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Adolescent Decision Making Implications for Prevention Programs Summary of a Workshop Baruch Fischhoff, Nancy A. Crowell, and Michele Kipke, Editors Board on Children, Youth, and Families Commission on Behavioral and Social Sciences and Education National Research Council Institute of Medicine NATIONAL ACADEMY PRESS Washington, D.C. 1999
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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 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. William 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. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council. This study was supported by Contract No. HHS-100-97-0028 between the National Academy of Sciences and the U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Additional copies of this report are available from: National Academy Press , 2101 Constitution Avenue N.W., Lockbox 285, Washington, D.C. 20055; (800) 624-6242 or (202) 334-3313 (in the Washington Metropolitan Area); internet http://www.nap.edu Printed in the United States of America Copyright 1999 by the National Academy of Sciences. All rights reserved.
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BOARD ON CHILDREN, YOUTH, AND FAMILIES JACK P. SHONKOFF (Chair), Heller Graduate School, Brandeis University DAVID V.B. BRITT, Children's Television Workshop, New York City LARRY BUMPASS, Center for Demography and Ecology, University of Wisconsin SHEILA BURKE, John F. Kennedy School of Government, Harvard University DAVID CARD, Department of Economics, University of California, Berkeley KEVIN GRUMBACH, Department of Family and Community Medicine, University of California, San Francisco MAXINE HAYES, Assistant Secretary of Community and Family Health, Department of Health, Olympia, Washington MARGARET HEAGARTY, Harlem Hospital Center, Columbia University ALETHA C. HUSTON, Department of Human Ecology, University of Texas, Austin RENEE R. JENKINS, Department of Pediatrics and Child Health, Howard University Hospital SHEILA KAMERMAN, School of Social Work, Columbia University SANDERS KORENMAN, School of Public Affairs, Baruch College HON. CINDY S. LEDERMAN, 11th Judicial Circuit, Juvenile Division, Dade County, Florida SARA McLANAHAN, Office of Population Research, Princeton University VONNIE McLOYD, Department of Psychology, University of Michigan PAUL NEWACHECK, Institute of Health Policy Studies and Department of Pediatrics, University of California, San Francisco DEBORAH STIPEK, Graduate School of Education, University of California, Los Angeles PAUL WISE, Department of Pediatrics, Boston Medical Center EVAN CHARNEY (Liaison), Council, Institute of Medicine RUTH T. GROSS (Liaison), Board on Health Promotion and Disease Prevention, Institute of Medicine ELEANOR E. MACCOBY (Liaison), Commission on Behavioral and Social Sciences and Education MICHELE KIPKE, Director NANCY A. CROWELL, Study Director ANNE BRIDGMAN, Program Officer for Communications DRUSILLA BARNES, Administrative Associate
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Contents Preface vii Introduction 1 The Decision-Making Framework 2 The World of Adolescence 8 Media Influences 10 Programs for Adolescents 11 Issues for Youth Programs 14 References 16 Workshop Participants 21
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Preface Risk taking is a natural part of teenagers' lives. They need to take some risks in order to grow, trying new activities, generating new ideas, experimenting with new roles. However, they can also get into trouble with their risk taking when it involves behaviors such as sex, drinking, smoking, violence, and drug use. Concern over such "risk behaviors" has led to the creation of many interventions, based to varying degrees on the growing scientific literature on adolescent development. Some of these interventions have attempted to manipulate teenagers' beliefs, values, and behaviors, hoping to get them to act more cautiously. Other interventions have attempted to improve their ability to make sensible decisions, hoping to get them to make wise choices on their own. Having general decision-making skills might enable teenagers to protect themselves in many situations. Interest in the role that decision making plays in adolescents' involvement in high-risk behaviors led the Office of the Assistant Secretary of Planning and Evaluation of the U.S. Department of Health and Human Services to request the Board on Children, Youth, and Families to convene a workshop on adolescent decision making. The Board on Children, Youth, and Families is a joint activity of the National Research Council (NRC) and the Institute of Medicine. A workshop was held on January 6–7, 1998, to examine what is known about adolescents' decision-making skills and the implications of that knowledge for programs to further their healthy development. The workshop was designed to pull together the diverse perspectives that researchers and practitioners have adopted, when looking at adolescent decision making. In order to provide a common frame of reference, the workshop used a decision-theory perspective as an organizing device. The many distinguished presenters described their evidence in terms of teenagers' ability to make effec-
