Potential Risk Compensation Research Articles

A temporal statistical assessment of the effectiveness of bicyclist safety helmets in mitigating injury severities in vehicle/bicyclist crashes

This study estimates mixed logit models taking into account heterogeneity in means and partially constrained parameters in order to explore possible shifts within parameters over time to study factors influencing bicyclist injury severity outcomes. Separate statistical models are estimated for two bicyclist helmet-wearing scenarios (helmet and non-helmet) using a comprehensive dataset from Florida covering a three-year period to assess COVID-19 effects from the 1st of January 2019 to the 31st of December 2021. This research evaluates several factors influencing helmeted and non-helmeted bicyclist injury severity, encompassing the attributes of drivers and cyclists, the environment and weather, the features of the roads and their temporal aspects, and the different types of vehicles. The performed analysis further enhances model robustness by assessing the temporal stability and transferability across different contexts through likelihood ratio tests, alongside an in-depth examination of the temporal consistency of explanatory variables via marginal effects analysis, confirming significant variations between non-helmeted and helmeted bicyclist models and revealing temporal shifts in factors affecting injury severity during the study period. Findings from the model estimations identify several significant variables with consistent parameter estimates across years. Stop signs, cycling with traffic, and dark, unlit conditions increase severe injury risk in non-helmet models, while the stop sign indicator consistently reduces severe injury risk in helmet models. Statistically significant random parameters are identified across different years and helmet-wearing scenarios, including the male driver indicator, which exhibits varying effects on injury severity. Out-of-sample prediction analysis suggests helmets reduce severe injury probability but may increase minor injuries and decrease no-injury accidents, indicating potential risk compensation behavior among helmeted bicyclists. Although helmets offer protection against severe injuries for bicyclists, it is crucial to adopt a comprehensive safety approach, particularly given the evolving demographics of bicyclists amid the COVID-19 outbreak. This entails considering factors like bicyclist and driver behavior, environmental conditions, and infrastructure enhancements. Policymakers, road safety professionals, and advocacy groups should collaborate to develop holistic strategies to address the determinants of bicycle crash severity outcomes and enhance safety measures for bicyclists across diverse road environments.

The Potential Risk Compensation after Receiving HPV Vaccination among Men Who Have Sex with Men in Southwest China: A HAPA-Based Analysis.

Background: men who have sex with men (MSM) are a high-risk group for human papillomavirus (HPV) infection, and the HPV vaccine is effective in preventing it. However, according to risk compensation theory, people may increase sexual risk behaviors after receiving HPV vaccination. Based on the Health Action Process Approach (HAPA), this study investigated the influencing factors to predict intention to reduce condom use (risk compensation intention) among MSM after taking HPV vaccination in southwest China. Methods: we conducted a cross-sectional study among 948 MSM in southwest China using a non-probability sampling method and an electronic questionnaire including sociodemographic characteristics, sexual risk behavior characteristics, HPV-related prevention behavior, and the HAPA scale. Confirmatory factor analysis was performed using a structural equation model. Results: among 948 MSM, the incidence rate of reducing the frequency of condom use was 14.1%. The structural equation model showed that self-efficacy (β = -0.378, p = 0.020) and positive outcome expectancy (β = 0.366, p < 0.05) had greater effects on behavioral intention, followed by negative outcome expectancy (β = -0.296, p < 0.05) and risk perception (β = -0.232, p < 0.05). Conclusions: risk compensation may not be a major barrier to receiving HPV vaccination among MSM. Nevertheless, the recognition of possible risk compensation is necessary to implement appropriate interventions to reduce the occurrence of risk compensation.

Pedestrian distraction: Mobile phone use and its associations with other risky crossing behaviours and conflict situations

Pedestrian distraction related to mobile phone use has become an emerging road safety issue. While much research has investigated the effects of pedestrian distraction on risky crossing behaviours, little is understood about potential risk compensation behaviours and the relationships between pedestrian distraction and safety outcomes, such as near-misses or involvement in a conflict situation. This paper aims to explore pedestrian distraction and its associations with other risky crossing behaviours and safety outcomes, using field observation data in Hanoi, Vietnam. Associations between pedestrian distraction and risky behaviours or conflict situations were identified using log-binomial and logistic regression. Results show that around 14.4% of pedestrians were distracted while crossing. Interestingly, while distracted pedestrians were more likely not to observe traffic while crossing, they were less likely to violate traffic signals or cross outside the marked crosswalks. These findings suggest distracted pedestrians may have risk compensation behaviours. Results also indicated a relatively small yet significant effect of mobile phone distraction on conflict situations.

Assessment of risk compensation following use of the dapivirine vaginal ring in southwestern Uganda

ObjectivesParticipation in HIV prevention trials could trigger risk compensation among participants. We evaluated potential risk compensation following use of a vaginal ring microbicide by women in a phase III trial...

