Using the Health Belief Model to understand intention to vaccinate for Lyme disease in the United States.

AIMS: A growing number of Lyme disease (LD) cases in the U.S. are reported in states neighbouring those with high-incidence (>10 cases per 100,000 population) rates. Considering the evolving epidemiology, high-incidence counties in many of these "neighbouring states," and the forthcoming vaccines, understanding the drivers of vaccination intention is critical, particularly how drivers of intention in neighbouring states vary relative to regions currently classified as high incidence. This study uses the Health Belief Model (HBM) to determine the key drivers associated with vaccine intention for U.S. adults and caregivers of children residing in neighbouring states. METHODS AND RESULTS: Using an established panel with quotas for age, sex, race/ethnicity and urbanity, we surveyed 887 adults and 822 caregivers of children residing in U.S. neighbouring states. Survey items included measures of intention and HBM constructs, all of which were assessed using 5-point Likert scales. We subsequently used structural equation modelling to understand the influence of the HBM constructs on LD vaccine intention. Estimates from structural equation modelling show that the HBM constructs explain much of the variation in intention to vaccinate against LD. Intentions to vaccinate for both adults and caregivers are positively influenced by cues to action, perceived susceptibility of LD, and perceived benefits to vaccination. Both are also negatively influenced by perceived barriers to vaccination. The caregiver's intention to vaccinate is also positively influenced by the perceived severity of LD. CONCLUSION: The intention to vaccinate for respondents residing in LD neighbouring states is strongly influenced by recommendations from healthcare providers or the Centers for Disease Control and Prevention (CDC). As incidence rises in neighbouring states and the need to prevent disease becomes more overt, public health officials should strongly recognize the influence of healthcare providers and CDC recommendations on intention to vaccinate against LD.

Potential consumer response to the healthy symbol proposed by the U.S. food and Drug Administration.

The U.S. Food and Drug Administration (FDA) has proposed updates to the definition of "healthy," including distinctions between types of sugar and fats and limits on added sugar, saturated fat, and sodium. To communicate the updated standards, the FDA is developing a Healthy symbol to display on food packages, which could reduce knowledge gaps by assisting U.S. consumers in meeting recommended nutritional guidelines. This study aimed to explore the potential for the label to increase consumers' ability to correctly identify a food product that met the FDA's criteria for a healthy symbol. To complete the study objective, 1018 adults were recruited to represent the U.S. population regarding gender, age, income, and geographic region, and a randomized group experiment was used to determine the potential communication value of an FDA Healthy symbol. Respondents were randomized to a group shown either a healthy yogurt with the FDA symbol, a healthy yogurt without the symbol, or an unhealthy yogurt. Respondents were then asked whether they considered the yogurt shown to be healthy, a question examining the desired criteria for the Healthy symbol, willingness to accept various costs to implement the symbol, and questions to measure objective dietary knowledge. Adding the symbol to yogurt that already met the healthy criteria only yielded about a 4 percentage point increase in the proportion of respondents identifying it as healthy. However, 53 % of participants still identified a yogurt too high in added sugars as healthy. For the desired label criteria, 64 % of respondents selected limits on added sugars, 57 % selected limits on sodium, and 54 % selected limits on saturated fats, which all align with the proposed updates to the definition of healthy. Over half of the participants supported the implementation of the label, even at a cost of $40 annually, and 86 % supported implementation at no cost.

U.S. public opinion about the safety of gene editing in the agriculture and medical fields and the amount of evidence needed to improve opinions.

Introduction: Implementation of gene editing in agriculture and medicine hinges on public acceptance. The objectives of this study were to explore U.S. public opinion about gene editing in agricultural and medical fields and to provide more insight into the relationship between opinions about the safety of gene editing and the potential impact of evidence to improve opinions about safety. Methods: Data were from two samples of U.S. respondents: 1,442 respondents in 2021 and 3,125 respondents in 2022. Survey respondents provided their opinions about the safety of gene editing in the agricultural and medical fields and answered questions about the number of studies or length of time without a negative outcome to improve opinions about the safety of gene editing in the agricultural and medical fields. Results: Results indicated that respondents in both samples were more familiar, more likely to have an opinion about safety, and more positive about the safety of gene editing in the agricultural field than in the medical field. Also, familiarity was more closely associated with opinions about safety than the strength of opinions. Discussion: These findings add to the literature examining perceptions of gene editing in the agricultural or medical fields separately. Opinions about the safety of gene editing were generally more favorable for respondents who were aware of the use of gene editing. These results support a proactive approach for effective communication strategies to inform the public about the use of gene editing in the agricultural and medical fields.

