ADOLESCENT RISK AND VULNERABILITY

CONCEPTS AND MEASUREMENT

Baruch Fischhoff, Elena O. Nightingale, Joah G. Iannotta, Editors

Board on Children, Youth, and Families

Division of Behavioral and Social Sciences and Education

National Research Council and

Institute of Medicine

NATIONAL ACADEMY PRESS
Washington, D.C.



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Adolescent Risk and Vulnerability: Concepts and Measurement ADOLESCENT RISK AND VULNERABILITY CONCEPTS AND MEASUREMENT Baruch Fischhoff, Elena O. Nightingale, Joah G. Iannotta, Editors Board on Children, Youth, and Families Division of Behavioral and Social Sciences and Education National Research Council and Institute of Medicine NATIONAL ACADEMY PRESS Washington, D.C.

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Adolescent Risk and Vulnerability: Concepts and Measurement NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The study was supported by Grant No. B7128 and B6815 between the National Academy of Sciences and the Carnegie Corporation of New York. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Adolescent risk and vulnerability : approaches to setting priorities to reduce their burden / Baruch Fischhoff, Elena O. Nightingale, Joah G. Iannotta, Editors. p. cm. Includes bibliographical references. ISBN 0-309-07620-X (perfectbound) 1. Risk-taking in adolescence (Psychology)—United States—Congresses. 2. Teenagers—United States—Social conditions—Congresses. 3. Teenagers—Health risk assessment—United States—Congresses. 4. Youth—Government policy—United States—Congresses. I. Fischhoff, Baruch, 1946- II. Nightingale, Elena O. III. Iannotta, Joah G. HV1431 .A633 2001 362.7′083′0973—dc21 2001005256 Additional copies of this report are available from the National Academy Press, 2101 Constitution Avenue, N.W., Lock Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area) This report is also available online at http://www.nap.edu Printed in the United States of America Copyright 2001 by the National Academy of Sciences. All rights reserved. Suggested citation: National Research Council and Institute of Medicine. (2001). Adolescent risk and vulnerability: Concepts amd measurement. Board on Children, Youth, and Families. Division of Behavioral and Social Sciences and Education. Baruch Fischhoff, Elena O. Nightingale, and Joah G. Iannotta, Eds. Washington, DC: National Academy Press.

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Adolescent Risk and Vulnerability: Concepts and Measurement THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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Adolescent Risk and Vulnerability: Concepts and Measurement BOARD ON CHILDREN, YOUTH, AND FAMILIES EVAN CHARNEY (Chair), Department of Pediatrics, University of Massachusetts JAMES A. BANKS, Center for Multicultural Education, University of Washington DONALD COHEN, Child Study Center, Yale University THOMAS DEWITT, Children’s Hospital Medical Center of Cincinnati MARY JANE ENGLAND, Washington Business Group on Health, Washington, DC MINDY FULLILOVE, Center for Children’s Environmental Health, Columbia University PATRICIA GREENFIELD, Department of Psychology, University of California, Los Angeles RUTH T. GROSS, Department of Pediatrics, Stanford University KEVIN GRUMBACH, Department of Family and Community Medicine, University of California, San Francisco/San Francisco General Hospital NEAL HALFON, School of Public Health, University of California, Los Angeles MAXINE HAYES, Washington State Department of Health, Olympia, Washington MARGARET HEAGARTY, Department of Pediatrics, Harlem Hospital Center, Columbia University RENEE JENKINS, Department of Pediatrics and Child Health, Howard University HARRIET KITZMAN, School of Nursing, University of Rochester SANDERS KORENMAN, School of Public Affairs, Baruch College HON. CINDY LEDERMAN, Juvenile Justice Center, Dade County, Florida VONNIE McLOYD, Center for Human Growth and Development, University of Michigan GARY SANDEFUR, Department of Sociology, University of Wisconsin-Madison ELIZABETH SPELKE, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology RUTH STEIN, Department of Pediatrics, Montefiore Medical Center, Bronx, New York

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Adolescent Risk and Vulnerability: Concepts and Measurement ELEANOR E. MACCOBY (Liaison, Division of Behavioral and Social Sciences and Education), Department of Psychology (Emerita, Stanford University WILLIAM ROPER (Liaison, Institute of Medicine), School of Public Health, University of North Carolina, Chapel Hill Elena O. Nightingale, Scholar-in-Residence Michele D. Kipke, Director Mary Graham, Associate Director, Dissemination and Communications Sonja Wolfe, Administrative Associate Joah G. Iannotta, Research Assistant

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Adolescent Risk and Vulnerability: Concepts and Measurement Contents     PREFACE   ix 1   ADOLESCENT RISK AND VULNERABILITY: OVERVIEW Elena O. Nightingale and Baruch Fischhoff   1 2   PERCEPTIONS OF RISK AND VULNERABILITY Susan G. Millstein and Bonnie L. Halpern-Felsher   15 3   VULNERABILITY, RISK, AND PROTECTION Robert William Blum, Clea McNeely, and James Nonnemaker   50 4   MODELING THE PAYOFFS OF INTERVENTIONS TO REDUCE ADOLESCENT VULNERABILITY Martha R. Burt, Janine M. Zweig, and John Roman   73 5   ADOLESCENT VULNERABILITY: MEASUREMENT AND PRIORITY SETTING Baruch Fischhoff and Henry Willis   109     APPENDIX: WORKSHOP MATERIALS   145

