Health-risk perception and its mediating effect on protective behavioral adaptation to heat waves

Effect of environmental education program implemented with university student participation on secondary school students' environmental attitude

Study aimed to increase university students' sensitivity and the environmental attitudes of secondary school students through environmental education program. It was planned as quasi-experimental research. The first phase was completed with five fourth-year students who took Social Awareness Course at a university's nursing department in Turkey. In second phase, sample consisted of 264 5th-grade students studying at Secondary School in Black Sea Region. University students implemented Environmental Education Program for secondary school students for four weeks. Mean environmental attitude scale score of 5th-grade students before education was 2.79 ± 0.32, and after education was 3.51 ± 0.41. A statistically significant difference was determined between mean total scale scores of university and 5th-grade students before and after education (p ˂ 0.05). It was determined that environmental sensitivity of university students and environmental attitudes of secondary school students were at medium level before Environmental Education Program and high level after education.

Heatwave warnings mitigate long-term cardiovascular diseases risk from heat-related illness: a real-world prospective cohort study

Background

Global warming is intensifying, exacerbating associated health issues. Heat-related illness, a critical risk during heatwaves, significantly impacts public health, yet its long-term health effects remain poorly understood. We established a cohort to investigate these health impact and explore the mitigative role of heatwave warnings.

Methods

Our cohort study enrolled 9,658,745 participants free of cardiovascular disease (CVD) at baseline from 1332 hospitals and 922 primary care centres in Shenzhen, China. The cohort was observed and followed up from January 1, 2017, to July 31, 2023. We utilized Cox proportional hazards model to analyse CVD incidence among participants who had heat-related illness versus those who did not, and further assessed causal relationship using instrumental variable approach. We employed stratified logistic regression to explore the protective effects of heatwave warning policies.

Findings

Among 9,658,745 participants followed up to 6 years, 238,278 (2.47%) developed CVD. People who developed CVD were generally older, male, with a higher degree of education, and with more hospital admissions before baseline. Heat-related illness was associated with CVD, with a hazard ratio of CVD 2.526 (95% CI = 2.301-2.773) among patients with heat-related illness compared with those without heat-related illness, and instrumental variable approach analysis suggested causation. Issuing heatwave warnings reduced hospital admissions for heat-related illness (OR [95% CI] = 0.902 [0.832-0.977]) and future CVD risk (OR [95% CI] = 0.964 [0.946-0.982]). The mitigative role of heatwave warnings suggested delayed effect, with mitigative effect at greatest magnitude one to two days after issuance for heat-related illness admission and three to four days for CVD.

Interpretation

Our study suggested that heat-related illness has significant long-term impacts on future CVD incidence, which can be mitigated by heatwave warnings.

Funding

This study was supported by the National Natural Science Foundation of China (No. 42277419), the Sanming Project of Medicine in Shenzhen (No. SZSM202111001), and the Research Fund of Vanke School of Public Health in Tsinghua University.

The perception of air pollution and its health risk: a scoping review of measures and methods

BACKGROUND

Although there is increasing awareness of the health risks of air pollution as a global issue, few studies have focused on the methods for assessing individuals' perceptions of these risks. This scoping review aimed to identify previous research evaluating individuals' perceptions of air pollution and its health effects, and to explore the measurement of perceptions, as a key resource for health behaviour.

METHODS

The review followed the methodological framework proposed by Arksey and O'Malley. PubMed and Web of Science were searched. After initial and full-text screening, we further selected studies with standardised scales that had previously been tested for reliability and validity in assessing awareness and perceptions.

RESULTS

After full-text screening, 95 studies were identified. 'Perception/awareness of air quality' was often measured, as well as 'Perception of health risk.' Only nine studies (9.5%) used validated scaled questionnaires. There was considerable variation in the scales used to measure the multiple dimensions of risk perception for air pollution.

CONCLUSION

Few studies used structured scales to quantify individuals' perceptions, limiting comparisons among studies. Standardised methods for measuring health risk perception are needed.

Dynamics of natural hazard risk awareness: Panel analysis insights from Switzerland

