Out of control mortality matters: the effect of perceived uncontrollable mortality risk on a health-related decision

Risk perception, compliance with COVID-19 measures, and the role of social media after China's lockdown lift

Introduction

Few studies have investigated people's reactions after a sudden lift. The transitional experiences of Chinese people at the end of 2022 serve as a valuable reference for pandemic management. Therefore, this study investigates Chinese people's perception of risks after the lifting, the influence of risk perception on their compliance with COVID-19 measures, and the moderating effect of social media on this influence.

Methods

Initially, using a random sampling approach, we carried out an online questionnaire survey through Questionnaire Star, an online questionnaire platform. 417 (304 females, 13-64 years old) participants responded to questions on their perception of risks, compliance with COVID-19 measures, and trust in social media. Then, in the follow-up experiment, we observed another 60 (30 females, 18-22 years old) participants' actual behaviors to see how they comply with COVID-19 measures (for the peak of the confirmed cases, we chose to make do with this small size). We also asked them to complete a paper questionnaire on risk perception and trust in social media.

Results

The initial survey indicated that, after the lifting, Chinese citizens perceived high risks (they reported a possibility of 61.04 out of 100 to be infected and threatened by COVID-19. The number was 54 in a previous study), showed a low degree of adherence to COVID-19 measures (on a scale of 1-5, they reported a score of 2.04 in private, and 1.89 in public), and social media positively moderated the relationship between risk perception and adherence (ΔR2 = 0.10, p < .01 for private behavior; ΔR2 = 0.13, p < .01 for public behavior). The follow-up experiment further confirmed these findings.

Conclusion

This study suggests that, when lifting lockdowns on a national scale, the government should inform the public about the risks accurately, encourage healthy behaviors, and make full use of social media to promote adherence to COVID-19 measures. By using a hybrid approach that combines a questionnaire survey with actual behavior observation, this study expands earlier research into the understudied context of lockdown lifts. Finding effective strategies to support individuals through the transition period can facilitate global pandemic management.

The Relationship Between Perceived Uncontrollable Mortality Risk and Health Effort: Replication, Secondary Analysis, and Mini Meta-analysis

BACKGROUND

The Uncontrollable Mortality Risk Hypothesis (UMRH) states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviors. Greater levels of perceived uncontrollable mortality risk (PUMR) have been associated with lower health effort in previous research, but the topic remains understudied.

PURPOSE

To examine the evidence for the UMRH by replicating a previous study investigating the effects of PUMR on social gradients in health effort, and conducting a mini meta-analysis of the overall relationship between PUMR and health effort.

METHODS

We replicated Pepper and Nettle (2014), who reported a negative relationship between PUMR and health effort, and that the positive effect of subjective socioeconomic position on health effort was explained away by PUMR. We also compared the predictive effect of PUMR on health effort with that of dimensions from the Multidimensional Health Locus of Control scale-a well-used measure of a similar construct, which is frequently found to be associated with health behavior. Finally, we conducted a mini meta-analysis of the relationship between PUMR and health effort from the available research.

RESULTS

PUMR was negatively associated with health effort, and mediated 24% of the total effect of subjective socioeconomic position on health effort, though this mediation effect was weaker than in Pepper and Nettle (2014). PUMR was shown to be a substantially stronger predictor of health effort than the relevant dimensions of the MHLC scale. Finally, our mini meta-analysis indicated a medium-sized negative relationship between PUMR and health effort.

CONCLUSIONS

Our findings offer support for the role of PUMR in mediating the relationship between subjective socioeconomic position and health effort. The results highlight the importance of measuring and understanding PUMR in studying socioeconomic inequalities in health behaviors. We discuss potential areas for future research, including determining the accuracy of PUMR, investigating influential cues, examining the role of media in shaping risk perceptions, and understanding individuals' awareness of their own perceptions of mortality risk.

