What Influences Young People

1
What Influences Young Peoples Decisions To Take
Risk?

• Assoc Prof John Scott
• Centre for Young Peoples Health, The University
  of Queensland
• jscott_at_hms.uq.edu.au

2
A spectrum from need a little help to dont
care?

• Risk-taking behaviour - volitional behaviour in
  which the outcomes remain uncertain with the
  possibility of an identifiable negative health
  outcome
• About 13 of teenagers fit the risk-taker
  profile
• Six categories of risk-taking behaviour
• Unsafe sexual activity
• Violence, accident and injury
• Alcohol and other drug use
• Use of tobacco products
• Poor nutritional habits
• Minimal physical activity
• Presence of chronic physical or mental health
  problems or disabilities increases these risks
  further

3
Risk-taking

• Becomes more common in 10 24 year age group
• Associated with changes in patterns of morbidity
  and mortality, some temporary, some permanent
• Part of normal adolescent development, but is not
  consistent for all young people
• An important life-stage for determining the
  lifestyle an individual adopts
• Transition process actively under the control of
  the individual but is also strongly influenced by
  the environment in which they live
• General characteristics of high-risk youth
• low school achievement and low basic skills
• lack of parental support (often due to parental
  health and behaviour problems)
• background in a disadvantaged racial group
• low resistance to peer influences
• early acting out in any of the behavioural
  domains
• residence in an impoverished neighbourhood.

4
Young people have been described as existing in
four worlds
School World
Peer World
Family World
Inner World
Dr Michael Carr-Gregg, Albert Road Centre for
Health
5
The inner world

• A persons perception of the world determines
  their likely behaviour. Likelihood of action is
  defined by perceived benefits minus perceived
  barriers. Major concepts are
• individual perceptions eg
• perceived susceptibility to serious outcomes
• perceived seriousness of outcomes
• modifying factors eg
• demographic variables
• psychosocial variables
• structural variables (knowledge, previous
  experience with health promotion etc)
• and the individuals
• perceived threat of adverse health outcome
• perceived cues to action (mass media campaigns,
  advice or encouragement from others)

6

• Individual perceptions are inherently subjective
  and influenced by personal biases. Adolescent
  issues
• availability bias
• how easily the event can be brought to mind
• influenced by frequency of the event, personal
  experience of the event, memorability of the
  event and vividness of the memory
• note potential impact of the media
• adolescents dont have a lot of experience to
  draw on and until they have a negative experience
  their lack of a negative experience may foster
  their bias
• representativeness bias
• where correlates with one attribute of a person
  generate biased perspectives on other attributes
• no more likely in adolescents than in adults
• inferential biases
• more likely to view ones own situation as more
  favourable than others in a similar position
• no more likely in adolescents than in adults
• attributional biases
• optimistic approach, never my fault, I am doing
  everything I need to do to avoid unfavourable
  outcomes no more likely in adolescents than in
  adults
• Overall, there does not appear to be any evidence
  to support an adolescent view of invulnerability
  that ignores reason

7
The family world and the peer world

• The information young people receive, and on
  which they base a lot of their risk-related
  decisions is variable and difficult to
  categorise. Factors to consider and which might
  be able to be influenced include
• strength of evidence
• bias of the information-provider
• social/political leanings of the provider
• intent of the provider (eg to sensationalise or
  play down the strength of a message)
• goal of the provider (eg to promote consumption
  of a product or to limit a behaviour)
• authoritative stance of the source (parent,
  teacher, peer, or media)
• Sociologists describe influences on young people
• increasing individualisation, at the same time as
  
• increasing conformity and control, associated
  with
• increasing individual isolation as the risks of
  the world are interpreted as personal and
  solutions to these risks are perceived and also
  portrayed as requiring an element of personal
  responsibility

8
Where the inner world meets the family and peer
worlds is a dynamic place

• Risk-taking reflects interactions between
• the adolescents developing personality system
• the environment perceived by the young person
• their developing behaviour system

9
The Personality System

• researchers recognise adolescent health risk
  takers and propose sensation seeking (seeking
  varied, novel, complex and intense sensations and
  experiences, with a willingness to take physical,
  social, legal and financial risks for the sake of
  such experience) as an index for this behaviour
  type. They also describe sensation avoidance.
• researchers propose that humans have individual
  levels of need for stimulation at which they are
  most comfortable and this affects attention.
  However high sensation seekers are not
  necessarily impulsive and we need to
  differentiate the two traits.
• for designing prevention messages for young
  people researchers propose we (a) use sensation
  seeking as a targeting variable (b) conduct
  formative research with target audience members
  (c) design high sensation-value prevention
  messages, and (d) place messages in high
  sensation-value contexts eg television programmes
  exciting to the target audience.

