Abstract
Mortality is an important outcome in evaluating crime prevention programs, but little is known about the effects on mortality during the full life course. To determine the long-term outcomes of a crime prevention program on mortality and whether the iatrogenic effects on mortality observed in middle age persist or change in old age. This longitudinal follow-up was conducted in a cohort of boys included in a matched-pair randomized clinical trial (the Cambridge-Somerville Youth Study). Six hundred fifty boys aged 5 to 13 years who lived and attended public and parochial schools in working-class areas of Cambridge and Somerville, Massachusetts, and were identified as at risk for antisocial behavior were matched by age and demographic characteristics. One member of each pair was randomly allocated to the treatment condition. The original trial was performed from June 1, 1939, to December 1945. Follow-up in the present analysis was performed from January 2016 through June 2018. Treatment group participants received individual counseling through a range of activities and home visits for an extended duration (mean, 5.5 years). Control group participants received no special services. The 4 outcomes of interest include age at mortality, mortality at latest follow-up, premature mortality (younger than 40 years), and cause of mortality (natural vs unnatural). In the original analysis, 650 participants were matched and randomized to treatment or control conditions, of whom 506 were retained in the analysis (mean [SD] age, 9.8 [1.7] years). Through early 2018, records for 488 participants (96.4%) were located. A total of 446 participants were confirmed dead (88.1%) and 42 alive (8.3%). Matched-pairs analyses showed no significant differences between the treatment and control groups for mortality at latest follow-up (relative risk [RR], 1.05; 95% CI, 0.99-1.11), premature mortality (RR, 1.15; 95% CI, 0.55-2.43), or cause of mortality (RR, 1.19; 95% CI, 0.65-2.18) (P > .05 for all). Cox proportional hazard regression indicated no difference in time to death between groups (hazard ratio, 1.18; 95% CI, 0.98-1.41; P = .09). Iatrogenic effects on mortality were not detected in this long-term follow-up. The longitudinal analysis provides information on the utility of life-long assessments of crime prevention programs and draws attention to the need for quality-of-life assessments of participants and their children.
Highlights
Matched-pairs analyses showed no significant differences between the treatment and control groups for mortality at latest follow-up, premature mortality (RR, 1.15; 95% CI, 0.55-2.43), or cause of mortality (RR, 1.19; 95% CI, 0.65-2.18) (P > .05 for all)
Cox proportional hazard regression indicated no difference in time to death between groups
Iatrogenic effects on mortality were not detected in this longterm follow-up
Summary
The first randomized clinical trial to investigate effects of a preventive intervention on children’s criminal behavior, the Cambridge-Somerville Youth Study (CSYS), was initiated in the 1930s12-14 by Richard Clarke Cabot, MD, a physician and professor of clinical medicine and social ethics at Harvard University.[15,16] The preventive intervention holds some similarities to mentoring programs today.[17]. The CSYS has been the subject of 3 prior assessments of criminal behavior and other outcomes in 1948, 1956, and 1975 through 1979. Results from the first 2 assessments did not show any effects on criminal behavior.[18,19,20] The later assessment,[21,22] performed 30 years after the intervention (mean [SD] age of participants, 47.4 [1.7] years), found that the program produced iatrogenic effects. Compared with the control group, treatment group participants were significantly more likely to commit 2 or more crimes, have symptoms of alcoholism, manifest signs of mental illness, have occupations with lower prestige, have high blood pressure or heart trouble, and experience premature mortality (younger than 35 years).[21,22]
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