Predicting Cancer‐Prevention Behavior: Disentangling the Effects of Risk Aversion and Risk Perceptions

Experimental and survey research spanning the last two decades concludes that people who are more risk tolerant are more likely to engage in risky health activities such as smoking and heavy alcohol consumption, and are more likely to be obese. Subjective perceptions of the risk associated with different activities have also been found to be associated with health behaviors. While there are numerous studies that link risk perceptions with risky behavior, it is notable that none of these controls for risk aversion. Similarly, studies that control for risk aversion fail to control for risk misperceptions. We use a survey of 474 men and women to investigate the influence of risk aversion, risk misperceptions, and cognitive ability on the choice to engage in behaviors that either increase or mitigate cancer risk. We measure optimism in two dimensions: baseline optimists are those who inaccurately believe their cancer risk to be below its expert‐assessed level, while control optimists are those who believe they can reduce their risk of cancer (by changing their lifestyle choices) to a greater extent than is actually the case. Our results indicate that baseline optimism is significantly and negatively correlated with subjects′ tendencies to engage in cancer‐risk‐reducing behaviors, and positively correlated with risky behaviors. Subjects’ control misperceptions also appear to play a role in their tendency to engage in risky and prevention behaviors. When controlling for both of these types of risk misperception, risk aversion plays a much smaller role in determining health behaviors than found in past studies.     

Environmental Tobacco Smoke Revisited: The Reliability of the Data Used for Risk Assessment

Several epidemiological studies have found a weak, but consistent association between lung cancer in nonsmokers and exposure to environmental tobacco smoke (ETS). In addition, a purported link between such exposure and coronary heart disease (CHD) has been of major concern. Although it is biologically plausible that ETS has a contributory role in the induction of lung cancer in nonsmoking individuals, dose-response extrapolation-supported by the more solid database for active smokers-gives an additional risk for lung cancer risk that is more than one order of magnitude lower than that indicated by major positive epidemiological studies. The discrepancy between available epidemiological data and dosimetric estimates seems, to a major part, to reflect certain systematic biases in the former that are difficult to control by statistical analysis when dealing with risks of such low magnitudes. These include, most importantly, misclassification of smoking status, followed by inappropriate selection of controls, as well as certain confounding factors mainly related to lifestyle, and possibly also hereditary disposition. A significant part of an association between lung cancer and exposure to ETS would disappear, if, on the average, 1 patient out of 20 nonsmoking cases had failed to tell the interviewer that he had, in fact, recently stopped smoking. In the large International Agency for Research on Cancer (IARC) multicenter study even lower misclassification rates would abolish the weak, statistically nonsignificant associations that were found. In the former study an apparent significant protective effect from exposure to ETS in childhood with respect to lung cancer later in life was reported, a most surprising finding. The fact that the mutation spectrum of the p53 tumor suppressor gene in lung tumors of ETS-exposed nonsmokers generally differs from that found in tumors of active smokers lends additional support to the notion that the majority of tumors found in ETS-exposed nonsmokers have nothing to do with tobacco smoke. The one-sided preoccupation with ETS as a causative factor of lung cancer in nonsmokers may seriously hinder the elucidation of the multifactorial etiology of these tumors. Due to the high prevalence of cardiovascular disease in the population, even a modest causal association with ETS would, if valid, constitute a serious public health problem. By pooling data from 20 published studies on ETS and heart disease, some of which reported higher risks than is known to be caused by active smoking, a statistically significant association with spousal smoking is obtained. However, in most of these studies, many of the most common confounding risk factors were ignored and there appears to be insufficient evidence to support an association between exposure to ETS and CHD. Further, it seems highly improbable that exposure to a concentration of tobacco smoke at a level that is generally much less than 1% of that inhaled by a smoker could result in an excess risk for CHD that-as has been claimed-is some 30% to 50% of that found in active smokers. There are certainly valid reasons to limit exposure to ETS as well as to other air pollutants in places such as offices and homes in order to improve indoor air quality. This goal can be achieved, however, without the introduction of an extremist legislation based on a negligible risk of lung cancer as well as an unsupported and highly hypothetical risk for CHD.     

