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What Influences Young People

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What Influences Young People s Decisions To Take Risk? Assoc Prof John Scott Centre for Young People s Health, The University of Queensland – PowerPoint PPT presentation

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Title: 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
11
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

13
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
14
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

15
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.

16
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
17
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

20
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.

21
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

23
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

24
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

25
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

26
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.

27
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.

28
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

29
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

30
Winning the Fight Against Road Deaths15 - 19
year old males
31
We just need the right level of investment and a
supportive environment for change
32
Good Luck
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