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PubMed1993

Risk as moral danger: the social and political functions of risk discourse in public health.

Risk is a concept with multiple meanings and is ideologically loaded. The author reviews the literature on risk perception and risk as a sociocultural construct, with particular reference to the domain of public health. Pertinent examples of the political and moral function of risk discourse in public health are given. The author concludes that risk discourse is often used to blame the victim, to displace the real reasons for ill-health upon the individual, and to express outrage at behavior deemed socially unacceptable, thereby exerting control over the body politic as well as the body corporeal. Risk discourse is redolent with the ideologies of mortality, danger, and divine retribution. Risk, as it is used in modern society, therefore cannot be considered a neutral term.

Australia↗

PubMed1996

Sex, drugs, intervention, and research: from the individual to the social.

Epidemiological estimates of the sexual risk behavior of drug users have provided essential indicators to the current and future prevalence of HIV transmission. An overview of recent research shows the majority of drug injectors to be sexually active, low levels of reported condom use, a significant minority of female injectors to be involved in prostitution, relatively high levels of sexual mixing between drug injectors and noninjectors, and only scant indications of sexual behavior change. Epidemiological studies of risk, however, are unable to yield the data required to understand the interaction between individual risk behavior and social relationships. This is required if obstacles to safer sex compliance and sexual behavior change are to be overcome, and demands recognition of the influence and importance of social context on the production of sexual risk behavior in future research and intervention designs. In response, the paper explores the future role of qualitative research in understanding the social relations of "risk" and in contributing toward theoretical advancements in explanations of risk perception and risk behavior. The paper concludes by discussing the implications of this analysis for developing interventions which aim to target social relationships as agents of social network and community change.

Condoms↗

PubMed1999

Substance use, injury, and risk-taking dispositions in the general population.

Alcohol consumption has been found to be associated with injury occurrence and with risk-taking dispositions, and these dispositions, themselves, have been found to be associated with injury. Few studies have analyzed both alcohol consumption and risk-taking dispositions, or illicit drug use, on risk of injury across all types of injuries. Data on risk perception, risk-taking/impulsivity, sensation seeking, alcohol and drug use, demographic characteristics, and injury in the last year are reported from the 1995 National Alcohol Survey of 4925 respondents living in households in the 48 contiguous states. Moderate drinking, alcohol treatment, drug use, simultaneous use of alcohol and drugs, and risk-taking dispositions were all positively associated with reporting an injury. In multiple logistic regression, only risk-taking dispositions maintained significance when other variables were controlled. In separate regressions by ethnicity, risk-taking dispositions were significant predictors of injury for whites, whereas none of the variables were significant for blacks or Hispanics. Data suggest that risk-taking dispositions may be more important predictors of injury than either drinking or drug use variables, but this may vary by ethnicity. Risk-taking disposition may influence the effectiveness of strategies to reduce alcohol-related injuries; future research is important, therefore, for informing intervention and prevention efforts.

Adolescent↗

PubMed2003

Cluster-randomised trial of risk communication to enhance informed uptake of cervical screening.

BACKGROUND: Women overestimate both population and individual risk of cervical cancer. This may contribute to the recognised excess screening frequency for low-risk women. AIM: To investigate whether an individualized risk communication package could affect stated preferences for screening interval and actual screening behaviour. DESIGN: Pragmatic, practice-based cluster randomised controlled trial. SETTING: Twenty-nine practices (15 intervention, 14 control) in North Wales recruited 1890 women attending for cervical smears. METHOD: A risk communication package containing visual material was compared with normal practice. Practice nurses received training in its delivery. The short-term primary outcome was stated preference for screening interval; the long-term primary outcome was actual screening behaviour. RESULTS: In the short term, intervention arm women were significantly less likely to prefer a shorter than recommended interval (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.41 to 0.64; P < 0.0001). At the five-year follow-up, fewer women in the intervention arm had attended for screening sooner than their recommended recall. The magnitude of difference in excess screening interval preference and behaviour was similar, but behaviour had a wider confidence interval and a marginally non-significant P-value (OR = 0.61, 95% CI = 0.36 to 1.03; P = 0.063). Better knowledge and more accurate risk perceptions were demonstrated, with an improvement in measures of anxiety. The extra cost per woman receiving the intervention was 6 Pounds. CONCLUSIONS: Women's perception of risk contributes to determining screening intervals in addition to practice factors. Simple risk information delivered in primary care affected women's stated preferences for tests. The impact on actual screening behaviour was more equivocal. Overall, the intervention showed a substantial benefit and any disbenefit can be ruled out. This approach to providing risk information could, at low cost, benefit other screening programmes and may relieve anxiety.