10
The perceived environment and health-promoting
settings

• adolescent beliefs and interpretations of risk
  are related to social and/or cultural experiences
  and knowledge and also to developmental
  differences in interpretation of risk,
  relationships and prevention messages.
• the social environment of a school and the
  overall quality of students relationships with
  teachers and with other students is important.
• teachers judgments are critically important and
  evidence suggests their classroom assessments are
  better than parents and peers in assessing
  future student outcomes

But environment is a fluid concept
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Translating personality and environmental
interaction to behaviours

• Problem-Behaviour Theory
• Young peoples perceptions of their environment
  are dynamic and based on variables in play at
  that particular time
• Behaviour is the outcome of the interaction
  between the young persons personality and this
  perceived environment
• The perceived environment includes
• distal variables - perceived support from
  parents, perceived support from friends,
  perceived controls from parents, perceived
  controls from friends, parent-friends
  compatibility of expectations, and relative
  influence of parents and friends
• (more important?) proximal variables - friends
  approval or disapproval, parents approval or
  disapproval and friends models of particular
  behaviours important at the time)
• Within the young persons personality system
  three goals are thought to be particularly
  salient peer affection, academic success and
  independence
• Behaviours thought to constitute a problem are
  not defined intrinsically by the young person but
  are defined by the norms of conventional society
  and by adult authority. Personal belief
  structures then may or may not prevent the young
  person from engaging in these problem behaviours
  and these structures are classified in four
  domains social criticism, alienation,
  self-esteem and internal-external locus of
  control.

12
Translating personality and environmental
interaction to behaviours

• Refinements of Problem-Behaviour Theory
• Resilience or a capacity to be shielded from
  negative environmental influences by what were
  defined as protective factors
• Protective factors considered to fall into three
  groups
• positive behaviours in the young persons
  personality or adaptive temperament
• a stable, cohesive and supportive family
• social and cognitive skills attained in a
  nurturing school environment

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Relevant influences, and how achievable is
resilience?

• Protective factors within the individual

Temperament Beliefs Skills
Sense of humour Internal locus of control Early communication
Positive self-image Religiosity Competent academically
Prone to engage in self-care strategies Intolerant of deviance Engaged in extra-curricular activities

• Protective factors within the family

Parents who Are caring and concerned Are at home at key times of day Have high expectations of academic performance Disapprove of health-risk behaviours Have not had prolonged separation from their children Families with Both parents in the home Fewer than four children Cohesion and structure

• Protective factors within the community

Caring adults Peers Access to resources
Positive role-modelling by adults Easy access to supportive resources Normative expectations
Communities exhibiting prosocial values and behaviours Value placed on adolescents contributions to the community Clear and consistent boundaries
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Translating these to behaviours

• Further Refinements of Problem-Behaviour Theory
• Contextualism theory of adolescent development
• Single outcomes are the final consequence of a
  long train of influences, some individual, some
  environmental
• The theory recognises positive environmental
  influences or protective factors and also
  negative influences
• Cannot say with certainty what a set of
  influences will create in terms of outcomes for a
  young person we can only be probabilistic about
  what is likely or unlikely
• Judgement (more than pure cognition) is likely
  to be very important, where judgement is
  influenced by the young persons sense of
  responsibility, of perspective, and temperance

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And just to make it more confusing

• Recent functional MRI evidence suggests
  significant variation in timing of brain
  maturation
• The pre-frontal cortex in particular appears to
  be the last part of the brain to develop
• Recent research suggests this area is intimately
  associated with research-based measures of
  cognition, decision-making and judgement, in
  controlling aggression and other impulses, in
  governing impulsivity, judgement, planning for
  the future, foresight of consequences, and other
  characteristics that make people morally (and
  criminally) culpable
• The process and its impacts are further
  complicated by the effects of increasing but
  unstable levels of sex hormones particularly for
  males, and the timing and psychosocial effects of
  pubertal maturation.

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To achieve their potential, children and
adolescents need families who love and care for
them friends who cherish and stand by them
communities that respect and include them a
world that makes sense to them and a future that
offers them hope. They also need, at least some
of the time and in some respects, freedom from
all these things, or from what they imply
freedom from care, from media intrusion,
manipulation and exploitation, from adult
intervention, supervision and worries freedom to
be themselves, to explore their world, to take
risks, to set their own pace.
Well Good, Richard Eckersley
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Evidence from the area of drug use

• indications are that behaviours can be influenced
  by social factors
• awareness of risks will influence use and
  increased risk perception has been followed by
  decreased use in a number of substances
• role models (both positive and negative) are
  important in influencing young peoples
  behaviours
• advice to Just say no is not sufficient for
  prevention. Evidence is young people do have some
  capacity to differentiate between levels of risk
  and engaging groups in discussion about the
  problems, the risks and strategies to avoid the
  negative outcome are all worthwhile

18
Evidence from the areas of smoking and sexual
behaviour

• willingness (as distinct from preparedness) to
  engage in a risk behaviour is a less thoughtful
  reaction to a risk-conducive situation (involving
  relatively little precontemplation or
  consideration), and involves less internal
  attribution of responsibility for the behaviour
  or its attendant consequences. This suggests one
  intervention might be to facilitate adolescents
  contemplation of the situation and their
  responses before they are in the situation. This
  is something that can especially be supported by
  parents
• for young people, immediate short-term costs and
  benefits loom larger than long-term costs or
  benefits. This implies time perspective should be
  considered in interventions with emphasis being
  placed on communicating explicitly the
  longer-term costs and benefits as part of the
  strategy

