Gender and cross-country differences in the determinants of sustainable diet intentions: a multigroup analysis of the UK, China, Sweden, and Brazil

Introduction

Gender differences have been identified in both the engagement in and the determinants of sustainable diet behaviours. However, as engagement in pro-environmental behaviours varies across countries, the consistency of gender differences could follow similar patterns. Understanding the factors underlying gender and country differences in diet intentions is important for determining how to promote sustainable diets in different populations.

Methods

Using survey data from the UK, China, Sweden and Brazil (N=4,569), this paper examines the influence of subjective norms, diet-related identity, perceived status of meat consumption, environmental identity and environmental concern on sustainable diet intentions. Multigroup analysis was used to explore gender and country differences in the influence of these variables, and whether gender differences were consistent across the four countries.

Results

The findings show that there are gender differences in the influence of diet-related identity and perceived status of meat consumption, as well as cross-country differences in all factors except subjective norms. Holding a strong diet-related meat identity negatively affected sustainable diet intentions in all groups. Crucially, however, gender differences are not consistent across countries.

Discussion

These results suggest that individuals' intentions to engage in sustainable diet behaviours are influenced by nationally unique gender associations.

Factors and framing effects in support for net zero policies in the United Kingdom

Achieving ambitious carbon reduction targets requires transformative change to society, with behaviour change playing an important role. Climate change mitigation ('net zero') policies are needed to accelerate and support such behaviour change. This study examined factors and framing effects in public support for net zero policies in the United Kingdom (UK), making use of a large probability sample (ntotal = 5,665) survey conducted in August 2021. It found that net zero policies are widely supported, with only taxes on red meat and dairy products being supported by less than half of the UK public. Climate worry and perceived fairness were the strongest and most consistent predictors of policy support for net zero policies. The results further suggest that support for net zero policies can be increased by emphasising the co-benefits of the policies, in particular where they are beneficial for health. However, the framing effects were very small. In contrast, public support for net zero policies is lower when potential lifestyle and financial costs are mentioned. This suggests that perceived fairness of the distribution of costs and lifestyle implications of policies are crucial for building and maintaining support for net zero.

Emotional reactions to climate change: a comparison across France, Germany, Norway, and the United Kingdom

We present a study of emotional reactions to climate change utilizing representative samples from France, Germany, Norway, and the United Kingdom (UK). Drawing on appraisal theories of emotion, we examine relations between appraisals, emotions, and behavioral intentions in the context of climate change. We compare the four countries concerning emotional differences and commonalities and relate our findings to pertinent models of cultural values. Five distinct emotions were measured: worry, hope, fear, outrage, and guilt. In addition, the survey asked respondents to appraise a set of climate-related statements, such as the causality of climate change, or the efficacy of mitigation efforts. Also, a set of climate-relevant actions, such as willingness to reduce energy consumption or support for climate policies, was assessed. Findings show that appraisals of human causation and moral concern were associated with worry and outrage, and appraisals of efficacy and technological solutions were associated with hope. Worry and outrage are associated with intentions to reduce one's energy consumption, whereas hope and guilt are related to support for policies such as tax and price increases. A country comparison shows that French respondents score high on outrage and worry and tend to engage in individual behaviors to mitigate climate change, whereas Norwegian respondents score high on hope and show a tendency to support policies of cost increase. Generally, worry is the most and guilt the least intense emotion. Moral concerns and perceived collective efficacy of one's country in addressing climate change are relatively strong in France, while beliefs in human causation and in negative impacts of climate change prevail in Germany, and confidence in technological solutions are prevalent in Norway. In sum, findings reveal typical patterns of emotional responses in the four countries and confirm systematic associations between emotions and appraisals as well as between emotions and behaviors. Relating these findings to models of cultural values reveals that Norway, endorsing secular and egalitarian values, is characterized by hope and confidence in technological solutions, whereas France and Germany, emphasizing relatively more hierarchical and traditional values, are rather characterized by fear, outrage, and support for behavioral restrictions imposed by climate change policies.

Comparing coronavirus (COVID-19) and climate change perceptions: Implications for support for individual and collective-level policies

COVID-19 (coronavirus) and climate change are both global issues that have wide-reaching and serious consequences for human health, the economy, and social outcomes for populations around the world, and both require a combination of systemic governmental policies and community support for action. This paper compares people’s responses to the coronavirus pandemic and climate change in the United Kingdom (UK). A representative survey of the UK population (n = 1,518) conducted in November and December 2020 explored public perceptions of (a) personal and government responsibility, (b) efficacy and trust, and (c) support for policies to address the two issues. The results show that, while there are a number of similarities between coronavirus and climate change, major differences exist regarding individual action. In comparison to the coronavirus pandemic, people feel less personal responsibility, think that their own personal actions are less efficacious, and express lower levels of support for (in particular individual-level) policies to address climate change. These findings suggest that experiences from the coronavirus pandemic cannot directly be translated to climate change, and thus that climate change is likely to require different policy responses and framing.

Cohort profile: The UK COVID-19 Public Experiences (COPE) prospective longitudinal mixed-methods study of health and well-being during the SARSCoV2 coronavirus pandemic

Public perceptions of pandemic viral threats and government policies can influence adherence to containment, delay, and mitigation policies such as physical distancing, hygienic practices, use of physical barriers, uptake of testing, contact tracing, and vaccination programs. The UK COVID-19 Public Experiences (COPE) study aims to identify determinants of health behaviour using the Capability, Opportunity, Motivation (COM-B) model using a longitudinal mixed-methods approach. Here, we provide a detailed description of the demographic and self-reported health characteristics of the COPE cohort at baseline assessment, an overview of data collected, and plans for follow-up of the cohort. The COPE baseline survey was completed by 11,113 UK adult residents (18+ years of age). Baseline data collection started on the 13th of March 2020 (10-days before the introduction of the first national COVID-19 lockdown in the UK) and finished on the 13th of April 2020. Participants were recruited via the HealthWise Wales (HWW) research registry and through social media snowballing and advertising (Facebook®, Twitter®, Instagram®). Participants were predominantly female (69%), over 50 years of age (68%), identified as white (98%), and were living with their partner (68%). A large proportion (67%) had a college/university level education, and half reported a pre-existing health condition (50%). Initial follow-up plans for the cohort included in-depth surveys at 3-months and 12-months after the first UK national lockdown to assess short and medium-term effects of the pandemic on health behaviour and subjective health and well-being. Additional consent will be sought from participants at follow-up for data linkage and surveys at 18 and 24-months after the initial UK national lockdown. A large non-random sample was recruited to the COPE cohort during the early stages of the COVID-19 pandemic, which will enable longitudinal analysis of the determinants of health behaviour and changes in subjective health and well-being over the course of the pandemic.

The role of perceived public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak

Research has consistently shown that access to parks and gardens is beneficial to people's health and wellbeing. In this paper, we explore the role of both public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak that took place in the UK in the first half of 2020. It makes use of the longitudinal COVID-19 Public Experiences (COPE) study, with baseline data collected in March/April 2020 (during the first peak) and follow-up data collected in June/July 2020 (after the first peak) which included an optional module that asked respondents about their home and neighbourhood (n = 5,566). Regression analyses revealed that both perceived access to public green space (e.g. a park or woodland) and reported access to a private green space (a private garden) were associated with better subjective wellbeing and self-rated health. In line with the health compensation hypothesis for green space, private gardens had a greater protective effect where the nearest green space was perceived to be more than a 10-minute walk away. This interaction was however only present during the first COVID-19 peak when severe lockdown restrictions came into place, but not in the post-peak period when restrictions were being eased. The study found few differences across demographic groups. A private garden was relatively more beneficial for men than for women during but not after the first peak. The results suggest that both public and private green space are an important resource for health and wellbeing in times of crisis.

