Climate change anxiety, hurricane exposure, and climate change actions and attitudes: results from a representative, probability-based survey of US Gulf Coast residents.

BACKGROUND: Exposure to climate change-related threats (eg, hurricanes) has been associated with mental health symptoms, including post-traumatic stress symptoms. Yet it is unclear whether climate change anxiety, which is understudied in representative samples, is a specific mental health threat, action motivator, or both, particularly in populations exposed to climate-change related disasters. We sought to examine the associations between exposure to hurricanes, climate change anxiety, and climate change actions and attitudes in a representative sample of US Gulf Coast residents. METHODS: This study used data from a 5-year, representative, prospectively assessed, probability-based, longitudinal cohort sample of residents in Texas and Florida (USA) exposed to exogenous catastrophic hurricanes rated category 3 or greater. Participants were adults aged 18 years and older and were initially recruited from the Ipsos KnowledgePanel in the 60 h before Hurricane Irma (Sept 8-11, 2017). Relationships between climate change anxiety, hurricane exposure, hurricane-related post-traumatic stress symptoms, general functional impairment, and climate change-related individual-level actions (eg, eating a plant-based diet and driving more fuel efficient cars) and collective-level actions (eg, petition signing and donating money) and climate change action attitudes were evaluated using structural equation modelling. FINDINGS: The final survey was completed by 1479 individuals (787 [53·2%] women and 692 [46·8%] men). Two climate change anxiety subscales (cognitive-emotional impairment and perceived experience of climate change) were confirmed using confirmatory factor analysis. Mean values were low for both climate change anxiety subscales: cognitive-emotional impairment (mean 1·31 [SD 0·63], range 1-5) and perceived climate change experience (mean 1·67 [SD 0·89], range 1-5); these subscales differentially predicted outcomes. The cognitive-emotional impairment subscale did not significantly correlate with actions or attitudes; its relationship with general functional impairment was attenuated by co-occurring hurricane-related post-traumatic stress symptoms, which were highly correlated with general functional impairment in all three models (all p<0·0001). The perceived climate change experience subscale correlated with climate change attitudes (b=0·57, 95% CI 0·47-0·66; p<0·0001), individual-level actions (b=0·34, 0·21-0·47; p<0·0001), and collective-level actions (b=0·22, 0·10-0·33; p=0·0002), but was not significantly associated with general functional impairment in any of the final models. Hurricane exposure correlated with climate change-related individual-level (b=0·26, 0·10-0·42; p=0·0011) and collective-level (b=0·41, 0·26-0·56; p<0·0001) actions. INTERPRETATION: Expanded treatment for post-traumatic stress symptoms after disasters could help address climate change-related psychological distress; experiences with climate change and natural hazards could be inflection points to motivate action. FUNDING: National Science Foundation and the National Center for Atmospheric Research.

A longitudinal investigation of risk perceptions and adaptation behavior in the US Gulf Coast.

Climate change is occurring more rapidly than expected, requiring that people quickly and continually adapt to reduce human suffering. The reality is that climate change-related threats are unpredictable; thus, adaptive behavior must be continually performed even when threat saliency decreases (e.g. time has passed since climate-hazard exposure). Climate change-related threats are also intensifying; thus, new or more adaptive behaviors must be performed over time. Given the need to sustain climate change-related adaptation even when threat saliency decreases, it becomes essential to better understand how the relationship between risk perceptions and adaptation co-evolve over time. In this study, we present results from a probability-based representative sample of 2,774 Texas and Florida residents prospectively surveyed 5 times (2017-2022) in the presence and absence of exposure to tropical cyclones, a climate change-related threat. Distinct trajectories of personal risk perceptions emerged, with higher and more variable risk perceptions among the less educated and those living in Florida. Importantly, as tropical cyclone adaptation behaviors increased, personal risk perceptions decreased over time, particularly in the absence of storms, while future tropical cyclone risk perceptions remained constant. In sum, adapting occurs in response to current risk but may inhibit future action despite increasing future tropical cyclone risks. Our results suggest that programs and policies encouraging proactive adaptation investment may be warranted.

Eco-emotions as the planetary boundaries: framing human emotional and planetary health in the global environmental crisis.