19
In promoting positive behaviours in young people,
it is important to

• recognise social influences, including media
  coverage, and promote or address where
  appropriate
• consider the influence of role models, both
  negative and positive
• appreciate that telling them to Just Do It may
  not be sufficient
• engage in discussion to
• determine whether saying they will can translate
  into committed action
• ensure they fully appreciate long-term benefits
  and costs

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Getting the message across, or how to harness the
resources at hand

• Two relevant perspectives, Epidemic Modelling of
  the Onset of Social Activities (EMOSA) and the
  Tipping Point model, recognise a number of
  activists and concepts as being important
• Mavens who hold and pass on relevant important
  information
• connectors who know the networks and are good at
  passing information around
• salesmen who are good at getting their friends to
  change their behaviour
• the Law of the Few which says some people
  matter more than others
• the Stickiness Factor which says there are
  specific ways of making a contagious message
  memorable
• the Power of Context which says the key to
  getting people to change their behaviour
  sometimes lies with the smallest details of their
  immediate situation.

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To make a difference, it is important to

• understand the beliefs and attitudes of the
  audience and use and strengthen the culture
  and relationships of the school teachers know
  these best
• identify the sensation seekers and keep them
  entertained (within reason!) usually the others
  will follow
• use the most stimulating media and messages
  wherever possible
• understand and use the influential student
  dynamics and contexts relevant to your message

22
The message form and the evidence

• the evidence on which to choose the best message
  is very thin.
• five influences are recognised
• (a) perceptions of severity of outcome weak,
  mixed evidence
• (b) perceptions of vulnerability to outcome
  weak, mixed evidence
• (c) perceptions of extrinsic and intrinsic
  rewards vs costs for participating in the risk or
  protective behaviour strong evidence across
  time, environments and issues
• (d) perceptions of the effectiveness of the
  protective behaviour weak, mixed evidence
• (e) perceptions of ones ability to conduct the
  protective behaviour weak, mixed evidence.
• intervention options include
• face-to-face boosters - reinforce old
  messages, present new ones, provide correct
  information, potentially build on social
  interactions developed in earlier sessions, and
  enable interactive question-and-answer exchange,
  but probably only useful for two sessions
• mass media - particularly effective for changing
  perceptions of peer norms, can alter perceptions
  of severity and vulnerability, unlikely to alter
  perceptions of self-efficacy, or of intrinsic
  reward or core values.
• parental monitoring the most important for
  sustaining and broadening the effect

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Message topics

• topics where there is agreement are likely to
  have a higher rate of success when designing a
  campaign
• depending on the behaviour being addressed, young
  people with different perceptions of risk may
  have different perceptions of health-related
  issues and different beliefs about positive and
  negative consequences eg alcohol at a party
  always causes trouble, or people who dont
  drink always have more fun
• there will be issues on which both high and
  low-risk groups will agree eg accidents when
  drunk can cause serious injury, or hydration is
  an important issue at dance parties though they
  are likely to differ on the magnitude of the
  effect

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Delivering the messages

• evidence for the most effective approach is thin
• stimulating an appreciation of the potential
  rewards for the young person has by far the best
  evidence
• face-to-face discussion and media are useful but
  parental support is the most effective
• choose topics of focus for which all young people
  can see a positive, even if some will be more in
  agreement than others

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Things that work

• intensive individual attention (often reflects a
  role as a surrogate parent)
• early intervention
• focus on schools (school as an experience school
  as a site)
• services provided in schools by outside
  organisations, including bringing the funding
• comprehensive multi-agency, communitywide
  programmes
• parents have a defined (real) role
• peers (maybe also high-risk) have a defined
  (real) role
• arrangements for training of teachers, including
  funding and release time
• need to link to the world of work

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Things that dont work

• providing information only, with no change to
  social skills
• saying no or Just Do It programmes
• scare campaigns
• programmes for high-risk kids that isolate them
• special cultural programmes
• stigmatising children may be better to have
  special programmes for high-risk schools based on
  local demographics.

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Youth development programs (United States)

• Eight features for positive developmental
  settings
• physical and psychological safety
• appropriate structure
• supportive relationships
• opportunities to belong
• positive social norms
• support for developing efficacy and building a
  sense of mattering
• opportunities for skill building
• integration of family, school and community
  efforts.

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We know behaviours can be changed to improve
health despite

• Powerful addictions
• Peer pressures
• Social taboos
• Vested commercial interests
• Ingrained social values
• Huge increasing rates
• Unknown causes

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We know behaviours can be changed to improve
health despite

• Powerful addictions - tobacco
• Peer pressures - wearing sun hats
• Social taboos - AIDS safe sex ads
• Vested commercial interests - tobacco
• Ingrained social values - tanning
• Huge increasing rates heart disease
• Unknown causes cot death

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Winning the Fight Against Road Deaths15 - 19
year old males
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We just need the right level of investment and a
supportive environment for change
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Good Luck