Journal of Health Communication, 11:7591, 2006

Copyright # Taylor & Francis Group, LLC

ISSN: 1081-0730 print/1087-0415 online
DOI: 10.1080/10810730500461091

Defining Moments in Risk Communication

Research: 19962005

KATHERINE A. MCCOMAS
Cornell University, Ithaca, New York, USA

Ten years ago, scholars suggested that risk communication was embarking on a new
phase that would give increased attention to the social contexts that surround and
encroach on public responses to risk information. A decade later, many researchers
have answered the call, with several defining studies examining the social and
psychological influences on risk communication. This article reviews risk communi-
cation research appearing in the published literature since 1996. Among studies,
social trust, the social amplification of risk framework, and the affect heuristic fig-
ured prominently. Also common were studies examining the influence of risk in the
mass media. Among these were content analyses of media coverage of risk, as well as
investigations of possible effects resulting from coverage. The use of mental models
was a dominant method for developing risk message content. Other studies examined
the use of risk comparisons, narratives, and visuals in the production of risk mes-
sages. Research also examined how providing information about a risks severity,
social norms, and efficacy influenced communication behaviors and intentions to
follow risk reduction measures. Methods for conducting public outreach in health
risk communication rounded out the literature.

For observers of risk communication, the last decade contained many defining
moments: critical times when events or circumstancesin some cases tragic
resulted in opportunities to pause and reflect, initiate much-needed dialogue, redress
past mistakes, and, with any luck, develop a more sophisticated understanding of the
issue at hand. For risk communication, these moments included efforts to curb the
spread of communicable diseases, such as AIDS in sub-Saharan Africa, foot-and-
mouth disease among livestock in Europe, and avian influenza in Asia. Natural dis-
asters necessitating risk communication included the 9.0 magnitude earthquake off
the coast of Sumatra that caused a tsunami killing more than 280,000 people in
10 countries, and Hurricane Katrina, which devastated the U.S. Gulf Coast along
Louisiana and Mississippi and cost an as-yet-unknown number of lives. Due to risk
communication efforts, previously unknown terms, acronyms, and exotic-sounding
diseases became part of the popular lexicon, including acrylamides, the West Nile
virus, Y2K, rBGH (recombinant bovine growth hormone), SARS (severe acute
respiratory syndrome), GMOs (genetically modified organisms), EMFs (electro-
magnetic fields), and BSE (mad cow disease). Terrorist attacks on the U.S. World
Trade Centers and the Pentagon on September 11, 2001; the bombing of Madrids
commuter train network on March 11, 2004; and two strikes on Londons

Address correspondence to Katherine A. McComas, Assistant Professor, 313 Kennedy

Hall, Department of Communication, Cornell University, Ithaca, NY 14853, USA. E-mail:
kam19@cornell.edu

75
76 K. A. McComas

Underground and bus system in July 2005 exacted a heavy toll on public confidence
in transportation safety while calling yet again for concerted risk communication
efforts.
More mundane but just as demanding of risk communicators attention were
ongoing day-to-day challenges, among them periodic outbreaks of food borne ill-
ness, unexplained cases of community cancer clusters, the continued prevalence
of smoking and increasing evidence of the dangers of second-hand smoke, in-home
threats from radon gas and flaking lead paint, backyard threats of Lyme disease, the
ever-present impasses surrounding the siting of local landfills and hazardous waste
sites, and a heightened awareness of and concern about an epidemic of obesity
in America.
Rather than being exhaustive, this list is meant to be evocative of the risks we as
individuals and members of society encountered over the last 10 years. In response to
the risks, we witnessed a constant stream of messages warning of dangers to public
health and safety and suggesting safer courses of action. Whereas some of these mes-
sages achieved their intended effects, other messages elicited little if any public
response. In turn, efforts to improve risk communication efforts spawned a growing
literature investigating a practice that traditionally took place without much thought
of research (Bostrom & Lofstedt, 2003).
Risk has been defined as the things, forces, or circumstances that pose danger
to people or to what they value (p. 215) and typically is described in terms of a like-
lihood or probability of loss occurring (Stern & Fineberg, 1996). In turn, risk com-
munication can be broadly understood as an iterative exchange of information
among individuals, groups, and institutions related to the assessment, characteriza-
tion, and management of risk. Inherent to the understanding of risk, and the practice
of risk communication, is an awareness that risk encompasses both objective and
subjective qualities and that risk judgments are, to some degree, a by-product of
social, cultural, and psychological influences (Slovic, 1999). According to Leiss
(1996), recognizing that risk is, in part, a social construct marked an evolution in
thought about risk communication.1 Cvetovich and Lofstedt (1999) similarly
remarked that current research in risk assessment and management indicates an
understanding that judgments of risk are not limited to assessments of physical pro-
cesses . . . [but] are also reflections of the understanding of social systems and the
actors playing roles within them (p. 3).
This evolution in thought is reflected in the last 10 years of risk communication
research, which this article seeks to synthesize with some important caveats. First,
because of the wealth of research, a 10-year literature review must, by necessity,
exclude some noteworthy articles in an effort to include others.2 Readers seeking
additional perspectives are referred to other excellent reviews (Bier, 2001; Boholm,

