Tailoring Can Improve Consumers' Hygienic Food-Handling Behavior to Reduce the Transmission Risk of Antimicrobial-Resistant Bacteria through Food.

Antimicrobial-resistant (AMR) bacteria spread via food to humans and can seriously impair infection treatment. Hygienic food handling is an effective measure to avoid the transmission of bacteria. Therefore, we tested three types of interventions (tailored, generic, and no intervention) for their effectiveness in improving consumers' hygienic food handling against the spread of antimicrobial-resistant bacteria through foods in a longitudinal randomized control trial. We based the determinants of hygienic food-handling behavior on the Health Action Process Approach (HAPA). The tailored intervention raised self-reported hygienic food handling, self-efficacy, and perceived likelihood of risk compared to no intervention. Moreover, interventions yielded different effects for participants with high vs. low intentions to improve their food-handling behavior. However, there were no differences between the tailored and generic interventions. More research is needed to find out whether including other behavior change techniques in the tailored intervention may increase the effect of tailoring.

Knowledge, Social Influences, Perceived Risks and Benefits, and Cultural Values Explain the Public's Decisions Related to Prudent Antibiotic Use.

People should use antibiotics (AB) prudently to mitigate antibiotic resistance (ABR). Previous studies-and, subsequently, interventions-on ABR have focused mainly on improving public awareness and knowledge. We investigated a comprehensive theory-based explanatory model to understand the public's decision making regarding prudent AB use, based on, among others, the theory of planned behavior. In a cross-sectional online survey, the psychological determinants of people's decisions about prudent AB use were examined in a sample of 1,228 Swiss adults. The questionnaire assessed respondents' demand for AB, willingness to adopt measures that prevent the need for AB, perceived risks of ABR, perceived benefits of AB, attitudes and social influences regarding AB, knowledge of AB and ABR, and cultural values. Mokken scale analysis revealed three types of knowledge: knowledge of the functioning of AB, of ABR, and of preventive measures. Structural equation modeling indicated that respondents' demand for AB was mostly predicted by social influences, perceived benefits of AB, and knowledge of AB functioning. Willingness to prevent AB use was mainly related to conservative values, perceived risks of ABR, negative attitudes toward AB, and knowledge of preventive measures. Our study suggests that the provision of information about AB and preventive measures is a first step toward changing people's decisions related to prudent AB use. Future interventions that additionally utilize cultural values to convey important messages and target additional factors, such as social influences, the risks of ABR, and the benefits of cautious AB use, can be more successful in promoting prudent AB use.

Antimicrobial-resistant bacteria in food: which behaviour change strategies increase consumers' risk awareness and preventive food-handling behaviour?

OBJECTIVES: We aimed to identify the potential of behaviour change strategies to effectively increase consumers' risk awareness, behavioural intention, and preventive food-handling behaviour to reduce the transmission risk of antimicrobial-resistant bacteria through food. The applied strategies targeted knowledge and determinants of the health action process approach (HAPA). We tested techniques that are expected to increase knowledge, risk perception, and positive outcome expectancy (Study 1) as well as those that increase planning and coping self-efficacy (Study 2) in two randomised control trials. METHODS: In Study 1 (N = 328), a 2 × 2 between-subject design was employed to investigate the effects of an educational video about the spread of antimicrobial-resistant bacteria and a personalised risk message on knowledge, risk perception, outcome expectancy and consequently on intention regarding safe food-handling behaviour. In Study 2 (N = 129), we used a 2 × 2 design to examine to what extent goal setting (implemented vs. not implemented) and time (pre- vs. post-test) affected planning, coping self-efficacy, and preventive food-handling behaviour. RESULTS: In Study 1, we found that the video increased knowledge and the perceived susceptibility of risk compared to the control video. We found no increase on the dependent variables after receiving the personalised risk message. In Study 2, goal setting significantly improved safe food-handling behaviour compared to the control condition. Moreover, participants in the goal-setting condition showed more planning of safe food-handling measures and of dealing with emerging barriers than participants in the control condition. CONCLUSIONS: These findings demonstrate that the delivery of an educational video on the spread of antimicrobial-resistant bacteria is a useful strategy to increase risk awareness, whereas goal setting presents a promising approach to improve food-handling behaviour. Following the HAPA, an additional effective behaviour change technique is required that decreases negative outcome expectancies and improves coping self-efficacy, thereby further improving intention and behaviour.

Swiss Dairy Farmers' Perceptions Surrounding the Disposal of Waste Milk Containing Antibiotic Residues and Antibiotic Resistance.

