Young Black Women's Breast Cancer Knowledge and Beliefs: A Sequential Explanatory Mixed Methods Study.

INTRODUCTION: Black women under the age of 50 have a 111% higher breast cancer mortality rate than their White counterparts. The breast cancer mortality disparities among young Black women may be due in part to the fact that they are more likely to be diagnosed with late-stage, invasive breast cancer tumors. Psychosocial factors, such as lack of perceived risk for breast cancer, lack of awareness of breast cancer risk factors, and ambiguity about breast cancer screening guidelines are areas that are under investigated among young Black women. The purpose of this study was to identify young Black women's cancer beliefs and level of breast cancer risk knowledge. METHODS: A sequential explanatory mixed methods study was conducted using quantitative data from the Health Information Trends Survey 6 (HINTS 6) (n = 25) and qualitative data from interviews with young Black female college students (n = 13). The results of the quantitative data analysis were used to guide the development of the qualitative interview guide. Data regarding participants' cancer beliefs, cancer risk factor knowledge, perceived cancer risk, and ambiguity about cancer screening behaviors were analyzed. RESULTS: The findings indicated young Black women have low perceived risk of developing cancer. Most participants were not aware of cancer recommendations that were targeted towards women under the age of 40. In addition, knowledge about lifestyle behavior risk factors for breast cancer was relatively low. CONCLUSION: Our findings underscore the importance of developing, disseminating, and implementing breast cancer education interventions that are targeted towards young Black women.

Variation in Relative Risk Perceptions and Tobacco Use by Race and Socioeconomic Status among Older Adults who Smoke: Evidence from the Population Assessment of Tobacco and Health (PATH) Study.

INTRODUCTION: Older adults who smoke face significant risk of tobacco-related disease and hold misperceptions about health risks posed by nicotine product use. This study examined whether socioeconomic status and race are associated with variation in cigarette/e-cigarette relative risk perceptions, whether relative risk perceptions are associated with tobacco use behaviors, and whether socioeconomic status and race moderate associations between perceptions and use behaviors. METHODS: Five waves of PATH Study yielded data from 1,879 adults >55 who smoked within the past 30 days during Wave 1. Adjusted longitudinal logistic models estimated associations between higher vs. lower SES ("low-SES": less than high school diploma/GED. and annual household income<$25,000) and race (White vs. Black/African American; AA) and e-cigarette/cigarette relative risk perceptions, behavioral intentions, and e-cigarette use. RESULTS: Lower-SES adults were more likely to report e-cigarettes were very/extremely harmful to health (AOR: 1.74, p<0.01) and less likely to report e-cigarettes were less harmful than cigarettes (AOR: 0.65, p<0.01). Black/AA adults were less likely to report that e-cigarettes were less harmful than cigarettes. Participants rating e-cigarettes as equally/more harmful than cigarettes exhibited lower odds of intending to quit smoking or switch to e-cigarettes. Finally, Black/AA adults who also perceived e-cigarettes equally/more harmful than cigarettes exhibited greater odds of trying to reduce rather than quit smoking (AOR: 1.58, p=0.02). CONCLUSIONS: Many older adults who smoke perceive e-cigarettes as equally or more harmful than cigarettes, particularly low-SES and Black/AA older adults. Differences in relative risk perceptions among high priority populations could negatively influence cessation attempts and switching behaviors. IMPLICATIONS: This study found that Black/AA and low-SES older adults who smoke cigarettes were more likely to perceive e-cigarettes as harmful or more harmful than cigarettes. The absence of accurate, evidence-based information regarding the relative health risks associated with the long-term use of various tobacco products may impede policy efforts to reduce disparities in smoking-related disease through increased cessation and/or harm reduction.

Appropriateness of using numeric rating scales to assess risk perceptions for individuals with limited health numeracy.

