BOCYF Projects: Re-conceptualizing Adolescent Risk and Vulnerability

Adolescents face many threats to their health, safety, and well-being. Some are shared by their society as a whole (e.g., war, many diseases, and crime). Others are unique to, or at least accentuated by, their transition to arenas beyond the control of their guardians. Many adults devote much of their lives to reducing these vulnerabilities. There are school, community, and religious programs. There are medical screening, treatment, and education efforts. There are lectures, remonstrations, and rescues by parents. There are special laws governing adolescent driving and status offenses. There are summits and conferences, some with teen representation, some without.

Teens are often described as living in a fog of exaggerated personal invulnerability. However, both the scientific evidence and direct discussion show teens as having many concerns on their minds. They wonder if and how they’re going to get through this stage of their lives, with the world that they hope for reasonably intact. Chronic diseases are one part of that burden, especially when they induce moments of legitimate panic, like diabetes or asthma. Violence is another part, especially when teens feel as though they never know which minor incident (or sideways glance) is going to get out of control. Fear about the continuity of the larger world is yet another, especially for teens attuned to the erosion of faith in government, the assaults on the natural world (and on animals, with which many young people feel a special identity), the turmoil in racial relations, and the growing income inequality. Even in the current economic boom for some, many teens worry about having a decent career (not to mention a meaningful one).

These concerns notwithstanding, teens obviously do not always act in ways that serve their own best interests, even as they define them. Worrying about life in general is not incompatible with sometimes underestimating the risks posed by particular events (e.g., unsafe sex, drinking and driving). Adults, too, often have exaggerated feelings of control over life events.

In order to deal effectively with these vulnerabilities, teens and adults need to know how big they are and how much can be done about them. That means knowing how big the overall burden is, in order to decide what personal and societal resources to devote to them (relative to other priorities). It means knowing the relative size of different problems, and of the opportunities for risk reduction – so that one can invest in the “best buys” among currently available interventions – so that we can devise better ways to help adolescents. It means knowing what could be learned by systematic study or experimentation. That could include closing the gap between perceived and measured risks, so that these problems achieve the attention that they deserve, both overall and for specific cases.

The Forum is proposing to convene a workshop that will consider, and indeed reconsider adolescent vulnerability, and the implications of this new framework for policy and practice. It will take advantage of the growing societal concern for adolescents, the need to set priorities, and the opportunity to apply decision-making perspectives to this critical problem. It will have the following four elements, and background papers will be commissioned for each element:

Total burden of adolescent vulnerability – A cornerstone of decision analysis is that the definition of “risk” (or “cost” or “benefit”) depends on what one values, when setting public policy. The important risks to teens could be just deaths, or just mortality and physical morbidity, or all of the above plus psychological burdens. Risks could also include lost opportunities to realize teens’ life potential, and so on. This paper and presentation will illustrate this principle, with data made available from the preceding paper. It will summarize teens’ overall vulnerability in several different ways, each representing different values. In so doing, it will frame the challenge of setting priorities. That challenge will be both for society as a whole (how much of its resources to devote to teens) and for those concerned with teens’ welfare (where to focus those resources). The paper will conclude with a brief discussion of social mechanisms for priority setting.
Sources of vulnerability – A paper and presentation will summarize current data regarding the range of threats to the well-being of adolescents. It will cast a wide net, without worrying about aggregating the risks or translating them into a common unit. It will note data gaps, as well as provide links to existing sources. Using these data, a new concept of vulnerability will be developed and tested empirically.
Measures of vulnerability – A paper and presentation will examine issues related to the how we should be operationally defining, and measuring vulnerability and risk, including what tools exist to measure these concepts, what data sources are available and the strengths and limitations of these data sources, and what are useful ways of aggregating or disaggregating data used to measure vulnerability and risk.
Perceptions of vulnerability – The paper would review existing data, from both survey research and other sources, regarding beliefs about risks to adolescence – as held by both teens and adults. Particular attention would be to ensuring that terms are clearly enough defined that the accuracy of these risk perceptions can be evaluated. The paper would also consider what is known, in general, about adult and teens ability to judge risks, providing default assumptions for cases in which no directly available data exist. It will consider the links between beliefs and behaviors.

The workshop will be organized into two sessions. The first session that will examine our understanding of adolescent vulnerability and explores new ways for conceptualizing vulnerability. Each of the above-described commissioned papers will be presented during this first session. The second session will consider the application of this new construct to policy and practice. Key leaders from federal and state agencies and foundations, from the field of public health, researchers who develop behavioral interventions, and administrators from community-based organizations will be asked to participate in this discussion. The workshop will yield a summary report that would include the commissioned papers. Finally, the commissioned papers, presentations, and discussions at the workshop are likely to suggest future efforts to further develop this research and explore the implications of this research by the Forum and other organizations. For example, there is already discussion about how this effort can inform the work of the World Health Organization and for the United Nations Assembly Special Session for Follow-up to the World Summit for Children scheduled for September 2001. A new approach to adolescent vulnerability might also help us better understand how to help adolescents draw on their own capacity for decision making to increase their well-being.

A small advisory group has already been established to help guide the adolescent risk and vulnerability activity, including Baruch Fishhoff, Professor of the Department of Social and Decision Sciences at Carnegie Mellon University; Robert Blum, Professor of the Department of Pediatrics and Director of the Division of Adolescent Medicine at the University of Minnesota; Susan Millstein, Professor of Pediatrics at the University of California in San Francisco; and Elena Nightingale, Scholar-in-Residence at the National Academy of Sciences.