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Perceptions of Risk and Vulnerability

Susan G. Millstein and Bonnie L. Halpern-Felsher

INTRODUCTION

Why Are Perceptions of Risk and Vulnerability Important?

Individuals’ judgments about risk are viewed as a fundamental element of most theoretical models of health and risk behavior, including Social Cognitive Theory (Bandura, 1994), the Health Belief Model (Rosenstock, 1974), the Theory of Reasoned Action (Fishbein and Ajzen, 1975), the Theory of Planned Behavior (Ajzen, 1985), Self-Regulation Theory (Kanfer, 1970), and Subjective Culture and Interpersonal Relations Theory (Triandis, 1977). All of these theories posit that individuals’ beliefs about the consequences of their actions and perceptions of their vulnerability to those consequences play a key role in behavior. Although we will later question whether existing studies address these hypotheses adequately, the strength of the logical association between risk perceptions and behavior is compelling. As a result, risk perceptions play a fundamental role in behavioral intervention programs, which try to get adolescents to recognize and acknowledge their own vulnerability to negative outcomes. The ability to judge risks also is considered to be an essential element of decision-making competence, according to theorists, researchers, and practitioners in the behavioral sciences, medicine, social work, law, and social policy (Gittler et al., 1990; Hodne, 1995).

Adults have speculated about adolescents’ lack of competence in recog-



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Adolescent Risk and Vulnerability: Concepts and Measurement 2 Perceptions of Risk and Vulnerability Susan G. Millstein and Bonnie L. Halpern-Felsher INTRODUCTION Why Are Perceptions of Risk and Vulnerability Important? Individuals’ judgments about risk are viewed as a fundamental element of most theoretical models of health and risk behavior, including Social Cognitive Theory (Bandura, 1994), the Health Belief Model (Rosenstock, 1974), the Theory of Reasoned Action (Fishbein and Ajzen, 1975), the Theory of Planned Behavior (Ajzen, 1985), Self-Regulation Theory (Kanfer, 1970), and Subjective Culture and Interpersonal Relations Theory (Triandis, 1977). All of these theories posit that individuals’ beliefs about the consequences of their actions and perceptions of their vulnerability to those consequences play a key role in behavior. Although we will later question whether existing studies address these hypotheses adequately, the strength of the logical association between risk perceptions and behavior is compelling. As a result, risk perceptions play a fundamental role in behavioral intervention programs, which try to get adolescents to recognize and acknowledge their own vulnerability to negative outcomes. The ability to judge risks also is considered to be an essential element of decision-making competence, according to theorists, researchers, and practitioners in the behavioral sciences, medicine, social work, law, and social policy (Gittler et al., 1990; Hodne, 1995). Adults have speculated about adolescents’ lack of competence in recog-

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Adolescent Risk and Vulnerability: Concepts and Measurement nizing and assessing risk since the time of Aristotle. Adolescents typically are viewed as being unable to judge risk appropriately, and as having strong beliefs in their invulnerability to harm. In recent years, the question of adolescents’ competence has emerged as a result of efforts to regulate the legal rights of adolescents to make decisions in the realms of medical and mental health treatment, including their rights to refuse treatment or to obtain treatment without parental knowledge and/or consent, as well as their rights to participate in research, including experimental clinical trials. Additionally, adolescents’ capacity to exercise existing rights is of fundamental interest to the juvenile justice system (Butterfield, 1996). Much of the interest in adolescents’ perceptions of risk and vulnerability is motivated by the desire to understand why youth engage in potentially threatening behaviors, with an aim toward guiding the development of interventions that will be successful in preventing their onset. Relevant questions for gaining such understanding include the following: What skills are needed for assessing risk? Do adolescents have these skills? How competent are adolescents in identifying and assessing risk? What kinds of factors influence adolescents’ ability to judge risk? How do adolescents’ perceptions compare to those of adults? Do adolescents’ perceptions of risk influence their decisions? In this paper, we review existing data to address these questions. We acknowledge that answers to these questions will not give a complete picture of why adolescents engage in risky behavior—other crucial questions remain, such as whether adolescents are competent decision makers or able to apply their decision-making skills in all situations. Nevertheless, a focus on risk perception is a reasonable vantage point from which to consider adolescent risk and vulnerability. We will begin our discussion by giving the reader a sense of the size of the risks themselves. That is, how big are the risks that adolescents face? This will provide a context for later assessing the adequacy of adolescents’ judgments concerning those risks. How Big Are the Risks? Some of the threats to adolescents’ well-being pose sizable risks. For example, 40 percent of Latino youth fail to complete high school or the equivalent, such as the General Education Development Tests (GED) (Fed-

