Climate change, behavior change and health: a multidisciplinary, translational and multilevel perspective

Promising behavior change techniques for climate-friendly behavior change - a systematic review

Introduction

Besides societal and governmental actions to mitigate greenhouse gases, individual behavioral changes are also urgently needed to limit global temperature rise. However, these individual changes have proven to be difficult to achieve in the general population.

Methods

We conducted a systematic review in five electronic databases with the aim of systematically depicting the content of interventions that promote climate-friendly behavior in individuals and households in high- and upper-middle-income countries.

Results

We included 25 studies. The analyses included identification of the used Behavior Change Techniques (BCTs) and comparison of their promise ratio. Across our three outcome categories energy consumption, water consumption, and mobility the most frequently used BCT categories are not the ones that are most promising in terms of behavior change.

Discussion

Based on these results, our recommendation for climate change mitigation interventions is to include components that provide concrete instructions on how to perform the desired behavior (shaping knowledge), setting goals and commitments (goals and planning), substituting undesired behavior, and practicing desired behavior (repetition and substitution). Other reviews with similar aims use different wordings, definitions, or degrees of detail in their intervention component labelling which makes it difficult to compare the results. We recommend to use a standardized classification system, like the BCT taxonomy in combination with the promise ratio, which this study has shown to be a suitable tool to classify applied intervention techniques and give an indication of successful techniques.

Demonstration Projects to Test Built Environment Changes: A Systematic Review

CONTEXT

Built environment interventions (pedestrian/bicycle infrastructure and enhanced access) mitigate barriers to physical activity by making the healthy choice the default choice. Demonstration projects (eg, temporary pedestrian lanes or sidewalks marked with tape) are used to test these interventions before making permanent changes. However, it is unknown whether demonstration projects lead to desired built environment changes.

OBJECTIVE

To systematically review the literature to determine outcomes and overall public health impacts of demonstration projects and whether they lead to permanent changes to the built environment.

DESIGN

Systematic review, conducted from March to September 2022 by searching PubMed and EBSCOhost for peer-reviewed literature and Google for gray (non-peer-reviewed) literature. Inclusion criteria were policy, systems, or environmental interventions; temporary implementation; and presence of evaluation data. Exclusion criteria were individual/interpersonal-level interventions, permanent implementation, and absence of evaluation data. Two authors coded for inclusion/exclusion and resolved discrepancies, coded a portion of included sources and resolved discrepancies, refined coding guide definitions, and coded remaining sources.

MAIN OUTCOME MEASURES

Data were extracted based on the expanded RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, which incorporates constructs of the Implementation Outcomes Framework (acceptability, appropriateness, feasibility).

RESULTS

Gray (N = 23) and peer-reviewed (N = 1) sources describing unique demonstration projects (N = 31) met inclusion criteria. Projects tested built environment interventions including traffic calming measures, crosswalks, bike lanes, intersection design, and trails. Sources primarily reported effectiveness (typically improved safety), maintenance, acceptability, and appropriateness. Most sources did not report projects leading to permanent changes to the built environment.

CONCLUSIONS

Based on inconsistent reporting of key outcomes (number of community members reached, changes to physical activity levels), overall impacts are unknown. Most demonstration projects captured community members' feedback, which was typically positive, but it is unknown whether feedback led to long-term changes. We recommend providing improved demonstration project guidance for practitioners to facilitate robust data collection, including suggested evaluation methods and tools.

Exploring influences of environmental information, beliefs and self-efficacy on nurses' climate health behaviours and their relationships

BACKGROUND

To create a healthy nursing environment and protect human health in response to climate change, it is essential to encourage behaviour change among nurses. Although numerous studies have been conducted on nurses to address climate change, few studies have explored the relationships of factors that influence and promote nurses' climate health behavioural behavioural change, making it difficult to determine how nurses should act and prioritise regarding climate health behaviours.

AIMS

To investigate influential environmental factors on climate health behaviours among nurses through the causal relationships between environmental information, environmental beliefs and environmental self-efficacy using the Information-Motivation-Behavioural Skills (IMB) model.

DESIGN

A cross-sectional study.

METHODS

This study recruited 186 nurses working in hospitals nationwide in July 2023. Self-reported questionnaires (Climate, Health, and Nursing Tool; National Environmental Consciousness Survey; New Ecological Paradigm Scale; Personal Efficacy Scale) were used to collect the data. Path analysis was performed.

RESULTS

The factors influencing nurses' climate health behaviours were environmental information, environmental beliefs and environmental self-efficacy. Environmental self-efficacy was found to be more influenced by the exogenous variables of environmental information than environmental beliefs and to be the most significant factor affecting climate health behaviours.

