Predicting Adolescent Risk Behavior Using a ...

Journal of Youth and Adolescence, Vol. 25, No. 3, 1996

Predicting Adolescent Risk Behavior Using a Personalized Cost-Benefit Analysis Susan Moore 1 and Eleonora Gullone 2 Received December 7, 1994; accepted June 6, 1995

Risk was investigated from the subjective viewpoints of adolescents, with the aim of assessing adolescents' perceptions of what constitutes risky behavior and how risk behaviors and risk judgments relate. Participants were 570 school-based adolescents. Students named risky behaviors perceived as common to similarly aged peers, then rated level of engagement in these behaviors. The perceived positive and negative outcomes of risk were also nominated, and rated on perceived likelihood and desirability~undesirability. The sample viewed risky behaviors as smoking, drinking alcohol, dangerous driving, taking drugs, criminal behavior, sporting risks, antisocial behavior, minor rebellion, school-related risks, and sexual activity. Negative outcomes of risk were categorized as death, disablement, punishment, and social consequences. Payoffs included pleasure, material gain, and avoidance of negative outcomes. There was a consistent pattern of relationships between risk participation and outcome judgment, with perceived pleasantness and likelihood of positive outcomes, and unpleasantness of negative outcomes, strongly associated with behavior.

This research was supported by the Australian Rotary Health Research Fund. 1professor, Department of Psychology, Victoria University of Technology, St. Albans Campus, St. Albans, Victoria, Australia, 3021. Received Ph.D. from Florida State University. Research interests: adolescent development, risk taking, and sexuality. 2Senior Lecturer, Department of Psychology, Monash University, Clayton Campus, Clayton, Victoria, Australia, 3167. Received Ph.D. from Monash University. Research interests: adolescent development, emotional development, and families. 343 oo47-2891/96/o60o-o3435o9.5o/o9 1996PlenumPublishingCorporation

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INTRODUCTION

In alarming numbers, Australian adolescents engage in activities inimical to their health. These include smoking, substance abuse, binge drinking, dietary fads, unhealthy eating, unsafe sexual practices, prolonged sun exposure without protection, dangerous driving, and other reckless behaviors (Moore and Rosenthal, 1992, 1993). The health of adolescents is, in fact, most severely jeopardized by their own risky behaviors, with accidents ranking equally with suicide as the major cause of death for this age group in Australia. Some of these risks appear more dramatic than others, most particularly when the negative outcome happens clearly as a direct and immediate result of the behavior in question, such as serious accidents caused by drunken driving, or death from drug overdose. Potentially as serious though more "hidden" are the long-term effects of unhealthy practices begun or developed as habits in adolescence, such as smoking or prolonged sun exposure. Thus adolescent risk taking has become an important current topic on the research agenda. But what do we mean by the term "risk taking"? There appears to be a good deal of conceptual confusion. For example, classification of risky behaviors in published research includes such diverse activities as suicide attempts (Tonkin, 1987) and guessing on multichoice tests (Atkins et al., 1991). Do such diverse behaviors have anything in common? Much adolescent risk-taking research considers one type of risk only, such as substance abuse or sexual risk. The question arises as to whether results are generalizable to other risks. Evidence that there may be common patterns comes from a range of sources (Block et al., 1988; Gorsuch and Butler, 1976; Jessor and Jessor, 1977; Kandel, 1980). For example, Metzler et al. (1992) found high correlations between unsafe sexual activity and other health compromising behaviors such as smoking, alcohol, and marijuana use in three independent samples of 14-18-year-old teenagers. Moore and Rosenthal (1992) showed links between sexual risk (multiple partnering, unprotected intercourse), smoking, and risky (fast) driving among older adolescents, but their study also indicated that factors predicting risk perception among adolescents were more likely to be unique to specific risks rather than generalizable across risks. Is it possible to develop a general model of diverse risk-taking behaviors in adolescence, or do these behaviors follow idiosyncratic patterns in terms of their prediction and control? As described above, a generally held belief about risk taking is that it is deviant, leading to behaviors that compromise health and well-being. Teenagers engaging in these behaviors may be viewed as rebellious and alienated from the traditional institutions of society, especially the family and school. On the other hand, our society values certain forms of risk

