect of self-esteem
 Measurement of self-esteem
 Younger females appear to be more sensitive to these effects
 Consistent associations between age, influence of religion,
relationship experience and risky behaviors
 Strengths
 Large national dataset
 Rich information about sensitive topics and youth behavior
 Estimated effect of wave I variables on wave II/III outcomes
 Limitations
 Observational study
 Possible omitted variable bias (risk tolerance, opportunity, sense
of future, parental emphasis on avoiding sex/drugs, etc.)
Implications
 Continued efforts to improve academic performance and selfconfidence in youth are important, particularly at young ages,
and may have important long term health effects
 Measurement of self-esteem is complicated
 Non-linear, dynamic nature of self esteem
 Future research should explore the mechanisms through
which academic achievement and self-esteem are created
 Peer network modeling could provide additional insight
• Sally Stearns
• Edward Norton
• Sarah Birken
• Michaela Dinan
• Heather Beil
Control Variables

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Age
Race
Influence or importance of religion
Employment
Ever in a romantic relationship
Community-level socioeconomic/demographic variables
Any previous psychological treatment
Residence with both, one, or neither biological parent
Substance use models only:
•
•

Urban residence
Prior substance use in Wave I
Sexual debut models only:
•
•
Ever taken a public abstinence pledge
Height