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As older adults become more susceptible to certain health crises, their preoccupation with their risk of suffering such events increases. Understanding the implications of risk perceptions is critical because they may have consequences for psychological and physical well-being in later life. In the present study of older adults living in the community, the authors examined participants' comparative risk estimates (CREs)--their perceptions of their own risk relative to a similar other's risk--of suffering a hip fracture. Using multiple regression analyses, the authors examined the role of CREs on psychological well-being (negative emotions, life satisfaction) and self-rated physical well-being (general physical health, recent physical health). The authors expected perceived control (PC) to moderate the relationship between CREs and well-being. The predicted interaction did occur: Among individuals with high PC, comparative optimism (perceiving a comparatively low risk) was associated with better psychological well-being (fewer negative emotions and greater life satisfaction) and better physical well-being (general and recent physical health) relative to comparative pessimism (perceiving a comparatively high risk). Among individuals with low PC, there were no differences in well-being between comparative optimists and comparative pessimists. These findings suggest that the protective effect of comparative optimism on well-being is limited to older adults who have a strong sense of control. Keywords: age-related issues, comparative risk, health and well-being, optimism, perceived control, BECAUSE OLDER INDIVIDUALS often witness their peers or spouses suffering various health crises such as falls and hip fractures, they are inclined to contemplate their own risk of suffering similar [...]

Longitudinal data from 851 elderly residents of a retirement community (mean age = 73 years) were used to examine the correlates of self-assessments of health (SAH) and the predictors of changes in SAH over several follow-up periods ranging from 1 to 5 years. The authors hypothesized that indicators of positive health, including feelings of energy and positive mood, social support, and active functioning, are as important in determining current and future SAH as negative indicators such as disease history, disability, medication, and negative mood. Results of cross-sectional and longitudinal analyses showed that functional ability, medication use, and negative affect were salient to people judging their health, but positive indicators of activity and mood had an even stronger, independent effect. These findings show the importance of attending to the full illness-wellness continuum in studying people's perceptions of health.

Epidemiology is the main supplier of 'bases of action' for preventive medicine and health promotion. Epidemiology and epidemiologists therefore have a responsibility not only for the quality and soundness of the risk estimates they deliver and for the way they are interpreted and used, but also for their consequences. In the industrialised world, the value of, and fascination with health is greater than ever, and the revelation from epidemiological research of new hazards and risks, conveyed to the public by the media, has become almost an every-day phenomenon. This 'risk epidemic' in the modern media is paralleled in professional medical journals. It is in general endorsed by health promoters as a necessary foundation for increased health awareness and a desirable impetus for people to take responsibility for their own health through behavioural changes. Epidemiologists and health promoters, however, have in general not taken the possible side effects of increased risk awareness seriously enough. By increasing anxiety regarding disease, accidents and other adverse events, the risk epidemic enhances both health care dependence and health care consumption. More profoundly, and perhaps even more seriously, it changes the way people think about health, disease and death - and ultimately and at least potentially, their perspective on life more generally. The message from the odds ratios from epidemiological research advocates a rationalistic, individualistic, prospective life perspective where maximising control and minimising uncertainty is seen as a superior goal. The inconsistency between applying an expanded health concept, comprising elements of coping, self-realisation and psycho-physical functioning, and imposing intolerance to risk and uncertainty, is regularly overlooked. Acceptance and tolerance of risk and uncertainty, which are inherent elements of human life, is a prerequisite for coping and self-realisation. A further shift away from traditional working-class values like sociability, sharing, conviviality and tolerance can not be imposed without unwanted side effects on culture and human interaction. The moral and coercive crusade for increased risk awareness and purity in life style can too readily take on the form of cultural imperialism towards conformity. Epidemiologists and the health care movement in general have a mandate to fight disease and premature death; they have no explicit mandate to change culture. Key words - epidemiology, risk, health, social class, culture

School-based programs designed to measure health risk behavior and reduce the risk of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection have not addressed adequately the needs of adolescents outside of mainstream schools. In Florida, these youth represent a sizable proportion of the population and have been shown to be at increased risk for acquiring sexually transmitted diseases and human immunodeficiency virus. This article describes a peer-led STD/HIV intervention for students in a dropout prevention program in Dade County, Florida. Trained peer counselor/educators (PCEs) led schoolwide activities and classroom sessions covering STD/HIV information, community health resources, communication and negotiation skills, and safer sex strategies. Teachers and students rated the PCEs effective in promoting discussion and serving as sources of information about AIDS and community health resources. Pre/post intervention questionnaire results demonstrated an increase in AIDS awareness and discussion among students as well as an increase in condom use. Based on this social influences approach, peer education appears to be a promising health education strategy for students in dropout prevention programs. (J Sch Health. 1996;66(5):176-182), Compared with adolescents who attended school, out-of-school adolescents and those who participate in dropout prevention programs are at increased risk for acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus [...]

