Adolescents are a sub-population at particularly high risk from poor decisions in health-related behaviours, compared with other populations in wider society (Beyth-Marom and Fischhoff, 1997). Cohn et al (1995) identified that by the age of nineteen, on average adolescents will have experimented with a least one-health risk behaviour.

Risk communication is of critical importance if the estimates of risk are to be understood by, and effectively influence the behaviour of, the target audience (Pidgeon et al 2003). Risk communication currently targets numerous problem behaviours in the adolescent population. However, current strategies for public and stakeholder engagement generally use concepts that have been developed for adults (Fischhoff and Scheufele 2013). Thus, the question arises as to whether these current risk communication strategies, designed for adults, are appropriate for communicating risks to adolescents.

Adult-focused Risk Communication

Examples can be found of risk communication aimed at adults. Fischhoff (1995) describes how the field of risk communication has grown and developed over the last twenty years. Previously, the focus was on providing accurate information to stakeholders, believing that they would be able to make the correct decisions once sufficiently informed. This strategy subsequently developed to put such information into context, and then later focused upon building trust and creating partnerships with a community whilst providing the relevant information. Although the presentation of risk has evolved, the fundamental core of risk communication has not changed. Risk communication has consistently sought to provide accurate information, which ideally would be taken on board by the recipient and rationally considered prior to a decision being made.

A clear example of such thinking can be examined in the recent seminal paper by Fischhoff and Scheufele (2013) titled “The Science of Science Communication”.  In this paper Fischhoff and Scheufele propose a mental models type approach to be the answer to effective communications of risk. It is proposed that by providing pertinent information to fill gaps in knowledge, individuals will be able to make suitable risk decisions:

Effective science communications inform people about the benefits, risks, and other costs of their decisions, thereby allowing them to make sound choices (Fischhoff and Scheufele 2013, p1)

However, decisions about risk, especially those made by adolescents, often involve more than just a rational cognitive processing of the information provided.

Adolescent Risk-Taking and the Role of Affect

Strategies for communicating risk to adolescents have been presented in Kahneman’s (2011) book, ‘Thinking, Fast and Slow’, which is a summary of work conducted over 20 years.  Kahneman (2011) identified two systems with which the brain processes information, ‘fast think’ and ‘slow think’. ‘Fast think’ or ‘System 1 thinking’ is an automatic process, which occurs very quickly and requires no conscious effort of operation. It is the system that is responsible for emotional responses to situations (Kahneman 2011). ‘Slow think’ or ‘System 2 thinking’ is a slower, more deliberate process than ‘System 1 thinking’ and involves a conscious cognitive process (Kahneman 2011).  Commonly, risk communication strategies have understood ‘slow think’ cognitive processing to be the key to how individuals make risk based decisions. Decisions impacting behaviours were considered to be the result of a careful weighing-up of the pro’s and con’s presented through risk communication.

Increasingly, however, this idea is being challenged, with numerous theorists beginning to explore the role that feelings and emotion (‘affect’) have on risk decision-making. Slovic et al (2004) stated that “intuitive feelings are still the predominate method by which human beings evaluate risk” (p 311). Slovic et al (2004) recognized the important role of ‘affect’ in decision-making, as the “fast, instinctive and intuitive reactions to danger” (Slovic et al 2004, p 311), or the ‘fast think’ as identified by Kahneman (2011).

Adolescent Brain Development

Adolescents are considered to be a high-risk group due to poor risk decision making faculties (Beyth-Marom and Fischhoff 1997). Giedd et al (1999) explains that neuroscience is beginning to reveal how, during adolescence, the brain undergoes massive transformation, producing large numbers of new dendrites and synapses (Feinstein 2009). As these are created, they are followed by the production of myelin, which covers the neurons and allows for fast and more efficient flows of information within the brain. This process greatly increases the brains capacity to perform (Giedd et al 1999).

However, this ‘myelin revolution’ does not occur throughout the brain simultaneously. Fuster (2002) demonstrated that the release of myelin is dependent upon the individual. However, notably the frontal cortex (the part of the brain responsible for cognitive actions) was most commonly the last part of the brain to experience myelin growth. As a result, the part of the brain responsible for logical cognitive processing remains the least capable during adolescence, whilst the emotional centre, the amygdala, is operating faster and more effectively with the production of myelin covered neurons (Chugani et al 1999). In addition, Dahl (2003) identified that during adolescence serotonin levels in the brain are very low. Serotonin works in the brain as a calming agent inhibiting the firing of neurons in the emotional centres, relaxing the brain and counteracting the amygdala. Dahl (2003) showed how this, coupled with lower levels of glucose metabolism in the pre-frontal cortex and higher levels in the amygdala, hippocampus and thalamus, gives far more energy and prominence to the emotional areas of the brain. As such, these emotional centres are the more active areas available for decision-making, thereby increasing the influence of feeling in decision-making.