1
According to Leiss (1996) and others (Fischhoff, 1995; Plough & Krimsky, 1987), tech-
nical assessments dominated early approaches to risk communication. Persuasive approaches
geared at increasing audience acceptance of technical assessments characterized the next phase
of risk communication, which also saw a growing recognition of the importance of trust in risk
communication efforts. The pervasive lack of trust in many risk management institutions ush-
ered in the next phase, roughly since 1995, which included a greater acceptance that risk occurs
in a social context (Leiss, 1996).
2
In some cases, this article refers to seminal works published prior to 1996 for back-
ground purposes.
 Risk Communication: 19962005 77

1998; Bostrom & Lofstedt, 2003; Gurabardhi et al., 2004; Renn, 1998b).3 This article
further delimits its subject matter by focusing on risk communication related to
public health rather than environmental health; however, it maintains that the ori-
gins of public health risks can be environmental, technological, or medical.4 Finally,
although much risk communication takes place as part of risk reduction interven-
tions or campaigns, this review excludes campaign research, which is the focus of
another article in this anniversary issue. Rather, this review focuses on research
examining risk communication that occurs intentionally or unintentionally, often
in response to new or emerging health risks, between or among government agencies,
industries, scientists or technical experts, and members of the public.5 The first part
of the review is structured around research investigating public reactions to health
risks, including the influence of unintentional risk messages appearing in the mass
media. The next part of the review considers research on strategic risk communi-
cation, including the design and delivery of health risk messages.

Public Reaction to Health Risks

In the months preceding the terrorist strikes of September 11, 2001, Americans paid
witness to what Time magazine called in its July 30 cover story, the Summer of the
Shark (McCarthy, 2001). Although isolated incidents, shark attacks occurring off
the coasts of Florida, Virginia, and North Carolina, including two fatal attacks
around Labor Day weekend, resulted in a media feeding frenzy that some argued
amplified the risk of shark attacks, frightened vacationers away, and dampened tour-
ism along the East Coast. Calling the timing of the attacks coincidental, statisticians
tried to assuage concerns by pointing out that there were actually fewer shark attacks
reported in 2001 than 2000; they also noted that the greater number of people in the
water during the summer holidays increased the likelihood of shark attacks. Others
noted that people were more at risk from dying on the highway driving to the beach
than from a shark attack (Minor, 2001; Moran, 2002). An underlying risk message
was that fear of shark attacks was unwarranted, if not downright irrational.
3
Readers also are referred to journals that devoted special issues to risk communication,
among them the Journal of the National Cancer Institute Monographs, 1999, Number 25; the-
Journal of Health Communication, volume 8 supplement; Risk Analysis, volume 23, issue 3;
and Risk: Health, Safety & Environment, volume 10, number 3.
4
Although some scholars prefer to differentiate public health risk communication from
environmental risk communication, drawing a hard line between these two subfields may be
unwarranted. Many of the most prolific scholars in what may be considered environmental
risk communication are also frequent contributors to the literature on health risk communi-
cation (Gurabardhi et al., 2004), suggesting an implicit if not explicit link between these
two areas. This link arguably resides not in the origin of the risk but in its potential endpoint,
the injured party. For example, whether the risk of cancer originated with the voluntary use of
tobacco or an involuntary exposure to toxic waste, both circumstances ultimately pose a pub-
lic health risk and could be considered under the rubric of public health risk communication.
So, too, do potential risks related to biotechnology, water quality, and global climate change,
making their exclusion from a review of public health risk communication unnecessary.
5
Although risk communication frequently concerns risks where a large degree of scientific
consensus exists, it also is often less clear what the appropriate public response should be.
Thus, whereas persuasive strategies typify the former risk communication efforts, the latter
are better illustrated by efforts to provide balanced, accurate information so that people
can, in a sense, make up their own minds about what constitutes acceptable risk.
78 K. A. McComas

