Risk Communication Interventions Research Articles

Longitudinal impact of perceived harm and addiction on e-cigarette initiation among tobacco-naïve youth: Population Assessment of Tobacco and Health study (Waves 1–5)

ObjectivesThis study investigates the effect of e-cigarette-related harm and addiction perceptions on e-cigarette initiation among US tobacco-naïve adolescents. Study designThis is a longitudinal study. MethodsUsing data from five waves (2013–2019) of the Population Assessment of Tobacco and Health Study, we created a longitudinal data set for 2775 youth aged 12–17 years who had no prior use of tobacco products at Wave 1. E-cigarette initiation was defined as transitioning from non-use at Wave 1 to ever use in subsequent waves. Kaplan–Meier survival and Cox proportional hazard regression models were used to assess the impact of harm and addiction perceptions on e-cigarette initiation. ResultsOur analytic sample comprised 63.1% of youth who had never used tobacco products at Wave 1 and consequently initiated e-cigarette use in subsequent waves. Over time, fewer individuals perceived e-cigarettes as harmless (14.1%–2.1%), whereas more perceived them as likely to cause addiction (53.7%–76.6%). Compared with perceiving e-cigarettes as a lot of harm, those perceiving some harm (adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI]: 1.12–1.52), little harm (aHR = 1.42, 95% CI: 1.20–1.68), or no harm (aHR = 2.09, 95% CI: 1.64–2.65) were more likely to initiate e-cigarette use. Demographic factors for initiation included being Black or Hispanic ethnicity (vs White), younger age (12–14 vs15–17 years), and receiving over $20 per week (vs $0) in pocket money, with P-values <0.05. However, in adjusted results, addiction perceptions did not significantly impact e-cigarette initiation (P-values >0.05). ConclusionsAmong youth without prior tobacco/nicotine use, perceiving e-cigarettes as having low harm significantly predicted initiation over time. Effective prevention strategies, including targeted risk communication interventions, are essential for discouraging e-cigarette use among youth.

Reopening schools safely and educating youth (ROSSEY) study: Protocol for a community-based, cluster randomized controlled trial

IntroductionROSSEY is a community–academic partnership aiming to develop and test a COVID-19 risk communication intervention for elementary school students and families in Yakima County, Washington. We describe the ROSSEY study protocol that will be implemented in the Yakima School District. MethodsAim 1 is to identify the community's social, ethical, and behavioral needs and resources for students to return to school and maintain onsite learning. We will conduct semi-structured interviews with students and school employees and focus groups with parents. Aim 2 is to evaluate the effectiveness of risk communication on students' school attendance. We will conduct a cluster randomized control trial. We will enroll 14 Yakima School District elementary schools with 900 student participants and randomize the schools into the COVID-19 risk communication intervention or control group. Aim 3 will assess implementation of the risk communication intervention and schools' COVID-19 mitigation strategies. We will use the RE-AIM framework to guide this work, which will entail conducting semi-structured interviews with students and school employees and focus groups with parents. DiscussionImplementation of science-based risk communication can educate the community on the benefits and safety of COVID-19 testing and vaccination. Risk communication may also inform families about the role of COVID-19 testing and vaccines as part of mitigation strategies to allow for safe in-person learning. Schools have extraordinary influence to promote children's health through policy and practice change. Study findings will provide evidence to facilitate policy decisions and best practices at schools that facilitate adoption of COVID-19 risk communication. Trial registrationClinicalTrials.govNCT04859699. Registered on April 26, 2021.

COVID-19 preventive measures in Rohingya refugee camps: An assessment of knowledge, attitude and practice.