This study examined public interest regarding genetic testing for colon cancer susceptibility. Survey data were collected from 383 adults in Utah. Respondents were very (47.3%) or somewhat (36.6%) interested in taking this genetic test. Nearly 95% reported that they would share their results with others. Individuals with higher income and with a perceived risk of getting colon cancer were the most interested in testing. Individuals without health insurance and widowed individuals were the least likely to share their test results. If respondents were told that they carried a gene for colon cancer, most would be concerned with how to reduce their risk of getting the disease. (Am J Public Health. 1995;85:1435-1438), Most adults would likely be interested in a taking genetic screening test for susceptibility to colon cancer if informed about the availability of such a test and the effects f the disease. Researchers surveyed 383 randomly selected adult Utah residents about their attitudes toward a genetic screening test for colon cancer. Only 16% reported they would not be interested in taking such a test. Interest in the test was higher among respondents with higher income and those who thought they were at high risk. If the test were positive, 94% would share the results with others, generally their doctor and their spouse. Those with insurance would be somewhat more likely to tell their doctor. Half would want to know about how to reduce the risk of cancer, one-quarter would worry about themselves, and 13% would worry about the risk to family members, especially their children. Few worried about the effect on health insurance coverage or employment, which suggests that the public is generally unaware of the potential implications of being identified as at-risk for cancer.

Constructing environmental and health policies appropriate across diverse communities is challenging. Group differences in the circumstances of exposure and in responses to environmental risk are common. Consequences of this variability may become more apparent given recent calls for more deregulation and an increased use of participatory strategies to manage environmental risks. Approaches requiring active public participation will be successful only if diverse groups can be engaged. Psychological studies of individual differences in risk behaviors can provide policymakers with insights about why responses vary in risk situations and how effective certain participatory strategies may be across a multicultural society. Responses of Mexican immigrant farmworkers to pesticide risk illustrate how the broader context of exposure can contribute to variability among communities in risk adaptation and affect the implementation of innovative policies.

People typically attribute lower health risks to themselves than to others, a phenomenon referred to as unrealistic optimism. The present study tested the person positivity bias as a previously unexamined explanation of the phenomenon and analyzed the relationship between unrealistic optimism and expectations of control. High-school students estimated their own and one of three other persons' (the average student's, a randomly chosen student's, or their best same-sex friend's) chances of getting health problems. They also filled out questionnaires measuring locus of control and health-protective behavior. In contrast with the person positivity explanation, unrealistic optimism was not restricted to the 'average other' condition. However, unrealistic optimism was stronger in subjects with a more internal locus of control than in subjects with a rather external locus of control. An unpredicted effect of estimation order was observed: Unrealistic optimism was stronger in subjects who estimated the comparison person's risks first than in subjects who started with own risks. This effect can be understood in terms of Codol's observation that people perceive others as more similar to themselves than they themselves are to others.

This study examines the determinants of an individual's decision to be tested for HIV infection. Using data from the 1988 AIDS Knowledge and Attitudes Survey we develop and test a conceptual model of the factors that impact the testing decision. We estimate the impact that individuals' risk characteristics, sociodemographic characteristics, knowledge about HIV infection, and access to testing have on their decision to be tested. We also examine the impact of state confidentiality policies on the testing decision. Our results indicate that risk group membership, knowledge about HIV infection, and the sociodemographic characteristics of the individual exert a significant impact on the decision to receive an HIV test. In addition, state policies that preserve confidentiality also have a significant effect on an individual's decision to be tested.

With the election behind us, brace yourself for the real debate about the future of Social Security and Medicare. The alarmists in this fight have a simple central argument: Many [...]

The authors discuss the need for the creation of carcinogen risk assessment guidelines specific to children. The difference between infant and child versus adult developmental stages, susceptibility to radiation exposure, care of children exposed to carcinogens, and the EPA's commitment to child health protection standards are evaluated.

This study examines the importance of attitudinal and demographic variables in discriminating those residents who had moved prior to the restart of the Three Mile Island nuclear reactor in 1985 from those who remained. Findings indicate that movers and stayers were discriminated by demographic factors, age, and length of residence in the vicinity. Movers and nonmovers also differed in the interrelatedness of their attitudes pertaining to environmental threat and perceived contro. Among those who left, perceived threat of radiation was associated with lack of contol; among those who stayed, perceived control was related to faith in experts. This difference was related to a possible defensive adaptation to environmental threat through disassociation of sense of control from worry about environmental threat by those who remained in the area.