This example illustrates the divide that can exist between scientific and nonscien-
tific assessments of risknamely, public perceptions of risk frequently do not align
with scientific assessments. Indeed, several decades worth of risk perception research
supports the finding that nonexpert audiences bring other factors to bear on risk judg-
ments, such as a risks voluntariness, controllabilty, catastrophic potential, scientific
understanding, effects on future generations, and dread (Slovic, 1987, 1999, 2000).
While sometimes perceiving greater risk, individuals also are prone to optimistic
biases or illusions of invulnerability, meaning the tendency to believe that negative
events are more likely to happen to other people than to oneself (Gurmankin et al.,
2004; Salmon et al., 2003; Weinstein, 1989).
The last decade saw continued study of risk perceptions. Particularly promising
were advances made with respect to the affective dimensions of risk-related
behaviors (Loewenstein et al., 2001; Peters et al., 2004; Poortinga & Pidgeon,
2005; Savadori et al., 2004; Sinaceur et al., 2005; Slovic, 1999, 2001; Slovic et al.,
2004). In describing what they term the affect heuristic, Slovic and colleagues
(2004) explained that people base their risk judgments not only on what they think
about the risk but also on what they feel about it. If people have positive feelings
about an activity, they tend to judge the risks as lower than if they have negative
feelings about the activity and vice versa. Feelings also can override analytical
reasoning. Research on young adults smoking behavior found, for example, that
feelings more than risk perceptions drove decisions to start smoking (Romer &
Jamieson, 2001). Similarly, Loewenstein and colleagues (2001) suggested a risk-
as-feelings hypothesis, which posits that an individuals feelings can at times super-
sede what that individual considers the wisest course of action.
Research on the affect heuristic is still developing, and its implications for risk
communication research and practice remain largely uncharted (Slovic et al.,
2004). Loewenstein and colleagues (2001) suggested that the risk-as-feelings hypoth-
esis can explain gender and age-related differences in responses to risk, as well as why
vivid language, narratives, or affective-laden imagery, often accompanying news
stories, strongly influence peoples reactions to risk. One study found, for instance,
that using the term mad cow rather than the scientific label influenced individuals
to react more on emotion than on personal risk estimates (Sinaceur et al., 2005).
Understanding the role of affect also may lead to a greater ability to explain and pre-
dict the development of stigma and its impact on risk perceptions and communi-
cation (Peters et al., 2004). Other research, reviewed in further detail below, has
noted the influence of affect, such as worry, on individuals risk-information-seeking
behaviors (Griffin, Neuwirth, Dunwoody, & Giese, 2004).
The publics reaction to the shark attacks off the East Coast offers an example of
how affect can guide behavior (e.g., images of shark attacks, perhaps even primed by
the movie Jaws, provoke a visceral aversion to the water). It also provides an
example of what social scientists have termed the social amplification of risk, which
is said to occur when risk events interact with psychological, social, institutional, and
cultural processes in ways that amplify or attenuate peoples risk perceptions
and subsequently their risk behavior (Kasperson & Kasperson, 2005; Pidgeon,
Kasperson, & Slovic, 2003). An integrative framework, it aims to describe why some
risks that scientists consider to pose relatively little threat to society receive a dispro-
portionate amount of attention, whereas other risks considered to pose more serious
risk receive scant notice (Kasperson et al., 2003). Potential consequences of risk
amplification or attenuation include not only harm to public health but also
 Risk Communication: 19962005 79

