Table 3. Theme 2.

The adolescent stage.

Subtheme	Concept	Exemplar quote
Developmental impulses	Appetite for novelty and experimentation	I did [have fun drinking with my friends]. It was more fun because it was like the introduction to it, not because of the people I was doing it with. I was trying something new, and it was sort of adventurous. (18-year-old female with JIA) I figured I'll give [marijuana] a try, whatever. It was never like a pressure situation. It was just like I wanna see what it does to you. (17-year-old male with T1D)
	Reactance against perceived authority (psychological reactance)	…I was always told that I can’t [drink], so that made me want to do it more. (18-year-old female with JIA) For a lot of kids, it's like, the temptation to drink is because they're not allowed to, like their parents say “no.” (18-year-old female with T1D)
	Value for autonomous decision-making	It's possible that someone with [Rheumatoid Arthritis] isn't going to care as much about their body as I do and that's perfectly fine like, “you do you.” (18 year-old female with JIA) We know there are a lot of people that do[drugs] and I mean if they want to do it…[that is] their own business… I have nothing to do it with it…If you're gonna do that, then do it. But I'm not gonna do it. (19-year-old male with JIA) …there wasn't like any peer pressure or anything either. [Drinking] was like my decision I made on my own. (19-year-old male with JIA) Everyone has their own choices and opinions [about marijuana]. (19-year-old female with asthma)
Social and contextual influences	Perceived friend group norms	I'd say starting at the beginning of junior year [of high school] basically like everyone drinks like, if you don't drink you really can't socialize. (18-year-old female with JIA) …this must've been on my mind that other people were doing it (drinking), so I might as well try it. (19-year-old male with JIA)
	Observational learning	…after my friend had passed away–she had diabetes and she did have complications that were directly from drinking, so like that was partially why I like chose to not drink. (19-year-old female with T1D) …when [my cousin] got a little bit older she started to neglect [her diabetes] and not take her insulin, and she would drink a lot of alcohol and got into drugs and things like that. And now she has lost a lot of her vision and has gastroparesis and stuff like that that I don't want to have. (17-year-old female with T1D) …Every weekend [people] would [drink] and that would just be so normal to them, and I feel like they learn a lot doing it. (18-year-old female with JIA)
	Availability of attractive alternatives	Well, I have plenty of fun without alcohol itself and I just like to enjoy the situation. Like if we are having a fire, I will make a nice s'more or at least roast some marshmallows for someone else. (17-year-old male with T1D) It was one of those things where it was just like I was bored over summer and I wanted to do it (drink). (18-year-old female with JIA)
Balancing adolescent impulses and chronic disease concerns	Adjusting treatment regimen	I try really hard to take my methotrexate on the day that's like, the furthest from the day that I would be drinking. So like if I was drinking on a Saturday, I would try to take it on a Tuesday or Wednesday night. (18-year-old female with JIA) I have to give myself 60 units [of insulin] per beer…so say I'm heading out, I'll give myself 120 units, have a couple beers, wait a little bit, have some more units, have some more beers. It's kind of like that. (17-year-old male with T1D)
	Minimization of risk	…with all the technology now you really don't have to worry about [diabetes] that much [while drinking]. If you just have it in the back of your mind, then you're fine. I really just can live life normally. (18-year-old male with T1D) I’m just not like stupid about [drinking on methotrexate]…I wouldn’t like chug an insane amount. (18-year-old female with JIA) I keep [my drinking] under control pretty good. I'm not an alcoholic or anything so it doesn't affect [my diabetes] much. (17 year-old male with T1D)
	Substitution	…I have like tried pot instead [of drinking] and like even [my parents] were obviously not happy about that decision, but like understood that it wasn't like affecting my diabetes as much as like other decisions might have. (19-year-old female with T1D) I get high instead of getting drunk…Well, the diabetes–that's pretty much it…That’s pretty much the only reason [why I don’t drink]. (19-year-old male with T1D)