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Adolescent Risk and Vulnerability: Concepts and Measurement eral Interagency Forum on Child and Family Statistics, 2000). However, for many risks, the actual chance of a negative outcome occurring is relatively small. For example, Fischhoff et al. (2000) reported that for adolescents, the actual probability of a female getting pregnant within one year is less than 6 percent, and the probability of a male getting someone pregnant in the next year is less than 3 percent. The probability of being the victim of a violent crime (e.g., homicide, rape, robbery) is less than 10 percent. Even smaller is the probability of an adolescent dying from any cause in the next year (.08 percent) or by the time an adolescent turns 20 (.04 percent). Of course, the probability of experiencing these outcomes is highly dependent on one’s behavior and environment. Risks for acquiring sexually transmitted diseases (STDs) are quite high among youth who have highly connected sexual networks involving people who live in areas of high infectivity. The risks are far lower for adolescents who live in geographic areas of low disease rates, and are essentially nil for sexually inactive youth. But small risks are not unimportant. Although many of the actual risks adolescents face are numerically small, their potential outcomes can be severe and life altering. For example, STDs such as gonorrhea and chlamydia are associated with subsequent rates of pelvic inflammatory disease (PID) as high as 10 to 40 percent. It is estimated that of the approximately 200,000 to 400,000 adolescent females who develop PID each year, 40,000 to 84,000 of them eventually will find themselves infertile. The fiscal costs are also high; excluding costs related to HIV and AIDS, we spend an estimated $882 million yearly treating STDs in adolescents (Gans et al., 1995). Furthermore, most causes of adolescent morbidity and mortality are preventable, thus behooving us to make attempts to reduce them. Adults’ Perspectives on Adolescent Vulnerability Although few empirical data speak directly to adults’ perceptions concerning risks to adolescents, other indicators point to the sources of adults’ concerns. Reading the popular press, listening to parents of teenagers, and examining the content of preventive programs makes it clear that adults’ concerns focus primarily on the major causes of morbidity and mortality and adolescents’ involvement in behaviors that are associated with these negative health and social outcomes. In a series of focus groups with high-risk youth, their parents and grandparents, a report from the Office of Disease Prevention and Health Promotion (1993) found that parents were concerned about the lack of adult supervision for their children and the

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Adolescent Risk and Vulnerability: Concepts and Measurement failure of schools and communities to meet the needs of adolescents. Other areas of concern included peer influences and poor schools. Ferguson and Williams (1996) found that among a group of parents of 17 year olds, 38 percent expressed concerns about their children’s driving; 43 to 97 percent of the parents supported additional restrictions to protect their children. Parents of adolescents also view adolescents as more vulnerable than do adolescents themselves. Beyth-Marom et al. (1993) found that across a series of risky behaviors, adolescents’ perceptions of the risks to themselves were significantly lower than the risks their parents perceived for them. Similar findings are reported by Cohn et al. (1995). For example, although 31 percent of the adolescents believed there was little or no harm in getting drunk once or twice, only 9 percent of the parents believed this. These formal comparisons of adults’ perceptions of adolescents’ risks with adolescent perceptions of their own risks is confounded by the fact that the adult is judging risks for another person—and such judgments are typically higher than personal risk judgments (Weinstein, 1980, 1983, 1984; Whalen et al., 1994). Conceptualizing and Measuring Perceptions of Risk and Vulnerability There are many ways to conceptualize and measure perceptions of risk and vulnerability. We can examine the content of individuals’ risk and vulnerability beliefs—identifying those things that worry or concern them, as well as the degree of anxiety generated by these concerns. We can observe whether people recognize the risks inherent in a given situation, or we can look at how accurately someone judges a specific risk. Risk judgments may focus on situations (e.g., is having unprotected sex dangerous?) or on their potential outcomes (e.g., what is the chance that you will get an STD?). Personal risk can be viewed in absolute terms (e.g., what is your chance . . . ?) or relative terms (e.g., how does your risk compare to others?). For any given individual, we can also examine his or her relative ranking of the importance of various “risks” to assess his or her risk perceptions. Each of the many ways of assessing individuals’ perceptions has something to tell us about their sense of risk and vulnerability. But they also appear to measure different aspects of this construct we call vulnerability. The literature reflects this conceptual diversity, making it difficult to compare across studies. In our review, we will consider them separately. We will not attempt to tell the reader which of these approaches are best. Rather, we

