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PubMed2005

Anger as a moderator of safer sex motivation among low-income urban women.

Theoretical models suggest that both HIV knowledge and HIV risk perception inform rational decision making and, thus, predict safer sex motivation and behavior. However, the amount of variance explained by knowledge and risk perception is typically small. In this cross-sectional study, we investigated whether the predictive power of HIV knowledge and HIV risk perception on safer sex motivation is affected by trait anger. We hypothesized that anger may disrupt rational decision making, distorting the effects of both HIV knowledge and risk perception on safer sex intentions. Data from 232 low-income, urban women at risk for HIV infection were used to test a path model with past sexual risk behavior, HIV knowledge, and HIV risk perception as predictors of safer sex intentions. Moderator effects of anger on safer sex intentions were tested by simultaneous group comparisons between high-anger and low-anger women (median split). The theoretically expected "rational pattern" was found among low-anger women only, including (a) a positive effect of knowledge on safer sex intentions, and (b) buffer (inhibitor) effects of HIV knowledge and HIV risk perception on the negative path leading from past risk behavior to safer sex intentions. Among high-anger women, an "irrational pattern" emerged, with no effects of HIV knowledge and negative effects of both past risk behavior and HIV risk perception on safer sex intentions. In sum, the results suggest that rational knowledge- and risk-based decisions regarding safer sex may be limited to low-anger women.

Adolescent↗

PubMed2003

Perception of risk of HIV/AIDS and sexual behaviour in Kenya.

The association between perception of risk of HIV infection and sexual behaviour remains poorly understood, although perception of risk is considered to be the first stage towards behavioural change from risk-taking to safer behaviour. Using data from the 1998 Kenya Demographic and Health Survey, logistic regression models were fitted to examine the direction and the strength of the association between perceived risk of HIV/AIDS and risky sexual behaviour in the last 12 months before the survey. The findings indicate a strong positive association between perceived risk of HIV/AIDS and risky sexual behaviour for both women and men. Controlling for sociodemographic, sexual exposure and knowledge factors such as age, marital status, education, work status, residence, ethnicity, source of AIDS information, specific knowledge of AIDS, and condom use to avoid AIDS did not change the direction of the association, but altered its strength slightly. Young and unmarried women and men were more likely than older and married ones to report risky sexual behaviour. Ethnicity was significantly associated with risky sexual behaviour, suggesting a need to identify the contextual and social factors that influence behaviour among Kenyan people.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Racial differences in the use of BRCA1/2 testing among women with a family history of breast or ovarian cancer.

CONTEXT: Given the current context of racial disparities in health and health care and the historical context of eugenics, racial disparities in the use of genetic susceptibility testing have been widely anticipated. However, to our knowledge there are no published studies examining the magnitude and determinants of racial differences in the use of genetic susceptibility testing. OBJECTIVES: To investigate the relationship between race and the use of BRCA1/2 counseling among women with a family history of breast or ovarian cancer and to determine the contribution of socioeconomic characteristics, cancer risk perception and worry, attitudes about genetic testing, and interactions with primary care physicians to racial differences in utilization. DESIGN, SETTING, AND PARTICIPANTS: Case-control study (December 1999-August 2003) of 408 women with a family history of breast or ovarian cancer, of whom 217 underwent genetic counseling for BRCA1/2 testing (cases) and 191 women did not (controls). Participants received primary care within a large health system in greater Philadelphia, Pa. MAIN OUTCOME MEASURES: Probability of carrying a BRCA1/2 mutation, socioeconomic characteristics, perception of breast and ovarian cancer risk, worry about breast and ovarian cancer, attitudes about BRCA1/2 testing, and primary care physician discussion of BRCA1/2 testing were measured prior to undergoing BRCA1/2 counseling for cases and at the time of enrollment for controls. RESULTS: African American women with a family history of breast or ovarian cancer were significantly less likely to undergo genetic counseling for BRCA1/2 testing than were white women with a family history of breast or ovarian cancer (odds ratio, 0.22; 95% confidence interval, 0.12-0.40). This association persisted after adjustment for probability of BRCA1/2 mutation, socioeconomic characteristics, breast and ovarian cancer risk perception and worry, attitudes about the risks and benefits of BRCA1/2 testing, and primary care physician discussion of BRCA1/2 testing (adjusted odds ratio for African American vs white, 0.28; 95% confidence interval, 0.09-0.89). CONCLUSIONS: Racial disparities in the use of BRCA1/2 counseling are large and do not appear to be explained by differences in risk factors for carrying a BRCA1/2 mutation, socioeconomic factors, risk perception, attitudes, or primary care physician recommendations. The benefit of predictive genetic testing will not be fully realized unless these disparities can be addressed.

