VALERIE REYNA: So as John said, this is really a dialogue. So stop me at any time. I do have a few numbers I'm going to put up there, but it's mainly to remind me of things I want to tell you. And happy to stop and explain and go over it, too. But this can be very-- if I don't get to the end of my slides, that's fine, as long as we have some fun here today and try to understand young people.
And the question that was posed by John is can science help us overcome the dangers of risky adolescent decision-making. And I probably-- that's the most important message that I'm carrying today, and that is the importance of science and evidence. In psychology, a lot of people have opinions, especially about young people. We have myths that we believe in very, very deeply because that's what we were told, and everyone repeats them, and so they must be true.
And I think it's so important especially-- and I mean this from the bottom of my heart-- that journalists educate the public about what the evidence is. Because a lot of human suffering occurs as a result of really not understanding what the facts are. We believe all kinds of things that aren't true, and it harms people. So I'm so glad you're here today and you want to hear about the science behind adolescent risky decision-making.
So really, there's three parts to the presentation I'm going to make. I'm going to talk a little bit about the brain itself and how it changes massively between five and the early 20s. And that's really, really new research that has upended a lot of our assumptions about adolescent development. I'm going to talk a little bit about this theory that's evidence-based, this fuzzy trace theory that I and my colleagues have developed that explains changes in thinking during this age range and also explains changes in motivation and self-control, which as you all know, has something to do with risky decision-making.
And then based on the theory, we've designed programs to help adolescents. And that's the last part of the talk. We'll be presenting evidence about the nature of those programs, how they actually affect the adolescent brain, and therefore human behavior. So those are the three parts.
So I think it's important to think about some of the statistics involving adolescent risky decision-making. And I could go on and on. I had a presentation where I just had slide after slide after depressing slide that had car accidents and alcohol and every kind of bad thing. But this is just some of the stand-ins for a much larger list of tragedies.
So there's a lot of preventable human suffering and death that occurs as a result of poor decision-making or poor choices during this period. There is people embarking on the rest of their life. They're at the threshold of life in adolescence. They're going into the work world, they're into college, they're maybe going to start a family of their own, and so on. This is the threshold, the launching pad, if you will, for their life.
The economic cost is huge. The US Department of Transportation estimates that the cost of crashes involving the drivers in this age range is $40.8 billion. Now, you could quibble about is it really only $20 billion. But that's a lot of money. And it's a leading cause of death, vehicle accidents, in this age range.
And some of it is due to inexperience-- being inexperienced, rather. But a lot of it is due to poor choices-- speeding, reckless driving, driving under the influence, and so on. And another estimate, for example, said that we would have a benefit to our US economy of $100 trillion-- this is covered in the book in the introduction-- if our educational achievement were to match levels of the highest-performing countries. If we had the same achievement as Finland and Canada, this would add an approximate $100 trillion to our economy at a time when that kind of boost would be terrific. And of course, these young people are the future.
AUDIENCE: Educational achievement of whom?
VALERIE REYNA: Of Finland and Canada. So if you look at the international-- the PISA and the TIMSS and those--
AUDIENCE: Of everybody?
VALERIE REYNA: Exactly. So Finland and Canada do better than we do in these international tests in these math and science areas. If we could be as good as Finland-- Hungary does amazingly well. These are not enormously rich countries. You could say, well, Canada. OK. But we can do at least as well as Canada, I think.
So this is the kinds of issues that are at stake. We're talking about educational issues. We're talking about life trajectory, the using of the human mind to essentially adapt in the classroom, to adapt outside of the classroom.
So importance of the adolescent brain-- because that's the instrument that's used to make these decisions. That's the instrument that's used to learn in the classroom. That's the human brain.
How do you survive and thrive in a world full of temptations, in a world full of unhealthy possible risk-taking, and in a knowledge-based economy, an increasingly knowledge-based economy? So people have argued, for many years, at the level of the individual, and also with respect to evolution, it's that ability to adapt, to use our minds to overcome, that's really the secret to success. So that's why we want each individual young person to have that opportunity-- the ability to learn, to facilitate their learning, to facilitate their reasoning, and to facilitate their decision-making, both in the classroom and in the real world.
So what would be the benefits of this from a more specific perspective? Well, a cognitive enrichment, or the ability to develop your mind to think about reasoning and decision-making, these higher-order cognitions, higher-order thinking, allows you to do all kinds of things.
So for example, in 2009, I wrote a review of the literature on what's called numeracy. Numeracy is just the ability to understand and use numbers. And that's actually related to your health outcomes and your medical decision-making. So you actually manage your medication better if you're more numerate.
And you can think about-- think about diabetes and all the things, or think about giving medicine to your child by bodyweight, having to divide numbers. That sort of thing, it turns out there are millions of Americans who cannot do that. They're not able-- even though they've graduated high school, they're not able to do fractions, for example. Fractions turn out to be particularly difficult.
So if you think about probability and risk-- so we tell a patient if you don't manage your diabetes, this is the probability you're going to have amputation or blindness, et cetera. If you drive drunk, this is the probability that this bad thing-- and they don't know what probability is. They don't understand ratios.
They don't know whether 0.01 is bigger or smaller than point 0.001. For real. There are real standardized tests where that-- and it turns out that that's related to health and medical decision-making, your ability to do that. So you can see how the ability to use your mind-- if you're an informed consumer, you're an informed patient, you can affect your own fate.
There's things like emotion regulation. We were talking earlier, before everyone arrived, about the marshmallow study. This is the study where the child is put in the room, and they can have one marshmallow. Or if they wait, they get two marshmallows. So they have to resist. They're looking at the marshmallow. This is a metaphor for life.
And in fact, that test, the ability to wait in that test, predicts, 20 years later, whether you're going to do well-- whether you're going to do well economically and educationally. The ability to delay gratification for greater rewards, like education and so on-- that ability turns out to be very, very important.
How did the little kids who succeeded in waiting-- how did they succeed? It turns out that they distract themselves. They engage in cognitive strategies. They don't just white knuckle it and resist. I just don't think of a marshmallow. They do all kinds of mental gymnastics to distract themselves from the temptation. And that's how they succeed. And that is what's correlated with later success. So we can develop the power of the human mind. We can develop the ability to regulate our emotions and engage with the world.
And then the CBT there is Cognitive Behavioral Therapy. Cognitive behavioral therapy is one of the most effective kinds of therapies available. And what is it about? It doesn't say here's an emotional intervention for an emotional problem. It says if we can change the way people think, we can change whether they can cope with the world. And in fact, the evidence shows that that's effective. So that's the sort of analogy that I'm getting at.
In fact, I'm actually collaborating with a woman at Weill Medical School with paranoid delusional adolescents, people who are prodromal. In other words, they're about to manifest into a more serious illness, but they have very, very serious problems already. And she delivered a curriculum based on this fuzzy trace theory that I'm going to talk about that's basically about how do you change the way people process the information that's coming to them.
And in fact, she got amazing results with this patient population. By changing the nature of the thinking-- and I'm going to go into detail about what the nature of that thinking is-- she was actually able to reduce the delusions that patients had. So the ability to cope by using your mind is an extremely adaptive thing to do.
And also, staving off age-related cognitive declines-- one of the most important things you can do to prevent Alzheimer's is to be educated. Because you have a cognitive reserve. So all of these things are connected from the beginning trajectory of life all the way to the end of life. You're drawing on that fund that you built up, this bank account you started as an adolescent of being educated, of having a life trajectory that's successful.
And we're actually studying mild cognitive impairment and Alzheimer's, too, in our spare time. But we actually are-- using a lot of the same concept.
So this is a picture of the book, The Adolescent Brain, which again, feel free to take a copy of. And this gives you a little bit more information and is a gateway to all kinds of resources. I am the extension leader for human development, so we've gathered together a number of resources of speakers who come in and have spoken on a range of topics of relevance to young people and so on. So that's the book.
So what's different about this book? How is this book? It's different than other books, perhaps, about the adolescent mind, and so on. Well, the first thing is it's the first book on higher cognition in the adolescent brain taking advantage of all this recent neuroscience evidence about the brain, and connecting it to this notion of higher cognition thinking, reasoning, problem solving, decision making. Believe it or not, there has not been a book about that before this one. And a lot of the neuroscience evidence is very, very recent, so that makes sense.
