Improve Risk Communication Research Articles

Relationship Between Long-term Flooding and Serious Mental Illness After the 2011 Flood in Thailand.

The present study aimed to evaluate the long-term psychological effects of the 2011 flood in Thailand on flood victims and unaffected residents, taking into account risk factors such as floodwater levels in the house, period of flooding, and disruption to essential services. Surveys were conducted in Salaya and Nakhon Chaisri subdistrict, Nakhonpatom Province, from May to June 2012. Approximately 400 households were selected. Measures of sociodemographic variables, exposure to flooding, incidents (eg, disruption of services), and outcome variables (Kessler 10) were recorded. A total of 407 respondents completed the survey. The results of the univariate analysis showed that possible serious mental illness was approximately 1.5 times higher in flood victims than in unaffected respondents. After adjustment for potential confounding factors, significant associations were found for disruption of essential services and hypertension or diabetes with possible serious mental illness. Disruption of essential services and chronic illness may affect psychological distress among flood victims. Public health agencies should develop and evaluate strategies to improve risk communication and psychological support for flood victims. (Disaster Med Public Health Preparedness. 2017;11:300-304).

Hypertension, Obesity, Diabetes, and Heart Failure–Free Survival: The Cardiovascular Disease Lifetime Risk Pooling Project

ObjectivesThis study was designed to quantify the relationship between the absence of heart failure risk factors in middle age and incident heart failure, heart failure-free survival, and overall survival. BackgroundQuantification of years lived free from heart failure in the context of risk factor burden in mid-life may improve risk communication and prevention efforts. MethodsWe conducted a pooled, individual-level analysis sampling from communities across the United States as part of 4 cohort studies: the Framingham Heart, Framingham Offspring, Chicago Heart Association Detection Project in Industry, and ARIC (Atherosclerosis Risk In Communities) studies. Participants with and without hypertension (blood pressure ≥140/90 mm Hg or treatment), obesity (body mass index ≥30 kg/m2), or diabetes (fasting glucose ≥126 mg/dl or treatment), and combinations of these factors, at index ages of 45 years and 55 years through 95 years. Competing risk-adjusted Cox models, a modified Kaplan-Meier estimator, and Irwin’s restricted mean were used to estimate the association between the absence of risk factors at mid-life and incident heart failure, heart failure-free survival, and overall survival. ResultsFor participants at age 45 years, over 516,537 person-years of follow-up, 1,677 incident heart failure events occurred. Men and women with no risk factors, compared to those with all 3, had 73% to 85% lower risks of incident heart failure. Men and women without hypertension, obesity, or diabetes at age 45 years lived on average 34.7 years and 38.0 years without incident heart failure, and they lived on average an additional 3 years to 15 years longer free of heart failure than those with 1, 2, or 3 risk factors. Similar trends were seen when stratified by race and at index age 55 years. ConclusionsPrevention of hypertension, obesity, and diabetes by ages 45 years and 55 years may substantially prolong heart failure-free survival, decrease heart failure-related morbidity, and reduce the public health impact of heart failure.

Motivating Action under Uncertain Conditions: Enhancing Emergency Briefings during Coastal Storms

Abstract Coastal flood risk communication is most effective at motivating action when the medium and timing of delivery provide understandable information with clear directives when residents need it most. The U.S. National Weather Service (NWS) has many useful coastal flood forecast tools and products, but how and when this information is delivered are of critical importance. To assess how coastal residents understand and interpret NWS coastal flood products and the best mechanisms for delivery, five focus groups (including residents and emergency managers) in Monmouth and Ocean Counties in New Jersey were conducted. These focus groups employed a scenario-based approach that walked participants through the seven days leading up to Hurricane Sandy. Results support the use of emergency briefing packages as a preferred method for disseminating storm and flood risk information. However, changes to improve visual clarity, provide more succinct information, and localize messages must be undertaken for risk communication to be effective. Further, while residents prefer storm information four to five days prior to storm landfall, emergency managers preferred information seven days prior in order to have time to disseminate information to the community. Findings from this study, which include proposed revisions to NWS products, are expected to improve risk communication and community resiliency in the face of coastal storm threats.

