The Health Impact of Mandatory Bicycle Helmet Laws

This article seeks to answer the question whether mandatory bicycle helmet laws deliver a net societal health benefit. The question is addressed using a simple model. The model recognizes a single health benefit—reduced head injuries—and a single health cost—increased morbidity due to foregone exercise from reduced cycling. Using estimates suggested in the literature on the effectiveness of helmets, the health benefits of cycling, head injury rates, and reductions in cycling leads to the following conclusions. In jurisdictions where cycling is safe, a helmet law is likely to have a large unintended negative health impact. In jurisdictions where cycling is relatively unsafe, helmets will do little to make it safer and a helmet law, under relatively extreme assumptions, may make a small positive contribution to net societal health. The model serves to focus the mandatory bicycle helmet law debate on overall health.     

Polarization in the Reaction to Health‐Risk Information: A Question of Social Position?

Dissemination of risk information is ubiquitous in contemporary society. We explore how individuals react in everyday life to health-risk information, based on what they report in personal interviews. Health-risk information was without exception recognized as unstable and inconsistent. This conformity, however, did not extend to the narratives regarding how health-risk information should be handled. Two opposite positions (ideal-typical strategies) are presented. Either you tend to process and evaluate new information or you tend to ignore it as a whole. Our attempt to reveal the underlying rationality in these two very different approaches involved the exploration of three different avenues of interpretation and brings together two scientific paradigms--economics and sociology--that provide the framework for our analysis. First, we suggest that a greater long-term experience of explicit choice implies that this kind of action becomes more natural and less resource consuming, whereas a reliance on habits in daily life--a natural adjustment to a lack of resources--makes it is more costly to bother about new information. Second, with fewer resources in the short run, fewer opportunities to mitigate bad outcomes, and greater exposure to social and material risks, one is less likely to devote resources to deal with health-risk information. Third, there are several possible links between a low propensity to take account of risk information and a high relative importance of genuine uncertainty in one's life. These theoretical perspectives provide a viable set of hypotheses regarding mechanisms that may contribute to social differences in the response to health-risk information.     

A Hybrid Methodology for Modeling Risk of Adverse Events in Complex Health‐Care Settings

In spite of increased attention to quality and efforts to provide safe medical care, adverse events (AEs) are still frequent in clinical practice. Reports from various sources indicate that a substantial number of hospitalized patients suffer treatment‐caused injuries while in the hospital. While risk cannot be entirely eliminated from health‐care activities, an important goal is to develop effective and durable mitigation strategies to render the system “safer.” In order to do this, though, we must develop models that comprehensively and realistically characterize the risk. In the health‐care domain, this can be extremely challenging due to the wide variability in the way that health‐care processes and interventions are executed and also due to the dynamic nature of risk in this particular domain. In this study, we have developed a generic methodology for evaluating dynamic changes in AE risk in acute care hospitals as a function of organizational and nonorganizational factors, using a combination of modeling formalisms. First, a system dynamics (SD) framework is used to demonstrate how organizational‐level and policy‐level contributions to risk evolve over time, and how policies and decisions may affect the general system‐level contribution to AE risk. It also captures the feedback of organizational factors and decisions over time and the nonlinearities in these feedback effects. SD is a popular approach to understanding the behavior of complex social and economic systems. It is a simulation‐based, differential equation modeling tool that is widely used in situations where the formal model is complex and an analytical solution is very difficult to obtain. Second, a Bayesian belief network (BBN) framework is used to represent patient‐level factors and also physician‐level decisions and factors in the management of an individual patient, which contribute to the risk of hospital‐acquired AE. BBNs are networks of probabilities that can capture probabilistic relations between variables and contain historical information about their relationship, and are powerful tools for modeling causes and effects in many domains. The model is intended to support hospital decisions with regard to staffing, length of stay, and investments in safety, which evolve dynamically over time. The methodology has been applied in modeling the two types of common AEs: pressure ulcers and vascular‐catheter‐associated infection, and the models have been validated with eight years of clinical data and use of expert opinion.     

Information Sources as Explanatory Variables for the Belgian Health‐Related Risk Perception of the Fukushima Nuclear Accident

The media play an important role in risk communication, providing information about accidents, both nearby and far away. Each media source has its own presentation style, which could influence how the audience perceives the presented risk. This study investigates the explanatory power of 12 information sources (traditional media, new media, social media, and interpersonal communication) for the perceived risk posed by radiation released from the damaged Fukushima nuclear power plant on respondents’ own health and that of the population in general. The analysis controlled for attitude toward nuclear energy, gender, education, satisfaction with the media coverage, and duration of attention paid to the coverage. The study uses a large empirical data set from a public opinion survey, which is representative for the Belgian population with respect to six sociodemographic variables. Results show that three information sources are significant regressors of perceived health‐related risk of the nuclear accident: television, interpersonal communication, and the category of miscellaneous online sources. More favorable attitudes toward nuclear power, longer attention to the coverage, and higher satisfaction with the provided information lead to lower risk perception. Taken together, the results suggest that the media can indeed have a modest influence on how the audience perceives a risk.     

