Skip to main content
  • More from ADA
    • Diabetes
    • Diabetes Care
    • Clinical Diabetes
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, abridged
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Spectrum

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Browse
    • Issue Archive
    • Saved Searches
    • COVID-19 Article Collection
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
  • More from ADA
    • Diabetes
    • Diabetes Care
    • Clinical Diabetes
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, abridged
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Spectrum
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Browse
    • Issue Archive
    • Saved Searches
    • COVID-19 Article Collection
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
Feature Articles

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

  1. Rachel Wasserman,
  2. Barbara J. Anderson and
  3. David D. Schwartz
  1. Baylor College of Medicine—Pediatrics, Houston, TX
  1. Corresponding author: Rachel Wasserman, rmwasser{at}texaschildrens.org
Diabetes Spectrum 2017 Feb; 30(1): 3-10. https://doi.org/10.2337/ds15-0060
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • PDF
Loading

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.

Across chronic health conditions, adolescence—roughly the period between puberty onset and the completion of brain maturation in the mid to late second decade of life (1)—is singled out as the developmental stage in which adherence and self-management problems escalate. Adolescence is a time of dramatic physical, behavioral, social, and neurodevelopmental changes (1,2) that significantly complicate diabetes adherence, which has been defined as “the extent to which a person’s behavior coincides with medical or health advice” (3). It is estimated that nonadherence (the extent to which a person’s behavior does not coincide with medical advice) affects 50–75% of youth with chronic conditions (4).

Many developmental and individual factors have been found to contribute to nonadherence, including transition of responsibility for medical treatment from parent to child (5), increased family conflict (5,6), less frequent parental monitoring (7,8), increased involvement with peers (9), lower socioeconomic status (10), and minority ethnic/racial background (11,12). Although all of these factors contribute to the increase in nonadherence in adolescence, they do not fully explain it, suggesting that adherence in adolescence is extremely complex (3). We propose that risk-taking behavior is another, previously understudied, factor in adolescent nonadherence.

Adolescents tend to take more risks than either children or adults. For example, adolescents are more likely to engage in health risk be-haviors such as binge drinking, un-protected sex, and reckless driving, and these behaviors contribute to an increase in morbidity and mortality in youth (13). Given the propensity for risk-taking in adolescence, it is possible that some nonadherence may be the result of youth taking risks with their medical treatment. In fact, this hypothesis has been proposed previously by several researchers (14–19).

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). In addition, researchers have hypothesized ways in which general risk-taking behaviors may have more severe health consequences for youth with chronic illnesses (22). However, to our knowledge, no previous studies have examined nonadherence as a risk-taking behavior in itself. In this article, we develop the hypothesis that illness-specific risk-taking behaviors may be a related, but unique, factor in the health of youth with chronic illnesses, and specifically those with type 1 diabetes.

Type 1 diabetes provides a good example through which to illustrate the ways in which risk-taking may have an effect on adherence. Management of diabetes is extremely complex, intrusive, and aversive, and adolescence is known to be an especially challenging time for people with type 1 diabetes (30). Adolescents assume increasing responsibility for diabetes care (5), with decreasing parental supervision (7,8), at the same time they face many physical, psychosocial, and developmental changes. Furthermore, it is well documented that adherence and glycemic control typically decline in adolescence (5,31,32). If complex diabetes management tasks are not completed accurately and blood glucose levels are not adequately controlled, the risk for severe and life-threatening health consequences increases. Short-term consequences include seizures resulting from severe hypoglycemia and life-threatening diabetic ketoacidosis associated with chronic hyperglycemia. Long-term consequences include retinopathy, nephropathy, neuropathy, cardiovascular disease (33), and cognitive late effects (34).

In the following sections, we first review the recent literature on general adolescent risk-taking and studies that have examined risk-taking in youth with chronic illness. These findings and current theories of general risk-taking are used to develop an integrated working model of adolescent risk-taking. We then propose and define a construct of “illness-specific risk-taking.” We apply the risk-taking model to type 1 diabetes as an example, drawing on clinical experience and behavioral research in diabetes. Finally, we discuss clinical implications of the model and suggest directions for future research.

General Risk-Taking in Adolescence

During adolescence, an increase in novelty-seeking and risk-taking behavior occurs in most mammals, including humans, and it has been surmised that these are adaptive behaviors that promote independence and reproductive success (35). From this perspective, risk-taking can be thought of as normative behavior that is driven by biological motivations (36,37). Common motivators include rewards such as sexual intercourse, food, and social approval, all of which activate the brain’s dopaminergic reward system and all of which are associated with health risk behaviors (such as having unprotected sexual intercourse). Risky behavior may also be motivated by avoidance of harm and unpleasant states such as when youth decide to take their chances driving drunk rather than tell their parents they have been drinking.