Explaining intention to reduce red and processed meat in the UK and Italy using the theory of planned behaviour, meat-eater identity, and the Transtheoretical model

This study aimed to contribute to the growing literature investigating the psychosocial factors associated with intentions to reduce red and processed meat consumption, given the significant negative impact of meat on public health and in contributing to climate change. A framework combining the Theory of Planned Behaviour with meat-eater identity and the Transtheoretical Model was used to explain intention to reduce red and processed meat consumption across participant samples in the UK and Italy, to identify the factors involved in encouraging behaviour change whilst also considering differences in culinary practices. University students in the UK (n = 320) and Italy (n = 304) completed an online survey including measures from the Theory of Planned Behaviour and the Transtheoretical Model, as well as a measure of meat-eater identity. The results showed differences in the relative impact of subjective norm, perceived behavioural control, and meat-eater identity, on behavioural intention across the different stages of change and across the two countries. On the other hand, attitude remained a stable predictor across the different stages of change and in both countries. The results are discussed in relation to existing literature, with the goal of increasing understanding of how reduced meat consumption might be encouraged across different populations.

Outcome expectancies moderate the association between worry about climate change and personal energy-saving behaviors

This paper explores whether efficacy beliefs can alter the relationship between worry about climate change and personal energy-saving behaviors, controlling for climate change beliefs and socio-demographics. For this purpose, we used data from 23 countries that participated in the European Social Survey Round 8 (N = 44 387). Worry about climate change, personal efficacy, personal outcome expectancy, and collective outcome expectancy were each associated with personal energy-saving behaviors concerning either energy curtailment or energy efficiency. The results further show that outcome expectancies moderate the association between worry about climate change and both types of energy behaviors. Worry was more strongly related to energy curtailment behaviors among those with high levels of personal and collective outcome expectancy. A similar pattern was found for energy efficiency behaviors, which were more strongly predicted by worry about climate change when combined with high levels of collective outcome expectancy. These findings are relevant for climate change communication, especially informational campaigns aiming to lower overall household energy use.

Behaviour change to address climate change

Addressing climate change requires profound behaviour change, not only in consumer action, but also in action as members of communities and organisations, and as citizens who can influence policies. However, while many behavioural models exist to explain and predict mitigation and adaptation behaviours, we argue that their utility in establishing meaningful change is limited due to their being too reductive, individualistic, linear, deliberative and blind to environmental impact. This has led to a focus on suboptimal intervention strategies, particularly informational approaches. Addressing the climate crisis requires a focus on high-impact behaviours and high-emitting groups; interdisciplinary interventions that address the multiple drivers, barriers and contexts of behaviour; and timing to ensure interventions are targeted to moments of change when habits are weaker.

Two Birds, One Stone: The Effectiveness of Health and Environmental Messages to Reduce Meat Consumption and Encourage Pro-environmental Behavioral Spillover

There is a growing consensus that reducing excess meat consumption will be necessary to meet climate change targets, whilst also benefitting people’s health. Strategies aimed at encouraging reduced meat consumption also have the potential to promote additional pro-environmental behaviors through behavioral spillover, which can be catalyzed through an increased pro-environmental identity. Based on this, the current study tested the effectiveness of a randomized two-week messaging intervention on reducing red and processed meat consumption and encouraging pro-environmental behavioral spillover. Participants were undergraduate students in the United Kingdom (n = 320 at baseline) randomly allocated to four conditions in which they received information about the health, environmental, or combined (health and environmental) impacts of meat consumption, and a no-message control. The results showed that receiving information on the health and/or environmental impacts of meat was effective in reducing red and processed meat consumption compared to the control group during the intervention period, with some effects remaining one-month later. However, the intervention did not have any effect on pro-environmental identity and there was little evidence of behavioral spillover. Implications for future research and interventions aimed at reducing meat consumption are discussed.

Political Orientation Moderates the Relationship Between Climate Change Beliefs and Worry About Climate Change

Public perceptions are well established as a key factor in support for climate change mitigation policies, and they tend to vary both within and between countries. Based on data from the European Social Survey Round 8 (N = 44,387), we examined the role of climate change beliefs and political orientation in explaining worry about climate change across 23 countries. We show that belief in anthropogenic climate change, followed by expectations of negative impacts from climate change, are the strongest predictors of worry about climate change. While the strength of the association between political orientation and worry about climate change varies across countries, self-positioning further to the right of the political spectrum is associated with lower levels of worry in most of the countries included in the analysis. We further show that political orientation moderates the relationship between climate change beliefs and worry. While increased confidence in the anthropogenic nature of climate change and expectations of negative impacts are both associated with increased worry across the political spectrum, the relationship is weaker among right-leaning as compared to left-leaning individuals. Notably, the main effect of political orientation on worry about climate change is no longer statistically significant when the interaction terms are present. Finally, a relatively small amount of the explained variance in worry is attributable to differences between countries. The findings might inform strategies for climate change communication in a European context.

Does having children increase environmental concern? Testing parenthood effects with longitudinal data from the New Zealand Attitudes and Values Study

Having children is a transformative experience and may change the way people think about the future. Parents invest time, energy and resources to ensure the survival and reproductive success of offspring. Having children may also induce environmental concerns and investments in actions aimed at guaranteeing the quality of natural resources available to offspring. However, there is limited empirical support for this parenthood effect, and little is known about how environmental attitudes and behaviour change over time following the birth of a child. This pre-registered study uses data from the first seven waves (2009-2015) of the New Zealand Attitudes and Values Study-a longitudinal national probability study of social attitudes, personality, and health outcomes-with multilevel interrupted time series analysis. Respondents' belief in the reality and causes of climate change, sacrifices to standard of living to protect the environment, and changes in daily routine to protect the environment did not change significantly following the birth of a child; and nor were there changes in the underlying trends of attitudes or pre-birth anticipation effects. The study further found no gender differences in the attitudinal effects of childbirth. Additional exploratory analyses suggest that becoming a parent for the first time may increase beliefs in the reality of climate change but does not appear to change other environmental attitudes. Overall, our findings provide little empirical evidence for parenthood effects on environmentalism.

Scientific truth or debate: On the link between perceived scientific consensus and belief in anthropogenic climate change

Scientists overwhelmingly agree that climate change exists and is caused by human activity. It has been argued that communicating the consensus can counter climate scepticism, given that perceived scientific consensus is a major factor predicting public belief that climate change is anthropogenic. However, individuals may hold different models of science, potentially affecting their interpretation of scientific consensus. Using representative surveys in the United Kingdom, France, Germany and Norway, we assessed whether the relationship between perceived scientific consensus and belief in anthropogenic climate change is conditioned by a person's viewing science as 'the search for truth' or as 'debate'. Results show that perceived scientific consensus is higher among climate change believers and moreover, significantly predicts belief in anthropogenic climate change. This relationship is stronger among people holding a model of science as the 'search for truth'. These results help to disentangle the effect of implicit epistemological assumptions underlying the public understanding of the climate change debate.

