Deaths of decision-making are killing American teens. Schools can fix it.

The recent Make America Healthy Again (MAHA) report argues that “to turn the tide and better protect our children, the United States must act decisively.” Ironically, that report—like far too many conversations about the health of America’s young people—fails to account for the most significant threat to the lives of American teenagers: deaths of decision-making.

Consider what we do with the most important social program we have for young people, which serves 50 million people every year at a cost of over $800 billion: schools. We might expect that the mandatory health class that most American students experience in middle or high school would include a focus on the greatest risks to the lives of our young people. But while health education classes typically include important lessons on things like nutrition, sex ed, and the like, the data tell us a different story about what is actually killing American teenagers. It’s (mercifully) not malnutrition. It’s murders (most often with a gun), suicides, car crashes, and overdoses.

What do these seemingly disparate causes of death have in common? They all stem from terrible decision-making—impulsive, in-the-moment choices with permanent and devastating consequences.

Of course, everyone is prone to making mistakes in fraught, emotionally challenging situations. (Just ask my teenage daughter about my gracious description of the last guy who cut me off in Chicago traffic.) But while I can just muddle through my outburst of colorful language as I drive safely away, muddling through feels wildly insufficient for young people making split-second decisions in highly charged situations where the stakes can sometimes be life or death.

The key to what we can do about this comes down to understanding how our brains are wired. By expressly teaching students about this wiring and delivering instruction that helps them develop the skills to recognize and manage it, we can equip them to better manage their actions in moments of high emotion and high stakes.

As Daniel Kahneman explains in his 2011 book ”Thinking, Fast and Slow,” most of the thinking humans do is what Kahneman calls “System 1”: fast, instinctive, and emotional. But to grapple with complex, difficult situations, we need to tap into our “System 2” thinking: slowing down, evaluating context, and making a reasoned decision. Humans—all of us—make predictable cognitive errors when our System 1 remains in the driver’s seat in a situation that demands slower, System 2 thinking.

In the case of gun violence, the results of this type of cognitive error are devastating. As my colleague Jens Ludwig details in his new book, ”Unforgiving Places: The Unexpected Origins of American Gun Violence,” most shootings are neither premeditated nor motivated by economic considerations (robbery, drug turf, etc.). Instead, most shootings start as arguments; heat-of-the-moment, interpersonal conflicts gone horribly wrong because someone has a gun.

It’s easy to see how other frequent causes of death for young people follow this same cognitive pattern. Suicides reflect the tragic but all-too-common failure of rational decision-making in a moment of crisis. The drinking and drug use that too often result in drunk driving crashes and overdoses can be viewed as artifacts of the notoriously impulsive decision-making of teenagers. And so on.

One would think, given that the leading causes of death of American teenagers involve terrible decision-making, that instruction on behavioral change to improve decision-making would be a cornerstone of every high school health class in the United States. So, why isn’t it?

Perhaps it’s because it feels too hard. Teaching kids about healthy eating habits is comparatively easy. Driving true behavior change feels more elusive.

But it needn’t feel so hard. There are lots of comparatively low-cost ways to prevent the predictable mistakes people make in those difficult situations. Over a decade of research at the University of Chicago Crime Lab, where I am executive director, we have found concrete ways to help young people improve cognitive decision-making in difficult situations. So-called “cognitive behavioral intervention” programs, in which kids practice these skills in safe, simulated social interactions, have been shown to cause a 40-50% decrease in their likelihood of involvement in violence. In as little as 20 hours, kids can dramatically improve their ability to navigate highly charged situations. The research shows these skills are also unusually “sticky,” with the results persisting for years after the program is delivered.

In some cases, we can deliver this type of programming at large scale with almost no additional cost. We just need to repurpose some of the vast amounts of low-opportunity-cost time we have in so many of our youth-serving institutions. For example, a few years ago, the Crime Lab worked with the Juvenile Temporary Detention Center to train correctional staff to deliver this sort of program, during the afternoon downtime when kids would have otherwise just been watching TV in the common room. That cost almost nothing—after all, the corrections officers were already there—and reduced recidivism by over 20%. Study after study after study has shown similarly encouraging results.

If detention staff can successfully deliver this sort of program at basically no extra cost, surely the educators teaching our health classes can, too. Since virtually every American high school student takes a high school health class at some point, the impacts on public health in the U.S. could be dramatic.

Many nonprofits around the country have been running these sorts of programs for years. Here in Chicago, the Crime Lab and our sister lab, the University of Chicago Education Lab, are working with nearly a dozen nonprofits to assemble the key lessons learned and best practices into a sort of “best of” curriculum. By later this year, this curriculum will be made publicly available for free, in an open-source format for anyone to use—so that teachers, coaches, mentors, and any other adults who work with young people can start to incorporate this cognitive skill-building into their work.

Much like an athlete learns the fundamentals of fitness exercises—squats, lunges, chest presses—our mind is a sort of muscle, too. We need to teach kids these skills so they build the muscle memory for decision-making that will help them avoid the all-too-common cognitive errors that can have such devastating consequences.