Adolescent expectations of early death predict young adult socioeconomic status

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Abstract

Among adolescents, expectations of early death have been linked to future risk behaviors. These expectations may also reduce personal investment in education and training, thereby lowering adult socioeconomic status attainment. The importance of socioeconomic status is highlighted by pervasive health inequities and dramatic differences in life expectancy among education and income groups. The objectives of this study were to investigate patterns of change in perceived chances of living to age 35 (Perceived Survival Expectations; PSE), predictors of PSE, and associations between PSE and future socioeconomic status attainment. We utilized the U.S. National Longitudinal Study of Adolescent Health (Add Health) initiated in 1994–1995 among 20,745 adolescents in grades 7–12 with follow-up interviews in 1996 (Wave II), 2001–2002 (Wave III) and 2008 (Wave IV; ages 24–32). At Wave I, 14% reported ≤50% chance of living to age 35 and older adolescents reported lower PSE than younger adolescents. At Wave III, PSE were similar across age. Changes in PSE from Wave I to III were moderate, with 89% of respondents reporting no change (56%), one level higher (22%) or one level lower (10%) in a 5-level PSE variable. Higher block group poverty rate, perceptions that the neighborhood is unsafe, and less time in the U.S. (among the foreign-born) were related to low PSE at Waves I and III. Low PSE at Waves I and III predicted lower education attainment and personal earnings at Wave IV in multinomial logistic regression models controlling for confounding factors such as previous family socioeconomic status, individual demographic characteristics, and depressive symptoms. Anticipation of an early death is prevalent among adolescents and predictive of lower future socioeconomic status. Low PSE reported early in life may be a marker for worse health trajectories.

Highlights

► Low perceived chances of living to age 35 were substantial among American adolescents. ► The origins of these perceptions were multi-faceted involving structural, family, and individual factors. ► Adolescent expectations of early death predicted lower socioeconomic status in young adulthood.

Introduction

While relatively accurate mortality expectations have been observed among adults (Hurd & McGarry, 1995), substantial uncertainty regarding personal mortality has been found among adolescents. Among 15 and 16 year olds in the U.S. National Longitudinal Survey of Youth, mean perceived probabilities of dying in the next year and by age 20 were 18.6% and 20.3%, respectively (Fischhoff et al., 2000). A handful of studies have tied anticipation of an early death during adolescence to an array of risk behaviors. Adolescents who believed they would not live to age 30 were more likely to be out-of-school, to have engaged in suicide planning within the past year, and to have greater impulsive sensation-seeking (Jamieson & Romer, 2008). Studies using data from the U.S. National Longitudinal Study of Adolescent Health (Add Health) have related expectation of death before age 35 (Perceived Survival Expectations, PSE) to future risk behaviors and their consequences like selling drugs, suicide attempt, fight-related injury, unsafe sexual activity, police arrest, and HIV diagnosis (Borowsky, Ireland, & Resnick, 2009; Harris, Duncan, & Boisjoly, 2002) – and recently to cigarette-smoking and fast-food consumption (McDade et al., 2011).

Low PSE may reflect an overall tendency to view the future pessimistically and with resignation. Anticipation of an early death may indicate hopelessness. Indeed, there are current movements to incorporate considerations of survival expectations into hopelessness theory. For instance, Bolland added the following item to his hopelessness scale: “I don't expect to live a very long life” (Bolland, 2003). Essential components of hopelessness include the expectation that desired events will not occur, negative events will occur, and nothing can be done to change the course of these events (Beck, Weissman, Lester, & Trexler, 1974). The literature on hopelessness has documented that a belief in the inevitability of negative events is a risk factor for future negative events. Among inner-city youth in Alabama, Bolland and colleagues connected hopelessness with violent behavior, teen pregnancy, substance abuse, and unintentional injury (Bolland, 2003). As mentioned above, similar associations have been found between anticipation of an early death and risk behaviors (Borowsky et al., 2009).

