Climate Change Harm Perception Among U.S. Adults in the NCI Health Information National Trends Survey,2022

Abstract

Purpose

To examine associations between 1) sociodemographics and 2) trust in health information sources with climate change harm perception.

Methods

Weighted adjusted logistic regression models examined correlates of climate change harm perception (harm vs no harm/don’t know) among a nationally representative sample of U.S. adults (2022, n = 5585).

Results

Sixty-four percent of U.S. adults believed climate change will harm their health. College education (vs high school or less) (AOR 1.7, 95% CI 1.3, 2.2) and having greater trust in doctors (AOR 1.4, 95% CI 1.2, 1.7), scientists (aOR 1.8, 95% CI 1.6, 2.0), and government health agencies (AOR 1.7, 95% CI 1.5, 1.9) for health information were associated with believing climate change harms health. Conversely, greater trust in religious organizations was associated with 16% lower odds of believing climate change harms health (95% CI .74, .94).

Conclusions

Climate change harm perception varied by sociodemographics and trust in health information source. Health communication delivered via alternative and diverse channels could expand the reach of climate and health messaging and ultimately increase public awareness and support for measures to mitigate the health impacts of climate change.

Keywords

climate change harm perceptions health communication public opinion information source trust

Purpose

The health effects of climate-related events are becoming more pronounced as extreme weather events, including heat waves, wildfires, and floods, increase in both frequency and intensity.^1,2 Both direct and indirect effects of climate change have been associated with heat-related illness, respiratory conditions, vector-borne diseases, and greater exposure to carcinogens.^3,4 Climate change-related weather events have also been associated with healthcare system disruptions leading to delays in care and decreased access to health services.²

Public belief that climate change poses harm to human health is vital to realize public health actions, such as climate change mitigation, adaptation, and disaster preparedness. However, a gap between public perception and scientific consensus about the harms of climate change to human health has been identified. In the United States (U.S.), many Americans view the health effects of climate change as a distant threat or one that doesn’t affect them personally.⁵ For example, nationally representative surveys have found that between 32% and 64% of Americans perceive climate change as harmful to human health, yet often express that climate change is likely to harm someone else’s health rather than their own.^5-7

Higher levels of trust in health information sources could address the gap in public perception regarding climate change harms, and, in turn, promote behavior change and support for climate-related policies. Trust in scientists and environmental groups has been associated with climate-friendly behaviors, including support for climate-related policy and intention to adopt behaviors to prevent climate change.⁸ In the U.S., a majority of the population reports that they trust doctors and government health agencies as sources of health information.⁹ However, the COVID-19 pandemic has adversely affected the public’s trust of scientists as only 29% of U.S. adults in 2022 reported having a great deal of confidence in medical scientists to act in the best interest of the public, down from 40% in 2020.¹⁰ Given changing levels of trust in health information sources, and increases in the public’s exposure to climate-related extreme weather events and natural disasters, this study evaluates: (1) sociodemographic correlates of climate change harm perception, and (2) whether trust in 6 different health information sources is associated with climate change harm perception.

Methods

Design

Data were analyzed from the National Cancer Institute’s (NCI) Health Information National Trends Survey (HINTS) 6 (fielded in 2022; N = 6252; 28.1% response rate). HINTS is a nationally representative, cross-sectional, probability-based postal and web-based survey. Additional survey methodology details are available elsewhere.¹¹

Sample

HINTS includes adults aged ≥18 and is administered among the civilian, non-institutionalized U.S. population. Analyses were restricted to respondents with complete data on all analytical variables (n = 5585). As HINTS data are publicly available and deidentified, the current study was not considered human subjects research.

Measures

Perception of climate change harm was measured by a single item, “How much do you think climate change will harm your health?”. Respondents could select “A lot”, “Some”, “A little”, “Not at all”, and “Don’t know”. Responses were categorized as “climate change will harm health” (combining “A lot”, “Some”, and “A little”), “climate change will not harm health” (Not at all), and Don’t know.

