Self-esteem and value of health as correlates of adolescent health behavior

Adolescence,  Summer, 1995  by Rivas Torres,  Fernandez Fernandez,  Dosil Maceira

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INTRODUCTION

Much recent research in the health behavior field has adopted a psychosocial approach centering on personal variables. Significant work on the relationship between health behavior and personality factors has included studies of self-efficacy (Leventhal, Zimmerman, & Gutman, 1984; Rogers, 1983; Rosenstock, Strecher, & Becker, 1988) and locus of control (Giblin, Poland, & Ager, 1988; Lau, 1988; Strickland, 1978; Wallston, Maides, & Wallston, 1976), while studies of self-esteem (Giblin et al., 1988; Jessor, 1983) and of personal autonomy in relation to health behavior (Seeman & Seeman 1983) have helped reveal the direct influence of these factors in health education. Value of health also has been found to be decisive in many forms of prevention behavior (Levenson, Morrow, Gregory, & Pfefferbaum, 1984; Wurtele, Britcher, & Saslawsky, 1985), and models of value of health now constitute an independent study area.

Evaluation of relevant personal variables should aid in design of health education programs focusing on factors which facilitate voluntary adaptation of behavior that affects welfare. Thus, prior to the projected design of a health education program for N. W. Spanish adolescents, we undertook to study such variables in this group. Adolescence is a critical period regarding health behavior since it is a time when many personal qualities are acquired or consolidated.

One of the first to recognize that research on health behavior should consider personal variables such as self-concept, ability to cope, and value of health was Jessor (1983), who further proposed (Jessor, 1984) that adolescent health behavior be studied in the framework of his problem behavior theory, which encompasses a complex of psychosocial constructs including environmental variables (e.g., parental support, social support), predisposing demographic, socialization, and educational variables, and personality variables (e.g., motivation, values, attitudes, self-concept, locus of control). The present study investigated the influence of two of these variables selected on the basis of preliminary studies: self-esteem and value of health.

Self-esteem, as a "valuative assessment one makes regarding personal satisfaction with role(s) and the quality of . . . performance" (Beave & Lipka, 1980, p. 1), is considered to be one of the variables with greatest potential for inhibitory or promotional influence on health behavior. The chief reasons for this are as follows:

1. Individuals with high self-esteem exhibit well-integrated behavior, and their cognitive processes are characterized by the ability to discriminate between relevant and irrelevant information (Lewin, 1935). Such individuals are assumed to make optimal use of the information given them concerning health matters, and to perceive the consequences of certain actions for their health.

2. High self-esteem reduces susceptibility to the influence of ephemeral events in the environment, and increases personal perception of self-efficacy (Lewin, 1935). This enhances positive health behavior by reducing the detrimental influence of social and environmental factors such as peer group pressure, which generally has a strong effect on smoking, drinking, and drug abuse, especially during late adolescence (McAlister, 1983).

3. According to Humanist Theory, concept of oneself plays a fundamental role in the determination of behavior (Jourard & Landsman, 1980). Consequently, the way people view and/or assess themselves can affect the way they behave with regard to maintenance of their health. Those who look on themselves as bold and carefree may refuse to use safety belts because the belted driver does not fit their image of themselves, whereas those who look on themselves as competent and responsible for their own lives may develop positive health habits. This is confirmed by the fact that competence and ability to cope are both inherent in self-esteem (Harter, 1983).

A "value" may be defined as "an enduring belief that a specific mode of conduct or end-state of existence is personally or socially preferable to an opposite or converse mode of conduct or end-state of existence" (Rockeach, 1973, p. 5). The degree to which any particular individual values health may be greater or less than the value he or she gives to other things, such as acceptance by peers or the enactment of a given role, and the balance among these different values will determine involvement in activities affecting health, such as smoking. It may reasonably be hypothesized that such interplay among different values may be especially critical during adolescence.

Despite these considerations, studies of self-esteem and value of health in relation to health behavior among adolescents have been few and often methodologically limited. Their findings nevertheless constitute a valuable starting point. With regard to self-esteem, early studies of adolescent pregnancy (Freeman, Rickels, & Huggins, 1984; Vernon, Green, & Frothingham, 1983) showed that self-esteem of teenage mothers reduced the incidence of depression and psychosomatic disorders in teenage mothers. Similarly, Giblin, Poland, & Sachs, 1987) found that self-esteem, together with financial resources, satisfaction, and current situational stability, accounted for 16% of variance in postnatal clinic attendance by adolescent mothers. With regard to adolescent drug abuse, Dielman, Leech, & Lorenger (1984) found that between 3% and 9% of variance was accounted for by self-esteem and locus of control, while with regard to beneficial use of drugs, Neel, Jay, & Litt, (1985) found that 36% of variance in compliance with therapy among epileptic adolescents was attributable to self-esteem and psychosocial variables measuring independence, personal autonomy, and family relationships.