Did the temporary suspension of Vaxzveria vaccinations influence COVID-19 vaccination intentions, vaccination perceptions and trust in the vaccination campaign? A repeated survey study in the Netherlands.

In spring 2021, several countries, among which the Netherlands, suspended vaccinations against COVID-19 with the Vaxzevria vaccine from AstraZeneca after reports of rare but severe adverse events. This study investigates the influence of this suspension on the Dutch public's perceptions of COVID-19 vaccinations, trust in the government's vaccination campaign, and COVID-19 vaccination intentions. We conducted two surveys in a population of general Dutch public (18 + ), one shortly before the pause of AstraZeneca vaccinations and one shortly thereafter (N eligible for analysis = 2628). Our results suggest no changes in perceptions nor intentions regarding the COVID-19 vaccines in general but do suggest a decline in trust in the government's vaccination campaign. In addition, after the suspension, perceptions of the AstraZeneca vaccines were more negative in comparison to those of COVID-19 vaccinations in general. AstraZeneca vaccination intentions were also considerably lower. These results stress the need to adapt vaccination policies to anticipated public perceptions and responses following a vaccine safety scare, as well as the importance of informing citizens about the possibility of very rare adverse events prior to the introduction of novel vaccines.

COVID-19 Vaccination Intent and Belief that Vaccination Will End the Pandemic.

High vaccination coverage is considered to be key in dealing with the coronavirus disease (COVID-19) pandemic. However, vaccine hesitancy can limit uptake. We examined the specific coronavirus beliefs that persons have regarding COVID-19 and COVID-19 vaccines and to what extent these beliefs explain COVID-19 vaccination intentions. We conducted a survey among 4,033 residents of the Netherlands that examined COVID-19 vaccination intentions and various beliefs. Random forest regression analysis explained 76% of the variance in vaccination intentions. The strongest determinant in the model was the belief the COVID-19 crisis will only end if many persons get vaccinated. Other strong determinants were beliefs about safety of vaccines, specifically in relation to vaccine development and approval process; (social) benefits of vaccination; social norms regarding vaccination behavior; and effectiveness of vaccines. We propose to address these specific beliefs in communications about COVID-19 vaccinations to stimulate vaccine uptake.

Dynamics in public perceptions and media coverage during an ongoing outbreak of meningococcal W disease in the Netherlands.

BACKGROUND: From 2015 to 2018, the Netherlands faced an outbreak of invasive meningococcal disease (IMD) caused by serogroup W. To counter the rise in infections, the government introduced a catch-up menACWY vaccination campaign for teenagers in 2018 and 2019. The outbreak situation induced substantial media attention and a run on menACWY vaccines outside the vaccination campaign. This study aimed to gain insights into the dynamics of public perceptions of and responses to the outbreak and the menACWY vaccination, and into the media coverage about the outbreak. METHODS: Three repeated surveys (N = 1110) between 2017 and 2019 were sent to parents of teenagers invited for a menACWY catch-up vaccination, other parents, and individuals with no under-age children. These surveys assessed IMD risk perceptions, attitudes towards the menACWY vaccination, trust in involved institutions, and willingness to vaccinate with the menACWY vaccine. Changes in the public perceptions and responses were studied with linear multilevel regression analyses. In addition, 103 national newspaper articles from the period 2017-2019 were thematically coded with themes about IMD and the menACWY vaccination. RESULTS: The survey results showed clear increases in perceived IMD severity, positive attitude towards the menACWY vaccination, and willingness to vaccinate over time. Perceived IMD vulnerability remained low across all three waves, and trust in involved institutions increased slightly. Differences between the survey groups were limited. The newspaper articles discussed the rise in infections extensively, the disease symptoms, and the possible fatal outcome of IMD. In addition, while many articles discussed the menACWY vaccine shortage, few discussed the safety or effectiveness of the vaccine. CONCLUSION: The real-time insights into the interrelated dynamics of public perceptions, responses, and media coverage provide an integrated portrait of the social developments during this outbreak. The focus on IMD severity and the absence of doubt in the public discussion about vaccine safety may have played an important role in the societal response to this outbreak and the recommended vaccine.

How to Address Consumers' Concerns and Information Needs about Emerging Chemical and Microbial Contaminants in Drinking Water; The Case of GenX in The Netherlands.

The perceived safety of tap water is an important condition for consumers to drink it. Therefore, addressing consumers' concerns should be included in the roadmap towards the UN SDG 6 on safe drinking water for all. This paper studies consumers' information needs regarding emerging contaminants in drinking water using a mental model approach for the development of targeted risk communication. As most consumers expect safe drinking water, free of contamination, communication on emerging contaminants may increase concerns. Here, we showed that communication strategies better tailored to consumers' information needs result in smaller increases in risk perception compared with existing strategies.