BACKGROUND: Affective processes play an important role in physical and mental health and in adaptation responses to the global environmental crisis. Eco-emotions-emotions that are substantially associated with the environment and anthropogenic changes happening within it-are complex and culturally varied. Despite the disproportionate impact of the global environmental crisis on low-income and middle-income countries, most psychological research to date has been conducted in high-income countries and has focused on climate change and negative climate emotions (eg, climate anxiety). The absence of diverse, globally representative evidence about emotions associated with the global environmental crisis beyond climate change hinders evidence-based action on psychological adaptation and the development of contextually and culturally appropriate coping strategies toward the wider range of negative anthropogenic effects. To account for this wider range of anthropogenic effects, we previously introduced an eco-emotions framework built on the planetary boundaries concept. We aimed to apply this framework to the current research on eco-emotional responses to identify remaining gaps that hinder evidence-based action. METHODS: We conducted a literature review of peer-reviewed studies assessing core affect (ie, emotional valence and arousal) and emotions with emphasis on study populations from low-income and middle-income countries and on the eight non-climate change planetary boundaries (biodiversity loss, freshwater use, ocean acidification, chemical pollution, air pollution, land system change, ozone depletion, and nitrogen and phosphorus perturbation). We searched Web of Science from database inception to Oct 31, 2023, for observational empirical studies of adults, using planetary boundary-specific (eg, freshwater use) or wider, newer, or overarching emotional concept (eg, solastalgia, environmental change) search terms. FINDINGS: In contrast to previous climate emotions work, our preliminary results of 135 peer reviewed studies identified a significant body of literature beyond climate change concerning emotional responses to the planetary boundaries of biodiversity loss, freshwater scarcity, and chemical pollution as well as emerging evidence of emotional responses to the other five planetary boundaries. INTERPRETATION: We found that the spectrum of eco-emotional responses ranged from being specific to a single planetary boundary to encompassing all planetary boundaries. Our findings underscore the importance of and urgent need for more holistic and diverse psychological intervention strategies targeting the wider range of anthropogenic effects during the rapidly intensifying global environmental crisis. FUNDING: Emmett Interdisciplinary Program in Environment and Resources; McGee and Levorsen Research Grant Program; and Center on Philanthropy and Civil Society at Stanford University.

Associations between mindfulness and mental health after collective trauma: results from a longitudinal, representative, probability-based survey.

BACKGROUND/OBJECTIVES: Trait mindfulness (TM) may protect against post-trauma mental health ailments and related impairment. Few studies have evaluated this association in the context of collective traumas using representative samples or longitudinal designs. DESIGN/METHOD: We explored relationships between TM and collective trauma-related outcomes in a prospective, representative, probability-based sample of 1846 U.S. Gulf Coast residents repeatedly exposed to catastrophic hurricanes, assessed twice during the COVID-19 outbreak (Wave 1: 5/14/20-5/27/20; Wave 2: 12/21/21-1/11/22). Generalized estimating equations examined longitudinal relationships between TM, COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment; ordinary least squares regression analyses examined the cross-sectional association between TM and COVID-19-related posttraumatic stress symptoms (PTSS) at Wave 1. Event-related stressor exposure was explored as a moderator. RESULTS: In covariate-adjusted models including pre-event mental health ailments and demographics, TM was negatively associated with COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment over time; in cross-sectional analyses, TM was negatively associated with COVID-19-related PTSS. TM moderated the relationship between COVID-19 secondary stressor exposure (e.g., lost job/wages) and both global distress and functional impairment over time. CONCLUSIONS: Results suggest TM may buffer adverse psychosocial outcomes following collective trauma, with some evidence TM may protect against negative effects of secondary stressor exposure.

Hurricane adaptation behaviors in Texas and Florida: exploring the roles of negative personal experience and subjective attribution to climate change.