Current models suggest that risk-taking can reflect both planned and impulsive aspects of behavior. The Prototype Willingness model (38,39) posits that risk can arise either from a reasoned consideration of costs and benefits or from an unplanned reaction to circumstances. The reasoned pathway (39) reflects calculated risk arising from a decision process of weighing costs against benefits (e.g., engaging in unprotected sex after deciding that the odds of pregnancy are relatively low) (40,41). At the same time, experience tells us that much risk-taking is unplanned—a spur-of-the-moment response to a situation or opportunity (e.g., impulsively getting into a car whose driver has been drinking). This sort of impulsive response, which has been termed the social-reactive pathway to risk (39), is, as the name implies, much more likely in social situations.

Many researchers (e.g., Steinberg [42]) have suggested that adolescents are more likely to act in risky ways because they are more impulsive and have poorer self-control than adults, an assumption that finds support in the neurodevelopmental literature (see below). However, some researchers (notably Reyna and Farley [43]) have argued that developmental differences exist in reasoning that might also predispose youth to more risk-taking. Specifically, they note research suggesting that youth may be more likely to weigh costs and benefits of risky behaviors (such as having unprotected sex), whereas adults are more likely to consider such high-risk behaviors “not worth thinking about.” Thus, developmental differences in both the reasoned and social-reactive pathways might account for the increase in adolescent risk-taking (44).

Dual Systems Models: Neurodevelopmental Findings

Consistent with the hypothesis that there are separate processes that lead to risk-taking behavior, neuroimaging studies have revealed two distinct brain systems that appear to be implicated in risk-taking. The first, which has been called the social-emotional system (42), reflects activity in the ventral striatum, which is involved in reward processing and approach behaviors, and the amygdala, which is involved in emotion processing and avoidance (36). The social-emotional system is thought to be fast, reactive, and largely automatic (i.e., not under conscious control). The second system is an executive or cognitive control system, which is largely instantiated in the prefrontal cortex. This second system tempers the first by inhibiting initial reactions, evaluating social-emotional inputs, and weighing behavioral options before initiating an action (45,46).

Dual systems models (e.g., Steinberg [42], Casey et al. [47], and the triadic model of Ernst et al. [36]) posit that adolescent risk-taking largely reflects the interaction between the social-emotional system, which motivates risk-taking behavior, and the executive control system, which tempers it. Importantly, these two systems mature at different rates. Starting at puberty, the social-emotional system begins to show significantly heightened activity and responsiveness, peaking in activity in mid-adolescence (48,49). Associated with this peak in activity, adolescents show an increase in sensitivity to reward (49), tend to value immediate reward more highly than delayed reward, have greater difficulty than adults with delayed gratification (2), and engage in more sensation-seeking behavior (50). In comparison, development of the executive control system lags, not reaching maturity until the third decade of life (51).

It has been argued that this “maturational imbalance” (47) between reward sensitivity and self-control accounts for increased risk-taking behavior in youth (42). One might also infer that risk-taking would spike in mid-adolescence, when the maturational gap is at its widest, but risk-taking behavior actually does not peak until the early 20s (52,53). The reason for this seems straightforward. Although sensation-seeking may slowly decline from middle adolescence to early adulthood, op-portunities to engage in risky behavior increase as adolescents gain greater independence from their parents (54,55).

Changes in Social Context

Older adolescents experience many social changes that increase the likelihood of risk-taking behavior. Parental monitoring, a major moderator of risky behavior (7), declines at the same time youth begin to spend more time with friends. Compared to adults, adolescents are more likely to show an increase in risk-taking behavior in social situations (56). Youth drive more recklessly with peers (57) and are more likely to drink alcohol or experiment with drugs (58). As adolescents leave their parents’ homes, they often experience frequent changes in residence and life circumstances without yet having many of the constraints of adult social roles (52), further increasing opportunities for risk.

Illness-Specific Risk-Taking: A Proposed Part of Nonadherence

The research reviewed above leads to some general conclusions. First, the increase in risk-taking in adolescence reflects normal development, resulting from changes in the social-emotional system that outpace the tempering ability of the immature executive control system (42). Sec-ond, social situations activate the social-emotional reward-seeking system and make risk-taking more likely. Third, adult supervision reduces the likelihood of risk, but supervision decreases during the adolescent period; by early adulthood, risky behavior is at its height. Perhaps not coincidentally, nonadherent behaviors also increase over the course of adolescence and peak in early adulthood (52), a concern that was recently highlighted in a position statement of the American Diabetes Association (59).

These observations have led us to hypothesize that some adolescent nonadherence may be a specific type of risk-taking in youth. We define illness-specific risk-taking as a type of risk-taking in which youth engage in nonadherence behaviors that put them at risk for poor health outcomes (Figure 1). By viewing nonadherence through the lens of risk-taking, we can apply the risk-taking literature to develop hypotheses about this subsection of nonadherence behaviors.

FIGURE 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 1.

Illness-specific risk-taking in youth with chronic illnesses.

To better apply current knowledge of risk-taking to youth with chronic illness, we first outline a working model of general risk-taking (Figure 2). Control factors that mitigate risk are represented in the top row, whereas the bottom row delineates motivational factors that increase the likelihood of risky be-havior. The columns show how control and motivational factors are in opposition to each other within the individual (column 1) and social contexts (column 2). The likelihood of engaging in risk-taking behavior is conceptualized as resulting from the interaction of control and motivational factors at both the individual and contextual levels, which interact with each other and with situational specifics to determine whether a risky behavior is initiated.