Evaluating lay perceptions of maternal mortality to improve risk communication: a case study in Rivers State, Nigeria

ABSTRACTMaternal mortality is one of the major challenges in reproductive health in Nigeria. Approximately two-thirds of the women (three quarters in rural Nigeria) deliver their babies outside of health facilities and without medically skilled birth attendants. Communication and education are vital since so many births take place outside formal health care environments, and the high mortality rate suggests there is potential for progress, which can supplement Nigerian government efforts. The purpose of the study was to elicit lay knowledge and interpretations about the major components of the problem as part of a wider mental models study aimed at improving risk communication. These knowledge and perceptions were elicited through semi-structured interviews with women of childbearing age (15–49 years). Interviews were analysed to evaluate common themes that will be used to model lay perceptions for comparison to the expert mental model as part of the wider method. The emergent themes will be presented and discussed in the context of the identification of important gaps in knowledge and misperceptions that have the potential for development of improved risk communication.

'Should we reconsider the role of age in treatment allocation for primary prevention of cardiovascular disease?' No, but we can improve risk communication metrics.

The opinion piece published in this edition of the European Heart Journal by Leening and colleagues1 represents one of the two main opposing views on the role of age in cardiovascular disease (CVD) risk prediction scores and for determining risk-reducing treatment thresholds. Leening et al . raise concerns about the dominance of age in CVD risk prediction scores and propose the use of two new risk metrics that do not rely on age. In contrast Wald and colleagues have advocated that for simplicity, age, rather than multivariable predicted risk, should be the sole criterion used to determine eligibility for treatment.2 In our opinion both positions are problematic. We agree with Wald et al . that age is the single best predictor of a patient's short-term (e.g. 5- or 10-year) CVD risk and is also the single best predictor of the short-term benefits of CVD risk reduction.2 However, we disagree that the simplicity of an age-only treatment threshold would outweigh the incremental improvement in predictive power and the greater acceptability (to patients and clinicians) of risk prediction scores that include the standard modifiable CVD risk factors alongside age. We also disagree with Leening and colleagues that the dominant role of age in CVD risk prediction calculators is a problem because, as stated above, age is best single predictor of future CVD risk and treatment benefit. We acknowledge the concerns that they and many others have regarding the apparent dominance of age in CVD risk prediction, but we disagree with their assumptions about the role of age in CVD risk prediction and about how predicted CVD risk should be used to inform management decisions. …

Prevalence and Correlates of Worry About the Health Harms of Medical Imaging Radiation in the General Population.

In recent years, there have been dramatic increases in medical imaging use and increasing media attention to increased exposure to ionizing radiation in the United States. Patient perspectives on medical imaging radiation (MIR) use is understudied, but could guide primary care discussions. This study examines prevalence of worry about the health harms from MIR in the US general population. This cross-sectional study used the 2012-2013 Health Information National Trends Survey conducted by the National Cancer Institute. A nationally representative sample (N = 3532) was drawn from the US general population to observe prevalence of worry about MIR as well as potential covariates, including demographic, medical, and psychological factors, health information-seeking, physician trust in providing cancer information, and cancer fatalism. About 65% of the sample population reported experiencing at least some worry about MIR. Univariable and multivariable logistic regressions indicate higher rates of MIR worry among women, racial/ethnic minorities, those with lower educational attainment, foreign-born Americans, those who self-report poorer health, and those with a personal history of cancer. Lower trust in cancer information from physicians and greater attention to cancer information from popular media were each associated with higher rates of worry about health harms of MIR. An accurate assessment of public worry about MIR will aid primary care providers' efforts to understand patient responses to medical imaging and identify addressable knowledge gaps regarding benefits and risks of medical imaging. These data may improve risk communication regarding medical imaging among referring primary care physicians, radiologists, and patients.