Although many studies were conducted on COVID-19 knowledge, attitude, and practice (KAP) among the general population in many countries, very little is known about refugees, particularly Rohingya refugees in Cox's Bazar. A vast array of risk communication and community engagement (RCCE) interventions were implemented in Cox's Bazar with the intent of reducing disease transmission by empowering the community to adopt public health measures. The study aimed to assess the level of knowledge, attitude and practice (KAP) of COVID-19 preventive measures among the Rohingya refugees in Cox's Bazar, and to identify their socio-demographic determinants. A cross-sectional study was conducted with 500 Rohingya individuals. Participants in the study were Rohingya refugees residing in five randomly selected camps where International Organization for Migration (IOM) Health was operating. Using a structured questionnaire, skilled community health workers surveyed the Rohingya population. In addition to the survey on knowledge, attitude, and practice, the study gathered information on the perspectives and relevance of sociodemographic factors that influence KAP. The study findings indicate that the mean scores for knowledge, attitude, and practice were 9.93, 7.55, and 2.71 respectively. Association was found between knowledge and practice level and age group-the elderly age group (>/ = 61 years) had less level of knowledge (AOR 0.42, P value = 0.058) and the late mid-age group (46-60 years) had better practice level (AOR 2.67, P value <0.001). Our study found that the Rohingya refugee community in Cox's Bazar has improved knowledge and attitude toward COVID-19 preventive measures. However, the practice level of these measures remains low compared to the knowledge and positive attitude. The reason behind the poor practice of preventive measures needs to be identified and addressed engaging the community in similar future outbreaks.

Addressing COVID-19 inequities using bidirectional crisis and emergency risk communication and vaccine clinic interventions: a descriptive study

BackgroundIm/migrants (immigrants and migrants, including refugees, asylum seekers, and individuals without legal documentation) experience unique assets and needs in relation to coronavirus disease 2019 (COVID-19). Community-based participatory research (CBPR) is one way to engage im/migrant communities. Rochester Healthy Community Partnership (RHCP) is a CBPR partnership in Rochester, Minnesota. RHCP partners noted that credible COVID-19 information was not available to their communities. In response, RHCP formed a COVID-19 Task Force and adapted the Centers for Disease Control and Prevention’s Crisis and Emergency Risk Communication (CERC) framework to create an intervention that prioritized im/migrant groups experiencing health disparities. In the CERC intervention, communication leaders delivered COVID-19 health messages to their social networks and documented related concerns. RHCP relayed these concerns to regional leaders to ensure that im/migrant experiences were included in decision making. Once vaccines were available, RHCP continued to deploy the CERC intervention to promote vaccination equity. The aims of this paper are to (1) describe the implementation of a bidirectional CERC intervention for vaccination equity, and (2) describe a community-engaged and community-based vaccine clinic intervention.MethodsFirst, we surveyed participants (n = 37) to assess COVID-19 experiences, acceptability of the CERC intervention, and motivation to receive a COVID-19 vaccination. Second, we collaborated with community partners to hold vaccine clinics. We report descriptive statistics from each intervention.ResultsWhen asked about the acceptability of the CERC intervention for vaccine equity, most participants either reported that they ‘really liked it’ or ‘thought it was just ok’. Most participants stated that they would recommend the program to family or friends who have not yet received the COVID-19 vaccine. Almost all participants reported that they felt ‘much more’ or ‘somewhat more’ motivated to receive a COVID-19 vaccine after the intervention. We administered 1158 vaccines at the vaccination clinics.ConclusionsWe found that participants viewed the CERC intervention for vaccination equity as an acceptable way to disseminate COVID-19-related information. Nearly all participants reported that the intervention convinced them to receive a COVID-19 vaccine. In our experience, community-engaged and community-based clinics are a successful way to administer vaccines to im/migrant communities during a pandemic.

Perceived public alarm and comprehension of risk communication messages about Lassa fever in Nigeria: a gauge of the risk communication model

IntroductionLassa fever constitutes a threat to the public health system in Nigeria with the reoccurring annual epidemics and its attendant risk communication intervention challenges.ObjectiveThis study examined the influence of public alarm (if any) on respondents' comprehension of risk communication messages about the most common host of the Lassa virus, modes of transmission, risk factors, and protective measures for Lassa fever. The risk communication model (mental noise hypothesis) served as the benchmark for measuring respondents' perceptions in the most endemic states in Nigeria.MethodThe study adopted a quantitative approach, using the survey method. Data for this study were collected from 653 respondents through a structured questionnaire. Respondents were selected through a multi-stage sampling technique. Frequency tables were used to profile the respondents' characteristics and key variables while regression coefficients were used to draw inferences.ResultsThe study found a high level of perceived public alarm among the respondents but maximum attention was paid to risk communication messages amid the high level of anxiety. Knowledge of the common Lassa virus-host, modes of transmission, risk factors, and risk reduction measures was adequate irrespective of the high level of perceived public alarm. Public alarm significantly influenced audience comprehension of the risk information about Lassa fever in Ebonyi and Ondo at r2 = 0.040 and 0.076, at p &amp;lt; 0.05 but not in Edo state at r2 = 0.010, at p &amp;gt; 0.05.ConclusionThe authors conclude that devoting adequate attention to outbreak communication messages amid a high level of anxiety could lead to improved knowledge of infectious diseases.

