Individual Versus Community-Level Risk Compensation Following Preexposure Prophylaxis of HIV

Total Page:16

File Type:pdf, Size:1020Kb

Individual Versus Community-Level Risk Compensation Following Preexposure Prophylaxis of HIV AJPH PREEXPOSURE PROPHYLAXIS Individual Versus Community-Level Risk Compensation Following Preexposure Prophylaxis of HIV We analyzed the concept of risk Martin Holt, PhD, and Dean A. Murphy, PhD compensation and how it has been applied in HIV prevention, See also Landers and Kapadia, p. 1534. to consider the impact of PrEP on paying particular attention to community norms and practices the strategy of HIV preexposure and not only on the immediate reexposure prophylaxis and safety and recalibrate their prophylaxis (PrEP). In risk com- recipients of the intervention. P (PrEP) is one of the most actions if they perceive that pensation, reduced perceptions Risk compensation theory significant developments in HIV they are exceeding their target of risk after the introduction relies on a rational actor model prevention, providing an al- or acceptable level of risk. A of a preventative intervention of human behavior, which is ternative and supplement to pre- key part of risk compensation derived from classic economic lead to more frequent risk- vention methods such as theory is that the benefits of an theory and has not been without taking behavior. Such a change condoms. PrEP involves intervention (e.g., seatbelts) can its critics.9,10 The idea that risk may undermine the interven- HIV-negative people regularly be outweighed over time as compensation is inevitable is tion’sprotectivebenefits. taking antiretroviral drugs to people begin to feel safer and contested, particularly when We found that many studies prevent HIV infection.1,2 It has then increase their risk-taking highly effective interventions purporting to investigate risk been found to be highly effective behavior (e.g., driving faster or are introduced. Also, it is not in preventing HIV acquisition more dangerously). The theory compensation do not assess or straightforward to measure contends that an intervention report changes in perceptions of in multiple population groups, people’stargetlevelsofrisk, may fail unless the target or ac- risk, instead relying on behavioral particularly gay and bisexual men, making the theory difficult to ceptable level of risk is reduced, measures. Our analysis suggests as long as recipients regularly take test. Because of the variability that is, unless people are moti- a complex and sometimes coun- the prescribed drugs (at least in findings (in road safety and 3 vated, educated, or incentivized terintuitive relationship between four doses per week). However, other areas), researchers suggest the development of PrEP has to behave more prudently. the introduction of a new pre- that more attention needs to not been without controversy. vention intervention, perceptions be paid to the conditions under Before the efficacy of PrEP was of HIV risk, and subsequent which risk compensation does demonstrated, researchers were and does not occur. changes in behavior. already concerned that “PrEP RISK COMPENSATION As PrEP is introduced, we be- may be used as a justification for We considered how risk lieve comprehensive assessment of increasing the frequency or types compensation has been used in community-level risk compen- of risk-taking behaviors, which the HIV field, particularly in sation—that is, changes in risk could result in higher rates of relation to PrEP. We discuss RISK COMPENSATION perceptions and behavior as sexually transmitted infections the theory of risk compensation AND HIV a result of increased optimism and fuel HIV transmission.”4(p864) and how it has been measured. Risk compensation has gar- about avoiding HIV among The concept of increased risk We suggest alternative ways to nered attention as a way to un- people not directly protected by taking undermining the effective- assess the impact of PrEP, in- derstand why the uptake of “ PrEP—should not be omitted. ness of an intervention is often cluding evaluating prevention HIV prevention measures “ optimism.” We argue that re- sometimes fail to achieve a re- We therefore suggest ways to referred to as risk compensa- ”5,6 searchers and evaluators need duction in HIV infections assess prevention optimism tion, and the implementation of PrEP has intensified debates and community-level risk com- about it. ABOUT THE AUTHORS pensation. (AmJPublicHealth. Risk compensation is a con- Martin Holt and Dean A. Murphy are with the Centre for Social Research in Health, 2017;107:1568–1571. doi:10.2105/ University of New South Wales, Sydney, Australia. Dean A. Murphy is also with the cept derived from risk homeo- Department of Gender and Cultural Studies, University of Sydney, Australia. AJPH.2017.303930) 7,8 stasis theory. It suggests that Correspondence should be sent to Martin Holt, Centre for Social Research in Health, Level 2, people continually evaluate the John Goodsell Building, UNSW Sydney, NSW 2052, Australia (e-mail: [email protected]. fi au). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. potential risks and bene ts of This article was accepted May 16, 2017. their actions for their health doi: 10.2105/AJPH.2017.303930 1568 Commentary Peer Reviewed Holt and Murphy AJPH October 2017, Vol 107, No. 10 AJPH PREEXPOSURE PROPHYLAXIS and as something to monitor when randomized trials in Africa have PREEXPOSURE which is higher than in the introducing new interventions.5,6 foundlittleevidencethatmed- PROPHYLAXIS AND placebo-controlled phase.1 A It has been investigated in relation ical male circumcision leads to RISK COMPENSATION large, open-label trial in the to condoms, HIV treatment, male increased sexual activity or more United Kingdom found that 15,16 PrEP researchers were cog- circumcision, and PrEP as well condomless sex. nizant of the potential for risk PrEP reduced the risk of HIV as potential future strategies (e.g., Fourth, changes in behavior fi infection by 86% among gay and compensation, and the rst large 22 microbicides and vaccines). IfHIV may be rendered irrelevant be- randomized controlled trials bisexual men and that after one interventions lead to a reduced cause a prevention strategy is so year PrEP users were more likely monitored the sexual behavior perception of risk and subsequent effective that there is little chance than were nonusers to report of participants over time.1,2,4 adoption of compensatory be- of increased HIV transmission, recent, receptive condomless sex The trials did not focus on per- havior such as more sexual partners despite changes in perceived risk (21% vs 12%). ceptions of risk (as participants or more acts of condomless or sexual behavior. For example, In these open-label studies, did not officially know whether sex, then risk compensation is studies have found that adopting changes in behavior did not di- they were receiving PrEP or considered to have occurred. condom use may precede people minish the efficacy of PrEP in a placebo). The first completed There are several observa- having more partners or engaging preventing HIV infection. In- studies found that the combined tions we can draw from previous in more frequent sex, but there creased condomless sex, along drugs tenofovir and emtricitabine research on risk compensation is little evidence that this leads to an with the increased monitoring reduced the risk of HIV infec- andHIV.First,moststudiesrely increased risk of HIV.12 When that PrEP users receive, may, tion by 44% to 75% (modified on behavioral measures (e.g., efficacy is lower, risk compensation however, contribute to the high intention-to-treat analysis), with number of partners or con- may pose a greater problem. The rates of other sexually transmitted higher efficacy among people domless sex), without measur- promotion of male circumcision infections that have been ob- who had detectable drug levels. ing or reporting on attitudinal as a population-level prevention served among PrEP users.23 The studies found no evidence changes or perceptions of strategy, for example, has been However, because PrEP is not risk.11,12 Failing to assess per- controversial because of its of increased condomless sex designed to reduce the risk of fi during the trial period (in fact, ceived risk overlooks a key part moderate ef cacy and lack of 1,2 sexually transmitted infections, of risk compensation theory7,8 protection for female partners.17 condom use increased). A re- increases in sexually transmitted and means that changes in sexual Finally, most research on risk cent systematic review and infections should perhaps be behavior are assumed to be compensation and HIV focuses meta-analysis of 18 trials found considered unintended conse- evidence of risk compensation, on individuals who receive or use that PrEP reduced the risk of HIV quences of PrEP rather than rather than demonstrating that an intervention, rather than infection by 70%, compared with a failure of the HIV-related in- changes in attitudes or percep- considering the effect of in- placebo, as long as participants tervention. How to manage 3 tion precede changes in behavior. terventions on risk perceptions were at least 70% adherent. The sexually transmitted infections as Second, even when attitudes and behavior in the broader review also found no evidence PrEP use increases remains and risk perceptions are mea- community.5 An example of of increased risk-taking behavior a subject of debate. sured, the temporal relationship a compensatory effect occurring in the studies. with behavior may not be clear. beyond those who are the direct To assess risk compensation This relationship is important targets of an intervention is that of related to PrEP, we recommend because some prospective studies HIV treatment optimism: the examining situations outside have found that more frequent belief that it is easier to avoid HIV randomized controlled trials in PREVENTION engagement in condomless sex, (or less serious to contract HIV) as which users know that they are OPTIMISM for example, can precede the a result of effective antiretroviral receiving an active drug that is The effect of PrEP on risk 20 development of optimistic atti- treatment.18,19 People with op- effective in preventing HIV.