increased liability, economic costs, loss of trust in institutions, and stigmatization. In

essence, the framework represents an effort to capture the dualistic nature of risk as
both an objective event as well as a social construct.
First introduced in the late 1980s, the social amplification of risk framework was
used over the last decade to investigate public reactions to several real or potential
health risks, including Y2K (MacGregor, 2003), measles, mumps, rubella (MMR)
vaccines (Petts & Niemeyer, 2004), cancer clusters (Trumbo, 1996), acrylamides
(Lofstedt, 2003), genetically modified foods (Frewer et al., 2002), and nuclear power
(Flynn et al., 1998). Although its strength to date lies primarily in its explanatory
power, some have suggested that risk managers can use the framework to better
anticipate and respond to risk controversies (Leiss, 2003).

Risk in the Media

Memorial Day Weekend traditionally marks the start of the summer movie season in
the United States, and in 2004, the American film industry was banking on the glo-
bal climate change thriller, The Day After Tomorrow, to attract large audiences.
Critics aside, the movie did not disappoint, becoming a commercial success. For
observers of risk communication, the film was most notable for the debate it sparked
about possible effects on public perceptions of health risks from global climate
change (Leiserowitz, 2004). A comparison of movie viewers and nonviewers atti-
tudes before and after its debut suggested the film may have had short-term impacts
on viewers risk perceptions; however, the study cautiously noted that, despite its
commercial success, only a small proportion of the U.S. population saw the movie
(Leiserowitz, 2004).
The controversy surrounding The Day After Tomorrow illustrates how people
often ascribe great powers to the mass media to influence public attitudes and beha-
viors. Because of their ability to increase the availability of risk images and therefore
contribute to possible overestimation of risks (Tversky & Kahneman, 1974), mass
media often are pointed to as having great influence over public reactions to risk.
In fact, the literature investigating medias influence on risk perceptions is much
less certain (af Wahlberg & Sjoberg, 2000). Rather than showing strong effects, stu-
dies over the last decade generally were consistent with Tyler and Cooks (1984)
impersonal impact hypothesis, which posited that media coverage generates societal
level, not personal level, judgments of risk. For example, Morton and Duck (2001)
found that individuals exposed to risk information in the mass media tended to
believe others were more likely to be victims of risk than themselves. The study
did find, however, that when respondents were more dependent on media as impor-
tant sources of health information, they were more likely to view risk information as
relating to their own health risk. Others also have examined the influence of tele-
vision viewing on individuals fear of being a crime victim and found that, although
television exposure may have some limited effects, direct experience with a crime is a
stronger predictor (Gross & Aday, 2003; Shrum, 2001).
Whereas mass media may alert the public about health risks and help them form
societal level judgments, research has shown that people more often rely on interper-
sonal channels of communication, such as social networks, to assess their personal
health risks (Petts & Niemeyer, 2004; Scherer & Cho, 2003). Still, some research
suggests that mass media can sometimes influence risk perceptions more than
80 K. A. McComas

