Health Scares: Tracing Their Nature, Growth and Spread Scientific Update and Overview Health Scares: Tracing Their Nature, Growth and Spread Kate MacKrill 1 , Michael Witthöft 2 , Simon Wessely 3 , Keith J. Petrie 1 [1] Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. [2] Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Mainz, Germany. [3] Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom. Clinical Psychology in Europe, 2023, Vol. 5(4), Article e12209, https://doi.org/10.32872/cpe.12209 Received: 2023-06-19 • Accepted: 2023-10-18 • Published (VoR): 2023-12-22 Handling Editor: Winfried Rief, Philipps-University of Marburg, Marburg, Germany Corresponding Author: Kate MacKrill, Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 28 Park Ave, Grafton, Auckland 1023, New Zealand. E-mail: k.mackrill@auckland.ac.nz Abstract Background: Health scares are highly publicised threats to health that increase public concern and protective behaviours but are later shown to be unfounded. Although health scares have become more common in recent times, they have received very little research attention. This is despite the fact that health scares often have negative outcomes for individuals and community by affecting health behaviours and causing high levels of often unnecessary anxiety. Method: In this paper we undertook a review and analysis of the major types of health scares as well as the background factors associated with health scares and their spread. Results: We found most health scares fell into seven main categories; environmental contaminants, food, malicious incidents, medical treatments, public health interventions, radiation from technology and exotic diseases. For most health scares there are important background factors and incident characteristics that affect how they develop. Background factors include conspiracy theories, trust in governmental agencies, anxiety, modern health worries and wariness of chemicals. Incident characteristic include being newly developed, not understood or unseen, man-made rather than natural and whether the incident is out of personal control. We also identified the aspects of traditional and social media that exacerbate the rapid spread of health scares. Conclusion: More research is needed to identify the characteristics of media stories that intensify the levels of public concern. Guidelines around the media’s reporting of health incidents and potential health threats may be necessary in order to reduce levels of public anxiety and the negative public health impact of health scares. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License, CC BY 4.0, which permits unrestricted use, distribution, and reproduction, provided the original work is properly cited. https://crossmark.crossref.org/dialog/?doi=10.32872/cpe.12209&domain=pdf&date_stamp=2023-12-22 https://orcid.org/0000-0002-8128-0678 https://orcid.org/0000-0002-4928-4222 https://orcid.org/0000-0002-6743-9929 https://orcid.org/0000-0002-6337-2480 https://www.psychopen.eu/ https://cpe.psychopen.eu/ https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ Keywords health scares, media, environmental incidents, technology, nocebo effect Highlights • Most health scares can be categorised into one of seven types. • Underlying environment and social factors influence the development of health scares. • Traditional and social media could reduce the negative public health impact of health scares. We live in the age of health scares, defined as a highly publicised threat (or perceived threat) to health that causes increases in public concern, avoidance or protective behav­ iour but is substantially disproportionate to the risk involved (MacKrill, 2021). News stories frequently appear in the media that raise concern about common household products, food or medication. While the respective health risk appears frighteningly large initially, it turns out to be comparatively low or unfounded in retrospect (Hooker, 2010). The early stage of a health scare is characterised by an increase in concerns and public anxiety which is followed by the gradual reduction in the frequency and tone of coverage, until the event is no longer newsworthy. Consequently, it is the response of the public and the media that elevates a health incident into a scare (Whitworth et al., 2017). Many health scares involve the unexpected dangers of modern or new technology, such as 5G or Wi-Fi. Others, such as in modern food production, are concerned with chemical additives, processing or colourings. Most countries have experienced some form of scare over artificial sweeteners, the overuse of antibiotics in food, and genetically modified ingredients. Modern medicine has also been implicated, with drugs and other medical treatments always being a prominent source of public concern. Anxieties about vaccination are as old as the intervention itself but have recently gained more visibility with the COVID-19 pandemic. Understanding the nature of health scares has become more important with increas­ ing recognition and numerous examples of the public health consequences they can have. For example, the COVID-19 crisis has provided many unfortunate illustrations of how unfounded health scares about the virus and its control can cause negative outcomes for individuals and communities. These included the belief that COVID-19 was spread by 5G towers, which lead to a number of towers being damaged (Ahmed et al., 2020). A related scare was that COVID-19 vaccines alter people’s DNA and that the vaccine was developed to control individuals by placing a microchip inside them for easy tracking (Sanders, 2020). This has contributed to a greater hesitancy for some individuals to be vaccinated and consequently affected uptake and community immunity. Health scares can be rapidly transmitted on informal social networks spreading fur­ ther anxiety and negative expectations in a community (Southwell et al., 2019). Research Health Scares 2 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ suggests that individuals who hold strong conspiracy beliefs also are more likely to be­ lieve that some of the same factors that are commonly associated with health scares also cause cancer, such as eating genetically modified food and microwave ovens (Paytubi et al., 2022). The transmission of these beliefs can establish negative expectations that may subsequently produce a nocebo effect when the individual has been exposed to the focus of concern (Crichton, Dodd, et al., 2014). A nocebo effect is defined as adverse effects that are caused by negative expectations rather than any physical effects from exposure to an object of concern (Petrie & Rief, 2019). In this paper we start by providing a taxonomy of common health scares, followed by an analysis of the background factors and circumstances associated with their devel­ opment, as well factors involved in their spread. We end with a discussion of areas for future research on health scares. Taxonomy of Health Scares Research on health scares identifies particular health interventions, consumer goods or features of modern life that are often the subject of unexplained adverse reactions or unfounded concerns. From our analysis of this literature, we found that health scares fell into seven main categories; environmental contaminants, food, malicious incidents, medical treatments, public health interventions, radiation from technology and exotic diseases (Table 1). Consistent across many health scares is the fact that they can arise from a legitimate concern but what distinguishes health scares is the disconnect between the level of perceived and actual risk. The first category of environmental contaminants involves instances where the pub­ lic believe they have been exposed to a noxious substance in the environment, such as infrasound from wind turbines or chemicals in drinking water. These exposures are unlikely to have a physical effect on health but people report symptoms due to the perception of harm (Crichton, Chapman, et al., 2014; David & Wessely, 1995). Health scares relating to exotic diseases occur when it is retrospectively determined that the catastrophic outcomes initially predicted when the disease first appeared did not occur. For example, the World Health Organisation (WHO) warned in 2004 that the bird flu virus could kill millions of people (Bird, 2005), however, to date there has been 457 deaths globally (WHO, 2023). Potentially this category represents an important dilemma that robust and effective prevention strategies that are used to contain an outbreak or virus could potentially increase anxiety and contribute to the creation of a health scare, as the public may see preventative measures as a sign of a severe and imminent health threat. Food scares involve concerns that additives in food or genetic modification cause health problems. Scares may also occur when there is a confirmed contamination case but the public responds by avoiding foods unrelated to the incident (Whitworth et al., MacKrill, Witthöft, Wessely, & Petrie 3 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ 2017). On a broader level various foods containing gluten, dairy, flavourings, lactose, and various additives, such as sulphites can also cause avoidance and anxiety from time to time (Haen, 2014; Vernia et al., 2010). A further category is comprised of scares involving malicious incidents. This category is characterised by targeted attacks on individuals that involve methods like radiation that could potentially impact the wider community and cause significant public anxiety, even if the actual risk of harm to the wider public is low. After the poisoning of the former Russian secret service agent Alexander Litvininko in London in 2006, a survey found 12% of Londoners believed their own health was at risk due to the Polonium Table 1 Taxonomy of Common Health Scare Areas With Examples of Health Concerns and Evidence for the Scare Health Scare Reference Examples Environmental contaminants Building ventilation/sick building Kinman & Griffin, 2008; Mendelson et al., 2000; Ooi & Goh, 1997 Water scares Banner, 2018; David & Wessely, 1995; Petrie & Wessely, 2004; Roy et al., 2023 Wind turbine infrasound Chapman et al., 2013; Crichton, Chapman, et al., 2014 Exotic diseases Swine flu Klemm et al., 2016 SARS Hooker, 2008; Tausczik et al., 2012 Food scares Genetically modified food Frewer et al., 2002; Shaw, 2002 Food contamination Jacob et al., 2011 Additives Bearth et al., 2014; Haen, 2014 Malicious incidents Anthrax Leask et al., 2003; Wills et al., 2008 Deliberate chemical or radiation poisoning Rubin et al., 2007; Rubin & Dickmann, 2010; Rubin et al., 2020 Medical treatments Amalgam fillings Dodes, 2001; Flanders, 1992; Molin, 1992 Generic drugs and medicine reformulation Boone et al., 2018; Faasse et al., 2009; Faasse et al., 2012; MacKrill et al., 2019 Hormone replacement therapy Bluming & Tavris, 2009; Haas et al., 2007 Public health interventions Vaccination programmes Burgess et al., 2006; MacKrill, 2023; Petts & Niemeyer, 2004 Water fluoridation Armfield, 2007; Carstairs & Elder, 2008; Howat et al., 2015 Radiation from technology Electromagnetic fields Rubin et al., 2010 Wi-Fi Bräscher et al., 2017; Bräscher et al., 2020; Witthöft & Rubin, 2013 5G Foster, 2019 Mobile phones and towers Burgess, 2004; Drake, 2006; INTERPHONE Study Group, 2010 Note. Adapted from MacKrill (2021). Health Scares 4 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ poisoning (Rubin et al., 2007). More recently following the deliberate poisoning of an ex-Russian intelligence officer and his daughter with Novichok in Salisbury, 19% of a sample of Salisbury locals reported avoiding the city despite it being a targeted rather than random event (Rubin et al., 2020). A large number of people with anxiety and dis­ tress-induced symptoms seek medical care following a terrorist attack or other malicious incident (Engel et al., 2007). Two categories relate to medical interventions, namely concerns about medical treatments, and worries about public health interventions. Scares involving medical treatments typically involve existing patient groups, where the treatment is subsequently revealed to have unexpected side effects or undergoes changes in ingredient formulation or appearance, which can elicit a nocebo response due to negative expectations (Faasse et al., 2009; Faasse et al., 2016). In regards to scares relating to public health interventions, these occur in non-patient groups receiving a medical treatment, such as in the case of large vaccination campaigns. This can foster worries and reluctance, as people experi­ ence no visible benefit, such as symptom reduction, and are instead exposing themselves or vulnerable others (such as in childhood vaccinations) to potential adverse reactions or the risk of unforeseen negative effects (Martin & Petrie, 2017; Petts & Niemeyer, 2004). Scares involving radiation from technology centre on the perceived harm of invisible electromagnetic fields, such as those from mobile phones, Wi-Fi or 5G, which do not have a physical effect no health (Rubin et al., 2010). A previous study has shown that when highly anxious participants are shown a television documentary about the possible health effects of Wi-Fi they are more likely to report symptoms after exposure to a sham Wi-Fi signal and to decide they were sensitive to electromagnetic fields (Witthöft & Rubin, 2013). The health scare taxonomy differentiates the primary areas of concern in seven main categories. Table 1 provides an illustration of the common health scares in each category, references to specific examples of health concerns, and evidence for the scare. However, we recognise this is to some extent an arbitrary categorisation. The categories could easily be divided further, which has been done for food scares by Page and colleagues (2006) and Whitworth et al. (2017) for environmental contaminations. It is important to note that health scares are typically wider and affect a greater number of people than incidents of mass psychogenic illness (MPI), which occur after a discrete event involving a closed community, such as a school or office building. Background Factors Health scares do not occur in a vacuum and are instead produced through the environ­ ment and social context that effects their development and spread. We term these the background factors, which shape an individual’s interpretation of threat and expectations about how their health may be affected. In this section we discuss a number of factors in MacKrill, Witthöft, Wessely, & Petrie 5 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ the contemporary social environment as well as individual factors that influence the im­ pact and spread of health scares, specifically: conspiracy theories, trust in governmental agencies, anxiety, modern health worries, and a wariness of chemicals. Conspiracy Theories While it is clear that conspiracy theories have been with us for as long as there have been theories, there is evidence that they increase during periods of uncertainty and threat as has been the experience for many during the COVID-19 pandemic (van Prooijen & Douglas, 2017). Often conspiracy theories, which ascribe events to malevolent people or powers, provide a ready-made explanation of events that may be threatening or anxiety provoking, providing a simplistic, albeit wrong, explanation of complex events (Aaronovitch, 2010). A conspiracy mentality, or the tendency to believe conspiracy theories, has impor­ tant health consequences and is likely to influence the spread of health scares. Oliver and Wood (2014) found medical conspiracy theories, such as the FDA is deliberately suppressing evidence about natural cures of cancer because of pressure from drug com­ panies, to be common in the US population. Conspiracy beliefs are associated with a wide range of health behaviours, such as preferences for organic food and avoidance of mainstream medicine (Oliver & Wood, 2014). There is evidence that the acceptance of conspiracy theories is associated with a shunning of vaccination (Jolley & Douglas, 2014) and lower adoption of recommended preventative actions against COVID-19 such as wearing a face mask (Romer & Jamieson, 2020). Trust in Governmental Agencies A similar influential factor is the degree to which people trust governmental agencies. Suspicion and distrust of government institutions makes reassurance from official chan­ nels less effective following a health scare (Uscinski et al., 2016). Distrust in the health­ care system is associated with a greater tendency to believe health misinformation (Scherer et al., 2021). In the Salisbury Novichok incident, lower trust in governmental agencies was associated with greater anxiety, perceived risk to self, and an increased likelihood of avoiding Salisbury (Rubin et al., 2020). Trust can also affect side effect reporting. In an experimental study, lower trust in pharmaceutical regulatory agencies was associated with a greater number of side effects being attributed to a placebo tablet (Webster et al., 2018). In a medicine brand change, lower trust in pharmaceutical agencies was associated with a lower belief in the efficacy of a new generic medicine (MacKrill & Petrie, 2018). Health Scares 6 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ Anxiety Anxiety is, by definition, associated with health scares. The publicization of health threats increases the general public’s anxiety but existing trait anxiety can be an impor­ tant background to factor in the development of health scares. Anxiety has a close relationship with the tendency to notice physical symptoms and to interpret them more negatively (Barsky et al., 2002; Watson & Pennebaker, 1989). It is this misattribution process that is key in health scares and research suggests individuals higher in anxiety not only experience a greater number of symptoms but there is a greater tendency to misattribute these to the effects of any given health scare (Faasse et al., 2009; Petrie et al., 2004; Witthöft & Rubin, 2013). Modern Health Worries Concerns related specifically to modernity or new technology have also been identified