Risk perceptions: assessment and relationship to influenza vaccination.

OBJECTIVE: Accurate measurement of beliefs about risk probability is essential to determine what role these beliefs have in health behavior. This study investigated the ability of several types of risk perception measures and of other constructs from health behavior theories to predict influenza vaccination. DESIGN: Prospective study in which students, faculty, and staff at 3 universities (N = 428) were interviewed in the fall, before influenza vaccine was available, and again early in the next calendar year. MAIN OUTCOME MEASURE: Self-reported influenza vaccination. RESULTS: Two interview questions that asked about feeling at risk and feeling vulnerable predicted subsequent behavior better (r = .44, p = .001) than 2 questions that asked for agreement or disagreement with statements about risk probability (r = .25, p = .001) or 4 questions that asked respondents to estimate the magnitude of the risk probability (r = .30, p = .001). Of the 4 perceived risk magnitude scales, a 7-point verbal scale was the best predictor of behavior. Anticipated regret was the strongest predictor of vaccination (r = .45, p = .001) of all constructs studied, including risk perceptions, worry, and perceived vaccine effectiveness. CONCLUSION: Risk perceptions predicted subsequent vaccination. However, perceived risk phrased in terms of feelings rather than as a purely cognitive probability judgment predicted better. Because neither feeling at risk nor anticipated regret is represented in the most commonly used theories of health behavior, the data suggest that these theories are missing important constructs.     

The role of risk perception in explaining parental sunscreen use

Objective: This study assessed: (1) whether risk perceptions about skin cancer were related to parent's use of sunscreen on their children; (2) which combination of assessments susceptibility and severity best explain parental sunscreen protection behaviours and (3) whether risk perceptions influence behaviour directly through intentions or through attitudes, subjective norms and self-efficacy. Design: Two longitudinal studies assessed sunscreen protection behaviours of parents for their toddlers (N?=?391) and young children (N?=?436). Main outcome measure: Parent's use of sunscreen on their children. Results: Risk perceptions correlated with future sunscreen protection behaviours of parents but were lower than those of attitude, social influence and self-efficacy. Treating susceptibility and severity as an additive function resulted in the best model fit. Risk perceptions were related with future intention and future sunscreen protection behaviour, but the effects were mediated through attitude, social influence and self-efficacy. Conclusions: Our path analyses suggest treating susceptibility and severity as an additive function. A multiplicative model without main effects - although often used - had the poorest fit. Risk perceptions influence behaviour by influencing attitudinal and self-efficacy beliefs. Addressing risk perceptions in health communication programs is relevant when the purpose is to increase awareness and to influence attitudes and self-efficacy.     

Comparative optimism for severity of negative health outcomes

People tend to be comparatively optimistic (i.e., believe that negative outcomes are less likely for themselves than for typical others) regarding their susceptibility to negative health outcomes. The present study investigates the extent to which perceptions of the severity of these health outcomes show similar comparative optimism. A student sample (study 1; N = 200) and a healthy non-student adult sample (study 2; N = 257) completed self-report measures of susceptibility, severity, worry, control and experience in relation to negative health outcomes. Participants in both studies demonstrated significant levels of comparative optimism for both perceived likelihood and severity of health outcomes. Comparative optimism concerning severity was very strongly associated (r = 0.85 to 0.89) with comparative optimism concerning susceptibility. In addition to being comparatively optimistic over their chances of experiencing negative health outcomes, people are also comparatively optimistic regarding how severe the health outcomes will be.     

The role of risk perception in explaining parental sunscreen use

Objective: This study assessed: (1) whether risk perceptions about skin cancer were related to parent's use of sunscreen on their children; (2) which combination of assessments susceptibility and severity best explain parental sunscreen protection behaviours and (3) whether risk perceptions influence behaviour directly through intentions or through attitudes, subjective norms and self-efficacy.

Design: Two longitudinal studies assessed sunscreen protection behaviours of parents for their toddlers (N?=?391) and young children (N?=?436).