The analysis of risk awareness should be the initial stage in integrated natural hazard risk management to promote appropriate and effective measures for mitigating risks and strengthening social resilience inside the multi-risk framework. Nevertheless, earlier studies focused on cross-sectional data and overlooked the changes in risk awareness levels and associated independent variables with time. This study analyzes for the first time a balanced nationwide panel dataset of 1612 respondent-year observations from Switzerland (period 2015-2021, including the epidemic of COVID-19) to examine and compare the effects of potential independent variables on the four dimensions of natural hazard risk awareness (NHRA), ranging from the broadest dimension of Relevance to higher dimensions of Perceived Probability of an event, Perceived Threat to life and valuables, and Perceived Situational Threat. The analysis in this study incorporates multiple methods of Random-Effect Model (RE), Generalized Linear Model (GLM), and mediation analysis. Results show that NHRA increased in Switzerland to different extents (up to 23.24%) depending on the dimension. Event memory, perceived information impact and reported individual informed level appeared to be the most consistent independent variables positively influencing panel NHRA. Among these, perceived information impact as an important indicator of risk communication, was also found to serve as a mediator from risk preparedness to risk awareness. By encouraging residents to engage in "Begin Doing Before Thinking" (BDBT) programs to leverage subliminal effects and self-reflection, this study proposes that behavior-cognition feedback loops may facilitate a virtuous cycle. Our promising observations provide recommendations for an effective awareness-rising strategy design and suggest extensive insights from potential short-interval panel analysis in the future.

Exposure to heat wave risks across time and places: Seasonal variations and predictors of feelings of threat across heat wave geographical susceptibility locations

Vulnerability to heat waves and their negative effects on health vary not only due to individual factors but also due to situational factors, such as time and geography. Hence, we explored seasonal variations and predictors of heat wave feelings of threat across different heat wave geographical susceptibility locations in Portugal. A total of 238 Portuguese residents responded to a web-based longitudinal survey: before the summer, during a heat wave in the summer, during the summer, and after the summer. Geographical location was used as an indicator of risk exposure, operationalized as heat wave occurrence susceptibility (low, moderate, high). Heat wave demands and resources perceptions were assessed to compute an indicator of heat wave feelings of threat. During the heat wave, feelings of threat were higher among participants in high-susceptibility locations, with demands outweighing resources perceptions, suggesting greater distress and coping difficulty. Regression analysis suggested that older participants and female participants living in moderate-high-susceptibility locations had greater difficulty in recovering. Heat wave risk perception and positive affect about heat were identified as the most consistent predictors of heat wave feelings of threat, with risk perception increasing and positive affect decreasing such feelings. Participants with (individual and geographical) vulnerability profiles, who had greater difficulty in coping and recovering from heat waves, could benefit from resource-building/enhancing interventions. In a climatic crisis context, monitoring psychological responses to heat waves (e.g., threat) may enable anticipated action to build resilience before, rather than after, the effects become damaging to physical and psychological health.

Defending against environmental threats: Unveiling household adaptation strategies and population heterogeneity

Humanity faces a variety of risks from pollution and environmental degradation. Societal advancement has equipped the public with numerous self-protection measures to mitigate these threats. However, the ways in which individuals deploy and balance self-defence mechanisms within this complex risk landscape and the resulting consequences remain largely unexplored. Drawing on a detailed survey of households' self-defence practices, this study rigorously analyses the heterogeneity and driving factors behind household-level self-defence strategies. Through exploratory latent class modelling, we identified four distinct defence patterns: inaction, water-sensitive, air-sensitive, and multifaceted. These patterns reveal varied defence capabilities among the population. By integrating frameworks from economics and social psychology, significant disparities were found in the driving factors behind these patterns. Practices aimed at combating air pollution are primarily driven by the actual severity of pollution and perceived coping capabilities, whereas measures to enhance water quality are influenced more by perceived threats. This disparity arises from variations in information availability and health awareness. The study also highlights a misalignment between the distribution of defence capabilities and the levels of pollution. Given that income restricts self-defence options, this mismatch indicates that economically disadvantaged groups are disproportionately affected by severe health inequalities.

The mediating role of pro-environmental attitude and intention on the translation from climate change health risk perception to pro-environmental behavior

Climate change is a serious environmental issue appearing in China. As a public service institution operating around the clock, the negative impact of hospitals on the environment is evident, promoting their workers' pro-environmental behavior (PEB) through increasing climate change health risk perception (CHRP) is an effective method to protect the environment and achieve sustainable development. This study investigates how CHRP shapes pro-environmental attitude (PEA), pro-environmental intention (PEI), and pro-environmental behavior (PEB) among hospital workers. Using structural equation modeling (SEM) to determine the chain of causation from CHRP to PEB among hospital workers. The result shows that CHRP positively affects PEA and PEI, and PEI positively affects their PEB. In addition, although CHRP has no significant direct effect on PEB, it can play a crucial indirect effect through the mediating role of PEI. Moreover, the result of multiple regression shows that there are significant differences regarding PEA, PEI, and PEB.

