Predictive Genetic Testing for Alzheimer''s Disease: Impact upon Risk Perception

The aim of this study was to determine the impact on risk perceptions of disclosing genetic test results used to estimate the risk of Alzheimer's disease (AD). Adult children (n = 149) of people with AD were randomized to one of two groups--Intervention group: lifetime risk estimates of AD based on age, gender, family history, and Apolipoprotein E (APOE) genotype; Control group: lifetime risk estimates of AD based on the same risk factors excluding APOE genotype. Perceptions of personal risk (PPR) for AD were assessed six weeks after risk assessments. PPR were correlated with actual lifetime risk estimates (r = 0.501; p < 0.0001). After controlling for lifetime risks communicated to participants, age, and number of affected relatives, PPR scores among those with an epsilon4-positive test result (the test result associated with increased AD susceptibility) (adjusted mean: 3.4 (SD: 0.7)) were not different from the PPR scores in the Control group (adjusted mean: 3.4 (SD: 0.7) (F1,91= 1.98; p = 0.162). Again, controlling for lifetime risk estimates, age, and number of affected relatives, the PPR score of those receiving an epsilon4-negative test result was significantly lower (adjusted mean: 3.1 (SD: 0.8)) than those in the Control group (adjusted mean: 3.4 (SD: 0.7) (F1,95 = 6.23; p = 0.014). Perceptions of risk of developing AD are influenced by genetic test disclosure in those receiving epsilon4-negative, but not those receiving epsilon4-positive test results. Despite the reduced perceptions of risk in the former group, there was no evidence of false reassurance (i.e., perceiving risks as equal to or lower than population risks of AD), although this possibility should be assessed in other testing contexts.     

The Dynamics of Risk Perception: How Does Perceived Risk Respond to Risk Events?

This paper examines the relationship between perceived risk and experience. This research addresses the processes by which people learn about risk and choose among real life prospects with associated uncertainties, risks and benefits. By comparing the impact of acute risk events with that of chronic risk events on public perception of risk during and after the events, this research focuses on the learning processes that characterize what kinds of risk events alter the perception of risk. Comparing materialized hazards at existing facilities with the risks associated with potential facilities, this research addresses risk choices among real life prospects. This study uses a classic pre-post quasi-experimental design. Surveys conducted in the Spring of 1992 on perceived and acceptable risk in Odessa and La Porte, Texas were conducted prior to risk events. Respondents from that survey were re-interviewed in the Spring of 1993 after the risk events to form a panel design. This paper analyzes the affect of risk events on perceived risk and the implications of these experiences for public policy concerning technological risk. The empirical results suggest that the social processes that construct and maintain risk in the public eye are at least as important as, if not more important than, the physical and psychological dimensions of risk.     

Do Reports on Drinking Water Quality Affect Customers' Concerns? Experiments in Report Content