FIGURE 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 2.

Working model for general risk-taking behaviors in adolescence.

This model is most applicable to risky behavior on the social-reactive pathway, given the well-documented relationship between the dual systems model, social context, and impulsive risk-taking (e.g., Steinberg [42]). It is less clear how the model might relate to risk-taking on the reasoned pathway.

Youth who take risks with their diabetes management may be especially likely to experience short- and long-term negative consequences. For example, an adolescent with type 1 diabetes may risk a severe hypoglycemic event by taking more insulin than instructed because she is frustrated by a high blood glucose reading that will not come down. Table 1 provides additional examples of diabetes-related risk-taking. The type of illness-specific risk-taking in which this adolescent is engaging is not discussed in the literature as a part of general risk-taking (e.g., alcohol or drug use). Moreover, illness-specific risk-taking behaviors are not captured in most assessments of adherence, which primarily focus on frequency of adherence behaviors. Because there is no precedent for conceptualizing nonadherence as risk-taking, we can apply the risk-taking literature to in-form our understanding of this new concept.

View this table:
  • View inline
  • View popup
TABLE 1.

Examples of Illness-Specific Risk-Taking Behaviors in Type 1 Diabetes

To identify behaviors that fall un-der the construct of illness-specific risk-taking, we apply the idea that risk-taking is an adaptive behavior fueled by biological motivations or avoidance of harm. As mentioned above, common biological rewards include sexual intercourse, food, soc-ial approval, and excitement. There are many ways in which adolescents with type 1 diabetes might take risks with their medical treatment to seek such rewards. For example, because sexual intercourse is a powerful, biological reward, an adolescent with type 1 diabetes might forgo a pre-sex blood glucose check and risk hypoglycemia despite awareness that he or she should check blood glucose before any physical activity. Similarly, because food is another inherent biological reward, an adolescent may risk high blood glucose levels by eating without first checking blood glucose or taking insulin because the immediacy of the food is a stronger motivator. Adolescents with type 1 diabetes may also engage in illness-specific risk-taking to avoid punishment or harm. For example, an adolescent might avoid changing his or her insulin pump site to avoid pain.

Individual Differences and Illness-Specific Risk-Taking

Applying the risk-taking model (Figure 2) to illness-specific risk-taking leads to a number of testable predictions regarding nonadherence be-haviors. The model suggests that individual differences in the development of executive control, impulsivity, and sensation-seeking would all make an adolescent more or less likely to engage in illness-specific risk-taking. Specifically, the dual systems models may have important impli-cations for illness-specific risk-taking behaviors, especially when adherence behaviors have a delayed effect on health and well-being. There are some chronic illnesses for which treatment provides immediate and recognizable rewards (e.g., pain relief medication). However, in type 1 diabetes, there is usually no immediate reward from taking insulin. Instead, taking insulin is needed to prevent serious life-threatening complications that may occur in the future. The dual systems models posit that adolescents in particular have increased sensitivity to rewards and greater difficulty with delaying gratification. Thus, adolescents with type 1 diabetes may have difficulty prioritizing their medical treatment when other, more exciting and immediate rewards are present. For example, if an adolescent typically goes to the restroom to take insulin shots when eating out, she may forgo the insulin shot and risk higher blood glucose to stay at the table with her friends.

Contextual Factors and Illness-Specific Risk-Taking

The contextual factors outlined in the risk-taking model (Figure 2) suggest that illness-specific risk-taking would be more likely in social situations and when adult supervision is low. Reduced parental supervision is clearly associated with a decline in illness control across a range of pediatric conditions (18). In contrast, adolescents who experience more parental involvement, monitoring, and collaborative teamwork in diabetes management tend to have better adherence (7). For youth with type 1 diabetes, parents often transition responsibilities for medical tasks during adolescence (5). Thus, adolescents are provided greater freedom and opportunities for risk-taking in their everyday lives, as well as with their medical tasks, giving them more opportunities for illness-specific risk-taking. For example, many parents allow children with diabetes to manage their own insulin and blood glucose monitoring; thus, adolescents could go several days or weeks without a parent realizing that they had been taking too little insulin.

Over the course of adolescence, youth tend to spend increasing am-ounts of time with peers and are more likely to take risks when they are with peers (56). Thus, it is possible that ad-olescents would engage in more illness-specific risk-taking when they are with friends than when they are alone or with adults. Although this idea has not been empirically evaluated, it has clinical support, as families often say that adolescents have a harder time checking blood glucose and taking insulin when they are out with friends (60). Also, it has been demonstrated that health-promoting peer support is an important factor in adolescent adherence in social settings (61).

Reasoned/Reactive Pathways and Illness-Specific Risk-Taking

Theories of risk-taking suggest that there may be different ways to arrive at the same illness-specific risk-taking behavior. Youth may weigh the costs and benefits of engaging or not engaging in an adherence behavior (the reasoned pathway), or they may engage in nonadherence as a result of their reaction to circumstances (the reactive pathway). In both of these situations, adolescents could engage in the same illness-specific risk-taking behavior, but the way in which the behavior comes about is different. The reasoned versus the reactive pathway hypothesis may be particularly useful when examining causes or antecedents of illness-specific risk-taking behaviors.