as a risk factor for health scares generally (Petrie et al., 2001). Modern health worries are surprisingly prevalent with a large proportion of people acknowledging concerns about the safety of food or the health effects of chemicals in household products. A German study found that 94% of people report some concerns about the effect of modernity on health and that this was associated with greater symptom reporting (Rief et al., 2012). Other studies have found higher levels of modern health worries to be associated with a greater use of organic food and alternative medicine (Devcich et al., 2007; Furnham, 2007). The influence of modern health worries in a particular health scare was exam­ ined in a prospective study looking at the health effects of an aerial pesticide spray programme to control an invasive moth species in New Zealand. Individuals with higher levels of modern health worries were found to attribute more symptoms to the spray programme and to also believe the spray caused more health problems for themselves, their children and pets compared to those with lower levels of modern health worries (Petrie et al., 2005). Wariness of Chemicals A related factor is an increase in the fear of chemicals or the association of chemicals with cancer, death and toxicity (Siegrist & Bearth, 2019). This has been called “toxico­ histrionics” (Banner, 2018) and is often associated with the belief that modern manufac­ turing produces products that have dangerous levels of chemical substances that are hazardous to health (Saleh et al., 2019) and may be particularly associated with water and food-related health scares. Negative attitudes towards chemicals are associated with a greater preference for natural foods (Dickson-Spillmann et al., 2011). People with high levels of concerns about chemical substances that are present in food or the environment often do not consider the importance of dose (the dose makes the poison) or that the dis­ tinction between synthetic and natural chemicals is irrelevant when assessing chemical MacKrill, Witthöft, Wessely, & Petrie 7 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ risk in food (Paarlberg, 2021) or water (Roy et al., 2023). It seems that this concern is increasing while the risk of such exposures has decreased over time (Entine, 2011). Incident Characteristics Background factors are only one part of the foundation required to develop health scares. Health-related worries on their own will not manifest symptoms, rather a threatening event is also required to influence bodily awareness and the misattribution of symptoms to a particular category of scare. For instance, worry about power lines did not influence symptom reporting for people who did not live next to high voltage transmission lines, whereas for those living in these areas, the most worried respondents were more likely to report health problems (McMahan & Meyer, 1995). It seems logical that background factors alone can’t create a health scare and that a threatening event is also necessary. However, not all health interventions or environmental events will be perceived as threatening. Incidents that often develop into larger health scares have certain character­ istics that instil worry. These characteristics include: being newly developed, not well understood or unseen threats, natural versus man-made, and out of personal control (MacKrill, 2021). Newly Developed A frequent unifying factor of many common examples of health scares is that the event or medical intervention is modern or newly developed. Through history it is evident that health scares often follow the advent of a new form of technology. When the bicycle was created in the 1880s it was believed that the riding position would cause hernias and curvature of the spine and that women in particular could become possessed by ‘cyclemania’ (Whorton, 1978). As the novelty of the technology begins to decline so does concern; it is now accepted that cycling conveys many health benefits. Anxiety and concerns surrounding modernity still exist but the focus has shifted towards the latest technological advancement such as 5G (Elwood & Wood, 2019). It should be noted that this can also include changes to existing familiar interventions, such as medications, that take on a new form or colour (Faasse et al., 2009). Not Understood and Unseen It is often the case with newly developed technology that the underlying science is not be well understood by lay people. The general public may believe that the safety of the intervention has not been proven and unidentified negative effects might still occur. An example here is the new mRNA COVID-19 vaccines that use new technology to produce an immune response. The public’s confusion and concern about the potential unknown effects of these interventions can be fuelled by the perception of ‘unseen’ harms. For Health Scares 8 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ example, these interventions are often described as an invisible danger and people can be concerned that they are being unknowingly exposed to a perceived health threat (e.g., Owens & Feldman, 2004; Reekie, 2017). This has also been the case for health scares about electromagnetic fields (EMFs), such as those from Wi-Fi, mobile phones and microwave ovens. Public discussion about the health effects of EMFs has focused on the radiation emitted, with claims that mobile phones or Wi-Fi can cause cancer (Swerdlow et al., 2011). Despite the widespread use of phones there has actually been a decrease in the diagnosis of brain and other nervous system cancers over the last 15 years in the United States (United States Food and Drug Administration, 2020). Confusion can be further exacerbated through factually correct albeit unclear information like the World Health Organisation (WHO) classifying mobile phones as “possibly carcinogenic” (WHO, 2014). While this sounds alarming to the general public, there are other normal, everyday things, like pickled vegetables and carpentry, that also share this classification. Man-Made Versus Natural In a similar vein is the differing perception of harm from natural versus man-made interventions. There is a common misconception that synthetic chemicals, at any con­ centration, are harmful (Entine, 2011). Chemicals of natural origin are perceived to be healthier and safer than synthetic chemicals, since the latter involve human intervention (Saleh et al., 2019). Even though a medicine’s efficacy and safety may be clinically proven, patients can be fearful of putting ‘unnatural chemicals’ into their bodies and instead turn to untested ‘natural’ remedies (Petrie & Wessely, 2002). Low Personal Control If a situation is perceived to be out of an individual’s control then this can also promote health scares. The perception of threat can be high when an incident is uncontrollable (Slovic, 1987). A feeling of lacking personal agency can occur through the government acting on behalf of the public. This is the case with water fluoridation, which despite the overwhelming evidence that fluoride is safe and effective at reducing tooth decay, is viewed as a violation of people’s rights not to be subjected to compulsory medication (Reekie, 2017). When compulsory vaccination was introduced in Britain in the mid-19th century, opponents claimed that people’s freedoms were being invaded by Parliament (Hussain et al., 2018). In mandatory medication switches from branded to generic medi­ cines there are often backlash as patients fear side effects from the new brand and per­ ceive their medicine options being removed due to a government cost-cutting strategy (Faasse et al., 2009). As a result, the nocebo effect frequently occurs in medicine brand changes (Weissenfeld et al., 2010). MacKrill, Witthöft, Wessely, & Petrie 9 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ Health Scare Spread The concerns about and nocebo reactions to a perceived health threat initially start as an individual response. However, these issues can grow and be spread to a wider population through traditional and social media. As will be discussed in the next sections, it is this spread and publicity that transforms a health incident to a health scare. Traditional Media It has been claimed that the traditional media, such as newspapers and television, can turn a health incident into a crisis (Doeg, 1995). The media is central in the dissemination of health alarms (Burgess, 2008) and health scares are frequently characterised by mass media reporting creating panic about a health issue or intervention (Guillaume & Bath, 2004). Observational studies clearly illustrate the impact of the media on spreading worry and adverse event reporting. Negative media coverage of the MMR vaccine by a local newspaper in the United Kingdom was associated with a decrease in vaccination rates by almost 14% in the area covered by the newspaper (Mason & Donnelly, 2000). Newspaper coverage of side effects was also found to be associated with an increase in adverse event reports from the HPV vaccination (Faasse et al., 2017). Media coverage discussing