Factors Associated with the Enactment of Safety Belt and Motorcycle Helmet Laws

It has been shown that road safety laws, such as motorcycle helmet and safety belt laws, have a significant effect in reducing road fatalities. Although an expanding body of literature has documented the effects of these laws on road safety, it remains unclear which factors influence the likelihood that these laws are enacted. This study attempts to identify the factors that influence the decision to enact safety belt and motorcycle helmet laws. Using panel data from 31 countries between 1963 and 2002, our results reveal that increased democracy, education level, per capita income, political stability, and more equitable income distribution within a country are associated with the enactment of road safety laws.     

A Hint of Risk: Tradeoffs Between Quantitative and Qualitative Risk Factors

Risk-perception research plays an active role in discussions of risk-management alternatives. However, little guidance is provided regarding how public concerns should be weighed against other sources of cost and benefits. This paper reports the results of two experiments that measure tradeoffs among cost (in dollars), a quantitative risk measure (number of deaths or injuries), and several qualitative characteristics associated with perceived risk. Most subjects were willing to make the requested trade. However, the perceived risk information led others to reject the proposed technology.     

Health‐care Nonprofits: Enhancing Governance and Public Trust

Nonprofits are a major part of the U.S. economy and they are not immune from corporate malfeasance controversies. Even Congress has expressed concern about the crisis in nonprofit governance. The nonprofit response to Congress has been a historic initiative recognizing critical challenges to nonprofit governance. In contrast to their for‐profit counterparts, nonprofits are committed to missions serving the public benefit and not to shareholder profits. Accordingly, their missions and financial resources are intrinsic to their very existence, which is built upon the public trust. That trust is rooted in fiduciary responsibility and reflected in best practices. This article traces the history of the nonprofit public trust and fiduciary standards and examines principles of Sarbanes–Oxley and other best practices as they apply to nonprofits. The authors sampled 80 health‐care nonprofit corporation web sites from eight asset classes to determine compliance with Sarbanes–Oxley and identification of fiduciary duty, ethical values, and other best practices. Among the very largest health‐care nonprofits, many comply with Sarbanes–Oxley and identify fiduciary duty, ethical values, and other best practices. However, there are substantial deficiencies in such compliance and identification among all remaining seven asset classes ranging from 99.9 million to less than 100,000. The results appear to corroborate the urgent necessity for reform articulated by the Congress and the nonprofit sector. Nonprofit governance has entered a new era where best practices must be implemented to sustain the public trust.     

Examining the 100‐Year Floodplain as a Metric of Risk,Loss, and Household Adjustment

An understudied, but central aspect in understanding flood impacts is the way we conceptualize, identify, and delineate risk. The 100‐year floodplain is the longstanding metric in the United States for determining and acting upon the possibility of an area being inundated. This spatial delineation guides local planning and development decisions, triggers insurance purchases and other household adjustments, and serves as the fundamental indicator for whether it is safe to build a structure on a particular site. However, increasing evidence suggests that the 100‐year floodplain is neither accurate nor sufficient in guiding communities and household decisions to mitigate the adverse economic impacts of floods. In this perspective, we examine the effectiveness of the 100‐year floodplain as an appropriate marker of risk. First, we review existing studies on location and flood damage. Next, we apply these concepts to repetitive flood losses data in Harris County, Texas. We conclude that the apparent inability of the floodplain designation to effectively capture the likelihood of property damage and potential loss of human life in coastal areas has left potentially millions of property owners unaware of the flood risk and unprepared to mitigate their adverse impacts. Relying on traditional 100‐year floodplain boundaries, local decision makers are hampered in their ability to ensure community development occurs in a resilient manner. Finally, we set forth an agenda for future research to better capture the conditions associated with flood risk and account for the large percentage of damage outside the designated floodplain.     

