Using a Familiar Risk Comparison Within a Risk Ladder to Improve Risk Understanding by Low Numerates: A Study of Visual Attention

Previous experimental research provides evidence that a familiar risk comparison within a risk ladder is understood by low‐ and high‐numerate individuals. It especially helps low numerates to better evaluate risk. In the present study, an eye tracker was used to capture individuals’ visual attention to a familiar risk comparison, such as the risk associated with smoking. Two parameters of information processing—efficiency and level—were derived from visual attention. A random sample of participants from the general population (N= 68) interpreted a given risk level with the help of the risk ladder. Numeracy was negatively correlated with overall visual attention on the risk ladder (r_s=?0.28, p= 0.01), indicating that the lower the numeracy, the more the time spent looking at the whole risk ladder. Numeracy was positively correlated with the efficiency of processing relevant frequency (r_s= 0.34, p < 0.001) and relevant textual information (r_s= 0.34, p < 0.001), but not with the efficiency of processing relevant comparative information and numerical information. There was a significant negative correlation between numeracy and the level of processing of relevant comparative risk information (r_s=?0.21, p < 0.01), indicating that low numerates processed the comparative risk information more deeply than the high numerates. There was no correlation between numeracy and perceived risk. These results add to previous experimental research, indicating that the smoking risk comparison was crucial for low numerates to evaluate and understand risk. Furthermore, the eye‐tracker method is promising for studying information processing and improving risk communication formats.     

High Risk or Low: How Location on a "Risk Ladder" Affects Perceived Risk

Efforts to explain risk magnitude often rely on a "risk ladder" in which exposure levels and associated risk estimates are arrayed with low levels at the bottom and high ones at the top. Two experiments were conducted to test the hypothesis that perceived threat and intended mitigation vary with the location of the subject's assigned level on the risk ladder. Subjects were New Jersey homeowners, asked to assume a particular level of radon or asbestos contamination in their homes, to read a brochure explaining the risk, and then to complete a questionnaire. Both studies found that the difference between an assigned level one-quarter of the way up the ladder and the same level three-quarters of the way up the ladder significantly affected threat perception; the effect on mitigation intentions was significant in only one of the studies. Variations in assigned risk also affected threat perception and mitigation intentions. Variations in test magnitude (e.g., 15 fibers per liter vs. 450 fibers per cubic foot, roughly equivalent risks) had no effect, nor did the distinction between radon and asbestos affect the dependent variables. These findings suggest that communicators can design risk ladders to emphasize particular risk characteristics.     

Lay Understanding of Synergistic Risk: The Case of Radon and Cigarette Smoking

The combination of radon and smoking produces a synergistic risk of lung cancer. Lay understanding of this risk was examined from the perspectives of mental models theory, the psychometric approach to risk perception, and optimistic bias. As assessed by interview, participants ( N = 50) had more extensive mental models for the risks of smoking than for the risks of radon or the combination of radon and smoking; 32% knew little or nothing about radon. Despite reading an informational brochure, their risk-perception ratings of the three hazards showed no perception of the synergy between smoking and radon risk, although the combined hazard was rated as less familiar but more controllable than the average of the single hazards ( p < .01). No evidence of optimistic bias for the health consequences of radon, or the combination of radon and smoking was observed. Participants appeared to be combining the single-hazard risks subadditively to arrive at their combined-hazard risk perceptions. Further research on the integration of perceived risks would be beneficial for designing optimal communications about synergistic risk.     

Evaluating Risk Communication: Narrative vs. Technical Presentations of Information About Radon

This paper reports on an experiment to test the hypothesis that people respond better to risk communication that reflects more closely the conditions of their social and cultural lives. The experiment used the case of radon to determine whether technical or narrative forms of risk communication were more effective at drawing people's attention, imparting information, and modifying behavior. Two series of articles on radon were placed in the local newspapers of two Massachusetts communities. Homeowner attitudes, knowledge, and responses were monitored in baseline and follow-up telephone surveys. A third community was selected for comparison. The newspaper series were developed on the basis of previous research and six focus groups conducted with homeowners. The technical series presented authoritative, factual risk information, in the scientific style of the passive voice with generalized and impersonal language. The narrative series consisted of dramatized accounts of individuals making decisions about radon testing and mitigation, written in a more personal style. The findings from the focus groups confirm the results of previous studies, but the small size of the follow-up samples was a limiting factor in drawing definitive conclusions about the relative effectiveness of the two formats. The experiment demonstrates the difficulty of any risk communication effort on radon and underscores the need for good research design.(ABSTRACT TRUNCATED AT 250 WORDS)     