Understanding motivation to adopt personal household adaptation behaviors in the face of climate change-related hazards is essential for developing and implementing behaviorally realistic interventions that promote well-being and health. Escalating extreme weather events increase the number of those directly exposed and adversely impacted by climate change. But do people attribute these negative events to climate change? Such subjective attribution may be one cognitive process whereby the experience of negative climate change-related events may increase risk perceptions and motivate people to act. Here we surveyed a representative sample of 1,846 residents of Florida and Texas, many who had been repeatedly exposed to hurricanes on the Gulf Coast, facing the 2020 Atlantic hurricane season. We assessed prior hurricane negative personal experience, climate change-related subjective attribution (for hurricanes), risk appraisal (perceived probability and severity of a hurricane threat), hurricane adaptation appraisal (perceived efficacy of adaptation measures and self-efficacy to address the threat of hurricanes), and self-reported hurricane personal household adaptation. Our findings suggest that prior hurricane negative personal experiences and subjective attribution are associated with greater hurricane risk appraisal. Hurricane subjective attribution moderated the relationship between hurricane negative personal experiences and risk appraisal; in turn, negative hurricane personal experience, hurricane risk appraisal, and adaptation appraisal were positively associated with self-reported hurricane personal adaptation behaviors. Subjective attribution may be associated with elevated perceived risk for specific climate hazards. Communications that help people understand the link between their negative personal experiences (e.g., hurricanes) and climate change may help guide risk perceptions and motivate protective actions, particularly in areas with repeated exposure to threats.

Media exposure, threat processing, and mitigation behaviors in Gulf Coast residents facing the co-occurring threats of COVID-19 and hurricanes.

The 2020 hurricane season threatened millions of Americans concurrently grappling with COVID-19. Processes guiding individual-level mitigation for these conceptually distinct threats, one novel and chronic (COVID-19), the other familiar and episodic (hurricanes), are unknown. Theories of health protective behaviors suggest that inputs from external stimuli (e.g., traditional and social media) lead to threat processing, including perceived efficacy (self- and response) and perceived threat (susceptibility and severity), guiding mitigation behavior. We surveyed a representative sample of Florida and Texas residents (N = 1846) between April 14, 2020 and April 27, 2020; many had previous hurricane exposure; all were previously assessed between September 8, 2017 and September 11, 2017. Using preregistered analyses, two generalized structural equation models tested direct and indirect effects of media exposure (traditional media, social media) on self-reported (1) COVID-19 mitigation (handwashing, mask-wearing, social distancing) and (2) hurricane mitigation (preparation behaviors), as mediated through perceived efficacy (self- and response) and perceived threat (susceptibility and severity). Self-efficacy and response efficacy were associated with social distancing (p = .002), handwashing, mask-wearing, and hurricane preparation (ps < 0.001). Perceived susceptibility was positively associated with social distancing (p = 0.017) and hurricane preparation (p < 0.001). Perceived severity was positively associated with social distancing (p < 0.001). Traditional media exhibited indirect effects on COVID-19 mitigation through increased response efficacy (ps < 0.05), and to a lesser extent self-efficacy (p < 0.05), and on hurricane preparation through increased self-efficacy and response efficacy and perceived susceptibility (ps < 0.05). Social media did not exhibit indirect effects on COVID-19 or hurricane mitigation. Communications targeting efficacy and susceptibility may encourage mitigation behavior; research should explore how social media campaigns can more effectively target threat processing, guiding protective actions.

As California burns: the psychology of wildfire- and wildfire smoke-related migration intentions.

Climate change impacts and rapid development in the wildland-urban interface are increasing population exposure and vulnerability to the harmful effects of wildfire and wildfire smoke. The direct and indirect effects of these hazards may impact future mobility decisions among populations at risk. To better understand how perceptions and personal experience inform wildfire- and smoke-associated migration intentions, we surveyed a representative sample of 1108 California residents following the 2020 wildfire season. We assessed the associations between threat appraisal, coping appraisal, personal experience, migration intentions, the impact of wildfire and smoke on migration intentions and place satisfaction, and the potential likelihood of future migration. Results indicate that roughly a third of our sample intended to move in the next 5 years, nearly a quarter of whom reported that wildfire and smoke impacted their migration decision at least a moderate amount. Prior negative outcomes (e.g., evacuating, losing property) were associated with intentions to migrate. Perceived susceptibility and prior negative outcomes were associated with a greater impact of wildfire and smoke on migration intentions. For those intending to remain in place, prior negative outcomes were associated with a greater impact of wildfire and smoke on place satisfaction, which was in turn associated with a greater reported likelihood of future migration. Our findings suggest that perceptions of and experiences with wildfire and smoke may impact individual mobility decisions. These insights may be leveraged to inform risk communications and outreach campaigns to encourage wildfire and smoke risk mitigation behaviors and to improve climate migration modeling. Supplementary Information: The online version contains supplementary material available at 10.1007/s11111-022-00409-w.

