Correcting misperceptions of the material benefits associated with union membership increases Americans' interest in joining unions.

How accurate are Americans' perceptions of the material benefits associated with union membership, and do these perceptions influence their support for, and interest in joining, unions? We explore these questions in a preregistered, survey experiment conducted on a national sample, representative of the US population on a number of demographic benchmarks (n = 1,430). We find that Americans exhibit large and consistent underestimates of the benefits associated with unionization, as compared to evidence from the Bureau of Labor Statistics and peer-reviewed academic research. For example, 89% of Americans underestimated the life-time income premium associated with union membership, 72% underestimated the percentage of union members who receive health insurance from their employer, and 97% overestimated the average union dues rate. We next randomly assigned half of the participants to receive a brief, informational correction conveying results of academic and government research on the material benefits associated with union membership, or not. Those who received the correction reported 11.6% greater interest in joining a union, 7.8% greater support for unions, and 6.9% greater interest in helping to organize a union in their workplace, as compared to the control group. These results suggest that, overall, Americans tend to underestimate the material benefits associated with unionization, misperceptions of these benefits are causally linked to Americans' support for unionization, and correcting these misperceptions increases a range of pro-union sentiments in the American mass public.

Mortality risk information and health-seeking behavior during an epidemic.

In a context where pessimistic survival perceptions have been widespread as a result of the HIV/AIDS epidemic (Fig. 1 A), we study vaccine uptake and other health behaviors during the recent COVID-19 pandemic. Leveraging a longitudinal cohort study in rural Malawi that has been followed for up to 25 y, we document that a 2017 mortality risk information intervention designed to reduce pessimistic mortality perceptions (Fig. 1 B) resulted in improved health behavior, including COVID-19 vaccine uptake (Fig. 1 C). We also report indirect effects for siblings and household members. This was likely the result of a reinforcing process where the intervention triggered engagement with the healthcare system and stronger beliefs in the efficacy of modern biomedical treatments, which led to the adoption of health risk reduction behavior, including vaccine uptake. Our findings suggest that health information interventions focused on survival perceptions can be useful in promoting health behavior and participation in the formal healthcare system, even during health crises-such as the COVID-19 pandemic-that are unanticipated at the time of the intervention. We also note the importance of the intervention design, where establishing rapport, tailoring the content to the local context, and spending time with respondents to convey the information contributed to the salience of the message.

Correcting misperceptions of the other political party does not robustly reduce support for undemocratic practices or partisan violence.

A growing consensus suggests that a cause of support for undemocratic practices and partisan violence is that partisans misperceive the other side. That is, they vastly exaggerate the extent to which members of the other party support undemocratic practices and violence. When these misperceptions are corrected, citizens' own beliefs moderate. I present results from an experiment that show that misperception corrections do not have an effect in the presence of competing information (i.e., that challenges the validity of the correction or offers a conflicting narrative). Basic corrections do not constitute a robust way to counter democratic backsliding stemming from citizens' misperceptions. The results highlight the need to devise stronger misperception interventions and, more generally, to consider competing information environments when devising any scalable behavioral intervention.

Correcting misperceptions of out-partisans decreases American legislators' support for undemocratic practices.

There is substantial concern about democratic backsliding in the United States. Evidence includes notably high levels of animosity toward out-partisans and support for undemocratic practices (SUP) among the general public. Much less is known, however, about the views of elected officials-even though they influence democratic outcomes more directly. In a survey experiment conducted with state legislators (N = 534), we show that these officials exhibit less animosity toward the other party, less SUP, and less support for partisan violence (SPV) than the general public. However, legislators vastly overestimate the levels of animosity, SUP, and SPV among voters from the other party (though not among voters from their own party). Further, those legislators randomly assigned to receive accurate information about the views of voters from the other party reported significantly lower SUP and marginally significantly lower partisan animosity toward the other party. This suggests that legislators' democratic attitudes are causally linked to their perceptions of other-party voters' democratic attitudes. Our findings highlight the importance of ensuring that office holders have access to reliable information about voters from both parties.

Perceptions of a reduced nicotine policy and predictors of policy support: A nationally representative U.S. survey.