Environmental health knowledge and competences in Basque health workers. A comparison of different professional profiles

Environmental exposures are responsible for a quarter of morbidity and mortality rates globally. Primary care professionals work in a privileged position to detect and intervene on environmental health matters. Nevertheless, due to lack of specific training, international literature shows that primary care health professionals have limited skills to deal with those. The objectives of this study were to assess the levels of environmental health (EH) knowledge and competence of a sample of 446 health professionals and students in the Basque Country and explore the presence that EH has on their daily practice. Only a very small proportion of participants had received training and took environmental clinical history regularly. Participants were confident to deal, and actually dealt, with tobacco, pollen and sun exposures but less able to address topics like biomarkers, pesticides and endocrine disruptors. Finally, and in accordance to previous works, we found moderate levels of EH knowledge and skills in our sample, and observed that nurses and nursing students reported higher EH skills than other professional profiles but scored lower in knowledge. Despite the manifold impacts of environmental exposures on health, interventions to strengthen health professionals' EH competence are required.

The effects of attitudes, norms, and perceived control on the adaptation of elderly individuals and individuals with chronic health conditions to heatwaves

BACKGROUND

In this study, the theory of planned behaviour (TPB) was used to examine the determinants of the heat protection intentions and actions of elderly individuals and individuals with chronic health conditions. This is an important topic as understanding the motivations for adapting behaviours to heatwaves can inform the design of warning systems and awareness campaigns by public health authorities to mitigate the adverse effects of weather hazards on health.

METHODS

Three phone surveys were conducted in 2015 and 2016 to collect data on a large sample of individuals with increased vulnerability to heatwaves in the city of Longueuil, Canada. Prospective and panel fixed effects logit models for ordinal variables were used to analyse the factors that influenced heat protection intentions and actions.

RESULTS

Attitudes, norms, and perceived control have positive effects on intentions to adopt heatwave protection actions and intentions on the effective adoption of these preventive measures. The hypothesis according to which perceived control moderates the effect of attitudes and norms on intentions is rejected. In addition, the results suggest that elderly individuals are less likely than individuals in other age groups to adopt heat protection actions. Health conditions related to vulnerability to hot weather do not seem to significantly improve the adoption of heat protection behaviours.

CONCLUSIONS

The adoption of heatwave protection actions can be improved by public health interventions that influence attitudes and social norms related to heat protection behaviours and facilitate their adoption.

Effects of Prolonged Exposure to Air Pollution and Neighborhood Disadvantage on Self-Rated Health among Adults in the United States: Evidence from the Panel Study of Income Dynamics

BACKGROUND

Although overall air quality has improved in the United States, air pollution remains unevenly distributed across neighborhoods, producing disproportionate environmental burdens for minoritized and socioeconomically disadvantaged residents for whom greater exposure to other structurally rooted neighborhood stressors is also more frequent. These interrelated dynamics and layered vulnerabilities each have well-documented associations with physical and psychological health outcomes; however, much remains unknown about the joint effects of environmental hazards and neighborhood socioeconomic factors on self-reported health status.

OBJECTIVES

We examined the nexus of air pollution exposure, neighborhood socioeconomic disadvantage, and self-rated health (SRH) among adults in the United States.

METHODS

This observational study used individual-level data from the Panel Study of Income Dynamics merged with contextual information, including neighborhood socioeconomic and air pollution data at the census tract and census block levels, spanning the period of 1999-2015. We estimated ordinary least squares regression models predicting SRH by 10-y average exposures to fine particulate matter [particles ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 )] and neighborhood socioeconomic disadvantage while controlling for individual-level correlates of health. We also investigated the interaction effects of air pollution and neighborhood socioeconomic disadvantage on SRH.

RESULTS

On average, respondents in our sample rated their health as 3.41 on a scale of 1 to 5. Respondents in neighborhoods with higher 10-y average PM 2.5 concentrations or socioeconomic disadvantage rated their health more negatively after controlling for covariates [β = - 0.024 (95% CI: - 0.034 , - 0.014 ); β = - 0.107 (95% CI: - 0.163 , - 0.052 ), respectively]. We also found that the deleterious associations of PM 2.5 exposure with SRH were weaker in the context of greater neighborhood socioeconomic disadvantage (β = 0.007 ; 95% CI: 0.002, 0.011).

DISCUSSION

Study results indicate that the effects of air pollution on SRH may be less salient in socioeconomically disadvantaged neighborhoods compared with more advantaged areas, perhaps owing to the presence of other more proximate structurally rooted health risks and vulnerabilities in disinvested areas (e.g., lack of economic resources, health access, healthy food options). This intersection may further underscore the importance of meaningful involvement and political power building among community stakeholders on issues concerning the nexus of environmental and socioeconomic justice, particularly in structurally marginalized communities. https://doi.org/10.1289/EHP11268.

Heat waves and adaptation: A global systematic review

BACKGROUND

Given the increasing trend of global warming and extreme weather conditions, including heat waves and its effects on health, the present study was done to investigate adaptive behaviors of communities in the world for combating heat waves.

