Neil D. Weinstein

Unrealistic optimism about future life events

Two studies investigated the tendency of people to be unrealistically optimistic about future life events. In Study 1, 258 college students estimated how much their own chances of experiencing 42 events differed from the chances of their classmates. Overall, they rated their own chances to be above average for positive events and below average for negative events, ps<.001. Cognitive and motivational considerations led to predictions that degree of desirability, perceived probability, personal experience, perceived controllability, and stereotype salience would influence the amount of optimistic bias evoked by different events. All predictions were supported, although the pattern of effects differed for positive and negative events. Study 2 tested the idea that people are unrealistically optimistic because they focus on factors that improve their own chances of achieving desirable outcomes and fail to realize that others may have just as many factors in their favor. Students listed the factors that they thought influenced their own chances of experiencing eight future events. When such lists were read by a second group of students, the amount of unrealistic optimism shown by this second group for the same eight events decreased significantly, although it was not eliminated.

The precaution adoption process.

This article presents a critique of current models of preventive behavior. It discusses a variety of factors that are usually overlooked-including the appearance of costs and benefits over time, the role of cues to action, the problem of competing life demands, and the ways that actual decision behavior differs from the rational ideal implicit in expectancy-value and utility theories. Such considerations suggest that the adoption of new precautions should be viewed as a dynamic process with many determinants. The framework of a model that is able to accommodate these additional factors is described. This alternative model portrays the precaution adoption process as an orderly sequence of qualitatively different cognitive stages. Data illustrating a few of the suggestions made in the article are presented, and implications for prevention programs are discussed.

Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide sample

A mailed questionnaire was used to obtain comparative risk judgments for 32 different hazards from a random sample of 296 individuals living in central New Jersey. The results demonstrate that an optimistic bias about susceptibility to harm-a tendency to claim that one is less at risk than ones peers—is not limited to any particular age, sex, educational, or occupational group. It was found that an optimistic bias is often introduced when people extrapolate from their past experience to estimate their future vulnerability. Thus, the hazards most likely to elicit unrealistic optimism are those associated with the belief (often incorrect) that if the problem has not yet appeared, it is unlikely to occur in the future. Optimistic biases also increase with the perceived preventability of a hazard and decrease with perceived frequency and personal experience. Other data presented illustrate the inconsistent relationships between personal risk judgments and objective risk factors.

Unrealistic optimism about susceptibility to health problems.

In this study, 100 college students compared their own chances of experiencing 45 different health- and life-threatening problems with the chances of their peers. They showed a significant optimistic bias for 34 of these hazards, consistently considering their own chances to be below average. Attempts to account for the amount of bias evoked by different hazards identified perceived controllability, lack of previous experience, and the belief that the problem appears during childhood as factors that tend to increase unrealistic optimism. The investigation also examined the importance of beliefs and emotions as determinants of self-reported interest in adopting precautions to reduce ones risk. It found that: (a) beliefs about risk likelihood, beliefs about risk severity, and worry about the risk all made independent contributions to interest in risk reduction; (b) unrealistic optimism undermined interest in risk reduction indirectly by decreasing worry; and (c) beliefs about risk likelihood and severity were not sufficient to explain the amount of worry expressed about different hazards.

Meta-Analysis of the Relationship Between Risk Perception and Health Behavior: The Example of Vaccination

BACKGROUND Risk perceptions are central to many health behavior theories. However, the relationship between risk perceptions and behavior, muddied by instances of inappropriate assessment and analysis, often looks weak. METHOD A meta-analysis of eligible studies assessing the bivariate association between adult vaccination and perceived likelihood, susceptibility, or severity was conducted. RESULTS Thirty-four studies met inclusion criteria (N = 15,988). Risk likelihood (pooled r = .26), susceptibility (pooled r = .24), and severity (pooled r = .16) significantly predicted vaccination behavior. The risk perception-behavior relationship was larger for studies that were prospective, had higher quality risk measures, or had unskewed risk or behavior measures. CONCLUSIONS The consistent relationships between risk perceptions and behavior, larger than suggested by prior meta-analyses, suggest that risk perceptions are rightly placed as core concepts in theories of health behavior.

Testing four competing theories of health-protective behavior.