The Effect of Income and Wealth on Behavioral Strategies, Personality Traits, and Preferences

Individuals living in either harsh or favorable environments display well-documented psychological and behavioral differences. For example, people in favorable environments tend to be more future-oriented, trust strangers more, and have more explorative preferences. To account for such differences, psychologists have turned to evolutionary biology and behavioral ecology, in particular, the literature on life-history theory and pace-of-life syndrome. However, critics have found that the theoretical foundations of these approaches are fragile and that differences in life expectancy cannot explain vast psychological and behavioral differences. In this article, we build on the theory of optimal resource allocation to propose an alternative framework. We hypothesize that the quantity of resources available, such as income, has downstream consequences on psychological traits, leading to the emergence of behavioral syndromes. We show that more resources lead to more long-term orientation, more tolerance of variance, and more investment in low marginal-benefit needs. At the behavioral level, this translates, among others, into more large-scale cooperation, more investment in health, and more exploration. These individual-level differences in behavior, in turn, account for cultural phenomena such as puritanism, authoritarianism, and innovation.

Individual characteristics associated with perceptions of control over mortality risk and determinants of health effort

People who believe they have greater control over health and longevity are typically more likely to invest in their long-term health. Investigating individual differences in perceived control over risk and exploring different determinants of health effort may help to tailor health promotion programs to more effectively encourage healthy behaviors. From a sample of 1500 adults, we measured perceived control over 20 causes of death, overall perceived uncontrollable mortality risk (PUMR), state-level optimism, self-reported health effort, and the accuracy of estimations of avoidable deaths. We found individual differences in perceptions of control over specific causes of death based on age, gender, and income. PUMR was predicted by socioeconomic variables expected to influence exposure to risk and resource availability. Higher levels of PUMR, not perceptions of control over specific causes of death, predicted self-reported health effort. The strength of relationship between PUMR and lower health effort was not moderated by state-level optimism. Age and education both positively predicted greater accuracy in assessing the prevalence of avoidable deaths. We suggest that PUMR may capture people's "general sense" of mortality risk, influenced by both exposure to hazards and the availability of resources to avoid threats. Conversely, perceived control over specific risks may involve more deliberate, considered appraisals of risk. This general sense of risk is thought to play a more notable role in determining health behaviors than specific assessments of control over risk. Further study is needed to investigate the degree to which PUMR accurately reflects objective measures of individual risk.

Perceptions of control over different causes of death and the accuracy of risk estimations

Background

A large number of deaths could be avoided by improving health behaviours. The degree to which people invest in their long-term health is influenced by how much they believe they can control their risk of death. Identifying causes of death believed to be uncontrollable, but likely to occur, may provide actionable targets for health interventions to increase control beliefs and encourage healthier behaviours.

Method

We recruited a nationally representative online sample of 1500 participants in the UK. We assessed perceived control, perceived personal likelihood of death, certainty of risk estimation, and perceived knowledge for 20 causes of death. We also measured overall perceived uncontrollable mortality risk (PUMR) and perceived prevalence for each of the Office for National Statistics' categories of avoidable death.

Findings

Risk of death due to cancer was considered highly likely to occur but largely beyond individual control. Cardiovascular disease was considered moderately controllable and a likely cause of death. Drugs and alcohol were perceived as risks both high in control and low in likelihood of death. However, perceptions of control over specific causes of death were found not to predict overall PUMR, with the exception of cardiovascular disease. Finally, our sample substantially overestimated the prevalence of drug and alcohol-related deaths in the UK.

Conclusions

We suggest that more can be done by public health communicators to emphasise the lifestyle and behavioural changes that individuals can make to reduce their general cancer risk. More work is needed to understand the barriers to engaging with preventative behaviours and maintaining a healthy heart. Finally, we call for greater journalistic responsibility when reporting health risks to the public.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01910-8.

Does higher perceived risk of morbidity and mortality decrease risk-taking?