Priming close social contact protective behaviors enhances protective social norms perceptions, protection views, and self-protective behaviors during disasters.

Many people do not make choices that minimize risk in the face of health and environmental threats. Using pre-registered analyses, we tested whether a risk communication that primed perceptions about health-protective preparation and behavior of close social contacts promoted protection views and protective behaviors. From December 10-24, 2020, we fielded a 2 (threat vignette: wildfire or COVID-19) x 3 (social contact prime: control, inaction, or action) experiment to a representative sample of 1,108 California residents facing increased COVID-19 cases/deaths, who had recently experienced the most destructive wildfire season in California history. Outcome variables were protection views and protective behavior (i.e., information seeking). Across threat conditions, stronger social norms, efficacy, and worry predicted greater protection views and some protective behaviors. Priming social-contact action resulted in greater COVID-19 information-seeking compared to the control. In the wildfire smoke condition, priming social contact action and inaction increased perceived protective behavior social norms compared to the control; social norms partially mediated the relationships of priming with protection views and protective behaviors; and having existing mask supplies enhanced the relationship between priming inaction and greater protection views compared to priming action or the control. Findings highlight the importance of social influence for health protection views and protective behaviors. Communications enhancing social norms that are sensitive to resource contexts may help promote protective behaviors.

Association Between Repeated Exposure to Hurricanes and Mental Health in a Representative Sample of Florida Residents.

Importance: During the past century, more than 100 catastrophic hurricanes have impacted the Florida coast; climate change will likely be associated with increases in the intensity of future storms. Despite these annual threats to residents, to our knowledge, no longitudinal studies of representative samples at risk of hurricane exposure have examined psychological outcomes associated with repeated exposure. Objective: To assess psychosocial and mental health outcomes and functional impairment associated with repeated hurricane exposure. Design, Setting, and Participants: In this survey study, a demographically representative sample of Florida residents was assessed in the 60 hours prior to Hurricane Irma (wave 1: September 8-11, 2017). A second survey was administered 1 month after Hurricane Irma (wave 2: October 12-29, 2017), and a third survey was administered after Hurricane Michael (wave 3: October 22 to November 6, 2018). Data were analyzed from July 19 to 23, 2021. Exposure: Hurricanes Irma and Michael. Main Outcomes and Measures: The main outcomes were posttraumatic stress symptoms (PTSS), global distress, worry about future events (generalized worries), and functional impairment. Path models were used to assess associations of individual-level factors (prior mental health, recent adversity), prior storm exposures (loss and/or injury, evacuation), and direct, indirect, and media-based exposures to hurricanes Irma and Michael with those outcomes. Poststratification weights were applied to facilitate population-based inferences. Results: Of 2873 individuals administered the survey in wave 1, 1637 responded (57.0% completion rate) (894 [54.6%, weighted] women; mean [SD] age, 51.31 [17.50] years); 1478 in wave 2 (90.3% retention from wave 1) and 1113 in wave 3 (75.3% retention from wave 2) responded. Prior mental health ailments (b, 0.18; 95% CI, 0.07-0.28), prior hurricane-related loss and/or injury (b, 0.09; 95% CI, 0.02-0.17), hours of Hurricane Irma-related media exposure (b, 0.03; 95% CI, 0.02-0.04), being in an evacuation zone during Hurricane Irma and not evacuating (b, 0.14; 95% CI, 0.02-0.27), and loss and/or injury in Hurricane Irma (b, 0.35; 95% CI, 0.25-0.44) were positively associated with PTSS after Hurricane Irma; most associations persisted and were associated with responses to Hurricane Michael. Prior mental health ailments (b, 0.10; 95% CI, 0.03-0.17), hours of Hurricane Michael-related media exposure (b, 0.01; 95% CI, 0.003-0.02), hurricane Irma-related PTSS (b, 0.42; 95% CI, 0.34-0.50), recent individual-level adversity (b, 0.03; 95% CI, 0.005-0.05), being in an evacuation zone during Hurricane Irma and evacuating (b, 0.10; 95% CI, 0.002-0.19), and direct (b, 0.36; 95% CI, 0.16-0.55) and indirect (b, 0.12; 95% CI, 0.05-0.18) Hurricane Michael-related exposures were directly associated with Hurricane Michael-related PTSS. After Hurricane Michael, prior mental health ailments (b, 0.17; 95% CI, 0.06-0.28), and PTSS related to hurricanes Irma (b, 0.11; 95% CI, 0.001-0.22) and Michael (b, 0.58; 95% CI, 0.47-0.69) were associated with respondents' functional impairment. Analogous analyses using global distress and generalized worries as mediators of functional impairment yielded a similar pattern of results. Conclusions and Relevance: In this survey study, repeated direct, indirect, and media-based exposures to hurricanes were associated with increased mental health symptoms among Florida residents who experienced hurricanes Irma and Michael, suggesting that people were sensitized to respond with more psychological symptoms over time. These results may inform targeted public health intervention efforts for natural disasters.

