Risk perception and behavioural intentions in a nuclear host community: evidence from Wolsong, South Korea

Background: The current practice of counseling high-risk breast cancer patients using probabilistic risk estimates has not proven to be effective in engaging women, with less than 1% of eligible women participating in medical interventions to reduce breast cancer risk. Further, studies show that racial and ethnic minority women are under-represented in breast cancer prevention clinical trials (Cyrus-David, 2006), and they are less likely than whites to be aware of, discuss, or take chemoprevention agents (Kaplan et al., 2006). This study seeks to describe how a diverse group of women use explanatory models of risk to describe perceptions of breast cancer risk and make decisions about risk-reducing behaviors. Methods: 30 in-depth, qualitative interviews were collected at two US academic hospitals as part of a National Surgical Adjuvant Breast and Bowel Project mixed-methods study to oversample for racial and ethnic minorities. Women identified to have an elevated risk of developing breast cancer were interviewed following risk counseling with a medical provider. A thematic analysis informed by grounded theory methods was conducted. The explanatory model framework (Kleinman, 1978) guided formation of codes around explanatory model topic areas (etiology, symptoms, pathophysiology, course of illness, and treatment). These explanatory model codes were supplemented with inductive codes developed through open coding related to beliefs about cancer, risk, health, and social context. Results: Two key themes were identified as closely linked to women's explanatory models of risk: ‘risk perception’ and ‘control over risk’. These perceptions of risk and control were used to identify patterns in how women chose to manage their risk for breast cancer. Whether women had high or low perceptions of risk and control affected the ways in which they used explanatory models to describe their decisions. For example, women with perceptions of high risk and high control all discussed their social network as influential in modeling how they could reduce their own risk. These women adopted a variety of behaviors to gain control over risk, ranging from diet and exercise changes to the use of chemoprevention agents. Conversely, women with perceptions of high risk and low control based decisions much more closely on their general explanatory models of health, falling back on established philosophies in their decision-making. Women who opted for chemoprevention agents in this group discussed their philosophy of decision making as dependent on physician recommendations. How women interpreted ‘symptoms’ of risk was also essential to women's descriptions of their participation in risk-reduction behaviors. Those women who perceived their risk to be high interpreted symptoms such as ADH, ALH, or LCIS as a disease that required medical intervention. On the other hand, women with perceptions of low risk interpreted these symptoms as in the normal course of bodily changes, contrasting with information provided by physicians suggesting an increased risk for breast cancer. Discussion: There are important differences in how women use explanatory models of risk that contribute to the adoption of medical interventions. Risk counseling must address patient explanatory models, which influence both perceptions of risk and control over risk. These perceptions subsequently influence the ways in which women describe their decisions about participating in risk-reducing behaviors. New approaches are needed to address patient beliefs and perceptions about risk and prevention for breast cancer. Failing to acknowledge the experiences of patients threatens to marginalize minority groups from preventive care. Citation Format: Christine M. Gunn, Barbara Bokhour, Tracy A. Battaglia, Sarah Blakeslee, Christine Holmberg. Explanatory models of risk: The role of social context in breast cancer risk perception and decision making. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B68.

A high perception of risk may exert a preventive effect against the initiation of risky activities. The aims of the present study were (1) to analyze the risk perception for traumatic incidents according to drug intake (alcohol, cannabis, cocaine, no consumption) by trauma patients admitted to our hospital, and (2) to explore the influence of drugs on trauma recidivism. Between 1 November 2011 and 1 April 2012, 404 patients aged between 16 and 70years were admitted to our hospital for trauma cases. In 363 (89.9%) of the patients, data were gathered on age, the trauma mechanism, and the consumption of alcohol and other drugs. Out of these 363 patients, 286 (78.8%) attended a motivational interview and reported their consumption habits and their perception of the risk of trauma after alcohol and/or illegal drug consumption, as well as the antecedents of previous traumatisms. Alcohol and/or illegal drugs were detected in 37% of the sample, with alcohol being the most frequently detected, followed by cannabis, cocaine, and other drugs. Among the trauma patients with no consumption, a high perception of trauma risk was associated with alcohol intake by 95.9%, with cannabis consumption by 68.4%, and with cocaine consumption by 53.4%, whereas these percentages were significantly lower for patients testing positive for substances (79.3, 21.1, and 8.3% respectively). Among the patients experiencing their first trauma, the mean age was almost 15years younger in those who were positive for these substances than in those who were negative (p<0.001). Finally, a history of previous trauma was reported by a majority (64%) of the trauma patients testing positive for alcohol and/or drugs, but by a minority (36%) of those testing negative (p<0.001). The low perception of risk associated with alcohol, cannabis, or cocaine consumption by trauma patients under the influence of these substances on admission may be a predisposing factor for recidivism. Recommendations for both primary and secondary prevention are presented.

