Should Medical Insurance Review Serve the Patient's Best Interests? Examples and Considerations Illustrated by Behavioral Health Cases.

ABSTRACT: Physician medical directors working for health care insurance companies conduct utilization reviews, participate in quality-of-care reviews, and adjudicate appeals. As a result, they have access to substantial and important clinical information. The medical director may have both current and historical information that can assist the treatment team in providing care. Sharing this information with a patient's current health care provider(s) is problematic due to concerns about patient privacy and the insurer's goal of not assuming legal liability for patient care. While this paper considers legal issues, it predominantly addresses the ethical responsibilities of medical directors who have valuable information unavailable to or unrecognized by the treatment team. Although it is important to consider sharing general medical information, this paper emphasizes the sharing of behavioral health information, which can be highly sensitive but also pertinent to psychiatric and other medical treatment choices. We suggest that clinical information should flow from insurer to provider when the insurer has information that will benefit the patient or prove crucial to optimal care rather than just flow from provider to insurer for the purposes of claims payments. To support and secure that flow, the paper outlines procedures for determining the need to share information, the means of providing that information, ways to separate liability, and processes for protecting privacy.

Roles of socioeconomic status, ethnicity and teacher beliefs in academic grading.

BACKGROUND: Educational outcomes in the United Kingdom vary as a function of students' family background, with those of lower socioeconomic status (SES) and certain ethnic minority groups among the worst affected. AIMS: This pre-registered study investigates: (i) whether knowledge about students' socioeconomic and ethnic background influences teachers' judgements about the quality of their work and potential for the future, and (ii) the role of teachers' beliefs-most notably about meritocracy-in their practices. SAMPLE: Our findings are based on the responses of 416 in-service (88%) and trainee (12%) teachers who successfully passed several stringent exclusion criteria. METHODS: As part of a 2 × 2 independent measures design, teachers were randomly assigned to assess an identical piece of work ostensibly written by a student who varied by SES (higher vs. lower) and ethnicity (White British vs. Black Caribbean). Following this, they responded to several measures assessing their beliefs about education. RESULTS: Teachers judged students of lower SES to be inferior to students of higher SES across a range of indicators. By contrast, we found no evidence of racial bias in teachers' judgements, though potential reasons for this are discussed. Teachers who believed that schooling is meritocratic were significantly less likely to support equity-enhancing teaching practices and initiatives. CONCLUSIONS: Unconscious teacher biases and beliefs may be contributing to the relative underperformance of students from poorer backgrounds. These findings provide a mandate for educational institutions to help teachers reflect upon, and develop the skills required to mitigate potentially harmful biases.

A cohort study of the impact of COVID-19 on the quality of life of people newly diagnosed with dementia and their family carers.

Introduction: COVID-19 has impacted people with dementia and their family carers, yet little is known about effects on overall quality of life. Methods: In a UK cohort study, pre- and post-pandemic data were collected from 114 carers and 93 recently diagnosed people with dementia. Latent growth curve modeling examined change in quality of life. Results: Carers reported significant decline in quality of life, although no change was demonstrated by people with dementia. In multivariable analyses, higher levels of cognitive impairment, deprivation, study site, and lower number of memory clinic contacts were associated with greater decline in carer quality of life. Discussion: Maintaining life quality for people with dementia during the pandemic appears to have come at the expense of their family carers. This inequity has fallen hardest on those caring for people with more severe dementia, in deprived areas, and with least support from memory services. These effects may be prevented or reversed by post-diagnostic care.

'People like me don't do well at school': The roles of identity compatibility and school context in explaining the socioeconomic attainment gap.

BACKGROUND: School students who are eligible for reduced or free school meals (FSM) - an indicator of economic disadvantage - have lower academic attainment than their peers. AIMS: We investigated whether identity compatibility - the perceived compatibility between one's social identities and the stereotype of a high-achieving student - contributes to this socioeconomic attainment gap, and whether the association between socioeconomic status and identity compatibility is moderated by school context. SAMPLE: Our sample was 4,629 students aged 15-16 years old across 29 schools in England. METHOD: We assessed students' perceptions of identity compatibility via self-report questionnaires 8 months prior to them taking national, standardized exams. RESULTS: Multilevel regression analyses revealed a negative indirect effect from eligibility for FSM to exam results via identity compatibility. These effects existed even while accounting for students' gender and language status, other psychological variables known to predict academic attainment, and their previous exam results. Furthermore, school context moderated the relationship between FSM eligibility and identity compatibility. In line with the identities in context model of educational inequalities, there was a significant negative association between FSM and identity compatibility only for students attending schools in which there was previously a relatively large socioeconomic attainment gap. CONCLUSIONS: Our results demonstrate the importance of social psychological variables in explaining educational inequalities, and of the local educational context in determining the educational experience of students from lower socioeconomic status backgrounds.

