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November 21, 2014

Advising young risk-takers against actions

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Rachel Carey and Kiran Sarma examine why ‘fear-appeals’ may not work when it comes to addressing

risk-taking behaviour in young people

Health service providers are regularly confronted with the aftermath of risk-taking behaviour by Irish youth, including drug and      alcohol misuse, unprotected sexual intercourse and dangerous driving. They are also aware that such advice, while often effective in  modifying behaviour, can go unheeded and be manifest in repeated presentation with the same problem.

Social scientists have explored the psychological and socio-demographic factors that are believed to predict how young people  respond to health-related advice. In recent years attention has focused, in particular, on the efficacy of fear-messages (that you may  suffer injury or death) on behaviour and this has been articulated within the theoretical paradigm, Terror Management Theory  (TMT).

TMT proponents ask the question: how can we continue to function in life, knowing that death is inevitable and can occur at any  time? Terror of death is managed, they argue, by minimising vulnerability. So when told by a clinician that risky sexual behaviour  can lead to acquiring a serious sexually transmitted disease (mortality salient information), the young male is confronted with death and should cope through minimising vulnerability (behaviour avoidance).

However, behaviour avoidance clearly does not always occur and TMT postulates that this arises from two possible reasons. First, the youth may deny vulnerability to the threat through cognitive distortions that may, for instance, take the form of ‘it won’t happen to me because I’m young’ or ‘it won’t happen to me because I’m a great driver’ cognitions.

Second, and at an unconscious level, where the risk-taking behaviour is part of the individual’s self-esteem, he may react defensively to the message and actually engage in the behaviour more reverently as a defence mechanism. So in responding to mortality salient advice, and where the behaviour is part of the self-esteem of the youth, he may defend against the terror-emotion by bolstering self-esteem and continue to engage in the risky behaviour, potentially on a more extreme level.

‘Where self-esteem is linked to the risky behaviour, fear messages are less effective and can be counter-productive’

Boy racers

Self-esteem is a latent concept that is difficult to expose to academic enquiry. But experimental research is strongly suggestive that it explains why some youth respond to fear messages with increasingly risky behaviour.

Behaviours such as dangerous driving, tanning, binge drinking or having unsafe sex, while presenting a serious threat to one’s health, may facilitate feelings of self-worth. For example, risky driving involves the possibility of serious injury or death, but may be central to the personal identity of the youth (e.g. a ‘boy racer’) and a core part of his self-esteem.

An Israeli study reported that drivers with high driving-related self-esteem respond to fear messages (that dangerous driving can kill) with a greater intention to take driving risks than those with lower driving-related self-esteem.

The same effect has been shown by researchers in the UK and most recently by the authors of this article in an experiment conducted at the National University of Ireland, Galway, with young male drivers.

Counter-productive

A wide range of other risk-taking behaviours have also been examined, including binge drinking, intentions to buy a high-factor sunscreen product, risky sexual behaviour and drug abuse and studies have consistently suggested that where self-esteem is linked to the risky behaviour, fear messages are less effective and can be counter-productive.

In the main these studies have been laboratory-based, and it is unclear to what extent the measures of behaviour are valid barometers of actual behaviour in the wake of appeals. Intention to take driving risks is, in reality, a poor measure of risky driving.

Not withstanding the limitations of the growing body of literature in this area, concern is growing that fear-based health promotion advertisements and one-on-one advice may be largely ineffective with some risk-takers, and may actually promote such behaviours. This was the conclusion reached by a group of experts reviewing road safety messages in Australia, where unlike Ireland, messages were unimodal and heavily fear-based.

In Ireland, the Road Safety Authority (RSA) already runs multi-modal media campaigns and is working with adolescents and teenagers to undermine the experiential, group dynamic and dispositional factors that may lead to risky-driving behaviour in the future.

Self-esteem is just one part of a bigger picture, and research is needed that links self-esteem with other personality variables such as impulsiveness and sensation seeking. In fact, the literature is suggestive of a biopsychosocial model of resilience to fear appeal messages.

Targeted advice

The implication of TMT is that self-esteem is one pertinent factor and that advice needs to be targeted to fit the psychological profile of the recipient or audience. This is something that experienced health service providers do instinctively.

What TMT does is attempt to articulate why fear-appeals fail and what the psychological profile of those resilient to fear appeals may look like. In doing so it allows us to think more systematically about advice-content (message-content), the utility of multi-modal messages and targeted messages in more sophisticated and informed ways.

It may also be of some utility in the training of healthcare staff who work at the coal face in responding to the consequences of high-risk behaviours.

  • Rachel Carey and Kiran Sarma, School of Psychology, NUI Galway.

Please address correspondence to kiran.sarma@nuigalway.ie