Protective Responses to Household Risk: A Case Study of Radon Mitigation

This study analyzes the effectiveness of a mass-media radon information and testing campaign conducted in the Washington, D.C. area in the winter of 1988. Although an impressive number of test kits (approximately 100,000) were sold, the ultimate mitigation rates resulting from the campaign were extremely low. Analyses show that low mitigation rates cannot be explained by postulating that people's responses to radon are insensitive to the level of objective risk. They may instead be due to characteristics of the protective response required to reduce radon risk. Radon may be thought of as one of a family of household risks which have risk response profiles that make them particularly difficult for people to manage and remediate. Traditional information campaigns for such risks are likely to be ineffective; instead, they may require regulatory strategies or programs which provide active guidance and assistance.     

The Perceived Health Risks of Indoor Radon Gas and Overhead Powerlines: A Comparative Multilevel Approach

Radon and overhead powerlines are two radiation risk cases that have raised varying levels of concern among the general public and experts. Despite both involving radiation—a typically feared and unseen health hazard—individuals' perceptions of the two risk cases may invoke rather different factors. We examined individual and geographic-contextual factors influencing public perceptions of the health risks of indoor radon gas and overhead powerlines in a comparative research design, utilizing a postal questionnaire with 1,528 members of the general public (response rate 28%) and multilevel modeling techniques. This study found that beliefs about the two risk cases mainly differed according to the level of "exposure"—defined here in terms of spatial proximity. We argue that there are two alternative explanations for this pattern of findings: that risk perception itself varies directly with proximity, or that risk is more salient to concerned people in the exposed areas. We also found that while people living in high radon areas are more concerned about the risks of indoor radon gas, they find these risks more acceptable and have more trust in authorities. These results might reflect the positive effects of successive radon campaigns in high radon areas, which may have raised awareness and concern, and at the same time may have helped to increase trust by showing that the government takes the health risks of indoor radon gas seriously, suggesting that genuine risk communication initiatives may have positive impacts on trust in risk management institutions.     

Does Iconicity in Pictographs Matter? The Influence of Iconicity and Numeracy on Information Processing,Decision Making,and Liking in an Eye‐Tracking Study

Researchers recommend the use of pictographs in medical risk communication to improve people's risk comprehension and decision making. However, it is not yet clear whether the iconicity used in pictographs to convey risk information influences individuals’ information processing and comprehension. In an eye‐tracking experiment with participants from the general population (N = 188), we examined whether specific types of pictograph icons influence the processing strategy viewers use to extract numerical information. In addition, we examined the effect of iconicity and numeracy on probability estimation, recall, and icon liking. This experiment used a 2 (iconicity: blocks vs. restroom icons) × 2 (scenario: medical vs. nonmedical) between‐subject design. Numeracy had a significant effect on information processing strategy, but we found no effect of iconicity or scenario. Results indicated that both icon types enabled high and low numerates to use their default way of processing and extracting the gist of the message from the pictorial risk communication format: high numerates counted icons, whereas low numerates used large‐area processing. There was no effect of iconicity in the probability estimation. However, people who saw restroom icons had a higher probability of correctly recalling the exact risk level. Iconicity had no effect on icon liking. Although the effects are small, our findings suggest that person‐like restroom icons in pictographs seem to have some advantages for risk communication. Specifically, in nonpersonalized prevention brochures, person‐like restroom icons may maintain reader motivation for processing the risk information.     

Multiple Health Risk Perception and Information Processing Among African Americans and Whites Living in Poverty

We investigated the risk‐information‐processing behaviors of people living at or near the poverty line. Because significant gaps in health and communication exist among high‐ and low‐income groups, increasing the information seeking and knowledge of poor individuals may help them better understand risks to their health and increase their engagement in health‐protective behaviors. Most earlier studies assessed only a single health risk selected by the researcher, whereas we listed 10 health risks and allowed the respondents to identify the one that they worried about most but took little action to prevent. Using this risk, we tested one pathway inspired by the risk information seeking and processing model to examine predictors of information insufficiency and of systematic processing and extended this pathway to include health‐protective action. A phone survey was conducted of African Americans and whites living in the southern United States with an annual income of ≤$35,000 (N= 431). The results supported the model pathway: worry partially mediated the relationship between perceived risk and information insufficiency, which, in turn, increased systematic processing. In addition, systematic processing increased health‐protective action. Compared with whites and better educated respondents, African Americans and respondents with little education had significantly higher levels of information insufficiency but higher levels of systematic processing and health‐protective action. That systematic processing and knowledge influenced health behavior suggests a potential strategy for reducing health disparities.     

