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Gaze describes the experiential way that tourists perceive destinations during trips. Destination-related risks are inevitable in tourism; however, little attention has been given to the tourist gaze based on travel risk. Our research addresses this disparity by proposing and exploring the concept of tourist risk gaze. In Study 1, findings suggest that this type of gaze involves three interrelated aspects: risk information gaze, risky attraction gaze, and risky behavior gaze. In Study 2, we invited 50 Chinese university students to participate in an eye-tracking experiment to test tourist risk gaze. Participants displayed distinct visual attention patterns toward these three aspects when tourists encountered them during trips. This research offers a new lens through which to consider the tourist gaze and risk perception. It also introduces a novel eye-tracking method to analyze travel risk and the tourist gaze. [ABSTRACT FROM AUTHOR]

Moving from the ongoing debate on the benefits of mandating environmental reporting, this paper provides an analysis of the role of narrative information quality in enhancing environmental reporting, considering the moderating effect of firm‐level and country‐level incentives. We examine an international sample of listed firms belonging to an environmental‐sensitive industry and construct disclosure indices based on a content analysis of the company's reporting. Results reveal that mandatory narrative information quality is positively associated with the quality of environmental reporting displaying a credibility effect beyond earnings quality. Country‐level factors that increase the demand for environmental information weaken this relation by reducing the marginal benefit of disclosing environmental information. Our approach advances existing literature on the link between CSR and financial reporting and highlights the unintended consequences of mandating environmental reporting. [ABSTRACT FROM AUTHOR]

With the scope and severity of disasters continuing to grow, encouraging public engagement in emergency preparedness activities is becoming increasingly important. Recently, this has included governments introducing emergency alert systems to warn people of nearby danger to life. However, to date, little research focus has been directed towards understanding what mechanisms affect public willingness to engage in preparing for emergencies. Accordingly, this study aims to improve understanding of what social and cognitive factors impact public willingness to take action to prepare for emergencies. Data was collected from 157 members of the public in one region of the UK using focus groups (N = 36) and questionnaires (N = 121). Thematic analysis of data highlighted six key themes of importance for improving public engagement in emergency preparedness activities: (i) provide information that allows people to Assess potential risks; (ii) Create a sense of community and responsibility; (iii) use Trustworthy sources; (iv) Inform the public regularly about risk updates; (v) provide feasible and practical information on how to Overcome risks; and (vi) Normalize engagement (‘ACTION’). Findings pose important implications for emergency planning theory and practice, including improving how multiagency emergency planning and response partnerships engage with local communities to promote emergency preparedness. [ABSTRACT FROM AUTHOR]

The provision of information to consumers is a common input to tackling various public health issues. By comparison to the information given on food and alcohol products, information on gambling products is either not given at all, or shown in low-prominence locations in a suboptimal format, e.g. the 'return-to-player' format, 'this game has an average percentage payout of 90%'. Some previous research suggests that it would be advantageous to communicate this information via the 'house edge' format instead: the average loss from a given gambling product, e.g. 'this game keeps 10% of all money bet on average'. However, previous empirical work on the house edge format only uses this specific phrasing, and there may be better ways of communicating house edge information. The present work experimentally tested this original phrasing of the house edge against an alternative phrasing that has also been proposed, 'on average this game is programmed to cost you 10% of your stake on each bet', while both phrasings were also compared against equivalent return-to-player information (N = 3333 UK-based online gamblers). The two dependent measures were gamblers' perceived chances of winning and a measure of participants' correct understanding. Preregistered Stage 1 protocol: (date of in-principle acceptance: 28/11/2022). The alternative house edge phrasing resulted in the lowest perceived chances of winning, but the original phrasing had the highest rate of correct understanding. Compared to return-to-player information, the original phrasing had both lower perceived chances of winning and higher rates of correct understanding, while the alternative phrasing had only lower perceived chances of winning. These results replicated prior work on the advantages of the original house edge phrasing over return-to-player information, while showing that the alternative house edge phrasing has advantageous properties for gamblers' perceived chances of winning only. The optimal communication of risk information can act as an input to a public health approach to reducing gambling-related harm. [ABSTRACT FROM AUTHOR]

Air pollution is known to be one of the major risk factors for premature morbidity and mortality globally, which are preventable. Therefore, the public is informed about air pollution through the Air Quality Index (AQI). The AQI represents integrated data of selected pollutants and produces a combined overall index for specific locations and time. The AQI algorithm generates a range of numbers and categories of colors that indicate likely health risks from air pollutants and the public's actions to minimize the risks. However, it lacks emerging evidence on chemical toxicity or composition. Hence, policymakers may also consider addinga toxicity matrix of fine particles to refine the algorithm, such as oxidative potential. Further, the risk is commonly communicated in numbers and not in color as dictated by the AQI. The AQI values and categories vary significantly between countries for the same pollution concentration, leading to confusion. Hence, we recommend developing a universal AQI (UAQI) with a consistent relationship between colors, concentrations, and toxicity to communicate air pollution risks to the public. Further, communication media should be encouraged to use universal color-coding rather than AQI values, i.e., numbers. Therefore, a global policy framework for regulatory authorities and policymakers is needed to communicate air pollution risk information consistently and to minimize public health exposure.