The English Plastic Bag Charge Changed Behavior and Increased Support for Other Charges to Reduce Plastic Waste

Plastic bags create large amounts of waste and cause lasting environmental problems when inappropriately discarded. In 2015, England introduced a mandatory five pence (US$0.06/€0.06) charge to customers for each single-use plastic bag taken from large stores. Combining a longitudinal survey (n = 1,230), supermarket observations (n = 3,764), and a longitudinal interview study (n = 43), we investigated people's behavioral and attitudinal responses to the charge. We show that all age, gender, and income groups in England substantially reduced their plastic bag usage within 1 month after the charge was introduced, with interviewees highlighting the ease of bringing their own bags. Support for the bag charge also increased among all key demographic groups. Increased support for the plastic bag charge in turn predicted greater support for other charges to reduce plastic waste, suggesting a "policy spillover" effect. Results indicate a broad and positive effect of the bag charge, which appears to have catalyzed wider waste awareness among the British public. This may facilitate the introduction of other policies to eliminate avoidable single-use plastics and packaging.

Health insurance and social capital in Ghana: a cluster randomised controlled trial

BACKGROUND

The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003, enrolment is still far from the desired target of universal coverage. Low community engagement in the design and management of the system was identified as one of the main barriers. The aim of the current study was to explore the role of social capital in NHIS enrolment in two regions of Ghana, Western and Greater Accra.

METHODS

The study involved a cluster-randomised controlled trial of 3246 clients of 64 healthcare facilities who completed both a baseline and a follow-up survey. Thirty-two facilities were randomly selected to receive two types of intervention. The remaining facilities served as control. The interventions were co-designed with stakeholders. Baseline and follow up surveys included measures of different types of social capital, as well as enrolment in the health insurance scheme.

RESULTS

The study found that the interventions encouraged NHIS enrolment (from 40.29 to 49.39% (intervention group) versus 36.49 to 36.75% (control group)). Secondly, certain types of social capital are associated with increased enrolment (log-odds ratios (p-values) of three types of vertical social capital are 0.127 (< 0.01), 0.0952 (< 0.1) and 0.15 (< 0.01)). Effectiveness of the interventions was found dependent on initial levels of social capital: respondents with lowest measured level of interpersonal trust in the intervention group were about 25% more likely to be insured than similar respondents in the control group. Among highly trusting respondents this difference was insignificant. There was however no evidence that the interventions effect social capital. Limitations of the study are discussed.

CONCLUSION

We showed that the interventions helped to increase enrolment but that the positive effect was not realized by changes in social capital that we hypothesised based on result of the first phase of our study. Future research should aim to identify other community factors that are part of the enrolment process, whether other interventions to improve the quality of services could help to increase enrolment and, as a result, could provide community benefits in terms of social capital.Our findings can guide the NHIS in Ghana and other health organizations to enhance enrolment.

TRIAL REGISTRATION

Ethical Clearance by Ghana Health Service Ethical Committee No. GHS-ERC 08.5.11.

Emergency hospital admissions associated with a non-randomised housing intervention meeting national housing quality standards: a longitudinal data linkage study

BACKGROUND

We investigated tenant healthcare utilisation associated with upgrading 8558 council houses to a national quality standard. Homes received multiple internal and external improvements and were analysed using repeated measures of healthcare utilisation.

METHODS

The primary outcome was emergency hospital admissions for cardiorespiratory conditions and injuries for residents aged 60 years and over. Secondary outcomes included each of the separate conditions, for tenants aged 60 and over, and for all ages. Council home address and intervention records for eight housing cointerventions were anonymously linked to demographic data, hospital admissions and deaths for individuals in a dynamic cohort. Counts of health events were analysed using multilevel regression models to investigate associations between receipt of each housing improvement, adjusting for potential confounding factors and regional trends.

RESULTS

Residents aged 60 years and over living in homes when improvements were made were associated with up to 39% fewer admissions compared with those living in homes that were not upgraded (incidence rate ratio=0.61, 95% CI 0.53 to 0.72). Reduced admissions were associated with electrical systems, windows and doors, wall insulation, and garden paths. There were small non-significant reductions for the primary outcome associated with upgrading heating, adequate loft insulation, new kitchens and new bathrooms.

CONCLUSION

Results suggest that hospital admissions can be avoided through improving whole home quality standards. This is the first large-scale longitudinal evaluation of a whole home intervention that has evaluated multiple improvement elements using individual-level objective routine health data.

Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study

Background

Poor-quality housing adversely affects residents’ health but there is a paucity of high-quality evidence to support this.

Objective

This research investigated the health impact of bringing housing to a national quality standard.

Design

A natural experiment of improvements to housing quality analysed using repeated measures of health-care utilisation and economic outcomes at an individual person level.

Setting

Carmarthenshire, UK.

Participants

A total of 32,009 residents registered for a minimum of 60 days at 8558 social homes that received housing improvements between January 2005 and March 2015.

Interventions

Multiple internal and external housing improvements, including wall and loft insulation, windows and doors, heating system upgrades, new kitchens and bathrooms, garden path safety improvements and electrical system upgrades (adding power sockets, and extractor fans in kitchens and bathrooms).

Main outcome measures

Emergency hospital admissions for cardiorespiratory conditions and injuries. Primary health-care utilisation for respiratory and common mental health disorders, emergency department injury attendances and health-care utilisation costs.

Data sources

Carmarthenshire County Council home address and intervention records were anonymously linked within the Secure Anonymous Information Linkage databank to demographic information from the Welsh Demographic Service data set; hospital admission data from the Patient Episode Dataset for Wales; primary care contacts and prescribed medications from general practice data; emergency department attendances from the Emergency Department Data Set; and deaths from the Office for National Statistics mortality register.

Methods

The study used a longitudinal panel design to examine changes in standard of eight housing cointervention from intervention records, and linked to individuals registered at intervention homes. Health outcomes were obtained retrospectively for each individual in a dynamic cohort and were captured for up to 123 consecutive months. An additional local authority region could not be utilised as a comparator owing to different reporting pressures resulting in the recording of a different intervention. The exposure group for each cointervention was compared with an internal reference group of people living in homes that did not receive the cointervention during their tenancy. A multilevel modelling approach was used to account for repeated observations for individuals living in intervention homes. Counts of health outcomes were analysed using negative binomial regression models to determine the effect of each cointervention that reached housing quality standards during an individual’s period of tenancy, compared with those living in properties that did not. We adjusted for potential confounding factors and for background trends in the regional general population. A cost–consequences analysis was conducted as part of the health economic evaluation.

Results

Residents aged ≥ 60 years living in homes in which electrical systems were upgraded were associated with 39% fewer admissions than those living in homes in which they were not [incidence rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.53 to 0.72;p < 0.01]. Reduced admissions were also associated with windows and doors (IRR 0.71, 95% CI 0.63 to 0.81;p < 0.01), wall insulation (IRR 0.75, 95% CI 0.67 to 0.84;p < 0.01) and gardens and estates (IRR 0.73, 95% CI 0.64 to 0.83;p < 0.01) for those living in homes in which these cointervention were upgraded. There were no associations of change in emergency admissions with upgrading heating (IRR 0.91, 95% CI 0.82 to 1.01;p = 0.072), loft insulation (IRR 0.98, 95% CI 0.86 to 1.11;p = 0.695), kitchens (IRR 0.98, 95% CI 0.83 to 1.17;p = 0.843) or bathrooms (IRR 0.93, 95% CI 0.81 to 1.06;p = 0.287).