Recommended publications
  • Safety Regulations, Risk Compensation, and Individual Behavior
    82 Injury Prevention 2000;6:82–90 HADDON MEMORIAL LECTURE Inj Prev: first published as 10.1136/ip.6.2.82 on 1 June 2000. Downloaded from Risky business: safety regulations, risk compensation, and individual behavior James Hedlund Editors comment: We are Government regulations and industry practices paper, behavioral adaptation describes all be- proud to be able to bring to constrain our behavior in many ways in an havioral change in response to perceived our readers this full text version of the Haddon attempt to reduce injuries. Safety features are changes in risk and risk compensation describes Memorial Lecture delivered designed into products we use: cars now have the special case of behavior change in response at the recent Fifth World airbags; medicine bottles have “childproof” to laws and regulations. The distinction Conference on Injury Pre- vention and Control in caps. Laws require us to act in a safe manner: we becomes murky at times: if a new safety feature New Delhi, India. James must wear seat belts while driving and hard hats appears on all chain saws, any behavioral reac- Hedlund oVers a brilliant in construction areas. But do these measures tion won’t depend on whether the feature is review of one of the most important areas of debate influence our behavior in other ways? Risk com- required by government regulation or adopted in the entire field of injury pensation theory hypothesizes that they do, that voluntarily by all manufacturers. The risk control. This is the most we “use up” the additional safety though more compensation definition adopted here focuses complete, most perceptive, and well balanced apprais- risky actions.
    [Show full text]
  • CIRCUMCISION, INFORMATION, and HIV PREVENTION Susan Godlonton, Alister Munthali, and Rebecca Thornton*
    RESPONDING TO RISK: CIRCUMCISION, INFORMATION, AND HIV PREVENTION Susan Godlonton, Alister Munthali, and Rebecca Thornton* Abstract—Understanding behavioral responses to changes in actual or per- In this paper, we study asymmetric responses to informa- ceived risk is important because risk-reduction goals can be undermined by risk-compensating behavior. This paper examines the response to new tion about personal risk in which new information informs information about the risk of HIV infection. Approximately 1,200 circum- individuals of their type, either high or low risk. Individuals cised and uncircumcised men in rural Malawi are randomly informed that learning their type should revise their beliefs about personal male circumcision reduces the HIV transmission rate, predicting asym- metric behavioral responses. We find no evidence that the information risk either upward or downward, predicting opposite beha- induces circumcised men to engage in riskier sex while uncircumcised vioral responses. While the new information may be used men practice safer sex in response to the information. There were no sig- beneficially by one risk type, the same information may nificant effects of the information on child circumcisions after one year. cause the other type to engage in potentially harmful risk- compensating behavior. The theoretical predictions of the behavioral responses to information about risk are straight- I. Introduction forward, yet testing these predictions empirically is more difficult. Access to information about risk is typically corre- EGINNING with the seminal work of Peltzman lated with unobserved characteristics that introduce bias to (1975), economists have sought to understand beha- B causal inference. Moreover, it is difficult to identify a set- vioral responses to changes in actual or perceived risk.