Purpose: In this study, we explored how patients experience current information provision and decision-making about post-treatment surveillance after breast cancer. Furthermore, we assessed patients' perspectives regarding less intensive surveillance in case of a low risk of recurrence. Methods: We conducted semi-structured interviews with 22 women in the post-treatment surveillance trajectory in seven Dutch teaching hospitals. Results: Although the majority of participants indicated a desire for shared decision-making (SDM) about post-treatment surveillance, participants experienced no SDM. Information provision was often suboptimal and unstructured. Participants were open for using risk information in decision-making, but hesitant towards less intensive surveillance. Perceived advantages of less intensive surveillance were: less distressing moments, leaving the patient role behind, and lower burden. Disadvantages were: fewer moments for reassurance, fear of missing recurrences, and a higher threshold for aftercare for side effects. Conclusions: SDM about post-treatment surveillance is desirable. Although women are hesitant about less intensive surveillance, they are open to the use of personalised risk assessment for recurrences in decision-making about surveillance. Implications for Cancer Survivors: To facilitate SDM about post-treatment surveillance, the timing and content of information provision should be improved. Risk information should be provided in an accessible and understandable way. Moreover, fear of cancer recurrence and other personal considerations should be addressed in the process of SDM. [ABSTRACT FROM AUTHOR]

To develop a new measure of preferred sources for risk information, two studies asked respondents to indicate what channels they were reliant on for information about COVID‐19, from 25 news channels ranging across the political spectrum. Unexpectedly, dependencies clustered around level of reliability rather than the political orientation of the news channel. In other words, each cluster included media channels from both the left and right side of the political spectrum, while dependencies clustered into sources that varied by the degree to which their content is reliable. Participants who turned to lower reliability channels indicated lower risk perceptions, less accurate probability estimations, reduced vaccination intentions, and lower protective behavioral intentions. Those inclined to use higher reliability channels indicated higher risk perceptions, more accurate probability estimations, increased vaccination intentions, and higher protective behavioral intentions. These relationships are discussed in terms of implications for our understanding of source reliance and risk perception, information sufficiency, and implications for both future research and public health interventions. [ABSTRACT FROM AUTHOR]

Jing Wang, Chuqing Guo, Tingyu Lin School of Economics and Management, Fuzhou University, Fuzhou, 350116, People’s Republic of ChinaCorrespondence: Jing Wang, Fuzhou University, Fuzhou, 350116, People’s Republic of China, Email jingwang1110@fzu.edu.cnBackground: Risk perception is a key factor influencing the public’s behavioral response to major public health events. The research on public risk perception promotes the emergency management system to adapt to the needs of modern development. This article is based on a risk information perspective, using the COVID-19 event as an example. From the micro and macro perspectives, the influencing factors of public risk perception in major public health events in China are extracted, and the attribution model and index system of public risk perception are established.Methods: In this paper, the five-level Likert scale is used to collect and measure the risk perception variable questionnaire through the combination of online and offline methods (a total of 550 questionnaires, the overall Alpha coefficient of the questionnaire is 0.955, and the KMO test coefficient t=0.941), and through independent samples t-test, correlation analysis, multiple regression analysis and other methods to draw relevant conclusions.Results: The results showed that gender and age were significantly associated with risk perception (p< 0.005), and education level was significantly negatively associated with risk perception (p < 0 0.005). Risk information attention and risk perception were significantly positively correlated (p< 0.005), media credibility was significantly positively correlated with risk perception (p< 0.005), while risk information identification and media exposure had no significant interaction with risk perception (p=0.125, p=0.352).Conclusion: Factors such as gender, age, education level, place of residence, media exposure, media credibility, risk information attention, and recognition lead to different levels of risk perception. This conclusion helps to provide a basis for relevant departments to conduct public risk management of major public health events based on differences in risk perceptions.Keywords: public health events, risk perception, influencing factors, COVID-19, risk information

Introduction: Informed decision making is recommended in breast cancer screening. Decision aids with balanced information on harms and benefits are recommended to support informed decision making. However, informed screening decision making may be challenged by overly positive attitudes toward cancer screening. We hypothesized that a substantial proportion of Danish women would want to participate in screening regardless of the presented information. Therefore, we aimed to estimate the prevalence of Danish women wanting to participate in a hypothetical breast cancer screening offering no reduction in breast cancer mortality but potential harms related to unnecessary treatment. Methods: In a cross-sectional study, we invited a random sample of 751 women in the nonscreening population aged 44 to 49 y in the Central Denmark Region to an online questionnaire using the official digital mailbox system. The questionnaire included a description of a hypothetical screening and questions about thoughts on breast cancer, health literacy, and questions on the assessment of the hypothetical screening including intended participation, understanding, and belief in information. Data were linked to register data on sociodemographic factors. Results: In total, 43.0% (323/751) responded to the questionnaire. Of these, 247 (82.3% [95% confidence interval: 77.5–86.5]) wanted to participate in the hypothetical breast cancer screening (participation group). More than two-thirds in both the participation group and nonparticipation group seemed to understand the presented information. Half of the women who understood the information disbelieved it. Conclusions: Exceeding our expectations, a majority of women wanted to participate in a hypothetical screening with potential harms but no reduction in breast cancer mortality. A large proportion understood but disbelieved the screening information. This could indicate that Danish women make their screening decisions based on beliefs rather than presented screening information. This study was registered at ClinicalTrials.gov (Identifier: NCT04509063) Highlights: The majority of Danish women wanted to participate in a hypothetical breast cancer screening with potential harms related to unnecessary treatment but no reduction in mortality. A large proportion of women understood but disbelieved the hypothetical screening information. Informed decision making may be challenging when women disbelieve the information they receive. Enthusiasm for cancer screening and potential disbelief in information are important factors when developing and improving screening information and invitation. [ABSTRACT FROM AUTHOR]