Limitations

There was no randomisation, there were incomplete data on the scale of the intervention for individual households and there were no estimates for the impact of the whole programme.

Conclusions

This complex interdisciplinary study found that hospital admissions could be avoided through improving housing quality standards.

Future work

At their initiation, future non-health projects should have a built-in evaluation to allow intervention exposures to be randomly allocated to residents, with the simultaneous analysis of multiple health outcomes in one statistical model.

Funding

The National Institute for Health Research Public Health Research programme.

The health impacts of energy performance investments in low-income areas: a mixed-methods approach

Background

Cold homes and fuel poverty contribute to health inequalities in ways that could be addressed through energy efficiency interventions.

Objectives

To determine the health and psychosocial impacts of energy performance investments in low-income areas, particularly hospital admissions for cardiorespiratory conditions, prevalence of respiratory symptoms and mental health status, hydrothermal conditions and household energy use, psychosocial outcomes, cost consequences to the health system and the cost utility of these investments.

Design

A mixed-methods study comprising data linkage (25,908 individuals living in 4968 intervention homes), a field study with a controlled pre-/post-test design (intervention,n = 418; control,n = 418), a controlled multilevel interrupted time series analysis of internal hydrothermal conditions (intervention,n = 48; control,n = 40) and a health economic assessment.

Setting

Low-income areas across Wales.

Participants

Residents who received energy efficiency measures through the intervention programme and matched control groups.

Main outcome measures

Primary outcomes – emergency hospital admissions for cardiorespiratory conditions, self-reported respiratory symptoms, mental health status, indoor air temperature and indoor relative humidity. Secondary outcomes – emergency hospital admissions for chronic obstructive pulmonary disease-related cardiorespiratory conditions, excess winter admissions, health-related quality of life, subjective well-being, self-reported fuel poverty, financial stress and difficulties, food security, social interaction, thermal satisfaction and self-reported housing conditions.

Methods

Anonymously linked individual health records for emergency hospital admissions were analysed using mixed multilevel linear models. A quasi-experimental controlled field study used a multilevel repeated measures approach. Controlled multilevel interrupted time series analyses were conducted to estimate changes in internal hydrothermal conditions following the intervention. The economic evaluation comprised cost–consequence and cost–utility analyses.

Data sources

The Patient Episode Database for Wales 2005–14, intervention records from 28 local authorities and housing associations, and scheme managers who delivered the programme.

Results

The study found no evidence of changes in physical health. However, there were improvements in subjective well-being and a number of psychosocial outcomes. The household monitoring study found that the intervention raised indoor temperature and helped reduce energy use. No evidence was found of substantial increases in indoor humidity levels. The health economic assessment found no explicit cost reductions to the health service as a result of non-significant changes in emergency admissions for cardiorespiratory conditions.

Limitations

This was a non-randomised intervention study with household monitoring and field studies that relied on self-response. Data linkage focused on emergency admissions only.

Conclusion

Although there was no evidence that energy performance investments provide physical health benefits or reduce health service usage, there was evidence that they improve social and economic conditions that are conducive to better health and improved subjective well-being. The intervention has been successful in reducing energy use and improving the living conditions of households in low-income areas. The lack of association of emergency hospital admissions with energy performance investments means that we were unable to evidence cost saving to health-service providers.

Future work

Our research suggests the importance of incorporating evaluations with follow-up into intervention research from the start.

Funding

The National Institute for Health Research Public Health Research programme.

The impact of parenthood on environmental attitudes and behaviour: a longitudinal investigation of the legacy hypothesis

Willingness to engage in sustainable actions may be limited by the psychological distance of climate change. In this study, we test the legacy hypothesis, which holds that having children leads parents to consider the legacy left to offspring in respect of environmental quality. Using the Understanding Society dataset, a longitudinal survey representative of the UK population (n = 18,176), we assess how having children may change people's individual environmental attitudes and behaviour. Results indicate that having a new child is associated with a small decrease in the frequency of a few environmental behaviours. Only parents with already high environmental concern show a small increase in the desire to act more sustainably after the birth of their first child. Overall, the results do not provide evidence in support of the legacy hypothesis in terms of individual-level environmental attitudes and behaviours. We argue that the transition to parenthood is a time where concern is prioritised on the immediate wellbeing of the child and not on the future environmental threats.

Social and health outcomes following upgrades to a national housing standard: a multilevel analysis of a five-wave repeated cross-sectional survey

BACKGROUND

While existing research indicates that housing improvements are associated with health improvements, less is known about the wider social and health benefits of meeting national housing standards, as well as those of their specific constituent measures. This study evaluates the impacts of a managed housing upgrade programme through a repeated cross-sectional survey design.

METHODS

A five-wave repeated cross-sectional survey was conducted over a seven-year period from 2009 to 2016 (n = 2075; n = 2219; n = 2015; n = 1991; and n = 1709, respectively). The study followed a managed upgrade programme designed to meet a national social housing standard over an extended period. The data were analysed from a multilevel perspective to take account of the time-dependent nature of the observations and differences in socio-demographic composition.

RESULTS

The installation of the majority of individual housing measures (new windows and doors; boilers; kitchens; bathrooms; electrics; loft insulation; and cavity/external wall insulation) were associated with improvements in several social (housing suitability, satisfaction, and quality; thermal comfort and household finances) and health (mental, respiratory and general health) outcomes; and analyses showed relationships between the number of measures installed and the total amount invested on the one hand and the social and health outcomes on the other. There were however a few exceptions. Most notably, the installation of cavity wall insulation was associated with poorer health outcomes, and did not lead to better social outcomes. Also, no association was found between the number of measures installed and respiratory health.

CONCLUSIONS

The study suggests that substantial housing investments through a managed upgrade programme may result in better social and health outcomes, and that the size of the improvements are proportionate to the number of measures installed and amount invested. However, there may be risks associated with specific measures; and more attention is needed for mechanical ventilation when upgrading energy efficiency of houses through fabric work. In addition to providing new evidence regarding the wider social and health outcomes, the study provides an analytical approach to evaluate upgrade programmes that are delivered over multiple years.

Cold homes, fuel poverty and energy efficiency improvements: A longitudinal focus group approach

Cold homes and fuel poverty have been identified as factors in health and social inequalities that could be alleviated through energy efficiency interventions. Research on fuel poverty and the health impacts of affordable warmth initiatives have to date primarily been conducted using quantitative and statistical methods, limiting the way how fuel poverty is understood. This study took a longitudinal focus group approach that allowed exploration of lived experiences of fuel poverty before and after an energy efficiency intervention. Focus group discussions were held with residents from three low-income communities before (n = 28) and after (n = 22) they received energy efficiency measures funded through a government-led scheme. The results show that improving the energy efficiency of homes at risk of fuel poverty has a profound impact on wellbeing and quality of life, financial stress, thermal comfort, social interactions and indoor space use. However, the process of receiving the intervention was experienced by some as stressful. There is a need for better community engagement and communication to improve the benefits delivered by fuel poverty programmes, as well as further qualitative exploration to better understand the wider impacts of fuel poverty and policy-led intervention schemes.