OBJECTIVE: Numeric rating scales (NRSs) could be inappropriate for assessing constructs such as risk perception if individuals with limited health numeracy (LHN) have difficulty expressing their perceptions on such scales. This paper compares the psychometric functioning of numerical risk perception ratings for an e-cigarette obtained from LHN individuals, comparing them to those from individuals with adequate health numeracy (AHN). METHODS: In a randomized trial of a risk-related message (not evaluated here), participants (N = 12,557) used NRSs to rate their perception of (1) overall risk of harm (from 0 %-100 % harmful to health), and (2) likelihood (0-100 %) of suffering four tobacco-related diseases from using e-cigarettes; and used a 4-point adjectival scale ('not at all harmful' to 'very harmful') to rate the harm of using e-cigarettes. Based on the Newest Vital Sign (NVS), 29 % of participants were classified as LHN. RESULTS: Numeric ratings of e-cigarette harm in LHN and AHN groups showed a nearly identical and equally strong relationship to verbal perceived risk ratings. Analyses of disease-specific ratings as a unidimensional scale demonstrated configural, metric, and scalar invariance between ratings from LHN and AHN individuals. CONCLUSION: LHN individuals are able to make meaningful ratings using numeric scales, comparable to those from AHN individuals.

Patient-reported outcomes, and perceptions and knowledge about recurrence in women with hormone receptor-positive breast cancer.

PURPOSE: Over half of hormone receptor-positive (HR+) breast cancer recurrences occur >5 years from diagnosis, however, little is known about well-being or breast cancer risk perceptions and knowledge in long-term HR+ breast cancer survivors. METHODS: From 1/2021 to 1/2022, we surveyed patients with a history of stage II/III, HR+ breast cancer, ≥5 years from diagnosis, without recurrence about concerns and perceptions related to their diagnosis and recurrence risk, physical and emotional health, knowledge, and risk reduction. Logistic regression identified factors associated with overestimation of 5-10 year distant recurrence risk. RESULTS: Among 166 women, median age at diagnosis was 51, 2.4% were Black and 1.2% Hispanic; 19.3% did not have a college degree. Median time from diagnosis was 10 years (range: 5-23). Median PROMIS anxiety (53; range: 37-73), physical (51, range: 32-68), and mental (51, range: 25-68) scores were similar to population norms (score of 50). 40% of women estimated metastatic recurrence risk to be ≥20% 5-10 years post-treatment; patients without a college degree were more likely to overestimate this risk (multivariable prevalence odds ratio: 3.69, 95% confidence interval: 1.49, 9.18). Only 17% correctly indicated HR+ breast cancer as having a higher risk of recurrence after 5 years; over one-third inaccurately responded that alcohol in moderation decreases recurrence risk. CONCLUSION: While physical and emotional health were comparable to the general population, many survivors harbored inaccurate risk perceptions and knowledge. The association between lower educational attainment and risk overestimation underscores the importance of attention to literacy and numeracy when developing interventions to improve risk communication.

The role of alcohol consumption in the lives of older Australian women: qualitative insights and an agenda for further research, policy and practice.

BACKGROUND: Alcohol consumption presents a threat to the health and wellbeing of women. The alcohol industry often pushes back at global efforts to prioritise the prevention of alcohol harms to women. Qualitative researchers have investigated how younger and midlife women conceptualise their alcohol consumption, but there is very limited research relating to older women (those 60 years and over). METHODS: Using data collected from an online qualitative survey, this paper explored the factors that influence how older Australian women drinkers (n = 144. 60-88 years) conceptualised the role of alcohol in their lives. The study used a 'Big Q' reflexive approach to thematic analysis, drawing upon sociological theories of risk and symbolic interactionism to construct four themes from the data. RESULTS: First, alcohol consumption was viewed by participants as an accepted and normalised social activity, that was part of Australian culture. Second, alcohol played a role for some participants as a way to cope with life changes (such as retirement), as well as managing stressful or challenging life circumstances (such as loneliness). Third, alcohol was part of the routines and rituals of everyday life for some women. For example, women discussed the consumption of wine with their evening meal as an important part of the structure of their day. Fourth, participants had clear personal expectancies about what it meant to be a 'responsible drinker'. They had clear narratives about personal control and moral obligation, which in some cases created a reduced perception of their own risk of alcohol-caused harm. CONCLUSIONS: This research provides a starting point for future public health research examining the factors that may shape older women's alcohol consumption beliefs and practices. Public health activities should consider the unique needs and potential vulnerabilities of older women drinkers, and how these may be potentially exploited by the alcohol industry.

