Reaping the Benefits and Avoiding the Risks: Unrealistic Optimism in the Health Domain

People's perceptions of benefits and risks play a key role in their acceptance or rejection of medical interventions, yet these perceptions may be poorly calibrated. This online study with N = 373 adults aged 19–76 years focused on unrealistic optimism in the health domain. Participants indicated how likely they were to experience benefits and risks associated with medical conditions and completed objective and subjective numeracy scales. Participants exhibited optimistic views about the likelihood of experiencing the benefits and the side effects of treatment options described in the scenarios. Objective and subjective numeracy were not associated with more accurate ratings. Moreover, participants’ underestimation of the risks was significantly greater than their overestimation of the benefits. From an applied perspective, these results suggest that clinicians may need to ensure that patients do not underestimate risks of medical interventions, and that they convey realistic expectations about the benefits that can be obtained with certain procedures.     

Seeing What You Want to See: How Imprecise Uncertainty Ranges Enhance Motivated Reasoning

In this article, we consider a novel criterion for evaluating representations of uncertainty ranges, namely, the extent to which a representation enhances motivated reasoning. In two studies, we show that perceptions of the distribution underlying ambiguous numerical ranges are affected by the motivations and worldviews of end users. This motivated reasoning effect remained after controlling for objective numeracy and fluid intelligence but was attenuated when the correct interpretation was made clear. We suggest that analysts and communicators explicitly consider the potential for motivated evaluation when evaluating uncertainty displays.     

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.     

Adolescents’ and Young Adults’ Online Risk Taking: The Role of Gist and Verbatim Representations

Young people are exposed to and engage in online risky activities, such as disclosing personal information and making unknown friends online. Little research has examined the psychological mechanisms underlying young people's online risk taking. Drawing on fuzzy trace theory, we examined developmental differences in adolescents’ and young adults’ online risk taking and assessed whether differential reliance on gist representations (based on vague, intuitive knowledge) or verbatim representations (based on specific, factual knowledge) could explain online risk taking. One hundred and twenty two adolescents (ages 13–17) and 172 young adults (ages 18–24) were asked about their past online risk‐taking behavior, intentions to engage in future risky online behavior, and gist and verbatim representations. Adolescents had significantly higher intentions to take online risks than young adults. Past risky online behaviors were positively associated with future intentions to take online risks for adolescents and negatively for young adults. Gist representations about risk negatively correlated with intentions to take risks online in both age groups, while verbatim representations positively correlated with online risk intentions, particularly among adolescents. Our results provide novel insights about the underlying mechanisms involved in adolescent and young adults’ online risk taking, suggesting the need to tailor the representation of online risk information to different age groups.     

Tailoring value elicitation to decision makers' numeracy and fluency: Expressing value judgments in numbers or words

In organizational settings, options evaluation requires managers to express value judgments on multiple criteria. This research investigates the influence of decision makers' numeracy (ability to use appropriate numerical principles) and fluency (ability to express oneself in words) on their subjective experience of value elicitation as supported by two different techniques: direct rating and MACBETH. The former asks for value judgments to be expressed numerically, the latter non-numerically. The results of our experiment indicate that the two techniques are not psychologically equivalent: decision makers with higher numeracy express values more easily when assisted by the numerical technique whereas decision makers with higher fluency find value elicitation easier with the non-numerical technique. These findings highlight the importance of tailoring value elicitation to decision makers' numeracy and fluency. Implications for decision scientists and analysts are discussed.     

Equity in Social Risk: Some Empirical Observations

In societal risk analysis the equity of the distribution of risks is often an important consideration owing to the special nature of health risks. We empirically validate some assumptions about equity that have been discussed in the decision analytic literature. Our results show that the way fatalities are distributed throughout a society is considered along with the number of fatalities in evaluating alternative policies involving mortality risks. The concepts of ex ante equity and ex post equity are both shown to be important in judgments of fairness. We next present a decision model based on multiattribute preference theory incorporating the number of fatalities, as well as ex ante equity and ex post equity. When ex ante equity and ex post equity are positively weighted in this fair-risk model , options with more equal risk distributions are ranked higher. Next we empirically show that the distribution of benefits has an impact on judgments of fairness. The fair-risk model does not include information on the benefits distribution, so it would apply when benefits are distributed equally or when the decision maker wishes to not include benefits in the model. We briefly discuss how the notion of proportional equity can incorporate benefits into judgments of the fairness of risk distributions. We then include benefits in a more general model in which fair risk-benefit combinations are those that are exchange equitable. A key implication of this envy-free risk–benefit model is that an unequal distribution of risks may be preferred if it is accompanied by a compensatory differential in benefits consistent with peoples' preference tradeoffs between received benefits and assumed risks. Finally, we discuss how perceived deservedness may influence judgments about equity. We conclude with a discussion of the implications of research on alternative notions of equity for policy makers dealing with social risks.     