We also have researchers as authors, which I'm very, very proud of. So the people who contributed to this book were people who were actively doing research, which means that the material in the book is evidence-based. We also, of course, insisted on a high standard of evidence, on rigorous evidence. And again, as I mentioned before, this is particularly important in the area of adolescence, which is an exciting area, and people have a lot of very strong beliefs.
So for example, one of the beliefs is that adolescents take risks because they believe they're invulnerable. Turns out that's not true. That's something that we've repeated and many experts still say. But the evidence shows, when you actually do research on that, they are aware that they're more vulnerable than adults are. And they, in fact, do not think they're invulnerable.
If anything, they think they're going to die at a much higher probability than they are. So why not take risks? Because if you're going to die anyway, life is short, and you might as well go for it. And not most of them don't believe that, but a sizable number do. Most of them do realize that because of the behaviors they're engaging in, they are, in fact, at higher risk than adults, than comparable adults.
And then there's multiple disciplines represented between the covers of this book. We have neuroscientists. We have people who are very, very well-known in the area of education. We have a number of people contributing to this book who are experts in mathematics, for example, and how to teach mathematics. And so they're in this book, as well as psychologists, and so on.
So one of the things we really wanted to do is bring people together across these divides of disciplines so that we could work on behalf of the adolescent, helping them be successful. We want educators to talk to psychologists, and psychologists to talk to educators and neuroscientists so we can pool all this information and accelerate the translation process from the laboratory to real life. So at least that's the goal.
AUDIENCE: What's the target audience of your book?
VALERIE REYNA: Well, the target audience is professionals of all kinds, people ranging social workers, clinical psychologists, research folks. We really had a wide swath. As the editor, I insisted on people defining terms. And as I say in the introduction, there's also-- I highly recommend the APA Dictionary for Psychology as well, which you actually can use online. They're going to have an electronic version so you can just click on the words.
So we really did try, because we had multiple disciplines represented, to make the terms more explicit than they would normally be. So it's a very difficult challenge-- and you can tell me, when you read the book, if we managed to get there-- to really make it cutting edge research, the kind of book that would really advance the ball, not just be old things from many years ago, really on the cutting edge, but also things that people from different areas could read. That was the goal.
So as I said, the book reviews recent neuroscience discoveries about how the brain develops, their implications, and in particular, the implications for how we teach young people and how we prepare them to make healthy life choices. And I should say there's several chapters in the book that talks about training and the effects of training, just like the kind of training that I'm going to talk about today that really goes in there and tries to make a difference in young people's lives.
So there are ways to actually increase your fluid intelligence, it appears. So we think of intelligence as a fixed quantity. You have a certain amount of IQ points at birth. It's the way many people think of it. Binet did not think of it that way, by the way. He thought of it as something malleable. So there are ways, if you really understand the nature of the brain, that you can facilitate the development of intelligence. And there's articles about that in the book.
So let's get to some data. Massive changes in the adolescent brain-- up until recently, we did not realize how much the brain changed during adolescence. So this is an illustration of, from five years of age, anatomical scans of the brain. 2,000 scans were summarized here of the same kids over time, many of the same kids at multiple time points. So this is from five years of age all the way to 20 years of age.
And over here on the right, you can see that this is thickness of gray matter, cortical thickness. So as you can see, as you get into the more purplish-- rather, as you get into the more-- on the left here, the yellow and so on, that's thinner. And as you go from left to right, you actually see a thinning of gray matter over time.
So this yellowish reddish disappears and is replaced by the blue. So you go from the top of this to the bottom of this in terms of cortical thickness, and I'll go into more detail on it. But this was an astounding finding when it first appeared.
First of all, the idea that there were significant changes in the brain's morphology during adolescence was shocking. Because most people thought by the time you get to be adolescents, your brain is pretty much formed. The action was really here in early childhood. Au contraire. There's significant brain development that occurs after that, and in particular during adolescence.
And the nature of the change was shocking. It was loss of gray matter. You get pruning of the brain. The brain goes away-- a lot of it goes away-- during this period. So that shocked a lot of people. Most of the theories of information processing and brain development would have said most of the development stops before this age. And if anything, you're adding connections, you're adding brain, because you are enriching the brain. So why is the brain going down in gray matter volume, which is-- again--
AUDIENCE: What goes up?
VALERIE REYNA: Ah, I'm so glad you asked that question. Because I have a slide on that. So as you can see here, the dark lines on the top are males, and the lighter lines on the bottom are females. Males have larger brains, but that doesn't make them smarter.
So as you can see, this is total brain volume over age from seven years of age to 19. And the gray matter over here on the right-- this essentially shows what you saw in the picture, that gray matter goes up a little bit, and then it comes down. And it does that a little bit more sharply in the females. But in both cases, you see that pruning, a reduction in gray matter volume over time.
Now, white matter-- white matter has to do with the efficient connection of regions in the brain to one another. Now, that goes up during that same period. So it's as though as-- as you can see here, there's an increase in white matter here. And there's various other things in the other part of the brain, like the connections between the hemispheres. That also increases.
So the overall picture here-- and this is each one of the scans, the trajectory is all mapped on top of one another. The dark ones, again, are the males on the top, and the light gray ones are the females on the bottom. So this shows you every data point that went into all of these averages. As you can see, there's a huge amount of variability. That's mainly the message of the thing on the left. But as you can see also, as they go up, you get that increase, and then the downward turn. But this is the averages right here on the right for that.
So what is the denouement of all of that? Well, there are-- in terms of broadly consistent explanations, like why would the connections go up and the gray matter go down-- if you think about that in broad terms, this is consistent with the behavioral evidence that we've gathered on fuzzy trace theory.
Now, what is a fuzzy trace? A fuzzy trace is your encoding of experience based on the gist. It's the bottom line, vague, qualitative essence of information or experience. So if you go away from this discussion, and a week from now, someone says what did Valerie Reyna talk about when you went to the talk she gave, you would probably not remember exact words. But hopefully I would have communicated some essential, bottom-line pieces of information. That's what you would take away and remember and use in the future.
So people encode what's called a gist representation. It means just what you think it means. It's the everyday use of the term. And they also, at the same time, encode what's called a verbatim representation, which is the exact wording.
The verbatim representation fades very rapidly. So you can't exactly remember exact wording, but you hold onto the gist over a longer period of time. And what this theory says is-- and it's based on a lot of evidence, and I won't torture you with all of that. But there's mathematical models and experiments where we test hypotheses, we make predictions, and then test them, and that sort of thing.
But what the data have shown is that there's greater reliance on gist in adulthood. So as you move from childhood to adulthood, you become more bottom-line oriented, more thinking about just the basic, essential bottom line of information and less caught up in the details. It's as though you see the forest as opposed to each individual tree and getting wrapped up in the individual, superficial details. So that's across many, many different tasks.
So the essential bottom line of information is the concept of less is more. So that's broadly consistent with this notion that based on experience, parts of the brain that aren't really needed go away, and we create this superhighway, this expressway of connections that's integrated and more connected-- simpler, less cut-to-the-chase kind of information processing. And that's why, of course, you get greater connectivity.
So there's this notion of gist-based intuition that you use to process information-- we have a very specific definition of intuition-- and verbatim-based analysis. And there's two ways you can approach many, many different problem-solving tests, many, many different decisions in life.
You can focus on the exact details. What's the probability that I'm going going to get in a car accident if I drive drunk? It's only two miles. It's only four miles. What's the probability? Low, probably. If you do it a lot, the cumulative probability is high. But the individual instance is low.
So if you think about all that superficial detail, you miss the big point, which is are you kidding. Don't do that. That's really dumb. So that's what we're talking about.
So a lot of people talk about risky decision-making in terms of sensation seeking and self-control. And when I talked before about the Walter Mischel resisting the marshmallow, I was talking about self-control, how do you control yourself and the strategies for doing that. So what we try to do in fuzzy trace theory is we try to bring all these things together-- how young people think, how adults think, how that changes with age, and then how do the emotions and motivations mix in there with your thinking.
And if you think back to the example about cognitive behavioral therapy, if you think about things differently-- if you frame them differently, you have different emotions. You have different motivations. If you see the world in a different way, if you parse it differently, that changes what's tempting anymore.