Exposure to e-cigarette and heated tobacco product advertisements via digital, traditional media, and points-of-sale: An examination of associations with use intentions and perceived risk among adults in Armenia and Georgia.

INTRODUCTION: E-cigarette and heated tobacco product (HTP) marketing often leverages digital media and points-of-sale (POS) and advertises risk reduction, including in Armenia and Georgia where male cigarette use rates are high. METHODS: Using 2022 survey data from Armenian and Georgian adults (n=1468, mean age=42.92 years, 51.4% female; and past-month use of e-cigarettes 3.2%, HTPs 2.7%, and cigarettes 31.6%), multivariable linear regression examined 4 outcomes - e-cigarette and HTP use intentions and perceived risk (1=not at all, to 7=extremely) - in relation to past-month e-cigarette or HTP advertisement exposure via digital media, traditional media, and POS, controlling for covariates (country, age, gender, education level, relationship status, children, past-month cigarette and e-cigarette/HTP use). RESULTS: E-cigarette and HTP use intentions were low (mean score=1.47, SD=1.39 each), while perceived risk was high (mean score=5.83, SD=1.6, and mean score=5.87, SD=1.56, respectively). Past-month exposure to e-cigarette and HTP advertisements, respectively, were 12.9% and 11.2% via digital media, 6.1% and 4.8% traditional media, and 22.5% and 21.1% POS. For e-cigarettes, ad exposure via digital media was associated with greater use intentions (ß=0.24; 95% CI: 0.03-0.44), ad exposure via traditional media (ß= -0.32; 95% CI: -0.55 - -0.09) and POS (ß= -0.30; 95% CI: -0.60 - -0.004) was associated with lower risk perceptions. For HTPs, ad exposure via digital media (ß=0.35; 95% CI: 0.14-0.56) and POS (ß=0.21; 95% CI: 0.04-3.63) was associated with greater use intentions, and ad exposure at POS was associated with lower risk perceptions (ß= -0.23; 95% CI: -0.42 - -0.03). CONCLUSIONS: Tobacco control efforts should monitor and regulate e-cigarette and HTP marketing, particularly via digital media which may effectively promote use, and via POS which may target and influence risk perceptions.

Impact of perceived neighborhood social cohesion on vaccination intentions in the post-pandemic era.

OBJECTIVE: To examine the relationship between perceived neighborhood social cohesion (NSC) and intentions to obtain seasonal influenza and COVID-19 vaccines among US adults post COVID-19 pandemic. METHODS: We conducted a cross-sectional, nationally representative survey of US residents (N = 2189) in May 2023 on their perceived NSC, COVID-19 and seasonal influenza vaccination intentions, healthcare access, perceived risk of COVID-19 or flu infection, loneliness, and trust in doctors. We used bivariate probit regressions to examine joint associations between perceived NSC and intentions to receive influenza and COVID-19 vaccines, controlling for several participant characteristics (e.g., race). RESULTS: 2164 respondents provided consent to study questions. Trust-related NSC (trust in neighbors) was positively associated with intentions to become vaccinated against both influenza and COVID-19 viruses. Higher relational NSC (perception of a close-knit neighborhood) was positively associated while higher value-based NSC (perception that neighbors share the same values) was negatively associated with intentions to become vaccinated against COVID-19. Healthcare access, perceived risk of infection (COVID-19 or flu), and trust in doctors were positively associated with intentions to become vaccinated against both viruses. CONCLUSIONS: In a post-pandemic era, higher trust-related and relational, perceived NSC (vaccine-dependent), greater access to healthcare, higher perceived risk of infection, and greater trust in doctors were related to higher influenza and COVID-19 vaccination intentions, while higher value-based NSC was related to lower COVID-19 vaccination intentions among US adults. Thus, specific aspects of NSC, healthcare access barriers, misinformation on infection risk, and medical mistrust may influence an individual's willingness and ultimate decision to become vaccinated.