Genomic diagnostics in polycystic kidney disease: an assessment of real-world use of whole-genome sequencing.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is common, with a prevalence of 1/1000 and predominantly caused by disease-causing variants in PKD1 or PKD2. Clinical diagnosis is usually by age-dependent imaging criteria, which is challenging in patients with atypical clinical features, without family history, or younger age. However, there is increasing need for definitive diagnosis of ADPKD with new treatments available. Sequencing is complicated by six pseudogenes that share 97% homology to PKD1 and by recently identified phenocopy genes. Whole-genome sequencing can definitively diagnose ADPKD, but requires validation for clinical use. We initially performed a validation study, in which 42 ADPKD patients underwent sequencing of PKD1 and PKD2 by both whole-genome and Sanger sequencing, using a blinded, cross-over method. Whole-genome sequencing identified all PKD1 and PKD2 germline pathogenic variants in the validation study (sensitivity and specificity 100%). Two mosaic variants outside pipeline thresholds were not detected. We then examined the first 144 samples referred to a clinically-accredited diagnostic laboratory for clinical whole-genome sequencing, with targeted-analysis to a polycystic kidney disease gene-panel. In this unselected, diagnostic cohort (71 males :73 females), the diagnostic rate was 70%, including a diagnostic rate of 81% in patients with typical ADPKD (98% with PKD1/PKD2 variants) and 60% in those with atypical features (56% PKD1/PKD2; 44% PKHD1/HNF1B/GANAB/ DNAJB11/PRKCSH/TSC2). Most patients with atypical disease did not have clinical features that predicted likelihood of a genetic diagnosis. These results suggest clinicians should consider diagnostic genomics as part of their assessment in polycystic kidney disease, particularly in atypical disease.

DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers (DETERMIND): A protocol paper.

OBJECTIVES: DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) is designed to address fundamental, and, as yet unanswered questions about inequalities, outcomes and costs following diagnosis with dementia. These answers are needed to improve the quality of care and equity of access to care, and therefore the quality of life, of people with dementia and their carers. METHOD: DETERMIND is a programme of research consisting of seven complementary workstreams (WS) exploring various components that may result in unequal dementia care: WS1: Recruitment and follow-up of the DETERMIND cohort-900 people with dementia and their carers from three geographically and socially diverse sites within six months following diagnosis, and follow them up for three years. WS2: Investigation of the extent of inequalities in access to dementia care. WS3: Relationship between use and costs of services and outcomes. WS4: Experiences of self-funders of care. WS5: Decision-making processes for people with dementia and carers. WS6: Effect of diagnostic stage and services on outcomes. WS7: Theory of Change informed strategy and actions for applying the research findings. OUTCOMES: During the life of the programme, analysing baseline results and then follow-up of the DETERMIND cohort over 3 years, we will establish evidence on current services and practice. DETERMIND will deliver novel, detailed data on inequalities in dementia care and what drives positive and negative outcomes and costs for people with dementia and carers, and identify factors that help or hinder living well with dementia.

Insights into student assessment outcomes in rural clinical campuses.

BACKGROUND: There is an ongoing debate about the impact of studying medicine in rural vs. metropolitan campuses on student assessment outcomes. The UNSW Medicine Rural Clinical School has five main campuses; Albury-Wodonga, Coffs Harbour, Griffith, Port Macquarie and Wagga Wagga. Historical data of student assessment outcomes at these campuses raised concerns regarding potential biases in assessment undertaken, as well as the availability and quality of learning resources. The current study aims to identify the extent to which the location of examination (rural versus metropolitan) has an impact on student marks in OSCEs. METHODS: Assessment data was employed for this study from 275 medical students who sat their final examinations in Years 3 and 6 of the undergraduate Medicine program at UNSW in 2018. The data consists of matched student assessment results from the Year 3 (Y3) MCQ examination and OSCE, and from the Year 6 (Y6) MCQ, OSCE and management viva examinations. The analysis used Univariate Analysis of Variance and linear regression models to identify the impact of site of learning and site of examination on assessment outcomes. RESULTS: The results demonstrate that neither site of learning nor site of examination had any significant impact on OSCE or Management Viva assessment outcomes while potential confounders are controlled. CONCLUSION: It is suggested that some of the supposed disadvantages inherent at rural campuses are effectively mitigated by perceived advantages; more intensive interaction with patients, the general and medical communities at those sites, as well as effective e-learning resources and moderation of assessment grades.