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Adolescent Risk and Vulnerability: Concepts and Measurement will comment on the use and limitations of each. To avoid confusion, we will use the following terms throughout this paper. We use the term risk judgment to reflect magnitude assessments of risk. A risk judgment that focuses solely on an outcome (e.g., how likely are you to get an STD?) would be considered to be a nonconditional risk judgment. In contrast, a situation-specific or conditional risk judgment is one in which explicit mention of an antecedent condition such as a situation or a behavior is made (e.g., how likely are you to get an STD if you have unprotected sex?). When assessments of risk do not involve magnitude estimates, we use the term risk identification. These assessments may focus solely on a situation (e.g., is it risky to have unprotected sex?) or may include identification of specific consequences as well (e.g., what might happen if you have unprotected sex?). Although risk identification and judgment may be the most direct ways to tap assessments of risk, individuals’ affective responses to specific situations and/or outcomes also can be informative. When assessments focus on the degree of anxiety or concern individuals have about particular situations (e.g., how worried would you be if you had unprotected sex?) or outcomes (e.g., do you worry about getting an STD?), we refer to them as feelings or perceptions of vulnerability. Like the more cognitive aspects of risk perception, these affective manifestations can be conditional or unconditional. Asking people to identify the things that concern them (e.g., what kinds of health problems do you worry about?) points to content areas where perceptions of vulnerability may exist; we refer to these simply as concerns. We acknowledge that individual differences such as generalized anxiety or pessimism may influence the degree to which situations or outcomes are identified, judged, or experienced as risky. However, we do not consider these generalized states or their measurement to reflect perceptions of risk or vulnerability. ADOLESCENTS’ PERCEPTIONS We will now review what we know about the content of adolescents’ concerns, their perceptions of vulnerability, their ability to identify risk, and their ability to judge risk. In each section, we will first give the reader a sense of how adolescents as a group perform, followed by an examination of how these capacities vary by the age of the adolescent. Other sources of variation in risk perception and assessment, such as gender, race/ethnicity, and economic status, are discussed later.

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Adolescent Risk and Vulnerability: Concepts and Measurement Sources of Concern One approach to understanding adolescents’ perceptions of vulnerability is to identify those issues about which adolescents express concern. Numerous surveys have documented these concerns. Common adolescent concerns include those related to appearance (height, weight, acne), emotional states (depression, anxiety), interpersonal relationships (parents, friends, and other adults), school (schoolwork, school problems, and career), environmental threats (air pollution and nuclear war), and health and physical complaints (headaches, stomachaches, vision problems, dental problems). Adolescents also acknowledge the importance of the health issues most frequently identified by health professionals, including substance use, sexual behavior, birth control, sexually transmitted disease, and pregnancy (Alexander, 1989; Benedict et al., 1981; Brunswick, 1969; Giblin and Poland, 1985; Marks et al., 1983; Millstein and Irwin, 1985; Parcel et al., 1977; Sternlieb and Munan, 1972). Although adolescents clearly acknowledge a wide range of concerns, only a few issues consistently rank high. These include issues pertaining to school, dental health, acne, interpersonal relationships, and mental health (American School Health Association et al., 1989; Sternlieb and Munan, 1972). Concerns related to substance use, sexual behavior, nutrition, and exercise rank lower in most adolescent samples (Eme et al., 1979; Feldman et al., 1986; Sobal et al., 1988). Age Differences in Adolescents’ Concerns Observed age differences in health concerns are consistent with the developmental tasks faced by adolescents. Younger adolescents (between 11 and 13) generally are more concerned with physical development, including puberty (Byler et al., 1969), and with how one is viewed by members of the opposite sex. Middle adolescents (i.e., about 14–15 years old) are more concerned with appearance (especially among female adolescents), interpersonal relationships with peers and members of the opposite sex, and self-esteem. Older adolescents are more concerned with school, grades, and their future career plans (Eme et al., 1979; Violato and Holden, 1988) as well as their emotional health. A study of more than 5,000 children and adolescents found increasing interest among youth in topics such as growth and development, preventive health behaviors, mental health, and social-emotional development as children moved into the early adolescent years (Byler et al., 1969).

