Too Scared or Too Capable? Why Do College Students Stay Away from the H1N1 Vaccine?

Although college students were among the populations that had the highest frequency of infection for H1N1 influenza, only 8% of them received H1N1 vaccine this past flu season nationwide. During the peak of this pandemic, information about H1N1 vaccine was widely available. However, knowledge test and behavioral data indicated that most college students were not equipped with basic facts about H1N1 and the H1N1 vaccine. To investigate socio‐psychological factors that might have deterred this high‐risk population from learning about and getting the H1N1 vaccine, this study tested the utility of a risk information seeking model in addressing this health communication problem. Data collected from an online survey of 371 college students showed that respondents seemed to overestimate how much they knew about the vaccine. Risk information seeking, however, positively influenced their intentions to get the vaccine. Results suggested that to communicate effectively to this population, it is important to emphasize the difference between perceived knowledge and actual knowledge, monitor emotional responses to potential risks, and promote getting flu vaccination as a socially desirable behavior.     

Intentions to Seek Information About the Influenza Vaccine: The Role of Informational Subjective Norms,Anticipated and Experienced Affect,and Information Insufficiency Among Vaccinated and Unvaccinated People

When deciding whether to vaccinate, people often seek information through consequential processes that are not currently well understood. A survey of a nationally representative sample of U.S. adults (N = 2,091) explored the factors associated with intentions to seek influenza vaccine information in the 2018–2019 influenza season. This survey shed light on what motivates intentions to seek information about the influenza vaccine through the lens of the risk information seeking and processing (RISP) model. The model explained information-seeking intentions well among both unvaccinated and vaccinated respondents. Key findings show that informational subjective norms, information insufficiency, and different types of affect are strong predictors of information-seeking intentions. Theoretical insights on extending the RISP model and practical guidance on designing interventions are provided.     

The Role of Risk Perception in Flu Vaccine Behavior among African‐American and White Adults in the United States

Seasonal flu vaccination rates are low for U.S. adults, with significant disparities between African and white Americans. Risk perception is a significant predictor of vaccine behavior but the research on this construct has been flawed. This study addressed critical research questions to understand the differences between African and white Americans in the role of risk perception in flu vaccine behavior: (1) What is the dimensionality of risk perception and does it differ between the two races?  (2) Were risk perceptions of white and African‐American populations different and how were sociodemographic characteristics related to risk for each group? (3) What is the relation between risk perception and flu vaccine behaviors for African Americans and whites? The sample, drawn from GfK's Knowledge Panel, consisted of 838 whites and 819 African Americans. The survey instrument was developed from qualitative research. Measures of risk perception included cognitive and emotional measures of disease risk and risk of side effects from the vaccine. The online survey was conducted in March 2015. Results showed the importance of risk perception in the vaccine decision‐making process for both racial groups. As expected, those who got the vaccine reported higher disease risk than those who did not. Separate cognitive and emotional factors did not materialize in this study but strong evidence was found to support the importance of considering disease risk as well as risk of the vaccine. There were significant racial differences in the way risk perception predicted behavior.     

Development and validation of the Legitimate Monitoring and Control Questionnaire (LMCQ)

In this paper, we present the multidimensional Legitimate Monitoring and Control Questionnaire (LMCQ), which is based on social-exchange and institutional theory. Our aim was to develop and validate a widely applicable leadership inventory that accounts for comparable criterion variance as transformational leadership. While transformational leadership scales emphasize charismatic or visionary behavior, the basis for the LMCQ is the belief that perceptions of control legitimacy are essential and lead to high-quality social-exchange relationships between supervisors and subordinates. To build the dimensions comprising the LMCQ, an exploratory study (study 1, 38 respondents) was conducted to investigate which kinds of socioemotional benefits actually drive subordinates' perceptions of control legitimacy. The interview data were used to compile an initial item pool that was condensed as a subsequent step (study 2, 494 respondents). Lastly, the resulting measurement instrument representing six dimensions of legitimacy-enhancing supervisory behavior was validated (study 3, 936 respondents).     