Attitudes toward driving after cannabis use: a systematic review.

BACKGROUND: Driving after cannabis use (DACU) is associated with increased risk of motor vehicle collisions. As cannabis legalization expands, DACU is emerging as a major public safety concern. Attitudes have a significant impact on behavioural decision making. As such, understanding the degree to which people have favorable or unfavorable evaluations of DACU is an important first step for informing prevention efforts. This systematic review summarizes existing evidence on attitudes toward DACU, their association with actual or intended DACU, and changes in attitudes following legalization of recreational cannabis. METHODS: Four electronic databases (MEDLINE, EMBASE, PsycINFO, and TRID) were searched for studies that reported attitudes or changes in attitudes toward DACU published between their inception dates and February 26 2024. A total of 1,099 records were retrieved. Studies were analyzed using an inductive thematic synthesis approach. RESULTS: Seventy studies from seven countries originating predominantly from the United States and Canada met inclusion criteria. Thematic analysis identified six themes. (I) Attitudes toward the safety and acceptability of DACU are mixed; participants in 35 studies predominantly expressed negative attitudes toward DACU (e.g., DACU is dangerous, affects driving ability, and increases crash risk). However, 20 studies reported opposing views. (II) Attitudes toward DACU vary by age, sex/gender, and cannabis use frequency; youth, men, and frequent cannabis users tended to view DACU more favorably than older participants, women, and occasional or non-users. (III) Attitudes toward DACU are associated with past DACU and intention to DACU. (IV) DACU is viewed more favorably than driving after drinking alcohol. (V) The relationship between legal status of recreational cannabis and attitudes toward DACU is unclear. (VI) Perceived risk of apprehension for DACU is low to moderate. CONCLUSIONS: This review found that perceptions of DACU are primarily negative but mixed. Findings suggest that attitudes toward DACU are important targets for interventions to reduce this behaviour.

COVID-19 Vaccination Among Adolescents and Young Adults: Test of the Triandis Model of Interpersonal Behavior and the Health Belief Model.

This study purpose was to test the Health Belief Model (HBM) and the Triandis Model of Interpersonal Behavior (TMIB) in predicting COVID-19 vaccine uptake among adolescents and young adults (AYAs). Data from an anonymous online survey were collected. Clusters of risk perceptions of infection were identified using Latent Class Analysis, and predictive values of TMIB and HBM factors were evaluated using logistic regression models. Response rate was 30% (468 participants). There was a combined significant effect of TMIB model components (habitual health behavior, intention, and facilitation conditions) on having received ≥1 dose of COVID-19 vaccine. Having received influenza vaccine in the past 12 months was associated with higher odds of COVID-19 vaccine uptake. Perceived vaccination benefits, and perceived risks of infection were associated with vaccine receipt; however, the HBM model performed inadequately. The HBM is commonly used in vaccine acceptance research; however, the TMIB may be more effective among AYAs.

A longitudinal analysis of the effects of COVID-19 on tourists' health risk perceptions.

The COVID-19 pandemic provoked a large impact on tourism because of the enforcement of harsh travel restrictions and the increased global health risks caused by international mobility. This paper utilizes a longitudinal analysis to tests the impact of COVID-19 on tourists' health risk perceptions, and their relationships with destination image perception and visiting intentions. Tourists are surveyed at two different points of time, before and after the COVID-19 pandemic. Multi-group structural equation modeling is utilized for the comparison of the relationships at the two points of time. The results show that the negative influence of health risk perceptions on destination image perception and visiting intentions are significantly larger after the COVID-19 pandemic while there are no significant differences in the impact of destination image perception on visiting intentions. Thus, not only are tourists more sensitive to health risk perceptions after COVID-19, but this higher sensitivity has larger impacts both on their perceptions of destination image and on the behavioural implication. The results have useful implications in terms of the need to dedicate more efforts for the management of health conditions of destinations after COVID-19.