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taking, as evidenced by the approval afforded to those who excel at dangerous sports, do brave deeds on impulse, make "creative leaps" in science, arts, or politics, are socially outgoing, or even daring in fashion. Chassin et al. (1989) propose the interesting hypothesis that young people who engage in negative forms of risk taking may also be more likely to engage in, or at least have the potential for, more positive, constructive forms of teenage unconventionality, reflecting independence and creativity. Underlying personality traits such as impulsivity and sensation seeking may provide the link between adaptive and maladaptive forms of risk. In their study of adolescent health-related behaviors, Chassin and his colleagues showed that while some adolescents at risk for substance abuse were rebellious and alienated, another at-risk group were "nondeviant," while being unconventional, creative, independent, and assertive. This second group were more likely to engage in health-protective behaviors such as sport, along with their more destructive activities like smoking and drinking. Few researchers have examined positive risk, that is, behavior that has the likelihood of adaptive, healthy outcomes, but involves potential cost, such as the social costs of embarrassment or failure, the physical cost of accident and injury, or the emotional cost of fear. Such activities are important for adolescent development as they engender a sense of independence (Baumrind, 1991; Lavery and Siegel, 1993). Are they related to risk behaviors that are potentially health compromising or harmful in other ways? While Chassin et al.'s evidence gives an indication that the traits underlying risk taking in its maladaptive sense can also underlie valued behaviors, the exploration of these positive behaviors within the context of general models of risk taking has not progressed far (Bell and Bell, 1993; and see Lyng, 1993, for a comparison of "voluntary risk taking" such as mountain climbing and criminal behavior). Models of the decision-making process have been applied to the prediction of adolescent risk taking, but with only moderate success. For example, Ajzen and Fishbein's (1980) Theory of Reasoned Action (TRA) postulates relationships between engaging in a behavior and attitudes toward it, knowledge of its likely outcomes, and intentions with respect to carrying out the behavior in question. While this model works relatively well in predicting adult behaviors that are premeditated and rationally governed (Ajzen and Fishbein, 1980; Ajzen and Madden, 1986), it is less successful in explaining actions in which contextual and emotional factors have a major role. In these cases, intentions are often thwarted or discarded. An example in the sexual domain is the limited relationship between intention to use a condom and actual use, with situational factors such as sexual arousal and alcohol use frequently interfering with young people's good intentions to engage in safe sex (Boldero et al., 1992). Such situational

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factors may be more likely to sway adolescents than adults, because of their lack of experience in dealing with contingencies. It is also possible that adolescents actually define risk differently from adults because they are less able to recognize the persuasive power of situations. Another rational decision-making paradigm, the Health Belief Model (HBM; Janz and Becker, 1984), has also been applied to adolescent risk taking in the areas of sexual risk (Rosenthal et al., 1992), and dieting and exercising behavior (O'Connell et al., 1985) among others, with only limited success. Most supportive research with both the TRA and the HBM appears to have been conducted with adult or child samples rather than adolescents per se, and describes the prediction of compliance to particular health routines, for example, having regular dental check ups) (Weisenberg et al., 1980), or protective behaviors such as taking the contraceptive pill for pregnancy protection (Jacard and Davidson, 1972). Fewer studies have examined the success of these models in explaining the avoidance of unhealthy or otherwise risky behaviors, such as smoking or binge drinking. Effect size, that is, the power of the model to accurately predict the behavior in question, has not been reported in many of the studies reviewed (Adler et al., 1992). One serious conceptual problem within the study of adolescent risk taking is that the decision as to what constitutes risky behavior is invariably made by the researcher. This is despite the fact that theorists such as Levitt et al. (1991) have stressed the importance of "personal meaning" as a variable in models of risk prediction. Adult conceptions of risky activity may or may not correspond with those of young people (Alexander et al., 1990). In the present study we were interested in high-risk behavior from the subjective viewpoints of adolescents. Our aim was to determine adolescents' perceptions of what is risky, what kinds of behavioral outcomes they perceive as desirable, and what kinds undesirable. Beyth-Marom et al. (1993) argue that an open-ended format for assessing risk consequences more accurately simulates the circumstances under which risk decisions are actually made, with the implication that such a format is a more valid indicator of perceived risk consequences than closed answer questionnaires. We have used such an open-ended format to explore both risk definition and risk consequences in this study. We also assessed the ratings of outcome desirability and their perceived likelihood for adolescent-chosen risks, with the aim of assessing whether these adolescent judgments of outcome relate to engagement in the particular behaviors. That is, are there risks for which positive outcomes are judged as outweighing the negative, and vice versa? Do such judgments and the perceived likelihood of occurrence relate to the behaviors in question? Adolescent views of what is "worth the risk" may well differ from