Implications for Interventions and Future Research

The literature reviewed here suggests that some degree of risk-taking is normal adolescent behavior driven by maturational changes in the brain that interact with social and family contexts. Diabetes risk-taking behaviors such as omitting glucose monitoring or insulin would therefore seem to be more or less expected in adolescence, especially in social contexts and in contexts with immediate rewards. Thus, it may be important for health care providers and parents to be aware of illness-specific risk-taking behaviors and to discuss and assess their frequency. Although we used the example of type 1 diabetes to illustrate the concept of illness-specific risk-taking, there are likely other risk-taking behaviors that are unique to other chronic illness populations. The current model provides a framework for identifying illness-specific risk-taking behaviors. We hope that this model will allow clinicians and researchers to identify and conceptualize illness-specific risk-taking behaviors not only for youth with type 1 diabetes, but also across other chronic illness groups.

Further research will be necessary to examine the frequency of illness-specific risk-taking and determine which behaviors may be most important to routinely assess in clinical care. Once illness-specific risk-taking behaviors are identified, measures can be developed for use in both research and clinical practice. Measures of general risk-taking (e.g., Vrouva et al. [62] and Centers for Disease Control and Prevention [63]) and risk-taking propensity (e.g., Lejuez et al. [64]) may be helpful in developing and validating illness-specific measures. Research is also needed to investigate the association between general risk-taking and illness-specific risk-taking, as well as between illness-specific risk-taking and health outcomes. In particular, it may be of interest to learn which diabetes-specific risk-taking behaviors are most likely to cause negative health outcomes (e.g., hypoglycemic events, diabetic ketoacidosis, or glycemic variability). Determining the level of risk associated with these behaviors would allow clinicians to focus their assessments and interventions on the specific risk behaviors that are most likely to result in serious health complications.

Family communication and problem-solving skills may be especially important in addressing illness-specific risk-taking. The more involved parents are with medical tasks, the fewer opportunities adolescents have for taking risks, but the greater the opportunity is for family conflict. The existence of developmental differences in reasoning about risk (43) suggests that adolescents and adults might assess and approach illness-specific risk-taking differently. For example, an adolescent might weigh the costs/benefits of omitting insulin for 24 hours, whereas an adult would not even consider it because the risk of a severe health consequences would not be considered worth any benefit. If adults and youth reason differently about illness management, parents (and caregivers) may not understand and empathize with adolescents’ decisions to take risks with medical tasks. Clinical intervention to improve family communication and manage conflict might reduce risky behavior by helping parents and youth develop a shared understanding of youths’ adherence behaviors and allow parents to better guide youths’ reasoning around treatment decisions.

Risk-taking is also likely to be an important consideration in clinically referred samples of youth with type 1 diabetes and mental health concerns. For example, depression is associated with both risk-taking and nonadherence (14). Youth with attention deficit hyperactivity disorder engage in significantly more general risk-taking behaviors (65–67), suggesting they likely also will exhibit more illness-specific risk-taking. However, in some cases, the relationship between psychosocial functioning and risk-taking may be more complex. For example, anxiety is associated with general risk avoidance (68,69), as well as with reduced adherence (e.g., frequency of blood glucose monitoring [70]). Parsing the different contributions of risk-taking, risk avoidance, and adherence is an important area for future research.

Adolescence is a crucial time to intervene to prevent or reduce illness-related risk-taking. Illness-related risk-taking is a likely extension of the increase in general risk-taking that occurs as a part of normal adolescent development. The period of adolescence affords great opportunity for risk-taking behaviors to be at their peak. Moreover, there is evidence that a negative developmental trajectory around diabetes management during adolescence may persist into early adulthood, accelerating the risk of long-term medical and psychological complications of diabetes (71). This research underscores the importance of optimizing adherence and reducing illness-related risk-taking during the challenging developmental period of adolescence. More research is needed to determine how to assess the developmental trajectory of illness-specific risk-taking behaviors. In addition, clinical interventions designed to reduce illness-specific risk-taking during this opportune period of development will need to be evaluated. Of course, not all youth engage in significant risk-taking behavior. Identifying and reinforcing the resilience factors that help protect youth against risky behavior in general may also help minimize diabetes-specific risk-taking.

Acknowledgments

This manuscript was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (5K12DK097696) to B.J.A.

Duality of Interest

No potential conflicts of interest relevant to this article were reported.

  • © 2017 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0 for details.