side effects from a generic antidepressant was associated with an increase in adverse event reporting, with television increasing the reporting rate by more than 210% compared to print media (MacKrill et al., 2019; MacKrill et al., 2020). Recently, the discussion of rare COVID-19 vaccine side effects in the media resulted in increased reporting of cardiac complaints, which were likely self-diagnosed (MacKrill, 2023). We identified two key factors responsible for the media’s ability to spread nocebo responding and anxiety about a health event: 1) the faming of the news item; and 2) the process of social modelling. The way the media frames issues can influence the public’s expectations about a health event. The media is often people’s first source of information about a health threat and because it is considered to be a trusted source, the reporting has the ability to shape long-lasting expectations (Guillaume & Bath, 2004). However, it is usually negative expectations that are developed, as the media is more interested in stories about an intervention causing harm than stories about benefit (Kitzinger, 1999). Tobert and Newman (2016) give the example of how “Statins have very few adverse effects” is not newsworthy, but “Cholesterol drugs taken by millions are dangerous” often is. This media focus has resulted in strong expectations in the general public that statins are associated muscle pain and other side effects, resulting in high discontinuation rates (Matthews et al., 2016). There is often an imbalance between how much media attention a health issue receives and its actual public health significance (Cooper & Roter, 2000). News articles about health threats disproportionately discuss toxic and environmental causes of illness, Health Scares 10 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ while neglecting lifestyle factors that are more common causes of illness (Frost et al., 1997). Even if experts or officials deny a link between a health event and an adverse reaction, the media have been known to report on an individual personal account of harm, allowing the perceived risk to enter public awareness (Kitzinger, 1998). Almost three quarters of British newspaper reports presented a mainly electromagnetic cause for complaints of symptoms from EMFs and used the experiences of particular people as examples (Eldridge-Thomas & Rubin, 2013). Repeated reporting of a health issue can also be detrimental. The availability heuris­ tic can influence people’s estimation of the probability of events due to how readily confirmatory examples can be brought to mind (Kahneman et al., 1982). When the media continuously highlights a health issue, examples of harm can be readily recalled causing people to overestimate its incidence (Gollust et al., 2019). Additionally, artificial balance can be created by the media. In the United Kingdom, the media often gave equal coverage to both sides of the MMR-autism debate, which led the public to assume there was equal evidence for each argument (Hargreaves et al., 2003). News stories often simplify a health issue (Seale, 2003). In the case of genetically modified food, media coverage reduced the complexity of this issue into a simple conflict between organic versus processed foods. Organic food has been framed as safe, natural and nutritious, while the alternatives that are created through new technology are artificial, threatening and untrustworthy, which has been linked to a rising anti-genetic modification attitude in the general public (Lockie, 2006). Media coverage is also able to spread adverse reaction reporting through the process of social modelling. It has been well documented in experimental placebo studies that seeing another person report side effects can influence the treatment outcome in the observer (Faasse & Petrie, 2013). Seeing a study confederate report side effects from a placebo tablet results in a reduced placebo effect as well as increased side effect reporting (Faasse et al., 2015). Similarly, after inhaling an inert substance described as a toxin, female participants reported more side effects if they saw a model also report side effects (Lorber et al., 2007; Mazzoni et al., 2010). Watching a model display more pain after a placebo cream was applied resulted in participants also reporting greater pain (Vögtle et al., 2013). Media coverage replicates this social modelling effect on a larger scale. The act of seeing someone in a media story report medication side effects can lead to increased expectations in the observer that they too will experience this response (Faasse & Petrie, 2016). When participants were shown television coverage of people reporting negative health effects from wind turbine noise, they reported more symptoms and of higher intensity than those who watched a neutral information video (Crichton, Dodd, et al., 2014). This effect has also been found in research investigating EMFs (Bräscher et al., 2017; Witthöft & Rubin, 2013; Witthöft et al., 2018). This can also occur with written information. Participants who read a leaflet containing media warnings about environ­ MacKrill, Witthöft, Wessely, & Petrie 11 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ mental pollution and a case example of someone with Multiple Chemical Sensitivity, reported more side effects after inhaling an inert substance than those who did not receive prior warning (Winters et al., 2003). Social Media More recently, social media has been a key medium in the spreading of negative beliefs about health interventions. Unlike traditional media, social media has allowed opponents of medical interventions to directly share their concerns, which are not required to factually accurate (Wilson & Keelan, 2013). For example, the vaccine-autism link has been shown to be discussed more frequently on social media than in online mainstream news sites (Jang et al., 2019). Similarly, in the 2014 Ebola crisis, news shared on the social media platform Reddit amplified panic and uncertainty surrounding Ebola, while traditional newspaper coverage was significantly less likely to produce panic-inducing coverage (Brown et al., 2019). In another study, mothers who do not support childhood vaccination were more likely to share opinions and negative information on social media compared to those who did support vaccination (McKeever et al., 2016). Negative health information appears to spread more readily on social media than accurate or positive public health appeals. An analysis of news stories on Twitter found that false stories spread faster and more broadly than true stories, potentially due to them containing more novel information (Vosoughi et al., 2018). Exposure to misinforma­ tion on the internet about health threats can lead to negative expectations, which further reinforces opposition (Crichton & Petrie, 2015). Conclusion and Future Directions This review provides the basis for how health scares are likely to develop and spread to wider populations. When a threatening incident occurs, background factors unique to an individual become more salient and influence expectations and health behaviours. Through examining health scare and nocebo effect literature, we identified specific influ­ ential background factors, namely conspiracy theories, trust in governmental agencies, anxiety, modern health worries, and a wariness of chemicals. Additionally, characteristics of incidents that appear to influence threat appraisals include being newly developed, not well understood or unseen threats, natural versus man-made, and out of personal control. Past research clearly shows that health concerns and adverse reactions can spread rapidly to a wider group of people through the attention of traditional and social media. This review has also provided a taxonomy to aid the grouping of health scares into common areas of concern. It is hoped that this taxonomy will help researchers differentiate between different types of health scares and encourage a greater analysis Health Scares 12 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ of how different factors way be involved in the development and resolution of specific scares. It is evident that more research is needed on interventions to reduce the development and spread of health scares, in particular identifying the characteristics of media stories that intensify the levels of public concern and increase the likelihood a story will be shared widely. A cardinal characteristic of health scares is the perceived level of risk is disproportional to the actual level of risk. Unlike many areas of health where researchers wish to increase the public’s attention to risky behaviour or substances, in the case of health scares the need is to develop effective strategies to increase reassurance and alleviate public concern. It may be beneficial to provide an additional explanation of how beliefs and concerns can manifest symptoms and be misattributed to a treatment or other exposure, as this has been shown to be effective at reducing anxiety and symptom reporting (Crichton, Chapman, et al., 2014; MacKrill