    [Show full text]
  • Amherst Multimodal Master Plan Utilizing Systematic Safety Principles to Develop a Town-Wide Multimodal Network
    Amherst Multimodal Master Plan Utilizing Systematic Safety Principles to Develop a Town-wide Multimodal Network Amherst Bicycle & Pedestrian Advisory Committee Amherst Multimodal Master Plan Multimodal Master Plan Version 9.2.1 June 1, 2019 Amherst Bicycle & Pedestrian Advisory Committee Amherst, New Hampshire Principal Authors Christopher Buchanan and Simon Corson Amherst Bicycle & Pedestrian Advisory Committee Members George Bower Christopher Buchanan, chairman Patrick Daniel, recreation commission ex-officio Richard Katzenberg, vice chair Wesley Robertson, conservation commission ex-officio Judy Shenk Christopher Shenk Alternate Members Mark Bender Jared Hardner, alternate conservation commission ex-officio John Harvey Carolyn Mitchell Wendy Rannenberg, alternate recreation commission ex-officio With the Assistance of Bruce Berry Susan Durling Matthew Waitkins, Senior Transportation Planner, Nashua Regional Planning Commission Page i Amherst Multimodal Master Plan Table of Contents 1 A Town-Wide Multimodal Network ......................................................................................................... 1 1.1 The Amherst Bicycle and Pedestrian Advisory Committee .......................................................... 1 1.2 Purpose ............................................................................................................................................... 1 1.3 Plan Outreach & Engagement .......................................................................................................... 1 1.4
    [Show full text]
  • Analysis of Legislation to Change to Primary Enforcement of Seat Belt Law for the Health District of Northern Larimer County Board of Directors
    Analysis of Legislation to Change to Primary Enforcement of Seat Belt Law For the Health District of Northern Larimer County Board of Directors Issue Summary: Legislation would allow police officers to stop a car if the driver and front-seat passengers were not wearing seatbelts. This is known as primary enforcement. Sponsors: Senate – Peter Groff House – Joe Rice History: Bill is expected to be filed by Senator Groff in late January or early February Date of Analysis: January 16, 2007 Prepared by: Carrie Cortiglio Bill Summary The bill is expected to be a refile of a bill from last session, HB 06-1125. (Last year the Health District Board voted to strongly support HB06-1125.) The bill will make it a primary offense for a driver to operate a vehicle if the driver and/or front-seat passengers are not wearing seat belts. This means a police officer may stop a vehicle solely because the driver or front-seat passenger is not wearing a seat belt. The bill will likely contain a provision specifically noting that it is the intent of the general assembly that the statutory prohibition against profiling should be strictly observed by each law enforcement officer who stops a driver for an alleged restraining device violation. Current Law Under current Colorado law, both drivers and front-seat passengers are required to wear a seat belt. Colorado is currently a secondary enforcement state meaning that officers can only cite drivers for non-use of seat belts if they are stopping the vehicle for another vehicle or traffic offense.
    [Show full text]
  • Risk Homeostasis in Information Security: Challenges in Confirming Existence and Verifying Impact
    Risk homeostasis in information security: challenges in confirming existence and verifying impact Karen Renaud Merrill Warkentin © the authors 2017. This is the author's version of the work. It is posted here for your personal use. Not for redistribution. The definitive Version of Record was published in Proceedings of the 2017 New Security Paradigms Workshop (NSPW’17), http://dx.doi.org/10.1145/3171533.3171534 Risk Homeostasis in Information Security: Challenges in Confirming Existence and Verifying Impact Karen Renaud Merrill Warkentin School of Arts, Media and Computer Games College of Business Abertay University, Scotland Mississippi State University University of South Africa MS, USA [email protected] [email protected] ABSTRACT CCS CONCEPTS The central premise behind risk homeostasis theory is that • General and reference → Empirical studies; • Secu- humans adapt their behaviors, based on external factors, to rity and privacy → Social aspects of security and pri- align with a personal risk tolerance level. In essence, this vacy; means that the safer or more secure they feel, the more likely it is that they will behave in a risky manner. If this KEYWORDS eect exists, it serves to restrict the ability of risk mitigation Risk Homeostasis, Challenges techniques to eect improvements. The concept is hotly debated in the safety area. Some ACM Reference Format: authors agree that the eect exists, but also point out that Karen Renaud and Merrill Warkentin. 2017. Risk Homeostasis in it is poorly understood and unreliably predicted. Other re- Information Security: Challenges in Conrming Existence and Ver- searchers consider the entire concept fallacious. It is impor- ifying Impact.
