Although it is well known that adolescence is a time of increased risk-taking behavior across all socioeconomic levels, by ages 16 to 18, our cohort had a greater prevalence of TAEs than the general US adolescent population1–5
but one similar to comparable low socioeconomic urban populations.9,10
Two early childhood environmental factors were associated with TAE occurrence in our cohort, exposure to violence and poorer home environment. Interestingly, we found no correlation between specific childhood perceptions and the future occurrence of corresponding TAEs.
Our finding that early childhood environmental factors were associated with TAE occurrence in late adolescence supports previous research. Although this link has been shown previously,30
few studies have collected early childhood data prospectively in a cohort that has been followed since birth. Recent retrospective studies in primarily middle-class, white participants have compared adverse childhood experiences with adolescent risk behavior.31,32
The Adverse Childhood Experience (ACE) score assessed past exposure to 8 ACEs, including exposure to violence and home environment factors. Statistically significant associations were shown between higher ACE scores and adolescent drug use and teen pregnancy. The cohort examined regarding drug use extended across 4 successive birth cohorts, dating back to 1900. Because the relationship between ACE score and initiation of drug use was maintained in all birth cohorts, authors suggest that ACEs transcend secular changes such as increased availability of drugs and changing social attitudes toward drug use. They conclude that progress in preventing drug use thus will necessitate not only national campaigns to reduce drug use but reduction of ACEs as well. Our study, showing links between early childhood experiences and later TAEs in a poor primarily African American cohort, supports these conclusions.
To our knowledge, this is the first report using prospectively collected data to link childhood perceptions and intentions in poor, inner-city youth with outcomes in late adolescence. Somewhat unexpectedly, at ages 8 to 10, our children were optimistic regarding their futures, yet by late adolescence, more than half of the cohort had experienced at least 1 TAE. In another longitudinal study assessing relations between childhood intentions and outcomes in late adolescence, Andrews et al33
investigated nonillicit drug use (cigarettes, alcohol). In this study of mostly white, middle- to low-income families, childhood intentions regarding cigarette and alcohol use in elementary school were compared with actual use in adolescence. Interestingly, these investigators found a statistically significant association between childhood intentions at age 9.5 ± 1.2 years and actual cigarette and alcohol use in later adolescence. It is unclear whether our study differs because of our measurement of illicit rather than nonillicit drugs, the study population, or another unknown variable. Our study results suggest that the overall positive intentions of our cohort at ages 8 to 10 may have been altered at some point between ages 8 to 10 and 16 to 18. Indeed, future studies are needed to evaluate how poor, inner-city youths’ perceptions change over time because this information could be critical to the design of public health measures targeting at-risk youth.
Findings from our study showing an association between a poor home environment and exposure to violence in early childhood with TAEs later in adolescence provide support for future preventative public health initiatives targeting poor inner-city youth in early childhood. Both the Perry Preschool Project34
and the Harlem Children’s Zone35,36
provide support for the association of early childhood environmental interventions with fewer trajectory altering events later in adolescence. The Perry Preschool Study,34
a randomized control trial of 123 low-income, African American youth in Michigan, provided half of the cohort with enriched preschool at ages 3 and 4 as well as home visits. At 40 years of age, those in the intervention group had higher rates of graduation from high school, higher incomes, and lower rates of overall arrests when compared with controls. Similarly, the Harlem Children’s Zone program,35,36
is enriching the family, school and neighborhood environments of children living in a 100-block section of Harlem. Interventions include prenatal parenting classes, preschool programs, and charter schools. There also are free community-wide interventions including sessions on public benefits, financial advice, and reduction of domestic violence. This community-wide intervention has resulted in improved standardized test scores and increased graduation rates. The findings from our prospective study in combination with interventions noted earlier support implementation of widespread public health initiatives aimed at improving the environment of poor, inner-city youth in early childhood.
Certain limitations to our study should be noted. Our measurement of child expectations was limited to the set of items available from the YHRBI evaluations completed at ages 8 to 10. Thus, our use of the item regarding knowledge that one could get pregnant with first-time sex, although not explicitly addressing expectations regarding teen parenthood, was the most relevant item available to link with teen parenthood, an important TAE. Next, our sample size was fairly small. With a larger sample, we would have had increased power to identify additional factors associated with TAE occurrence. Additionally, there were measures unavailable in our cohort, such as parenting and peer assessments, which if available for analyses, may have been found to be associated with TAE occurrence. Such variables would provide promising areas of investigation for future studies. The generalizability of our results is limited to populations of poor, inner-city, African American youth. Finally, it is important to note that although we use the term “trajectory-altering event” to describe drug use, adjudication, school failure, and teen pregnancy, we acknowledge that these are not insurmountable events from which adolescents cannot later recover. However, previous studies have shown that these events, when occurring in adolescence, are associated with additional impediments in young adulthood. For example, becoming a teen parent is associated with a decreased rate of graduation from high school.37
Not obtaining a high school diploma is associated with lower income later in life compared with high school graduates.38
Additional follow-up of our cohort is necessary to assess whether the TAEs measured are associated with poorer outcomes later in adulthood. Such additional investigations into adulthood also could provide insight regarding factors associated with resilience within this cohort of young adults.