Recollection Bias and Its Underpinnings: Lessons from Terrorism Risk Assessments

Recollection bias is the phenomenon whereby people who observe a highly unexpected event hold current risk beliefs about a similar event that are no higher than their recollection of their prior beliefs. This article replicates and extends the authors’ previous study of recollection bias in relation to individuals’ perceptions of the risks of terrorism attacks. Over 60% of respondents in a national U.S. sample of over 900 adults believe that the current risk of a future terrorist attack by either an airplane or in a public setting is no higher than they recall having believed, respectively, before the 9/11 attack and before the Boston Marathon bombing. By contrast, a rational Bayesian model would update to a higher currently assessed risk of these previously uncontemplated events. Recollection bias is a persistent trait: individuals who exhibited this bias for the 9/11 attack exhibited it for the Boston Marathon bombing. Only one‐fifth of respondents are free of any type of recollection bias. Recollection bias is negatively correlated with absolute levels of risk belief. Recollection bias in relation to highly unexpected terrorist events—the belief that perceived risks did not increase after the surprise occurrence—dampens support for a variety of anti‐terrorism measures, controlling for the level of risk beliefs and demographic factors. Persistent recollection bias for both 9/11 and the Boston Marathon bombing is especially influential in diminishing support for protective policy measures, such as surveillance cameras in public places. Given that public attitudes influence policy, educating the public about risk is critical.     

Diminishing Willingness to Pay per Quality‐Adjusted Life Year: Valuing Acute Foodborne Illness

We design and conduct a stated‐preference survey to estimate willingness to pay (WTP) to reduce foodborne risk of acute illness and to test whether WTP is proportional to the corresponding gain in expected quality‐adjusted life years (QALYs). If QALYs measure utility for health, then economic theory requires WTP to be nearly proportional to changes in both health quality and duration of illness and WTP could be estimated by multiplying the expected change in QALYs by an appropriate monetary value. WTP is elicited using double‐bounded, dichotomous‐choice questions in which respondents (randomly selected from the U.S. general adult population, n = 2,858) decide whether to purchase a more expensive food to reduce the risk of foodborne illness. Health risks vary by baseline probability of illness, reduction in probability, duration and severity of illness, and conditional probability of mortality. The expected gain in QALYs is calculated using respondent‐assessed decrements in health‐related quality of life if ill combined with the duration of illness and reduction in probability specified in the survey. We find sharply diminishing marginal WTP for severity and duration of illness prevented. Our results suggest that individuals do not have a constant rate of WTP per QALY, which implies that WTP cannot be accurately estimated by multiplying the change in QALYs by an appropriate monetary value.     

It's Complicated: The 2014–2015 U.S. Measles Outbreak and Parents’ Vaccination Beliefs,Confidence, and Intentions

While it seems intuitive that highly visible vaccine‐preventable disease outbreaks should impact perceptions of disease risk and facilitate vaccination, few empirical studies exist to confirm or dispel these beliefs. This study investigates the impact of the 2014–2015 Disneyland measles outbreak on parents’ vaccination attitudes and future vaccination intentions. The analysis relies on a pair of public opinion surveys of American parents with at least one child under the age of six (N = 1,000 across each survey). Controlling for basic demographics, we found higher levels of reported confidence in the safety and efficacy of childhood vaccinations in our follow‐up data collection. However, this confidence was also accompanied by elevated levels of concern toward childhood vaccines among American parents. We then examined how different subgroups in the population scored on these measures before and after the outbreak. We found that parents with high levels of interest in the topic of vaccines and a child who is not fully upto date with the recommended vaccination schedule reported more supportive attitudes toward vaccines. However, future intentions to follow the recommended vaccination schedule were not positively impacted by the outbreak. Possible explanations for these results and implications for vaccination outreach are discussed.     

Reliability but not bias: Developing a scale to measure preferred channels for risk information during the COVID pandemic

To develop a new measure of preferred sources for risk information, two studies asked respondents to indicate what channels they were reliant on for information about COVID-19, from 25 news channels ranging across the political spectrum. Unexpectedly, dependencies clustered around level of reliability rather than the political orientation of the news channel. In other words, each cluster included media channels from both the left and right side of the political spectrum, while dependencies clustered into sources that varied by the degree to which their content is reliable. Participants who turned to lower reliability channels indicated lower risk perceptions, less accurate probability estimations, reduced vaccination intentions, and lower protective behavioral intentions. Those inclined to use higher reliability channels indicated higher risk perceptions, more accurate probability estimations, increased vaccination intentions, and higher protective behavioral intentions. These relationships are discussed in terms of implications for our understanding of source reliance and risk perception, information sufficiency, and implications for both future research and public health interventions.     

