From Our 2009 Archives

Teen Fatalism Linked to Risky Behavior

Survey Shows 15% of Teens Believe They Will Die Young

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

June 29, 2009 -- New research challenges the widely held belief that teens underestimate the dangers associated with risky behaviors because they think they are invincible.

The study found that adolescents who engaged in risky behaviors such as drug use, fighting, and unsafe sex were more likely to believe that they would die young than those who didn't.

And those who thought they would die young were more likely to report these risky behaviors.

The research was based on surveys of more than 20,000 middle and high school students questioned three times between 1995 and 2002.

In the first set of interviews, nearly 15% of the teens predicted that their chance of living to age 35 was 50/50 or less.

These teens were more likely to report engaging in risky behaviors in subsequent interviews than teens who initially predicted that they were almost certain to be alive in their mid-30s.

"The conventional wisdom has been that teens underestimate their risk, but there are also studies showing that they are no worse than adults at perceiving their vulnerability to risk and that they tend to overestimate their risk of dying," pediatrician and study researcher Iris Borowsky, MD, PhD, of the University of Minnesota tells WebMD.

Conflicting Views of Death Risk

In one such study, in which a nationally representative sample of 15- and 16- year-olds were asked to estimate their probability of dying before their 20th birthday, one in five said they probably would die before this age.

The actual probability of dying before reaching age 20 is closer to one in 250, according to the National Center for Health Statistics.

The newly published study is one of the largest ever to examine teen perceptions about their risk of death and whether these perceptions persisted or changed over time.

It is also among the largest to examine the relationship between perceived risk for early death and behaviors that could increase actual death risk.

There were 94 actual deaths over the six years of follow-up among the 20,594 teens who took part in the study, but no significant relationship was seen between perceived risk of dying and actual death.

The surveys revealed that:

  • Perceptions of early death risk varied widely by race and ethnic group, with 29% of Native Americans reporting that they would probably die young, compared to around 25% of African-Americans, 21% of Hispanics, 15% of Asians, and 10% of whites.
  • Living with just one parent, being on welfare, and living in an urban vs. rural environment were all associated with a higher belief among those questioned that they would die young.
  • A perceived high risk for early death was strongly linked to involvement in health-jeopardizing behaviors.
  • Teens who believed they would die early were seven times more likely than those who did not to become HIV positive over the course of the trial.

The findings appear in the July issue of the journal Pediatrics.

Should Clinicians Ask Teens about Death?

The study suggests that teens with a fatalistic view of their future may engage in risky behaviors because they feel they have little to lose.

"Our findings reinforce the importance of instilling a sense of hope and optimism in youth," Borowsky noted. "Strong connections with parents, families, and schools as well as positive media messages, are likely important factors in developing an optimistic outlook for young people."

She says adolescent screenings should include questions about perceived risk for early death, but child and adolescent psychiatrist Benjamin Shain, MD, isn't so sure.

Shain heads the division of child and adolescent psychiatry at the North Shore University Health System in Illinois.

"Certainly this would be appropriate if a child shows signs of suicidality, but I can't see this as a general screening question," he says. "I think there are better ways to assess the likelihood of engaging in risky behaviors, not the least of which is assessing past behavior."

SOURCES: Borowsky, I.W. Pediatrics, July 2009; vol 124: online edition. Iris Wagman Borowsky, MD, PhD, associate professor of pediatrics, University of Minnesota Medical School, Minneapolis. Benjamin Shain, MD, director, division of child and adolescent psychiatry, North Shore University Health System, Evanston, Ill. Fischhoff Public Opinion Quarterly, Summer 2000; vol 64: pp 189-205.

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