References

  1. 1.↵
    1. Colver A,
    2. Longwell S
    . New understanding of adolescent brain development: relevance to transitional healthcare for young people with long term conditions. Arch Dis Child 2013;98:902–907
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Blakemore SJ,
    2. Robbins TW
    . Decision-making in the adolescent brain. Nat Neurosci 2012;15:1184–1191
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Modi AC,
    2. Pai AL,
    3. Hommel KA, et al
    . Pediatric self-management: a framework for research, practice, and policy. Pediatrics 2012;129:e473–e485
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Rapoff MA
    1. Rapoff MA
    . Consequences of nonadherence and correlates of adherence. In Rapoff MA. Adherence to Pediatric Medical Regimens. New York, Springer, 2010, p. 33–45
  5. 5.↵
    1. Ingerski LM,
    2. Anderson BJ,
    3. Dolan LM,
    4. Hood KK
    . Blood glucose monitoring and glycemic control in adolescence: contribution of diabetes-specific responsibility and family conflict. J Adolesc Health 2010;47:191–197
    OpenUrlCrossRefPubMedWeb of Science
  6. 6.↵
    1. Anderson BJ
    . Family conflict and diabetes management in youth: clinical lessons from child development and diabetes research. Diabetes Spectrum 2004;17:22–26
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    1. Ellis DA,
    2. Podolski CL,
    3. Frey M,
    4. Naar-King S,
    5. Wang B,
    6. Moltz K
    . The role of parental monitoring in adolescent health outcomes: impact on regimen adherence in youth with type 1 diabetes. J Pediatr Psychol 2007;32:907–917
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. Wysocki T,
    2. Gavin L
    . Paternal involvement in the management of pediatric chronic diseases: associations with adherence, quality of life, and health status. J Pediatr Psychol 2006;31:501–511
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Thomas AM,
    2. Peterson L,
    3. Goldstein D
    . Problem solving and diabetes regimen adherence by children and adolescents with IDDM in social pressure situations: a reflection of normal development. J Pediatr Psychol 1997;22:541–561
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. Hassan K,
    2. Loar R,
    3. Anderson BJ,
    4. Heptulla RA
    . The role of socioeconomic status, depression, quality of life, and glycemic control in type 1 diabetes mellitus. J Pediatr 2006;149:526–531
    OpenUrlCrossRefPubMedWeb of Science
  11. 11.↵
    1. Auslander WF,
    2. Thompson S,
    3. Dreitzer D,
    4. White NH,
    5. Santiago JV
    . Disparity in glycemic control and adherence between African-American and Caucasian youths with diabetes: family and community contexts. Diabetes Care 1997;20:1569–1575
    OpenUrlAbstract/FREE Full Text
  12. 12.↵
    1. Gallegos-Macias AR,
    2. Macias SR,
    3. Kaufman E,
    4. Skipper B,
    5. Kalishman N
    . Relationship between glycemic control, ethnicity and socioeconomic status in Hispanic and white non-Hispanic youths with type 1 diabetes mellitus. Pediatr Diabetes 2003;4:19–23
    OpenUrlCrossRefPubMed
  13. 13.↵
    1. Kann L,
    2. Kinchen S,
    3. Shanklin S, et al
    . Youth risk behavior surveillance—United States, 2013. MMWR Surveillance Summ 2014;63(Suppl. 4):1–68
    OpenUrl
  14. 14.↵
    1. Bender BG
    . Risk taking, depression, adherence, and symptom control in adolescents and young adults with asthma. Am J Respir Crit Care Med 2006;173:953–957
    OpenUrlCrossRefPubMedWeb of Science
  15. 15.↵
    1. Hackworth NJ,
    2. Hamilton VE,
    3. Moore SM,
    4. Northam EA,
    5. Bucalo Z,
    6. Cameron FJ
    . Predictors of diabetes self-care, metabolic control, and mental health in youth with type 1 diabetes. Aust Psychol 2013;48:360–369
    OpenUrl
  16. 16.
    1. Joseph HD,
    2. Patterson B
    . Risk taking and its influence on metabolic control: a study of adult clients with diabetes. J Adv Nurs 1994;19:77–84
    OpenUrlCrossRefPubMedWeb of Science
  17. 17.
    1. Sawyer SM,
    2. Drew S,
    3. Yeo MS,
    4. Britto MT
    . Adolescents with a chronic condition: challenges living, challenges treating. Lancet 2007;369:1481–1489
    OpenUrlCrossRefPubMedWeb of Science
  18. 18.↵
    1. Schwartz DD,
    2. Axelrad ME
    1. Axelrad ME
    . Adherence in adolescence. In Healthcare Partnerships for Pediatric Adherence. Schwartz DD, Axelrad ME (Eds.) Cham, Switzerland, Springer International Publishing, 2015, p. 71–90
  19. 19.↵
    1. Sultan S,
    2. Bungener C,
    3. Andronikof A
    . Individual psychology of risk-taking behaviours in non-adherence. J Risk Res 2002;5:137–145
    OpenUrl
  20. 20.↵
    1. Barnard K,
    2. Sinclair JM,
    3. Lawton J,
    4. Young AJ,
    5. Holt RI
    . Alcohol-associated risks for young adults with type 1 diabetes: a narrative review. Diabet Med 2012;29:434–440
    OpenUrlCrossRefPubMed
  21. 21.
    1. Hanna KM,
    2. Guthrie DW
    . Health-compromising behavior and diabetes mismanagement among adolescents and young adults with diabetes. Diabetes Educ 2001;27:223–230
    OpenUrlAbstract/FREE Full Text
  22. 22.↵
    1. Louis-Jacques J,
    2. Samples C
    . Caring for teens with chronic illness: risky business? Curr Opin Pediatr 2011;23:367–372
    OpenUrlCrossRefPubMed
  23. 23.↵
    1. Peters EN,
    2. Leeman RF,
    3. Fucito LM,