    [Show full text]
  • Addressing Risk Compensation Behavior Through FDA Regulation of Prescription Drugs
    Risk-Taking and Rulemaking: Addressing Risk Compensation Behavior Through FDA Regulation of Prescription Drugs Kristen Underhillt Despite widespread acclaim for their potential to reduce public health harms, technological advances in health and safety frequently raise the ominous specter of risk compensation behavior-thepossibility that individuals protected by these technologies will increase their risk-taking on the belief that they are protectedfrom harm. Risk compensation has been a rallying cry for opponents of new technologies such as the HPV vaccine, needle exchange programs for drug users, or prescription pills for the prevention of HIV infection. Although these concerns are frequently voiced in the language of morality andpersonal responsibility,it may be more productive to consider this phenomenon through the lens of behavioral science, with an emphasis on respecting individuals' behavioralpreferences. This Article aims to present the theoretical basis for risk compensation behavior, to categorize diferent types of risk compensation effects, to enumerate ways in which the law may address these effects, and to illustrate an application of these legal strategies to FDA regulation of prescription drugs. Throughout, this Article reframes risk compensation behavior as a presumptively rational mechanism for value conversion, by which the protective value of a health or safety technology is transformed into another type of value that may better satisfy individual preferences. But where imperfect information or negative externalities lead to harm, there may be a role for a regulatory response. Introduction.................................... ............ 378 I. Risk Compensation and Risk Homeostasis Theory................ 383 A. TheoreticalBasis ..........................................384 1. Criticisms of Risk Homeostasis Theory................ 386 t Fellow in Law and Public Health, Yale Law School.
    [Show full text]
  • Seat Belts and Risk Compensation
    LONDON, SATURDAY 21 SEPTEMBER 1985 MEDICAL JOURNAL Seatbelts andriskcompensation The introduction of the compulsory use of front seat belts in cyclists and pedestrians; and, though his methods are January 1983 led to big reductions in death and injuries to demonstrably wrong, the risk compensation theory is still front seat car occupants. The trend line has shifted down- being quoted as an argument for removing the seat belt ward by about 25% at the same time as the use of belts rose legislation.5 from about 40% in 1982 to over 90% after the law came in.' Research-as opposed to speculation-shows that when The seat belt law is saving about 400 lives a year and perhaps risk taking behaviour by drivers is studied those who wear 5000 casualties being admitted to hospital. This law-and seat belts (under either voluntary or mandatory regimens) in the surprisingly high level of acceptance of it by the driving fact take fewer risks than those who do not wear belts. public-must be one of the most successful pieces of public Measurements of speeds, headways, and gap acceptance (the health legislation ever. We might, therefore, expect strong time interval between cars in the approaching traffic stream pressures to extend the law to occupants of rear seats, which you accept or reject when you are turning right across coaches, and trucks, with politicians lining up to introduce it) all show that, if anything, use of belts is related to lower such lifesaving measures. Instead, some doubts have been levels of risk taking; risk compensation applied to seat belt cast on the measure because of the risk compensation use cannot be detected in actual traffic studies.67 hypothesis.