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prevailing social wisdom, and one task of this study is to investigate this possibility. Common views of what constitute risk seem to involve some kind of balance between the positive and negative outcomes. If the positives by far outweigh the negatives, then the behavior is not usually considered risky except by the most cautious of people. An example would be doing the shopping (you could be killed but it is extremely unlikely). If the negatives by far outweigh the positives, the behavior may be considered suicidal, selfdestructive, or extremely foolhardy. Examples would be playing Russian Roulette, or an untrained person walking across the Niagara Falls on a highwire. In these cases, the word "risky" seems an understatement of the likely outcomes, and an inaccurate reflection of the motives behind the behaviors. Our definition of risk therefore is behavior that involves potential negative consequences (or loss) but balanced in some way by perceived positive consequences (gain). In this definition, we extend that of Yates (1992), who concentrates on the loss side of the equation only. The prediction of risk taking was tested in this study by a simple model that combines elements of the rational decision-making approach with consideration of adolescents' views of what is risky and why. Benthin et al. (1993) showed, among a small sample of high school students, that participants in risk-taking behaviors perceived greater benefits in these behaviors than nonparticipants, while they judged potentially negative outcomes as less noxious. We postulate on similar lines that the likelihood of engaging in risk behavior is a function of the product of the perceived desirability of the positive outcomes and their perceived likelihood, minus the product of the perceived undesirability of the negative outcomes and their perceived likelihood. For example, consider the risk of engaging in unprotected sexual intercourse. An adolescent female may perceive the desirability of sexual intercourse with an attractive male friend as being high. She may also perceive the likelihood of this event occurring and being enjoyable as strong. Her perception relating to the aversiveness of some of the potential consequences may be extremely high given that AIDS is a life-threatening disease. However, she may perceive the probability of this negative outcome and/or others as relatively low, or even insignificant. The final outcome regarding whether or not she engages in the behavior will be predicted by a combinations of these considerations. In contrast to Benthin et al. (1993), the definition in our study of what constitutes risk, and of the nature of the positive and negative outcomes, were subject (adolescent) based rather than researcher based. In this way the study goes beyond the conventional testing approach for models of rational decision making.

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In summary, risky behavior and its potential consequences were investigated from the subjective viewpoints of adolescents. The major aims of the research were to assess (a) adolescents' perceptions of what constitutes risky behavior and their judgments about its consequences, (b) differences between gender and age groups in risk judgments, and (c) the relationships between risk behaviors and risk judgments.

METHOD Subjects Participants in this study were 570 school-based adolescents (291 males, 279 females), aged 12-17, from six coeducational state secondary schools in Melbourne, Australia. Schools were selected with a view to obtaining a representative sample with regard to socioeconomic status; hence schools from both working- and middle-class areas were included. Students whose parents gave permission volunteered to participate in the study after reading an explanatory statement about the nature of the research. This resulted in a response rate of approximately 85% with most nonrespondents being those who forgot to return their consent form rather than direct refusals to participate. Five year levels were tested (Years 7-11), the numbers in each year level ranging from 101 (Year 8) to 129 (Year 7). There were approximately equal numbers of males and females sampled across each year level.

The Questionnaire The questionnaire comprised several sections, including the following: (a) Demographic questions relating to age, sex, mother's and father's occupations, mother's, father's, and child's country of birth, and language spoken at home. (b) Risk designation: Adolescents were asked to name up to four behaviors that they saw as both risky and common to young people their age. They were then asked via two separate questions to designate their perceptions of the positive and negative outcomes for each of their nominated behaviors. ("What are the bad/good things that could happen to you if you did this?") For the negative outcomes, students were asked, "How unpleasant would it be for these bad things to happen?" They responded on a 5-point Likert scale ranging from 1 = not at all unpleasant to 5 = extremely unpleasant. Their perceived likelihood of the nominated consequences was

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also rated on a 5-point scale, ranging from 1 = no chance to 5 = very high chance. In a similar manner for the perceived positive outcomes, students were asked, "How pleasant would it be for these good things to happen?" They provided their responses on a 5-point rating scale ranging from 1 = not at all pleasant to 5 = extremely pleasant. Their perceived likelihood for the nominated positive consequences was assessed in the same manner as for the perceived negative outcomes. Finally, in order to determine the relationships between perceptions and behaviors, students were asked, "Do you engage in this behavior?" They responded on a 5-point scale ranging from 1 = never do, to 5 = often do.

Procedure The risk questionnaire described above was administered to all respondents. The instructions were read aloud to the students who were required to independently complete the questionnaire. It was emphasized to respondents that there were no right or wrong answers, and that they should work independently. The questionnaire took approximately 40 minutes to complete, and was completed anonymously to increase validity of responses.