CONCLUSIONS

It is more important for nurses to obtain environmental information than environmental beliefs to achieve the goal of climate health behaviours. This in turn, will lead to personal self-efficacy that nurses can mitigate the climate crisis. Their strong self-efficacy affects their climate health behaviours.

IMPLICATIONS FOR THE PROFESSION

Nurses should seek and draw on the appropriate environmental information related to climate health change and nurses with environmental self-efficacy become environmental nursing leaders, encouraging other health care workers to participate actively in climate health behaviours and continuously carry out the behaviours within daily life, hospital and community environments.

IMPACT

The study addressed the lack of relationship research on factors influencing nurses' climate health behaviours, emphasizing the importance of accessing environmental information to foster self-efficacy. Nurses with heightened self-efficacy can lead healthcare professionals in climate health actions.

REPORTING METHOD

This research has adhered to relevant EQUATOR and STROBE.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Health science students' preparedness for climate change: a scoping review on knowledge, attitudes, and practices

INTRODUCTION

Climate change (CC) is a global public health issue, and the role of health professionals in addressing its impact is crucial. However, to what extent health professionals are prepared to deal with CC-related health problems is unclear. We aimed to evaluate the knowledge, attitudes, and practices of health students about the CC.

METHODS

We conducted a scoping review through systematic searches in PubMed, Scopus, Web of Science, Proquest, and EBSCO. We included original scientific research with no language or time restrictions. Two authors independently reviewed and decided on the eligibility of the studies, then performed data extraction.

RESULTS

21 studies were included, with a total of 9205 undergraduate nursing, medical, pharmacy, and public health students mainly. Most health science students (> 75%) recognized human activities as the main cause of CC. However, they perceived a lack of knowledge on how to address CC. Moreover, we found inadequate coverage or limited development of CC in related curricula that may contribute to incomplete learning or low confidence in the theoretical and practical concepts of students.

CONCLUSION

The findings of our scoping review suggest that while health sciences students possess a general understanding of CC, there is a significant gap in their knowledge regarding its specific health impacts. To address this gap, there is a need for targeted education and training for future health care professionals that emphasizes the health effects of CC.

Physical Activity Dependence on Relative Temperature and Humidity Characteristics in a Young, Insufficiently Active Population: A Weather Typing Analysis

BACKGROUND

Physical activity (PA) is an important contributor to one's physical and mental health both acutely and across the lifespan. Much research has done on the ambient environment's impact on PA; however, these studies have used absolute values of atmospheric measures such as temperature and humidity, which vary spatiotemporally and make comparisons between studies which differ in location or time of year difficult to square with one another.

METHODS

Here, we employ the Global Weather Type Classification, Version 2, to determine the combined impact of temperature and humidity on PA in a sample of insufficiently active young adults. We conducted secondary analyses of data from a single-group behavioral intervention trial that varied the number of digital messages sent daily. Young adults (n = 81) wore Fitbit Versa smartwatches for a 6-month period sometime between April 2019 and July 2020, and location was tracked using a custom smartphone application.

RESULTS

Mixed linear models indicated that, across 8179 person-days, PA was significantly lower on days with humid conditions and significantly higher on warm dry days, though the latter relationship was no longer significant when controlling for timing in relation to the COVID-19 pandemic declaration. Demographic factors did not affect the relationship between weather and PA.

CONCLUSIONS

Results are a first step in providing additional guidance for encouraging PA in insufficiently active individuals given forecasted daily weather conditions. Future work should examine seasonal variability in the weather type-PA relationship without the influence of a world-altering event influencing results.

Climate change views examined through a behavioral medicine frame: are there potential target mechanisms for change beyond political ideology?

The threat of climate change is associated with both profound health consequences and failures by many individuals to take preventive actions. Behavioral science research on health behavior engagement may serve as a lens through which to better understand attitudes associated with the threat of climate change. This study was designed to examine individual differences in attitudinal responses to climate change, understanding the degree to which these responses can be predicted by both political beliefs and more readily modified psychological factors commonly associated with health behavior engagement: locus of control, anxiety sensitivity, delay discounting, and intolerance of uncertainty. Participants (N = 234) were US adults (62% male; 57% Non-Hispanic White; 44% Democrat) who completed an online survey. Stepwise multiple linear regressions examined which variables provided non-redundant prediction in models of climate change beliefs and concerns. In addition to providing support for the role of political affiliation and related ideology in climate change views (9-23% variance), this study underscores the importance of a behavioral health frame in understanding climate change concerns and beliefs. Known risk factors for negative health behaviors - prominently, locus of control, anxiety sensitivity, and delay discounting - contributed strongly to the understanding of these views, accounting for 4-28% of variance. Our findings encourage greater attention to health behavior-related constructs for understanding attitudes relevant to climate change action.