Previous studies have shown that people change their behaviour in response to negative shocks such as economic downturns or natural catastrophes. Indeed, the optimal behaviour in terms of inclusive fitness often varies according to a number of parameters, such as the level of mortality risk in the environment. Beyond unprecedented restrictions in everyday life, the COVID-19 pandemic has profoundly affected people's environment. In this study, we investigated how people form their perception of morbidity and mortality risk associated with COVID-19 and how this perception in turn affects psychological traits, such as risk-taking and patience. We analysed data from a large survey conducted during the first wave in France on 3353 nationally representative people. We found that people use public information on COVID-19 deaths in the area where they live to form their perceived morbidity and mortality risk. Using a structural model approach to lift endogeneity concerns, we found that higher perceived morbidity and mortality risk increases risk aversion. We also found that higher perceived morbidity and mortality risk leads to less patience, although this was only observed for high levels of perceived risk. Our results suggest that people adapt their behaviour to anticipated negative health shocks, namely the risk of becoming sick or dying of COVID-19.

Predicting attitudes towards screening for neurodegenerative diseases using OCT and artificial intelligence: Findings from a literature review

Recent developments in artificial intelligence (AI) and machine learning raise the possibility of screening and early diagnosis for neurodegenerative diseases, using 3D scans of the retina. The eventual value of such screening will depend not only on scientific metrics such as specificity and sensitivity but, critically, also on public attitudes and uptake. Differential screening rates for various screening programmes in England indicate that multiple factors influence uptake. In this narrative literature review, some of these potential factors are explored in relation to predicting uptake of an early screening tool for neurodegenerative diseases using AI. These include: awareness of the disease, perceived risk, social influence, the use of AI, previous screening experience, socioeconomic status, health literacy, uncontrollable mortality risk, and demographic factors. The review finds the strongest and most consistent predictors to be ethnicity, social influence, the use of AI, and previous screening experience. Furthermore, it is likely that factors also interact to predict the uptake of such a tool. However, further experimental work is needed both to validate these predictions and explore interactions between the significant predictors.

Impacts of COVID-19 lockdown on private domestic groundwater sample numbers, E. coli presence and E. coli concentration across Ontario, January 2020-March 2021: An interrupted time-series analysis

Approximately 1.5 million individuals in Ontario are supplied by private water wells (private groundwater supplies). Unlike municipal supplies, private well water quality remains unregulated, with owners responsible for testing, treating, and maintaining their own water supplies. The COVID-19 global pandemic and associated non-pharmaceutical interventions (NPIs) have impacted many environmental (e.g., surface water and air quality) and human (e.g., healthcare, transportation) systems over the past 15-months (January 2020 to March 2021). To date, the impact of these interventions on private groundwater systems remains largely unknown. Accordingly, the current study aimed to investigate the impact of a province-wide COVID-19 lockdown (late-March 2020) on health behaviours (i.e., private domestic groundwater sampling) and groundwater quality (via Escherichia coli (E. coli) detection and concentration) in private well water in Ontario, using time-series analyses (seasonal decomposition, interrupted time-series) of a large-spatio-temporal dataset (January 2016 to March 2021; N = 743,200 samples). Findings indicate that lockdown concurred with an immediate (p = 0.015) and sustained (p < 0.001) decrease in sampling rates, equating to approximately 2200 fewer samples received per week post-interruption. Likewise, a slightly decreased E. coli detection rate was observed approximately one month after lockdowns began (p = 0.003), while the proportion of "highly contaminated" samples (i.e., E. coli > 10 CFU/100 mL) was shown to increase within one month (p = 0.02), followed by a sustained decrease for the remainder of the year (May 2020-December 2020). Analyses strongly suggest that COVID-19 interventions resulted in discernible impacts on both well user behaviours and hydrogeological mechanisms. Findings may be used as an evidence-base for assisting policy makers, public health practitioners and private well owners in developing recommendations and mitigation strategies to manage public health risks during extreme and/or unprecedented future events.

COVID-19: the relationship between perceptions of risk and behaviours during lockdown

AIM

Understanding COVID-19 risk perceptions and their impact on behaviour can improve the effectiveness of public health strategies. Prior evidence suggests that, when people perceive uncontrollable risks to their health, they are less likely to engage in healthful behaviour. This article aims to understand the extent to which COVID-19 is perceived as an uncontrollable risk, and to assess whether this perceived risk is associated with health behaviour.