Annual Burden of Occupationally‐Acquired Influenza Infections in Hospitals and Emergency Departments in the United States

Infections among health‐care personnel (HCP) occur as a result of providing care to patients with infectious diseases, but surveillance is limited to a few diseases. The objective of this study is to determine the annual number of influenza infections acquired by HCP as a result of occupational exposures to influenza patients in hospitals and emergency departments (EDs) in the United States. A risk analysis approach was taken. A compartmental model was used to estimate the influenza dose received in a single exposure, and a dose–response function applied to calculate the probability of infection. A three‐step algorithm tabulated the total number of influenza infections based on: the total number of occupational exposures (tabulated in previous work), the total number of HCP with occupational exposures, and the probability of infection in an occupational exposure. Estimated influenza infections were highly dependent upon the dose–response function. Given current compliance with infection control precautions, we estimated 151,300 and 34,150 influenza infections annually with two dose–response functions (annual incidence proportions of 9.3% and 2.1%, respectively). Greater reductions in infectious were achieved by full compliance with vaccination and IC precautions than with patient isolation. The burden of occupationally‐acquired influenza among HCP in hospitals and EDs in the United States is not trivial, and can be reduced through improved compliance with vaccination and preventive measures, including engineering and administrative controls.     

Discount Rates in Risk Versus Money and Money Versus Money Tradeoffs

We use data from a survey of residents of five Italian cities conducted in late spring 2004 to estimate the discount rates implicit in (1) money versus future risk reductions and (2) money versus money tradeoffs. We find that the mean personal discount rate is 0.3-1.7% in (1) and 8.7% in (2). The latter is lower than the discount rates estimated in comparable situations in many recent studies, greater than market interest rates in Italy at the time, and exhibits modest variation with age and gender. The discount rate implicit in money versus risk tradeoffs is within the range of estimates from studies in the United States and Europe, and does not depend on observable individual characteristics. We use split samples to investigate whether a completely abstract risk reduction - one where the risk reduction delivery has been stripped of all specifics, so that respondents should focus on the risks without being distracted by details - results in WTP and discount figures comparable to those from an identified delivery mechanism (a medical test). We find that while WTP for an immediate risk reduction is 42-73% higher with the abstract risk reduction, the discount rate in the money versus risk tradeoffs and the variance of the error term in the WTP equation are the same across the two variants of the questionnaire.     

Psychometric and Demographic Predictors of the Perceived Risk of Terrorist Threats and the Willingness to Pay for Terrorism Risk Management Programs

A 2009 national telephone survey of 924 U.S. adults assessed perceptions of terrorism and homeland security issues. Respondents rated severity of effects, level of understanding, number affected, and likelihood of four terrorist threats: poisoned water supply; explosion of a small nuclear device in a major U.S. city; an airplane attack similar to 9/11; and explosion of a bomb in a building, train, subway, or highway. Respondents rated perceived risk and willingness to pay (WTP) for dealing with each threat. Demographic, attitudinal, and party affiliation data were collected. Respondents rated bomb as highest in perceived risk but gave the highest WTP ratings to nuclear device. For both perceived risk and WTP, psychometric variables were far stronger predictors than were demographic ones. OLS regression analyses using both types of variables to predict perceived risk found only two significant demographic predictors for any threat—Democrat (a negative predictor for bomb) and white male (a significant positive predictor for airline attack). In contrast, among psychometric variables, severity, number affected, and likelihood were predictors of all four threats and level of understanding was a predictor for one. For WTP, education was a negative predictor for three threats; no other demographic variables were significant predictors for any threat. Among psychometric variables, perceived risk and number affected were positive predictors of WTP for all four threats; severity and likelihood were predictors for three; level of understanding was a significant predictor for two.     

Weighing the Risks of Nuclear Energy and Climate Change: Trust in Different Information Sources,Perceived Risks,and Willingness to Pay for Alternatives to Nuclear Power

We examined how individuals perceive nuclear energy in the context of climate change mitigation and how their perceptions are associated with trust in different risk information sources. We analyzed the interrelationships between trust, perceived risk of nuclear power, climate change concern, perception of nuclear energy as an acceptable way to mitigate climate change, and willingness to pay (WTP) for alternatives to nuclear power. A nationwide survey (N = 967) collected in Finland was analyzed with structural equation modeling. The associations between trust and perceived risk of nuclear power, climate change concern, and perception of nuclear power as a way to mitigate climate change varied by the type of information source. Political party support and other background variables were associated with trust in different information sources. The effect of trust in information sources on WTP was mediated by perceived risks and benefits. The results will increase our understanding of how individuals perceive nuclear energy as a way to cut CO₂ emissions and the role of trust in different information sources in shaping nuclear risk perceptions and energy choices.     

Do People Actually Pursue Risk Elimination in Environmental Risk Management?

This study examines whether people pursue the total elimination of environmental risks even if the risk reduction occurs incrementally and requires steadily increasing amounts of money to achieve. Participants' willingness to pay (WTP) was measured for various levels of reduction in the risk of cancer caused by dioxin. Results showed that: (1) people were willing to pay more for an initial reduction in risk than for subsequent reductions, (2) the WTP for the final risk decrement-which achieved total risk elimination-was higher than the WTP for either of the two previous decrements but barely half of that for the first reduction, and (3) the manner in which the questions were framed did not affect participants' responses. These results suggest that the public will not always try to pursue perfect safety at the cost of a large sum of money, but rather may seek a decreasing expenditure as the risk level is reduced.     

