Childhood Lead Poisoning in a Somali Refugee Resettlement Community in New Hampshire

Despite the gradual decrease in childhood lead poisoning in the United States, the risk for lead poisoning among African refugee children who resettle in the United States remains elevated. Communication methods implemented by resettlement agencies in the public health system for preventing childhood lead poisoning in this at-risk population warrant further investigation. We utilized structured interviews with key stakeholders (resettlement agencies, social service agencies developed by African refugees and resettled Somali refugees) involved in the refugee resettlement process to (1) describe the agency’s role in the refugee resettlement process; (2) examine communication methods utilized and barriers experienced by the public health system in reference to childhood lead poisoning; (3) describe the refugee population’s perception of childhood lead poisoning; (4) examine general challenges experienced by the public health system and the refugee population during the resettlement process; and (5) describe stakeholders’ recommendations to improve health communication efforts. Based on our findings, we propose that communities are important determinants in health-related problems for refugee populations. Each community has its own environment and public health system that interacts with each other to influence health risks and risk perceptions of its populations. We advocate that understanding a community’s ecology and implementing a culture-centered approach is essential for the public health system to help educate and prevent communication inequalities and health disparities among an at-risk African refugee population. This action can reduce a population’s resistance to communication and help build a community’s capacity to address a persistent public health problem, such as childhood lead poisoning.     

Social agents and news media as risk amplifiers: a case study on the public debate about the E. coli outbreak in Germany 2011

The social amplification of risk framework highlights the role which the news media play in risk communication by interacting with other agents in amplifying risk. However, the precise ways in which the media and other social agents actually amplify risks in public debates are unclear. In this article we draw on insights from the sociology of news to examine whether and to what extent social agents and news media amplify an emerging health risk. We use the debate about the Escherichia coli outbreak in Germany in 2011 to examine three issues: the amount of risk reporting by news media and social agents in their function as news sources; their evaluation of risk; and how they contribute to the escalation of risk, also known as ripple effects. In this article we draw on data from a content analysis of press releases from public health authorities and affected stakeholders and of news items in leading German news media. We found that the affected stakeholders were amplifying the risk to the greatest extent. We also found that there was a shift over time in the use of dominant frames. At the start of the debate the risk was framed as a public health issue and linked to medical-scientific progress. As the debate developed, more attention was given to political and economic consequences of the outbreak and the original health risk event was layered by other risk-related events.     

Risking public safety: Experts,the medical profession and ‘acceptable’ drug injury

By locating expertise within an institutional framework, this paper examines the roles of regulators, the pharmaceutical industry and the medical profession in drug risk assessment and in the construction of ‘acceptable’ drug injury in particular. It is suggested that, while public perceptions of risks are important, they may be extremely limited due to relative secrecy surrounding some risk-generating activities, such as pharmaceutical development and regulation. Under these circumstances, a necessary starting point is the investigation of the formation of expert risk assessments. Taking the case of the anaesthetic drug, Althesin, the article explains how drug risks, largely unknown to the public, came to be defined as acceptable by expert and regulatory interpretation for over a decade. The reasons for and drivers of the regulatory route taken, together with alternative regulatory approaches are identified in relation to the salient risk – benefit problems: extrapolation of animal toxicology to humans, construction of therapeutic benefit, comparative risk assessment, unpredictability of risk and risk – benefit evaluation. It is argued that professional closure between expert regulators, the manufacturer and sections of the anaesthesiology profession led to passive decision-making and a regulatory approach towards acceptable drug injury unlikely to have been sustainable if it had been subjected to public accountability. The Althesin experience also suggests that regulators, the medical profession and other stakeholders concerned about drug risks should focus their attention not only on improving the evidence-base of risk assessment, but also on more robust interpretation and informative communication of the evidence already available at any particular time. Finally, the Althesin case demonstrates that, contrary to popular claims, major drug risks have not necessarily only been discovered upon widespread use after marketing approval and that, even after discovery of life-threatening risks, drugs have not necessarily been withdrawn quickly by the UK regulatory authorities despite the availability of safer alternatives.     