interpersonal sources, especially during times of heightened media coverage

(Verbeke et al., 1999).
During these periods of constant media attention, researchers have pointed
to media coverage as a contributing factor in the social amplification of risk
(Flynn et al., 1998; Frewer et al., 2002; Hill, 2001; Lofstedt, 2003; McInerney et al.,
2004), as well as the development of stigma (Flynn et al., 1998; Flynn et al., 2001). In
turn, the last decade saw several studies examining whether mass media
disproportionately sensationalize risk or emphasize negative impacts. Rather than
showing a consistent bias toward sensationalism or negativism, however, a review
of the available research suggests more moderate or neutral reporting of risks
(af Wahlberg & Sjoberg, 2000; Freudenburg et al., 1996; Sachsman et al., 2004).
When mass media do include risk information, research suggests that the
stories often lack important information for people to evaluate risks. One cross-
national study of newspaper content appearing 10 years after the Chernobyl
accident found that coverage included little use of statistics and provided few
comparisons to help people understand the risks (Rowe et al., 2000). Another
study of womens magazines found that articles discussing breast cancer risks
tended to report incorrect or incomplete information, leading the authors to ques-
tion whether the reports could contribute to womens misunderstanding about
breast cancer risks (Marino & Gerlach, 1999). Other research found that media
tended to under-represent certain causes of death, like tobacco use and heart
disease, while over-representing others, like deaths caused by motor vehicles or
toxic agents (Frost et al., 1997).
In addition to unintentional risk messages, media often are used intentionally for
risk communication. For example, after the September 11, 2001, terrorist strikes and
the subsequent anthrax attacks, the U.S. Centers for Disease Control and Prevention
(CDC) monitored the media to help shape its communication responses for the pub-
lic (Prue et al., 2003). In another study of CDC risk communication efforts, Mebane
and colleagues (2003) compared print media coverage to CDC press releases during
the anthrax attacks of 2001 and found that, although the media generally followed
CDC releases, they gave less weight to covering who was exposed, how they were
exposed, and the role of antibiotics in preventing anthrax.
As noted above, even were people to rely on media for personal risk infor-
mation, media frequently did not include relevant risk information to enable them
to estimate personal health risks. In turn, one study sought to determine how the
inclusion of population data along with frequency data would influence individuals
apprehension about risk, as well as their perceived victimization (Berger, 1998). The
study found that when population data were included before frequency data, male
subjects exhibited less apprehension and less perceived victimization for high risks.
The inclusion of population data did not have similar influences for males for low
risks, and the data had no influence on female subjects risk perceptions.
In another study of media effects, Neuwirth, Dunwoody, & Griffin (2000)
examined the influence of health risk information in news media on individuals
intention to seek additional information. The results found that when media
included information about the risks severity, individuals were more influenced
to seek additional information, as well as express willingness to take protective
actions. Information about the level of risk and what actions individuals could take
(i.e., efficacy) also influenced whether individuals expressed a willingness to take
protective actions.
 Risk Communication: 19962005 81

Strategic Risk Communication

To this point, much of the review has focused primarily on public reactions to
unintentional messages about health risks communicated via mass media or other
sources. Whereas risk communicators may have little control over the design,
delivery, and impact of these unofficial risk messages, research also has examined ways
to improve intentional or strategic risk communication over which communicators
can exercise greater control. Some of this research focuses on the design of risk
messages, whereas other research investigates the processes and outcomes of delivery.

Developing Health Risk Messages

As a method for identifying specific content for risk messages, the mental models
approach continued to receive attention and support (Cox et al., 2003; Fischhoff,
1999; MacGregor et al., 1999; Morgan et al., 2002; Niewohner et al., 2004; Zaksek
& Arvai, 2004). The mental models method uses interviews with expert groups and a
representative sample of target audience members to determine how expert and
lay understanding of risk differs. These interviews then help communicators choose
content to include in risk communication materials.
The language used in risk messages also received attention. Among studies,
Jardine and Hrudey (1997) examined how several words commonly used by risk
managers to describe risk, such as significant and nonsignificant, can confuse
lay audiences. Research also found that the inclusion of information about risk ben-
efits can influence reactions to risk messages, particularly when the risks already
were considered low (Gaskell et al., 2004; Knuth et al., 2003).
Other research examined public attitudes toward risk comparisons. Contrary to
previous assumptions that counseled against risk comparisons, results found that
comparisons can at times elicit positive reactions from the public (Johnson, 2003,
2004a, 2004b). Trust in the source of the information appeared key to whether
individuals view the comparisons as valid (Johnson & Chess, 2003).
In addition to examining public attitudes toward risk, research sought to examine
how particular information about risk influenced risk behavior. Lipkus and
colleagues tested the influence of information about risk factors and risk severity in
messages informing individuals about colorectal cancer risks (Lipkus et al., 1999;
Lipkus et al., 2003). The authors found that risk factor information increased
participants knowledge of the risks but did not influence their affective responses
(e.g., worry, anxiety, or fear) or intentions to get screened for colorectal cancer the
following year (Lipkus et al., 1999). Results of a subsequent study did find, however,
that increasing the perceived severity of the risks in the information materials influ-
enced participants likelihood of having a follow-up screening (Lipkus et al., 2003).
To examine what contributes toward long-term behavior changes in health risk
behavior, Griffin and colleagues (1999, 2002) developed the risk information seeking
and processing (RISP) model. This model integrates the heuristic-systematic proces-
sing model (Eagly & Chaiken, 1993) and the theory of planned behavior (Ajzen,
1988) to examine how people differentially react to risk information. The RISP
model posits that the gap between what people know and what they perceive they
need to know (information sufficiency) will influence information processing
(i.e., heuristic or systematic) and information seeking (i.e., active, routine, avoid-
ance) behaviors. In turn, information sufficiency is predicted by affective responses
82 K. A. McComas