Trust in health information sources was measured for 6 separate sources with the following stem: “In general, how much would you trust information about cancer from each of the following?”. The sources were: (1) a doctor, (2) government health agencies, (3) scientists, (4) family or friends, (5) charitable organizations, and (6) religious organizations and leaders. Respondents indicated their trust in each source using a continuous scale of 1 to 4 (“Not at all” = 1, “A little” = 2, “Some” = 3, “A lot” = 4), with higher values indicating greater trust.

Data for this study included: age group (18-34, 35-49, 50-64, 65-74, ≥75), sex (female, male), self-reported race and ethnicity (non-Hispanic Asian, non-Hispanic Black or African American, Hispanic or Latino, non-Hispanic Other Race, and non-Hispanic White), highest level of education completed (high school or less, some college or post high school training, college degree or more), annual household income (<$20,000, $20,000 to <$50,000, $50,000 to <$75,000, >=$75,000), and metropolitan status of respondents’ county of residence (metropolitan, non-metropolitan). Due to low cell sizes, respondents who identified as non-Hispanic ethnicity and either American Indian or Alaska Native, Native Hawaiian, Pacific Islander, or respondents who selected multiple races were combined and recoded as non-Hispanic Other race and ethnicity. County of residence metropolitan status was determined using the 2013 U.S. Department of Agriculture’s Rural-Urban Continuum Codes for metropolitan (codes 1-3) and non-metropolitan areas (codes 4-9).

Analyses

Analyses were conducted using Stata/SE 16.1 (StataCorp, College Station, TX, USA) survey procedures to account for the complex sampling design of HINTS. All analyses used sample weights to produce population-level point estimates, and jackknife replicate weights to compute variance estimates. Frequencies and weighted, unadjusted proportions for climate harm perception categories by sociodemographic characteristics were calculated. Weighted means were calculated for each trust in health information source item overall, and by climate harm perception category. Weighted, multivariable logistic regression models examined correlates of climate change harm perception (climate change will harm health = 1 vs climate change will not harm health/don’t know = 0). The first model examined sociodemographic correlates of climate harm perception. Six separate models examined associations between each trust in health information source and climate change harm perception, adjusting for sociodemographic covariates (age, sex, race/ethnicity, education, household income, county metropolitan status). Tests of significance were conducted at the P < .05 level.

Results

Sociodemographic characteristics of the sample and the weighted percentages that fall into each climate change harm perception category are presented in Table 1. The majority of U.S. adults (64.0%, 95% CI 64.6, 66.4) believed that climate change will harm their health at least “a little”, while 19.8% (95% CI 18.0%, 21.7%) believed that it will not harm their health at all, and 16.2% (95% CI 14.4%, 18.1%) said they did not know.

Table 1.

Sociodemographic Characteristics of U.S. Adults Endorsing Each Climate Change Harm Perception Category, 2022 (N = 5585).