IntroductionPublic health is not only threatened by diseases, pandemics, or epidemics. It is also challenged by deficits in the communication of health information. The current COVID-19 pandemic demonstrates that impressively. One way to deliver scientific data such as epidemiological findings and forecasts on disease spread are dashboards. Considering the current relevance of dashboards for public risk and crisis communication, this systematic review examines the state of research on dashboards in the context of public health risks and diseases.MethodNine electronic databases where searched for peer-reviewed journal articles and conference proceedings. Included articles (n = 65) were screened and assessed by three independent reviewers. Through a methodological informed differentiation between descriptive studies and user studies, the review also assessed the quality of included user studies (n = 18) by use of the Mixed Methods Appraisal Tool (MMAT).Results65 articles were assessed in regards to the public health issues addressed by the respective dashboards, as well as the data sources, functions and information visualizations employed by the different dashboards. Furthermore, the literature review sheds light on public health challenges and objectives and analyzes the extent to which user needs play a role in the development and evaluation of a dashboard. Overall, the literature review shows that studies that do not only describe the construction of a specific dashboard, but also evaluate its content in terms of different risk communication models or constructs (e.g., risk perception or health literacy) are comparatively rare. Furthermore, while some of the studies evaluate usability and corresponding metrics from the perspective of potential users, many of the studies are limited to a purely functionalistic evaluation of the dashboard by the respective development teams.ConclusionThe results suggest that applied research on public health intervention tools like dashboards would gain in complexity through a theory-based integration of user-specific risk information needs.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=200178, identifier: CRD42020200178.

Introduction: This study explored the formation mechanism of consumers’ selfprotective behavior during the COVID-19 pandemic, which is very important for policy settings to regulate consumer behavior. Based on the basic framework of the Protective Action Decision Model (PADM), this study analyzed the formation mechanism of consumers’ self-protective willingness from the perspective of risk information, and explained the deviation between consumers’ self-protective willingness and behavior from the perspective of protective behavior attributes. Methods: Based on 1,265 consumer survey data during the COVID-19 pandemic, the empirical test was carried out. Results and Discussion: The amount of risk information has a significant positive impact on the consumers’ self-protective willingness, where the credibility of risk information plays a positive moderating role between them. Risk perception plays a positive mediating role between the amount of risk information and the consumers’ self-protective willingness, and the positive mediating effect of risk perception is negatively moderated by the credibility of risk information. In the protective behavior attributes, hazard-related attributes play a positive moderating role between the consumers’ self-protective willingness and behavior, while resource-related attributes play the opposite role. Consumers pay more attention to hazard-related attributes than resource-related attributes, and they are willing to consume more resources to reduce risk. [ABSTRACT FROM AUTHOR]

In fire emergencies, pedestrians often face uncertainty about the safety of evacuation routes due to a lack of risk information, which makes the emergency evacuation highly challenging. Although risk information is crucial for effective evacuation, the effect of varying levels of risk information on fire evacuation remains insufficiently explored. This study aims to address this gap by investigating the influence of different levels of risk information on pedestrian evacuation through virtual experiments and survey. We conducted a series of multiplayer fire evacuation experiments in Minecraft. The risk information provided to pedestrians before evacuation was controlled at three levels: no risk information, partial risk information, and complete risk information, by giving different risk information cues. The results of experiments indicated that risk information can improve pedestrian evacuation efficiency during fire emergencies, while more complete risk information can further improve pedestrian evacuation efficiency. Additionally, an information transfer phenomenon was observed during fire evacuations, in which pedestrians adjusted their behaviour based on perceived fire, leading others to avoid the fire in advance. The analysis of pedestrian behaviour revealed that pedestrians did not exhibit imitative behaviour in evacuation direction choices during fire emergencies. Pedestrian route choices were significantly influenced by the initial distance of pedestrians relative to the exits. Moreover, complete risk information cues did not significantly influence pedestrians' route choices compared with partial risk information cues. A post-experimental survey was conducted to assess pedestrians' route choice preferences under different risk information cue scenarios. The results showed that pedestrians preferred the nearest route. [ABSTRACT FROM AUTHOR]

Over the last years, infectious diseases have been traveling across international borders faster than ever before, resulting in major public health crises such as the Covid-19 pandemic. Given the rapid changes and unknown risks that mark such events, risk communication faces the challenge to raise awareness and concern among the public without creating panic. Drawing on the social amplification of risk framework-a concept that theorizes how and why risks are amplified or attenuated during the (1) transfer of risk information (by, for instance, news media) and (2) audiences' interpretation and perception of these information-we were interested in the portrayal of risk information and its impact on audiences' risk perception over the first wave of the Covid-19 pandemic in Germany. We therefore conducted a quantitative content analysis of a major public and private television (TV) newscast (N = 321) and combined it with survey data (two-wave panel survey, t1: N = 1378 and t2: N = 1061). Our results indicate that TV news (as a major information source at that time) were characterized by both risk-attenuating and risk-amplifying characteristics, although risk-amplifying attributes were particularly pronounced by the private TV newscast. Notably, those who only used private TV news between both waves showed the highest perceived severity at time 2. However, the interaction effect of time and use of public and/or private TV news was only significant for perceived susceptibility. Overall, more research is needed to examine the effects of different types of media and changes in risk perceptions over time., (© 2024 The Author(s). Risk Analysis published by Wiley Periodicals LLC on behalf of Society for Risk Analysis.)