I just don't think of a donut the same way since I read our curriculum. We have this obesity prevention curriculum. And I liked donuts. I thought donuts were sort of harmless. Oh, my goodness. And my apologies to the donut industry. I still eat your donuts. But I know a lot more about donuts, shall we say, now than I used to know. And I just look at them differently than I did before. They have a different image to me at a very basic level.
And what the data have shown is that it's the basic valence of that image, not the details, that move us and motivate us. So if you think about smoking in movies-- it's an image. Unfortunately, it's a cool image. It still is today, and it's still used to immediately communicate that in movies. And it's not the details. It's just that kind of general valence.
So we think sensation seeking-- sensation seeking just means wanting that excitement, wanting that reward, wanting that sizzle in life, like young people do. And that's true. They do want that. And then self-control.
But also, much adolescent risk-taking. And this is a very radical notion, but it is based on data. And I'm going to show you some of the data. What we have shown-- and I've reviewed the literature, too, looking at other people's data-- and what that's shown is that a lot of this risk-taking is not impulsive.
Some of it is. Some of it is acting without thinking. A lot of it is calculated and considered, weighing a cost-benefit kind of analysis, thinking about it very logically, and then deciding to take a risk because it's, quote, worth it for the benefits.
So that's a very different kind of thinking than many adults have who are getting along in the world.
AUDIENCE: You're describing the stock market.
VALERIE REYNA: Yes, exactly.
AUDIENCE: It's the perfect analogy.
VALERIE REYNA: Thank you.
AUDIENCE: With 50-year-old men.
VALERIE REYNA: Yes. And who's drawn to playing gambles? Not the average person. Because most people-- and this has been shown for centuries in risk-taking research-- the average adult is risk-averse for gains, meaning they prefer a smaller sure thing to the upside potential of being really rich.
But there's a small group of people, and these are the sensation seekers, who want that thrill, who want that reward, who want more. Does anyone remember that movie with Edgar G. Robinson? He says, what do you want, Rocco? What do you want, Rocco? More. I want more. There's people like that. They want more. So they don't want to be safe. They want more.
So there's that small group of people. And those are the people, I would think, would be attracted to gambling of all forms.
AUDIENCE: There's a malignation with the pyramid schemes.
AUDIENCE: Would their brains look like adolescent brains?
VALERIE REYNA: Well, that's a really interesting question. We must do that study. The neuroscience technology, the magnetic resonance imaging and functional magnetic, is very new. And I would have to look up and see if people have done pathological gambling, and whether they've actually looked at their brain, and whether they've compared it to adolescents.
There's not a lot of-- there's a little bit of work on adolescence in the brain. There's some, and we summarize it in this book. But there's been a lot of work that hasn't been done. We're actually starting to do some of that work ourselves.
AUDIENCE: For me, I think about the way that companies-- say, like auto makers-- decide whether they're going to recall a car or not. They weigh up the cost and the benefits. And it's not as simple as, oh, my god, people are being killed because there's a dangerous or defective part. It's like, well, let's think about this for a second.
What's the-- how many people are being killed? How much is it going to cost for the payout of the price of a lawsuit? And is it going to cost more money for the lawsuit, or is it going to cost more money for-- so there's that--
VALERIE REYNA: That's weighing, trading the probability and the magnitude of the loss. And they do engage in verbatim-based analysis.
And in fact, sometimes that is a good idea-- especially, I think, in situations where long-term payouts from retirement-- you really want to calculate it out, often. And that's because there are other humans in the marketplace who are trying to sell you something. So it's not really-- although people told me who are an investment, no, they use just two.
Accountants tell me we use gist all the time. Accounting is about judgment and inference. It's not about a bunch of rules that you follow, like a cookbook. It's about understanding. So in that case, it would be not just about the superficial details of is it 9.2 million or 9.1 million.
So the question is when, in medical decisions and health decisions, can an insight that cuts through the details really be the right thing. And often, we're saying that is true in adolescence in these public health domains.
So think about, for example, HIV risk. If you were to calculate your probability of getting HIV, it would be low in almost every population. Even in fairly high-risk populations, the HIV virus is not transmitted very easily compared to the cold virus and other things.
So if you just thought about the facts, you might be tempted-- and in fact, young people are tempted-- the benefits of sex, and the risk, and they weigh them, and they're willing to take risks that we would think are appalling.
If you just think of it as a calculation, they're right. But if you think of it as a categorical possibility of disaster-- that would be gist-- the categorical possibility of a really bad thing. Then you think about it in a different way. And that's what we're trying to inculcate in our curriculum, as a matter of fact.
So sensation seeking and self-control. Let me show you a little bit about the motivational things first, too. Now, a lot of the brain theories-- and Adriana Galvan has a wonderful chapter in the book that summarizes the latest research on that, and this is just another summary article that's recent. This is a theoretical graph, and it shows age increasing from left to right here on the x-axis and development of the brain on the y-axis.
And so the theory goes-- and there's evidence for it-- these subcortical regions of the brain, like the limbic areas, the amygdala, the parts of the brain that respond to reward, that get all excited about all of these wonderful fun things one might do-- that those develop earlier than the parts of the brain that have to do with self-control-- the prefrontal cortex, and lateral prefrontal cortex, and so on.
These cortical areas come online later than the emotion and reward areas of the brain. And therefore, there's this gap in adolescence between the amount of reward you're experiencing-- so your brain gets all excited about, oh, boy, fun thing that we're going to do, but your ability to control has not come online yet.
Now, this is a theoretical curve. There's evidence for this in terms of activation of what's called the nucleus accumbens in the brain, which is a reward center in the brain, being more active in adolescence. There's a lot of variability, and there's only a few studies, but there is evidence for this. And the prefrontal cortex coming online and being less able to control emotional responses during this age period-- so there's evidence for this.
And in fact, some students and I did a study-- and this is actual data as opposed to a theoretical curve-- that's broadly consistent with this notion. And these are all, by the way, Cornell students. This is a grad student from Cornell, an undergraduate from Cornell, an undergraduate from Cornell, undergraduate from Cornell, and a graduate student. And some of them were in law school, and some of them are in medical school now. And this article just came out.
But if you look, for example, at this curve-- this is real means. And this is age across the bottom again, from 14 to 21, and then mean rating on two kinds of raging scales. On the one hand, we have this curvilinear pattern that goes up significantly and then comes down. I don't know if you can see it.
Let me try this. Yeah, there we go. It goes up and then comes down. This is sensation seeking. This is a questionnaire that's very reliable that we give to young people. And I like to go to wild parties. Yeah, I agree with that. I want to go bungee jumping. Remember bungee jumping? Anyway--
AUDIENCE: I never wanted to do that.
VALERIE REYNA: Me, either. I don't understand it. I just want to go on the little merry-go-round that goes around the circle. I'd score low on this.
So there is this-- and this has been shown over the years, that there's a peak in sensation seeking around adolescence. So that's consistent with the brain idea, that those areas are becoming more sensitized to reward during this period. And then they come down with age.
And then you see this linear pattern in what's called the behavioral inhibition scale. This is the responsiveness to fear, to punishment, to consequences. So in that questionnaire, this went steadily up with age. This is actually significantly different than this. So it goes up.
And as you can see, the gap between the ability to control your behavior through fear and consequences versus to be excited by rewards-- this gap gets bigger, and therefore, your ability to control yourself actually increases.
AUDIENCE: Male or female?
VALERIE REYNA: These are both male and female.
AUDIENCE: Say what the top--
VALERIE REYNA: So this is behavioral inhibition-- to control your impulses here, and to respond to I might get punished, I might get in trouble, that kind of thing. So this goes up steadily with age, your ability to inhibit.
And then your ability to get excited-- that goes up, but then it falls. So here you're less tempted and better able to control yourself. This gap helps you resist risk-taking over here on the right. Over here, they're battling it out for who's in control. The reward center says reward me, and the inhibition center says OK.
So that's the disparity that the theoretical curve was talking about. So these behavioral data are consistent with the brain data. So there are motivational differences there. They're being tempted more than we are, and they're less able to inhibit.
So if you put that together, you get greater reward sensitivity and inhibition in adolescence and this asymmetry in brain development. But also, adolescents who take unhealthy risks also reason differently. They think differently. They're from another planet, in some ways.