Discrimination, Vulnerability, and Justice in the Face of Risk

Recent research finds that perceived risk is closely associated with race and gender. In surveys of the American public a subset of white males stand out for their uniformly low perceptions of environmental health risks, while most nonwhite and nonmale respondents reveal higher perceived risk. Such findings have been attributed to the advantageous position of white males in American social life. This article explores the linked possibility that this demographic pattern is driven not simply by the social advantages or disadvantages embodied in race or gender, but by the subjective experience of vulnerability and by sociopolitical evaluations pertaining to environmental injustice. Indices of environmental injustice and social vulnerability were developed as part of a U.S. National Risk Survey (n= 1,192) in order to examine their effect on perceived risk. It was found that those who regarded themselves as vulnerable and supported belief statements consistent with the environmental justice thesis offered higher risk ratings across a range of hazards. Multivariate analysis indicates that our measures of vulnerability and environmental injustice predict perceived risk but do not account for all of the effects of race and gender. The article closes with a discussion of the implications of these findings for further work on vulnerability and risk, risk communication, and risk management practices generally.     

Risk Communication,Values Clarification,and Vaccination Decisions

Many health‐related decisions require choosing between two options, each with risks and benefits. When presented with such tradeoffs, people often make choices that fail to align with scientific evidence or with their own values. This study tested whether risk communication and values clarification methods could help parents and guardians make evidence‐based, values‐congruent decisions about children's influenza vaccinations. In 2013–2014 we conducted an online 2×2 factorial experiment in which a diverse sample of U.S. parents and guardians (n = 407) were randomly assigned to view either standard information about influenza vaccines or risk communication using absolute and incremental risk formats. Participants were then either presented or not presented with an interactive values clarification interface with constrained sliders and dynamic visual feedback. Participants randomized to the risk communication condition combined with the values clarification interface were more likely to indicate intentions to vaccinate (β = 2.10, t(399) = 2.63, p < 0.01). The effect was particularly notable among participants who had previously demonstrated less interest in having their children vaccinated against influenza (β = –2.14, t(399) = –2.06, p < 0.05). When assessing vaccination status reported by participants who agreed to participate in a follow‐up study six months later (n = 116), vaccination intentions significantly predicted vaccination status (OR = 1.66, 95%CI (1.13, 2.44), p < 0.05) and rates of informed choice (OR = 1.51, 95%CI (1.07, 2.13), p < 0.012), although there were no direct effects of experimental factors on vaccination rates. Qualitative analysis suggested that logistical barriers impeded immunization rates. Risk communication and values clarification methods may contribute to increased vaccination intentions, which may, in turn, predict vaccination status if logistical barriers are also addressed.     

Cross‐Cultural Differences in Risk Perceptions of Disasters

Public risk perceptions of mass disasters carry considerable influences, both psychologically and economically, despite their oft‐times imprecise nature. Prior research has identified the presence of an optimistic bias that affects risk perception, but there is a dearth of literature examining how these perceptions differ among cultures—particularly with regard to mass disasters. The present study explores differences among Japanese, Argentinean, and North American mental health workers in their rates of the optimistic bias in risk perceptions as contrasted between natural disasters and terrorist events. The results indicate a significant difference among cultures in levels of perceived risk that do not correspond to actual exposure rates. Japanese groups had the highest risk perceptions for both types of hazards and North Americans and Argentineans had the lowest risk perceptions for terrorism. Additionally, participants across all cultures rated risk to self as lower than risk to others (optimistic bias) across all disaster types. These findings suggest that cultural factors may have a greater influence on risk perception than social exposure, and that the belief that one is more immune to disasters compared to others may be a cross‐cultural phenomenon.     

Risk Perception and the Value of Safety

This paper examines the relationship between perceived risk and willingness-to-pay (WTP) for increased safety from technological hazards in both conceptual and empirical terms. A conceptual model is developed in which a given household's WTP for risk reductions is a function of traditional socioeconomic variables (i.e., income and base level of risk) and perceived characteristics of the hazards (i.e., dread, knowledge, and exposure). Data to estimate the model are obtained through a combined contingent valuation and risk perception survey that considers 10 technological hazards, five of which are well-defined (e.g., death rates are known and the risks are relatively common) and five are less well-defined. Econometric results, using TOBIT estimation procedures, support the importance of both types of variables in explaining WTP across all 10 hazards. When the risks are split into two groups, the results show that WTP for well-defined hazards is most influenced by perceived personal exposure, while WTP for less well-defined risks is most influenced by levels of dread and severity.     