Occupational health and safety policy and psychosocial risks in Europe: The role of stakeholders’ perceptions

Introduction

Psychosocial risks are now largely acknowledged throughout Europe as important challenges in occupational health and safety. However, there appear to be wide gaps in perception between experts and the general population on the nature and the relevance of psychosocial risks that have a potential impact on policy development and implementation in this area.

Methods

This study investigated the level of knowledge among European stakeholders, of legislation on occupational safety and health, focusing particularly on psychosocial risk factors. 75 members of employers’ associations, trade unions and government institutions from 21 countries in the European Union (EU) participated in the study. In addition, to further elaborate the findings of the survey, focus groups were organised during a 2-day stakeholder workshop.

Results

The level of application of European Directive 89/391 for the assessment and management of psychosocial risks and work-related stress was largely reported by the stakeholders as inadequate. This opinion was more marked in the new EU27 countries than the older EU15, and the difference was significant as regards the impact of the Directive on the assessment and management of psychosocial risks. Overall, psychosocial risks and work-related stress were reported to be important occupational health and safety concerns; however there were important differences among stakeholders in different countries.

Conclusions

Despite the development of knowledge and activities on both the policy and practice levels in recent years, further work is still needed to harmonize stakeholder perceptions in this area in the various EU member states.     

Examining uncertainties in government risk communication: citizens' expectations

With the shift towards more participative approaches to risk communication and risk management, policymakers are expected to be more transparent with the public concerning existing uncertainties about health risks, such as lack of data or contradictory evidence. There is, however, a debate among researchers as to whether this transparency about uncertainties is indeed welcomed by the public and if it is effective in promoting trust in risk regulatory institutions. The qualitative study on which this article is based aimed to clarify citizens' perceptions of diverse sources of uncertainty in government risk communication and their expectations with respect to discussing uncertainties. Forty-seven adults from two major Canadian cities took part in focus groups or individual interviews in which they voiced their expectations about who should be involved in risk communication, why uncertainties should be communicated, what sources of uncertainties were preferred, as well as how and when these should be discussed. Their discussions showed that they expected the government to include citizens in evaluating and managing uncertainties pertaining to risks under individual control and directly informing consumer choices about health risks. In contrast, they questioned the relevance of systematically exposing uncertainties relating to risks perceived as outside individual control, and associated with very low probability scenarios of possible threats. Globally, they appraised the desirability of discussing uncertainties in risk communication in relation to the perceived utility of the information for decision-making. These findings indicate that risk communicators and managers need to consider ways in which discussions of uncertainties can empower citizens.     

Strategies for dismissing dietary risks: insights from user-generated comments online

Communication around chronic dietary risks has proved challenging as dietary health risks are ostensibly met with attenuated perceptions of their likelihood and consequences. In this article, we examine the strategies that an online public use to negotiate risk messages from expert stakeholders that may be incongruent with their own position on a risk. Progressing from conceptualisations of amplification as laid out in the social amplification of risk framework, we are particularly interested in understanding whether and how amplifications of risk may be attributed towards other stakeholders. The article presents an analysis of comments posted on a website oriented to a British audience. These comments were left by members of the public in reply to two online media articles published in 2012 reporting on an epidemiological study carried out in the United States on the risks of red meat consumption. We found that the comments generally expressed resistance to the risk message, embodied in two main strategies. The first strategy was to discount the message itself by deploying rules of thumb that undermined the applicability of the general risk message to the particularities of the individual. The second strategy was to undermine the risks by casting doubt on the credibility of the message source. Together, these strategies allowed the commenters to argue that the risks and the process of communicating them resulted in an exaggerated picture. These findings highlight that by attributing amplification to others, further polarisation of risk views between stakeholders may occur. Thinking about amplification as an attribution provides a distinct and significant conceptual contribution to the study of incongruent risk responses.     