	Total (N = 5585)	Climate change will harm health (n = 3721)	Climate change will not harm health (n = 1008)	Don’t know (n = 856)
	Unweighted N	Weighted % (95% CI)	Weighted % (95% CI)	Weighted % (95% CI)
Total	5585	64.0 (61.6, 66.4)	19.8 (18.0, 21.7)	16.2 (14.4, 18.1)
Age group (Years)
18-34	858	71.2 (64.7, 76.9)	13.5 (10.5, 17.1)	15.4 (10.9, 21.3)
35-49	1150	66.5 (61.5, 71.2)	19.9 (16.3, 24.1)	13.6 (10.8, 17.0)
50-64	1639	59.1 (54.6, 63.4)	23.1 (19.2, 27.6)	17.8 (14.9, 21.2)
65-74	1228	61.1 (57.3, 64.8)	21.7 (18.6, 25.1)	17.2 (14.7, 20.1)
75+	710	55.9 (50.9, 60.7)	24.3 (20.3, 28.9)	19.8 (15.5, 25.0)
Sex
Female	3364	67.6 (65.4, 69.7)	15.2 (13.5, 17.1)	17.2 (15.3, 19.2)
Male	2221	60.3 (55.8, 64.7)	24.6 (21.3, 28.2)	15.1 (12.0, 18.9)
Race/Ethnicity
Hispanic	939	67.4 (60.6, 73.6)	15.3 (11.2, 20.5)	17.3 (12.5, 23.5)
Non-hispanic Asian	308	81.6 (68.5, 90.0)	7.09 (4.22, 11.7)	11.3 (4.20, 27.0)
Non-hispanic black/African American	930	67.1 (62.1, 71.8)	12.9 (9.86, 16.8)	19.9 (15.7, 25.0)
Non-hispanic other race	173	65.4 (51.9, 76.8)	21.7 (14.6, 30.9)	13.0 (6.77, 23.4)
Non-hispanic white	3235	60.8 (57.2, 64.3)	23.3 (20.9, 25.9)	15.9 (13.7, 18.3)
Education
High school or less	1280	60.3 (54.8, 65.4)	21.4 (17.0, 26.4)	18.4 (14.8, 22.6)
Some college or post high school training	1609	59.4 (54.7, 64.0)	20.8 (18.1, 23.8)	19.8 (16.0, 24.2)
College or more	2696	72.4 (70.0, 74.7)	17.3 (15.2, 19.7)	10.3 (8.90, 11.9)
Annual household income
Less than $20,000	818	61.4 (55.5, 66.9)	21.0 (16.0, 27.1)	17.6 (13.4, 22.8)
$20,000 to <$50,000	1326	63.7 (58.5, 68.7)	18.5 (15.0, 22.5)	17.8 (14.1, 22.1)
$50,000 to <$75,000	1563	67.1 (62.2, 71.6)	15.2 (12.0, 19.2)	17.7 (14.0, 22.1)
$75,000 or more	1429	63.8 (59.7, 67.7)	21.8 (19.2, 24.7)	14.4 (11.5, 17.8)
County of residence metropolitan status
Metropolitan	4856	65.2 (62.5, 67.7)	19.0 (17.1, 21.0)	15.9 (14.0, 18.0)
Non-metropolitan	729	56.0 (50.4, 61.4)	25.6 (21.5, 30.3)	18.4 (15.0, 22.3)

Among U.S. adults aged 18-34 years, 71.2% (95% CI 64.7%, 76.9%) believed that climate change will harm their health compared to only 55.9% (95% CI 50.9%, 60.7%) of adults aged 75 years and older (Table 1). A higher proportion of females (67.6%, 95% CI 65.4%, 69.7%) compared with males (60.3% 95% CI 55.8%, 64.7%) believed that climate change will harm their health. By race/ethnicity, 81.6% of non-Hispanic Asian adults believed that climate change will harm their health (95% CI 68.5%, 90.0%), compared to 67.4% of Hispanic (95% CI 60.6%, 73.6%) and 67.1% of non-Hispanic Black adults (95% CI 62.1%, 71.8%).

The belief that climate change does not harm health was endorsed most frequently by those aged 75 years and older (24.3%, 95% CI 20.3%, 28.9%), males (24.6%, 95% CI 21.3%, 28.2%), and people living in non-metropolitan areas (25.6%, 95% CI 21.5%, 30.3%). In contrast, only 12.9% of non-Hispanic Black adults (95% CI 9.86%, 16.8%) reported that they believe that climate change does not harm health compared with 23.3% of non-Hispanic white adults (95% CI 20.9%, 25.9%). Adults ages 75 and older (19.8%, 95% CI 15.5%, 25.0%), those who were non-Hispanic Black (19.9%, 95% CI 15.7%, 25.0%), and those with either some college (19.8%, 95% CI 16.0%, 24.2%) and high school or less education (18.4%, 95% CI 14.8%, 22.6%) reported the highest frequencies of not knowing whether climate change harms health.

