Risky behaviors:

• Injury-related behaviors
• Motor vehicle use
• Substance use
• Unsafe sexual behavior
• Violence and crime
• Suicide
• Unhealthy eating behaviors

• death
• physical and psychological disability
• sexually-transmitted disease
• unplanned pregnancy
• school failure
• premature cardiovascular disease
• hypertension
• obesity
• osteoporosis
• heart failure

Risk-taking Behavior in Adolescents: The Paradigm
by Charles E. Irwin, Jr., Vivien Igra, Stephen Eyre, and Susan Millstein, UCSF
 

Two assumptions drive the research on risk-taking in adolescents:

1) teenagers engage in a series of "risky " behaviors and feel invulnerable to the consequences of these behaviors as compared to adults.

2) All risk-taking behaviors occurring through the second decade of life are driven by similar mechanisms and the behaviors themselves are similar.

For later discussion: Views that challenge the paradigm:
"Risk behavior, the dominant construct explaining adolescent morbidity and mortality, is inadequate because it assumes that all adolescents develop similarly when, in fact, gender, race, and socioeconomic status force different developmental patterns and health outcomes." p. 126 Beyond Risk Taking (FS140R course reader)
 

The paradigm of risk is explained using 3 approaches:
1. dispositional
2. ecological
3. biological
 

Why do we need to explain risk using a distinct model?
Because these models have implications for intervention and prevention programs.
 

1. Risk-taking as a dispositional trait:

The paradigm:

• Focussed on the individual.  You change the behavior by changing the individual.

Tenets:

• Some teens have a tendency to engage in risky behaviors.
• Risk-taking is a deviant behavior.

Version One: deviance is a function of a character deficit:

• self-esteem
• depression
• inadequate social skills
• impulsivity (characteristic of ADD)
• general propensity for deviance

Implications for intervention:
Direct education and intervention programs at improving self-esteem, reducing depression, decreasing impulsivity, etc. (address the individual behavior trait).

Counter arguments to this view:

• Some research shows that risk-taking can raise self esteem.
• In some studies, certain risky behaviors (such as sexual behavior) have been shown to correlate with higher self-esteem.

Version two: dispositional model: sensation-seeking

• Individuals differ in their underlying needs for stimulation or sensation thrill-seeking.
• substance use, motor vehicle use, dangerous sports, sexual behavior provide "needed" stimulation

Implications for intervention?...
 

 2. Risk-taking from an ecological perspective:

The paradigm:

• Ecological theory considers the human organism within its social and environmental context.

• The social environment provides social norms, models, opportunities, and reinforcements for adolescent participation in risky behaviors
• Implies teens engage in risky behavior not because they internally "want" to, but because of external pressures and stimuli.

Implications for intervention:
Change the social context
Give teens tools to navigate their environment.

Example of an ecological model:
from M. Brofenbrenner: The ecology of human development. Experiments by Nature and Design.  1979.

An ecological paradigm for adolescents' social world:

1. Microsystem: proximal contexts, direct interaction

• peers
• family members
• social instituitions, e.g. church, school

2. Exosystems: more distal social contexts

• community
• mass media
• social policies

3. Macrosystems: the most distant social contexts

• culture
• economics
• politics

1. Microsystems:
risk research traditionally focuses on peers and parents

Peers
 

• "peer pressure"
• identity formation outside the home
• conformity (peaks during early adolescence)
• peers as models
• opportunities

Research documents a correlation between a teen's behavior and that of her peers.

Counterpoint: Maybe adolescents who are inclined to take risks just choose peers who are similarly inclined (disposition).
 

Implications for intervention:

• Teach teens skills to resist peer pressure
• Give them other outlets for developing identity outside of the home (e.g. sports)
• Give them alternative models
• Change the perceived norms:
• "There is evidence that people who perceive a norm of safer sex behaviors are more likely to protect themselves." p.127 adolescent sexual risk-taking (FS140R Course Reader)

Parents:
Risky behavior correlates to two dimensions of parenting style:
1. level of demand that parents place on their adolescents  (demanding vs. not demanding)
2. the degree of emotional responsibility parents place on their adolescents (responsive vs. not responsive)

Research shows:

least risky behavior  ------------------------------------------------------->most risky behavior
demanding, responsive                          demanding, unresponsive                 undemanding, unresponsive
                                                            undemanding, responsive

Other Parental Influences:
 

• Lack of supervision:

• Modeling:

Implications for Intervention:
Focus more education campaigns on parental behavior change.
 