BACKGROUND: The U.S. Food and Drug Administration is considering a policy to reduce nicotine in cigarettes to non-addictive levels. Although current evidence supports the public-health benefits of a reduced-nicotine policy, almost half of people who smoke (∼ 40%) do not support the policy. This study estimates the factors most strongly associated with support or opposition toward the policy, including tobacco use status, perceived effects of a reduced nicotine policy, trust in the FDA, and psychological distress. The study aims to inform messaging campaigns and policy makers. METHODS: Data were collected in 2021 with nationally representative samples of U.S. adults (n = 1763). After receiving information about the reduced nicotine policy, participants indicated their beliefs and support for or opposition to the policy, along with other individual difference characteristics. Univariate population parameters and multinomial logistic regression coefficients were estimated. RESULTS: In adjusted models, people who formerly or never smoked were less likely to oppose the policy compared to those who currently smoke; people with higher psychological distress and those who believe the policy will promote switching to e-cigarettes were more likely to oppose the policy. In addition, people were more likely to support the policy if they believed it would make quitting easier or that the FDA is trustworthy. CONCLUSIONS: Educational campaigns about reduced nicotine policy should expect higher impact by targeting prevalent perceptions and those more strongly associated with policy sentiment. In anticipation of the policy rollout, there may be a critical window to shape public opinion.

Effects of communicating lifetime risks and screening rates of colorectal cancer and breast cancer.

Colorectal cancer and breast cancer are among the most common types of cancer in the United States, and cancer screening is an effective way to detect and treat these cancers early. Health news stories, medical websites, and media campaigns regularly highlight the national lifetime risks of specific cancers and their screening rates, but recent research suggests that people tend to overestimate the prevalence of health problems but underestimate the prevalence of disease prevention behaviors in the absence of numerical information. This study featured two online experiments, one focused on breast cancer (N = 632) and one focused on colorectal cancer (N = 671), to examine the effects of communicating national cancer lifetime risks and screening rates among samples of screening-eligible adults in the United States. Findings confirmed prior work in showing that people overestimated colorectal/breast cancer lifetime risks but underestimated colorectal/breast cancer screening rates. Communicating the national lifetime risk of dying from colorectal/breast cancer lowered people's national risk estimates, which in turn was associated with lower perceived cancer risks for themselves. In contrast, communicating the national colorectal/breast cancer screening rate increased people's estimates of the prevalence of cancer screening, which in turn was associated with higher perceived self-efficacy to engage in cancer screening and greater screening intentions. We conclude that efforts to promote cancer screening may benefit from messages that include data on national cancer screening rates but may not benefit from including national rates of lifetime cancer risks.

Narrative versus statistical messages: The interplay of perceived susceptibility and misperceptions on vaccine intention.

Although there is enough scientific evidence to show the benefits and safety of vaccines, vaccine rates are low, while misperceptions about vaccines are on the rise. The main purposes of the current study are to 1) examine the effects of narrative vs. statistical messages on vaccine intention, 2) test the mediating role of perceived expectancies, and 3) examine the moderating roles of perceived susceptibility and misperceptions on vaccine intention. Data were collected with an online experiment through Amazon Mturk. The online experiment was conducted via Qualtrics once the study was considered exempt by the Institutional Research Board of a large University in the U.S. A total of 300 participants aged 18 and above completed the survey. Findings show that perceived expectancies mediate the relationship between message manipulation and vaccine intention. Our findings also show a three-way interaction which indicates that among individuals with high misperceptions, statistical messages are more persuasive for individuals with high perceived susceptibility, while narrative messages are more influential for individuals with low perceived susceptibility.

Boosting Understanding and Identification of Scientific Consensus Can Help to Correct False Beliefs.

Some people hold beliefs that are opposed to overwhelming scientific evidence. Such misperceptions can be harmful to both personal and societal well-being. Communicating scientific consensus has been found to be effective in eliciting scientifically accurate beliefs, but it is unclear whether it is also effective in correcting false beliefs. Here, we show that a strategy that boosts people's understanding of and ability to identify scientific consensus can help to correct misperceptions. In three experiments with more than 1,500 U.S. adults who held false beliefs, participants first learned the value of scientific consensus and how to identify it. Subsequently, they read a news article with information about a scientific consensus opposing their beliefs. We found strong evidence that in the domain of genetically engineered food, this two-step communication strategy was more successful in correcting misperceptions than merely communicating scientific consensus. The data suggest that the current approach may not work for misperceptions about climate change.