The Perception of Cancer Risk in Patients With Prevalent Barrett’s Esophagus Enrolled in an Endoscopic Surveillance Program

Vaccination has become the primary means for citizens to prevent severe morbidity and mortality during the pandemic. However, vaccine hesitancy poses a major threat to global public health security. Based on the data from Chinese General Social Survey in 2021, this study aims to explore the socio-political aspects of COVID-19 vaccine hesitancy, focusing on the relationship between COVID-19 risk perceptions, institutional trust and vaccine hesitancy. Among the samples, 39.8% of the respondents exhibited COVID-19 vaccine hesitancy, 48.9% had a high awareness of the risk of COVID-19, and 74.6% presented a high level of trust in institutions. The results showed that higher risk perception and institutional trust are negatively correlated with vaccine hesitancy (p < .001). Institutional trust had no statistically significant moderating effect on the association between risk perception and vaccine hesitancy, but the role of institutional trust in influencing vaccine hesitancy is more significant at a lower level of perceptions of COVID-19 risk. Furthermore, regional variations in the factors contributing to vaccine hesitancy were demonstrated in China. These findings have important implications for developing strategies to address vaccine hesitancy.

This study investigated the relation between physiological markers associated with exercise (measured and self-reported) and self-reported risk perception (RP) among hikers in extremely hot environments. Participants (n=340, 43% female, 40.1±12.9 years) were recruited at hiking trails during two hot and dry summers in Phoenix, Arizona, USA. Participants completed an onsite exit questionnaire, and a subsample participated in physiological testing. Outcomes were stratified for participants with a high and low RP. Self-reported heat stress (3.0, IQR: 3.0–5.3 vs. 3.0, IQR: 2.0–4.0, p=0.001) and thirst (38.0, IQR: 23.0–52.0 vs. 31.0, IQR: 19.0-47.8, p=0.039) were significantly higher in hikers with high RP vs. low RP scores, respectively. However, perceived exertion (6.0, IQR: 6.0–12.0), body temperature (35.3℃, IQR: 34.2–35.0), urine specific gravity (1.021, IQR: 1.015–1.026), and fitness level (48.6, IQR: 41.9–56.7), were not associated with RP scores (p≥0.100). Most participants considered ambient temperature and hike duration when planning fluid intake, however, although the high-risk group reported these safety behaviors more frequently, no group difference was seen in hydration status, amount of fluid carried (1000 mL, IQR: 500–1999), or fluid consumed (591 mL, IQR: 355–1000). In conclusion, RP may influence how individuals anticipate and respond to environmental challenges, such as reporting more heat stress and thirst in those with a high RP. Greater awareness regarding a heat safety campaign and precautionary behaviors were seen in high RP, but this did not translate into measurable differences in other physiological outcomes or actual hydration practices.

Purpose The purpose of this paper is to investigate whether the numeric representation of a relatively low risk in terms of a ratio versus a percentage affects risk perception. Design/methodology/approach We propose a conceptual framework that explains the differential effects of ratio and percentage formats on risk perceptions and purchase intentions. We investigate the process driving the differential effects, and delineate boundary conditions. We experimentally show that a ratio representation is more concrete than a percentage, engendering more pronounced mental imagery, higher negative affect and risk perceptions and lower purchase intentions. Findings The extent to which individuals can imagine themselves in the risk situation is higher when the risk is described as a ratio compared to an equivalent percentage, inducing greater negative affect, and higher risk perceptions. Further, individuals’ construal level moderates the effect of frequency format on risk perceptions. Finally, they show that impairing individuals’ spontaneous process of imagining the risk by encouraging a more “rational” processing of the risk information attenuates the effects of frequency format. Research limitations/implications They examine how the numeric representation of relatively low risks in terms of a ratio versus a percentage affects risk perceptions. Practical implications They outline strategies that could be used to affect risk perceptions, and product purchase decisions and related behaviors. Social implications Communicating risk in a manner to encourage individuals to take preventive measures is better achieved with frequency information presented as a ratio versus a percentage. Originality/value They propose a comprehensive framework that explains the differential effect of frequency format on risk perceptions. They experimentally demonstrate that a ratio representation is more concrete than a percentage, engendering more pronounced mental imagery, higher negative affect and risk perceptions.

