Tailoring Can Improve Consumers' Hygienic Food-Handling Behavior to Reduce the Transmission Risk of Antimicrobial-Resistant Bacteria through Food.

Antimicrobial-resistant (AMR) bacteria spread via food to humans and can seriously impair infection treatment. Hygienic food handling is an effective measure to avoid the transmission of bacteria. Therefore, we tested three types of interventions (tailored, generic, and no intervention) for their effectiveness in improving consumers' hygienic food handling against the spread of antimicrobial-resistant bacteria through foods in a longitudinal randomized control trial. We based the determinants of hygienic food-handling behavior on the Health Action Process Approach (HAPA). The tailored intervention raised self-reported hygienic food handling, self-efficacy, and perceived likelihood of risk compared to no intervention. Moreover, interventions yielded different effects for participants with high vs. low intentions to improve their food-handling behavior. However, there were no differences between the tailored and generic interventions. More research is needed to find out whether including other behavior change techniques in the tailored intervention may increase the effect of tailoring.

Knowledge, Social Influences, Perceived Risks and Benefits, and Cultural Values Explain the Public's Decisions Related to Prudent Antibiotic Use.

People should use antibiotics (AB) prudently to mitigate antibiotic resistance (ABR). Previous studies-and, subsequently, interventions-on ABR have focused mainly on improving public awareness and knowledge. We investigated a comprehensive theory-based explanatory model to understand the public's decision making regarding prudent AB use, based on, among others, the theory of planned behavior. In a cross-sectional online survey, the psychological determinants of people's decisions about prudent AB use were examined in a sample of 1,228 Swiss adults. The questionnaire assessed respondents' demand for AB, willingness to adopt measures that prevent the need for AB, perceived risks of ABR, perceived benefits of AB, attitudes and social influences regarding AB, knowledge of AB and ABR, and cultural values. Mokken scale analysis revealed three types of knowledge: knowledge of the functioning of AB, of ABR, and of preventive measures. Structural equation modeling indicated that respondents' demand for AB was mostly predicted by social influences, perceived benefits of AB, and knowledge of AB functioning. Willingness to prevent AB use was mainly related to conservative values, perceived risks of ABR, negative attitudes toward AB, and knowledge of preventive measures. Our study suggests that the provision of information about AB and preventive measures is a first step toward changing people's decisions related to prudent AB use. Future interventions that additionally utilize cultural values to convey important messages and target additional factors, such as social influences, the risks of ABR, and the benefits of cautious AB use, can be more successful in promoting prudent AB use.

Potential and Challenges of Community-Based Surveillance in Animal Health: A Pilot Study Among Equine Owners in Switzerland.

Animal owners' potential to observe and report clinical signs, as the persons with the closest contact to their animals, is an often neglected source of information in surveillance. Allowing community members other than health care professionals, such as animal owners, to report health events can contribute to close current surveillance gaps and enhance early detection. In the present study, we tested a community-based surveillance (CBS) approach in the equine community in Switzerland. We aimed at revealing the attitudes and intentions of equine owners toward reporting clinical signs by making use of an online questionnaire. We further set up and operated an online CBS tool, named Equi-Commun. Finally, we investigated potential reasons for the lack of its use by applying qualitative telephone interviews. The majority of the respondents of the online questionnaire (65.5%, 707/1,078) answered that they could see themselves reporting clinical observations of their equine. The multivariate logistic regression analysis indicated that French-speaking equine owners and those belonging to the positive attitude cluster are more likely to report to a CBS tool. Equi-Commun operated between October 2018 and December 2019 yet received only four reports. With the addition of qualitative interviews, we identified three critical, interlinked issues that may have led to the non-use of Equi-Commun within the Swiss equine community: (1) for successfully implementing CBS, the need for surveillance within the community of interest must be given; (2) the respective population under surveillance, here the equine, needs to show enough clinical cases for owners to be able to maintain the memory of an existing tool and its possible use; and (3) targeted and high effort communication of the system is key for its success. While CBS relying only on lay animal owners, complementary to existing surveillance systems, could potentially provide a good proxy of timely surveillance data, it is questionable whether the added value of generated surveillance knowledge is in balance with efforts necessary to implement a successful system. With this study, we showcased both the potential and challenges of CBS in animal health, as this may be of relevance and guidance for future initiatives.