2. Exosystems:
Media and community are common examples.

Media
- studies link tv violence and childhood aggression
- media portrayals of body image and dieting behaviors correlate to unhealthy eating behaviors

Community
- environment controls availability to risks
(cigarettes, alcohol, drugs)
- how well communities "link the achievement of future goals to the absence of risk-behaviors" influences risk behavior
- decreasing access to health-care and lack of insurance
 

Implications for intervention:

• Regulate the media.
• Use the media to promote safe behavior.
• Use the media to change perception of norms.
• Community-based intervention.

 3. Macrosystems: the impact of culture.

Risk-taking behavior rates vary in different cultural, economic, and political contexts

examples:
- despite similar ages of sexual debut, the US has the highest rates of adolescent childbearing and abortion in the developed world.

- Rates of contraceptive use vary significantly by religious affiliation

- Eating behaviors vary by culture
 

Little research has explored the meaning of risk taking in different cultures.

Implications for intervention:?...
 

 3. Risk-taking from a biological perspective:

The paradigm:

• Biological models says that biologic factors such as genetics, neuroendocrine factors, hormones, and the timing of pubertal events, drive risk-taking behavior.

Examples

direct influences of biology:

• Genetic predisposition has been established in adolescent alcohol abuse (adoption studies).
• sex hormones are implicated in risky sexual behavior, esp. testosterone
• Neuroendocrine factors may explain sensation-seeking behavior

• pubertal onset may change expectations for behavior:
• family interactions
• parental feelings
• peer expectations
• adolescent's respond to physical changes of puberty

•  Pubertal onset changes peer relationships, such as interaction with the opposite sex

Implications for Intervention:

• Treat risky behavior as a biological problem.
• Treat hormonal and neuroendocrine "problems" with drug-therapy.
• Only target certain genetic profiles for intervention.

Example: Sexual Risk-Taking:

behaviors:

•   early sexual debut
•   no or inconsistent contraception
•   multiple sexual partners or serial monogamy
•   no or inconsistent condom use

•   unwanted pregnancy or abortion
•   STD's

Facts:

• Sexually active adolescents are at greatest risk for contracting STDs.
• By age 20, 75% of females have experienced sexual intercourse.
• Of these adolescents, fewer than 40% reported using condoms at last intercourse.
• Gonorrhea, chlamydia, and possibly human papilloma virus infection rates are highest among 15- to 19-year-olds.

Biopsychosocial factors:
Risk co-variation:
Adolescents who are having unsafe sex are also engaging in other risk behaviors.

Predictable Temporal sequence of risk behaviors:
In one study, 5x as many females initiated substance use prior to sexual activity than initiated sexual activity prior to substance use.

Racial/ethnic differences:
In another study, the number of risk behaviors (substance use, dangerous vehicle use, etc.) correlated with intention to become sexually active in white, but not black women (intended sexual debut only correlated with age).
 

Timing of Pubertal events:
earlier maturing girls:

• are more depressed
• have more popularity with older males
• have an earlier sexual debut

Risk Perception
Egocentrism

Knowledge doesn't imply action:

• A study of 99 adolescent women at a comprehensive adolescent clinic found that, although 62% of the women reported that a fear of AIDS had influenced their contraceptive behavior, less than 18% reported asking their partner to use a condom to prevent AIDS.
• Another study found that although 74% of the females knew that condom use provided effective protection from STDs and AIDS, less than 20% reported using a condom for that purpose.

Other risk-taking research:

• Health considerations played a minor role in determining condom use compared to other immediate consequences, such as perceived inconvenience of use and perceived partner attitude.

• Young adolescents may not yet accept their own sexual identity and therefore have difficulty complying with contraceptive methods that involve anticipating intercourse.

• Male adolescents perceive their partners want them to use condoms, whereas females feel uncertain about males' desires to use them.

• A female's perception that her partner wants to use condoms significantly increases consistent use, regardless of the exclusiveness or duration of the relationship.

 Challenging the paradigm: points for discussion...

"Risk behavior, the dominant construct explaining adolescent morbidity and mortality, is inadequate because it assumes that all adolescents develop similarly when, in fact, gender, race, and socioeconomic status force different developmental patterns and health outcomes." p. 126 Beyond Risk Taking
 

"The implication of much of our research is that sexual behavior during adolescence is "risky" behavior that is unacceptable.  Erhardt points out that many developed countries of the world view adolescent sexual activity as normal and acceptable.  Intervention strategies are directed at preventing unintended negative consequences such as pregnancy but these interventions are framed within  a context of acceptance of sexual expression in adolescence."  (most other developed countries have lower pregnancy rates than the US).  p. 131 adolescent sexual risk-taking
 

"When gender has been considered in prevention efforts, it is typically to enhance the self-esteem, self-efficacy or decision-making skills of girls as opposed to challenging the social contexts that proscribe sexual roles and expectations for women and that create or support an imbalance of power in their relationships with men." p. 127 Beyond Risk Taking