Denial Of Risk Research Articles

Percepção de riscos do uso de agrotóxicos por trabalhadores da agricultura familiar do município de Rio Branco, AC

OBJETIVO: Conhecer as percepções de risco associadas ao uso de agrotóxicos no trabalho rural de pequenos produtores rurais. MÉTODO: Estudo de percepção de riscos relacionados ao trabalho rural, realizado entre o segundo semestre de 2008 e o primeiro de 2009, com base na avaliação psicológica de 42 pequenos agricultores do município de Rio Branco, AC, por meio de questionário estruturado com questões abertas e fechadas e aplicação de escalas psicométricas. RESULTADOS: Entre as mulheres, destacou-se a invisibilidade dos riscos associados ao uso desses agentes químicos no seu cotidiano de trabalho. A maioria das mulheres participantes não percebia a seriedade dos problemas de saúde relacionados à exposição a agrotóxicos, nem identificava como perigosas as atividades de trabalho que desempenhava. Entre os homens, observou-se a construção de estratégias defensivas baseadas na negação dos riscos, tática utilizada por esses indivíduos como forma de permanecerem, dia após dia, inseridos em um processo de trabalho sabidamente injurioso. CONCLUSÃO: O estudo mostrou que a percepção de riscos daquele grupo de pequenos agricultores influencia suas práticas de trabalho e a forma como responde frente ao risco representado pelo uso de agrotóxicos, devendo ser, portanto, objeto de análise em ações de vigilância em saúde do trabalhador e no escopo de iniciativas de gerenciamento de riscos.

The dragon and the tiger: realties in the control of tuberculosis.

India and China are two Asian super-powers with developing economies carried on the shoulders of their booming populations. This growth can only be sustained by nurturing their “human resource”. However increasing reports of insufficient public health (PH) initiatives in India when compared to the aggressive PH system of China may prove to be the Achilles' heels for India. This review compares the PH system in India and China for combating Tuberculosis (TB), the disease responsible for maximum mortality and morbidity by a single infectious agent. While China has acknowledged the disease load and thereafter has methodically improved its reporting, detection, diagnosis and treatment, India is still in denial of the imminent health risk. The Indian PH system still considers TB as a “facultative” disease for which the required control measures are already in place and functioning. Globally, India and China recorded the highest Multi-Drug Resistant TB (MDR) cases notified in 2010 (64000 and 63000, respectively). Additionally non-government sources reported extremely high proportions of MDR in India. Here we have compared the medical, social and economic approaches of the two nations towards better management and control of TB. Does India have lessons to learn from China?

Is cannabis use normalized, celebrated or neutralized? Analysing talk as action

In qualitative interviews with 100 cannabis users in Norway, three discursive repertoires were particularly frequent. The first emphasized how users were ‘normal’ with statements, such as ‘everyone smokes cannabis’ or ‘cannabis users are not different from others’. The second discursive repertoire emphasized the fascinating difference of both users and the drug. Many cannabis users, stated that cannabis was used by ‘free-thinking, open people’ and triggered creativity. The third discursive repertoire was different techniques of risk denial, arguing that cannabis ‘is just a plant’ or that cannabis use did not have any harmful consequences. These three discursive repertoires are the empirical foundations for three conflicting theoretical traditions in studies of illegal drugs. Cannabis has been described as ‘normalized’, interpreted in a subcultural framework, or researchers have emphasized how illegal drug use is neutralized by users. The interdiscursivity of Norwegian cannabis users challenge all three theoretical frameworks and can only be understood by analysing talk as action. This article argues that all three discursive repertoires can be understood as responses to stigmatization. The conclusion is that the theoretical framework of ‘normalization’ is not the best way to understand cannabis use in Norway and possibly elsewhere.