Table 2 shows the average level of trust in each health information source overall and by each climate change harm perception category. Overall, U.S. adults reported the highest levels of trust in doctors (3.66, 95% CI 3.63, 3.69), followed by scientists (3.35, 95% CI 3.31, 3.38) and government health agencies (2.89, 95% CI 2.85, 2.93). The least trusted source for health information was religious organizations (1.91, 95% CI 1.86, 1.95). Trust in doctors was highest among those reporting that climate change will harm their health (3.71, 95% CI 3.68, 3.74) compared with those reporting that climate change will not harm their health (3.55, 95% CI 3.48, 3.62) and those who did not know (3.60, 95% CI 3.49, 3.71). Trust in government health agencies (3.07, 95% CI 3.02, 3.11) and scientists (3.51, 95% CI 3.48, 3.54) was also higher among those reporting that climate change will harm their health, and lower among those reporting that it will not harm their health and those who did not know (Table 2). Although trust in religious organizations for health information was relatively low overall, it was lowest among those who believed that climate would harm their health (1.86, 95% CI 1.81, 1.91) and higher among those who believed that it would not (2.03, 95% CI 1.92, 2.15) or who did not know (1.95, 95% CI 1.84, 2.06). Similar patterns were found for charitable organizations as were found for religious organizations but mean trust in family/friends as a health information source was relatively similar across harm perception categories (Table 2).

Table 2.

Trust in Health Information Sources^a Overall, and by Climate Change Harm Perception Category Among U.S. Adults, 2022 (N = 5585).

	Total mean (95% CI)	Climate change will harm health mean (95% CI)	Climate change will not harm health mean (95% CI)	Don’t know mean (95%CI)
Doctors	3.66 (3.63, 3.69)	3.71 (3.68, 3.74)	3.55 (3.48, 3.62)	3.60 (3.49, 3.71)
Government	2.89 (2.85, 2.93)	3.07 (3.02, 3.11)	2.47 (2.37, 2.57)	2.71 (2.59, 2.83)
Scientists	3.35 (3.31, 3.38)	3.51 (3.48, 3.54)	2.93 (2.81, 3.05)	3.20 (3.10, 3.31)
Family/friends	2.54 (2.50, 2.58)	2.56 (2.51, 2.61)	2.54 (2.45, 2.64)	2.46 (2.34, 2.57)
Charitable organizations	2.37 (2.33, 2.41)	2.46 (2.41, 2.51)	2.20 (2.11, 2.28)	2.26 (2.16, 2.36)
Religious organizations	1.91 (1.86, 1.95)	1.86 (1.81, 1.91)	2.03 (1.92, 2.15)	1.95 (1.84, 2.06)

^aRespondents indicated whether they trusted each source from a scale of 1 to 4 (“Not at all” = 1, “A little” = 2“, Some” = 3, “A lot” = 4) so that higher values corresponded with greater trust.

Table 3 presents the weighted logistic regression model examining the demographic correlates of endorsing that climate change will harm health vs will not harm/don’t know. Compared with those aged 18-34 years, adults ages 50-64 (AOR .65, [95% CI .46, .91]), 65-74 (AOR .71, [95% CI .52, .97]) and 75 years and older (AOR .59, 95% CI .40, .87), had significantly lower odds of believing that climate change will harm their health. Females (vs males) had 1.41 times greater odds of believing that climate change will harm their health (95% CI 1.31, 1.74). Compared to non-Hispanic whites, non-Hispanic Black/African American adults had 1.34 times greater odds of believing that climate change will harm their health (AOR 1.34, 1.01, 1.77), while non-Hispanic Asians had over twice the odds of believing that climate change will harm their health (AOR 2.33, 95% CI 1.03, 5.26). Adults with a college degree or more education had 1.71 times greater odds of believing that climate change will harm their health compared to those with a high school degree or less education (95% CI 1.31, 2.24). There were no significant associations between household income and county of residence metropolitan status.

Table 3.

Sociodemographic Correlates of Believing That Climate Change Will Harm Your Health (vs Will Not Harm Health or Don’t Know) Among U.S. Adults, 2022 (N = 5585).

