Search

In this editorial, I explore the contribution of the recent special issue ofHealth, Risk & Society(Volume 16, Issue 1), and three related papers published in the current volume (Volume 16, Issue 6), and identify themes and concepts which are consistent across these papers. The aims of the special issue were twofold; the call for papers invited articles on the topic of risk in relation to pregnancy and childbirth, and which sought to explore risk theorisation in this field. Looking at these papers as a body of work, I explore the breadth of this collective endeavour, and identify areas which have been researched at some depth, whilst drawing attention to other areas which manage to evade our theoretical gaze. I also reflect on the ways in which these papers have, independently and together, added to the field of risk theorisation, and propose some future directions which might usefully help move beyond the current limits of our enquiry. The combined body of work in these issues represents a considerable resource, and one which makes a clear contribution to contemporary understandings of risk, pregnancy and birth, however I argue that of late, the focus of enquiry has become narrowed, with much of our research providing new evidence from the perspective of relatively privileged women from high-income countries, who have good access to safe, high quality maternity care. The sum of this work is now such that it is possible to synthesise themes across studies and settings, which is valuable to our understanding, but the lack of research amongst women from developing nations, or amongst those with less privilege in high-income countries, means that our resource is incomplete, and fails to do justice to women’s broader experience of pregnancy and birth. Developments of risk theorisation are evident in the collected papers; authors have interrogated the positioning of individuals as subjects, and drawn new conclusions about historicised risk, and practices of resistance to risk discourse. I review these developments in this editorial, and also propose that the collection generates many new dimensions to our initial understanding of the ‘virtual object’ of risk in the context of pregnancy and birth. I conclude by outlining potential new directions and approaches to meet some of the identified gaps in our exploration and theorisation of risk in pregnancy and birth. [ABSTRACT FROM PUBLISHER]

The relationship between risk and inequality has become a key area of research and theoretical debate in sociology and risk studies more broadly. My aim in this paper is to explore the role culture plays in the (re)production of inequalities of risk exposure. More specifically, I examine the ways cultural systems shape and animate judgements about acceptable standards of risk exposure for different groups within a society. The case study examines divergent policy judgements about acceptable risk exposure to road accident injury and death between a group of temporary visa workers and all other private passengers in Singapore. A key objective of the paper is to demonstrate the conceptual and empirical utility of Mary Douglas' cultural perspective for studying interconnections between risk and inequality. In particular, how taking up the problem of 'risk acceptability' is an effective way of approaching and studying the ways risk and inequality operate as mutually constitutive relations. In the discussion I show that what counts as risk and how acceptable or not risk is judged to be depends on the cultural system of classification used and the stratified social order it (re)produces. In the conclusion I consider the broader utility and significance of this critical approach for studying relations between risk and inequality through the problem of risk acceptability. A utility that may take on a particular significance in the present time of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Although uncertainty is a key characteristic of epilepsy, and despite the close relationship between uncertainty and risk, our understanding of individuals' experiences of childhood epilepsy in relation to risk is limited. In this paper I explore family members' perceptions of the risks associated with the condition by drawing on qualitative data collected during 2013 and 2014 from 24 families with a child with epilepsy (including data from 28 parents, 13 children with epilepsy and 14 siblings). The diagnosis of childhood epilepsy provided parents and children with a new framework that they used to evaluate risks posed by the physical environment. Indeed, roads, water and heights were reconceptualised when viewed through an 'epilepsy lens' and were seen to present more risk to the child with epilepsy in comparison to the level of risk the same hazards posed to their siblings or peers. Furthermore, while parents described prioritising new and reconceptualised physical risks to their child, the children with epilepsy were more concerned about being stigmatised by their peers. The children's discussions surrounding stigma suggest that this results from interactions with their peers, rather than stigma being learnt within the family, as previous studies have suggested. Overall, I demonstrate that risk is a central feature of contemporary experiences of epilepsy for children with the condition and their parents, but that parents and children perceive and prioritise risks differently. [ABSTRACT FROM AUTHOR]

In this paper, we examine discourse in public deliberations in pre-development locales in the UK and US about advantages and disadvantages of future shale development ('fracking'). We aimed to understand how people anticipate potential health effects, broadly construed, of environmental toxicity and disturbance in the context of planned, but not yet implemented, energy development. In day-long deliberations with small, diverse groups in two cities in each country (London, Cardiff in the UK; Los Angeles, Santa Barbara in the US), participants discussed impacts on health and well-being using three main rubrics: 'It's money or health', 'Why take chances?' and 'Beyond the tipping point'. Throughout, participants framed health as an intrinsically moral issue, with collective responsibility as a dominant normative frame. We identify the concept of compound risk to underscore effects of multiple risks and hazards on people's sensibilities about anticipated future health and environmental harm. The findings demonstrate how and why diverse publics in pre-impact sites in both countries saw shale extraction as high stakes development that poses significant, often unacceptable, risks to human and environmental health and well-being. Risks extended beyond toxicity to broad threats to health, including, for some, the end of life as we know it on the planet. Overall, participants' discussions of health were more connected to social categories and their underlying moral principles than to technological details. This work contributes evidence of blurred boundaries between environment and health as well as the importance people place on social risks in the context of proposed energy system change. [ABSTRACT FROM AUTHOR]

In this article, we examine how injection drug users who do not attribute their HIV infection to engaging in HIV risk behaviours take up and critique discourses of individual responsibility and citizenship relating to HIV risk and HIV prevention. We draw on data from a study in Vancouver, Canada (2006–2009) in which we interviewed individuals living with HIV who had a history of injection drug use. In this paper, we focus on six cases studies of participants whodid notattribute their HIV infection to engaging in HIV risk behaviours. We found that in striving to present themselves as responsible HIV citizens who did not engage in HIV risk behaviours, these participants drew on individually focused HIV prevention discourses. By identifying themselves in these ways, they were able to present themselves as ‘deserving’ HIV citizens and avoid the blame associated with being HIV positive. However, in rejecting the view that they and their risk behaviours were to blame for their HIV infection and by developing an explanation that drew on broader social, structural and historical factors, these individuals were developing a tentative critique of focus on individual responsibility in HIV transmission as opposed to dangers of infection arising from the socio-economic environment. By framing the risk of infection in environmental rather than individual risk-behaviour terms, these individuals redistributed responsibility to reflect the social-structural realities of their lives. In this article, we reflect on the implications of these findings for public health measures such as risk prevention messages. We argue that it is important that such messages are not restricted to individual risk prevention but also include a focus of broader shared responsibilities of HIV. [ABSTRACT FROM AUTHOR]

In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013–2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes. [ABSTRACT FROM PUBLISHER]

A central tenet in the sociology of risk is that risk-taking is inherently linked to masculinity. Recent research, however, demonstrates gender identity is only one of the many social contexts that influence professional risk-taking. The interaction between the various occupational social contexts – such as social class, occupational socialisation, institutions, and gender identity – contributes to the development of risk-taking occupational identities. These occupational identities are associated with unique understandings of risk which influence whether workers are likely to embrace or avoid risk. While there has been a plethora of research exploring how occupational identities encourage risk-taking, relatively little research has explored how occupational identities determine thetypesof risks embraced by workers. After all, there is substantial occupational variation in the types of risks workers take. In this paper I draw on data from a series of interviews conducted in 2010 and 2011 with US electrical construction workers to explore perceptions of job site safety procedures to understand how electrical workers view various job site hazards. I argue that the proximity of a hazard to the occupation’s core competencies determines the level of support the safety procedure receives from those within the occupation. [ABSTRACT FROM PUBLISHER]