Adult↗

PubMed2002

Measuring perceptions of synergistic circulatory disease risk due to smoking and the oral contraceptive pill.

There is evidence that the oral contraceptive pill (OCP) and smoking contribute independently to risk of circulatory disease. There is mixed evidence that the combined risk may be greater than the sum of these factors operating in isolation. Little is known about how the general population views the risks from OCP use, singly and in combination with smoking. Previous attempts at assessing whether the public views risks as operating synergistically have generally found evidence for subadditive models, where the combined risk is less than the sum of factors operating in isolation. However, concerns have been expressed over the validity of the measures of risk perception used. Therefore, this study used three distinct methods of measurement to assess the extent to which 241 undergraduate students perceive the risks of smoking and the OCP separately and combined, for circulatory disease. For all three methods, respondents read each of four vignettes describing information about a woman's risk factors (with high and low levels of both OCP and smoking), and then estimated risk of circulatory disease using one of the three risk measures. The three measures produced similar ratings. Consistent with the epidemiological evidence, information about smoking had more impact on estimates of overall risk than did information about the OCP For all three measures, responses were consistent with an additive model of risk from smoking and the OCP. This convergence of results from different methods suggests that all three methods of measurement employed, which all had a large number of response options, may be valid.

Adult↗

PubMed2004

Randomized trial in family practice of a brief intervention to reduce STI risk in young adults.

BACKGROUND: Young adults represent a high-risk group for sexually transmissible infections (STIs). No randomized controlled trials of interventions in family practice to reduce sexual risk have been reported. OBJECTIVES: We evaluated the impact of brief advice initiated in routine consultations in 20 family practices to modify young adults' risk perception and self-reported risk behaviour for STIs, particularly human immunodeficiency virus (HIV) and hepatitis. METHODS: Patients aged 18-25 years completed self-administered confidential questionnaires in the waiting-room before seeing participating family physicians (FPs). Patients were unobtrusively randomized to receive advice about safe sex and complementary resources from their FP (INT group) or usual care (CONTROL group). Three months later, patients completed mailed follow-up questionnaires to assess changes in risk perception and behaviour. RESULTS: Three hundred and twelve patients completed baseline questionnaires. Of 237 who agreed to follow-up, 156 (68%) returned self-administered follow-up questionnaires. At post-test, we found equivalent self-reported use of questions to assess any new sexual partner's risk (33 versus 36%) and equivalent self-reported use of condoms on first occasion of sex with a new partner (73 versus 77%). While self-reported behaviour did not change significantly, we demonstrated significant change from pre- to post-test for knowledge of hepatitis risk, for both intervention and control groups. Multiple regression showed that the odds of risk perceptions were significantly higher at post-test than at pre-test for the CONTROL group but not the INT group. CONCLUSION: FPs remain to be convinced that allocation of time within consultations to opportunistic health promotion is worthwhile. Indeed, there are many competing demands for such time. Our results do not yet provide compelling evidence for the impact of a brief intervention about STI risk by FPs. As primary prevention efforts for young adults remain important, randomized controlled trials of larger scope are needed.

Adolescent↗

PubMed2001

The extent of patients' understanding of the risk of treatments.

The scientific understanding of how people perceive and code risks and then use this information in decision making has progressed greatly in the last 20 years. There is considerable evidence that people employ simplifying heuristics in judgement and decision making. These heuristics may lead to bias in how people interpret information. However, much of our understanding of risk perception is based on laboratory studies. It is much less clear whether risk perception in the real world (as in the case of medical treatments) exhibits the same patterns and biases. This paper reviews the published literature on risk perception in patients who face substantial treatment risks. It examines how accurate patients' perception of risk is, what factors affect the perception of risk, and several possible explanations for why patients' risk perception is not always accurate.