A Multicriteria Decision Analysis Model and Risk Assessment Framework for Carbon Capture and Storage

Multicriteria decision analysis (MCDA) has been applied to various energy problems to incorporate a variety of qualitative and quantitative criteria, usually spanning environmental, social, engineering, and economic fields. MCDA and associated methods such as life‐cycle assessments and cost‐benefit analysis can also include risk analysis to address uncertainties in criteria estimates. One technology now being assessed to help mitigate climate change is carbon capture and storage (CCS). CCS is a new process that captures CO₂ emissions from fossil‐fueled power plants and injects them into geological reservoirs for storage. It presents a unique challenge to decisionmakers (DMs) due to its technical complexity, range of environmental, social, and economic impacts, variety of stakeholders, and long time spans. The authors have developed a risk assessment model using a MCDA approach for CCS decisions such as selecting between CO₂ storage locations and choosing among different mitigation actions for reducing risks. The model includes uncertainty measures for several factors, utility curve representations of all variables, Monte Carlo simulation, and sensitivity analysis. This article uses a CCS scenario example to demonstrate the development and application of the model based on data derived from published articles and publicly available sources. The model allows high‐level DMs to better understand project risks and the tradeoffs inherent in modern, complex energy decisions.     

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.     

Representations as Decision Aids: The Asymmetric Effects of Words and Numbers on Auditors' Inherent Risk Judgments*

Decision aids often change the representations used to express risk cue information and communicate risk judgments. In this study, we hypothesize that numbers and words may have asymmetric effects when used to represent risk cue information as opposed to when used to communicate risk judgments. Specifically, decision makers' agreement on cue weights and judgment consensus may be higher with cue information stated in words rather than numbers, since appropriately chosen words can more directly convey the risk implications of information cues. In contrast, decision makers' consistency in applying their judgment policies and judgment consensus may be higher with risk judgments communicated in numbers instead of words, because the greater precision available with numbers allows finer discriminations of risk. To test our hypotheses, we conducted an experiment in which experienced financial auditors made inherent risk judgments for a hypothetical manufacturing client. Cue and response representations were manipulated between numbers and words. The results generally support our arguments. In addition, representing cue information in words increased the time required to acquire cue information relative to numeric representation. In contrast, requiring auditors to express their risk judgments in numbers increased the time required to express risk assessments relative to     

Public Perceptions of Regulatory Costs,Their Uncertainty and Interindividual Distribution

Public perceptions of both risks and regulatory costs shape rational regulatory choices. Despite decades of risk perception studies, this article is the first on regulatory cost perceptions. A survey of 744 U.S. residents probed: (1) How knowledgeable are laypeople about regulatory costs incurred to reduce risks? (2) Do laypeople see official estimates of cost and benefit (lives saved) as accurate? (3) (How) do preferences for hypothetical regulations change when mean‐preserving spreads of uncertainty replace certain cost or benefit? and (4) (How) do preferences change when unequal interindividual distributions of hypothetical regulatory costs replace equal distributions? Respondents overestimated costs of regulatory compliance, while assuming agencies underestimate costs. Most assumed agency estimates of benefits are accurate; a third believed both cost and benefit estimates are accurate. Cost and benefit estimates presented without uncertainty were slightly preferred to those surrounded by “narrow uncertainty” (a range of costs or lives entirely within a personally‐calibrated zone without clear acceptance or rejection of tradeoffs). Certain estimates were more preferred than “wide uncertainty” (a range of agency estimates extending beyond these personal bounds, thus posing a gamble between favored and unacceptable tradeoffs), particularly for costs as opposed to benefits (but even for costs a quarter of respondents preferred wide uncertainty to certainty). Agency‐acknowledged uncertainty in general elicited mixed judgments of honesty and trustworthiness. People preferred egalitarian distributions of regulatory costs, despite skewed actual cost distributions, and preferred progressive cost distributions (the rich pay a greater than proportional share) to regressive ones. Efficient and socially responsive regulations require disclosure of much more information about regulatory costs and risks.     

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.     

