Public information needs after the poisoning of Alexander Litvinenko with polonium-210 in London: cross sectional telephone survey and qualitative analysis

Objectives To identify public perceptions of the risk to health after the poisoning of Alexander Litvinenko with polonium-210 (²¹⁰Po) in London and to assess the impact of public health communications.Design Cross sectional telephone survey and qualitative interviews.Setting London, United Kingdom.Participants 1000 people completed the cross sectional survey and 86 potentially exposed people completed the qualitative interviews.Main outcome measures Perception of risk to personal health after the ²¹⁰Po incident. Qualitative interviews were analysed with an emphasis on information needs.Results 11.7% of the survey sample (n=117) perceived their health to be at risk. Aside from personal variables the main predictors of perceived risk to health were believing that the incident was related to terrorism (odds ratio 2.7, 95% confidence interval 1.5 to 4.6) rather than to espionage, that it was targeted at the wider public rather than one person (5.9, 3.2 to 10.9), and that it could affect people who had not been in the contaminated area (3.2, 2.1 to 5.1). Participants in the qualitative interviews were generally satisfied with the information they had received, although they would have preferred more information about their individual risk of exposure, the results of their urine tests, and the health implications of the incident.Conclusions Perceptions of the public that the ²¹⁰Po incident in London in 2006 was related to espionage helped to reassure them that the risks to personal health were low. In the event of future incidents it is important to ensure that detailed, comprehensible information about the risks of any exposure is available.     

Perceived Extrinsic Mortality Risk and Reported Effort in Looking after Health

Socioeconomic gradients in health behavior are pervasive and well documented. Yet, there is little consensus on their causes. Behavioral ecological theory predicts that, if people of lower socioeconomic position (SEP) perceive greater personal extrinsic mortality risk than those of higher SEP, they should disinvest in their future health. We surveyed North American adults for reported effort in looking after health, perceived extrinsic and intrinsic mortality risks, and measures of SEP. We examined the relationships between these variables and found that lower subjective SEP predicted lower reported health effort. Lower subjective SEP was also associated with higher perceived extrinsic mortality risk, which in turn predicted lower reported health effort. The effect of subjective SEP on reported health effort was completely mediated by perceived extrinsic mortality risk. Our findings indicate that perceived extrinsic mortality risk may be a key factor underlying SEP gradients in motivation to invest in future health.     

Beyond the Hazard: The Role of Beliefs in Health Risk Perception

This article addresses how beliefs about health risks cluster and how these relate to perceptions of risk among Canadians. A principal components analysis conducted on items reflecting various beliefs from the Canadian National Health Risk Perception Survey extracted four underlying dimensions: Cancer Dread, Trust in Regulators, Environmental Concern, and Personal Agency. Factor scores were then used to investigate relationships between belief factors and the perceived health risk of various hazards with gender, education, income, and province of residence as covariates. Environmental and Therapeutic health risk perceptions were significantly higher in respondents with high Cancer Dread and high Environmental Concern, but lower in respondents with high Trust in Regulators. Environmental health risk perceptions were lower in respondents with high Personal Agency, whereas Social health risk perceptions were higher in respondents with high Cancer Dread and Personal Agency. Results suggest that information about health risk–related beliefs can be useful in improving our understanding of the public's perceived risk of health hazards.     

Cardiovascular risk and attitudes to lifestyle: what do patients think?