    [Show full text]
  • The Effects of Mandatory Seat Belt Laws on Driving Behavior and Traffic Fatalities
    ISSN 1045-6333 THE EFFECTS OF MANDATORY SEAT BELT LAWS ON DRIVING BEHAVIOR AND TRAFFIC FATALITIES Alma Cohen Liran Einav Discussion Paper No. 341 11/2001 Harvard Law School Cambridge, MA 02138 The Center for Law, Economics, and Business is supported by a grant from the John M. Olin Foundation. This paper can be downloaded without charge from: The Harvard John M. Olin Discussion Paper Series: http://www.law.harvard.edu/programs/olin_center/ Last revision: October 2001 The Effects of Mandatory Seat Belt Laws on ^ Driving Behavior and Traffic Fatalities Alma Cohen Department of Economics Harvard University [email protected] Liran Einav Department of Economics Harvard University [email protected] This paper investigates the effects of mandatory seat belt laws on driver behavior and traffic fatalities. Using a unique panel data set on seat belt usage rates in all U.S. jurisdictions, we analyze how such laws, by influencing seat belt use, affect traffic fatalities. Controlling for the endogeneity of seat belt usage, we find that it decreases overall traffic fatalities. The magnitude of this effect, however, is significantly smaller than the estimate used by the National Highway Traffic Safety Administration. Testing the compensating behavior theory, which suggests that seat belt use also has an adverse effect on fatalities by encouraging careless driving, we find that this theory is not supported by the data. Finally, we identify factors, especially the type of enforcement used, that make seat belt laws more effective in increasing seat belt usage. JEL Classifications: C13, I12, K32, K42, R40 ^ We are grateful to Lucian Bebchuk, Gary Chamberlain, David Cutler, John Graham, Shigeo Hirano, Caroline Hoxby, Lawrence Katz, Ariel Pakes, Jack Porter, Manuel Trajtenberg, Kip Viscusi and seminars participants at Harvard University for helpful comments.
    [Show full text]
  • Pay at Risk: Compensation and Employment Risk in the United States and Canada
    Upjohn Press Upjohn Research home page 1-1-2001 Pay at Risk: Compensation and Employment Risk in the United States and Canada John A. Turner AARP Public Policy Institute Follow this and additional works at: https://research.upjohn.org/up_press Part of the Labor Economics Commons Citation Turner, John A., ed. 2001. Pay at Risk: Compensation and Employment Risk in the United States and Canada. Kalamazoo, MI: W.E. Upjohn Institute for Employment Research. https://doi.org/10.17848/ 9780880994194 This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License. This title is brought to you by the Upjohn Institute. For more information, please contact [email protected]. Pay at Risk Compensation and Employment Risk in the United States and Canada John A. Turner Editor 2001 W.E. Upjohn Institute for Employment Research Kalamazoo, Michigan Library of Congress Cataloging-in-Publication Data Pay at risk : compensation and employment risk in the United States and Canada / John A. Turner, editor. p. cm. Includes bibliographical references and index. ISBN 0-88099-222-0 (cloth : alk. paper) — ISBN 0-88099-221-2 (paper : alk. paper) 1. Wage payment systems—United States. 2. Wage payment systems—Canada. 3. Compensation management—United States. 4. Compensation management—Canada. 5. Labor economics—United States. 6. Labor economics—Canada. 7. Employee fringe benefits—Finance. 8. Social security—Finance. 9. Old age pensions—Finance. 10. Insurance, Health—Finance. 11. Job security. I. Turner, John A. HD4927.U6 P39 2001 331'.0971—dc21 2001023606 © 2001 W.E. Upjohn Institute for Employment Research 300 S. Westnedge Avenue Kalamazoo, Michigan 49007–4686 The facts presented in this study and the observations and viewpoints expressed are the sole responsibility of the authors.