Antimicrobial-resistant bacteria in food: which behaviour change strategies increase consumers' risk awareness and preventive food-handling behaviour?

OBJECTIVES: We aimed to identify the potential of behaviour change strategies to effectively increase consumers' risk awareness, behavioural intention, and preventive food-handling behaviour to reduce the transmission risk of antimicrobial-resistant bacteria through food. The applied strategies targeted knowledge and determinants of the health action process approach (HAPA). We tested techniques that are expected to increase knowledge, risk perception, and positive outcome expectancy (Study 1) as well as those that increase planning and coping self-efficacy (Study 2) in two randomised control trials. METHODS: In Study 1 (N = 328), a 2 × 2 between-subject design was employed to investigate the effects of an educational video about the spread of antimicrobial-resistant bacteria and a personalised risk message on knowledge, risk perception, outcome expectancy and consequently on intention regarding safe food-handling behaviour. In Study 2 (N = 129), we used a 2 × 2 design to examine to what extent goal setting (implemented vs. not implemented) and time (pre- vs. post-test) affected planning, coping self-efficacy, and preventive food-handling behaviour. RESULTS: In Study 1, we found that the video increased knowledge and the perceived susceptibility of risk compared to the control video. We found no increase on the dependent variables after receiving the personalised risk message. In Study 2, goal setting significantly improved safe food-handling behaviour compared to the control condition. Moreover, participants in the goal-setting condition showed more planning of safe food-handling measures and of dealing with emerging barriers than participants in the control condition. CONCLUSIONS: These findings demonstrate that the delivery of an educational video on the spread of antimicrobial-resistant bacteria is a useful strategy to increase risk awareness, whereas goal setting presents a promising approach to improve food-handling behaviour. Following the HAPA, an additional effective behaviour change technique is required that decreases negative outcome expectancies and improves coping self-efficacy, thereby further improving intention and behaviour.

Swiss Dairy Farmers' Perceptions Surrounding the Disposal of Waste Milk Containing Antibiotic Residues and Antibiotic Resistance.

The feeding of waste milk containing antibiotic residues (WMA) to calves has been associated with the shedding of antibiotic-resistant bacteria by calves. However, little is known regarding farmers' intrinsic factors affecting this practice, and on which it would be relevant to intervene in order to change this practice. The objectives of this study were (1) to describe the farmers' intrinsic factors, such as perceived benefits, risks, and social norms related to the feeding of WMA to calves, antibiotic resistance, and antibiotic use, and (2) to evaluate how the feeding of WMA to calves is related to farmers' personal values and perceptions related to WMA feeding and antibiotic resistance. Answers to an online survey were collected from 233 Swiss dairy producers (38.3% response rate). The proportion of respondents who fed WMA to calves was 48.3%. In a hierarchical logistic regression model, only perception factors extracted by factor analysis were associated with the feeding of WMA to calves, namely (in decreasing order of magnitude): farm-level benefits of WMA feeding, the interaction of farm-level benefits with support from governmental authorities, and causes and threats of antibiotic resistance. The results suggest that, in order to reduce the feeding of WMA to calves, communications to dairy producers should focus on changing the perceived benefits of this practice in comparison to those of alternative WMA disposal methods carrying a lower risk of antibiotic resistance. The involvement of veterinarians and governmental authorities in these communications and in supporting producers may increase the successful adoption of alternative WMA disposal methods.

Exposure Pathways to Antimicrobial Resistance at the Human-Animal Interface-A Qualitative Comparison of Swiss Expert and Consumer Opinions.

