Risky business! Are you a sensation seeker?

Much of my research and professional experience focuses upon ergonomics, workplace hazards, and traffic safety. A major component of improving public health in these realms is compliance. Well, really, that's a problem with any public health program: How do we get people to do what we want them to do? That IS the basis of our course of study, at least in the social and behavioral realm.

We generally try to avoid blaming the individual person for his or her health decisions, rather focusing on the system that fosters such choices. Systemic changes, we think, enable people to naturally make the "right" choice for themselves, or at least a well-informed "wrong" choice.

Some people, though (myself included), are just high-risk folks. I always theorize that certain professions attract social deviants:

• If police officers weren't cops, they'd be criminals.
• If chemists weren't working on pharmaceuticals, they would be making meth.
• If ski patrol wasn't bombing for avalanches, they'd be arsonists.
• If safety professionals weren't teaching safety, they'd be dead.

Here's a cool link to a self-assessment tool for determining your sensation-seeking rating (goes from "titmouse" to "adrenaline junkie").  I, consequently, fall into the highest category, which makes sense.

I feel as though I am a great public health/safety professional because I'm the most likely person to do stupid stuff. I've skied helmetless in the backcountry, ridden motorcycles at 70mph on the freeway while the driver was drunk, and raced at speeds up to 120mph on San Antonio's roads. I've worked in chemical demil facilities that had gallons of VX nerve agent in the lab hood. I have handled dangerous chemicals without gloves or protective eyewear, and I did the same with urine on more than one occasion. I SCUBA dive, ride in small planes, get on every roller coaster I see ... and yes, I've had unprotected sex. I still run with scissors (don't tell anyone). I've done it all wrong.

I have had (in the past) almost no regard for my own personal safety. Frankly, I hit age 25 and was shocked to still be around. I was lucky. Other people aren't. This is why I appreciate the importance of safety initiatives and messages; people really do get hurt. I just lived long enough to tell my story.

In other words, I am my own target audience. If you can make me change a health behavior, you can probably convince anyone.

This is a great asset, because I'm able to critically evaluate programs' ability to succeed in real life. Is the program inconvenient? Culturally insensitive? Gender-biased? Yep, I'll find any excuse to not be healthy. Which is why I'm perfect for this discipline. If I can save people from one of the horrific deaths that I narrowly avoided, then I must be fulfilling my greater destiny. And I suspect that many public health professionals can say the same.

I hope to see some comments telling me about YOUR sensation-seeking scores! It's really a fun test.

CDC's Health Out Loud ... Entertainment and public health belong together

Here at the School of Rural Public Health, we are often encouraged to think about innovative ways of including public health messages in general media. Specifically at our school, because of our proximity to the Mexican border, we often discuss telenovelas, popular soap operas that have previously been used to disseminate information to disadvantaged Hispanic populations. These are very well-received and prompt a significant change (in some cases), when paired with other public health efforts.

I be you didn't know that the exact same thing happens on American television! Check out the CDC's blog today about a new episode of "Army Wives" that addresses the topic of Traumatic Brain Injury (TBI). Link here.

Here's also a link to the actual video clip in which TBI is discussed.


Although this approach is nothing new (I've read documents dating back to the 70's that address public health in the media), it's interesting to see how issues have changed, and how they may have remained the same.

One of the biggest issues we face as public health practitioners is the continued portrayal of illness as:

• Quickly cured
• Affecting only white, middle-class patients
• Exotic and difficult to define (i.e., not diabetes ... instead, amnesia!)

This, frankly, is not what illness is in this nation. We are a group of people with chronic conditions that are fairly common. We have high blood pressure, diabetes, arthritis, heart disease ... none of which are particularly glamorous. Trauma makes for better TV, but it doesn't help Americans understand the health care system.

I have to admit that I am particularly fond of the TLC show that shows true stories from the ER; although some of the ailments are sensationalized, we get a feeling for what might actually happen in an Emergency Department, rather than what Hollywood would have us believe. Teens actually do come in after overdosing on drugs, for example, and car crashes are among the leading causes of preventable deaths for Americans in general. The TLC show portrays these events accurately, in my opinion.

In essence, I hope that we see more information dispersal like this clip from Army Wives. Although it wasn't on a major network, I think it portrayed a fairly realistic situation. We have an obligation, as public health professionals, to promote these surreptitious but effective mechanisms for social change.

The four types of risk-based decision-makers

Traffic safety has long relied upon the theory of deterrence to maintain positive public health outcomes. That is, we have assumed the following:

(1) The human being is a rational actor,

(2) Rationality involves an end/means calculation,

(3) People (freely) choose all behavior, both conforming and deviant, based on their rational calculations,

(4) The central element of calculation involves a cost benefit analysis: Pleasure versus Pain,

(5) Choice, with all other conditions equal, will be directed towards the maximization of individual pleasure, (6) Choice can be controlled through the perception and understanding of the potential pain or punishment that will follow an act judged to be in violation of the social good, the social contract,

(7) The state is responsible for maintaining order and preserving the common good through a system of laws (this system is the embodiment of the social contract),

(8) The Swiftness, Severity, and Certainty of punishment are the key elements in understanding a law's ability to control human behavior.

(taken from Robert Keel's article here)

Examining these ideas, however, launches us into a whole mess of social issues, particularly those dealing with behavior. I don't believe that the deterrence theory actually describes individuals' likelihood of risky driving; people are not inherently rational, and so threat of punishment is not always the most effective way to initiate change.

Rather, I would argue that these guys have a much more compelling viewpoint concerning individual risk assessment and driving behavior. (Bear with me, I know it's an article about deranged world leaders, but it really does apply ...)

Lebow & Stein argue that four types of risk-based decision-makers exist:

-          Risk-prone gain maximizers: Likely to drive distracted because they gain something.

-          Risk-prone loss minimizers: Likely to drive distracted because they are afraid of losing something.

-          Risk-averse gain maximizers: Less likely to drive distracted because not doing so brings benefits.

-          Risk-averse loss minimizers: Less likely to drive distracted because they are afraid of losing something.

They also argue that the most dangerous among these are the risk-prone loss minimizers, because they have the proverbial something to lose.

I would contend that this is also the case. People don't want to put their cell phones down in the car because they're afraid of missing an important communique; an inflated sense of self-importance has encouraged us to imagine that the actions of the whole world hinge upon our ability to answer our phones. Imagine having that ability ripped from your grasp.

Just another theory in the toolbox of effective public health promotion .... Today's lesson? Identify and target your audience.