Misperception Of Risk Research Articles

Perceived Risk of Ischemic and Bleeding Events in Acute Coronary Syndromes

Acute coronary syndrome registries report the use of incomplete guideline therapies, especially among the highest risk patients. Whether this treatment gap results from misperceptions of risk by physicians is uncertain. The Perceived Risk of Ischemic and Bleeding Events in Acute Coronary Syndrome Patients (PREDICT) study was a prospective acute coronary syndrome registry in Australia, China, India, and Russia, involving 58 hospitals between May 2009 and February 2011. In-hospital care and events up to 6 months were assessed. At least 2 clinicians involved in patient care estimated the untreated risk and change in risk with each therapy. Physician risk assessment and objective risk measures (eg, Global Registry of Acute Coronary Events [GRACE] score) for death, death/myocardial infarction, and bleeding events were compared using the c statistic and integrated discrimination improvement. In total, 1542 patients and 4230 patient-specific physician estimates were obtained. Of responding clinicians, 81.9% were cardiovascular specialists (years of practice: mean [SD], 11.5 [7.7] years). The median physician-perceived risk of 6-month death was 25% (interquartile range, 14%-35%). The GRACE score was superior to physician estimation (c statistic: GRACE score, 0.812 [95% confidence interval, 0.772-0.851] versus physician, 0.652 [95% confidence interval, 0.596-0.708]; P<0.0001). The GRACE score added to clinician intuition improved discrimination (integrated discrimination improvement, 0.0632 [SE, 0.012]; P<0.0001). Invasive management correlated with physician-estimated risk but not with GRACE risk. Among patients not at high risk by physician estimation, increased risk by GRACE score was associated with higher mortality (3.7% versus 0.8%; P<0.001). Objective risk assessment provides superior risk discrimination when compared with physician-estimated risk. Whether systematic use of objective risk stratification improves clinical outcomes should be studied in appropriately designed clinical trials.

Distinguishing Probability Weighting from Risk Misperceptions in Field Data

We outline a strategy for distinguishing rank-dependent probability weighting from systematic risk misperceptions in field data. Our strategy relies on singling out a field environment with two key properties: (i) the objects of choice are money lotteries with more than two outcomes; and (ii) the ranking of outcomes differs across lotteries. We first present an abstract model of risky choice that elucidates the identification problem and our strategy. The model has numerous applications, including insurance choices and gambling. We then consider the application of insurance deductible choices and illustrate our strategy using simulated data.

The trouble with deficits

In their recent paper, “Misperceptions of climate-change risk as barriers to climate-change adaptation: a case study from the Rewa Delta, Fiji,” Lata and Nunn (2012) argue that “lack of awareness” and “cultural impediments ... such as short-term planning perspectives, spiritual beliefs, traditional governance structures” are barriers to climate change adaptation in Fiji’s Rewa Delta (p. 169). Understanding how vulnerable, often marginalized people can or will adapt to the future effects of climate change is a core concern of human dimensions of climate change scholars and the policy community more broadly. We thus feel obliged to point out that this paper has substantial methodological and conceptual shortcomings. These shortcomings seriously undermine the authors’ conclusion that public deficits, in their many manifestations in this paper, are barriers to climate change adaptation in the Rewa Delta. We begin with the methodological shortcomings by asking: Of whom can the authors legitimately speak? The study focuses on one urban (Nausori Town, population approx. 25,000) and one rural location (Vutia, population approx. 900, distributed across three villages) in the Rewa Delta, Fiji. 32 inhabitants from each location were selected for interview in a non-random manner (both samples were purposive, and apparently haphazard), rendering the authors’ generalisations to each population invalid. Equally troubling, one criterion for inclusion in the study—eligible participants had to have lived in the area continuously for at least 30 years—excluded 92 % of the rural population from the study. Those excluded were “foreigner” family groups, those who in the past 20–30 years had Climatic Change (2013) 118:501–504 DOI 10.1007/s10584-013-0750-3

Abstract 22: Accuracy of Perceived Stroke Risk among Young to Middle-Aged Rural African Americans