et al., 2021). Social media has taken some steps to curb the spread of misinformation and scares by attaching a warning to posts that contain inaccurate information. In a similar vein, guidelines around the media’s reporting of side effects and potential health threats may be necessary in order to reduce the effect of social modelling and the spread of anxiety. There needs to be a balance between creating a newsworthy story but not needlessly exacerbating worries. Future research will further our understanding of the role of psychology in intensifying perceived health threats, which will aid the development of strategies to reduce the likelihood of health scares occurring in the future. Funding: The authors have no funding to report. Acknowledgments: The authors have no additional (i.e., non-financial) support to report. Competing Interests: The authors have declared that no competing interests exist. References Aaronovitch, D. (2010). Voodoo histories: How conspiracy theory has shaped modern history. Random House. Ahmed, W., Vidal-Alaball, J., Downing, J., & Seguí, F. L. (2020). COVID-19 and the 5G conspiracy theory: Social network analysis of Twitter data. Journal of Medical Internet Research, 22(5), Article e19458. https://doi.org/10.2196/19458 Armfield, J. M. (2007). When public action undermines public health: A critical examination of antifluoridationist literature. Australia and New Zealand Health Policy, 4(1), Article 25. https://doi.org/10.1186/1743-8462-4-25 Banner, W. (2018). “Toxicohistrionics”: Flint, Michigan and the lead crisis. The Journal of Pediatrics, 197, 15–16. https://doi.org/10.1016/j.jpeds.2018.03.008 MacKrill, Witthöft, Wessely, & Petrie 13 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://doi.org/10.2196/19458 https://doi.org/10.1186/1743-8462-4-25 https://doi.org/10.1016/j.jpeds.2018.03.008 https://www.psychopen.eu/ Barsky, A. J., Saintfort, R., Rogers, M. P., & Borus, J. F. (2002). Nonspecific medication side effects and the nocebo phenomenon. Journal of the American Medical Association, 287(5), 622–627. https://doi.org/10.1001/jama.287.5.622 Bearth, A., Cousin, M. E., & Siegrist, M. (2014). The consumer’s perception of artificial food additives: Influences on acceptance, risk and benefit perceptions. Food Quality and Preference, 38, 14–23. https://doi.org/10.1016/j.foodqual.2014.05.008 Bird, L. (2005). Bird flu scare. Nature Reviews Immunology, 5(1), Article 4. https://doi.org/10.1038/nri1539 Bluming, A. Z., & Tavris, C. (2009). Hormone replacement therapy: Real concerns and false alarms. Cancer Journal, 15(2), 93–104. https://doi.org/10.1097/PPO.0b013e31819e332a Boone, N. W., Liu, L., Romberg-Camps, M. J., Duijsens, L., Houwen, C., van der Kuy, P. H. M., Janknegt, R., Peeters, R., Landewé, R. B. M., Winkens, B., & van Bodegraven, A. A. (2018). The nocebo effect challenges the non-medical infliximab switch in practice. European Journal of Clinical Pharmacology, 74(5), 655–661. https://doi.org/10.1007/s00228-018-2418-4 Bräscher, A.-K., Raymaekers, K., Van den Bergh, O., & Witthöft, M. (2017). Are media reports able to cause somatic symptoms attributed to WiFi radiation? An experimental test of the negative expectation hypothesis. Environmental Research, 156, 265–271. https://doi.org/10.1016/j.envres.2017.03.040 Bräscher, A.-K., Schulz, S. M., Van den Bergh, O., & Witthöft, M. (2020). Prospective study of nocebo effects related to symptoms of idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). Environmental Research, 190, Article 110019. https://doi.org/10.1016/j.envres.2020.110019 Brown, D. K., Yoo, J., & Johnson, T. J. (2019). Spreading Ebola panic: Newspaper and social media coverage of the 2014 Ebola health crisis. Health Communication, 34(8), 811–817. https://doi.org/10.1080/10410236.2018.1437524 Burgess, A. (2004). Cellular phones, public fears, and a culture of precaution. Cambridge University Press. Burgess, A. (2008). Health scares and risk awareness. In D. Wainwright (Ed.), A sociology of health (pp. 56-75). Sage. Burgess, D. C., Burgess, M. A., & Leask, J. (2006). The MMR vaccination and autism controversy in United Kingdom 1998–2005: Inevitable community outrage or a failure of risk communication? Vaccine, 24(18), 3921–3928. https://doi.org/10.1016/j.vaccine.2006.02.033 Carstairs, C., & Elder, R. (2008). Expertise, health, and popular opinion: Debating water fluoridation, 1945–80. The Canadian Historical Review, 89(3), 345–371. https://doi.org/10.3138/chr.89.3.345 Chapman, S., St George, A., Waller, K., & Cakic, V. (2013). The pattern of complaints about Australian wind farms does not match the establishment and distribution of turbines: Support for the psychogenic ‘communicated disease’ hypothesis. PLoS One, 8, Article e76584. https://doi.org/10.1371/journal.pone.0076584 Health Scares 14 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://doi.org/10.1001/jama.287.5.622 https://doi.org/10.1016/j.foodqual.2014.05.008 https://doi.org/10.1038/nri1539 https://doi.org/10.1097/PPO.0b013e31819e332a https://doi.org/10.1007/s00228-018-2418-4 https://doi.org/10.1016/j.envres.2017.03.040 https://doi.org/10.1016/j.envres.2020.110019 https://doi.org/10.1080/10410236.2018.1437524 https://doi.org/10.1016/j.vaccine.2006.02.033 https://doi.org/10.3138/chr.89.3.345 https://doi.org/10.1371/journal.pone.0076584 https://www.psychopen.eu/ Cooper, C. P., & Roter, D. L. (2000). “If it bleeds it leads”? Attributes of TV health news stories that drive viewer attention. Public Health Reports, 115(4), Article 331. https://doi.org/10.1093/phr/115.4.331 Crichton, F., Chapman, S., Cundy, T., & Petrie, K. J. (2014). The link between health complaints and wind turbines: Support for the nocebo expectations hypothesis. Frontiers in Public Health, 2, Article 220. https://doi.org/10.3389/fpubh.2014.00220 Crichton, F., Dodd, G., Schmid, G., Gamble, G., & Petrie, K. J. (2014). The power of positive and negative expectations to influence reported symptoms and mood during exposure to wind farm sound. Health Psychology, 33(12), 1588–1592. https://doi.org/10.1037/hea0000037 Crichton, F., & Petrie, K. J. (2015). Accentuate the positive: Counteracting psychogenic responses to media health messages in the age of the Internet. Journal of Psychosomatic Research, 79(3), 185– 189. https://doi.org/10.1016/j.jpsychores.2015.04.014 David, A. S., & Wessely, S. C. (1995). The legend of Camelford: Medical consequences of a water pollution accident. Journal of Psychosomatic Research, 39(1), 1–9. https://doi.org/10.1016/0022-3999(94)00085-J Devcich, D. A., Pedersen, I. K., & Petrie, K. J. (2007). You eat what you are: Modern health worries and the acceptance of natural and synthetic additives in functional foods. Appetite, 48(3), 333– 337. https://doi.org/10.1016/j.appet.2006.09.014 Dickson-Spillmann, M., Siegrist, M., & Keller, C. (2011). Attitudes toward chemicals are associated with preference for natural food. Food Quality and Preference, 22(1), 149–156. https://doi.org/10.1016/j.foodqual.2010.09.001 Dodes, J. E. (2001). The amalgam controversy: An evidence-based analysis. The Journal of the American Dental Association, 132(3), 348–356. https://doi.org/10.14219/jada.archive.2001.0178 Doeg, C. (1995). Crisis management in the food and drinks industry. Chapman & Hall. Drake, F. (2006). Mobile phone masts: Protesting the scientific evidence. Public Understanding of Science, 15(4), 387–410. https://doi.org/10.1177/0963662506057246 Eldridge-Thomas, B., & Rubin, G. J. (2013). Idiopathic environmental intolerance attributed to electromagnetic fields: A content analysis of British newspaper reports. PLoS One, 8(6), Article e65713. https://doi.org/10.1371/journal.pone.0065713 Elwood, M., & Wood, A. W. (2019). Health effects of radiofrequency electromagnetic energy. The New Zealand Medical Journal, 132(1501), 64–72. Engel, C. C., Locke, S., Reissman, D. B., DeMartino, R., Kutz, I., McDonald, M., & Barsky, A. J. (2007). Terrorism, trauma, and mass casualty triage: How might we solve the latest mind-body problem? Biosecurity and Bioterrorism, 5(2), 155–163. https://doi.org/10.1089/bsp.2007.0004 Entine, J. (2011). Scared to death: How Chemophobia threatens public health. American Council on Science and Health. Faasse, K., Cundy, T., & Petrie, K. J. (2009). Thyroxine: Anatomy of a health scare. BMJ, 339, Article b5613. https://doi.org/10.1136/bmj.b5613 MacKrill, Witthöft, Wessely, & Petrie 15 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://doi.org/10.1093/phr/115.4.331 https://doi.org/10.3389/fpubh.2014.00220 https://doi.org/10.1037/hea0000037 https://doi.org/10.1016/j.jpsychores.2015.04.014 https://doi.org/10.1016/0022-3999(94)00085-J https://doi.org/10.1016/j.appet.2006.09.014 https://doi.org/10.1016/j.foodqual.2010.09.001 https://doi.org/10.14219/jada.archive.2001.0178 https://doi.org/10.1177/0963662506057246 https://doi.org/10.1371/journal.pone.0065713 https://doi.org/10.1089/bsp.2007.0004 https://doi.org/10.1136/bmj.b5613 https://www.psychopen.eu/ Faasse, K., Gamble, G., Cundy, T., & Petrie, K. J. (2012). Impact of television coverage on the number and type of symptoms