SUBJECT AND METHODS

We surveyed a nationally representative sample of 496 participants during the first UK lockdown. We assessed perceptions of COVID-19-related risk, self-reported adherence to infection control measures recommended by the UK Government, and general health behaviours. We predicted that increased perceived extrinsic mortality risk (the portion of mortality risk perceived to be uncontrollable) would disincentivise healthy behaviour.

RESULTS

Perceived threat to life was the most consistent predictor of reported adherence to infection control measures. Perceived extrinsic mortality risk was found to have increased due to the pandemic, and was associated with lower reported adherence to Government advice on diet, physical activity, and smoking.

CONCLUSIONS

Our findings suggest that health messages that highlight threat to life may be effective in increasing adherence to infection control, but may also lead to a reduction in health-promoting behaviours. We suggest that messages that highlight threat to life should be accompanied by statements of efficacy. Further, messages evoking feelings of concern for others may be effective in promoting compliance with anti-infection measures, without the potential for the unwelcome side-effect of discouraging healthy behaviour.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10389-021-01543-9.

Path Tortuosity in Virtual Reality: A Novel Approach for Quantifying Behavioral Process in a Food Choice Context

There is a pressing need to better understand how parents make feeding decisions for their children, but extant measures focus primarily on outcomes rather than examining the process of food choice as it unfolds. This exploratory study examined parents' translational movement as they moved throughout a virtual reality-based buffet restaurant to select a lunch for their child. Our aim was to explore whether translational movement would be related to cognitive and affective variables that underlie motivation, effort, and ultimate choices within food decision-making contexts (e.g., guilt, self-efficacy). Movement data were quantified in terms of path tortuosity: the degree of straightness of one's path while traveling through a space. Greater path tortuosity predicted a reduction in parents' guilt about their child feeding, above and beyond actual food chosen. Results suggest path tortuosity serves as an implicit measure of effort put forth by parents throughout the food decision-making process. Future work should continue to explore the utility of novel metrics that can be obtained from unique data sources, such as location tracking, for elucidating complicated behavioral processes such as food choice.

Broadening horizons: Sample diversity and socioecological theory are essential to the future of psychological science

The present lack of sample diversity and ecological theory in psychological science fundamentally limits generalizability and obstructs scientific progress. A focus on the role of socioecology in shaping the evolution of morphology, physiology, and behavior has not yet been widely applied toward psychology. To date, evolutionary approaches to psychology have focused more on finding universals than explaining variability. However, contrasts between small-scale, kin-based rural subsistence societies and large-scale urban, market-based populations, have not been well appreciated. Nor has the variability within high-income countries, or the socioeconomic and cultural transformations affecting even the most remote tribal populations today. Elucidating the causes and effects of such broad changes on psychology and behavior is a fundamental concern of the social sciences; expanding study participants beyond students and other convenience samples is necessary to improve understanding of flexible psychological reaction norms among and within populations. Here I highlight two examples demonstrating how socioecological variability can help explain psychological trait expression: (i) the role of environmental harshness and unpredictability on shaping time preference and related traits, such as impulsivity, vigilance, and self-efficacy; and (ii) the effects of industrialization, market integration, and niche complexity on personality structure. These cases illustrate how appropriate theory can be a powerful tool to help determine choices of diverse study populations and improve the social sciences.

