The transition from adolescence to early adulthood is a neglected area of research, despite the high prevalence of risk behaviors that emerge and the potential for these risk behaviors to set in motion a pattern of behavior that will persist throughout adulthood and put one at risk for chronic disease. This transition is even more critical for youth with diabetes as they assume primary responsibility for self-care behavior and transition out of the pediatric health care system. Yet, very little is known about how this transition occurs. The primary goal of this study is to examine the health implications of the transition to young adulthood for youth with and without diabetes and to compare the level of difficulties between the two groups. To this end, we are in the middle of a longitudinal study of adolescents with and without diabetes who were enrolled when they were in grades 5-7. Because we interview them every year, we have extensive psychosocial and medical data available. The primary goal of this competing continuation is to follow these youth as they complete high school and during the first two years after high school. We will (a) describe the life situations of those with and without diabetes, and determine if there are group differences;(b) examine the effects of group and time on psychosocial variables determined to be important in the original study: depressive symptoms, disturbed eating behavior, somatization, and peer relationships;(c) examine the effects of group and time on risk behaviors that are relevant to young adulthood and critical to health: alcohol, smoking, diet, and activity;and (d) examine the impact of time and life situations on the health care utilization patterns of youth with diabetes. A second goal is to link key aspects of the parent relationship to risk behaviors and mental health outcomes for both groups and to health care utilization and diabetes outcomes for youth with diabetes. A third goal is to link key psychosocial variables, as specified in aims 1 and 2, to the same set of outcomes. We will use the results of this study to determine if and when diabetes affects the transition in terms of important life choices made;depressive symptoms, an important comorbid condition of diabetes in adulthood;disturbed eating behavior;and risk behaviors that have important consequences for health. For youth with diabetes, we will use our wealth of demographic and psychosocial data to predict contact with the health care system and to identify youth who are at risk for leaving the health care system prematurely.
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