So they're not just younger versions of us, adolescents. They really have a different way of thinking. And that different way of thinking we're talking about is verbatim-based analysis-- cost-benefit kind of thing, like you were talking about. So they think about risks as about playing the odds, calculating, play the odds. The odds are with you.
You know when young people say it isn't going to happen to me, and we say, boy, are they crazy to say that? They're actually technically correct. The base rate guess is that whatever that bad thing, it probably-- it's not a majority. It's not 90% of people are going to fall over dead because they had a cheeseburger right then and there. Or most people don't necessarily die of lung cancer from smoking, even if they smoke. They die of a whole range of things. If you added them up, they'd be massive. But that one thing isn't going to necessarily get them. So technically, they're right about the details. But obviously, they're missing the point, and we would say they're missing the gist.
The kind of thinking that would be exemplified in gist-based intuition would be it just takes once. It just takes once to get pregnant. It just once to get HIV. It just takes once to die in a horrible-- in a way that could have been prevented. You don't have the rest of your life, or to have some awful injury.
So if you think about that, that makes such sense to us, I think. But it's actually technically wrong. We're not the logical ones. They are. Because it just takes once. It's not a numerical, quantitative concept or probability.
In fact, there are curricula for teenagers that say we've got to train this out of them, that that's a bad way to think, and we have to teach them probability theory, and they should make gradations of risk, and they should make these fine-- yes, this is most of the literature, really. I can show you the-- and I have some friends who actually developed these curricula, and we get involved in these very friendly debates about is that a good thing to teach them or not. Well, I'm going to show you some evidence that speaks directly to that point, about whether it's good or bad to think it only takes once.
And then again, I think we've probably gone over this, but this is why would it be a healthy thing to be an intuitive, gist-based thinker. Because it does only take once, and these things are categorically different. And we don't want them to start with-- if people are weighing the odds, they're already on the wrong path. If they're thinking about, gee, how probable would it be if I got AIDS if I did this, this, and this, this is not a good sign. They're thinking in a way that we would probably find appalling.
So global risk avoidance, or gist-based thinking, ignores the magnitude of potential benefits and thus is protective. It says this is so awful or so potentially-- going to destroy my life that I'm not going to weigh the odds. I'm just going to not do this. I'm going to have a policy, like adults think.
AUDIENCE: Go back one.
VALERIE REYNA: Sure.
AUDIENCE: The magnitude of--
VALERIE REYNA: The magnitude of potential benefits. So unfortunately, there are benefits to some of these things. They are rewarding. Having sex has its rewards. Now they have me on tape. Oh, well. I guess I can't deny that, can I? But it has risks.
So the idea is that there are benefits. And if you have ratings from adolescents, you can ask them, rate on a one to seven scale how beneficial is this activity of a whole variety of types. If you look through the literature-- and I've reviewed the literature-- on whether it's alcohol, sex, all of these different kinds of risk-taking-- they rate the benefits as very high, and they rate the risks as high. In fact, they overestimate the risks. But the benefits are so high, they outweigh the risks.
So again, if you're just calculating, clearly the message is do it. If you're being a rational, economist-like thinker, weighing the costs and benefits, you would take the risk, because it would be, quote, worth it because of the benefits that would offset, that trade-off kind of thinking.
So here's a scale that we developed ourselves based on this theory. It says, well, if this is true, then we ought to be able to measure this kind of thinking scientifically, this categorical thinking about risk. And it has items like this. If you keep having unprotected sex, the risks will add up, and you're going to get pregnant. Eventually, it's going to be 1.0.
We don't say exactly when or how much. Just look. The point is it's going to add up. It's going to be 1.0. It's going to happen eventually. And they add up faster than you think.
Even low risks add up to 100% if you keep doing. It only takes once to get pregnant or to get an STD. Once you have AIDS, there's no second chance, et cetera. These are all categorical. They're not quantitative nuances. They're qualitative, categorical. This is bad. This is an all or none way of thinking.
And then they have a five-point scale, strongly disagree to strongly agree on this kind of scale. And it has good reliability. So that's a kind of gist thinking.
Here's another scale that we use to measure this kind of thinking. It's called the gist principle scale. And by principles, we mean values. So what matters to you?
We do not impose our values on young people in these curriculum. We ask them what do you value. And they say, well, I actually care about my parents. Many young people really care about their parents, and they don't want to disappoint their parents, and they look up to their parents. So that's actually a motivator.
So we say if any of these are things that you believe in that motivate you, you just check them off. The more of these basic, bottom-line policies and values you check off, the less likely you are to have unprotected sex and all of these other things. So it's very simple. These are not detailed kinds of things. Well, only on Tuesdays between 2:00 and 4:00. This is very bottom-line values and principles. And that's part of our curriculum as well. So that's one of the things we measure.
So based on this theory, we've developed programs. With the help of my colleagues who are here, we're implementing these all over the place. And the main thing that's different about our approach is rather than have kids memorize a whole long list of health facts-- the HPV, Human Papillomavirus base rate, is 24.5% in college-age students, that sort of thing-- we say that's the stuff that causes warts. It's really higher than you think. A lot of people have that. And it's a virus. And a virus means you can't take a pill for it. That would be the other thing. This is stuff you can't necessarily cure.
So we talk about how to think differently in this gist, bottom-line kind of way, how to retrieve your values in context, rapidly and automatically, and then how to apply the values to your mental representation to output the decision. So that that's mainly the three things that are different about our approach.
So in this New York sample that I'm talking about, there are 189 students enrolled so far, altogether, counting all sides. About 55% are female. As you can see, this is a diverse population, 29% African-American. And a lot of the folks who are other are mixed, various ethnicities. And about 17% are Hispanic.
And we have two arms to this curriculum. One of them is this pregnancy prevention curriculum that I mostly talked about, pregnancy and STD prevention. But also, there's another arm of it that's the beginnings of an obesity prevention curriculum. We scoured the literature, and we're looking for a curriculum that have been tested using randomized controlled trials with real experiments and a control group and that sort of stuff on obesity prevention in this age group, and there weren't any.
Yeah. Did you have a question? OK. I'm used to my students. I'm trained to respond immediately when I see a hand. I'm salivating, too.
So the obesity prevention curriculum-- as you know, obesity is an incredible public health threat. And it turns out-- there was a study, a paper presented at the American Heart Association in November of just this past year, saying that based on a representative sample of adolescents in this country, that this is the most unhealthy generation in history since they've been measuring.
Right now, we have adolescents who are the most unhealthy. There was nobody-- none of the people-- there's over 5,000 kids in the study-- who actually scored well on the health indices-- exercise, diet, so on. They just-- nobody did well. And this was appalling.
And again, these kinds of lifestyle decisions that are made in adolescents affect the rest of your life. You start building up these plaques in your arteries at that age. You build up your lifestyle habits. Those are formed at this age. Eventually, if you have a family, you transmit those to the next generation. So we thought this is an opportunity, maybe, to expand the kinds of things we're doing.
We're just starting out. So at the moment, we're taking the standard curriculum that other people have developed called Eat Fit, an award-winning extension program that's never been evaluated using a randomized controlled trial. We're evaluating it as step one, and then we're going to adapt it to try to get it to be as effective as possible.
So young people are randomized to one of these two arms. So they either get this reducing the risk for pregnancy and STDs or they get the obesity prevention. So each group is the control group for the other group, if you will. But they both hopefully get something of value. So that's one way to say you can have your cake and eat it too in terms of scientific design.
So here are the locations around New York. We go from Queens, Brooklyn, Harlem, Bronx, and so on. And then we have other sites in New York-- Broome County and also Central New York. So we've been-- thanks to our collaborators, we've managed to get all over New York and have a variety of different kinds of populations, which we're very grateful for.
Now, this is a little bit of a busy slide, but I wanted to give you some flavor of what the curriculum was. What we did is we took what's called Reducing the Risk, a curriculum to reduce sexual risk-taking and pregnancy and STDs, and gist-ified it. So we just took an effective curriculum-- one that the CDC said had evidence to support it being effective-- and we said it's far from fully effective, but we want to start with a head start.
And we're going to take that, and we're going to get to what's the bottom line of each lesson, what's the essence. Do the kids get the gist before they leave the door? Not all the details, but do they get the main point of what we're saying?
And so we took that curriculum, we gist-ified it. We had a list of values that kids could endorse and select that were their personal values that they thought were relevant, like three to five or the most small number. And then we would reinforce those at each lesson with role-playing and a variety of kinds of pedagogical techniques to reach young people.