Consumer perceptions of the effectiveness of food risk management practices: A cross-cultural study

Consumer perceptions of food hazards and how the associated risks are managed are likely to be an important determinant of consumer confidence in food safety. While there is a body of research that examines public perceptions of various types of food hazards, less attention has been directed to understanding how the public perceives food risk management practices. Utilizing elements of the repertory grid approach in focus group discussions, this research explored public attitudes regarding the effectiveness of current food risk management practices in four European countries (Denmark, Germany, Greece and the UK). While the issue of food safety did not emerge as a key factor in everyday food choice, participants were concerned about health aspects of food. There were three main factors that participants considered to be evidence of ‘good’ food risk management: the existence of identifiable control systems that respond quickly to contain a risk, the instigation of preventive measures and the availability of information that offers individuals the ability to exercise informed choice. These evaluations were similar in each of the countries under consideration and were linked to ideas regarding the controllability of risks and to questions of who is responsible for managing the risks.     

Are Australians concerned about nanoparticles? A comparative analysis with established and emerging environmental health issues

Objective: Introducing new technologies into society raises considerable public concern. We determine the public concern about nanoparticles, and compare this concern to other environmental health issues such as wind farms and coal seam gas production. Methods: A repeat cross sectional survey examining views on environmental health issues, risk, chemicals and trust was undertaken in more than 1,300 Australian residents in 2000 and 2013. Logistic regression and principal component analysis was used to investigate predictors of nanoparticle concern and identify a component structure for environmental health issues that could explain a trend of future nanoparticle concern. Results: Australians have a relatively low level of concern about the risks of nanoparticles to health when compared to their concerns about other environmental health issues. Items associated with concern included gender, a general wish to avoid chemicals and possibly trust in politicians. Concern over nanoparticles clustered with similar views on technological risks. Conclusions: Current public concern over the risks of nanoparticles is low. However, a reframing of the issue towards ‘chemicals’ is likely to have a negative effect on risk perceptions. This paper raises questions about appropriate channels for the effective communication of risk.     

Mad cows,mad corn and mad communities: the role of socio-cultural factors in the perceived risk of genetically-modified food

The rapid globalization of the world economy has increased the need for a knowledge base of reliable socio-cultural differences in perceptions, values and ways of thinking about new food technologies. Awareness of socio-cultural differences is important because collaborative efforts to deal with food hazards presuppose some understanding of where, how and why the viewpoints of various stakeholders may differ. In the present paper factors that influence public perceptions of genetically-modified (GM) food are discussed, with a special focus on the unique circumstances of populations in the USA, Europe and developing countries. It is argued that effective communication and decision making about the risk of GM food depends critically on understanding how socio-cultural groups differ in their values and in the way they deal with the risks and benefits of new technologies. The implications of psychological aspects of perceived risk (including the roles of qualitative dimensions of risk, world views and trust) for public acceptance of new food technologies are highlighted.     

Risk is normal to life itself

Health and safety professionals face an enormous challenge. We must communicate about safety in the context of all risks that society faces. The health and safety professional must be scientifically accurate while working in an atmosphere that is frequently emotionally charged. As professionals, we face decisions that force us to balance voluntary risks and externally imposed risks. How do we set "safety levels" in this context? Even more important, are we allowing rational risk decisions to be relegated to computerized risk analyses that have so many compounded errors that common sense tells us the estimates are clearly wrong? Absurd conclusions, of course, lead to loss of credibility in the entire field of risk assessment. In an emotionally-charged environment, perceptions are reality. Perceptions are frequently far from scientific reality, but perceptions are so strongly held that scientific reality alone cannot change opinion. Until risk communicators learn to address perceptions concurrently with scientific reality, we will find little improvement in the general understanding of relative risk and, hence, little acceptance of slight risks. No one has the correct answer to effective risk communication yet, but we must continue the search for optimum communication techniques.     