Background &amp; Purpose: Stroke has increased among young adults, which is concerning for African Americans (AA) who have more severe stroke-related outcomes than Caucasians. Since stroke is more common in older adults, younger adults may not recognize stroke as a threat or take action to reduce modifiable stroke risk factors. The purpose of this study was to examine accuracy of perceived stroke risk by comparing perceived risk of future stroke with actual risk of stroke among rural AA aged 19-54 years. Methods: A cross-sectional design was used and AA were recruited from rural Alabama. Perceived risk of stroke was measured using a single-item subjective rating of 10-20 year risk of stroke and factors participants attributed to their risk were also explored. Actual stroke risk was calculated based on the presence of eight risk factors: history of hypertension, high cholesterol, diabetes, atrial fibrillation, cigarette smoking, family history of stroke, BMI &gt; 30 and lack of exercise. Based on the number of actual risk factors, participants were categorized into one of three groups; no risk, low risk (1-2 factors); or moderate-high risk (&gt; 3 risk factors). Results: Participants (N=66) had a mean age of 43.3+9.4 years, were 71% female, with at least 12 years of school (89%), and unemployed (62%). The majority (66%) perceived their risk of future stroke as no or low risk. However, actual risk factors averaged 2.97+1.63 out of 8 with 59% in the moderate-high actual stroke risk category. In comparing perceived versus actual risk, 44% underestimated, 47% were accurate, and 9% overestimated their risk. Sample characteristics were not associated with accuracy. Most (69%) participants with hypertension (n= 35); 80% of cigarette smokers (n= 25), 93% of diabetics (n= 13) and 88% of overweight/obese participants (n= 49) did not identify their personal risk factors as contributing to their risk of future stroke. Conclusion: Despite the number of risk factors observed, participants did not perceive a high risk of future stroke, almost half underestimated their risk of stroke, and few recognized personal risk factors. Strategies to address risk misperceptions should be explored to improve accuracy of perceived stroke risk and facilitate tailoring of interventions to reduce stroke.

Distinguishing Probability Weighting from Risk Misperceptions in Field Data

The paper outlines a strategy for distinguishing rank-dependent probability weighting from systematic risk misperceptions in field data. Our strategy relies on singling out a field environment with two key properties: (i) the objects of choice are money lotteries with more than two outcomes and (ii) the ranking of outcomes differs across lotteries. We first present an abstract model of risky choice that elucidates the identification problem and our strategy. The model has numerous applications, including insurance choices and gambling. We then consider the application of insurance deductible choices and illustrate our strategy using simulated data.

P305: Infectious risk perception and knowledge of medical dentists hygiene of the region Bizerte – Tunisia

The risk of infection control in dental health care settings must be an institutional priority, it is an ethical, moral and legal obligation to provide care in hygienic conditions so as to reduce the risk of infection in acts of dental care. The problem that arises in the Tunisian context is primarily a misperception of risk on the one hand, and non-compliance with standard and supplementary precautions.

Barriers to helmet use for drivers of all-terrain vehicles

BackgroundInjuries from all-terrain vehicles (ATV) often result in head injuries with substantial risk of death and disability. Despite these risks, helmet use is less than 50%.ObjectiveTo identify barriers to helmet...

Dementia worry: a psychological examination of an unexplored phenomenon.

According to recent surveys, dementia worry (DW) is a widespread phenomenon in mid-life and old age, at least in Western populations. DW has been shown to be only loosely related to sociodemographic factors. Unfortunately, the concept of DW has found only very little conceptual and empirical attention in previous research. In this conceptual review, we take (mostly) a psychological approach to DW. First, we define DW as an emotional response to the perceived threat of developing dementia. We then conceptualise DW as a hybrid, combining elements of ageing anxiety and health anxiety. On the population level, we argue that the high prevalence of DW may be reflective of the increasing awareness of dementia in times of increasing ''dementia encounters', widespread misperceptions of risks and consequences of dementia and a perceived lack of coping resources. Finally, we propose that DW may affect a range of important behaviours, such as how people interpret evidence of their own or others' age-related cognitive changes, how they interact with people with dementia, how they anticipate and plan for their future, how they engage in screening and prevention behaviours and how they exploit healthcare resources. We conclude with suggestions for future research, including a further in-depth investigation of psychological and micro-/macrosocial factors associated with DW.