	Odds ratio	(95% CI)
Age group (Years)
18-34	Ref
35-49	.85	.57, 1.26
50-64	.65	.46, .91
65-74	.71	.52, .97
75+	.59	.40, .87
Sex
Female	1.41	1.13, 1.74
Male	Ref
Race/Ethnicity
Hispanic	1.28	.86, 1.90
Non-hispanic Asian	2.33	1.03, 5.26
Non-hispanic black/African American	1.34	1.01, 1.77
Non-hispanic other race	1.16	.60, 2.24
Non-hispanic white	Ref
Education
High school or less	Ref
Some college or post high school training	.96	.70, 1.31
College degree or more	1.71	1.31, 2.24
Annual household income
Less than $20,000	Ref
$20,000 to <$50,000	1.11	.77, 1.61
$50,000 to <$75,000	1.25	.87, 1.79
$75,000 or more	.99	.72, 1.38
County of residence metropolitan status
Metropolitan	Ref
Non-metropolitan	.78	.60, 1.02

Table 4 presents the results of 6 separate weighted logistic regression models for each health information source, adjusted for sociodemographic characteristics. Higher levels of trust in health information from a doctor (AOR 1.41, 95% CI 1.18, 1.68), scientists (AOR 1.73, 95% CI 1.54, 1.94), government health agencies (AOR 1.77, 95% CI 1.56, 2.00), and charitable organizations (AOR 1.30, 95% CI 1.16, 1.46) were each associated with greater odds of believing climate change will harm their health. However, higher levels of trust in health information from religious organizations (AOR .84, 95% CI .74, .94) was associated with reduced odds. Trust in information from family/friends was not associated with individuals’ perception of climate change harm.

Table 4.

Associations Between Trust in Health Information Sources and Believing That Climate Change Will Harm Your Health (vs Will Not Harm Health or Don’t Know) Among U.S. Adults, 2022^a (N = 5585).

Trust in health information Sources^b	AOR	(95% CI)
Doctors	1.41	1.18, 1.68
Government	1.73	1.54, 1.94
Scientists	1.77	1.56, 2.00
Family/friends	1.13	.98, 1.31
Charitable organizations	1.30	1.16, 1.46
Religious organizations	.84	.74, .94

AOR = adjusted odds ratio.

^aSeparate logistic regression models adjusted for age group, sex, race/ethnicity, education, annual household income, and county of residence metropolitan status.

^bRespondents indicated whether they trusted each source from a scale of 1 to 4 (“Not at all” = 1, “A little” = 2“, Some” = 3, “A lot” = 4) so that higher values corresponded with greater trust.

Discussion

Climate change poses an immediate threat to public health, and the adverse health effects from climate change are worsening.¹² Understanding public perception about the link between climate change and human health is important to inform communication and public health efforts to mitigate the effects of climate change. Consistent with previous studies in both the U.S.^5,13 and Canada,⁷ approximately 64% of this nationally representative sample of U.S. adults believed that climate change will harm their health. With more than one-third of the sample reporting that either they do not know if climate change will harm their health (16%) or they believe climate change will not harm their health (20%), our findings highlight the opportunity to intervene with communication and messaging on the negative health effects of climate change.

Understanding who does and who does not perceive climate change as a threat to health, and which information sources are most trusted and associated with climate harm perception can help identify appropriate messaging and communication channels to deliver information about climate change mitigation and adaptation strategies.¹⁴ Towards this end, findings indicate that individuals identifying as younger (18-34 years), female, and having a college degree or more education had greater odds of believing that climate change will harm their health. These findings add to a growing body of evidence across North America that identify similar sociodemographic differences in the perception of vulnerability or harm from climate change.^15-17 Further, findings indicate that both non-Hispanic Black and Hispanic populations perceive climate change as a threat to their health, consistent with current research documenting communities with greater proportions of Black and Hispanic residents are disproportionately burdened by the adverse effects of climate change.^18,19

The current study also found a link between trust in certain health information sources and climate change harm perception, consistent with previous research that found an association between trust in scientists and belief in global warming and climate change in general.^20,21 Understanding which health information sources are associated with climate change harm perception is particularly important given that belief in climate change has been associated with greater support for environmentally protective policies and behaviors. For example, a study of farmers in Iowa found that greater trust in environmental information sources, including scientists and government agencies, was associated with greater climate change risk perceptions, and in turn, greater support for climate adaptation strategies.²² Another study found that individuals that perceive harm from environmental hazards were more willing to take civic action against climate change in the form of voting for elected officials that emphasize environmental protection efforts, writing letters to elected officials, attending local government meetings, and donating money to environmental groups.²³

