Influence of Risk Perception on Attitudes and Norms Regarding Electronic Cigarettes.

The use of electronic cigarettes has grown substantially over the last few years. Currently, about 4% of adults use electronic cigarettes, about 16% of high school students report use in the past 30 days, as do approximately 11-25% of college students. A hallmark of the reduction in tobacco use has been the shift in social norms concerning smoking in public. Such norms may also drive views on acceptability of public electronic cigarette use. While normative factors have been given attention, little substantive application of the literature on risk perception has been brought to bear. The overall aim of this study was to place a cognitive-affective measure of risk perception within a model that also includes social cues for e-cigarettes, addictiveness beliefs, and tobacco use to predict perceived social acceptability for public use of e-cigarettes. To do so, a cross-sectional study using an online survey was conducted among a sample of undergraduate students at a Western university (n = 395). A structural equation model showed that the acceptability of public e-cigarette use was influenced by social cues, beliefs about addiction, and cognitive risk perception, even after controlling for nicotine use. What is revealed is that cognitive assessment of e-cigarette risk and perception of addictiveness had a suppressing effect on perceived acceptability of public vaping, while greater exposure to social cues exerted a countervailing effect. This is evidence of the role that risk perception and social norms may play in the increases in electronic cigarette use that have been observed.

A Cognitive-Affective Scale for Hurricane Risk Perception.

The aim of this study was to develop a reliable and valid measure of hurricane risk perception. The utility of such a measure lies in the need to understand how people make decisions when facing an evacuation order. This study included participants located within a 15-mile buffer of the Gulf and southeast Atlantic U.S. coasts. The study was executed as a three-wave panel with mail surveys in 2010-2012 (T0 baseline N = 629, 56%; T1 retention N = 427, 75%; T2 retention N = 350, 89%). An inventory based on the psychometric model was developed to discriminate cognitive and affective perceptions of hurricane risk, and included open-ended responses to solicit additional concepts in the T0 survey. Analysis of the T0 data modified the inventory and this revised item set was fielded at T1 and then replicated at T2 . The resulting scales were assessed for validity against existing measures for perception of hurricane risk, dispositional optimism, and locus of control. A measure of evacuation expectation was also examined as a dependent variable, which was significantly predicted by the new measures. The resulting scale was found to be reliable, stable, and largely valid against the comparison measures. Despite limitations involving sample size, bias, and the strength of some reliabilities, it was concluded that the measure has potential to inform approaches to hurricane preparedness efforts and advance planning for evacuation messages, and that the measure has good promise to generalize to other contexts in natural hazards as well as other domains of risk.

Perceptual influences on self-protective behavior for West Nile virus, a survey in Colorado, USA.

BACKGROUND: The endemic state of West Nile virus (WNv) in North America underscores the need to examine mechanisms influencing human self-protective behavior. Based on previous findings and theory, this study is designed to achieve two specific aims. First, the study will examine self-protective behavior for WNv through a hybridized treatment of the Health Belief Model that includes cognitive, affective, ecological, and proximity risk perception measures. Second, within the resulting hybridized model explore the role of ethnicity in self-protective behavior for WNv. METHODS: Data were collected in Greeley, Colorado, using a self-administered mail survey. 384 completed surveys were returned (49% completion rate). The questionnaire used items on cognitive-affective risk perception, ecological and proximity risk perception constructs, the Health Belief Model and demographics. RESULTS: Analysis revealed that newer risk perception models (ecological and proximity) provide some power to explain protective behavior. The psychometric measures of risk perception (cognitive and affective components) provided the best explanatory power. Self-protective behavior was further enhanced by the perception of benefits associated with such actions and the exposure to information cues to action. Hispanic/Latinos demonstrate greater perception of risk/susceptibility and greater exposure to information cues to action, and were more likely to practice self-protective behavior. CONCLUSIONS: The findings in this study point to several useful openings for effective public health communication and intervention for WNv based on affective response, information exposure, and ethnicity. The results also have relevance for vectored diseases generally. It is becoming clear that changes in global climate will bring increased threat from mosquito vectored diseases. Mosquito protection will be an increasingly salient topic for public health communicators in the coming years.

Individual- and community-level effects on risk perception in cancer cluster investigations.

This article focuses on the relative influence of individual versus community effects on risk perception. The study is grounded in literature examining how individuals manage information and make risk judgments in the context of suspected environmental cancer threats. We focus on three individual-level perspectives: the psychometric model of risk perception, an adaptation of the heuristic-systematic information processing model, and cancer anxiety. We also evaluate five sets of community-level variables that frame cancer cluster investigations: demographic, epidemiologic, sociologic, etiologic, and pathologic. Data were collected through a mail survey of 30 communities in which cancer cluster investigations were being conducted. Response rates averaged 43%, with 1,111 records in the final data set. Through multilevel modeling and other techniques, the results show that the individual-level model developed in previous work remains a robust description of risk perception in these cases. However, the analysis also shows that the community-level measures neither improve the individual-level model nor offer any substantial explanatory power of their own. We provisionally conclude that, within the context of cancer cluster investigations, risk perception is a phenomenon located in a common psychological dimension that is substantially independent of contextual influences. We also suggest that risk communication efforts in this specific context might successfully draw from a common approach informed more by individual than community factors.

