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. Author manuscript; available in PMC: 2022 Jun 1.
Published in final edited form as: J Sch Health. 2021 Mar 30;91(6):482–489. doi: 10.1111/josh.13024

Self-Perceptions, Normative Beliefs, and Substance Use Associated with High School Girls Comparing Themselves to Peers

Ashley L Merianos 1, E Melinda Mahabee-Gittens 2, Wura Jacobs 3, Oluyomi Oloruntoba 4, Adam E Barry 5, Matthew Lee Smith 6
PMCID: PMC8218720  NIHMSID: NIHMS1707707  PMID: 33786816

Abstract

BACKGROUND:

This study assessed whether self-descriptions, self-perceptions, perceived substance use of friends, and actual substance use were associated with high school girls’ frequency of making social comparisons to peers.

METHODS:

Adolescent Health Risk Behavior Survey data were analyzed from 357 high school girls. Multinomial logistic regression was used.

RESULTS:

Compared to those who ‘never/rarely’ made social comparisons, participants who self-described as fearing something constantly (p=.014) and forced to imitate the people they like (p=.009) were more likely to ‘usually’ compare themselves to peers. Participants who described themselves as feeling forced to imitate the people they like (p=.022), were not the person they would like to be (p=.005), and did not remain calm under pressure (p=.010), were more likely to ‘often/always’ make social comparisons. Participants who perceived themselves as unattractive (p=.034) and self-centered (p=.016) were more likely to ‘often/always’ make social comparisons. Participants who perceived a larger proportion of friends used illicit drugs were less likely to ‘usually’ make social comparisons (p=.027). Participants who perceived a larger proportion of friends drank alcohol were more likely to ‘often/always’ make social comparisons (p=.018).

CONCLUSIONS:

Girls who perceive and describe themselves more negatively are at increased odds of making social comparisons to peers.

Keywords: adolescent, high school, girls, self-concept, peer pressure, substance use

Due to a constellation of personal, social and academic pressures, high school represents a stressful time for adolescents and girls in particular.1 During this time, peer relationships become an increasingly important influential factor. Social pressures elevate as adolescents often feel the need to “fit in” by looking like and acting like their peers so that they can be accepted.1 These pressures combined with insecurities about their attributes and appearances may result in low levels of self-esteem, self-worth, or self-confidence, which can in turn lead to depression, behavioral problems, and risky behaviors including substance use such as smoking and alcohol use.1–5

Numerous studies have demonstrated that female youth with higher self-confidence are less likely to have alcohol-related problems and engage in risky sexual behaviors.6–8 Conversely, female adolescents and adults with lower self-esteem are more likely to: 1) be ever or current smokers; and 2) engage in heavier drinking patterns.7,9,10 Moreover, low perceptions of self-worth or self-confidence may impact adolescents’ choices of friends. Teens have a tendency to gravitate towards peers with similar self-perceptions, who may be poor role models or who have already initiated alcohol use.6,10,11 Alcohol and tobacco use have been associated with having lower self-concept and making higher social comparisons among high school students.12

In addition to low self-esteem, many female adolescents conduct social comparisons to their peers, which can augment their already distorted self-perceptions if they feel they do not “measure up” to their peers.2,13 Given the increased stress that many high school girls experience due to social, family, and academic pressures, these social comparisons can be detrimental to their self-esteem.1 These issues are further compounded by the widespread use of social media by adolescents. When social comparisons are conducted in person or on social media, teens are more likely to experience depression, anxiety, and further dissatisfaction with their body appearance and low self-esteem14–16 – factors that commonly co-occur with alcohol use initiation and other risky behavior.

The purpose of this study was to assess whether high school girls’ negative self-descriptions and negative self-perceptions were associated with their frequency of making social comparisons to peers. We also examined the relationships between perceived substance use of friends and actual use of licit and illicit drugs and frequency of making social comparisons to peers among high school girls. We hypothesized that girls who described themselves negatively and/or perceived themselves negatively would be more likely to report frequently comparing themselves to peers than female students who rated themselves and described themselves positively. We also posited that girls who perceived a high percentage of their friends smoked cigarettes, drank alcohol regularly, used illicit drugs, and had higher engagement in lifetime use of licit and illicit drugs, would be at increased odds of frequently comparing themselves to their peers than girls who perceived a low percentage of their friends engaged in substance use and had lower/no engagement in lifetime use of drugs.