Fatal opioid overdoses in the United States have rapidly increased since 1999. While several risk factors for overdose are known, the association of overdose risk perception with subsequent overdose is not well understood. We used data from a randomized trial of a counseling intervention to reduce opioid overdose among overdose survivors who use nonprescribed opioids. Participants were followed up for 16 months with visits every 4 months. At study visits participants were asked how likely they were to overdose in the next 4 months (risk perception) and whether they had overdosed since their last visit. Responses of "extremely likely" or "likely" were considered "higher risk perception," and those of "neutral," "unlikely," and "extremely unlikely" were considered "lower risk perception." We conducted an adjusted generalized estimating equation among participants in the control group to examine the association of higher versus lower risk perception and subsequent overdose. We adjusted for visit, recent overdose, and sociodemographic characteristics that were selected a priori due to known associations with risk perception or opioid overdose. Among 135 control participants, median age was 42 years (interquartile range: 34-49) and over half were male (59%). Higher risk perception was associated with 2.65 times the adjusted odds of having a subsequent overdose compared with lower risk perception (95% confidence interval: 1.35-5.23, P = <.01). Incorporating an assessment of risk perception into opioid overdose prevention efforts may help prioritize prevention efforts.

Between 20% and 50% of Asian American women report experiencing partner violence (PV). Furthermore, nearly half of PV victims experience their first assault between the age of 18 and 24 years, suggesting that Asian American college women may be particularly at risk of PV. Experiencing childhood abuse (CA) may impair women's capacity to perceive risk during a potential PV situation, increasing their risk for revictimization. The purpose of the current study was to examine differences among Asian American college women's (N = 324) in-the-moment behavioral intention, risk perception, and likelihood to stay in an abusive relationship during a progressively threatening PV scenario, based on victimization history and posttraumatic stress disorder (PTSD) symptoms. We tested three path models, each assessing the relations among CA, PV, PTSD, current and future risk perception, likelihood of staying in the relationship, and one of three behavioral intentions (soothe the perpetrator, escape, and escalation/resistance). As hypothesized, CA history positively predicted PV history and PTSD symptoms. Furthermore, CA and PV predicted more in-the-moment soothe behavioral intentions and fewer escape behavioral intentions which, in turn, predicted diminished current and future risk perception. CA and PV also predicted stronger escalation/resistance behavioral intentions, such that escalation/resistance intentions were associated with higher risk perception during a more violent part of the scenario but lower risk perception during a less violent part of the scenario. Finally, higher risk perception predicted lower likelihood of staying in the relationship. Findings indicate that victimization history is associated with increased risky behavioral intentions among Asian American college women and suggest that targeted interventions to improve assault-exposed Asian American women's awareness of risk cues may be warranted.

CITATION; Evans, D., et al. 2018. Knowledge, risk perception and access to healthcare services for HIV and tuberculosis among university students in Johannesburg, South Africa. South African Journal of Child Health, 12(2):S19-S31, doi:10.7196/SAJCH.2018.v12i2b.1525.

Flood risk perception and communication: The role of hazard proximity

The Perception of Cancer Risk in Patients With Prevalent Barrett’s Esophagus Enrolled in an Endoscopic Surveillance Program