Bias↗

PubMed1996

Developing a subject-derived terminology to describe perceptions of chemicals in foods.

Risk perception may be influenced by a number of factors, such as unfamiliarity, lack of control, perceived consequences, and hazards being seen as catastrophic and having risk for future generations. Risk perception researchers have typically used such investigator-selected characteristics to assess hazards. In the first study reported here, the repertory grid method was used to elicit the terminology that subjects (n = 30) use to distinguish between 30 different chemicals. The data were submitted to generalized Procrustes analysis. The first principal axis of the resulting consensus plot separated the chemicals ranging from "poisonous or toxic," "harmful or dangerous," and "sounds negative" at one end, to "positive effect on health," "often present in food nowadays," and "sounds positive" at the other end. The second principal axis ranged from "familiar with or knowledge of" and "chemical" to "natural." A second study (n = 226) was carried out to look at the general validity of the results of the repertory grid interviews using a fixed questionnaire. The data were submitted to principal components analysis and internal preference mapping. The first principal component ranged from "safe" and "healthy" at one end, to "poisonous" and "harmful" at the other end. The chemicals also separated in terms of "familiar," "chemical," and "natural." All three methods of data collection and analysis yield essentially similar results.

Attitude↗

PubMed2001

Factors associated with perceived risk in automotive employees at increased risk of colorectal cancer.

Risk perception may be an important motivator of health-related behaviors. To develop effective risk communication messages, it is important to understand both the patterns of association between perceived risk and health-related behaviors as well as the correlates of risk perception. Very little is known about whether correlates of risk perception are similar in cross-sectional data compared with prospective data. Furthermore, there are scant data on consistency of correlates of risk perception across groups who vary in objective medical risk. If correlates differ, it would underscore the need to tailor intervention messages based on subgroup characteristics as well as increase awareness of the limitations of basing intervention messages only on cross-sectional data. We analyzed data on a subset of 5042 employees who participated in The Next Step Trial, a randomized health promotion trial to encourage colorectal cancer screening and dietary change. We restricted our analysis to only those automotive workers who were white, male, and did not have colorectal cancer (4477/5042) and who returned surveys both at baseline (2,684/4,477) and at year 2 of follow-up (1955/2684). Initial analyses detected interactions between a history of polyps and several of the other covariates. Therefore, univariate and multivariable analyses were conducted separately for men with and without a personal history of colorectal polyps. Within each of the four subgroups (those with or without polyps in the baseline or follow-up analyses), we examined associations between perceived risk measured at baseline (cross-sectional analyses) and at year 2 of follow-up (prospective analyses) in relation to intervention group status, demographic, medical history, psychosocial, and worksite characteristics measured at baseline. To assess the predictive ability of the models, we computed sensitivity and specificity as measures of each model's ability to correctly classify men into their respective subgroup. Although there was no association between perceived risk and intervention group status in the four subgroups analyzed, we included intervention group status as a covariate in all analyses. At baseline (cross-sectional analyses) among men with and without a history of polyps, perceived risk was positively associated with family history of colorectal polyps or cancer, family support for screening, and worry about being diagnosed with colorectal cancer. In addition, for men without polyps, perceived risk was positively associated with being a current smoker. At year 2 of follow-up (prospective analyses) for men with and without polyps, perceived risk at year 2 was positively associated with family history and baseline perceived risk and was negatively associated with having a normal screening examination or no examinations during the trial. In addition, for men with polyps, perceived risk was positively associated with belief in the salience and coherence of screening and with intention to be screened and was negatively associated with access to screening at the worksite. Specificity was higher than sensitivity in three of four subgroups and was >65% in all subgroups. Except for family history, messages to influence perceived risk would emphasize different factors, depending on whether associations were based on baseline or follow-up data and depending on whether men reported a personal history of polyps. For example, although intervention messages using baseline data would emphasize the same factors for men with or without polyps, messages based on follow-up data would emphasize psychosocial characteristics, such as salience and coherence of screening and intention for men with a history of polyps but not for men without. Our findings support the need to delineate subgroups in the study population to target and tailor health-related messages based on respondent characteristics. Our findings also underscore the need to base health-related messages on prospective data as well as cross-sectional data to better address health-related beliefs and behaviors.