Sage mir,wie viel Zeit du hast,und ich sage dir,wer du bist

Time as a dimension of the social value of persons in Bourdieu’s ?Meditations“In his book ?Meditations“ (2001), Pierre Bourdieu’s idea of ?Habitus“ plays a major role also with respect to the role and influence of ?time“. Only if expectations and possibilities are in close correspondence, our feeling of time does function in the sense, that time goes by unnoticed and continuously. Bourdieu does concede time to be of major influence and to be a powerful parameter of our lives, e.g. when unemployed workers lose control over their lives because they have too much time they cannot use it in a satisfying way. At the other extreme, people are as well able to dominate others by using this power of time (e.g. by waiting respectively letting people wait etc.). The shortage and in fact the importance, which is granted for a man’s time, in Bourdieu’s eyes is a relevant factor for the social value of a person in general.     

An approach to the treatment evaluation of Hodgkin's disease

Hodgkin's disease is a cancer of the lymphatic system. The major feature influencing the type of treatment employed, and the ultimate prognosis, is the stage or extent of disease prior to therapy. This paper is concerned with evaluating the difference in patient progress of two staging procedures. One (pathological staging) procedure is more extensive than the other (clinical staging). The evaluation is carried out by firstly developing a mathematical model of patient progress for pathologically staged patients and then using this model to predict what would have happened to clinically staged patients if they had been treated according to their pathological stage. Comparison of these predictions with actual results suggests that pathologically staged patients appear to remain in disease free survival (remission) following radio-therapy longer than clinically staged patients.     

Database marketing for competitive advantage

Achieving fully integrated Database Marketing is a long way off for most companies but the technology to achieve it is available today. More and more companies in different sectors are increasing the degree of automation in their marketing every year. By the 1990s there will be major manufacturing and distribution companies able to claim that their marketing is truly integrated with all their other functional activities through database marketing.     

Cancer Anxiety and the Perception of Risk in Alarmed Communities

Cancer is a significant public health topic and is frequently a factor in public reactions to environmental hazards. It may be reasonable to suggest that a unique form of health anxiety exists - one specific to cancer. In this article, we explore a measure of cancer anxiety that has applicability to risk perception in the specific context of communities that are alarmed over suspect cancer rates thought to be associated with environmental hazards. A literature search was used to identify survey questions previously used to measure cancer worry, fear, anxiety, etc. A list of 24 items was employed in a mail survey sent to 30 communities in which cancer rates were under investigation (part of a broader study). An analysis of the dataset of 1,111 responses yields two versions of a cancer anxiety scale: one an additive combination of 21 items (alpha= 0.77) and the other a two-factor model consisting of nine- and four-item subscales (alpha= 0.74 and 0.69). The resulting scales are evaluated for their ability to predict perception of risk from the environmental hazards in these cases. Controlling for age, sex, and cancer status, the scales explain between 2% and 10% of risk perception (full R(2) values ranging from 0.17 to 0.24). Given the range of concepts required to model risk perception, we conclude that this measure of cancer anxiety is sufficiently reliable and robust to be recommended for use in circumstances involving hazards associated with cancer. Other uses and further development of the measure are discussed.     

Skin Cancer and Inorganic Arsenic: Uncertainty-Status of Risk

The current U.S. EPA standard for inorganic arsenic in drinking water is 50 ppb (μg/L), dating to the National Interim Primary Drinking Water Regulation of 1976. The current EPA risk analysis predicts an increased lifetime skin cancer risk on the order of 3 or 4 per 1000 from chronic exposure at that concentration. Revision of the standard to only a few ppb, perhaps even less than 1 ppb, may be indicated by the EPA analysis to reduce the lifetime risk to an acceptable level. The cost to water utilities, and ultimately to their consumers, to conform to such a large reduction in the standard could easily reach several billion dollars, so it is particularly important to assess accurately the current risk and the risk reduction that would be achieved by a lower standard. This article addresses the major sources of uncertainty in the EPA analysis with respect to this objective. Specifically, it focuses on uncertainty and variability in the exposure estimates for the landmark study of Tseng and colleagues in Taiwan, analyzed using a reconstruction of the their exposure data. It is concluded that while the available dataset is suitable to establish the hazard of skin cancer, it is too highly summarized for reliable dose-response assessment. A new epidemiologic study is needed, designed for the requirements of dose-response assessment.     