Editorial: Factualities - establishing empirical truths in child psychology and psychiatry.

Empirical science is a fact-finding enterprise. This raises the question when we know enough about a particular topic to draw firm conclusions and can stop searching for additional evidence in order to save efforts for issues that are less well-established. Clarity on when scientific evidence has passed the stage of to-be-tested hypotheses is important, and setting up criteria for such stopping rules is a necessary as well as thought-provoking challenge. Not only over-investigating phenomena is undesirable but the opposite, falsely assuming beliefs to be facts, as well. Two common reasons for such misperceptions are that negative news is more likely to spread around than positive news (negativity instinct), and that individuals tend to look at problems from always the same perspective (single-perspective instinct). Our field is not immune to those instincts: child psychologists and psychiatrists tend to focus on messages suggesting that the burden of children´s mental health problems calls for more intervention and research, rather than on reports that the majority of children are doing quite well. This focus on problems may obscure the reality that the vast majority of children and adolescents never experience severe mental health problems, despite the challenges of growing up in a complex world.

Stigma, beliefs and perceptions regarding prostate cancer among Black and Latino men and women.

BACKGROUND: Health disparities in prostate cancer (PC) are thought to reflect the complex interplay of socioeconomics, environment and biology. The potential impact of beliefs and perceptions about PC among Black and Latino populations on clinical disparities are not well understood. This qualitative study was conducted to assess current prevalent and pervasive stigma, beliefs and perceptions regarding PC among Blacks and Latinos living in a large metropolitan area, thereby identifying potentially modifiable barriers to care. METHODS: Qualitative data were collected through four separate focus groups of self-identified Black and Latino adult men and women living in Philadelphia to better understand their perceptions of PC diagnosis, screening and treatment. Each focus group was single-sex and conducted by racial/ethnic group in order to assess possible differences in beliefs about PC based on gender and racial/ethnic affiliation. Audio recordings were transcribed verbatim by trained research assistants and qualitative data analysis was conducted using modified grounded theory. RESULTS: There were a total of 34 participants: 19 Hispanics/Latinos and 15 Blacks, with equal numbers of men and women (n=17). Median age was 57 years (range: 18 to 85 years). Dominant themes that emerged with respect to PC diagnosis included the stigma surrounding this condition and the perceived role of an "unhealthy lifestyle" and certain sexual behaviors as risk factors for PC development. While the majority of participants acknowledged the importance of PC screening and early detection, discussion centered around the barriers to both the interest in seeking medical care and the likelihood of securing it. These barriers included misunderstanding of PC etiology, distrust of the medical profession, and financial/access limitations. Men expressed substantial confusion about PC screening guidelines. In the Black female group, the role of faith and religion in the course of disease was a major theme. Both Black and Latina females discussed the role of fear and avoidance around PC screening and treatment, as well as the prevalence of misinformation about PC in their familial and social communities. CONCLUSION: Black and Latino focus groups revealed the existence of cultural beliefs, misunderstandings and fears pertaining to PC which could influence health-related behaviors. Some themes were common across groups; others suggested racial and gender predilections. Future targeted efforts focused on directly addressing prevalent misperceptions among underserved communities in urban settings could help to improve health literacy and equity in PC outcomes in these populations.

Normative misperceptions of unhealthy snacking amongst 11- to 12-year-old secondary school students.

Younger adolescents are at an age where they have increasing control of their diet, and where peers become an important social reference for acceptable and normative dietary behaviours. These normative perceptions are often inaccurate and can lead to the development of unhealthy eating practices; although, the role of normative misperceptions of peers' unhealthy snacking behaviours in younger adolescents' personal snacking behaviours is not clear. The current study was a cross-sectional analysis of baseline data from a social norms-based healthy eating intervention sampling two secondary schools in deprived areas of England. Students aged 11-12 years (n = 252) completed self-report measures of their demographic characteristics and personal behaviours, attitudes, intentions, and normative perceptions (descriptive and injunctive norms), relating to unhealthy snacking. Results indicated students overestimated peers' daily unhealthy snacks consumption by approximately 3.2 portions, misperceived peers to have more positive attitudes towards unhealthy snacking and more negative attitudes towards reducing snacking. The greater these misperceptions of peers' behaviours and attitudes, the more likely students were to consume unhealthy snacks and have positive attitudes about unhealthy snacking. Girls had a stronger intention to reduce their snacking behaviours if they had more positive attitudes to reducing snacking behaviours and misperceived peers to also have a positive attitude. In summary, 11- to 12-year-olds misperceive the snacking behaviour and attitudes of their peers, and such normative misperceptions are associated with students' own snacking behaviours and attitudes. Interventions which challenge these misperceptions may assist in reducing the social acceptability of unhealthy snacking and in reducing unhealthy snacking amongst young adolescents.