reported during a health scare: A retrospective pre–post observational study. BMJ Open, 2(4), Article e001607. https://doi.org/10.1136/bmjopen-2012-001607 Faasse, K., Grey, A., Jordan, R., Garland, S., & Petrie, K. J. (2015). Seeing is believing: Impact of social modeling on placebo and nocebo responding. Health Psychology, 34(8), 880–885. https://doi.org/10.1037/hea0000199 Faasse, K., Martin, L. R., Grey, A., Gamble, G., & Petrie, K. J. (2016). Impact of brand or generic labeling on medication effectiveness and side effects. Health Psychology, 35(2), 187–190. https://doi.org/10.1037/hea0000282 Faasse, K., & Petrie, K. J. (2013). The nocebo effect: Patient expectations and medication side effects. Postgraduate Medical Journal, 89(1055), 540–546. https://doi.org/10.1136/postgradmedj-2012-131730 Faasse, K., & Petrie, K. J. (2016). From me to you: The effect of social modeling on treatment outcomes. Current Directions in Psychological Science, 25(6), 438–443. https://doi.org/10.1177/0963721416657316 Faasse, K., Porsius, J. T., Faasse, J., & Martin, L. R. (2017). Bad news: The influence of news coverage and Google searches on Gardasil adverse event reporting. Vaccine, 35(49), 6872–6878. https://doi.org/10.1016/j.vaccine.2017.10.004 Flanders, R. A. (1992). Mercury in dental amalgam – A public health concern? Journal of Public Health Dentistry, 52(5), 303–311. https://doi.org/10.1111/j.1752-7325.1992.tb02293.x Foster, K. R. (2019, September 16). 5G Is coming: How worried should we be about the health risks? Scientific American. https://blogs.scientificamerican.com/observations/5g-is-coming-how-worried-should-we-be- about-the-health-risks/ Frewer, L. J., Miles, S., & Marsh, R. (2002). The media and genetically modified foods: Evidence in support of social amplification of risk. Risk Analysis, 22(4), 701–711. https://doi.org/10.1111/0272-4332.00062 Frost, K., Frank, E., & Maibach, E. (1997). Relative risk in the news media: A quantification of misrepresentation. American Journal of Public Health, 87(5), 842–845. https://doi.org/10.2105/AJPH.87.5.842 Furnham, A. (2007). Are modern health worries, personality and attitudes to science associated with the use of complementary and alternative medicine? British Journal of Health Psychology, 12(2), 229–243. https://doi.org/10.1348/135910706X100593 Gollust, S. E., Fowler, E. F., & Niederdeppe, J. (2019). Television news coverage of public health issues and implications for public health policy and practice. Annual Review of Public Health, 40, 167–185. https://doi.org/10.1146/annurev-publhealth-040218-044017 Guillaume, L. R., & Bath, P. A. (2004). The impact of health scares on parents’ information needs and preferred information sources: A case study of the MMR vaccine scare. Health Informatics Journal, 10(1), 5–22. https://doi.org/10.1177/1460458204040664 Health Scares 16 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://doi.org/10.1136/bmjopen-2012-001607 https://doi.org/10.1037/hea0000199 https://doi.org/10.1037/hea0000282 https://doi.org/10.1136/postgradmedj-2012-131730 https://doi.org/10.1177/0963721416657316 https://doi.org/10.1016/j.vaccine.2017.10.004 https://doi.org/10.1111/j.1752-7325.1992.tb02293.x https://blogs.scientificamerican.com/observations/5g-is-coming-how-worried-should-we-be-about-the-health-risks/ https://blogs.scientificamerican.com/observations/5g-is-coming-how-worried-should-we-be-about-the-health-risks/ https://doi.org/10.1111/0272-4332.00062 https://doi.org/10.2105/AJPH.87.5.842 https://doi.org/10.1348/135910706X100593 https://doi.org/10.1146/annurev-publhealth-040218-044017 https://doi.org/10.1177/1460458204040664 https://www.psychopen.eu/ Haas, J. S., Miglioretti, D. L., Geller, B., Buist, D. S., Nelson, D. E., Kerlikowske, K., Carney, P. A., Dash, S., Breslau, E. S., & Ballard-Barbash, R. (2007). Average household exposure to newspaper coverage about the harmful effects of hormone therapy and population-based declines in hormone therapy use. Journal of General Internal Medicine, 22(1), 68–73. https://doi.org/10.1007/s11606-007-0122-7 Haen, D. (2014). The paradox of E-numbers: Ethical, aesthetic, and cultural concerns in the Dutch discourse on food additives. Journal of Agricultural & Environmental Ethics, 27(1), 27–42. https://doi.org/10.1007/s10806-013-9440-4 Hargreaves, I. L., Lewis, J., & Speers, T. (2003). Towards a better map: Science, the public and the media. Economic and Social Research Council. Hooker, C. (2008). SARS as a health scare. In H. Ali & R. Keil (Eds.), Networked disease: Emerging infectious disease in the global city (pp. 123-137). Wiley-Blackwell. Hooker, C. (2010). Health scares: Professional priorities. Health, 14(1), 3–21. https://doi.org/10.1177/1363459309341875 Howat, P., Binns, C., & Jancey, J. (2015). New international review supports community water fluoridation as an effective and safe dental health promotion measure. Health Promotion Journal of Australia, 26(1), 1–3. https://doi.org/10.1071/HEv26n1_ED Hussain, A., Ali, S., Ahmed, M., & Hussain, S. (2018). The anti-vaccination movement: A regression in modern medicine. Cureus, 10(7), Article e2919. https://doi.org/10.7759/cureus.2919 INTERPHONE Study Group. (2010). Brain tumour risk in relation to mobile telephone use: Results of the INTERPHONE international case–control study. International Journal of Epidemiology, 39(3), 675–694. https://doi.org/10.1093/ije/dyq079 Jacob, C. J., Lok, C., Morley, K., & Powell, D. A. (2011). Government management of two media- facilitated crises involving dioxin contamination of food. Public Understanding of Science, 20(2), 261–269. https://doi.org/10.1177/0963662509355737 Jang, S. M., Mckeever, B. W., Mckeever, R., & Kim, J. K. (2019). From social media to mainstream news: The information flow of the vaccine-autism controversy in the US, Canada, and the UK. Health Communication, 34(1), 110–117. https://doi.org/10.1080/10410236.2017.1384433 Jolley, D., & Douglas, K. M. (2014). The effects of anti-vaccine conspiracy theories on vaccination intentions. PLoS One, 9(2), Article e89177. https://doi.org/10.1371/journal.pone.0089177 Kahneman, D., Slovic, P., & Tversky, A. (Eds.). (1982). Judgment under uncertainty: Heuristics and biases. Cambridge University Press. Kinman, G., & Griffin, M. (2008). Psychosocial factors and gender as predictors of symptoms associated with sick building syndrome. Stress and Health, 24(2), 165–171. https://doi.org/10.1002/smi.1175 Kitzinger, J. (1998). Silenced voices and false memories. In C. Carter, G. Branston, & S. Allan (Eds.), News, gender, and power (pp. 186-204). Routledge. Kitzinger, J. (1999). Researching risk and the media. Health Risk & Society, 1(1), 55–69. https://doi.org/10.1080/13698579908407007 MacKrill, Witthöft, Wessely, & Petrie 17 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://doi.org/10.1007/s11606-007-0122-7 https://doi.org/10.1007/s10806-013-9440-4 https://doi.org/10.1177/1363459309341875 https://doi.org/10.1071/HEv26n1_ED https://doi.org/10.7759/cureus.2919 https://doi.org/10.1093/ije/dyq079 https://doi.org/10.1177/0963662509355737 https://doi.org/10.1080/10410236.2017.1384433 https://doi.org/10.1371/journal.pone.0089177 https://doi.org/10.1002/smi.1175 https://doi.org/10.1080/13698579908407007 https://www.psychopen.eu/ Klemm, C., Das, E., & Hartmann, T. (2016). Swine flu and hype: A systematic review of media dramatization of the H1N1 influenza pandemic. Journal of Risk Research, 19(1), 1–20. https://doi.org/10.1080/13669877.2014.923029 Leask, A., Delpech, V., & McAnulty, J. (2003). Anthrax and other suspect powders: Initial responses to an outbreak of hoaxes and scares. New South Wales Public Health Bulletin, 14(12), 218–221. https://doi.org/10.1071/NB03059 Lockie, S. (2006). Capturing the sustainability agenda: Organic foods and media discourses on food scares, environment, genetic engineering, and health. Agriculture and Human Values, 23(3), 313–323. https://doi.org/10.1007/s10460-006-9007-3 Lorber, W., Mazzoni, G., & Kirsch, I. (2007). Illness by suggestion: Expectancy, modeling, and gender in the production of psychosomatic symptoms. Annals of Behavioral Medicine, 33(1), 112–116. https://doi.org/10.1207/s15324796abm3301_13 MacKrill, K. (2021). Improving the understanding and measurement of the nocebo effect [Doctoral thesis, The University of Auckland]. ResearchSpace@Auckland. https://hdl.handle.net/2292/57853 MacKrill, K. (2023). Impact of media coverage on side effect reports from the COVID-19 vaccine. Journal of Psychosomatic Research, 164, Article 111093. https://doi.org/10.1016/j.jpsychores.2022.111093 MacKrill, K., Gamble, G. D., Bean, D. J., Cundy, T., & Petrie, K. J. (2019). Evidence of a media- induced nocebo response following a nationwide antidepressant drug switch. Clinical Psychology in Europe, 1(1), Article e29642. https://doi.org/10.32872/cpe.v1i1.29642 MacKrill, K., Gamble, G. D., & Petrie, K. (2020). The effect of television and print news stories on the nocebo responding following a generic medication switch. Clinical Psychology in Europe, 2(2), Article e2623. https://doi.org/10.32872/cpe.v2i2.2623 