Cuing both positive and negative episodic foresight reduces delay discounting but does not affect risk-taking

Humans frequently create mental models of the future, allowing outcomes to be inferred in advance of their occurrence. Recent evidence suggests that imagining positive future events reduces delay discounting (the devaluation of reward with time until its receipt), while imagining negative future events may increase it. Here, using a sample of 297 participants, we experimentally assess the effects of cued episodic simulation of positive and negative future scenarios on decision-making in the context of both delay discounting (monetary choice questionnaire) and risk-taking (balloon-analogue risk task). Participants discounted the future less when cued to imagine positive and negative future scenarios than they did when cued to engage in control neutral imagery. There were no effects of experimental condition on risk-taking. Thus, although these results replicate previous findings suggesting episodic future simulation can reduce delay discounting, they indicate that this effect is not dependent on the valence of the thoughts, and does not generalise to all other forms of “impulsive” decision-making. We discuss various interpretations of these results, and suggest avenues for further research on the role of prospection in decision-making.

Low perceived control over health is associated with lower treatment uptake in a high mortality population of Bolivian forager-farmers

Indigenous people worldwide suffer from higher rates of morbidity and mortality than neighboring populations. In addition to having limited access to public health infrastructure, indigenous people may also have priorities and health perceptions that deter them from seeking adequate modern healthcare. Here we propose that living in a harsh and unpredictable environment reduces motivation to pursue deliberate, costly action to improve health outcomes. We assess whether variation in Health Locus of Control (HLC), a psychological construct designed to capture self-efficacy with respect to health, explains variation in treatment uptake behavior among Tsimane Amerindians (N = 690; age range: 40-89 years; 55.8% female; data collection: 2008-2012), a high mortality and morbidity indigenous population in the Bolivian Amazon, Beni Department. Comparisons with two industrialized populations in Japan (Miyagi prefecture; e0 = 76.6 years) and the United Kingdom (Caerphilly county borough; e0 = 81.2 years) confirm that Tsimane (e0 = 54.1 years) have a more externalized HLC. Multilevel level models were used to investigate whether HLC predicts treatment uptake, and mediates the relationship between modernization and treatment uptake. External HLC scores were predictive of treatment outcomes: Powerful others scores were positively associated with probability of receiving modern treatment (adjusted odds ratio [OR] = 1.33), while Chance scores were negatively associated with probability of receiving modern treatment (adjusted OR = 0.76). We found no effects, however, of Internal HLC or educational capital on treatment uptake. Overall, our findings indicate that health-related decision-making is influenced more by a psychological orientation affecting self-efficacy, shaped in part by perceptions of environmental unpredictability and harshness, than by limited knowledge, education or other indicators of modernization.

Local environmental quality positively predicts breastfeeding in the UK's Millennium Cohort Study

Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis-one 'objective' (based on an independent assessor's neighbourhood scores) and one 'subjective' (based on respondent's scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women's decision making contexts when considering behaviours relevant to public health.

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Background

Bowel cancer screening reduces cancer-specific mortality. There is a socioeconomic gradient in the uptake of the English NHS Bowel Cancer Screening Programme (BCSP), which may lead to inequalities in cancer outcomes.

Objective

To reduce socioeconomic inequalities in uptake of the NHS BCSP’s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group.

Design

Workstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘gist’ information, (2) a ‘narrative’ leaflet, (3) ‘general practice endorsement’ (GPE) and (4) an ‘enhanced reminder’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention.

Methods

Interventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘usual care’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘gist’ leaflet (n = 163,525), (2) ‘narrative’ leaflet (n = 150,417), (3) GPE on the invitation letter (n = 265,434) and (4) ER (n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual’s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘definitive’ test result of either ‘normal’ (i.e. no further investigation required) or ‘abnormal’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome.

Results

The gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; allp-values > 0.05). GPE showed no effect on the gradient (p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10;p < 0.0001]. ER showed a significant interaction with SECs (p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20;p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06;p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11;p = 0.001). All interventions were inexpensive to provide.

Limitations

In line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect.

Conclusions

Enhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results highlight the challenge of achieving equitable delivery of the screening offer when all communication is written; the format is universal and informed decision-making mandates extensive medical information.

Future work

Socioculturally tailored research to promote communication about screening with family and friends should be developed and evaluated.

Trial registration

Current Controlled Trials ISRCTN74121020.

Funding

This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information.