Media exposure, risk perceptions, and fear: Americans' behavioral responses to the Ebola public health crisis.

We examined media exposure, psychological fear and worry, perceptions of risk, and health protective behaviors surrounding the 2014 Ebola virus outbreak in a probability-based, representative, national sample of Americans (N = 3447). Structural equation models examined relationships between amount (hours/day) and content (e.g., graphic images of dead bodies) of media exposure and counts of self-reported health protective behaviors that participants performed or would perform if Ebola spread to their community. Ebola-related risk perceptions and fear and worry were potential mediators. Greater total hours and more graphic media exposure positively correlated with more fear and worry; greater total hours of media exposure also positively correlated with higher perceived risk. Higher risk perceptions were associated with more health protective behaviors performed and intended. Greater fear and worry were associated with more behaviors performed. Amount and content of media exposure exhibited indirect effects on behaviors performed; amount of media exposure had indirect effects on intentions. Media may help promote health protective behaviors during public health threats; the amount and content should be congruent with threat to minimize distress and maximize resources.

A path forward for qualitative research on sustainability in the COVID-19 pandemic.

The unique strengths of qualitative research, through in-depth inquiry and identification of unexpected themes and linkages, is essential to our growing understanding of COVID-19's impacts on the social world and its intersection with sustainability science. However, many challenges-physical, psychological, and ethical in nature-face qualitative researchers during the pandemic, as social distancing and travel restrictions prevent in-person field work. In this paper, we outline the essential contributions of qualitative study to sustainability science, discuss current challenges, and in turn, provide recommendations for researchers.

A Decision-Centered Method to Evaluate Natural Hazards Decision Aids by Interdisciplinary Research Teams.

There is a growing number of decision aids made available to the general public by those working on hazard and disaster management. When based on high-quality scientific studies across disciplines and designed to provide a high level of usability and trust, decision aids become more likely to improve the quality of hazard risk management and response decisions. Interdisciplinary teams have a vital role to play in this process, ensuring the scientific validity and effectiveness of a decision aid across the physical science, social science, and engineering dimensions of hazard awareness, option identification, and the decisions made by individuals and communities. Often, these aids are not evaluated before being widely distributed, which could improve their impact, due to a lack of dedicated resources and guidance on how to systematically do so. In this Perspective, we present a decision-centered method for evaluating the impact of hazard decision aids on decisionmaker preferences and choice during the design and development phase, drawing from the social and behavioral sciences and a value of information framework to inform the content, complexity, format, and overall evaluation of the decision aid. The first step involves quantifying the added value of the information contained in the decision aid. The second involves identifying the extent to which the decision aid is usable. Our method can be applied to a variety of hazards and disasters, and will allow interdisciplinary teams to more effectively evaluate the extent to which an aid can inform and improve decision making.

Change in Public Concern and Responsive Behaviors Toward Air Pollution Under the Dome.