Health‐Economics Analyses Applied to ELF Electric and Magnetic Fields

Extremely low frequency electric and magnetic fields (ELF EMFs) are a common exposure for modern populations. The prevailing public‐health protection paradigm is that quantitative exposure limits are based on the established acute effects, whereas the possible chronic effects are considered too uncertain for quantitative limits, but might justify precautionary measures. The choice of precautionary measures can be informed by a health‐economics analysis (HEA). We consider four such analyses of precautionary measures that have been conducted at a national or state level in California, the Netherlands, the United Kingdom, and Israel. We describe the context of each analysis, examine how they deal with some of the more significant issues that arise, and present a comparison of the input parameters and assumptions used. The four HEAs are methodologically similar. The most significant qualitative choices that have to be made are what dose‐response relationship to assume, what allowance if any to make for uncertainty, and, for a CBA only, what diseases to consider, and all four analyses made similar choices. These analyses suggest that, on the assumptions made, there are some low‐cost measures, such as rephasing, that can be applied to transmission in some circumstances and that can be justifiable in cost‐benefit terms, but that higher cost measures, such as undergrounding, become unjustifiable. Of the four HEAs, those in the United Kingdom and Israel were influential in determining the country's EMF policy. In California and Netherlands, the HEA may well have informed the debate, but the policy chosen did not stem directly from the HEA.     

Challenges in Development and Implementation of Health‐Risk‐Based Soil Quality Guidelines: Turkey's Experience

Management of contaminated sites is a critical environmental issue around the world due to the human health risk involved for many sites and scarcity of funding. Moreover, clean‐up costs of all contaminated sites to their background levels with existing engineering technologies may be financially infeasible and demand extended periods of operation time. Given these constraints, to achieve optimal utilization of available funds and prioritization of contaminated sites that need immediate attention, health‐risk‐based soil quality guidelines should be preferred over the traditional soil quality standards. For these reasons, traditional soil quality standards are being replaced by health‐risk‐based ones in many countries and in Turkey as well. The need for health‐risk‐based guidelines is clear, but developing these guidelines and implementation of them in contaminated site management is not a straightforward process. The goal of this study is to highlight the problems that are encountered at various stages of the development process of risk‐based soil quality guidelines for Turkey and how they are dealt with. Utilization of different definitions and methodologies at different countries, existence of inconsistent risk assessment tools, difficulties in accessing relevant documents and reports, and lack of specific data required for Turkey are among these problems. We believe that Turkey's experience may help other countries that are planning to develop health‐risk‐based guidelines achieve their goals in a more efficient manner.     

Quantile Uncertainty and Value‐at‐Risk Model Risk

This article develops a methodology for quantifying model risk in quantile risk estimates. The application of quantile estimates to risk assessment has become common practice in many disciplines, including hydrology, climate change, statistical process control, insurance and actuarial science, and the uncertainty surrounding these estimates has long been recognized. Our work is particularly important in finance, where quantile estimates (called Value‐at‐Risk) have been the cornerstone of banking risk management since the mid 1980s. A recent amendment to the Basel II Accord recommends additional market risk capital to cover all sources of “model risk” in the estimation of these quantiles. We provide a novel and elegant framework whereby quantile estimates are adjusted for model risk, relative to a benchmark which represents the state of knowledge of the authority that is responsible for model risk. A simulation experiment in which the degree of model risk is controlled illustrates how to quantify Value‐at‐Risk model risk and compute the required regulatory capital add‐on for banks. An empirical example based on real data shows how the methodology can be put into practice, using only two time series (daily Value‐at‐Risk and daily profit and loss) from a large bank. We conclude with a discussion of potential applications to nonfinancial risks.     

Health‐Care Reform and ESI: Reconsidering the Relationship Between Employment and Health Insurance

The health‐care reform promised by the Patient Protection and Affordable Care Act of March 2010 continues our dependence on a central feature of the American health‐care system: employer‐sponsored insurance (ESI). In this article I will criticize the assumptions regarding market and welfare concerns on which this dependence is based and argue that efforts to mandate ESI ignore both the dynamics of the employment relation and the nature of health‐care needs. A comparison between investing in employee education and investing in employee health will reveal the pragmatic challenges to ESI and the covert appeal to employer beneficence on which ESI rests. This paper argues that relying on ESI to guarantee appropriate care for a significant segment of the population is undesirable and unsustainable from both market and moral perspectives.     

Beyond Value‐at‐Risk: GlueVaR Distortion Risk Measures

We propose a new family of risk measures, called GlueVaR, within the class of distortion risk measures. Analytical closed‐form expressions are shown for the most frequently used distribution functions in financial and insurance applications. The relationship between GlueVaR, value‐at‐risk, and tail value‐at‐risk is explained. Tail subadditivity is investigated and it is shown that some GlueVaR risk measures satisfy this property. An interpretation in terms of risk attitudes is provided and a discussion is given on the applicability in nonfinancial problems such as health, safety, environmental, or catastrophic risk management.     

The Tradeoffs Associated with Rerouting Highway Shipments of Hazardous Materials to Minimize Risk

Recent legislative and regulatory activities at the federal level have focused attention on the highway routing of hazardous materials. The question is whether routes that minimize the risk of release accidents (i.e., the expected number of persons impacted by releases of hazardous materials) should be used in lieu of the routes that have the lowest operating costs. This policy issue is addressed for interstate shipments by using a national network model to determine the practical route and minimum risk route between each of 100 different origin-destination pairs (state capitals). The resulting cost-risk tradeoffs are then used to estimate the average cost of rerouting per fatality averted, the value of which turns out to be within the range of values for a number of familiar existing regulations.     

