Communicating foodborne disease risk.

The food industry, like many others, has a risk communication problem. That problem is manifested in the public's desire to know the truth about outbreaks of foodborne diseases; ongoing concern about the safety of foods, additives, and food-processing procedures; and continued apathy regarding aspects of routine food hygiene. If these concerns are addressed in a coherent and trustworthy way, the public will have better and cheaper food. However, sloppy risk communication can itself cause public health damage. Because citizens are ill-equipped to discriminate among information sources, the food industry as a whole bears responsibility for the successes and failures of its individual members. We review risk communication research and practice for their application to the food industry

How Do NYPD Officers Respond to Terror Threats?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155976/1/ecca12328.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155976/2/ecca12328_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155976/3/ecca12328-sup-0001-Appendix.pd

A cautionary note on global recalibration

We report a mathematical result that casts doubt on the possibility of recalibration of probabilities using calibration curves. We then discuss how to interpret this result in the light of behavioral research

Assessing the validity of using serious game technology to analyze physician decision making

Background: Physician non-compliance with clinical practice guidelines remains a critical barrier to high quality care. Serious games (using gaming technology for serious purposes) have emerged as a method of studying physician decision making. However, little is known about their validity. Methods: We created a serious game and evaluated its construct validity. We used the decision context of trauma triage in the Emergency Department of non-trauma centers, given widely accepted guidelines that recommend the transfer of severely injured patients to trauma centers. We designed cases with the premise that the representativeness heuristic influences triage (i.e. physicians make transfer decisions based on archetypes of severely injured patients rather than guidelines). We randomized a convenience sample of emergency medicine physicians to a control or cognitive load arm, and compared performance (disposition decisions, number of orders entered, time spent per case). We hypothesized that cognitive load would increase the use of heuristics, increasing the transfer of representative cases and decreasing the transfer of non-representative cases. Findings: We recruited 209 physicians, of whom 168 (79%) began and 142 (68%) completed the task. Physicians transferred 31% of severely injured patients during the game, consistent with rates of transfer for severely injured patients in practice. They entered the same average number of orders in both arms (control (C): 10.9 [SD 4.8] vs. cognitive load (CL):10.7 [SD 5.6], p = 0.74), despite spending less time per case in the control arm (C: 9.7 [SD 7.1] vs. CL: 11.7 [SD 6.7] minutes, p<0.01). Physicians were equally likely to transfer representative cases in the two arms (C: 45% vs. CL: 34%, p = 0.20), but were more likely to transfer non-representative cases in the control arm (C: 38% vs. CL: 26%, p = 0.03). Conclusions: We found that physicians made decisions consistent with actual practice, that we could manipulate cognitive load, and that load increased the use of heuristics, as predicted by cognitive theory. © 2014 Mohan et al

Decision-Making Competence: More Than Intelligence?

Decision-making competence refers to the ability to make better decisions, as defined by decision-making principles posited by models of rational choice. Historically, psychological research on decision-making has examined how well people follow these principles under carefully manipulated experimental conditions. When individual differences received attention, researchers often assumed that individuals with higher fluid intelligence would perform better. Here, we describe the development and validation of individual-differences measures of decision-making competence. Emerging findings suggest that decision-making competence may tap not only into fluid intelligence but also into motivation, emotion regulation, and experience (or crystallized intelligence). Although fluid intelligence tends to decline with age, older adults may be able to maintain decision-making competence by leveraging age-related improvements in these other skills. We discuss implications for interventions and future research

Initial psychological responses to influenza A, H1N1 ("Swine flu")

