The RT-18: A new instrument to assess adolescent and young adult risk-taking behavior

Healthcare is built on decisions. In order to make a decision, the potential benefits and risks involved need to be judged. Some individuals are inclined to take more risk, where others are rather risk averse. Such a general predisposition towards risks (e.g. risk-taking or risk-avoiding) can have great impact on health decisions made and the behavior displayed by that individual, whether it concerns a healthcare professional or a patient.

This thesis focused on individual differences in risk-taking behavior by assessing the underlying psychological component as well as the actual expressed risk behavior. We have therefore developed a new instrument, the Risk-Taking questionnaire 18 items (RT-18) to measure the postulated personality trait of risk-taking behavior at an individual level.

We tested the RT-18 in various populations of university students recruited in the vicinity of Utrecht on correlations with alcohol, drugs, and medication use and other risk variables. We found, among other things, that the RT-18 was able to differentiate recreational drug users from social drinkers and men from women in a sample of 7834 young adults. When we classified another sample of 6002 young adults in abstinent, non-binge and binge drinkers based on self-report, we found that the RT-18 associated with these levels of alcohol consumption. A 31-day-diary study in 109 university students study pointed out that RT-18 scores were increased for those who engaged in high levels of recreational drug use, smoking and drinking. In a study with 777 adolescents, we found associations between the RT-18 scores and the beliefs about medicines questionnaire, and although the effects were small, they were highly significant.

Like any model or theory, the validity of the RT-18 can never be completely established, and evidence will accumulate that is either supportive or unsupportive of the hypothesized construct. Combining all the pieces we found thus far, there is substantial evidence to support the RT-18 indeed measures the personality construct of risk-taking behavior and that risk-taking behavior comprises two factors; risk-taking and risk assessment. Hence, we feel that at this moment, the RT-18 is a sufficiently valid measure of risk-taking behavior in adolescents and young adults. An advantage of the RT-18 is the short time that is needed for the administration, in general 2-5 minutes.

We do stress that the validity of the RT-18 and the underlying personality construct need to be clarified much more, for instance in other target-populations and across cultures. It should also be noted, that although the validity of the RT-18 is sufficient, certain psychometric properties still need to be improved or have room for improvement.

In short, we have taken the first promising steps towards the development and validation of the RT-18, an instrument to assess risk-taking behavior in adolescents and young adults. The RT-18 might prove to be useful in a number of situations; from gaining insight in the processes underlying medical decision making and thereby aiding the shared decision making process, to guiding healthcare professionals when dealing with risk-behaviors like non-adherence to prescribed medication.