METHOD

ology: In this systematic review, out of 1529 results, 57 relevant and authoritative English papers on adaptation to heat waves hazard were extracted and evaluated using valid keywords from valid databases (PubMed, WOS, EMBASE, and Scopus). In addition, multiple screening steps were done and then, the selected papers were qualitatively assessed. Evaluation results were summarized using an Extraction Table.

RESULTS

In this paper, the adaptive behaviors for combating heat waves hazard were summarized into 11 categories: Education and awareness raising, Adaptation of critical infrastructure, Governments measures, Health-related measures, Application of early warning system, Protective behaviors in workplace, Physical condition, Adaptive individual behaviors, Design and architecture of the building, Green infrastructure (green cover), and Urban design.

CONCLUSION

The findings of this study showed that community actions have significant effects on adaptation to heat wave. Therefore, for reducing heat wave-related negative health effects and vulnerability, more attention should be paid to the above-mentioned actions for mitigation, preparation, and responding regarding heat waves.

PROSPERO REGISTRATION NUMBER

CRD42021257747.

Perception of health risks in contexts of extreme climate change in semiarid Northeastern Brazil: an analysis of the role of socioeconomic variables

BACKGROUND

Global climate change poses a significant challenge in contemporary society, particularly affecting vulnerable populations like small farmers residing in arid and semiarid regions. This study aims to investigate the perception of health risks and adaptive responses in the semiarid region of Northeast Brazil (NEB). Four questions were formulated: (1) How do socioeconomic factors influence the perception of health risks during extreme climate events? (2) How do socioeconomic factors impact the adoption of adaptive responses to mitigate health risks during extreme weather events? (3) How does the perceived risk level affect the utilization of adaptive responses? (4) What is the influence of extreme climate events on the perceived risks and the adoption of adaptive responses?

METHOD

The research was conducted in the rural community of Carão, situated in the Agreste region of the State of Pernambuco, NEB. Semi-structured interviews were conducted with 49 volunteers aged 18 and above. The interviews aimed to gather socioeconomic information, including sex, age, income, access to healthcare services, family size, and education level. Additionally, the interviews explored the perceived risks and responses employed during different extreme climate events such as droughts or heavy rainfall. The perceived risks and adaptive responses data were quantified to address the research questions. Generalized linear models were employed to analyze the data for the first three questions, while the nonparametric Mann-Whitney test was used for the fourth question.

RESULTS

The study found no significant differences in the level of perceived risk and adaptive responses between the two climate extremes. However, the quantity of adaptive responses was found to be directly influenced by the perceived risks, regardless of the type of extreme climate event.

CONCLUSION

The study concludes that risk perception is influenced by various complex factors, including socioeconomic variables, and plays a critical role in the adoption of adaptive responses during extreme climate events. The findings suggest that specific socioeconomic variables have a more pronounced influence on how individuals perceive and adapt to risks. Furthermore, the results indicate a cause-and-effect relationship between perceived risks and the generation of adaptive responses. These findings contribute to a better understanding of the factors shaping risk perception and provide valuable insights for future studies in regions prone to extreme climate events.

Perceived COVID-19 Severity, Risk of Infection, and Prevention Self-Efficacy in Saudi Arabia During Lockdown: A Population-Based National Study

Evidence shows that the risk perception of humans can significantly affect their response to a threat. This population-based, cross-sectional study explored the determinants of perceived disease seriousness, perceived disease infectiveness, and perceived prevention self-efficacy of coronavirus disease (COVID-19), during the lockdown period, using the health belief model for preventive behavior (HBMPB) among 4423 adults in Saudi Arabia from 13 provinces. Multivariate binary regression was used to analyze the independent factors of three risk perception variables and to measure their effect on adherence to preventive measures. Overall, COVID-19 seriousness was perceived to be higher than that of diabetes and lower than that of a heart attack, while its infectiousness was perceived to be high by 75.3% of the participants. Furthermore, 66.6% had a low perception of their prevention self-efficacy. The HBMPB showed independent effects of all three risk perception parameters on adherence to the preventive measures, including perceived seriousness (Odd's ratio [OR] = 1.26; 95% confidence interval [95% CI] = 1.01-1.56), infectiousness (OR = 1.90; 95% CI = 1.52-2.38), and prevention self-efficacy (OR = 1.51; 95% CI = 1.20-1.91). Authorities should maintain an optimal level of communication on the COVID-19 risk, communicate more about the virus' cycle and the disease to demystify the rationale of the preventive measures, and enhance confidence in their efficiency.

Factors affecting outdoor physical activity in extreme temperatures in a sub-tropical Chinese urban population: an exploratory telephone survey

BACKGROUND

Physical activity (PA) can be affected by extreme temperatures, however fewer studies have identified factors impacting this relationship. This study sought to identify factors associated with changes of outdoor PA during extreme cold/heat events in a sub-tropical Chinese urban population, including factors of sociodemographic, health conditions, temperature-related awareness and attitude, and protective behaviours.

