Video feature: Q&A on decision-making

Most of us have seen it before.  Maybe it was a neighborhood boy riding his bike down the middle of the road, or a group of girls performing stunts on the diving board at the local pool. Whatever the circumstance, it’s fairly common knowledge that young people don’t always make the best decisions. In fact, it’s a topic we’ve written about here on EBL.  But given the stakes, it’s one worth revisiting.

Earlier this month, Cornell professor Valerie Reyna — an expert in decision-making  — was featured in a new video on the topic.  In it, Reyna explains the science behind decision-making in adolescents, as well as how the neuroscience of decision-making plays a role in other areas of our lives including health care and memory.

It’s certainly worth a watch!

What does the evidence say about risk communication?

The U.S. Food and Drug Administration has published a new report that’s right up our alley. It’s called Communicating Risks and Benefits: An Evidence-Based User’s Guide.

The introduction offers an explanation of evidence-based health communications that we believe should be the standard for all organizations, from corporations to government agencies to universities.

“…Sound communications must be evidence-based in two related ways. One is that communications should be consistent with the science — and not do things known not to work nor ignore known problems. The second is communications should be evaluated — because even the best science cannot guarantee results. Rather, the best science produces the best-informed best guesses about how well communications will work. However, even these best guesses can miss the mark, meaning that they must be evaluated to determine how good they are and how they can be improved.”

The report goes onto address the concept of communicating risks and benefits across a wide range of fields – in health provider settings, news coverage and corporate communications to name a few – and offer practical tips about using evidence in all sorts of communications.

Cornell’s own Valerie Reyna, whom we’ve written about before, authored Chapter 12 about communicating risks and benefits to people of all ages, and her work is extensively quoted in other chapters of the report.

The report is chock-full of useful recommendations.  Among them are:

  • Health professionals should receive specific training on how to communicate the risks and benefits of medical procedures and medicines.
  • Provide information along with explaining meaning to help consumers make good decisions.
  • Test the readability of health care messages to ensure they use plain language.

If you work in the field of health care, this report is a must-read!

New insights into the teenage brain

We have all heard the frightening statistics before.  Teens ages 15 to 19 are age group most likely to die due to injury – about six times more likely than 10- to 14-year-olds. Crime rates are highest among young males. Teens are also more likely to abuse alcohol and engage in risky sexual behavior compared with people of other ages.

Now a new paper published by the National Institute of Mental Health sums up the body of research on the vulnerability of teenagers. Much of the problem, it turns out, has to do with their brain development.

The paper explains that brain scans have revealed that the brain doesn’t resemble that of an adult until most people are in their early 20s. And the parts of the brain responsible for behaviors such as controlling impulses and planning ahead are among the last to mature.

Research also shows that the parts of the brain involved in emotional responses are more active in teenagers compared with adults, which may help explain teenagers tendencies to act impulsively and take on more risks.

So what’s a parent to do?  Cornell Professor Valerie Reyna studies risky behavior among teenagers. (In fact, we’ve written about her research before.)   She’s created a web page of resources on Risky Decision-Making in Adolescence to help teachers and parents guide kids.   She offers a long list of strategies to keep young people safe, such as using positive role models and role playing to simulate risky situations.

If there are teenagers in your life, it’s worth understanding how their brains and developing and what you can do to help them make good decisions.

Medicine by the numbers: Cornell professor on how we make health care decisions

These days, a routine trip to the doctor’s office can easily morph into a complicated calculation of risks and benefits. With the advent of pharmaceutical advertising and the plethora of medical information on the Internet, patients have more choices and responsibility to make decisions than ever before.

Enter Cornell professor Valerie Reyna, a faculty member in human development and expert in judgment and decision-making.

Her ground-breaking research has shown that medical information is difficult to understand for people of all education levels. In laboratory studies and analyses of real-world data, Reyna has found that adults tends to make all decisions – including medical decisions – based on the overall meaning or gist of situation, instead of using statistics and details. So there is a disconnect between the way medical information is presented and the way people make decisions. 

