Critical review of methods for risk ranking of food-related hazards, based on risks for human health.

This study aimed to critically review methods for ranking risks related to food safety and dietary hazards on the basis of their anticipated human health impacts. A literature review was performed to identify and characterize methods for risk ranking from the fields of food, environmental science and socio-economic sciences. The review used a predefined search protocol, and covered the bibliographic databases Scopus, CAB Abstracts, Web of Sciences, and PubMed over the period 1993-2013. All references deemed relevant, on the basis of predefined evaluation criteria, were included in the review, and the risk ranking method characterized. The methods were then clustered-based on their characteristics-into eleven method categories. These categories included: risk assessment, comparative risk assessment, risk ratio method, scoring method, cost of illness, health adjusted life years (HALY), multi-criteria decision analysis, risk matrix, flow charts/decision trees, stated preference techniques and expert synthesis. Method categories were described by their characteristics, weaknesses and strengths, data resources, and fields of applications. It was concluded there is no single best method for risk ranking. The method to be used should be selected on the basis of risk manager/assessor requirements, data availability, and the characteristics of the method. Recommendations for future use and application are provided.

Risk/Benefit Communication about Food-A Systematic Review of the Literature.

A systematic review relevant to the following research questions was conducted (1) the extent to which different theoretical frameworks have been applied to food risk/benefit communication and (2) the impact such food risk/benefit communication interventions have had on related risk/benefit attitudes and behaviors. Fifty four papers were identified. The analysis revealed that (primarily European or US) research interest has been relatively recent. Certain food issues were of greater interest to researchers than others, perhaps reflecting the occurrence of a crisis, or policy concern. Three broad themes relevant to the development of best practice in risk (benefit) communication were identified: the characteristics of the target population; the contents of the information; and the characteristics of the information sources. Within these themes, independent and dependent variables differed considerably. Overall, acute risk (benefit) communication will require advances in communication process whereas chronic communication needs to identify audience requirements. Both citizen's risk/benefit perceptions and (if relevant) related behaviors need to be taken into account, and recommendations for behavioral change need to be concrete and actionable. The application of theoretical frameworks to the study of risk (benefit) communication was infrequent, and developing predictive models of effective risk (benefit) communication may be contingent on improved theoretical perspectives.

The impact of double-blind placebo- controlled food challenge (DBPCFC) on the socioeconomic cost of food allergy in Europe.

BACKGROUND: Double-blind placebo controlled food challenge (DBPCFC) is the gold standard diagnostic test in food allergy because it minimizes diagnostic bias. OBJECTIVE: To investigate the potential effect of diagnosis on the socioeconomic costs of food allergy. METHODS: A prospective longitudinal cost analysis study was conducted in Spain and Poland within the EuroPrevall project. Food-allergic patients were enrolled into the study and in all cases diagnosis was confirmed through a standardized DBPCFC. Data were collected through a self-administered survey on all aspects of health and social care resource use, costs of living, and costs of leisure activities. Costs were measured before and 6 months after the DBPCFC and reported in international dollars with 2007 as the benchmark year. RESULTS: Forty-two patients were enrolled. Twenty-one patients had a negative DBPCFC and the suspected food was reintroduced into their diet. Comparing total direct costs before and after the DBPCFC, the reactive group spent a significantly higher amount (median increase of $813.1 over baseline), while the tolerant group's spending decreased by a median of $87.3 (P = .031). The amount of money spent on food 6 months after diagnosis was also significantly higher in the reactive group (P = .040). Finally, a larger, but not statistically significant, decrease in total indirect costs was observed in the tolerant group compared with the reactive group ($538.3 vs $32.3). CONCLUSION: DBPCFC has an impact on indirect and direct costs of living. The main contribution to this increase was money spent on food.

Food fraud and the perceived integrity of European food imports into China.