METHODS

Two telephone surveys were conducted a week after extreme cold/heat events in 2016 and 2017 among a cohort of Hong Kong residents over age 15. Data was collected on self-reported changes in outdoor PA level during the periods of extreme temperatures, health status, comorbidities, sociodemographic, and temperature-related awareness, and behavioural variables. We conducted multivariable logistic regression analyses to assess predictors of change in outdoor PA over the two extreme temperature events.

RESULTS AND CONCLUSION

Among 435 participants (42.8% response rate), over a third of the participants reported decreased outdoor PA level in extreme temperature events, while 10% reported an increase in extreme heat. Self-reported cardiovascular diseases were associated with decreased PA level in extreme cold, while hypertension was associated with unchanged/increased PA level in extreme heat. These results suggest physical activity to be an important consideration in the understanding of climate change-and-health pathways and meriting further research.

Knowledge, Attitude, Risk Perception, and Health-Related Adaptive Behavior of Primary School Children towards Climate Change: A Cross-Sectional Study in China

BACKGROUND

Children are disproportionately affected by climate change while evidence regarding their adaptive behavior and relevant influencing factors is limited.

OBJECTIVES

We attempted to investigate health-related adaptive behavior towards climate change for primary school children in China and explore potential influencing factors.

METHODS

We conducted a survey of 8322 primary school children in 12 cities across China. Knowledge, attitude, risk perception, and adaptive behavior scores for children were collected using a designed questionnaire. Weather exposures of cities were collected from 2014 to 2018. We applied a multiple linear regression and mixed-effect regression to assess the influencing factors of adaptive behavior. We also used the structural equation model (SEM) to validate the theoretical framework of adaptive behavior.

RESULTS

Most children (76.1%) were aware of climate change. They mainly get information from television, smartphones, and the Internet. A 1 score increase in knowledge, attitude, and risk perception was associated with 0.210, 0.386, and 0.160 increase in adaptive behavior scores, respectively. Females and children having air conditioners or heating systems at home were positively associated with adaptive behavior. Exposure to cold and rainstorms increased the adaptive behavior scores, while heat exposure had the opposite effects. The SEM showed that knowledge was positively associated with attitude and risk perception. Knowledge, attitude, and risk perception corresponded to 31.6%, 22.8%, and 26.1% changes of adaptive behavior, respectively.

CONCLUSION

Most primary school children in China were aware of climate change. Knowledge, attitude, risk perception, cold, and rainstorm exposure were positively associated with health-related adaptive behavior towards climate change.

Geographic and socioeconomic differences in heat-related mortality among the Dutch population: a time series analysis

OBJECTIVES

This study was conducted to examine modification in heat-related mortality in the Netherlands by sociodemographic and geographical factors including socioeconomic position and population density (PD).

DESIGN

This observational study applied time series analysis on daily mortality counts according to mean daily temperature (°C).

SETTING

Statistics Netherlands.

PARTICIPANTS

Death registrations in 2006, 2018 and 2019 from residents registered at the Dutch Personal Records Database, restricted to deaths in the period between April and October.

MAIN OUTCOME MEASURES

Assuming a V-like relation between temperature and mortality, a segmented linear model was used to estimate the temperature effects on mortality. In order to estimate the effects of severe heat, a second model including a heat threshold of 22°C was included in the model. We stratified by sociodemographic groups, calendar year and the five main causes of death (cardiovascular, respiratory, neoplasm, psychological and nervous system, and other) and controlled for time trend and seasonality.

RESULTS

The effect of 1°C increase in temperature whereby the mean daily temperature exceeded 16°C was a 1.57% (95% CI 1.51% to 1.63%) increase in mortality among the total population. In temperature segments whereby the mean daily temperature exceeded 22°C, this effect was 2.84% (95% CI 2.73% to 2.93%). Low-income groups were at higher risk of heat-related mortality, compared with high-income groups. Areas with a high PD show relatively weak effects within both the warm and heat segments.

CONCLUSION

Results of this study highlight the variation in terms of heat vulnerability among the Dutch population, whereby poor living conditions specifically may increase the effect on high temperature on mortality.