Objective: Breast cancer patients for whom less intensive surveillance is sufficient can be identified based on the risk for locoregional recurrences (LRRs). This study explores health care professionals' (HCPs) perspectives on less intensive surveillance, preferences for shared decision‐making (SDM) about surveillance and perspectives on the use of patients' estimated personal risk for LRRs in decision‐making about surveillance. Methods: We conducted semi‐structured interviews with 21 HCPs providing follow‐up care for breast cancer patients in seven Dutch teaching hospitals (Santeon hospitals). Results: HCPs were predominantly positive about less intensive surveillance for women with a low risk for recurrences. They mentioned important prerequisites such as clearly defined surveillance schedules based on risk categories, information provision and communication support for patients and HCPs. Most HCPs supported SDM about surveillance and were positive about using patients' estimated personal risk for LRRs. HCPs specified prerequisites such as clear visualisation and explanation of risk information, attention for fear of cancer recurrence (FCR) and defined surveillance schedules for specific risk groups. Conclusion: Mentioned prerequisites for less intensive surveillance need to be accounted for. Information needs and existing misconceptions need to be addressed. Outcome information regarding risks for LRRs and FCR can enrich the SDM process about surveillance. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to: (1) determine the accuracy of Dutch breast cancer survivors' estimations of the locoregional recurrence risk (LRR); (2) examine which variables influence (the accuracy of) risk estimations, and risk appraisals; and (3) investigate the influence of the objective LRR risk (estimated using the INFLUENCE-nomogram), risk estimations and risk appraisals on fear of cancer recurrence (FCR). Findings of this study will inform clinicians on risk communication and can improve communication about FCR. Methods: In a cross-sectional survey among 258 breast cancer survivors, women's recurrence risk estimations (in odds) and risk appraisals (in high/low), FCR, demographics and illness perceptions, about one year after surgery were measured and compared to the objective risk for LRRs estimated using the INFLUENCE-nomogram. Results: Half of the women (54%) accurately estimated their LRR risk, 34% underestimated and 13% overestimated their risk. Risk estimations and risk appraisals were only moderately positively correlated (r = 0.58). Higher risk appraisals were associated with radiotherapy (r = 0.18) and having weaker cure beliefs (r = − 0.19). Younger age was associated with overestimation of risk (r = − 0.23). Recurrence risk estimations and risk appraisals were associated with more FCR (r = 0.29, r = 0.39). In regression, only risk appraisal contributed significantly to FCR. Conclusion: Although women were fairly accurate in recurrence risk estimations, it remains difficult to predict over- or underestimation. Recurrence risk estimations and risk appraisal are two different concepts which are both associated with FCR and should therefore be addressed in patient-provider communication. [ABSTRACT FROM AUTHOR]

In qualitative, non-numerical models, there are numerous challenges raised by the ambiguity, uncertainty, and risk within variables. The root of this ambiguity may lie in the variable itself or other related variables, or be due to expert opinions. Fuzzy cognitive maps allow better understanding of such problems, determining the cause-effect relationships between variables. When dealing with problems where the associated numerical data are unavailable, or the nature of the problem is qualitative, cognitive maps are constructed based on the statements of related experts. One of the problems with using the common cognitive maps model that it fails to consider uncertainty, risk and error within expert comments. This problem affects the quality and credibility of the models applied to complex issues. This paper proposes an R-cognitive maps approach, based on the distance-based automatic construction approach and R-numbers, in order to capture possible risks, uncertainty and ambiguity of expert opinions, with regard to variables and causality relationships. The proposed approach can function as a decision support tool for risk-based cognitive maps problems involving expert opinions, and is tested numerically with an engineering problem. [ABSTRACT FROM AUTHOR]

The communication of information about natural hazard risks to the public is a difficult task for decision makers. Research suggests that newer forms of technology present useful options for building disaster resilience. However, how effectively these newer forms of media can be used to inform populations of the potential hazard risks in their community remains unclear. This research uses primary data from an in-person survey of 164 residents of Newport Beach, California during the spring of 2014 to ascertain the current and preferred mechanisms through which individuals receive information on flood risks in their community. Factor analysis of survey data identified two predominant routes of dissemination for risk information: older traditional media and newer social media sources. A logistic regression model was specified to identify predictors for choosing a particular communication route. This analysis revealed that age is the central factor in predicting the sources people use to receive risk information. We follow the analysis by discussing this finding and its policy implications.

The communication of information about natural hazard risks to the public is a difficult task for decision makers. Research suggests that newer forms of technology present useful options for building disaster resilience. However, how effectively these newer forms of media can be used to inform populations of the potential hazard risks in their community remains unclear. This research uses primary data from an in-person survey of 164 residents of Newport Beach, California during the spring of 2014 to ascertain the current and preferred mechanisms through which individuals receive information on flood risks in their community. Factor analysis of survey data identified two predominant routes of dissemination for risk information: older traditional media and newer social media sources. A logistic regression model was specified to identify predictors for choosing a particular communication route. This analysis revealed that age is the central factor in predicting the sources people use to receive risk information. We follow the analysis by discussing this finding and its policy implications.