RESULTS AND DISCUSSION

Adolescent Perceptions of Risk All risks mentioned (N = 2206) were listed and tallied, then grouped into broad categories by the researchers, who independently developed potentially workable groupings, then discussed these with the aim of achieving consensus on a manageable (relatively small) set of categories for further analysis. For example, driving without a seatbelt, speeding, and driving while drunk were all subsumed under the category of "dangerous driving." A similar procedure was followed for the categories comprising perceived positive and negative outcomes. Two raters were then given definitions of the categories, and they independently rated 20% of all responses. Interrater agreement, which was measured by counting the number of agreements, dividing by the total number of responses rated, and multiplying by 100, was 96%. Nonagreements were decided by discussion. On the basis of this high rate of agreement, one rater grouped the remaining risks and outcomes. An arbitrary decision was made to select only those categories of risk nominated by 10% or more of the sample. Table I shows these groups of

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Moore and Gullone Table I. Major Adolescent-Generated Risk Categories and Their Perceived Positive

and Negative Outcomes Risk

N

Smoking

286

Drinking Alcohol

271

Taking Drugs

340

Criminal Behavior (major & minor)

264

Sex-related

140

Dangerous Driving

89

Anti-social Behavior

87

School-related Behavior Minor Rebellion

82 78

Sport-related

48

Negative Outcomes Sickness/disease Death Get into trouble Sickness/disease Psychological trauma Death Get into trouble Feel foolish Death Sickness/disease Psychological trauma Serious injury Get into trouble Get into trouble Severe punishment Hurt others Death Sickness/disease Pregnancy/baby Death Accident Get into trouble Injury Get into trouble Hurt others Get into trouble Education suffers Get into trouble Hurt others Serious injury Sickness/disease Death Accident

Positive Outcomes Peer acceptance Relaxation Pleasure/high relaxation

Pleasure/high

Material gain Get away with it Pleasure/high Pleasure Pregnancy/baby Love/closeness Get away with it Pleasure in violence Get away with it Get away with it Pleasure/high Pleasure/high Get away with it Freedom Pleasure/high

risky behaviors. Sport-related behavior, nominated by only 8.4% of participants, was also included because it was the only positive risk nominated by an appreciable number of adolescents. It constitutes the largest category of risk nominated by below 10% of the sample. The perceived positive and negative outcomes of these risks are also shown in Table I. Note that major and minor criminal behaviors have been collapsed into one group in Table I, because their perceived positive and negative outcomes were the same. However, both major criminal and minor criminal behaviors were mentioned by 10% or more of the sample (N = 57 and N = 207, respectively), and they are considered separately in later analyses. Risks nominated by

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fewer than 10% of the sample, with the exception of sport-related risk, were not subject to further analyses, due to the small Ns involved (e.g., emotional/social risks, N = 15; weight-related risks, N = 15). Smoking referred to smoking cigarettes. The drinking alcohol and drugs categories included behaviors describing both indulgence (underage drinking) and overindulgence (getting drunk). Criminal behaviors covered a very wide range of activities, varying from the highly antisocial (murder, rape, robbery) to more minor misdemeanors, such as joyriding or shoplifting. Among sex-related behaviors were included just sex without elaboration, but also items such as unsafe sex, not using a c o n d o m or contraceptives, sex with a prostitute, and homosexual activity. Dangerous driving covered speeding, reckless driving behavior of various kinds, and drink driving. The antisocial behavior category included activities that were not illegal but which could involve harm or distress to others, such as fighting, making racist remarks, or "mooning." They differed from the minor rebellion category, which described mild reaction against authority (usually parents), rather than against peers. Examples were lying to parents, staying out late, and sneaking out. School-related behaviors sometimes included such minor rebellious activities, but we decided to put them in a separate category because of their number. Skipping school, not doing homework, cheating, and answering back at teachers were examples of this category. Finally, sport-related behaviors included sports with an element of risk or danger, such as deep sea diving, rock climbing, parachuting, and the like. Perceived positive and negative outcomes are included in Table I if they were nominated by 10% or more of the group who mentioned the related risk. Death, disease, injury, and psychological trauma (such as "freaking out," "having a bad trip," or "hating myself") were commonly listed as negative outcomes that could affect the respondent, belying the sometimes expressed ideas that adolescents are unaware of the seriousness of these potential hazards, and that their risk-taking behaviors will be minimized through increased educational efforts about negative consequences. The perceived power of adult authority was reflected in the commonly stated negative outcome, for 8 of the risk groups, of "get into trouble." However, harm to others was mentioned by a significant number of adolescents for only 3 risk groups (criminal behavior, minor rebellion, and antisocial behavior). Interestingly, pregnancy or having a baby was suggested as a negative outcome of sex-related behavior by more than 10% of the subsample who saw sex as a major category of risk activity, but it was also mentioned by more than 10% as a potentially positive outcome. On the whole, young people did not have much idea why they engaged in risk activity, with the general outcome of "pleasure" seen as a major positive potential outcome of risk, for eight of the ten risk groups. The

