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Social Norms, Social Connections, and Sex Differences in Adolescent Mental and Behavioral Health


This study examined whether sex-related health disparities that emerge during adolescence are linked to social norms and social connections within three primary social contexts: families, friendships, and schools. Using data from the National Longitudinal Study of Adolescent Health (N = 18,921), we assessed links between social norms and social connections with parents, friends, and schools and depressive symptoms and substance use separately for males and females. In addition, we considered parents, friends, and schools as both combined and sex-specific contexts. Results suggested that links between social norms and adolescent health were stable across the sex of the recipient but varied by sex of the provider, whereas links between social connections and adolescent health varied across the sex of both provider and recipient. Social norms from mothers and female schoolmates (but not from fathers or male schoolmates) were associated with both male and female substance use. In contrast, connectedness with fathers served as a protective factor for male depressive symptoms, whereas connectedness with female friends was a risk factor for female depressive symptoms. These findings extend the literature investigating sex disparities in adolescent mental and behavioral health by locating significant influences from multiple social contexts, revealing sex-specific social norms and social connections within these contexts as playing a salient role, and identifying several areas for preventative efforts, specifically (a) maternal and female schoolmate social norms in reducing substance use, (b) paternal connectedness in reducing male depressive symptoms, and (c) connectedness within female friendships as a risk for female adolescents’ mental health.

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This research was funded with generous support from the W. T. Grant Foundation (grant 10909). This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 27516-2524 (

Author contributions

CML: collaborated with the design of this study and wrote the manuscript. RLC: collaborated with the design and writing of the study. JS and ADL: analyzed the data and collaborated with the writing of the study. JRM: collaborated with the design and writing of the study.

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Correspondence to Caitlin McPherran Lombardi.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with ethical standards. The Institutional Review Board at Boston College approved this study.

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Informed consent was obtained from all participants included in the study.

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Lombardi, C.M., Coley, R.L., Sims, J. et al. Social Norms, Social Connections, and Sex Differences in Adolescent Mental and Behavioral Health. J Child Fam Stud 28, 91–104 (2019).

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  • Social norms
  • Social connections
  • Adolescence
  • Substance use
  • Depressive symptoms