Impact of government risk communication on residents’ decisions to adopt earthquake insurance: Evidence from a field survey in China

This study employs a field survey of 640 rural households in a seismically active area of China to examine the impact of government risk communication intervention on the adoption of earthquake insurance. Four treatments were performed, and they were accepted in various forms depending on the level of risk communication. Findings indicate that door-to-door risk communication from the government motivates residents to buy earthquake insurance. Furthermore, after receiving tailored risk communication, low-income groups and ethnic minorities demonstrate greater willingness to pay for insurance. These findings have implications for how comprehensive frameworks for managing disaster risk should be created in developing nations faced with escalating natural disaster hazards.

Testing Explanations for Skepticism of Personalized Risk Information.

The promise of precision medicine could be stymied if people do not accept the legitimacy of personalized risk information. We tested 4 explanations for skepticism of personalized diabetes risk information. We recruited participants (N = 356; Mage = 48.6 [s = 9.8], 85.1% women, 59.0% non-Hispanic white) from community locations (e.g., barbershops, churches) for a risk communication intervention. Participants received personalized information about their risk of developing diabetes and heart disease, stroke, colon cancer, and/or breast cancer (women). Then they completed survey items. We combined 2 items (recalled risk, perceived risk) to create a trichotomous risk skepticism variable (acceptance, overestimation, underestimation). Additional items assessed possible explanations for risk skepticism: 1) information evaluation skills (education, graph literacy, numeracy), 2) motivated reasoning (negative affect toward the information, spontaneous self-affirmation, information avoidance); 3) Bayesian updating (surprise), and 4) personal relevance (racial/ethnic identity). We used multinomial logistic regression for data analysis. Of the participants, 18% believed that their diabetes risk was lower than the information provided, 40% believed their risk was higher, and 42% accepted the information. Information evaluation skills were not supported as a risk skepticism explanation. Motivated reasoning received some support; higher diabetes risk and more negative affect toward the information were associated with risk underestimation, but spontaneous self-affirmation and information avoidance were not moderators. For Bayesian updating, more surprise was associated with overestimation. For personal relevance, belonging to a marginalized racial/ethnic group was associated with underestimation. There are likely multiple cognitive, affective, and motivational explanations for risk skepticism. Understanding these explanations and developing interventions that address them will increase the effectiveness of precision medicine and facilitate its widespread implementation.

Improving Uptake of Cancer Genetic Risk Assessment in a Remote Tailored Risk Communication and Navigation Intervention: Large Effect Size but Room to Grow.

Cancer genetic risk assessment (CGRA) is recommended for women with ovarian cancer or high-risk breast cancer, yet fewer than 30% receive recommended genetic services, with the lowest rates among underserved populations. We hypothesized that compared with usual care (UC) and mailed targeted print (TP) education, CGRA uptake would be highest among women receiving a phone-based tailored risk counseling and navigation intervention (TCN). In this three-arm randomized trial, women with ovarian or high-risk breast cancer were recruited from statewide cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TP received a mailed educational brochure. Participants assigned to TCN received the mailed educational brochure, an initial phone-based psychoeducational session with a health coach, a follow-up letter, and a follow-up navigation phone call. Participants' average age was 61 years, 25.4% identified as Hispanic, 5.9% identified as non-Hispanic Black, and 17.5% lived in rural areas. At 6 months, more women in TCN received CGRA (18.7%) than those in TP (3%; odds ratio, 7.4; 95% CI, 3.0 to 18.3; P < .0001) or UC (2.5%; odds ratio, 8.9; 95% CI, 3.4 to 23.5; P < .0001). There were no significant differences in CGRA uptake between TP and UC. Commonly cited barriers to genetic counseling were lack of provider referral (33.7%) and cost (26.5%), whereas anticipated difficulty coping with test results (14.0%) and cost (41.2%) were barriers for genetic testing. TCN increased CGRA uptake in a group of geographically and ethnically diverse high-risk breast and ovarian cancer survivors. Remote personalized interventions that incorporate evidence-based health communication and behavior change strategies may increase CGRA among women recruited from statewide cancer registries.