Benefit of COVID-19 vaccination accounting for potential risk compensation

People receiving COVID-19 vaccines may subsequently markedly increase their previously suppressed exposure risk. A simple model can evaluate the benefit of vaccination to the vaccinated (index) person and others exposed to that person; and calculate the amount of risk compensation required to eliminate all the benefits or to halve the benefit. As shown, 2.5-fold increase in exposure will eliminate the benefit of a vaccine of moderate efficacy (E = 0.6) unless the probability of infection in the population of interest is very high. With very high vaccine efficacy (E = 0.95), substantial benefit is maintained except in situations where there is a very low probability of infection in the population. If the vaccine efficacy decreases to 0.8, the benefit gets eroded easily with modest risk compensation. Risk compensation may markedly affect the benefit of COVID-19 vaccination, especially if vaccine efficacy in real-life or specific high-risk populations (e.g., nursing home residents) is not very high.

Benefit of COVID-19 Vaccination Accounting for Potential Risk Compensation

Newly developed vaccines have tremendous potential in the fight against the COVID-19 pandemic. Risk compensation is the phenomenon where people receiving vaccines or other preventive measures may subsequently increase their previously suppressed exposure risk. Here a parsimonious mathematical model is presented that aims to evaluate the benefit of vaccination to the vaccinated (index) person and others exposed to that person; and calculate the amount of risk compensation required to eliminate all the benefit or to halve the benefit. As shown, 2.5-fold increase in exposure may eliminate the benefit of a vaccine of moderate efficacy (E=0.6) unless the probability of infection in the population of interest is very high. With very high vaccine efficacy (E=0.95), substantial benefit is maintained except in situations where there is very low probability of infection in the population. If the vaccine efficacy decreases to 0.8, the benefit may get eroded easily with modest risk compensation. Risk compensation may markedly affect the benefit of COVID-19 vaccination, especially if vaccine efficacy in real-life or specific high-risk populations (e.g. nursing home residents) is not very high.

Comparisons in Cell Phone Use Rates between Talking and Manually Manipulating the Handheld Device

Cell phone use is among the most prevalent types of in-vehicle distractions. Studies have shown cell phones to have a negative impact on driving performance, with the magnitude of these impacts varying based on the level of engagement required for phone use, as well as the complexity of the driving environment. The development of effective policies and programs to mitigate distracted driving is contingent on an improved understanding of the nature of these relationships. To this end, this study investigates the rate of cell phone use under various settings through a statewide direct observation survey. Data were collected from 200 roadside locations throughout the State of Michigan and a random effects multinomial logit model was estimated to assess how the prevalence of cell phone use varies across drivers. While several studies have investigated the prevalence of cell phone use, this study distinguishes differences in the manner of cell phone use (i.e., talking on a handheld device versus manual manipulation of the device) across drivers while controlling for important contextual factors. The results show cell phone use is generally higher among female drivers and use rates consistently decrease with age. The prevalence of cell phone use is also shown to vary significantly depending on the manner of use. Use rates are shown to differ based on changes in the driving environment, suggesting potential risk compensation on the part of motorists. The results also show a significant correlation in use rates at the same sites over time, which is reflective of important unobserved site-specific factors.

Australian interdisciplinary healthcare providers' perspectives on the effects of broader pre-exposure prophylaxis (PrEP) access on uptake and service delivery: a qualitative study.

Semistructured interviews, conducted before PBS listing (October 2016-April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study. Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia's universal healthcare insurance system). Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.

Pre-exposure prophylaxis: awareness, acceptability and risk compensation behaviour among men who have sex with men and the transgender population.

This exploratory study examined the facilitators of and barriers to acceptance of pre-exposure prophylaxis (PrEP) and potential risk compensation behaviour emerging from its use among men who have sex with men (MSM) and transgender individuals (TGs) in India. A questionnaire was administered to 400 individuals registered with a targeted intervention programme. Logistic regression models were used to identify facilitators of and barriers to PrEP acceptance. The respondents consisted of 68% MSM and 32% TGs. Risk behaviour categorization identified 40% as low risk, 41% as medium risk and, 19% as high risk for HIV infection. About 93% of the respondents were unaware of PrEP, but once informed about it, 99% were willing to use PrEP. The facilitators of PrEP acceptance were some schooling [odds ratio (OR) 2.16; P = 0.51], being married or in a live-in relationship (OR 2.08; P = 0.46), having a high calculated risk (OR 3.12; P = 0.33), and having a high self-perceived risk (OR 1.8; P = 0.35). Increasing age (OR 2.12; P = 0.04) was a significant barrier. TGs had higher odds of acceptance of PrEP under conditions of additional cost (OR 2.12; P = 0.02) and once-daily pill (OR 2.85; P = 0.04). Individuals identified as low risk for HIV infection showed lower odds of potential risk compensation, defined as more sexual partners (OR 0.8; P = 0.35), unsafe sex with new partners (OR 0.71; P = 0.16), and decreased condom use with regular partners (OR 0.95; P = 0.84), as compared with medium-risk individuals. The associations, although not statistically significant, are nevertheless important for public health action given the limited scientific evidence on PrEP use among MSM and TGs in India. With high acceptability and a low likelihood of risk compensation behaviour, PrEP can be considered as an effective prevention strategy for HIV infection among MSM and TGs in India.