The feeding of waste milk containing antibiotic residues (WMA) to calves has been associated with the shedding of antibiotic-resistant bacteria by calves. However, little is known regarding farmers' intrinsic factors affecting this practice, and on which it would be relevant to intervene in order to change this practice. The objectives of this study were (1) to describe the farmers' intrinsic factors, such as perceived benefits, risks, and social norms related to the feeding of WMA to calves, antibiotic resistance, and antibiotic use, and (2) to evaluate how the feeding of WMA to calves is related to farmers' personal values and perceptions related to WMA feeding and antibiotic resistance. Answers to an online survey were collected from 233 Swiss dairy producers (38.3% response rate). The proportion of respondents who fed WMA to calves was 48.3%. In a hierarchical logistic regression model, only perception factors extracted by factor analysis were associated with the feeding of WMA to calves, namely (in decreasing order of magnitude): farm-level benefits of WMA feeding, the interaction of farm-level benefits with support from governmental authorities, and causes and threats of antibiotic resistance. The results suggest that, in order to reduce the feeding of WMA to calves, communications to dairy producers should focus on changing the perceived benefits of this practice in comparison to those of alternative WMA disposal methods carrying a lower risk of antibiotic resistance. The involvement of veterinarians and governmental authorities in these communications and in supporting producers may increase the successful adoption of alternative WMA disposal methods.

Exposure Pathways to Antimicrobial Resistance at the Human-Animal Interface-A Qualitative Comparison of Swiss Expert and Consumer Opinions.

Antimicrobial resistance (AMR) is an emerging global health concern, affecting both the animal and the human population. Transmission pathways of AMR are therefore abundant and complex, and ways to prevent or reduce transmission to consumers must be identified. The overall goal of this study was to define the content of an intervention study aimed at reducing the transmission of AMR from animal sources to humans. To identify the most relevant pathways, Swiss experts and consumers were interviewed about their opinions on the risks of transmission of AMR. Opinions of experts and consumers were then qualitatively compared and the main gaps identified. The results revealed that Swiss consumers had several misconceptions regarding the sources and transmission of AMR, and that they in particular underestimated the importance of poultry meat and pets as a potential source of AMR. Furthermore, high uncertainty was noted in experts regarding the prevalence of AMR in pets and the potential of transmission to their owners. Consequently, awareness of AMR transmission pathways should be increased among consumers to overcome common misconceptions, which will help reduce the risk of transmission. Further research is needed to better understand the pets' potential to harbor and transmit AMR to their owners, and to identify most effective methods to increase risk awareness in consumers as well as intervention strategies promoting consumer behaviors to mitigate AMR transmissions at the human-animal interface.

Smaller servings vs. information provision: Results of two interventions to reduce plate waste in two university canteens.

Two interventions were systematically evaluated in two university canteens on their effectiveness to reduce visitors' plate waste. The evaluation was theory-based and focused not only at the effects on the amount of plate waste, but also at the psychological predictors underlying plate waste behaviour. In Intervention A, visitors received information about food waste over a period of three weeks. In Intervention B, in addition to information, smaller servings were offered. The actual amount of plate waste and visitors' attitudes, personal norms, beliefs, perceived behavioural control, intentions and plate waste reduction behaviour were measured before and after the interventions. Intervention B reduced the amount of plate waste by 20%, whereas no reduction was found after Intervention A. In both interventions, the provided information resulted in more positive beliefs and stronger personal norms regarding avoiding plate waste. The information also caused attitudes to have a stronger influence on plate waste reduction behaviour, whereas intention to reduce became less important for reducing plate waste. Personal norms regarding food waste were the strongest predictor of plate waste reduction behaviour, before and after the interventions. The provided information was thus insufficient to reduce plate waste, simply offering smaller servings could achieve this. Although our intervention study only included two university canteens and was conducted for a short period, our data seem to imply that a combination of both information and smaller servings reduces plate waste in the food service industry.

Public Perception of Uncertainties Within Climate Change Science.

Climate change is a complex, multifaceted problem involving various interacting systems and actors. Therefore, the intensities, locations, and timeframes of the consequences of climate change are hard to predict and cause uncertainties. Relatively little is known about how the public perceives this scientific uncertainty and how this relates to their concern about climate change. In this article, an online survey among 306 Swiss people is reported that investigated whether people differentiate between different types of uncertainty in climate change research. Also examined was the way in which the perception of uncertainty is related to people's concern about climate change, their trust in science, their knowledge about climate change, and their political attitude. The results of a principal component analysis showed that respondents differentiated between perceived ambiguity in climate research, measurement uncertainty, and uncertainty about the future impact of climate change. Using structural equation modeling, it was found that only perceived ambiguity was directly related to concern about climate change, whereas measurement uncertainty and future uncertainty were not. Trust in climate science was strongly associated with each type of uncertainty perception and was indirectly associated with concern about climate change. Also, more knowledge about climate change was related to less strong perceptions of each type of climate science uncertainty. Hence, it is suggested that to increase public concern about climate change, it may be especially important to consider the perceived ambiguity about climate research. Efforts that foster trust in climate science also appear highly worthwhile.

