Preventing Risk Behaviors: What Works

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Preventing Risk Behaviors What Works?

• Dr. Terri Prodoehl
• James Madison University
• 7/25/2006
• Health and Physical Activity Institute

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Outline

• Adolescents and Behavior
• What are risk behaviors?
• Important risk behaviors
• Predictors of risk behavior
• Prevention trends in risk behaviors
• Components of effective programs
• Influences on Risk Behavior
• Protective Factors
• Risk Factors
• Key Components Highlighted
• Self-competence, self-efficacy, coping and
  resiliency, social norms, social support
• Summary
• Resources

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Why do we do what we do?
Who Knows?
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How do we explain adolescent behavior?

• Emotional Outbursts.
• Reckless Risk Taking.
• Rule Breaking.
• Pursuit of Sex, Drugs, and Rock n Roll.

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They Cant Help It

• Its their hormones and their brains

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A Tinderbox of Emotions

• Sex hormones are especially active in the brains
  emotional center the limbic system.
• Feeling reach a flash point more
  easily.
• Teens seek out situations
  where they can allow their
  emotions and passions to
  run wild.

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Adolescents are actively looking for
experiences to create intense feelings. Dahl
(2002)
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Sensation Seeking

• Hint that there is some hormone-brain
  relationship.
• Contributes to
  the appetite for thrills,
  strong sensations,
  and excitement.
• Thrill seeking may have evolved to promote
  exploration, an eagerness to leave the nest and
  seek out ones own path and partner.
• Also puts teenagers at risk.

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Wacky Behavior and Dumb Decisions

• Identification of Emotions Using Functional
  Magnetic Resonance Imaging (Yurgelun-Todd, 2002)
• Adolescents rely heavily on the amygdala.
• Adults rely more on the frontal lobe.
• Adolescents under 14 make more
  mistakes than adults.
• Identify fearful expressions as angry,
  confused or sad.
• May explain why adolescent so frequently
  misread emotional signals.
• May see anger and hostility when it does not
  exist.
• www.pbs.org/wgbh/pages/frontline/shows/teenbrain/w
  ork/
• frontline inside the teenage brain work in
  progress one reason teens respond differently to
  the world PBS

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Risk Assessment Decision Making

• Yellow Light Study (Steinberg, 2002)
• Both adults and teens make safe
  choices when playing alone.
• Group play, teenagers take more
  risks in the presence of their friends.
• Differences in decision making and judgment may
  be due to high emotional
  arousal or have high social importance.

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Risk Assessment Drugs and Alcohol

• Dopamine is the brain chemical involved in
  motivation and in
  reinforcing behavior.
  
• Dopamine is particularly abundant and active in
  the teen years.

Nucleus Accumbens Region in Frontal Cortex that
directs motivation to seek rewards. Less activity
than adults Immediate payoffs more motivating.
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What to Do?

• Best estimate when brain is truly mature is age
  25, the age at which you can rent a car.
• Helpful to provide structure,organizing their
  time, guiding them through tough decisions.
• Patience and love.
• NEA Brain Development in Young Adolescents

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On to the risky behaviors.

• And what helps with prevention.

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Risk Behaviors

• Health compromising behaviors
• Common causes of morbidity and mortality in U.S.
• Primarily begin in adolescence and continue to
  adulthood
• Primary health concerns in an otherwise healthy
  adolescent population
• Primarily under an individuals control

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Significant Risk Behaviors

• Tobacco Use
• Physical Inactivity
• Poor Nutrition
• Substance Abuse-Alcohol and Drugs
• Safety Behaviors-Unintentional injuries,
  violence, suicide
• Unsafe Sexual Behaviors

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Traditional Predominant Predictors of Risk
Behavior

• Demographics
• Race
• Black Hispanic-weapons, early sex
• White-drink and smoke cigarettes
• White Hispanic-suicide
• Income
• Lower income family higher risk
• Family Structure-
• One parent family higher risk
• Still good predictors but not as strong as once
  thought

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Better Predictors

• 3-8 times better predictors than demographics
• School failure
• Too much unstructured time
• Poor family relationships

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Prevention Programs

• 1960s-
• Information, knowledge based
• 1970s-
• Affective methods, ie. Self-esteem, clarify
  values
• 1980-1990s-
• Psychosocial factors and Skills based programs

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Successful Prevention Programs

• Multifaceted Approach
• Individual
• Biological, psychological dispositions,
  attitudes, values, knowledge, skills, problem
  behaviors
• Family
• Function, management, bonding, support
• Peer
• Norms, activities, support
• School
• Bonding, climate, norms, resources, support
• Community
• Bonding, norms, resources, awareness/mobilization,
  policy/sanctions

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Individual Level

• Risk Factors
• Favorable attitude toward negative behavior
• Exaggerated perceptions of prevalence
• Poor school performance
• Not involved in school activities
• Lack of information
• Depression
• Conduct disorders
• Working

• Protective
• Self-efficacy
• Positive attitude
• Achievement oriented
• Self-discipline
• Active in school
• Sense of humor
• High IQ
• Good coping skills
• Religious involvement

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Peers

• Risk Factors
• Peers who participate in negative
• Peers who have access

• Protective
• Peers who disapprove
• Peers who participate in the positive
• Choice of social group is key
• Based upon self-perception of competence