Adult↗

PubMed1995

Perceptions of risk during pregnancy amongst urban women in northeast Brazil.

The aim of the study was to explore the influences on the perceptions of potential risks of pregnancy in a developing country. The perceptions were analyzed in order to construct a local explanatory model of health which could be compared to the activities promoted by the health services. The relationship of perceptions of risk to women's reported motivation for using the health services is assessed. The findings are presented in relation to four specific research questions: 1, How do women view the state of being pregnant? 2, What potential risks are associated with being pregnant? 3, How are these risks explained? 4, What are women's motivations for using prenatal care services? The paper discusses the influence of the local explanatory model on women's perceptions of health risks during pregnancy, the compatibility with the biomedical model and the influence of either on the use of health services by women. In the course of analysing the findings, a number of questions emerged concerning the assumptions often underlying this kind of study. First, the results suggested that seeking one coherent explanatory medical model for local perceptions of risk may not be appropriate. Secondly, different explanations for perceived risks does not necessarily mean a conflict with the activities of the health services. Thirdly, the explanatory model is only part of the influences on women's perceptions of health risks. The socio-economic context of their lives and the structure and practices of the local health system are equally important factors. An approach based on different assumptions which locates individual experiences within the influences of explanatory medical models, the socio-economic circumstances and the structure and practices of the health system provides a better understanding of how perceptions of health risks are formed, how they influence use of the health services and how they change over time.

Abortion, Spontaneous↗

PubMed2003

Local perceptions of risk to livelihood in semi-arid Tanzania.

This paper examines variation in local perceptions of risk in semi-arid Tanzania, identifying factors that influence local perceptions of problems and testing the feasibility of risk mapping as a technique. Twelve villages in six districts were visited between February and April 2001. Villagers were asked about their worries and concerns in providing for themselves and their families using a risk questionnaire. The responses were grouped into 21 categories of problem and incidence and severity indices were calculated for each category. Most problems were associated with the availability of natural resources on which livelihoods depend but others related to human and social capital assets. In addition to environmental factors, livelihood strategy and gender both influenced people's perceptions of risk. Problems of irrigation and weather, for example, were important for agricultural communities while problems relating to livestock diseases, access to land and hunger were more important in pastoral communities. The risks cited by men and women generally reflected their traditional roles in society. Very broadly, the risks associated with natural capital tended to be seen as higher by men while women mentioned more problems relating to human and social capital. However, this was not always the case. Problems linked to finance, traditionally the concern of men, were ranked similarly by men and women. In projects designed to facilitate community management and control over common pool resources, the identification of common interests is particularly important. Risk mapping can provide a cost-effective way of gaining insights to help improve research design and to inform policy development.

Adult↗

PubMed1999

The power of perception: health risk attributed to air pollution in an urban industrial neighbourhood.

This paper describes a multi-stakeholder process designed to assess the potential health risks associated with adverse air quality in an urban industrial neighborhood. The paper briefly describes the quantitative health risk assessment conducted by scientific experts, with input by a grassroots community group concerned about the impacts of adverse air quality on their health and quality of life. In this case, rather than accept the views of the scientific experts, the community used their powers of perception to advantage by successfully advocating for a professionally conducted community health survey. This survey was designed to document, systematically and rigorously, the health risk perceptions community members associated with exposure to adverse air quality in their neighborhood. This paper describes the institutional and community contexts within which the research is situated as well as the design, administration, analysis, and results of the community health survey administered to 402 households living in an urban industrial neighborhood in Hamilton, Ontario, Canada. These survey results served to legitimate the community's concerns about air quality and to help broaden operational definitions of 'health.' In addition, the results of both health risk assessment exercises served to keep issues of air quality on the local political agenda. Implications of these findings for our understanding of the environmental justice process as well as the ability of communities to influence environmental health policy are discussed.

Air Pollution↗

PubMed2004

Battered women's perceptions of risk versus risk factors and instruments in predicting repeat reassault.