Information needs during an emerging outbreak of meningococcal W135 disease in the Netherlands: a study among teenagers, their parents and healthcare professionals.

BACKGROUND: To counter the rise in invasive meningococcal disease (IMD) serogroup W, the Netherlands introduced a menACWY catch-up vaccination campaign for teenagers in 2018 and 2019. Teenagers and parents who have questions or who seek advice from a professional about vaccinations are likely to consult a youth healthcare professional or their general practitioner. This study aimed to appraise the ability of these healthcare professionals to meet the information needs of teenagers and their parents at the start of the vaccination campaign. METHODS: With online surveys, we assessed information needs in teenagers (N = 1603) and parents (N = 1784) concerning IMD and the menACWY vaccination, and in healthcare professionals (N = 520) in their communication with teenagers and parents. We additionally studied healthcare professionals' expectations of the information needs of teenagers and parents. RESULTS: We identified several information needs about IMD and the menACWY vaccination in teenagers, parents and healthcare professionals. Some important commonalities in the information needs in these three groups were found, with regard to the topics IMD prevention, vaccine effectiveness and vaccine protection duration. Healthcare professionals' expectations of the information needs of teenagers and parents were quite accurate but some important discrepancies were found. CONCLUSION: Our results suggest that healthcare professionals might not have been optimally equipped or prepared for questions from teenagers and their parents at the beginning of the vaccination campaign. We recommend public health institutes to timely assess and meet information needs about new vaccines in healthcare professionals to optimally equip them for consultations.

The role of the media in the amplification of a contested health risk: Rubber granulate on sport fields.

This study aims to increase insights into the potential role of the media in the amplification and attenuation of modern risks in society, by studying the dynamics and contents of the newspaper coverage about the potential health risk posed by rubber granulate in the Netherlands. We thematically analysed 153 national newspaper articles about the risks posed by rubber granulate between September 2016 and February 2017. Our results suggest that newspaper coverage might have contributed to heightened public risk perceptions by presenting the negligible health risk as uncertain, focusing on controversy between authorities and experts, describing responses such as concerns, commotion, and adopted risk mitigation measures by members of the public, and by providing insufficient contextualization on whether hazardous substances in rubber granulate pose a threat to health. The risks posed by rubber granulate is one of the many modern risks that has become subject to heated and mediated public discussions. Our results provide in-depth insights into important content elements in media coverage during such discussions and the impact of these elements on public perceptions. Public health institutes and other authorities might be able to mitigate the amplification of risks through media coverage by means of appropriate preparedness and response.

Dynamic Public Perceptions of the Coronavirus Disease Crisis, the Netherlands, 2020.

A key component of outbreak control is monitoring public perceptions and public response. To determine public perceptions and public responses during the first 3 months of the coronavirus disease (COVID-19) outbreak in the Netherlands, we conducted 6 repeated surveys of ≈3,000 persons. Generalized estimating equations analyses revealed changes over time as well as differences between groups at low and high risk. Overall, respondents perceived the risks associated with COVID-19 to be considerable, were positive about the mitigation measures, trusted the information and the measures from authorities, and adopted protective measures. Substantial increases were observed in risk perceptions and self-reported protective behavior in the first weeks of the outbreak. Individual differences were based mainly on participants' age and health condition. We recommend that authorities constantly adjust their COVID-19 communication and mitigation strategies to fit public perceptions and public responses and that they tailor the information for different groups.

Meningococcal W135 Disease Vaccination Intent, the Netherlands, 2018-2019.

To control the rise in Neisseria meningitidis strain W infections, during 2018-2019, the Netherlands launched a catch-up meningococcal conjugate (MenACWY) vaccination campaign for teenagers (13-18 years of age). Applying a mental models approach, we surveyed teenagers and their parents about their knowledge and beliefs about meningococcal disease, the MenACWY vaccination, vaccinations in general, and their MenACWY vaccination intentions. Using random forest analysis, we studied predictions of vaccination intentions by knowledge and beliefs. Survey response rate was 52.8% among teenagers and 59.4% among parents. MenACWY vaccination intentions were best predicted by knowledge and beliefs about vaccinations in general, surpassing knowledge and beliefs about meningococcal disease and the MenACWY vaccination. For teenagers, their parents' intention that the teenager be vaccinated was a strong predictor of the teenagers' own vaccination intention. To optimize vaccination uptake during future outbreaks, we recommend that communications emphasize the effectiveness and safety of vaccines and continue to focus on parents.