Neighborhood Quality and Attachment: Validation of the Revised Residential Environment Assessment Tool

Various studies have shown that neighborhood quality is linked to neighborhood attachment and satisfaction. However, most have relied upon residents' own perceptions rather than independent observations of the neighborhood environment. This study examines the reliability and validity of the revised Residential Environment Assessment Tool (REAT 2.0), an audit instrument covering both public and private spaces of the neighborhood environment. The research shows that REAT 2.0 is a reliable, easy-to-use instrument and that most underlying constructs can be validated against residents' own neighborhood perceptions. The convergent validity of the instrument, which was tested against digital map data, can be improved for a number of miscellaneous urban form items. The research further found that neighborhood attachment was significantly associated with the overall REAT 2.0 score. This association can mainly be attributed to the property-level neighborhood quality and natural elements components. The research demonstrates the importance of private spaces in the outlook of the neighborhood environment.

The short-term health and psychosocial impacts of domestic energy efficiency investments in low-income areas: a controlled before and after study

BACKGROUND

Research suggests that living in fuel poverty and cold homes contributes to poor physical and mental health, and that interventions targeted at those living in poor quality housing may lead to health improvements. However, little is known about the socio-economic intermediaries and processes that contribute to better health. This study examined the relationship between energy efficiency investments to homes in low-income areas and mental and physical health of residents, as well as a number of psychosocial outcomes likely to be part of the complex relationship between energy efficiency measures and health outcomes.

METHODS

A quasi-experimental field study with a controlled pretest-posttest design was conducted (intervention n = 364; control n = 418) to investigate the short-term health and psychosocial impacts of a domestic energy efficiency programme that took place across Wales between 2013 and 2015. Survey data were collected in the winters before and after installation of energy efficiency measures, including external wall insulation. The study used a multilevel modelling repeated measures approach to analyse the data.

RESULTS

The energy efficiency programme was not associated with improvements in physical and mental health (using the SF-12v2 physical and mental health composite scales) or reductions in self-reported respiratory and asthma symptoms. However, the programme was associated with improved subjective wellbeing (B = 0.38, 95% CI 0.12 to 0.65), as well as improvements in a number of psychosocial outcomes, including increased thermal satisfaction (OR = 3.83, 95% CI 2.40 to 5.90), reduced reports of putting up with feeling cold to save heating costs (OR = 0.49, CI = 0.25 to 0.94), fewer financial difficulties (B = -0.15, 95% CI -0.25 to -0.05), and reduced social isolation (OR = 0.32, 95% CI 0.13 to 0.77).

CONCLUSION

The study showed that investing in energy efficiency in low-income communities does not lead to self-reported health improvements in the short term. However, investments increased subjective wellbeing and were linked to a number of psychosocial intermediaries that are conducive to better health. It is likely that better living conditions contribute to improvements in health outcomes in the longer term. Better understanding of the impacts on recipients of energy efficiency schemes, could improve targeting of future fuel poverty policies.

Habit Discontinuity, Self-Activation, and the Diminishing Influence of Context Change: Evidence from the UK Understanding Society Survey

Repeated behaviours in stable contexts can become automatic habits. Habits are resistant to information-based techniques to change behaviour, but are contextually cued, so a change in behaviour context (e.g., location) weakens habit strength and can facilitate greater consideration of the behaviour. This idea was demonstrated in previous work, whereby people with strong environmental attitudes have lower car use, but only after recently moving home. We examine the habit discontinuity hypothesis by analysing the Understanding Society dataset with 18,053 individuals representative of the UK population, measuring time since moving home, travel mode to work, and strength of environmental attitudes. Results support previous findings where car use is significantly lower among those with stronger environmental views (but only after recently moving home), and in addition, demonstrate a trend where this effects decays as the time since moving home increases. We discuss results in light of moving into a new home being a potential 'window of opportunity' to promote pro-environmental behaviours.

Social capital and active membership in the Ghana National Health Insurance Scheme - a mixed method study

BACKGROUND

People's decision to enroll in a health insurance scheme is determined by socio-cultural and socio-economic factors. On request of the National health Insurance Authority (NHIA) in Ghana, our study explores the influence of social relationships on people's perceptions, behavior and decision making to enroll in the National Health Insurance Scheme. This social scheme, initiated in 2003, aims to realize accessible quality healthcare services for the entire population of Ghana. We look at relationships of trust and reciprocity between individuals in the communities (so called horizontal social capital) and between individuals and formal health institutions (called vertical social capital) in order to determine whether these two forms of social capital inhibit or facilitate enrolment of clients in the scheme. Results can support the NHIA in exploiting social capital to reach their objective and strengthen their policy and practice.

METHOD

We conducted 20 individual- and seven key-informant interviews, 22 focus group discussions, two stakeholder meetings and a household survey, using a random sample of 1903 households from the catchment area of 64 primary healthcare facilities. The study took place in Greater Accra Region and Western Regions in Ghana between June 2011 and March 2012.

RESULTS

While social developments and increased heterogeneity seem to reduce community solidarity in Ghana, social networks remain common in Ghana and are valued for their multiple benefits (i.e. reciprocal trust and support, information sharing, motivation, risk sharing). Trusting relations with healthcare and insurance providers are, according healthcare clients, based on providers' clear communication, attitude, devotion, encouragement and reliability of services. Active membership of the NHIS is positive associated with community trust, trust in healthcare providers and trust in the NHIS (p-values are .009, .000 and .000 respectively).

CONCLUSION

Social capital can motivate clients to enroll in health insurance. Fostering social capital through improving information provision to communities and engaging community groups in health care and NHIS services can facilitate peoples' trust in these institutions and their active participation in the scheme.

Values, perceived risks and benefits, and acceptability of nuclear energy

We examined how personal values and perceptions of risks and benefits are associated with the acceptability of nuclear energy (NE). A theoretical model is tested in which beliefs about the risks and benefits of NE mediate the relationship between values and acceptability. The results showed that egoistic values are positively related to the perceived benefits and acceptability of NE. In contrast, altruistic and biospheric values were positively related to the perceived risks of NE. Although it has been argued that NE may help to combat climate change through lower CO(2) emissions, these environmental benefits were not acknowledged by people with strong biospheric values. Furthermore, results confirmed that the more risks respondents perceived, the less they were inclined to accept NE. In contrast, the more a person believed that NE has beneficial consequences, the more acceptable NE was. Finally, as expected, perceived risks and benefits were found to partly mediate the relationship between personal values and acceptability. We discuss the theoretical and practical implications of these findings.