COVID-19 related policies: The role of environmental concern in understanding citizens' preferences

COVID-19 has led to an unprecedented health and economic crisis worldwide. Many governments of the world have accelerated an adoption of public policies to address this crisis; however, a trade-off between the economy and public health exists. Previous studies in this area have mainly focused on the impact of COVID-19 on human life and the environment. This work adds to the literature by analyzing how individual environmental concern can affect citizens' preferences for public policies that deal with COVID-19. A data set of 26,131 participants from 26 countries was used to test the research model. Results indicate that environmental concern is positively associated with a preference for long-term oriented altruistic policies, and it shapes the relationship between economic and health problems at the country level on our dependent variable. Specifically, as the level of environmental concern increases, the negative effect of COVID-19's economic problems on the preference for long-term altruistic policies is diminished. In turn, in the case of health problems, the impact on the preference for long-term altruistic policies increases as environmental concern increases. Also, both individual-level and country-level characteristics affect citizens' preferences for policies related to the COVID-19 pandemic.

Effective interventions on health effects of Chinese rural elderly under heat exposure

Due to climate change, the heatwave has become a more serious public health threat with aging as an aggravating factor in recent years. There is a pressing need to detect the most effective prevention and response measures. However, the specific health effects of interventions have not been characterized on an individual scale. In this study, an intervention experiment was designed to explore the health effects of heat exposure at the individual level and assess the effects of different interventions based on a comprehensive health sensitivity index (CHSI) in Xinyi, China. Forty-one subjects were recruited randomly, and divided into one control group and three intervention groups. Interventions included education (Educate by lecturing, offering relative materials, and communication), subsidy support (offer subsidy to offset the cost of running air conditioning), and cooling-spray (install a piece of cooling-spray equipment in the yard). Results showed that systolic blood pressure (SBP) and deep sleep duration (DSD) were significantly affected by short-term heat exposure, and the effects could be alleviated by three types of interventions. The estimated CHSI indicated that the effective days of the education group were longer than other groups, while the lower CHSI of the subsidy group showed lower sensitivity than the control group. These findings provide feasible implementation strategies to optimize Heat-health action plans and evaluate the intervention performance.

ELECTRONIC SUPPLEMENTARY MATERIAL

Supplementary material is available in the online version of this article at 10.1007/s11783-022-1545-4 and is accessible for authorized users.

Does Ethnic Diversity Impact on Risk Perceptions, Preparedness, and Management of Heat Waves?

Detrimental health impacts of heatwaves, including excess mortality, are increasing worldwide. To assess risk perceptions, protective knowledge and behaviors concerning heatwaves in Israel, a study was initiated, comparing attitudes of majority (Jewish) and minority (Arab) populations. A quantitative survey was disseminated through an internet panel, to a representative sample of 556 individuals (79% Jews; 21% Arabs). Overall, 74% consider heatwaves a problem, 93% believe that heatwaves' frequencies will increase, 27% are very concerned about the effects of heatwaves. Higher levels of awareness to heatwaves were found among Jewish compared to Arab respondents; 90 vs. 77% (respectively) could name heatwaves' symptoms (p < 0.001); 81 vs. 56% (respectively) reported knowing how to protect themselves (p < 0.001); 74 vs. 47% (respectively) reported knowing what to do when someone suffers from heat stroke (p < 0.001). Arab compared to Jewish respondents presented higher levels of concern about heatwaves' effects (3.22 vs. 3.09 respectively; t −2.25, p = 0.03), while knowledge of protective measures was higher among Jews compared to Arabs (3.67 vs. 3.56 t = 2.13 p = 0.04). A crucial component of enhancing preparedness to heatwaves is empowerment of minority as well as majority groups, to strengthen their capacity to implement protective behavior and elevate their self-belief in their individual ability and fortitude.

The driving influences of human perception to extreme heat: A scoping review

Prior research demonstrates a link between heat risk perception and population response to a heat warning. Communicating a precise and understandable definition of "heat" or "heatwaves" can affect how a population perceives and responds to extreme heat. Still, little is known about how heat perception affects behavior changes to heat and heat communication across diverse populations. This scoping review aims to identify and describe the main themes and findings of recent heat perception research globally and map critical research gaps and priorities for future studies. Results revealed risk perception influences a person's exposure to and behavioral response to excessive heat. Risk perception varied geographically along the rural-urban continuum and was typically higher among vulnerable subgroups, including populations who were low-income, minority, and in poor health. A more integrated approach to refining risk communication strategies that result in a behavioral change and incorporates the individual, social, and cultural components of impactful group-based or community-wide interventions is needed. Research employing longitudinal or quasi-experimental designs and advanced statistical techniques are required to tease apart the independent and interacting factors that causally influence risk communication, heat perception, and adaptive behaviors. We advance a framework to conceptualize the structural, environmental, personal, and social drivers of population heat risk perception and how they interact to influence heat perception and adaptive behaviors. Our findings map future research priorities needed for heat perception and a framework to drive future research design.