In this article, we explore the risks associated with direct payments to users enabling them to purchase social care. These payments are intended to enable people with disabilities to make choices and increase their autonomy. However, there is little evidence in the existing literature about the risks involved in direct payments as seen by service users. In this paper, we draw on data from a qualitative study of direct payments for people with disabilities in a federal state of Germany. We interviewed 37 individuals involved in direct payment schemes including individuals receiving payments, care assistants, members of organisations providing care and the administrative officers of the local authorities between December 2011 and January 2014. In this article, we use a governmentality perspective to explore how individuals who received the payments saw and sought to manage the risks associated with the scheme. We found that while users reported that direct payments reduced the risk associated with being directly dependent on the care providers and hence increased their desired self-determination, they identified new risks linked to their liability for the transferred money, problems associated with their liquidity and cash flow, challenges presented by budget cuts, and sanctions resulting from violation of norms of ‘appropriate use’ and the difficulties of negotiating with the funders. To manage these perceived risks users indicated that they had subjected themselves to a new way of active self-control and self-management, normalising their behaviour. We note that risk to service users has been neglected in policy design and should be acknowledged more explicitly. [ABSTRACT FROM AUTHOR]

In the field of cycling studies, explicit and implicit theories of risk are frequently used for the purposes of research design, data collection, data analysis, and policy. In this article, we argue that this field may benefit from theories and concepts that speak to – but go beyond – theories of risk, and more directly focus on matters of right and recognition. Drawing on grounded theory research involving interviews with 28 cyclists in Dublin, Ireland, we analyse the 'risk talk' from five participant accounts through an application of the rights-orientated perspective of precarious entitlement theory. We argue for its utility as a theory, specifically as a complementary alternative to risk-focused approaches. First, we illustrate how precarious entitlement goes beyond the conceptual limits of understanding cycling experience from perspectives of 'risk' and 'safety', by consolidating a concern with 'right' and 'risk'. Second, we illustrate how interpreting particular cycling practices as patterns of submission and social struggle (privatising vulnerability and provoking responsibility) can transcend individualised interpretations of such practices as 'risk management' and 'risk-taking'. In the discussion, we consider the value of this theory in relation to existing research in this field, with reference to socio-cultural risk theory. In conclusion, we argue for a more transparently rights-based approach to cycle policy in light of the dominance of a specific variety of risk discourse that arguably obscures a consideration of rights to use public space and what a realisation of such rights might require from both the public and the state. [ABSTRACT FROM AUTHOR]

This article draws on data collected from a qualitative study designed to assess the effectiveness of an early intervention programme aimed to raise awareness of Child Sexual Exploitation (CSE) among young people. The programme was implemented by a large police force area, referred to as Shireland. Drawing on semi-structured interviews with practitioners implementing safeguarding policies within the police service, youth and social welfare work designed to support young people, we focus on the mobilisation of perceptions of risk and vulnerability as they translate in professional practice via a specific preventative initiative. More specifically, we wish to examine the extent to which blurring occurs between constructions of 'risk' and 'vulnerability' in relation to practitioners' understandings of the dangerousness of young people's behaviour. In our analysis, we draw attention to a palpable tension apparent in the interview narratives of those involved in delivering the programme, between expressed understandings which on the one hand universalise vulnerability and, on the other, extricate specific risk factors. [ABSTRACT FROM AUTHOR]

When making decisions about whether to transfer residents to hospital, care home staff consider the possible benefits and risks of different courses of action. However, to date, an in-depth and theoretically informed engagement with these decision-making processes and their associated behaviours has been lacking. We conducted an ethnographic study of care home staff's decision-making about resident hospital transfers in England between May 2018 and November 2019. We combined staff interviews at six care home sites, with 30 members of staff, with 113 hours of ethnographic observation at three care homes sites. 'Risk' and risk management emerged as important overarching themes. In this article we conceptualise staff decision-making about potential hospital transfers for residents as a form of risk work. In doing so, we identify the different forms of risk knowledge that staff used to conceptualise risk and explore the ways staff navigated tensions between different forms of risk knowledge. We highlight the ways individual understandings of risk were influenced by social interactions with others, both at an interpersonal and organisational level, before identifying strategies that staff use to manage risk. By understanding transfer decisions explicitly in terms of the different forms of risk that care home staff manage, our analysis provides new insights into hospital transfers from care homes and contributes to the wider literature around risk work, demonstrating the utility of this concept in researching organisations that fall under the umbrella of social care, which have been previously neglected in academic research. [ABSTRACT FROM AUTHOR]

Lay constructions of risk impact upon public health activities and underpin social reactions to experiences and understandings of infectious diseases. In this article, we explore the social construction of COVID-19 risk and responsibility by citizens of Jakarta and the Greater Jakarta Area, Indonesia. We draw upon digital diaries produced each week by 37 participants across a 5-week period from April to June 2020, a time of substantial policy flux in Indonesia. Key findings reflect the everyday construction of risk within the context of changing government restrictions regarding physical distancing. In the context of perceived confusion around government activity, the participants narrated individualised accounts of risk production, as they reflected upon the transmission of COVID-19. Our findings indicate the emergence of the concept of the 'ignorant imagined other' as underpinning how lay persons locate risks in unknowledgeable others and see themselves as socially protected through their own perceived knowledgeability of COVID-19. Our findings contribute to the literature on the social perception of infectious disease through the examination of the understudied context of urban Indonesia and by demonstrating the social location of risk in relation to a generalised imagined other, within a wider context of public health governance. [ABSTRACT FROM AUTHOR]

Drawing upon data collected within 20 focus groups with consumers from five European countries, in this article we investigate how perceptions of human health risk and current anxieties regarding agricultural food production affect citizens' acceptance of the use of an emerging biotechnology, synthetic biology, in the development of vaccines for animals bred for food production. In focus group discussions in Austria, the UK, Poland and Denmark, participants tended to value the positive potential of synthetic vaccines if they could solve existing problems. Participants argued that the technology could be beneficial for animal welfare and was a potential solution to the problem of risks to human health posed by the use of antibiotics on livestock. The perceived drawbacks of antibiotic use affected the discussions towards acceptance of synthetic biology and the use of vaccines in meat production despite concerns over the potential risks. The participants from Spain stood out in that their acceptance of the synthetic vaccine appeared to be disconnected from concerns about risks related to the use of antibiotics. Participants from all countries found the vaccine to have potential uses, but also expressed concerns about health risks for consumers. In general consumers were perceived as those bearing the heaviest burden of risk, while pharmaceutical companies were perceived as likely to benefit most from production of the vaccine. We found that institutional trust and national contexts of (dis)engagement with science influenced the participants' understandings of the degree to which the synthetic livestock vaccine had a fair risk-benefit balance. [ABSTRACT FROM AUTHOR]

