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.     

Laypeople's Health Concerns and Health Beliefs in Regard to Risk Perception of Mobile Communication

The consensus scientific view is that there is an absence of convincing scientific evidence for health risks of exposures to electromagnetic fields (EMF) at levels below those recommended in international guidelines. Nevertheless, some citizens are worried about EMF emitted by mobile communication and its consequences for health. The present study explored, by means of a mail survey, health concerns and the prevalence of health beliefs related to EMF in the general population. A random sample (n = 765, response rate 41%) of the German-speaking population in Switzerland was asked to assess various health beliefs. Results suggest that health concerns are widespread but lower than health concerns in regard to other hazards. About two-thirds of the respondents believed that some people suffer from electromagnetic hypersensitivity (EHS). Health beliefs items were analyzed using the Mokken scale. This scale was related to respondents' health concerns and showed that health beliefs differed in regard to sociodemographic variables. For example, analyses showed that females, younger respondents, and respondents who believed that some people are affected by EHS endorsed significantly more health beliefs than males, older respondents, and non-EHS respondents. Results indicate that it is important for policy-makers to develop a clear understanding of the possible effects of health beliefs on health concerns and risk perception. These findings may provide guidance for the further development of information materials and strategies.     

Leisure‐Time Physical Activity and Reduced Plasma Levels of Obesity‐Related Inflammatory Markers

Objective: This study investigated the relationship between physical activity and the obesity‐related inflammatory markers C‐reactive protein, interleukin‐6, and soluble tumor necrosis factor receptors (sTNF‐Rs) 1 and 2. Furthermore, we examined the relationship between physical activity and insulin sensitivity (insulin, C‐peptide, and hemoglobin A_1c levels) and whether inflammatory markers mediate this association. Research Methods and Procedures: Biomarkers were measured in 405 healthy men and 454 healthy women from two large ongoing prospective studies. Information about physical activity and other variables was assessed by questionnaires. Results: After adjustment for other predictors of inflammation, physical activity was inversely associated with plasma levels of sTNF‐R1, sTNF‐R2, interleukin‐6, and C‐reactive protein (p = 0.07, p = 0.004, p = 0.04, and p = 0.009). After further adjustment for BMI and leptin, as a surrogate for fat mass, most of these associations were no longer significant. Physical activity was also inversely related to insulin and C‐peptide levels (p = 0.008 and p < 0.001); however, in contrast to BMI and leptin, levels of inflammatory markers explained only very little of this inverse relationship. Discussion: These results suggest that frequent physical activity is associated with lower systemic inflammation and improved insulin sensitivity. These associations can partially be explained by a lower degree of obesity in physically active subjects. Although inflammatory markers may mediate obesity‐dependent effects of physical activity on inflammatory related diseases such as type 2 diabetes or coronary heart disease, our study suggests that they do not directly account for the beneficial effects of physical activity on insulin resistance.     

Comparison of Regional Fat Distribution and Health Risk Factors in Middle‐Aged White and African American Women: The Healthy Transitions Study

Objective: Both ethnicity and menopause appear to influence intra‐abdominal fat distribution. This study evaluated intra‐abdominal fat distribution and obesity‐related health risks in perimenopausal white and African American women. Research Methods and Procedures: Baseline data from a longitudinal study of changes in body composition and energy balance during menopause are reported. Healthy women (55 African Americans and 103 whites) who were on no medication and had at least five menstrual cycles in the previous 6 months were recruited. Body composition was assessed by DXA, and visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were assessed by computed tomography scan. SAT was divided into deep and superficial layers demarcated by the fascia superficialis. Results: African American women were slightly younger (46.7 ± 0.2 vs. 47.7 ± 0.2 years, p = 0.002) and fatter (42.4% ± 1.0% vs. 39.4% ± 0.8% body fat, p = 0.02) than white women. In unadjusted data, African Americans had significantly more total abdominal fat and total, deep, and superficial SAT than whites. After adjustment for percent body fat and age, only total and superficial SAT remained significantly higher in African Americans. VAT although slightly less in African American women, did not differ significantly by race. In multiple regression analysis, VAT was the strongest predictor of serum lipids, glucose, and insulin in women of both races, although superficial SAT was significantly associated with fasting glucose in whites. Conclusions: Middle‐aged African American women have larger SAT depots, adjusted for total body fatness, but do not differ from white women with regard to VAT. The complexity of the relationship between abdominal fat and metabolic risk is increased by ethnic differences in such associations.     

