Gazing into the crystal ball: Do adolescent survival expectations predict premature mortality risk in the United States?

A robust body of research has demonstrated that adolescents' survival expectations are predictive of important facets of their young adult lives. Specifically, adolescent perceptions of a low chance of surviving to young adulthood are associated with worse physical and mental health, higher engagement in risky behaviors, and lower socioeconomic status in young adulthood. Using data from a nationally representative sample of adolescent participants in the National Longitudinal Study of Adolescent to Adult Health, the purpose of the present study is to extend this line of research by investigating if adolescents' survival expectations are associated with premature (ages 14-46) all-cause mortality risk in the United States. We further consider whether this relationship varies by sex. Our results show that in the overall sample, adolescents who perceive they have a 50% chance or less of surviving to age 35 have a higher risk of mortality relative to their peers who perceive they are almost certain they will survive to age 35 net of sex and race/ethnicity (HR = 1.66, 95% CI: 1.19-2.32); the magnitude of this risk is reduced in a stepwise manner with the inclusion of indicators for socioeconomic status, physical and mental health, risky behaviors and exposure to violence (fully adjusted model HR = 1.31, 95% CI: 0.94-1.82). In sex stratified models, we find that adolescents' perceptions of a lower chance of surviving to age 35 are strongly associated with higher premature mortality risk among female adolescents but not male adolescents. Our findings add to the body of literature that underscores the detrimental consequences of adolescents' low expectations for survival to young adulthood on life trajectories by demonstrating that these consequences extend to actual survival.