It is estimated that up to ten per cent of people with motor neurone disease (MND) have an inherited form of the disease. Families with a history of inherited MND may face specific issues around managing the condition in relatives and adapting to life knowing that they too could develop the disease, which we refer to as living 'at risk'. This qualitative study is based on a thematic analysis of posts from 37 threads shared on the MND Association Forum between 2010 and 2019. Through this analysis we explore how forum users make sense of, and negotiate, genetic risk in this online space. We unpack how risk is constructed through a tracing and reframing of family history in relation to MND; we draw out the different ways uncertainty is expressed by people living with the threat of the disease; and we outline how future decisions around genetic testing and reproductive choices play out on the forum. Genetic risk was articulated temporally, with posters reflecting on past, present and expected future experiences across posts. This was crosscut by profound uncertainty. How people understood and expressed experiences of living 'at risk' – and the responses they received from others – were grounded in different forms of experiential knowledge, intertwined with biomedical and genetic information. We propose the MND Association forum as an interactional site where uncertainties are negotiated and risk is made sense of by individuals with a family history of MND, alongside those affected by 'sporadic' forms of the disease. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic signifies not only a global health crisis but has also proven to be an infodemic characterised by many conspiracy theories. Prior research informs us that belief in health-related conspiracies can harm efforts to curtail the spread of a virus. Therefore, as the global efforts of mass inoculation are underway, it is crucial to understand which factors shape tendencies to believe in conspiracy theories. In the current study, we explore how Pakistani adults' perceived risk of COVID-19, sense of national identity, and trust in traditional and social media sources, are associated with their belief in conspiracy theories related to the pandemic. The data for this study come from an online survey of 501 adults ages 18–49 conducted in April and May 2020 in Pakistan. Our results show that a perception of risk makes it less likely for the participants to believe in conspiracy theories even when taking into account key demographic factors. Furthermore, trust in social media has a positive association with belief in conspiracy theories, whereas trust in traditional media and people's sense of national identity are not associated with conspiracy beliefs. This study offers important scholarly and policy implications for navigating major global health issues, in Pakistan and other similarly situated countries. [ABSTRACT FROM AUTHOR]

Social workers are at the heart of drives to improve child health and wellbeing, with knowledge sharing between them and other professionals viewed as a way to reduce the uncertainty associated with this area of risk work. We aim to fill a significant gap in the literature by examining how social workers assess, interpret, filter and share knowledge relating to risk and uncertainty – what we call the translation of risk – within their profession. Based on data from a qualitative study with social workers in England between 2012 and 2013, we identify two main approaches social workers employ. We conceptualise them as 1) reluctant translating, and 2) dynamic translating. Our analysis shows that epistemic assumptions such as how social workers conceptualise the fact/value separation; how they view what we call 'grey evidence'; and how they understand the relationship between objectivity and subjectivity, underpin how social workers translate risk. We add a new dimension to the literature on risk by arguing that we need to pay attention to the epistemological values that underpin 'client-facing' risk work. Thus, we aid understanding of not only how knowledge is shared in particular ways, but also why this is the case. We identify reasons why some social workers include valuable 'grey evidence' and prioritise adequacy over accuracy in their translations of risk. We highlight, however, that through an over-emphasis on accuracy and boundaries, evidence-based practice might end up driving out 'grey evidence' and inadvertently hampering effective decision-making, judgement and knowledge sharing on risk. [ABSTRACT FROM AUTHOR]

Although intimate partnerships where both partners inject drugs have emerged as the focus of research and interventions, the gender dynamics characterising risk behaviours in injecting partnerships have largely been neglected. This study explored qualitative interview accounts focusing on the ways gender dynamics that reflect power differences between male and female injecting partners influenced risk perception and management. It drew upon a qualitative study of risk negotiation practices of injecting partners (n = 16) in Uyo, Nigeria. Analysis highlighted three key themes: 'caring and drug-using partnerships'; 'risk reduction and production', and 'male dominance and gendered violence'. Although the intimate partnerships of PWID provided emotional and social support in a high-risk environment, factors operating within these partnerships, including affection, trust, and gendered violence, undermined agency and risk-reducing behaviours, creating conditions that increased vulnerability to HIV particularly for women. The findings support calls to move beyond individual risk factors and privilege a relationship orientation in HIV prevention work. In particular, the analysis highlights a need for intervention models that build and maintain trust among drug-using partners, while improving communication skills, preventing violence and promoting HIV prevention through the adoption of risk-reducing measures. [ABSTRACT FROM AUTHOR]

Older people (OP) living at home alone face several health risks. Health professionals are increasingly called upon to contribute to the prevention of these risks. In this article we to develop an analytical framework to look at volition to risk taking in the ordinary everyday activities of OP living at home alone. We conducted a qualitative study to explore how OP think about risk throughout their actions, how risk influences them in their activities and the place they give to risk in the ordinary activities of their daily lives. Twenty participants (twelve women, eight men) living alone at home in French-speaking Switzerland were interviewed using the specific explicitation interview method. Focusing on micro-action sequences, the participants were asked to convey their subjective experiences while performing these actions. Occupational and activity choices seem to always have underlying motivations rooted in a set of values, such as maintaining a sense of control over one's own existence, competence (perceived self-efficacy), and identity congruence. Risk taking was closely associated with OP's intimate volition to maintain their own personal trajectory. The way in which OP understand the risks they face in their daily lives and what they do to cope with these risks serves as an analytical tool for studying ageing. We consider that a more detailed understanding of which risks affect or benefit OP, and how, makes a valuable contribution to studies of ageing and to studies into the nature and role of risk in everyday life. [ABSTRACT FROM AUTHOR]

Drawing on data from a study with Southern European parents living in Norway, this article discusses the experiences of migrant parents with professional advice on family leisure and outdoor play. The study is situated broadly in research about the contemporary parenting role and the social construction of parents as risk-managers. Within this construction, parents are understood as continually managing a 'double-bind', in which they are asked to both protect children from multiple risks, and expose them to risk to develop resilience. Norway provides an interesting context for further investigation, given its institutionalised emphasis on the importance of outdoor life and play. This is embedded in public provision for children and in dominant understandings of how families should use leisure time and how children should play. We explore how migrant parents respond to the associated discourses of risk in their encounters with kindergarten professionals and community health nurses. Participants navigated risk discourse in professional advice on family leisure and children's outdoor play in three ways: contesting discourses of risk; feigning cooperation; and accepting professional intervention and advice in either collaborative or compliant relationships. Migrant parents experienced professional constructions of risk-management as implying a form of individual responsibility, which typically recognised risks to children's wellbeing linked with their lifestyle choices. Although some found ways to negotiate risk and accommodate, parental experience was characterised by tension and difficulties in encountering the double-bind, which deserves further attention. [ABSTRACT FROM AUTHOR]