Adaptation of a bidirectional crisis and emergency risk communication framework by community-engaged research partnerships in rural Mississippi during the COVID-19 pandemic

Community engagement is important for reaching populations at risk for health inequities in the coronavirus disease 2019 (COVID-19) pandemic. A community-engaged risk communication intervention implemented by a community-engaged research partnership in Southeast Minnesota to address COVID-19 prevention, testing, and socioeconomic impacts has demonstrated high acceptability, feasibility, perceived efficacy, and sustainability. In this study, we describe the adaptation of the intervention by a community-academic partnership with rural African American populations in three Mississippi counties with high COVID-19 disparities. Intervention reach was assessed by the number of messages delivered by Communication Leaders to members of their social networks. Perceived scalability of the intervention was assessed by the Intervention Scalability Assessment Tool. Bidirectional communication between Communication Leaders and community members within their social networks was used by the partnership to refine messages, meet resource needs, and advise statewide decision-makers. In the first 3 months, more than 8482 individuals were reached in the three counties. The intervention was deemed to be highly scalable by partnership members. Adaptation of a community-engaged pandemic CERC intervention is feasible and scalable, and it has the potential to reduce COVID-19 inequities across heterogeneous populations. This approach may be incorporated into current and future pandemic preparedness policies for community engagement.

Understanding cancer genetic risk assessment motivations in a remote tailored risk communication and navigation intervention randomized controlled trial

ABSTRACT Background National guidelines recommend cancer genetic risk assessment (CGRA) (i.e. genetic counseling prior to genetic testing) for women at increased risk for hereditary breast and ovarian cancer (HBOC). Less than one-half of eligible women obtain CGRA, leaving thousands of women and their family members without access to potentially life-saving cancer prevention interventions. Purpose The Genetic Risk Assessment for Cancer Education and Empowerment Project (GRACE) addressed this translational gap, testing the efficacy of a tailored counseling and navigation (TCN) intervention vs. a targeted print brochure vs. usual care on CGRA intentions. Selected behavioral variables were theorized to mediate CGRA intentions. Methods Breast and ovarian cancer survivors meeting criteria for guideline-based CGRA were recruited from three state cancer registries (N = 654), completed a baseline survey, and were randomized. TCN and targeted print arms received the brochure; TCN also participated in a tailored, telephone-based decision coaching and navigation session grounded in the Extended Parallel Process Model and Ottawa Decision Support Framework. Participants completed a one-month assessment. Logistic regression was used to compare the rate of CGRA intentions. CGRA intentions and theorized mediator scores (continuous level variables) were calculated using mixed model analysis. Results CGRA intentions increased for TCN (53.2%) vs. targeted print (26.7%) (OR = 3.129; 95% CI: 2.028, 4.827, p < .0001) and TCN vs. usual care (23.1%) (OR = 3.778, CI: 2.422, 5.894, p < .0001). Perceived risk (p = 0.023) and self-efficacy (p = 0.035) mediated CGRA intentions in TCN. Conclusions Improvements in CGRA intentions and theorized mediators support the use of a tailored communication intervention among women at increased HBOC risk. (Clinicaltrials.gov: NCT03326713.) Trial registration: ClinicalTrials.gov identifier: NCT03326713.

Factors associated with older adults' perception of health risks of hot and cold weather event exposure: A scoping review.