This study partially replicates and expands on a previous study that showed women's perceptions of risk to be a strong predictor of reassault among batterers. The current study employed a larger and multisite sample, a longer follow-up period of 15 months, and multiple outcomes including "repeated reassault" (n = 499). According to the multinomial logistic regressions, women's perceptions of risk improved prediction with risk factors (ROC area under the curve improved by.04 and sensitivity of repeated reassault increased 12 percentage points). In comparison to simulated risk instruments, women's perceptions by themselves were better predictors than the K-SID, similar in predictive ability to the SARA, and almost as strong as the DAS. The best prediction of repeated reassault was obtained using risk markers, including women's perceptions (ROC AUC =.83; 70% sensitivity) or by using the DAS and women's perceptions together (ROC AUC =.73; 64% sensitivity).

Adult↗

PubMed2006

Public perception and risk communication in regard to bioterrorism against animals and plants.

This paper examines the total international prohibition on the use of disease to attack humans, animals and plants, noting that in the past several countries had developed programmes for attacks on animals and plants as well as humans. Current activities undertaken by intergovernmental organisations - the World Health Organization (WHO), Food and Agricultural Organization (FAO) and World Organisation for Animal Health (OIE)--to counter the threat of attacks on humans, animals and plants are examined. Effective countermeasures to deliberate attacks need to be developed in harmony with existing measures to control natural or accidental outbreaks of disease. Finally the paper assesses the risk and the public perception of it, and considers what risk communication is needed and to whom. Clear mandates are needed for the FAO and OIE to be prepared to deal with outbreaks of disease, and with contamination of the food supply chain, whether accidental or intentional.

Animal Diseases↗

PubMed1996

Perception of risk by home health care administrators and field workers.

The home health care industry has grown significantly over the past 15 years, primarily as the result of an increasing percentage of elderly needing services. Although personal risk has always been a contextual factor of home visiting, an additional challenge facing home health care administrators today is ensuring field worker safety, because visits are now made 24 hr a day, 7 days a week. The purpose of this study was to compare home health care administrators' with field workers' perceptions of risk involved in making home visits. The Home Health Care Perception of Risk Questionnaire (HHCPRQ), a self-report measure, was administered to a national random sample of 93 home health care administrators and 705 field workers to determine perception of risk within the context of making home visits. Findings indicate significant differences between home health care administrators' and field workers' perceptions of risk in making home visits. Suggestions for enhancing communication among all agency personnel and developing in-service education programs that are specifically for field workers are identified.

Administrative Personnel↗

PubMed2004

Intended message versus message received in hypothetical physician risk communications: exploring the gap.

We examined the risk perception that is derived from hypothetical physician risk communications. Subjects (n= 217) completed a questionnaire on the Web for $3. Subjects were presented with four hypothetical cancer risk scenarios that included a physician risk communication in one of three risk communication formats: verbal only, verbal plus numeric probability as a percent, and verbal plus numeric probability as a fraction. In each scenario, subjects were asked to imagine themselves as the patient described and to state their perceived personal susceptibility to the cancer (i.e., risk perception) on a 0 to 100 scale, as well as responses to other measures. Subjects' risk perceptions were highly variable, spanning nearly the entire probability scale for each scenario, and the degree of variation was only slightly less in the risk communication formats in which a numeric statement of risk was provided. Subjects were more likely to overestimate than underestimate their risk relative to the stated risk in the numeric versions, and overestimation was associated with the belief that the physician minimized the risk so they wouldn't worry, innumeracy, and worry, as well as decisions about testing for the cancer. These results demonstrate significant gaps between the intended message and the message received in physician risk communications. Implications for medical decisions, patient distress, and future research are discussed.

Communication↗

PubMedDate not supplied

Perception of risk by administrators and home health aides.