Cluster subtypes appropriate for preventing postpartum smoking relapse

Objective While the majority of women quit smoking either before or during pregnancy, 60 to 80% relapse in the postpartum period. The objective of this research was to examine postpartum women who quit smoking during their pregnancies and to determine the predictive factors for relapse in the postpartum period by identifying different subgroups that predict risk of relapse. Method One hundred forty four postpartum women who were abstinent at the time of delivery were recruited. Data regarding the Acquisition Stage of Change, Decisional Balance and Situational Temptations to Smoke were assessed in the immediate postpartum period. Based on their intention to remain abstinent, 121 women identified in the acquisition-Precontemplation (aPC) group comprised the study sample. Smoking status was assessed again at 2 months postpartum. Results A cluster analysis was performed to idenitfy subgroups of the acquisition-Precontemplation (aPC) group. Four subgroups were identified and were labeled Most Protected, Ambivalent, Risk Denial, and High Risk. Logistic regression was performed to establish external validity of the clusters. The clusters and exclusive breastfeeding were the only statistically significant variables associated with relapse at 2 months postpartum. Conclusions The results confirmed the clusters identified in previous prevention research with both adolescents and postpartum women, The cluster profiles can serve to guide the development of a tailored intervention program.

The Increasing Impact of Human Immunodeficiency Virus Infections, Sexually Transmitted Diseases, and Viral Hepatitis in Durham County, North Carolina: A Call for Coordinated and Integrated Services

Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues. We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care. We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy. Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population. Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.

Denial of smoking‐related risk among pregnant smokers

To examine pregnant women's denial of risk, tobacco dependence and their partner's smoking status on smoking behavior during pregnancy. Cross-sectional design with convenience sampling. Data collection was carried out in hospitals and antenatal clinics in Budapest and 12 other Hungarian cities. A total of 406 adult pregnant women (mean age: 28.2 years; SD = 5.6) with a mean gestational age of 23.3 weeks ranging from 4 to 40 (SD = 8.9). Pregnant women were enrolled in the study by midwives and home-care attendants. Smoking status was assessed by self-report questions. Further measures included the Fagerstrom Test of Nicotine Dependence to assess nicotine dependence, and the Wisconsin Inventory of Smoking Dependence Motives to assess the motivational background of smoking. Risk perception was assessed by Haslam and Draper's (2000) 12-item risk perception questionnaire. Prevalence of occasional and daily smokers was 21.7 and 29.3%, respectively. Some 59.7% of the pregnant women have a partner who smokes. Daily smokers had a higher level of risk denial than occasional or non-smokers (Welch F = 91.607; p < 0.001). Current smokers also had a higher denial than temporary quitters (t = -3.153; p = 0.003). Denial of risk correlated significantly with nicotine dependence (r = 0.30) and the main motivational factors (r = 0.34-0.48). A multinomial logistic regression model of denial of risk concurrently predicted women's smoking status (p = 0.001), even when controlling for age, education, partner's smoking status and parity. A higher level of risk denial seems to be one of the major determinants of women's smoking status during pregnancy.

Examining the Influence of Denial, Motivation, and Risk on Sexual Recidivism

This study examined the relationship between denial, motivation, static risk (Risk Matrix 2000), and sexual recidivism. Denial was measured in three ways: A Denial Index (resulting from the combination of several measures of different aspects of denial), Absolute Denial, and Denial of Risk. Motivation for treatment was also examined. Logistic regression analyses in a sample of 180 sex offenders using a fixed 10-year follow-up found that risk moderated the relationships between the Denial Index, Absolute Denial, and sexual recidivism. In particular, among high-risk offenders, denial predicted decreased sexual recidivism. An opposite pattern was observed for the low-risk offenders who were in denial, although these differences were not significant. In terms of Denial of Risk, those who were denying they presented a future risk for offending (i.e., higher on Denial of Risk) were less likely to reoffend than those who reported seeing themselves as presenting a high risk. Motivation for treatment was positively correlated with recidivism, but the effect disappeared once static risk was controlled.