Review of Radon and Lung Cancer Risk

Radon, a long-established cause of lung cancer in uranium and other underground miners, has recently emerged as a potentially important cause of lung cancer in the general population. The evidence for widespread exposure of the population to radon and the well-documented excess of lung cancer among underground miners exposed to radon decay products have raised concern that exposure to radon progeny might also be a cause of lung cancer in the general population. To date, epidemiological data on the lung cancer risk associated with environmental exposure to radon have been limited. Consequently, the lung cancer hazard posed by radon exposure in indoor air has been addressed primarily through risk estimation procedures. The quantitative risks of lung cancer have been estimated using exposure-response relations derived from the epidemiological investigations of uranium and other underground miners. We review five of the more informative studies of miners and recent risk projection models for excess lung cancer associated with radon. The principal models differ substantially in their underlying assumptions and consequently in the resulting risk projections. The resulting diversity illustrates the substantial uncertainty that remains concerning the most appropriate model of the temporal pattern of radon-related lung cancer. Animal experiments, further follow-up of the miner cohorts, and well-designed epidemiological studies of indoor exposure should reduce this uncertainty.     

Strategic control of factory automation

This article identifies strategic control as an unexpected difficulty in implementing the ‘factory of the future’ and as a major stumbling block to firms in their automation efforts. The concept of strategic control is discussed and an example is given. The results of a study in this area are then described and used to explain how managers have unknowingly relinquished control of the manufacturing operation. The article concludes with advice for managers in setting up strategic control systems in their firms that will facilitate rather than hinder the progress of factory automation.     

Differences in Perception of Risk Between People Who Have and Have Not Experienced Salmonella Food Poisoning

It is believed that food hygiene precautions in domestic kitchens are an important strategy in efforts to reduce the incidence of sporadic food poisoning, but recent research has shown that people who have suffered food poisoning handle the same types of foods and adopt similar food hygiene precautions in their kitchens to the rest of the population. This suggests the need to examine other factors. A case-control study of sporadic Salmonella food poisoning was conducted to investigate several domestic kitchen risk factors. Measures of perception of risk, knowledge, and control associated with food poisoning in case and control respondents are reported here. It was found that perceived personal risk from food poisoning in the home was less than perceived risk to other people. In contrast, ratings of personal knowledge about food poisoning and personal control over food poisoning in the home were seen to be greater than other people's knowledge and control. There were no differences between the cases and the controls in their ratings of knowledge about food poisoning or their control over food poisoning. However, cases perceived their personal risk from food poisoning to be higher than controls. Both case and control samples exhibited optimistic bias but this was reduced in the case sample, suggesting that experience with food poisoning may reduce optimistic bias.     

Revisiting the relationship between ownership and control in international business operations: Lessons from transition economies

This article develops a conceptual model linking two interrelated dimensions of foreign business operations in transition economies: resources committed to the entry in terms of ownership, and resources committed to control the operations. The model outlines four types of foreign operations in transition economies: 1) arm's length contractor (low degree of foreign ownership and low level of foreign control over the operations); 2) hands-on contractor (low ownership and high control); 3) brand protector (high ownership and control); and 4) market share maximizer (high ownership and low control). These types are illustrated with examples of companies in four sectors of the Russian economy: metals, textiles, oil products, and beverages.We contribute to the literature on ownership and control in foreign operations, and their linkage to resource commitment at different stages of operations. In particular, we explicate situations characteristic of transition economies where ownership and control are not positively correlated. Moreover, we illustrate that the (financial) resources committed at the entry stage do not necessarily correlate with the managerial resources committed to the operations. For example, contractual collaborations in transition economies typically require few financial resources but more managerial resource commitment than in more developed market economies. On the other hand, operations with major commitment in the form of foreign equity investment may be managed autonomously by a local manager or a minority shareholder.     

Exploring the nature of control and its role in the appraisal of workplace stress

The concept of control is a prominent component of theories of stress. From a transactional framework, appraisal of control is seen as important in influencing coping behaviour. However, little attention has been paid to the measurement of the appraisal of control in a work-related situation. In this paper it is argued that situational control should not be reduced to a simple assessment of whether or not an individual has control over a given situation. Instead it is believed that it is important to identify the factors that an individual strives to have control of, as well as the perceived degree of control over those factors. A major component of the present study was the use of a measure that viewed control in this way and that examined control as a multifaceted construct (task control, predictability, self-control and general control). This paper reports on an analysis that examines the multifaceted nature of perceived control with other situational appraisals in the process of coping with workplace stress. A total of 134 employees from four public sector organizations in New Zealand took part in this research. Having control over work tasks was for this sample considered to be less important in giving a sense of control than either predictability or self-control. When it came to reporting how much control they actually had, respondents reported higher levels of self-control than other aspects of control. However, in general respondents reported lower levels of actual control than what they perceived it was important for them to have. This research emphasizes the importance of having a sense of self-control, particularly when it comes to the use of different coping strategies. Overall these findings point to the need to better understand the nature and type of control and its importance if we are to advance our knowledge of work stress.     

