Communicating epidemiological results through alternative indicators: Cognitive interviewing to assess a questionnaire on risk perception in a high environmental risk area

Figures & data

Table 1. Questions R2 and R3, aimed to compare the respondents’ risk perception when the same results were expressed in terms of % excess risk (Questionnaire A) and Time Needed to Harm (Questionnaire B)

	Question R2
Questionnaire A	From 2001 to 2006, death rates from cancer in Livorno-Collesalvetti were 4,5% higher than in Tuscany, with 620 overall deaths every year
	Please state your concern about this result on a scale ranging from 1 (no concern) to 10 (extremely concerned)
Questionnaire B	From 2001 to 2006, we observed 1 more death from cancer every 13 days in Livorno-Collesalvetti in respect to Tuscany
	Please state your concern about this result on a scale ranging from 1 (no concern) to 10 (extremely concerned)
	Question R3
Questionnaire A	From 2001 to 2006, we observed the following results in Livorno-Collesalvetti:
	(1) The risk of death from ovarian cancer was 25% higher than in Tuscany, with an overall number of 13 deaths every year; (2) The risk of deaths from thyroid cancer in women was 60% higher than in Tuscany, with an overall number of 2 deaths every year; (3) The risk of deaths from acute myocardial infarction in women was 6% higher than in Tuscany, with an overall number of 152 deaths every year.
	Please, tick which result is the most concerning to you and which result is the least concerning to you
Questionnaire B	From 2001 to 2006, we observed the following results in Livorno-Collesalvetti:
	(1) One more death every 4 months in respect to Tuscany from ovarian cancer; (2) One more death every 14 months in respect to Tuscany from thyroid cancer in women; (3) One more death every 46 days in respect to Tuscany from acute myocardial infarction in women.
	Please, tick which result is the most concerning to you and which result is the least concerning to you

Table 2. Questions R4 and R5, aimed to compare the respondent’s judgment on the reliability of the results when statistical uncertainty was expressed in terms of statistical significance/p-value (Questionnaire A) or in terms of q-value (Questionnaire B)

	Question R4
Questionnaire A	From 2001 to 2006 in the Livorno-Collesalvetti area, we observed a higher risk of death from melanoma than in Tuscany. If I say that this result is:
	(1) Statistically significant, how reliable do you rate this result on a scale ranging from 1 (not at all) to 10 (completely)? (2) Highly statistically significant, how reliable do you rate this result on a scale ranging from 1 (not at all) to 10 (completely)? (3) Not statistically significant, how reliable do you rate this result on a scale ranging from 1 (not at all) to 10 (completely)?
Questionnaire B	From 2001 to 2006 in the Livorno-Collesalvetti area, we observed a higher risk of death from melanoma than in Tuscany.
	(1) If I say that there is a 20% probability that this result does not represent a true higher risk of death, how reliable do you rate this result on a scale ranging from 1 (not at all) to 10 (completely)? (2) If I say that there is a 5% probability that this result does not represent a true higher risk of death, how reliable do you rate this result on a scale ranging from 1 (not at all) to 10 (completely)? (3) If I say that there is a 80% probability that this result does not represent a true higher risk of death: how reliable do you rate this result on a scale ranging from 1 (not at all) to 10 (completely)?
	Question R5
Questionnaire A	In the Livorno-Collesalvetti area, in 2001–2006 we observed:
	(1) A 13% excess of mortality from breast cancer in women in respect to Tuscany. This result is statistically significant (p-value = 0.02). How probable do you think that this excess is due to chance on a scale ranging from 1 (not at all) to 10 (completely)? (2) A 68% excess of mortality from pleural cancer in men in respect to Tuscany. This result is highly statistically significant (p-value = 0.0001). How probable do you think that this excess is due to chance on a scale ranging from 1 (not at all) to 10 (completely)? (3) A 100% excess of mortality from testis cancer in respect to Tuscany. This result is not statistically significant (p-value = 0.08). How probable do you think that this excess is due to chance on a scale ranging from 1 (not at all) to 10 (completely)? (4) An 8% excess of mortality from bone cancer in men in respect to Tuscany. This result is not statistically significant (p-value = 0.32). How probable do you think that this excess is due to chance on a scale ranging from 1 (not at all) to 10 (completely)?
Questionnaire B	In the Livorno-Collesalvetti area, in 2001–2006 we observed:
	(1) One more death every 2 months from breast cancer in women in respect to Tuscany, with a q-value of 20%. How probable do you think that this excess is due to chance on a scale ranging from 1 (not at all) to 10 (completely)? (2) One more death every 3 months from pleural cancer in men in respect to Tuscany, with a q-value of 3%. How probable do you think that this excess is due to chance on a scale ranging from 1 (not at all) to 10 (completely)? (3) One more death every 6 years from testis cancer in respect to Tuscany, with a q-value of 50%. How probable do you think that this excess is due to chance on a scale ranging from 1 (not at all) to 10 (completely)? (4) One more death every 6 and a half years from bone cancer in men in respect to Tuscany, with a q-value of 52%. How probable do you think that this excess is due to chance on a scale ranging from 1 (not at all) to 10 (completely)?

Table 3. Main characteristics of the interviewees

Interview number	Sex	Age	Marital status	Education	Employement	Environmental activism
1	W	56	Single	High school diploma	Public employee	No
2	M	67	Married	Master’s degree	Retired	No
3	W	51	Married	High school diploma	Employee in trade	No
4	W	74	Widow	Junior high school diploma	Retired	No
5	M	52	Married	Junior high school diploma	Public employee	No
6	W	59	Married	Master’s degree	Public manager	No
7	M	54	Single	High school diploma	Employee in trade	Yes
8	M	53	Married	High school diploma	Public employee	Yes
9	M	46	Married	High school diploma	Driver in railway	Yes
10	M	57	Single	Master degree	Public employee	No
11	W	55	Married	High school diploma	Employee in service sector	No
12	M	37	Single	High school diploma	Employee in building	No
13	M	39	Single	High school diploma	Manager/owner in the hotel	No
14	M	35	Single	Junior high school diploma	Vendor	Yes
15	W	39	Divorced	High school diploma	Private employee (ticket inspector in Railway)	Yes