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Adolescent Risk and Vulnerability: Concepts and Measurement Adults’ Perceptions About Adolescents’ Concerns Adults underestimate the degree of concern adolescents report about their health (Sobal et al., 1988) and appear to have misperceptions about adolescents’ level of knowledge about specific topics such as AIDS (Manning and Balson, 1989). Adults also fail to recognize some of the specific health concerns of adolescents. An example occurs in regard to dental and oral health. Across studies, adolescents consistently rank dental concerns of being of great importance (Parcel et al., 1977; Sobal et al., 1988; Sternlieb and Munan, 1972). Yet this topic rarely receives attention in discussions of adolescent health. Other areas in which adults fail to recognize adolescents’ concerns include school problems and teens’ relationships with adults (Sobal et al., 1988). To summarize, existing data indicate that adolescents do express concerns about negative effects that can result from volitional behaviors as well as from environmental hazards such as natural disasters, technological risks, and violence. Adults often underestimate these concerns. Although examination of adolescents’ concerns gives us some indication of the sources of concern, it does not inform us about the degree to which these concerns are accompanied by feelings of vulnerability. For example, to what degree do concerns about oral health translate into adolescents’ feelings of personal vulnerability to caries or gum disease? For this reason, perceptions of vulnerability may be a closer reflection of adolescents’ beliefs about their vulnerability. Perceptions of Vulnerability Data from numerous studies indicate that adolescents feel vulnerable to experiencing negative outcomes. Adolescents’ worry and feelings of vulnerability to AIDS have been well documented (DiClemente et al., 1987; Pleck et al., 1990; Price et al., 1985; Strunin, 1991). Other behavior-related risks, such as getting sick from drinking alcohol and acquiring an STD also appear to generate feelings of vulnerability. In a recent study, we found that a majority of sexually inexperienced seventh and ninth graders reported that they would be worried and concerned about getting an STD if they had sex without a condom; 53 percent said they would be very worried and 26 percent reported feeling somewhat worried. Similar percentages were obtained for adolescents’ ratings of concern. Feelings of vulnerability appear to generalize beyond behavior-related risks. When asked to imagine being at a picnic when a tornado strikes, 36 percent of adoles-

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Adolescent Risk and Vulnerability: Concepts and Measurement cents in seventh and ninth grade reported that they would be very worried that they would die, and 22 percent reported being somewhat worried about dying from the tornado. The corresponding values for being concerned with dying were 43 percent and 20 percent. Bachman (1983) showed that 30 percent of high school seniors reported worrying frequently about the threat of nuclear war. Age Differences Among Adolescents In our recent study (Millstein and Halpern-Felsher, 2001) cross-sectional analyses showed a negative relationship between age and feelings of vulnerability to alcohol (r=–.30) and sex risks (–.35). Feelings of vulnerability to alcohol-caused illness were significantly higher in fifth and seventh graders than ninth graders and adults. Perceptions of vulnerability to STDs were significantly higher in seventh and ninth graders than adults. Longitudinal analyses (in progress) showed that among sexually inexperienced seventh and ninth graders, worry over getting an STD as a result of unprotected sex decreased significantly over a 6-month period. However, reported concern for STDs did not. Additional data supporting these findings are provided by data from the National Survey of Adolescent Males (Pleck et al., 1993), which showed that adolescent males’ (ages 15–19) worry about AIDS decreased over a two-year period. Thus, in contrast to popular views that adolescents do not worry or concern themselves about risks, the data indicate that many, and in some cases most, adolescents report feeling vulnerable to negative outcomes. It is not entirely clear, however, what these assessments really mean. Do they reflect true anxiety and/or perceptions of potential harm, or are they primarily cognitive expressions, meant to acknowledge that these are things, in general, to worry about? Who, after all, does not worry (at least academically) about negative outcomes such as AIDS? Risk Identification Studies of adolescents’ capacity for considering consequences have shown that even young adolescents have the ability to identify negative consequences associated with medical procedures (Kaser-Boyd et al., 1985; Lewis, 1981; Weithorn and Campbell, 1982) and with engaging in risky behaviors (Beyth-Marom et al., 1993; Finn and Brown, 1981; Furby et al., 1997). Typically, these studies ask participants to imagine themselves in a