Antimicrobial resistance (AMR) is an emerging global health concern, affecting both the animal and the human population. Transmission pathways of AMR are therefore abundant and complex, and ways to prevent or reduce transmission to consumers must be identified. The overall goal of this study was to define the content of an intervention study aimed at reducing the transmission of AMR from animal sources to humans. To identify the most relevant pathways, Swiss experts and consumers were interviewed about their opinions on the risks of transmission of AMR. Opinions of experts and consumers were then qualitatively compared and the main gaps identified. The results revealed that Swiss consumers had several misconceptions regarding the sources and transmission of AMR, and that they in particular underestimated the importance of poultry meat and pets as a potential source of AMR. Furthermore, high uncertainty was noted in experts regarding the prevalence of AMR in pets and the potential of transmission to their owners. Consequently, awareness of AMR transmission pathways should be increased among consumers to overcome common misconceptions, which will help reduce the risk of transmission. Further research is needed to better understand the pets' potential to harbor and transmit AMR to their owners, and to identify most effective methods to increase risk awareness in consumers as well as intervention strategies promoting consumer behaviors to mitigate AMR transmissions at the human-animal interface.

Understanding the Underlying Psychosocial Determinants of Safe Food Handling among Consumers to Mitigate the Transmission Risk of Antimicrobial-Resistant Bacteria.

In this study, we aimed to explore the psychosocial factors related to consumers' safe food-handling behaviors to reduce the transmission risk of antimicrobial-resistant bacteria through food products. To this end, we investigated the extent to which the variables of the health action process approach (HAPA) and subjective norms can predict safe food handling by consumers. Data were collected from a representative sample of consumers belonging to the German-speaking part of Switzerland by administering a self-reporting questionnaire. The results showed that risk perception, self-efficacy, and positive outcome expectancy (i.e., the motivational phase of HAPA) were significant predictors of the intentions to handle food in a safe manner (see graphical abstract below). Additionally, in the volitional phase of HAPA, intention was found to be a significant predictor of safe food-handling behaviors. Contrary to expectations based on HAPA, action planning did not mediate the intention-behavior relationship. Only a small part of the variance in behavior was explained by coping planning and action control. The findings confirmed that the motivational phase of HAPA may be useful for determining safe food handling.

Smaller servings vs. information provision: Results of two interventions to reduce plate waste in two university canteens.

Two interventions were systematically evaluated in two university canteens on their effectiveness to reduce visitors' plate waste. The evaluation was theory-based and focused not only at the effects on the amount of plate waste, but also at the psychological predictors underlying plate waste behaviour. In Intervention A, visitors received information about food waste over a period of three weeks. In Intervention B, in addition to information, smaller servings were offered. The actual amount of plate waste and visitors' attitudes, personal norms, beliefs, perceived behavioural control, intentions and plate waste reduction behaviour were measured before and after the interventions. Intervention B reduced the amount of plate waste by 20%, whereas no reduction was found after Intervention A. In both interventions, the provided information resulted in more positive beliefs and stronger personal norms regarding avoiding plate waste. The information also caused attitudes to have a stronger influence on plate waste reduction behaviour, whereas intention to reduce became less important for reducing plate waste. Personal norms regarding food waste were the strongest predictor of plate waste reduction behaviour, before and after the interventions. The provided information was thus insufficient to reduce plate waste, simply offering smaller servings could achieve this. Although our intervention study only included two university canteens and was conducted for a short period, our data seem to imply that a combination of both information and smaller servings reduces plate waste in the food service industry.

Public Perception of Uncertainties Within Climate Change Science.

Climate change is a complex, multifaceted problem involving various interacting systems and actors. Therefore, the intensities, locations, and timeframes of the consequences of climate change are hard to predict and cause uncertainties. Relatively little is known about how the public perceives this scientific uncertainty and how this relates to their concern about climate change. In this article, an online survey among 306 Swiss people is reported that investigated whether people differentiate between different types of uncertainty in climate change research. Also examined was the way in which the perception of uncertainty is related to people's concern about climate change, their trust in science, their knowledge about climate change, and their political attitude. The results of a principal component analysis showed that respondents differentiated between perceived ambiguity in climate research, measurement uncertainty, and uncertainty about the future impact of climate change. Using structural equation modeling, it was found that only perceived ambiguity was directly related to concern about climate change, whereas measurement uncertainty and future uncertainty were not. Trust in climate science was strongly associated with each type of uncertainty perception and was indirectly associated with concern about climate change. Also, more knowledge about climate change was related to less strong perceptions of each type of climate science uncertainty. Hence, it is suggested that to increase public concern about climate change, it may be especially important to consider the perceived ambiguity about climate research. Efforts that foster trust in climate science also appear highly worthwhile.