Do Preferred Risk Formats Lead to Better Understanding? A Multicenter Controlled Trial on Communicating Familial Breast Cancer Risks Using Different Risk Formats.

PURPOSE: Counselees' preferences are considered important for the choice of risk communication format and for improving patient-centered care. We here report on counselees' preferences for how risks are presented in familial breast cancer counseling and the impact of this preferred format on their understanding of risk. PATIENTS AND METHODS: As part of a practice-based randomized controlled trial, 326 unaffected women with a family history of breast cancer received their lifetime risk in one of five presentation formats after standard genetic counseling in three Dutch familial cancer clinics: 1) in percentages, 2) in frequencies ("X out of 100"), 3) in frequencies plus graphical format (10×10 human icons), 4) in frequencies and 10-year age-related risk and 5) in frequencies and 10-year age-related risk plus graphical format. Format preferences and risk understanding (accuracy) were assessed at 2-week follow-up by a questionnaire, completed by 279/326 women. RESULTS: The most preferred risk communication formats were numbers combined with verbal descriptions (37%) and numbers only (26%). Of the numerical formats, most (55%) women preferred percentages. The majority (73%) preferred to be informed about both lifetime and 10-year age-related risk. Women who had received a graphical display were more likely to choose a graphical display as their preferred format. There was no significant effect between the intervention groups with regard to risk accuracy. Overall, women given risk estimates in their preferred format had a slightly better understanding of risk. CONCLUSION: The results suggest that the accuracy of breast cancer risk estimation is slightly better for women who had received this information in their preferred format, but the risk format used had no effect on women's risk accuracy. To meet the most frequent preference, counselors should consider providing a time frame of reference (eg, risk in the next 10 years) in a numerical format, in addition to lifetime risk.

'It is not entirely healthy.' A qualitative study into public appraisals of uncertain risks of chemical substances in food.

For some chemical substances in food, scientific uncertainty prevents definitive statements about the presence of risk for human health. In this qualitative study, we explored the public's understanding and risk appraisal of these substances. During semi-structured interviews, participants from the public were presented with inconclusive risk information about either a food additive or one of two food contaminants. Findings show that interviewees had no prior knowledge and constructed their risk appraisal on the spot. Results suggest that generic and case specific beliefs and inferences affect understanding and appraisal. Respondents' interpretations of the risk messages used in this study were often not in line with what the message intended to convey. In addition, specific use of scientific jargon was associated with increased risk. In general, respondents were more apprehensive about the presence of the chemical in food than that they were worried about the chance of experiencing health effects.

'All chemical substances are harmful.' public appraisal of uncertain risks of food additives and contaminants.

In toxicological health risk assessment, epistemic uncertainties (e.g. about a chemical's intrinsic properties or toxicity) often remain, preventing definitive statements about whether a chemical constitues a risk. In this study, we analyzed public appraisals of uncertain risks of food additives and contaminants. We identified three major characteristics of public appraisal. First, hazard appraisals differed consistently from risk appraisals: respondents were less disturbed by a possible health risk than by the mere presence of the chemical substance in food. Second, while a majority understood that exposure determines whether a chemical constitutes a risk, many respondents thought that all chemicals are equally harmful. This suggests a mismatch between beliefs about exposure and beliefs about toxicity. Finally, the higher people valued certainty about food safety and the less they considered uncertainty about a risk acceptable, the more severe they appraised the presence of the chemical substance in food. This suggests that a mismatch between the level of uncertainty that people expect about food safety and the actual level of scientific uncertainty, affects how people evaluate the presence of chemical substances in food. Following the findings, implications for risk communication are discussed.

Intensive Livestock Farming and Residential Health: Experts' Views.

The presence of intensive livestock farms in close vicinity to residential areas in the Netherlands is a complex problem characterised by knowledge uncertainty about the effects on residential health, overlapping value-driven concerns and stakeholder diversity. In order to address concerns about the health effects and effectively manage the debate about intensive livestock farming, constructive stakeholder dialogues are encouraged, informed by current scientific insights. We explored the current knowledge, beliefs and concerns of scientific experts, following the mental models approach. A summary expert model was derived from scanning the relevant literature and informed by interviews with 20 scientific experts. The study shows imprecise use of terminology by experts. Moreover, they appear to perceive intensive livestock farming not as a major health problem at least at this moment for neighbouring residents in the Netherlands. Broader themes such as (environmental) unsustainability and biodiversity loss seem a more prominent concern among the experts. Our study questions whether dialogues should only focus on residential health or cover broader values and concerns. However, mental models about risk may differ with other stakeholders, impeding communication. Hence, we will identify other stakeholders' knowledge, beliefs and value-based concerns in the light of facilitating constructed dialogues between stakeholders.

