Effect of COVID-19 vaccine allocation strategies on vaccination refusal: A national survey.

Currently, one of the most pressing public health challenges is encouraging people to get vaccinated against COVID-19. Due to limited supplies, some people have had to wait for the COVID-19 vaccine. Consumer research has suggested that people who are overlooked in initial distribution of desired goods may no longer be interested. Here, we therefore examined people's preferences for proposed vaccine allocation strategies, as well as their anticipated responses to being overlooked. After health-care workers, most participants preferred prioritizing vaccines for high-risk individuals living in group-settings (49%) or with families (29%). We also found evidence of reluctance if passed over. After random assignment to vaccine allocation strategies that would initially overlook them, 37% of participants indicated that they would refuse the vaccine. The refusal rate rose to 42% when the vaccine allocation strategy prioritized people in areas with more COVID-19 - policies that were implemented in many areas. Even among participants who did not self-identify as vaccine hesitant, 22% said they would not want to vaccine in that case. Logistic regressions confirmed that vaccine refusal would be largest if vaccine allocation strategies targeted people who live in areas with more COVID-19 infections. In sum, once people are overlooked by vaccine allocation, they may no longer want to get vaccinated, even if they were not originally vaccine hesitant. Vaccine allocation strategies that prioritize high-infection areas and high-risk individuals in group-settings may enhance these concerns.

Robustness of Decision-Making Competence: Evidence from two measures and an 11-year longitudinal study.

Decision-making competence is the ability to follow normative principles when making decisions. In a longitudinal analysis, we examine the robustness of decision-making competence over time, as measured by two batteries of paper-and-pencil tasks. Participants completed the youth version (Y-DMC) at age 19 and/or the adult version (A-DMC) eleven years later at age 30, as part of a larger longitudinal study. Both measures are comprised of tasks adapted from ones used in experimental studies of decision-making skills. Results supported the robustness of these measures and the usefulness of the construct. Response patterns for Y-DMC were similar to those observed with a smaller initial sample drawn from the same population. Response patterns for A-DMC were similar to those observed with an earlier community sample. Y-DMC and A-DMC were significantly correlated, for participants who completed both measures, 11 years apart, even after controlling for measures of cognitive ability. Nomological validity was observed in correlations of scores on both tests with measures of cognitive ability, cognitive style, and environmental factors with predicted relationships to decision-making competence, including household SES, neighborhood disadvantage, and paternal substance abuse. Higher Y-DMC and A-DMC scores were also associated with lower rates of potentially risky and antisocial behaviors, including adolescent delinquency, cannabis use, and early sexual behavior. Thus, the Y-DMC and A-DMC measures appear to capture a relatively stable, measurable construct that increases with supportive environmental factors and is associated with constructive behaviors.

Consumers' perceptions of energy use and energy savings: A literature review.

Background: Policy makers and program managers need to better understand consumers' perceptions of their energy use and savings to design effective strategies for promoting energy savings. Methods: We reviewed 14 studies from the emerging interdisciplinary literature examining consumers' perceptions electricity use by specific appliances, and potential savings. Results: We find that: (1) electricity use is often overestimated for low-energy consuming appliances, and underestimated for high-energy consuming appliances; (2) curtailment strategies are typically preferred over energy efficiency strategies; (3) consumers lack information about how much electricity can be saved through specific strategies; (4) consumers use heuristics for assessing the electricity use of specific appliances, with some indication that more accurate judgments are made among consumers with higher numeracy and stronger pro-environmental attitudes. However, design differences between studies, such as variations in reference points, reporting units and assessed time periods, may affect consumers' reported perceptions. Moreover, studies differ with regard to whether accuracy of perceptions was evaluated through comparisons with general estimates of actual use, self-reported use, household-level meter readings, or real-time smart meter readings. Conclusion: Although emerging findings are promising, systematic variations in the measurement of perceived and actual electricity use are potential cause for concern. We propose avenues for future research, so as to better understand, and possibly inform, consumers' perceptions of their electricity use. Ultimately, this literature will have implications for the design of effective electricity feedback for consumers, and related policies.

Late-life Depression, Suicidal Ideation, and Attempted Suicide: The Role of Individual Differences in Maximizing, Regret, and Negative Decision Outcomes.