Intention to vaccinate for Lyme disease using the Health Belief Model.

AIMS: Lyme disease (LD) cases in the United States are estimated to be approaching 500,000 annually. Protective measures, such as repellent use and wearing protective clothing are recommended by public health officials. However, no protective measure has been proven to be consistently effective, partly because they require consistent and persistent behaviour change. While safe and effective vaccines are in development, it is unclear what factors influence the intention to vaccinate against LD. This study uses the Health Belief Model (HBM) framework to determine key drivers associated with vaccine intention. The HBM is widely applied in public health research and uses the following constructs: perceived susceptibility and severity of disease, perceived benefits and barriers to disease prevention, and cues to action for disease prevention to predict health behaviours. To date, the HBM framework has not been applied to vaccination intention for LD. METHODS AND RESULTS: Data were collected from 874 adults and 834 caregivers of children residing in US states endemic to LD. Sampling adults and caregivers allows us to explore how the intention to vaccinate differs among those at-risk. Estimates from structural equation modelling (SEM) show that the HBM constructs explain much of the variation in intention to vaccinate against LD. Both adult and caregiver intentions to vaccinate are positively influenced by cues to action, perceived susceptibility of LD, and perceived benefits to vaccination. However, there is variation in the influence of constructs across the samples. Caregiver's intention to vaccinate is positively influenced by the perceived severity of LD and negatively influenced by safety concerns about the vaccine, whereas adult intention is negatively influenced by perceived barriers to vaccination. CONCLUSION: A strong relationship of cues to action on vaccine intention in samples of adults and caregivers suggests the importance of a recommendation from a healthcare provider or the Centers for Disease Control and Prevention (CDC).

Peer feedback can decrease consumers' willingness to pay for food: Evidence from a field experiment.

The vast majority of consumer products fail to attract sufficient consumer demand. Word of mouth marketing and online feedback from other consumers have become focal marketing strategies for many products as social media has increased the size of networks and amplified the impact of messages from other consumers. The current literature on the influence that consumer feedback can have on consumers' willingness to pay (WTP) for food products is mixed and often draws upon studies with small samples and hypothetical situations. This study investigates how this feedback can impact other consumers' food preferences using an economic field experiment involving 1,068 adult consumers who make choices on oysters, mushrooms, and chocolate. Results suggest that knowledge of peer preferences, such as the willingness to pay for similar products and/or how often they consume these products, caused a decrease (5%-9%) in consumers' willingness to pay.

Private costs of carbon emissions abatement by limiting beef consumption and vehicle use in the United States.

A popular strategy for mitigating climate change is to persuade or incentivize individuals to limit behaviors associated with high greenhouse gas emissions. In this study, adults in the mid-Atlantic United States bid in an auction to receive compensation for eliminating beef consumption or limiting vehicle use. The auction incentivized participants to reveal their true costs of accepting these limits for periods ranging from one week to one year. Compliance with the conditions of the auction was confirmed via a random field audit of the behavioral changes. The estimated median abatement costs were greater than $600 per tCO2e for beef consumption and $1,300 per tCO2e for vehicle use, values much higher than the price of carbon offsets and most estimates of the social cost of carbon. Although these values may decline over time with experience or broader social adoption, they imply that policies that encourage innovations to reduce the costs of behavior change, such as meat alternatives or emission-free vehicles, may be a more fruitful than those that limit beef consumption or vehicle use.

Paying Americans to take the vaccine-would it help or backfire?

This research investigates the extent to which financial incentives (conditional cash transfers) would induce Americans to opt for vaccination against coronavirus disease of 2019. We performed a randomized survey experiment with a representative sample of 1000 American adults in December 2020. Respondents were asked whether they would opt for vaccination under one of three incentive conditions ($1000, $1500, or $2000 financial incentive) or a no-incentive condition. We find that-without coupled financial incentives-only 58 per cent of survey respondents would elect for vaccination. A coupled financial incentive yields an 8-percentage-point increase in vaccine uptake relative to this baseline. The size of the cash transfer does not dramatically affect uptake rates. However, incentive responses differ dramatically by demographic group. Republicans were less responsive to financial incentives than the general population. For Black and Latino Americans especially, very large financial incentives may be counter-productive.