Public Perceptions of Contentious Risk: The Case of Rubber Granulate in the Netherlands.

This paper reports on the perceptions of risk related to practicing sports on fields containing rubber granulate infill, and preferences for mitigation measures, among people with and without offspring exposed to rubber granulate. Two repeated surveys were conducted among members of the general population and parents of children aged under 18, in the middle of a dynamic public discussion about the potential health risks of exposure to rubber granulate. The first survey (N = 1033) was administered in December 2016 at a time characterized by considerable public uncertainty and contrasting opinions in the public risk debate. The second survey (N = 782) was conducted in January 2017 after the publication of a risk assessment report, which concluded that practicing sport on fields containing rubber granulate is safe. Multilevel analyses were performed to study changes in perceptions of risk and mitigation preferences in the time between the two surveys, the influence of being familiar with new information following the risk assessment report, and the differences in the perceptions of risk and mitigation preferences between groups with and without offspring exposed to rubber granulate. The results of this study show that, initially, a substantial proportion of the Dutch public perceived practicing sports on fields containing rubber granulate as a potential health threat to children. Over time, after publication of a new risk assessment study stating that practicing sports on fields containing rubber granulate is safe, perceived risk and preferences for mitigation of this risk decreased, especially among those who were familiar with the new information. Parents of children under the age of 18, in particular those with children who were exposed to rubber granulate, were more likely to perceive the risk as higher and to prefer a stricter mitigation policy. These insights may be important to inform public health communication strategies with respect to the timing and tailoring of risk messages to various groups.

Where there's smoke, there's fire: focal points for risk communication.

Large fires involving hazardous materials are often characterized by failing crisis communication. In this study, we compared opinions of experts regarding the risks of major fires to lay beliefs using a mental models approach. Amongst lay people this revealed relevant knowledge gaps and beliefs in opposition to those held by experts. While, experts considered the chance of getting cancer from inhaling smoke from a chemical fire extremely small, most lay people thought that even at a great distance, the chance of getting cancer to be large. To improve crisis communication about risk in a case of large chemical fires, and reduce the potential for messages to be misunderstood, distrusted or dismissed, we recommend a clarification of cancer risk in communications about public health emergencies such as chemical fires, for which lay people equate even small exposures to carcinogenic chemicals make one more likely to get cancer later in life.

"These Power Lines Make Me Ill": A Typology of Residents' Health Responses to a New High-Voltage Power Line.

Little attention has been devoted to the potential diversity in residents' health responses when exposed to an uncertain environmental health risk. The present study explores whether subgroups of residents respond differently to a new high-voltage power line (HVPL) being put into operation. We used a quasi-experimental prospective field study design with two pretests during the construction of a new HVPL, and two posttests after it was put into operation. Residents living nearby (0-300 m, n = 229) filled out questionnaires about their health and their perception of the environment. We applied latent class growth models to investigate heterogeneity in the belief that health complaints were caused by a power line. Classes were compared on a wide range of variables relating to negative-oriented personality traits, perceived physical and mental health, and perceptions of the environment. We identified five distinct classes of residents, of which the largest (49%) could be described as emotionally stable and healthy with weak responses to the introduction of a new power line. A considerable minority (9%) responded more strongly to the new line being activated. Residents in this class had heard more about the health effects of power lines beforehand, were more aware of the activation of the new line, and reported a decrease in perceived health afterwards. Based on our findings we can conclude that there is a considerable heterogeneity in health responses to a new HVPL. Health risk perceptions appear to play an important role in this typology, which has implications for risk management.

Nocebo responses to high-voltage power lines: Evidence from a prospective field study.

BACKGROUND: Experimental studies suggest that nocebo responses might occur after exposure to equipment emitting electromagnetic fields such as high voltage power lines (HVPLs) or mobile phone base stations. OBJECTIVES: The present study investigates to what extent health responses to a new HVPL can be explained by beliefs of residents regarding the health effects of HVPLs. METHODS: We used a quasi-experimental prospective field study design with two pretests during the construction of a new HVPL, and two posttests after it has been put into operation. Residents living near (0-300 m, n=229; 300-500 m, n=489) and farther away (500-2000 m, n=536) filled out questionnaires about their health and their beliefs about the negative health effects of power lines. Longitudinal mediation models were applied to investigate to what extent these beliefs could explain a change in reported symptoms after the new line was put into operation. RESULTS: Significant (p<.01) indirect effects were found for proximity on the increase in reported cognitive (R(2)=0.41) and somatic (R(2)=0.79) symptoms after the power line was put into operation through an increase in the belief that power lines causes health effects. The direct effects of proximity on an increase in reported symptoms were not significant. CONCLUSIONS: Our findings suggest that increases in reported health complaints after a new HVPL has been put into operation can be explained by nocebo mechanisms. Future field studies are needed to know whether our findings extend to other environmental health issues in a community.

