Do Americans Understand That Global Warming Is Harmful to Human Health? Evidence From a National Survey

Background: Global warming has significant negative consequences for human health, with some groups at greater risk than others. The extent to which the public is aware of these risks is unclear; the limited extant research has yielded discrepant findings. Objectives: This paper describes Americans' awareness of the health effects of global warming, levels of support for government funding and action on the issue, and trust in information sources. We also investigate the discrepancy in previous research findings between assessments based on open- versus closed-ended questions. Methods: A nationally representative survey of US adults (N = 1275) was conducted online in October 2014. Measures included general attitudes and beliefs about global warming, affective assessment of health effects, vulnerable populations and specific health conditions (open- and closed-ended), perceived risk, trust in sources, and support for government response. Findings: Most respondents (61%) reported that, before taking the survey, they had given little or no thought to how global warming might affect people's health. In response to a closed-ended question, many respondents (64%) indicated global warming is harmful to health, yet in response to an open-ended question, few (27%) accurately named one or more specific type of harm. In response to a closed-ended question, 33% indicated some groups are more affected than others, yet on an open-ended question only 25% were able to identify any disproportionately affected populations. Perhaps not surprising given these findings, respondents demonstrated only limited support for a government response: less than 50% of respondents said government should be doing more to protect against health harms from global warming, and about 33% supported increased funding to public health agencies for this purpose. Respondents said their primary care physician is their most trusted source of information on this topic, followed by the Centers for Disease Control and Prevention, the World Health Organization, and their local public health department. Conclusions: Most Americans report a general sense that global warming can be harmful to health, but relatively few understand the types of harm it causes or who is most likely to be affected. Perhaps as a result, there is only moderate support for an expanded public health response. Primary care physicians and public health officials appear well positioned to educate the public about the health relevance of climate chang

Perceived Importance of Climate Change Adaptation and Mitigation According to Social and Medical Factors Among Residents of Impacted Communities in the United States

Purpose: To determine whether perceived importance of local climate change adaptation and mitigation efforts differs according to social or medical factors among residents of impacted communities. Methods: An online survey was conducted among residents of California (Los Angeles/Orange), Florida (Miami-Dade/Broward), and Arizona (Maricopa) counties in July 2018 (n=605). Multivariable ordered logistic regression measured associations between the perceived importance of adaptation/mitigation approaches and income, race/ethnicity, and health conditions, controlling for age, political party, and county. Results: Lower income was associated with higher perceived importance of improved emergency alerts, government-subsidized costs of household air conditioners and energy-efficient appliances, strengthening buildings against extreme weather, regulation of greenhouse gas emissions, urban planning using “cooling” technologies, and expanding community gardens/local agriculture. Black respondents perceived evacuation services for those with financial barriers during extreme weather, government-subsidized costs of energy-efficient appliances, and communication from government agencies about local climate impacts and mitigation as significantly more important compared to non-Black, non-Hispanic respondents. Hispanic respondents perceived significantly greater importance of improved emergency alerts and health care access during extreme weather, evacuation services for residents without transportation, government-subsidized costs of energy-efficient appliances, regulation of greenhouse gas emissions, communication from government agencies about local climate impacts and mitigation efforts, and intergovernmental cooperation on mitigation compared to non-Hispanic respondents. Conclusions: Perceptions of the importance of specific local climate actions differ according to race/ethnicity and income. Community engagement is recommended to help local decisions reflect priorities of the most affected residents

Determinants of risk behaviors in the containment of highly pathogenic avian influenza

Background: Highly pathogenic avian influenza (H5N1) is endemic among poultry in Indonesia, where routine contact with live poultry is common. This dissertation describes the relationship between attitudinal predictors, social or structural covariates, and behavioral outcomes in routine (“maintenance”) conditions, rather than outbreaks. Recommendations inform risk communications encouraging vigilance and preventing complacency. Methods: Cross-sectional surveys of Indonesian households (n=2,843) and poultry workers (n=1,404) in 2009 were used. Study #1 measured the association between attitudinal predictors (risk perception [RP] defined as perceived susceptibility and perceived severity; self-efficacy [SE]) and behavioral outcomes. Study #2 tested the association between audience segments and behavioral outcomes. Audience segments: responsives (high RP, high SE), proactives (low RP, high SE), avoidants (high RP, low SE), indifferents (low RP, low SE). Study #3 measured associations between workers’ attitudinal predictors (same as earlier studies, plus collective efficacy) and features of the occupational environment with behavioral outcomes. Multilevel random effects regression models were used, controlling for covariates. Results for subdistricts with no recent incidence of H5N1 in poultry (“maintenance”) are presented. Results: Study #1: Greater perceived susceptibility was positively associated with high-risk and protective behaviors. Self-efficacy was positively associated protective behaviors. Perceived severity was not a significant predictor of behaviors. Study #2: Audience segments differed significantly by income and age. Responsives had the highest likelihood of protective behaviors of any cluster. Indifferents were least likely to perform several protective behaviors of any cluster. Avoidants had the lowest income and had a greater likelihood of high-risk behavior than responsives. Study #3: High collective efficacy was positively associated with multiple protective behaviors. High self-efficacy was inconsistent in predicting behavioral outcomes. Workplaces providing supplies was positively associated with protective behaviors. Conclusions: Audience segmentation provides a clearer picture of determinants of risk/protective behaviors in maintenance conditions compared to tests of each attitudinal variable. Behavioral outcomes are best among household respondents with high RP and high SE, and poor among the indifferent majority. Proactives are vulnerable to overconfidence, while avoidants may require structural interventions. For poultry workers, providing supplies will improve protective actions. Emphasizing RP and SE is not recommended for poultry workers, but community efficacy and occupational norms can encourage behavioral vigilance