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tive decisions. Some presenters focused on decision making as a cognitive process. Others considered social, affective, and institutional barriers to sound decision making. Still others dealt with concurrent individual and cultural changes that affect teenagers' ability to act in their own best interests. The ensuing discussions revealed the need to integrate these different perspectives as a necessary step to helping teenagers to deal with the many difficult choices that they face. This necessity also creates opportunities for novel research collaborations, both among basic researchers and between scientists and practitioners. A common lament was the frequent gap between research and practice: programs don't always reflect current research, and they often aren't evaluated at all, or at least not in terms that will inform theory. Perhaps the workshop encouraged some of the dialogue needed to bridge research and practice, giving teenagers all the help that we, collectively, can muster. As this activity was getting under way, the Forum on Adolescence was being launched by the Board on Children, Youth, and Families. The forum provides an interdisciplinary, nonpartisan focal point for taking stock of what is known about adolescent health and development, applying this knowledge base to pressing issues facing adolescents, and stimulating new directions for innovation and scientific inquiry. Forum members, several of whom were instrumental in the planning of the workshop, include: David Hamburg (Chair), president emeritus, Carnegie Corporation of New York; Huda Akil, Mental Health Research Institute, University of Michigan; Cheryl Alexander, School of Hygiene and Public Health, The Johns Hopkins University; Claire Brindis, Institute for Health Policy Studies, University of California, San Francisco; Camille Zubrinsky Charles, Population Studies Center, University of Pennsylvania; Greg Duncan, Institute for Policy Research, Northwestern University; Jacquelynne Eccles, Institute for Social Research, University of Michigan; Abigail English, Adolescent Health Care Project, National Center for Youth Law, Chapel Hill, NC; Eugene Garcia, School of Education, University of California, Berkeley; Helene L. Kaplan, Skadden, Arps, Slate, Meagher, and Flom, New York, NY; Iris Litt, School of Medicine, Stanford University; John Merrow, The Merrow Report, New York, NY; Anne Petersen, W.K. Kellogg Foundation, Battle Creek, MI; Karen Pittman, International Youth Foundation, Takoma Park, MD; Anne Pusey, Jane Goodall Institute's Center, Department of Ecology, Evolution, and Behavior, University of Minnesota; Michael Rutter, Institute of Psychiatry, University of London; Stephen Small, Department of Child and Family Studies, University of Wisconsin, Madison; and Beverly Daniel Tatum, Dean, Mount Holyoke College. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness
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to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their participation in the review of this report: John H. Flavell, Department of Psychology, Stanford University; Iris Litt, School of Medicine, Stanford University; Eugene Oetting, Triethnic Center, Colorado State University; Cheryl L. Perry, School of Public Health, University of Minnesota; and Stephen Small, Department of Child and Family Studies, University of Wisconsin, Madison. Although the individuals listed above have provided constructive comments and suggestions, it must be emphasized that responsibility for the final content of this report rests entirely with the authoring committee and the institution. Many individuals deserve recognition for their contributions to the workshop and report. Michele Kipke, director of the Forum on Adolescence at the time of the workshop (she has since assumed the position of director of the Board on Children, Youth, and Families), and Nancy Crowell, staff officer for this workshop, spent long hours discussing the workshop agenda and potential presenters with experts in the field. The workshop would not have taken place without their efforts. The workshop presenters provided the basis of this report; their names are listed in the appendix. Many thanks are owed to editor Christine McShane for making the report more readable. The workshop and this report were funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services. We are grateful to Ann Segal, Elisa Koff, Emily Novick, and Matt Stagner within ASPE for their support and contributions to this effort. BARUCH FISCHHOFF CARNEGIE MELLON UNIVERSITY CHAIR, WORKSHOP ON ADOLESCENT DECISION MAKING MEMBER, COMMISSION ON BEHAVIORAL AND SOCIAL SCIENCES AND EDUCATION
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