Hot and cold weather events are increasingly becoming a global burden resulting in premature and preventable morbidity and mortality, particularly in vulnerable groups such as older people and people with chronic health conditions. However, risk perception regarding weather is generally poor among vulnerable groups which often acts as a barrier to the uptake of critical health-protective behaviours. A more cohesive understanding of determinants of risk perception is needed to inform public health risk communication and behaviour change interventions that promote protective health behaviours. This scoping literature review aimed to understand factors influencing perception of personal health risks in vulnerable groups as a result of exposure to hot and cold weather events. A five-stage scoping review framework was followed. Searches were run across Medline, PsychInfo, Web of Science and EMBASE. Papers were included if they provided rationale for risk perceptions in vulnerable groups in indoor/domestic environments and focussed on samples from OECD countries. In total, 13 out of 15,554 papers met the full inclusion criteria. The majority of papers focused on hot weather events: one study exclusively examined cold weather events and one study addressed both cold and hot weather events. Included papers focused on older adults aged 65+ years. The papers identified eight factors that were associated with older adults' personal health risk perception of hot and cold weather events: (1) Knowledge of the relationship between hot/cold weather and health risks, (2) presence of comorbidities, (3) age and self-identity, (4) perceived weather severity, (5) Beliefs associated with regional climate, (6) past experience with weather, (7) misconceptions of effectiveness of protective behaviours, and (8) external locus of control. Future research should explore risk communication methods by implementing the identified risk perception determinants from this review into health protection interventions targeting older adults. Further understanding is needed regarding risk perceptions in non-elderly vulnerable groups, for examples individuals with chronic diseases or disabilities.

Narrative Review of COVID-19 Vaccine Hesitancy: Evidence in Late 2021

The coronavirus disease, COVID-19, has changed daily life dramatically since early 2020. Although COVID-19 vaccines are available in the United States, many express distrust in this primary prevention measure and doubt both the seriousness of COVID-19 and its associated morbidity and mortality. Vaccine hesitancy, also described as the reluctance or refusal of vaccines despite availability, exists on a continuum and was a known public health threat prior to the coronavirus pandemic. This narrative review examines studies related to the determinants of COVID-19 vaccine hesitancy among adults in the United States. Also explored are the factors related to COVID-19 vaccine risk communication and available interventions to address COVID-19. Perceived severity of and susceptibility to COVID-19, trust in public health authorities and government in general, educational attainment, income, race, and sex were found to be significant determinants of vaccine hesitancy. Due to lack of available evidence-based interventions to counter COVID-19 vaccine hesitancy, peer-reviewed commentaries and other health communication principles formed the basis of additional recommendations for COVID-19 vaccine hesitancy interventions. Recommendations included trust-building efforts at the community, national, and institutional levels, as well as addressing social determinants of health. These findings may be limited by recent vaccine mandates related to education and to employment. Future research is needed to identify any changes in acceptance, uptake, and trust in institutions such as public health agencies and universities, and representatives of those institutions.

Effectiveness and quality of risk communication process in Ethiopia: The case of risk communication during cholera outbreak in Addis Ababa, Ethiopia.

BackgroundWHO states risk communication as the conversation of actual information, guidance, and thoughts between specialists and people fronting risks to their well-being, economic or social safety. As risk communication activities are complex and costly usually, evaluation assessment are the best approach to advance risk communication interventions. This study aims to evaluate the effectiveness of risk communication and the quality of health communication materials developed during the 2019 cholera outbreak at Addis Ababa, Ethiopia.MethodsA community-based parallel mixed design was conducted from May to June 2020 at Addis Ababa. A total of 605 adults were selected randomly from Addis Ketema sub-city and ten purposely selected adults were interviewed for qualitative data. In addition eight health communication materials on cholera were randomly selected for evaluation. The quantitative data were analyzed using SPSS version 25. After audio recorded interviews transcribed verbatim and translated into English the qualitative data were entered into open code version 4.02 for analysis. And then the data were analyzed using thematic analysis.ResultRespondents exposed for cholera related messages and outbreak information were 71.8% and 52.7% respectively. Respondents have moderate knowledge for cholera with (M = 14.72 and SD ±4.02) with (0–34) scale range. Both Television and radio spots were found as simple and easy to understand and printed health communication materials score low quality. Poor documentation, lack of data management system and less attention for risk communication activities were identified as a gaps in risk communication in the study settings.Conclusionthis study revealed the positive effects of risk communication messages in increasing individuals’ knowledge. Even though the risk communication spots were found to be simple and easy to understand, the quality of printed materials was low and less attention was given for the risk-communication activities. Thus, strengthening the quality of risk communication and materials development process is very important to bring desired effects in disease prevention strategies and for effective emergency responses in the future.