Cohort profile: the housing regeneration and health study

A cohort comprising residents of a housing regeneration and health programme was created from routinely collected data using a system which allows us to anonymously link housing data to individuals and their health. The regeneration programme incorporating four rolling work packages runs from 2009 to 2014. The main intervention cohort we describe here contains the 18 312 residents of 9051 residences at baseline. The cohort will be followed continuously through routine health data (demographics, mortality, hospital admissions and general practitioner records including prescriptions) with periodic updates of housing regeneration intervention data. Here, we describe the baseline data for the primary health outcomes of emergency hospital admissions for cardiovascular and respiratory conditions and injuries for those aged ≥60 years. We will compare the health of residents within the homes before and after the housing regeneration work has taken place, and we will calculate the change in health service costs with use of hospital and General Practitioners (GP) services. We will also use a difference in differences approach to assess changes in comparison with comparator cohorts. These data will be accessible at the end of the study period in 2016. Further information about this study can be obtained from Ronan Lyons; r.a.lyons@swansea.ac.uk.

Exploring early public responses to geoengineering

Proposals for geoengineering the Earth's climate are prime examples of emerging or 'upstream' technologies, because many aspects of their effectiveness, cost and risks are yet to be researched, and in many cases are highly uncertain. This paper contributes to the emerging debate about the social acceptability of geoengineering technologies by presenting preliminary evidence on public responses to geoengineering from two of the very first UK studies of public perceptions and responses. The discussion draws upon two datasets: qualitative data (from an interview study conducted in 42 households in 2009), and quantitative data (from a subsequent nationwide survey (n=1822) of British public opinion). Unsurprisingly, baseline awareness of geoengineering was extremely low in both cases. The data from the survey indicate that, when briefly explained to people, carbon dioxide removal approaches were preferred to solar radiation management, while significant positive correlations were also found between concern about climate change and support for different geoengineering approaches. We discuss some of the wider considerations that are likely to shape public perceptions of geoengineering as it enters the media and public sphere, and conclude that, aside from technical considerations, public perceptions are likely to prove a key element influencing the debate over questions of the acceptability of geoengineering proposals.

The psychological distance of climate change

Avoiding dangerous climate change is one of the most urgent social risk issues we face today and understanding related public perceptions is critical to engaging the public with the major societal transformations required to combat climate change. Analyses of public perceptions have indicated that climate change is perceived as distant on a number of different dimensions. However, to date there has been no in-depth exploration of the psychological distance of climate change. This study uses a nationally representative British sample in order to systematically explore and characterize each of the four theorized dimensions of psychological distance--temporal, social, and geographical distance, and uncertainty--in relation to climate change. We examine how each of these different aspects of psychological distance relate to each other as well as to concerns about climate change and sustainable behavior intentions. Results indicate that climate change is both psychologically distant and proximal in relation to different dimensions. Lower psychological distance was generally associated with higher levels of concern, although perceived impacts on developing countries, as an indicator of social distance, was also significantly related to preparedness to act on climate change. Our findings clearly point to the utility of risk communication techniques designed to reduce psychological distance. However, highlighting the potentially very serious distant impacts of climate change may also be useful in promoting sustainable behavior, even among those already concerned.

Awareness and perceptions of the risks of exposure to indoor radon: a population-based approach to evaluate a radon awareness and testing campaign in England and Wales

The current study aimed to evaluate the locally directed radon roll-out program that was conducted between 2001 and 2005 in England and Wales to increase radon awareness and testing rates. A representative sample of 1,578 residents aged 16 and older were interviewed who lived in radon-affected areas of 15 local authorities in England and Wales that were eligible for participation in the program. The study systematically sampled across participating and nonparticipating local authorities, "actionable" and "nonactionable" radon-affected areas, and geographic regions with different campaign histories (Wales, Southwest England, and the rest of England). As a multistage sampling strategy was used, the data were analyzed from a multilevel perspective. This study found that participants living in participating local authorities had higher levels of awareness and were more likely to have tested their home for radon than participants living in nonparticipating local authorities. Similar results were found for participants living in "actionable" areas as compared to those living in "nonactionable" radon-affected areas. The study further found that radon awareness and testing rates were the highest in Southwest England and the lowest in Wales. This study suggests that the radon roll-out program has been effective in raising awareness and testing rates, and that ongoing domestic radon campaigns in Southwest England may have raised radon awareness and testing in these areas, showing important reinforcement effects of multiple risk communication campaigns.

Health locus of control beliefs and socio-economic differences in self-rated health

BACKGROUND

Social inequalities in health are well documented in the social epidemiology literature. However, less is known about the mechanisms linking individual and area-level socio-economic status to health. In this paper we examine whether health locus of control (HLC) beliefs can help to explain socio-economic differences in self-rated health using the multidimensional HLC scale.

METHODS

Data for this study come from the Caerphilly Health and Social Needs Survey (n=10,892). Multilevel modelling was used to examine the variation in HLC beliefs across different socio-demographic groups and levels of neighbourhood socio-economic status, and to investigate whether HLC beliefs mediate the health effects of individual and neighbourhood socio-economic position.

RESULTS

This study found that the HLC scales were significantly associated with individual and neighbourhood socio-economic status, as well as with self-rated health. HLC beliefs appeared to mediate some of the health effects of individual socio-economic status and to a lesser extent the health effects of neighbourhood socio-economic status.

CONCLUSIONS

Some evidence was found that HLC forms part of the pathway between individual and neighbourhood socio-economic status and health. Future research should further explore the psychological consequences of living in economically deprived conditions, alongside material, social and behavioural processes, and examine how this impacts upon people's health and well-being.

Reframing nuclear power in the UK energy debate: nuclear power, climate change mitigation and radioactive waste

In the past decade, human influence on the climate through increased use of fossil fuels has become widely acknowledged as one of the most pressing issues for the global community. For the United Kingdom, we suggest that these concerns have increasingly become manifest in a new strand of political debate around energy policy, which reframes nuclear power as part of the solution to the need for low-carbon energy options. A mixed-methods analysis of citizen views of climate change and radioactive waste is presented, integrating focus group data and a nationally representative survey. The data allow us to explore how UK citizens might now and in the future interpret and make sense of this new framing of nuclear power--which ultimately centers on a risk-risk trade-off scenario. We use the term "reluctant acceptance" to describe how, in complex ways, many focus group participants discursively re-negotiated their position on nuclear energy when it was positioned alongside climate change. In the concluding section of the paper, we reflect on the societal implications of the emerging discourse of new nuclear build as a means of delivering climate change mitigation and set an agenda for future research regarding the (re)framing of the nuclear energy debate in the UK and beyond.

The perceived health risks of indoor radon gas and overhead powerlines: a comparative multilevel approach

Radon and overhead powerlines are two radiation risk cases that have raised varying levels of concern among the general public and experts. Despite both involving radiation-a typically feared and unseen health hazard-individuals' perceptions of the two risk cases may invoke rather different factors. We examined individual and geographic-contextual factors influencing public perceptions of the health risks of indoor radon gas and overhead powerlines in a comparative research design, utilizing a postal questionnaire with 1,528 members of the general public (response rate 28%) and multilevel modeling techniques. This study found that beliefs about the two risk cases mainly differed according to the level of "exposure"-defined here in terms of spatial proximity. We argue that there are two alternative explanations for this pattern of findings: that risk perception itself varies directly with proximity, or that risk is more salient to concerned people in the exposed areas. We also found that while people living in high radon areas are more concerned about the risks of indoor radon gas, they find these risks more acceptable and have more trust in authorities. These results might reflect the positive effects of successive radon campaigns in high radon areas, which may have raised awareness and concern, and at the same time may have helped to increase trust by showing that the government takes the health risks of indoor radon gas seriously, suggesting that genuine risk communication initiatives may have positive impacts on trust in risk management institutions.