Behavioral Economics and Environmental Policy

This article provides an interpretive survey on implications of insights from behavioral economics for environmental policy. In particular, it discusses whether, and if so how, policy implications based on conventional economic theory have to be modified when insights from behavioral economics are considered. More specifically, it discusses concerns for cooperation, fairness, self-image, social approval, and status. Moreover, it addresses potential crowding-out effects, context-dependent and incoherent preferences, risk misperceptions, ambiguity aversion, and regulator bias. We conclude that behavioral economics has a lot to offer environmental economics and that some normative policy recommendations have to be modified. Yet the most fundamental policy recommendations in environmental economics generally prevail and are sometimes even reinforced through behavioral economics insights.

Awareness and attitude of the general public toward HIV AIDS in coastal South India - a community based crossectional study

Background Acquired Immunodeficiency Syndrome (AIDS) is one of the most dreaded entities that modern medicine has ever had to tackle. Adult HIV prevalence in India is approximately 0.36%. HIV-related stigma and discrimination remains an enormous barrier to effectively fighting the HIV and AIDS epidemic, There are several reasons for the stigma toward PLWHA among the general population, one of them could be inaccurate information about the transmission of HIV; creating irrational behavior and misperceptions of personal risks.

Risk perception and effectiveness of uncoordinated behavioral responses in an emerging epidemic

Beyond control measures imposed by public authorities, human behavioral changes can be triggered by uncoordinated responses driven by the risk perception of an emerging epidemic. In order to account for spontaneous social distancing, a model based on an evolutionary game theory framework is here proposed. Behavioral changes are modeled through an imitation process in which the convenience of different behaviors depends on the perceived prevalence of infections. Effects of misperception of risk induced by partial or incorrect information concerning the state of the epidemic are considered as well. Our findings highlight that, if the perceived risk associated to an epidemic is sufficiently large, then even a small reduction in the number of potentially infectious contacts (as a response to the epidemic) can remarkably affect the infection spread. In particular, the earlier the warning about the epidemic appears, the larger the possible reduction of the peak prevalence, and of the final epidemic size. Moreover, the epidemic spread is delayed if individuals’ perception of risk is based on a memory mechanism and the risk of infection is initially overestimated. In conclusion, this analysis allows noteworthy inferences about the role of risk perception and the effectiveness of spontaneous behavioral changes during an emerging epidemic.

Misperceptions of HIV Risk Common Among MSM

Bathhouses have been a target of scrutiny in the U.S. since the dawn of the HIV epidemic among men who have sex with men (MSM). These commercial sex

Memory-induced misperceptions of going concern risk by experienced auditors in a multi-client environment

This study examines whether an audit evaluation of contextually similar evidence pertaining to a second client affects memory-induced perceptions of the initially evaluated client. Prior research suggests that the experienced auditors’ use of task-specific knowledge to process contextually similar evidence sets for two clients makes them susceptible to fragile memory associations between the evidence set and its source client. Fragile associations increase the auditors’ susceptibility to misattributing evidence to a client potentially resulting in improper audit assessments of the client. Auditors evaluated evidence for two similarly positioned companies with dissimilar operational weaknesses and then provided going concern risk perceptions of the client evaluated first. Risk perceptions related to the threat posed by negative trends that were either strongly or weakly connected with the first client’s condition. Strongly connected trends were perceived as less threatening after the evaluation of the second company, while weakly connected trends were perceived as more threatening.

CRIMINAL CHILD NEGLECT AND THE "FREE RANGE KID": IS OVERPROTECTIVE PARENTING THE NEW STANDARD OF CARE?