Individuals with different cultural worldviews conceptualise risks in distinct ways, yet this work has not extended to personal illness risk perception. The purpose of this study was to 1) examine the relationships between two types of cultural worldviews (Hierarchy-Egalitarian; Individualism-Communitarianism) and perceived risk (perceived severity and susceptibility) for diabetes and colon cancer, 2) test whether health literacy modifies the above relationships, and 3) investigate whether trust in government health information functions as a putative mediator of the relations between cultural worldviews and disease perceived risk. We recruited (N = 600) participants from a nationally-representative Internet survey panel. Results were weighted so the findings are representative of the general United States population. People with a more hierarchical worldview expressed lower perceived susceptibility to developing both diabetes and colon cancer, and perceived these diseases to be less severe, relative to those with a less hierarchical (more egalitarian) worldview. There was no significant association between individualistic worldview and perceived risk. Health literacy modified the relationships between hierarchical worldview and perceived risk; the associations between hierarchical worldview and lower perceived severity were stronger for those with limited health literacy. We did not observe indirect effects of cultural worldviews on perceived risk through trust in health information from government sources. It may be useful to identify specifically tailored risk communication strategies for people with hierarchical and individualistic worldviews, especially those with limited health literacy, that emphasise their important cultural values. Further research examining cultural components of illness risk perceptions may enhance our understanding of risk-protective behaviours. [ABSTRACT FROM AUTHOR]

Research suggests that cultural worldviews bias how and what people think about various societal risks. But how does this mechanism manifest when people receive balanced information about a highly publicised health issue such as cigarette smoking? Using the cultural cognition worldview scales, we demonstrate that despite the considerable interventions post the 1964 landmark Surgeon General's Report, young adults in the U.S. still perceive smoking risks in ways that affirm their cultural worldviews along two dimensions: egalitarianism-hierarchism and individualism-communitarianism. Those who subscribe to hierarchical and individualistic worldviews were more dismissive of the risks associated with cigarette smoking and exposure, while egalitarians and communitarians associated smoking with higher risks. We observed an interaction between the two worldview dimensions. Besides, exposed to balanced information – as is often the case in media coverage based on the journalistic norm of balance – about the risks and benefits of smoking, those who are concurrently hierarchical and individualistic in their outlook assimilated information about benefits while discounting the dangers of smoking. Egalitarian communitarians (on the other end of the continuum) discounted the benefits information vis-à-vis the risk information. Thus, culturally-biased cognition of risk perception does not only apply to novel and abstract risks but also highly publicised ones. Communication and public policy implications are discussed. [ABSTRACT FROM AUTHOR]

Framed both as a solution to and as an additional part of the tobacco problem, e-cigarettes have been the subject of risk controversies since they were launched in 2006, followed by massive divergence in media, public health approaches and regulations across the world. This study explores vapers' risk perceptions and accounts of the public risk communication and regulation of e-cigarettes in a Norwegian context were nicotine-containing e-liquids are prohibited from being sold by domestic retailers. Based on analyses of semi-structured qualitative interviews (n = 30, 17 males) with adult vapers, I find that the participants emphasised three important dimensions related to risk. First, they perceived vaping as harm reduction by substituting for smoking. Second, they devalued much of the risk communication about e-cigarettes from Norwegian health authorities and media. Interlinked with their harm-reduction approach, they perceived the present regulation of nicotine e-liquid and vaporisers as increasing risk by decreasing their availability to smokers. Third, in general they preferred the lay expertise available online to the health authorities' information on e-cigarettes. The analysis displays a lack of trust among the participants in what can be labelled as top-down information. Based on these dimensions, I conclude that the dissonance between vapers risk perceptions and the regulation and mixed messages in risk communication of e-cigarettes has contributed to their preference for bottom-up expertise. From the vapers' point of view, e-cigarettes represent harm reduction, and the vaper community symbolises a bottom-up health movement where peer assistance compensates for a perceived lack of assistance from health authorities. [ABSTRACT FROM AUTHOR]

Past research has provided evidence of the important role that trust plays in people's decisions regarding food consumption. This study examines the reasons for people's distrust in food production systems and how they conceptualise and handle food-related risks in everyday life in a context in which food scandals have occurred frequently. In-depth interviews were conducted with 39 married Taiwanese women. Our findings indicated that the women believed that collusion commonly occurs between business and government entities and that such collusion frequently leads to food scandals. However, despite their distrust in the food system and suspicion towards the government, the women generally still relied on food labels and certifications when making food purchasing decisions. These 'in-between' strategies were formed by their knowledge and experiences of day-to-day living in Taiwan, and while the strategies may seem somewhat self-contradictory, they can be understood as empowering people to protect themselves and their families in circumstances of general distrust and helplessness. [ABSTRACT FROM AUTHOR]

In this article, we aim to better understand how a personal history of cancer influences perceptions of environmental risk factors for cancers and adoptions of health-related behaviours. Semi-structured individual and group interviews were conducted with French individuals with (n = 21) and without (n = 16) a personal history of cancer using the same topic guide. Interviews were transcribed, coded and analysed using a comparative approach. Our participants with and without a history of cancer tended to perceive the same environmental factors as causes of cancers, in particular pesticides and smoking. However, individuals without a history of cancer emphasised electromagnetic waves and sun exposure as causes of cancers while participants with a history of cancer emphasised unbalanced diet and stress/negative emotions. Our participants with a history of cancer tended to mention more factors than participants without. Finally, participants with a personal history of cancer all described themselves as adopting at least one behaviour mentioned as 'healthier', often following their cancer experience, while very few participants without a history of cancer mentioned adopting these behaviours. Participants with a history of cancer tended to be more concerned about environmental risk factors for cancers and about preventing cancers through adopting risk-reducing health-related behaviours than participants without a history of cancer. Our findings are consistent with and develop the idea that a personal experience of cancer can alter an individual's 'experience and life world'. We also observed similarities between individuals with and without a personal history of cancer. Our contextual findings need to be confirmed by further research. [ABSTRACT FROM AUTHOR]

Despite much ethical debate concerning non-invasive prenatal testing to abort or to detect genes, research on the experience of those who choose this new technology in China is limited, especially after the introduction of the Two-child Policy. In this article I analyse qualitative data from 25 interviews with pregnant women of advanced maternal age (pregnancy after 35) under the Two-child Policy, conducted in 2014 to 2016, as well as observational data from a 6-month, in-hospital participant observation in 2016. These data were collected with the aim to examine how non-invasive prenatal testing affects pregnant women's risk perceptions and why this technology is widely accepted by pregnant women of advanced maternal age in China. I conclude that the women in my study accepted their 'high-risk' identity within prenatal care, and that non-invasive prenatal testing was integrated in this care. Women's interactions with genetic counsellors, their husbands and close friends and community doctors produced anxieties, with women feeling responsible for the health of their foetuses. Consequently, the women in my study were willing to 'buy' this test for reassurance. The consumption of this new technology by pregnant women after the Two-child Policy lays a foundation for the market development of this technology in urban China. [ABSTRACT FROM AUTHOR]