OBJECTIVE--To examine the relation between subjects'' level of cardiovascular risk and their beliefs about the harmfulness of their smoking habit, current diet, and level of exercise, together with their stated desire to modify such behaviour. DESIGN--Self administered postal health and life-style questionnaire followed by a structured health check conducted by a nurse. SETTING--Five general practices in Luton and Dunstable, Bedfordshire. SUBJECTS--5803 people aged 35-64 years enrolled in the OXCHECK trial who attended for a health check before 1 March 1992. MAIN OUTCOME MEASURES--Perceived risk to health of lifestyle behaviours, desire to modify behaviour, and a reported serious attempt to modify behaviour in the preceding year. RESULTS--A high proportion of smokers and those who were physically inactive perceived their behaviour to be harmful (1020; (76%; 95% confidence interval 74% to 79%) and 350 (74%; 70% to 78%) respectively) and wished to modify it (1212 (79%; 77% to 81%) and 375 (74%; 71% to 78%) respectively). In contrast, only 289 (45%; 41% to 48%) of obese people and 188 (14%; 12% to 16%) of people with a high dietary fat intake perceived their current diet to be harmful. The more cardiovascular risk factors present, the more likely subjects were to perceive a health risk attached to their diet and lack of exercise (p < 0.01 in both cases) and to want to improve their diet. CONCLUSION--Awareness of the health risk from smoking and motivation to stop is high. Further efforts are required, however, to educate the public about the risks associated with a high dietary fat intake. Although the health risks of inactivity were widely recognised, motivation to take more exercise needs to be increased.     

Is Younger Really Safer? A Qualitative Study of Perceived Risks and Benefits of Age-Disparate Relationships among Women in Cape Town,South Africa

Young women in age-asymmetric relationships may be at an elevated risk for acquisition of HIV, since relationships with older men are also correlated with other risk behaviors like less condom use. Qualitative studies have shown that women are motivated to participate in these relationships for money and emotional support. However, there is a paucity of research on women’s perceived risks of these relationships, particularly in South Africa. To this end, we conducted in-depth interviews with 23 women recruited from three urban communities in Cape Town. A thematic question guide was used to direct the interviews. Thematic content analysis was used to explore women’s perceived risks of age-disparate and non-age-disparate relationships, the benefits of dating older men, and risk perceptions that influence decisions around beginning or ending a relationship. A plurality of women thought that dating an older man does not bring any adverse consequences, although some thought that older men do not use condoms and may be involved in concurrent partnerships. Many women were less inclined to date same-age or younger men, because they were viewed as being disrespectful and abusive. This study points to the need for more awareness raising about the risks of age-disparate relationships. In addition to these initiatives, there is an urgent need to implement holistic approaches to relationship health, in order to curb intimate partner violence, improve gender equity and make non-age-disparate relationships more attractive.     

Discrepancies between estimated and perceived risk of cancer among individuals with hereditary nonpolyposis colorectal cancer

Communicating cancer risk and recommending adequate control programs is central for genetic counseling. Individuals affected by hereditary nonpolyposis colorectal cancer (HNPCC) are at about 80% life-time risk of colorectal cancer and for female carriers 40-60% risk of endometrial cancer and 10-15% risk of ovarian cancer. The perceived risk among mutation carriers may, however, deviate from the risk communicated and has been demonstrated to influence adherence to control programs. We investigated the perceived cancer risk among HNPCC mutation carriers (n = 47) and correlated the findings to individual characteristics. A perceived risk of colorectal cancer above 60% was reported by 22/45 individuals, and only one out of five mutation carriers reported a perceived risk > 80%. Female mutation carriers, individuals below age 50, and individuals who received their oncogenetic counseling within 1 year prior to the study reported higher, albeit not significantly, perceived risks of colorectal cancer. Higher perceived risks were also reported by individuals who had lost a parent to HNPCC-related cancer at early age, whereas individuals with a personal history of cancer did not report a higher perceived risk. Regarding gynecological cancer, 6/18 females reported a perceived risk of 40-60% for endometrial cancer, whereas the remaining women both underestimated and overestimated their risk, and none of the women referred to the risk of ovarian cancer. We conclude that despite educational efforts and an increasing amount of data on the cancer risk in HNPCC, a minority of the mutation carriers report a perceived risk at the same level as that communicated during oncogenetic counseling.     

