Decision-making and risk-taking as predictors of health risk behaviors in the Millennium Cohort Study

Facets of decision-making and risk-taking are implicated in adolescent health risk behaviors; however, whether they may lead to adolescent engagement in substance use, gambling, and self-harm is unknown.

We used the Millennium Cohort Study to test whether a task-based measure of decision-making and risk-taking predicts engagement in adolescent health risk behaviors. Participants were born in the United Kingdom (2000-2002) and surveyed in-home at ages 14 (n = 10,531) and 17 (n = 8417). A computerized task-based measure of decision-making and risk-taking for reward (Cambridge Gambling Task) measured impulsivity, quality of decision-making, risk adjustment, and risk-taking (exposures) at age 14. Several health risk behaviors (outcomes) were self-reported at 14/17 years: cigarette use, electronic cigarette/vaping use, drinking, cannabis use, other illegal drug use (e.g., ecstasy), gambling, and self-harm. We conducted adjusted multinomial and logistic regression models.

Computerized task-based measures of greater impulsivity and risk-taking were most consistently associated with self-reported health risk behaviors at 14 and 17 years. Better quality of decision-making and risk adjustment were inconsistently associated with health outcomes at age 14; however, better risk adjustment was related to a reduced likelihood of all levels of cigarette and e-cigarette/vaping use (e.g., occasionally/regularly) when compared to nonusers. At age 14, risk-taking was associated with every self-reported health risk behavior (e.g., substance use, gambling) except for self-harm. In prospective models, relationships were attenuated, but risk-taking predicted new onset engagement in all forms of substance use except alcohol consumption and self-harm. Risk-taking was most strongly associated with other drug use (age 14: odds ratio (OR) = 11.26, 95% CI: 1.48, 86.01) and predictive of former vaping use (age 17: OR = 4.10, 95% CI: 1.43, 11.76).

Risky betting on a computerized risk-taking task appears highly indicative of substance use and recent gambling at age 14 and predictive of new onset substance use and gambling 3 years later (age 17) for both sexes, but not self-harm.