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Adolescent Risk and Vulnerability: Concepts and Measurement Preface In September 1997 the Board on Children, Youth, and Families organized a planning meeting on indicators for the safety and security of adolescents. A number of important ideas developed in this workshop, including the need to reassess and redefine adolescent vulnerability in order to develop more effective policies and programmatic interventions to safeguard young people. Early in 2000, and under the auspices of the Board, the two moderators in the planning meeting, Elena Nightingale, Scholar-in-Residence with the Board on Children, Youth, and Families, and Baruch Fischhoff, Professor of Social and Decision Sciences at Carnegie Mellon University, initiated the development of a workshop to stimulate thinking about the meaning of adolescent vulnerability, the methodologies that can be employed to measure vulnerability and its disparate predisposing risk factors, and the steps that would advance the work necessary for setting priorities for policies and practices to reduce the total burden of vulnerability for young people. A small planning group was formed to develop a workshop on reconceptualizing adolescent risk and vulnerability. This committee included Robert William Blum, Professor of Pediatrics at the University of Minnesota; Martha R. Burt, Program Director and Principal Research Associate at the Urban Institute; Susan G. Millstein, Professor of Pediatrics at the University of California at San Francisco; as well as Baruch Fischhoff and Elena O. Nightingale, who served as co-chairs of the group. The task

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Adolescent Risk and Vulnerability: Concepts and Measurement was to plan a workshop that would bring together the work and experience of several disciplines, from health science to psychology, decision science, and economics, that could further current research and thinking about adolescent vulnerability. As a part of this task, Drs. Blum, Burt, Millstein, and Fischhoff and their colleagues wrote papers that focused on the particular aspect of reconceptualizing adolescent vulnerability within their respective field of expertise. These papers were deliberately interconnected with the intention of generating not only a new way of defining adolescent vulnerability, but also of creating new methodological approaches to conducting research on both vulnerability and positive attributes of young people that could offer a more effective knowledge base for policy and intervention than available currently. With funding from Carnegie Corporation of New York, the Workshop on Adolescent Risk and Vulnerability: Setting Priorities took place on March 13, 2001, in Washington, DC. The workshop’s goal was to put into perspective the total burden of vulnerability that adolescents face, taking advantage of the growing societal concern for adolescents, the need to set priorities for meeting adolescents’ needs, and the opportunity to apply decision-making perspectives to this critical area. The workshop included five sessions, the first four of which were based on the papers prepared for the workshop. The first session examined a new conceptual framework for understanding and moderating adolescent vulnerability. The second session focused on the social costs of adolescent risk taking and vulnerability. The discussion included ways to model the lifelong costs and benefits of risky behavior in adolescence and the payoffs of interventions to reduce them. The third session proposed ways to assess the total burden of adolescents’ vulnerability and its components, as well as what indices are useful to monitor progress in reducing vulnerability and what social mechanisms can be used to set priorities for reducing them. The fourth session centered on perceptions of vulnerability by adolescents and by adults and how their accuracy can be measured and analyzed. How beliefs about risks influence risk taking and adolescents’ ability to manage the risks and vulnerabilities they face also were discussed. The final session considered the implications of these approaches to adolescent vulnerability as well as opportunities they might provide to bridge research, policy, and practice. This report includes an introduction by co-chairs Fischhoff and Nightingale that summarizes issues raised at the workshop and the four papers prepared and presented by the planning group members. The summary

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Adolescent Risk and Vulnerability: Concepts and Measurement reflects the presentations and perspectives of the presenters and participants at the workshop. It is not intended to be a comprehensive review of all the issues that emerged at the workshop or of all those relevant to adolescent risk and vulnerability. Rather, it attempts to highlight key issues and viewpoints that emerged from the rich discussions that took place. The information distilled in this summary is drawn from the presentations of the speakers and the dialogue that ensued, and every effort has been made to accurately reflect the speakers’ content and viewpoints. The papers in this volume were reviewed in draft form by the workshop discussants, chosen for their diverse perspectives and technical expertise. For their insightful and constructive comments, we thank Mark Cohen, Susan Curnan, Peter Edelman, Beatrix A. Hamburg, Lloyd J. Kolbe, Richard M. Lerner, Ann S. Masten, Gary B. Melton, Shepherd Smith, Matthew Stagner, and Heather Weiss. We also especially thank Anne Petersen, who generously gave of her time to oversee the review and further strengthen the contents of this volume. Although the individuals listed provided constructive comments and suggestions, it must be emphasized that responsibility for the final content of the volume rests entirely with the authors. The Board is particularly grateful to the planning group that developed the workshop framework and prepared the papers included in this volume. We especially thank Elena O. Nightingale and Baruch Fischhoff, who co-chaired the workshop and who, with Joah Iannotta, edited this volume, and Mary Graham, who provided assistance in coordinating this publication. Michele D. Kipke, Director Board on Children, Youth, and Families

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