Theory and Practice in Risk Communication: A Review of the Literature and Visions for the Future

When Monica was in the 18th week of pregnancy with her fi rst child, her doctor ordered the quad screening test, which examines for four particular substances in maternal blood to identify pregnancies at risk for Down syndrome. A week after the test Monica received the results: Low levels of AFP and abnormal levels of hCG and estriol. The medical aide on the phone said very calmly, “This test may indicate that the developing baby has Trisomy 21 (Down syndrome). Your baby has a 1 in 200 chance of being born with Down syndrome.” The purpose of explaining these results was clear; it was to help Monica and her spouse make an eff ective decision among many options: Pursue potential interventions that may exist, begin planning for a child with special needs, address potential lifestyle changes, look for support groups, or make a decision about carrying the child to term. Monica had important information to digest and share with her husband. And, both had to understand that the baby might not have any special needs at all (in fact, the baby did not have Down syndrome)—indeed, uncertainty was high. This kind of risk information is vital to healthrelated decision making, though some individuals may not pursue interventions or additional testing regardless of the risk information. Perhaps they will have the baby regardless of the results; maybe aborting the pregnancy is not an option; and some parents choose not to allow any testing that poses a risk of harming the baby. In other words, receiver characteristics also play a substantial role in responses to risk information. This intersection between message and receiver, theory and practice, and their eff ect on risk decision making is the focus of this chapter.