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Society For Risk Analysis Annual Meeting 2009

Risk Analysis: The Evolution of a Science

Session Schedule & Abstracts

* Disclaimer: All presentations represent the views of the authors, and not the organizations that support their research. Please apply the standard disclaimer that any opinions, findings, and conclusions or recommendations in abstracts, posters, and presentations at the meeting are those of the authors and do not necessarily reflect the views of any other organization or agency. Meeting attendees and authors should be aware that this disclaimer is intended to apply to all abstracts contained in this document. Authors who wish to emphasize this disclaimer should do so in their presentation or poster. In an effort to make the abstracts as concise as possible and easy for meeting participants to read, the abstracts have been formatted such that they exclude references to papers, affiliations, and/or funding sources. Authors who wish to provide attendees with this information should do so in their presentation or poster.

Common abbreviations

Poster Platform: Risk Communication and Health Sponsored by RCSG

Room: Salon E   10:30 AM-Noon

Chair(s): Ragnar Lofstedt

M2-D.1  10:30  Comparing clinical trial enrollment decisions of cancer patients and prospective healthy volunteers – thoughts, feelings, or social influence? YANG JZ*, McComas KA, Gay G, Leonard JP, Dannenberg AJ, Dillon H; SUNY Buffalo (1), Cornell University (2-6)

Abstract: With data from two comparable samples of healthy respondents and cancer patients and their caregivers, we examined a theoretical proposition that links the Theory of Planned Behavior together with a Risk Information Seeking and Processing model. By recognizing that clinical trial participation poses certain risks even though individual may benefit from the treatment, we view clinical trial participation as a proxy for risk. In testing this theoretical linkage, we explored the relative impacts of risk information processing strategies, emotional reactions to potential risks involved in clinical trials, and normative beliefs on individuals’ attitudes and behavioral intentions related to clinical trial participation. Our results indicated that optimistic feelings toward clinical trial participation, normative beliefs and systematic processing of risk information had stronger total effects on healthy respondents’ positive attitudes toward clinical trial participation. Normative beliefs and systematic processing also had stronger total effects on healthy respondents’ behavioral intentions toward clinical trial participation. However, both positive and negative emotions had stronger influences on cancer patients’ and their caregivers’ intentions to participate in clinical trials. Positive attitudes also had greater total effects on cancer patients’ and their caregivers’ behavioral intentions. No significant difference emerged from the two samples in the relationships between heuristic processing and behavioral intentions. These results suggest that communication efforts focused on improving clinical trial enrollment should balance among providing information, using emotional appeals, and stressing social norms in order to achieve attitudinal and behavioral change in more effective ways.

M2-D.2  10:30  Seeking and Processing Information about Influenza Vaccination: A Study of Healthcare Workers. Clarke C*, McComas K; Cornell University

Abstract: In the U.S. and elsewhere, low influenza vaccination rates among healthcare workers (HCWs) represent an important public health challenge. Although health officials have worked to understand facilitators and barriers to uptake and implement persuasive communication campaigns, little is known about how and why providers search for and attend to information about this issue, how these communication behaviors influence vaccine-related beliefs, attitudes, and behaviors, and how officials can develop better risk communication strategies based on these insights. To shed more light on these areas, this research applies concepts from a model of risk information seeking and processing (RISP) to explore how HCWs at a major urban hospital seek and engage with vaccine information. Concepts include need for information, social pressure to remain informed, beliefs about information channels, personal capacity to learn, intention to seek information, and seeking attitudes. It also explores the role of source credibility and perceived information relevance as model extensions. Theoretical and practical implications of this research – in terms of applying the RISP model to a previously-unexplored health behavior and suggesting strategies for more effective vaccine-related communication - are discussed.