Chronic heat stress induces the expression of HSP genes in the retina of chickens (Gallus gallus)

Introduction: Chronic heat stress during summer is a major challenge imposed by global warming. Chickens are more sensitive to heat stress than mammals because they lack sweat glands. Thus, chickens are more susceptible to heat stress during summer than other seasons. Induction of heat shock protein (HSP) genes is one of the primary defense mechanisms against heat stress. Tissue-specific responses exhibited by different classes of HSPs upon exposure to heat stress have been reported previously in different tissues including the heart, kidney, intestine, blood, and muscle, but not in the retina. Therefore, this study aimed to investigate the expression levels of HSP27, HSP40, HSP60, HSP70, and HSP90 in the retina under chronic heat stress.

Methods: This study was conducted during the summers of 2020 and 2021 in Kuwait. Chickens (Gallus gallus) were divided into control and heat-treated groups and sacrificed at different developmental stages. Retinas were extracted and analyzed by using Real Time quantitative Polymerase Chain Reaction (RT-qPCR).

Results: Our results from the summer of 2021 were similar to that from the summer of 2020, regardless of whether GAPDH or RPL5 was used as a gene normalizer. All five HSP genes were upregulated in the retina of 21-day-old heat-treated chickens and stayed upregulated until 35 days of age, with the exception of HSP40, which was downregulated. The addition of two more developmental stages in the summer of 2021 showed that at 14 days, all HSP genes were upregulated in the retina of heat-treated chickens. In contrast, at 28 days, HSP27 and HSP40 were downregulated, whereas HSP60, HSP70, and HSP90 were upregulated. Furthermore, our results showed that under chronic heat stress, the highest upregulation of HSP genes was seen at the earliest developmental stages.

Discussion: To the best of our knowledge, this is the first study to report the expression levels of HSP27, HSP40, HSP60, HSP70, and HSP90 in the retina under chronic heat stress. Some of our results match the previously reported expression levels of some HSPs in other tissues under heat stress. These results suggest that HSP gene expression can be used as a biomarker for chronic heat stress in the retina.

Weather associations with physical activity, sedentary behaviour and sleep patterns of Australian adults: a longitudinal study with implications for climate change

BACKGROUND

Weather is a potentially important influence on how time is allocated to sleep, sedentary behaviour and physical activity across the 24-h day. Extremes of weather (very hot, cold, windy or wet) can create undesirable, unsafe outdoor environments for exercise or active transport, impact the comfort of sleeping environments, and increase time indoors. This 13-month prospective cohort study explored associations between weather and 24-h movement behaviour patterns.

METHODS

Three hundred sixty-eight adults (mean age 40.2 years, SD 5.9, 56.8% female) from Adelaide, Australia, wore Fitbit Charge 3 activity trackers 24 h a day for 13 months with minute-by-minute data on sleep, sedentary behaviour, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) collected remotely. Daily weather data included temperature, rainfall, wind, cloud and sunshine. Multi-level mixed-effects linear regression analyses (one model per outcome) were used.

RESULTS

Ninety thousand eight hundred one days of data were analysed. Sleep was negatively associated with minimum temperature (-12 min/day change across minimum temperature range of 31.2 °C, p = 0.001). Sedentary behaviour was positively associated with minimum temperature (+ 12 min/day, range = 31.2 oC, p = 0.006) and wind speed (+ 10 min/day, range = 36.7 km/h, p< 0.001), and negatively associated with sunshine (-17 min/day, range = 13.9 h, p < 0.001). LPA was positively associated with minimum temperature (+ 11 min/day, range = 31.2 °C, p = 0.002), cloud cover (+ 4 min/day, range = 8 eighths, p = 0.008) and sunshine (+ 17 min/day, range = 13.9 h, p < 0.001), and negatively associated with wind speed (-8 min/day, range = 36.7 km/h, p < 0.001). MVPA was positively associated with sunshine (+ 3 min/day, range = 13.9 h, p < 0.001) and negatively associated with minimum temperature (-13 min/day, range = 31.2 oC, p < 0.001), rainfall (-3 min/day, range = 33.2 mm, p = 0.006) and wind speed (-4 min/day, range = 36.7 km/h, p < 0.001). For maximum temperature, a significant (p < 0.05) curvilinear association was observed with sleep (half-U) and physical activity (inverted-U), where the decrease in sleep duration appeared to slow around 23 °C, LPA peaked at 31 oC and MVPA at 27 °C.

CONCLUSIONS

Generally, adults tended to be less active and more sedentary during extremes of weather and sleep less as temperatures rise. These findings have the potential to inform the timing and content of positive movement behaviour messaging and interventions.

TRIAL REGISTRATION

The study was prospectively registered on the Australian New Zealand Clinical Trial Registry (Trial ID: ACTRN12619001430123).