Individual differences in numerical representations of risk in health decision making: A fuzzy-trace theory approach

Fuzzy-trace theory predicts that decisionmakers process numerical information about risk at multiple levels in parallel: the simplest level, nominal (categorical some-none) gist, and at more fine-grained levels, involving relative comparison (ordinal less-more gist) and exact quantities (verbatim representations). However, little is known about how individual differences in these numerical representations relate to judgments and decisions, especially involving health tradeoffs and relative risks. To investigate these differences, we administered measures of categorical and ordinal gist representations of number, objective numeracy, and intelligence in two studies (Ns = 978 and 956). In both studies, categorical and ordinal gist representations of number predicted risk judgments and decisions beyond objective numeracy and intelligence. Participants with higher scores in categorical gist were more likely to choose options to avoid cancer recurrence risks; those who were higher in ordinal gist of numbers were more likely to discriminate relative risk of skin cancer; and those with higher scores in objective numeracy were more likely to choose options that were numerically superior overall in terms of relative risk of skin cancer and of genetic risks of breast cancer (e.g., lower numerical probability of cancer). Results support parallel-processing models that assume multiple representations of numerical information about risk, which vary in precision, and illustrate how individual differences in numerical representations are relevant to tradeoffs and risk comparisons in health decisions. These representations cannot be reduced to one another and explain psychological variations in risk processing that go beyond low versus high levels of objective numeracy.     

Measuring Perceptions of Synergistic Circulatory Disease Risk Due to Smoking and the Oral Contraceptive Pill

There is evidence that the oral contraceptive pill (OCP) and smoking contribute independently to risk of circulatory disease. There is mixed evidence that the combined risk may be greater than the sum of these factors operating in isolation. Little is known about how the general population views the risks from OCP use, singly and in combination with smoking. Previous attempts at assessing whether the public views risks as operating synergistically have generally found evidence for subadditive models, where the combined risk is less than the sum of factors operating in isolation. However, concerns have been expressed over the validity of the measures of risk perception used. Therefore, this study used three distinct methods of measurement to assess the extent to which 241 undergraduate students perceive the risks of smoking and the OCP separately and combined, for circulatory disease. For all three methods, respondents read each of four vignettes describing information about a woman's risk factors (with high and low levels of both OCP and smoking), and then estimated risk of circulatory disease using one of the three risk measures. The three measures produced similar ratings. Consistent with the epidemiological evidence, information about smoking had more impact on estimates of overall risk than did information about the OCP For all three measures, responses were consistent with an additive model of risk from smoking and the OCP. This convergence of results from different methods suggests that all three methods of measurement employed, which all had a large number of response options, may be valid.     

The Influence of Uncertain Map Features on Risk Beliefs and Perceived Ambiguity for Maps of Modeled Cancer Risk from Air Pollution

Maps are often used to convey information generated by models, for example, modeled cancer risk from air pollution. The concrete nature of images, such as maps, may convey more certainty than warranted for modeled information. Three map features were selected to communicate the uncertainty of modeled cancer risk: (i) map contours appeared in or out of focus, (ii) one or three colors were used, and (iii) a verbal‐relative or numeric risk expression was used in the legend. Study aims were to assess how these features influenced risk beliefs and the ambiguity of risk beliefs at four assigned map locations that varied by risk level. We applied an integrated conceptual framework to conduct this full factorial experiment with 32 maps that varied by the three dichotomous features and four risk levels; 826 university students participated. Data was analyzed using structural equation modeling. Unfocused contours and the verbal‐relative risk expression generated more ambiguity than their counterparts. Focused contours generated stronger risk beliefs for higher risk levels and weaker beliefs for lower risk levels. Number of colors had minimal influence. The magnitude of risk level, conveyed using incrementally darker shading, had a substantial dose‐response influence on the strength of risk beliefs. Personal characteristics of prior beliefs and numeracy also had substantial influences. Bottom‐up and top‐down information processing suggest why iconic visual features of incremental shading and contour focus had the strongest visual influences on risk beliefs and ambiguity. Variations in contour focus and risk expression show promise for fostering appropriate levels of ambiguity.     