So this was-- we did evaluate this in a 807-adolescent, randomized controlled trial, the original version of the curriculum. We're doing an extension of that that adds the obesity prevention and also enhances that from Arizona, Texas, and New York. And of course, this is a collaboration between my lab in Ithaca and the Cornell Cooperative Extension.
So we're also fine-tuning the curriculum, and so on, and rolling it out beyond just the research environment, which we think is very, very important. We want to be able to have this be the kind of curriculum that people can implement all over the place.
So it consists of 14 one-hour lessons. That's all-- 14 hours in a very busy life of young people where there's many, many influences. So you think, 14 hours, how could it possibly affect anything? I'm going to let the cat out of the bag. It does, or I wouldn't be talking about it.
There's instructions in small groups and school settings and youth programs, role-playing. And we also encourage communication with parents. That's part of the curriculum. We think parents are very important. And we encourage and give kids tips on how to approach their parents about these delicate issues, and so on, so that the parents' values are instilled in the children. And you'd be amazed what people don't talk about. I know the people working with me wouldn't be amazed.
So we also do surveys, because it's very, very important to have research evidence. So many programs are delivered to young people, and people say, well, we don't have time to evaluate them properly. But that's a tragedy. We might have all kinds of effective things out there, but we really don't know what we have, because we don't really assess. So we assess. The original questionnaire had 314 items on it-- these poor young people. But we begged, and we pleaded, and we follow up. So thanks to, again, everyone's help.
So again, this curriculum, it emphasizes understanding the gist of knowledge to avoid or reduce behavior, engaging in gist-basic thinking rather than detailed analysis of the pros and cons, quickly and automatically recognizing signs and signals in a bottom line, intuitive way. This is an-- this is uh oh. This is going to be a forced sex situation.
So for example-- you're going to love this-- when you tell young people something like the following-- it's prom night. You all have rented a hotel room. There's alcohol. OK. Does anyone know the end of the story?
Would anybody be surprised by the end of this story? But Mom, I'm so responsible. I've never done anything bad. I can go to the hotel room. It's OK. I'm not going to do anything wrong. I've thought about this logically.
Does this sounds familiar to anybody? So we immediately connect the dots. That's what gist is. We use our experience in life to go, uh oh. So that uh oh response, that's what we're trying to get them to have insight to-- the immediate uh oh.
You don't have to say, OK, who's the boy, and is he responsible. We don't need to know who the boy is. We don't even need to know who the girl is. We are already know-- trouble. Trouble. So that's what we're talking about here-- getting that intuitive, immediate sense that something might happen. It's not unpredictable. It's highly predictable. And that's the gist.
We can't really explain why we think that. And if we got into a logic match, they'd win, because they have logic on their side. And nobody has done anything wrong. But we know-- trouble. So that's why we try to that kind of intuition. So quickly and automatically retrieving their core values and principles that are relevant and applying them.
And again, it may seem obvious that if you have strongly-held values, like this would disappoint my parents, or I care about my partner, and I don't want to hurt my partner, and maybe my partner doesn't want to get pregnant, and so on, and has a future, and an all that-- you'd think that those strongly-held values would be retrieved.
But one of the things we know from research is even if you know something really well and you really believe it, you don't necessarily retrieve it in context when you need it. You retrieve it later. And that's called regret. But this is true across a gamut of things.
We don't retrieve what we strongly believe, necessarily. You have to become automatized to do that. So a very different approach than other curricula. Other cirricula want a reflective teenager. And we you say if you're reflecting, it's too late.
We want you to respond the way troops in battle respond to gunfire. If the troops really thought about it, they'd be running the other way, maybe. But you have to be trained. You have to be overtrained and overlearned. What do you do when bullets start flying, and you're scared, and you're in harm's way?
What should you do when you're under emotional duress? That's the sort of thing. We want this so overlearned and automatic that they immediately think about it. They don't reflect, they don't calculate, and they know what to do, and they can apply those values. So a very, very fundamentally different kind of approach in our theory than in other theories.
So these are examples of gist. Viruses like herpes are not curable. You have them and give them to others for the rest of your life. Again, if you don't have background knowledge about medicine, you don't know that. That's news to a lot of kids. Germs are germs.
Reducing the risk of STDs-- other than not having sex, the second-best thing is to use condoms. And then of course, our categorical thinking and cumulative risk gist. Of course, we directly teach those. Here's examples, of course, again, of the principles-- never have sex because of pressure. It's always a bad idea if you're being pressured and that's the reason you're doing it.
When in doubt, delay or avoid. Saying no today does not mean saying no forever. And again, these are so simple. These are not elaborate manifestos. They're bottom-line-- we hope-- wisdom that gets across to young people what we maybe learned the hard way. We don't want them to have to learn the hard way.
So what about data? Now, I've got data values here, but don't worry. I'll explain what they mean. And this is predicting. If you look at sexual intention-- so these are self-reported intentions to have sex with young people-- and you look at what predicts sexual intentions, well, it turns out that sensation seeking-- that desire for rewards-- that does predict whether you had high sexual intentions.
Indeed, that's significant. This is how much weight there is to this x in terms of predicting this y. So sensation seeking has an effect on whether you have high sexual intentions. You're one of these people that that's-- your reward-driven, you're more likely to have sex as a teenager.
What about those gist principles? Well, indeed, that reduces your risk. There's a negative coefficient here. That means the more you agree with these bottom-line principles, that I showed you a list of, the lower your sexual intentions, significantly lower. So these little asterisks over here mean significant.
Your knowledge of the facts-- that's actually positively correlated with sexual intentions. Why? Because you're probably looking up birth control and finding out about a lot of things. And if you don't have that as a relevant behavior, you're not terribly interested in it. And so that's interesting. So you know all the knowledge about what's effective contraception and all these other things, because you're more likely to be engaging in the behavior, and a higher intention.
And gender-- if you're a male and you're a teenager-- you heard it here first-- you have more intentions to have sex. I know this is not news. But at least we found the obvious.
So as you can see, there's motivational components here. And there is how you think. All of this is determining whether people have intentions to have sex. And this is with our sample of 189. This at the pretest. When they come in, what predicts their current sexual intentions and their current sexual behavior at the outset? So this is the New York sample in the New York data.
If you look at sexual behavior-- and we've presented this in terms of-- for the tape, a linear regression, but we really did a logistic regression, which is the proper analysis. But this puts this all on the same footing as the other. And this is just whether you initiate sex.
So did you initiate sex yet at 15 and 1/2 on average? Remember, it was about 15.7 years on average for this sample. Have you started having sex or not? And what predicts that? Well, what predicts that is, again, how sensation seeking you are, how reward-driven you are, how tempted you are. But also, it reduces the probability that you've initiated sex if you adhere to these basic, bottom-line gist principles. Now these other factors are not significant, probably because this is a dichotomous variable of yes/no. But as you can see, the reward and the way you think both predict whether you've initiated sex.
And then finally, the number of sexual partners you've had. So as we know, if you increase your number of sexual partners, you increase the probability you're going to get sexually transmitted infections and all kinds of things. And probably-- we're talking again about 15 and 1/2-year-olds on average here.
So once again, here now, sensation seeking does not significantly predict the number of partners, but the gist principle still remains a significant predictor of the number of partners. The more you adhere to those basic principles, the fewer number of sexual partners you will have. So that predicts that. And that's, in fact, the only significant predictor in this analysis of number of sexual partners. And we have a lot of other data, but I wanted to show you the New York data in particular.
And then finally, do we know whether this curriculum is effective. This is, of course, the big question. Can we inculcate this kind of thinking in people? Now, with this 180, we don't have enough subjects yet to really do a fair test of the curriculum of obesity. Pretty soon, we're hoping to enroll enough.
But we did do this kind of analysis with the three groups that I talked to you before about in Texas and New York and Arizona. And we had a reducing the risk arm, which is just the standard curriculum, no gist enhancement. Then we had what we call RTR+, which is applying fuzzy trace theory, this gist-based intuition kind of thinking.
And then we had a control group, which actually had a friendship intervention about relationships with other people and friendship that wasn't about sex or sexual transmitted disease and other kinds of things. And the question is, was the enhanced curriculum any better than the curriculum already shown to be effective. Does this theory have any actual worth in terms of helping young people in terms of the outcome?