“It's Better Not To Know”: Perceived Barriers to HIV Voluntary Counseling and Testing among Sub-Saharan African Migrants in Belgium

This study explored perceptions, needs, and barriers of sub-Saharan African migrants in relation to HIV voluntary counseling and testing (VCT). Using an inductive qualitative methodological approach, data were obtained from focus group discussions. Results showed that participants were in principle in favor of VCT. However, they indicated that barriers outweighed advantages. Such barriers included fear of positive test results and its related personal and social consequences, lack of information, lack of preventive health behavior, denial of HIV risk, and missed opportunities. Limited financial resources were only a concern for some subgroups like young people, asylum seekers, and recent migrants. This study identified multiple and intertwined barriers to VCT from a community perspective. In order to promote VCT, interventions such as raising awareness through culturally sensitive education should be adopted at community level. At level of service provision, provider initiated HIV testing including target group tailored counseling should be promoted.

Older Adult Fall Prevention: Perceptions, Beliefs, and Behaviors

Falls in adults aged 65 years and older are an important health issue associated with excess mortality, functional limitations, loss of independence, and reduced quality of life. Physicians can reduce the likelihood of falls in their older patients by incorporating prevention strategies into their clinical practice. Research has identified effective interventions, notably clinical assessment and risk factor reduction and exercise programs with balance training, that require older adults to adopt new behaviors. However, some older adults believe falls are an inevitable consequence of aging, while others do not see themselves as personally vulnerable. Factors that facilitate adopting fall interventions include social support, low-intensity exercise, and the perception that the programs are relevant. Barriers include fatalism, denial of risk, poor self-efficacy, and no previous history of exercise. To encourage their patients’ participation, physicians need to present fall interventions as lifestyle enhancing and as a way to remain independent. Messages should focus on positive health and social benefits such as improving balance and maintaining independence, rather than emphasizing negative information about falls and fall injuries. Along with the support of family and friends, a personal invitation from a health care provider will encourage older adults to take part in fall prevention programs.

Représentations et attitudes du public vis-à-vis du cancer

Cancer has become a major public health issue. It is thus crucial to measure the general population's behaviours, opinions and perceptions about cancer and its associated risk factors. This article describes some of the main findings of a 2005 French survey (n = 4,046). Cancer is considered by a large majority to be the most serious disease, far before HIV/AIDS and cardiovascular diseases. The carcinogenic risk that is associated to main risk factors, such as sun exposure, tobacco-smoking and alcohol use appears to be well-known. However, many people justify dangerous behaviours with strongly-anchored beliefs, which maintain dangerous behaviours for health on the long-term. What's more, the perception of risk proliferation can also generate risk denial. Because self-exempting beliefs are still widespread within the general opinion, it is essential to continue public health information campaigns dedicated to cancer prevention, so as to induce better prevention practices within the general population and to reduce stigmatisation and isolation experienced by cancer patients. If risk denial is not systematically a consequence of a lack of information, it is generally associated to a cognitive construction that gives coherence to behaviours.

From the Editors

<i>From the Editors</i>

What mediates the effect of confrontational counselling on smoking cessation in smokers with COPD?

Objective Within the framework of a randomized, active treatment controlled trial, we used a mediation analysis to understand the mechanisms by which an intervention that uses confrontation with spirometry for smoking cessation achieves its effects. Methods Participants were 228 smokers from the general population with previously undetected chronic obstructive pulmonary disease (COPD), who were detected with airflow limitation by means of spirometry. They received two equally intensive behavioural treatments by a respiratory nurse combined with nortriptyline for smoking cessation: confrontational counselling with spirometry versus conventional health education and promotion (excluding confrontation with spirometry and COPD). Results Cotinine validated abstinence rates from smoking at 5 weeks after the target quit date were 43.1% in the confrontational counselling group versus 31.3% in the control group (OR = 1.67, 95%CI = 0.97–2.87). The effect of confrontational counselling on abstinence was independently mediated by the expectation of getting a serious smoking related disease in the future (OR = 1.76, 95%CI = 1.03–3.00), self-exempting beliefs (OR = 0.42, 95%CI = 0.21–0.84), and self-efficacy (OR = 1.38, 95%CI = 1.11–1.73). Conclusion We conclude that confrontational counselling increases risk perceptions and self-efficacy, and decreases self-exempting beliefs (risk denial) in smokers with previously undetected COPD. These changes in mediators are associated with a higher likelihood of smoking cessation. Practice implications Apart from the intensity, the content of smoking cessation counselling may be an important factor of success. A confrontational counselling approach as we applied may have the potential to alter smoking-related cognitions in such a way that smokers are more successful in quitting. Nurses can be trained to deliver this treatment.