Heat risk of residents in different types of communities from urban heat-exposed areas

Heat risk assessment is important due to serious health problems caused by heat waves. The complexity and diversity of socio-ecological characteristics in urban areas that lead to heat risk are more serious in heat-exposed areas, while risk assessments and determinant based on individuals in heat-exposed areas have been neglected in previous studies. This study pursues a new idea of combining questionnaire surveys and remote sensing analysis to identify urban heat-exposed areas and assess heat risk in heat-exposed areas of Beijing, China. Morphological spatial pattern analysis (MSPA) was used to identify large and continuous hotspot regions as urban heat-exposed areas based on summer surface temperature from 2011 to 2017. A total of 1484 valid questionnaires were completed by residents of heat-exposed areas. The majority of respondents (96.4%) indicated that they perceived heat risk. Moreover, the residents without a local "hukou" were a potentially vulnerable group (note: hukou refers to the population registration management system.). This study further analysed the diversity of community types within the heat-exposed areas. There were significant differences in heat risk among the different community types of multi-story residential districts, Hutong (a traditional architectural form) residential districts and city villages. In particular, the degree of heat risk perceived by residents living in these the community types was determined by whether they had pre-existing medical conditions; however, age only played a decisive role in city villages. This study not only enriches the current understanding of health risks affected by heat waves but also explores the determinants contributing to the severity of heat risk. The output provides important information for future development of heat mitigation and adaptation strategies.

Psychological Distance Toward Air Pollution and Purchase Intention for New Energy Vehicles: An Investigation in China

Air pollution in China has been drawing considerable attention in recent years. The emergence of new energy vehicles (NEVs) provides hope to reduce air pollutant emission. However, consumers' recognition and acceptance of NEVs remain at the early stage. This research aims to explore how consumers' environmental concern influences their NEV purchase intention. Specifically, this research conducted an online survey and an experiment to address the following issues: (1) how consumers' psychological distance (PD) toward air pollution influences their purchase intention for NEVs, and does their risk perception of the consequences of air pollution mediate this influence; (2) whether consumers' perceived price level of NEVs plays a moderating role in the relationship between risk perception and purchase intention; and (3) whether the construal level of stimulus can be manipulated to influence consumers' PD toward air pollution to increase their purchase intention for NEVs. The results of study 1, based on a total of 293 valid samples, show that consumers' PD toward air pollution significantly affects their purchase intention for NEVs, and risk perception of the consequences of air pollution plays a considerable mediating role. Meanwhile, consumers' perceived price level of NEVs has a significant negative moderating effect on the relationship between risk perception and purchase intention. The results of study 2, based on an online experiment, show that the construal level of stimulus can influence consumers' PD toward air pollution, which in turn affects their purchase intention for NEVs. The findings of this research have implications for businesses' promotional strategies and governments' policies. For instance, low-construal-level promotional materials can be developed to arouse consumers' environmental concern, thereby facilitating their eco-friendly consumption behavior. Governmental financial assistance and other policies can also increase consumers' willingness to purchase NEVs.

Local actions to health risks of heatwaves and dengue fever under climate change: Strategies and barriers among primary healthcare professionals in southern China

BACKGROUND

Climate change and extreme weather poses significant threats to community health, which need to be addressed by local health workforce. This study investigated the perceptions of primary healthcare professionals in Southern China on individual and institutional strategies for actions on health impacts of climate change and the related barriers.

METHODS

A mixed methodological approach was adopted, involving a cross-sectional questionnaire survey of 733 primary healthcare professionals (including medical doctors, nurses, public health practitioners, allied health workers and managers) selected through a multistage cluster randomized sampling strategy, and in-depth interviews of 25 key informants in Guangdong Province, China. The questionnaire survey investigated the perceptions of respondents on the health impacts of climate change and the individual and institutional actions that need to be taken in response to climate change. Multivariate logistic regression models were established to determine sociodemographic factors associated with the perceptions. The interviews tapped into coping strategies and perceived barriers in primary health care to adapt to tackle challenges of climate change. Contents analyses were performed to extract important themes.

RESULTS AND CONCLUSION

The majority (64%) of respondents agreed that climate change is happening, but only 53.6% believed in its human causes. Heat waves and infectious diseases were highly recognized as health problems associated with climate change. There was a strong consensus on the need to strengthen individual and institutional capacities in response to health impacts of climate change. The respondents believed that it is important to educate the public, take active efforts to control infectious vectors, and pay increased attention to the health care of vulnerable populations. The lack of funding and limited local workforce capacity is a major barrier for taking actions. Climate change should be integrated into primary health care development through sustainable governmental funding and resource support.