Suicide rates are highest in adults of middle and older age. Research with psychiatric patients has shown that proneness to feel regret about past decisions can grow so intense that suicide becomes a tempting escape. Here, we examine the additional role of individual differences in maximizing, or the tendency to strive for the best decision, rather than one that is good enough. We provided individual-differences measures of maximizing, regret proneness, and negative life decision outcomes (as reported on the Decision Outcome Inventory or DOI) to a non-psychiatric control group, as well as three groups of psychiatric patients in treatment for suicide attempts, suicidal ideation, or non-suicidal depression. We found that scores on the three individual-differences measures were worse for psychiatric patients than for non-psychiatric controls, and were correlated to clinical assessments of depression, hopelessness, and suicidal ideation. More importantly, maximizing was associated with these clinical assessments, even after taking into account maximizers' worse life decision outcomes. Regret proneness significantly mediated those relationships, suggesting that maximizers could be at risk for clinical depression because of their proneness to regret. We discuss the theoretical relevance of our findings and their promise for clinical practice. Ultimately, late-life depression and suicidal ideation may be treated with interventions that promote better decision making and regret regulation.

Communicating uncertainty in seasonal and interannual climate forecasts in Europe.

Across Europe, organizations in different sectors are sensitive to climate variability and change, at a range of temporal scales from the seasonal to the interannual to the multi-decadal. Climate forecast providers face the challenge of communicating the uncertainty inherent in these forecasts to these decision-makers in a way that is transparent, understandable and does not lead to a false sense of certainty. This article reports the findings of a user-needs survey, conducted with 50 representatives of organizations in Europe from a variety of sectors (e.g. water management, forestry, energy, tourism, health) interested in seasonal and interannual climate forecasts. We find that while many participating organizations perform their own 'in house' risk analysis most require some form of processing and interpretation by forecast providers. However, we also find that while users tend to perceive seasonal and interannual forecasts to be useful, they often find them difficult to understand, highlighting the need for communication formats suitable for both expert and non-expert users. In addition, our results show that people tend to prefer familiar formats for receiving information about uncertainty. The implications of these findings for both the providers and users of climate information are discussed.

Heat protection behaviour in the UK: results of an online survey after the 2013 heatwave.

BACKGROUND: The Heatwave Plan for England provides guidance for personal and home protection measures during heatwaves. Although studies in the USA, Australia and Europe have surveyed heat-related behaviours during heatwaves, few have been conducted in the UK. This study assesses personal and housing (at-home) behaviour and housing characteristics of the UK population during the 2013 heatwave. METHODS: This paper analyses data from 1497 respondents of an online survey on heat protection measures and behaviour. Participants were asked questions about their behaviour during the 2013 heatwave, the characteristics of their current housing as well as about any negative health outcomes experienced due to the hot weather. We used multinomial logit regression to analyse personal and home heat protection behaviour and logistic regression to analyse characteristics of participants' current home (installed air conditioner, curtains etc.). We stratified the outcomes by age, sex, ethnicity, income, education and regional location. RESULTS: In 2013, for all heat-related illness (except tiredness), a higher proportion of those in the younger age groups reported symptoms compared with those in the older age groups. Women, higher income groups and those with higher education levels were found to be more likely to report always/often taking personal heat protective measures. The elderly were less likely to take some personal and home protective measures but were more likely to live in insulated homes and open windows at night to keep their home cool. CONCLUSION: Our study has found a high level of awareness of the actions to take during heatwaves in the UK, and has identified important demographic indicators of sections of the UK population that might benefit from additional or more targeted information. The health agencies should attempt to provide better information about heatwaves to those vulnerable (elderly, those at risk living in London, low income earners) or identify any barriers that might be preventing them from undertaking protective behaviour.

New perspectives for motivating better decisions in older adults.

Decision-making competence in later adulthood is affected by declines in cognitive skills, and age-related changes in affect and experience can sometimes compensate. However, recent findings suggest that age-related changes in motivation also affect the extent to which adults draw from experience, affect, and deliberative skills when making decisions. To date, relatively little attention has been given to strategies for addressing age-related changes in motivation to promote better decisions in older adults. To address this limitation, we draw from diverse literatures to suggest promising intervention strategies for motivating older recipients' motivation to make better decisions. We start by reviewing the life-span developmental literature, which suggests that older adults' motivation to put effort into decisions depends on the perceived personal relevance of decisions as well as their self-efficacy (i.e., confidence in applying their ability and knowledge). Next, we discuss two approaches from the health intervention design literature, the mental models approach and the patient activation approach, which aim to improve motivation for decision making by improving personal relevance or by building self-efficacy or confidence to use new information and skills. Using examples from these literatures, we discuss how to construct interventions to motivate good decisions in later adulthood.