Somatic symptom reports in the general population: Application of a bi-factor model to the analysis of change.

OBJECTIVE: To investigate the latent structure of somatic symptom reports in the general population with a bi-factor model and apply the structure to the analysis of change in reported symptoms after the emergence of an uncertain environmental health risk. METHODS: Somatic symptoms were assessed in two general population environmental health cohorts (AMIGO, n=14,829 & POWER, n=951) using the somatization scale of the four-dimensional symptom questionnaire (4DSQ-S). Exploratory bi-factor analysis was used to determine the factor structure in the AMIGO cohort. Multi-group and longitudinal models were applied to assess measurement invariance. For a subsample of residents living close to a newly introduced power line (n=224), we compared a uni- and multidimensional method for the analysis of change in reported symptoms after the power line was put into operation. RESULTS: We found a good fit (RMSEA=0.03, CFI=0.98) for a bi-factor model with one general and three symptom specific factors (musculoskeletal, gastrointestinal, cardiopulmonary). The latent structure was found to be invariant between cohorts and over time. A significant increase (p<.05) was found only for musculoskeletal and gastrointestinal symptoms after the power line was put into operation. CONCLUSIONS: In our study we found that a bi-factor structure of somatic symptoms reports was equivalent between cohorts and over time. Our findings suggest that taking this structure into account can lead to a more informative interpretation of a change in symptom reports compared to a unidimensional approach.

Symptom reporting after the introduction of a new high-voltage power line: a prospective field study.

BACKGROUND: There is public concern about the potential health effects of exposure to extremely low frequency electromagnetic fields (ELF-EMF) of high-voltage power lines (HVPLs). Some residents living near HVPLs believe ELF-EMF might cause non-specific health complaints. OBJECTIVES: The present study is the first to prospectively investigate whether self-reported health complaints and causal beliefs increase after the construction of a new power line. METHODS: We used a quasi-experimental design with two pretests before and two posttests after a new HVPL was put into operation. Residents living near (0-300m, n=229; 300-500m, n=489) and farther away (500-2000m, n=536) participated in the study. Linear mixed models were fitted to test whether symptom reports and beliefs that power lines caused health complaints increased more in residents living close to the new line compared to residents living farther away. RESULTS: A significantly (p<.05) larger increase from baseline in symptom reports and causal beliefs was found in residents living within 300m from the new power line when compared to residents living farther away. While symptom reports did not differ at baseline, the belief that a power line could cause these symptoms was at baseline already stronger for residents living close compared to residents living farther away. CONCLUSIONS: We found a negative impact of a new HVPL on health perceptions of nearby residents, even before the line was put into operation.

Health responses to a new high-voltage power line route: design of a quasi-experimental prospective field study in the Netherlands.

BACKGROUND: New high-voltage power transmission lines will be introduced due to increasing demand for reliable and renewable energy supplies. Some residents associate non-specific health complaints with exposure to electromagnetic fields from nearby power lines. This study protocol describes the design and rationale of a prospective study investigating whether the introduction of a new power line triggers health responses in residents living nearby. METHODS/DESIGN: The study is designed as a quasi-experimental field study with two pretests during the construction of a new power line route, and two posttests after it has been put into operation. Key outcomes are self-reported non-specific somatic and cognitive health complaints, and attribution of these health complaints to a power line. The main determinant is proximity to the new power line route. One member of every household (n=2379) residing in close proximity (0-500 meters) to the overhead parts of a new power line route in the Netherlands is invited to participate, as well as a sample of household members (n=2382) residing farther away (500-2000 meters). Multilevel analysis will be employed to test whether an increase in key outcome measures is related to proximity to the line. Longitudinal structural equation models will be applied to test to what extent health responses are mediated by psychosocial health mechanisms and moderated by negative oriented personality traits. DISCUSSION: This is the first study to investigate health responses to a new power line route in a prospective manner. The results will provide theoretical insight into psychosocial mechanisms operating during the introduction of an environmental health risk, and may offer suggestions to policymakers and other stakeholders for minimizing adverse health responses when introducing new high-voltage power lines.