Well, no more numbers, but I will give you the-- I hope-- bottom line. This is an analysis comparing the standard curriculum, the gist-enhanced curriculum, how things changed over time-- because we've followed them up over time-- and then how those changes interacted. I wouldn't worry about the time so much. Just worry about the curriculum here for now.
A negative coefficient means that there is-- in terms of predicting number of sexual partners, the RTR+, the gist-enhanced curriculum, had significantly lowered the number of sexual partners. If you were in that group as opposed to the control group, you had a lower number of sexual partners. So that's a negative coefficient. That's means decreased. The numbers went down.
If your intentions to have sex were significantly lower in the gist-enhanced curriculum, there weren't significant differences in the RTR for these particular outcome measures. Now, most of the curricula-- people have done these wonderful reviews of the literature of these curriculum-- most curricula, the effective ones have an effect on two or three outcome variables. They don't have an effect on 12 or 14. They have an effect on two or three, which is considered good. That's top curriculum have an effect on two or three. So this is some of the ones that we have an effect on.
Your intentions to use birth control go up significantly in the gist-enhanced curriculum, and they also go up in the regular curriculum as well. Because remember, that is, in fact, an effective curriculum. So these are behavioral outcomes that were shown in a randomized clinical trial with 807 young people, adolescents, to be significantly more effective when you added these concepts about gist.
What about attitudes and norms? How did the curricula affect sexual attitudes, how permissive you felt about sex? It's OK to do it. Everybody is doing it. It's OK to do it. That's these kinds of things.
So sexual norms would be everybody is doing it. My friends are all having sex. And that tends to have a positive-- as you can imagine, it's been shown that the more you believe that, the more likely you are to have sex. So again, the RTR+ gist enhance lowered these permissive attitudes. You had a less permissive attitude. You said no, it's not a good idea, necessarily, to have sex. So that had a greater effect on the standard curriculum.
Your attitude towards birth control were enhanced in both of these groups. Your sexual norms went down, meaning you thought fewer of your friends were having sex. That's actually more accurate. So you don't believe everybody is doing it if you're in the RTR+ group.
And your norms for whether people who are having sex are using birth control, you now say yes. Yes, people who have sex use birth control. That's normal. So that had an effect in both curricula. And these are mediators of behavior. They've been shown to be mediators of behavior. I showed you behavior first because that's really the bottom line, but these are the things that cause behavior.
So again, what about self-efficacy, your ability to say no to sex? There is a remarkable amount of non-consensual sex that happens among young people, either with older people, older men with younger girls. And this self-efficacy, this belief in your ability to say no, is something that can be taught and can be taught effectively.
And as you can see in both curricula, in all of these things, there were effects of both cirricula-- significant effects viz-a-viz the control group, where you got a better ability to say no. The Ability to use birth control-- you felt you were more able to do it. I can go to the store. I can do this. I can implement this.
Behavioral control-- you feel you have control over your fate as opposed to things happening to you passively. And then the reasons not to have sex-- you agree with more reasons not to have sex than you did relative to the control group.
And knowledge and gist and warnings-- remember the uh oh remark? Remember the uh oh? Well, that goes up significantly in both intervention groups, as you can see. So there's a lot of effects on the nature of the thinking, the categorical thinking, the gist principles, and so on.
And in closing-- I know you probably have questions-- I just wanted to put in a plug for our new magnetic resonance imaging machine that we're going to be acquiring in Ithaca Cornell, while Cornell has had these for a little while. But this is the first non-clinical magnetic resonance imaging device that's going to be available in Ithaca. And I'm the co-director of this facility. And we plan to explore some of these things, including the mechanisms behind good outcomes in young people. We're looking at adolescent risk-taking while imaging their brains during these kinds of decisions.
AUDIENCE: So that's the machine?
VALERIE REYNA: This is the machine. This is-- it's going to scan the brain. Exactly.
AUDIENCE: I asked [INAUDIBLE] how big the machine was, but she said-- so it's like an MRI machine.
VALERIE REYNA: It's exactly an MRI machine. And we designed experiments where we were able to then isolate different areas of activation in the brain based on our hypotheses. Remember we showed those developmental curves about how the brain changes and what we think the brain is doing? These kinds of devices allow you to test those hypotheses and really literally look into the mind.
And we actually have preliminary data where we can see behavioral effects in the brain signals. It's cool. It gives chills.
AUDIENCE: What are you going to ask them? Are they supposed to be thinking about things?
VALERIE REYNA: We devise experiments to test hypotheses. So we have ways to manipulate whether you think verbatim or you think gist. We actually have, based on our theory, ways to induce gist-based thinking about risk that cause you, for example, in a game frame, to be risk averse. We can experimentally induce that kind of thinking based on the underlying mechanisms. I didn't show you those data because as you can imagine, it's fairly complicated.
Or we can get you to think more verbatim, more about the details and the numbers and so on, and then you're more risk-seeking in the game frame. We actually can induce that at will in people by changing the way you think and the way we present information. And we're going to study that in adolescents, who we think are more verbatim-based to begin with. So we're going to be able to, ideally, see certain areas of the brain light up when they make risky choices about outcomes that vary in magnitude and probability.
AUDIENCE: Based on responses to scenarios or questions that you might have while they are in the--
VALERIE REYNA: Exactly. And those scenarios-- we've already shown that those scenarios predict risk-taking in real life. That 2011 paper that we showed actually shows that there's a connection, a prediction, between what people do in the laboratory and what they do in the real world in terms of risky decision making. These are robust attitudes and ways of thinking that extend and are able to predict.
AUDIENCE: And we're going to be sending it out to a lot of the students who have been in the program.
VALERIE REYNA: Excellent. So just a final summary of all this, because I know it's a little overwhelming. There is, on the one hand, a kind of thinking, this verbatim-based analysis-- I'm calling it a kind of hyper-rationality that's acting, taking a risk by thinking about it, by calculating it. And a lot of adolescents engage in that.
When I reviewed the literature, their perception of the risks and benefits predicted their risk taking. So if you took their benefits and you took their risk and you multiplied, you got the likelihood that they would engage in risk taking. And if it's impulsive, you should not see that. You should see, oh, I regret it. I did what I don't really believe.
But what the teenagers are telling us is no, I actually did-- I lost the roll of the dice. It didn't come out the way I wanted it to, but I was going with the odds. So there's that hyper-rationality that promotes risk taking in adolescents-- a very different way of thinking than adults.
Then there's the standard impulsivity-- that also accounts for risk taking-- and the notion of responding to rewards. And then there's these developmental changes in the relationship between emotion, the limbic system, and the higher cognition prefrontal cortex and other higher order areas of the brain. And that relationship is changing simultaneously.
And then finally, bottom line is we think about learning, reasoning, and decision making, again, as these fixed quantities. Kids just develop. The brain just matures. But the brain matures as a function of experience. And we can change the way people think. We've shown that in the randomized controlled trial, and we've shown it in other experiments.
We are not just-- young people are not just fated to be risk takers, and we're just going to lose thousands of them. We actually can make a difference. And with each succeeding experiment, we're trying to increase or potentiate those effects in terms of health-promoting behaviors.
And then, of course, I got to thank all the wonderful people here who made it all possible, all the wonderful students. We have actual students, undergraduates and graduates, who deliver this curricula as well as the great folks here-- I'm so glad you're here-- Jackie, Michelle, and Eduardo who delivered the curriculum in New York City themselves. And they're right here.
AUDIENCE: Michelle [INAUDIBLE].
VALERIE REYNA: Yes, exactly. And NIH for funding the initial randomized control trial and our current funding, which is from USDA. We have a little bit of funding to do that obesity prevention. We're operating on a shoe string for this phase of our work, but we're getting it done. And it's, as we say, [SPANISH]. We're getting it done.
But anyway, thank you so much.
We're a small group.
We've been doing neuroimaging of adult brains. And we're looking at-- guess what-- sensation seeking, and those kinds of things, and seeing-- and I was just calculating-- before you came in, I got a little work done. And I was writing down the correlations with brain activations between sensation seeking and exactly this kind of thing we're talking about.
AUDIENCE: So once they are adults, they're pretty much incurable.