How Dangerous? Substance Use Risk Perceptions in Chilean Preadolescents.

Early substance use initiation among children represents a significant risk to public health. Research suggests that early positive perceptions and cognitions of elementary students toward substance use may predict later use during adolescence. Studies among adolescent populations have shown an inverse relationship between substance use and risk perceptions. To gain insight into alcohol, tobacco, and marijuana risk perceptions prior to adolescence, we analyzed data from the Chilean Early Childhood Longitudinal Survey (ELPI). In a sample of 5,278 families (mean age of preadolescents 10.63 years, SD = .64; 50.5% males), our findings showed that an important proportion of Chilean 10 years old did not perceive occasional tobacco, alcohol, or marijuana use to be high-risk activities. However, the majority of respondents did consider daily substance use to be a high-risk activity, with some variation across substances. Overall, older preadolescents were more likely to consider substance use to be less risky compared to their slightly younger counterparts. Our analysis also demonstrated that past month substances use by caregivers were all found to be predictive of low-medium risk perceptions among preadolescents surveyed, while conversely, caregivers' negative reactions to finding out their child had used a substance decreased the likelihood of holding low-medium risk perceptions. Individuals from single-parent households were less likely to consider substance use as being high-risk compared to their peers. Preadolescents with caregivers reporting higher average incomes were also more likely to hold lower risk perceptions of occasional substance use. Implications for public policies to prevent substance use in the pre-adolescent population are discussed.

Factors associated with support for social enforcement of smoke-free policies in Georgia and Armenia.

INTRODUCTION: Armenia's and Georgia's high rates of smoking and secondhand smoke and recent implementation of smoke-free laws provide a timely opportunity to examine factors that increase compliance, like social enforcement and support for governmental enforcement. METHODS: Using 2022 data from 1468 Armenian and Georgian adults (mean age=42.92 years, 48.6% male, 31.6% past-month smoking), multilevel linear regression examined tobacco-related media exposures, social exposures, and perceptions/attitudes in relation to: 1) likelihood of asking someone to extinguish cigarettes where a) prohibited and b) allowed; and 2) support of fines for smoke-free violations (1=not at all to 4=very). RESULTS: There was low average likelihood of asking someone to extinguish cigarettes where allowed (mean=1.01, SD=1.12) or prohibited (mean=1.57, SD=1.21) and 'little' agreement with fines for smoke-free violations (mean=2.13, SD=1.06). Having fewer friends who smoked, greater support for indoor smoke-free laws, and no past-month cigarette use were positively associated with all 3 outcomes. Greater exposure to media and community-based action supporting smoke-free policies, and witnessing more requests to stop smoking where prohibited, were associated with higher likelihood of asking someone to extinguish cigarettes where allowed or prohibited. Less exposure to news stories opposing smoke-free policies and cigarette ads and higher perceived harm of cigarettes were also related to higher likelihood of asking someone to stop smoking where prohibited. Higher perceived harm of cigarettes was also associated with greater agreement with fines for smoke-free violations. CONCLUSIONS: Comprehensive strategies targeting social norms, media exposure, and risk perceptions are needed to effectively facilitate strategies to enhance smoke-free law enforcement.

Pre- and post-pandemic risk perceptions and worries.