Main outcome measure: Parent's use of sunscreen on their children.

Results: Risk perceptions correlated with future sunscreen protection behaviours of parents but were lower than those of attitude, social influence and self-efficacy. Treating susceptibility and severity as an additive function resulted in the best model fit. Risk perceptions were related with future intention and future sunscreen protection behaviour, but the effects were mediated through attitude, social influence and self-efficacy.

Conclusions: Our path analyses suggest treating susceptibility and severity as an additive function. A multiplicative model without main effects – although often used – had the poorest fit. Risk perceptions influence behaviour by influencing attitudinal and self-efficacy beliefs. Addressing risk perceptions in health communication programs is relevant when the purpose is to increase awareness and to influence attitudes and self-efficacy.     

Predictors of perceived susceptibility of breast cancer and changes over time: a mixed modeling approach

OBJECTIVE: To examine predictors of perceived susceptibility to breast cancer and assess differences across three dependent measures. DESIGN: Annual surveys were completed by US women veterans (N = 3,758) participating in a repeat mammography intervention trial. Multivariable non-linear mixed model analyses examined individual- and group-level changes in perceived susceptibility to breast cancer. DEPENDENT MEASURES: Three single-item measures of perceived susceptibility to breast cancer (percent risk, ordinal risk, and comparative risk likelihood). Predictors included demographic, health status, health behavior, affect, knowledge, and subjective norm variables. RESULTS: Breast symptoms and greater cancer worry increased perceived susceptibility for all three measures. Other predictors varied by dependent measure. Random change, indicating individual variability, was observed for percent risk only. CONCLUSION: Despite small model effect sizes, breast symptoms and cancer worry were consistent predictors and may be good targets for messages designed to influence women's perceived susceptibility to breast cancer. Researchers may benefit from using measures of perceived susceptibility with larger response scales, but additional measurement research is needed. Combining indicators of perceived susceptibility may be undesirable when different predictors are associated with different measures.     

Risk taking from the participant's perspective: the case of driving and accident risk.

Although perceived health risk plays a prominent role in theories of health behavior, its empirical role in risk taking is less clear. In Study 1 (N = 129), 2 measures of drivers' risk-taking behavior were found to be unrelated to self-estimates of accident concern but to be related to self-ratings of driving skill and the perceived thrill of driving. In Study 2 (N = 405), out of a wide range of potential influences, accident concern had the weakest relationship with risk taking. The authors concluded that although health risk is a key feature in many theories of health behavior and a central focus for researchers and policy makers, it may not be such a prominent factor for those actually taking the risk.     

Persuasive communications to change actions: an analysis of behavioral and cognitive impact in HIV prevention.

This meta-analysis examined the validity of various theoretical assumptions about cognitive and behavioral change following a communication recommending condom use. The synthesis comprised 82 treatment and 29 control groups included in 46 longitudinal reports with measures of perceived severity and susceptibility, attitudes and expectancies, norms, perceptions of control, intentions, knowledge, behavioral skills, or condom use. Results indicated that across the sample of studies, communications taught recipients about facts related to HIV and also induced favorable attitudes and expectancies, greater control perceptions, and stronger intentions to use condoms in the future. Moreover, messages that presented attitudinal information and modeled behavioral skills led to increased condom use. Results are discussed in the context of theories of human behavior and change and in reference to HIV-prevention interventions.     

Illness risk representations and motivations to engage in protective behavior: The case of skin cancer risk

This study evaluates the contents of representations of skin cancer risk and their associations with risk appraisals, worry, and protection intentions and behaviors. The Assessment of Illness Risk Representations (AIRR) was used to measure conceptual and imagery contents of risk representations, as delineated by the Common-Sense Model. University students (N?=?120) completed the AIRR; measures of likelihood and severity appraisals, and worry; and measures of skin self-examination, clinical skin examination, and sun protection intentions and behaviors. Beliefs about identity, causal, and timeline risk were positively associated with likelihood appraisals, whereas consequences and timeline risk beliefs were positively associated with severity appraisals. Identity and timeline risk independently predicted worry. Representational attributes, including imagery vividness and valence, independently predicted intentions and behaviors, whereas likelihood and severity appraisals did not. Symptom imagery interacted with worry to predict detection and prevention intentions: worry predicted greater intentions for participants with symptom imagery but not for those without symptom imagery. The findings support the utility of the AIRR for assessing risk representations and identify ways in which risk representations may guide protective behavior.     

