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J Pediatr. 2015 May;166(5):1258-1264.e3. doi: 10.1016/j.jpeds.2015.01.019. Epub 2015 Feb 20.

Longitudinal Correlates of Health Risk Behaviors in Children and Adolescents with Type 2 Diabetes.

Collaborators (172)

McKay S, Haymond M, Anderson B, Bush C, Gunn S, Holden H, Jones S, Jeha G, McGirk S, Thamotharan S, Cuttler L, Abrams E, Casey T, Dahms W, Ievers-Landis C, Kaminski B, Koontz M, MacLeish S, McGuigan P, Narasimhan S, Geffner M, Barraza V, Chang N, Conrad B, Dreimane D, Estrada S, Fisher L, Fleury-Milfort E, Hernandez S, Hollen B, Kaufman F, Mansilla V, Miller D, Ortiz R, Xu Y, Yasuda P, Katz L, Berkowitz R, Boyd S, Keating C, Lassiter C, Lipman T, Schwartzman B, Willi S, Arslanian S, Bacha F, Foster S, Galvin B, Hannon T, Kriska A, Libman I, Marcus M, Porter K, Songer T, Venditti E, Goland R, Gallagher D, Kringas P, Leibel N, Ng D, Ovalles M, Seidman D, Goebel-Fabbri A, Hall M, Higgins L, Keady J, Rasbach L, Nathan D, Angelescu A, Bissett L, Ciccarelli C, Delahanty L, Goldman V, Hardy O, Larkin M, Levitsky L, McEachern R, Norman D, Nwosu D, Park-Bennett S, Richards D, Sherry N, Steiner B, Tollefsen S, Carnes S, Dempsher D, Flomo D, Whelan T, Wolff B, Weinstock R, Bowerman D, Bulger J, Izquierdo R, Kearns J, Saletsky R, Trief P, Zeitler P, Abramson N, Bradhurst A, Celona-Jacobs N, Klingensmith G, Nadeau K, Witten T, Copeland K, Boss E, Brown R, Chadwick J, Chalmers L, Chernausek S, Hebensperger A, Macha C, Newgent R, Nordyke A, Olson D, Poulsen T, Pratt L, Preske J, Schanuel J, Sternlof S, Amodei N, Barajas R, Cody C, Hale D, Hernandez J, Ibarra C, Morales E, Rivera S, Rupert G, Wauters A, White N, Flomo D, Jones J, Tanner M, Timpson A, Welch R, Caprio S, Grey M, Guandalini C, Lavietes S, Syme A, Tamborlane W, Hirst K, Edelstein S, Feit P, Grover N, Pyle L, Linder B, M S, Harting J, Marquez L, Sherman M, Wang J, Nichols M, Mayer-Davis E, Liu Y, Gidding S, Puccella J, Ricketts E, Danis R, Domalpally A, Goulding A, Neill S, Vargo P, Franklin K, Massmann C, Patterson J, Tibbs T, Van Buren D, Palmert M, Ratner R, Dremaine D, Silverstein J.

Author information

Division of Developmental/Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH.
Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO.
Department of Pediatrics, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Biostatistics Center, George Washington University, Rockville, MD. Electronic address:
Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, Philadelphia, PA.
Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Pediatric Diabetes, Yale University, New Haven, CT.
Department of Pediatrics, Child and Adolescent Psychiatry, SUNY Upstate Medical University, Syracuse, NY.
Medical Psychology, Columbia University Medical Center, New York, NY.
Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, CA.



To characterize, during a 2-year period, the proportion of youth with type 2 diabetes (T2D) enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth study that reported ever at least trying smoking cigarettes and/or drinking alcohol.


Longitudinal data were examined for participants with T2D ages 10-18 years at baseline. Youth psychosocial, parent/family, environmental, and biological correlates of trying health risk behaviors were tested via cross-sectional multivariate models at each time point. Longitudinal models were explored for selected factors.


Data were obtained from the Treatment Options for Type 2 Diabetes in Adolescents and Youth study's ethnically diverse participants at baseline (N=644), 6-month (N=616), and 24-month (N=543) assessments. The percentage of youth ever trying only smoking remained stable at 4%; only drinking alcohol increased from 17% to 26%, and both smoking and drinking increased from 10% to 18% during the 2-year period. Factors related to trying health risk behaviors were older age, male sex, non-Hispanic white race-ethnicity, lower grades, more depressive symptoms, and stressful life events. Depressive symptoms, stressful life events, and body mass index Z-score (the latter with smoking only) were related to engagement in health risk behaviors over time.


Youth with T2D who are already at risk for health complications and who reported engaging in activities that further increase the likelihood of life-threatening morbidities were characterized. Although most correlates of trying these risk behaviors are nonmodifiable, intervention efforts may need to focus on potentially modifiable factors, such as depressive symptoms and lower grades.

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