Chronically ill adolescents are more likely than their healthy peers to take up unsavoury habits such as drug use and vandalism, Swiss researchers have found.
The findings by a Lausanne University-led team have been published in the United States-based Pediatrics medical journal.
The team drew on data compiled from the 2002 Swiss Multicenter Adolescent Survey on Health, a nationally representative study of 7,548 young people aged 16 to 20 in the three language areas of Switzerland.
Among the participants were 750 young people who suffered from various disabilities or chronic conditions that lasted longer than six months and needed constant medical care.
They were found to be significantly more likely than their healthy peers to smoke daily, to be current cannabis users and to have performed violent or antisocial acts in the past year.
Overall they exhibited higher rates of involvement in all risk behaviours – defined for the study as daily smoking, alcohol misuse, use of cannabis or illegal drugs, early sexual activity, eating disorders, and involvement in violent and anti-social acts.
"Almost by definition, risk behaviours are of concern for healthy young people," note the study authors, led by Joan-Carles Surís, head of the university's Research Group on Adolescent Health at the Institute of Social and Preventive Medicine.
But there is increased potential for "adverse health outcomes" for those with chronic conditions, because of the interactions of such behaviour with their underlying condition, the authors say.
The study draws special attention to findings that one-fifth of young people with chronic conditions had performed violent acts ranging from attacking an adult to using a weapon in a fight, and one-third had carried out anti-social acts such as burglary and vandalism in the previous year - significantly more than their healthy peers.
"This is the first time that violent behaviours have been investigated in young people with chronic conditions," the authors say.
They believe the reason for this particular group to be prone to violence is that they have more problems integrating into the social mainstream and tend to associate with risk-takers who accept them more easily.
The general higher involvement in risk behaviour could be explained as this group feeling a greater need to be accepted by their healthy peers. Taking part helps show they are no different to others, the study suggests.
Sufferers are also more likely to experience higher rates of emotional distress, a recognised factor associated with a range of risk behaviours.
The study says that although these activities are common in teenage development, they bring a "double whammy" for the chronically ill, as behaviour can go unchecked.
By and large chronically ill young people do not receive as much counselling to warn them about such behaviour, and health care providers are less likely to screen them for substance abuse and sexual issues.
The study recommends that such health care workers need to become more aware and "would do well to appreciate that the presence of a chronic condition does not protect young people from participating in risk behaviour".
"This data emphasises the importance of health risk screening and preventive counselling in young people in general and reminds us that young people with chronic conditions are first and foremost young people who face additional challenges in adolescence," the study concludes.
"As with other adolescents, they need time alone with their health care providers so that these issues, among others, can be discussed."
Long-term studies would also help understand the duration of such behaviours and qualitative research would be valuable to explore why they are present, the study notes.
The study, Health Risk Behaviours in Adolescents with Chronic Conditions, was led by the Research Group on Adolescent Health at the Institute of Social and Preventive Medicine at Lausanne University, together with the Centre for Adolescent Health at the Royal Children's Hospital in Australia, the Department of Paediatrics at the University of Melbourne and the Murdoch Children's Research Institute in Australia.
Data was drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a nationally representative survey of 7,548 adolescents in post-mandatory school aged 16-20.
There were 760 subjects who reported a chronic illness and/or a disability. The comparison group consisted of 6,493 subjects who answered negatively to both questions.
The study found that 43% of chronically ill smoked daily and 40% used cannabis. The figures were 37% and 34% respectively in healthy young people.
20% of chronically ill engaged in violent behaviour compared to 16% in health youth, while 35% of sufferers were involved in anti-social behaviour compared to 28% of their healthy peers.