Background The outbreak of the pandemic flu, Influenza A H1N1 (Swine Flu) in early 2009, provided a major challenge to health services around the world. Previous pandemics have led to stockpiling of goods, the victimisation of particular population groups, and the cancellation of travel and the boycotting of particular foods (e.g. pork). We examined initial behavioural and attitudinal responses towards Influenza A, H1N1 ("Swine flu") in the six days following the WHO pandemic alert level 5, and regional differences in these responses. Methods 328 respondents completed a cross-sectional Internet or paper-based questionnaire study in Malaysia (N = 180) or Europe (N = 148). Measures assessed changes in transport usage, purchase of preparatory goods for a pandemic, perceived risk groups, indicators of anxiety, assessed estimated mortality rates for seasonal flu, effectiveness of seasonal flu vaccination, and changes in pork consumption Results 26% of the respondents were 'very concerned' about being a flu victim (42% Malaysians, 5% Europeans, p < .001). 36% reported reduced public transport use (48% Malaysia, 22% Europe, p < .001), 39% flight cancellations (56% Malaysia, 17% Europe, p < .001). 8% had purchased preparatory materials (e.g. face masks: 8% Malaysia, 7% Europe), 41% Malaysia (15% Europe) intended to do so (p < .001). 63% of Europeans, 19% of Malaysians had discussed the pandemic with friends (p < .001). Groups seen as at 'high risk' of infection included the immune compromised (mentioned by 87% respondents), pig farmers (70%), elderly (57%), prostitutes/highly sexually active (53%), and the homeless (53%). In data collected only in Europe, 64% greatly underestimated the mortality rates of seasonal flu, 26% believed seasonal flu vaccination gave protection against swine flu. 7% had reduced/stopped eating pork. 3% had purchased anti-viral drugs for use at home, while 32% intended to do so if the pandemic worsened. Conclusion Initial responses to Influenza A show large regional differences in anxiety, with Malaysians more anxious and more likely to reduce travel and to buy masks and food. Discussions with family and friends may reinforce existing anxiety levels. Particular groups (homosexuals, prostitutes, the homeless) are perceived as at greater risk, potentially leading to increased prejudice during a pandemic. Europeans underestimated mortality of seasonal flu, and require more information about the protection given by seasonal flu inoculation

Do closed survey questions over-estimate public perceptions of food risks?

In this paper we show that the widely accepted methodology for the assessment of risk perception – Likert type survey questions featuring a set of risks with fixed response alternatives measuring the extent of worry or concern – may over-estimate food risk perception. Using a European representative sample survey (n=26,961) that included an open-ended question asking about problems and risks with food and eating, followed by a battery of closed questions assessing food risk perception we find a similar ranking of perceived food risks across the two methods. Across Europe the five priority concerns are chronic food related illness; food origins and quality; acute food related illness; chemical contamination, and adulteration of food. However, the discrepancies between mentioning a risk in the open ended question and the expression of worry about risks in the closed question are substantial. Of those who did not mention a specific risk category in the open question, between 60% and 83% (depending on risk category) expressed worry in the closed question. This parallels previous research on the fear of crime, showing that survey responses lead to greatly inflated estimates of the public’s fear of crime than is evidenced by qualitative questioning. It is also consistent with evidence from research on cognitive aspects of survey methodology suggesting that survey questions may frame the respondent’s thinking about an issue. We conclude with recommendations for the use of branched questions in the quantitative elicitation of public perceptions of risk

Book reviews

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45456/1/11077_2004_Article_BF00137631.pd

Sources of non-compliance with clinical practice guidelines in trauma triage: a decision science study

Background: United States trauma system guidelines specify when to triage patients to specialty centers. Nonetheless, many eligible patients are not transferred as per guidelines. One possible reason is emergency physician decision-making. The objective of the study was to characterize sensory and decisional determinants of emergency physician trauma triage decision-making.Methods: We conducted a decision science study using a signal detection theory-informed approach to analyze physician responses to a web-based survey of 30 clinical vignettes of trauma cases. We recruited a national convenience sample of emergency medicine physicians who worked at hospitals without level I/II trauma center certification. Using trauma triage guidelines as our reference standard, we estimated physicians' perceptual sensitivity (ability to discriminate between patients who did and did not meet guidelines for transfer) and decisional threshold (tolerance for false positive or false negative decisions).Results: We recruited 280 physicians: 210 logged in to the website (response rate 74%) and 168 (80%) completed the survey. The regression coefficient on American College of Surgeons - Committee on Trauma (ACS-COT) guidelines for transfer (perceptual sensitivity) was 0.77 (p<0.01, 95% CI 0.68 - 0.87) indicating that the probability of transfer weakly increased as the ACS-COT guidelines would recommend transfer. The intercept (decision threshold) was 1.45 (p<0.01, 95% CI 1.27 - 1.63), indicating that participants had a conservative threshold for transfer, erring on the side of not transferring patients. There was significant between-physician variability in perceptual sensitivity and decisional thresholds. No physician demographic characteristics correlated with perceptual sensitivity, but men and physicians working at non-trauma centers without a trauma-center affiliation had higher decisional thresholds.Conclusions: On a case vignette-based questionnaire, both sensory and decisional elements in emergency physicians' cognitive processes contributed to the under-triage of trauma patients. © 2012 Mohan et al.; licensee BioMed Central Ltd