A basic assumption about natural hazard policy is risk information will influence risk perception, which will in turn affect individual adaptive behaviors. This paper tests this basic assumption in the context of the National Flood Insurance Program and flood insurance purchasing in San Francisco Bay, California. Using spatially explicit household survey data, we use mediation models to analyze how an individual’s knowledge about which flood zone they live is associated with their flood risk perception and likelihood of purchasing flood insurance. The results suggest that the relationship between risk information, perception, and behavior varies across “risk-informed” who are aware of their flood zone designation versus “risk-uninformed” individuals who are unsure of their flood zone designation. The findings highlight the importance accurately mapping and communicating flood risks in the context of variation in topography, urban structure, and future climate change. [ABSTRACT FROM AUTHOR]

Abstract Background Targeted surveillance of at-risk individuals in families with increased risk of hereditary cancer is an effective prevention strategy if relatives are identified, informed and enrolled in screening programs. Despite the potential benefits, many eligible at-risk relatives remain uninformed of their cancer risk. This study describes the general public’s opinion on disclosure of hereditary colorectal cancer (CRC) risk information, as well as preferences on the source and the mode of information. Methods A random sample of the general public was assessed through a Swedish citizen web-panel. Respondents were presented with scenarios of being an at-risk relative in a family that had an estimated increased hereditary risk of CRC; either 10% (moderate) or 70% (high) lifetime risk. A colonoscopy was presented as a preventive measure. Results were analysed to identify significant differences between groups using the Pearson’s chi-square (χ2) test. Results Of 1800 invited participants, 977 completed the survey (54%). In the moderate and high-risk scenarios, 89.2 and 90.6% respectively, would like to receive information about a potential hereditary risk of CRC (χ2, p = .755). The desire to be informed was higher among women (91.5%) than men (87.0%, χ2, p = .044). No significant differences were found when comparing different age groups, educational levels, place of residence and having children or not. The preferred source of risk information was a healthcare professional in both moderate and high-risk scenarios (80.1 and 75.5%). However, 18.1 and 20.1% respectively would prefer to be informed by a family member. Assuming that healthcare professionals disclosed the information, the favoured mode of information was letter and phone (38.4 and 33.2%). Conclusions In this study a majority of respondents wanted to be informed about a potential hereditary risk of CRC and preferred healthcare professionals to communicate this information. The two presented levels of CRC lifetime risk did not significantly affect the interest in being informed. Our data offer insights into the needs and preferences of the Swedish population, providing a rationale for developing complementary healthcare-assisted communication pathways to realise the full potential of targeted prevention of hereditary CRC.

Abstract Background Biomarker research is gaining increasing attention focusing on the preclinical stages of the disease. Such interest requires special attention for communication and disclosure in clinical contexts. Many countries give dementia a high health policy priority by developing national strategies and by improving guidelines addressing disclosure of a diagnosis; however, risk communication is often neglected. Main text This paper aims to identify the challenges of disclosure in the context of dementia prediction and to find out whether existing clinical guidelines sufficiently address the issues of disclosing a dementia diagnosis and of disclosing the risk of developing dementia in asymptomatic and MCI stage. We will examine clinical guidelines and recommendations of three countries (USA, Canada and Germany) regarding predictive testing and diagnostic disclosure in dementia and Mild Cognitive Impairment (MCI) to show their potentials and limits. This will provide a background to address ethical implications of predictive information and to identify ways how to proceed further. We will start by examining the guidelines and recommendations by focusing on what there is already and what is missing regarding the challenges of disclosing dementia prediction and MCI. Then, we will highlight the novel ethical issues generated by the shift to identify preclinical stages of the disease by biomarkers. We will argue for the need to develop guidelines for disclosing a risk status, which requires different considerations then disclosing a diagnosis of dementia. Finally, we will make some suggestions on how to address the gap and challenges raised by referring to German Stakeholder Conference, which presents us a good starting point to the applicability of involving stakeholders. Conclusions This paper underlines the need to develop empirically based guidelines that address the ethical and social strategies for risk communication of dementia prediction by genetic as well as non-genetic biomarkers. According to our analysis, the guidelines do not address the new developments sufficiently. International efforts should aim for specific guidelines on counseling, communicating risk and disclosing results. We argue that guidelines on (risk) disclosure should be developed by involving various stakeholders and should be informed by socio-empirical studies involving laypersons’ needs and wishes regarding risk communication.