Previous research has also linked trust in healthcare providers to environmentally protective behaviors and has found that doctors are trusted sources of information about global warming.²⁴ For example, an intervention in which pediatricians discussed climate change and its associated health harms with patients and their families during routine clinic visits found that 89% of families reported on a post-visit survey that they were likely to change their energy use behaviors and 91% reported that they were likely to support clean energy initiatives.²⁵ Study findings that trust in doctors was associated with greater climate harm perception indicates an opportunity to increase climate change mitigation actions and support using communication between healthcare professionals and the public.²⁶ Furthermore, the current research suggests the need for developing, testing, and disseminating strategies that can enable health professionals to engage patients in learning more about impacts of climate change on health. Research to develop and assess the effectiveness of communication strategies that build on the public’s trust of healthcare providers is needed.

In contrast to other information sources, greater trust in health information from religious organizations was associated with lower odds of perceiving climate change as a harm to health. Greater trust in health information sources has been found to vary by sociodemographics, with greater trust in religious organizations being endorsed more frequently by non-Hispanic Black and Hispanic populations, those with limited English proficiency, and those with less than a high school education.^9,27 This finding may indicate an opportunity for tailored climate change messaging from trusted sources for populations that may be disproportionately burdened by the harmful health consequences of climate change.²⁸ For example, delivering climate change messaging in religious settings by trusted leaders with framing based on social identity and religious values may result in positive changes in environmental and climate change beliefs.²⁹ Similarly, faith-based settings have a history of successful health education and health behavior intervention implementation that can be leveraged for the delivery of messaging about climate and health.³⁰

Limitations

Study findings must be interpreted considering several limitations. All data were cross-sectional; therefore causality cannot be assessed. A single item was used to assess climate change harm perception, with a focus on personal harm. Future research should also assess perceptions of climate change being harmful to others, similar to previous research.⁷ We also lacked information about prior exposure to climate-related events, such as extreme heat, wildfires, or flooding. Experiences with these events have been found to be associated with climate change harm perceptions,³¹ and items regarding this exposure is proposed for inclusion in future iterations of HINTS. This survey did not measure political ideology or trust in politicians, which could be important for understanding how to deliver climate change information to U.S. citizens. Finally, understanding the psychological and social mechanisms underlying trust/mistrust of health information sources could help inform how best to reach populations expressing lower levels of trust in sources typically used to deliver information about climate change and health.

Public Health Implications

Framing messaging about climate change in terms of the human health relevance may be a promising health communication strategy to engage the public in information about climate change.^14,32 However, framing alone may not be sufficient to advance public understanding about the harms of climate change or to change behaviors that would help prevent or mitigate health effects from climate change.³³ Trusted sources are needed to deliver messages that may be unfamiliar, feel too far removed from the present, or perceived as politically polarizing. Health communication delivered via trusted and diverse channels could expand the reach of climate and health messaging and ultimately increase public awareness and support for measures to mitigate the health impacts of climate change.

So What?

What is Already Known on This Topic?

The health effects of climate change related events are becoming increasingly pronounced. Public perception of health risks due to climate change is vital to public health actions, such as mitigation, adaptation, and disaster preparedness.

What Does This Article Add?

This paper examines associations between sociodemographic characteristics, trust in health information sources, and climate change harm perceptions. In doing so, the current study identifies determinants of public perception of climate change health harm.

What are the Implications for Health Promotion Practice or Research?

Health communication delivered via alternative and diverse channels could expand the reach of climate and health messaging and increase public support for measures to mitigate the health impacts of climate change. Our findings can help to guide climate change messaging and communication efforts.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Disclaimer

The opinions expressed by the authors are their own and this material should not be interpreted as representing the official viewpoint of the U.S. Department of Health and Human Services, the National Institutes of Health, or the National Cancer Institute.

ORCID iD

Heather D’Angelo

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