Patient Perceptions About Opioid Risk Communications Within the Context of a Randomized Clinical Trial

Opioid overdose rates continue to increase, and extant literature suggests that many individuals who use heroin were first introduced to opioids through a medical prescription. To explore patient experiences related to decisions regarding analgesia after an emergency department visit within the context of a randomized clinical trial aimed to test the efficacy of risk communication interventions on treatment preference, risk recall, and use of opioids. This qualitative study of 36 patients making decisions regarding analgesia included qualitative interviews with participants in 2 risk intervention groups. Interviews were audio recorded, transcribed, and edited to remove identifying information to protect the confidentiality of participants. Interviews were conducted from June 4, 2019, to August 6, 2019. We conducted thematic analysis from August to December 2019 using a mixed inductive and deductive approach. Participants received $20 in compensation. The study was conducted in 4 geographically diverse emergency departments in the United States. Participants were adults presenting to the emergency department with either musculoskeletal back or neck pain or kidney stone-related pain. Eligibility criteria included being aged 18 to 70 years, capable of providing informed consent, English speaking or having English comprehension, eligible for emergency department discharge within 24 hours of enrollment, and able to access email or a smartphone. Participants enrolled from the main randomized clinical trial received 1 of 2 risk interventions: a probabilistic opioid risk tool or a narrative-enhanced probabilistic risk tool (ie, participants viewed eight 1- to 3-minute short videos of patients discussing their experiences with pain treatment and positive and negative experiences with opioid use). Factors reported by participants to have influenced their decision-making regarding acute pain and treatment. Thirty-six participants were interviewed, 18 in the group who received the probabilistic risk tool alone and 18 in the group who received the additional narrative-enhanced probabilistic risk tool intervention. The median age was 38 years (range, 21-67 years), 22 individuals were female (61%), 14 were Black or African American (39%), and 14 were White (39%). Five themes emerged from the analysis in the following domains: the factors associated with the risk interventions; clinician paternalism; analgesia attributes and previous experiences; individual self-identity, attitudes, and values; and perceptions of clinician bias. Most participants commented on the powerful lessons they learned from the risk interventions. More research is needed to understand how patients incorporate risk information into their decision-making process.

Differences in comprehending and acting on pandemic health risk information: a qualitative study using mental models

BackgroundA worldwide pandemic of a new and unknown virus is characterised by scientific uncertainty. However, despite this uncertainty, health authorities must still communicate complex health risk information to the public. The mental models approach to risk communication describes how people perceive and make decisions about complex risks, with the aim of identifying decision-relevant information that can be incorporated into risk communication interventions. This study explored how people use mental models to make sense of scientific information and apply it to their lives and behaviour in the context of COVID-19.MethodsThis qualitative study enrolled 15 male and female participants of different ages, with different levels of education and occupational backgrounds and from different geographical regions of Norway. The participants were interviewed individually, and the interview data were subjected to thematic analysis. The interview data were compared to a expert model of COVID-19 health risk communication based on online information from the Norwegian Institute of Public Health. Materials in the interview data not represented by expert model codes were coded inductively. The participants’ perceptions of and behaviours related to health risk information were analysed across three themes: virus transmission, risk mitigation and consequences of COVID-19.ResultsThe results indicate that people placed different meanings on the medical and scientific words used by experts to explain the pandemic (e.g., virus transmission and the reproduction number). While some people wanted to understand why certain behaviour and activities were considered high risk, others preferred simple, clear messages explaining what to do and how to protect themselves. Similarly, information about health consequences produced panic in some interviewees and awareness in others.ConclusionThere is no one-size-fits-all approach to public health risk communication. Empowering people with decision-relevant information necessitates targeted and balanced risk communication.