Introduction: The present study is a cross-sectional investigation of worry and risk perceptions regarding various hazards and destinations, measured before, during, and after the COVID-19 pandemic. Methods: Questionnaire data were collected from tourists in Norway during the summer seasons of 2012 (N = 2,669), 2019 (N = 1,666), and 2022 (N = 956), and from a representative sample of Norwegians in 2020 (N = 1,003). Results: The results show a general decline in the level of worry and risk perceptions post-pandemic compared to those pre-pandemic, with the exception of infectious diseases, whose perceived risk slightly increased in 2022. Conclusion: The results highlight the importance of employing cross-sectional or longitudinal data to investigate changes in risk perceptions over time. The findings also indicate that pessimistic predictions of a continued decline in tourism appear to be unwarranted.

Optimism Bias Among Gun Owners: Associations With Firearm Injury Prevention Practices and Policy Support.

Optimism bias is common across health risk assessments, including firearm injury risk, and can have behavioral consequences. Using data from the 2018 California Safety and Wellbeing Survey, we examine whether optimism bias influences firearm injury prevention practices and policy support by comparing the characteristics, behaviors, and opinions of gun owners who believed having a gun at home is comparatively safer for themselves than for similar others (Optimism Bias group) with (1) those who unequivocally believe guns increase safety for themselves and others (Always Safer group), and (2) those who said they "don't know" or "it depends" in both the self and other scenarios (Uncertain group). Weighted multinomial logistic regression results indicated that gun owners in the Optimism Bias group were more often female, members of minoritized racial or ethnic groups, and new gun owners than the Always Safer and Uncertain groups; they also demonstrated greater support for 4 of 5 firearm injury prevention policies/interventions. Despite similar prevalence of owning a gun for protection, gun owners in the Optimism Bias group less often carried a loaded firearm or stored a gun in an unsecure way compared with the Always Safer group. Findings suggest that gun owners characterized by optimism bias, who acknowledged some risk associated with firearms, even if only or more so for others than for themselves, may represent a "movable middle" that is more receptive to firearm injury prevention efforts. Public health messages emphasizing other-oriented (vs. personal) risk and collective responsibility may be perceived as less threatening to the symbolic significance of guns to individual identity, thus enhancing effectiveness.

Measuring Relationship Influences on Romantic Couples' Cancer-Related Behaviors During the COVID-19 Pandemic: Protocol for a Longitudinal Online Study of Dyads and Cancer Survivors.

BACKGROUND: Research has established the effects of romantic relationships on individuals' morbidity and mortality. However, the interplay between relationship functioning, affective processes, and health behaviors has been relatively understudied. During the COVID-19 pandemic, relational processes may influence novel health behaviors such as social distancing and masking. OBJECTIVE: We describe the design, recruitment, and methods of the relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study. This study was developed to understand how relational and affective processes influence romantic partners' engagement in cancer prevention behaviors as well as health behaviors introduced or exacerbated by the COVID-19 pandemic. METHODS: The relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study used online survey methods to recruit and enroll 2 cohorts of individuals involved in cohabiting romantic relationships, including 1 cohort of dyads (n=223) and 1 cohort of cancer survivors (n=443). Survey assessments were completed over 2 time points that were 5.57 (SD 3.14) weeks apart on average. Health behaviors assessed included COVID-19 vaccination and social distancing, physical activity, diet, sleep, alcohol use, and smoking behavior. We also examined relationship factors, psychological distress, and household chaos. RESULTS: Data collection occurred between October 2021 and August 2022. During that time, a total of 926 participants were enrolled, of which about two-thirds were from the United Kingdom (n=622, 67.8%) and one-third were from the United States (n=296, 32.2%); about two-thirds were married (n=608, 66.2%) and one-third were members of unmarried couples (n=294, 32%). In cohorts 1 and 2, the mean age was about 34 and 50, respectively. Out of 478 participants in cohort 1, 19 (4%) identified as Hispanic or Latino/a, 79 (17%) as non-Hispanic Asian, 40 (9%) as non-Hispanic Black or African American, and 306 (64%) as non-Hispanic White; 62 (13%) participants identified their sexual orientation as bisexual or pansexual, 359 (75.1%) as heterosexual or straight, and 53 (11%) as gay or lesbian. In cohort 2, out of 440 participants, 13 (3%) identified as Hispanic or Latino/a, 8 (2%) as non-Hispanic Asian, 5 (1%) as non-Hispanic Black or African American, and 398 (90.5%) as non-Hispanic White; 41 (9%) participants identified their sexual orientation as bisexual or pansexual, 384 (87.3%) as heterosexual or straight, and 13 (3%) as gay or lesbian. The overall enrollment rate for individuals was 66.14% and the overall completion rate was 80.08%. CONCLUSIONS: We discuss best practices for collecting online survey data for studies examining relationships and health, challenges related to the COVID-19 pandemic, recruitment of underrepresented populations, and enrollment of dyads. Recommendations include conducting pilot studies, allowing for extra time in the data collection timeline for marginalized or underserved populations, surplus screening to account for expected attrition within dyads, as well as planning dyad-specific data quality checks. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48516.

