Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e81-e88 (doi:10.1542/peds.2008-3425)
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ARTICLE

Health Status and Behavioral Outcomes for Youth Who Anticipate a High Likelihood of Early Death

Iris Wagman Borowsky, MD, PhDa, Marjorie Ireland, PhDa,b and Michael D. Resnick, PhDb

a Divisions of General Academic Pediatrics
b Adolescent Health and Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota

OBJECTIVE: The relationship between adolescents' perceived risk for dying and their involvement in risk behaviors is unknown. We sought to determine the proportion of US youth who anticipate a high likelihood of early mortality and relationships with health status and risk behaviors over time.

METHODS: We analyzed data from times 1 (1995), 2 (1996), and 3 (2001–2002) of the National Longitudinal Study of Adolescent Health, a nationally representative sample of youth in grades 7 through 12. The relationship between perceived risk for premature mortality and health behaviors/outcomes was assessed by using bivariate and multivariate analyses.

RESULTS: At time 1, 14.7% of the 20594 respondents reported at least a 50/50 chance that they would not live to age 35. In adjusted models, illicit drug use, suicide attempt, fight-related injury, police arrest, unsafe sexual activity, and a diagnosis of HIV/AIDS predicted early death perception at time 2, time 3, or both (adjusted odds ratios: 1.26–5.12). Conversely, perceived early mortality at time 1 predicted each of these behaviors and outcomes, except illicit drug use, at time 2 or time 3, most strongly a diagnosis of HIV/AIDS (adjusted odds ratios: 7.13 [95% confidence interval: 2.50–20.36]).

CONCLUSIONS: Adolescent involvement in risk behaviors predicted a belief in premature mortality 1 and 7 years later. Reciprocally, adolescents' perceived risk for early death predicted serious health outcomes, notably a diagnosis of HIV/AIDS in young adulthood. Given its frequency and influence on behavior and health, adolescents' perceived risk for early death should be incorporated into psychosocial assessments and interviews.

Key Words: adolescent health • perceptions of mortality • risk behaviors • health outcomes • HIV

Abbreviations: Add Health—National Longitudinal Study of Adolescent Health

Accepted Feb 24, 2009.


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