METHODS

Participants and Procedure

As part of a larger study using the Adolescent Health Risk Behavior Survey (AHRBS),17 data were analyzed from a sample of 357 high school girls (grades 9 to 12) in one Indiana County. In brief, the AHRBS was conducted to gain information on the prevalence of health-risk behaviors among middle school and high school students that attribute to leading causes of morbidity and deaths, including but not limited to, substance use behaviors.17 A random sample of schools were first selected from the one county followed by randomly selecting the sample school’s classrooms for participation. Specifically stratifying by grade level, purposive quota clustering sampling design was used to select students eligible for participation (N=1,992). Passive parental consent was obtained, and student participation was voluntary. A total of 1,430 middle school students and high school students completed the AHRBS in a hard-copy format during class, resulting in a 72% response rate. Of the 1,213 returned instruments with usable data, we initially excluded male students (n=599), then female students in middle school (n=229). Those with missing data on the dependent variable and other variables of interest were then excluded (n=28). All procedures for this secondary analysis were approved through the Institutional Review Boards at Texas A&M University and University of Georgia. More details about this larger initiative and the AHRBS are well-documented elsewhere.18–25

Instrumentation

Dependent variable.

The dependent variable of this study was the frequency in which participants compared themselves to peers. Participants were asked, “How often do you compare how well things are going for you in general (socially, personally, etc.) with other people?” Response choices were collected using a 5-point Likert-type scale ranging from “never” to “always.” Based on the frequency distribution, responses were trichotomized into the following categories: ‘never/rarely,’ ‘usually,’ and ‘often/always.’ For multivariate analyses, ‘never/rarely’ served as the referent group.

Self-descriptions.

Students were asked to rate how well positive and negative statements described them using a 6-point Likert type scale ranging from “describes me very well” (0) to “does not describe me at all” (5).

The seven negative self-descriptions included: (1) “I fear something constantly,” (2) “In the past year I have been very worried about my health,” (3) “I seem to be forced to imitate people I like,” (4) “Very often I think that I am not at all the person I would like to be,” (5) “I frequently feel ugly and unattractive,” (6) “When others look at me they must think that I am poorly developed,” and (7) “I feel that I have no talent whatsoever.”

The four positive self-descriptions included: (1) “I can take criticism without resentment,” (2) “Even under pressure I manage to remain calm,” (3) “I am proud of my body,” and (4) “I feel that I am able to make decisions.” Responses for positive self-descriptions were reverse coded as “describes me very well” = 5 to “does not describe me at all” = 0. Therefore, higher scores on all four items indicated worse or less desirable self-descriptions, which is a negative connotation.

Self-perceptions.

Students were asked to endorse how much they perceived positive and negative traits were like them using a 5-point Likert type scale ranging from “not at all like me” (0) to “exactly like me” (4).

The six negative self-perceptions included: (1) “confused,” (2) “immature,” (3) “unattractive,” (4) “dull (boring),” (5) “careless,” and (6) “self-centered.” The six positive self-perceptions included: (1) “popular,” (2) “smart,” (3) “considerate,” (4) “cool (sophisticated),” (5) “self-confident,” and (6) “independent.” Responses for positive self-perceptions were reverse coded for analyses as “not at all like me” = 4 to “exactly like me” = 0. Therefore, in analyses higher scores on all six items indicated worse or less desirable self-perceptions, which is a negative connotation.

Perceived substance use of friends.

Students answered three questions on the proportion of their friends that they thought engaged in substance use starting with “What percentage of your friends…” (1) “smoke cigarettes?,” (2) “drink alcohol regularly?,” and (3) “use illicit drugs?” Responses were collected using a 6-point scale ranging from “0%” to “100%” (in 20% increments). These three ordinal variables were individually analyzed continuously. Higher scores indicated students perceived a larger proportion of their friends used the substance.

Lifetime drug use.