Does environmental friendliness equal healthiness? Swiss consumers' perception of protein products.

Food production and consumption have major impacts on the environment. At the same time, changes in human diets worldwide are increasingly leading to health problems. Both issues are highly influenced by consumers' everyday food choices and could be addressed by reducing consumption of meat and other animal products. To promote sustainable food consumption, we need to know how consumers perceive the environmental friendliness and healthiness of food products, on which criteria they base their evaluations of environmental friendliness and healthiness, and how their estimations relate to life cycle assessments and nutrient profiling. We presented 30 protein products, which varied in provenance, production methods, and processing, to 85 participants from Switzerland. They were asked to sort the products once according to their perceived environmental friendliness and once according to their perceived healthiness. The mean distances between the products were compared to the products' life cycle assessments and nutrient profiles. The results showed that perceived environmental friendliness and healthiness are highly correlated. The main predictors of the products' perceived environmental friendliness were product category, presence of an organic label, and provenance; and for perceived healthiness, these predictors were product category, fat content, processing, and presence of an organic label. Environmental friendliness and healthiness estimations were significantly correlated to the life cycle assessments and the nutrient profiles of the products, respectively. Hence, to promote healthy and environmentally friendly food choices, motivators related to environmental friendliness and healthiness could be used in synergy. Awareness about meat's environmental impact should be increased and better information is needed for consumers to make an accurate environmental impact and healthiness assessments of protein products.

Does better for the environment mean less tasty? Offering more climate-friendly meals is good for the environment and customer satisfaction.

Food consumption comprises a significant portion of the total environmental impact of households. One way to reduce this impact may be to offer consumers more climate-friendly meal choices, such as when eating out. However, the environmental benefits of such an intervention will depend on not only consumers' liking of the climate-friendlier meals, but also on the perceived environmental impact. We therefore investigated the relationship between the global warming potential (GWP) of and consumers' liking of meals in two field studies in the same restaurant. Visitors to the restaurant were asked to rate the taste of the meal they had just consumed. These taste ratings were then related to the meals' GWP and number of purchases. In the second study, an intervention was tested consisting of a climate-friendly choice label and information posters. Contrary to expectations, it was found in both studies that the GWP of the meals was unrelated to the taste or the number of purchases. Offering more climate-friendly meals did not change consumer satisfaction. As expected, the introduction of the climate-friendly choice label increased the number of climate-friendly meal purchases. Therefore, offering more climate-friendly meals with a climate-friendly choice label can affect consumers' meal choices, but not their preferences or satisfaction, which is beneficial for the climate, consumers and gastronomic establishments.

Public Perception of Climate Change: The Importance of Knowledge and Cultural Worldviews.

The importance of knowledge for lay people's climate change concerns has been questioned in recent years, as it had been suggested that cultural values are stronger predictors of concern about climate change than knowledge. Studies that simultaneously measured knowledge related to climate change and cultural values have, however, been missing. We conducted a mail survey in the German-speaking part of Switzerland (N = 1,065). Results suggested that cultural worldviews and climate-related knowledge were significantly related with people's concern about climate change. Also, cultural worldviews and climate-relevant knowledge appeared important for people's willingness to change behaviors and to accept climate change policies. In addition, different types of knowledge were found to have different impacts on people's concern about climate change, their willingness to change behaviors, and their acceptance of policies about climate change. Specifically, causal knowledge significantly increased concern about climate change and willingness to support climate-friendly policies. We therefore concluded that risk communication should focus on causal knowledge, provided this knowledge does not threaten cultural values.

How a nuclear power plant accident influences acceptance of nuclear power: results of a longitudinal study before and after the Fukushima disaster.