Climate Change and Health Risk Perceptions of Arkansas Small Farmers through the Application of the Health Belief Model.

Climate change poses health risks to Arkansas small farmers. Farmers face an increased risk of heat-related illnesses (e.g., heat exhaustion, cerebral vascular accidents, and cardiovascular issues) and work-related injuries, death, and mental health conditions due to climate change. This cross-sectional survey employed the health belief model (HBM) as its theoretical framework. This study aimed to assess the health status of small farmers, climate change beliefs, adaptive agricultural practices, and the perceived effects of climate change on health. Study data were collected using non-probability sampling methods from small farmers (n = 72) with a gross farm income of < USD 250,000. The study findings show that 93% of participants reported good-excellent health, 69% believe the climate is changing and getting warmer, 58.3% believe people are responsible for the changes in our climate, and 75% believe the changing climate impacts farmers. Among the HBM predictive variables, participants reported self-efficacy (50%), perceived susceptibility (48.6%), and perceived severity (43%). Only 16.7% of farmers reported believing they have all the information needed to prepare for climate-related health impacts. This study suggests small farmers have protective factors and adaptive capacity, including health status, income, and education levels, but believe they lack the information necessary to protect their health from climate change.

Understanding cooperative contact tracing: Factors explored through privacy management theories.

This study investigates the factors influencing the comfort level of the general public when disclosing personal information for the coronavirus disease 2019 contact tracing. This is a secondary analysis of the American Trends Panel, a national probability-based online panel of American adults, with data collected by the Pew Research Center between July 13 and 19, 2020. Grounded in privacy management theories, ordered logistic regression analyses examined three types of information disclosure: places visited, names of contacts, and location data from cell phones. Key independent variables measured trust in the stakeholders' ability to protect data and perceived risks to health and finances. The findings suggest that higher levels of trust in entities' data security capabilities can predict individuals' comfort levels when disclosing personal data. Additionally, the participants were more comfortable with noncommercial data use, especially when it was used by researchers and state and local officials. However, financial threats showed variations in sharing certain types of data. Individuals were less likely to feel at ease sharing contact tracing data as concerns about personal finances increased. Similarly, when individuals perceived threats to the U.S. economy, they were less likely to feel comfortable sharing their location data from cell phones, which might have been perceived as intrusive. Public health outreach efforts should account for individual differences and the nature of the information requested in commercial and noncommercial contexts. Future studies can enhance the explanatory capacity of data disclosure models by incorporating additional relevant contextual and environmental variables.

Attitudes, knowledge, and risk perceptions of patients who received elective genomic testing as a clinical service.