    4. Toll BA,
    5. Corbin WR,
    6. O’Malley SS
    . Co-occurring marijuana use is associated with medication nonadherence and nonplanning impulsivity in young adult heavy drinkers. Addict Behav 2012;37:420–426
    OpenUrlPubMed
  24. 24.↵
    1. Scaramuzza AE,
    2. De Palma A,
    3. Mameli C,
    4. Spiri D,
    5. Santoro L,
    6. Zuccotti GV
    . Adolescents with type 1 diabetes and risky behaviour. Acta Paediatr 2010;99:1237–1241
    OpenUrlCrossRefPubMed
  25. 25.↵
    1. Suris JC,
    2. Michaud PA,
    3. Akre C,
    4. Sawyer SM
    . Health risk behaviors in adolescents with chronic conditions. Pediatrics 2008;122:e1113–e1118
    OpenUrlAbstract/FREE Full Text
  26. 26.↵
    1. Weitzman ER,
    2. Ziemnik RE,
    3. Huang Q,
    4. Levy S
    . Alcohol and marijuana use and treatment nonadherence among medically vulnerable youth. Pediatrics 2015;136:450–457
    OpenUrlAbstract/FREE Full Text
  27. 27.↵
    1. Hanna KM,
    2. Stupiansky NW,
    3. Weaver MT,
    4. Slaven JE,
    5. Stump TE
    . Alcohol use trajectories after high school graduation among emerging adults with type 1 diabetes. J Adolesc Health 2014;55:201–208
    OpenUrlCrossRefPubMed
  28. 28.↵
    1. Frey MA,
    2. Guthrie B,
    3. Loveland-Cherry C,
    4. Park PS,
    5. Foster CM
    . Risky behavior and risk in adolescents with IDDM. J Adolesc Health 1997;20:38–45
    OpenUrlCrossRefPubMedWeb of Science
  29. 29.↵
    1. Murray CB,
    2. Lennon JM,
    3. Devine KA,
    4. Holmbeck GN,
    5. Klages K,
    6. Potthoff LM
    . The influence of social adjustment on normative and risky health behaviors in emerging adults with spina bifida. Health Psychol 2014;33:1153–1163
    OpenUrl
  30. 30.↵
    1. Borus JS,
    2. Laffel L
    . Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention. Curr Opin Pediatr 2010;22:405–411
    OpenUrlCrossRefPubMed
  31. 31.↵
    1. Rausch JR,
    2. Hood KK,
    3. Delamater A, et al
    . Changes in treatment adherence and glycemic control during the transition to adolescence in type 1 diabetes. Diabetes Care 2012;35:1219–1224
    OpenUrlAbstract/FREE Full Text
  32. 32.↵
    1. Anderson B,
    2. Ho J,
    3. Brackett J,
    4. Finkelstein D,
    5. Laffel L
    . Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus. J Pediatr 1997;130:257–265
    OpenUrlCrossRefPubMedWeb of Science
  33. 33.↵
    1. DCCT Research Group
    . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–986
    OpenUrlCrossRefPubMedWeb of Science
  34. 34.↵
    1. Schwartz DD,
    2. Wasserman R,
    3. Powell PW,
    4. Axelrad ME
    . Neurocognitive outcomes in pediatric diabetes: a developmental perspective. Curr Diab Rep 2014;14:1–10
    OpenUrl
  35. 35.↵
    1. Spear LP
    . Neurobehavioral changes in adolescence. Curr Dir Psychol Sci 2000;9:111–114
    OpenUrlAbstract/FREE Full Text
  36. 36.↵
    1. Ernst M,
    2. Pine DS,
    3. Hardin M
    . Triadic model of the neurobiology of motivated behavior in adolescence. Psychol Med 2006;36:299–312
    OpenUrlCrossRefPubMedWeb of Science
  37. 37.↵
    1. Strang NM,
    2. Chein JM,
    3. Steinberg L
    . The value of the dual systems model of adolescent risk-taking. Front Hum Neurosci 2013;7:223–227
    OpenUrl
  38. 38.↵
    1. Gerrard M,
    2. Gibbons FX,
    3. Houlihan AE,
    4. Stock ML,
    5. Pomery EA
    . A dual-process approach to health risk decision making: the Prototype Willingness model. Dev Rev 2008;28:29–61
    OpenUrlCrossRefWeb of Science
  39. 39.↵
    1. Gibbons FX,
    2. Gerrard M,
    3. Blanton H,
    4. Russell DW
    . Reasoned action and social reaction: willingness and intention as independent predictors of health risk. J Pers Soc Psychol 1998;74:1164–1180
    OpenUrlCrossRefPubMedWeb of Science
  40. 40.↵
    1. Wilhelms EA,
    2. Reyna VF
    . Fuzzy trace theory and medical decisions by minors: differences in reasoning between adolescents and adults. J Med Philos 2013;38:268–282
    OpenUrlAbstract/FREE Full Text
  41. 41.↵
    1. Ajzen I
    . The theory of planned behavior. Organ Behav Hum Decis Process 1991;50:179–211
    OpenUrlCrossRefWeb of Science
  42. 42.↵
    1. Steinberg L
    . A dual systems model of adolescent risk-taking. Dev Psychobiol 2010;52:216–224
    OpenUrlCrossRefPubMedWeb of Science
  43. 43.↵
    1. Reyna VF,
    2. Farley F
    . Is the teen brain too rational? Sci Am Mind 2006;17:58–65
    OpenUrl
  44. 44.↵
    1. Reyna VF,
    2. Brainerd CJ
    . Dual processes in decision making and developmental neuroscience: a fuzzy-trace model. Dev Rev 2011;31:180–206
    OpenUrlCrossRefPubMed
  45. 45.↵
    1. Evans JS,
    2. Stanovich KE
    . Dual-process theories of higher cognition advancing the debate. Perspect Psychol Sci 2013;8:223–241
    OpenUrlAbstract/FREE Full Text
  46. 46.↵
    1. Steinberg L
    . A social neuroscience perspective on adolescent risk-taking. Dev Rev 2008;28:78–106
    OpenUrlCrossRefPubMedWeb of Science
  47. 47.↵
    1. Casey BJ,
    2. Jones RM,
    3. Somerville LH
    . Braking and accelerating of the adolescent brain. J Res Adolesc 2011;21:21–33
    OpenUrlCrossRefPubMed
  48. 48.↵
    1. Galvan A
    . Adolescent development of the reward system. Front Hum Neurosci 2010;4:116–124
    OpenUrl
  49. 49.↵
    1. Galvan A,
    2. Hare TA,
    3. Parra CE, et al