Values and Risk Perceptions: A Cross‐Cultural Examination

This article examines the relationship between values and risk perceptions regarding terror attacks. The participants in the study are university students from Turkey (n = 536) and Israel (n = 298). Schwartz value theory (1992, 1994) is applied to conceptualize and measure values. Cognitive (perceived likelihood and perceived severity) and emotional (fear, helplessness, anger, distress, insecurity, hopelessness, sadness, and anxiety) responses about the potential of (i) being personally exposed to a terror attack, and (ii) a terror attack that may occur in one's country are assessed to measure risk perceptions. Comparison of the two groups suggests that the Turkish participants are significantly more emotional about terror risks than the Israeli respondents. Both groups perceive the risk of a terror attack that may occur in their country more likely than the risk of being personally exposed to a terror attack. No significant differences are found in emotional representations and perceived severity ratings regarding these risks. Results provide support for the existence of a link between values and risk perceptions of terror attacks. In both countries, self‐direction values are negatively related to emotional representations, whereas security values are positively correlated with emotions; hedonism and stimulation values are negatively related to perceived likelihood. Current findings are discussed in relation to previous results, theoretical approaches (the social amplification of risk framework and cultural theory of risk), and practical implications (increasing community support for a course of action, training programs for risk communicators).     

Technical and Democratic Values in Risk Analysis1

So, we can argue that the lay public are not fools in their attitudes about risk. That nonexperts should show more concern over hazardous waste facilities in their neighborhoods than radon levels in their homes is not a sign of irrationality (because aggregate and individual risks are greater from the radon), but simply a sign that nonexperts are working from a different set of criteria. These criteria are incorporated in what I call the democratic model. The democratic model evaluates risk based on its social and political consequences, such as possible disruption in the social fabric or a loss of communality. Lay criteria for assessing the impact of risk decisions are not explicit, like the those of the risk analyst, but are embedded in cultural values. Similarly, lay evaluations of risk incorporate substantive and procedural democratic values, such as the acceptability of processes for making decisions, the ethics of the distribution of risk, and the capacity to control a source of risk in the community's interests. Finally, the democratic model relates judgments about risks to the competence (Can we trust them?) and the legitimacy (Should we trust them?) of the social institutions that impose and control those risks. The public's judgments about risk are not inferior, but different, and arguably richer than those of the experts.     

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.     

Improving Risk Management: From Lame Excuses to Principled Practice

The three classic pillars of risk analysis are risk assessment (how big is the risk and how sure can we be?), risk management (what shall we do about it?), and risk communication (what shall we say about it, to whom, when, and how?). We propose two complements as important parts of these three bases: risk attribution (who or what addressable conditions actually caused an accident or loss?) and learning from experience about risk reduction (what works, and how well?). Failures in complex systems usually evoke blame, often with insufficient attention to root causes of failure, including some aspects of the situation, design decisions, or social norms and culture. Focusing on blame, however, can inhibit effective learning, instead eliciting excuses to deflect attention and perceived culpability. Productive understanding of what went wrong, and how to do better, thus requires moving past recrimination and excuses. This article identifies common blame‐shifting “lame excuses” for poor risk management. These generally contribute little to effective improvements and may leave real risks and preventable causes unaddressed. We propose principles from risk and decision sciences and organizational design to improve results. These start with organizational leadership. More specifically, they include: deliberate testing and learning—especially from near‐misses and accident precursors; careful causal analysis of accidents; risk quantification; candid expression of uncertainties about costs and benefits of risk‐reduction options; optimization of tradeoffs between gathering additional information and immediate action; promotion of safety culture; and mindful allocation of people, responsibilities, and resources to reduce risks. We propose that these principles provide sound foundations for improving successful risk management.     

A Comparative Analysis of PRA and Intelligent Adversary Methods for Counterterrorism Risk Management

In counterterrorism risk management decisions, the analyst can choose to represent terrorist decisions as defender uncertainties or as attacker decisions. We perform a comparative analysis of probabilistic risk analysis (PRA) methods including event trees, influence diagrams, Bayesian networks, decision trees, game theory, and combined methods on the same illustrative examples (container screening for radiological materials) to get insights into the significant differences in assumptions and results. A key tenent of PRA and decision analysis is the use of subjective probability to assess the likelihood of possible outcomes. For each technique, we compare the assumptions, probability assessment requirements, risk levels, and potential insights for risk managers. We find that assessing the distribution of potential attacker decisions is a complex judgment task, particularly considering the adaptation of the attacker to defender decisions. Intelligent adversary risk analysis and adversarial risk analysis are extensions of decision analysis and sequential game theory that help to decompose such judgments. These techniques explicitly show the adaptation of the attacker and the resulting shift in risk based on defender decisions.     