Environmental Health Risk Perception of a Nationwide Sample of Taiwan College Students Majoring in Engineering and Health Sciences

The present study aims to characterize Taiwan college students’ risk perception on 26 environmental health hazards, and to identify influential factors contributing to their perceived risk. A total of 1218 nationwide college students and 35 professors participated in the study. Despite their varying demographic background, the students on average show very similar perceived relative risks, particularly for hazards of high-rank risk. Aggregate-level data analyses show that the perceived risk of a hazard increases with its increasing dreadfulness, but decreases with its increasing unknown to the participants. On the other hand, the factors contributing to the perceived risk by an individual are more complex. The dread component is the dominant factor affecting both the students’ and professors’ perceived risk. However, unlike the students, the professors’ perceived risk is also strongly driven by considerations for the exposure characteristics, the uncontrollable nature, and the newness of a hazard. It is notable that, for certain hazards, the perception gaps between the students and professors are substantial, thus highlighting areas of interest for additional risk communication efforts.     

Analyzing the Relationship between Objective–Subjective Health Status and Public Perception of Climate Change as a Human Health Risk in Coastal Tanzania

Climate change is considered as the biggest threat to human health in the 21st century. Sub-Saharan Africa, which is the most-at-risk region of the world, is estimated to have a disproportionately large share of the burden of climate change–induced environmental and human health risks. To develop effective adaptations to protect public health, it is essential to consider how individuals perceive and understand the risks, and how they might be willing to change their behaviors in response to them. Using a cross-sectional survey of 1253 individuals in coastal Tanzania we analyzed the relationship between subjective health status (self-reported health) and objective health status on the one hand and perceived health risks of climate change. Generally, higher subjective health status was associated with lower scores on perceived health risks of climate change. Concerning objective health status, the results were varied. Individuals who affirmed that they had been previously diagnosed with hepatitis, skin conditions, or tuberculosis had lower scores on perceived health risks of climate change, unlike their counterparts who affirmed that they had been previously diagnosed with malaria in the past 12 months or had been diagnosed with HIV/AIDS. These relationships persist even when biosocial and sociocultural attributes are taken into consideration. The results underscore the complex ways in which objective and subjective health interact with both biosocial and sociocultural factors to shape perceived health risks of climate change.     

Patterns of bushmeat hunting and perceptions of disease risk among central African communities

There is a great need to determine the factors that influence the hunting, butchering and eating of bushmeat to better manage the important social, public health and conservation consequences of these activities. In particular, the hunting and butchering of wild animals can lead to the transmission of diseases that have potentially serious consequences for exposed people and their communities. Comprehension of these risks may lead to decreased levels of these activities. To investigate these issues, 3971 questionnaires were completed to examine the determinants of the hunting, butchering and eating of wild animals and perceptions of disease risk in 17 rural central African villages. A high proportion of individuals reported perceiving a risk of disease infection with bushmeat contact. Individuals who perceived risk were significantly less likely to butcher wild animals than those who perceived no risk. However, perception of risk was not associated with hunting and eating bushmeat (activities that, compared with butchering, involve less contact with raw blood and body fluids). This suggests that some individuals may act on perceived risk to avoid higher risk activity. These findings reinforce the notion that conservation programs in rural villages in central Africa should include health-risk education. This has the potential to reduce the levels of use of wild animals, particularly of certain endangered species (e.g. many non-human primates) that pose a particular risk to human health. However, as the use of wild game is likely to continue, people should be encouraged to undertake hunting and butchering more safely for their own and their community's health.     

Preventive attitudes,beliefs, and practices of physicians in fee-for-service and health maintenance organization settings.

