in the context of seizures (Kyngas, 2001; Kyngas et al., 2000), asthma (Kyngas, 1999), diabetes (Wysocki et al., 2000; Ott et al., 2000), or sexual risk avoidance (Stanton et al., 1996; St. Lawrence et al., 1995; Jemmott and Jemmott, 1994).

These conceptual considerations lead directly to specific interventions, such as motivational enhancement strategies to encourage youths’ substance abuse treatment compliance (Carroll et al., 2001), engaging them in sexual risk prevention activities (Stanton et al., 1996; St. Lawrence et al., 1995), and using collaborative goal-setting strategies in enhancing adolescent diabetes self-care (Delamater et al., 2001). In addition, these theories help explain why and how child compliance may be positively (or adversely) affected by peer and family support (LaGreca and Bearman, 2002; LaGreca et al., 2002; Liss et al., 1998), as well as the support available through a good relationship between the youth and his or her health care team (DiMatteo, 2000; Kyngas et al., 2000). The effect of and the need for support may vary as a function of age (Steinberg, 1999).

Research has documented the impact of chronic illness on child and adolescent adjustment (DiMatteo, 2000; Kyngas et al., 2000). Not infrequently, depression, anxiety, low self-esteem, or other adjustment difficulties may ensue as a result of the underlying illness, increasing risk for treatment nonadherence (Wise et al., 2001; Murphy et al., 2001; Davis et al., 2001) or worsening the outcome of the primary illness (Kuttner et al., 1990; Hauser et al., 1990). Available evidence suggests that good communication skills and the development of positive relationships with the clinical team may offset the effects of negative emotions on health care adherence (Buston, 2002; García and Weisz, 2002; Shaw, 2001).

Emotion, Cognition, and External Influences

The importance of cognitive ability and understanding inappropriate health-related behaviors must also be considered. Children’s ability to understand safety rules and health behaviors increases with age (Morrongiello et al., 2001). Over time they acquire the capacity to conceptualize and understand the longer term consequences of their behaviors on their health (Thomas et al., 1997). Conversely, children with developmental disabilities or impaired language ability often show increased difficulties in adhering to necessary behaviors, including health-maintaining ones (Stansbury and Zimmerman, 1999).

While attitudinal, motivational, cognitive, and emotional factors may all exert direct effects on health-related behaviors, the role of environmental factors in these behaviors should not be underestimated. For example, under some circumstances, behavioral factors may contribute less to youths’ actual health care behaviors than making available a more easily used medication, such as a long-acting form of medication in the case of birth control (Stevens-Simon et al., 2001; Omar et al., 2002) or providing more stable living situations in the case of adolescents’ likelihood of adhering to an HIV/AIDS drug regimen (Conanan et al.,



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