Should Persons with Diabetes Be Licensed to Drive Trucks?—Risk Management

How should a regulatory agency interpret a risk analysis that concludes there is a small increase in risk? The agency must decide on behalf of society whether the increased risk is large enough to justify banning the risky activity or taking some other step to lessen the risks. In a companion paper (Songer et al.), we conclude that licensing insulin using persons to drive commercial motor vehicles in interstate commerce would result in 42 additional crashes each year. Here we address risk management issues by interpreting the number of additional crashes and the relative risks of the prospective handicapped drivers. Are the number of additional crashes (42) significant? Is the increase in the annual crash risk (from 0.00785 to 0.032 for non-insulin dependent and 0.048 for insulin dependent persons) significant? Are the relative risks significant for all insulin using drivers (4.7)? For drivers with a history of severe hypoglycemic reactions (19.8)? How should society tradeoff risk increases for increases in opportunity for these handicapped persons? We review other social decisions concerning highway safety: Accepting the increasing risks of letting 16 year olds drive, allowing extremely light cars, allowing some unsafe highways, and allowing extremely unsafe driving conditions at some times of day. We conclude that the additional risks from insulin using persons are well within the current accepted range of risks. Currently, 70% of states permit insulin using persons to drive trucks within their state. Nonetheless, the social cost, due to fatalities, injuries, and property damage from allowing a person with a history of severe hypoglycemic reactions to drive is more than $19,700 per year.     

Applying a Health Behavior Theory to Explore the Influence of Information and Experience on Arsenic Risk Representations, Policy Beliefs, and Protective Behavior

The common sense model (CSM) shows how people process information to construct representations, or mental models, that guide responses to health threats. We applied the CSM to understand how people responded to information about arsenic-contaminated well water. Constructs included external information (arsenic level and information use), experience (perceived water quality and arsenic-related health effects), representations, safety judgments, opinions about policies to mitigate environmental arsenic, and protective behavior. Of 649 surveys mailed to private well users with arsenic levels exceeding the maximum contaminant level, 545 (84%) were analyzed. Structural equation modeling quantified CSM relationships. Both external information and experience had substantial effects on behavior. Participants who identified a water problem were more likely to reduce exposure to arsenic. However, about 60% perceived good water quality and 60% safe water. Participants with higher arsenic levels selected higher personal safety thresholds and 20% reported a lower arsenic level than indicated by their well test. These beliefs would support judgments of safe water. A variety of psychological and contextual factors may explain judgments of safe water when information suggested otherwise. Information use had an indirect effect on policy beliefs through understanding environmental causes of arsenic. People need concrete information about environmental risk at both personal and environmental-systems levels to promote a comprehensive understanding and response. The CSM explained responses to arsenic information and may have application to other environmental risks.     

At Home on the Range? Lay Interpretations of Numerical Uncertainty Ranges

Numerical uncertainty ranges are often used to convey the precision of a forecast. In three studies, we examined how users perceive the distribution underlying numerical ranges and test specific hypotheses about the display characteristics that affect these perceptions. We discuss five primary conclusions from these studies: (1) substantial variation exists in how people perceive the distribution underlying numerical ranges; (2) distributional perceptions appear similar whether the uncertain variable is a probability or an outcome; (3) the variation in distributional perceptions is due in part to individual differences in numeracy, with more numerate individuals more likely to perceive the distribution as roughly normal; (4) the variation is also due in part to the presence versus absence of common cues used to convey the correct interpretation (e.g., including a best estimate increases perceptions that the distribution is roughly normal); and (5) simple graphical representations can decrease the variance in distributional perceptions. These results point toward significant opportunities to improve uncertainty communication in climate change and other domains.     

Perception of Hazards: The Role of Social Trust and Knowledge

Recent research indicates that social trust of those who manage a hazard is strongly correlated to judgments about the hazard's risk and benefits. The present study investigates the more specific question of “For which hazards is this?” It was postulated that when an individual lacks knowledge about a hazard, social trust of authorities managing the hazard determines perceived risks and benefits. On the other hand, when an individual has personal knowledge about a hazard and therefore does not need to rely on managing authorities, social trust is unrelated to judged risks and benefits. Participants (N = 91) assessed risks, benefits, and trust in managing authorities and personal knowledge associated with 25 hazardous technologies and activities. As expected, strong correlations between social trust and judged risks and benefits were observed for hazards about which people did not possess much knowledge. No significant correlations between social trust and judged risks and benefits were found for hazards about which people were knowledgeable. Results suggest that the lay public relies on social trust when making judgments of risks and benefits when personal knowledge about a hazard is lacking. Replicating findings of other studies, the present study also found negative correlations between perceived risks and perceived benefits. When social trust was controlled for, correlations between perceived risks and benefits diminished. Implications of the results for risk management are discussed.