Conventional Wisdom on Risk Communication and Evidence from a Field Experiment

A recent comprehensive review of the literature identified a number of facts and principles governing risk communication. This paper evaluates several of these propositions using recent evidence from a field experiment in communicating the risks from radon in homes. At this point in the research, data relates primarily to the response of risk perceptions to different information treatments and different personal characteristics. The effect of various causal factors is sensitive to the particular test of risk perception applied. No information treatment was clearly superior for all tasks. An important implication of these findings is that risk communicators must determine what specific task or tasks the information program should enable people to do.     

Radon Testing Behavior in a Sample of Individuals with High Home Radon Screening Measurements

Although radon exposure has been identified as the second leading cause of lung cancer, fewer than 6% of U.S. homeowners test their homes for radon. This report examines participants'follow-up radon testing behavior subsequent to receiving an initial screening radon level greater than 20 pCi/L. Sixty-two participants in the Iowa State-Wide Rural Radon Screening Survey who had radon screening measurements over 20 pCi/L were questioned by phone survey 3 months after receipt of their radon screening result to assess: whether participants were aware of radon's health risk; if participants recalled the radon screening results; how participants perceived the relative health risk of radon and whether participants planned follow-up radon testing. Only 19% of the respondents specifically identified lung cancer as the possible adverse health outcome of high radon exposure, and the majority of participants underestimated the health risks high radon levels pose when compared to cigarettes and x-rays. In addition, less than one third (29%)of the participants actually remembered their radon screening level within 10 pCi/L 3 months after receiving their screening results. Only 53% of the individuals correctly interpreted their screening radon level as being in the high range, and only 39% of the participants planned follow-up radon measurements. Receipt of radon screening test results indicating high radon levels was not an adequate motivational factor in itself to stimulate further radon assessment or mitigation. Our findings suggest that free radon screening will not result in a dramatic increase in subsequent homeowner initiated remediation or further recommended radon testing.     

Why Study Risk Perception?

Studies of risk perception examine the opinions people express when they are asked, in various ways, to characterize and evaluate hazardous activities and technologies. This research aims to aid risk analysis and societal decision making by (i) improving methods for eliciting opinions about risk, (ii) providing a basis for understanding and anticipating public responses to hazards, and (iii) improving the communication of risk information among laypeople, technical experts, and policy makers.     

Enhancing Self‐Protective Behavior: Efficacy Beliefs and Peer Feedback in Risk Communication

In times of a high‐impact safety incident citizens may have a variety of sources available to help them cope with the situation. This research focuses on the interplay of efficacy information in risk communication messages and peer feedback, such as responses on social network sites (SNSs) in the context of a high‐impact risk on the intention to engage in self‐protective behavior. The study pitted high and low efficacy information messages against supporting and opposing peer feedback (N = 242). Results show a significant interaction effect between efficacy information in a news article and peer feedback from SNS messages on both the intention to engage in self‐protective behavior and levels of involvement. Participants who received the article with more efficacy information and also received supportive peer feedback via SNS messages were more likely to express higher levels of involvement and greater intentions to engage in protective behavior. When confronted with a low efficacious news article, the effect of peer feedback on these two variables was significantly stronger. Finally, implications for theory and government risk communication are discussed.     

Risk Perception Among Smokers: A Qualitative Study

The aim of this qualitative study is to identify the dimensions people used to assess the risk of smoking and then compare them with those used by health professionals in primary healthcare. Five discussion groups were conducted. The field work was carried out in Barcelona (Spain), from February 2005 to January 2006. Data were analyzed following a semantic‐thematic categorical content analysis (ACC‐ts). Results showed that people tend to employ stereotypical discourses when evaluating the risk of smoking. Similarly, they reassess the risk in the context of their life experience and incorporate new nuances to the arguments sustaining their behavior. Once this reassessment takes place, the decision to continue smoking emerges, and smokers come up with additional arguments justifying their habit (i.e., age, benefits related to costs). Professionals are aware of this process and its multidimensional nature. Nevertheless, their discourse loses this multidimensional feature when discussing the strategies they use at smoking cessation interventions. This qualitative study increases the understanding of various meanings that people attribute to their life experience. These assumptions may be useful for developing health practices that are closer to people. As a practical utility of these results, it would be interesting to apply a preliminary assessment of the different meanings that people attribute to smoking from their life context in risk communication.     

