Adolescent Decision Making: Implications for Prevention Programs . Introduction


Adolescence is frequently described as a time of engaging in risk-taking behaviors.  In 1996, 45 percent of high school seniors reported having tried marijuana, 30 percent reported being drunk in the past two weeks, and 22 percent reported smoking cigarettes daily (U.S. Department of Health and Human Services, 1997).  Nearly two-thirds of U.S. teenagers reported initiation of sexual intercourse prior to high school graduation (Centers for Disease Control and Prevention, 1996) and they experience a high number of sexually transmitted diseases (Institute of Medicine, 1996) and unintended pregnancies (U.S. Department of Health and Human Services, 1997).  Adolescents are involved in a disproportionate number of automobile accidents (National Committee for Injury Prevention and Control, 1989).  In the past 10 years, violence among adolescents has increased to the point that homicide is the second leading cause of death among young people (Singh et al., 1996).

Adolescents' involvement in risk-taking behaviors has been explained in a number of ways.  Some researchers suggest that teenagers tend to be especially high in sensation seeking (Zuckerman et al., 1978).  Others suggest that they use these behaviors to appear more mature (Jessor, 1987) or because they have heightened egocentrism (Elkind, 1985).  Many authors (e.g., Arnett, 1992; Jessor, 1987; National Research Council, 1993) attribute these behaviors to a combination of individual, social, and environmental factors.  One of these factors that has received much research attention in recent years is adolescent decision making.

Interest in the role that decision making plays in adolescents' involvement in high-risk behaviors led the Office of the Assistant Secretary for 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 and the Institute of Medicine.  A two-day workshop was held on January 6-7, 1998, to (1) identify and discuss the major findings from the last decade of research on adolescent decision making, particularly as they relate to high-risk behavior among adolescents; (2) discuss the research on efforts to intervene in adolescent high-risk behaviors; and (3) highlight the implications of this research for interventions to reduce high-risk behavior among the nation's youth, particularly in the areas of substance abuse and sexuality.  The workshop brought policy makers and service providers together with researchers studying adolescent decision making, individuals evaluating programs to prevent high-risk behaviors, and advertising professionals developing materials aimed at teenagers.  Using decision theory as a framework, the workshop presentations examined who adolescents are as decision makers, the kinds of decisions they face, the contexts in which those decisions must be made, and the kinds of supports adolescents need in order to make decisions that are consistent with healthy development.

This report summarizes the discussions held at the workshop.  It provides a brief overview of decision theory and how decision theory might be applied to adolescent behavior.  The report next considers cognitive, social, affective, and institutional factors that may influence effective decision making.  The role of the media is briefly explored, followed by information on several youth development and prevention programs.  Finally, the report summarizes issues that were raised throughout the workshop that might be important to the design and implementation of programs for youth.

The report is not intended to provide a complete review of decision theory, adolescent development, or program evaluation literature.  General theories of adolescent development were mentioned only in passing in the workshop, and therefore are not covered in this report.  The workshop did not cover adolescent ego development or adolescent moral development, nor did it deal with adolescents as sensation seekers.  Finally, the workshop did not examine all types of youth development and prevention programs.  Rather than a comprehensive overview, this report should be seen as a reflection of ideas of the workshop presenters that may spur new research and more collaboration between researchers and service providers.