Objectives We examine colleges' current practices for communicating about e-cigarettes in terms of risk, campus policy, and cessation resources based on the American College Health Association (ACHA)'s and other tobacco-free campus policy guidelines. Methods: Websites of 581 universities prohibiting e-cigarette use on campus were analyzed. The relationship between the presence of e-cigarette information and campus characteristics was examined. Results: There was a lack of e-cigarette risk information. Health and other risks of e-cigarette use were rarely or never mentioned. One fifth did not specify e-cigarettes to be prohibited. While many colleges were promoting the health benefit of a tobacco-free policy, the financial/professional benefits were rarely mentioned. Less than half mentioned on-campus tobacco cessation resources and less than one third listed off-campus resources. A few campus characteristics (e.g., the U.S. census region of campus, campus housing, funding type) were associated with presence of e-cigarette information on websites. Conclusion: Our findings suggest the need for colleges to make e-cigarette risk, policy, and cessation information more accessible via official college websites for students and other campus members. This may increase students' support for vape-free policy and assist successful adoption of complete tobacco-free policies on campus. [ABSTRACT FROM AUTHOR]

Patients and public have sought mortality risk information throughout the pandemic, but their needs may not be served by current risk prediction tools. Our mixed methods study involved: (1) systematic review of published risk tools for prognosis, (2) provision and patient testing of new mortality risk estimates for people with high-risk conditions and (3) iterative patient and public involvement and engagement with qualitative analysis. Only one of 53 (2%) previously published risk tools involved patients or the public, while 11/53 (21%) had publicly accessible portals, but all for use by clinicians and researchers. Among people with a wide range of underlying conditions, there has been sustained interest and engagement in accessible and tailored, pre- and postpandemic mortality information. Informed by patient feedback, we provide such information in 'five clicks' (https://covid19-phenomics. org/OurRiskCoV.html), as context for decision making and discussions with health professionals and family members. Further development requires curation and regular updating of NHS data and wider patient and public engagement. [ABSTRACT FROM AUTHOR]

We aimed to identify how additional information about benefits and harms of cervical cancer (CC) screening impacted intention to participate in screening, what type of information on harms women preferred receiving, from whom, and whether it differed between two national healthcare settings. We conducted a survey that randomized screen-eligible women in the United States (n = 1084) and Norway (n = 1060) into four groups according to the timing of introducing additional information. We found that additional information did not significantly impact stated intentions-to-participate in screening or follow-up testing in either country; however, the proportion of Norwegian women stating uncertainty about seeking precancer treatment increased from 7.9% to 14.3% (p = 0.012). Women reported strong system-specific preferences for sources of information: Norwegians (59%) preferred it come from a national public health agency while Americans (59%) preferred it come from a specialist care provider. Regression models revealed having a prior Pap-test was the most important predictor of intentions-to-participate in both countries, while having lower income reduced the probabilities of intentions-to-follow-up and seek precancer treatment among U.S. women. These results suggest that additional information on harms is unlikely to reduce participation in CC screening but could increase decision uncertainty to seek treatment. Providing unbiased information would improve on the ethical principle of respect for autonomy and self-determination. However, the clinical impact of additional information on women’s understanding of the trade-offs involved with CC screening should be investigated. Future studies should also consider country-specific socioeconomic barriers to screening if communication re-design initiatives aim to improve CC screening participation.

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Consumer's understanding of health risks is a key determinant of effective risk communication about health care options. Individuals make decisions about their health under uncertainty, yet the influence of risk perception, risk preferences and information processing has not been well researched in the health economics literature. Here, a novel extension of the standard discrete choice experiment framework is developed to investigate the effect of a "risk shock" (the difference between an individual's perceived risk and updated information) on consumption and health care decisions. In the experiment, consumers were asked to evaluate a basket of health service and lifestyle choices to lower cardiovascular risk. While most individuals, on average, aim to lower their CVD risk to a level of 1.37% points below the updated information provided, the response was asymmetrical, whereby the response to a "negative shock" was less than a "positive shock". Furthermore, we find evidence that risk perception, rather than risk preferences, are more likely to affect consumer health and behaviour changes. Given the global pandemic of CVD, these findings suggest there are public health gains to be made from personalised risk communication if it is better tailored to account for individuals' preferences and risk perception. [ABSTRACT FROM AUTHOR]

• The AQI color code and category correspond to different pollution levels in different countries. • An internationally compatible universal AQI for risk communication to the public is proposed. • Risk communication should focus on the universal color-coded index instead of numbers. • Public awareness must be increased through the citizen science approach. • The public should be engaged in air quality monitoring. Air pollution is known to be one of the major risk factors for premature morbidity and mortality globally, which are preventable. Therefore, the public is informed about air pollution through the Air Quality Index (AQI). The AQI represents integrated data of selected pollutants and produces a combined overall index for specific locations and time. The AQI algorithm generates a range of numbers and categories of colors that indicate likely health risks from air pollutants and the public's actions to minimize the risks. However, it lacks emerging evidence on chemical toxicity or composition. Hence, policymakers may also consider addinga toxicity matrix of fine particles to refine the algorithm, such as oxidative potential. Further, the risk is commonly communicated in numbers and not in color as dictated by the AQI. The AQI values and categories vary significantly between countries for the same pollution concentration, leading to confusion. Hence, we recommend developing a universal AQI (UAQI) with a consistent relationship between colors, concentrations, and toxicity to communicate air pollution risks to the public. Further, communication media should be encouraged to use universal color-coding rather than AQI values, i.e., numbers. Therefore, a global policy framework for regulatory authorities and policymakers is needed to communicate air pollution risk information consistently and to minimize public health exposure. [ABSTRACT FROM AUTHOR]