Four competing theories of health-protective behavior are reviewed: the health belief model, the theory of reasoned action, protection motivation theory, and subjective expected utility theory. In spite of their commonalities, these models are seldom tested against one another. The review points out the similarities and differences among these theories and the data and analyses needed to compare them. In addition to describing the content of the models, their conceptualization of key variables, and the combinatorial rules used to make predictions, some general problems in theory development and testing for health behaviors are examined. The articles goal is to help investigators design studies that will clarify the strengths and weaknesses of these models, leading toward a better understanding of health behavior.

Stage theories of health behavior: Conceptual and methodological issues

Despite growing interest in stage theories of health behavior, there is considerable confusion in the literature concerning the essential characteristics of stage theories and the manner in which such theories should be tested. In this article, the 4 key characteristics of a stage theory-a category system, an ordering of categories, similar barriers to change within categories, and different barriers to change between categories--are discussed in detail. Examples of stage models of health behavior also are described. Four major types of research designs that might be used for testing stage theories are examined, including examples from the empirical literature. The most commonly used design, which involves cross-sectional comparisons of people believed to be in different stages, is shown to have only limited value for testing whether behavior change follows a stage process.

Resistance of personal risk perceptions to debiasing interventions.

The tendency to believe that ones own risk is less than that of others may reduce interest in health-protective behaviors. This article describes 4 attempts to reduce such optimistic biases. In Study 1, New Jersey residents (N = 222) were provided with lists of risk factors for several health problems. This manipulation was strengthened in Study 2 by presenting risk factors in such a way that participants (164 undergraduates) might see their own standing as inferior to that of others. In Study 3, risk factors were presented one at a time, and participants (190 undergraduates) incorporated them into a mental image of a high-risk individual. Finally, 374 undergraduates in Study 4 generated lists of personal attributes that they believed increased their risk. Optimistic biases were found in each study, but none of the manipulations reduced these biases consistently. In contrast, conditions using opposite manipulations often exacerbated the biases.

The Health Information National Trends Survey (HINTS): Development, Design, and Dissemination

Little is known about access, sources, and trust of cancer-related information, or factors that facilitate or hinder communication on a populationwide basis. Through a careful developmental process involving extensive input from many individuals and organizations, the National Cancer Institute(NCI)developed the Health Information National Trends Survey(HINTS)to help fill this gap. This nationally representative telephone survey of 6,369 persons aged ≥ 18 years among the general population was first conducted in 2002–2003, and will be repeated biennially depending on availability of funding. The purpose of creating a population survey to be repeated on a cyclical basis is to track trends in the publics rapidly changing use of newcommunication technologies while charting progress in meeting health communication goals in terms of the publics knowledge, attitudes, and behaviors. The HINTS survey instrument was built upon extant models of health communication and behavior change, taking into account the rapidly changing communication environment. Questions in the survey were drawn from an overall theoretical framework that juxtaposed the“push”aspects of traditional broadcast media against the“pull”aspects of new media. HINTS data will be made widely available for researchers and practitioners; it will help further research in health communication and health promotion and provide useful information for programs, policies, and practices in a variety of settings.

Risk Perceptions: Assessment and Relationship to Influenza Vaccination

OBJECTIVE Accurate measurement of beliefs about risk probability is essential to determine what role these beliefs have in health behavior. This study investigated the ability of several types of risk perception measures and of other constructs from health behavior theories to predict influenza vaccination. DESIGN Prospective study in which students, faculty, and staff at 3 universities (N = 428) were interviewed in the fall, before influenza vaccine was available, and again early in the next calendar year. MAIN OUTCOME MEASURE Self-reported influenza vaccination. RESULTS Two interview questions that asked about feeling at risk and feeling vulnerable predicted subsequent behavior better (r = .44, p = .001) than 2 questions that asked for agreement or disagreement with statements about risk probability (r = .25, p = .001) or 4 questions that asked respondents to estimate the magnitude of the risk probability (r = .30, p = .001). Of the 4 perceived risk magnitude scales, a 7-point verbal scale was the best predictor of behavior. Anticipated regret was the strongest predictor of vaccination (r = .45, p = .001) of all constructs studied, including risk perceptions, worry, and perceived vaccine effectiveness. CONCLUSION Risk perceptions predicted subsequent vaccination. However, perceived risk phrased in terms of feelings rather than as a purely cognitive probability judgment predicted better. Because neither feeling at risk nor anticipated regret is represented in the most commonly used theories of health behavior, the data suggest that these theories are missing important constructs.