Gene editing isn't just about food: comments from U.S. focus groups.

In the United States, adult public perception of genetic modification has been well documented in the domain of agriculture and food; however, recent international news on gene editing in medical applications may present new challenges for science communicators who seek to proactively share benefits of emerging gene editing technology. While research traditionally considers perceptions of agricultural and medical applications separately, gene editing may bridge the gap between the two domains. We find that when asked about thoughts regarding gene editing, adult focus groups discussed medical applications more frequently and extensively than agricultural applications. Although, when examining the length of discussion about specific topics, designer babies, cures for disease, and food were discussed at similar lengths. Understanding audiences' current perceptions of the technology is the first step in shaping strategic communication efforts to inform public opinion. A proper understanding of the benefits and risks of new technology is central to its application.

Consumers' decisions to access or avoid added sugars information on the updated Nutrition Facts label.

The Nutrition Facts (NF) label was recently updated and now includes the added sugars content in an effort to reduce added sugars consumption. This study investigated whether consumers wanted to access or avoid the added sugars content using an online experiment and five product categories (yogurt, cereal, fruit juice, snack bar, ice cream). We recruited a sample of 490 U.S. adults (49% female; 73% White/Caucasian). Respondents were randomly assigned to an information treatment (simple or full) before making decisions on whether to access or avoid the added sugars content. The simple information treatment explained that added sugars information was now available on the NF label, while the full information treatment included additional details (e.g., how to interpret the added sugars content and associated diseases). After making the access or avoid decisions for each product category, respondents rated their likelihood of purchase for ten products (two per category). Rates of information avoidance were much lower than what has been observed in previous studies, and rates of avoidance did not vary by information treatment. The majority of respondents (75-87% across the five product categories) preferred to access the added sugars content. Still, we found some consumers preferred to avoid this information, with higher rates of avoidance for the ice cream product category. Additionally, we found significant differences in likelihood of purchase ratings between information accessors and avoiders. Respondents who chose to access the added sugars information exhibited healthier purchasing behaviors for all product categories; they were more likely to purchase low added sugars products and less likely to purchase high added sugars products relative to information avoiders. Given consumers' demonstrated interest in accessing the added sugars content, it is important that the new changes to the NF label be broadly communicated to promote healthy eating behaviors.

Homegrown perceptions about the medical use and potential abuse of CBD and THC.

Despite heightened consumer interest in cannabinoids such as cannabidiol (CBD) and tetrahydrocannabinol (THC), little is known about public perceptions regarding their medical use and potential for abuse, particularly relative to commonly used medications. Using data from 1,050 U.S. adult respondents from a national survey conducted in 2019, this study found that more than half of respondents perceived CBD, THC, hemp, and marijuana as having medical use. They also perceived the potential for abuse of CBD, THC, hemp, and marijuana as significantly less than potential for abuse of commonly prescribed anti-anxiety and pain medications. At the nexus of medical use and potential abuse, public perceptions classified CBD and hemp as similar to over-the-counter pain relief medications such as Advil and Tylenol and did not classify marijuana as a Schedule I substance. Slightly more than 20% of respondents reported having consumed CBD and/or THC. CBD was consumed more than THC to reduce pain while THC was consumed more than CBD for recreation. There were no differences in the types of medications they were replacing with CBD and THC.

Beverage milk consumption patterns in the United States: Who is substituting from dairy to plant-based beverages?

This research used a survey of 995 US households to explore how dairy milk and plant-based beverage substitutes were consumed. Long-term trends of declining beverage milk consumption have been exacerbated in recent years by increasing consumption of plant-based beverages. Although beverage milk consumption has been declining, total dairy consumption in the United States continues to increase, driven by growth in sales of cheese, butter, and yogurt. Using k-means cluster analysis, 3 consumption clusters for US households were identified. The largest cluster, consisting of 61.6% of households, consumed dairy milk with some regularity and consumed little or no plant-based beverages. A second cluster, flexitarian households, consisting of 15.6% of respondent households, frequently consumed both dairy milk and plant-based beverages. The third cluster, plant-based consumers, consisting of 22.8% of households, consumed almost exclusively plant-based beverages. Examining differences in demographics between clusters, flexitarian households were larger, more likely to include young children, more likely to include a vegetarian or vegan, and more liberal than traditional dairy-consuming households. Plant-based households had many similarities to flexitarian households. The flexitarian and plant-based clusters were willing to substitute plant-based beverages for dairy milk for almost all consumption uses.