In the last generation, American parenting norms have shifted strongly in favor of Intensive Parenting, placing particular emphasis on protecting children from risks of harm. Recently, a backlash to this trend has emerged. “Free Range” parenting is based on the concern that coddling children through overprotection inhibits the development of their independence and responsibility. Indeed, a growing body of literature suggests that parental overreaction to remote and even illusory risks of physical harm is exposing children to far more serious risks to their well-being and development. But the powerful influence of media has sensationalized the risks to children, skewing popular perceptions of the genuine risks children face and of what constitutes a reasonable or appropriate response to such risks. Consequently, individuals who do not buy into Intensive Parenting norms, including those from different cultural and socio-economic backgrounds, may be subjecting themselves to criminal prosecution for child neglect and endangerment. The criminal statutes are, for the most part, very vague, leaving these prosecutions—which amount to little more than one person’s second-guessing the parenting choices of another—in the discretion of prosecutors, who bring the charges, and of juries, who render verdicts. If prosecutors and jurors share the media-fed misperceptions of risk, overprotective parenting becomes the de facto legal standard of care. To counter this possibility, it is necessary to define criminal child neglect with far greater specificity and to allow defendants to introduce expert testimony to put the actual risks to children, as well as the downside risk of the precautions themselves, in perspective. Absent such changes, fear of prosecution may effectively force parents to conform to the overprotective parenting norm, to the detriment of society, families, and the children themselves.

P4-10-04: Automated Breast Cancer Risk Assessment: Identifying High Risk Women in the Primary Care Setting.

Abstract Background: Despite the availability of risk assessment tools and risk-reducing interventions, high risk women are not routinely identified in clinical practice, and the few that are, rarely choose interventions — often due to misperception of risk. Identification of patients at risk needs to begin in the primary care setting, rather than the breast health specialty world. To accomplish this, we developed a web-based tool that provides automated risk assessment and personalized decision support designed for collaborative use between patients and clinicians in the primary care setting. We assessed the feasibility and efficacy of using this tool in a primary care clinic at an academic hospital to identify women at high. Methods: Women aged 40 to 65 years of age were recruited from a schedule of patients attending annual physicals at a primary care clinic in an academic hospital. Patients with a history of breast cancer, genetic testing, or chemoprevention education were excluded. Information used to assess breast cancer risk was gathered from medical record review and phone interviews when necessary. Risk assessment was performed on all patients using four risk assessment models (Gail, Claus, BRCAPRO, and BCSC Density). Patients were randomized to view the decision aid either before their appointment or with their PCP during their appointment. Prior to each visit, providers received a risk report that summarized patient risk and recommended referrals. Outcomes were gathered from surveys administered to patients before and after appointments, and to providers after appointments. Results: Over 4-months, 98 women were approached to reach the enrollment goal of 60 women (61%). 24/60 (40%) patients were identified to be high risk for breast cancer using standard high risk thresholds. 9/60 (15%) of patients fit criteria for referral to genetic counseling, while 15/60 (25%) fit the criteria for referral to a BC specialist. Out of the 24 patients who fit the referral criteria, 17 (71%) were referred to a high risk clinic by their PCPs. 9/17 (53%) patients followed through in scheduling the appointment within 4 months of the referral date. The PCPs’ perceptions of these patients’ risk was in line with the calculated risk for 21 (88%) of the patients. A discussion regarding breast cancer risk reduction occurred with 22/24 (92%) of these patients during the visit, while the PCPs chose to use the decision aid with only 13/24 (54%) of them. PCP chose to view the decision aid during the visit with more high risk patients than average risk patients (p=0.04). Use of the DA during the appointment did not alter provider satisfaction with visit. A majority of patients thought the DA was helpful in making a decision and would recommend it to women like them. Conclusions: Performing personalized risk assessment and use of the decision aid in the primary care setting was feasible and acceptable. These results suggest risk assessment alone may be enough to encourage a discussion about breast cancer risk reduction for some providers. This method of risk assessment and decision support holds promise in the effort to reduce the incidence and burden of breast cancer. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-10-04.