Does environmental friendliness equal healthiness? Swiss consumers' perception of protein products.

Food production and consumption have major impacts on the environment. At the same time, changes in human diets worldwide are increasingly leading to health problems. Both issues are highly influenced by consumers' everyday food choices and could be addressed by reducing consumption of meat and other animal products. To promote sustainable food consumption, we need to know how consumers perceive the environmental friendliness and healthiness of food products, on which criteria they base their evaluations of environmental friendliness and healthiness, and how their estimations relate to life cycle assessments and nutrient profiling. We presented 30 protein products, which varied in provenance, production methods, and processing, to 85 participants from Switzerland. They were asked to sort the products once according to their perceived environmental friendliness and once according to their perceived healthiness. The mean distances between the products were compared to the products' life cycle assessments and nutrient profiles. The results showed that perceived environmental friendliness and healthiness are highly correlated. The main predictors of the products' perceived environmental friendliness were product category, presence of an organic label, and provenance; and for perceived healthiness, these predictors were product category, fat content, processing, and presence of an organic label. Environmental friendliness and healthiness estimations were significantly correlated to the life cycle assessments and the nutrient profiles of the products, respectively. Hence, to promote healthy and environmentally friendly food choices, motivators related to environmental friendliness and healthiness could be used in synergy. Awareness about meat's environmental impact should be increased and better information is needed for consumers to make an accurate environmental impact and healthiness assessments of protein products.

Does better for the environment mean less tasty? Offering more climate-friendly meals is good for the environment and customer satisfaction.

Food consumption comprises a significant portion of the total environmental impact of households. One way to reduce this impact may be to offer consumers more climate-friendly meal choices, such as when eating out. However, the environmental benefits of such an intervention will depend on not only consumers' liking of the climate-friendlier meals, but also on the perceived environmental impact. We therefore investigated the relationship between the global warming potential (GWP) of and consumers' liking of meals in two field studies in the same restaurant. Visitors to the restaurant were asked to rate the taste of the meal they had just consumed. These taste ratings were then related to the meals' GWP and number of purchases. In the second study, an intervention was tested consisting of a climate-friendly choice label and information posters. Contrary to expectations, it was found in both studies that the GWP of the meals was unrelated to the taste or the number of purchases. Offering more climate-friendly meals did not change consumer satisfaction. As expected, the introduction of the climate-friendly choice label increased the number of climate-friendly meal purchases. Therefore, offering more climate-friendly meals with a climate-friendly choice label can affect consumers' meal choices, but not their preferences or satisfaction, which is beneficial for the climate, consumers and gastronomic establishments.

Public Perception of Climate Change: The Importance of Knowledge and Cultural Worldviews.

The importance of knowledge for lay people's climate change concerns has been questioned in recent years, as it had been suggested that cultural values are stronger predictors of concern about climate change than knowledge. Studies that simultaneously measured knowledge related to climate change and cultural values have, however, been missing. We conducted a mail survey in the German-speaking part of Switzerland (N = 1,065). Results suggested that cultural worldviews and climate-related knowledge were significantly related with people's concern about climate change. Also, cultural worldviews and climate-relevant knowledge appeared important for people's willingness to change behaviors and to accept climate change policies. In addition, different types of knowledge were found to have different impacts on people's concern about climate change, their willingness to change behaviors, and their acceptance of policies about climate change. Specifically, causal knowledge significantly increased concern about climate change and willingness to support climate-friendly policies. We therefore concluded that risk communication should focus on causal knowledge, provided this knowledge does not threaten cultural values.

Alternatives to the use of antimicrobial agents in pig production: A multi-country expert-ranking of perceived effectiveness, feasibility and return on investment.