This study evaluates the effect of the documentary Under the Dome on the concern and responsive behaviors of the public regarding air pollution in China, with two surveys conducted before and after watching the documentary. Employing difference-in-differences regression, this study answers two research questions: (1) Does Under the Dome change public concern about air pollution? (2) Does Under the Dome change public behaviors in response to air pollution, including protective behaviors (i.e., wearing face masks) and mitigation behaviors (i.e., reducing car driving)? We find that the information campaign (1) protects against the decline of public concern about air pollution in Beijing and (2) moderates the degree to which people's perceived severity, perceived susceptibility, and sense of self-efficacy influence protective behaviors and moderates the degree to which people's belief in the cooperative behaviors by others influences mitigation behaviors. This study provides evidence that information campaigns of the Under the Dome type are effective in raising public awareness; however, the information campaign did not directly influence public protective and mitigation behaviors.

Effect of Using an Indoor Air Quality Sensor on Perceptions of and Behaviors Toward Air Pollution (Pittsburgh Empowerment Library Study): Online Survey and Interviews.

BACKGROUND: Air quality affects us all and is a rapidly growing concern in the 21st century. We spend the majority of our lives indoors and can be exposed to a number of pollutants smaller than 2.5 microns (particulate matter, PM2.5) resulting in detrimental health effects. Indoor air quality sensors have the potential to provide people with the information they need to understand their risk and take steps to reduce their exposure. One such sensor is the Speck sensor developed at the Community Robotics, Education and Technology Empowerment Lab at Carnegie Mellon University. This sensor provides users with continuous real-time and historical PM2.5 information, a Web-based platform where people can track their PM2.5 levels over time and learn about ways to reduce their exposure, and a venue (blog post) for the user community to exchange information. Little is known about how the use of such monitors affects people's knowledge, attitudes, and behaviors with respect to indoor air pollution. OBJECTIVE: The aim of this study was to assess whether using the sensor changes what people know and do about indoor air pollution. METHODS: We conducted 2 studies. In the first study, we recruited 276 Pittsburgh residents online and through local branches of the Carnegie Library of Pittsburgh, where the Speck sensor was made available by the researchers in the library catalog. Participants completed a 10- to 15-min survey on air pollution knowledge (its health impact, sources, and mitigation options), perceptions of indoor air quality, confidence in mitigation, current behaviors toward air quality, and personal empowerment and creativity in the spring and summer of 2016. In our second study, we surveyed 26 Pittsburgh residents in summer 2016 who checked out the Speck sensor for 3 weeks on the same measures assessed in the first study, with additional questions about the perception and use of the sensor. Follow-up interviews were conducted with a subset of those who used the Speck sensor. RESULTS: A series of paired t tests found participants were significantly more knowledgeable (t25=-2.61, P=.02), reported having significantly better indoor air quality (t25=-5.20, P<.001), and felt more confident about knowing how to mitigate their risk (t25=-1.87, P=.07) after using the Speck sensor than before. McNemar test showed participants tended to take more action to reduce indoor air pollution after using the sensor (χ225=2.7, P=.10). Qualitative analysis suggested possible ripple effects of use, including encouraging family and friends to learn about indoor air pollution. CONCLUSIONS: Providing people with low- or no-cost portable indoor air quality monitors, with a supporting Web-based platform that offers information about how to reduce risk, can help people better express perceptions and adopt behaviors commensurate with the risks they face. Thus, thoughtfully designed and deployed personal sensing devices can help empower people to take steps to reduce their risk.

Public Understanding of Ebola Risks: Mastering an Unfamiliar Threat.