The accuracy of patients' perceptions of the risks associated with localised prostate cancer treatments.

OBJECTIVES: To assess the accuracy of patients' perceptions of the risks associated with localised prostate cancer treatments (radical prostatectomy [RP], radiotherapy [RT], and active surveillance [AS]), and to identify correlates of misperceptions. PATIENTS AND METHODS: We used baseline data (questionnaires completed after treatment information was provided but before treatment) of 426 patients with newly diagnosed localised prostate cancer who participated (87% response rate) in a prospective, longitudinal, multicentre study. Patients' pretreatment perceptions of differences in adverse outcomes of treatments were compared to those based on the literature. We used univariate and multivariate linear regression to identify correlates of misperceptions. RESULTS: About two-thirds (68%, n = 211) of the patients did not understand that the risk of disease recurrence is comparable between RP and RT. More than half of the patients did not comprehend that RP patients are at greater risk of urinary incontinence (65%, n = 202) and erectile dysfunction (61%, n = 190), and less at risk of bowel problems (53%, n = 211) compared to RT patients. Many patients overestimated the risk of requiring definitive treatment following AS (45%, n = 157) and did not understand that mortality rates following AS, RP, and RT are comparable (80%, n = 333). Consulting a radiotherapist or a clinical nurse specialist was positively associated with, and emotional distress was negatively associated with, better understanding of the risks (P < 0.05), although effect sizes were small. CONCLUSION: Prior to choosing treatment, most patients with prostate cancer poorly understood the differences in treatment risks. Greater efforts should be made to better understand why these misperceptions occur and, most importantly, how they can be corrected.

Attitudes and barriers associated with seasonal influenza vaccination uptake among public health students; a cross-sectional study.

BACKGROUND: Although research has explored influenza vaccination uptake among medical and college students, there is a dearth of research in understanding influenza vaccination uptake and attitudes toward the vaccine among future public health practitioners. Undergraduate public health students represent future public health practitioners who may be a significant educational resource for health information, including the importance of vaccinations. METHODS: This cross-sectional study utilized survey data from 158 undergraduate public health students attending a large public university in Southern California. The survey assessed public health students' attitudes and beliefs towards the seasonal influenza vaccine and seasonal vaccination rates among this population. RESULTS: Over 88% of respondents reported having been encouraged to receive the seasonal influenza vaccine, while only 43.0% reported receipt. Of the students who reported not receiving the vaccine, 49.4% believed it may give them the flu, 30.4% believed there may be dangerous side effects, and 28.9% believed they were not at risk for contracting the flu. Access to health care practitioners (OR: 3.947, 95% CI [1.308-11.906]) and social encouragement (OR: 3.139, 95% CI [1.447-6.811]) were significantly associated with receipt of the seasonal influenza vaccine. CONCLUSION: As public health program curriculum includes information about seasonal influenza vaccination and 68% of the sample were seniors soon to be exiting the program with an undergraduate degree in public health education, this low seasonal influenza vaccination rate is disturbing. This study may add to the body of data demonstrating how knowledge of the vaccine does not always guarantee vaccine uptake. Results of the current study suggest that it may be beneficial to provide additional information targeted to public health students, aimed at mediating safety concerns and increasing social pressure to assist in improving vaccine acceptance and rates in this population. Maximizing seasonal influenza vaccination uptake by addressing attitudes, barriers and misperceptions may not only improve vaccination rates among public health students, but also in communities served by these future public health practitioners.

The Alice in Worderland Syndrome.