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Adolescent Risk and Vulnerability: Concepts and Measurement hypothetical situation, and to identify any risks that they perceive in that situation. For example, Beyth-Marom et al. (1993) asked adolescents to consider what might happen if they engaged in six different risky activities. They found that adolescents identified, on average, four to seven consequences for each activity. A broad range of consequences were mentioned, including physical effects, psychological effects, and social reactions from family, other authority figures, and peers. A few studies have examined the extent to which adolescents spontaneously mention or consider risks, which may give a more realistic picture of adolescents’ ability to recognize risk in real-life situations. Lewis (1981) asked 108 adolescents in grades 7, 8, 10, and 12 about the advice they would give to peers facing cosmetic surgery and to peers considering participation in a clinical trial of a new acne medicine. Sixty percent of the adolescents mentioned possible risks associated with the situations, and 26 percent mentioned potential future consequences. Halpern-Felsher and Cauffman (2001) used the same scenarios in their study of 190 adolescents (grades 6, 8, 10, and 12). They found that 12 to 32 percent of teens mentioned risks and 10 to 13 percent mentioned future consequences in the cosmetic surgery scenario. In the informed consent scenario, 42 to 63 percent of the adolescents recognized risks and 7 to 16 percent recognized future consequences. Age Differences in Risk Identification Studies examining age differences in adolescents’ ability to identify risks report conflicting findings. Lewis (1981) found dramatic increases in awareness of risks between grades 10 (50 percent of subjects mentioning) and 12 (83 percent). Mention of future consequences showed steady increases over grades 7–8 (11 percent), 10 (25 percent), and 12 (42 percent). However, a replication of the Lewis study using a somewhat larger sample (Halpern-Felsher and Cauffman, 2001) reported no significant age differences in adolescents’ consideration of risks and long-term consequences. Two other studies also failed to find age differences. In a small sample (N=62) of people with learning and behavior problems, Kaser-Boyd et al. (1985) found younger adolescents to be as competent as older adolescents in their ability to consider consequences. Ambuel (1992) studied 13 to 21 year olds (N=75) who suspected an unplanned pregnancy and were seeking a pregnancy test. Comparisons between younger minors (ages 13–15 years) and

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Adolescent Risk and Vulnerability: Concepts and Measurement older minors (16-17) showed no differences in their consideration of consequences. In four studies focusing on risk identification that compared adolescents and adults, two found adults to be more competent in identifying risk. Beyth-Marom et al. (1993) reported small age-related differences in subjects’ ability to generate consequences associated with six risky behaviors, with adults spontaneously mentioning more consequences than adolescents on one-third of the behaviors examined. Halpern-Felsher and Cauffman (2001) found that in comparison to adolescents, adults considered a greater number of risks as well as long-term consequences. Both of these studies used hypothetical situations to estimate participants’ capacity for identifying risk. In contrast, the other two studies focusing on risk identification examined perceptions of risk in real life decision-making situations and failed to find differences between adolescents and adults in their ability to consider consequences (Ambuel, 1992; Kaser-Boyd et al., 1985). Both samples were relatively small, including fewer than 80 participants. To summarize, it is clear that many adolescents, especially older adolescents, are capable of recognizing and identifying risks. Adolescents also are able to identify risks spontaneously, in response to hypothetical scenarios as well as in real-life decision situations. However, the overall level of competence among adolescents is not exceptionally high. In the Lewis (1981) study, few of the younger adolescents and less than half of the tenth graders could be considered competent in identifying important potential risks. Halpern-Felsher and Cauffman (2001) also reported lower than expected levels of awareness of risks among both adolescents and adults. Furthermore, most studies that have examined age differences in risk identification report age-related increases in individuals’ awareness and consideration of risks (Ambuel, 1992; Beyth-Marom et al., 1993; Lewis, 1981); fewer have failed to find such differences (Lewis, 1980; Weithorn and Campbell, 1982). Although it is not clear whether there are absolute points at which one should be considered competent in identifying risks, the finding of age-related increases in risk identification does call into question the degree to which we should consider adolescents, particularly younger adolescents, competent. The extent to which the ability to identify risks changes over time has not been studied using longitudinal data, nor has the link between risk identification and risk behavior been studied.

