Using a Deliberative Poll on breast cancer screening to assess and improve the decision quality of laypeople.

Balancing the benefits and harms of mammography screening is difficult and involves a value judgement. Screening is both a medical and a social intervention, therefore public opinion could be considered when deciding if mammography screening programmes should be implemented and continued. Opinion polls have revealed high levels of public enthusiasm for cancer screening, however, the public tends to overestimate the benefits and underestimate the harms. In the search for better public decision on mammography screening, this study investigated the quality of public opinion arising from a Deliberative Poll. In a Deliberative Poll a representative group of people is brought together to deliberate with each other and with experts based on specific information. Before, during and after the process, the participants' opinions are assessed. In our Deliberative Poll a representative sample of the Danish population aged between 18 and 70 participated. They studied an online video and took part in five hours of intense online deliberation. We used survey data at four timepoints during the study, from recruitment to one month after the poll, to estimate the quality of decisions by the following outcomes: 1) Knowledge; 2) Ability to form opinions; 3) Opinion stability, and 4) Opinion consistency. The proportion of participants with a high level of knowledge increased from 1% at recruitment to 56% after receiving video information. More people formed an opinion regarding the effectiveness of the screening programme (12%), the economy of the programme (27%), and the ethical dilemmas of screening (10%) due to the process of information and deliberation. For 11 out of 14 opinion items, the within-item correlations between the first two inquiry time points were smaller than the correlations between later timepoints. This indicates increased opinion stability. The correlations between three pairs of opinion items deemed theoretically related a priori all increased, indicating increased opinion consistency. Overall, the combined process of online information and deliberation increased opinion quality about mammography screening by increasing knowledge and the ability to form stable and consistent opinions.

Estimating disability prevalence and disability-related inequalities: Does the choice of measure matter?

RATIONALE: Different measures for quantifying the percentage of people with a disability in surveys result in diverging estimates of prevalence and disability-related inequalities. Thus understanding the implications of using different disability measures is of vital policy importance. This study is the first to investigate the within-survey variation in disability prevalence based on two internationally recognized measures: the Washington Group Short Set (WGSS) and the Global Activity Limitation Indicator (GALI). It is also the first to examine the disability-related inequality in voter turnout, based on official validated voter records. METHODS: We use data on 11,308 25-54-year-old respondents from the 2016 wave of the Survey of Health, Impairment and Living Conditions in Denmark (SHILD) to estimate the disability prevalence based on the WGSS and the GALI. Moreover, we investigate health characteristics of individuals with a disability according to the two measures and inequalities in two central social policy success parameters: voter turnout and employment. RESULTS: The WGSS estimates higher disability prevalence (10.6%) than the GALI (5.5%). Only 2.5% of the sample are in both groups, implying that largely, different individuals are defined as having a disability depending on which measure is used. The health profiles of the two groups also differ, as people with a GALI-defined disability are significantly more likely to report a severe mental illness or a major physical health problem. The GALI estimates indicate larger inequalities between people with and without a disability than the WGSS for the probability of being employed, whereas there are no significant differences for voter turnout. CONCLUSION: The choice of disability measure strongly influences within-survey estimates of disability prevalence, the health profile of the defined groups, and inequalities in outcomes. The WGSS underrepresents the number of people suffering from severe mental illness. Estimated inequalities in employment are larger for the GALI than for the WGSS.

Genetic predictors of educational attainment and intelligence test performance predict voter turnout.

Although the genetic influence on voter turnout is substantial (typically 40-50%), the underlying mechanisms remain unclear. Across the social sciences, research suggests that 'resources for politics' (as indexed notably by educational attainment and intelligence test performance) constitute a central cluster of factors that predict electoral participation. Educational attainment and intelligence test performance are heritable. This suggests that the genotypes that enhance these phenotypes could positively predict turnout. To test this, we conduct a genome-wide complex trait analysis of individual-level turnout. We use two samples from the Danish iPSYCH case-cohort study, including a nationally representative sample as well as a sample of individuals who are particularly vulnerable to political alienation due to psychiatric conditions (n = 13,884 and n = 33,062, respectively). Using validated individual-level turnout data from the administrative records at the polling station, genetic correlations and Mendelian randomization, we show that there is a substantial genetic overlap between voter turnout and both educational attainment and intelligence test performance.