The influence of self‐efficacy,subjective norms,and risk perception on behavioral intentions related to the H1N1 flu pandemic: A comparison between Korea and the US

This study examined the extent to which individualism‐collectivism moderates the relative effects of agency control beliefs (i.e., self‐efficacy), social norms (i.e., subjective norms), and risk perception (perceived vulnerability and perceived severity) on behavioral intention to engage in self‐protection behavior in the context of the H1N1 flu pandemic. Using multistage stratified sampling, the present study sampled people from the US (n = 399) and Korea (n = 500), two countries that have been found to be prototypical of individualistic and collectivistic national cultures, respectively. Consistent with the contrast between individualism and collectivism, the results of moderated regression analyses showed that intrapersonal control beliefs (i.e., self‐efficacy) and risk perception (i.e., perceived severity) had stronger effects on behavioral intention in the American sample than in the Korean sample, whereas social norms (i.e., subjective norms) had a stronger predictive power for the Korean sample than for the American sample. Overall, the findings contribute to health and risk studies by specifying which aspects of risk perceptions or beliefs are affected by national culture and how this translates into cross‐national variations in health risk behavioral intention.     

Why it won't happen to me: perceptions of risk factors and susceptibility

Four studies were conducted with college student subjects to examine: (1) perceptions of susceptibility to health and safety risks; (2) factors that subjects see as important in determining their susceptibility; and (3) subjects' actual standing on objective risk factors. Subjects were generally unbiased about hereditary risk factors and were even somewhat pessimistic about environmental risk factors. Their views of their own actions and psychological attributes, however, were excessively optimistic. Few acknowledged actions or psychological attributes that increased their risk. This pattern of findings helps to explain why risks thought to be controllable (i.e., preventable by personal action) are likely to evoke unrealistic optimism about susceptibility. Family histories of health problems were incorporated into judgments of susceptibility, but, except for smoking, correlations between behavioral risk factors and judgments of susceptibility were surprisingly weak. Self-esteem enhancement is suggested as a motive that could explain many of the present findings. Several recommendations are offered for health campaigns that seek to produce more realistic perceptions of susceptibility to health and safety problems.     

Using the common-sense model to predict risk perception and disease-related worry in individuals at increased risk for venous thrombosis.

OBJECTIVE: This study applied the Common-Sense Model (CSM) to predict risk perception and disease-related worry in 174 individuals with a genetic predisposition to venous thrombosis (thrombophilia). DESIGN: Participants completed an adapted version of the Illness Perception Questionnaire-Revised (IPQ-R) and measures assessing risk perception and worry. RESULTS: Regression analyses revealed that illness perceptions were predictors of risk perception and thrombosis worry. The hypothesis that illness perceptions mediate the relationship between a person's experience of venous thrombosis and perceived risk and thrombosis worry could not be confirmed. CONCLUSIONS: Further research should refine the IPQ-R for populations at risk of a disease and examine the value of the CSM in explaining the relationship between risk perception, worry, and health behavior.     

Perceived susceptibility and self-protective behavior: a field experiment to encourage home radon testing

Tested in a field experiment (N = 647) the hypothesis that perceptions of personal susceptibility are important in decisions to test one's home for radioactive radon gas. Experimental group subjects received a personal telephone call to tell them they lived in a high-risk area and a personal letter to reinforce the telephone message. After the intervention, experimental subjects were significantly more likely than minimal-treatment subjects to acknowledge the possibility of high radon levels in their homes. Perceptions of susceptibility and illness severity were significantly correlated with orders of radon test kits and with testing intentions. Nevertheless, there were no differences between groups in test orders or intentions. Results are discussed in terms of the difficulty of getting people to acknowledge susceptibility and the factors other than risk perceptions that influence self-protective behavior.     