The promises and challenges of pre‐exposure prophylaxis as part of the emerging paradigm of combination HIV prevention

IntroductionTowards the end of the twentieth century, significant success was achieved in reducing incidence in several global HIV epidemics through ongoing prevention strategies. However, further progress in risk reduction was uncertain. For one thing, it was clear that social vulnerability had to be addressed, through research on interventions addressing health systems and other structural barriers. As soon as antiretroviral treatment became available, researchers started to conceive that antiretrovirals might play a role in decreasing either susceptibility in uninfected people or infectiousness among people living with HIV. In this paper we focus on the origin, present status, and potential contribution of pre-exposure prophylaxis (PrEP) within the combination HIV prevention framework.DiscussionAfter a phase of controversy, PrEP efficacy trials took off. By 2015, daily oral PrEP, using tenofovir alone or in combination with emtricitabine, has been proven efficacious, though efficacy seems heavily contingent upon adherence to pill uptake. Initial demonstration projects after release of efficacy results have shown that PrEP can be implemented in real settings and adherence can be high, leading to high effectiveness. Despite its substantial potential, beliefs persist about unfeasibility in real-life settings due to stigma, cost, adherence, and potential risk compensation barriers.ConclusionsThe strategic synergy of behavioural change communication, biomedical strategies (including PrEP), and structural programmes is providing the basis for the combination HIV prevention framework. If PrEP is to ever become a key component of that framework, several negative beliefs must be confronted based on emerging evidence; moreover, research gaps regarding PrEP implementation must be filled, and appropriate prioritization strategies must be set up. Those challenges are significant, proportional to the impact that PrEP implementation may have in the global response to HIV.

No Evidence of Sexual Risk Compensation in the iPrEx Trial of Daily Oral HIV Preexposure Prophylaxis

ObjectivePreexposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) reduced HIV acquisition in the iPrEx trial among men who have sex with men and transgender women. Self-reported sexual risk behavior decreased overall, but may be affected by reporting bias. We evaluated potential risk compensation using biomarkers of sexual risk behavior.Design and methodsSexual practices were assessed at baseline and quarterly thereafter; perceived treatment assignment and PrEP efficacy beliefs were assessed at 12 weeks. Among participants with ≥1 follow-up behavioral assessment, sexual behavior, syphilis, and HIV infection were compared by perceived treatment assignment, actual treatment assignment, and perceived PrEP efficacy.ResultsOverall, acute HIV infection and syphilis decreased during follow-up. Compared with participants believing they were receiving placebo, participants believing they were receiving FTC/TDF reported more receptive anal intercourse partners prior to initiating drug (12.8 vs. 7.7, P = 0.04). Belief in receiving FTC/TDF was not associated with an increase in receptive anal intercourse with no condom (ncRAI) from baseline through follow-up (risk ratio [RR] 0.9, 95% confidence interval [CI]: 0.6–1.4; P = 0.75), nor with a decrease after stopping study drug (RR 0.8, 95% CI: 0.5–1.3; P = 0.46). In the placebo arm, there were trends toward lower HIV incidence among participants believing they were receiving FTC/TDF (incidence rate ratio [IRR] 0.8, 95% CI: 0.4–1.8; P = 0.26) and also believing it was highly effective (IRR 0.5, 95% CI: 0.1–1.7; P = 0.12).ConclusionsThere was no evidence of sexual risk compensation in iPrEx. Participants believing they were receiving FTC/TDF had more partners prior to initiating drug, suggesting that risk behavior was not a consequence of PrEP use.

Study designs for identifying risk compensation behavior among users of biomedical HIV prevention technologies: Balancing methodological rigor and research ethics

The growing evidence base for biomedical HIV prevention interventions – such as oral pre-exposure prophylaxis, microbicides, male circumcision, treatment as prevention, and eventually prevention vaccines – has given rise to concerns about the ways in which users of these biomedical products may adjust their HIV risk behaviors based on the perception that they are prevented from infection. Known as risk compensation, this behavioral adjustment draws on the theory of “risk homeostasis,” which has previously been applied to phenomena as diverse as Lyme disease vaccination, insurance mandates, and automobile safety. Little rigorous evidence exists to answer risk compensation concerns in the biomedical HIV prevention literature, in part because the field has not systematically evaluated the study designs available for testing these behaviors. The goals of this Commentary are to explain the origins of risk compensation behavior in risk homeostasis theory, to reframe risk compensation as a testable response to the perception of reduced risk, and to assess the methodological rigor and ethical justification of study designs aiming to isolate risk compensation responses. Although the most rigorous methodological designs for assessing risk compensation behavior may be unavailable due to ethical flaws, several strategies can help investigators identify potential risk compensation behavior during Phase II, Phase III, and Phase IV testing of new technologies. Where concerns arise regarding risk compensation behavior, empirical evidence about the incidence, types, and extent of these behavioral changes can illuminate opportunities to better support the users of new HIV prevention strategies. This Commentary concludes by suggesting a new way to conceptualize risk compensation behavior in the HIV prevention context.

Testing the risk compensation hypothesis for safety helmets in alpine skiing and snowboarding

Objective: The prevalence of helmet use by alpine skiers and snowboarders was estimated and self-reports on risk taking were assessed to test for potential risk compensation when using helmets in...