Public inactivity has been addressed by scholars across different academic disciplines. Risk communication and behaviour change is difficult and costly due to limited attention to various messages in the public sphere. Crises pose particular challenges if organisations are to communicate effectively with the public to protect them from potential risks. The present study attempts to better understand what makes the public inactive when faced with a crisis. Specifically, I focus on how people perceive a crisis and the reasons they remain inactive during the crisis. Using 28 in-depth interviews with Korean citizens during two food-related crises, this study revealed that people interpreted the crisis within a broader social context, made underlying assumptions in understanding the crisis and believed what the media vividly showed. The findings also showed that people remained inactive because they avoided dealing with risks due to being distracted by their daily lives, they trusted social systems to manage the problem, and they felt they had high efficacy in resolving the crisis although they did not expect to make fundamental changes in the long-run. [ABSTRACT FROM AUTHOR]

The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs – and bodies – were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP. [ABSTRACT FROM AUTHOR]

HPV-associated anal cancer is one of the most prevalent non-AIDS defining cancers affecting gay men living with HIV. Drawing on interviews with 25 HIV-positive gay men living in Toronto in 2017, we explored their responses to anal cancer as a comorbidity risk and the necessity of preventative screening. These participants had previously been screened for anal cancer through a clinical trial. The majority of our sample did not initially consider anal cancer a health priority. They relied on narratives of living with HIV - that is, on their HIV biographies - to make sense of anal cancer’s significance given their self-described lack of knowledge. This included references to personal-level narratives of the biographical disruption and revision associated with a HIV diagnosis, as well as reflections on community-level and socio-historical trends in the HIV epidemic. Drawing on these narratives, some started to accept anal cancer as a significant comorbidity risk, while others remained ambivalent. Those who began to accept anal cancer as significant integrated it into their HIV biographies to present anal cancer as a threat to the ontological security they have gained managing HIV in an era of effective treatment and to position themselves as pragmatic, responsible health-seekers. Others drew on their HIV biographies to vocalise resistance to chronic risk and medicalisation. Our analysis points to the fundamental role narratives play on everyday risk perception practices, health decision-making and, for those managing a chronic illness, on securing ontological security and presenting a coherent self-identity under conditions of expanding risks and prevention possibilities. [ABSTRACT FROM AUTHOR]

In the UK care sector, as much as other fields of work, managers need to check and monitor the immigration status of their staff. In this article, we examine accounts from care home and home care managers of making decisions about recruitment and employment practices placing these in the context of risk work. We use data from a secondary analysis of interviews with 121 social care managers that took place in four contrasting English local authority areas in two rounds over the period 2009-2014. In the interviews, we explored managers ' views and experiences of employing or deciding not to recruit migrant workers and the extra work this potentially entailed. We identified three major themes in these interviews: vigilance, being caught, and shifting resources. The Vigilance in recruitment and managing staff theme highlighted managers' experiences of and concerns about implementing the regulations around employment permissions and indicated their feelings that it was essential to comply with new government regulations relating to migrant workers. The Being caught theme was based on managers' fears about the risks of being in breach of the regulations and worry about the severity of the penalties. The Shifting sources theme highlighted managers' continued work in reaching out to fresh sources of recruitment as a response to changes in immigration regulations. Our findings expose the potentially stressful nature of managers' roles in implementing new regulations and managing the risks of non-compliance. This new aspect of risk work reveals the tensions of managers' role in performing their obligations to scrutinise documentation and abide by changing regulations while still running their services. As the UK moves to Brexit (leaving the European Union), these tensions look set to increase in the context of further migrant working regulations and amendments to immigration permissions. [ABSTRACT FROM AUTHOR]

Progressive public health authorities in high-income countries have advocated supervised consumption facilities, where people who use illicit drugs can consume them in a hygienic, supervised environment, as a way of reducing drug-related risks to both people who use drugs and communities. However, the planning of such facilities has often met with strong reactions from the local community. ‘Not in my backyard’ (NIMBY) type reactions are frequently encountered and public opinion polling is limited in its ability to provide detailed insights into the reasons why people support or oppose these facilities in Toronto and Ottawa. We explore perceptions of residents and business representatives to the proposed implementation of supervised consumption facilities, and examine their perceptions of risks from these facilities. We collected qualitative data from 2008–2010 using focus groups and interviews with 38 residents and 17 business representatives in these two large Canadian cities lacking supervised consumption facilities. We used thematic analysis to examine expressed benefits and risks regarding supervised consumption facilities amongst community members. These participants saw these facilities as potentially risk-reducing, but recognised that the facilities could also create risks for their communities. While community members accepted that facilities could have positive health effects, they expressed a level of concern regarding the risk of public nuisance associated with supervised consumption facilities that seemed unwarranted based on the existing evidence. Discussions on the risks involved in the establishment of supervised consumption facilities should move beyond a focus on the benefits to facility users, to exploring community-level benefits and risks, and integrate evidence regarding actual risk experiences from other locations. Similar approaches may apply to NIMBY concerns related to other contentious issues. [ABSTRACT FROM AUTHOR]

How people deal with risk and uncertainty has fuelled public and academic debate in recent decades. Researchers have shown that common distinctions between rational and ‘irrational’ strategies underestimate the complexity of how people approach an uncertain future. I suggested in 2008 that strategies in-between do not follow standards of instrumental rationality nor they are ‘irrational’ but follow their own logic which works well under particular circumstances. Strategies such as trust, intuition and emotion are an important part of the mix when people deal with risk and uncertainty. In this article, I develop my original argument. It explores in-between strategies to deal with possible undesired outcomes of decisions. I examine ‘non-rational strategies’ and in particular the notions of active, passive and reflexive hope. Furthermore, I argue that my original typology should be seen as a triangular of reasonable strategies which work well under specific circumstances. Finally, I highlight a number of different ways in which these strategies combine. [ABSTRACT FROM AUTHOR]

The increased accessibility of medicines across the globe has expanded choice in therapeutic consumption. These changes give rise to increasing complexity and new uncertainties regarding the repertoire of therapeutic resources available for everyday users. This raises questions of how individuals evaluate different therapeutic resources and how they choose among such diversity in their daily lives. Using ongoing research in Maputo, Mozambique, in this article I explore how different modalities of trust influence decision-making processes concerning medicine use for minor ailments, particularly the role of trust in the management of perceived uncertainty and risk in a context of therapeutic pluralism. In this article, I draw on data from a study on pharmaceutical use in Maputo, Mozambique. The research included 8 months of ethnographic fieldwork in 2013 and 2014 plus seven focus group discussions with a total of 42 participants. I found that three main layers of trust framed individuals’ relations to medicine use: trust in medical systems, trust in health organisations and providers and trust in personal and socially shared experiences. Despite being strongly intertwined, these different layers played different roles in decision-making. The third layer, grounded on ‘lay’ bases of knowledge and experience, played a major role when individuals chose between the available repertoire of therapeutic resources for minor ailments. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses articles in the issue on topics including Dealing with Uncertainty and Risk in Everyday Practice, multiple rationalities and study of the sharing of uncertainties among people in the aftermath of cancer recovery.