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Adolescent Risk and Vulnerability: Concepts and Measurement Risk Judgments In addressing whether adolescents are able to judge risks accurately, one can use a number of different indicators. One indicator might be to look at whether adolescents view themselves as “invulnerable,” a common attribution that would render them unable to judge risks adequately. If we interpret invulnerability as meaning that the individual judges risk as nonexistent (i.e., risk estimates of zero-percent chance), research does not support this characterization of adolescents. Both Quadrel et al. (1993) and Millstein and Halpern-Felsher (2001) found perceptions of invulnerability to characterize a minority of the adolescents they sampled. Ideally, we would judge adolescents’ competence in assessing risk by comparing their perceptions to their actual risk status. But determining an individual’s risk for experiencing a specific negative outcome is difficult because it depends on so many individual and environmental factors. Two people drinking the same amount of alcohol and getting into their car to drive can have very different probabilities of having an accident, depending on their body weight, food consumption, level of tolerance for alcohol, weather conditions, and so on. Similarly, the risk of pregnancy depends on factors, such as the individual’s age, history of sexually transmitted disease, stage in the menstrual cycle, and type and extent of contraceptive use. Because of the complexity in ascertaining risk status, estimates of individuals’ risks often are based on aggregated risk. Thus, for example, we might judge an adolescent’s risk of acquiring an STD as a function of the incidence of STDs in sexually active adolescents. Using this approach, Fischhoff et al. (2000) compared adolescents’ risk judgments with data for estimating actual risk. Their sample included more than 3,500 15 to 16 year old adolescents from the 1997 National Longitudinal Study of Youth. The adolescents were asked to judge the probability that they would experience specific outcomes (i.e., risk judgments were nonconditional). The comparisons indicated that, as a group, adolescents’ estimates were fairly accurate for some events (such as being in school one year later or becoming pregnant over the next year). For example, adolescents estimated their chance of experiencing or causing pregnancy within the year as 6.3 percent, which is very close to the actual probability of less than 6 percent. They were slightly optimistic about their chances of obtaining a high school diploma and getting a 4-year college degree. They were pessimistic about their estimates concerning the probability of serving time in jail or prison,

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Adolescent Risk and Vulnerability: Concepts and Measurement about the elderly. Decreasing judgments of risk also may reflect greater awareness of actual probabilities (which are generally low) and a move toward greater accuracy in older individuals. These are questions to be explored in further research. CONCLUSIONS AND NEXT STEPS Ultimately, we are interested in understanding why adolescents make the decisions they do and their competence in making these decisions. Why do adolescents engage in potentially threatening behaviors? Are they able to make informed decisions about undergoing or foregoing potentially dangerous medical treatments? Should we be granting them more legal rights or should they be more restricted? In considering adolescents’ perceptions of risk and vulnerability, we are acknowledging the importance of these perceptions in addressing these larger questions. Existing research has offered us insights into how adolescents view risk and vulnerability, identified some of the important correlates of these constructs, and raised interesting questions concerning the effects of these perceptions on adolescents’ behavior. It also has suggested to us some important next steps for a comprehensive research agenda and for program development, and some implications for a broad range of social policies concerning adolescents. Despite strong beliefs to the contrary, there is little in the scientific literature to indicate that adolescents see themselves as invulnerable to harm. If anything, they appear to overestimate many of the risks around them. Given this, we believe that efforts to decrease public and scientific perceptions of “the invulnerable adolescent” may be warranted. As noted by others (Beyth-Marom et al., 1993; Hamburg et al., 1993), we may be doing adolescents a disservice by perpetuating this myth. Perceptions of “the invulnerable adolescent” could, for example, have negative influences on policy or funding priorities relating to adolescents. It becomes much easier for policy makers to believe that adolescent interventions are futile if they have been convinced that adolescents are destined to see themselves as invulnerable. Although we see little evidence to suggest that adolescents perceive themselves as invulnerable to harm, existing data are more ambiguous when it comes to the question of adolescents’ actual competence in identifying and judging risk. Most studies report age-related increases in individuals’ awareness and consideration of risks, with adults showing greater awareness than adolescents. Depending on the standards used, adolescents’ compe-

