Health status and behavioral outcomes for youth who anticipate a high likelihood of early death.
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.
Borowsky
Iris Wagman
IW
Department of Pediatrics, Division of General Academic Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA. borow004@umn.edu
Ireland
Marjorie
M
Resnick
Michael D
MD
D000293:Adolescent; D000294:Adolescent Behavior; D040343:Behavioral Risk Factor Surveillance System; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D012309:Risk-Taking; D014481:United States / Q000453:epidemiology