Risk communication as a core public health competence in infectious disease management: Development of the ECDC training curriculum and programme.

Risk communication has been identified as a core competence for guiding public health responses to infectious disease threats. The International Health Regulations (2005) call for all countries to build capacity and a comprehensive understanding of health risks before a public health emergency to allow systematic and coherent communication, response and management. Research studies indicate that while outbreak and crisis communication concepts and tools have long been on the agenda of public health officials, there is still a need to clarify and integrate risk communication concepts into more standardised practices and improve risk communication and health, particularly among disadvantaged populations. To address these challenges, the European Centre for Disease Prevention and Control (ECDC) convened a group of risk communication experts to review and integrate existing approaches and emerging concepts in the development of a training curriculum. This curriculum articulates a new approach in risk communication moving beyond information conveyance to knowledge- and relationship-building. In a pilot training this approach was reflected both in the topics addressed and in the methods applied. This article introduces the new conceptual approach to risk communication capacity building that emerged from this process, presents the pilot training approach developed, and shares the results of the course evaluation.

Lessons from the Ebola Outbreak: Action Items for Emerging Infectious Disease Preparedness and Response.

As the Ebola outbreak in West Africa wanes, it is time for the international scientific community to reflect on how to improve the detection of and coordinated response to future epidemics. Our interdisciplinary team identified key lessons learned from the Ebola outbreak that can be clustered into three areas: environmental conditions related to early warning systems, host characteristics related to public health, and agent issues that can be addressed through the laboratory sciences. In particular, we need to increase zoonotic surveillance activities, implement more effective ecological health interventions, expand prediction modeling, support medical and public health systems in order to improve local and international responses to epidemics, improve risk communication, better understand the role of social media in outbreak awareness and response, produce better diagnostic tools, create better therapeutic medications, and design better vaccines. This list highlights research priorities and policy actions the global community can take now to be better prepared for future emerging infectious disease outbreaks that threaten global public health and security.

Toward responsible development and effective risk management of nano-enabled products in the U.S. construction industry

The global construction sector is experiencing major improvements to building materials used in large quantities through commercial applications of nanotechnology. Nano-enabled construction products hold great promise for energy efficiency and resource conservation, but risk assessments lag as new products emerge. This paper presents results from an inventory, survey, and exposure assessment conducted by the authors and explores these findings in the broader context of evolving research trends and responsible development of nanotechnology. An inventory of 458 reportedly nano-enabled construction products provided insight into product availability, potential exposures, and deficiencies in risk communication that are barriers to adoption of proactive safety measures. Seasoned construction trainers surveyed were largely unaware of the availability of nano-enabled construction products. Exposure assessment demonstrated the effectiveness of ventilation to reduce exposures during mechanical abrasion of photocatalytic tiles containing titanium dioxide (TiO2). Dissociated particles of TiO2 just above the nanoscale (138 nm) were detected in the debris collected during cutting of the tiles, but measurements were below recommended exposure limits for TiO2. Exposure assessments remain scarce, and toxicological understanding primarily pertains to unincorporated nanomaterials; less is known about the occupational risks of nano-enabled construction products across their life cycle. Further research is needed to characterize and quantify exposure to debris released from nanocomposite materials for realistic risk assessment, and to ascertain how nanocomposite matrices, fillers, and degradation forces interact to affect release dynamics. Improving risk communication strategies and implementing safe work practices will cultivate responsible development of nanotechnology in construction, as will multidisciplinary research efforts.

Risk reality vs risk perception

Here we explore new tools to improve risk communication within built infrastructure procurement by considering quantitative engineering risk and perceived risk associated with groups of stakeholders. In particular, the perceived risk is assumed to be dependent on motivational values that individuals identify with. The motivational values are evaluated using 40 questions Swartz Portrait Value Questionnaires. Ten hazards are considered in a survey to identify two dimensions, fear and unknown for a specific group of stakeholders. From the outcomes, it was identified that using a hybrid approach to establish the motivational values and risk perceptions for the stakeholder group risk communication could be improved. Furthermore, the outcomes could be used to target information to stakeholders or intervene to ensure that infrastructure performs according to expectation. As a result, it could become possible to revise what are currently inconsistent acceptable risk levels that have been embedded in regulatory documentation.