Neighbourhood deprivation and self-rated health: the role of perceptions of the neighbourhood and of housing problems

It has been known for a long time that people living in socially and economically deprived neighbourhoods generally experience poorer health. However, it is often not clear what processes underlie the relationship between neighbourhood deprivation and individual health. In this study we explore the association between neighbourhood socio-economic status and self-rated health using the Caerphilly Health and Social Needs Survey (n=10,892). We found that the association between neighbourhood deprivation and self-rated health was substantially reduced after adjusting for individual socio-economic status, but remained statistically significant. This suggests that the health effects of neighbourhood deprivation are partly contextual. We also found that the association between neighbourhood deprivation and self-rated health was further attenuated when controlling for perceptions of the neighbourhood and of housing problems, suggesting that these variables may play a role in mediating the health effects of neighbourhood deprivation. The implications of the results are that health policy should target 'places' as well as 'people'; and that policies aimed at improving the quality of housing, access to amenities, neighbourhood safety, and social cohesion may help to reduce health inequalities.

Perceptions of the neighbourhood environment and self rated health: a multilevel analysis of the Caerphilly Health and Social Needs Study

BACKGROUND

In this study we examined whether (1) the neighbourhood aspects of access to amenities, neighbourhood quality, neighbourhood disorder, and neighbourhood social cohesion are associated with people's self rated health, (2) these health effects reflect differences in socio-demographic composition and/or neighbourhood deprivation, and (3) the associations with the different aspects of the neighbourhood environment vary between men and women.

METHODS

Data from the cross-sectional Caerphilly Health and Social Needs Survey were analysed using multilevel modelling, with individuals nested within enumeration districts. In this study we used the responses of people under 75 years of age (n = 10,892). The response rate of this subgroup was 62.3%. All individual responses were geo-referenced to the 325 census enumeration districts of Caerphilly county borough.

RESULTS

The neighbourhood attributes of poor access to amenities, poor neighbourhood quality, neighbourhood disorder, lack of social cohesion, and neighbourhood deprivation were associated with the reporting of poor health. These effects were attenuated when controlling for individual and collective socio-economic status. Lack of social cohesion significantly increased the odds of women reporting poor health, but did not increase the odds of men reporting poor health. In contrast, unemployment significantly affected men's health, but not women's health.

CONCLUSION

This study shows that different aspects of the neighbourhood environment are associated with people's self rated health, which may partly reflect the health impacts of neighbourhood socio-economic status. The findings further suggest that the social environment is more important for women's health, but that individual socio-economic status is more important for men's health.

Associations of physical activity with smoking and alcohol consumption: a sport or occupation effect?

BACKGROUND

The aim of this study was to explore the associations of physical activity with smoking and alcohol consumption. It examined whether these associations are due to people participating in organized sports (the sport hypothesis), and/or reflect the concentration of drinking and smoking in manual occupational groups (the occupation hypothesis).

METHODS

Data from the 2003 Health Survey for England (n=11,617) were analyzed from a multilevel perspective. Four models were specified to examine the variation of heavy drinking, smoking, sports activity, and occupational activity across different sociodemographic groups; and four sets of analyses further explored the associations of sports and occupational activity with heavy drinking and smoking.

RESULTS

Some support was found for both the sport and occupation hypothesis. Sports activity and heavy drinking were more prevalent among sportsclub members, and occupational activity and heavy drinking were more prevalent among manual occupational groups. Sportsclub membership accounted for some of the association between sports activity and heavy drinking; and occupational position partly accounted for the association between occupational activity and heavy drinking. The occupation hypothesis is the more likely explanation for the association between physical activity and smoking.

CONCLUSIONS

This study shows that it is worthwhile to distinguish between different types of physical activity; and that multiple processes underlie the clustering of health behaviors.

The prevalence and clustering of four major lifestyle risk factors in an English adult population

BACKGROUND

The aim of this study was to examine the clustering of four major lifestyle risk factors (smoking, heavy drinking, lack of fruit and vegetables consumption, and lack of physical activity), and to examine the variation across different socio-demographic groups in the English adult population.

METHODS

The study population was derived from the 2003 Health Survey for England (n=11,492). Clustering was examined by comparing the observed and expected prevalence of the different possible combinations. A multinomial multilevel regression model was conducted to examine the socio-demographic variation in the clustering of the four risk factors.

RESULTS

The study found that, when using British health recommendations, a majority of the English population have multiple lifestyle risk factors at the same time. Clustering was found at both ends of the lifestyle spectrum and was more pronounced for women than for men. Overall, multiple risk factors were more prevalent among men, lower social class households, singles, and people who are economically inactive, but less prevalent among home owners and older age groups.

CONCLUSIONS

The clustering of multiple risk factors provides support for multiple-behavior interventions as opposed to single-behavior interventions.

Perceptions of the environment, physical activity, and obesity

Obesity rates are rising rapidly across the developed and developing world. Until recently obesity research has mainly focused on biological, psychological and behavioural factors. But there is growing agreement that environmental factors play an important role as well. In this study data from the 2003 Health Survey for England (n = 14,836) were analysed from a multilevel perspective to examine (1) the associations of the perceptions of the local environment with obesity, self-rated health, and physical activity, and (2) whether physical activity mediates the association between the perceptions of the environment, and obesity and self-rated health. This study found that perceptions of the friendliness of the local environment were mainly associated with self-rated health; perceived access to leisure facilities with sports activities; perceived access to a post office with walking; and the presence of social nuisances with obesity and poor self-rated health. In addition, positive perceptions of the social environment (i.e., social support and social capital) were associated with higher levels of physical activity, and lower levels of poor self-rated health and obesity. Only limited support was found for the idea that health behaviours mediate the associations between the perceptions of the environment, obesity, and self-rated health. Controlling for the three physical activity measures only rendered a small number of associations with self-rated health non-significant, and did not affect the associations with obesity. Overall, the results show that certain aspects of the environment may contribute to the risk of obesity and poor health. More research is needed to examine the specific mechanisms that link (the perceptions of) the environment to obesity and health.

Do health behaviors mediate the association between social capital and health?

INTRODUCTION

There is increasing evidence that social capital is important for people's health. However, there is still considerable disagreement about the specific pathways that links social capital to health. This study investigates the hypothesis that the association between social capital and health is mediated by people's health behaviors.

METHOD

Data from the 2002 Health Survey for England (n = 7394) were used and analyzed from a multilevel perspective. The association between social capital and self-rated health were examined before and after controlling for smoking, alcohol intake, and fruit/vegetable consumption.

RESULTS

Social capital was found to be associated with self-rated health, as well as with the different health behaviors. In addition, the health behaviors were significantly related to self-rated health. However, controlling for smoking, alcohol intake, and fruit/vegetable consumption did not substantially affect the association between social capital and self-rated health.

CONCLUSIONS

The results demonstrate that social capital and support are important determinants of self-rated health and health behaviors. But only limited support was found for the hypothesis that health behaviors mediate the association between social capital and health.