Students were asked to report whether they engaged in lifetime use of 17 different licit, including alcohol, tobacco, marijuana, and many other illicit substances. Lifetime drug use was measured by creating a standardized measure using 2PL item response theory to calculate theta scores pertaining to these drugs.18,21 Theta score calculation details are available elsewhere.18 Higher theta scores were indicative of the severity of self-reported substance use relative to other students in the sample.

Demographic characteristics.

Students’ grade level (9 through 12) and school type (public, private) were collected and used in the current study.

Data Analysis

All statistical analyses were performed using SPSS version 25. Descriptive statistics were computed for all study variables of interest, which were then compared by the three dependent variable categories. Chi-square tests were used to identify distribution differences for categorical variables. One-way analyses of variance (ANOVAs) were used to identify mean differences for continuous variables. A multinomial logistic regression model with backwards elimination was fitted to identify factors associated with the frequency of comparing one’s self to peers. The category ‘never/rarely’ comparing one’s self to peers served as the referent category. After 19 iterations, the final model had strong model fit (−2 Log Likelihood = 619.10, χ2 = 116.82, df = 22, p < .001, Nagelkerke R2 = .331).

RESULTS

Table 1 reports sample characteristics by social comparison frequency. Of the 357 high school girls in the sample, 30.0% reported ‘never/rarely’ making social comparisons, 36.1% ‘usually’ making social comparisons, and 33.9% ‘often/always’ making social comparisons. The largest proportion of participants were in 12th grade (36.7%), followed by 9th (22.7%), 11th (22.1%), and 10th (18.5%) grades. The majority of participants attended public schools (91.6%).

Table 1.