During adolescence the frontal lobes of the brain are developing and, as they do so, adolescents begin to adapt to the new ways of thinking which this enables. Platek et al (2004) recently showed how, during adolescence, the corpus callosum develops significantly. This part of the brain acts as a bridge between the right hemisphere of the brain, responsible for self-awareness, and the left hemisphere, responsible for the awareness of others. Therefore, development of the corpus callosum allows adolescents to begin to establish a sense of their place in the world. Adolescents place themselves at the centre of this new worldview, assuming themselves to be of great importance. As such, as Rice and Dolgin (2002) suggest, in the minds of adolescents bad things will only happen to others as they are far to unique to be impacted. This phenomenon is termed ‘egocentrism’ and plays a key role in adolescent risk decision-making.

Ego-centrism and Optimism Bias

Ego-centrism in adolescents occurs as they become self-aware and spend more of their time thinking about themselves and their place in the world (Weinstein 1987). Adolescents increasingly know more about their own situations in comparison to others. When making decisions, adolescents have plenty of information about themselves but will struggle to accurately use information about other groups. As a result, weighting of possibilities is often impacted, influencing perceived likelihood of outcomes (Shepperd et al 2002). More often than not, adolescents fail to fully comprehend the consequences of their decisions. This is not necessarily a problem unique to adolescents, but due to the process of brain development it is far more prominent in adolescents. Weinstein (1980) identified what has been termed ‘optimism bias’ as a cognitive error, causing individuals to perceive their own risks to be less than those of others. A particular difficulty, which risk communication faces when confronting optimism bias, is how individuals have far more information about themselves than about others or more generalised groups. It may be difficult for individuals to fully comprehend others and they may not consider themselves to be affected in the same way as an ‘average person’ (Weinstein 1980).

However, studies have pointed to how optimism bias may be overcome, presenting a solution for risk communication strategies. Weinstein (1980) identified that the amount of knowledge available on another group directly impacts an individuals perceptions of their own chances of experiencing a relevant risk. The importance of this study is in how it may suggest the benefit of using narrative in a risk communication. As an individual learns more about another group that has experienced a risk, they will come to understand better their own vulnerability and, in doing so, the heuristic of optimism bias will be reduced. Shepperd et al (2013), as well as Gouveia and Clarke (2001), have both linked experiencing an event to a decrease in optimism bias. As the individual learns more about what had been an ambiguous individual or group, they can begin to relate to them and, thus, recognize their own vulnerabilities. Therefore, a narrative-based risk communication strategy delivered to adolescents may be able to replicate an experience and thereby reduce optimism bias.

Further to this, Weinstein (1980) also showed how individuals often perceive themselves to have taken all precautions to ensure their safety whilst engaging in an activity. They perceive others who have suffered from engaging in the activity as having failed to take such precautions. Narrative again may have the potential to play an important role by providing information on another individual or group and by demonstrating circumstances surrounding risk events.  This may impact their perceptions and consequently their decision-making.

Both Helweg-Larsen and Shepperd (2001) and Shepperd et al (2002) have identified how optimism bias is heavily influenced by the emotional mood of an individual. An individual in a positive mood is likely to show a greater degree of optimism bias than when they are in a negative mood. As such the use of emotive language within a risk communication is also likely to impact optimism bias. As identified by Branstrom and Brandberg (2010), optimism bias is a major reason for individuals neglecting to undertake positive health behaviours and instead engaging in activities such as smoking and unhealthy eating. Radcliffe and Klein (2002) see optimism bias as a critical factor in why individuals fail to take preventive measure to adjust risky behaviours.

Emotive Language and Narrative

Beyth-Marom and Fischhoff (1997) recognise that there is a gap in risk communication literature for communicating to adolescents. As previously mentioned, there is a need to consider alternative strategies, which take into account the role of feelings in decision-making. Such strategies would be more pertinent for communicating risks to adolescents and these will now be considered. Whilst Fischhoff and Scheufele (2013) failed to fully consider the importance of slow think non-cognitive process, the paper does identify a key requirement for risk communications by showing that “a communication is adequate if it… is in a form that they can comprehend” (Fishchoff and Scheufele 2013, p5). They thereby recognise a need to provide pertinent formats of risk communication to particular audiences.