Modeling the Modification of the Risk of Radon-Induced Lung Cancer by Environmental Tobacco Smoke

The presence of environmental tobacco smoke (ETS) in homes has been implicated in the causation of lung cancer. While of interest in its own right, ETS also influences the risk imposed by radon and its decay products. The interaction between radon progeny and ETS alters the exposure, intake, uptake, biokinetics, dosimetry, and radiobiology of those progeny. The present paper details model predictions of the various influences of ETS on these factors in the U.S. population and provides estimates of the resulting change in the risk from average levels of radon progeny. It is predicted that the presence of ETS produces a very small (perhaps unmeasurable) increase in the risk of radiation-induced tracheobronchial cancer in homes with initially very high particle concentrations for both active and never-smokers, but significantly lowers the risk in homes with initially lower particle concentrations for both groups when generation 4 of the lung is considered the target site. For generation 16, the presence of ETS generally increases the radon-induced risk of lung cancer, although the increase should be unmeasurable at high initial particle concentrations. The net effect of ETS on human health is suggested to be a complicated function of the initial housing conditions, the concentration of particles introduced by smoking, the target generation considered, and the smoking status of exposed populations. This situation precludes any simple statements concerning the role of ETS in governing the incidence of lung cancer in a population.     

Residential Radon in Canada: An Uncertainty Analysis of Population and Individual Lung Cancer Risk

Following a comprehensive evaluation of the health risks of radon, the U.S. National Research Council (US-NRC) concluded that the radon inside the homes of U.S. residents is an important cause of lung cancer. To assess lung cancer risks associated with radon exposure in Canadian homes, we apply the new (US-NRC) techniques, tailoring assumptions to the Canadian context. A two-dimensional uncertainty analysis is used to provide both population-based (population attributable risk, PAR; excess lifetime risk ratio, ELRR; and life-years lost, LYL) and individual-based (ELRR and LYL) estimates. Our primary results obtained for the Canadian population reveal mean estimates for ELRR, PAR, and LYL are 0.08, 8%, and 0.10 years, respectively. Results are also available and stratified by smoking status (ever versus never). Conveniently, the three indices (ELRR, PAR, and LYL) reveal similar output uncertainty (geometric standard deviation, GSD approximately 1.3), and in the case of ELRR and LYL, comparable variability and uncertainty combined (GSD approximately 4.2). Simplifying relationships are identified between ELRR, LYL, PAR, and the age-specific excess rate ratio (ERR), which suggest a way to scale results from one population to another. This insight is applied in scaling our baseline results to obtain gender-specific estimates, as well as in simplifying and illuminating sensitivity analysis.     

Bad News Has Wings: Dread Risk Mediates Social Amplification in Risk Communication

Social diffusion of information amplifies risk through processes of birth, death, and distortion of message content. Dread risk—involving uncontrollable, fatal, involuntary, and catastrophic outcomes (e.g., terrorist attacks and nuclear accidents)—may be particularly susceptible to amplification because of the psychological biases inherent in dread risk avoidance. To test this, initially balanced information about high or low dread topics was given to a set of individuals who then communicated this information through diffusion chains, each person passing a message to the next. A subset of these chains were also reexposed to the original information. We measured prior knowledge, perceived risk before and after transmission, and, at each link, number of positive and negative statements. Results showed that the more a message was transmitted the more negative statements it contained. This was highest for the high dread topic. Increased perceived risk and production of negative messages was closely related to the amount of negative information that was received, with domain knowledge mitigating this effect. Reexposure to the initial information was ineffectual in reducing bias, demonstrating the enhanced danger of socially transmitted information.     

Some Limitations of Qualitative Risk Rating Systems

Qualitative systems for rating animal antimicrobial risks using ordered categorical labels such as “high,”“medium,” and “low” can potentially simplify risk assessment input requirements used to inform risk management decisions. But do they improve decisions? This article compares the results of qualitative and quantitative risk assessment systems and establishes some theoretical limitations on the extent to which they are compatible. In general, qualitative risk rating systems satisfying conditions found in real‐world rating systems and guidance documents and proposed as reasonable make two types of errors: (1) Reversed rankings, i.e., assigning higher qualitative risk ratings to situations that have lower quantitative risks; and (2) Uninformative ratings, e.g., frequently assigning the most severe qualitative risk label (such as “high”) to situations with arbitrarily small quantitative risks and assigning the same ratings to risks that differ by many orders of magnitude. Therefore, despite their appealing consensus‐building properties, flexibility, and appearance of thoughtful process in input requirements, qualitative rating systems as currently proposed often do not provide sufficient information to discriminate accurately between quantitatively small and quantitatively large risks. The value of information (VOI) that they provide for improving risk management decisions can be zero if most risks are small but a few are large, since qualitative ratings may then be unable to confidently distinguish the large risks from the small. These limitations suggest that it is important to continue to develop and apply practical quantitative risk assessment methods, since qualitative ones are often unreliable.