Admixture Mapping of Obesity‐related Traits in African Americans: The Atherosclerosis Risk in Communities (ARIC) Study

Obesity is an important cause of morbidity and mortality worldwide. In the United States, the prevalence of obesity is higher in African Americans than whites, even after adjustment for socioeconomic status (SES). This leads to the hypothesis that differences in genetic background may contribute to racial/ethnic differences in obesity‐related traits. We tested this hypothesis by conducting a genome‐wide admixture mapping scan using 1,350 ancestry‐informative single‐nucleotide polymorphisms (SNPs) in 3,531 self‐identified blacks from the Atherosclerosis Risk in Communities (ARIC) study. We used these markers to estimate the overall proportions of European ancestry (PEAs) for each individual and then scanned for the association between PEA and obesity‐related traits (both continuous and dichotomous) at each locus. The median (interquartile range) PEA was 0.151 (0.115). PEA was inversely correlated with continuous BMI, weight, and subscapular skinfold thickness, even after adjusting for socioeconomic factors. In contrast, PEA was positively correlated with BMI‐adjusted waist circumference. Using admixture mapping on dichotomized traits, we identified a locus on 2p23.3 to be suggestively associated with BMI (locus‐specific lod = 4.11) and weight (locus‐specific lod = 4.07). After adjusting for global PEA, each additional copy of a European ancestral allele at the 2p23.3 peak was associated with a BMI decrease of ～0.92 kg/m² (P = 2.9 × 10^?5). Further mapping in this region on chromosome 2 may be able to uncover causative variants underlying obesity, which may offer insights into the control of energy homeostasis.     

Copy Number Variations Associated With Obesity‐Related Traits in African Americans: A Joint Analysis Between GENOA and HyperGEN

Obesity is a highly heritable trait and a growing public health problem. African Americans (AAs) are a genetically diverse, yet understudied population with a high prevalence of obesity (BMI >30 kg/m²). Recent studies based upon single‐nucleotide polymorphisms (SNPs) have identified genetic markers associated with obesity. However, a large proportion of the heritability of obesity remains unexplained. Copy number variation (CNV) has been cited as a possible source of missing heritability in common diseases such as obesity. We conducted a CNV genome‐wide association study of BMI in two African‐American cohorts from Genetic Epidemiology Network of Arteriopathy (GENOA) and Hypertension Genetic Epidemiology Network (HyperGEN). We performed independent and identical association analyses in each study, then combined the results in a meta‐analysis. We identified three CNVs associated with BMI, obesity, and other obesity‐related traits after adjusting for multiple testing. These CNVs overlap the PARK2, GYPA, and SGCZ genes. Our results suggest that CNV may play a role in the etiology of obesity in AAs.     

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.     

Low Recognition of Childhood Overweight and Disease Risk among Native‐American Caregivers**

Objectives: Pediatric obesity is a significant and increasing problem in Native‐American communities. The aim of this study was to determine whether parents and other caregivers from three Wisconsin tribes recognized overweight children. We also assessed caregiver attributes associated with levels of concern for risk of future overweight and chronic disease. Research Methods and Procedures: Data were obtained from child health screenings and caregiver surveys. Participants included 366 kindergarten‐through‐second grade child–caregiver dyads. Children's BMI percentiles were calculated and compared with caregiver responses. We assessed the relationships between predictors of caregiver concern for health risk factors and recognition of overweight. Results: Twenty‐six percent of children were overweight (≥95th percentile), and 19% were at risk for being overweight (≥85th to <95th percentile) using Centers for Disease Control standards. Caregivers recognized only 15.1% of overweight children. Factors predictive of child overweight recognition included a child BMI >99th percentile and grandmother as caregiver. Overall, caregivers were more concerned about diabetes and cardiovascular disease than obesity. Parents with diabetes and heart disease were more concerned than others about risk for these diseases; however, only diabetic parents made a connection between child weight status and future risk of obesity‐related disease. Child sex, child age, and parental education level were not significant predictors for caregiver recognition of an overweight child. Discussion: Most caregivers did not recognize overweight children or associate excess weight with increased risk of disease. When designing community interventions, it is crucial to incorporate caregivers’ attitudes and beliefs regarding childhood overweight and risk of future disease.     

