Dismissing “Don’t Know” Responses to Perceived Risk Survey Items Threatens the Validity of Theoretical and Empirical Behavior-Change Research

Since the middle of the 20th century, perceptions of risk have been critical to understanding engagement in volitional behavior change. However, theoretical and empirical risk perception research seldom considers the possibility that risk perceptions do not simply exist: They must be formed. Thus, some people may not have formulated a perception of risk for a hazard at the time a researcher asks them, or they may not be confident in the extent to which their perception matches reality. We describe a decade-long research program that investigates the possibility that some people may genuinely not know their risk of even well-publicized hazards. We demonstrate that indications of not knowing (i.e., “don’t know” responses) are prevalent in the U.S. population, are systematically more likely to occur among marginalized sociodemographic groups, and are associated with less engagement in protective health behaviors. “Don’t know” responses are likely indications of genuinely limited knowledge and therefore may indicate populations in need of targeted intervention. This body of research suggests that not allowing participants to indicate their uncertainty may threaten the validity and generalizability of behavior-change research. We provide concrete recommendations for scientists to allow participants to express uncertainty and to analyze the resulting data.

“Don’t Know” Responses for Nicotine Vaping Product Features among Adult Vapers: Findings from the 2018 and 2020 ITC Four Country Smoking and Vaping Surveys

Nicotine vaping products (NVPs) have evolved rapidly, and some vapers have difficulty reporting about their NVP. NVP knowledge may be important for providing accurate survey data, understanding the potential risks of NVP use, and assessing legal and regulated products. This paper examines current vapers who responded “don’t know” (DK) regarding their NVP features. Data are from adult daily/weekly vapers in Waves Two (2018, n = 4192) and Three (2020, n = 3894) of the ITC Four Country Smoking and Vaping Survey. Analyses assessed DK responses for NVP features (e.g., type/appearance, nicotine) and consumption. A DK index score was computed based on the percent of all features with DK responses, which was tested for associations with demographics, smoking/vaping status, NVP features, purchase location, and knowledge of NVP relative risks. NVP description and appearance were easily identified, but DK was more common for features such as nicotine content (7.3–9.2%) and tank/cartridge volume capacity (26.6–30.0%). DK responses often differed by vaping/smoking status, NVP type/appearance, purchase location, and country. Vapers who are younger, use box-shaped NVPs, purchase online, and exclusive daily vapers were associated with lower DK index scores. Higher DK index scores were associated with poorer knowledge of relative health risks of NVP use. The diversity of the NVP market and wide variation in how products are used makes it challenging to capture information from users about device features, such as nicotine content and capacity, in population surveys.

Moral Reasoning about Aggressive Behavior in Relation to Type of Aggression, Age and Gender in South Korean Pupils

Studies of moral reasoning in relation to aggressive behaviors have paid limited attention to different types of aggression, and have mainly been conducted in Western societies. We describe findings from a study of 157 children, aged 6 or 11 years, from two schools in South Korea. Using a cartoon scenario methodology, we assessed moral reasoning about eight types of aggression: verbal, physical individual, physical group, social exclusion, rumor spreading, breaking one’s belongings, sending a nasty text via mobile phone, and sending a nasty message/email via computer. Four aspects of moral reasoning were assessed: moral judgment, harmfulness, reason for judgment, and causal responsibility. Many significant differences by type of aggression were found, especially for social exclusion (seen as less wrong and harmful, and more the victim’s responsibility), physical group aggression (seen as more wrong or harmful, and a matter of fairness, especially in older children and boys), and cyber aggression (seen more as the aggressor’s responsibility). Older children gave more reasons based on welfare, and fewer “don’t know” responses for reasons and attributions. Gender differences were relatively few, but girls did make more use of welfare in the moral reasoning domain. Findings are discussed in relation to previous research and the cultural context in South Korea.

