There is a large pool of research focusing on how adolescents’ perceptions of survival predict important aspects of their young adult lives, especially their physical and mental health, risky behaviors, and socioeconomic status. Using nationally representative data from Wave I of the National Longitudinal Study of Adolescent to Adult Health (Add Health), Carlyn Graham et. al. investigated whether those perceptions extend beyond these aspects to actually predict premature mortality, controlling for demographic, socioeconomic, health, and behavioral factors. Perceived survival expectations were measured using a single Wave I survey question asking, “What do you think are the chances you will live to age 35?” Responses ranged from “almost no chance” to “almost certain” and were categorized into three groups: “50% chance or less,” “a good chance,” and “almost certain.” The outcome, all-cause mortality (measured binarily as alive or deceased), was tracked from Wave I (1994–95) through December 2021 using the Mortality Outcomes Surveillance Data files.
The study included 18,923 participants and findings showed that when adjusting for sex and race, adolescents who perceived a 50% chance or less of surviving to age 35 had a higher risk of mortality compared to those who were almost certain they would survive. The strength of this association was weakened after sequentially adjusting for socioeconomic status, physical and mental health, risky behaviors, and exposure to violence. When separating analysis by sex, lower perceived survival was strongly associated with higher premature mortality risk among female adolescents, but not males. This study highlights the importance of addressing adolescents’ survival perceptions, emphasizing that healthcare providers should pay special attention to females’ sense of risk at a young age.
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Graham, Carlyn, Robert A. Hummer, and Carolyn T. Halpern. 2025. “Gazing into the Crystal Ball: Do Adolescent Survival Expectations Predict Premature Mortality Risk in the United States?” Social Science & Medicine 364:117548. doi:10.1016/j.socscimed.2024.117548.