Radon awareness and mitigation in Vermont: a public health survey.

Radon exposure is associated with an increased incidence of lung cancer, and elevated levels may be found in as many as 1 out of 15 homes. The U.S. EPA recommends testing homes for radon and mitigating over the advisory level of 4 picocuries per liter (4 pCi L(-1), or 148 Bq m(-3)). A sample population from a list of Vermont residents who had tested their residence for radon through the Vermont Department of Health and who had elevated levels were mailed a survey to assess demographic characteristics, knowledge about radon, mitigation rates, types of mitigation, as well as barriers to mitigation. The response rate was 63%. Forty-three percent of respondents mitigated. Roughly half were not completely knowledgeable of radon based upon the ability to associate radon exposure with lung cancer risk. Reasons not to mitigate radon levels in homes were cost and lack of concern over elevated levels. A multivariate logistic regression analysis revealed factors associated with mitigating: an education level of college or higher (p = 0.02), concern that a high radon level would affect real estate value (p = 0.04), and home age less than 10 y (p = 0.05). In summary, less than half of Vermonters with elevated radon levels participating in the Department of Health program mitigated. We identify factors associated with radon mitigation that may lead to improved radon education and mitigation practice.

A Comparison of Students and Non-Students with Respect to Orientation Toward E-cigarettes.

We examine differences between college students and non-students with respect to orientation toward e-cigarettes. Participants were U.S. adults 18-24 (465 students, 409 non-students). Data collection employed an online survey by GfK Custom Research. Smoking, vaping, and use of alternate tobacco were assessed, as were variables from the Theory of Reasoned Action and Diffusion of Innovations. This study showed that smoking status largely explains use and orientation toward electronic cigarettes among both students and non-students, with differences attributable to higher smoking rates among non-students. Results also showed that among student smokers there was a greater level of information exposure concerning electronic cigarettes, and more prevalence in the use of alternate tobacco. Hookah use in that group was significantly greater than for non-student smokers. Together these findings suggest that students may be more vulnerable to electronic cigarette use due to higher related information exposure and the integration of vaping into hookah culture.

Orientation of US Young Adults toward E-cigarettes and their Use in Public.

OBJECTIVES: We examined use of e-cigarettes and views toward their use in public. METHODS: An online survey of US adults aged 18-24 (N = 874) was used. Measures included tobacco/e-cigarette use, acceptability of public cigarette/e-cigarette use, intention to use e-cigarettes, attitudes and norms. RESULTS: There was greater acceptance of public e-cigarette use than cigarettes. A path model revealed that attitudes and norms concerning e-cigarettes predicted the use of e-cigarettes beyond the effect of smoking. Attitudes also were shown to predict intention for future e-cigarette use above the effect of current and past smoking, and to predict acceptability of public use of e-cigarettes. CONCLUSIONS: Normative acceptance of e-smoking in public may contribute to the wider adoption of e-cigarettes.

Perceived Characteristics of E-cigarettes as an Innovation by Young Adults.

OBJECTIVES: We examined channels through which information about e-cigarettes has flowed, public perception of e-cigarettes as an innovation, and how these may influence use. METHODS: An online survey of US adults aged 18-24 years (N = 874) was used. Measures included information channels, perception of e-cigarettes as an innovation, and intention to use. RESULTS: Television ranked first for exposure to e-cigarette information. The most positive innovation attributes were observability and relative advantage. A structural model showed that information exposure and favorable perception as an innovation predicted use. CONCLUSIONS: The high degree of e-cigarette awareness combined with depiction of the devices as a favorable innovation may contribute to their wider adoption and may argue for regulation of e-cigarette advertising.

The effect of electronic cigarette advertising on intended use among college students.

INTRODUCTION: . Aside from prohibiting health claims, there are presently no restrictions on electronic cigarette advertising in the U.S. Studies have shown college students have a positive view of e-cigarettes and use on campuses is increasing. The purpose of this study was to test if the appeal of e-cigarette advertisements and beliefs about the addictiveness of e-cigarettes may affect their uptake among college students. METHODS: The study was framed within the Theory of Reasoned Action, which posits that behavioral intention can be understood in terms of social norms and attitudes toward a behavior. We also included variables capturing appeal of e-cigarette advertisements, belief that e-cigarettes are not as addictive as cigarettes, and tobacco use. Attitudes toward e-cigarettes, perceived norms concerning their use, beliefs that e-cigarettes are not as addictive as cigarettes, and positive appraisal of e-cigarette advertising videos were all hypothesized to be independently positively associated with intention to use an e-cigarette. Data were collected through a survey of students at a major U.S. university (participation rate 78%, N=296). Participants were exposed to three e-cigarette video advertisements in random order. RESULTS: In a regression analysis we found positive reaction to the ads and holding the belief that e-cigarettes are not as addictive were both independently associated with intention. Attitudes and norms were also associated but were controlled by inclusion of the other variables. CONCLUSIONS: These findings suggest that advertising may promote the uptake of e-cigarettes and may do so in addition to current smoking and alternate tobacco use status.