Understanding Risk Communication Effectiveness From Public Interest, Mobility, and COVID-19 Cases: A Case Study of COVID-19 in Nigeria

Since the emergence of COVID-19 in 2020, various actions have been taken by governments and agencies globally to curtail its spread and devastating effects. Risk communication is an essential component of such actions. Examination of public interest, risk perception and new cases of COVID-19 is vital to understanding the effectiveness of risk communication strategies implemented. With data paucity plaguing policymaking in Nigeria, there is a need to examine new data sources to support the enhancement of risk communication. The study explored Google Trends (GT) and Google Mobility Reports (GMR) in monitoring public restlessness and risk perception, respectively, toward COVID-19 in Nigeria. This is geared toward understanding the effectiveness of the national risk communication strategy. COVID-19 case statistics, stringency index, mobility, and search indices for selected terms were collated (February 28 to June 30, 2020). Temporal dynamics were examined while correlation analysis was carried out to examine the association. Public attention peaked just around the commencement of the nationwide lockdown and declined considerably afterwards despite increasing new cases. Mobility toward most place categories showed a sharp decline at the beginning of the pandemic, except for residential areas. This trend also reversed soon after the lockdown. COVID-19 case statistics were found to be negatively correlated with the public interest. Public interest had a weak but both negative and positive association with the stringency index, while mobility exhibited a weak negative association with the case statistics (except residential area mobility). The results indicated that the risk communication efforts were inadequate in providing a prolonged health behavior change. The initial risk communication and lockdown created a positive outcome, however, the impact soon faded out. The evidence suggests that risk perception may have been poorly targeted by risk communication interventions. It is recommended that continuous monitoring of public interest and risk perception is implemented during an emergency and risk communication adjusted accordingly.

Understanding Cancer Genetic Risk Assessment Intentions in a Tailored Risk Communication Intervention Randomized Controlled Trial

Background: Pathogenic variants in cancer predisposition genes increase second, hereditary cancer risk among women with breast and/or ovarian cancer, and primary cancers in their relatives. National guidelines recommend cancer genetic risk assessment (CGRA) (genetic counseling and/or genetic testing) for women at increased hereditary breast and ovarian cancer (HBOC) risk. Yet, less than half of high risk women, including rural dwellers and racial minorities have accessed CGRA. Purpose: The Genetic Risk Assessment for Cancer Education and Empowerment Project (GRACE), a superiority trial, addressed this translational gap, testing the efficacy of a targeted print brochure (TP) vs tailored counseling and navigation (TCN) vs usual care (UC) on CGRA intentions. TCN targeted behavioral variables theorized to mediate CGRA intentions. We believe GRACE is the first study of its kind promoting guideline-based CGRA to women at increased HBOC risk. Methods: CGRA-eligible women were recruited from three state cancer registries (N=641), completed a baseline survey, and randomized to TCN, TP or UC. TP and TCN received the mailed educational brochure. TCN also engaged in a telephone-based decision coaching and navigation session using motivational interviewing and tailored materials based on the Extended Parallel Process Model and Health Action Process Approach. Participants completed a follow-up survey at one month. Results: TCN improved CGRA intentions compared to TP (0.64, p&amp;lt;0.001, CI 0.32, 0.97) and UC (0.69, p&amp;lt;0.001, CI 0.37, 1.02). Theoretical targets, perceived risk (0.77, p=0.02, CI 0.11, 1.44) and self-efficacy (0.67, p=0.04, CI 0.05, 1.28) mediated CGRA intentions in TCN. Stratification showed increases in CGRA intentions for TCN vs TP among non-Hispanic Whites, Hispanics, urban dwellers, and women with low health literacy and no family history of breast and/or ovarian cancer (FBOC). In TCN, perceived self-efficacy improved in women with no FBOC. Conclusions: Improvements in CGRA intentions and theorized mediators support use of tailored risk communication interventions in Hispanics and women with low health literacy and no FBOC. Further tailoring may improve CGRA intentions in Blacks, other minorities, rural dwellers, and women with high health literacy and FBOC.

Perceived Risk and Associated Factors towards COVID-19 infection among the residents of Ondo State, Southwest Nigeria