Sample Characteristics by Comparisons of Self to Peers

Compare Self to Peers
Total (N = 357) Never/ Rarely (n = 107) Usually (n = 129) Often/ Always (n = 121) χ2 or f P
Grade - - - - 10.32 .112
 9th 22.7% 23.4% 25.6% 19.0% - -
 10th 18.5% 10.3% 22.5% 21.5% - -
 11th 22.1% 21.5% 21.7% 23.1% - -
 12th 36.7% 44.9% 30.2% 36.4% - -
- - - - - -
School Type - - - - 3.10 .212
 Public 91.6% 87.9% 92.2% 94.2% - -
 Private 8.4% 12.1% 7.8% 5.8% - -
- - - - - -
Self-Descriptions - - - - - -
 Fear Something Constantly 1.81 (± 1.52) 1.44 (± 1.53) 1.88 (± 1.37) 2.07 (± 1.60) 5.27 .006
 Been Worried About My Health 1.67 (± 1.52) 1.38 (± 1.47) 1.71 (± 1.48) 1.88 (± 1.57) 3.20 .042
 Forced to Imitate People I Like 1.14 (± 1.09) .78 (± .95) 1.28 (± 1.05) 1.31 (± 1.18) 8.81 < .001
 Not the Person Would Like To Be 2.01 (± 1.50) 1.47 (± 1.32) 1.88 (± 1.23) 2.62 (± 1.70) 19.24 < .001
 Feel Ugly and Unattractive 1.86 (± 1.52) 1.39 (± 1.37) 1.68 (± 1.30) 2.47 (± 1.68) 17.06 < .001
 Feel Others Think I Am Poorly Developed 1.11 (± 1.30) .82 (± 1.22) 1.02 (± 1.09) 1.47 (± 1.50) 7.90 < .001
 Have No Talent Whatsoever .90 (± 1.21) .66 (± .99) .81 (± 1.16) 1.21 (± 1.36) 6.73 .001
 Take Criticism without Resentment* 2.17 (± 1.24) 1.85 (± 1.19) 2.07 (± 1.13) 2.57 (± 1.30) 10.85 < .001
 Remain Calm Under Pressure* 1.88 (± 1.09) 1.52 (± .97) 1.84 (± .98) 2.23 (± 1.20) 12.87 < .001
 Proud of My Body* 2.25 (± 1.41) 2.06 (± 1.40) 2.15 (± 1.21) 2.53 (± 1.58) 3.77 .024
 Able to Make Decisions* 1.34 (± 1.14) 1.21 (± 1.05) 1.32 (± 1.10) 1.48 (± 1.24) 1.69 .186
Self-Perceptions
 Confused 1.61 (± 1.67) 1.37 (± 1.66) 1.38 (± 1.54) 2.07 (± 1.74) 7.09 .001
 Immature .54 (± 1.19) .50 (± 1.11) .45 (± 1.07) .66 (± 1.38) .95 .388
 Unattractive 1.00 (± 1.45) .88 (± 1.44) .70 (± 1.19) 1.42 (± 1.62) 8.55 < .001
 Dull (boring) .45 (± 1.04) .30 (± .90) .39 (± .87) .66 (± 1.28) 3.90 .021
 Careless .76 (± 1.26) .62 (± 1.24) .67 (± 1.18) .98 (± 1.35) 2.82 .061
 Self-Centered .65 (± 1.27) .39 (± 1.01) .50 (± 1.09) 1.04 (± 1.53) 9.39 < .001
 Popular* 1.66 (± 1.52) 1.81 (± 1.52) 1.46 (± 1.41) 1.75 (± 1.62) 1.92 .149
 Smart* .80 (± 1.24) .88 (± 1.26) .67 (± 1.04) .88 (± 1.39) 1.20 .303
 Considerate* .31 (± .85) .32 (± .92) .23 (± .69) .38 (± .94) .95 .389
 Cool (sophisticated)* 1.17 (± 1.43) 1.20 (± 1.46) 1.13 (± 1.39) 1.19 (± 1.46) .10 .903
 Self-Confident* 1.26 (± 1.53) .99 (± 1.41) 1.10 (± 1.35) 1.67 (± 1.72) 6.95 .001
 Independent* .82 (± 1.30) .79 (± 1.28) .85 (± 1.29) .81 (± 1.33) .08 .921
Perceived Substance Use of Friends
 Smoke Cigarettes .94 (± 1.25) .94 (± 1.20) .71 (± .99) 1.19 (± 1.47) 4.75 .009
 Drink Alcohol Regularly 1.44 (± 1.51) 1.41 (± 1.46) 1.22 (± 1.42) 1.71 (± 1.62) 3.33 .037
 Use Illicit Drugs .52 (± .99) .59 (± 1.04) .28 (± .64) .69 (± 1.19) 6.06 .003
Theta Score (severity of substance use) .33 (± .82) .41 (± .90) .21 (± .65) .39 (± .91) 2.30 .102
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*

reverse coded (higher scores have a negative connotation)

When comparing high school girls’ responses by the frequency in which they make social comparisons, significant differences were observed (see Table 1). Generally, participants who made social comparisons more frequently associated themselves with negative self-descriptions. On average, compared to those who ‘never/rarely’ made social comparisons, participants who ‘often/always’ made social comparisons identified significantly more with 10 of the 11 self-description statements in a negative way (p < .05). On average, compared to those who ‘never/rarely’ made social comparisons, participants who ‘often/always’ made social comparisons identified significantly more with the self-perception words in a negative way including confused (f = 7.09, p = .001), unattractive (f = 8.55, p < .001), dull (boring) (f = 3.90, p = .021), self-centered (f = 9.39, p < .001), and self-confident (f = 6.95, p = .001). On average, participants who ‘often/always’ made social comparisons perceived larger proportions of their friends smoke cigarettes (f = 4.75, p = .009), drink alcohol regularly (f=3.33, p = .037), and use illicit drugs (f = 6.06, p = .003) compared to participants who ‘never/rarely’ made social comparisons.

Findings from multivariate analyses are reported in Table 2. Compared to participants who ‘never/rarely’ made social comparisons to peers, participants who frequently described themselves as fearing something constantly (odds ratio [OR] = 1.33, p = .014) and felt forced to imitate the people they like (OR = 1.56, p = .009) were more likely to ‘usually’ compare themselves to peers. Participants who reported a larger perceived proportion of their friends used illicit drugs regularly were significantly less likely to ‘usually’ compare themselves to peers (OR = .59, p = .027).

Table 2.