Mass-mediated information effects on testicular self-examination among college students.

The author assessed the effects of a youth-targeted national cable broadcast that promoted testicular self-examination (TSE). A telephone survey of 524 college men included variables from the theory of reasoned action, as well as measures of self-exam compliance, message exposure, knowledge, attention, and the effects of humor and fear. Exposure to the show, with attitudes and norms controlled for, demonstrated a statistically significant but very weak effect on viewers' behavioral intentions. Although also statistically significant, the effect of the show on awareness, knowledge, and facilitating interpersonal communication was as weak or weaker than its effect on intention. Furthermore, dose measures failed to demonstrate any significant effect among those who saw the show. It is conceivable that the show might be integrated into a broader effort toward TSE education, but the results of this study do not argue that it could be effectively used as a media-only TSE promotion.

Use and perception of electronic cigarettes among college students.

OBJECTIVE: This study provides insight into how electronic cigarettes (e-cigarettes) may affect the social normative environment for tobacco use among college students. PARTICIPANTS: Participants were 244 freshman and sophomore students. METHODS: Students completed an online self-report survey in April 2011. RESULTS: There is a higher acceptance rate of e-cigarette smoking in public than traditional tobacco. For intention to use an e-cigarette, the strongest predictor is current tobacco use, followed by a positive orientation toward public use of e-cigarettes. Positive orientation toward public use of e-cigarettes is significantly predicted by the use of alternate tobacco, intention to use or try e-cigarettes, positive orientation toward public use of tobacco, positive attitude toward e-cigarettes, positive perception of social norms for use of e-cigarettes, and favorable orientation toward e-cigarettes as an innovation. CONCLUSIONS: These models suggest attitudinal, social normative, innovation, and behavioral factors may combine to bring the e-cigarette into wider use among college students.

Cancer anxiety and the perception of risk in alarmed communities.

Cancer is a significant public health topic and is frequently a factor in public reactions to environmental hazards. It may be reasonable to suggest that a unique form of health anxiety exists - one specific to cancer. In this article, we explore a measure of cancer anxiety that has applicability to risk perception in the specific context of communities that are alarmed over suspect cancer rates thought to be associated with environmental hazards. A literature search was used to identify survey questions previously used to measure cancer worry, fear, anxiety, etc. A list of 24 items was employed in a mail survey sent to 30 communities in which cancer rates were under investigation (part of a broader study). An analysis of the dataset of 1,111 responses yields two versions of a cancer anxiety scale: one an additive combination of 21 items (alpha= 0.77) and the other a two-factor model consisting of nine- and four-item subscales (alpha= 0.74 and 0.69). The resulting scales are evaluated for their ability to predict perception of risk from the environmental hazards in these cases. Controlling for age, sex, and cancer status, the scales explain between 2% and 10% of risk perception (full R(2) values ranging from 0.17 to 0.24). Given the range of concepts required to model risk perception, we conclude that this measure of cancer anxiety is sufficiently reliable and robust to be recommended for use in circumstances involving hazards associated with cancer. Other uses and further development of the measure are discussed.

Public meetings about suspected cancer clusters: the impact of voice, interactional justice, and risk perception on attendees' attitudes in six communities.

Holding a public meeting is a frequent method of communicating with community residents during official investigations into possible cancer clusters; however, there has been little formal research into the effectiveness of this method of health communication. This article presents research examining the influence of public meetings held during ongoing cancer cluster investigations in six U.S. communities. Drawing on social psychological theories of organizational justice, it examines the degree to which three specific elements of justice, including having a voice in the process, receiving fair interactional treatment, and facing equal risk of loss (i.e., cancer), influenced five outcome variables: meeting satisfaction, community connectedness, willingness to accept meeting outcomes or recommendations, willingness to attend future public meetings, and concern about the potential cancer cluster. The analysis of data collected from meeting attendees who responded to the mailed survey (N = 165) confirms a strong role for justice concerns in public meeting evaluations. In particular, perceptions of voice and interactional treatment had consistently large effects on the outcome variables, suggesting that managing a fair public engagement process can contribute to positive civic outcomes even during periods of heightened community concern about area cancer rates.

The function of credibility in information processing for risk perception.

This study examines how credibility affects the way people process information and how they subsequently perceive risk. Three conceptual areas are brought together in this analysis: the psychometric model of risk perception, Eagly and Chaiken's heuristic-systematic information processing model, and Meyer's credibility index. Data come from a study of risk communication in the circumstance of state health department investigations of suspected cancer clusters (five cases, N = 696). Credibility is assessed for three information sources: state health departments, citizen groups, and industries involved in each case. Higher credibility for industry and the state directly predicts lower risk perception, whereas high credibility for citizen groups predicts greater risk perception. A path model shows that perceiving high credibility for industry and state-and perceiving low credibility for citizen groups-promotes heuristic processing, which in turn is a strong predictor of lower risk perception. Alternately, perceiving industry and the state to have low credibility also promotes greater systematic processing, which consistently leads to perception of greater risk. Between a one-fifth and one-third of the effect of credibility on risk perception is shown to be indirectly transmitted through information processing.