Biomedical subjects
Publications and source records attributed to Baruch Fischhoff.
Adolescent females in this study knew more about their previously diagnosed sexually transmitted infections (STIs) than about other STIs, including ones that they had unknowingly contracted. They appeared to learn about STIs primarily after diagnosis, too late for effective prevention, early detection, or prompt treatment of their disease.
Explore the source record for details and available documents.
Cancer poses many, often difficult choices. Studying these choices poses several strategic decisions for researchers, including (a) whether to conduct formal analyses of the choices being studied, (b) whether to adopt a persuasive stance (or only facilitate independent decision making), (c) whether to focus on optimizing specific choices or securing broader mastery, and (d) which individual differences to address. Behavioral decision research's strategic approach is demonstrated in 4 contexts relevant to cancer-related decisions: (a) informed consent, (b) prevention, (c) infectious disease, and (d) medical emergencies. Each example contains interacting elements of normative analysis, identifying optimal choices; descriptive research, characterizing actual behavior; and prescriptive interventions, seeking to bridge the gap between the normative ideal and the descriptive reality.
The authors examined the evolution of cognitive and emotional responses to terror risks for a nationally representative sample of Americans between late 2001 and late 2002. Respondents' risk judgments changed in ways consistent with their reported personal experiences. However, they did not recognize these changes, producing hindsight bias in memories for their judgments. An intensive debiasing procedure failed to restore a foresightful perspective. A fear-inducing manipulation increased risk estimates, whereas an anger-inducing manipulation reduced them-both in predictions (as previously observed) and in memories and judgments of past risks. Thus, priming emotions shaped not only perceptions of an abstract future but also perceptions of a concrete past. These results suggest how psychological research can help to ensure an informed public.
Laypeople's perceptions of health and safety risks have been widely studied, but only a few studies have addressed perceptions of ecological hazards. We assembled a list of 39 attributes of ecological hazards from the literatures on comparative risk assessment, ecological health, environmental conservation and management, environmental psychology, and risk perception. In Study 1, 125 laypeople evaluated 83 hazards on subsets of this attribute set. Factor analysis of attribute ratings (averaged over participants) revealed six oblique factors: ecological impacts, human impacts, human benefits, aesthetic impacts, scientific understanding, and controllability. These factors predicted mean judgments of overall riskiness, ecological riskiness, acceptability, and regulatory strictness. In Study 2, 30 laypeople each evaluated 34 hazards on 17 attributes and 3 dependent variables. Aggregate-level factor analysis of these data replicated the appropriate portion of the factor solution and yielded similar regression results. Parallel analyses at the individual-participant level yielded factors that explained less variance in judgments of overall riskiness, ecological riskiness, and acceptability. However, the decrease in explanatory power was much less than is often reported for disaggregate-level analyses of psychometric data. This discrepancy illustrates the importance of distinguishing between the level of analysis (aggregate versus disaggregate) and the focus of analysis (distinctions among hazards versus distinctions among participants). In a hybrid analysis, aggregate-level factor scores predicted individual participants' riskiness judgments reasonably well. Psychometric studies such as these provide a sound empirical basis for selecting attributes of ecological hazards for use in comparative risk assessment.
A longitudinal randomized design was used to evaluate the impact of a theoretically based, stand-alone interactive video intervention on 300 urban adolescent girls' (a) knowledge about sexually transmitted diseases (STDs), (b) self-reported sexual risk behavior, and (c) STD acquisition. It was compared to two controls, representing high-quality informational interventions. One used the same content in book form; the other used commercially available brochures. Following randomization, the interventions were administered at baseline, with booster sessions at 1, 3, and 6 months. Self-reports revealed that those assigned to the interactive video were significantly more likely to be abstinent in the first 3 months following initial exposure to the intervention, and experienced fewer condom failures in the following 3 months, compared to controls. Six months after enrollment, participants in the video condition were significantly less likely to report having been diagnosed with an STD. A non-significant trend in data from a clinical PCR assay of Chlamydia trachomatis was consistent with that finding.
Shortly after the 2002 terrorist attacks in Bali, readers of Conde Nast Traveler magazine were surveyed regarding their views on the risks of travel to various destinations. Their risk estimates were highest for Israel, and lowest for Canada. Estimates for the different destinations correlated positively with (1) one another, (2) concern over aspects of travel that can make one feel at risk (e.g., sticking out as an American), (3) worries about other travel problems (e.g., contracting an infectious disease), and (4) attitudes toward risk. Respondents' willingness to travel to a destination was predicted well by whether their estimate of its risk was above or below their general threshold for the acceptability of travel risks. Overall, the responses suggest orderly choices, based on highly uncertain judgments of risks. Worry played a significant role in these choices, even after controlling for cognitive considerations, thereby supporting the recently proposed "risk as feelings" hypothesis. Thus, even among people who have generally consistent and defensible beliefs, emotions may affect choices. These results emerged with people selected for their interest in and experience with the decision domain (travel), but challenged to incorporate a new concern (terror).
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The aftermath of September 11th highlights the need to understand how emotion affects citizens' responses to risk. It also provides an opportunity to test current theories of such effects. On the basis of appraisal-tendency theory, we predicted opposite effects for anger and fear on risk judgments and policy preferences. In a nationally representative sample of Americans (N = 973, ages 13-88) fear increased risk estimates and plans for precautionary measures; anger did the opposite. These patterns emerged with both experimentally induced emotions and naturally occurring ones. Males had less pessimistic risk estimates than did females, emotion differences explaining 60 to 80% of the gender difference. Emotions also predicted diverging public policy preferences. Discussion focuses on theoretical, methodological, and policy implications.