Vaccine safety: risk communication--a global perspective

The complexity of risks connected with both vaccine-preventable diseases as well as with immunization will be discussed and used as the basis for conclusions: -what should be done to avoid damage to current and future immunization programs and -how to improve risk communication. The need for more complete data on true, perceived and unknown immunization risks necessitates strengthening our research capabilities as well as surveillance and vaccine safety programs, and to critically examine the factors influencing public sentiments, taking into account that public perceptions of risk vary depending on the characteristics of risk. A concerted effort is needed to improve benefit and risk communication at all levels. The medical community should play a key role for improved communication.     

The role of the public in the management of public health risks

OBJECTIVE: To critique current models of public involvement in the management of public health risks. METHODS: Two case studies are used to highlight the challenges of contemporary practice. RESULTS: Current models often result in affected communities having perceptions of risk that conflict with those responsible for risk management. This can lead to ineffective decision making. CONCLUSIONS: Involving the public throughout the risk assessment and risk management process may lessen conflict and result in better decisions. IMPLICATIONS: Those responsible for responding to public health risks should aim for transparent processes that highlight assumptions and uncertainties, and involve the public wherever possible.     

Pharmaceutical risk communication: Sources of uncertainty and legal tools of uncertainty management

The purpose of this article is to differentiate between the different functions of pharmaceutical risk communication and make explicit their different legal natures and implications. Risk communication has been generally categorised as a warning act, which is performed in order to prevent or minimise risk. Risk analysis has also drawn attention to the role played by information in reducing uncertainty about risk. Both approaches focus on the safety aspects of communication and its role in harm reduction. However, there are cases where a risk cannot be avoided or uncertainty reduced, for example the side effects associated with pharmaceutical products or when a decision about drug approval or withdrawal has to be made on the basis of available evidence. In these instances, risk communication has other purposes than preventing risk or reducing uncertainty. This article analyses the legal instruments which have been developed to control and manage the risks related to drugs (such as the notion of ‘development risk’ or ‘residual risk’) and relates them to different kinds of uncertainty. These are conceptualised as epistemic, ecological, metric, ethical and stochastic, depending on their nature. By referring to this taxonomy, different functions of pharmaceutical risk communication are identified and connected with the legal tools of uncertainty management.     

Competing perspectives on public involvement: Planning for risk characterization and risk communication about radiological contamination from a national laboratory

Public involvement is increasingly emphasized as part of government agencies' responses to environmental health hazards, including risk characterization and risk communication. For example, there is a growing body of literature on health and risk communication proposing best practices and evaluating processes, yet there has been little attention to the ways that preferences for process features and criteria for evaluating success may vary among stakeholders and between stakeholders and government agency staff. This paper reports on a study into how participants associated with an effort to address public health risks from the distribution of plutonium contaminated sewage sludge in Livermore, California, think about the most appropriate way to conduct a process integrating public involvement. Using Q method this paper identifies five perspectives about what constitutes a good collaborative process in this case. The lessons for organizers and participants of risk characterization and risk communication efforts when people subscribe to different (sometimes competing) perspectives about process are discussed.     

Cannabis,risk and normalisation: evidence from a Canadian study of socially integrated,adult cannabis users

Howard Parker’s ‘normalisation thesis’ has made a significant contribution to youth drug studies in many countries. Parker’s thesis has been less investigated, however, for its application across the life course, and few scholars have considered its utility for assessments of the meaning and experience of drug-related health risks. This article adds to discussions of drugs, normalisation and risk by analysing qualitative data collected from 165 long-term cannabis users aged 20–49 years in four Canadian provinces between 2008 and 2010. We focus on participants’ assessments of the risks and harms associated with persistent cannabis use and the strategies they employed to mitigate these risks. Our findings indicate important distinctions between culturally mediated conceptions of cannabis-related risks and the more narrowly grounded perception of cannabis harms based on personal or peer experience. These distinctions correspond with participants’ reports of a significant shift in cannabis’ risk profile in Canada. Participants attributed this shift to three factors: the growing prevalence of cannabis use; the rise of ‘medical marijuana’ and renewed attention to the drug’s therapeutic benefits and what they perceived to be the low incidence of cannabis-related harms in Canada. We conclude that understanding how health risks are assessed and managed by cannabis users should help to clarify how and why more tolerant attitudes about cannabis have emerged in Canada and how this change may impact on non-users’ expectations about any future initiation of use. We close by reflecting on the implications of our findings for cannabis-related public health, education and harm reduction initiatives.     