VALERIE REYNA: Well, there's a small group of people that remain sensation seekers. And I don't think they're incurable. I don't, again-- thanks so much, Michelle. Thank you so much. Hugs, right? Yeah.
So I don't think people are incurable. I think what you have to do is channel those impulses. So for example, let me give you a real life example. This is an example-- he knows I use him as an example. He's an old friend.
Richard Carmona-- does anybody know who Richard-- yes. Oh, very good.
AUDIENCE: He was the school chancellor.
VALERIE REYNA: Actually, surgeon general. I knew you knew him, though. Richard Carmona was US Surgeon General. He was a friend of mine in Tucson.
And he was a young man who started out in New York, as a matter of fact. He's Latino. And he got into a little trouble as in adolescence with the law, And he dropped out of high school. And he had all the risk factors. And he was clearly-- he's clearly an example sensation seeking. I know him.
So he's really-- he's a trauma surgeon SWAT team member in Tuscon. So he would carry a gun. And just he was an unusual fellow. But he started off going exactly down the wrong path, exactly down the wrong path-- background, not affluent at all, and so on.
He went to Vietnam. And in those days, if you didn't have a high school diploma, you could go to the Army, and so on. He became a medic, then he became a nurse, then he got a-- went to medical school. He became a trauma surgeon. He even got a master's in public health.
And guess how I met him? We were sitting around writing a grant for a youth program in Tucson, the two of us, because we both care, because we come from those kinds of backgrounds where a lot of things happen to people that were preventable. And we were there-- I think it was Christmas Eve, too. Not good. But it was due. You understand. I know you can relate, Jackie.
So that's how I met him. And he was clearly a risk-taking, stimulus-seeking-- he ran-- when the gunfire was going off, he thought that was exciting. The rest of us would be like, oh, no. He's like, yeah. He's a SWAT team. He gets out there, and he goes into hostage situations. He's the doc. And guns are blazing as the bulletproof vest on.
Clearly, he was headed down the wrong path because of some of those individual differences. That stimulus seeking was getting him into trouble. But then he challenged it. What does a trauma surgeon have to do?
Blood is gushing. People are screaming. Half the people are drunk, yelling. He loves it. He loves it. He went into an environment that was able to take advantage of his sensation seeking. I would be overstimulated by that. He was like, I can handle it. Now I'm about right. People are yelling. That's good. So that was a way to channel that kind of thing.
So it wasn't a death sentence. It wasn't the end of his life. It was something he, in fact, could use as a talent.
AUDIENCE: To dovetail on that question, one of the things that comes to mind as you were sharing your research and the findings is that we know that young people-- if we think about the ecological model-- young people grow up in households with parents, with adults. They grow up in communities. They grow up in society.
And the question that I kept coming back to is how do we introduce this, how do we nurture this in spite of the fact that we do have-- that these young people are not just looking at their peers, but they're also looking at the adults in their lives, who are not necessarily-- who are these--
VALERIE REYNA: Parental norms, other people. We know that risk opportunity has an effect. So people around-- say you could go either way, and people around you are getting into trouble. Hey, let's go down and rob the liquor store. And you just go along. You're carried away because your friends are doing it. You are at higher risk, all factors being equal.
So we know, and those kinds of risks have been studied. But we also know that most people who grow up in those areas do not end up in trouble. Most people do not, despite everything. So that's the majority.
And we know that there are things you can do to change the individual's way of looking at those options that they have in life, framing them differently. And that's what this curriculum is about-- to empower the individual with the power of the mind, with the power of the brain, to be able to make a difference and have a different trajectory.
AUDIENCE: Just to build on Eduardo's point-- so what is that that allows people who may not have had the benefit of this curriculum yet to then wind up not going through those risk--
VALERIE REYNA: Again, this has been-- there's been a lot of work on building out before my work was done. Some people get lucky. They're not on the corner the day that they decide to-- and we all know-- I know people like that. They just happened to be sick that day when their friends decided to go rob the liquor store, and they escape. Or they happen to have an adult that is supervising them.
The number of hours of unsupervised time is directly correlated with all kinds of risk taking. So if there's somebody there watching you, monitoring you directly, you're much less likely to get into trouble, and so on. So you add up all these causal factors, plus individual differences, plus the way you think, you get a recipe for either disaster or for a good trajectory. Bob, did you have a question?
AUDIENCE: I'm really interested-- you said the average age was 15?
VALERIE REYNA: 15.7 in that particular-- and the other one is about 15.5. It was high school age, though.
AUDIENCE: And the majority of the kids in this-- the the study is ongoing, still?
VALERIE REYNA: Well, the 807 was completed. The 189 is still ongoing.
AUDIENCE: OK. The whole group-- I'm fascinated with the idea of what are these kids going to be like at 19. The farther they get away from having gone through this experience-- at 19, they're still vulnerable.
VALERIE REYNA: It's a really good question. And tell NIH, please. If I could-- I've thought of that. If they would give me money to track them more, I would be delighted, and I would do it.
AUDIENCE: The framing of the study-- something [INAUDIBLE].
VALERIE REYNA: Exactly. But I should tell you-- one of the reasons we had gist is this exact reason. Notice your memory for details does what-- fades. But the gist is what you retain over time. So when we originally devised this, what I put in the application for the grant money was we think, perhaps, this might prevent fadeout.
Fadeout is a common problem with every health and educational intervention, from head start all the way up. You have this fadeout effect. As you get farther away-- just as you said-- from the initial dose without any reinoculations, the effect tends to go away.
Well, we thought if you base it on gist, that's what you remember over the long term. So maybe that will allow this. And that's exactly what we showed-- that these effects lasted up to a year after they were delivered.
And remember, a year and in high school student's life is a longer period of time than it is for us. That's distinctly different. Between 15, 16, 16 to 70-- that's a long time. And if we can keep them safe while they mature, while they gain that insight, while the brain develops, while the tempting stuff becomes less tempting and the self-control goes up-- if we could just stave that off, hopefully they'll be in a much better frame of mind and make the right healthy decisions.
AUDIENCE: You glossed over the individual differences business. And for example, we all know-- I know I was not a risk person, although there were things that I could point to that were risky that I did. Basically, I thought gist my whole life, even as an adolescent.
My kids did, also. My kids would say, what the hell are they doing standing around on the street corner? Well, the kid who was standing around the street corner was the one who slashed the model. In an affluent neighborhood of Brooklyn-- nothing dangerous about this. It's just that they were-- my sons could not understand what the point was standing around on the street corner. So they went out and played basketball or whatever.
So what I saw, as my kids were growing up, were real significant individual differences in their willingness to take risks, to think outside the box, as it were.
VALERIE REYNA: Well, that's a good point. And adolescents go-- in general, this curvilinear pattern is most kids. Most kids increase their responsiveness to rewards and then decrease.
We all like to believe we're completely unique, but actually, we're not. So there are these group things that account for a lot of behavior. When you add in not only the individual difference-- the personality, the responsiveness to reward, and the ability to control yourself, but the environmental things-- so risk opportunity is greater in some areas than it is in others.
If you're kind of an on-the-fence kid-- so you're a little sensation seeking, you lack a little self-control, but you're not really all that abnormal, but you've got lots of risk opportunity-- the cumulative probability. It's just like catching the flu. If you shook hands with 1 million people who have the flu, the chances of getting the flu are higher.
So all of these things combine in a causal fashion. Now, this individual difference-- like I said, there's a group of people, but not the majority. This is what's called adolescent dependent risk-taking, and then adolescents that are independent. There's people who, for the rest of their life, are the sensation seekers, lack impulse control.
And they account, for example, for the majority of crimes. Most crime is an age-related thing. So most taking chances, and robbing, and getting into trouble, and taking substances, which then, of course, increase your chances of getting into trouble-- all of that goes together. That is a very age-dependent thing. You can watch the crime statistics rise and fall based on how many young boys there are in the society at any one time.
Most people age out of that. They age out of it. There's this group, though, that continues, and they're responsible for a disproportionate amount of this kind of reckless behavior that ruins their lives and ruins other people's lives.
But again, I think even with those risk factors-- that's why I told the story of Richard Carmona. Because he had all those risk factors, I think. Now, I'm not going to get into any more detail than that. But let's just say he was in trouble with the law. He admits that.