Multinomial Logistic Regression Results of Self-Descriptions, Self-Perceptions, and Substance Use Factors with High School Girls Comparing Themselves to Peers

‘Usually’ Compare Self to Peers ‘Often/Always’ Compare Self to Peers
95% CI 95% CI
OR P Lower Upper OR P Lower Upper
Self-Description: Take Criticism without Resentment 1.03 .835 .78 1.37 1.34 .056 .99 1.80
Self-Description: Remain Calm Under Pressure 1.37 .068 .98 1.92 1.59 .010 1.12 2.27
Self-Description: Fear Something Constantly 1.33 .014 1.06 1.68 1.12 .327 .89 1.42
Self-Description: Forced to Imitate People I Like 1.56 .009 1.12 2.18 1.49 .022 1.06 2.10
Self-Description: Not the Person Would Like To Be 1.14 .311 .88 1.48 1.45 .005 1.12 1.88
Self-Perception: Smart* .80 .093 .62 1.04 .71 .010 .54 .92
Self-Perception: Unattractive .86 .223 .67 1.10 1.30 .034 1.02 1.64
Self-Perception: Self-Centered 1.08 .628 .80 1.44 1.41 .016 1.07 1.87
Proportion of Friends: Drink Alcohol Regularly 1.11 .465 .84 1.46 1.41 .018 1.06 1.88
Proportion of Friends: Use Illicit Drugs .59 .027 .37 .94 .82 .319 .55 1.21
Theta Score (severity of substance use) .69 .090 .44 1.06 .62 .035 .40 .97
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Referent Category: ‘Never/Rarely’ Compare Self to Peers

Nagelkerke R2 = .331

*

reverse coded (higher scores have a negative connotation)

Compared to participants who ‘never/rarely’ made social comparisons to peers, participants who described themselves as feeling forced to imitate the people they like (OR = 1.49, p = .022), thought they were not the person they would like to be (OR = 1.45, p = .005), and did not remain calm under pressure (OR = 1.59, p = .010) were more likely to ‘often/always’ compare themselves to peers. Participants who perceived themselves to be unattractive (OR=1.30, p = .034) and self-centered (OR=1.41, p = .016) were more likely to ‘often/always’ compare themselves to peers. Further, participants who reported a larger perceived proportion of their friends drank alcohol regularly were more likely to ‘often/always’ compare themselves to peers (OR = 1.41, p = .018). Conversely, compared to participants who ‘never/rarely’ made social comparisons to peers, participants who perceived themselves as not smart were less likely to ‘often/always’ compare themselves to peers (OR = .71, p = .010). Participants with higher substance use theta scores were less likely to ‘often/always’ compare themselves to peers (OR = .62, p = .035; see Table 2).

DISCUSSION

The present study assessed the associations between negative self-descriptions, negative self-perceptions, and substance use factors with high school girls’ frequency of making social comparisons to peers. As hypothesized, girls who described themselves negatively, such as felt forced to imitate someone they liked, were more likely to frequently (usually, often/always) compare themselves to peers. Our results about high school girls’ self-perceptions varied by frequency of comparing themselves to peers; girls who perceived themselves more negatively, such as unattractive, were often/always more likely to make social comparisons; however, no differences were identified between self-perceptions and usually making social comparisons.

Adolescence is a period in which persons formulate their identity in order to establish autonomy from parents and portray independence in decision-making.1 Adolescents increasingly seek peer relationships during this developmental time. While we found similar trends of more negative self-descriptions and self-perceptions among high school girls based on frequency of making social comparisons, the only consistent significant finding among girls who usually or often/always compared themselves to peers was describing themselves as feeling forced to imitate the people they like. This particular finding further establishes that high school girls are more prone to engage in reassurance-seeking behaviors such as perceiving the need to imitate the behaviors of people they like to fit in.26

