An assessment of health hazard/health risk appraisal.

A state-of-the-art review of a widely-used health promotion technique, the health hazard/health risk appraisal (HHA/HRA), was conducted. The review included preparing a 212-item annotated bibliography, compiling an inventory of 217 programs that have used HHA/HRA, holding discussions with HHA/HRA developers and users, conducting formal site visits to 15 HHA/HRA programs, and consultation with experts on epidemiology, biostatistics, and behavioral science as well as developers and users of HHA/HRA. Programs use HHA/HRA primarily as a promotional device, as a tool for structuring education about health-related behaviors, and as a motivational device for stimulating behavioral change. The scientific basis for HHA/HRA risk predictions is problematic, but their arithmetic imprecision is of less concern than insufficiency of the scientific evidence for certain behavioral recommendations, and inaccuracies in client-supplied data. Widely-held beliefs in HHA/HRA's efficacy for motivating behavioral change cannot be substantiated from available evidence, nor can the assumed absence of adverse effects. The importance of this particular health promotion technique appears to have been exaggerated.