Context‐Specific,Scenario‐Based Risk Scales

Reacting to an emergency requires quick decisions under stressful and dynamic conditions. To react effectively, responders need to know the right actions to take given the risks posed by the emergency. While existing research on risk scales focuses primarily on decision making in static environments with known risks, these scales may be inappropriate for conditions where the decision maker's time and mental resources are limited and may be infeasible if the actual risk probabilities are unknown. In this article, we propose a method to develop context‐specific, scenario‐based risk scales designed for emergency response training. Emergency scenarios are used as scale points, reducing our dependence on known probabilities; these are drawn from the targeted emergency context, reducing the mental resources required to interpret the scale. The scale is developed by asking trainers/trainees to rank order a range of risk scenarios and then aggregating these orderings using a Kemeny ranking. We propose measures to assess this aggregated scale's internal consistency, reliability, and validity, and we discuss how to use the scale effectively. We demonstrate our process by developing a risk scale for subsurface coal mine emergencies and test the reliability of the scale by repeating the process, with some methodological variations, several months later.     

Participatory Organizational Research: Examining Voice in the Co‐production of Knowledge

This paper advances participatory methods in management research. We propose the term participatory organizational research to describe this adjunct to action research. We illustrate the potential of the method to allow sometimes unheard organizational members to generate alternative perspectives that can offer the potential for the co‐production of new forms of knowledge that are locally relevant. Participatory methods originate from work with marginalized groups and have been used more commonly in community and organizational development. The aim of such research is, generally, to change the social and organizational conditions within which participants operate by using their perspectives as active participants to develop alternative possibilities. As such, this research method has significant potential for management researchers in providing the means for unheard organizational members to voice their perspectives: a central component, we argue, in knowledge co‐production. Based on a participatory study of care quality in elder care institutions, we examine in detail how participatory organizational research can enable voice and explore some of the structural limitations particularly in respect of research ethics.     

Examining the Impact of Pre‐Implementation Expectations on Post‐Implementation Use of Enterprise Systems: A Longitudinal Study

This article builds upon the technology acceptance model and theories of technology sensemaking to explore pre‐enterprise system adoption expectations and post‐enterprise system adoption outcomes in a longitudinal setting. Building on the exploitation and exploration paradigm, we propose that task productivity and task innovation expectations are the key drivers of users’ pre‐adoption enterprise system usage intention. Further, we argue that the enterprise system facilitates generation of a common knowledge base that may encourage a more integrated organizational culture and promote shared understanding among employees. Considering the distinction between mandatory and voluntary contexts, we propose that user acceptance of the enterprise system at the pre‐ and post‐adoption stages will mediate these relationships in a mandatory context. The results show that the influence of pre‐adoption expectations regarding task productivity and task innovation on intention to use an enterprise system is mediated by user acceptance of the enterprise system. Intention to use an enterprise system is positively related to actual use. At the post‐adoption stage, the influence of actual use on shared understanding is mediated by user acceptance of an enterprise system and enterprise system use has a direct negative impact on task efficiency in the initial period after implementation. Overall, the results highlight that user acceptance at both pre‐ and post‐adoption stages are critical factors when usage is mandatory. These findings suggest a number of important implications for research and for managerial action.     

Assessing End‐Of‐Supply Risk of Spare Parts Using the Proportional Hazard Model

Operators of long field‐life systems like airplanes are faced with hazards in the supply of spare parts. If the original manufacturers or suppliers of parts end their supply, this may have large impacts on operating costs of firms needing these parts. Existing end‐of‐supply evaluation methods are focused mostly on the downstream supply chain, which is of interest mainly to spare part manufacturers. Firms that purchase spare parts have limited information on parts sales, and indicators of end‐of‐supply risk can also be found in the upstream supply chain. This article proposes a methodology for firms purchasing spare parts to manage end‐of‐supply risk by utilizing proportional hazard models in terms of supply chain conditions of the parts. The considered risk indicators fall into four main categories, of which two are related to supply (price and lead time) and two others are related to demand (cycle time and throughput). The methodology is demonstrated using data on about 2,000 spare parts collected from a maintenance repair organization in the aviation industry. Cross‐validation results and out‐of‐sample risk assessments show good performance of the method to identify spare parts with high end‐of‐supply risk. Further validation is provided by survey results obtained from the maintenance repair organization, which show strong agreement between the firm's and the model's identification of high‐risk spare parts.     

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.