To be afflicted with a chronic illness when young is itself a major problem. Now it turns out that adolescents with such problems could be more prone than the rest to risky health behaviour like drug use or unsafe sex.
Susan Sawyer, Professor of Adolescent Health (Pediatrics) at the University of Melbourne, says there is growing evidence that having a chronic places them at increased risk of negative health effects because of their underlying condition.
"For example, the risk from smoking is much higher in adolescents with diabetes, asthma and cystic fibrosis than in otherwise healthy adolescents," she says.
In May, her research on chronic illness in adolescents appeared in the high-profile international medical journal The Lancet and last month she authored an article in Australian Family Physician.
Professor Sawyer says up to 12 per cent of adolescents live with a chronic conditions ranging from diabetes to cystic fibrosis.
She says that until recently many health professionals assumed adolescents with chronic illness were less likely to be involved in risky behaviour.
However, as evidence emerges that they are involved in greater risk-taking than healthy teenagers, new strategies are needed to help deal with the problem.
"We need to better understand how the social and emotional outcomes of young people with a chronic disease can be improved, and how we can better support young people's capacity to manage their illness," she says.
"Efforts to limit the onset of health risk behaviour, should be a major part of this approach."
Professor Sawyer says management of chronic illnesses will be more successful if it is underpinned by a knowledge of the developmental challenges facing adolescents, the behavioural and emotional issues they experience and the social context in which they live.
Many difficulties face chronically ill adolescents, she says. Having visible signs of illness, such as scars or deformity, can affect their confidence in making friends, including intimate relationships.
The desire to be 'normal' means that many young people inappropriately avoid important disease management behaviour when with their friends.
"For example, young people with diabetes find taking insulin publicly to be challenging, with many omitting doses inappropriately," she says.
"Also behaviour that might be considered to be a normal part of experimentation in healthy adolescents can have severe consequences for those with chronic illness," she says.
"Alcohol can reduce the seizure threshold, which means that alcohol can place adolescents with epilepsy at increased risk of seizures."
Professor Sawyer says there is little research about how young people take on the challenges of living with a chronic condition.
Together with Dr Sarah Drew (Paediatrics, Royal Children's Hospital) and Dr Rony Duncan (Murdoch Children's Research Institute) she is involved in research that aims to address this very question.
Professor Sawyer says the Centre for Adolescent Health (of which she is the director) has run the Chronic Illness Peer Support (CHIPS) Group for many years. "In this group, young people become brave enough to realise that life is indeed here to be lived - with or without a chronic illness - and that how they live life is up to them, rather than their parents or doctors," she says.