BackgroundIn many parts of the world, including in China, extreme heat events or heat waves are likely to increase in intensity, frequency, and duration in light of climate change in the next decades. Risk perception and adaptation behaviors are two important components in reducing the health impacts of heat waves, but little is known about their relationships in China. This study aimed to examine the associations between risk perception to heat waves, adaptation behaviors, and heatstroke among the public in Guangdong province, China.MethodsA total of 2,183 adult participants were selected using a four-stage sampling method in Guangdong province. From September to November of 2010 each subject was interviewed at home by a well-trained investigator using a structured questionnaire. The information collected included socio-demographic characteristics, risk perception and spontaneous adaptation behaviors during heat wave periods, and heatstroke experience in the last year. Chi-square tests and unconditional logistic regression models were employed to analyze the data.ResultsThis study found that 14.8%, 65.3% and 19.9% of participants perceived heat waves as a low, moderate or high health risk, respectively. About 99.1% participants employed at least one spontaneous adaptation behavior, and 26.2%, 51.2% and 22.6% respondents employed <4, 4–7, and >7 adaptation behaviors during heat waves, respectively. Individuals with moderate (OR=2.93, 95% CI: 1.38-6.22) or high (OR=10.58, 95% CI: 4.74-23.63) risk perception experienced more heatstroke in the past year than others. Drinking more water and wearing light clothes in urban areas, while decreasing activity as well as wearing light clothes in rural areas were negatively associated with heatstroke. Individuals with high risk perception and employing <4 adaptation behaviors during heat waves had the highest risks of heatstroke (OR=47.46, 95% CI: 12.82-175.73).ConclusionsThere is a large room for improving health risk perception and adaptation capacity to heat waves among the public of Guangdong province. People with higher risk perception and fewer adaptation behaviors during heat waves may be more vulnerable to heat waves.

Public health and social measures (PHSM) are critical aspects of limiting the spread of infections in pandemics. Compliance with PHSM depends on a wide range of factors, including behavioral determinants such as emotional response, trust in institutions or risk perceptions. This study examines self-reported compliance with PHSM during the COVID-19 pandemic in the Federation of Bosnia and Herzegovina (FBIH). We analyze the association between compliance and behavioral determinants, using data from five cross-sectional surveys that were conducted between June 2020 and August 2021 in FBIH. Quota-based sampling ensured that the 1000 people per wave were population representative regarding age, sex, and education level based on the data from the latest census in Bosnia and Herzegovina. One-way analysis of variance (ANOVA) was used to identify significant changes between studies on determinants and PHSM measures. Regression was used to find relations between behavioral determinants and PHSM. Participants reported strong emotional responses to the rapid spread of the virus and its proximity to them. Risk perception was spiking in December 2020 when rates of infection and death were particularly high. Trends in policy acceptance were divergent; participants did not rate PHSM as exaggerated, but perceived fairness was low. Trust in institutions was low across all waves and declined for specific institutions such as the health ministry. In five wave-specific regression analyses, emotional response (βmin/max = .11*/.21*), risk perception (βmin/max = .06/.18*), policy acceptance (βmin/max = .09/.20*), and trust in institutions (βmin/max = .06/.21*) emerged as significant predictors of PHSM. This study contributes to the body of research on factors influencing compliance with PHSM. It emphasizes the importance of behavioral monitoring through repeated surveys to understand and improve compliance. The study also affirms the impact of public trust on compliance, the risk of eroding compliance over time, and the need for health literacy support to help reinforce protective behaviors.

Could smog pollution lead to the migration of local skilled workers? Evidence from the Jing-Jin-Ji region in China

This study presents an analysis of risk and resilience perceptions in two villages of Far West Nepal, Sunkuda and Bajedi, located in the upper Karnali River Basin. The area has been affected by deep-seated and shallow landslides, which have had a devastating impact on many rural lives and livelihoods. While both villages are exposed to landslides, Bajedi is situated in a higher risk zone. Using structured surveys, semi-structured interviews and insights from stakeholder workshops, the risk and resilience perceptions of household residents of the two villages are elicited. The objectives of the study are 1) to understand how residents perceive their risk and resilience to landslides, and 2) to provide evidence and insights on the factors that influence risk perception. Results show that landslides are perceived as an existential risk in both villages, although risks are perceived as more serious in Bajedi. The higher risk perception in Bajedi is shown to be mainly driven by households’ ability to cope, including their energy sources, whether they know whom to call in case of a landslides, as well as household savings and income sources. In Sunkuda, risk perception is shown to be influenced by households’ access to and status of community forests, expenditure on medication, the seasonality and types of water sources, and ethnicity. In both villages, additional drivers of risk perception include households’ social networks, their perceived triggers of landslides, their outstanding loans, and who collects the water. The results demonstrate the interconnectedness of risk perception and indicators of resilience. By elucidating the risk perception of Sunkuda and Bajedi, this study has important implications for local risk management strategies and policies.