PURPOSE: Elective genomic testing (EGT) is increasingly available clinically. Limited real-world evidence exists about attitudes and knowledge of EGT recipients. METHODS: After web-based education, patients who enrolled in an EGT program at a rural nonprofit health care system completed a survey that assessed attitudes, knowledge, and risk perceptions. RESULTS: From August 2020 to April 2022, 5920 patients completed the survey and received testing. Patients most frequently cited interest in learning their personal disease risks as their primary motivation. Patients most often expected results to guide medication management (74.0%), prevent future disease (70.4%), and provide information about risks to offspring (65.4%). Patients were "very concerned" most frequently about the privacy of genetic information (19.8%) and how well testing predicted disease risks (18.0%). On average, patients answered 6.7 of 11 knowledge items correctly (61.3%). They more often rated their risks for colon and breast cancers as lower rather than higher than the average person but more often rated their risk for a heart attack as higher rather than lower than the average person (all P < .001). CONCLUSION: Patients pursued EGT because of the utility expectations but often misunderstood the test's capabilities.

Perceived relative harm and addictiveness compared with cigarettes and intentions to use modified risk tobacco products utilizing FDA-authorized marketing claims among adults in the United States.

INTRODUCTION: We assessed adults' perceived relative harm and addictiveness of products using FDA-authorized modified risk tobacco products (MRTP) claims and associations with intentions to use MRTPs. METHODS: Data were from the May 2022 Rutgers Omnibus study among US 18-45-year-old adults (n=2964), collected by the Rutgers Institute for Nicotine and Tobacco Studies (INTS). Outcomes were perceived relative harm and addictiveness versus a typical cigarette and intentions to use a product stating a reduced harm claim (General Snus) or a reduced exposure claim (VLN King). We conducted regression analyses of associations between perceived relative harm and addictiveness and intentions to use each product, stratified by smoking status. RESULTS: The minority of participants perceived products with a reduced harm claim as much less harmful vs. cigarettes (21 %, 19 %, 7 %, and 8 % among persons who smoked daily, smoked some days, formerly smoked, and never smoked respectively) and products with a reduced exposure claim as much less addictive vs. cigarettes (24 %, 26 %, 14 %, 20 % respectively). Perceived lower relative harm and addictiveness were significantly associated with higher intentions to use products stating reduced harm or reduced exposure claim across all smoking statuses with one exception (relative addictiveness was not associated with intention to use products stating the reduced harm claim among persons who formerly smoked). CONCLUSIONS: Two current FDA-authorized MRTP claims were not effective in conveying that MRTPs were less harmful or addictive than cigarettes to most participants. Perceiving products as less harmful or addictive were significantly associated with intentions to use MRTPs.

Gender differences in the perception of leptospirosis severity, behaviours, and Leptospira exposure risk in urban Brazil: a cross-sectional study.

Background: Vulnerability to climate hazards and infectious diseases are not gender-neutral, meaning that men, women, boys, girls, and other gender identities experience different health risks. Leptospirosis, a zoonotic climate sensitive infectious disease, is commonly transmitted to humans via contact with animals and the environment, particularly soil and flood water. Gender differences in leptospiral infection risk are reported globally, with men consistently found to be at higher risk than women. However, the drivers of this difference in risk are poorly understood. Previous studies suggest that the interplay of knowledge, perceptions, and behaviours may shape differential infection risk among genders. Methodology/Principal Findings: To examine gender differences in Leptospira exposure risk we conducted a cross-sectional serosurvey among adult participants (n = 761) in four urban, marginalised, informal settlements in the city of Salvador, Brazil. We found that seroprevalence was 14.6% and 9.4% across men and women respectively. We then applied causal inference methodology to a two-part sex-disaggregated analysis to investigate: 1) the association of perceptions and behaviours with Leptospira seropositivity and 2) the association of perceptions with behaviours. We found that men who perceived leptospirosis as extremely serious had lower odds of seropositivity, walking through sewage water, or walking barefoot, suggesting an important link between perceptions, behaviours, and exposure risk. These associations were not found in women, and these behaviours were not associated with seropositivity in men or women. Conclusions: Our results highlight perceived severity of disease as a potential driver of behaviour in men, and perceptions of disease may be an important target for health education programs. Furthermore, our study identifies evidence gaps in the understanding of infection risks in women. As the first sex-disaggregated study investigating Leptospira infection risks, we advocate for a gendered lens in future studies to further understand risks specific to different gender identities.