Children’s Signaling of Incomprehension: The Diagnosticity of Practice Questions During Interview Instructions

Forensic interviewers are routinely advised to instruct children that they should indicate when they do not understand a question. This study examined whether administering the instruction with a practice question may help interviewers identify the means by which individual children signal incomprehension. We examined 446 interviews with children questioned about abuse, including 252 interviews in which interviewers administered the instruction with a practice question (4- to 13-year-old children; M age = 7.7). Older children more often explicitly referred to incomprehension when answering the practice question and throughout the interviews, whereas younger children simply requested repetition or gave “don’t know” responses, and individual children’s responses to the practice questions predicted their responses later in the interviews. Similarly, older children were more likely to seek confirmation of their understanding of interviewers’ questions and to request specification. The results highlight the need for interviewers to test and closely monitor younger children’s responses for ambiguous signs of incomprehension.

European adult smokers’ perceptions of the harmfulness of e-cigarettes relative to combustible cigarettes: cohort findings from the 2016 and 2018 EUREST-PLUS ITC Europe Surveys

Background This study presents perceptions of the harmfulness of electronic cigarettes (e-cigarettes) relative to combustible cigarettes among smokers from six European Union (EU) countries, prior to the implementation of the EU Tobacco Products Directive (TPD), and 2 years post-TPD. Methods Data were drawn from the EUREST-PLUS ITC Europe Surveys, a cohort study of adult smokers (≥18 years) from Germany, Greece, Hungary, Poland, Romania and Spain. Data were collected in 2016 (pre-TPD: N = 6011) and 2018 (post-TPD: N = 6027). Weighted generalized estimating equations were used to estimate perceptions of the harmfulness of e-cigarettes compared to combustible cigarettes (less harmful, equally harmful, more harmful or ‘don’t know’). Results In 2016, among respondents who were aware of e-cigarettes (72.2%), 28.6% reported that they perceived e-cigarettes to be less harmful than cigarettes (range 22.0% in Spain to 34.1% in Hungary). In 2018, 72.2% of respondents were aware of e-cigarettes, of whom 28.4% reported perceiving that e-cigarettes are less harmful. The majority of respondents perceived e-cigarettes to be equally or more harmful than cigarettes in both 2016 (58.5%) and 2018 (61.8%, P > 0.05). Overall, there were no significant changes in the perceptions that e-cigarettes are less, equally or more harmful than cigarettes, but ‘don’t know’ responses significantly decreased from 12.9% to 9.8% (P = 0.036). The only significant change within countries was a decrease in ‘don’t know’ responses in Spain (19.3–9.4%, P = .001). Conclusions The majority of respondents in these six EU countries perceived e-cigarettes to be equally or more harmful than combustible cigarettes.

Programmatic assessment condensed: Introducing progress testing approaches to a single semester paramedic subject

The paramedic profession is rapidly evolving and has witnessed significant expansion in the scope of practice and the public expectations of the paramedic role in recent years. Increasing demands for greater knowledge and skills for paramedics has implications for the university programs tasked with their pre-employment training. The certification of paramedic student knowledge typically occurs incrementally across degree programs with aggregate results used to determine student qualification. There are concerns regarding learning sustainability of this approach. The narrowed focus of assessment practices within siloed subjects often neglects the more holistic and integrated paramedic knowledge requirements. Programmatic assessment is becoming increasingly common within medical education, offering more comprehensive, longitudinal information about student knowledge, ability and progress, obtained across an entire program of study. A common instrument of programmatic assessment is the progress test, which evaluates student understanding in line with the full broad expectations of the discipline, and is administered frequently across an entire curriculum, regardless of student year level. Our project explores the development, implementation and evaluation of modified progress testing approaches within a single semester capstone undergraduate paramedic topic. We describe the first reported approaches to interpret the breadth of knowledge requirements for the discipline and prepare and validate this as a multiple-choice test instrument. We examined students at three points across the semester, twice with an identical MCQ test spaced 10 weeks apart, and finally with an oral assessment informed by student’s individual results on the second test. The changes in student performance between two MCQ tests were evaluated, as were the results of the final oral assessment. We also analysed student feedback relating to their perceptions and experiences. Mean student correct response increased by 65 percent between test 1 and 2, with substantial declines in numbers of incorrect and don’t know responses. Our results demonstrate a substantial increase in correct responses between the two tests, a high mean score in the viva, and broad agreement about the significant impact the approaches have had on learning growth.