Explaining contradictory relations between risk perception and risk taking

Different studies have documented opposite relations between perceived risk and behavior. The present study tested a theoretical explanation that reconciles these conflicting results. Adolescents (N= 596) completed alternative measures of risk perception that differed in cue specificity and response format. As predicted by fuzzy-trace theory, measures that emphasized verbatim retrieval and quantitative processing produced positive correlations between perceived risk and risky behavior; risk perceptions reflected the extent to which adolescents engaged in risky behavior. In contrast, measures that assessed global, gist-based judgments of risk produced negative correlations; higher risk perceptions were associated with less risk taking, a protective rather than reflective relation. Endorsement of simple values and principles provided the greatest protection against risk taking. Results support a dual-processes interpretation of the relation between risk perception and risk taking according to which observed relations depend on whether the cues in questions trigger verbatim or gist processing.     

Human papillomavirus vaccination intentions and uptake in college women

Objective: Using the health belief model (HBM) and theory of planned behavior (TPB) as theoretical frameworks, the objectives of this study were: (a) to identify correlates of human papillomavirus (HPV) vaccination intentions and (b) to explore differences between correlates of HPV vaccination intentions and uptake. Methods: Undergraduate women (N = 447) who did not intend to receive (n = 223), intended to receive (n = 102), or had received (n = 122) the HPV vaccine were surveyed. Logistic regressions were conducted to examine the correlates of vaccination intentions and uptake. Results: Negative health consequences of the vaccine, physician's recommendation, positive attitudes toward the vaccine, and subjective norms were significant correlates of vaccination intentions. When comparing correlates of vaccination intentions to correlates of vaccination uptake, physician's recommendation, subjective norms, and perceived susceptibility to HPV were unique correlates of uptake. Conclusion: Differences between correlates of vaccination intentions and uptake suggest that social influences of liked and trusted individuals may make an important and unique contribution in motivating young women to receive the HPV vaccine beyond other variables from the HBM and TPB. Future utilization of longitudinal designs is needed to understand which factors may cause individuals to decide to receive the HPV vaccine. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The Use of Risk and Need Factors in Forensic Mental Health Decision-Making and the Role of Gender and Index Offense Severity

Canadian legislation makes Review Boards (RBs) responsible for rendering dispositions for individuals found Not Criminally Responsible on account of Mental Disorder (NCRMD) after considering public safety, the mental condition of the accused, and his/her potential for community reintegration. We reviewed 6,743 RB hearings for 1,794 individuals found NCRMD in the three largest Canadian provinces to investigate whether items from two empirically supported risk assessment measures, the Historical Clinical Risk Management-20 and the Violence Risk Appraisal Guide, were considered. Less than half the items were included in expert reports or in RBs' reasons for dispositions, and consideration of these items differed according to gender and index offense severity of the accused. These items included evidence-based risk factors and/or legally specified criteria: mental health, treatment, and criminal history. These results illustrate the gap between research on risk factors and the integration of this evidence into practice. In particular, we recommend the implementation of structured measures to reduce the potential for clinicians to be unduly influenced by gender and offense severity. Copyright © 2015 John Wiley & Sons, Ltd.     

Dimensions of impulsivity and aggression associated with suicide attempts among bipolar patients: a preliminary study

Impulsivity and hostility are often thought to be interrelated among depressed patients with suicidal behavior, but few studies have examined this relationship empirically. In this study, we assessed trait impulsivity and hostility among 52 DSM-IV bipolar subjects with and without histories of suicide attempts. Impulsivity and hostility were correlated among attempters (r = .41, p = .03) but not non-attempters (r = .22, p = .28). As compared to non-attempters, attempters had significantly higher levels of overall hostility, more extensive subcomponents of hostility, and a trend toward higher overall impulsivity. Associations between lifetime suicide attempts and overall hostility were significant while controlling for current depression severity and lifetime illness duration. Aggression and impulsivity appear linked among bipolar patients with lifetime suicide attempts but may be independent constructs among non-attempters. The presence of both factors may elevate risk for suicidal behavior.     