Abstract Background Excess body weight and sub-optimal lifestyle are modifiable causes of breast cancer and other diseases. There is little evidence that behaviour change is possible within screening programmes and whether this is influenced by prior knowledge of disease risk. We determined whether breast cancer risk influences uptake, retention and efficacy of a weight control programme in the UK National Health Service Breast Screening Programme, and whether additional cardiovascular disease and type 2 diabetes risk information improves uptake and retention further. Method Overweight/obese women in the UK National Health Service Breast Screening Programme identified at high, moderately increased, average and low-risk of breast cancer were randomised to receive individualised breast cancer risk information (breast cancer prevention programme), or individualised breast cancer, cardiovascular disease (QRISK2) and type 2 diabetes (QDiabetes, HbA1c) information (multiple disease prevention programme). Personalised breast cancer risk feedback was given before randomisation in Study-1, and after randomisation in Study-2. Results Recruitment was 9% (126/1356) in Study-1 and 7% (52/738) in Study-2. With respect to breast cancer risk, odds ratio of uptake for high/moderately increased vs low risk women was 1.99 (95% CI 1.24–3.17, P = 0.004) in Study-1 and 3.58 (95% CI 1.59–8.07, P = 0.002) in Study-2. Odds ratio of retention for high/moderately increased -risk vs. low risk women was 2.98 (95% CI 1.05–8.47, P = 0.041) in Study-1 and 3.88 (95% CI 1.07–14.04, P = 0.039) in Study-2. Weight loss of ≥5% at 12 months was achieved by 63% high/moderate vs. 43% low-risk women in Study-1 (P = 0.083) and 39% vs. 8% in Study-2 (P = 0.008). Uptake, retention and weight loss were equivalent in both the breast cancer prevention programme and the multiple disease prevention programme in both studies. Conclusions Women who are informed that they are at increased breast cancer risk were significantly more likely to join and remain in the programmes and consequently lose more weight across both studies. High risk women are more likely engage in a lifetyle prevention programme and also have the greatest potential benefit fom risk reduction strategies. Trial registration ISRCTN91372184 Registered 28 September 2014.

Predictive testing information raises questions about risk communication, health responsibility, and about how to deal with the gap between knowledge of risks and options to act on this knowledge. For some diseases identified by predictive testing, specific treatments or interventions are available, while other diseases, thus far, remain untreatable or unpreventable; this triggers different forms of responsibility. Gender also often intersects with moral responsibility, regarding risk communication but also responsibilities of care which may become necessary with a family member's onset of disease. The aim of the study was to analyze laypeople's attitudes towards predictive testing with a special focus on forms of responsibility arising while dealing with uncertainty of risk information. We conducted seven focus groups with laypeople (n = 43) in four German cities in 2016. Participants were provided with different genetic testing scenarios (breast cancer, early-onset Alzheimer's disease, pharmacogenetics in rectal cancer) for discussing their responsibilities and risk perceptions. We identified three different forms of responsibility: self-responsibility and self-care, family responsibility and care for others, and professional responsibility. For laypeople, the decision for predictive genetic testing seems voluntary and free from external constraint; however, both family and professional conditions influence an individual's decision. [ABSTRACT FROM AUTHOR]

In elucidating the spread of risk information through microblogging, it is important to understand the behaviors of numerous average users, in addition to the activities of authorities. We followed the transmission pathways of 10 actual widely spread tweets concerning several risk information topics, including natural disasters, nuclear disasters, and infectious diseases, and we identified the types of risk that affected retweeting by classifying each tweet based on Slovic's risk‐perception model. Furthermore, we examined the types of users who did and did not retweet the information. Users with few connections in the form of followers (i.e., people who are following a user) or followees (people a user is following), or with a low ratio of mutual followers within their connections, had a tendency to retweet a large amount of risk information, regardless of the type of risk involved. On the other hand, users with a high ratio of mutual followers exhibited a greater tendency to retweet risk information when it was perceived as dreadful, though they did not retweet risk information much on the whole. These results suggest that there are two mechanisms by which risk information is spread within the Twitter network: information exchange and social sharing of personal reactions. [ABSTRACT FROM AUTHOR]

The implementation of the State program of the Russian Federation “Development of nuclear power industry”, Federal target program «Ensuring Nuclear and Radiation Safety from 2016 to 2020 and up to 2030», introduction of new imaging modalities in medicine that are associated with high patient and staff doses, poor public awareness of the presence and level of hazard of natural sources of ionizing radiation determine the relevance of the current study. The aim of the study was to develop the effective methods of risk communication for the improvement of the radiation protection and safety of the population, to introduce these methods in the daily practice of Rospotrebnadzor and, eventually, to assist in the formation of a risk-oriented society in the Russian Federation. Currently, Russian-language terminology in the field of risk communication is not developed; Russian terms are frequently just poor adapted/translated versions of English terms. This manuscript is focused on the definition of the basic concepts of risk communication and the formation of uniform terminology in the field of the radiation safety of the population. A glossary of basic terms in the field of riskcommunication is attached to the manuscript. The authors, considering the analysis of scientific data, suggest the following definition of risk communication: a process of interaction with other participants that is intentionally initiated by one of the participants in the information field of risk and is aimed at the evaluation of the attitudes on risk, their formation or change in other participants; formation or change of own attitudes on risk.