Effects of Risk Representation and Scope on Willingness to Pay for Reduced Risks: Evidence from Tokyo Bay, Japan

When applying the contingent valuation method (CVM) in risk reduction studies, some studies report that willingness to pay (WTP) is insensitive to the magnitude of risk reduction while other studies do not. On the other hand, social-psychological research has shown that the affect heuristic biases judgments on probability, relative frequency, and risk. This article examines both magnitude (or scope) effect and affect heuristic (or representation) effect on WTP for risk reduction measures against tsunamis by introducing two experimental (i.e., absolute and relative) systems with four different representations to evaluate public behaviors in two different scenarios of risk reduction. Two common denominators (100 and 10,000) are introduced into absolute risk reduction representation (i.e., "of every 100 persons, from present 2 deaths to 1") to form different formats (i.e., "of every 10,000 persons from 200 to 100," and "of every 100,000 persons from 2,000 deaths to 1,000"). There is little evidence that WTP estimates are sufficiently sensitive to the magnitude of risk reduction, but relative risk reduction representations may be better than the absolute one given in CVM mail surveys when the risk is small. There is a statistically insignificant effect of risk reduction representations on respondent frequency, but mixed effects on the monetary values of WTP at the level of 0.05. The representation effect of absolute risk reduction on the WTP value varies with the common denominator. The larger the common denominator, the less the WTP to reduce the risk of tsunamis, and the significance probability is improved to less than the level of 0.05 when the common denominator becomes large enough. The findings suggest that improved methods are required for estimating the rates of tradeoff between fatality risk and other goods among consumers.     

Avian Influenza Risk Perception and Live Poultry Purchase in Guangzhou, China, 2006

Human H5N1 highly pathogenic avian influenza (HPAI) infection is associated with intimate exposure to live poultry. Perceptions of risk can modify behaviors, influencing actual exposure. However, greater hazard is not necessarily followed by perception of greater risk and more precautionary behavior because self-serving cognitive biases modulate precautionary and hazardous behaviors. We examined risk perception associated with avian influenza. A total of 1,550 face-to-face within-household interviews and 1,760 telephone interviews were derived to study avian influenza risk perception and live poultry use in Guangzhou and Hong Kong, respectively. Chi-square and Mann-Whitney tests assessed bivariate associations and risk distributions, respectively, and fully adjusted multivariate logistic models determined independent risk associations. Relative to Hong Kong, perceived "generalized" risk from buying live poultry (GZ, 58%, 95% confidence interval 55–60% vs. HK, 41%, 39–43%; χ²= 86.95, df  = 1, p < 0.001) and perceived self/family risk from buying ( z  =−2.092, p  = 0.036) were higher in Guangzhou. Higher perceived "generalized" risk was associated with not buying live poultry (OR = 0.65, 0.49–0.85), consistent with the pattern seen in Hong Kong, while perceived higher self/family risk was associated with buying ("likely/very likely/certain" OR = 1.74, 1.18–2.59); no such association was seen in Hong Kong. Multivariate adjustment indicated older age was associated with buying live poultry in Guangzhou (OR = 2.91, 1.36–6.25). Guangzhou respondents perceived greater risk relative to Hong Kong. Buying live poultry was associated with perceptions of less "generalized" risk but more self/family risk. Higher generalized risk was associated with fewer live poultry purchases, suggesting generalized risk may be a useful indicator of precautionary HPAI risk behavior.     

Provision of a Wildfire Risk Map: Informing Residents in the Wildland Urban Interface

Wildfires in the wildland urban interface (WUI) are an increasing concern throughout the western United States and elsewhere. WUI communities continue to grow and thus increase the wildfire risk to human lives and property. Information such as a wildfire risk map can inform WUI residents of potential risks and may help to efficiently sort mitigation efforts. This study uses the survey-based contingent valuation (CV) method to examine annual household willingness to pay (WTP) for the provision of a wildfire risk map. Data were collected through a mail survey of the East Mountain WUI area in the State of New Mexico (USA). The integrated empirical approach includes a system of equations that involves joint estimation of WTP values, along with measures of a respondent's risk perception and risk mitigation behavior. The median estimated WTP is around U.S. $12 for the annual wildfire risk map, which covers at least the costs of producing and distributing available risk information. Further, providing a wildfire risk map can help address policy goals emphasizing information gathering and sharing among stakeholders to mitigate the effects of wildfires.