The Safe Drinking Water Act Amendments of 1996 required U.S. utilities to report on drinking water quality to their customers annually, beginning in fall 1999, on the assumption that such reports would alert them to quality problems and perhaps mobilize pressure for improvement. A random sample of New Jersey customers read alternative versions of a water quality report, in an experiment on reactions to water quality information under U.S. Environmental Protection Agency (USEPA) rules. Experiment design was 2 x 3 + 1: two versions each--one with, one without, a violation of a health standard--of a report that was (1) Qualitative (without water quality numbers, thus not meeting USEPA rules); (2) Basic, with minimal information meeting the rules; or (3) Extended, adding reading aids and utility performance information; plus a control instrument without any hypothetical report. Results of ANOVA suggest the reports will have less effect than hoped or feared. These manipulations were successful: people reading the Qualitative versions were less likely to say that the report gave the amounts of substances found in the water, and those reading Violation versions were more likely to report a violation of a health standard. The main differences in responses to the report involved the judged adequacy of the information, and to a lesser extent responses on a Concern scale (constructed from measures of concern, judged risk, clean-up intentions, distrust of utility information, and doubt that the utility was doing all it could to improve water quality). Overall judgments of water quality and utility performance did not change, either relative to the controls or in before versus after responses. Qualitative reports performed worse than others, confirming the decision to have utilities report actual contaminant levels. Extended reports did only slightly better than the Basic versions on these measures. Many respondents had trouble identifying the presence or absence of substance amounts or violations, despite their seeming obviousness (e.g., in a \"bottom line\" summary on the front page of each report), suggesting many were not processing this information carefully. However, the pattern of responses for those who accurately identified the presence or absence of substance amounts or violations did not differ substantially from that for the group as a whole. Generic risk beliefs (serious local environmental problems; lack of control over risks to one's health) dominated demographic variables, attitudes toward utility water quality or trustworthiness, and the content and format of water quality reports in influencing concern about drinking water quality. Previous empirical and theoretical evidence for lack of change in public risk attitudes due to one-time or infrequent communications--e.g., role of personal experience, perseverance of prior trust or distrust--seems to be confirmed for annual water quality reports.     

What Do We Know About Making Risk Comparisons?

The risks of unfamiliar technologies are often evaluated by comparing them with the risks of more familiar ones. Such risk comparisons have been criticized for neglecting critical dimensions of risky decisions. In a guide written for the Chemical Manufacturers Association, Covello et al. (¹) have summarized these critiques and developed a taxonomy that characterizes possible risk comparisons in terms of their acceptability (or objectionableness). We asked four diverse groups of subjects to judge the acceptability of 14 statements produced by Covello et al. as examples of their categories. We found no correlation between the judgments of acceptability produced by our subjects and those predicted by Covello et al. .     

Risk-Perception Studies and Policy Priorities

The current fascination with risk acceptability, risk benefit analysis and other devices for relating risk to social gain is a manifestation of the loss of faith amongst certain groups in modern western society with the honesty and competence of those who assess and finally make judgements about public safety. The problem lies as much in a suspicion over the motives of leading personalities and the fidelity of assessment procedures as it does with the collective psychology of individual beliefs and judgements. "Real world" studies involving carefully sampled households monitored over a period of time may well reveal better information on the complexities of risk cognition and evaluation than laboratory investigation of the views of individuals responding in isolation.     

Trust,Emotion, Sex,Politics, and Science: Surveying the Risk-Assessment Battlefield

Risk management has become increasingly politicized and contentious. Polarized views, controversy, and conflict have become pervasive. Research has begun to provide a new perspective on this problem by demonstrating the complexity of the concept risk and the inadequacies of the traditional view of risk assessment as a purely scientific enterprise. This paper argues that danger is real, but risk is socially constructed. Risk assessment is inherently subjective and represents a blending of science and judgment with important psychological, social, cultural, and political factors. In addition, our social and democratic institutions, remarkable as they are in many respects, breed distrust in the risk arena. Whoever controls the definition of risk controls the rational solution to the problem at hand. If risk is defined one way, then one option will rise to the top as the most cost-effective or the safest or the best. If it is defined another way, perhaps incorporating qualitative characteristics and other contextual factors, one will likely get a different ordering of action solutions. Defining risk is thus an exercise in power. Scientific literacy and public education are important, but they are not central to risk controversies. The public is not irrational. Their judgments about risk are influenced by emotion and affect in a way that is both simple and sophisticated. The same holds true for scientists. Public views are also influenced by worldviews, ideologies, and values; so are scientists' views, particularly when they are working at the limits of their expertise. The limitations of risk science, the importance and difficulty of maintaining trust, and the complex, sociopolitical nature of risk point to the need for a new approach—one that focuses upon introducing more public participation into both risk assessment and risk decision making in order to make the decision process more democratic, improve the relevance and quality of technical analysis, and increase the legitimacy and public acceptance of the resulting decisions.