Altruism During Ebola: Risk Perception, Issue Salience, Cultural Cognition, and Information Processing.

A nationally representative sample of 1,046 U.S. adults was randomly assigned to two experimental conditions that triggered different degrees of risk perception related to the Ebola outbreak. In the high-risk condition, issue salience and deliberate processing increased individuals' altruistic behavioral intention. In contrast, cultural cognition worldview and negative emotions such as sadness and anger were significantly related to altruistic behavioral intention regardless of the experimental conditions. These findings suggest that affective responses diverge from cognitive processes in influencing risk-related decisions. Practically, as the United States continues to send experts to the affected countries in West Africa, results from this study suggest meaningful pathways to improve risk communication intended to encourage more altruistic and pro-social behaviors.

Shared Medical Decision Making in Lung Cancer Screening: Experienced versus Descriptive Risk Formats.

Annual lung cancer screening using low-dose computed tomography (LDCT) scans is associated with a survival benefit, but it is also associated with potential harm. Unlike descriptive probability formats, experienced tasks have been shown to decrease perceptions of rare events. The objective of this study was to compare descriptive versus experienced probability formats on patients' knowledge, beliefs, endorsement of screening for heavy smokers, and preference (choice predisposition) to undergo screening. A total of 276 patients attending an outpatient pulmonary practice were randomized to learn about screening using 1 of 3 formats: numbers only, numbers + icon arrays, numbers + a set of slides illustrating LDCT scans of 250 people in random order that displayed the number of normal scans, false-positive lung nodules, cancers found leading to a life saved, and cancers found leading to death despite treatment. Knowledge differed between the 3 formats (P= 0.001), with participants randomized to the numbers + icon array format having the highest knowledge score. Beliefs were more favorable among participants randomized to the numbers + experienced format compared with the numbers + icon array format (difference between means [95% confidence interval]= 1.6 [0.4-2.8]). Differences in participants' endorsement of screening (P= 0.4) and choice predisposition (P= 0.6) across probability format mirrored those of beliefs but were not statistically significant. Contrary to what we expected, the experienced format increased propensity toward screening compared with the numbers + icon array format, as indicated by more favorable beliefs and nonsignificant trends toward stronger choice predisposition and endorsement. Experienced risk formats may not be a practical approach to improve risk communication for patients deciding whether or not to undergo annual lung cancer screening.

"Know What to Do If You Encounter a Flash Flood": Mental Models Analysis for Improving Flash Flood Risk Communication and Public Decision Making.

Understanding how people view flash flood risks can help improve risk communication, ultimately improving outcomes. This article analyzes data from 26 mental models interviews about flash floods with members of the public in Boulder, Colorado, to understand their perspectives on flash flood risks and mitigation. The analysis includes a comparison between public and professional perspectives by referencing a companion mental models study of Boulder-area professionals. A mental models approach can help to diagnose what people already know about flash flood risks and responses, as well as any critical gaps in their knowledge that might be addressed through improved risk communication. A few public interviewees mentioned most of the key concepts discussed by professionals as important for flash flood warning decision making. However, most interviewees exhibited some incomplete understandings and misconceptions about aspects of flash flood development and exposure, effects, or mitigation that may lead to ineffective warning decisions when a flash flood threatens. These include important misunderstandings about the rapid evolution of flash floods, the speed of water in flash floods, the locations and times that pose the greatest flash flood risk in Boulder, the value of situational awareness and environmental cues, and the most appropriate responses when a flash flood threatens. The findings point to recommendations for ways to improve risk communication, over the long term and when an event threatens, to help people quickly recognize and understand threats, obtain needed information, and make informed decisions in complex, rapidly evolving extreme weather events such as flash floods.