Language as Obstacle and as Data in Sociological Research

The SSRC’s Committee on Sociolinguistics was committed to furthering attention to language, and linguistic difference, as an “unexploited kind of sociological data” in ethnographic and survey research. The committee convened a conference in 1968 to better understand the intersection of social and linguistic factors, summarized here by Allen D. Grimshaw. The group focused on four topics: the ethnography of asking questions; the meaning of words; the ways in which interviews themselves are “a part of the data” and “don’t know” responses are revealing answers to questions; and improving scholars’ training in framing questions and eliciting answers related to language and communication.

Abstract P242: Aspirin Awareness and Use for Cardiovascular Disease Prevention in a Community of Color

Background: Cardiovascular disease (CVD) and CVD risk factors are high among people of color. Aspirin (ASA) can reduce CVD risk. Yet little is known about primary prevention ASA use and its determinants among people of color. This study examined associations for ASA-related health beliefs and social norms, CVD risk factors and ASA use among Hispanic/Latino (HL) and African American (AA) adults without CVD history. Methods: In-person surveys were administered to adults ages 45-79 years at health fairs and community events in the Minneapolis-St. Paul metro querying demographics, CVD history, CVD risk factors and ASA use. CVD risk perceptions and ASA-related health beliefs and social norms were evaluated using a 4-point Likert scale. Poisson regression with adjustment for age, sex and risk factors was used to examine associations with ASA use. Surveys were offered in English or Spanish. Results: Of the 583 survey participants with no CVD history, 152 identified as HL and 431 as Non-Hispanic-AA. Compared with AA, the HL sample was younger, mean (SD) age of 53.0 (8.6) years vs 59.3 (9.3) years; 54.6% vs 65.7% were female. Risk factors were common among HL and AA, including diabetes (37.5% and 29.0%), hyperlipidemia (28.3% and 36.7%), hypertension (36.8% and 61.0%) and smoking (13.8% and 21.1%). Twenty-two percent of HL and 34% of AA participants regularly used ASA. When asked questions regarding health beliefs and social norms, HL adults had a high frequency of “Don’t Know” responses compared with AA’s (Figure). Participants with more “Don’t Know” responses were less likely to use ASA—RR of 0.87 (95% CI 0.77-0.99). Conversely, ASA use was positively associated with “Agree” responses (RR 1.40, 95% CI 1.29-1.52) and CVD risk factors (RR 1.43 95% CI 1.28-1.59). Associations did not differ by race/ethnicity (interaction p >0.05). Conclusion: ASA uncertainty is more pronounced among HL adults than AA and is associated with less preventive ASA use. Efforts should be made to improve knowledge regarding the appropriate use of ASA in this population.

College students’ understanding of social justice as sustainability

Purpose The purpose of this study was to explore college students’ understanding of sustainability and, specifically, the extent to which students see social justice as being integral to sustainability. Design/methodology/approach Between fall 2015 and 2017, an online survey study was deployed to students at a Midwestern University in the USA to assess attitudes and concerns about environmental issues and awareness of the university’s activities related to these issues. This analysis included ten assessment items from a larger study, of which 1,929 participants were included in the final sample. A chi-square goodness-of-fit and variable cluster analysis were performed on the included items. Findings Items such as “recycling,” “economic viability” and “fair treatment of all” were identified as integral to the concept of sustainability, while items such as “growing organic vegetables” and “reducing meat consumption” had high levels of “not applicable” and “don’t know” responses, with differences arising across gender and class standing. Social justice-related items were seen as more distally connected to sustainability. Research limitations/implications This study is limited by a non-random sample of students. Practical implications College students tend not to recognize the integral nature of social justice or the relevance of food to sustainability, providing an opportunity for universities to better prepare their students for a sustainable future. Social implications Universities might adopt policies and curricula that address these areas of ignorance. Originality/value This study is among the first to identify specific areas of college students’ lack of understanding about sustainability.