Determinants of risk behaviors in the containment of highly pathogenic avian influenza

Background: Highly pathogenic avian influenza (H5N1) is endemic among poultry in Indonesia, where routine contact with live poultry is common. This dissertation describes the relationship between attitudinal predictors, social or structural covariates, and behavioral outcomes in routine (“maintenance”) conditions, rather than outbreaks. Recommendations inform risk communications encouraging vigilance and preventing complacency. Methods: Cross-sectional surveys of Indonesian households (n=2,843) and poultry workers (n=1,404) in 2009 were used. Study #1 measured the association between attitudinal predictors (risk perception [RP] defined as perceived susceptibility and perceived severity; self-efficacy [SE]) and behavioral outcomes. Study #2 tested the association between audience segments and behavioral outcomes. Audience segments: responsives (high RP, high SE), proactives (low RP, high SE), avoidants (high RP, low SE), indifferents (low RP, low SE). Study #3 measured associations between workers’ attitudinal predictors (same as earlier studies, plus collective efficacy) and features of the occupational environment with behavioral outcomes. Multilevel random effects regression models were used, controlling for covariates. Results for subdistricts with no recent incidence of H5N1 in poultry (“maintenance”) are presented. Results: Study #1: Greater perceived susceptibility was positively associated with high-risk and protective behaviors. Self-efficacy was positively associated protective behaviors. Perceived severity was not a significant predictor of behaviors. Study #2: Audience segments differed significantly by income and age. Responsives had the highest likelihood of protective behaviors of any cluster. Indifferents were least likely to perform several protective behaviors of any cluster. Avoidants had the lowest income and had a greater likelihood of high-risk behavior than responsives. Study #3: High collective efficacy was positively associated with multiple protective behaviors. High self-efficacy was inconsistent in predicting behavioral outcomes. Workplaces providing supplies was positively associated with protective behaviors. Conclusions: Audience segmentation provides a clearer picture of determinants of risk/protective behaviors in maintenance conditions compared to tests of each attitudinal variable. Behavioral outcomes are best among household respondents with high RP and high SE, and poor among the indifferent majority. Proactives are vulnerable to overconfidence, while avoidants may require structural interventions. For poultry workers, providing supplies will improve protective actions. Emphasizing RP and SE is not recommended for poultry workers, but community efficacy and occupational norms can encourage behavioral vigilance

Cigar Use Progression Among New Cigar Initiators: A Two-Part Growth Curve Analysis Among a Youth and Young Adult Cohort

AbstractIntroductionYouth and young adults (YYAs) are at high risk of cigar use. This study’s objective was to examine progression and sociodemographic differences in current cigar use and frequency among new cigar initiators.Aims and MethodsWe conducted a two-part latent growth model among a nationally representative cohort of cigar initiators (aged 15–25) to examine 24-month trajectories of current cigar use and frequency (n = 1483). The cohort was recruited via address-based sampling with online data collection from 2014 to 2019 and surveyed approximately every 6 months.ResultsThe unconditional odds of current cigar use (ie, past 30-day use) within 6 months of initiation was 0.72 (95% confidence interval: 0.63, 0.82), corresponding to a probability of 42%. The odds of current use among recent cigar initiates declined 6 months after initiation and was followed by a stabilization in use over time. Among continued users, frequency (# days used in past 30 days) increased linearly over time but remained low (3.47 days/months at 24 months). Younger individuals, non-Hispanic African Americans, those with lower subjective financial status, and current users of cigarettes, other tobacco products and/or marijuana were at highest risk within 6 months of initiation. Males, younger users, and current cigarette smokers had the highest risk for cigar progression over time.ConclusionsThis study is the first to examine longitudinal cigar use patterns among YYA cigar initiators. Findings emphasize the need for research across the cigar use spectrum and the importance of interventions targeted by age, stage of use, cigarette, other tobacco, and marijuana use and key sociodemographics to interrupt use pathways.ImplicationsThis study is the first to examine progression of cigar use among YYAs who have newly initiated cigars. Results show a high probability of current cigar use within 6 months of initiation followed by a rapid decline and stabilization over time. Frequency increases among those who continue using cigars. Males, younger users, and current cigarette smokers had the highest risk for cigar progression over time. Findings emphasize the need for targeting interventions by age, stage of use, cigarette, other tobacco, and marijuana use and key sociodemographics to interrupt use pathways.</jats:sec

Developing effective communication materials on the health effects of climate change for vulnerable groups: a mixed methods study