To identify the self-reported differences in preventive practices, attitudes, and beliefs of physicians practicing in fee-for-service (FFS) and health maintenance organization (HMO) settings, we surveyed a 100% sample of primary care physicians practicing in a large, urban, closed-panel HMO and a random sample of physicians, in the same county, who were in an FFS practice. The FFS physicians were more likely to consider behavioral risk factors important than were HMO physicians, and they were more likely to ask their patients about behavioral risk factors. Fee-for-service physicians were more likely than HMO physicians to use continuing medical education courses to upgrade their skills in modifying behavioral risk factors. There was little difference in the self-reported proportion of patients with specific behavioral risks in the FFS and HMO practices. Also, both groups were comparable in their perception of their ability to do behavioral counseling and their perceived success in such counseling. We conclude that FFS physicians are more likely to have positive preventive beliefs, attitudes, and practices than are HMO physicians.     

Finding fault with health risk assessment: A typology for risk assessment criticism

Although systematic, quantitative assessment of environmental health risks is a staple of regulatory decision-making, complaints regarding its perceived failures and shortcomings are an intrinsic feature of the policy landscape. In this article, we (a) catalog the classic criticisms of conventional health risk assessment, (b) create a typology that orders the critiques according to their focus on either input errors or output biases, and (c) identify selected allegations that fall within each category. We also note that the risk assessment–risk management paradigm has evolved over the past several decades, partially in accordance with the general direction and spirit of these classic critiques. The debate continues today along familiar lines invoking the traditional critiques and rebuttals outlined here.     

Understanding risk perceptions to enhance communication about human-wildlife interactions and the impacts of zoonotic disease

Inclusion of wildlife in the concept of One Health is important for two primary reasons: (1) the physical health of humans, domesticated animals, and wildlife is linked inextricably through shared diseases, and (2) humans' emotional well-being can be affected by their perceptions of animal health. Although an explicit premise of the One Health Initiative is that healthy wildlife contribute to human health, and vice versa, the initiative also suggests implicitly that wildlife may pose threats to human health through zoonotic disease transmission. As people learn more about One Health, an important question surfaces: How will they react to communications carrying the message that human health and wildlife health are linked? In the absence of adequate relevant research data, we recommend caution in the production and dissemination of One Health messages because of possible unintended or collateral effects. Understanding how and why individuals perceive risks related to wildlife diseases is essential for determining message content that promotes public support for healthy wildlife populations, on the one hand, and, on the other, for identifying messages that might inadvertently increase concern about human health effects of diseased wildlife. To that end, we review risk perception research and summarize the few empirical studies that exist on perceived risk associated with zoonoses. We conclude with some research questions that need answering to help One Health practitioners better understand how the public will interpret their messages and thus how to communicate positively and without negative collateral consequences for wildlife conservation.     

Misuse,perceived risk,and safety issues of household insecticides: Qualitative findings from focus groups in Arequipa,Peru

BackgroundThe current body of research on insecticide use in Peru deals primarily with application of insecticides offered through Ministry of Health-led campaigns against vector-borne disease. However, there is a gap in the literature regarding the individual use, choice and perceptions of insecticides which may influence uptake of public health-based vector control initiatives and contribute to the thousands of deaths annually from acute pesticide poisoning in Peru.MethodsResidents (n = 49) of the Alto Selva Alegre and CC districts of peri-urban Arequipa participated in seven focus group discussions (FGD). Using a FGD guide, two facilitators led the discussion and conducted a role-playing activity. this activity, participants insecticides (represented by printed photos of insecticides available locally) and pretended to “sell” the insecticides to other participants, including describing their qualities as though they were advertising the insecticide. The exercise was designed to elicit perceptions of currently available insecticides. The focus groups also included questions about participants’ preferences, use and experiences related to insecticides outside the context of this activity. Focus group content was transcribed, and qualitative data were analyzed with Atlas.ti and coded using an inductive process to generate major themes related to use and choice of insecticides, and perceived risks associated with insecticide use.ResultsThe perceived risks associated with insecticides included both short- and long-term health impacts, and safety for children emerged as a priority. However, in some cases insecticides were reportedly applied in high-risk ways including application of insecticides directly to children and bedding. Some participants attempted to reduce the risk of insecticide use with informal, potentially ineffective personal protective equipment and by timing application when household members were away. Valued insecticide characteristics, such as strength and effectiveness, were often associated with negative characteristics such as odor and health impacts. “Agropecuarios” (agricultural supply stores) were considered a trusted source of information about insecticides and their health risks.ConclusionsIt is crucial to characterize misuse and perceptions of health impacts and risks of insecticides at the local level, as well as to find common themes and patterns across populations to inform national and regional programs to prevent acute insecticide poisoning and increase community participation in insecticide-based vector control campaigns. We detected risky practices and beliefs about personal protective equipment, risk indicators, and safety levels that could inform such preventive campaigns, as well as trusted information sources such as agricultural stores for partnerships in disseminating information.     