A game dynamic model for vaccine skeptics and vaccine believers: Measles as an example

Widespread avoidance of Measles–Mumps–Rubella vaccination (MMR), with a consequent increase in the incidence of major measles outbreaks, demonstrates that the effectiveness of vaccination programs can be thwarted by the public misperceptions of vaccine risk. By coupling game theory and epidemic models, we examine vaccination choice among populations stratified into two behavioral groups: vaccine skeptics and vaccine believers. The two behavioral groups are assumed to be heterogeneous with respect to their perceptions of vaccine and infection risks. We demonstrate that the pursuit of self-interest among vaccine skeptics often leads to vaccination levels that are suboptimal for a population, even if complete coverage is achieved among vaccine believers. The demand for measles vaccine across populations driven by individual self-interest was found to be more sensitive to the proportion of vaccine skeptics than to the extent to which vaccine skeptics misperceive the risk of vaccine. Furthermore, as the number of vaccine skeptics increases, the probability of infection among vaccine skeptics increases initially, but it decreases once the vaccine skeptics begin receiving the vaccination, if both behavioral groups are vaccinated according to individual self-interest. Our results show that the discrepancy between the coverages of measles vaccine that are driven by self-interest and those driven by population interest becomes larger when the cost of vaccination increases. This research illustrates the importance of public education on vaccine safety and infection risk in order to maintain vaccination levels that are sufficient to maintain herd immunity.

US City Managers' Perceptions of Disaster Risks: Consequences for Urban Emergency Management

Drawing on survey data collected from chief administrative officers (CAOs) from the largest US cities, this paper analyzes the role of CAO risk perception. Several major questions are asked. How valid are the perceptions of CAOs regarding the level of risks posed to their cities by natural disasters? Do differences in perceptions vary based upon how threatened CAOs say they feel? Do differences in management activities, public procedures, and political concerns result as a consequence of how threatened CAOs say they feel? Do perceptions of threat align with objective vulnerability characteristics? The findings show that there is misperception of risk among CAOs. Risk perceptions influence perceptions as well as management activities, public procedures, and political concerns.

“Cherry picking” in subprime mortgage securitizations: Which subprime mortgage loans were sold by depository institutions prior to the crisis of 2007?

Depository institutions may utilize securitization to “cherry pick,” meaning to transfer risk to investors along dimensions that the investors tend to disregard or misperceive. Using Home Mortgage Disclosure Act data merged with data on subprime loan delinquency by ZIP code, this paper examines sale of “high cost” mortgages by depository institutions during the subprime lending boom of 2005 and 2006. We find that the likelihood of sale increases with risk along dimensions viewed as indicative of cherry picking; for instance, it is positively associated with future, subprime delinquency rates across neighborhoods. In contrast, along the dimension of mutually observed and priced risk as represented by APR spread, likelihood of sale decreases with risk. Thus, the paper reinforces the view, increasingly prevalent in the literature, that inattention to or misperception of risk by the securitization market played a significant role in the subprime lending boom and subsequent market collapse.

Misperception of MRI risk in pregnancy

Misperception of MRI risk in pregnancy

Misperceptions of climate-change risk as barriers to climate-change adaptation: a case study from the Rewa Delta, Fiji

While increasing research is focusing on the effective adaptation to climate change in richer (developed) countries, comparatively little has focused specifically on this subject in poorer (developing) countries such as most in the Pacific Islands region. A significant barrier to the development of effective and sustainable adaptive strategies for climate change in such places is the gap between risk and perceived risk. This study looks at a vulnerable location in Fiji—the densely populated Rewa River Delta where environmental changes resulting from shoreline retreat and floods are expected to increase over the next few decades and entail profound societal disruption. The numbers of people living in the Rewa Delta who know of climate change and could correctly identify its contributory causes are few although many rank its current manifestations (floods, riverbank erosion, groundwater salinization) as among their most serious environmental challenges. While lack of awareness is a barrier to adaptation, there are also cultural impediments to this such as short-term planning perspectives, spiritual beliefs, traditional governance structures. One way forward is to empower community leaders in places like the Rewa Delta to make appropriate decisions and for regional governments to continue working together to find solutions that acknowledge the variation in sub-regional trans-national vulnerability to climate change.