One potential consequence of adverse life circumstances and experiences is the promotion of hopelessness, and these perceptions may exert detrimental effects independent of the triggers of low PSE. That is, while factors like low family socioeconomic status (SES) and exposure to violence may promote low PSE, these perceptions irrespective of their origins may have a harmful effect—by influencing behaviors and decision-making. For instance, people who perceive a severely bleak or limited future may respond to challenges with fatalism and less persistence. They may set fewer goals, seek less guidance, and develop or attempt fewer solutions to their problems (Peterson & Barrett, 1987). Establishing a relationship between low PSE in adolescence and future adult SES attainment (even after accounting for important correlates of low PSE) may highlight two levers of change: 1) combating hopelessness and related concepts, 2) broad-based interventions aimed toward the creation of environments conducive to healthy youth development (e.g., that are low in poverty, crime, discourage substance use, and allow for academic preparation).

Identified predictors of low adolescent PSE include health risk behaviors, parental unemployment, low adult and peer connection, and low self-esteem (Duke, Skay, Pettingell, & Borowsky, 2009). Low adolescent PSE are also more prevalent among males, who have higher rates of violence and substance use than females, and racial/ethnic minorities, who experience worse rates of mortality and morbidity (Borowsky et al., 2009). Hence, PSE appear to reflect considerations of physical, psychological, economic and social factors related to health and well-being.

Poor neighborhoods are associated with worse youth outcomes including higher rates of criminality, child abuse and injury (Sellström & Bremberg, 2006). Impoverished environments characterized by low institutional resources, low social controls, and the presence of illegitimate opportunity structures may encourage perceptions of a bleak future. Add Health, initiated in 1994 in response to a U.S. Congressional mandate to study adolescent health, follows members of a cohort who were adolescents during the peak in violent deaths occurring in the early 1990s (Supplemental Materials, Appendix A). Although homicides and other violent crime have declined since then, this cohort of adolescents may have been particularly at-risk for low PSE and associated outcomes. We further examine the influence of neighborhood context measured via neighborhood poverty and crime rates on PSE (in addition to examining perceptions of neighborhood safety and personal violence involvement as correlates of PSE). Moreover, we explore the consistency of predictors on adolescent (Add Health Wave I) and emerging adult (Add Health Wave III) PSE. Predictors of Wave III PSE have not been examined by previous studies.

Duke and colleagues found that increased self-esteem and adult connection predicted transitioning out of low PSE from Wave I to Wave II one year later (Duke, Skay, Pettingell, & Borowsky, 2011) and that increases in PSE were linked to better outcomes at Wave III including lower depressive symptoms and higher physical activity, civic engagement and education levels (Duke, Borowsky, Pettingell, Skay, & McMorris, 2011). We track changes in PSE from adolescence to early adulthood, an endeavor that may increase understanding of the evolution of risk perceptions and perceived vulnerability. We also examine PSE by time spent in the U.S. In the U.S., immigrants may experience food insecurity, less timely health care services, limited economic options/unpredictable day labor, and fear of discovery (among undocumented immigrants), along with other stressors specific to adaptation as an immigrant (Hadley et al., 2008). Lower PSE among the foreign-born and particularly among new immigrants may reflect uncertainty about the future.

Most previous studies have not examined the potential for anticipation of an early death to have broader consequences outside of risk behaviors—such as SES attainment. The importance of income and education is highlighted by pervasive health inequities by SES and dramatic differences in life expectancy ranging from 4 to 10 years across income and education groups (Rogot, Sorlie, & Johnson, 1992). However, the related concept of hopelessness has been linked to lower grade point average, less specified academic goals, and less academic counseling (Peterson & Barrett, 1987). Hopelessness may encourage fatalism and pacifism as a response to failures and challenges, thereby lowering the likelihood of academic and career success. Similarly, we expect that low PSE will lower commitment to education and training, and correspondingly be related to lower SES in young adulthood.