The Alice in Wonderland Syndrome (AWS) was first described more than 60 years ago by Lippman. It refers to episodes during which an individual may variously experience (as did Alice during her time in Wonderland) somatic, visuo-perceptual and/or visuo-spatial hallucinations, as well as feelings of depersonalisation, derealisation and distorted sense of time. Although the prevalence of AWS is unknown, indirect evidence from both retrospective and prospective studies suggests that it is a rare disorder. This paper describes the case of Zoe, a right-handed, native English speaker who was age 45 years when she experienced an episode of AWS. On neuropsychological assessment, Zoe demonstrated notable impairment of attention, learning and recall (particularly for visuo-spatial information) as well as executive dysfunction (viz., impairment of planning, cognitive flexibility and abstraction), consistent with fronto-temporal dysfunction. Detailed profiles of neuropsychological impairment in the context of AWS have not previously been reported, and it is unclear if such impairment is, indeed, a central and characteristic feature of AWS.

Factors Associated with Self-Estimated Breath Alcohol Concentration Among Bar Patrons.

BACKGROUND: Few studies have examined the context in which drinkers underestimate their breath alcohol concentration (BrAC) in natural drinking environments. This study examined factors associated with bar patrons' self-estimated BrAC in high-risk college town settings. METHODS: Guided interview and BrAC data were collected from 510 participants recruited as they exited bars located close to large universities: 1 in Florida and 1 in Texas. RESULTS: Participants with the highest measured BrACs underestimated their BrAC levels the most. Findings from multivariable linear regression analysis indicated that BrAC (std ß = 0.014, p < 0.001), number of alcoholic drinks consumed (std ß = 0.006, p < 0.01), and perceived drunkenness (std ß = 0.024, p < 0.001) had significant positive associations with BrAC self-estimates, where the regression coefficients were scaled by values approximately equal to each variable's interquartile range. Among the 321 participants with BrAC levels ≥ 0.08 g/dl, 21.2% believed their BrAC was below the legal per se driving limit of 0.08 g/dl. Results from a logistic regression analysis indicated that higher levels of perceived drunkenness were associated with better self-recognition that one's BrAC level exceeded the legal driving threshold (OR = 3.312, p < 0.001). Further, participants under 26 years of age had reduced odds of recognizing that their BrAC was greater than 0.079 g/dl (OR = 0.245, p < 0.05). CONCLUSIONS: These findings highlight the inaccuracy of self-estimated BrAC when drinking, particularly among younger drinkers. Adjusting for BrAC, situational factors were strongly associated with self-estimated BrAC. Future research is needed to better understand how altering drinking environments may improve accuracy of BrAC self-estimates and deter driving after drinking.

Multi-dimensional knowledge of malaria among Nigerian caregivers: implications for insecticide-treated net use by children.

BACKGROUND: Poor malaria knowledge can negatively impact malaria control programmes. This study evaluates knowledge distribution in the domains of causation, transmission, vulnerability, symptoms, and treatment of malaria. It assesses the association between a caregiver's knowledge about malaria and ownership and use of insecticide-treated nets (ITNs) by children. METHODS: Some 1939 caregivers of young children were recruited through a school-based survey in two Nigerian states. A 20-item, multi-dimensional survey instrument was developed and used to rank each caregiver's knowledge in five dimensions (cause, transmission, vulnerability, symptoms, treatment of malaria). Scores for each domain were used to create an aggregate knowledge score for each caregiver. The outcome measures were ITN ownership, and ITN use the night and week before the study. Regression models were used to evaluate the relationship between caregiver's knowledge (individual domains and aggregate score) and ownership and use of ITN after controlling for likely confounders. RESULTS: The main predictor of ITN use was ITN ownership (r = 0.653; p < 0.001); however, ownership only explains 43 % of variance in net use. Total knowledge index for the study population was significantly associated with both ITN ownership (r = 0.122; p = 0.001) and use (r = 0.095; p = 0.014). The spectrum of caregiver's knowledge of malaria and its causes captured in the various domains was, however, found to be poor. Fifty percent of the respondents knew that malaria is transmitted by female mosquitoes and 65 % still believe that too much exposure to the sun is a risk factor for malaria. Knowledge of populations most vulnerable to malaria (83 %) and knowledge of malaria transmission (32 %) were the domains with the highest and lowest average correct answers. CONCLUSIONS: There is a need to improve ITN coverage in Nigeria as ITN ownership was associated with ITN use. Additionally, treating knowledge as a multi-dimensional phenomenon revealed that a lot of misperceptions about malaria still exist. Distribution of ITNs through the public/private sector may need to be augmented with tailored behavioural change communication to dispel myths and improve the multi-dimensional knowledge of malaria in the local population.