“Un risque, ça va ! Trois risques, bonjour les dégâts?” Les difficultés de l'éducation pour la santé à prévenir des risques comportementaux multiples

Health education can have unexpected effects, sometimes even harmful, in particular when dealing with, on the one hand, multiple risk pathologies and, on the other, one risk factor that is connected to various different pathologies. Certain unexpected effects can be the result of too much information on prevention or when prevention is too focused on one target. In the first scenario, relativity of the information could arise faced with certain health risks or be used against public health objectives. When information is too focused on one target group, it can create discriminatory reactions for the groups at risk, which can translate into denial of the potential risk by those outside of the target group. Other prevention actions can have an unexpected effect, or none at all, because the target behavior is considered functional for the individual. In order to prevent a risk behavior, it is necessary to take into account the threats it is meant to avoid (concurrent risks) and other risk factors meant to attain the same objectives (substitutable risks). In order to understand and avoid different obstacles, people's beliefs and knowledge, which are often rooted in daily behavior and hence difficult to change, must be taken into account. It is also important to situate behavior in context, identifying its function and the concurrent and substitutable risks, which means researching as well the social sciences. In the future, the need for a global health approach will be evident because prevention of risk behaviors increasingly refers to multiple risks in one same pathology as well as concomitant prevention of multiple pathologies.

Organizational disasters: why they happen and how they may be prevented

PurposeThe purpose of this paper is to look at why organizational disasters happen, and to discuss how organizations can improve their ability to recognize and respond to warning events and conditions before they tailspin into catastrophe.Design/methodology/approachA review of research on organizational disasters suggests that there are a number of information difficulties that can prevent organizations from noticing and acting on warning signals. The paper describes these difficulties using recent examples of organizational mishaps from: 9/11, Enron, Merck Vioxx withdrawal, Barings Bank collapse, Columbia Space Shuttle breakup, and Children's Hospital Boston.FindingsThe paper identifies three types of information impairments that could lead to organizational disasters: epistemic blind spots, risk denial, and structural impediment. It examines common information and decision practices that make it hard for organizations to see and deal with warning signals. Finally, the paper suggests what individuals, groups, and organizations can do to raise their information vigilance.Originality/valueThe paper shows that organizational disasters have a structure and dynamic that can be understood, and proposes a number of strategies by which organizations can become better prepared to recognize and contain errors so as to avert disaster.

Neutralization Techniques, Crime Decision-making and Juvenile Thieves

ABSTRACT Theft is the most common criminal offence committed by juveniles and youngsters in Hong Kong. Based upon the qualitative data abstracted from semi-structured interviews with 30 subjects aged from 10 to 17, the author examined the decision-making of juvenile thieves, and found that neutralization techniques played a significant role in their decisions to offend. A majority of subjects of the study relied on three particular types of neutralization techniques to release themselves from discomfort and guilty feeling of criminal acts, namely (1) the denial of possible risk and harm, (2) denial of responsibility and (3) condemnation of others.

Smoking too few cigarettes to be at risk? Smokers’ perceptions of risk and risk denial, a French survey

Background: Past studies on smokers’ risk perception have produced mixed results. We endorsed a new approach to assess smokers’ perceptions of risk by asking them to estimate threshold values for...