Exploring the nature of control and its role in the appraisal of workplace stress

The concept of control is a prominent component of theories of stress. From a transactional framework, appraisal of control is seen as important in influencing coping behaviour. However, little attention has been paid to the measurement of the appraisal of control in a work-related situation. In this paper it is argued that situational control should not be reduced to a simple assessment of whether or not an individual has control over a given situation. Instead it is believed that it is important to identify the factors that an individual strives to have control of, as well as the perceived degree of control over those factors. A major component of the present study was the use of a measure that viewed control in this way and that examined control as a multifaceted construct (task control, predictability, self-control and general control). This paper reports on an analysis that examines the multifaceted nature of perceived control with other situational appraisals in the process of coping with workplace stress. A total of 134 employees from four public sector organizations in New Zealand took part in this research. Having control over work tasks was for this sample considered to be less important in giving a sense of control than either predictability or self-control. When it came to reporting how much control they actually had, respondents reported higher levels of self-control than other aspects of control. However, in general respondents reported lower levels of actual control than what they perceived it was important for them to have. This research emphasizes the importance of having a sense of self-control, particularly when it comes to the use of different coping strategies. Overall these findings point to the need to better understand the nature and type of control and its importance if we are to advance our knowledge of work stress.     

Deathbed visions from the Republic of Moldova: a content analysis of family observations

This is an interview-based study of 102 families and their observations of the last weeks and days of a dying family member. Forty-one families reported hearing about "visions," "hallucinations," or "dreams" from their dying loved one before their death. Of these 41 mixed cases, 37 cases demonstrated classic features of deathbed visions-reports of seeing dead relatives or friends communicating to the dying person. This article reports a content analysis of these 37 cases in order to identify the major psychosocial themes that seem to be conveyed by these kinds of experiences. Six major themes are identified. These themes are: support, comfort, companionship, reunion, prognosis, and choice and control. Implications of these themes are discussed in relation to their role in providing significant support for the psychological morale and social well being of dying people.     

Changes in production control required for untended operation of a flexible manufacturing cell

This article examines and improves the production control system of a firm that wants to operate its flexible manufacturing cell (FMC) in an untended third shift. The FMC consists of a machining centre, a pallet storage, a rail-guided transport vehicle for pallets and a clamping/unclamping station. The current production control system of the firm shows several deficiencies with respect to operating the FMC efficiently. This article proposes changes in the current production control hierarchy and introduces some new methods to solve major production control problems. The study illustrates the interaction between quantitative tools, organisational decisions and behavioural considerations. The approaches are general and can be used in other environments.     

Shared Values, Social Trust, and the Perception of Geographic Cancer Clusters

Extensive scientific investigations often fail to identify specific carcinogens that have caused geographic clusters of cancer cases. In many such examples, public health officials and other experts have concluded that the cluster is not the result of a particular local environmental condition. Despite this conclusion by experts, concerned members of local communities often persist in believing that the cancer cluster was not random. The present study accounts for the persistence of this belief on the basis of two factors: (a) the tendency of the human mind to identify patterns (and causes), rather than randomness; and (b) a lack of social trust in public health experts. It was expected that perceived shared values evoke social trust. Individuals who conclude that public health experts share their values should be more likely to accept the experts' conclusion that a cancer cluster reflects randomness, not a particular local cause. Individuals who trust authorities should be more inclined than individuals not having trust to accept that a geographic cluster of cancer cases is a coincidence. Data from Swiss students (N = 334) supported these expectations. Additionally, significant gender differences were observed. Females had less trust in authorities and perceived the cancer cluster as less likely to be a result of pure chance than did males. Practical implications of the results are discussed.     