Adult↗

PubMed1993

Understanding patients' decisions. Cognitive and emotional perspectives.

OBJECTIVE: To describe ways in which intuitive thought processes and feelings may lead patients to make suboptimal medical decisions. DESIGN: Review of past studies from the psychology literature. RESULTS: Intuitive decision making is often appropriate and results in reasonable choices; in some situations, however, intuitions lead patients to make choices that are not in their best interests. People sometimes treat safety and danger categorically, undervalue the importance of a partial risk reduction, are influenced by the way in which a problem is framed, and inappropriately evaluate an action by its subsequent outcome. These strategies help explain examples where risk perceptions conflict with standard scientific analyses. In the domain of emotions, people tend to consider losses as more significant than the corresponding gains, are imperfect at predicting future preferences, distort their memories of past personal experiences, have difficulty resolving inconsistencies between emotions and rationality, and worry with an intensity disproportionate to the actual danger. In general, such intangible aspects of clinical care have received little attention in the medical literature. CONCLUSION: We suggest that an awareness of how people reason is an important clinical skill that can be promoted by knowledge of selected past studies in psychology.

Comprehension↗

PubMed1994

Environmental hazards in the Chinese public's eyes.

The People's Republic of China suffers each year from various environmental hazards. Although risk perception study has a 40-year history in Europe and North America, little is known about risk perception in China. Previous studies of risk perception have primarily focused on unnatural hazards, but China has experienced many natural environmental hazards. Therefore, the Chinese public's perceptions of environmental hazard risks must be considered in order to support the IDNDR program. The Chinese public's perceptions of environmental hazards are similar to those of Europeans and North Americans, but different characteristics are observed.

Adult↗

PubMed1993

Environmental hazards in the Chinese public's eyes.

Adult↗

PubMed1990

Knowledge-based representations of risk beliefs.

Beliefs about risks associated with two risk agents, AIDS and toxic waste, are modeled using knowledge-based methods and elicited from subjects via interactive computer technology. A concept net is developed to organize subject responses concerning the consequences of the risk agents. It is found that death and adverse personal emotional and sociological consequences are most associated with AIDS. Toxic waste is most associated with environmental problems. These consequence profiles are quite dissimilar, although past work in risk perception would have judged the risk agents as being quite similar. Subjects frequently used causal semantics to represent their beliefs and "% of time" instead of "probability" to represent likelihoods. The news media is the most prevalent source of risk information although experiences of acquaintances appear more credible. The results suggest that "broadly based risk" communication may be ineffective because people differ in their conceptual representation of risk beliefs. In general, the knowledge-based approach to risk perception representation has great potential to increase our understanding of important risk topics.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Experience of parental cancer in childhood is a risk factor for psychological distress during genetic cancer susceptibility testing.

BACKGROUND: This study explores the effect of age at the time of parental cancer diagnosis or death on psychological distress and cancer risk perception in individuals undergoing genetic testing for a specific cancer susceptibility. PATIENTS AND METHODS: Cancer-related distress, worry and risk perception were assessed in 271 applicants for genetic testing of an identified mutation in BRCA1/2 (BReast CAncer) or a HNPCC (Hereditary Nonpolyposis Colorectal Cancer) related gene before, one week after, and six months after genetic test disclosure. The course of distress and risk perception were compared between individuals having witnessed parental cancer or loss due to cancer in childhood, adolescence, adulthood and having unaffected parents. RESULTS: Individuals with parental cancer in childhood (under age 13) reported the highest level of cancer related distress, worry and risk perception. Women having their mother affected by breast cancer in puberty (aged 10-13 years) perceived higher breast cancer risks than women with an affected mother in adulthood or without an affected mother. Individuals with an affected parent perceived cancer risks as higher than individuals without an affected parent, but were not more distressed. CONCLUSIONS: Experience of parental cancer in childhood is a risk factor for psychological distress during the genetic testing process.

Adolescent↗

PubMed2002

[Women's perceptions on risk pregnancy and family implications].