And he ended up the Surgeon General. And he still has those characteristics, absolutely. So I think it is a question of science. We don't think with human behavior, it's a question of science. We think, oh, it's not subject to the laws of nature.
Yes, it is. The principles of the scientific method are the same, whether it's the mechanism of the cell or a mechanism of the mind.
AUDIENCE: The question I think I really want to ask is is when you have this MRI thing, can you look to see whether there are brain differences or brain reaction differences between kids who are more sensation-seeking as opposed to more just--
VALERIE REYNA: Exactly. That's exactly what we're doing. There's one study, for example, that looked at this-- remember I talked about the reward area, this nucleus accumbens part of the brain? And there's this curvilinear relationship on average, so that younger kids respond less to monetary rewards in an experiment. And then adolescents, their accumbens goes bing, bing, bing more, and then it comes down.
There's one study linking that to risk-taking behavior. So that's Adriana Galvan's work, and so on. We're following up on that, but we're looking at gist-based intuition and verbatim-based analysis. And we're going to do exactly what you said.
AUDIENCE: I guess what I really want to know is are some kids really predestined to be in that high sensation-seeking group, just the way Richard Carmona was.
VALERIE REYNA: Well, again, predestined-- do they have risk factors, just like you have risk factors for disease? But it's not inevitable, necessarily. Nothing is inevitable. And this is my belief. And I've based this-- this is partly because of where I came from and the people that I saw and grew up with. But I really-- and I think the data showed that.
You can change the trajectory. You can change. And remember, that brain changes a lot. But it's not changing in a vacuum. It's changing as a result of experience. That's what's modeling the brain. The brain is being remodeled based on experience. So that experience-- we can have an effect on that experience.
But the key thing is to use scientific data. So many people just use what they believe. I have faith in this method. It feels good to me. That's not good enough. That's not good enough for me, and it's certainly not good enough to perpetrate this on young people. We must discipline ourselves to use the science. That's probably the most important point I'm going to make, far beyond any importance in my individual theory or anything.
And that is mainly not being done. That's mostly-- almost all the things we do with young people, including positive youth, all of these things that it sounds so good, and probably are effective-- we don't test it. We don't demand that it be tested. It's not a matter of course.
It's like the old days of medicine before they had clinical trials. That was only in the 1940s when those became routine. That's recent history. We don't do that in human behavior. We just make it up.
AUDIENCE: But I think there is focus on using evidence-based materials, and there is more of an effort to do that kind of testing of the projects that we--
VALERIE REYNA: And Cornell extension is in the forefront.
AUDIENCE: And I just wanted to share a real quick story of something that I experienced last week-- Tuesday-- when I went to visit one of the classes. We were doing a 4-H Youth Voice, Youth Choice nutrition, and physical fitness project. And we were talking with the class about some of the objectives of doing this project, which included helping them make better choices about the foods that they're eating, et cetera.
And one of the young ladies in the class raised her hand. She said, Miss, Miss. And I said, yes. What's your name? Her name was Britney. And she said, look, I think you need to be doing this project with elementary school kids. Because I'm already 17 years old, and I'm set in my ways. I'm going to be 18 soon.
So you just need to do this for younger people. And so we had a whole conversation about that. But it was just priceless. I said, so I guess the rest of us might as well just go crawl under a rock.
VALERIE REYNA: I think at any age, people can change, And all this notion that your life is over and-- you continue to change. People continue to develop across their lifespan. That's what the data show. And there's always hope.
And we really can change. Someone should tell Britney.
AUDIENCE: I told her that, and I told her the story--
AUDIENCE: But she's right, to a large extent. You know that.
AUDIENCE: Well, I told her we were going to use that into what we did do.
AUDIENCE: But it would really be a lot easier if we started young.
VALERIE REYNA: Actually not. It's very counterintuitive. I actually went to this workshop, thanks to the good old NIH. Thank you, NIH, for educating me. And I met with these people.
And I remember this guy going, oh-- everybody was saying early experience. Intervene early. That's the best thing to do. That's the most effective. It turns out for these behaviors, it's not. The data show that if you intervene too early, it's not even relevant. They're playing with dolls. They're like, what are you talking about condoms? Let me play with my dolls. So it actually is less effective. You have to have that sweet spot of when it's about to be relevant.
VALERIE REYNA: When I was a kid, I couldn't imagine being older than 18. I just assumed I'd be dead.
AUDIENCE: What we told Britney was that we wanted her to learn the information and then go with us to teach the younger youth. So that will give her ultra reinforcement for learning it, and also-- they'll listen more to a teenager than to somebody like us.
AUDIENCE: Would it be possible to see a sample of how this information is presented to kids? Because you said that, basically, you don't want to get into a debate with them because they will defeat you with their logic. And that's completely understandable.
So you want to get them to-- maybe it's trick, or whatever it is, whatever the method to come to these conclusions by themselves, by some method, so they're empowering themselves to do this. Because they hate to be told what to do.
But they can also smell when they're being told what to do, because they've been told what to do for 15 years.
VALERIE REYNA: That's right. That's why we use their values. We don't give them values. We say, you pick which ones matter to you.
And it's interesting the kinds of things that kids really are about. They're about love and sex. And they're about-- it's interesting what their actual values are.
One example, for example, we use is the Russian roulette example. We say, OK, what if I gave you $1 million to play Russian roulette. And here's the gun right here. Would you put it to your head and pull the trigger?
And so there's six chambers in the gun, and only one bullet, and I'm going to give you $1 million. Now, the odds are with you. Now, I don't tell them that. I just say what would you do. And usually, about half of the kids-- we use this in our lesson. Because this is actually a paper that I wrote years ago when I said this is the difference in their thinking and our thinking.
Half the kids will say I'd do it. It's a lot of money, and it's a very low probability. And you say, are you kidding? So then you look at the other half, and you go, aha, you're OK. They say, no. I want more money. I'd do it for $1 billion. It's just a question of price.
Now, you notice that's the difference between the way we think and the way they think. So I use this example. And we say every time you have unprotected sex, it's like rolling these bullets in a chamber of a very large gun with only one bullet in maybe 100 chambers, or even fewer than that. But your number is going to come up at some point.
And then we do these various kinds of exercises to demonstrate the qualitative nature of this. So we do an exercise. We show that if you have unprotected sex only once a month per year, at the end of the month-- at the end of the year, it's about a 1.0 probability that you're pregnant. Because it's 1 out of 12, you do it again, and so on. So it becomes it's going to happen. It's just a question of when.
So rather than worry-- OK, this partner is slightly less risky than that partner. I'll have sex with the partner that's less risky. People definitely do do this. I remember this. People will say I have sex with a virgin, because that way, I won't get STDs. And I'll do the-- I'll game the system somehow. I'll find my way through the maze of probabilities and risk.
We say don't. It's going to add up. Your number is going to come up. It's just a question of when. It's a very different way of thinking. So we model this qualitative kind of thinking that we're engaging in now, which is almost Greek to the kids. So we model that.
And when we first started this, I thought I don't know if we can do this. Because how do you get those insights? Experience. You see this happening, and you go, that's a lot worse than I imagined it to be. This is a deal breaker. I'm just not going to go there. So you develop that.
Can we synthesize experience for young people? Is that even possible? And frankly, I really didn't believe we could. But the data are the data. As you can see, outcome after outcome, this-- and it's amazing. Actually, I do a lot of work on medical decision making as well. And you say to people, so what is the point of your message, your risk message. And people who even deliver the messages don't know the gist.
So if they don't know the bottom line, how can we transmit the bottom line? So people are not necessarily focusing on that. They're saying here's a bunch of facts you have to memorize. This is the effectiveness of a condom. This is the probability of this. This is the base rate of that. Memorize, memorize.
Six months later-- I don't remember. What was that? I didn't even know what a virus was. And you're telling me this, and I'm writing it down verbatim, and I'm memorizing it, and I'm passing the quiz. And then my behavior-- I'm not making any connection with what's the bottom line. It's a very simple idea, really, our theory. But it really changes the nature of what you try to do in a lesson.
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Valerie Reyna presented research on how adolescent minds make decisions, and lessons on dealing with students who struggle with dangerous choice, during the March 13, 2012 Inside Cornell session at Cornell's ILR Conference Center in Midtown Manhattan.
Reyna is a professor of human development and director of New York City outreach programs for risk reduction in youth.