Japanese marketing strategies in the United Kingdom

This article is based on a study which examined hypotheses about Japanese marketing using a matched sample of British companies and their major Japanese competitors. Japanese subsidiaries in Britain were shown to be much more marketing-oriented, more responsive to strategic opportunities, and more single-minded in their pursuit of market share. Organizationally, there were few differences between the two groups. The Japanese subsidiaries, however, were more inclined to use product or market-based divisions and continuous, informal planning and control procedures. The result is that managerial focus and responsibility are centred upon overall product-market rather than financial or production performance, with continuous feedback facilitating rapid adaptation and implementation of marketing plans and strategy.     

A Meta-analysis of Factors Leading to Management Control in International Joint Ventures

In international joint ventures (IJVs), management control exerted by parent firms is fundamental since it can direct employees' activities to strive for the overall goals, to safeguard parent firms' idiosyncratic investments and to decrease opportunistic behaviors. Using a meta-analytic approach, we investigate the main factors influencing management control in IJVs. A search of the published and unpublished literature uncovered 45 articles that yielded 329 reported correlations between the factors and management control with a total sample size of 15,252 IJVs. Results indicate that the factors can be ordered in the following way in terms of the average size of their association with management control: resource contribution; equity share; trust; and strategic importance to the IJVs. Three moderators including operating country (China versus other countries), industry type (manufacturing versus service) and management control type (formal control versus informal control) were proposed to examine the heterogeneity issue. Our meta-analysis suggests that there is a bias of the empirical studies given that a majority of the samples are IJVs operating in the Chinese manufacturing industry, which indicates that results of this meta-analysis may not be representative of all IJVs and that future empirical research should include IJVs in other countries and in other industries.     

Significance of Exposure Assessment to Analysis of Cancer Risk from Inorganic Arsenic in Drinking Water in Taiwan

The primary source of evidence that inorganic arsenic in drinking water is associated with increased mortality from cancer at internal sites (bladder, liver, lung, and other organs) is a large ecologic study conducted in regions of Southwest Taiwan endemic to Blackfoot disease. The dose-response patterns for lung, liver, and bladder cancers display a nonlinear dose-response relationship with arsenic exposure. The data do not appear suitable, however, for the more refined task of dose-response assessment, particularly for inference of risk at the low arsenic concentrations found in some U.S. water supplies. The problem lies in variable arsenic concentrations between the wells within a village, largely due to a mix of shallow wells and deep artesian wells, and in having only one well test for 24 (40%) of the 60 villages. The current analysis identifies 14 villages where the exposure appears most questionable, based on criteria described in the text. The exposure values were then changed for seven of the villages, from the median well test being used as a default to some other point in the village's range of well tests that would contribute to smoothing the appearance of a dose-response curve. The remaining seven villages, six of which had only one well test, were deleted as outliers. The resultant dose-response patterns showed no evidence of excess risk below arsenic concentrations of 0.1 mg/l. Of course, that outcome is dependent on manipulation of the data, as described. Inclusion of the seven deleted villages would make estimates of risk much higher at low doses. In those seven villages, the cancer mortality rates are significantly high for their exposure levels, suggesting that their exposure values may be too low or that other etiological factors need to be taken into account.     

Assessing Cancer Risks from Short-Term Exposures in Children

For the vast majority of chemicals that have cancer potency estimates on IRIS, the underlying database is deficient with respect to early-life exposures. This data gap has prevented derivation of cancer potency factors that are relevant to this time period, and so assessments may not fully address children's risks. This article provides a review of juvenile animal bioassay data in comparison to adult animal data for a broad array of carcinogens. This comparison indicates that short-term exposures in early life are likely to yield a greater tumor response than short-term exposures in adults, but similar tumor response when compared to long-term exposures in adults. This evidence is brought into a risk assessment context by proposing an approach that: (1) does not prorate children's exposures over the entire life span or mix them with exposures that occur at other ages; (2) applies the cancer slope factor from adult animal or human epidemiology studies to the children's exposure dose to calculate the cancer risk associated with the early-life period; and (3) adds the cancer risk for young children to that for older children/adults to yield a total lifetime cancer risk. The proposed approach allows for the unique exposure and pharmacokinetic factors associated with young children to be fully weighted in the cancer risk assessment. It is very similar to the approach currently used by U.S. EPA for vinyl chloride. The current analysis finds that the database of early life and adult cancer bioassays supports extension of this approach from vinyl chloride to other carcinogens of diverse mode of action. This approach should be enhanced by early-life data specific to the particular carcinogen under analysis whenever possible.