Published online July 1, 2005
PEDIATRICS Vol. 116 No. 1 July 2005, pp. 24-31 (doi:10.1542/peds.2004-0892)
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Will I Be Alive in 2005? Adolescent Level of Involvement in Risk Behaviors and Belief in Near-Future Death

Adela Valadez-Meltzer, MD, PhD*, Tomas J. Silber, MD, MASS{ddagger}, Arthur A. Meltzer, PhD§ and Lawrence J. D'Angelo, MD, MPH{ddagger}

* University of Maryland/Sheppard Pratt Psychiatry Residency Program, Baltimore, Maryland
{ddagger} Division of Adolescent and Young Adult Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
§ Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland

OBJECTIVE.: We examined the association between a belief in one's future mortality and various risk-taking behaviors among urban black adolescents. In particular, we investigated whether adolescents with higher levels of participation in various risk behaviors were more likely to believe in their future death as compared with adolescents with lesser levels of risk-taking behavior.

METHODS.: Data obtained from April 1994 to March 1997 were analyzed for a total of 2694 adolescents, aged 12 to 21 years. The odds of believing that one would die within the next 2 years were calculated for various levels of participation in risk behaviors involving alcohol, drugs, and criminal or violent acts.

RESULTS.: A total of 160 adolescents (7.1% of all boys and 5.4% of all girls) reported that they believed that they would die within the next 2 years. The adjusted odds of future death belief among adolescents who both actively engaged in and knew others who participated in all of the various risk behaviors, relative to adolescents who neither personally engaged in nor knew others who participated in any of the risk behaviors, was 3.22 (95% confidence interval [CI]: 2.01–5.17) vs 1.14 (95% CI: 0.67–1.95) for drug use and drug selling, 2.01 (95% CI: 1.38–2.92) vs 0.8 (95% CI: 0.39–1.62) for combined alcohol and drug use, and 5.60 (95% CI: 2.03–15.47) vs 1.61 (95% CI: 1.08–2.42) for violent physical behavior. In addition, residence in a foster home was significantly associated with death belief after adjustment for all other variables.

CONCLUSIONS.: There is a significant relationship between certain risk behaviors and belief in near-future death. Moreover, higher levels of involvement in risk behaviors were associated with a stronger likelihood of belief in near-future mortality. Identification of adolescents who engage in certain risky behaviors, combined with a recognition of the degree to which the adolescent participates in the particular behavior(s), may be used to facilitate more rapid intervention among youths who either believe in their imminent demise or engage in behaviors that increase the likelihood of their untimely death.

Key Words: adolescence • attitude toward death • risk-taking behavior • substance abuse/use • black youths

Abbreviations: YRBSS, Youth Risk Behavior Surveillance System • OR, odds ratio • CI, confidence interval

Accepted Oct 14, 2004.


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