This study aimed to identify the women's perceptions of risk pregnancies and to investigate its implications to the families. The data was collected through a qualitative approach, using semi-structured interviews during the months of March and April of 1999. Five pregnant women were interviewed at the Obstetric Clinic of the University Hospital Júlio Müller in Cuiabá/MT. It was found that the women sometimes experience confused and contradictory feelings, since the "myth of motherhood and maternal love" is still very strong in our society. It was observed that the involvement and support of the family during a risky pregnancy are very important to the pregnant woman.

Family Health↗

PubMed1986

Perception of risk in motor-cyclists.

In a survey of 72 motor-cyclists, their experience of motor-cycle accidents and their perception of future risk were assessed. The results show that they underestimate the chance of having an accident and that their perception of the risks increases following personal contact with the victims of such accidents.

Accidents, Traffic↗

PubMed2002

The media and genetically modified foods: evidence in support of social amplification of risk.

Empirical examinations of the "social amplification of risk" framework are rare, partly because of the difficulties in predicting when conditions likely to result in amplification effects will occur. This means that it is difficult to examine changes in risk perception that are contemporaneous with increases and/or decreases in social or media discussion of the risks associated with a particular risk event. However, the collection of attitude data before, during, and after the increased reporting of the risks of genetically modified food in the United Kingdom (spring 1999) has demonstrated that people's risk perceptions do increase and decrease in line with what might be expected upon examination of the amplification and attenuation mechanisms integral to the framework. Perceptions of benefit, however, appeared to be permanently depressed by negative reporting about genetically modified food. Trust in regulatory institutions with responsibility for protecting the public was not affected. It was concluded that the social amplification of risk framework is a useful framework for beginning to explain the potential impact on risk perceptions of a risk event, particularly if that risk event is presented to the public as a new hazard occurring in a crisis context.

Adolescent↗

PubMed2003

Trust in risky messages: the role of prior attitudes.

Risk perception researchers have observed a "negativity bias" for hazard-related information. Messages indicating the presence of risk seem to be trusted more than messages indicating the absence of risk, and risk perceptions seem more affected by negative than positive information. Two experiments were conducted to examine alternative explanations of this finding within the area of food additives. Study 1 (N = 235) extended earlier work by (a) unconfounding message valence (positive or negative) from message extremity (definite or null finding) and (b) exploring the role of prior attitudes. Results suggested that negative/risky messages were indeed trusted more even when extremity was taken into account. However, prior attitudes significantly moderated the effect of message valence on trust. Positive messages were distrusted only by those with negative prior attitudes. Study 2 (N = 252), further explored the role of prior attitudes and extended the work by examining reactions to risky messages about a positively viewed additive--a vitamin. The results again found a moderating effect of prior attitudes on message valence. Participants had greater confidence in messages that were more congruent with their prior attitudes, irrespective of valence. Furthermore, positive messages had a greater impact on risk perception than negative messages. These findings suggest that greater trust in negative messages about hazards may be a product of a "confirmatory" rather than a "negativity" bias.

Adolescent↗

PubMed2004

Trustworthiness of information about blood donation and transfusion in relation to knowledge and perceptions of risk: an analysis of UK stakeholder groups.

There is evidence that the public perceive blood transfusion as risky, and there is a growing literature exploring factors associated with perceived transfusion risk. One contributory factor might be the types of information different key stakeholders (e.g. general practitioners, anaesthetists, health/life style journalists and blood donors) rely on for information. This article addresses four unanswered questions about transfusion/donation risk, namely (1) do different stakeholder groups perceive different sources of information as more or less trustworthy, (2) to what extent is the perceived trustworthiness related to levels of knowledge and perceived risk, (3) is optimistic bias observed across the stakeholder groups, and (4) is knowledge related to levels of perceived risk across the stakeholder groups? A questionnaire survey was used to assess the trustworthiness of sources of information, perceived risk and knowledge. Four stakeholder groups were examined, namely (1) blood donors (n = 250), (2) general practitioners (n = 88), (3) anaesthetists (n = 143) and (4) medical journalists (n = 20). The results showed that (1) judgements of trustworthiness vary as a function of stakeholder groups, and (2) it is what people think they know rather than what they actually know that is related to judgements of trustworthiness and perceptions of risk. Judgements of trustworthiness are generally unrelated to perceptions of risk, and all stakeholder groups show optimistic bias. The implications of these findings for risk communication, specifically relating to transfusion medicine, are discussed.