Exploring the structure of attitudes toward genetically modified food

Although it is often thought that the British public is opposed to genetically modified (GM) food, recent qualitative work suggests that most people are ambivalent about GM food and crops. In this article we explore the structure of attitudes in order to examine whether attitudinal ambivalence can be captured by more quantitative methods. Based on the finding that the perceived risks and benefits of GM food can be treated as independent dimensions, we propose a four-way typology of attitudes, consisting of a positive, negative, indifferent, and ambivalent group. This study showed that the differences between the four groups could best be described by three main dimensions: (1) a general evaluative dimension, (2) an involvement dimension, and (3) an attitudinal certainty dimension. While these different attitudinal dimensions have generally been studied in isolation, we argue that they should be studied collectively.

Social relations or social capital? Individual and community health effects of bonding social capital

Social capital has become one of the most popular topics in public health research in recent years. However, even after a decade of conceptual and empirical work on this subject, there is still considerable disagreement about whether bonding social capital is a collective resource that benefits communities or societies, or whether its health benefits are associated with people, their personal networks and support. Using data from the 2000 and 2002 Health Survey for England this study found that, in line with earlier research, personal levels of social support contribute to a better self-reported health status. The study also suggests that social capital is additionally important for people's health. In both datasets the aggregate social trust variable was significantly related to self-rated health before and after controlling for differences in socio-demographics and/or individual levels of social support. The results were corroborated in the second dataset with an alternative indicator of social capital. These results show that bonding social capital collectively contributes to people's self-rated health over and above the beneficial effects of personal social networks and support.

Social capital: an individual or collective resource for health?

Although it is now widely acknowledged that the social environment plays an important role in people's health and well-being, there is considerable disagreement about whether social capital is a collective attribute of communities or societies, or whether its beneficial properties are associated with individuals and their social relationships. Using data from the European Social Survey (22 countries, N = 42,358), this study suggests that, rather than having a contextual influence on health, the beneficial properties of social capital can be found at the individual level. Individual levels of social trust and civic participation were strongly associated with self-rated health. At the same time, the aggregate social trust and civic participation variables at the national level were not related to people's subjective health after controlling for compositional differences in socio-demographics. Despite the absence of a main contextual effect, the current study found a more complex cross-level interaction for social capital. Trusting and socially active individuals more often report good or very good health in countries with high levels of social capital than individuals with lower levels of trust and civic participation, but are less likely to do so in countries with low levels of social capital. This suggests that social capital does not uniformly benefit individuals living in the same community or society.

Using surveys in public participation processes for risk decision making: the case of the 2003 British GM Nation? Public debate

This article takes as its case study the "GM Nation?" public debate, a major participation process on the commercialization of agricultural biotechnology, which occurred in Britain during the summer of 2003. We investigate possible self-selection biases in over 36,000 open questionnaire responses on the risks and benefits of genetically modified crops and food obtained during GM Nation? A comparison sample of equivalent responses from a statistically representative sample (n = 1,363) of the British general public obtained shortly after the conclusion of the debate is reported. This comparison shows that the GM Nation? open responses were indeed not fully representative of British "public opinion" regarding agricultural biotechnology. Rather, such opinion is not a unitary whole, but fragmented, with considerable ambivalence coexisting alongside outright opposition to GM agriculture. The methodological implications for multistage participation processes are discussed: in particular, the need to anticipate outcomes of complex design decisions, and to include representative public surveys as standard where measures of broader public attitudes to risk are an important objective.

Trust in risk regulation: cause or consequence of the acceptability of GM food?

Although there is ample empirical evidence that trust in risk regulation is strongly related to the perception and acceptability of risk, it is less clear what the direction of this relationship is. This article explores the nature of the relationship, using three separate data sets on perceptions of genetically modified (GM) food among the British public. The article has two discrete but closely interrelated objectives. First, it compares two models of trust. More specifically, it investigates whether trust is the cause (causal chain account) or the consequence (associationist view) of the acceptability of GM food. Second, this study explores whether the affect heuristic can be applied to a wider number of risk-relevant concepts than just perceived risk and benefit. The results suggest that, rather than a determinant, trust is an expression or indicator of the acceptability of GM food. In addition, and as predicted, "affect" accounts for a large portion of the variance between perceived risk, perceived benefit, trust in risk regulation, and acceptability. Overall, the results support the associationist view that specific risk judgments are driven by more general evaluative judgments The implications of these results for risk communication and policy are discussed.

Trust, the asymmetry principle, and the role of prior beliefs

Within the risk literature there is an ongoing debate on whether trust is vulnerable or enduring. Previous research on nuclear energy by Slovic in 1993 has shown that negative events have much greater impact on self-reported trust than do positive events. Slovic attributes this to the asymmetry principle: specifically, that trust is much easier to destroy than to create. In a questionnaire survey concerning genetically modified (GM) food in Britain (n= 396) we similarly find that negative events have a greater impact on trust than positive events. Because public opinion in Britain is skewed in the direction of opposition toward GM food, the pattern of results could either be caused by the fact that negative information is more informative than positive information (a negativity bias) or reflect the influence of people's prior attitudes toward the issue (a confirmatory bias). The results were largely in line with the confirmatory bias hypothesis: participants with clear positive or negative beliefs interpreted events in line with their existing attitude position. However, for participants with intermediate attitudes, negative items still had greater impact than the positive. This latter finding suggests that, congruent with the negativity bias hypothesis, negative information may still be more informative than positive information for undecided people. The study also identified the labeling of GM products, consulting the public, making biotechnology companies liable for any damage, and making a test available to detect GM produce as being particularly important preconditions for maintaining trust in the regulation of agricultural biotechnology.

Exploring the dimensionality of trust in risk regulation

This article investigates possible differential levels of trust in government regulation across five different risk contexts and the relationship between a number of concepts that might be thought of as comprising distinctive "dimensions" of trust. It appeared that how people perceive government and its policies toward risk regulation was surprisingly similar for each of the five risk cases. A principal-component analysis showed that the various trust items could best be described by two dimensions: a general trust dimension, which was concerned with a wide range of trust-relevant aspects, such as competence, care, fairness, and openness, and a scepticism component that reflects a sceptical view regarding how risk policies are brought about and enacted. Again, the results were surprisingly similar across the five risk cases, as the same solution was found in each of the different samples. It was also examined whether value similarity has an additional value in predicting trust in risk regulation, compared to the more conventional aspects of trust. Based on the two independent trust factors that were found in this study, a typology of trust is proposed that ranges from full trust to a deep type of distrust. It is argued that for a functioning society it could well be more suitable to have critical but involved citizens in many situations.

Temporal factors in resource dilemmas

The conflict between present and future consumption lies at the heart of resource dilemmas (RDs), yet the role of time has received little attention in this research area. Emphasis was on factors related to the social rather than the temporal conflict inherent in an RD. We propose a model that deals explicitly with the temporal distribution of outcomes. The model combines three basic elements: a simple algebraic model, representing the RD's payoff structure; a growth function, reflecting the autonomous growth of the resource pool; and a discount function, describing how the temporal distance of outcomes affects their perceived value. The model provides a comprehensive framework for understanding the role of temporal factors in RD situations. It enables us to identify four relevant temporal RD characteristics (people's discount rates, their time horizon, the inter-trial delay, and the pool's growth rate) and to describe how these would be expected to affect people's tendency to cooperate. Theoretical, methodological and practical implications of the work are briefly discussed.