Health perceptions and demographic characteristics associated with underassessment of body weight

Objectives: To describe the relationship between BMI and perceived weight status and to determine how underassessment of weight status is associated with demographic characteristics, self‐reported general health, and perceived health risk in relation to one's body weight. Methods and Procedures: In the 2004 Styles surveys, 3,888 US adult participants described their current weight status (underweight, about right, slightly overweight, very overweight), which we compared with self‐reported BMI in order to determine concordance. We used multivariable logistic regression to evaluate associations between underassessment of body weight and characteristics of interest. Results: Among persons with a BMI ≥25, women were more likely than men to recognize their overweight status (slightly or very overweight; 93.0% of women vs. 73.5% of men) and the extent to which they were overweight: 70.4% of obese women vs. 49.5% of obese men described themselves as very overweight. Among the overweight and obese of both sexes, disagreement with regard to current weight as a health risk was associated with underassessment of weight. Additional factors associated with underassessment were education and race/ethnicity among overweight women; race/ethnicity among overweight men; household income and self‐rated health among obese women; and self‐rated health among obese men (P < 0.05). Discussion: While most of the obese participants recognized that they were overweight, many of them, particularly among the men, did not realize the extent to which they were overweight. Public health messages may be more effective if they are specifically tailored to target audiences, besides emphasizing the health risks associated with excess body weight.     

Effects of alternative styles of risk information on EMF risk perception

Risk scenarios characterized by exposures to new technologies with unknown health effects, together with limited appreciation of benefits pose a challenge to risk communication. The present report illustrates this situation through a study of the perceived risk from mobile phones and mobile masts in residential areas. Good information should objectively convey the current state of knowledge. The research question is then how to inform lay people so that they trust and understand the information. We used an Internet‐based survey with 1687 Danish participants randomized to three types of information about radiation from mobile phones and masts. The objective was to study whether different types of information were rated as equally useful, informative, comprehensible, and trustworthy. Moreover, an important issue was whether information would influence risk perception and intended behavior. The conclusion is that lay people rate information about risks associated with a new and largely unknown technology more useful and trustworthy when provided with brief statements about how to handle the risk, rather than more lengthy technical information about why the technology may or may not entail health hazards. Further, the results demonstrate that information may increase concern among a large proportion of the population, and that discrepancies exist between expressed concern and intended behavior. Bioelectromagnetics 31:504–512, 2010. © 2010 Wiley‐Liss, Inc.     

Scientists versus Regulators: Precaution,Novelty & Regulatory Oversight as Predictors of Perceived Risks of Engineered Nanomaterials

