gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

Health threats: Risk perception, knowledge and use of preventive measures among students in Hamburg

Meeting Abstract

  • Silvia Klein - Hamburg University of Applied Sciences, Hamburg
  • Annika Borczyskowski - Hamburg University of Applied Sciences, Hamburg
  • Karin Mossakowski - Hamburg University of Applied Sciences, Hamburg
  • Sabine Schipf - Hamburg University of Applied Sciences, Hamburg
  • Ralf Reintjes - Hamburg University of Applied Sciences, Hamburg

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds235

The electronic version of this article is the complete one and can be found online at:

Published: September 8, 2005

© 2005 Klein et al.
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In the health sector there is increasing interest in risk, risk perception, knowledge, and management as well as communication of risk. Much of this has concentrated on the measurement and communication of objective assessments of risk. It is probable that the public response to situations of possible risk is driven, not by objective assessment of risk, but by subjective impression. To influence the public about the real risk of certain events a better understanding of subjective perception of risk and mechanisms that form this perception is needed.

The present study analysed perceived risk of being affected by potential health threats, knowledge about the transmission of infectious diseases, and the (potential) use of preventive measures among high school graduates and students in Hamburg.


A cross-sectional survey among high school graduates and students from three different study fields (Health Sciences, Nutrition and Home Economics, and Natural Sciences and Technology) was conducted in November 2004. Next to demographic data, information on risk perception, knowledge on transmission of diseases, use of preventive measures as immunisation against hepatitis B and influenza, and willingness to use potentially new vaccines against HIV and SARS were collected in self-administered questionnaires. Risk perception was compared to results of a Dutch study [1]. Data were analysed using SPSS 11.0 and Epi Info 6.0.


524 individuals participated, of which 68 % (n = 354) were female. 41 % of the responders were high school graduates (n = 216, mean age 21 years, 71 % female), while 58 % were students (Health Sciences: n = 123, mean age 29 years, 76 % female; Nutrition and Home Economics: n = 88, mean age 25 years, 85 % female; Natural Sciences and Technology: n = 89, mean age 21 years, 33 % female). The response rate was estimated as 95-97 %.

Regarding knowledge, 77 % of all participants knew that the transmission of hepatitis B is easier than that of HIV. The results varied by age groups from 59 % (≤20 years) to 92 % (≥36 years). The knowledge about transmission of these diseases was significantly higher among students than among high school graduates (85 % vs. 66 %, p < 0.0010). Health Sciences as well as Natural Sciences and Technology students were better informed than Nutrition and Home Economics students (88 %, 89 %, and 78 %, respectively). 75 % of all participants responded that it is more likely to get infected with influenza than with SARS. Knowledge differed by gender (78 % female, 69 % male, p = 0.05) and age. The youngest and the oldest age group were better informed about transmission of influenza and SARS (80 %) than the age group in between (64 %-76 %).

The risk of being affected by HIV, SARS and hepatitis B was rated high or very high by a very low proportion of the study population, only slightly more people considered themselves at risk of influenza. In contrast the majority of study subjects thought they were likely or very likely to be affected by common cold during the next year. There were several differences in risk perception among students of different study fields and the group of high school graduates. The most striking were that more high school graduates considered the risk for accidents high or very high compared to the student groups. Students of Health Sciences were the group with the lowest percentage of people considering their risk of acquiring influenza as high or very high, while at the same time this group had the highest percentage of participants considering themselves as at risk of common cold (see table 1 [Tab. 1]).

Regarding use of preventive measures, 70 % of the study population were immunized against hepatitis B (73 % female, 64 % male), while only 11 % were vaccinated against influenza (12 % female, 8 % male). Significantly more women than men were immunized (p = 0.027) against hepatitis B, and also a significantly higher proportion of high school graduates were immunized than students in general (p = 0.020). The highest immunisation rate was found in the group of Health Sciences students (80 %), followed by Natural Sciences (63 %) and the lowest rate in Nutrition and Home Economics (49 %). There was a significantly higher immunisation rate for participants with a health profession background than without (87 % vs. 52 %, p < 0.0001). Regarding influenza vaccination status there were no significant differences between sex, study fields, or professional background.

Most people would be interested in a vaccination against HIV (86 %) or SARS (87 %) if it was available. Hepatitis B vaccination status did not significantly predict willingness for HIV vaccination (RR = 1.07; 95% CI 0.99-1.17), while influenza vaccination was associated with willingness for SARS vaccination (RR = 1.13; 95% CI 1.03-1.24). Neither a high risk perception for SARS (RR = 1.13; 95% CI 0.96-1.33) nor HIV (RR = 1.16; 95% CI 1.12-1.20) significantly predicted willingness for vaccination. This was also true for risk perception of hepatitis B and the status of immunisation (RR = 1.08; 95 % CI 0.81-1.44). In contrast the relationship between high risk perception and status of immunisation was highly significant for influenza (RR = 3.09; 95% CI 1.80-5.31).


In this study there was a high proportion of hepatitis B immunized students. One reason could be a background in health profession implying a duty of immunisation.

In comparison to the study by Brug et al. (2004), which observed risk perception in a random sample of members of an Internet research panel from the age of 19 to 78 years in 2003, there is no significant difference to this study (table 1 [Tab. 1]), although there were important differences between the two study populations, e.g. the age.

Regarding this study, one limitation is the highly selected group of participants that is not representative for the total population of Hamburg. The results can therefore only be transferred to students and high school graduated eligible for university studies in this catchment area. Thus it is possible that the knowledge about infectious diseases could be overestimated.

Nevertheless, the results show that it is necessary to improve public awareness on influenza and hepatitis B. It seems that risk perception depends more on public discussion in media than real risk and knowledge about diseases. The willingness to use potential new vaccines against HIV and SARS is higher than the actual status on immunisation in similar vaccine-preventable diseases like hepatitis B or influenza. In addition, it becomes obvious that knowledge about transmission of diseases does not lead to higher immunisation rates. To support realistic risk perception and effective precautions, communication through various information sources is essential. It should get a higher priority for Public Health in the future.


Brug J, Aro AR, Oenema A, de Zwart O, Richardus JH, Bishop GD. SARS Risk Perception, Knowledge, Precautions, and Information Sources, the Netherlands. Emerging Infectious Diseases 2004; Vol. 10, No. 8: 1486-9