Damon Mohebbi, Katherine Ogurtsova, Jan Dyczmons, Markos Dintsios, Nadja Kairies-Schwarz, Christian Jung, Andrea Icks
Cost-effectiveness of incentives for physical activity in coronary heart disease in Germany: pre-trial health economic model of a complex intervention following the new MRC framework
BMJ open sport & exercise medicine
crime smoking drug use alcoholism reckless driving many unhealthy patterns behavior play lifetime often debut adolescence avoiding risks buying time set different lifetime pattern changing unhealthy behaviors adolescence would broad impact society reducing burdens disease injury human suffering associated economic costs program designed prevent change risky behaviors founded clear idea normative behaviors ideally program foster descriptive adolescents making decisions absence program prescriptive practices realistically move adolescent decisions closer normative ideal normatively decision processes evaluated coherence thinking process nonsensical illogical selfcontradictory correspondence outcomes decisions positive behaviors promote positive physical mental health outcomes modern society odds selected evolution eg early procreation healthy behaviors may also conflict decision makers goals adolescents goals likely maximize immediate pleasure strict decision analysis implies many kinds unhealthy behavior drinking drug use could deemed rational however based data showing developmental changes goals important policy promote positive longterm outcomes rather adolescents shortterm goals developmental data also suggest greater risk aversion generally adaptive decision processes support aversion advanced support risk taking key question whether adolescents developmentally competent make decisions risks principle barring temptations high rewards individual differences reduce selfcontrol ie ideal conditions adolescents capable rational decision making achieve goals practice much depends particular situation decision made heat passion presence peers spur moment unfamiliar situations trading risks benefits favors bad longterm outcomes behavioral inhibition required good outcomes adolescents likely reason poorly adults brain maturation adolescence incomplete impulsivity sensation seeking thrill seeking depression individual differences also contribute risk taking resists standard riskreduction interventions although conditions depression effectively treated approaches major explanatory models risky decision making roughly divided including healthbelief models theory planned behavior adhere rational behavioral decisionmaking framework stresses deliberate quantitative trading risks benefits b emphasize nondeliberative reaction perceived gists prototypes immediate decision environment gist fuzzy mental representation general meaning information experience prototype mental representation standard typical example category although perceived risks especially benefits predict behavioral intentions risktaking behavior behavioral willingness even better predictor susceptibility risk takingand unique explanatory powerbecause adolescents willing riskier things either intend expect dualprocess models prototypewillingness model fuzzytrace theory identify two divergent paths risk taking reasoned reactive route models explain apparent contradictions literature including different causes risk taking different individuals interventions reduce risk taking must take account different causes behavior effective longitudinal experimental research needed disentangle opposing causal processesparticularly produce positive versus negative relations risk perceptions behaviors counterintuitive findings must accommodated adequate theory risk taking include following despite conventional wisdom adolescents perceive invulnerable perceived vulnerability declines increasing age b although object many interventions enhance accuracy risk perceptions adolescents typically overestimate important risks hiv lung cancer c despite increasing competence reasoning biases judgment decision making grow age producing irrational violations coherence among adults among adolescents younger children latter occurs known developmental increase gist processing age one implication findings traditional interventions stressing accurate risk perceptions apt ineffective backfire young people already feel vulnerable overestimate risk addition research shows experience good teacher children younger adolescents tend learn little negative outcomes favoring use effective deterrents monitoring supervision although learning experience improves considerably age experience absence negative consequences may increase feelings invulnerability thus explain decrease risk perceptions early late adolescence exploration increases finally novel interventions discourage deliberate weighing risks benefits adolescents may ultimately prove effective enduring mature adults apparently resist taking risks conscious deliberation choice intuitively grasp gists risky situations retrieve appropriate riskavoidant values never proceed slippery slope actually contemplating tradeoffs risks benefits