The ‘moral career’ of cigarette smokers: A French survey

This paper aims to illustrate the relevance of Howard S. Becker's sociological model of deviance for a better understanding of contemporary adult smoking. From this perspective, one crucial aspect of smoking is smokers' ability to develop and entertain convincing rationalizations that help them to deny smoking hazards and challenge anti-tobacco messages. Several hypotheses are derived from this model and most of them are successfully tested with quantitative data from a cross-sectional survey conducted in the Paris Ile-de-France Region. As expected, most smokers agreed that smoking damages health and considered being well-informed about smoking hazards, even those who denied these hazards for themselves. Moreover, smokers' rationalizations were closely correlated to cigarette consumption and duration since smoking initiation. Paradoxically, risk denial was also stronger among smokers who have some characteristics usually considered as protective factors against smoking (especially future-orientation and importance attached to one's health). More generally, our sociological perspective leads to consider smokers' risk denial as the result of acquired cognitive skills instead of the consequences of lack of information or psychological bias. We believe it provides a promising avenue for further research.

Process Evaluation of Bringing Nutrition Screening to Seniors in Canada (BNSS)

Although nutrition risk is prevalent in Canadian older adults, the process of screening must be considered before nationwide programs can be recommended. A process evaluation of the Bringing Nutrition Screening to Seniors in Canada demonstration project was completed. Through the use of the 15-item Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN(c)) questionnaire, risk was identified in convenience samples of 1,196 community-living older adults recruited from five Canadian communities. All at-risk participants were offered referrals to community resources. Telephone follow-up of at-risk participants occurred after screening. Telephone interviews with screening administrators and older adults revealed screening benefits and challenges. Nutrition risk occurred in 38.9% of the sample. Most participants found screening helpful. Among the at-risk group (n=465), 39% accepted referrals for additional services. Older adults provided several reasons for refusing referrals, including denial of risk. Dietitian services were an identified gap, as were prevention-level resources. Nutrition risk is prevalent and older adults can benefit from screening. Training, ongoing support, and prioritization (policy, time, and money) are needed for sustainable screening programs. Before implementation of a nationwide screening program, sufficient and appropriate community resources are required, as is a national strategy for screening older adults.

Risk denial about smoking hazards and readiness to quit among French smokers: An exploratory study

In most developed countries, a significant part of the population is still smoking despite comprehensive tobacco control policies. Among other reasons, many smokers may endorse self-exempting beliefs that help them to deny the smoking hazards for themselves. We investigated the relationship between smokers' risk denial and their readiness to quit making use of a French cross-sectional survey conducted in the Paris Ile-de-France Region ( N = 939 smokers). Self-exempting beliefs were quite widespread among participants and two of them were significant predictors of a low readiness to quit: considering that one's cigarette consumption is too low to be harmful and believing that one's way of smoking can protect from smoking-related diseases. Future tobacco control messages and interventions should specifically address these self-exempting beliefs that reduce smokers' cognitive dissonance and then inhibit their willingness to quit.

Identifying cluster subtypes for the prevention of adolescent smoking acquisition

School-based smoking prevention programs are typically identical for all students. Tailoring prevention materials to focus on individual needs with an emphasis on students at highest risk is a promising alternative. Recent prevention programs have tailored materials based on the Stages of Acquisition, an extension of the Stages of Change used to tailor smoking cessation materials effectively for adults. Three stages of acquisition have been identified: Acquisition Precontemplation (aPC), Acquisition Contemplation (aC) and Acquisition Preparation (aPR). However, about 90% of nonsmoking adolescents classify themselves in the aPC stage. A cluster analysis was performed, using the Decisional Balance and Situational Temptations scales, for three random subsamples of adolescents within the aPC stage ( N 1 = N 2 = N 3 = 514). Four distinct subtypes were identified in each subsample: High Risk, Protected, Ambivalent, and Risk Denial. External validity was established using family support for nonsmoking, peer variables, and stage classification at follow-up assessment (12, 24, and 36 months). Family support for nonsmoking was related to subtype much more strongly than peer interactions. Subjects in the Protected subgroup were the most likely to remain in the aPC stage at each follow-up assessment. Subtype membership, along with membership in the aC and aPR stages, provides important additional information for tailoring smoking prevention materials. Tailored interventions can focus on those adolescents at highest risk and limit or avoid expending resources on those at very low risk.