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

Abstract

Risky behavior is often at its lifetime peak in adolescence. Chronic illness creates additional opportunities for risk because nonadherence behaviors can jeopardize adolescents’ health. Adolescents with type 1 diabetes could engage in risky behavior around insulin administration that would put them in danger of severe health consequences. It is possible that some nonadherence behaviors observed in adolescents with type 1 diabetes may result from youth taking risks with their medical treatment. Illness-specific risk-taking behaviors are not captured in most assessments of adherence, which primarily focus on frequency of adherence behaviors. This article reviews current models of general risk-taking and their implications for diabetes management. The authors argue that illness-specific risk-taking may be an important, understudied aspect of illness management that can inform future studies and treatment of nonadherence in adolescents with type 1 diabetes.

Promoting High-Quality Health Communication Between Young Adults With Diabetes and Health Care Providers

“…The structure of a diabetes clinic visit also influences the content and quality of YA-HCP communication. YAs with diabetes are at increased risk of psychosocial concerns and engagement in risky behaviors, including those related to substance use, sexual behaviors, and diabetes self-management challenges (35,36). Starting in adolescence, having time alone with HCPs is recommended to facilitate the discussion of sensitive topics such as sexual health, substance use, mood/emotional concerns, and other questions that have direct relevance for daily diabetes management (37,38) but may be infrequently discussed in routine diabetes care (39,40).…”

The Diabetes-Specific Risk-Taking Inventory: Piloting a New Measure for Adolescents With Type 1 Diabetes

“…Prior researchers have noted that poor self-management behaviors such as forgoing insulin or not taking a pill could be a form of risk-taking (14). The current authors took this assertion a step further by creating a model for and formally defining "illness-specific risk-taking" as a type of behavior in which youths make decisions about disease management that put them at risk for acute complications of their health condition or adverse events resulting from potential consequences of their health condition (15). For adolescents, risk-taking behaviors can either precede poor self-management choices (e.g., excessive alcohol use can lead to an inability to participate in type 1 diabetes self-care tasks) or take the form of poor self-management choices (e.g., engaging in unhealthy weight loss strategies by restricting insulin).…”

Diabetes-Specific Risk-Taking in Young Adulthood: A Closer Look

“…We previously proposed that adolescents and YAs may knowingly engage in behaviors that are unhealthy and that some nonadherence behaviors observed in adolescents and YAs with type 1 diabetes may result from risks that individuals take with their diabetes care (5) in favor of meeting other psychosocial goals (e.g., fitting in with peers and having increased independence). Such behaviors, which we termed "diabetes-specific risk-taking" behaviors, focus on behaviors related to type 1 diabetes management or outcomes.…”