France, 2006; Eder, Hillyer, Dy, Notari, & Benjamin, 2008; France, France, Roussos, & Ditto, 2004). Youth is the main risk factor associated with vasovagal reactions, and thus minimizing the likelihood VVR is especially pertinent when maintaining young, novice donors (Khan & Newman, 1999; Newman, 2014; Olatinju, Etzel, & Ciesielski, 2010; Schlump et. al., 2008). Other risk factors for VVR include body size, number of previous donations, gender (i.e. women are more likely to experience a reaction due to lower BMI), and length of phlebotomy (Newman, 2014). Mild reactions, including dizziness, weakness, and lightheadedness, are rather frequent during the blood donation procedure and these symptoms significantly deter donors from donating again in the future (France et. al., 2004). In one study, researchers France et al. (2004) showed that amongst 1052 donors, those who scored higher on the BDRI were much less likely to give blood again in the following year. Of those who scored below 10 on the BDRI (i.e. experiences less symptoms), 55% returned to donate in the following year, compared to a 35% return rate of those who scored above 10 on the BDRI (i.e. experienced more or more symptoms). Furthermore, techniques to reduce vasovagal reactions, such as applied tension, have been shown to reduce reported vasovagal symptoms during blood donation (Ditto et. al., 2003; Holly, Baleigh, & Ditto, 2011; Holly, Torbit, & Ditto, 2011). Women who practiced this technique were more likely to report a fewer vasovagal symptoms and reduced levels of anxiety. Further research has suggested that, for female donors, vasovagal symptoms can function as a mediator between pre-donation levels of anxiety and donor retention ((Ditto & France, 2006). Pain & Pain Catastrophizing Measures of pain experienced during the blood donation process have usually been acquired through numerical rating scales or visual analogue scales that are given post-donation
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