Some vaccine supporters interpret vaccine uncertainties as a form of public ignorance caused by patients’ online research, failed physician–patient relationships, or inadequate knowledge translation. These interpretations often portray health professionals as homogeneously accepting of all scheduled vaccines for all patients. Nonetheless, health professionals may have limited knowledge about vaccines because the demands of their profession require them to have a broad understanding of a variety of health topics. In this article, I draw on data from interviews with twenty-six physicians and seven nurses in Alberta, Canada between 2013 and 2014, to examine how they used narratives to convey confidence, uncertainty, or doubts in vaccines. All interviewees supported the culturally dominant vaccine narrative that vaccines are essential to population health, yet they also spoke about uncertainties. Interviewees managed their uncertainties through tactics that confirmed accepting vaccination was the most desirable course of action. With each of these tactics, interviewees shared narratives about communicable diseases, vaccine benefits and risks to individual patients, and their reasons for trusting in medical science. When these narratives did not fully resolve medical uncertainties, health professionals often explained that either vaccination was beyond their professional responsibilities or that their uncertainties were irrelevant. [ABSTRACT FROM PUBLISHER]

Preventive medications such as statins are recommended to an increasingly large number of people. To those who make these recommendations, prevention is synonymous with risk reduction; the clinical task of helping people decide about preventive medication is therefore widely framed as one of risk communication. In this article, I explore the role of risk and uncertainty in accounts of medication decisions, drawing on qualitative data from interviews carried out between 2011 and 2013 in the east of England with people who had been offered statins. I found that very few participants mentioned risk or likelihood, or described weighing benefits against harms, the process central to the risk communication project. Instead, those who had decided to take statins described their certainty that statins were needed to treat current problems. This certainty was informed by knowledge about the present or the past; information about possible future harms was presented solely as contributing to concern about current problems. In contrast, those who had decided not to take statins explained their decisions in terms of the inherent uncertainty of information about the future, presenting this uncertainty as a reason to decline medication. This asymmetry between explanations for accepting and for declining statins is rooted in differences between the ways past, present and future information are handled. These findings challenge the assumption that decisions about statins are construed as decisions about risk by those offered them, and raise questions about the usefulness of using risk and uncertainty as key concepts for theoretical accounts of what is going on when people consider taking preventive medication. [ABSTRACT FROM PUBLISHER]

Many long-term care systems are seeking to address problems of growing demand, increasing expense, and higher user expectations. For many of them fostering care at home and private care arrangements are attractive options. The long-term care sector in England is typical of these systems. Over the last 2 decades, government policy in England has placed stronger emphasis on people’s choice and control when receiving care services. People with care and support needs may be eligible for public funds to employ care workers or to use them in other ways promote their well-being. These financial transactions are a major part of the policy of personalisation in adult social care, as confirmed by the Care Act 2014. Drawing on findings from life story interviews with 31 migrant care workers who had worked for disabled or older people in England, conducted 2011–2013, we note the potential for expanding the sociologically inspired concept ‘personalised risk’. This necessitates an appreciation of risks potentially faced by the multiple parties in the care relationship and a differentiated set of structural risks. Applying a multilevel analysis we highlight the potential risks of ‘informality’ of employment conditions experienced by directly employed care workers, the ‘emotional’ content of care worker-employer relationships, and ‘intimacy’ of employer/employee roles. In this article, we offer an empirical based contribution to the wider discussion of risks and risk theory derived from policy changes being adopted by many developed countries that increasingly emphasise individual responsibility for personal welfare within an uncertain and mobile social world. [ABSTRACT FROM PUBLISHER]

In this article we examine a risk management tool that was used in a pilot programme of applied health research in the south-west of England funded by the National Institute for Health Research (NIHR). During a wider internal evaluation of the NIHR Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, we became interested in how risk was being defined and managed in the programme. Our search of the empirical literature showed that little attention had been given to risk governance within large-scale organisational change programmes in the health field. Through analysis of official documents and interviews with senior managers, we examined the nature and the value of the risk tool that was used by the programme managers. This highlighted that the programme was believed to be a 'relatively risky' initiative that required active management. The senior managers developed a risk tool for this purpose, which was regularly used throughout the pilot. It was perceived to have value in three main ways-providing assurance to members of the collaboration, responsiveness to the wider context and acceptability as part of routine programme implementation. Our analysis also highlighted intentional risk-taking within a complex partnership programme that sought to facilitate the translation of evidence into everyday practice. We discuss the implications of our insights for the further development of risk tools and the potential value of 'edgework' as a theoretical framework to inform further research of risk management in complex programmes. [ABSTRACT FROM AUTHOR]

In this article I examine how a group of female university students in Ontario, Canada navigated the notion of 'gendered risk' that underpins the current promotion of human papillomavirus (HPV) vaccine. In 2010, I interviewed 24 female university students from across the province of Ontario focussing on their experiences of making decisions about whether or not to have the HPV vaccine. I found that each student's vaccine decision - whether it was to forgo vaccination, to wait to make a decision or to vaccinate - involved the consideration of notions of gender, negotiation of sexual health issues and management of the uncertainty of a relatively new vaccine. These considerations created a complex situation and produced a complex decision-making context, one that required the women to reflect on the ways in which they exercised their ethical agency. As a result, the women in my sample practiced identity-based vaccine decision-making that was driven by their developing sense of self as a young woman emerging into adulthood. [ABSTRACT FROM AUTHOR]

Health guidelines in many countries advise women that not drinking alcohol during pregnancy is the safest option for their babies. This advice is based on a lack of evidence about what is a safe amount of alcohol and increasing concern about Foetal Alcohol Spectrum Disorders. While there is some knowledge of factors informing women's views and practices in relation to alcohol consumption during pregnancy, there is little knowledge or understanding of the ways women interpret and respond to the abstinence public health advice in Australia and its bearing, if any, on their own practices. In this article, we examine women's experiences of alcohol consumption during pregnancy and their views of the abstinence advice. We locate our analysis within the body of thinking that views pronouncements about risks during pregnancy as bound up with social and cultural values and ideas about what it means to be a 'good' or 'bad' mother, as much as they are about science. We draw on a study that we undertook in 2014 of 20 women, who were either pregnant, had recently had a child or who had young children, or who were planning for pregnancy, who took part in one-to -one qualitative interviews or participated in focus group discussions in Canberra, Australia. We found that the women in our study variously described receiving reassurance after drinking in early pregnancy; opting to abstain as the safest option in the face of uncertainty; and having an occasional drink if they felt like it. In response to the abstinence advice, we found that some women understood it as a responsible message, even if they had not necessarily adhered to it, while others criticised it as an example of policing pregnant women. Overall, the women in our study accepted that it was possible to drink responsibly during pregnancy and defended this view through strategies of normalising the occasional drink, emphasising a woman's right to make her own decisions, and associating low-level consumption with low risk. [ABSTRACT FROM AUTHOR]

