Adolescent Risk and Vulnerability Concepts and Measurement (2001) / Chapter Skim
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5. Adolescent Vulnerability: Measurement and Priority Setting
5. Adolescent Vulnerability: Measurement and Priority Setting
Pages 109-144
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From page 109... ...
There are special laws governing adolescent driving and status offenses. There are summits and conferences, some with teen representation, some without.
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From page 110... ...
. It means knowing the relative size of specific threats, and of the expected costs and benefits of opportunities for risk reduction, in order to identify the "best buys" in risk reduction.
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From page 111... ...
Within options potentially under their control, parents, too, must decide whether to invest in problem-focused interventions (e.g., grounding, curfews, driver education) or youth development ones (e.g., home schooling, family activities, religion)
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From page 112... ...
The following section, "Social Mechanisms for Priority Setting," contrasts two general approaches to determining priorities, differing in how explicitly they address value issues. The next section, "Deliberative Mechanisms for Priority Setting," considers ways to determine the relevant values, with particular reference to analogous processes developed for setting environment priorities, over the past generation.
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From page 113... ...
Risk analyses can, in principle, consider a broad set of considerations without the sometimescontroversial monetization required by economic analyses (the primary current form of integrative approach)
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The first list, from Healthy People 2010, has primarily health effects and (fairly proximal) predisposing conditions.
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Some of the approaches described here may be useful to those empowered to complete the work. Deliberately Embedding Values in a Method One place in which Healthy People 2010 does attempt to direct the process is in measuring those outcomes that a prioritizing group decides to value.
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116 MEASUREMENT AND PRIORITY SETTING terms of lost life expectancy arising from those deaths. Considering the number of years lost with each death puts a premium on deaths among young people.
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BARUCHFISCHHOFFAND HENRY WILLIS 117 riosclerosis. Of course, focusing on deaths raises the profile of risks such as auto accidents relative to ones that cause mostly morbidity and misery (such as drugs)
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Were that the case, then the second list would represent a broader definition of the conditions that our society owes its citizens. If not, then including these additional conditions reflects an alternative view of the facts regarding predisposing causes, with a larger role assigned to social and economic factors, such an employment and housing status.2 Evi~lence-Driven Criteria The third set of criteria is taken from an international document, the United Nations (UN)
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From page 119... ...
Another apparent difference in the UN Convention criteria is the inclusion of such "positive" criteria such as education developing personality, talents, and mental and physical abilities. Like nondiscrimination, these criteria might be treated as ends or means.
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From page 120... ...
In the context of adolescent welfare and vulnerability, equal representation means, for example, assigning no special weight to the fate of teens from particularly challenged backgrounds (such as those
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From page 121... ...
That might happen for justifiable reasons (e.g., there are many different problems, with relatively distinct etiology, under "infectious diseases") or more questionable ones (e.g., there are many more scientists working in one area who have had time to develop a larger suite of measures)
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From page 122... ...
Unfortunately, without some independent assessment, action alone does not guarantee that people have understood the facts of a situation nor the implications of their own values for it. Substantial literatures document the potential fallibility of people's judgments offacts and the malleability of their values (when people must articulate the implications of their basic values in novel situations)
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, in which case nutrition plays little role in the buyer's choice. In another context, debate rages over whether labeling foods containing genetically modified grains would provide consumers with vital information or misinform them by suggesting a nonexistent risk.
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If one accepts these estimates of dollars spent and lives saved, then these programs do not reveal a consistent societal preference of willingness to pay for life saving. It is difficult to say, then, what they do reveal.
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From page 125... ...
NIH's (1998) response was that it followed a multiattribute approach to prioritization, considering factors such as consequences other than mortality, the losses associated with each death (as a quality adjusted life years EXALT or disability adjusted life years EDALy evaluations might try to capture)
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Properly designed studies can explain the issues in ways that improve participants' understanding. They can present alternative perspectives and help people to triangulate among them so that they can articulate the implications of their basic values for particular situations.
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From page 127... ...
Stimulus material characterizing risks at the hypothetical Centerville Middle School can be found at http://www.epp.cmu.edu/research/EPP_risk.html.3 Characterizing Risks Priorities should be based on the best available technical information. but without having the data analyses prejudge value issues (in any of the ways discussed earlier)
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(in press) discuss other design choices in creating our experimental test bed, as well as how they may have affected priorities.
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. · We grouped risks according to potential interventions (e.g., separating accidents into falls, sports, school buses, and commuting in private vehicles because interventions for each category lie in different jurisdictions)
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Within it, information is organized in brief, conceptually distinct units intended to allow approaching information for different purposes. The top of the first page identifies the risk category (e.g., school bus accidents)
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The second is individuals' need to articulate values for these specific questions, consistent with their basic values on the general issues. The third challenge is that when people lack prepared answers to a question, they can be subject to framing effects, such that ostensibly equivalent ways of posing questions can lead to different answers.
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The latter uses a simplified multiattribute procedure: participants rate the risk attributes in terms of relative importance, which the moderators convert into implied risk rankings. When the holistic and analytic rankings diverge, participants are encouraged to reflect on the reasons and seek reconciliation.
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It increases the risk of biasing expressed preferences, if the offerings are unbalanced. CONCLUSION Although this chapter makes the case for setting priorities systematically, it also shows the challenges that such exercises face.
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offer formal models for characterizing particular situations and simulating the expected yield of different strategies for prioritizing their risks. These models reflect concerns about the limits to analysis identified by Lindblom (1959)
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From page 136... ...
So, being pretty naive, I said, 'Why not take the money that the EPA is talking about for lowering lead levels in drinking water and putting it into nourishing inner city kids? "' The EPA said it didn't feed children; the NIH said it didn't have the money.
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From page 137... ...
ANNEX SETTING PRIORITIES BY WEIGHTING ATTRIBUTES The essence of priority setting is to identify the issues that matter, decide how important each is in the focal context, and then evaluate each option, considering how it stacks up on each issue, weighted by the relative importance ofthose issues. Multiattribute utility theory formalizes this logic (Fischhoff et al., 1984; Keeney and Raiffa, 1976; vonWinterfel~t and Edwards, 19861.
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From page 138... ...
aort-term 1nlurles or illnesses (cases per year) O 0 0.200 0.025 Time between exposure and health effects O O 0 0.100 Quality of scientific understanding O O 0 0.100 Uncertainty regarding death, illness, and injury O O 0 0.100 Ability of student/parent to control exposure O O 0 0.100 Sum of weights 1.000 1.000 1.000 1.000 probability of death.
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From page 139... ...
Thus, under the circumstances of this hypothetical school, relative concern over some of these sources of vulnerability varies considerably, depending on the weight given to the different attributes. On the other hand, lead poisoning merits relatively little concern, whatever the weighting scheme.
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From page 141... ...
In that case, Centerville Middle School might have a mandate, and perhaps resources, to deal with a problem of relatively little local concern. REFERENCES Bendor, J
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From page 142... ...
Washington, DC: Author. Federal Interagency Forum on Child and Family Statistics.
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From page 143... ...
, Comparing environmental risks (pp.
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From page 144... ...
. Social benefit versus technological risk.
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