to a risk and beliefs about what others think they should know about the risk (Griffin
et al., 2004). When people have greater affective responses (e.g., more worry) and feel
greater social pressure to learn more about the risk, they tend to perceive a greater
need for information. Moreover, research has found that the larger the gap, the more
likely individuals are to process the information systematically (Kahlor et al., 2003).
Research also investigated the influence of efficacy information on promoting
healthy behaviors. Much of this research builds on the extended parallel process model
(Witte, 1994), which posits that when people perceive a threat and become scared, they
are motivated to reduce that fear. Whether individuals engage in danger control (e.g.,
seek additional information or adopt risk reduction behaviors) or fear control (e.g.,
ignore warnings or denigrate the message source) depends on their perceived efficacy,
with higher levels of perceived efficacy leading to danger control. To help predict
whether individuals will engage in danger or fear control, Witte and colleagues
(1996) developed and tested a risk behavior diagnosis scale for use by practitioners.
Expanding efficacy research, Rimal (2001) examined the relationship among
self-efficacy, perceived risk, and information seeking behaviors, and found that when
self-efficacy was high, individuals perceiving greater risks were more likely to seek
information. Rimal and Real (2003) also found some support that when people
are made more aware of the risks, as well as what they could do to reduce their
exposure (i.e., efficacy), they are more likely to report intentions to increase risk
reduction behaviors. Despite the apparent importance of enhancing efficacy beliefs
to promote risk reduction behaviors, one study of government and nongovernment
produced food safety materials found that self-efficacy statements appeared far less
frequently than risk-stimulating statements (Gordon, 2003).
For an alternative to traditional fact sheets, researchers also investigated the
use of novel formats of message delivery, including the use of narratives or stories
(Greene & Brinn, 2003; Johnson, 2004b; Scherer et al., 1999). One study that offered
promising results found that narratives about the risks of tanning bed use were rated
high on realism and promoted intentions not to use tanning beds (Greene & Brinn,
2003). Finally, research examined the use of visuals, such as diagrams, charts, and
risk ladders, to aid in communication efforts (Connelly & Knuth, 1998; Gibson &
Zillmann, 2000; Lipkus & Hollands, 1999).

Communicating Health Risk Messages

It may be a truism to say that even the most carefully developed risk messages are
destined to fail if people do not trust the messengers; however, some would argue
that it is also the case that, until quite recently, trust largely was unappreciated in
risk management efforts (Slovic, 1993). Building on research trends that began in
the early 1990s, the last decade saw sustained study of trust and its brethren concept,
source credibility (Frewer et al., 1996; Frewer et al., 2003; Heath et al., 1998;
Jungermann et al., 1996; Maeda & Miyahara, 2003; McComas & Trumbo, 2001;
R. G. Peters et al., 1997; Poortinga & Pidgeon, 2005; Siegrist et al., 2003; Trumbo
& McComas, 2003). Perhaps most prominent among risk communication research
was the elaboration and testing of social trust related to risk management
(Cvetkovich & Lofstedt, 1999; Earle & Cvetkovich, 1995; Lofstedt, 2005). Although
a specific definition of social trust in risk management remains somewhat elusive, a
general understanding considers it a process whereby individuals choose to trust or
rely on risk management institutions, and the often unknown individuals operating
 Risk Communication: 19962005 83