Personal Cold Protection Behaviour and Its Associated Factors in 2016/17 Cold Days in Hong Kong: A Two-Year Cohort Telephone Survey Study

Background: Despite larger health burdens attributed to cold than heat, few studies have examined personal cold protection behaviours (PCPB). This study examined PCPB during cold waves and identified the associated factors in a subtropical city for those without central heating system. Methods: A cohort telephone survey was conducted in Hong Kong during a colder cold wave (2016) and a warmer cold wave (2017) among adults (≥15). Socio-demographic information, risk perception, self-reported adverse health effects and patterns of PCPB during cold waves were collected. Associated factors of PCPB in 2017 were identified using multiple logistic regression. Results: The cohort included 429 subjects. PCPB uptake rates were higher during the colder cold wave (p < 0.0005) except for ensuring indoor ventilation. Of the vulnerable groups, 63.7% had low self-perceived health risks. High risk perception, experience of adverse health effects during the 2016 cold wave, females and older groups were positive associated factors of PCPB in 2017 (p < 0.05). Conclusions: PCPB changed with self-risk perception. However vulnerable groups commonly underestimated their own risk. Indoor ventilation may be a concern during cold days in settings that are less prepared for cold weather. Targeted awareness-raising promotion for vulnerable groups and practical strategies for ensuring indoor ventilation are needed.

Safety Behaviors to Reduce Risk of Using Chemical Household Products: An Application of the Risk Perception Attitude Framework

Various chemical household products (CHPs) can make life more convenient; however, CHP users have higher rates of chemical exposure and are faced with the risk of accidents associated with using these products. Safe use of CHPs requires that individuals perform safety-related behaviors such as reading and following CHP risk information. As such, it may be worthwhile to apply the Risk Recognition Attitude (RPA) framework to classify groups of CHP users and investigate whether there is a difference in the safety behaviors between them. Therefore, the objectives of this study are to (a) examine social determinants of each group in the RPA framework, (b) identify different policies that would be effective for each group, and (c) provide evidence to inform the development of effective policies and risk communication strategies that encourage safety behaviors. The study included 1537 subjects and used an ANOVA with a post-hoc Tukey test to examine practices of the four groups in terms of two safety behaviors. A multinomial logistic regression was performed to identify factors that influence the classification of the group types. The results confirmed that safety behaviors associated with using CHPs differed according to weak levels of efficacy beliefs. Two groups of particular concern for low rates of safety behaviors were those with lower education and income levels. Recommendations include (a) customized safety policies and risk communications based on RPA characteristics, (b) distinctive messaging for different groups, (c) policy support for vulnerable populations, and (d) implementing ‘user-centered’ rather than ‘substance-centered’ policies and communications for the public.

Who feels a greater environmental risk? Women, younger adults and pro-environmentally friendly people express higher concerns about a set of environmental exposures

Health-related risk perceptions concerning environmental exposures reflect the public's awareness of certain environmental issues that may compromise their health. These perceptions may trigger coping strategies and self-protective behaviors, which are key for protecting people's health. With this study, we sought 1) to assess the general public's perceptions of risk from a set of environmental exposures compared with the assessment of experts; and 2) to build predictive models of the general public's risk perceptions using a comprehensive set of sociodemographic and psycho-environmental variables. We recruited a sample of 338 inhabitants (208 women, 45.8 years on average) of Gipuzkoa (Basque Country). Participants completed a paper-and-pencil questionnaire comprising questions on general sociodemographic characteristics and on health-related behaviors, and several psycho-environmental scales assessing general environmental knowledge, nature relatedness, pro-environmental behavior, environmental concerns and place attachment. Additionally, we contacted 33 regional experts who also evaluated the risk associated with the given set of exposures. Risk scores assigned by participants ranged from 1.51 to 3.42 (out of 4) and were higher than those assigned by the experts. Nonetheless, the pattern of risk prioritization was similar in the two groups. Explanatory models accounted for small to moderate shares of the variance in environmental exposure risk (R² = 0.05 to 0.17). The best predictors of risk perceptions were gender, age, environmental knowledge and egoistic environmental concerns. Biospheric concerns, nature relatedness and educational level hardly made any contribution. Assessment of past experiences with each environmental exposure, affective reactions towards them and psychological traits could enrich future explanatory models.

Heat-health action plans in Europe: Challenges ahead and how to tackle them

High temperatures have periodically affected large areas in Europe and urban settings. In particular, the deadly 2003 summer heat waves precipitated a multitude of national and subnational health prevention and research efforts. Building on these and other international experiences the WHO Regional Office for Europe developed and published in 2008 a comprehensive framework for prevention, the heat-health action plans (HHAPs). This provided a blueprint used by several national and subnational authorities to design their prevention efforts. A decade after the publication of the WHO guidance, a wealth of new evidence and acquired implementation experience has emerged around HHAP effectiveness; heat exposure; acclimatization and adaptation; heat-health governance and stakeholder involvement; and the role of urban design and greening interventions in prevention. This evidence and experience can guide the strategies to tackle current and upcoming challenges in protecting health from heat under a warming climate.