BACKGROUND/AIMS: Persistent incidents of food fraud in China have resulted in low levels of consumer trust in the authenticity and safety of food that is domestically produced. We examined the relationship between the concerns of Chinese consumers regarding food fraud, and the role that demonstrating authenticity may play in relieving those concerns. METHODS: A two-stage mixed method design research design was adopted. First, qualitative research (focus groups n = 7) was conducted in three Chinese cities, Beijing, Guangzhou and Chengdu to explore concerns held by Chinese consumers in relation to food fraud. A subsequent quantitative survey (n = 850) tested hypotheses derived from the qualitative research and theoretical literature regarding the relationship between attitudinal measures (including risk perceptions, social trust, and perceptions of benefit associated with demonstrating authenticity), and behavioral intention to purchase "authentic" European products using structural equation modelling. RESULTS: Chinese consumers perceive food fraud to be a hazard that represents a food safety risk. Food hazard concern was identified to be geographically influenced. Consumers in Chengdu (tier 2 city) possessed higher levels of hazard concern compared to consumers in Beijing and Guangzhou (tier 1). Structural trust (i.e. trust in actors and the governance of the food supply chain) was not a significant predictor of attitude and intention to purchase authenticated food products. Consumers were shown to have developed 'risk-relieving' strategies to compensate for the lack of trust in Chinese food and the dissonance experienced as a consequence of food fraud. Indexical and iconic authenticity cues provided by food manufacturers and regulators were important elements of product evaluations, although geographical differences in their perceived importance were observed. CONCLUSIONS: Targeted communication of authenticity assurance measures, including; regulations; enforcement; product testing; and actions taken by industry may improve Chinese consumer trust in the domestic food supply chain and reduce consumer concerns regarding the food safety risks associated with food fraud. To support product differentiation and retain prestige, European food manufactures operating within the Chinese market should recognise regional disparities in consumer risk perceptions regarding food fraud and the importance of personal risk mitigation strategies adopted by Chinese consumers to support the identification of authentic products.

Ethics, Risk and Benefits Associated with Different Applications of Nanotechnology: a Comparison of Expert and Consumer Perceptions of Drivers of Societal Acceptance.

Examining those risk and benefit perceptions utilised in the formation of attitudes and opinions about emerging technologies such as nanotechnology can be useful for both industry and policy makers involved in their development, implementation and regulation. A broad range of different socio-psychological and affective factors may influence consumer responses to different applications of nanotechnology, including ethical concerns. A useful approach to identifying relevant consumer concerns and innovation priorities is to develop predictive constructs which can be used to differentiate applications of nanotechnology in a way which is meaningful to consumers. This requires elicitation of attitudinal constructs from consumers, rather than measuring attitudes assumed to be important by the researcher. Psychological factors influencing societal responses to 15 applications of nanotechnology drawn from different application areas (e.g. medicine, agriculture and environment, food, military, sports, and cosmetics) were identified using repertory grid method in conjunction with generalised Procrustes analysis. The results suggested that people differentiate nanotechnology applications based on the extent to which they perceive them to be beneficial, useful, necessary and important. The benefits may be offset by perceived risks focusing on fear and ethical concerns. Compared to an earlier expert study on societal acceptance of nanotechnology, consumers emphasised ethical issues compared to experts but had less concern regarding potential physical contact with the product and time to market introduction. Consumers envisaged fewer issues with several applications compared to experts, in particular food applications.

Perceptions of pesticides exposure risks by operators, workers, residents and bystanders in Greece, Italy and the UK.

The EU Directive on the sustainable use of pesticides (EU128/2009/EC) requires European Member States to develop training activities targeting occupational exposure to pesticides, and communication material aimed at residents and bystanders. Risk perceptions, knowledge and attitudes associated with passive and occupational exposure to pesticide potentially influence the extent to which different stakeholders adopt self-protective behaviour. A methodology for assessing the link between attitudes, adoption of self-protective behaviours and exposure was developed and tested. A survey was implemented in the Greece, Italy and the UK, and targeted stakeholders associated with pesticide exposure linked to orchards, greenhouse crops and arable crops respectively. The results indicated that the adoption of protective measures is low for residents and bystanders, with the exception of residents in Greece, when compared to operators and workers, who tend to follow recommended safety practices. A regression analysis was used to examine the factors affecting the probability of adopting protective measures as well the as the level of exposure in the case of operators and workers where data are available. The results indicate that the likelihood of engaging in self-protective behaviour is not significantly affected by perceptions of own health being affected by pesticides for residents and bystanders. However, operators who perceive that their heath has been negatively affected by the use of pesticides are found to be more likely to adopt self-protective behaviours. Gender and country differences, in perceptions, attitudes and self-protection are also observed. Recommendations for improved communication, in particular for vulnerable groups, are provided.

The effects of nefazodone, imipramine and placebo, alone and combined with alcohol, in normal subjects.