Comparing Perceptions with Actual Reports of Close Friend's HIV Testing Behavior Among Urban Tanzanian Men.

Men have lower rates of HIV testing and higher rates of AIDS-related mortality compared to women in sub-Saharan Africa. To assess whether there is an opportunity to increase men's uptake of testing by correcting misperceptions about testing norms, we compare men's perceptions of their closest friend's HIV testing behaviors with the friend's actual testing self-report using a unique dataset of men sampled within their social networks (n = 59) in Dar es Salaam, Tanzania. We examine the accuracy and bias of perceptions among men who have tested for HIV (n = 391) and compare them to the perceptions among men who never tested (n = 432). We found that testers and non-testers did not differ in the accuracy of their perceptions, though non-testers were strongly biased towards assuming that their closest friends had not tested. Our results lend support to social norms approaches designed to correct the biased misperceptions of non-testers to promote men's HIV testing.

Caregiver perceptions of childhood weight: demographic moderators and correlates.

BACKGROUND: To examine whether ethnicity moderates the association between caregiver characteristics and perceptions of childhood weight and whether these perceptions are associated with their child's obesity status. METHODS: Caregivers recruited from paediatricians' offices (n = 453) completed a survey about childhood health; nurses weighed and measured the children. Caregivers reported their own weight and height, demographic information about their family and made ratings of healthy weight for children in general and for their own child in particular. RESULTS: African American caregivers were more likely to view heavier girls as healthier, but this association held only for lower income families or caregivers with higher body mass index. Hispanic caregivers were more likely to misperceive their own child's weight if either the caregiver or the child had a higher body mass index. Parents who perceived heavier weight as healthier or misperceived their own child's weight were more likely to have a child with obesity. This latter association held regardless of ethnicity. CONCLUSION: The association between ethnicity and perceptions of healthy childhood weight are complex. The relation between caregivers' perceptions of healthy weight and their own child's obesity status, however, was similar regardless of ethnicity.

Attitudes toward utility, effects and side effects of treatment for anxiety and depression.

OBJECTIVES: Negative perceptions about psychiatric treatment are likely to affect treatment adherence. We compared attitudes of patients with psychiatric illness and those of medical patients towards psychiatric treatment. METHODS: Both patients with psychiatric illness and medical patients (controls) were shown a printed copy of two vignettes depicting major depression and generalized anxiety disorder. They were asked for their perceptions on the utility, effects and possible side effects of psychiatric medications, as well as the utility of psychotherapy in treating major depression and generalized anxiety disorder. Responses between psychiatric patients and medical patients were compared using appropriate statistical tests, including logistic regression. RESULTS: Patients with psychiatric illness were more likely than medical patients to endorse the utility of medications in treating major depression and generalized anxiety disorder (p<0.001). Those with psychiatric illness were more likely to endorse the utility of psychotherapy in treating major depression (p=0.004). Both groups of patients were of the view that psychotherapy would benefit generalized anxiety disorder. Older and lesser educated patients held negative beliefs about medications. CONCLUSIONS: While patients with psychiatric illnesses endorsed favourable attitudes toward medications (p<0.001), the older and lesser educated were more likely to hold negative views (p<0.05). Psychoeducation should be tailored to the needs of older and lesser educated patients.

Is the hospital decision to seek accreditation an effective one?

The rapid expansion in the number of accredited hospitals justifies inquiry into the motives of hospitals in seeking accreditation and its social effectiveness. This paper presents a simple decision-theoretic framework where cost reductions and improved quality of care represent the endpoint benefits from accreditation. We argue that hospital accreditation, although acting as a market-signaling device, might be a socially inefficient institution. First, there is at present no convincing evidence for accreditation causing output quality improvements. Second, hospitals could seek accreditation, even though doing so is socially inefficient, because of moral hazard, consumer misperceptions, and nonprofit motivations. Finally, hospitals that seek accreditation need not themselves believe in output quality improvements from accreditation. Consequently, while awaiting additional evidence on accreditation, policy makers and third-party payers should exercise caution in encouraging such programs.