Engineered nanoscale materials (ENMs) present a difficult challenge for risk assessors and regulators. Continuing uncertainty about the potential risks of ENMs means that expert opinion will play an important role in the design of policies to minimize harmful implications while supporting innovation. This research aims to shed light on the views of ‘nano experts’ to understand which nanomaterials or applications are regarded as more risky than others, to characterize the differences in risk perceptions between expert groups, and to evaluate the factors that drive these perceptions. Our analysis draws from a web-survey (N = 404) of three groups of US and Canadian experts: nano-scientists and engineers, nano-environmental health and safety scientists, and regulatory scientists and decision-makers. Significant differences in risk perceptions were found across expert groups; differences found to be driven by underlying attitudes and perceptions characteristic of each group. Nano-scientists and engineers at the upstream end of the nanomaterial life cycle perceived the lowest levels of risk, while those who are responsible for assessing and regulating risks at the downstream end perceived the greatest risk. Perceived novelty of nanomaterial risks, differing preferences for regulation (i.e. the use of precaution versus voluntary or market-based approaches), and perceptions of the risk of technologies in general predicted variation in experts'' judgments of nanotechnology risks. Our findings underscore the importance of involving a diverse selection of experts, particularly those with expertise at different stages along the nanomaterial lifecycle, during policy development.     

The Role of Convictions and Trust for Public Protest Potential in the Case of Carbon Dioxide Capture and Storage (CCS)

For the public to accept new technologies, trust and convictions play an important role. In the present research, we used structural equation modeling to examine an extensive causal model of the role of convictions and trust for the public's protest potential against carbon dioxide capture and storage (CCS) among a large sample of the general population (N = 769). Trust, convictions, perceived benefits, and risks were included in the model. Our model fitted the data well. Convictions regarding emission reduction, decentralization of energy production, and tampering with natural structures in the deep subsurface influenced the perception of benefits and risks. Trust, in contrast, was barely influential. Perceived benefits were more prominent for public protest potential than perceived risks. However, perceived benefits did not dominate perceived risks as much as earlier studies found for acceptance. We argue that trust can become fully effective as a determinant of perceived risks and benefits only when the public perceives the distinct positioning of the stakeholders involved. Until then, laypeople are likely to draw on their own convictions and intuitive mental concepts for making decisions about accepting a new technology or protesting it.     

RISK DETECTION IN INDIVIDUAL HEALTH CARE: ANY LIMITS?

Background: Biomedical science is producing an avalanche of data about risk factors, often with a small predictive value, associated with a broad diversity of diseases. Prevention and screening are increasingly moving from public health into the clinic. Therefore, the question of which risk factors to investigate and disclose in the individual patient, becomes ethically increasingly urgent. In line with Wilson and Jungner's public health‐related 10 principles for screening, it seems crucial to distinguish important from unimportant health risks. Aim: to explore the ways in which clinicians distinguish important from unimportant health risks. Methods: We interviewed 36 respondents (gastroenterologists and gynaecologists/obstetrics) in 5 focus group interviews and 15 open in‐depth interviews on their interpretation of what makes a health risk important. Results: Physicians primarily interpreted importance as the severity of the possible harm, less often its probability. Possibilities of prevention or reassurance strongly influenced their judgment on importance. Discussion: It is not likely that interpreting ‘important’ as ‘severe’ will help in differentiating meaningful from meaningless risk knowledge. A more fundamental change in our ways of dealing with risk may be called for. We discuss existing literature on resilience as an alternative way to deal with risk. Balancing prevention and risk reduction with resilience could be a fruitful direction.     

Community nurse assessment of cardiovascular behavioural risk factors--a qualitative analysis within the CroHort study

The aim of our study was to identify major determinants of cardiovascular behavioural risk factors among subjects at increased risk of cardiovascular disease (CVD). The data for the qualitative analysis were obtained from the Croatian Adult Health Cohort Study (CroHort). The data analysis was based on the principles of Grounded Theory. We have generated the concept of an individual in a vicious circle of risky health behaviour, defined by the low level of motivation and unfavourable personal characteristics which in interaction with unsupportive social environment adversely influence one's health behaviour, leading to negative health outcomes that produce negative effects on one's motivation and social environment. Community nurses assessed that the respondents often weren't adequately recognising their CVD risk and were very reluctant about the change in their risky habits. Our results are supported by the quantitative analysis and are complementing other analyses of the cardiovascular risks within the CroHort study.