them, to protect them and their interests from risk (Cvetkovich & Lofstedt, 1999). As
such, social trust differs from what researchers term interpersonal trust, meaning
trust that is placed in specific individuals based on the perceived presence or absence
of certain traits (more akin to source credibility; Earle & Cvetkovich, 1995).
Research conducted during the last decade suggests that social trust in risk man-
agement is based, in part, on perceived shared values, which are learned via stories or
narratives that institutions tell (Earle & Cvetkovich, 1995, 1999). Perceiving shared
values also can influence perceived risks and benefits (Siegrist et al., 2000; Siegrist
et al., 2001). For example, Siegrist and colleagues (2001) found in a study of cancer
cluster communication that individuals were more likely to believe that clusters
could occur randomly when they believed risk managers shared their values.
Other studies examining the relationship between trust or credibility and public
acceptance of risk have generally found a correlation between trust or credibility and
risk perceptions: namely, when trust or credibility is found wanting, people perceive
greater risks and vice versa (Cvetkovich et al., 2002; Frewer et al., 2003; McComas &
Trumbo, 2001; Poortinga & Pidgeon, 2005; Siegrist et al., 2005; Trumbo &
McComas, 2003).6 Recent research has tried to disentangle the causal relationship,
that is, whether risk acceptability encourages people to trust, or trust encourages
people to be more accepting of risk (Poortinga & Pidgeon, 2005). Finally, supporting
the axiom that trust is easier lost than regained, research found that even after receiv-
ing positive information about their actions, people were less likely to trust
previously distrusted risk managers (Cvetkovich et al., 2002).
Although much health risk communication involves providing information on
an individual basis to allow people to make personal choices, some requires gather-
ing people together in formalized settings to seek, discuss, or provide information
about risks having societal as well as personal implications. How to conduct public
outreach7 effectively was a frequent topic of interest during the last decade, as was
what it meant to be effective or successful in public outreach efforts.8
Questions surrounding audience representation was a common line of inquiry
(Allen, 1998). Representation is considered important to health risk communication
on several fronts. For one, successful risk characterization can depend on having a rep-
resentative sample of stakeholder input (Stern & Fineberg, 1996). For another, having
the target audience present ensures that people receive the risk information they need
to take appropriate precautions. Finally, having decisions or recommendations based

6
One exception was a study showing that knowledge of the risk may be a greater predictor
of risk perception than trust or credibility (Sjoberg, 2001).
7
This article uses the term outreach rather than participation or involvement to refer to
the numerous formalized techniques used to communicate health risks to members of the pub-
lic in organized social settings. It recognizes that public outreach has many formats and func-
tions, ranging from simply providing health risk information to targeted audiences to fully
engaging audience members in collective deliberation about health risks. Whereas the former
may typify many health risk communication efforts, the latter endeavors to make audience
members or stakeholders more active contributors to the characterization, assessment, and
management of risk.
8
Among challenges associated with determining what counts as effective or success-
ful public outreach is a lack of common criteria or benchmarks for evaluation (Chess &
Purcell, 1999; Rowe & Frewer, 2000). For example, some studies focus on procedural
elements, such as who participated in the process, while others focus on outcomes, such as
whether the process resulted in better decisions. Participants and organizers of public outreach
processes also sometimes disagree on criteria for evaluating success (Santos & Chess, 2003).
84 K. A. McComas

on representative opinions also can influence perceptions of fairness and legitimacy in