Effective Communication in Outbreak Management – Experiences and Suggestions by European Public Health Experts

Background: The 2009/2010 A/H1N1 pandemic affected 214 countries and led to ˜18.500 reported deaths. Major communication difficulties within Europe were observed along with a low vaccination uptake and limited public trust in official recommendations. Therefore the overall aim of the EU funded E-com@EU project is to improve risk communication strategies during major epidemic outbreaks in Europe. Within this framework the objective of this study is to analyse the experiences and suggestions of European Public Health Experts who were directly involved in the risk-communication process during the A/H1N1 pandemic. Methods: Semi-structured qualitative interviews with 25 European stakeholders were conducted. The experts came from eight European countries (Germany, Italy, The Netherlands, Poland, Romania, Spain, Sweden and United Kingdom) and three different management levels: Micro level (physicians, health-care staff), Meso level (local public health authorities) and Macro level (national health authorities). The interviews were analysed using Mayrings' qualitative content analysis methodology. Results: During the pandemic some stakeholders were overwhelmed by the sheer amount of daily information and wished for a manageable number of reliable sources that summarize the information precisely. Personal and telephone meetings to exchange information were highly valued. Using new media like short video clips or social media to disseminate relevant information to the public was suggested. The considerable role of influential persons, health care support staff and the media in the decision making process of the public was also pointed out. Discussion: Although recall-bias (pandemic in 2009/10, interviews in 2013/14) and language barriers may have played a role, the results clearly indicate that there is a need to develop evidence-based risk-communication strategies for Europe in preparation for major pandemics. For example establishing better relations between public health and media representatives is required. Investing in measures to increase the society's trust in public health authorities is another area for improvement.

Environmental Justice and Emerging Information Communication Technology: A Review for U.S. Natural Disaster Management

Abstract The Internet age has led to a proliferation of so-called emerging information communication technologies (eICTs). As the personal use of the Internet, mobile devices, and social media has expanded and evolved, these eICTs have been incorporated into strategies to improve risk communication associated with natural disaster management. A review of eICT use as part of natural disaster communication is critical to knowing whether the new technologies support the needs and risk cultures of historically disenfranchised populations and whether they ultimately provide an opportunity to better address both acute and chronic environmental hazards. There is a need to know whether eICTs differ from other technologies in the ways that they exacerbate old environmental injustices and/or create new ones. This article reviews the eICT literature based with a focus on the U.S. Through a review of published and gray literature, we evaluate whether research articles acknowledge or directly address environmental and...

If It Is Meant to Be, Let It Be: Risk communication among Bosnian Refugees Resettled in the U.S.

The purpose of this paper is to explore and understand how a Bosnian refugee community perceives and responds to the potential risk of a natural disaster in order to identify tailored approaches to improve risk communication. This is a qualitative study. Participants resettled in St Louis, Missouri were identified through criterion and snowball sampling. Thirty-three face-to-face interviews were conducted using a semi-structured interview guide. Data were analyzed using both content and thematic analysis. Findings indicate that due to their war experiences, cultural and religious understanding of natural disaster, and social influence on their risk interpretation, participants tended to underestimate the potential threat of natural disaster. Media was the main communication methods in times of potential natural disaster. Lack of organizational support during risk communication was a major concern. Ethnic radio stations and word of mouth were rated as the most popular communication channels for disseminating messages in preparation of a natural disaster. Using a community-based participatory approach to identify community needs and involve Bosnian community partners in risk communication planning, implementation, and evaluation, is vital for a Bosnian community.

Screening for Cervical, Prostate, and Breast Cancer: Interpreting the Evidence.