Nefazodone (200 mg, 400 mg/day) imipramine (150 mg/day) and placebo were administered to 12 normal, healthy volunteer subjects for a period of 8 days each. A measured dose of alcohol was consumed with the drug on day 8. A battery of physiological, psychomotor, cognitive and subjective tests was carried out before drug administration and 2 h after drug administration on days 1, 7, and 8. Nefazodone had little effect on heart rate and blood pressure whereas imipramine increased both heart rate and diastolic blood pressure. Nefazodone 400 mg impaired the critical flicker fusion threshold. Dose-dependent improvements in psychomotor performance (Gibson Spiral Maze) and complex memory performance (learning, pursuit rotor, and visual working memory) were produced by nefazodone while imipramine administration impaired performance on these tasks. Subjective changes in alertness and bodily symptoms were produced by all active compounds. While nefazodone failed to potentiate the sedative-hypnotic (depressant) effects of alcohol, imipramine tended to enhance them for psychomotor performance, memory assessments, and some subjective ratings. Thus, nefazodone, particularly at lower dose levels, causes less disruption of human performance than imipramine. This effect probably reflects the lack of anticholinergic activity of nefazodone. Also, nefazodone failed to potentiate the depressant effects of alcohol, perhaps because of its minimal alpha-blockade.

Understanding patients' preferences for treatment: the need for innovative methodologies.

Treatment selection is now much more consumer driven than in the past. However, there is a need to develop investigative methodological approaches that are sensitive to differences in patient preferences if full account is to be taken of what the patient sees as the best option in terms of different possible treatments available for a particular condition. Previous attitude research has been criticised because it does not provide insight into reasons why people hold different preferences or beliefs. A methodology is described which allows people to describe their concerns and values associated with different treatment options in their own words. This is the repertory grid method of eliciting personal constructs used in conjunction with generalised Procrustes analysis (GPA). An example of the use of this methodology is provided, drawn from research directed towards understanding people's beliefs about genetic technologies. A possible application of the method to understanding treatment preferences related to type 2 diabetes is also discussed. It is concluded that the use of innovative methodologies is essential if our understanding of patient preferences regarding treatment options is to have a significant impact on patient quality of life.

The effect of betel nut on human performance.

The effects of low doses of betel nut on early-stage visual information processing were examined, using a cross-over experimental design. Three assessment measures were used, critical flicker fusion (an index of the efficiency of the visual processing system), heart rate, and analogue scales of subjective alertness. Only heart rate was shown to be significantly elevated, immediately following betel nut administration. From these results, it was concluded that there is no evidence to suggest that betel nut usage facilitates visual information processing at low-dose levels in habituated subjects, but there is some evidence that peripheral stimulation occurs.

Genetically modified animals from life-science, socio-economic and ethical perspectives: examining issues in an EU policy context.

The interdisciplinary EC consortium (the PEGASUS project) aimed to examine the issues raised by the development, implementation and commercialisation of genetically modified (GM) animals, and derivative foods and pharmaceutical products. The results integrated existing social (including existing public perception) environmental and economic knowledge regarding GM animals to formulate policy recommendations relevant to new developments and applications. The use of GM in farmed animals (aquatic, terrestrial and pharmaceutical) was mapped and reviewed. A foresight exercise was conducted to identity future developments. Three case studies (aquatic, terrestrial and pharmaceutical) were applied to identify the issues raised, including the potential risks and benefits of GM animals from the perspectives of the production chain (economics and agri-food sector) and the life sciences (human and animal health, environmental impact, animal welfare and sustainable production). Ethical and policy concerns were examined through application of combined ethical matrix method and policy workshops. The case studies were also used to demonstrate the utility of public engagement in the policy process. The results suggest that public perceptions, ethical issues, the competitiveness of EU animal production and risk-benefit assessments that consider human and animal health, environmental impact and sustainable production need to be considered in EU policy development. Few issues were raised with application in the pharmaceutical sector, assuming ethical and economic issues were addressed in policy, but the introduction of agricultural GM animal applications should be considered on a case-by-case basis.

Defining European preparedness and research needs regarding emerging infectious animal diseases: results from a Delphi expert consultation.