Environmental and Regulatory Concerns During the COVID-19 Pandemic: Results from the Pandemic Food and Stigma Survey.

In this article, we present data from the monthly Pandemic Food and Stigma Survey (PFSS), a nationwide representative sample of adults in the United States designed to identify how the pandemic is affecting concerns about food and the environment. Two surveys were conducted in May and June 2020. Our analysis suggests that the public's concern about contracting COVID-19 has been high; however, infection with COVID-19 was not the only concern. A majority of respondents remained strongly concerned about environmental issues, such as climate change, while responses to sudden relaxations of environmental and food safety policies varied. We analyze the PFSS data to identify factors associated with concerns about pandemic and environmental regulatory changes. In general, we find that people whose food security has been threatened by COVID-19 remain concerned about relaxation of environmental regulations, and those most inclined to take steps to reduce spread of the virus, such as wearing masks and social distancing, are more concerned about relaxed regulations than those less willing to take mitigating actions.

Can the updated nutrition facts label decrease sugar-sweetened beverage consumption?

Sugar-sweetened beverages are the primary source of added sugar consumption in the U.S, and the Food and Drug Administration recently updated the Nutrition Facts Label to communicate the amount of added sugars in manufactured food. The changes to the Nutrition Facts Label (NFL) is concurrent with some cities implementing policies that place an excise tax on sugar-sweetened beverages. While sugar-sweetened beverages taxes may be effective at changing quantity demanded, the updated NFL has the potential to shift the demand curve by decreasing friction and mental gaps associated with the communication of nutrition information. We conducted a randomized control trial using eye tracking technology to determine if the updated NFL garnered more visual attention or affected beverage choice. Participants were also exposed to an information intervention to determine if the updated NFL affected choice after receiving information about added sugars. We found that consumers were more visually attentive to nutrition information displayed by the updated NFL; however, viewing the updated label did not affect choice of beverages nor did it improve the effectiveness of the dietary information on subsequent choices.

Consumer preferences for beef with improved nutrient profile1.

Although beef is a nutrient-rich foodstuff excelling in protein, vitamins, and minerals, there is controversy regarding the fat content of beef and its healthfulness in the diet. Although much of the fatty acid (FA) content in beef is considered "healthy fats," many consumers are confused about the different classifications of FA. The objectives of this study were to determine consumers' knowledge about the nutritional value of beef and its importance in purchasing decisions, and to gain a better understanding about preferences for changes in FA composition. Objectives of the study were completed through 2 consumer studies: 1) an online survey and 2) a taste-panel auction. In the online survey, respondents were asked to choose between 2 steaks that varied in polyunsaturated and saturated FA levels, iron content, and price. Respondents were also asked to categorize "Monounsaturated Fat," "Polyunsaturated Fat," "Saturated Fat," and "Trans Fat," as either "healthy" or "unhealthy" both before and after an educational excerpt was provided. The results from the online survey indicated many consumers are unclear about the differences in beef nutritional value, specifically FA content. Initially, only 66.4%, 69.1%, 79.1%, and 79.2% of respondents correctly categorized the monounsaturated, polyunsaturated, saturated, and trans fat, respectively. However, more than 90% of respondents correctly categorized the various FAs after an educational excerpt was provided. After survey respondents better understood the healthfulness of FA in beef, they were also willing to pay a premium for a steak with improved FA composition. However, these premiums diminished when participants had to actually put forth a monetary value for a steak in the taste-panel auction. Research shows that there is variation among cattle for FA composition. This provides opportunity to identify cattle with a favorable composition and market this product to the increasing population of health-conscious consumers. Our results provide insight for beef promotion and marketing opportunities and indicate that relaying information about FA content is extremely important to collect a premium for healthier beef.

A review of nutrition labeling and food choice in the United States.