M2-D.3  10:30  An Expert Model of influences on recruitment and retention of women into pregnancy registries. Thorne S.L.*, Cummins S., Eggers S.L., Butte G.; Decision Partners

Abstract: A pregnancy exposure registry is an important risk management tool for providing evidence needed to support adequate medical treatment of women during pregnancy. A critical component to the quality of information generated through such registries is adequate participation by pregnant women and their healthcare providers (HCPs). Developing strategies to optimize registry participation requires a clear understanding of the complex system of influences on recruitment and retention in such registries, including the influences on potential registry participants’ decisions to seek information and participate. We adopted an expert model/mental models method to identify and compare experts’, HCPs’, and women’s perceptions of pregnancy registries and the influences on the decisions of HPCs and women to participate in them. As a first step, we conducted a literature review, expert interviews, and panel workshops to a) assess current processes for recruitment and retention, b) identify key issues, and c) develop hypotheses of influences on women’s and HCPs’ decision making. This knowledge was integrated into an Expert Model of Influences on the Quality of Recruitment and Retention of Women into Pregnancy Registries. Among the key findings were the revealed differences among experts’ understanding of the role and intended benefits of registries, and the wide variation in current communications and processes for recruitment and retention targeted to women and HCPs related to registries. The expert model will serve to guide the design and analysis of comparative empirical research (mental models) with women and HCPs, and will ultimately support improving registry design and communications strategies.

M2-D.4  10:30  Mental models research into healthcare providers' treatment decisions for preganant and nursing women. Eggers S.*, Ostrove N., Buck E., Dirolf K., Thorne S.; Decision Partners, LLc.

Abstract: We employed an expert model/mental models research method to better understand a) the complexity of healthcare providers' (HCPs') treatment decisions for pregnant or nursing women with chronic conditions; b) how they counsel women about prescription drug use during pregnancy and nursing; and c) how they use FDA-approved prescribing information to support those decisions. We conducted 54 in-depth, semi-structured telephone interviews with HCPs, consisting of nurse/midwives, primary care providers, obstetricians/gynecologists and specialists. The coded and analyzed interview results were used to support the development of aggregate mental models diagrams illustrating the primary influences on respondents' treatment decisions. The key findings of the research reveal a) the complexity of treatment decisions requiring HCPs to weigh the risks, benefits and tradeoffs based on a number of factors and contingencies; b) the role of team-based health care and shared decision making with patients; c) the primary sources of information HCPs rely on to support decisions; and d) the opportunities to improve HCPs’ confidence in their decisions through improved communications. The findings also suggest potential key differences among the mental models of different types of HCPs. The results of this project and subsequent work can be used to support the development of communications to facilitate improved decision making by HCPs and their patients and, ultimately, improve public health.

M2-D.6  10:30  One Less: Television advertising and awareness of HPV risk among young women. Grantham S*, Connolly-Ahern C, Ahern L; University of Hartford, Penn State

Abstract: Physicians have long been the primary source of information about prescription drugs in the United States. Patients rely on the physician’s expertise and diagnostic abilities when determining the best course of treatment for whatever ails them. In the 1990s pharmaceutical companies altered the doctor/patient landscape by marketing information directly to consumers through product claim ads, or ads that include the product name and its use or claim of benefit. Marketers maintain that the ads educate consumers, create awareness about their product lines and treatment options, and increase sales. Hundreds of pharmaceutical products have been advertised on the television, the radio, the internet and in magazines and newspapers. Direct-to-consumer pharmaceutical advertising has addressed specific ailments (diabetes, chronic indigestion), and gender-specific issues when relevant (erectile dysfunction, birth control). However, it was not until 2006 when Merck introduced Gardasil through its One Less campaign highlighting the protection against the transmission of HPV and resulting minimization of risk to cervical cancer, that a pharmaceutical company specifically focused its direct-to-consumer marketing toward both young adult females and minor females. The purpose of this study was to determine how young women (current age 18-25) learned about Gardasil, how effectively the campaign dealt with various perceptions of risk from HPV and cervical cancer, and how much of an impact the One Less campaign had on the patient’s decision to receive or decline the Gardasil vaccines. Results indicate that the vast majority of participants learned about Gardasil from television advertising. Additionally, the participants felt that the campaign effectively addressed the control and empowerment dimensions of the risk associated with HPV and cervical cancer. While the campaign raised awareness about these issues, physicians remained the primary source of influence when the young women chose to receive or decline the vaccine series.

