Linking adolescent future expectations to health in adulthood: Evidence and mechanisms

Abstract

Rationale: Previous studies have suggested that the expectations adolescents have about their future are related to health behaviors and, consequently, to health conditions in adolescence and adulthood. However, few studies have addressed whether observed associations reflect unobserved family background. Moreover, relatively little attention has been paid to how adolescents' future expectations influence health in adulthood. Objective: This study investigated whether the association between future expectations (on future survival and college attainment) during adolescence and health in adulthood is spurious owing to family background. This study also explored the mechanisms that undergird the relationship between adolescents' future expectations and physical health. Methods: Participants were drawn from nearly 3,500 family samples of the National Longitudinal Study of Adolescent to Adult Health. This study used sibling fixed-effect approach to take into account genetic factors, family environment, as well as childhood social context such as school and neighborhood effects. Results: Sibling fixed-effect estimates revealed that survival expectations are associated with adult physical health (Framingham Risk Score for 30-year cardiovascular risk), net of unobserved background characteristics shared by siblings. The association between college expectations and adult physical health, however, was confounded by family background characteristics. In contrast to physical health, the influence of both survival and college expectations on psychological health in adulthood was robust to adjustment for sibling fixed effects. Regarding mediating pathways that connect future expectations to physical health, Sobel-Goodman mediation tests showed that binge drinking and unhealthy dietary habits explain about 38 percent of the relationship between survival expectations and physical health. Conclusion: Adolescents' future expectations are positively associated with health and well-being in adulthood net of unobserved family background characteristics. Substance use and dietary habits are relevant mediating pathways that link future expectations (particularly about survival) to physical health. Improving adolescents' future orientations about their life chances may improve adult health.