A proliferation of processed food and labeling claims motivated the Nutrition Labeling and Education Act of 1990, which mandated the Nutrition Facts Label. Providing nutrition information is often put forth as a way to change food choice; however, despite efforts to provide dietary information using nutrition labeling, more than a third of the US has obesity and portions of the population continue to under consume vital nutrients. There has been progress beyond the Nutrition Facts Label in recent years with front-of-package labeling and menu labeling, which is crucial given changes in consumption trends for food-away-from-home. Additionally, changes were recently made to the Nutrition Facts Label due to lack of awareness, understanding, and ability to effectively improve diet quality. This paper explores the literature to track the evolution of knowledge about attention to nutrition information and how nutrition information affects dietary choices.

Perceptions of Genetically Engineered Technology in Developed Areas.

Consumer doubts and concerns about genetically engineered (GE) foods have been identified through surveys and calls for labeling. Comparing American, Canadian, and European consumer perceptions about GE technology provides insights to stakeholders interested in possible hurdles associated with technology adoption, which is especially important given the emerging growth of genome editing.

Impact of food choice on sodium intake patterns from multiple NHANES surveys.

To examine how the food consumption from various food groups would impact American adults' sodium intake and whether this impact structurally changes over time, data were obtained from six-cycle National Health and Nutrition Examination Survey (NHANES) 1999-2010. Foods were categorized by the first two digits of the USDA food code. Regression models were employed to investigate the associations between the consumption of each food group and sodium intake, and whether there were changes in the associations in consecutive six cycles. Results show that the calorie consumption of oils, beverages and water, fruit juices, fruits, lamb, fruit products, and sugars and sweets had no significant impact on individuals' sodium intake, while calorie consumption of tomatoes, fish, dark-green vegetables, and crackers contributes the most to sodium intake. The contribution to sodium intake of most food groups does not change significantly over time, with the exception of salad dressing whose contribution to sodium intake increased in four consecutive years when compared to that of 1999-2000. The sodium amount contributed by one calorie consumption (sodium density) of most food was above the daily recommendation level, 1.2 mg per calorie per day. Lowering individuals' sodium intake involves either guiding individuals to consume more fruit related products or decreasing the amount of sodium in most food groups at the production or food preparation stages.

The Unknowns and Possible Implications of Mandatory Labeling.

The National Bioengineered Food Disclosure Standard requires a mandatory label for genetically modified (GM) food. Currently, some aspects of the bill are unknown, including what constitutes a food to be considered GM. The costs associated with this legislation will depend on how actors in the food value chain respond.

Examining the Gap between Science and Public Opinion about Genetically Modified Food and Global Warming.

There is great uncertainty due to challenges of escalating population growth and climate change. Public perception that diverges from the scientific community may decrease the effectiveness of scientific inquiry and innovation as tools to solve these challenges. The objective of this study was to identify the factors associated with the divergence of public opinion from scientific consensus regarding the safety of genetically modified (GM) foods and human involvement in global warming (GW). Results indicate that the effects of knowledge on public opinion are complex and non-uniform across types of knowledge (i.e., perceived and actual) or issues. Political affiliation affects agreement with science; Democrats were more likely to agree that GM food is safe and human actions cause GW. Respondents who had relatively higher cognitive function or held illusionary correlations about GM food or GW were more likely to have an opinion that differed from the scientific community.

What consumers don't know about genetically modified food, and how that affects beliefs.

In the debates surrounding biotechnology and genetically modified (GM) food, data from consumer polls are often presented as evidence for precaution and labeling. But how much do consumers actually know about the issue? New data collected from a nationwide U.S. survey reveal low levels of knowledge and numerous misperceptions about GM food. Nearly equal numbers of consumers prefer mandatory labeling of foods containing DNA as do those preferring mandatory labeling of GM foods. When given the option, the majority of consumers prefer that decisions about GM food be taken out of their hands and be made by experts. After answering a list of questions testing objective knowledge of GM food, subjective, self-reported knowledge declines somewhat, and beliefs about GM food safety increase slightly. Results suggest that consumers think they know more than they actually do about GM food, and queries about GM facts cause respondents to reassess how much they know. The findings question the usefulness of results from opinion polls as a motivation for creating public policy surrounding GM food.-McFadden, B. R., Lusk, J. L. What consumers don't know about genetically modified food, and how that affects beliefs.