Abstract Background Individuals with chronic health conditions or low socioeconomic status (SES) are more vulnerable to the health impacts of climate change. Health communication can provide information on the management of these impacts. This study tested, among vulnerable audiences, whether viewing targeted materials increases knowledge about the health impacts of climate change and strength of climate change beliefs, and whether each are associated with stronger intentions to practice recommended behaviors. Methods Low-SES respondents with chronic conditions were recruited for an online survey in six cities. Respondents were shown targeted materials illustrating the relationship between climate change and chronic conditions. Changes in knowledge and climate change beliefs (pre- and post-test) and behavioral intentions (post-test only) were tested using McNemar tests of marginal frequencies of two binary outcomes or paired t-tests, and multivariable linear regression. Qualitative interviews were conducted among target audiences to triangulate survey findings and make recommendations on the design of messages. Results Respondents (N = 122) reflected the target population regarding income, educational level and prevalence of household health conditions. (1) Knowledge. Significant increases in knowledge were found regarding: groups that are most vulnerable to heat (children [p < 0.001], individuals with heart disease [p < 0.001], or lung disease [p = 0.019]); and environmental conditions that increase allergy-producing pollen (increased heat [p = 0.003], increased carbon dioxide [p < 0.001]). (2) Strength of certainty that climate change is happening increased significantly between pre- and post-test (p < 0.001), as did belief that climate change affected respondents’ health (p < 0.001). (3) Behavioral intention. At post-test, higher knowledge of heat vulnerabilities and environmental conditions that trigger pollen allergies were associated with greater behavioral intention scores (p = 0.001 and p = 0.002, respectively). In-depth interviews (N = 15) revealed that vulnerable audiences are interested in immediate-term advice on health management and protective behaviors related to their chronic conditions, but took less notice of messages about collective action to slow or stop climate change. Respondents identified both appealing and less favorable design elements in the materials. Conclusions Individuals who are vulnerable to the health effects of climate change benefit from communication materials that explain, using graphics and concise language, how climate change affects health conditions and how to engage in protective adaptation behaviors

Patterns of oral nicotine pouch use among U.S. adolescents and young adults

Oral nicotine pouches are gaining popularity, yet national-level research on youth and young adult use is still needed. We examined characteristics of those who use oral nicotine pouches and trends in use over time in a sample of U.S. youth and young adults. Data were obtained from a weekly, national, online, continuous tracking survey of approximately 315 unique participants (aged 15–24) per week. Bivariate analyses were conducted on those surveyed December 2021 to May 2022 (n = 7,832) summarizing demographic and tobacco product use characteristics of those currently using oral nicotine pouches, those who had ever used oral nicotine pouches, but not currently, and those who never used pouches. From December 2021 to May 2022, 16% of participants ever used nicotine pouches and 12% currently used the product. Participants who currently used oral nicotine pouches were more likely to report being aged 21+, male, and lower income. Seventy-three percent of those who currently used pouches and 33% of those who ever, but not currently, used pouches reported current cigarette smoking. Results suggest that many young people who smoke cigarettes are concurrently using oral nicotine pouches. We also examined current and ever use in respondents surveyed between September 2020 and May 2022 to assess trends over the two-year period (n = 25,944) and findings indicate stable oral nicotine product use rates over time among adolescents and young adults. Appropriate regulation is needed so nicotine naïve individuals do not initiate use and those currently using tobacco do not use oral nicotine pouches concurrently with other products

The impact of e-cigarette use on health and tobacco use behaviors: An umbrella review

The planned umbrella review will examine how e-cigarette use affects health and tobacco use behaviors

A resurgence of e-cigarette use among adolescents and young adults late in the COVID-19 pandemic

Background Early in the COVID-19 pandemic, e-cigarette use significantly declined among young people due, in part, to losing access through social sources. As the pandemic progressed, adolescents and young adults gained opportunities to resume contact with peers. This study sought to determine whether e-cigarette use has returned to pre-pandemic levels among adolescents and young adults. Methods Data were drawn from a cross-sectional weekly survey of adolescents (aged 15–17) and young adults (aged 18–24) (N = 37,331). Logistic regression analyses measured odds of past 30-day e-cigarette use among respondents surveyed (a) late in the pandemic (April 2021—April 2022) compared to early in the pandemic (March–July 2020) and (b) late in the pandemic (August–December 2021) compared to prior to the pandemic (August–December 2019). Results The odds of current e-cigarette use were significantly higher later in the COVID-19 pandemic (April 2021–April 2022), compared to its initial months (March–July 2020) (OR:1.27, 95% CI: 1.17–1.38; p = 0.001). There was no significant difference in the odds of e-cigarette use for youth and younger adults late in the pandemic (August–December 2021) compared to the same time period prior to the pandemic (August–December 2019), but odds were greater for young adults aged 21 years or older (OR:1.16; 95% CI: 1.01–1.32; p = 0.030). Conclusions E-cigarette use has returned to pre-pandemic levels among adolescents and young adults. Young adults over age 21 are more likely to use e-cigarettes than young adults of the same age surveyed prior to the pandemic. Findings have implications for targeted e-cigarette prevention and cessation efforts. </jats:sec