The Concept of Data Utility in Health Risk Assessment: A Multi-Disciplinary Perspective

Human and ecological health risk assessments and the decisions that stem from them require the acquisition and analysis of data. In agencies that are responsible for health risk decision-making, data (and/or opinions/judgments) are obtained from sources such as scientific literature, analytical and process measurements, expert elicitation, inspection findings, and public and private research institutions. Although the particulars of conducting health risk assessments of given disciplines may be dramatically different, a common concern is the subjective nature of judging data utility. Often risk assessors are limited to available data that may not be completely appropriate to address the question being asked. Data utility refers to the ability of available data to support a risk-based decision for a particular risk assessment. This article familiarizes the audience with the concept of data utility and is intended to raise the awareness of data collectors (e.g., researchers), risk assessors, and risk managers to data utility issues in health risk assessments so data collection and use will be improved. In order to emphasize the cross-cutting nature of data utility, the discussion has not been organized into a classical partitioning of risk assessment concerns as being either human health- or ecological health-oriented, as per the U.S. Environmental Protection Agency's Superfund Program.     

Human Health Risks of Selenium-Contaminated Fish: A Case Study for Risk Assessment of Essential Elements

A screening level human health risk assessment (HHRA) was applied to evaluate the human health implications of consuming selenium found in fish tissues collected downstream of coal mines in southeastern British Columbia, Canada. The study evaluated the potential for adverse human health effects associated with selenium, and considered known and potential benefits of selenium and fish ingestion. The results indicated that risks of selenosis due to consumption of selenium-contaminated fish in the region are negligible. Conclusions were strengthened by consideration of the potential benefits of selenium to human health, including: selenium essentiality for maintenance of good health; potential cancer prevention properties due to its role as an antioxidant; potential benefits for cardiovascular health; and other positive health benefits. The findings indicated that some aspects of the traditional framework for HHRA (e.g., application of safety factors to “err on the side of safety”) are inappropriate for the assessment of selenium-contaminated fish. Due to both deficiency and toxicity in the selenium dose-response relationship, application of compounding conservatism in risk assessment may lead to recommended intakes of fish that are contrary to the public health interest. The need for balancing risk types, for incorporating positive responses in risk assessments, and the linkage to the precautionary principle, are discussed.     

A Human Health Risk Assessment Software for Facilitating Management of Urban Contaminated Sites: A Case Study: The Massa Site,Tuscany, Italy

The goal of this article is to present the Human Health Risk Assessment (HRA) software developed as one of the NORISC ^{1 1}NORISC is the acronym of the project “Network Oriented Risk assessment by In-situ Screening of Contaminated sites” realized under under the 5th European Union Community Framework Programme for Research, Technological Development and Demonstration Activities. View all notes decision support software system components that could be used as a tool for facilitating management of urban contaminated sites. The NORISC-HRA software provides sufficient technical and procedural support to conduct a simple site-specific risk assessment. The employed HRA methodology is generally based on U.S. Environmental Protection Agency (USEPA) procedures. The software determines the level and spatial distribution of human health risks at a given site and sets up site-specific preliminary Health-Based Remedial Goals (HBRGs)/Risk-Based Concentrations (RBCs) for soil and groundwater. The NORISC-HRA software is recommended for use when national soil and groundwater limit values are exceeded. Exposure pathways considered in this software are associated with three land use patterns—residential, industrial/commercial, and recreational. The aricle also presents the software testing results obtained at one of the NORISC test sites—the Massa site (Avenza-Carrara, Tuscany, Italy). Findings of the HRA indicated that the contaminated soil at the Massa test site might pose potential cancer and non-cancer risks to industrial workers in its present condition. Arsenic was the dominant substance responsible for most of the baseline risk and at the RBC of 1.77 mg/kg it was the primary driver of remedial decisions at the Massa site.     

Profound Perturbation of the Metabolome in Obesity Is Associated with Health Risk

1. Download high-res image (253KB)
2. Download full-size image

     

Obesity Prevention in Preschool Native‐American Children: A Pilot Study Using Home Visiting