Ensiling fermentation reveals pre-treatment effects for anaerobic digestion of sugarcane biomass: An assessment of ensiling additives on methane potential.

Ensiling of sugarcane trash (SCT) and sugarcane stalks (SCS) was studied to assess the effects of molasses (MOL) and lactic acid bacteria (LAB) inoculant on methane potential. The experiment was run for 70 days and monitoring parameters were analyzed at days 0, 5, 15 and 70. Biochemical methane potential (BMP) tests performed with fresh and ensiled material at day 70 showed an increase in methane potential by 24.0%, 23.4%, 1.7% and 71.1% for SCSctr, SCTctr, SCTmol and SCTmol + lab, respectively. Such improved performance is explained by the formation of organic acids (mostly acetate and lactate) which were able to decrease the pH of the silages from 5.7-5.9 to 3.8-4.2 for all SCT treatments and from 5.9 up to 3.4 for SCS treatment. Thus, the ensiling process provided similar effects to a pre-treatment at low acid concentrations, which in turn improved the digestibility of the cellulosic biomass for methane production.

Knowledge maps: a tool for online assessment with automated feedback.

In higher education, most assessments or examinations comprise either multiple-choice items or open-ended questions such as modified essay questions (MEQs). Online concept and knowledge maps are potential tools for assessment, which might emphasize meaningful, integrated understanding of phenomena. We developed an online knowledge-mapping assessment tool, which provides automated feedback on student-submitted maps. We conducted a pilot study to investigate the potential utility of online knowledge mapping as a tool for automated assessment by comparing the scores generated by the software with manual grading of a MEQ on the same topic for a cohort of first-year medical students. In addition, an online questionnaire was used to gather students' perceptions of the tool. Map items were highly discriminating between students of differing knowledge of the topic overall. Regression analysis showed a significant correlation between map scores and MEQ scores, and responses to the questionnaire regarding use of knowledge maps for assessment were overwhelmingly positive. These results suggest that knowledge maps provide a similar indication of students' understanding of a topic as a MEQ, with the advantage of instant, consistent computer grading and time savings for educators. Online concept and knowledge maps could be a useful addition to the assessment repertoire in higher education.

Evolving concepts of assessment in a competency-based world.

Competency-based medical education (CBME) is an approach to the design of educational systems or curricula that focuses on graduate abilities or competencies. It has been adopted in many jurisdictions, and in recent years an explosion of publications has examined its implementation and provided a critique of the approach. Assessment in a CBME context is often based on observations or judgments about an individual's level of expertise; it emphasizes frequent, direct observation of performance along with constructive and timely feedback to ensure that learners, including clinicians, have the expertise they need to perform entrusted tasks. This paper explores recent developments since the publication in 2010 of Holmboe and colleagues' description of CBME assessment. Seven themes regarding assessment that arose at the second invitational summit on CBME, held in 2013, are described: competency frameworks, the reconceptualization of validity, qualitative methods, milestones, feedback, assessment processes, and assessment across the medical education continuum. Medical educators interested in CBME, or assessment more generally, should consider the implications for their practice of the review of these emerging concepts.

Assessment of Cardiac Troponin I Responses in Nonhuman Primates during Restraint, Blood Collection, and Dosing in Preclinical Safety Studies.