MacKrill, K., Morrison, Z., & Petrie, K. J. (2021). Increasing and dampening the nocebo response following medicine-taking: A randomised controlled trial. Journal of Psychosomatic Research, 150, Article 110630. https://doi.org/10.1016/j.jpsychores.2021.110630 MacKrill, K., & Petrie, K. J. (2018). What is associated with increased side effects and lower perceived efficacy following switching to a generic medicine? A New Zealand cross-sectional patient survey. BMJ Open, 8(10), Article e023667. https://doi.org/10.1136/bmjopen-2018-023667 Martin, L. R., & Petrie, K. J. (2017). Understanding the dimensions of anti-vaccination attitudes: The Vaccination Attitudes Examination (VAX) Scale. Annals of Behavioral Medicine, 51(5), 652–660. https://doi.org/10.1007/s12160-017-9888-y Mason, B. W., & Donnelly, P. D. (2000). Impact of a local newspaper campaign on the uptake of the measles mumps and rubella vaccine. Journal of Epidemiology and Community Health, 54(6), 473–474. https://doi.org/10.1136/jech.54.6.473 Matthews, A., Herrett, E., Gasparrini, A., Van Staa, T., Goldacre, B., Smeeth, L., & Bhaskaran, K. (2016). Impact of statin related media coverage on use of statins: Interrupted time series analysis with UK primary care data. BMJ, 353, Article i3283. https://doi.org/10.1136/bmj.i3283 Health Scares 18 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://doi.org/10.1080/13669877.2014.923029 https://doi.org/10.1071/NB03059 https://doi.org/10.1007/s10460-006-9007-3 https://doi.org/10.1207/s15324796abm3301_13 https://hdl.handle.net/2292/57853 https://doi.org/10.1016/j.jpsychores.2022.111093 https://doi.org/10.32872/cpe.v1i1.29642 https://doi.org/10.32872/cpe.v2i2.2623 https://doi.org/10.1016/j.jpsychores.2021.110630 https://doi.org/10.1136/bmjopen-2018-023667 https://doi.org/10.1007/s12160-017-9888-y https://doi.org/10.1136/jech.54.6.473 https://doi.org/10.1136/bmj.i3283 https://www.psychopen.eu/ Mazzoni, G., Foan, L., Hyland, M. E., & Kirsch, I. (2010). The effects of observation and gender on psychogenic symptoms. Health Psychology, 29(2), 181–185. https://doi.org/10.1037/a0017860 McKeever, B. W., McKeever, R., Holton, A. E., & Li, J.-Y. (2016). Silent majority: Childhood vaccinations and antecedents to communicative action. Mass Communication and Society, 19(4), 476–498. https://doi.org/10.1080/15205436.2016.1148172 McMahan, S., & Meyer, J. A. (1995). Symptom prevalence and worry about high voltage transmission lines. Environmental Research, 70(2), 114–118. https://doi.org/10.1006/enrs.1995.1055 Mendelson, M. B., Catano, V. M., & Kelloway, K. (2000). The role of stress and social support in Sick Building Syndrome. Work and Stress, 14(2), 137–155. https://doi.org/10.1080/026783700750051658 Molin, C. (1992). Amalgam – Fact and fiction. European Journal of Oral Sciences, 100(1), 66–73. https://doi.org/10.1111/j.1600-0722.1992.tb01811.x Oliver, J. E., & Wood, T. (2014). Medical conspiracy theories and health behaviors in the United States. JAMA Internal Medicine, 174(5), 817–818. https://doi.org/10.1001/jamainternmed.2014.190 Ooi, P. L., & Goh, K. T. (1997). Sick building syndrome: An emerging stress-related disorder? International Journal of Epidemiology, 26(6), 1243–1249. https://doi.org/10.1093/ije/26.6.1243 Owens, K., & Feldman, J. (2004). Getting the drift on chemical trespass. Pesticides and You, 24(2), 16– 21. Paarlberg, R. (2021). Resetting the table: Straight talk about the food we grow and eat. Knopf. Page, L. A., Petrie, K. J., & Wessely, S. C. (2006). Psychosocial responses to environmental incidents: A review and proposed typology. Journal of Psychosomatic Research, 60(4), 413–422. https://doi.org/10.1016/j.jpsychores.2005.11.008 Paytubi, S., Benavente, Y., Montoliu, A., Binefa, G., Brotons, M., Ibanez, R., Ochoa, C., Peremiquel- Trillas, P., Serrano, B., Travier, N., Alemany, L., & Costas, L. (2022). Everything causes cancer? Beliefs and attitudes towards cancer prevention among anti-vaxxers, flat earthers, and reptilian conspiracists: Online cross sectional survey. BMJ, 379, Article e072561. https://doi.org/10.1136/bmj-2022-072561 Petrie, K. J., Broadbent, E. A., Kley, N., Moss-Morris, R., Horne, R., & Rief, W. (2005). Worries about modernity predict symptom complaints after environmental pesticide spraying. Psychosomatic Medicine, 67(5), 778–782. https://doi.org/10.1097/01.psy.0000181277.48575.a4 Petrie, K. J., Moss-Morris, R., Grey, C., & Shaw, M. (2004). The relationship of negative affect and perceived sensitivity to symptom reporting following vaccination. British Journal of Health Psychology, 9(1), 101–111. https://doi.org/10.1348/135910704322778759 Petrie, K. J., & Rief, W. (2019). Psychobiological mechanisms of placebo and nocebo effects: Pathways to improve treatments and reduce side effects. Annual Review of Psychology, 70(1), 599–625. https://doi.org/10.1146/annurev-psych-010418-102907 Petrie, K. J., Sivertsen, B., Hysing, M., Broadbent, E., Moss-Morris, R., Eriksen, H. R., & Ursin, H. (2001). Thoroughly modern worries: The relationship of worries about modernity to reported MacKrill, Witthöft, Wessely, & Petrie 19 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://doi.org/10.1037/a0017860 https://doi.org/10.1080/15205436.2016.1148172 https://doi.org/10.1006/enrs.1995.1055 https://doi.org/10.1080/026783700750051658 https://doi.org/10.1111/j.1600-0722.1992.tb01811.x https://doi.org/10.1001/jamainternmed.2014.190 https://doi.org/10.1093/ije/26.6.1243 https://doi.org/10.1016/j.jpsychores.2005.11.008 https://doi.org/10.1136/bmj-2022-072561 https://doi.org/10.1097/01.psy.0000181277.48575.a4 https://doi.org/10.1348/135910704322778759 https://doi.org/10.1146/annurev-psych-010418-102907 https://www.psychopen.eu/ symptoms, health and medical care utilization. Journal of Psychosomatic Research, 51(1), 395– 401. https://doi.org/10.1016/S0022-3999(01)00219-7 Petrie, K. J., & Wessely, S. (2002). Modern worries, new technology, and medicine. BMJ, 324, Article 690. https://doi.org/10.1136/bmj.324.7339.690 Petrie, K. J., & Wessely, S. (2004). Getting well from water. BMJ, 329, Article 1417. https://doi.org/10.1136/bmj.329.7480.1417 Petts, J., & Niemeyer, S. (2004). Health risk communication and amplification: Learning from the MMR vaccination controversy. Health Risk & Society, 6(1), 7–23. https://doi.org/10.1080/13698570410001678284 Reekie, D. (2017). Fear of fluoride. British Dental Journal, 222(1), 16–18. https://doi.org/10.1038/sj.bdj.2017.23 Rief, W., Glaesmer, H., Baehr, V., Broadbent, E., Brähler, E., & Petrie, K. J. (2012). The relationship of modern health worries to depression, symptom reporting and quality of life in a general population survey. Journal of Psychosomatic Research, 72(4), 318–320. https://doi.org/10.1016/j.jpsychores.2011.11.017 Romer, D., & Jamieson, J. H. (2020). Conspiracy theories as a barrier to controlling the spread of COVID-19 in the U.S. Social Science & Medicine, 263, Article 113356. https://doi.org/10.1016/j.socscimed.2020.113356 Roy, S., Petrie, K. J., Gamble, G., & Edwards, M. A. (2023). Did a nocebo effect contribute to the rise in special education enrollment following the Flint, Michigan Water Crisis? Clinical Psychology in Europe, 5(1), Article e9577. https://doi.org/10.32872/cpe.9577 Rubin, G. J., & Dickmann, P. (2010). How to reduce the impact of “low-risk patients” following a bioterrorist incident: Lessons from SARS, anthrax, and pneumonic plague. Biosecurity and Bioterrorism, 8(1), 37–43. https://doi.org/10.1089/bsp.2009.0059 Rubin, G. J., Nieto‐Hernandez, R., & Wessely, S. (2010). Idiopathic environmental intolerance attributed to electromagnetic fields (formerly ‘electromagnetic hypersensitivity’): An updated systematic review of provocation studies. Bioelectromagnetics, 31(1), 1–11. https://doi.org/10.1002/bem.20536 Rubin, G. J., Page, L., Morgan, O., Pinder, R. J., Riley, P., Hatch, S., Maguire, H., Catchpole, M., Simpson, J., & Wessely, S. (2007). Public information needs after the poisoning of Alexander Litvinenko with polonium-210 in London: Cross sectional telephone survey and qualitative analysis. BMJ, 335(7630), Article 1143. https://doi.org/10.1136/bmj.39367.455243.BE Rubin, G. J., Webster, R., Amlot, R., Carter, H., Weston, D., & Wessely, S. (2020). Public responses to the Salisbury Novichok incident: A cross-sectional survey of anxiety, anger, uncertainty, perceived risk and avoidance behaviour in the local community. BMJ Open, 10(9), Article e036071. https://doi.org/10.1136/bmjopen-2019-036071 Saleh, R., Bearth, A., & Siegrist, M. (2019). “Chemophobia” today: Consumers’ knowledge and perceptions of chemicals. Risk Analysis, 39(12), 2668–2682. https://doi.org/10.1111/risa.13375 Sanders, L. (2020, May 27). The difference between what Republicans and Democrats believe to be true about COVID-19. YouGov. Health Scares 20 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://doi.org/10.1016/S0022-3999(01)00219-7 https://doi.org/10.1136/bmj.324.7339.690 https://doi.org/10.1136/bmj.329.7480.1417 https://doi.org/10.1080/13698570410001678284 https://doi.org/10.1038/sj.bdj.2017.23 https://doi.org/10.1016/j.jpsychores.2011.11.017 