While most studies on social comparisons to peers have focused on emerging adults/college students and adults,27–29 this study aligns with prior work that also found female adolescents’ negative self-descriptions are associated with more frequent social comparisons.30 Specific to our study, high school girls who feared something constantly were at increased odds of usually comparing themselves to peers, and girls who were not the person they would like to be and did not remain calm under pressure were at increased odds of often/always comparing themselves to peers. Thus, high school girls who reported higher comparisons to peers progressively described themselves more negatively. Female adolescents are still developing and have not fully developed emotional intelligence necessary for discerning erroneous or distorted portrayals by peers, which is associated with lower self-esteem, social competence, and clarity of feelings.31 Prior research indicates that that female adolescents tend to internalize their emotions and have more thoughts and worries and lower subjective well-being, and that increasing emotional competence and self-esteem can protect them against psychological maladjustment and low well-being.32

A healthy perception of self-worth is considered one of the most important determinants of an individual’s personal well-being, and is a particularly crucial aspect for a positive development during adolescence.33 The present study found that high school girls who do not perceive themselves in a positive light frequently, defined as often/always, engage in social comparisons to peers. Girls who often/always make social comparisons were at increased odds of perceiving themselves as unattractive, and were at reduced odds of perceiving themselves as not smart compared to girls who never make social comparisons. These findings corroborate prior research that has demonstrated low self-perceptions and self-worth is associated with susceptibility of making social comparisons among female emerging adults/college students.34,35 However, no differences were reported on self-perceptions between the usually and never making social comparison groups.

Adolescent health is shaped by the complex interactions of risk factors such as substance use, protective factors, and proximal social determinants of health such as peer connectedness.36 The associations between perceptions and actual use of substances and making social comparisons to peers are complex among high school girls, with results deviating from our hypothesis. More specifically, girls who perceived a greater proportion of their friends drank alcohol regularly were at increased odds to often/always make social comparisons, but girls who perceived a greater proportion of their friends used illicit drugs were at reduced odds to usually make social comparisons. Prior work reports higher perceptions of friends drinking is associated with actual lifetime alcohol use among high school students.23 Additionally, high school girls with a higher theta score – indicative of more severe licit and illicit drug use – were at increased risk to often/always make social comparisons to their peers. Findings from this study aligns with prior work that found alcohol and tobacco consumption are related to increased social comparison scale scores.12 Our results reinforce that high school girls’ social relationships play a role in shaping their own alcohol use,37 and illicit drug use behaviors.38 Early adolescent normative perceptions among peers has also been related to heavy alcohol use during the high school years.39,40

Limitations

The AHRBS has several limitations including the self-report, cross-sectional design that relies on the accuracy, and honesty of students and limits the ability to determine causal relationships. We were limited to the questions asked on the AHRBS instrument. We were unable to collect data on other possible related variables including frequency of drug use and students’ race/ethnicity. Our findings may not be generalized to other geographical areas or age groups since this instrument was administered to high school students enrolled in grades 9–12 located in one Midwestern County.

Conclusions

Social comparison can be a learned behavior, modelled from a variety of sources, including school activities, the media, and social media.41 High school environments can have a strong social impact on students, largely because of time spent on campus, the impressionable age of students, and the desire to conform to peer norms and pressures. Because comparisons and rankings are commonplace in many school systems and often linked to rewards and accommodations, making social comparisons may become engrained within students and transcend the high school years.42,43 While many schools adopt ranking systems based on academic performance, evidence shows influences external to merit alone factor into teacher and administrative rankings such as perceived popularity and sport performance,44 which may exacerbate social comparisons and competition. Further, in a time where high school girls are exposed to more media and social media outlets and messages than ever before, the ability to make social comparisons from a distance are present. Students can view the posts of their peers at any time on social media, which depict their activities, appearances, and thoughts. However, most social media is positively biased, with posts only sharing desirable qualities and attributes.45 These posts may give the impression that others’ lives seem ‘better than they are,’ which may force social comparisons and internal feelings of inferiority.46,47 Our common social structures promote and foster social comparisons, which may be harmful based on our study findings that high school girls with worse self-perceptions, normative beliefs, and substance use factors are more likely to make social comparisons to peers.48,49

IMPLICATIONS FOR SCHOOL HEALTH AND EQUITY.