Ebola was the most widely followed news story in the United States in October 2014. Here, we ask what members of the U.S. public learned about the disease, given the often chaotic media environment. Early in 2015, we surveyed a representative sample of 3,447 U.S. residents about their Ebola-related beliefs, attitudes, and behaviors. Where possible, we elicited judgments in terms sufficiently precise to allow comparing them to scientific estimates (e.g., the death toll to date and the probability of dying once ill). Respondents' judgments were generally consistent with one another, with scientific knowledge, and with their self-reported behavioral responses and policy preferences. Thus, by the time the threat appeared to have subsided in the United States, members of the public, as a whole, had seemingly mastered its basic contours. Moreover, they could express their beliefs in quantitative terms. Judgments of personal risk were weakly and inconsistently related to reported gender, age, education, income, or political ideology. Better educated and wealthier respondents saw population risks as lower; females saw them as higher. More politically conservative respondents saw Ebola as more transmissible and expressed less support for public health policies. In general, respondents supported providing "honest, accurate information, even if that information worried people." These results suggest the value of proactive communications designed to inform the lay public's decisions, thoughts, and emotions, and informed by concurrent surveys of their responses and needs.

Development and Testing of the MyHealthyPregnancy App: A Behavioral Decision Research-Based Tool for Assessing and Communicating Pregnancy Risk.

BACKGROUND: Despite significant advances in medical interventions and health care delivery, preterm births in the United States are on the rise. Existing research has identified important, seemingly simple precautions that could significantly reduce preterm birth risk. However, it has proven difficult to communicate even these simple recommendations to women in need of them. Our objective was to draw on methods from behavioral decision research to develop a personalized smartphone app-based medical communication tool to assess and communicate pregnancy risks related to preterm birth. OBJECTIVE: A longitudinal, prospective pilot study was designed to develop an engaging, usable smartphone app that communicates personalized pregnancy risk and gathers risk data, with the goal of decreasing preterm birth rates in a typically hard-to-engage patient population. METHODS: We used semistructured interviews and user testing to develop a smartphone app based on an approach founded in behavioral decision research. For usability evaluation, 16 participants were recruited from the outpatient clinic at a major academic hospital specializing in high-risk pregnancies and provided a smartphone with the preloaded app and a digital weight scale. Through the app, participants were queried daily to assess behavioral risks, mood, and symptomology associated with preterm birth risk. Participants also completed monthly phone interviews to report technical problems and their views on the app's usefulness. RESULTS: App use was higher among participants at higher risk, as reflected in reporting poorer daily moods (Odds ratio, OR 1.20, 95% CI 0.99-1.47, P=.08), being more likely to smoke (OR 4.00, 95% CI 0.93-16.9, P=.06), being earlier in their pregnancy (OR 1.07, 95% CI 1.02-1.12, P=.005), and having a lower body mass index (OR 1.07, 95% CI 1.00-1.15, P=.05). Participant-reported intention to breastfeed increased from baseline to the end of the trial, t15=-2.76, P=.01. Participants' attendance at prenatal appointments was 84% compared with the clinic norm of 50%, indicating a conservatively estimated cost savings of ~US $450/patient over 3 months. CONCLUSIONS: Our app is an engaging method for assessing and communicating risk during pregnancy in a typically hard-to-reach population, providing accessible and personalized distant obstetrical care, designed to target preterm birth risk, specifically.

Informing Public Perceptions About Climate Change: A 'Mental Models' Approach.

As the specter of climate change looms on the horizon, people will face complex decisions about whether to support climate change policies and how to cope with climate change impacts on their lives. Without some grasp of the relevant science, they may find it hard to make informed decisions. Climate experts therefore face the ethical need to effectively communicate to non-expert audiences. Unfortunately, climate experts may inadvertently violate the maxims of effective communication, which require sharing communications that are truthful, brief, relevant, clear, and tested for effectiveness. Here, we discuss the 'mental models' approach towards developing communications, which aims to help experts to meet the maxims of effective communications, and to better inform the judgments and decisions of non-expert audiences.

Team science for science communication.

Natural scientists from Climate Central and social scientists from Carnegie Mellon University collaborated to develop science communications aimed at presenting personalized coastal flood risk information to the public. We encountered four main challenges: agreeing on goals; balancing complexity and simplicity; relying on data, not intuition; and negotiating external pressures. Each challenge demanded its own approach. We navigated agreement on goals through intensive internal communication early on in the project. We balanced complexity and simplicity through evaluation of communication materials for user understanding and scientific content. Early user test results that overturned some of our intuitions strengthened our commitment to testing communication elements whenever possible. Finally, we did our best to negotiate external pressures through regular internal communication and willingness to compromise.