Limited information has been published on the use of cardiac troponin I (cTnI) as a biomarker of cardiac injury in monkeys. The purpose of these studies was to characterize the cTnI response seen in cynomolgus macaques during routine dosing and blood collection procedures typically used in preclinical safety studies and to better understand the pathogenesis of this response. We measured cTnI using two different methods, the Siemens Immulite cTnI assay and the more sensitive Siemens Troponin I-Ultra assay. We were able to demonstrate that after oral, subcutaneous, or intravenous dosing of common vehicles, as well as serial chair restraint for venipuncture blood collection, that minimal to mild transient increases in cTnI could be detected in monkeys with both assays. cTnI values typically peaked at 2, 3, 4, or 6 hr after sham dosing and returned to baseline at 22 or 24 hr. In addition, marked increases in heart rate (HR) and blood pressure (BP) occurred in monkeys during the restraint procedures, which likely initiated the cTnI release in these animals. Monkeys that were very well acclimated to the chairing procedures and had vascular access ports for blood sampling did not have marked increases in HRs and BP or increases in cTnI.

Twitter Influence on UK Vaccination and Antiviral Uptake during the 2009 H1N1 Pandemic.

OBJECTIVE: Information exchange via Twitter and other forms of social media make public health communication more complex as citizens play an increasingly influential role in shaping acceptable or desired health behaviors. Taking the case of the 2009-2010 H1N1 pandemic, we explore in detail the dissemination of H1N1-related advice in the UK through Twitter to see how it was used to discourage or encourage vaccine and antiviral uptake. METHODS: In three stages we conducted (1) an analysis of general content, retweeting patterns, and URL sharing, (2) a discourse analysis of the public evaluation of press releases and (3) a template analysis of conversations around vaccine and antiviral uptake, using Protection Motivation Theory (PMT) as a way of understanding how the public weighed the costs and benefits. RESULTS: Network analysis of retweets showed that information from official sources predominated. Analysing the spread of significant messages through Twitter showed that most content was descriptive but there was some criticism of health authorities. A detailed analysis of responses to press releases revealed some scepticism over the economic beneficiaries of vaccination, that served to undermine public trust. Finally, the conversational analysis showed the influence of peers when weighing up the risks and benefits of medication. CONCLUSION: Most tweets linked to reliable sources, however Twitter was used to discuss both individual and health authority motivations to vaccinate. The PMT framework describes the ways individuals assessed the threat of the H1N1 pandemic, weighing this against the perceived cost of taking medication. These findings offer some valuable insights for social media communication practices in future pandemics.

Online Self-Affirmation Increases Fruit and Vegetable Consumption in Groups at High Risk of Low Intake.

BACKGROUND: This study tested the efficacy of self-affirmation in promoting fruit and vegetable consumption in a sample of participants comprising two groups at high risk of low consumption: young adults and mothers of school-aged children with low social economic status (SES). METHODS: Baseline fruit and vegetable consumption was recorded for 85 participants (n = 26 mothers with low SES). Following randomisation to condition (Self-Affirmed or Non-Affirmed), participants viewed targeted, online, health recommendations about fruit and vegetable consumption. Fruit and vegetable intake was reported online every day for the following seven days. RESULTS: Self-affirmed participants reported consuming significantly more portions of fruit and vegetables (SA M = 3.96, NA M = 2.81). Analyses of simple slopes indicated that the effect was greatest amongst lowest baseline consumers. CONCLUSIONS: The findings demonstrate the efficacy of self-affirmation in increasing fruit and vegetable consumption in individuals who are at risk of having a low intake and whose consumption put them at the greatest risk of negative health outcomes. Application of these findings could help to reduce health care costs, through the use of cost-effective online interventions and reductions in treatment costs. Further research is needed to capitalise on the increased tailoring that online intervention allows in order to optimise the effects of self-affirmation.

A theory-based online health behaviour intervention for new university students (U@Uni:LifeGuide): results from a repeat randomized controlled trial.