Our findings highlight important implications for the design of school-based interventions to help high school girls’ enhance self-perceptions including self-esteem and self-worth to raise self-awareness, form healthy/positive identities, and foster adaptive coping strategies. Implications for school health and equity are outlined below:

  • Female adolescents’ social interactions play a fundamental role in how they perceive themselves. Thus, it is important for high schools to promote positive self-perceptions and supportive social environments for girls. This is especially important for those who perceive and describe themselves more negatively, which may potentially lead to making more social comparisons to peers. Efforts exist to achieve a healthy high school environment that fosters positive psychosocial adjustment to improve the health and equity of girls. One initiative educates key stakeholders who interact with girls regularly, including peers, parents, teachers and other school personnel. The “Dove Self-Esteem Project”50 is an educational program designed to enhance self-esteem and self-confidence among female students. This project offers freely available educational materials, resources, and training videos for youth leaders, parents and mentors, and teachers. There are single- and five-session workshops available for teachers and other school personnel, which both workshops include a component to increase girls’ understanding of the negative impact making peer comparisons may have on their self-image and self-esteem. For example, school personnel are provided with curriculum and activities to improve girls’ skills to identify and reduce the pressure of making comparisons to peers through discussion and role play tactics. The single, interactive classroom-based lesson delivered by teachers has been shown to be feasible and effective, with short-term psychosocial benefits observed among girls.51

  • Due to the current Coronavirus Disease-2019 (COVID-19) pandemic, the American Academy of Pediatrics52 has provided a guide for schools that emphasizes that school-related programs, delivered either face-to-face or virtually, are fundamental to the development of adolescents, including their social and emotional skills, and essential to addressing student inequities. Research indicates that caregivers of high school students prefer an on-campus/virtual hybrid instruction format for their youth during this 2020–2021 academic year, influenced by COVID-19 related health and safety concerns.53 Thus, a strongly recommended option during the COVID-19 pandemic is to also involve parents in self-esteem educational programming during at-home virtual instruction for their youth. For example, a randomized controlled trial of the brief, internet-based intervention version for parents delivered to mothers of female adolescents found that even mothers’ brief exposure to the “Dove-Self Esteem Project” website led to improvements of self-esteem and having more conversations with their daughters.54

  • A final, important implication is to identify at-risk girls with poor self-esteem and self-confidence who may need more intensive interventions beyond a program delivered in the traditional school setting. Therefore, high school personnel should be educated on identifying at-risk girls and making appropriate referrals to healthcare professionals when needed. Encouragingly, a pragmatic randomized controlled trial found that school referrals to “Girls on the Go!,” a 10-week program offered by a community health center to increase girls’ self-esteem and self-confidence, showed positive effects on the self-esteem and self-efficacy of at-risk, female preadolescents and adolescents from diverse backgrounds.55 In summary, the dissemination and implementation of existing, evidence-based programs to promote positive well-being and equity among high school girls are critical, and there are feasible options available that can be offered during the COVID-19 pandemic.

ACKNOWLEDGEMENTS

This work was supported, in part, by the National Institute on Drug Abuse (NIH Grant Number K01DA044313) and National Institute of Environmental Health Sciences (NIH Grant Numbers R01ES027815 and R01ES030743).

Footnotes

Human Subjects Approval Statement

All procedures for this secondary analysis were approved through the Institutional Review Boards at Texas A&M University (#20060522) and University of Georgia (#00005088).

Conflict of Interest Disclosure Statement

All authors of this article declare they have no conflicts of interest.

Contributor Information

Ashley L. Merianos, University of Cincinnati, PO Box 210068, Cincinnati, OH 45221-0068.

E. Melinda Mahabee-Gittens, Cincinnati Children’s Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati, College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229..

Wura Jacobs, California State University Stanislaus, Department of Kinesiology, One University Circle, Turlock, CA 95382.

Oluyomi Oloruntoba, Texas A&M University, School of Public Health, 212 Adriance Lab Road, College Station, TX 77843.

Adam E. Barry, Texas A&M University, Department of Health and Kinesiology, Gibb Gilchrist Building, College Station, TX 77843..

Matthew Lee Smith, Texas A&M University, Center for Population Health and Aging, 212 Adriance Lab Road, College Station, TX 77843.

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