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Adolescent Risk and Vulnerability: Concepts and Measurement tence in identifying risk does not appear to be exceptionally high. Furthermore, if we consider risk judgments to be measures of accuracy, age is associated with greater accuracy, and adults are more accurate (and thus more competent) than adolescents. Given that adults are generally more knowledgeable than adolescents, such an interpretation is reasonable. On the other hand, if we choose to interpret risk judgments as reflections of individuals’ sense of vulnerability, it would suggest that the young feel more vulnerable than older adolescents, and adolescents feel more vulnerable than adults. Given the consistency of age differences across different types of risk, it seems plausible to suggest the possibility that individuals’ risk judgments do reflect generalized feelings of vulnerability or anxiety, and that such feelings are greater among the young. Such an interpretation is reasonable in light of changes in cognitive development and exposure to a changing social environment and also suggests to us that more attention be paid to the more affective dimensions of risk perception. Caution is warranted in interpreting these results, however, because of serious concerns about whether the research paradigms used to study risk perception are able to give us an adequate picture of how adolescents judge risks in real situations. Most studies utilize hypothetical scenarios, which carry little of the emotion-arousing potential of real situations. Real-world studies have the advantage of offering contextually accurate settings but are often of limited generalizability due to their use of highly selected samples. Laboratory-based studies offer control and the ability to look for generalizable processes, but lack ecological validity. As a result, there has been a call for efforts to create more realistic, “real-world” simulations that would offer the advantages of laboratory research while maintaining salience and ecological validity (e.g., Ebbesen and Konecni, 1980). Such studies also could provide a means of more accurately measuring the affective components of risk perception. The need for definitive studies concerning the risk perception-risk behavior relationship cannot be overstated. Because of the theoretical importance of the perceived risk construct to behavior, prevention and intervention programs frequently invest a great deal of effort trying to get adolescents to recognize and acknowledge their own vulnerability to negative outcomes. Such approaches are supported by experimental studies that have shown it is possible to reduce risk perception biases (Weinstein, 1983). However, these efforts have taken place without having conducted the essential longitudinal studies. Such studies would take a large sample of young adolescents before they began to engage in risky behaviors, and then follow

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Adolescent Risk and Vulnerability: Concepts and Measurement them long enough to observe their perceptions of risk over time, as they engage in the behaviors and possibly experience negative outcomes. It would be most desirable to see such studies conducted in populations representing different cultural backgrounds and levels of economic advantage. In addition to addressing some of the fundamental questions concerning the developmental trajectory of perceptions of risk and vulnerability, longitudinal studies also could inform us about some of their hypothesized developmental correlates such as future perspective, perspective taking, autonomy needs, and impulse control. If risk judgments play a prominent role in the onset, continuation, or cessation of risky behavior, then perceptions about risk should continue to be incorporated into programs trying to prevent adolescent risk behavior and/or increase strategies to prevent such harm. Of course, doing so presents some real challenges. The actual risks posed by many of the behaviors we caution against are relatively small. Yet few educators would suggest providing adolescents with information about the actual risks, as doing so would (one fears) lead adolescents to minimize their importance. On the other hand, continuing to emphasize the likelihood of negative outcomes seems counterproductive if young people already feel a sense of heightened vulnerability, particularly in view of the inhibiting effects of excessive anxiety on preventive health behaviors (Leventhal, 1971). Furthermore, we have suggested that such an emphasis may backfire as adolescents become aware of the reality that most experiences with risky behaviors do not lead to negative outcomes and are in fact experienced as positive. A more appropriate goal in educating youth about health risks may be to find ways to translate small probabilities into real possibilities, without raising anxiety to unproductive levels. Theoretical models can help inform us about potentially useful approaches to intervention, whether or not perceptions of risk prove to be crucial. For example, the Theory of Reasoned Action (Fishbein and Ajzen, 1975) includes a role for beliefs about the value attached to potential outcomes, expectations about social norms, and perceived benefits. Programs that attempt to personalize and make vivid the reality of negative outcomes, such as those that expose adolescents to individuals who have AIDS, emphasize the meaning and impact of the outcomes rather than the probability of their occurrence (Sutton, 1982). To further develop such an emphasis would require not only that we understand what adolescents value, but also whether we, as a society, are providing adolescents with access to those outcomes. For many adolescents, such access is severely