BACKGROUND: This paper reports the results of a repeat trial assessing the effectiveness of an online theory-based intervention to promote healthy lifestyle behaviours in new university students. The original trial found that the intervention reduced the number of smokers at 6-month follow-up compared with the control condition, but had non-significant effects on the other targeted health behaviours. However, the original trial suffered from low levels of engagement, which the repeat trial sought to rectify. METHODS: Three weeks before staring university, all incoming undergraduate students at a large university in the UK were sent an email inviting them to participate in the study. After completing a baseline questionnaire, participants were randomly allocated to intervention or control conditions. The intervention consisted of a self-affirmation manipulation, health messages based on the theory of planned behaviour and implementation intention tasks. Participants were followed-up 1 and 6 months after starting university. The primary outcome measures were portions of fruit and vegetables consumed, physical activity levels, units of alcohol consumed and smoking status at 6-month follow-up. RESULTS: The study recruited 2,621 students (intervention n=1346, control n=1275), of whom 1495 completed at least one follow-up (intervention n=696, control n=799). Intention-to-treat analyses indicated that the intervention had a non-significant effect on the primary outcomes, although the effect of the intervention on fruit and vegetable intake was significant in the per-protocol analyses. Secondary analyses revealed that the intervention had significant effects on having smoked at university (self-report) and on a biochemical marker of alcohol use. CONCLUSIONS: Despite successfully increasing levels of engagement, the intervention did not have a significant effect on the primary outcome measures. The relatively weak effects of the intervention, found in both the original and repeat trials, may be due to the focus on multiple versus single health behaviours. Future interventions targeting the health behaviour of new university students should therefore focus on single health behaviours. TRIAL REGISTRATION: Current Controlled Trials ISRCTN07407344 .

A theory-based online health behaviour intervention for new university students (U@Uni): results from a randomised controlled trial.

BACKGROUND: Too few young people engage in behaviours that reduce the risk of morbidity and premature mortality, such as eating healthily, being physically active, drinking sensibly and not smoking. This study sought to assess the efficacy and cost-effectiveness of a theory-based online health behaviour intervention (based on self-affirmation theory, the Theory of Planned Behaviour and implementation intentions) targeting these behaviours in new university students, in comparison to a measurement-only control. METHODS: Two-weeks before starting university all incoming undergraduates at the University of Sheffield were invited to take part in a study of new students' health behaviour. A randomised controlled design, with a baseline questionnaire, and two follow-ups (1 and 6 months after starting university), was used to evaluate the intervention. Primary outcomes were measures of the four health behaviours targeted by the intervention at 6-month follow-up, i.e., portions of fruit and vegetables, metabolic equivalent of tasks (physical activity), units of alcohol, and smoking status. RESULTS: The study recruited 1,445 students (intervention n = 736, control n = 709, 58% female, Mean age = 18.9 years), of whom 1,107 completed at least one follow-up (23% attrition). The intervention had a statistically significant effect on one primary outcome, smoking status at 6-month follow-up, with fewer smokers in the intervention arm (8.7%) than in the control arm (13.0%; Odds ratio = 1.92, p = .010). There were no significant intervention effects on the other primary outcomes (physical activity, alcohol or fruit and vegetable consumption) at 6-month follow-up. CONCLUSIONS: The results of the RCT indicate that the online health behaviour intervention reduced smoking rates, but it had little effect on fruit and vegetable intake, physical activity or alcohol consumption, during the first six months at university. However, engagement with the intervention was low. Further research is needed before strong conclusions can be made regarding the likely effectiveness of the intervention to promote health lifestyle habits in new university students. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN67684181.

A theory-based online health behavior intervention for new university students: study protocol.

BACKGROUND: Too few young people engage in behaviors that reduce the risk of morbidity and premature mortality, such as eating healthily, being physically active, drinking sensibly and not smoking. The present research developed an online intervention to target these health behaviors during the significant life transition from school to university when health beliefs and behaviors may be more open to change. This paper describes the intervention and the proposed approach to its evaluation. METHODS/DESIGN: Potential participants (all undergraduates about to enter the University of Sheffield) will be emailed an online questionnaire two weeks before starting university. On completion of the questionnaire, respondents will be randomly assigned to receive either an online health behavior intervention (U@Uni) or a control condition. The intervention employs three behavior change techniques (self-affirmation, theory-based messages, and implementation intentions) to target four heath behaviors (alcohol consumption, physical activity, fruit and vegetable intake, and smoking). Subsequently, all participants will be emailed follow-up questionnaires approximately one and six months after starting university. The questionnaires will assess the four targeted behaviors and associated cognitions (e.g., intentions, self-efficacy) as well as socio-demographic variables, health status, Body Mass Index (BMI), health service use and recreational drug use. A sub-sample of participants will provide a sample of hair to assess changes in biochemical markers of health behavior. A health economic evaluation of the cost effectiveness of the intervention will also be conducted. DISCUSSION: The findings will provide evidence on the effectiveness of online interventions as well as the potential for intervening during significant life transitions, such as the move from school to university. If successful, the intervention could be employed at other universities to promote healthy behaviors among new undergraduates. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN67684181.