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somewhat oblique notion of "getting away with it" or "not getting caught" was also a commonly given positive outcome, for 5 of the 10 risks. This may be a reflection of risk taking as a form of either sensation seeking (Arnett, 1992) or rebellion against adult authority (Baumrind, 1991; Gardner, 1993; Jessor and Jessor, 1977). Improved relationships to others were part of the potential positive outcomes for only 2 of the risks. Increased peer acceptance was nominated as associated with smoking, and the potential for love and closeness as associated with sexual activity.

Sex Differences in Risk Designation

Chi-square analyses were conducted to investigate differences in rates of mentioning the major risks among males and females. Females were more likely to mention as risks smoking (22 = 3.51, p < .05), drinking (%2 = 6.33, p < .01), sex-related behaviors (~2 = 7.88, p < .01), and minor rebellion (22 = 18.41, p < .01). Boys were more likely to mention as risks major and minor criminal behaviors (~2 = 34.09, 11.24 respectively, p < .01), sport-related behaviors (~2 = 24.90, p < .01), and antisocial behavior (Zz = 9.15, p < .01).

Relationships Between Risks, Costs, and Benefits: A Test of the Model

For each of the 11 major risk groups (major and minor criminal activity now separated), correlations between extent of engagement in the behavior and the four variables--perceived pleasantness of positive outcomes, likelihood of positive outcomes, perceived unpleasantness of negative outcomes, and likelihood of negative outcomes--were calculated. The correlations are presented separately for males and females because of previously described sex differences in risk designation. These correlations could only be ascertained for individuals who had mentioned a particular risk; consequently, sample numbers vary across risks. In two cases where there were large sex differences in risk designation--major criminal activity and sport-related risks--correlations must be viewed with caution because of the small number of females. Table II shows these statistics. The pattern of correlations, rather than any individual relationship, is the focus of discussion here. It can be seen that there was a strong, consistent pattern of correlations between engaging in risky behavior and three of the four cost-benefit variables. Engagement in risk-taking behaviors significantly associated with perceived pleasantness of the potentially positive outcomes for males in 7, and females in 5, out of 11 cases. Beliefs about

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T a b l e II. R e l a t i o n s h i p s B e t w e e n P l e a s a n t n e s s a n d L i k e l i h o o d o f Positive O u t c o m e s , Unpleasantness and Likelihood of Negative Outcomes, and Engaging in the Risky Behavior (by Sex) Risk Behavior Smoking Drinking Drugs Dangerous driving Major criminal Minor criminal Sport related Sex related Minor rebellion School related Antisocial

Sex

N

F F M F M F M F M F M F M F M F M F M F M F

116 170 122 149 163 177 45 44 49 8 115 92 38 10 58 82 23 55 41 41 55 32

Pleasantness of Positive Outcome 0.33 a 0.23 a 0.37a 0.41 a 0.31 a 0.39a 0.49~ 0.20 0.27 0.00 0.19b 0.27 b 0.39b 0.13 0.11 0.22 0.04 0.14 0.28 0.40 b 0.29b 0.30

Likelihood of Positive Outcome 0.16 0.15 0.38a 0.46a 0.34 a 0.38a 0.56a 0.50a 0.36b 0.20 0.26a 0.35a 0.32 0.46 0.21 0.35 a 0.30 0.00 0.03 0.16 0.23 0.45 a

Unpleasantness of Negative Outcome -0.14 --0.17b --0.19b -0.25 a -0.50 a -0.41 a -0.20 -0.30 b -0.66 a -0.22 -0.37 = 0.08 -0.23 -0.90 a -0.27 -0.19 -0.14 -0.24 -0.15 -0.12 -0.40 a -0.16

Likelihood of Negative Outcome -0.02 -0.06 -0.03 0.00 -0.08 -0.07 -0.15 -0.12 0.27 -0.43 -0.09 -0.13 -0.22 -0.06 -0.08 0.01 0.00 -0.02 0.23 -0.04 -0.33 a 0.09

b p<