Background: Targeted surveillance of at-risk individuals in families with increased risk of hereditary cancer is an effective prevention strategy if relatives are identified, informed and enrolled in screening programs. Despite the potential benefits, many eligible at-risk relatives remain uninformed of their cancer risk. This study describes the general public's opinion on disclosure of hereditary colorectal cancer (CRC) risk information, as well as preferences on the source and the mode of information. Methods: A random sample of the general public was assessed through a Swedish citizen web-panel. Respondents were presented with scenarios of being an at-risk relative in a family that had an estimated increased hereditary risk of CRC; either 10% (moderate) or 70% (high) lifetime risk. A colonoscopy was presented as a preventive measure. Results were analysed to identify significant differences between groups using the Pearson's chi-square (χ2) test. Results: Of 1800 invited participants, 977 completed the survey (54%). In the moderate and high-risk scenarios, 89.2 and 90.6% respectively, would like to receive information about a potential hereditary risk of CRC (χ2, p =.755). The desire to be informed was higher among women (91.5%) than men (87.0%, χ2, p =.044). No significant differences were found when comparing different age groups, educational levels, place of residence and having children or not. The preferred source of risk information was a healthcare professional in both moderate and high-risk scenarios (80.1 and 75.5%). However, 18.1 and 20.1% respectively would prefer to be informed by a family member. Assuming that healthcare professionals disclosed the information, the favoured mode of information was letter and phone (38.4 and 33.2%). Conclusions: In this study a majority of respondents wanted to be informed about a potential hereditary risk of CRC and preferred healthcare professionals to communicate this information. The two presented levels of CRC lifetime risk did not significantly affect the interest in being informed. Our data offer insights into the needs and preferences of the Swedish population, providing a rationale for developing complementary healthcare-assisted communication pathways to realise the full potential of targeted prevention of hereditary CRC. [ABSTRACT FROM AUTHOR]

The risk information seeking and processing (RISP) model posits that information insufficiency could lead to information seeking, and the effect could be moderated by relevant channel beliefs and perceived information gathering capacity. The RISP model is tested in the context of Koreans' risk information seeking and processing related to toxic chemicals in consumer products. The present study showed that the impact of information insufficiency was moderated by relevant channel beliefs. On the other hand, the impact of information insufficiency was not moderated by perceived information gathering capacity; instead, perceived information gathering capacity had an independent effect on information seeking. [ABSTRACT FROM AUTHOR]

Background: Biomarker research is gaining increasing attention focusing on the preclinical stages of the disease. Such interest requires special attention for communication and disclosure in clinical contexts. Many countries give dementia a high health policy priority by developing national strategies and by improving guidelines addressing disclosure of a diagnosis; however, risk communication is often neglected.Main Text: This paper aims to identify the challenges of disclosure in the context of dementia prediction and to find out whether existing clinical guidelines sufficiently address the issues of disclosing a dementia diagnosis and of disclosing the risk of developing dementia in asymptomatic and MCI stage. We will examine clinical guidelines and recommendations of three countries (USA, Canada and Germany) regarding predictive testing and diagnostic disclosure in dementia and Mild Cognitive Impairment (MCI) to show their potentials and limits. This will provide a background to address ethical implications of predictive information and to identify ways how to proceed further. We will start by examining the guidelines and recommendations by focusing on what there is already and what is missing regarding the challenges of disclosing dementia prediction and MCI. Then, we will highlight the novel ethical issues generated by the shift to identify preclinical stages of the disease by biomarkers. We will argue for the need to develop guidelines for disclosing a risk status, which requires different considerations then disclosing a diagnosis of dementia. Finally, we will make some suggestions on how to address the gap and challenges raised by referring to German Stakeholder Conference, which presents us a good starting point to the applicability of involving stakeholders.Conclusions: This paper underlines the need to develop empirically based guidelines that address the ethical and social strategies for risk communication of dementia prediction by genetic as well as non-genetic biomarkers. According to our analysis, the guidelines do not address the new developments sufficiently. International efforts should aim for specific guidelines on counseling, communicating risk and disclosing results. We argue that guidelines on (risk) disclosure should be developed by involving various stakeholders and should be informed by socio-empirical studies involving laypersons' needs and wishes regarding risk communication. [ABSTRACT FROM AUTHOR]

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Objective: To explore differences in tobacco information–seeking behaviours and perceptions between sexual minority and heterosexual (or 'straight') adults and to determine if these differences are mediated by tobacco use. Design: Cross-sectional national survey. Setting: Nationally representative probability-based surveys of adults 18 years of age or older in the US civilian non-institutionalised population. Methods: Data from respondents identifying as gay, lesbian, bisexual (LGB; n = 156) or straight (n = 4,964) in the US National Cancer Institute's Health Information National Trends Survey Food and Drug Administration cycles 1 and 2 (HINTS-FDA 2015, 2017) were analysed. We compared the responses of sexual minority and straight respondents aged 18 years and older concerning tobacco information-seeking behaviours and perceptions. Results: Sexual minority respondents were more likely than their straight counterparts to seek out tobacco health information, to look for information about e-cigarettes and to use the Internet for health information searches. Some of these differences were mediated by tobacco use. Sexual minority respondents were similar to their straight counterparts regarding perceptions of trust and confidence in tobacco health information, as well as perceptions of the hazards of tobacco use. Conclusion: Because sexual minority adults have higher rates of tobacco use and higher rates of tobacco information seeking than others, tobacco health information campaigns should consider carefully tailoring the messages directed towards sexual minority populations. [ABSTRACT FROM AUTHOR]