    . Earlier development of the accumbens relative to orbitofrontal cortex might underlie risk-taking behavior in adolescents. J Neurosci 2006;26:6885–6892
    OpenUrlAbstract/FREE Full Text
  50. 50.↵
    1. Steinberg L,
    2. Albert D,
    3. Cauffman E,
    4. Banich M,
    5. Graham S,
    6. Woolard J
    . Age differences in sensation seeking and impulsivity as indexed by behavior and self-report: evidence for a dual systems model. Dev Psychol 2008;44:1764–1778
    OpenUrlCrossRefPubMedWeb of Science
  51. 51.↵
    1. Blakemore SJ
    . Imaging brain development: the adolescent brain. Neuroimage 2012;61:397–406
    OpenUrlCrossRefPubMedWeb of Science
  52. 52.↵
    1. Arnett JJ
    . Emerging adulthood: a theory of development from the late teens through the twenties. Am Psychol 2000;55:469–480
    OpenUrlCrossRefPubMedWeb of Science
  53. 53.↵
    1. O’Malley PM,
    2. Johnston LD
    . Epidemiology of alcohol and other drug use among American college students. J Stud Alcohol 2002;14:23–39
    OpenUrl
  54. 54.↵
    1. Laird RD,
    2. Pettit GS,
    3. Bates JE,
    4. Dodge KA
    . Parents’ monitoring-relevant knowledge and adolescents’ delinquent behavior: evidence of correlated developmental changes and reciprocal influences. Child Dev 2003;74:752–768
    OpenUrlCrossRefPubMedWeb of Science
  55. 55.↵
    1. Willoughby T,
    2. Good M,
    3. Adachi PJ,
    4. Hamza C,
    5. Tavernier R
    . Examining the link between adolescent brain development and risk taking from a social-developmental perspective. Brain Cogn 2013;83:315–323
    OpenUrlCrossRefPubMedWeb of Science
  56. 56.↵
    1. Gardner M,
    2. Steinberg L
    . Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study. Dev Psychol 2005;41:625–635
    OpenUrlCrossRefPubMedWeb of Science
  57. 57.↵
    1. Simons-Morton B,
    2. Lerner N,
    3. Singer J
    . The observed effects of teenage passengers on the risky driving behavior of teenage drivers. Accid Anal Prev 2005;37:973–982
    OpenUrlCrossRefPubMedWeb of Science
  58. 58.↵
    1. Lerner R,
    2. Steinberg L
    1. Chassin L,
    2. Hussong A,
    3. Beltran I
    . Adolescent substance use. In Handbook of Adolescent Psychology. Lerner R, Steinberg L (eds.). New York, Wiley, 2004, p. 665–696
  59. 59.↵
    1. Peters A,
    2. Laffel, L
    , American Diabetes Association Transitions Working Group. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems. Diabetes Care 2011;34:2477–2485
    OpenUrlFREE Full Text
  60. 60.↵
    1. La Greca AM,
    2. Auslander WF,
    3. Greco P,
    4. Spetter D,
    5. Fisher EB,
    6. Santiago JV
    . I get by with a little help from my family and friends: adolescents’ support for diabetes care. J Pediatr Psychol 1995;20:449–476
    OpenUrlAbstract/FREE Full Text
  61. 61.↵
    1. Hains AA,
    2. Berlin KS,
    3. Davies WH,
    4. Smothers MK,
    5. Sato AF,
    6. Alemzadeh R
    . Attributions of adolescents with type 1 diabetes related to performing diabetes care around friends and peers: the moderating role of friend support. J Pediatr Psychol 2007;32:561–570
    OpenUrlAbstract/FREE Full Text
  62. 62.
    1. Vrouva I,
    2. Fonagy P,
    3. Fearon PRM,
    4. Roussow T
    . The risk-taking and self-harm inventory for adolescents: development and psychometric evaluation. Psychol Assess 2010;22:852–865
    OpenUrlCrossRefPubMed
  63. 63.
    1. Centers for Disease Control and Prevention
    . Youth risk behavior survey. Available from http://www.cdc.gov/healthyyouth/data/yrbs/index.htm. Accessed 25 January 2016
  64. 64.
    1. Lejuez CW,
    2. Aklin WM,
    3. Zvolensky MJ,
    4. Pedulla CM
    . Evaluation of the Balloon Analogue Risk Task (BART) as a predictor of adolescent real-world risk-taking behaviours. J Adolesc 2003:26:475–479
    OpenUrlCrossRefPubMedWeb of Science
  65. 65.↵
    1. Flory K,
    2. Molina BS,
    3. Pelham WE,
    4. Gnagy E,
    5. Smith B
    . Childhood ADHD predicts risky sexual behavior in young adulthood. J Clin Child Adolesc 2006:35:571–577
    OpenUrl
  66. 66.
    1. Groen Y,
    2. Gaastra GF,
    3. Lewis-Evans B,
    4. Tucha O
    . Risky behavior in gambling tasks in individuals with ADHD: a systematic literature review. PLoS One 2013;8:e74909
    OpenUrlCrossRefPubMed
  67. 67.↵
    1. Thompson AL,
    2. Molina BS,
    3. Pelham W,
    4. Gnagy EM
    . Risky driving in adolescents and young adults with childhood ADHD. J Pediatr Psychol 2007;32:745–759
    OpenUrlAbstract/FREE Full Text
  68. 68.↵
    1. Broman-Fulks JJ,
    2. Urbaniak A,
    3. Bondy CL,
    4. Toomey KJ
    . Anxiety sensitivity and risk-taking behavior. Anxiety Stress Coping 2014;27:619–632
    OpenUrl
  69. 69.↵
    1. Giorgetta C,
    2. Grecucci A,
    3. Zuanon S, et al
    . Reduced risk-taking behavior as a trait feature of anxiety. Emotion 2012;12:1373–1383
    OpenUrlCrossRefPubMedWeb of Science
  70. 70.
    1. Herzer M,
    2. Hood KK
    . Anxiety symptoms in adolescents with type 1 diabetes: association with blood glucose monitoring and glycemic control. J Pediatr Psychol 2010;35:415–425
    OpenUrlAbstract/FREE Full Text
  71. 71.↵
    1. Hilliard ME,
    2. Wu YP,
    3. Rausch J,
    4. Dolan LM,
    5. Hood KK
    . Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. J Adolesc Health 2013;52:28–34
    OpenUrlCrossRefPubMedWeb of Science
PreviousNext
Back to top
Diabetes Spectrum: 30 (1)

