Family and neighborhood environments in adolescence and subsequent mortality

This study examined family and neighborhood conditions in adolescence and subsequent mortality over 29 years for a cohort of individuals recently reaching middle age.

We employed a nationally representative sample of adolescents (N = 18,921) from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Survey and linked contextual data from Wave I (1994-1995) offered information on conditions in adolescence (ages 12-19), and the Add Health Mortality Outcomes Surveillance Study (Add Health MOSS) provided mortality follow-up through the end of 2023.

Cox proportional hazard models revealed that adolescents in lower socioeconomic status (SES) families and neighborhoods with greater concentrated disadvantage had increased all-cause mortality from adolescence through midlife. These family and neighborhood measures were attenuated when accounting for one another and were further diminished when controlling for individual-level factors reflecting adolescent development, particularly cognitive skills and educational expectations. Neighborhood disadvantage showed stronger results for external causes, whereas low parental education displayed a more robust relationship with internal causes of death.

The findings support the long arm of childhood perspective in highlighting the importance of adolescent conditions for subsequent mortality up to midlife. The association between neighborhood concentrated disadvantage and mortality points to residential context as an important early life exposure for further research. Family SES, neighborhood disadvantage, and individual aptitude and motivation together influence the risk of death in adulthood. Our study contributes to a better understanding of individual, family, and neighborhood contexts in adolescence, which can ultimately improve aging and lengthen lives.