M2-D.7  10:30  Learning about controversial health technologies through a risk communication experiment: the case of pre-implantation genetic diagnosis. Longstaff H*; The University of British Columbia

Abstract: Pre-implantation genetic diagnosis (PGD) is the process of screening fertilized human embryos during in vitro fertilization (IVF). In Canada, the process is typically used to screen embryos for chromosomal abnormalities or specific genetic conditions or select embryos that are tissue matches for sick siblings. Using PGD for non medical purposes such as sex or hair colour selection is frequently viewed as controversial due to obvious eugenic inferences. The research study discussed here included three phases: (1) interviews with a heterogeneous collection of experts to determine the risks and benefits that PGD may pose to individuals, groups, and society; (2) mental model interviews with lay citizens to determine shared misconceptions and background knowledge of PGD; (3) and a series of risk communication experimental workshops with lay citizens informed by phase 1 and 2 findings. The results of this study demonstrate that the mental models approach is effective not only for communicating the risks and benefits of familiar hazards but also for novel hazards that are virtually unknown to most citizens. In this case, the approach helped to expose relevant pre-existing knowledge regarding IVF that could be supplemented, thereby optimizing the efficiency of the risk communication experimental workshop. The workshop was also successful in teaching a range of cognitive information about a virtually unknown hazard. Most participants agreed that it was sensible for risk communicators to rely on a collaborative process like this one when determining risk communication strategies for PGD. Study results also demonstrate that lay citizens with virtually no background knowledge can ultimately be encouraged to produce holistic, inclusive, and thus more ethical decisions about PGD. Findings from the risk communication workshops contribute empirical evidence to the body of knowledge surrounding public involvement efforts.

M2-D.9  10:30  Risk perception, trust and the willingness to register as a potential organ donor in an electronic database. Kuttschreuter M.*; University of Twente, Enschede, the Netherlands

Abstract: The demand for human donor organs is greater than the supply, resulting in long waiting lists and preventable deaths. To solve this shortage, governments have developed policies to enlarge the number of available donor organs. One such initiative is a national database registering whether or not an individual is willing to donate his organs after death. In the Netherlands, the results of this strategy are disappointing as only part of the public proved to be willing to register their wishes. The public’s distrust of the government's capabilities to adequately design and manage this database might possibly explain this phenomenon, as the government’s design and management of similar projects involving electronic data storage and transfer has been severely criticized. To investigate this, a survey was performed among Dutch citizens (n=134). Based on the risk perception literature and the Technology Acceptance Model, subjects were questioned regarding their donor registration behaviour, perceived usefulness of the register, perceived ease of use, trust in the governmental management capabilities of the database, trust in governmental integrity related to organ donation, perceived likelihood and perceived severity of personal data becoming public, and feelings of self-esteem related to registration. Preliminary results showed that 49% of the subjects had registered as a potential donor. Most subjects considered donor registration to be useful, regarded registration to be easy although emotionally tough, and took the risk of personal data becoming public seriously. Donor registration was found to be significantly related to perceived usefulness, perceived ease of use, perceived likelihood of personal data becoming public and trust in governmental integrity related to organ donation. Results will be compared to findings on risk perception and trust related to e-government, and consequences for risk communication will be discussed.

M2-D.10  10:30  Drug market initiative. Rivers L.*; Michigan State University

Abstract: Open air drug markets have exacted a heavy toll on poor and minority neighborhoods by exacerbating the breakdown in community social control characterized by disorder, crime, and fear of crime. As drug dealers exert control over public space, residents withdraw and the overall community condition deteriorates. At the same time, four decades of punitive drug enforcement has resulted in cycles of enforcement that result in large numbers of young dealers being incarcerated only to be replaced by a new group of young people drawn to the economic rewards of drug sales. The Drug Market Initiative (DMI) is an innovative intervention for closing down open air drug markets that at its core focuses on the police developing, or in many cases repairing, their relationship with affected communities. Effective implementation of the DMI relies on the participation of four linked stakeholder groups: the police, the local community, offenders and local social service providers. Of particular interest is the perception of each group of the intervention, their role in the intervention and how the DMI affects themselves and their community. This research project examines these concerns using a modified mental models approach. Mental models also allow for the comparison of expert knowledge versus layperson knowledge. The DMI presents an interesting mental models study in so far that the label of expert and laymen is very fluid depending on context. For example, the police are experts in enforcement matters but may be considered laymen in neighborhood matters where local community members could be considered experts.

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