Perception and Awareness of Diabetes Risk and Reported Risk-Reducing Behaviors in Adolescents

Abstract

ImportanceLifestyle change is central to diabetes risk reduction in youth with overweight or obesity. Feeling susceptible to a health threat can be motivational in adults.ObjectiveTo evaluate associations between diabetes risk perception and/or awareness and health behaviors in youth.Design, Setting, and ParticipantsThis cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2011 to 2018. Participants included youths aged 12 to 17 years with body mass index (BMI) in the 85th percentile or higher without known diabetes. Analyses were conducted from February 2022 to February 2023.Main Outcomes and MeasuresOutcomes included physical activity, screen time, and attempted weight loss. Confounders included age, sex, race and ethnicity, and objective diabetes risk (BMI, hemoglobin A1c [HbA1c]).ExposuresIndependent variables included diabetes risk perception (feeling at risk) and awareness (told by clinician), as well as potential barriers (eg, food insecurity, household size, insurance).ResultsThe sample included 1341 individuals representing 8 716 794 US youths aged 12 to 17 years with BMI in the 85th percentile or higher for age and sex. The mean age was 15.0 years (95% CI, 14.9-15.2 years) and mean BMI z score was 1.76 (95% CI 1.73-1.79). Elevated HbA1c was present in 8.6% (HbA1c 5.7%-6.4%: 8.3% [95% CI, 6.5%-10.5%]; HbA1c ≥6.5%: 0.3% [95% CI, 0.1%-0.7%]). Nearly one-third of youth with elevated HbA1c reported risk perception (30.1% [95% CI, 23.1%-38.1%), while one-quarter (26.5% [95% CI, 20.0%-34.2%]) had risk awareness. Risk perception was associated with increased TV watching (β = 0.3 hours per day [95% CI, 0.2-0.5 hours per day]) and approximately 1 less day per week with at least 60 minutes of physical activity (β = −1.2 [95% CI, −2.0 to −0.4) but not with nutrition or weight loss attempts. Awareness was not associated with health behaviors. Potential barriers had mixed associations: larger households (≥5 members vs 1-2) reported lower consumption of non–home-prepared meals (OR 0.4 [95% CI, 0.2-0.7]) and lower screen time (β = −1.1 hours per day [95% CI, −2.0 to −0.3 hours per day), while public insurance (vs private) was associated with approximately 20 fewer minutes per day of physical activity (β = −20.7 minutes per day [95% CI, 35.5 to −5.8 minutes per day]).Conclusions and RelevanceIn this cross-sectional study including a US-representative sample of adolescents with overweight or obesity, diabetes risk perception and awareness were not associated with greater engagement in risk-reducing behaviors in youth. These findings suggest the need to address barriers to engagement in lifestyle change, including economic disadvantage.

A Comprehensive Youth Diabetes Epidemiological Data Set and Web Portal: Resource Development and Case Studies

“…On the other hand, as our main purpose is to use POND as a conduit between this comprehensive youth pre-DM/DM database and interested researchers, our method can be adopted to longitudinal data sets should they become available in the future. Second, for the prediction of pre-DM/DM status, EI’s performance was found to be significantly better than the alternative approaches, including a modified form of the suggested guideline [ 45 ]. However, this performance assessment was based only on cross-validation, which is no substitute for validation on external data sets that is necessary for rigorous assessment.…”

“…To directly address this data gap, we turned to the National Health and Nutrition Examination Survey (NHANES), which offers a promising path for examining preDM/DM among the US youth population by providing a rich source of individual-and household-level epidemiological factors. As a result, NHANES has been a prominent data source for studying youth preDM/DM trends and associated factors [18,[42][43][44][45]. However, the utilization of NHANES data requires extensive data processing that is laborious and time-intensive [46].…”

Motivation for Physical Activity as a Key Determinant of Sedentary Behavior Among Postsecondary Students

“…Some studies have linked adolescent screen time to moderate-to-vigorous physical activity. 47 - 49 Others have found associations between motivation for physical activity, and engagement in physical activity in adolescents. 50 , 51 To date, less research has examined associations between motivation for physical activity and screen time.…”