1. Department of Social and Decision Sciences Adolescents at Risk Julie S. Downs, PhD

2. Department of Social and Decision Sciences Why Teens Take Risks Trade off costs (or risks) and benefits –Time horizon –Probabilistic Conventional wisdom –Failure to appreciate risks –Perceptions of invulnerability Fischhoff, Parker, Bruine de Bruin, Downs, Palmgren, Dawes, & Manski (2000)

3. Department of Social and Decision Sciences Goals: School and Work Have a a high school diploma by age 20? Working for pay more than 20 hours/week by age 30? estimateactual 93.4% 84% 92.3% 91%

4. Department of Social and Decision Sciences Risks: Crime Be the victim of a violent crime in the next year? Be arrested, whether rightly or wrongly, in the next year? estimateactual 14.7% 10% 10.2% <10%

5. Department of Social and Decision Sciences Risks: Mortality Die from any cause (crime, illness, accident, and so on) in the next year? Die from any cause (crime, illness, accident, and so on) by age 20? estimateactual 18.6% 0.08% 20.3% 0.4%

6. Department of Social and Decision Sciences Teens’ Risk Perceptions Mildly optimistic about achievements Greatly overestimate risk of dying young Implications for risk communications capitalizing on perceived invulnerability Perceptions follow from communications in non-obvious ways

7. Department of Social and Decision Sciences Optimistic Bias It’s not just for teenagers See less risk for ourselves –Even as we overestimate all risks –Feel in control of own outcomes Know risk of smoking, but… –Less at risk than the “typical smoker” –Think they can avoid risk

8. Department of Social and Decision Sciences Unrealistic Optimism Some who seem optimistic are realistic –Their health may actually be very good –Some are aware of their high risk Tie estimates to actual health –Mismatch is often optimistic –These people are particularly resistant to efforts to change behavior

9. Department of Social and Decision Sciences “Yeah, but for a fat guy who doesn’t exercise I’m in pretty good shape.” Unrealistic Optimism

10. Department of Social and Decision Sciences Risk Communications Often ignore common gaps in knowledge and misconceptions Halperin, 1999 Information chosen for reasons other than needs of target audience Bok & Morales, 1998 Often repeat well-worn messages that don’t change behavior Crosby & Yarber, 2001

11. Department of Social and Decision Sciences Are We Missing Something? “Despite massive sexual education efforts, more teenage girls are getting pregnant than ever before. Exactly how are all these teens getting pregnant?”

12. Department of Social and Decision Sciences Unhelpful Risk Messages Attention to very low risks Exaggeration of risk Various motivations –Assumption that teens don’t appreciate risk –Desire to control behavior –Liability concerns for products or messages Little concern about spill-over effects

13. Department of Social and Decision Sciences Overexposure to Warnings Come to expect warnings –Obvious –Unlikely Lawyers think it couldn’t hurt

14. Department of Social and Decision Sciences Risk Warnings Harmful if swallowed 12 fl. oz. (355 ml) DANGER: Harmful or fatal if swallow — FLAMMABLE Read carefully other cautions on the back panel, Child-protective spout Warning: this product moves when used Risk Warnings

15. Department of Social and Decision Sciences Too Many Warnings Sometimes compensate for poor product design –Better to fix the flaw –Burden on consumer Desensitize people to real warnings Lawyers think it couldn’t hurt –But it can hurt!

16. Department of Social and Decision Sciences Risk Estimates Conventional wisdom –Teens don’t appreciate risk –Need to make sure they are aware What happens when we distort the risk?

17. Department of Social and Decision Sciences Risks of Body Piercing (Schorzman, Gold, Downs & Murray, 2007)

18. Department of Social and Decision Sciences Problems with Exaggeration Inconsistency of information Source may become discredited –Discount all information from source –Ignore all risk messages Experience may interact with beliefs –Undermine all knowledge of domain –Draw inappropriate conclusions

19. Department of Social and Decision Sciences Seek Information After Risk unsafe sex pregnancy test prior to baseline condom failure OR=2.15* OR=2.12*

20. Department of Social and Decision Sciences Draw Reasoned Conclusion unsafe sex pregnancy test infertility belief misconceptions prior to baselineat baseline condom failure OR=1.22* OR=3.28*

21. Department of Social and Decision Sciences Act on Inferences unsafe sex pregnancy test unsafe sex infertility belief misconceptions OR=3.63* OR=7.98** prior to baselineat baselinesix months after baseline (Downs, Bruine de Bruin, Murray & Fischhoff, 2004)

22. Department of Social and Decision Sciences Communication of Values Focus on right vs wrong rather than risk Avoid problem of wrong information by not providing any But messages interact with context –Underlying knowledge –Inferences about risk –Inferences about message

23. Department of Social and Decision Sciences Communication of Values

24. Department of Social and Decision Sciences Definition of Abstinence What does abstinence really mean? –Chastity –Purity –Not having sex What “counts” as abstinence? What are abstinent teenagers doing?