Nineteen alternatives to antimicrobial agents were ranked on perceived effectiveness, feasibility and return on investment (ROI) from 0 (not effective, not feasible, no ROI) to 10 (fully effective, completely feasible, maximum ROI) by 111 pig health experts from Belgium, Denmark, France, Germany, Sweden and Switzerland. The top 5 measures in terms of perceived effectiveness were (1) improved internal biosecurity, (2) improved external biosecurity, (3) improved climate/environmental conditions, (4) high health/Specific Pathogen Free/disease eradication and (5) increased vaccination. The top 5 measures in terms of perceived feasibility were (1) increased vaccination, (2) increased use of anti-inflammatory products, (3) improved water quality, (4) feed quality/optimization and (5) use of zinc/metals. The top 5 measures in terms of perceived ROI were (1) improved internal biosecurity, (2) zinc/metals, (3) diagnostics/action plan, (4) feed quality/optimization and (5) climate/environmental improvements. Univariate linear regression showed that veterinary practitioners rank internal biosecurity, vaccination, use of zinc/metals, feed quality optimization and climate/environmental on average highest, while researchers and professors focused more on increased use of diagnostics and action plans. Financial incentives/penalties ranked low in all countries. Belgian respondents ranked feed quality significantly lower compared to the German respondents while reduction of stocking density was ranked higher in Belgium compared to Denmark. Categorical Principal Component Analysis applied to the average ranking supported the finding that veterinary practitioners had a preference for more practical, common and already known alternatives. The results showed that improvements in biosecurity, increased use of vaccination, use of zinc/metals, feed quality improvement and regular diagnostic testing combined with a clear action plan were perceived to be the most promising alternatives to antimicrobials in industrial pig production based on combined effectiveness, feasibility and ROI.

How a nuclear power plant accident influences acceptance of nuclear power: results of a longitudinal study before and after the Fukushima disaster.

Major nuclear accidents, such as the recent accident in Fukushima, Japan, have been shown to decrease the public's acceptance of nuclear power. However, little is known about how a serious accident affects people's acceptance of nuclear power and the determinants of acceptance. We conducted a longitudinal study (N= 790) in Switzerland: one survey was done five months before and one directly after the accident in Fukushima. We assessed acceptance, perceived risks, perceived benefits, and trust related to nuclear power stations. In our model, we assumed that both benefit and risk perceptions determine acceptance of nuclear power. We further hypothesized that trust influences benefit and risk perceptions and that trust before a disaster relates to trust after a disaster. Results showed that the acceptance and perceptions of nuclear power as well as its trust were more negative after the accident. In our model, perceived benefits and risks determined the acceptance of nuclear power stations both before and after Fukushima. Trust had strong effects on perceived benefits and risks, at both times. People's trust before Fukushima strongly influenced their trust after the accident. In addition, perceived benefits before Fukushima correlated with perceived benefits after the accident. Thus, the nuclear accident did not seem to have changed the relations between the determinants of acceptance. Even after a severe accident, the public may still consider the benefits as relevant, and trust remains important for determining their risk and benefit perceptions. A discussion of the benefits of nuclear power seems most likely to affect the public's acceptance of nuclear power, even after a nuclear accident.

Effectiveness and efficiency of different shapes of food guides.

OBJECTIVE: To compare the influence of a food guide's shape on its effectiveness and efficiency to convey nutritional information. METHODS: A between-subjects experiment was conducted by manipulating the graph's shape (circle, pyramid, or rainbow). Nutrition tasks were used to assess the effectiveness and eye-movement data (number/duration of fixations) to examine the efficiency of the formats. The data were quantitatively analyzed (chi-square, ANOVA). RESULTS: There were no overall differences between the formats regarding effectiveness and efficiency. However, there were differences between the formats in effectiveness regarding 3 of the 5 nutrition tasks (χ(2)s ≥ 7.044, Ps < .05). Furthermore, viewers' attention was drawn to different parts of the graph, depending on the format. CONCLUSIONS AND IMPLICATIONS: The results suggest that choosing different formats for practical nutrition communication does not play a major role in effectiveness or efficiency of this communication. However, different parts of the graph are more salient in various food guide formats.

Affective imagery and acceptance of replacing nuclear power plants.

