Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research

Purpose: To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. Methods: Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. Results: Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. Conclusion: This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development

On and Off the Liability Bandwagon: Explaining State Adoptions of Strict Liability in Hazardous Waste Programs

We analyze factors in states' decisions to switch their approaches to hazardous waste liability policy from negligence standards to policies based on strict liability. Many, but not all, states have switched in recent years. We explain differences in the timing of states' adoption of strict liability into their "mini-superfund" programs using data on states' industrial activities, environmental programs, wealth and education, and political orientation. We test implications of a theoretical model in which states adopt the liability regime (strict versus negligence-based liability) that they see as having greater net benefits. We test this model by estimating a probit equation of the presence or absence of strict liability in a state hazardous waste cleanup program. We find that the likelihood of a state adopting strict liability is positively associated with the number of large manufacturing plants located in that state, but negatively associated with the number of large mining establishments. We also find that educational attainment of residents, state government resources, effectiveness of other state environmental programs, and political variables are significant determinants of the likelihood of strict liability adoption. Our findings suggest states may view strict liability as better suited to industrial waste sites than to mining pollution, that they may be partly motivated by a "deep pocket" mentality, or that they may anticipate engaging in "precaution targeting" (T. H. Tietenberg, 1989, Land Economics 65:4, 305-319). Non-adopters may have fewer resources available to confront environmental problems, may not wish to discourage business activity, or may have other programs in place which effectively substitute (at least for a time) for strict liability imposed on parties responsible for hazardous waste releases.

Does Medical Malpractice Law Improve Health Care Quality?

Despite the fundamental role of deterrence in justifying a system of medical malpractice law, surprisingly little evidence has been put forth to date bearing on the relationship between medical liability forces on the one hand and medical errors and health care quality on the other. In this paper, we estimate this relationship using clinically validated measures of health care treatment quality constructed using data from the 1979 to 2005 National Hospital Discharge Surveys and the 1987 to 2008 Behavioral Risk Factor Surveillance System records. Drawing upon traditional, remedy-centric tort reforms — e.g., damage caps — we estimate that the current liability system plays at most a modest role in inducing higher levels of health care quality. We contend that this limited independent role for medical liability may be a reflection upon the structural nature of the present system of liability rules, which largely hold physicians to standards determined according to industry customs. We find evidence suggesting, however, that physician practices may respond more significantly upon a substantive alteration of this system altogether — i.e., upon a change in the clinical standards to which physicians are held in the first instance. The literature to date has largely failed to appreciate the substantive nature of liability rules and may thus be drawing limited inferences based solely on our experiences to date with damage-caps and related reforms

Health Behaviors and Pandemics

Human health behaviors are essential to reducing the spread and impact of pandemics. However, most behavioral scientists do not work in the area of pandemics given the infrequency of their occurrences. This editorial examines relevant health behavior theories, in particular the precaution adoption process model, and how these apply to the COVID-19 pandemic

CONSUMER RISK PERCEPTION PROFILES FOR THE FOOD-RELATED BIOTECHNOLOGY, RECOMBINANT BOVINE GROWTH HORMONE (rbGH)

Consumer risk perception, biotechnology, bovine growth hormone, Food Consumption/Nutrition/Food Safety,

The Effects of Malpractice Pressure and Liability Reforms on Physicians’ Perceptions of Medical Care

Considerable evidence suggests that the medical malpractice liability system neither provides compensation to patients who suffer negligent medical injury nor seeks to penalize physicians whose negligence causes patient injury. The relationship between liability reforms, malpractice pressure and physician perceptions of medical care is examined