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Family

• Risk
• No rules, unclear, or inconsistent
• No or little supervision
• Unstructured time
• Older siblings with negative behavior
• Parents who participate in negative

• Protective
• Clear rules
• Consistent
• Parent monitoring
• Parent communication concern, support
• Family patterns and values
• Models good coping

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Programs School-Community

• Risk
• High crime
• High access
• Lack of programs
• Lack of supervision
• Lack of parental involvement
• Lack of expectations

• Protective
• Coordination of messages
• High expectations
• Policies restricting access
• Services available
• Environmental modifications
• Encourage family participation

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Key Components

• Self Perception and Competence
• Affects hope, concerns for the future and choice
  of peers, strong influence on behavior
• Self-Efficacy of specific behaviors
• Belief in ability to do behavior
• Stress and Coping Abilities
• Resiliency
• Perceived Social Support
• Perceived Social Norms

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Self-Efficacy

• Considered one of the most important pre-req for
  behavior change
• Acquisition of new behavior
• Inhibition of existing behavior
• Disinhibition of behavior
• Efficacy Influences
• Amount of effort expended on a task
• Length of time one will persist with obstacles
• Emotional reactions

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Development of Efficacy

• Performance attainments
• Personal mastery of task, (self-control
  regulation, behavioral capability)
• Observational Learning (Vicarious Experience)
• Observing others performance-models
• Models must be similar to the observer (age, sex,
  etc) and be credible
• Models could be viewed overcoming obstacles with
  effort rather than ease
• Outcomes and rewards are clear
• Verbal persuasion
• Suggestions from others
• Emotional arousal
• Interpreting ones emotional state learning
  coping skills

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Stress and Risk Behaviors

• Some research suggests that those who are more
  distressed engage in more risk behavior than
  those who are not distressed

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Types of Coping

• Coping is what a person thinks and does to try to
  manage a stressful encounter
• Need for coping depends upon appraisals of
  situation, self, and resources
• Best coping style
• Using resources to confront the problem directly
  rather than avoidance or distraction
• Girls
• Ruminate, turn emotions inward
• Males
• More likely to use avoidance or diversions

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Resilience

• Balance between risk factors or stressors and
  adaptive coping
• The ability to meet and conquer adversity
• Protective- factors that decrease risk
• General Categories
• Within the individual
• Within the family
• Within the larger social environment

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Within Protective Factors

• IQ and school engagement
• Sense of humor
• Positive self-image
• Feelings of hope
• Internal locus of control
• How much does an individual feel his/her actions
  lead to reinforcements/change
• Two types
• Internal-Change under your control
• External-Change due to outside influences

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Within Family

• Caring and connected parents
• Two parents in home
• Home at key times
• High expectations from parents
• Disapproval of risk behaviors
• Fewer than 4 children
• Cohesion and structure

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Within Community

• Caring adults
• Positive role models
• Value on contribution to community
• Access to resources
• Clear and consistent boundaries

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Social Norms

• Perception of what is prevalent or popular
• Likely to sway someone toward a behavior if
  everyone is doing it
• More tolerant of negative behaviors is the
  perceptions is everyone is doing it
• Make messages that point out how many people DO
  NOT do the negative behavior

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Social Support

• The functional content of relationships
• The exchange of assistance through social
  relationships
• The degree to which social needs are met through
  interaction with others
• Perception that you can count on others for help
• Resources that other people provide tangible and
  intangible

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Broad Types of Social Support

• Emotional
• Expression of empathy, love, trust, caring
• Instrumental
• Tangible aid and service
• Informational support
• Advice, suggestions, and information
• Appraisal support
• Information that is useful for self-evaluation

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Sources of Social Support

• Family
• Friends
• Professional associates
• Religious congregations

• Neighbors
• Team mates
• People with whom one associates and to whom one
  could turn in time of need.

Social Support BSSS
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Social Support Health

• People with social support more likely to
• Engage in protective behaviors and less risk
  behaviors,
• Deal more successfully with stress.
• People who are socially isolated have poorer
  health and die earlier.

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Characteristics of Supportive Adults by
Adolescents

• Intelligent
• Openminded
• Trustworthy
• Friendly
• Interested in adolescent
• Willing to spend time with them
• Offer alternative ideas without coercion
• Sharing past experiences and lessons learned
• Willingly disclose about themselves
• Nonjudgmental and equal dialogue with adolescent

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Bottom Line Increase

• Self-competence
• Self-efficacy
• Coping and problem solving skills

• Social Support
• Family communication and ties
• School involvement success
• Community environment

• Perceptions of what is socially acceptable
• Positive social norms for protective behaviors
• Negative norms for risk behaviors

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Resources

• CDC Healthy Youth
• Healthy Youth - Division of Adolescent and School
  Health (DASH) - DASH/HealthyYouth
• Registry of Effective Programs
• Registries of Effective Programs -
  DASH/HealthyYouth
• Community Guide
• The Community Guide - Task Force on Community
  Preventive Services
• Cancer Control Planet
• Cancer Control PLANET
• Healthy Schools for Healthy Kids
• CDC Healthy Schools Healthy Youth
• Child Trends
• Child Trends