This study examined the relationship between the content of spontaneous associations with nuclear power plants and the acceptance of using new-generation nuclear power plants to replace old ones. The study also considered gender as a variable. A representative sample of the German- and French-speaking population of Switzerland (N= 1,221) was used. Log-linear models revealed significant two-way interactions between the association content and acceptance, association content and gender, and gender and acceptance. Correspondence analysis revealed that participants who were opposed to nuclear power plants mainly associated nuclear power plants with risk, negative feelings, accidents, radioactivity, waste disposal, military use, and negative consequences for health and environment; whereas participants favoring nuclear power plants mainly associated them with energy, appearance descriptions of nuclear power plants, and necessity. Thus, individuals opposing nuclear power plants had both more concrete and more diverse associations with them than people who were in favor of nuclear power plants. In addition, participants who were undecided often mentioned similar associations to those participants who were in favor. Males more often expressed associations with energy, waste disposal, and negative health effects. Females more often made associations with appearance descriptions, negative feelings, and negative environmental effects. The results further suggest that acceptance of replacing nuclear power plants was higher in the German-speaking part of the country, where all of the Swiss nuclear power plants are physically located. Practical implications for risk communication are discussed.

The role of health-related, motivational and sociodemographic aspects in predicting food label use: a comprehensive study.

OBJECTIVE: Previous studies focused on a limited number of determinants of food label use. We therefore tested a comprehensive model of food label use consisting of sociodemographic, health-related and motivating variables. These three predictor groups were chosen based on the previous literature and completed with new predictors not yet examined in a comprehensive study of frequency of label use. DESIGN: We sent questionnaires to a random sample of households in the German-speaking part of Switzerland. SETTING: The respondents filled in the questionnaire at home and returned it by mail. SUBJECTS: We analysed the data of 1162 filled-in questionnaires (response rate = 38 %). Of the respondents, 637 were women (55 %), and their mean age was 53·54 (sd 15·68) years. RESULTS: Health-related variables were the most important group of predictors of label use, followed by motivating factors and sociodemographic variables. Placing importance on health, healthy eating and nutritional value of food, perceived vulnerability for diet-related diseases, nutrition knowledge, numeracy and gender were positively associated with frequency of food label use whereas shopping habits and seeing eating as something positive were negative predictors of frequency of label use. CONCLUSIONS: People's health consciousness should be raised in order to increase the frequency of food label use. Furthermore, it should be stressed that reading labels and keeping a healthy diet do not contradict 'good eating', and that both of these aspects can be combined with the help of food labels.

Eating green. Consumers' willingness to adopt ecological food consumption behaviors.

Food consumption is associated with various environmental impacts, and consumers' food choices therefore represent important environmental decisions. In a large-scale survey, we examined consumers' beliefs about ecological food consumption and their willingness to adopt such behaviors. Additionally, we investigated in more detail how different motives and food-related attitudes influenced consumers' willingness to reduce meat consumption and to buy seasonal fruits and vegetables. We found consumers believed avoiding excessive packaging had the strongest impact on the environment, whereas they rated purchasing organic food and reducing meat consumption as least environmentally beneficial. Similarly, respondents appeared to be most unwilling to reduce meat consumption and purchase organic food. Taste and environmental motives influenced consumers' willingness to eat seasonal fruits and vegetables, whereas preparedness to reduce meat consumption was influenced by health and ethical motives. Women and respondents who preferred natural foods were more willing to adopt ecological food consumption patterns.

When reduced fat increases preference. How fat reduction in nutrition tables and numeracy skills affect food choices.

Zero-fat products may be good alternatives to regular-fat products for consumers who are watching their health. In a choice experiment, we investigated whether consumers were willing to consume zero-fat products on the basis of nutrition tables and whether numeracy skills affected this decision. We presented respondents with the same two products in three choice tasks, reducing the fat content at each choice. Product A always contained less fat than Product B. The participants could choose one of the two products or none. Most respondents favoured the lower-fat products over the higher-fat products. However, after a fat reduction to almost zero, significantly more respondents chose the fattier alternative than in the first choice. A fat reduction to zero further reduced the relative preference for the lower-fat product in favour of the fattier alternative. Many consumers thus seem unwilling to consume zero-fat products. Respondents lower in numeracy seemed to differentiate less between regular- and reduced-fat products than those higher in numeracy. We discuss the implications of these findings for food producers.