Prevalence and risk factors of poor sleep quality among Inner Mongolia Medical University students: A cross-sectional survey

Medical students face new challenges at the beginning of college life, such as being responsible for oneself, an unfamiliar environment, social obligations, and academic stress, all of which influence or even heavily change their sleep quality and life, leading to sleep-related problems to some degree. This study investigated the relationship between sleep quality and behavior among students at the Inner Mongolia Medical University in China. Self-administered questionnaires were used to collect information on sociodemographic characteristics and lifestyle habits. The Pittsburgh Sleep Quality Index was also used. A total of 6044 and 6085 students completed the questionnaires in 2011 and 2013. According to the index, 27.8% (1694) of students had poor sleep quality with major risk factors being poor academic performance and interpersonal relationships in 2013. Among others, regular exercise less than three times a week, skipping breakfast, and studying in higher grades were associated with poor sleep quality. These results will help university administrators understand the risk factors of poor sleep quality among students, which can be improved through individual efforts, and provide adequate counseling and systematic education to improve their behavior and lifestyle.

Appealing to fear: A meta-analysis of fear appeal effectiveness and theories

Fear appeals are a polarizing issue, with proponents confident in their efficacy and opponents confident that they backfire. We present the results of a comprehensive meta-analysis investigating fear appeals' effectiveness for influencing attitudes, intentions, and behaviors. We tested predictions from a large number of theories, the majority of which have never been tested meta-analytically until now. Studies were included if they contained a treatment group exposed to a fear appeal, a valid comparison group, a manipulation of depicted fear, a measure of attitudes, intentions, or behaviors concerning the targeted risk or recommended solution, and adequate statistics to calculate effect sizes. The meta-analysis included 127 articles (9% unpublished) yielding 248 independent samples (NTotal = 27,372) collected from diverse populations. Results showed a positive effect of fear appeals on attitudes, intentions, and behaviors, with the average effect on a composite index being random-effects d = 0.29. Moderation analyses based on prominent fear appeal theories showed that the effectiveness of fear appeals increased when the message included efficacy statements, depicted high susceptibility and severity, recommended one-time only (vs. repeated) behaviors, and targeted audiences that included a larger percentage of female message recipients. Overall, we conclude that (a) fear appeals are effective at positively influencing attitude, intentions, and behaviors; (b) there are very few circumstances under which they are not effective; and (c) there are no identified circumstances under which they backfire and lead to undesirable outcomes.

Effects of local extrinsic mortality rate, crime and sex ratio on preventable death in Northern Ireland

Variation in preventable death can be understood from an evolutionary life history perspective. However, previous studies have failed to isolate ecological effects on preventable death. We use population-wide Census data from Northern Ireland and find that extrinsic mortality rate and crime, but not sex ratio, impacts on male preventable death.

Background and objectives: Individual investment in health varies greatly within populations and results in significant differences in the risk of preventable death. Life history theory predicts that individuals should alter their investment in health (somatic maintenance) in response to ecological cues that shift the perceived fitness payoffs to such investments. However, previous research has failed to isolate the effects of different ecological factors on preventable death, and has often relied on macro-level data without individual controls. Here, we test some key predictions concerning the local ecology—that higher extrinsic mortality rate (EMR), crime rate and mate-scarcity (male/female-biased sex ratio) at the ward-level—will be associated with a higher risk of preventable death.

Methodology: We use census-based data from Northern Ireland (n = 927 150) on preventable death during an 8.7-year period from the 2001 Census and run Cox regressions for (i) accident/suicide or alcohol-related death and (ii) deaths from preventable diseases, for men and women separately, controlling for a wide range of individual variables.

Results: We find evidence of ward-level EMR and crime rate being positively associated with preventable death among men, particularly men with low socioeconomic position. There was a tentative relationship between male-biased sex ratio and preventable death among women, but not among men.

Conclusion and implications: Both behaviours that might lead to ‘risky’ death and health neglect might be adaptive responses to local ecologies. Efforts to reduce crime might be as effective as those to reduce extrinsic mortality, and both could have positive effects on various health behaviours.