Planning and Self-Efficacy in the Adoption and Maintenance of Breast Self-Examination: A Longitudinal Study on Self-Regulatory Cognitions

Many women may be reluctant to perform breast self-examination (B.S.E.) regularly due to motivational or self-regulatory deficits. The Health Action Process Approach (Schwarzer, R. (1992). Self-efficacy in the adoption and maintenance of health behaviors: theoretical approaches and a new model. In: Schwarzer, R. (Ed.), Self-efficacy: Thought Control of Action , pp. 217-243. Hemisphere, Washington DC; Schwarzer, R. (2001). Social-cognitive factors in changing health-related behavior. Current Directions in Psychological Science , 10 , 47-51.), a health behavior change model that advocates the separation of motivation and action phases, such as goal setting and goal pursuit, was applied to data from 418 young women whose risk perceptions, outcome expectancies, self-efficacy, intention to perform B.S.E., planning, and reported examination behaviors were examined at two points in time. Risk perception was found to have a negligible influence in a path analysis, whereas self-efficacy emerged as the best predictor of intention and planning. Planning, in turn, appeared to be the best predictor of B.S.E. behaviors, followed by self-efficacy. The results point to the influential role that self-regulatory strategies (such as planning) play in translating goals into action. The study contributes to the current debate on stage theories of health behavior change and the orchestration of self-beliefs and strategies in the context of goal-directed behaviors.     

Perceptions of risk in intimacy and social participation

The present study examined the relations between individuals' social lives and the risks they perceived in being intimate with others. Participants maintained a variant of the Rochester Interaction Record (Wheeler & Nezlek, 1977) and completed the Risk in Intimacy Inventory (Pilkington & Richardson, 1988). The results indicated that, compared to people who perceived less risk, people who perceived more risk in intimacy had less rewarding social lives on measures of socio-emotional and socio-instrumental dimensions of interaction. Risk in intimacy concerns were particularly salient for women in their interactions with the opposite sex and for men in their interactions with the same sex. In addition, the statistical associations between perceptions of risk in intimacy and characteristics of interactions within close opposite-sex personal relationships varied as a function of participants' sex and the nature of this personal relationship.     

Children's antisocial behavior, mental health, drug use, and educational performance after parental incarceration: a systematic review and meta-analysis

Unprecedented numbers of children experience parental incarceration worldwide. Families and children of prisoners can experience multiple difficulties after parental incarceration, including traumatic separation, loneliness, stigma, confused explanations to children, unstable childcare arrangements, strained parenting, reduced income, and home, school, and neighborhood moves. Children of incarcerated parents often have multiple, stressful life events before parental incarceration. Theoretically, children with incarcerated parents may be at risk for a range of adverse behavioral outcomes. A systematic review was conducted to synthesize empirical evidence on associations between parental incarceration and children's later antisocial behavior, mental health problems, drug use, and educational performance. Results from 40 studies (including 7,374 children with incarcerated parents and 37,325 comparison children in 50 samples) were pooled in a meta-analysis. The most rigorous studies showed that parental incarceration is associated with higher risk for children's antisocial behavior, but not for mental health problems, drug use, or poor educational performance. Studies that controlled for parental criminality or children's antisocial behavior before parental incarceration had a pooled effect size of OR = 1.4 (p < .01), corresponding to about 10% increased risk for antisocial behavior among children with incarcerated parents, compared with peers. Effect sizes did not decrease with number of covariates controlled. However, the methodological quality of many studies was poor. More rigorous tests of the causal effects of parental incarceration are needed, using randomized designs and prospective longitudinal studies. Criminal justice reforms and national support systems might be needed to prevent harmful consequences of parental incarceration for children.