Objective : To determine whether maternal participation in an obesity prevention plus parenting support (OPPS) intervention would reduce the prevalence of obesity in high‐risk Native‐American children when compared with a parenting support (PS)‐only intervention. Research Methods and Procedures : Forty‐three mother/child pairs were recruited to participate. Mothers were 26.5 ± 5 years old with a mean BMI of 29.9 ± 3 kg/m². Children (23 males) were 22 ± 8 months old with mean weight‐for‐height z (WHZ) scores of 0.73 ± 1.4. Mothers were randomly assigned to a 16‐week OPPS intervention or PS alone. The intervention was delivered one‐on‐one in homes by an indigenous peer educator. Baseline and week 16 assessments included weight and height (WHZ score and weight‐for‐height percentile for children), dietary intake (3‐day food records), physical activity (measured by accelerometers), parental feeding style (Child Feeding Questionnaire), and maternal outcome expectations, self‐efficacy, and intention to change diet and exercise behaviors. Results : Changes in WHZ scores showed a trend toward significance, with WHZ scores decreasing in the PS condition and increasing among the OPPS group (?0.27 ± 1.1 vs. 0.31 ± 1.1, p = 0.06). Children in the OPPS condition also significantly decreased energy intake (?316 ± 835 kcal/d vs. 197 ± 608 kcal/d, p < 0.05). Scores on the restriction subscale of the Child Feeding Questionnaire decreased significantly in the OPPS condition (?0.22± 0.42 vs. 0.08± 0.63, p < 0.05), indicating that mothers in the OPPS group were engaging in less restrictive child feeding practices over time. Discussion : A home‐visiting program focused on changing lifestyle behaviors and improving parenting skills showed promise for obesity prevention in high‐risk Native‐American children.     

Extrapolation in Human Health and Ecological Risk Assessments: Proceedings of a Symposium

A symposium was conducted in April 1998 by the U.S. Environmental Protection Agency's National Health and Environmental Effects Research Laboratory (NHEERL) to explore issues of extrapolation in human health and ecological risk assessments. Over the course of three and one half days, leading health and ecology experts presented and discussed research methods and approaches for extrapolating data among taxa and across levels of biological organization, through time, and across spatial scales. The intended result of this symposium was enhanced interaction among a diverse array of scientists, policymakers, and risk assessors to promote identification of approaches for reducing the uncertainties of extrapolation in risk assessment.     

BMI and Health‐Related Quality of Life in Adults 65 Years and Older

Objective: To examine relationships of BMI with health‐related quality of life in adults 65 years and older. Research Methods and Procedures: In 1996, a health survey was mailed to all surviving participants ≥ 65 years old from the Chicago Heart Association Detection Project in Industry Study (1967 to 1973). The response rate was 60%, and the sample included 3981 male and 3099 female respondents. BMI (kilograms per meter squared) was classified into four groups: underweight (<18.5), normal weight (18.5 to 24.9), overweight (25.0 to 29.9), and obese (≥30.0). Main outcome measures were Health Status Questionnaire‐12 scores (ranging from 0 to 100) assessing eight domains: health perception, physical functioning, role limitations‐physical, bodily pain, energy/fatigue, social functioning, role limitations‐mental, and mental health. The higher the score, the better the outcome. Results: With adjustment for age, race, education, smoking, and alcohol intake, obesity was associated with lower health perception and poorer physical and social functioning (women only) but not impaired mental health. Overweight was associated with impaired physical well‐being among women only. Both underweight men and women reported impairment in physical, social, and mental well‐being. For example, multivariable‐adjusted health perception domain scores for women were 50.8 (underweight), 62.7 (normal weight), 60.5 (overweight), and 52.1 (obese), respectively. Associations weakened but remained significant with further adjustment for comorbidities. Discussion: Compared with normal‐weight people, both underweight and obese older adults reported impaired quality of life, particularly worse physical functioning and physical well‐being. These results reinforce the importance of normal body weight in older age.     

Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study

The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0–74 years) who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40–59-year-old men and 60–69-year-old women, and in duration of hospitalization among 40–59 and 60–69-year-olds of both sexes and 70–74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts.     

Evaluation of the Influence of Cardiorespiratory Fitness on Diverse Health Risk Factors,Independent of Waist Circumference,in 40‐Year‐Old Flemish Males

Objective: To examine whether cardiorespiratory fitness is associated with health risk factors, independent of abdominal obesity (waist circumference). Research Methods and Procedures: Data from 141 40‐year‐old Flemish male subjects were used in a cross‐sectional design. The main outcome measure in this study was the health risk profile, composed of lipid parameters, blood pressure, and body composition parameters. Data were analyzed by regression analysis and by means of analysis of covariance with waist circumference (WC) as covariate and cardiorespiratory fitness as source of variance. Results: The data demonstrated that cardiorespiratory fitness was significantly associated with triglycerides, with the ratio of total cholesterol/serum high density lipoprotein cholesterol, and with percent body fat, independent of an association with WC. Discussion: Major findings of the present cross‐sectional study indicate that a high WC is associated with adverse health‐related lipid profile and body composition characteristics and that relatively high levels of aerobic fitness attenuate the health risk associated with a large WC.