Recently, using Add Health data, Duke and colleagues found that adolescents who reported low PSE (i.e., a 50–50 chance or less of living to age 35) at Waves I or II compared to those with high PSE at both waves were less likely to be in school, employed or in the military (single outcome) and less likely to have at least a high school diploma/GED at Wave III (respondents 18–26 years) (Duke, Borowsky et al., 2011). Nonetheless, education attainment is in flux particularly through early adulthood (Messersmith & Schulenberg, 2008). Approximately 25% of students who entered a public 4-year college in 1995-1996 had not obtained a degree and were not currently enrolled five years later (Peter & Horn, 2005). Additionally, close to 20% delay post-secondary education for 5 or more years (Chevalier & Griffiths, 2004). This is the first study to investigate PSE as a predictor of SES among adults 24–32 years when SES has become more stabilized. This study also examined multiple indicators of SES including education attainment, personal earnings and material hardships.

Furthermore, we examined PSE measured at Wave I (among adolescents) and Wave III (respondents 18 years and older) as predictors of Wave IV SES. Previous Add Health studies have not investigated links between Wave III PSE and future outcomes. However, PSE at Wave III may be informative of adult outcomes for a variety of reasons. First, it is temporally closer to Wave IV outcomes than Wave I PSE—which may increase its relevancy to Wave IV outcomes. Second, adults have more accurate risk perceptions compared to adolescents who overestimate the probability of negative health-related events (Millstein & Halpern-Felsher, 2002). Hence, low PSE at Wave III may be less subject to crude risk perceptions and may signal severe levels of hopelessness.

The primary study aim was to assess the relationship between PSE and future socioeconomic status attainment, independent of important potential confounding factors that relate to worse PSE and worse SES attainment. The secondary study aim was to describe change in PSE and predictors of PSE in order to further understand the highly understudied concept of early death perceptions among youth. This study used data from Add Health to test three hypotheses:

  • 1.

    With entry into adulthood (Wave III), most people will report high or higher PSE than in adolescence (Wave I).

  • 2.

    Higher community-level poverty and crime rates, foreign-birth, and less time in the U.S. will be associated with lower PSE at Waves I and III.

  • 3.

    Low PSE at Waves I and III will be predictive of lower education, lower personal earnings, and experience of material hardships and evictions in young adulthood (Wave IV).

Appendix B contains a conceptual diagram of predictors and potential effects of PSE derived from the current study's proposed relationships and from previous literature on PSE.

Section snippets

Study population

Add Health is a nationally representative field study of 20,745 U.S. adolescents in grades 7 through 12 during the 1994–1995 school year. The Wave I response rate was 79% (Harris et al., 2009). Three in-home follow-up interviews of the cohort have been completed: Wave II in 1996 (88% of the eligible cohort at Wave I), Wave III in 2001–2002 (77%), and Wave IV in 2008 (80%). By design, high school seniors at Wave I were not re-interviewed at Wave II, but were included in Waves III and IV. At Wave

Descriptive statistics

At Wave I, 14% (95% CI: 13, 16) of adolescents in grades 7–12 reported they had ≤50% chance of living to age 35 (Table 1). One year later at Wave II, a similar proportion (15%; 95% CI: 14, 17) reported PSE ≤ 50%. However at Wave III, when all respondents are 18 years and older, the proportion reporting PSE ≤ 50% was much lower (7%; 95% CI: 7, 8). At Wave I, the study population was balanced between the sexes. Two-thirds of respondents were white (65%) with large subpopulations of non-Hispanic

Discussion

Congruent with previous literature, we offer the following conclusions: PSE is informed by psychological and physical health as well as individual, family and neighborhood contexts reflecting lived experiences, exposures and resources. Low PSE is broadly predictive of many different detrimental outcomes in the short-term, as suggested by previous literature on adolescent risk-taking (Borowsky et al., 2009) and as this study demonstrates, in the long-term on adult SES attainment. The utility and

Acknowledgments

This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for

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