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Adolescent Risk and Vulnerability: Concepts and Measurement limited as a result of living in impoverished, racist, or violent environments. An even more challenging task would be to create opportunities that youth would find highly desirable, and which are simultaneously incompatible with risky behavior (Leventhal and Keeshan, 1993). Learning more about adolescents’ perceptions of the benefits associated with engaging in risky behaviors could help in this endeavor. Perceived benefits typically are not studied, perhaps because of adults’ understandable reluctance to acknowledge those benefits. Yet by helping us to understand better what draws adolescents to risky behavior, such research could assist us in identifying desirable alternatives to those behaviors. The social normative component has been utilized in preventive interventions that attempt to correct adolescents’ misperceptions about the number of teens engaging in risky behaviors. Adolescents who perceive higher levels of risk behavior in their peers view the risks of those behaviors as lower (Urberg and Robbins, 1984), and perceptions that peers condone more (or less) risky behavior are associated with more (or less) engagement in these behaviors (Boyer et al., 2000; DiClemente, 1991; Kinsman et al., 1998; Romer et al., 1994). Given that adolescents spend approximately twice as much time with their peers as they spend with parents or other adults (Brown, 1990; Savin-Williams and Berndt, 1990), peers and perceived peer norms thus become a major source of socialization and development during this period and a potentially effective intervention tool. Understanding the relationship between risk judgment and behavior also will require that we turn attention to contextual factors that may influence the relationship. We tend to ask whether risk judgment influences behavior, rather than asking about the conditions under which it does (or does not). A person may agree that driving drunk is risky, but may decide to do so when under the influence of alcohol. Judgments concerning the risks of HIV may do little to influence the sexual behavior of someone who believes he or she will not live past the age of 30. These kinds of contextual factors are crucial but have received little attention. An example of a neglected and potentially important contextual factor is emotion. Emotion is known to influence adults’ perceptions of risk (Isen, 1993; Nygren et al., 1996) as well as their risk tolerance. We would expect emotional states to influence adolescents’ perceptions as well. Important questions include: How do specific emotions influence adolescents’ judgments of risk? Do the effects of emotion on risk perception differ for adolescents and adults or as a function of development? For example, does fear play a more important role in adults’ risk judgments than for adolescents’? In a given situation, do

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Adolescent Risk and Vulnerability: Concepts and Measurement we see developmental differences in the degree to which emotion is experienced? To the degree that emotion is important, it would also have implications for the ways in which we study risk perception, suggesting that we create study environments that mimic the kinds of emotionally arousing situations in which judgments about risk are typically made. The importance of risk perceptions—theoretically, in program development, and in defining standards of decision-making competence—warrants rigorous study. Existing literature is fraught with problems, primarily stemming from issues concerning the measurement of risk perceptions and from the lack of longitudinal studies. But the problems we have identified are solvable, and we are optimistic that future studies will be able to answer many of the pressing questions we have raised. REFERENCES Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckman (Eds.), Control: From cognition to behaviors (pp. 11-39). New York: Springer-Verlag. Alexander, C. S. (1989). Gender differences in adolescent health concerns and self-assessed health. Journal of Early Adolescence, 9, 467-479. Ambuel, B. (1992). Social policy of adolescent abortion. The Child, Youth, and Family Services Quarterly, 15(2), 5-9. American Cancer Society. (1979). A study of health-related awareness and concerns among 4th, 5th and 6th graders (C.R.S. No. 5649). New York: Author. American School Health Association, Association for the Advancement of Health Education, & Society for Publication Health Education, Inc. (1989). The national adolescent student health survey: A report on the health of America’s youth. Oakland, CA: Third Party. Bachman, J. G. (1983). Schooling as a credential: Some suggestions for change. International Review of Applied Psychology, 32(4), 347-360. Bandura, A. (1994). Social cognitive theory and exercise of control over HIV infection. In R. J. DiClemente & J. L. Peterson (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 25-59). New York: Plenum Press. Baron, R. M. (1988). An ecological framework for establishing a dual-mode theory of social knowing. In D. Bar-Tal & A. W. Kruglanski (Eds.), The social psychology of knowledge (pp. 48-82). Cambridge, England: Cambridge University Press. Benedict, V., Lundeen, K. W., & Morr, B. D. (1981). Self-assessment by adolescents of their health status and perceived health needs. Health Values: Achieving High Level Wellness, 5, 239-245. Benthin, A., Slovic, P., & Severson, H. (1993). Psychometric study of adolescent risk perception. Journal of Adolescence, 16, 153-168. Bernstein, E., & Woodall, W. G. (1987). Changing perceptions of riskiness in drinking, drugs and driving: An emergency department-based alcohol and substance abuse prevention program. Annals of Emergency Medicine, 16, 1350-1354.

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