Variations in Decision-Making Profiles by Age and Gender: A Cluster-Analytic Approach.

Using cluster-analysis, we investigated whether rational, intuitive, spontaneous, dependent, and avoidant styles of decision making (Scott & Bruce, 1995) combined to form distinct decision-making profiles that differed by age and gender. Self-report survey data were collected from 1,075 members of RAND's American Life Panel (56.2% female, 18-93 years, Mage = 53.49). Three decision-making profiles were identified: affective/experiential, independent/self-controlled, and an interpersonally-oriented dependent profile. Older people were less likely to be in the affective/experiential profile and more likely to be in the independent/self-controlled profile. Women were less likely to be in the affective/experiential profile and more likely to be in the interpersonally-oriented dependent profile. Interpersonally-oriented profiles are discussed as an overlooked but important dimension of how people make important decisions.

INAPPROPRIATE CONFIDENCE AND RETIREMENT PLANNING: FOUR STUDIES WITH A NATIONAL SAMPLE.

Financial decisions about investing and saving for retirement are increasingly complex, requiring financial knowledge and confidence in that knowledge. Few studies have examined whether direct assessments of individuals' confidence are related to the outcomes of their financial decisions. Here, we analyzed data from a national sample recruited through RAND's American Life Panel (ALP), an internet panel of U.S. adults aged 18 to 88. We examined the relationship of confidence with self-reported and actual financial decisions, using four different tasks, each performed by overlapping samples of ALP participants. The four tasks were designed by different researchers for different purposes, using different methods to assess confidence. Yet, measures of confidence were correlated across tasks, and results were consistent across methodologies. Confidence and knowledge showed only modest positive correlations. However, even after controlling for actual knowledge, individuals with greater confidence were more likely to report financial planning for retirement and to successfully minimize fees on a hypothetical investment task. Implications for the role of confidence (even if it is unjustified) in investment behavior is discussed.

Assessing small non-zero perceptions of chance: The case of H1N1 (swine) flu risks.

Feelings of unwarranted invulnerability, seen in judgments of 0% risk, can reflect misunderstandings of risk and risk behaviors, suggesting increased need for risk communication. However, judgments of 0% risk may be given by individuals who feel invulnerable, and by individuals who are rounding from small non-zero probabilities. We examined the effect of allowing participants to give more precise responses in the 0-1% range on the validity of reported probability judgments. Participants assessed probabilities for getting H1N1 influenza and dying from it conditional on infection, using a 0-100% visual linear scale. Those responding in the 0-1% range received a follow-up question with more options in that range. This two-step procedure reduced the use of 0% and increased the resolution of responses in the 0-1% range. Moreover, revised probability responses improved predictions of attitudes and self-reported behaviors. Hence, our two-step procedure allows for more precise and more valid measurement of perceived invulnerability.

Implications of type 2 diabetes on adolescent reproductive health risk: an expert model.

PURPOSE: The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D). METHODS: Using a mental model approach, a panel of experts--representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health--was convened to discuss reproductive health issues for female adolescents with T2D. RESULTS: Several critical issues emerged. Compared with adolescents with type 1 diabetes, (1) adolescents with T2D may perceive their disease as less severe and have less experience managing it, putting them at risk for complications; (2) T2D is more prevalent among African Americans, who may be less trusting of the medical establishment; (3) T2D is associated with obesity, and it is often difficult to change one's lifestyle within family environments practicing sedentary and dietary behaviors leading to obesity; (4) teens with T2D could be more fertile, because obesity is related to earlier puberty; (5) although obese teens with T2D have a higher risk of polycystic ovary syndrome, which is associated with infertility, treatment with metformin can increase fertility; and (6) women with type 2 diabetes are routinely transferred to insulin before or during pregnancy to allow more intensive management. CONCLUSIONS: Findings from the expert panel provide compelling reasons to provide early, developmentally appropriate, culturally sensitive preconception counseling for teens with T2D.