Increasing numbers of persons over 65, decreased length of hospital stay, and need for chronic (custodial) health care have placed a strain on home health care agencies. The second largest group of persons providing care is home health aides (HHAs), who perform in-home, nonskilled, technical procedures with little or no on-site supervision. They are generally high school graduates or hold GEDs. The purpose of this study was to compare home health care administrators' (HHCAs) and HHAs' perceptions of risk involved in home visiting. Given HHAs' educational preparation and limited supervision, they are basically on their own for work performed. Although agencies provide orientation sessions for new workers, periodic in-services often relate to tasks and competency testing and little attention directed toward protecting the self-specifically, strategies to decrease personal risk. In order to determine to what extent HHCAs and HHAs perceive risk, the Home Health Care Perception of Risk Questionnaire, a self-report measure, was administered to a national random sample of 93 HHCAs and 227 HHAs. Findings suggest that these groups differ in perception of risk and level of agency support in making home visits. Suggestions for meeting the needs of this HHA provider group are offered.

Administrative Personnel↗

PubMed1999

Sexual behaviours, perception of risk of HIV infection, and factors associated with attending HIV post-test counselling in Ethiopia.

OBJECTIVES: To describe sexual behaviours, perception of risk of HIV infection, and factors associated with attending HIV post-test counselling (PTC) among Ethiopian adults. METHODS: Data on socio-demographic characteristics, knowledge of HIV infection, sexual history, medical examination, and HIV and syphilis serological status were compared, through uni- and multivariate analysis, in relation to attending PTC within 60 days of HIV testing. RESULTS: Between February 1997 and June 1998, 751 factory workers were enrolled in a cohort study of HIV infection progression. Despite reporting high-risk sexual behaviours, mainly for males (64% of males and 6% of females had more than five sexual partners in their lifetime, 16% of males and 2% of females reported having had recent casual partners), and knowing that HIV is commonly transmitted heterosexually in Ethiopia (97% of answers being correct, both genders combined), only 17% of males and 2% of females acknowledged having had activities which had put them at risk of HIV infection. HIV prevalence was 12%, and did not differ by gender. Of all study participants, 327 (43.5%) returned for PTC within 60 days of HIV testing. PTC attendance did not differ by age, gender, or HIV serological status. Factors independently associated with PTC attendance in males were: good knowledge of HIV infection, [odds ratio (OR) = 1.661, belief that medical follow-up improves the course of HIV infection (OR = 2.02), history of genital symptoms (OR = 2.83), positive syphilis serology (OR = 2.62), recent weight loss (OR = 1.89), and, with a negative association, being a manual worker (OR = 0.40), and history of recent casual sexual relationships (OR = 0.35). In women, belief that HIV/AIDS can be cured (OR = 3.16), never having been married (OR = 5.02), having five or less children (OR = 2.16), having been raped (OR = 3.42), and having used health facilities in the past year (OR = 1.73) were all positively and independently associated with PTC attendance. CONCLUSION: Study participants reported high-risk sexual behaviours, yet had a low perception of individual risk. Men attended for PTC because of their knowledge of HIV infection, their past sexual history or their current health status. Women attended for PTC because of their plans for the future, marriage and/or children, rather than their past sexual exposure. Only in cases of rape were they willing to learn of their HIV status.

AIDS Serodiagnosis↗

PubMed2002

Study of self-reported hypersensitivity to electromagnetic fields in California.

Cases of alleged hypersensitivity to electromagnetic fields (EMFs) have been reported for more than 20 years, and some authors have suggested some connection with the "multiple chemical sensitivity" illness. We report the results of a telephone survey among a sample of 2,072 Californians. Being "allergic or very sensitive" to being near electrical devices was reported by 68 subjects, resulting in an adjusted prevalence of 3.2% (95% confidence interval = 2.8, 3.7). Twenty-seven subjects (1.3%) reported sensitivity to electrical devices but no sensitivity to chemicals. Characteristics of the people reporting hypersensitivity to EMFs were generally different from those of people reporting being allergic to everyday chemicals. Alleging environmental illness or multiple chemical sensitivity diagnosed by a doctor was the strongest predictor of reporting being hypersensitive to EMFs in this population. Other predictive factors apart from self-reporting chemical sensitivity were race/ethnicity other than White, Black, or Hispanic; having low income; and being unable to work. The perception of risk of exposure to EMFs through the use of hair dryers (vs. exposure to power and distribution lines) was the factor the most associated with self-reporting about hypersensitivity to EMFs. However, risk perception was not sufficient to explain the characteristics of people reporting this disorder.

Adolescent↗