Facts,fallacies and fears: The public and the health professionals at odds

Risk assessment as well as risk perception and risk communication are essential skills for the occupational health professional. However, in view of the widespread failure of employed groups and the general public to reach national conclusions on risk, we are clearly failing in our duty to the wider world. This paper reviews the basis of public ignorance and disquiet as well as the essential elements needed for effective risk communication. Examples include the Brent Spar saga, electromagnetic fields, and bovine spongiform encephalopathy. The way public perceptions can effect symptomatology is discussed as well as low political and legal opinions can influence the risk debate. A way forward is proposed.     

城市居民对疾病负担归因的主要危险因素感知研究

目的了解我国人群对于WHO发布的东亚国家疾病负担归因的主要危险因素的主观感知。方法采用单纯随机抽样方法获取140名济南城市居民样本并进行入户调查,调查数据使用描述性统计分析与相关性分析方法,得出研究人群对各危险因素的感知水平;同时对比基于研究人群主观感知的危险因素排序与基于疾病负担评估得出的危险因素排序,考察二者一致性。结果人群对同一危险因素不同维度的感知水平存在较大差异,尤其对环境健康类危险因素的关注和了解较少。人群对东亚国家疾病负担贡献较大的危险因素的认知程度与这些危险因素客观的风险水平并不完全一致。结论本研究提示对不同危险因素应当采取针对性的风险交流与干预策略,提示了关注人群感知的切实意义与加强健康风险交流的必要性。     

The new millennium: values, perceptions of risk, and the key roles of science and technology

Radiation protection and management of radioactive waste streams and products are certain to be important areas of public policy, worker education, and technology development in the new millennium. Overriding values of freedom, sustainability, transparency, and public participation in decision making about technology's benefits and risks will shape the public policy agenda. Early engagement of stakeholders in the identification and assessment of risks and in communications about risk management will be beneficial in most cases. Putting specific environmental problems into broader public health and ecologic context will be helpful to all parties and will improve decisions about how best to utilize precious resources and enhance public confidence in the process and the outcomes.     

Exploring attribution of responsibility for visitor safety in a US national park

Attracting millions of visitors each year, US national parks represent one context in which unintentional injuries are recurrent and fatal. Given unique environmental and infrastructural risks, as well as varied recreational opportunities and social contexts, who is perceived as responsible for preventing visitor injuries, and how might this relate to risk perception? Further, how does attribution of responsibility relate to support for preventative risk management? Limited research has considered these questions yet increasing promotion of parks to diverse audiences suggests a need to build public support for risk management. Using quantitative and qualitative survey data, this study found that most visitors perceived themselves as responsible for their own safety, and perceptions of the uncontrollability of risks were positively related to these attributions; however, attribution failed to predict support for preventative risk management. Significant predictors included perceptions of risk, participation in high-risk activities, and travelling companions. Future directions for this research, including the role of voluntary risk-taking in recreational settings, are discussed.     

Risk communication, the West Nile virus epidemic, and bioterrorism: responding to the commnication challenges posed by the intentional or unintentional release of a pathogen in an urban setting

The intentional or unintentional introduction of a pathogen in an urban setting presents severe communication chanllenges. Risk communication—a science-based approach for communicating effectively in high-concern situations—provides a set of principles and tools for meeting those challenges. A brief overview of the risk communication theoretical perspective and basic risk communication models is presented here, and the risk communication perspective is applied to the West Nile virus epidemic in New York City in 1999 and 2000 and to a possible bioterrorist event. The purpose is to provide practical information on how perceptions of the risks associated with a disease outbreak might be perceived and how communications would be best managed.