Studies have shown that an individual’s perception of risk plays a central role in the adoption (or not) of health protective behaviours  (Schwarzer 1999 and De Vries et al 2003). How adolescents view the risks of certain behaviours has a strong influence upon their willingness to participate in them and, indeed, the extent that they will use available protective measures  (Gerrard et al 1996). As previously mentioned, adolescents predominantly use the emotional part of the brain in the decision-making process. Therefore, emotive language may have the potential to play an important role in informing these decisions. Macagno (2013) details how emotive language plays a powerful role in affecting emotional responses. Macagno (2013) identified how the use of emotive language in constructing personal attacks can be a potent weapon, capable of influencing an audience’s opinion. Although Macagno (2013) considers the use of emotive language in this negative light, it may also have a positive influence on an adolescent’s decision-making process.

Vranceanu et al (2011) identified how the emotive nature of language was instrumental in delivering quality healthcare advice. Along with the information conveyed, the use of emotive language directly impacted the efficacy of the message. Vranceanu et al (2011) clearly demonstrated that the emotional impact which risk communication can have on a respondent should be a key consideration in communication planning.

Alongside emotive language there is also a body of literature available, which combines to suggest that narrative also holds potential to assist in confronting ego-centrism and optimism bias and potentially play a role in improving risk communications to adolescents.

 Fisher (1987) states that narrative has been a tool of human communication throughout history. Moreover, Hillier (2006) identified, it is a powerful tool in conveying information. Kreuter et al (2007) defines narrative as ‘a representation of connected events and characters that has an identifiable structure, is bounded in space and time, and contains implicit or explicit messages about the topic being addressed’.

Golding et al (1992) identified how risk communications that reflect the social and cultural lives of those being communicated to have a greater impact. Golding et al (1992) evaluated narrative risk communications against non-emotive communications identifying three findings. Firstly, the study found that narrative encouraged readers to read more of the risk statement than non-emotive communications. Secondly, both narrative and non-emotive communications equally enhanced participants’ risk knowledge. Finally, the study showed neither non-emotive nor narrative risk communications motivated changes in behaviour. Lundgren and McMakin (2013) suggest that the reason for this last finding could well be down to individuals not identifying closely enough with the narrative.

Bandura’s (2004) model of social cognition theory suggests that individuals learn not only from past experiences, but also by observing others and shaping their behaviours based upon these observations. This theory is supported by recent studies from the field of neuroscience that have identified the presence of ‘mirror neurons’. Neuroscientists have identified a network of neurons, which are activated during an individual’s vicarious experience. Iacoboni (2008) and Sylwester (2007) have shown that the same areas of the brain are activated in an observer of the experience, such that the neurons of the observer mirror those of the individual directly involved in the experience. Further to this, individuals are more willing to change their own behaviour if those they are observing are considered to be similar to themselves (Bandura 2002). McQueen et al (2011) showed how African American women, when shown a film concerning Breast Cancer Screening with African American women in the film, showed a greater ability to lower perceived barriers to screening. Moyer-Gusé (2008) and Slater and Rouner (2002) showed that if an individual identifies closely with the characters in a risk narrative communication, they are more likely to use the given information to inform their decisions. Murphy et al (2013) concluded that how closely an audience aligns itself to a character or characters within a risk communication narrative, be it through association or attachment, strongly impacts changes in the audience’s cognition of a risk (Banerjee and Greene 2012), their attitudes towards that risk (Igartua and Barrios 2012) and, most importantly, their intentions and behaviours that concern a risk (Moyer-Gusé et al 2011). As such, a key measure when looking into the effectiveness of narrative is to identify how closely the audience associated itself with the narrative.

Conclusion

This paper therefore looks to suggest that adolescents are a particularly difficult group to communicate risk to and yet are highly requiring of it. Their development leaves them predisposed to taking risks and brain development means they are not particularly receptive to traditional methods of risk communication. Even when well informed, adolescents will rely on feelings about a situation over knowledge, making risk-based decisions difficult to influence. Due to such difficulties adolescents must be viewed as a particularly high-risk sub-population who are not yet adults and require additional protections to limit their exposure to risks.

However, literature around this subject points to the potential of emotive language and narrative in improving risk communication to adolescents. There is therefore a need to further explore this area of research to understand whether this potential holds substance and can be understood further to develop better strategies for communicating risk to adolescents.