Emerging and major infectious animal diseases can have significant international impact on social, economic and environmental level, and are being driven by various factors. Prevention and control measures should be prepared at both national and international level to mitigate these disease risks. Research to support such policy development is mostly carried out at national level and dedicated transnational research programmes are still in its infancy. This research reports on part of a process to develop a common strategic research agenda on emerging and major infectious diseases of livestock in Europe, covering a 5-15-year time span. A two round online Delphi study was conducted to explore the views of experts on issues relating to research needs on emerging infectious diseases of livestock in Europe. Drivers that may influence the incidence of emerging infectious animal diseases in both the short (next 5 years) and medium term (10-15 years) were identified. Drivers related to regulatory measures and biological science developments were thought to decrease the incidence, and socio-economic factors to increase the incidence of emerging infectious animal diseases. From the first round a list of threats to animal health was compiled and participants combined these threats with relevant drivers in the second round. Next to identifying threats to animal health, also possible mitigatory actions to reduce the negative impact of these threats were identified. Participants emphasised that interdisciplinary research is needed to understand drivers of emerging infectious animal diseases, as well as to develop prevention and control measures which are both socio-economic and technical. From this it can be concluded that interdisciplinary research combining both natural and social research themes is required. Some of the European member states research budget needs to be allocated so that effective prevention and mitigation strategies can be developed.

Impact of the European clinical trials directive on prospective academic clinical trials associated with BMT.

The European Clinical Trials Directive (EU 2001; 2001/20/EC) was introduced to improve the efficiency of commercial and academic clinical trials. Concerns have been raised by interested organizations and institutions regarding the potential for negative impact of the Directive on non-commercial European clinical research. Interested researchers within the European Group for Blood and Marrow Transplantation (EBMT) were surveyed to determine whether researcher experiences confirmed this view. Following a pilot study, an internet-based questionnaire was distributed to individuals in key research positions in the European haemopoietic SCT community. Seventy-one usable questionnaires were returned from participants in different EU member states. The results indicate that the perceived impact of the European Clinical Trials Directive has been negative, at least in the research areas of interest to the EBMT.

How trust in institutions and organizations builds general consumer confidence in the safety of food: a decomposition of effects.

This paper investigates the relationship between general consumer confidence in the safety of food and consumer trust in institutions and organizations. More specifically, using a decompositional regression analysis approach, the extent to which the strength of the relationship between trust and general confidence is dependent upon a particular food chain actor (for example, food manufacturers) is assessed. In addition, the impact of specific subdimensions of trust, such as openness, on consumer confidence are analyzed, as well as interaction effects of actors and subdimensions of trust. The results confirm previous findings, which indicate that a higher level of trust is associated with a higher level of confidence. However, the results from the current study extend on previous findings by disentangling the effects that determine the strength of this relationship into specific components associated with the different actors, the different trust dimensions, and specific combinations of actors and trust dimensions. The results show that trust in food manufacturers influences general confidence more than trust in other food chain actors, and that care is the most important trust dimension. However, the contribution of a particular trust dimension in enhancing general confidence is actor-specific, suggesting that different actors should focus on different trust dimensions when the purpose is to enhance consumer confidence in food safety. Implications for the development of communication strategies that are designed to regain or maintain consumer confidence in the safety of food are discussed.

Consumer acceptance of technology-based food innovations: lessons for the future of nutrigenomics.

Determinants of consumer adoption of innovations have been studied from different angles and from the perspectives of various disciplines. In the food area, the literature is dominated by a focus on consumer concern. This paper reviews previous research into acceptance of technology-based innovation from both inside and outside the food domain, extracts key learnings from this literature and integrates them into a new conceptual framework for consumer acceptance of technology-based food innovations. The framework distinguishes 'distal' and 'proximal' determinants of acceptance. Distal factors (characteristics of the innovation, the consumer and the social system) influence consumers' intention to accept an innovation through proximal factors (perceived cost/benefit considerations, perceptions of risk and uncertainty, social norm and perceived behavioural control). The framework's application as a tool to anticipate consumer reaction to future innovations is illustrated for an actual technology-based innovation in food science, nutrigenomics (the interaction between nutrition and human genetics).

Consumer evaluations of food risk management quality in Europe.

In developing and implementing appropriate food risk management strategies, it is important to understand how consumers evaluate the quality of food risk management practices. The aim of this study is to model the underlying psychological factors influencing consumer evaluations of food risk management quality using structural equation modeling techniques (SEM), and to examine the extent to which the influence of these factors is country-specific (comparing respondents from Denmark, Germany, Greece, Slovenia, and the United Kingdom). A survey was developed to model the factors that drive consumer evaluations of food risk management practices and their relative importance (n= 2,533 total respondents). The measurement scales included in the structural model were configurally and metrically invariant across countries. Results show that some factors appear to drive perceptions of effective food risk management in all the countries studied, such as proactive consumer protection, which was positively related to consumers' evaluation of food risk management quality, while opaque and reactive risk management was negatively related to perceived food risk management quality. Other factors appeared to apply only in certain countries. For example, skepticism in risk assessment and communication practices was negatively related to food risk management quality, particularly so in the UK. Expertise of food risk managers appeared to be a key factor in consumers' evaluation of food risk management quality in some countries. However, trust in the honesty of food risk managers did not have a significant effect on food risk management quality. From the results, policy implications for food risk management are discussed and important directions for future research are identified.