In this Issue

February 2017, 30(1)
  • Table of Contents
  • Table of Contents (PDF)
  • Index by Author
  • Masthead (PDF)
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Spectrum.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Illness-Specific Risk-Taking in Adolescence: A Missing Piece of the Nonadherence Puzzle for Youth With Type 1 Diabetes?
(Your Name) has forwarded a page to you from Diabetes Spectrum
(Your Name) thought you would like to see this page from the Diabetes Spectrum web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Illness-Specific Risk-Taking in Adolescence: A Missing Piece of the Nonadherence Puzzle for Youth With Type 1 Diabetes?
Rachel Wasserman, Barbara J. Anderson, David D. Schwartz
Diabetes Spectrum Feb 2017, 30 (1) 3-10; DOI: 10.2337/ds15-0060

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Illness-Specific Risk-Taking in Adolescence: A Missing Piece of the Nonadherence Puzzle for Youth With Type 1 Diabetes?
Rachel Wasserman, Barbara J. Anderson, David D. Schwartz
Diabetes Spectrum Feb 2017, 30 (1) 3-10; DOI: 10.2337/ds15-0060
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • General Risk-Taking in Adolescence
    • Illness-Specific Risk-Taking: A Proposed Part of Nonadherence
    • Implications for Interventions and Future Research
    • Acknowledgments
    • Duality of Interest
    • References
  • Figures & Tables
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Disparities in Text Messaging Interventions to Improve Diabetes Management in the United States
  • Improving Referrals to Diabetes Self-Management Education in Medically Underserved Adults
  • Optimizing Therapeutic Outcomes With Oral Semaglutide: A Patient-Centered Approach
Show more Feature Articles

Similar Articles

Navigate

  • Current Issue
  • Papers in Press
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Diabetes Care
  • Clinical Diabetes
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Spectrum Print ISSN: 1040-9165, Online ISSN: 1944-7353.