In high-income countries such as Finland, personal healthcare is organised around the management of lifestyle risks and minimisation of such risks forms a key part of public health policy. While the scientific development of the lifestyle risk model has been thoroughly studied, there has been less research on the history of popular experiences of the model. In this article, I examine lay people's response to a pioneering heart disease prevention programme in north-eastern Finland in the 1970s, the North Karelia Project, which promoted the lifestyle risk model. I use archival data from early 1970s that recorded the project interactions with the local population and their reactions to the project. I show that although local residents in North Karelia responded positively to the project, they did not necessarily subscribe to its preventive and risk minimising objectives. In an area of limited health resources, the project provided local residents with access to medical expertise. Local reactions indicated a clash of a cultural notion of illness embedded in the social life-world of Karelians with a specific rationality of government emphasising individual responsibility vis-á-vis heart conditions. Local residents who were critical of the public health risk model tended to minimise the role of lifestyle risk factors in cardiovascular disease causation or subsumed these factors into a more encompassing explanation that stressed the effects of the on-going structural social change in the area, highlighting the sense of loss caused by the waning of traditional small farm existence and their anxiety about the resulting economic and social insecurity. [ABSTRACT FROM AUTHOR]

Discourses about health risks can have major implications for individuals and cultures. In this article, we use risk orders theory to examine nurses' perceptions of patient safety risk in Obstetrics departments of US hospitals. According to risk orders theory, risk discourses can create social worlds that have the capacity to threaten individuals' social bonds, identity and moral character, and the imaginative potential of entire cultures. Risk orders theory proposes three orders of risk. First-order risks are constructed from claims about tangible dangers that individuals believe result from their actions or inactions. Second-order risks are threats experienced by individuals because of communication about first-order risk, including threats to social relationships or social risks, and threats to the sense of moral character or moral risk. Third-order risks are threats to collective agency and imagination underpinning shared culture. In this article, we draw on data from a survey of obstetric nurses who attended the Association of Women's Health, Obstetric and Neonatal Nurses conference in 2010 in Las Vegas, Nevada. We use a qualitative thematic analysis of 131 obstetrics nurses' narrative responses on a critical incident survey to refine theoretical constructs of risk orders theory. We identified a third type of second-order risk, identity risks, or threats to the sense of self. We also identified three types of third-order risks: agencyconstraining risks threaten members of a culture's ability to act freely; agentconstraining risks threaten cultural members' ability to define themselves freely; double-binding risks threaten their ability to make choices freely. We found that second-order and third-order risks did threaten some obstetrics nurses' social bonds, identity as a nurse, moral character and imaginative potential. [ABSTRACT FROM AUTHOR]

This article explores material from a citizen’s inquiry into the social and ethical implications of health biosensors. In ‘Our Bodies, Our Data’ a space was afforded for members of the public to examine two forms of health biosensing, and for the authors to research what happens when such examination shifts from the domain of experts to that of citizens. Drawing on data from this inquiry, which form part of a wider research project, ‘Living Data: making sense of health biosensors’, we open up conceptual and methodological questions about how to study innovative health technologies and contribute to debates about the direction of health biosensing by bringing forward the views of a group rarely heard in this domain: the public. The panel of 15 participants was shown examples, handled devices and heard evidence about the development of home ovulation monitoring and direct-to-consumer genetic testing. Citizens identified key areas of concern around the development, design and marketing of these devices, implicating technology companies, public bodies and civil society organisations. The panel articulated serious concerns relating to ethics, trust, accountability, quality and governance of health biosensors that operate ‘outside the clinic’. Their deliberations reflect concern for what kind of society is being made when genetic testing and home reproductive technologies are promoted and sold directly to the public. The panel process allowed us to re-imagine biosensors, wresting their narratives from the individualising discourses of self-optimisation and responsibilisation which have dominated their introduction in Euro-US markets. [ABSTRACT FROM AUTHOR]

Commentators view online screening and automated feedback interventions as low-cost ways of addressing alcohol and other drug-related harms. These interventions place people into categories of risk based upon scores from standardised screens and provide automated feedback about a person’s level of risk of developing alcohol and other drug ‘problems’. In this article, we examine how one particular alcohol and other drug online screening and feedback intervention enacts risky alcohol and other drug use and users, and explore how these enactments compare to alcohol and other drug users’ own accounts of risk. In order to do this, we undertook a qualitative analysis of intervention content and intervention recipients’ responses (n = 489) to an open-ended question about their experience of the online screening and feedback intervention. Our analysis highlights how the online screening and feedback intervention draws on prevention science to cultivate a sense of expertness and objectivity. Intervention recipients’ accounts of risk were either overshadowed by the ‘expert’ risk account provided by the intervention, ‘validated’ by the intervention or were not accurately reflected by the intervention. In the latter case, intervention recipient comments draw attention to the way in which the intervention enacts alcohol and other drug use as inherently risky without accounting for the context and purpose of use. While the online screening and feedback intervention assumes that people are capable of self-monitoring and managing their alcohol and other drug use and risk, recommendations for help provided enact intervention recipients as fragile and in need of professional help. We suggest that there is a need for the development of interventions that are better equipped to take account of the complexity of alcohol and other drug use and risk experiences and subjectivities. [ABSTRACT FROM AUTHOR]

In 2013, the ‘right to baby formula’ movement supported by educated, middle-class Chinese families in Hong Kong was launched online challenging the dominant message that ‘breast is best’. In this article, I focus on links between mediatisation, globalisation of formula milk and motherhood in post-colonial Hong Kong. Although previous research has examined ideologies of motherhood and mothers’ infant feeding decisions, little research has focused on the impact of digital media within post-colonial societies undergoing rapid social change. Drawing on data from a study of mothers living in Hong Kong that I conducted during 2010–2011 and 2013–2014, I show how digital media contribute to changes in individuals’ experiences with breastfeeding, perceptions of risk and health, as well as social relations, norms, values and identities in contemporary Hong Kong. I explore how and with what consequences the family, especially as it relates to motherhood and childhood, and the practices of infant feeding are intertwined with digital media and the body politic in neoliberal, post-colonial Hong Kong. I argue that although digital media have globalised the biomedical discourse that ‘breast is best’, mothers in Hong Kong have, through digital storytelling and virtual interaction, generated alternative interpretations of science, health and their embodied illness experience that serve to counterbalance the cultural contradictions of motherhood. I show that through social networking, parents have not only gained sufficient political power to secure formula milk, they are also simultaneously subsumed to consumer desire created by the marketing of international pharmaceutical companies. [ABSTRACT FROM AUTHOR]

US quarantine announcements do not include information that there is a moderate likelihood that Ebola-exposed people might exhibit symptoms, signalling infectiousness, beyond 21 days. As a result it is possible that if and when there is media coverage in the US of a delayed-symptom case, it might create citizen distrust in public health authorities and information and cause citizens to overestimate the risk of Ebola infection. In this article we report a research study which examined whether openness about post-21-day symptoms would attenuate negative reactions. We ran two experiments with online opportunity (Amazon mTurk) samples of Americans in late October-early November 2014, between the two deaths from Ebola in the US. In these experiments we assessed the reactions of respondents who saw quantitative estimates of post-21-day-symptom likelihood (n = 1413), or were informed about post-21-day symptoms with a rationale for the 21-day period after all saw a mock news story about a US case of 30th-day symptoms (n = 425). We found in both experiments that perceived risk increased and trust declined when people learned of post-21-day symptoms, and disbelief increased that 21 days without symptoms means no Ebola infection. In Study 2, informed persons and controls changed perceived risk and trust relative to baseline; test-group participants distrusted local medical personnel less and wanted shorter quarantines compared to controls who did not receive the information. Our findings suggest that informing Americans about the small likelihood of post-21-days Ebola symptoms would not increase perceived risk and distrust, and might diminish negative reactions to the media reporting a case who developed symptoms of Ebola after 21 days. Thus, public health officials wanting appropriate public responses to potential or actual epidemics may benefit from early communication of unpleasant infectious-disease facts before events reveal them, and signal officials’ lack of preparedness for public reactions. [ABSTRACT FROM PUBLISHER]