Cancer screening is an important component of prevention and early detection in public health and clinical medicine. The evidence for cancer screening, however, is often contentious. A description and explanation of disagreements over the evidence for cervical, breast, and prostate screening may assist physicians, policymakers, and citizens faced with screening decisions and suggest directions for future screening research. There are particular issues to be aware of in the evidence base for each form of screening, which are summarized in this paper. Five tensions explain existing conflicts over the evidence: (1) data from differing contexts may not be comparable; (2) screening technologies affect evidence quality, and thus evidence must evolve with changing technologies; (3) the quality of evidence of benefit varies, and the implications are contested; (4) evidence about harm is relatively new, there are gaps in that evidence, and there is disagreement over what it means; and (5) evidence about outcomes is often poorly communicated. The following principles will assist people to evaluate and use the evidence: (1) attend closely to transferability; (2) consider the influence of technologies on the evidence base; (3) query the design of meta-analyses; (4) ensure harms are defined and measured; and (5) improve risk communication practices. More fundamentally, there is a need to question the purpose of cancer screening and the values that inform that purpose, recognizing that different stakeholders may value different things. If implemented, these strategies will improve the production and interpretation of the methodologically challenging and always-growing evidence for and against cancer screening.

Improved predictive mapping of indoor radon concentrations using ensemble regression trees based on automatic clustering of geological units

PurposeAccording to estimations around 230 people die as a result of radon exposure in Switzerland. This public health concern makes reliable indoor radon prediction and mapping methods necessary in order to improve risk communication to the public. The aim of this study was to develop an automated method to classify lithological units according to their radon characteristics and to develop mapping and predictive tools in order to improve local radon prediction. MethodAbout 240 000 indoor radon concentration (IRC) measurements in about 150 000 buildings were available for our analysis. The automated classification of lithological units was based on k-medoids clustering via pair-wise Kolmogorov distances between IRC distributions of lithological units. For IRC mapping and prediction we used random forests and Bayesian additive regression trees (BART). ResultsThe automated classification groups lithological units well in terms of their IRC characteristics. Especially the IRC differences in metamorphic rocks like gneiss are well revealed by this method. The maps produced by random forests soundly represent the regional difference of IRCs in Switzerland and improve the spatial detail compared to existing approaches. We could explain 33% of the variations in IRC data with random forests. Additionally, the influence of a variable evaluated by random forests shows that building characteristics are less important predictors for IRCs than spatial/geological influences. BART could explain 29% of IRC variability and produced maps that indicate the prediction uncertainty. ConclusionEnsemble regression trees are a powerful tool to model and understand the multidimensional influences on IRCs. Automatic clustering of lithological units complements this method by facilitating the interpretation of radon properties of rock types. This study provides an important element for radon risk communication. Future approaches should consider taking into account further variables like soil gas radon measurements as well as more detailed geological information.

Cardiovascular risk perception in women: true unawareness or risk miscalculation?

Assessing the ‘accuracy’ of cardiovascular risk perception is a worthy scientific goal that may lead to targeted interventions aimed at improving risk communication and health outcomes. Current cardiovascular risk scores, however, have shown poor calibration when used in populations that differ temporally and/or geographically from the derivation sample, limiting their reliability as the reference standard for absolute risk. In addition, accurately assessing risk awareness is challenging, with few available validated tools for effectively accounting for the outcomes assessed (coronary heart disease vs. cardiovascular disease), the time span of prediction (10-year vs. lifetime risk), and concepts of absolute versus relative risk. In this context, assessing patient awareness of the role of age as the key, non-modifiable driver of absolute risk can be particularly challenging. This commentary will examine each of these issues, providing context for the interpretation of studies on ‘discordance’ between calculated and perceived cardiovascular risk, such as the one recently published by Oertelt-Prigione et al. Moreover, we explore alternative approaches aimed at overcoming those limitations, enhancing understanding of the factors and true magnitude associated with such discordance.Please see related article: http://www.biomedcentral.com/1741-7015/13/52.

HYPERTENSION, OBESITY, DIABETES, AND HEART FAILURE-FREE SURVIVAL: THE CARDIOVASCULAR LIFETIME RISK POOLING PROJECT

Quantification of heart failure (HF)-free survival in the context of risk factor burden in mid-life may improve risk communication and prevention efforts. We conducted a pooled, individual-level survival analysis from the Framingham Heart, Framingham Offspring, Chicago Heart Association Detection