Alcohol Use Trajectories After High School Graduation Among Emerging Adults With Type 1 Diabetes

Abstract

Objective Explore alcohol involvement trajectories and associated factors during the year post-high school (HS) graduation among emerging adults with type 1 diabetes. Methods Youth (N=181) self-reported alcohol use at baseline and every 3 months for 1 year post-HS graduation. Data were also collected on parent-youth conflict, diabetes self-efficacy, major life events, living and educational situations, diabetes management, marijuana use, cigarette smoking, and glycemic control. Trajectories of alcohol use were modeled using latent class growth analysis. Associations between trajectory class and specific salient variables were examined using analysis of variance, chi square, or generalized linear mixed model, as appropriate. Results Identified alcohol involvement trajectory classes were labeled as: 1) Consistent Involvement Group (n=25, 13.8%) with stable, high use relative to other groups over the 12 months; 2) Growing Involvement Group (n=55, 30.4%) with increasing use throughout the 12 months; and 3) Minimal Involvement Group (n=101, 55.8%) with essentially no involvement until month nine. Those with minimal involvement had the best diabetes management and better diabetes self-efficacy than those with consistent involvement. In comparison to those minimally involved, those with growing involvement were more likely to live independently of parents; those consistently involved had more major life events; and both the growing and consistent involvement groups were more likely to have tried marijuana and cigarettes. Conclusions This sample of emerging adults with type 1 diabetes has 3 unique patterns of alcohol use during the first year after high school. Implication and Contribution Among youth with type 1 diabetes in the year post-HS graduation, alcohol involvement knowledge was extended by identifying patterns of such use. Further research of alcohol use patterns is needed to guide health care professionals in their assessments and researchers in testing interventions that target unique patterns.

Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association

“…Care should be taken to respect a teen/young adult’s privacy, as lack of confidentiality is known to negatively affect adolescents’ health behavior, especially regarding what are considered taboo or risky behaviors (101). Discussions with adolescents should include questions about well-being in general, diabetes distress, and risk behaviors (e.g., substance use and sexual activity) (102,103). …”

Type 1 Diabetes in Young Adulthood

“…Young adults with type 1 diabetes reported comparable rates of substance use as the control population, including alcohol use (47.0%), binge drinking (29.9%), and smoking (34.7%) [27]. Early young adulthood may be a particularly risky time for alcohol use, as Hanna and colleagues found that approximately 1/3 of high school graduates reported increased intake of alcohol over the one year period after high school graduation, even though alcohol use at this age is illegal in the U.S. [86]. …”

Illness-Specific Risk-Taking in Adolescence: A Missing Piece of the Nonadherence Puzzle for Youth With Type 1 Diabetes?

“…Most of the literature on risk-taking in youth with chronic illness has focused on general health risk behaviors (e.g., smoking, alcohol/drug use, and unprotected sex) ( 14 , 15 , 20 – 26 ), and findings are mixed. For example, researchers have found evid-ence of an association between general risk-taking and nonadherence ( 14 , 15 , 23 , 24 , 26 , 27 ). There is also evidence that having a chronic illness may act as a buffer against adolescent risk-taking ( 28 , 29 ) or may increase the chances of general risk-taking ( 25 ).…”