Western medical approaches to childbirth typically locate risk in women’s bodies, making it axiomatic that ‘good’ maternity care is associated with medically trained attendants. This logic has been extrapolated to developing societies, like Vanuatu, an Island state in the Pacific, struggling to provide good maternity care in line with the World Health Organization’s Millennium Development Goals. These goals include the reduction of maternal mortality by two-thirds by 2015, but Vanuatu must overcome challenging hurdles – medical, social and environmental – to achieve this goal. Vanuatu is a hybridised society: one where the pre-modern and modern coincide in parallel institutions, processes and practices. In 2010, I undertook an inductive study of 30 respondents from four main subcultures – women living in outer rural communities with limited access to Western-trained health workers; women from inner urban communities with ease of access to medical clinics; traditional birth attendants who are formally untrained but highly specialised and practised mainly in remote communities; and Western-trained medical clinicians (obstetricians and midwives). I invited all the participants to comment on what constituted a ‘good birth’. In this article, I show that participants interpreted this variously according to how they believed the uncertainties of childbirth could be managed. Objectivist approaches that define risk as an objective reality amenable to quantifiable measurement are thus rendered inadequate. Interpretivist approaches better explain the reality that social actors not only find risk in different sites but gravitate towards different practices, discourses and individuals they can trust especially those with whom they feel a strong sense of community. Strategies are, therefore, formed less through scientific rationality but according to feelings and emotions and the lived experience. The concept of risk cultures conveys this complexity; they are formed aroundvaluesrather than calculable rationalities. Risk cultures form self-reflexively to manage contingent circumstances. [ABSTRACT FROM PUBLISHER]

Many Australians live in attractive urban-fringe and semi-rural environments which are said to be places that promote health and well-being. Yet, each summer, these residents are asked by authorities to prepare for episodic, intensely unpredictable bushfire emergency. In 2012/2013, we interviewed 17 people who lived on the rural fringe of Melbourne to gain insights into how people are able to feel secure whilst residing in bushfire risk environments. Our findings highlight the deep attachment that people have to place, the importance of learning from past experiences, recognition that any preparation has limitations, and the need to recognise one’s own limitations when confronted with fire. With reference to the bushfire preparedness narratives told in the interviews, we discuss the precariousness of living in a place that is seen as healthy and dangerous. The argument we develop furnishes insight into how individuals and families deal with the intensity and complexity of bushfire risk and more generally how they are taking on the emerging rationalities of disaster preparedness as a mode of risk management for survival. Such insights support policy makers to tailor advice that recognises the complexity of people’s understanding of fire risk. [ABSTRACT FROM PUBLISHER]

Bisphenol A is a chemical used to make certain types of plastics and is found in numerous consumer products. Because scientific studies have raised concerns about Bisphenol A’s potential impact on human health, it has been removed from some (but not all) products. What many consumers do not know, however, is that Bisphenol A is often replaced with other, less-studied chemicals whose health implications are virtually unknown. This type of situation is known as a potential ‘regrettable substitution’, because the substitute material might actually be worse than the material that it replaces. Regrettable substitutions are a common concern among policymakers, and they are a real-world manifestation of the tension that can exist between the desire to avoid risk (known possible consequences that might or might not occur) and ambiguity (second-order uncertainty), which is itself aversive. In this article, we examine how people make such trade-offs using the example of Bisphenol A. Using data from Study 1, we show that people have inconsistent preferences towards these alternatives and that choice is largely determined by irrelevant contextual factors such as the order in which the alternatives are evaluated. Using data from Study 2, we further demonstrate that when people are informed of the presence of substitute chemicals, labelling the alternative product as ‘free’ of Bisphenol A causes them to be significantly more likely to choose the alternative despite its ambiguity. We discuss the relevance of these findings for extant psychological theories as well as their implications for risk, policy and health communication. [ABSTRACT FROM AUTHOR]

In this article, we contribute to a growing body of literature that explores how risk discourse functions in the (globalised) neoliberal era of ‘intensive mothering’. A comparison of traditional Chinese medicine and Western biomedicine indicates that in these two approaches to medicine, pregnancy-related risks are derived from different sources and seen in different ways. In this article, we examine how women with a Chinese background living in North America negotiate these differences. More specifically, we use data from a qualitative research study to examine how 15 pregnant Chinese Canadian women living in Vancouver, British Columbia, understand and experience pregnancy-related risk and lifestyle directives. Examining data from a Foucauldian perspective that views ‘risk’ as a biopolitical technique of governance, we show that the ways in which the majority of the participants use traditional Chinese medicine and Western biomedicine – and identify risk – change as they move through the stages of pregnancy. While many of them integrated aspects of both traditional Chinese medicine and Western medicine prior to pregnancy (using Western medicine for acute issues and traditional Chinese medicine to restore bodily balance and strength), once pregnant the majority of the women in the study used biomedical ‘proof’ to guide them through a healthy pregnancy. They tended to avoid traditional Chinese remedies due to the ‘risk’ of teratogenic effects, and also avoided family advice intended to ensure bodily balance. Once the child was born, the participants viewed the (maternal) body in a different way: as a body out of balance in the yin-yang sense – and in need of traditionally ordained practices (typically called ‘doing the month’). [ABSTRACT FROM AUTHOR]

In this article we explore the construction of risk in government guidelines on alcohol intake during and before pregnancy in four Nordic countries given that there is no sound evidence linking a low level of alcohol intake during pregnancy to foetal harm. In the article we draw on two sources of data to examine the rationale behind the advice given to pregnant women: health education materials and other government documents, such as guidelines for professionals. We found that in all the four countries the government guidelines advised pregnant women to completely abstain from alcohol consumption, but there was some variation between the countries in the advice for non-pregnant women. The guidance in the four countries also differed in the extent to which they discussed the lack of evidence behind the abstinence advice and the precautionary approach on which the advice was based. In all the four countries the printed and widely circulated health education materials did not explain that the abstinence advice was not based on actual evidence of harm but on a precautionary approach. The other government documents adopted varying strategies for justifying the abstinence advice including not offering information about the uncertainty of the knowledge base, implying that there was evidence that low alcohol consumption was harmful to the foetus, acknowledging that a safe level of alcohol intake during pregnancy could not be specified and explaining the precautionary approach to risk. In this article we argue that the shift from ‘estimation of risk’ to the ‘precautionary principle’ is a part of a wider socio-cultural push towards broader employment of the precautionary principle as a strategy to manage uncertainty, and in the context of pregnancy, it is a part of the symbolic struggle to protect the purity of the foetus and construct the ‘perfect mother’. [ABSTRACT FROM PUBLISHER]