We adopted a comparative approach to evaluate and extend a generic methodology to analyze the different sets of beliefs held about chemical hazards in the workplace. Our study mapped existing knowledge structures about the risks associated with the use of perchloroethylene and rosin-based solder flux in differing workplaces. "Influence diagrams" were used to represent beliefs held by chemical experts; "user models" were developed from data elicited from open-ended interviews with the workplace users of the chemicals. The juxtaposition of expert and user understandings of chemical risks enabled us to identify knowledge gaps and misunderstandings and to reinforce appropriate sets of safety beliefs and behavior relevant to chemical risk communications. By designing safety information to be more relevant to the workplace context of users, we believe that employers and employees may gain improved knowledge about chemical hazards in the workplace, such that better chemical risk management, self-protection, and informed decision making develop over time.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
College students often delay or avoid seeking testing for sexually transmitted infections (STIs), even if the services are readily available. We used in-depth, semistructured interviews to survey 41 college students aged 18 to 23 years about factors that influence decisions about STI testing. We grouped statements into 9 themes that represent influences on the decision. The most frequently mentioned factors were negative consequences of testing and perceived vulnerability to infection; other issues that influenced decision making included perceived benefits, perceived severity of diseases, public knowledge and opinion, social norms, provider characteristics, test-site characteristics, and personal considerations. Social stigmas and negative consequences appear to represent significant barriers to college students' being tested, which could increase the risk of spreading infections to others. Clinicians and health educators should raise students' awareness of the need for screening and should work to reduce the barriers to screening, including social stigmas and negative consequences.
OBJECTIVES: To elicit mechanical ventilation preferences among patients who previously received prolonged (>/=48 hrs) mechanical ventilation, to identify patient characteristics associated with mechanical ventilation preferences, and to assess the association between the intensive care experience and mechanical ventilation preferences. DESIGN: Prospective cohort study conducted between June of 1997 and July of 2000. SETTING: Four intensive care units at a tertiary care institution. PATIENTS: Former critically ill patients (n = 133; mean age +/- sd, 51.8 +/- 17.1 yrs; 49% women) who survived for 12 months after prolonged mechanical ventilation. MEASUREMENTS: Patients' preferences toward their actual mechanical ventilation experiences, by asking patients to reflect on the decision to apply mechanical ventilation made 1 yr earlier. Preferences for hypothetical situations, by asking patients to evaluate mechanical ventilation choices, assuming that their experiences had been different in terms of pain or discomfort, familial financial burden and stress, and health status after mechanical ventilation. RESULTS: Of the 133 patients, 115 (86.5%) would have chosen mechanical ventilation, with younger and healthier patients having higher odds of choosing mechanical ventilation than older and sicker patients, respectively. One fourth of patients who initially would have chosen mechanical ventilation would have refused this therapy had their families' financial burdens been beyond certain thresholds. A similar proportion would have refused mechanical ventilation with greater mechanical ventilation pain or discomfort. CONCLUSION: Although most subjects would have made the same decision to receive mechanical ventilation, younger and healthier subjects were most likely to favor mechanical ventilation. Many patients indicated that factors such as the amount of pain or discomfort from mechanical ventilation and their families' financial burden would cause them to refuse this potentially life-saving intervention.
Studies using open-ended response modes to elicit probabilistic beliefs have sometimes found an elevated frequency (or blip) at 50 in their response distributions. Our previous research suggests that this is caused by intrusion of the phrase "fifty-fifty," which represents epistemic uncertainty, rather than a true numeric probability of 50%. Such inappropriate responses pose a problem for decision analysts and others relying on probabilistic judgments. Using an explicit numeric probability scale (ranging from 0-100%) reduces thinking about uncertain events in verbal terms like "fifty-fifty," and, with it, exaggerated use of the 50 response. Here, we present two procedures for adjusting response distributions for data already collected with open-ended response modes and hence vulnerable to an exaggerated presence of 50%. Each procedure infers the prevalence of 50s had a numeric probability scale been used, then redistributes the excess. The two procedures are validated on some of our own existing data and then applied to judgments elicited from experts in groundwater pollution and bioremediation.
Recent studies show diabetes can be prevented. Growing knowledge of its biological bases opens further prevention opportunities. This article focuses on behavioral science research that may advance these opportunities. An ecological model guides attention to how prevention research may be pursued at the individual, group, or community levels. Three key areas are reviewed: risk communication, screening, and preventive interventions. Research on diabetes risk communication is limited but suggests that many are relatively unaware of risks and may have misconceptions about the disease. Amid policy debates and research regarding the potential benefits and costs of screening, identification of diabetes may itself be risky in terms of psychological and social consequences. The Diabetes Prevention Program and other studies make clear that diabetes can be prevented, both by the combination of weight loss and physical activity and by medications. Research needs to address promoting these methods to individuals as well as to groups and even whole communities. Fundamental as well as applied research should address how risks of diabetes are understood and may be communicated; how to enhance benefits and minimize psychological and other risks of screening; how to promote healthy eating and weight loss, physical activity, and appropriate use of medications to prevent diabetes; and how to reduce socioeconomic and cultural disparities in all these areas.