Major nuclear accidents, such as the recent accident in Fukushima, Japan, have been shown to decrease the public's acceptance of nuclear power. However, little is known about how a serious accident affects people's acceptance of nuclear power and the determinants of acceptance. We conducted a longitudinal study (N= 790) in Switzerland: one survey was done five months before and one directly after the accident in Fukushima. We assessed acceptance, perceived risks, perceived benefits, and trust related to nuclear power stations. In our model, we assumed that both benefit and risk perceptions determine acceptance of nuclear power. We further hypothesized that trust influences benefit and risk perceptions and that trust before a disaster relates to trust after a disaster. Results showed that the acceptance and perceptions of nuclear power as well as its trust were more negative after the accident. In our model, perceived benefits and risks determined the acceptance of nuclear power stations both before and after Fukushima. Trust had strong effects on perceived benefits and risks, at both times. People's trust before Fukushima strongly influenced their trust after the accident. In addition, perceived benefits before Fukushima correlated with perceived benefits after the accident. Thus, the nuclear accident did not seem to have changed the relations between the determinants of acceptance. Even after a severe accident, the public may still consider the benefits as relevant, and trust remains important for determining their risk and benefit perceptions. A discussion of the benefits of nuclear power seems most likely to affect the public's acceptance of nuclear power, even after a nuclear accident.

Effectiveness and efficiency of different shapes of food guides.

OBJECTIVE: To compare the influence of a food guide's shape on its effectiveness and efficiency to convey nutritional information. METHODS: A between-subjects experiment was conducted by manipulating the graph's shape (circle, pyramid, or rainbow). Nutrition tasks were used to assess the effectiveness and eye-movement data (number/duration of fixations) to examine the efficiency of the formats. The data were quantitatively analyzed (chi-square, ANOVA). RESULTS: There were no overall differences between the formats regarding effectiveness and efficiency. However, there were differences between the formats in effectiveness regarding 3 of the 5 nutrition tasks (χ(2)s ≥ 7.044, Ps < .05). Furthermore, viewers' attention was drawn to different parts of the graph, depending on the format. CONCLUSIONS AND IMPLICATIONS: The results suggest that choosing different formats for practical nutrition communication does not play a major role in effectiveness or efficiency of this communication. However, different parts of the graph are more salient in various food guide formats.

The role of health-related, motivational and sociodemographic aspects in predicting food label use: a comprehensive study.

OBJECTIVE: Previous studies focused on a limited number of determinants of food label use. We therefore tested a comprehensive model of food label use consisting of sociodemographic, health-related and motivating variables. These three predictor groups were chosen based on the previous literature and completed with new predictors not yet examined in a comprehensive study of frequency of label use. DESIGN: We sent questionnaires to a random sample of households in the German-speaking part of Switzerland. SETTING: The respondents filled in the questionnaire at home and returned it by mail. SUBJECTS: We analysed the data of 1162 filled-in questionnaires (response rate = 38 %). Of the respondents, 637 were women (55 %), and their mean age was 53·54 (sd 15·68) years. RESULTS: Health-related variables were the most important group of predictors of label use, followed by motivating factors and sociodemographic variables. Placing importance on health, healthy eating and nutritional value of food, perceived vulnerability for diet-related diseases, nutrition knowledge, numeracy and gender were positively associated with frequency of food label use whereas shopping habits and seeing eating as something positive were negative predictors of frequency of label use. CONCLUSIONS: People's health consciousness should be raised in order to increase the frequency of food label use. Furthermore, it should be stressed that reading labels and keeping a healthy diet do not contradict 'good eating', and that both of these aspects can be combined with the help of food labels.

Eating green. Consumers' willingness to adopt ecological food consumption behaviors.

Food consumption is associated with various environmental impacts, and consumers' food choices therefore represent important environmental decisions. In a large-scale survey, we examined consumers' beliefs about ecological food consumption and their willingness to adopt such behaviors. Additionally, we investigated in more detail how different motives and food-related attitudes influenced consumers' willingness to reduce meat consumption and to buy seasonal fruits and vegetables. We found consumers believed avoiding excessive packaging had the strongest impact on the environment, whereas they rated purchasing organic food and reducing meat consumption as least environmentally beneficial. Similarly, respondents appeared to be most unwilling to reduce meat consumption and purchase organic food. Taste and environmental motives influenced consumers' willingness to eat seasonal fruits and vegetables, whereas preparedness to reduce meat consumption was influenced by health and ethical motives. Women and respondents who preferred natural foods were more willing to adopt ecological food consumption patterns.

When reduced fat increases preference. How fat reduction in nutrition tables and numeracy skills affect food choices.

Zero-fat products may be good alternatives to regular-fat products for consumers who are watching their health. In a choice experiment, we investigated whether consumers were willing to consume zero-fat products on the basis of nutrition tables and whether numeracy skills affected this decision. We presented respondents with the same two products in three choice tasks, reducing the fat content at each choice. Product A always contained less fat than Product B. The participants could choose one of the two products or none. Most respondents favoured the lower-fat products over the higher-fat products. However, after a fat reduction to almost zero, significantly more respondents chose the fattier alternative than in the first choice. A fat reduction to zero further reduced the relative preference for the lower-fat product in favour of the fattier alternative. Many consumers thus seem unwilling to consume zero-fat products. Respondents lower in numeracy seemed to differentiate less between regular- and reduced-fat products than those higher in numeracy. We discuss the implications of these findings for food producers.