health risk policy making (Renn et al., 1996). Among studies on representation,
research on public meetings found that meeting participants are demographically simi-
lar to nonparticipants; however, often they are more concerned about the potential
risks and are more skeptical of the official sources of information (McComas, 2001,
2003b). Outside of public meetings or hearings, research has examined ways to solicit
a more representative sample of viewpoints, such as via the use of public opinion
surveys (McComas & Scherer, 1999; Pidgeon et al., 2005). Some findings suggest that
surveys can provide rapid and representative insight into peoples attitudes, beliefs,
and knowledge during crises (Blendon et al., 2003; Pollard, 2003); however, questions
about response rate bias linger. For example, recent research conducted in the United
Kingdom about the use of biotechnology in agriculture found significant differences in
viewpoints between a representative sample and a self-selected sample of respondents
(Pidgeon et al., 2005).
In addition to issues of representation, research has offered evidence that per-
ceived fairness of discussion procedures in government-sponsored outreach efforts
can influence the audiences satisfaction with the process (McComas, 2003a; Webler
& Tuler, 2000) and acceptance of the decisions (Arvai, 2003). Promoting dialogue
and consideration of alternatives among participants and experts is increasingly
emphasized as a way of achieving more informed judgments about health risks
(Arvai et al., 2001; Renn, 1998a, 1999, 2003). Sharing control over the decision-
making procedures also is important to perceptions of fairness (Heath et al.,
2002), although this control may not necessarily translate into support for risk
management policies (Heath & Abel, 1996). Increased attention to the fairness of
deliberative procedures also is considered essential to efforts seeking to maintain
or rebuild trust in risk management institutions (Lofstedt, 2005).

Future Directions
A decade ago, scholars predicted a new era of risk communication research, one
moving beyond a narrow vision of risk communication as persuasion and toward
a broader understanding of the psychological, cultural, and social influences on risk
communication (Leiss, 1996). In particular, researchers pointed to the role that trust
plays in risk communication, while noting a pervasiveand some might suggest
deserveddistrust in many risk management institutions (Leiss, 1995). A review
of the literature suggests that many researchers answered the call, offering strong
theoretical contributions as well as some practical applications. Moreover, there
are several promising directions for future research.
In particular, research on the affect heuristic and risk-as-feelings hypothesis
undoubtedly will see continued attention. Among avenues for study include further
integration of affect into the social amplification of risk framework and the RISP
model, both of which currently use some affective measures. The influence of affect
on assessments of social trust seems another important line of inquiry. For example,
given that narratives influence affective judgments (Loewenstein et al., 2001), how do
stories that communicate shared values influence affective judgments and the pro-
motion of social trust? The interplay of affect, risk narratives, and visuals also merits
further study, as do the possible ethical implications involved with the potential
misuse of such message strategies.
 Risk Communication: 19962005 85

The last decade saw increasing risk communication over the Internet. Although
some research has addressed the Internets impact on risk communication (e.g.,
Hobbs et al., 2004), this is clearly an area for future growth.
The influence of perceived efficacy is another important line of inquiry, includ-
ing its impact on risk perceptions and intentions to employ risk reduction behaviors.
A lack of control is frequently noted as a factor that increases risk perceptions.
Accordingly, it might be useful to integrate some of the efficacy research emerging
from communication studies with the social amplification of risk concept to specify
the influence of efficacy on risk amplification. Research should also consider efficacy
related to public outreach efforts. That is, to what extent does believing that one can
influence health risk decisions (one measure of efficacy) impact social trust in risk
management and satisfaction with outcomes? Methods for public participation
deserve continued attention, including how perceptions of procedural fairness influ-
ence peoples willingness to participate in outreach sessions.
These are just a few of the possible research directions.9 The review also under-
scores some challenges in the field, notably a literature that is very dispersed among
several disciplines. Among the strengths of risk communication research is its multi-
disciplinary nature, allowing it to draw from a well-rounded pool of knowledge and
expertise. Yet this strength poses challenges in that knowledge is not centralized. Per-
haps due to this diversity, risk communication research presently is characterized by
many, sometimes overlapping, variable analytic studies but few integrative theoreti-
cal frameworks. Some exceptions include the social amplification of risk, as well as
the RISP model. Future research should strive for more theoretical integration, as
researchers capitalize on the advances made in neighboring sciences.
Risk events continue to try public confidence in risk management institutions,
necessitating concerted risk communication efforts to sustain and rebuild public
trust. If the increased visibility of the field and productivity of researchers offer an
indication, the next decade will see continued and more effective efforts aimed at
meeting these challenges.

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