25. Department of Social and Decision Sciences Disingenuous Communication Messages violating known facts –Exaggerated messages did not violate logical relationships –Values-oriented messages did not present logical arguments May require a network of insincere arguments to sustain

26. Department of Social and Decision Sciences Disingenuous Communication “If a player lands on the ‘Go To Bar’ square he must move directly to the ‘Bar.’ Player does not collect a ‘PINK ELEPHANT’ card. If the player in the ‘Bar’ does not throw a 7 or 11 on his first, second or third turn, he must leave the ‘Bar’ on his third turn by moving the number of squares and taking the number of drinks indicated by the roll of the dice.” —PassOut Rules MINORS FORBIDDEN TO PLAY THIS GAME NOT INTENDED FOR USE WITH ALCOHOLIC BEVERAGES Disingenuous Communication

27. Department of Social and Decision Sciences Reducing High-Risk Behavior Context affects message impact –Past and future communications –Past and future experiences Intuitive understanding of domain –As basis for new information –As challenge for changing understanding

28. Department of Social and Decision Sciences Qualitative Barriers Confidence may not be appropriate –Uncertainty may undermine beliefs –Overconfidence may lead to insensitivity to new information Conceptual misunderstanding can lead to incorrect inferences New information may not make sense

29. Department of Social and Decision Sciences Ignoring Misconceptions

30. Department of Social and Decision Sciences Guidance for Content Focus on well-formulated decision Gather input Compare what’s known with what should be known –Evaluate other messages –Develop new messages

31. Department of Social and Decision Sciences Mental Models Approach Integrated assessment of expertise Information from target audience Identify gaps, misconceptions and critical problems in comprehension Intervention to correct problems –present information relevant to decisions –use nonjudgmental, nonpersuasive tone Evaluate communication

32. Department of Social and Decision Sciences Teens’ HIV/AIDS Knowledge High levels of basic knowledge High confidence in knowledge Gaps and misconceptions –It only takes once to get HIV –Behaviors are either risky or safe –Protection from Condoms –Know your partner (Bruine de Bruin et al., 2007)

33. Department of Social and Decision Sciences Qualitative Study of Teen Sex Ignored risk, especially relative risk –Dismissing condoms as not 100% effective Felt powerless under situational influences –Must avoid normal social interactions Poor reproductive health knowledge Knew little of infections other than HIV (Downs et al., 2004)

34. Department of Social and Decision Sciences What Could You Do? Based on results from interviews –Extensively piloted for comprehension Nonjudgmental tone maintained Immediate, non-probabilistic outcomes –Focus on worry as negative outcome –Avoid scare tactics (e.g., fear of AIDS) Interactive video format

35. Department of Social and Decision Sciences Perceived Risk of Sex Misconceptions about risk in sexual behavior are common –Risks vary across behaviors –Risks increase cumulatively with more exposures –Risk can be reduced, even if not to zero Teens may define terms such as abstinence in creative ways

36. Department of Social and Decision Sciences Condom Effectiveness Misrepresentation of facts –Alleged microscopic “holes” in latex –Alleged link between condom education and sexual behavior Inappropriate risk comparisons –Dismiss value of relative risk reduction –User vs. method failure rates

37. Department of Social and Decision Sciences Hows & Whys of Condoms

38. Department of Social and Decision Sciences Perceived Control Over Sex Young women may not perceive choices about sexual behavior Many report sex as normatively driven, without thought about risk Potential alternative actions –Suggested explicitly in the story –Less risky behaviors are modeled

39. Department of Social and Decision Sciences Options for Control Over Sex

40. Department of Social and Decision Sciences Evaluation of Intervention Girls watching What Could You Do? benefited compared to controls –Twice as likely to become abstinent* –Condoms failed less than half as often* –45% less likely to report contracting a infection six months later* –Fewer tested positive for Chlamydia trachomatis *p<.05 (Downs et al., 2004)

41. Department of Social and Decision Sciences Conclusions Consider adolescents’ decision context –Be consistent with real-world information Mental models interventions –Avoid value judgments –Provide information that fits into the target audience’s existing understanding –Change behavior consistent with shared goals of communicator and audience

42. Department of Social and Decision Sciences Awards for Mental Models Risk Communications

43. Department of Social and Decision Sciences References Bruine de Bruin W, Downs JS, Fischhoff B. Adolescents’ thinking about the risks and benefits of sexual behavior. In: Lovett, M. & Shah, P. (Eds.) Thinking with data. Mahwah, NJ: Erlbaum, 2007. Downs JS, Bruine de Bruin W, Murray PJ, Fischhoff B. When “it only takes once” fails: perceived infertility predicts condom use and STI acquisition. Journal of Pediatric and Adolescent Gynecology, 17; 2004:224. Downs JS, Fischhoff B. Parents’ vaccination comprehension and decisions. Internal report to the Centers for Disease Control and Prevention, 2002. Downs JS, Murray PJ, Bruine de Bruin W, Penrose J, Palmgren C, Fischhoff B. Interactive video behavioral intervention to reduce adolescent females' STD risk: A randomized controlled trial, Social Science & Medicine, 59; 2004:1561-72. Fischhoff B, Downs J. Accentuate the relevant. Psychological Science, 8; 1997:154-158. Fischhoff B, Parker A, Bruine de Bruin W, Downs J, Palmgren C, Dawes RM, Manski C. Teen expectations for significant life events. Public Opinion Quarterly, 64; 2000:189-205. Schorzman C, Gold MA, Downs J, Murray PJ. Body piercing attitudes and practices among college students. Journal of the American Osteopathic Association, 107; 2007:432- 438..