Gone exercising: mental contrasting promotes physical activity among overweight, middle-aged, low-SES fishermen.

OBJECTIVE: Fantasy realization theory (Oettingen, 2012) proposes that fantasizing about a desired future or dwelling upon negative reality rarely changes behavior whereas mentally contrasting fantasy with reality can be an effective behavior change technique. This is because mental contrasting energizes people to overcome obstacles that stand in the way of their desired future. The present study tested whether mental contrasting promotes rates of physical activity among overweight, middle-aged, and low-SES men. METHOD: A randomized controlled trial was conducted with members of an angling club in the north of England (N = 467). At baseline, participants completed a postal questionnaire that measured cognitions about physical activity. The intervention was embedded in the questionnaire for relevant participants. Behavior was followed up via telephone at 1 month and 7 months postbaseline. The key outcome measure was a validated, self-report measure of physical activity (Godin, Jobin & Bouillon, 1986) taken at all three time-points. RESULTS: Longitudinal, explanatory, and intention-to-treat analyses each indicated that mental contrasting was effective in enhancing rates of physical activity. Mental contrasting also aided the translation of beliefs about the value and worth of physical activity (instrumental attitudes) into action. CONCLUSION: Mental contrasting appears to be an effective self-regulatory intervention for promoting physical activity and warrants further tests in health psychology.

The influence of the carbon surface chemical composition on Dubinin-Astakhov equation parameters calculated from SF6 adsorption data-grand canonical Monte Carlo simulation.

Using grand canonical Monte Carlo simulation we show, for the first time, the influence of the carbon porosity and surface oxidation on the parameters of the Dubinin-Astakhov (DA) adsorption isotherm equation. We conclude that upon carbon surface oxidation, the adsorption decreases for all carbons studied. Moreover, the parameters of the DA model depend on the number of surface oxygen groups. That is why in the case of carbons containing surface polar groups, SF(6) adsorption isotherm data cannot be used for characterization of the porosity.

Self-affirmation promotes health behavior change.

OBJECTIVE: Evidence shows that self-affirmation has a positive effect on message acceptance and other variables that motivate health behavior change; however, this has not been translated into actual behavioral change. We propose that particular features of the previous studies may account for this failure; the current study addresses this. It is designed to test whether a self-affirmation manipulation can increase a health-promoting behavior (fruit and vegetable consumption). It also explores the extent to which efficacy variables mediate the self-affirmation and behavior relationship. DESIGN: Women (N = 93) were randomly allocated to a self-affirmation or control task prior to reading a message regarding the health-promoting effects of fruit and vegetables. MAIN OUTCOME-MEASURES: Response-efficacy, self-efficacy, and intention measures were taken immediately after exposure to the message, followed by a 7-day diary record of fruit and vegetable consumption. RESULTS: Self-affirmed participants ate significantly more portions of fruit and vegetables, an increase of approximately 5.5 portions across the week, in comparison to the control group. This effect was mediated by response-efficacy. CONCLUSION: Self-affirmation interventions can successfully influence health-promoting behaviors.

Testing the limits of optimistic bias: event and person moderators in a multilevel framework.

N. D. Weinstein (1980) established that optimistic bias, the tendency to see others as more vulnerable to risks than the self, varies across types of event. Subsequently, researchers have documented that this phenomenon, also known as comparative optimism, also varies across types of people. The authors integrate hypotheses originally advanced by Weinstein concerning event-characteristic moderators with later arguments that such optimism may be restricted to certain subgroups. Using multilevel modeling over 7 samples (N = 1,436), the authors found that some degree of comparative optimism was present for virtually all individuals and events. Holding other variables constant, higher perceived frequency and severity were associated with less comparative optimism, higher perceived controllability and stereotype salience with more comparative optimism. Frequency, controllability, and severity were associated more with self-risk than with average-other risk, whereas stereotype salience was associated more with average-other risk than with self-risk. Individual differences also mattered: comparative optimism was related negatively to anxiety and positively to defensiveness and self-esteem. Interaction results imply that both individual differences and event characteristics should jointly be considered in understanding optimistic bias (or comparative optimism) and its application to risk communication.