BackgroundPerceived risk is an important factor in understanding why and how a population adopts health-prevention interventions. When diseases are perceived as low-risk, motivation to use and adhere to prevention interventions is low, which can aid the spread of highly infectious diseases such as COVID-19. In this study, we assessed risk perception and its associated factors towards COVID-19 infection among the residents of Ondo State, southwest Nigeria. MethodsA community-based, cross-sectional study design using a multi-stage sampling technique was used to recruit 593 heads of households in three local government areas (LGA) in Ondo State. Data were collected using an interviewer-administered questionnaire which captured information on sociodemographic variables, knowledge of COVID-19 prevention, COVID-19 infection prevention and control practices, and risk perception from September 1 to 30, 2021. ResultsThe respondents were mostly males 357 (60.2%). The mean age of respondents was 37.5±14.7 years with 409 (69%) between the age group of 20 to 40 years. Slightly more than one quarter of respondents were civil servants and 78.4% were of Yoruba ethnicity. More than three quarters, 522 (88%), of the respondents had good knowledge of COVID-19 and its preventive measures. The mean risk perception score was 49.0±12.1. Respondents who were civil servants, had good knowledge of COVID-19 and its preventive measures, had lower household income, and were of Yoruba ethnicity had significantly higher risk perception towards COVID-19 infection compared to other groups. Higher risk perception was associated with preventive measures, such as handwashing. ConclusionOur study shows a high-risk perception towards COVID-19 infection among residents in Ondo state, Nigeria. However, there were significant differences between varying knowledge levels, ethnic groups and civil versus non-civil servants. In view of this, we recommend intensified risk communication interventions targeting these groups to improve their risk perception to change health-protective behaviour towards COVID-19 infection.

(Mis)communication? Social listening and the exclusion of marginalised voices

This article aims to contribute to the growing scholarship on the use of social media by humanitarian organisations in a crisis. Although social media’s role in times of crisis has been rigorously studied, much of this work looks at the distribution or collection of information by first-responders or relief organisations. However, there is a growing interest in the analysis of social media content to understand community perceptions and to guide public health and risk communication interventions. This article aims to explore some key limitations of data collected using Social Media Analytics (SMA) tools in fairly representing community-wide perceptions. Through a review of ‘social listening reports’ produced by UN bodies and international aid organisations, this article will explore whether these data deficiencies are fairly represented. This article concludes that while there are many well documented limitations in the use of social media discourse to holistically represent community perceptions, these limitations are not adequately discussed in the reporting produced from this data. Consequentially, users of this analysis cannot adequately weigh the quality of the data when using it to influence policy decisions.

Prevalence and Predictors of Waterpipe Smoking Initiation and Progression Among Adolescents and Young Adults in Waves 1-4 (2013-2018) of the Population Assessment of Tobacco and Health (PATH) Study.

Waterpipe tobacco (WPT) smoking has increased among the young population in the United States. This study assessed the extent and predictors of WPT smoking initiation and progression among US adolescents (12-17 years) and young adults (18-24 years) longitudinally. We analyzed data from 4 waves (2013-2018) of the Population Assessment of Tobacco and Health (PATH) study comprising 10 692 respondents (adolescents = 5428 and young adults = 5264). Kaplan-Meier survival method estimated probabilities of WPT initiation and progression. Cox proportional hazards regression models delineated predictors of the outcomes. Between 2013 and 2018, 4.8% of adolescents initiated and 10.6% progressed WPT smoking. Among young adults, 18.5% initiated and 14.1% progressed WPT smoking during the same time interval. Predictors among adolescents included, WPT initiation: Hispanic ethnicity (adjusted odds ratio (aHR) = 1.75, 95% confidence interval (CI) = 1.23-2.49), lower harm perception (aHR = 2.89, 95% CI = 2.10-3.98), and other tobacco products use (aHR = 3.97, 95% CI = 2.73-5.78); WPT progression: illicit drug use (aHR = 4.60, 95% CI = 1.99-10.67). Predictors among young adults included, WPT initiation: non-Hispanic Black (aHR = 2.31, 95% CI = 1.78-3.00), Hispanic (aHR = 1.77, 95% CI = 1.34-2.33), lower harm perception (aHR = 2.77, 95% CI = 2.19-3.50), and other tobacco products use (aHR = 3.14, 95% CI = 2.25-4.38); WPT progression: non-Hispanic Black (aHR = 1.51 95% CI = 1.09-2.10), lower harm perception (aHR = 1.80, 95% CI = 1.41-2.30), and alcohol use (aHR = 1.61, 95% CI = 1.13-2.30). Results indicate a high prevalence of WPT initiation and progression among adolescents and young adults over time, with minority racial/ethnic groups being at greater risk for both. WPT-specific risk communication interventions (eg, educational campaigns and health warning labels) are warranted to limit WPT smoking among young people.