https://doi.org/10.1016/j.socscimed.2020.113356 https://doi.org/10.32872/cpe.9577 https://doi.org/10.1089/bsp.2009.0059 https://doi.org/10.1002/bem.20536 https://doi.org/10.1136/bmj.39367.455243.BE https://doi.org/10.1136/bmjopen-2019-036071 https://doi.org/10.1111/risa.13375 https://www.psychopen.eu/ https://today.yougov.com/topics/politics/articles-reports/2020/05/26/republicans-democrats- misinformation Scherer, L. D., McPhetres, J., Pennycook, G., Kempe, A., Allen, L. A., Knoepke, C. E., Tate, C. E., & Matlock, D. D. (2021). Who is susceptible to online health misinformation? A test of four psychosocial hypotheses. Health Psychology, 40(4), 274–284. https://doi.org/10.1037/hea0000978 Seale, C. (2003). Health and media: An overview. Sociology of Health & Illness, 25(6), 513–531. https://doi.org/10.1111/1467-9566.t01-1-00356 Shaw, A. (2002). “It just goes against the grain.” Public understandings of genetically modified (GM) food in the UK. Public Understanding of Science, 11(3), 273–291. https://doi.org/10.1088/0963-6625/11/3/305 Siegrist, M., & Bearth, A. (2019). Chemophobia in Europe and reasons for biased risk perceptions. Nature Chemistry, 11(12), 1071–1072. https://doi.org/10.1038/s41557-019-0377-8 Slovic, P. (1987). Perception of risk. Science, 236(4799), 280–285. https://doi.org/10.1126/science.3563507 Southwell, B. G., Niederdeppe, J., Cappella, J. N., Gaysynsky, A., Kelley, D. E., Oh, A., Peterson, E. B., & Chou, W. S. (2019). Misinformation as a misunderstood challenge to public health. American Journal of Preventive Medicine, 57(2), 282–285. https://doi.org/10.1016/j.amepre.2019.03.009 Swerdlow, A. J., Feychting, M., Green, A. C., Kheifets, L., Savitz, D. A., & International Commission for Non-Ionizing Radiation Protection Standing Committee on Epidemiology. (2011). Mobile phones, brain tumors, and the interphone study: Where are we now? Environmental Health Perspectives, 119(11), 1534–1538. https://doi.org/10.1289/ehp.1103693 Tausczik, Y., Faasse, K., Pennebaker, J. W., & Petrie, K. J. (2012). Changes in anxiety and information seeking following the H1N1 outbreak: An analysis of web blogs and Wikipedia Searches. Journal of Health Communication, 27(2), 179–185. https://doi.org/10.1080/10410236.2011.571759 Tobert, J. A., & Newman, C. B. (2016). The nocebo effect in the context of statin intolerance. Journal of Clinical Lipidology, 10(4), 739–747. https://doi.org/10.1016/j.jacl.2016.05.002 United States Food and Drug Administration. (2020). Do cell phones pose a health hazard? https://www.fda.gov/radiation-emitting-products/cell-phones/do-cell-phones-pose-health- hazard Uscinski, J. E., Klofstad, C., & Atkinson, M. D. (2016). What drives conspiratorial beliefs? The role of informational cues and predispositions. Political Research Quarterly, 69(1), 57–71. https://doi.org/10.1177/1065912915621621 van Prooijen, J.-W., & Douglas, K. M. (2017). Conspiracy theories as part of history: The role of societal crisis situations. Memory Studies, 10(3), 323–333. https://doi.org/10.1177/1750698017701615 Vernia, P., Di Camillo, M., Foglietta, T., Avallone, V. E., & De Carolis, A. (2010). Diagnosis of lactose intolerance and the “nocebo” effect: The role of negative expectations. Digestive and Liver Disease, 42(9), 616–619. https://doi.org/10.1016/j.dld.2010.02.005 MacKrill, Witthöft, Wessely, & Petrie 21 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://today.yougov.com/topics/politics/articles-reports/2020/05/26/republicans-democrats-misinformation https://today.yougov.com/topics/politics/articles-reports/2020/05/26/republicans-democrats-misinformation https://doi.org/10.1037/hea0000978 https://doi.org/10.1111/1467-9566.t01-1-00356 https://doi.org/10.1088/0963-6625/11/3/305 https://doi.org/10.1038/s41557-019-0377-8 https://doi.org/10.1126/science.3563507 https://doi.org/10.1016/j.amepre.2019.03.009 https://doi.org/10.1289/ehp.1103693 https://doi.org/10.1080/10410236.2011.571759 https://doi.org/10.1016/j.jacl.2016.05.002 https://www.fda.gov/radiation-emitting-products/cell-phones/do-cell-phones-pose-health-hazard https://www.fda.gov/radiation-emitting-products/cell-phones/do-cell-phones-pose-health-hazard https://doi.org/10.1177/1065912915621621 https://doi.org/10.1177/1750698017701615 https://doi.org/10.1016/j.dld.2010.02.005 https://www.psychopen.eu/ Vögtle, E., Barke, A., & Kröner-Herwig, B. (2013). Nocebo hyperalgesia induced by social observational learning. Pain, 154(8), 1427–1433. https://doi.org/10.1016/j.pain.2013.04.041 Vosoughi, S., Roy, D., & Aral, S. (2018). The spread of true and false news online. Science, 359(6380), 1146–1151. https://doi.org/10.1126/science.aap9559 Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress and distress: Exploring the central role of negative affectivity. Psychological Review, 96(2), 234–254. https://doi.org/10.1037/0033-295X.96.2.234 Webster, R. K., Weinman, J., & Rubin, G. J. (2018). Medicine‐related beliefs predict attribution of symptoms to a sham medicine: A prospective study. British Journal of Health Psychology, 23(2), 436–454. https://doi.org/10.1111/bjhp.12298 Weissenfeld, J., Stock, S., Lüngen, M., & Gerber, A. (2010). The nocebo effect: A reason for patients’ non-adherence to generic substitution? Die Pharmazie – An International. Journal of Pharmaceutical Sciences, 65(7), 451–456. https://doi.org/10.1691/ph.2010.9749 Whitworth, E., Druckman, A., & Woodward, A. (2017). Food scares: A comprehensive categorisation. British Food Journal, 119(1), 131–142. https://doi.org/10.1108/BFJ-06-2016-0263 Whorton, J. C. (1978). The hygiene of the wheel: An episode in Victorian sanitary science. Bulletin of the History of Medicine, 52(1), 61–88. Wills, B., Leikin, J. B., Rhee, J., Tameling, C., & Saeedi, B. (2008). Analysis of suspicious powders following the post 9/11 anthrax scare. Journal of Medical Toxicology, 4(2), 93–95. https://doi.org/10.1007/BF03160961 Wilson, K., & Keelan, J. (2013). Social media and the empowering of opponents of medical technologies: The case of anti-vaccinationism. Journal of Medical Internet Research, 15(5), Article e103. https://doi.org/10.2196/jmir.2409 Winters, W., Devriese, S., Van Diest, I., Nemery, B., Veulemans, H., Eelen, P., Van de Woestijne, K., & Van den Bergh, O. (2003). Media warnings about environmental pollution facilitate the acquisition of symptoms in response to chemical substances. Psychosomatic Medicine, 65(3), 332–338. https://doi.org/10.1097/01.PSY.0000041468.75064.BE Witthöft, M., Freitag, I., Nußbaum, C., Bräscher, A.-K., Jasper, F., Bailer, J., & Rubin, G. J. (2018). On the origin of worries about modern health hazards: Experimental evidence for a conjoint influence of media reports and personality traits. Psychology & Health, 33(3), 361–380. https://doi.org/10.1080/08870446.2017.1357814 Witthöft, M., & Rubin, G. J. (2013). Are media warnings about the adverse health effects of modern life self-fulfilling? An experimental study on idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). Journal of Psychosomatic Research, 74(3), 206–212. https://doi.org/10.1016/j.jpsychores.2012.12.002 World Health Organisation. (2014). Electromagnetic fields and public health: Mobile phones. https://www.who.int/news-room/fact-sheets/detail/electromagnetic-fields-and-public-health- mobile-phones World Health Organisation. (2023, January 6). Avian Influenza Weekly Update Number 877. https://iris.who.int/bitstream/handle/10665/365675/AI-20230106.pdf Health Scares 22 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://doi.org/10.1016/j.pain.2013.04.041 https://doi.org/10.1126/science.aap9559 https://doi.org/10.1037/0033-295X.96.2.234 https://doi.org/10.1111/bjhp.12298 https://doi.org/10.1691/ph.2010.9749 https://doi.org/10.1108/BFJ-06-2016-0263 https://doi.org/10.1007/BF03160961 https://doi.org/10.2196/jmir.2409 https://doi.org/10.1097/01.PSY.0000041468.75064.BE https://doi.org/10.1080/08870446.2017.1357814 https://doi.org/10.1016/j.jpsychores.2012.12.002 https://www.who.int/news-room/fact-sheets/detail/electromagnetic-fields-and-public-health-mobile-phones https://www.who.int/news-room/fact-sheets/detail/electromagnetic-fields-and-public-health-mobile-phones https://iris.who.int/bitstream/handle/10665/365675/AI-20230106.pdf https://www.psychopen.eu/ Clinical Psychology in Europe (CPE) is the official journal of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT). PsychOpen GOLD is a publishing service by Leibniz Institute for Psychology (ZPID), Germany. MacKrill, Witthöft, Wessely, & Petrie 23 Clinical Psychology in Europe 2023, Vol. 5(4), Article e12209 https://doi.org/10.32872/cpe.12209 https://www.psychopen.eu/ Health Scares (Introduction) Taxonomy of Health Scares Background Factors Conspiracy Theories Trust in Governmental Agencies Anxiety Modern Health Worries Wariness of Chemicals Incident Characteristics Newly Developed Not Understood and Unseen Man-Made Versus Natural Low Personal Control Health Scare Spread Traditional Media Social Media Conclusion and Future Directions (Additional Information) Funding Acknowledgments Competing Interests References