Impact of knowledge and misconceptions on benefit and risk perception of CCS.

Carbon Dioxide Capture and Storage (CCS) is assumed to be one of the key technologies in the mitigation of climate change. Public acceptance may have a strong impact on the progress of this technology. Benefit perception and risk perception are known to be important determinants of public acceptance of CCS. In this study, the prevalence and effect of cognitive concepts underlying laypeople's risk perception and benefit perception of CCS were examined in a representative survey (N=654) in Switzerland. Results confirm findings from previous qualitative studies and show a quantification of a variety of widespread intuitive concepts that laypeople hold about storage mechanisms as well as about leakage and socioeconomic issues, which all appeared to influence risk perception and benefit perception. The perception of an overpressurized reservoir and concerns about diffuse impacts furthermore amplified risk perception. Appropriate images about storage mechanisms and climate change awareness were increasing the perception of benefits. Knowledge about CO2 seemed to lower both perceived benefits and perceived risks. Implications for risk communication and management are discussed.

Health motivation and product design determine consumers' visual attention to nutrition information on food products.

OBJECTIVE: In the present study we investigated consumers' visual attention to nutrition information on food products using an indirect instrument, an eye tracker. In addition, we looked at whether people with a health motivation focus on nutrition information on food products more than people with a taste motivation. DESIGN: Respondents were instructed to choose one of five cereals for either the kindergarten (health motivation) or the student cafeteria (taste motivation). The eye tracker measured their visual attention during this task. Then respondents completed a short questionnaire. SETTING: Laboratory of the ETH Zurich, Switzerland. SUBJECTS: Videos and questionnaires from thirty-two students (seventeen males; mean age 24.91 years) were analysed. RESULTS: Respondents with a health motivation viewed the nutrition information on the food products for longer and more often than respondents with a taste motivation. Health motivation also seemed to stimulate deeper processing of the nutrition information. The student cafeteria group focused primarily on the other information and did this for longer and more often than the health motivation group. Additionally, the package design affected participants' nutrition information search. CONCLUSIONS: Two factors appear to influence whether people pay attention to nutrition information on food products: their motivation and the product's design. If the package design does not sufficiently facilitate the localization of nutrition information, health motivation can stimulate consumers to look for nutrition information so that they may make a more deliberate food choice.

Applying the evaluability principle to nutrition table information. How reference information changes people's perception of food products.

Consumers often neglect or misinterpret nutrition table information. We argue in this paper that this can be explained by the evaluability principle, which posits that people's evaluation of a product corresponds to a greater degree with the product's actual value when people receive reference information about the product than when they do not get this information. We tested this assumption concerning nutrition table information in two studies. In Study 1, respondents received one of six nutrition tables that differed on reference and summary information about either yogurt or chocolate. In the second study, we compared three nutrition tables from the previous study, as applied to either a low nutritional value yogurt or a high nutritional value yogurt. Participants were asked to rate the attractiveness and perceived healthiness of the product in both studies. Results indicated that reference information can change people's product perception. This seems to depend, however, on the product's nutritional value and on people's primary connotation for the product. In sum, the evaluability principle can explain people's perception of a food product. A nutrition table that is adapted to this principle appears to influence people's product perception so that it becomes more in line with its nutritional value. Implications for practice and further research are given.

Probability information in risk communication: a review of the research literature.

Communicating probability information about risks to the public is more difficult than might be expected. Many studies have examined this subject, so that their resulting recommendations are scattered over various publications, diverse research fields, and are about different presentation formats. An integration of empirical findings in one review would be useful therefore to describe the evidence base for communication about probability information and to present the recommendations that can be made so far. We categorized the studies in the following presentation formats: frequencies, percentages, base rates and proportions, absolute and relative risk reduction, cumulative probabilities, verbal probability information, numerical versus verbal probability information, graphs, and risk ladders. We suggest several recommendations for these formats. Based on the results of our review, we show that the effects of presentation format depend not only on the type of format, but also on the context in which the format is used. We therefore argue that the presentation format has the strongest effect when the receiver processes probability information heuristically instead of systematically. We conclude that future research and risk communication practitioners should not only concentrate on the presentation format of the probability information but also on the situation in which this message is presented, as this may predict how people process the information and how this may influence their interpretation of the risk.