    [Show full text]
  • Voluntary Male Circumcision and Risk for Human Immunodeficiency Virus in Homa Bay, Kenya
    Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Voluntary Male Circumcision and Risk for Human Immunodeficiency Virus in Homa Bay, Kenya George Obhai Gabriel Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons, and the Public Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by George O. Gabriel has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Hadi Danawi, Committee Chairperson, Public Health Faculty Dr. Peter Anderson, Committee Member, Public Health Faculty Dr. Shingairai Feresu, University Reviewer, Public Health Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2020 Abstract Voluntary Male Circumcision and Risk for Human Immunodeficiency Virus in Homa Bay, Kenya by George O. Gabriel MPH, International Health Sciences University, Uganda, 2011 BBM, Moi University, Kenya, 1998 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Specialization in Epidemiology Walden University November 2020 Abstract The role played by the belief about voluntary medical male circumcision (VMMC) in predicting HIV status has not been examined.
    [Show full text]
  • Safety Externalities of Suvs on Passenger Cars: an Analysis of the Peltzman Effect Using FARS Data
    Safety Externalities of SUVs on Passenger Cars: An Analysis Of the Peltzman Effect Using FARS Data By David R. Martinelli, Ph.D., and Maria-Paulina Diosdado-De-La-Pena West Virginia University Technical Report Documentation Page 1. Report No. 2. Government Accession No. 3. Recipient’s Catalog No. WVU-2006-02 4. Title and Subtitle 5. Report Date May 2008 Safety Externalities of SUVs on Passenger Cars: An Analysis of the 6. Performing Organization Code Peltzman Effect Using FARS Data 7. Author(s) 8. Performing Organization Report No. David Martinelli, Maria-Paulina Diosdada-De-La-Pena 9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) West Virginia University PO Box 6103 11. Contract or Grant No. Morgantown, WV 26505 DTRS99-G-0003 12. Sponsoring Agency Name and Address 13. Type of Report and Period Covered WVDOH 1900 Kanawha Blvd Final Charleston, WV 25305 14. Sponsoring Agency Code 15. Supplementary Notes COTR: 16. Abstract The sport utility vehicle (SUV) is a combination of a light pick up chassis of a passenger car (PC) with the space of a minivan. SUVs have been present in the American market since the 1980s, but it wasn’t until the 1990s that they became popular among consumers. With the growing popularity of the SUV, several issues have been raised. In 2003, Dr. Jeffery Runge, head of the U.S. National Highway Traffic Safety Administration (NHTSA), stated that due to the high roll over rate, this type of vehicle is very dangerous. In addition to the roll over rate, issues like road incompatibility and high gas consumption have also become concerns.
    [Show full text]
  • Risk Compensation: Revisited and Rebutted
    safety Commentary Risk Compensation: Revisited and Rebutted Barry Pless Professor Emeritus, Pediatrics and Epidemiology, McGill University, 434 Lansdowne, Westmount, QC H3Y2V2, Canada; [email protected]; Tel.: +1-514-935-9264 Academic Editor: Jake Olivier Received: 3 March 2016; Accepted: 22 August 2016; Published: 29 August 2016 Abstract: This Commentary addresses the ongoing disagreements between many safety advocates who endorse traditional models of prevention and those who oppose them, arguing that safety measures are offset by risk compensation (RCT). The debate is especially heated with respect to regulatory or legislative prevention measures. After explaining the rationale behind risk compensation (aka risk homeostasis theory) (RHT), I provide examples of RCT studies to explain why I believe they should be rejected. The main basis for my rebuttal, however, rests on data that show steady declines in unintentional injury mortality, which, according to RCT, should not have occurred. There are many other reasons for rejecting this theory, and it seems that the time has come for the debate to finally be concluded. Keywords: risk compensation; risk homeostasis 1. Introduction This paper is a distillation, update, and rebuttal of Risk Compensation Theory (RCT). It arises from a debate I engaged in with Gerald Wilde, the most prominent popularizer of the Risk Compensation idea. That debate took place over 20 years ago at a meeting of health journalists in Montreal. In this Commentary, I will restate Wilde’s theory as best I can and then provide a rebuttal. I begin with three important reminders:first, RCT initially was—and remains—a hypothesis or theory. It is still unproven.
    [Show full text]