Informed public preferences for electricity portfolios with CCS and other low-carbon technologies.

Public perceptions of carbon capture and sequestration (CCS) and other low-carbon electricity-generating technologies may affect the feasibility of their widespread deployment. We asked a diverse sample of 60 participants recruited from community groups in Pittsburgh, Pennsylvania to rank 10 technologies (e.g., coal with CCS, natural gas, nuclear, various renewables, and energy efficiency), and seven realistic low-carbon portfolios composed of these technologies, after receiving comprehensive and carefully balanced materials that explained the costs and benefits of each technology. Rankings were obtained in small group settings as well as individually before and after the group discussions. The ranking exercise asked participants to assume that the U.S. Congress had mandated a reduction in carbon dioxide emissions from power plants to be built in the future. Overall, rankings suggest that participants favored energy efficiency, followed by nuclear power, integrated gasification combined-cycle coal with CCS and wind. The most preferred portfolio also included these technologies. We find that these informed members of the general public preferred diverse portfolios that contained CCS and nuclear over alternatives once they fully understood the benefits, cost, and limitations of each. The materials and approach developed for this study may also have value in educating members of the general public about the challenges of achieving a low-carbon energy future.

Communicating about xenotransplantation: models and scenarios.

Xenotransplantation entails using organs from genetically modified animals as a way to solve the shortage of human organs for transplantation. As with other novel technologies, if xenotransplantation is to be judged fairly, proponents must explain its complex, uncertain, and unfamiliar risks and benefits. Xenotransplantation's risks include the possibility of a recombinant virus infecting human transplant recipients, potentially causing an epidemic of an unfamiliar disease. Using materials vetted by scientific experts, we communicated the variables and relationships determining this risk in three formally equivalent formats: (a) a graphic model, (b) scenarios structured by the graphic model, and (c) both the model and the scenarios. Participants were randomly assigned to receiving one set of materials. They rated them as equally clear and studied them equally long, suggesting similar ease of cognitive processing. Compared to participants receiving the scenarios, those who received the graphic model better identified causes and effects of the risk, and saw less risk of xenotransplantation. Participants who received both the model and the scenarios generally showed intermediate responses. The study demonstrates a general procedure for developing and evaluating formally equivalent graphic and scenario communications regarding highly uncertain risks. In this application to xenotransplantation, presenting a graphic representation improved people's understanding of the risk.

Parents' vaccination comprehension and decisions.

We report on 30 in-depth mental models interviews with parents discussing vaccination for their children, both in general terms and in response to communications drawn from sources supporting and opposing vaccines. We found that even parents favourable to vaccination can be confused by the ongoing debate, leading them to question their choices. Many parents lack basic knowledge of how vaccines work, and do not find the standard information provided to them to be particularly helpful in explaining it. Those with the greatest need to know about vaccination seem most vulnerable to confusing information. Opportunities for education may be missed if paediatricians do not appreciate parents' specific information needs.

Can adolescents predict significant life events?

We examine whether adolescents' probability judgments for significant life events are predictive and accurate. We find significant correlations with actual experiences, reported on successive waves of a national survey. Mean probability judgments approximated observed outcome rates, or were optimistic, except that adolescents greatly overestimated their probability of dying prematurely.

Travel risks in a time of terror: judgments and choices.

Shortly after the 2002 terrorist attacks in Bali, readers of Conde Nast Traveler magazine were surveyed regarding their views on the risks of travel to various destinations. Their risk estimates were highest for Israel, and lowest for Canada. Estimates for the different destinations correlated positively with (1) one another, (2) concern over aspects of travel that can make one feel at risk (e.g., sticking out as an American), (3) worries about other travel problems (e.g., contracting an infectious disease), and (4) attitudes toward risk. Respondents' willingness to travel to a destination was predicted well by whether their estimate of its risk was above or below their general threshold for the acceptability of travel risks. Overall, the responses suggest orderly choices, based on highly uncertain judgments of risks. Worry played a significant role in these choices, even after controlling for cognitive considerations, thereby supporting the recently proposed "risk as feelings" hypothesis. Thus, even among people who have generally consistent and defensible beliefs, emotions may affect choices. These results emerged with people selected for their interest in and experience with the decision domain (travel), but challenged to incorporate a new concern (terror).