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

Background 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. Methods 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. Results 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). Conclusion 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.