Responding to the Health Risk of Heat Exposure: Understanding the Mitigation and Adaptive Capacity in the General Population of New England

Extreme heat has been the leading cause of weather related mortality in the United States for the past thirty years with vulnerable populations including the elderly, young, and low income considered particularly vulnerable. While extreme heat events receive a significant amount of attention and continue to increase in duration, intensity and geographic extent, the majority of heat related illness and death have historically occurred outside of those events. Despite this general scientific understanding of the risks and impacts, as the climate continues to rapidly warm differentially around the globe, regional differences in the public perception of risk and tolerance for adaptive action have been less well studied. The Northeast US, for instance, is one of the fastest warming regions of the country and also has a relatively older population, older housing stock that lacks air conditioning and rural development pattern compared to generally hotter parts of the country or large urban centers.

To better understand the public perception of extreme heat, risk tolerance and adaptive action in the general population of the Northeast, an online stratified survey of Vermonters (N = 1818) was conducted in the late summer of 2022. The survey included questions in five topical areas: perception of extreme heat, communication of extreme heat, health related heat risk, strategies to mitigate extreme heat exposure risk, and demographic information. Based on CDC guidance and interest from research partners, five short term risk mitigation actions (staying hydrated, changing plans, checking on neighbors, using air conditioning or fans, and going to a cooling center or public air conditioned space) and three long term adaptive actions (installing air conditioning, home weatherization, and moving) were investigated. Questions were designed to leverage insights from the social-psychological theories of behavior change including the transtheoretical model (TTM) of behavior change and the theory of planned behavior (TPB). The TTM suggests that individuals move through stages as they adopt new behaviors including pre-contemplation when they are unaware of a particular behavior or problem; to contemplation when they are considering taking action; to preparation when they are taking steps to ready themselves for the change; then action when they make the behavior change; and then maintenance when the new behavior becomes habitual. Individuals can stagnate and move backward in the process as well. The TTM was applied in questions related to the short-term mitigation actions investigated. The TPB, meanwhile theorizes that an individual’s intention to act is based on their attitudes, their perceived social norms, and their perceived behavioral control in taking the action. These are theorized as latent constructs mediating behavioral, normative and control beliefs respectively. Despite high intention and high perceived behavioral control, structural conditions can further control and prevent action. The TPB was applied to the adaptive actions investigated which tend to be more singular in nature. The importance of self-efficacy, decisional balance and trust are also important to each of the two theories investigated. We employ logit regression models to examine the factors associated with being in a later stage of change for the risk mitigation actions; and we use structural equation modeling to determine the relative importance of socio-psychological factors in determining intention to implement the adaptive actions.

We present findings for each of the eight mitigation behaviors and adaptive actions with behavioral insights, identification of possible barriers to action and recommendations for policy and programmatic interventions. For instance, our findings suggest that more than 50 percent of respondents are in the action or maintenance stage of checking on friends and family when its particularly hot (N = 1744), however 34 percent of respondents were classified as being in pre-contemplation and 11 percent in contemplation. For these segments of the population, educational awareness of the efficacy of this activity in preventing adverse heat health outcomes and related illness may be warranted through public messaging and educational campaigns. We also will present the influence of demographics, past experience of heat health issues, and general level of concern about heat health impacts. We will also share evidence that a shift in decisional balance or structural barriers likely occurred in the last three years (for example, workplace changes resulting from the COVID-19 pandemic) that resulted in a significant number of respondents making larger adaptive and mitigation actions. Findings can inform program design and interventions including outreach campaigns to reduce the public health burden from heat in the New England region.