Attitude to Health↗

PubMed1999

Population risk, actual risk, perceived risk, and cancer control: a discussion.

Given the difficulty of converting population-based estimates of cancer risk into precise statements of individual risk, it is not surprising that (a) individual differences in risk perception are at best poorly correlated to the best available determination of "actual risk" and to behaviors to prevent and detect and treat cancer, and (b) success in bringing perceived risk into line with actual risk has been limited. These inconsistencies are of concern because individual perceptions of risk are thought to be important motivators of action for the prevention and early detection and treatment of cancer. Following the reviewer's suggestion that risk perceptions are readily influenced by contextual factors, we suggest examining risk perception in a self-regulatory framework in which both risk judgments and motivated action are products of underlying representations of cancer and the self. Self-assessments of risk may access only a part of the data necessary for motivation, whereas motivation to sustain action calls on a larger number of concrete features of the database (symptoms, time loss, consequences). Studies of cancer risk perception can make a major contribution to our understanding of processes involved in self-appraisals and self-management to maximize well-being and to avoid catastrophic disease.

Health Promotion↗

PubMed1998

Lay understanding of synergistic risk: the case of radon and cigarette smoking.

The combination of radon and smoking produces a synergistic risk of lung cancer. Lay understanding of this risk was examined from the perspectives of mental models theory, the psychometric approach to risk perception, and optimistic bias. As assessed by interview, participants (N = 50) had more extensive mental models for the risks of smoking than for the risks of radon or the combination of radon and smoking; 32% knew little or nothing about radon. Despite reading an informational brochure, their risk-perception ratings of the three hazards showed no perception of the synergy between smoking and radon risk, although the combined hazard was rated as less familiar but more controllable than the average of the single hazards (p < .01). No evidence of optimistic bias for the health consequences of radon, or the combination of radon and smoking was observed. Participants appeared to be combining the single-hazard risks subadditively to arrive at their combined-hazard risk perceptions. Further research on the integration of perceived risks would be beneficial for designing optimal communications about synergistic risk.

Adult↗

PubMed2004

Psychological responses to prenatal NTS counseling and the uptake of invasive testing in women of advanced maternal age.

This study examines women's psychological responses to prenatal group genetic counseling, and to subsequent individualized risk counseling. All women (N=123) aged 35 and older underwent nuchal translucency screening (NTS), a prenatal ultrasound screening test. After group counseling, decisional conflict decreased significantly among those reporting at baseline having made a decision about invasive testing (t(222)=2.0, P=0.014) and for those who were uncertain (t(222)=5.74, P <0.0005). After receiving NT-adjusted risks, decisional conflict decreased further for those uncertain about testing at baseline (t(222)=4.64, P <0.0005). There was no change in risk perception and anxiety after group counseling. After NT-adjusted risks were communicated, risk perception decreased significantly (t(230)=5.02, P <0.0005), as did anxiety (t(115)=7.91, P <0.005). Despite reassuring NTS results, the uptake rate for prenatal invasive testing was 78.4%. Risk perception, anxiety, and decisional conflict decreased after individual counseling for reassuring NTS results, but the uptake of invasive testing remained high.

Adult↗

PubMed2005

Dispositional motivations and genetic risk feedback.

This study examined interest in genetic testing for lung cancer susceptibility among college students, a group whose smoking rates have increased significantly in the last decade. Sixteen smokers who participated in focus group discussions indicated a generally high level of interest in testing. They also indicated that knowledge of genetic susceptibility would make them feel anxious and motivate them to quit smoking. The study also examined, in a separate sample of undergraduate smokers (n=186), whether these outcomes depend on personality differences in threat sensitivity-responsiveness of the behavioral inhibition system (BIS)--and reward sensitivity--responsiveness of the behavioral activation system (BAS). Smokers completed measures of personality and risk perceptions at baseline and rated risk perceptions, affect, and likelihood of changing smoking behavior in response to 2 hypothetical risk feedback scenarios (high vs. low risk). Smokers higher in reward sensitivity (reward responsiveness) evidenced greater interest in taking genetic tests. If a test indicated elevated risk smokers higher in reward responsiveness would perceive themselves at increased risk and attempt to quit smoking. Threat sensitive smokers would react with greater negative affect. Overall, results indicate that genetic biomarker feedback is a motivator for college student smokers to quit and would be more effective among smokers high in reward sensitivity.

Adolescent↗