For example, the risk of dying on the table during carotid endarterectomy (a vascular surgery procedure that removes plaque from the lining of your carotid artery) is 2 percent. In one of Reyna’s studies, some patients undergoing the surgery estimated their chance of dying as 10 percent, while others estimated as little 0 percent or no risk at all. Even though zero is numerically closer to two than ten is, someone who estimates 10 percent has made a more informed choice because that person grasps the important bottom-line: the surgery involves some risk.

But Reyna has found that gists are only as good as a person’s level of knowledge or understanding. For instance, the gist that “condoms block the exchange of bodily fluids” leads people to overestimate condoms’ effectiveness against sexually transmitted diseases, because it does not take into account infections that are transmitted by skin-to-skin contact, such as human papilloma virus. In this case, the bottom line is that some infections are transmitted skin to skin, not via exchange of fluids.

Reyna wants to help bridge this disconnect and make sure patients have the kind of information they need to make solid, informed choices. She has created a web page that explains how her basic research can help patients and their physicians map our health care choices.

She also offers some tips:

  • Health providers should explain options qualitatively. Instead of relying solely on numbers, it’s helpful to explain probabilities verbally, stressing the bottom-line meaning of information.
  • Display information visually. Simple bar graphs and pie charts help patients extract important information without getting hung up on memorizing the details.
  • Tailor the format to trigger the appropriate gist. Frame messages and choose the most suitable visual formats to convey the bottom line.

Why do you think kids make risky decisions? Bet you’re wrong…

On a trip to Dallas last week, I stayed in a large hotel that was playing host to a convention of high school student members of a service organization. A group of boys was roughhousing on a balcony where only a low railing served as a barrier against a 3-floor drop to the lobby, and it looked like a shove in the wrong direction would send someone over the edge. Down swept a small phalanx of chaperones exclaiming what a bunch of idiots the kids were. The young fellows sauntered off, muttering about “over-reacting,” and “always ruining it when we’re having fun.”

To adults, the reason for this behavior seems obvious: Kids are illogical and don’t understand the risks of their behavior. We assume that they do risky things – like use drugs, drive drunk, or have unprotected sex – because they are irrational beings. Like my grandmother would say: “Those kids just don’t have any sense.”

Enter Cornell professor Valerie Reyna to show us that we’re wrong about this, and our misconceptions have implications for how we try to help kids make less risky decisions. A faculty member in Human Development, Prof. Reyna conducts groundbreaking work on judgment and decision making. And she has taken the additional step of turning her basic research into practical programs to help young people.

In the laboratory under controlled conditions, she has conducted many studies of children and adolescents. Following a translational research model, she and her colleagues wanted to first understand the causal mechanisms that generated risky behavior. What she learned in the lab about the psychology of adolescent risk-taking and about how risky decision making changes with age, she found could then be used to modify unhealthy behavior.

The findings are fascinating. It turns out that adolescents don’t take risks because they are irrational and feel invulnerable and immortal. In fact, it’s because they are too logical. Adults can access informed intuition to avoid risk, whereas adolescents count up and weigh risks versus immediate benefits, and often the risk comes out on top. As Prof. Reyna puts it, “We found that teenagers quite rationally weigh benefits and risks. But when they do that, the equation delivers the message to go ahead and do that, because to the teen the benefits outweigh the risks.”

Existing prevention curricula that had been developed tended to have effects that faded over time and were not as large as they could be.  Prof. Reyna translated her research findings into a curriculum based on both theory and empirical findings.  She has created interventions to teach adolescents to think categorically—to make sweeping, automatic gist-based decisions about life: “unprotected sex bad,” “illegal drugs bad.”

After more than 800 teenagers participated in a randomized controlled trial, the investigators found that the curriculum was more broadly effective, and its effects lasted in many cases for long periods of time.

Prof. Reyna’s web page Resources on Risky Decision-Making in Adolescence is a terrific resource. I recommend starting by watching one of her presentations on the topic, conveniently available on the site. An article in the New York Times provides a quick overview. If you are a professional working with adolescents (or if you have one in your family) you’ll find a whole new way of looking at why kids take risks.

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