The elaboration likelihood model and communication about food risks.

Factors such as hazard type and source credibility have been identified as important in the establishment of effective strategies for risk communication. The elaboration likelihood model was adapted to investigate the potential impact of hazard type, information source, and persuasive content of information on individual engagement in elaborative, or thoughtful, cognitions about risk messages. One hundred sixty respondents were allocated to one of eight experimental groups, and the effects of source credibility, persuasive content of information and hazard type were systematically varied. The impact of the different factors on beliefs about the information and elaborative processing examined. Low credibility was particularly important in reducing risk perceptions, although persuasive content and hazard type were also influential in determining whether elaborative processing occurred.

What determines trust in information about food-related risks? Underlying psychological constructs.

Trust in risk information about food related-hazards may be an important determinant of public reactions to risk information. One of the central questions addressed by the risk communication literature is why some individuals and organizations are trusted as sources of risk information and others are not. Industry and government often lack public trust, whereas other sources (for example, consumer organizations, the quality media, medical doctors) are highly trusted. Problematically, previous surveys and questionnaire studies have utilized questions generated by the investigators themselves to assess public perceptions of trust in different sources. Furthermore, no account of the hazard domain was made. In the first study reported here, semistructured interviewing was used to elicit underpinning constructs determining trust and distrust in different sources providing food-related risk information (n = 35). In the second study, the repertory grid method was used to elicit the terminology that respondents use to distinguish between different potential food-related information sources (n = 35), the data being submitted to generalised Procrustes analysis. The results of the two studies were combined and validated in survey research (n = 888) where factor analysis indicated that knowledge in itself does not lead to trust, but that trusted sources are seen to be characterised by multiple positive attributes. Contrary to previous research, complete freedom does not lead to trust-rather sources which possess moderate accountability are seen to be the most trusted.

Methodological approaches to assessing risk perceptions associated with food-related hazards.

The psychometric approach developed by Slovic and his co-workers has been effectively used to assess risk perceptions associated with different food-related hazards. However, further examination (using questionnaire data and partial correlation techniques) has indicated that technological hazards are highly differentiated from lifestyle hazards, in terms of both hazard control and knowledge about the hazard. Optimistic bias was also seen to vary between hazards. Further research has focused on a particular hazard, genetic engineering. Risk perceptions associated with genetic engineering are underpinned by ethical concern and questions relating to perceived need for the technology, as well as perceptions of risk or harm. However, increasing the specificity of hazard stimuli was found to alter the factor structure of underlying risk perceptions. The utility of preference mapping procedures in determining individual differences in trust in risk regulators is also discussed.

Low-income consumers' attitudes and behaviour towards access, availability and motivation to eat fruit and vegetables.

OBJECTIVE: To determine low-income consumers' attitudes and behaviour towards fruit and vegetables, in particular issues of access to, affordability of and motivation to eat fruit and vegetables. DESIGN AND SETTING: Questionnaire survey mailed to homes owned by a large UK housing association. PARTICIPANTS: Participants were 680 low-income men and women, aged 17-100 years. RESULTS: Age, employment, gender, smoking and marital status all affected attitudes towards access, affordability and motivation to eat fruit and vegetables. Few (7%) participants experienced difficulty in visiting a supermarket at least once a week, despite nearly half having no access to a car for shopping. Fruit and vegetables were affordable to this low-income group in the amounts they habitually bought; purchasing additional fruits and vegetables was seen as prohibitively expensive. Less than 5% felt they had a problem with eating healthily and yet only 18% claimed to eat the recommended 5 or more portions of fruit and vegetables every day. CONCLUSIONS: Supported by research, current UK Government policy is driven by the belief that low-income groups have difficulties in access to and affordability of fruit and vegetables. Findings from this particular group suggest that, of the three potential barriers, access and affordability were only a small part of the 'problem' surrounding low fruit and vegetable consumption. Thus, other possible determinants of greater consequence need to be identified. We suggest focusing attention on motivation to eat fruit and vegetables, since no dietary improvement can be achieved if people do not recognise there is a problem.