Chemical exposure : european citizens’ perspectives, trust, and concerns on human biomonitoring initiatives, information needs, and scientific results

International Journal of Environmental Research and Public Health Article Chemical Exposure: European Citizens’ Perspectives, Trust, and Concerns on Human Biomonitoring Initiatives, Information Needs, and Scientific Results Maria Uhl 1,*, Ricardo R. Santos 2, Joana Costa 2, Osvaldo Santos 2,3, Ana Virgolino 2, David S. Evans 4, Cora Murray 5, Maurice Mulcahy 5, Dorothy Ubong 6, Ovnair Sepai 6, Joana Lobo Vicente 7, Michaela Leitner 1, Silvia Benda-Kahri 1and Daniela Zanini-Freitag 1,*   Citation: Uhl, M.; Santos, R.R.; Costa, J.; Santos, O.; Virgolino, A.; Evans, D.S.; Murray, C.; Mulcahy, M.; Ubong, D.; Sepai, O.; et al. Chemical Exposure: European Citizens’ Perspectives, Trust, and Concerns on Human Biomonitoring Initiatives, Information Needs, and Scientific Results. Int. J. Environ. Res. Public Health 2021,18, 1532. https:// doi.org/10.3390/ijerph18041532 Academic Editor: Juan Pedro Arrebola Received: 22 December 2020 Accepted: 27 January 2021 Published: 5 February 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1Environment Agency Austria, 1090 Vienna, Austria; [email protected] (M.L.); [email protected] (S.B.-K.) 2Environmental Health Behaviour Lab, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; ricardor[email protected] (R.R.S.); [email protected] (J.C.); [email protected] (O.S.); [email protected] (A.V.) 3Unbreakable Idea Research, 2550-426 Painho, Portugal 4Health Service Executive, Department of Public Health, Merlin Park Regional Hospital, H91N973 Galway, Ireland; [email protected] 5Health Service Executive, Environmental Health Service, H91EW40 Galway, Ireland; [email protected] (C.M.); [email protected] (M.M.) 6Public Health England, London SE1 8UG, UK; dorothy[email protected].uk (D.U.); ovnair[email protected].uk (O.S.) 7European Environment Agency, 1050 Copenhagen, Denmark; [email protected] * Correspondence: [email protected] (M.U.); [email protected] (D.Z.-F.); Tel.: +43-1-313043605 (M.U.); +43-1-313043468 (D.Z.-F.) Abstract: Over the last few decades, citizen awareness and perception of chemical products has been a topic of interest, particularly concerning national and international policy decision makers, expert/scientific platforms, and the European Union itself. To date, few qualitative studies on human biomonitoring have analysed communication materials, made recommendations in terms of biomonitoring surveillance, or asked for feedback in terms of specific biomonitoring methods. This paper provides in-depth insight on citizens’ perceptions of knowledge of biomonitoring, impact of chemical exposure on daily life, and claims on how results of research should be used. Four semi-structured focus groups were held in Austria, Portugal, Ireland, and the United Kingdom (UK). The cross-sectional observational qualitative design of this study allows for better understanding of public concern regarding chemicals, application, and use of human biomonitoring. The main findings of this study include citizens’ clear articulation on pathways of exposure, the demand on stakeholders for transparent decision-making, and sensitivity in communication of results to the public. Validated and trustful communication is perceived as key to empowering citizens to take action. The results can be used to facilitate decision-making and policy development, and feeds into the awareness needs of similar and future projects in human biomonitoring. Furthermore, it also brings to light ideas and concepts of citizens’ in shaping collaborative knowledge between citizens’, experts, scientists, and policy makers on equal terms. Keywords: human biomonitoring; focus group; citizen reflections; chemical exposure; policy decision making 1. Introduction Citizens are exposed to a wide range of environmental chemicals in their daily lives, in different contexts and via multiple routes, including indoors and outdoors (e.g., air, soil, and water contamination [ 1 , 2 ]; consumer products (e.g., cosmetics, cleaning agents, textiles) [ 3 – 5 ]; food, as chemicals are widely used in food production (e.g., antimicrobial Int. J. Environ. Res. Public Health 2021,18, 1532. https://doi.org/10.3390/ijerph18041532 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021,18, 1532 2 of 17 drugs in food-producing animals [ 6 ], including pesticides to control pests that affect crop production [ 7 ], food packaging [ 8 ], and pollinators which are directly involved in around one-third of global food production [ 9 ]); drinking water [ 10 ]; and at work [ 11 , 12 ]. Increased vulnerability to chemical exposure occurs during childhood [ 13 ] and pregnancy [ 14 , 15 ], which may impair lifetime health [16]. According to the Special Eurobarometer 456: Chemical Safety (with considerable variation by member states), 65% of citizens from 28 European Union (EU) member states are “a little” or “very much” concerned about being exposed to chemicals in their daily lives, while 45% of the respondents felt well informed about the potential dangers of chemicals included in consumer products. Perceptions regarding the safety of consumer products containing chemicals are divided, with 46% of EU citizens answering “not really” or “not at all”, and 49% tend to agree to some extent with the safety of these products [ 17 ]. Public perception of a chemical risk is linked to individual and place attributes; it is not limited to the type and strength of the exposure to a hazardous chemical. Previous studies have shown that chemical cues, for instance, may result in more attributions of symptoms to a chemical cause, even if no exposure occurred in reality [ 18 ]. This suggests that people assess risks by different means, according to the probabilistic risk assessments conducted by experts [ 19 ]. Different components (deliberative, affective, or experiential [ 20 ]), and many factors are involved in the formation of risk perceptions, including literacy and numeracy levels [ 21 ], dispositional situations [ 22 ], personal experiences, information availability and presentation [ 23 ], and physical and psychological well-being of the exposed individual [ 24 ]. Health risk perception of chemical exposure has been assessed in numerous settings and targeted populations (e.g., drinking water quality [ 25 ], chemical household products [ 24 , 26 ], food additives and contaminants [ 27 ], research laboratory workers [ 28 ], or recreational beach use by children [ 29 ]), as a starting point, to build-up effective risk communication strategies and public health interventions, which ultimately may lead to risk perception and health behaviour changes [20]. The inclusion of citizen perspectives and perceptions is part of a systematic, transparent, and participatory strategy within the Human Biomonitoring Initiative for Europe [ 30 ] (HBM4EU). The HBM4EU is a programme involving 30 European countries aimed at coordinating and advancing human biomonitoring in Europe while providing evidence that supports policymaking. A wide range of stakeholders, including governmental bodies, EU agencies, non-governmental organizations, and industry and trade unions participate in the initiative. One main concern within the HBM4EU consortium is to involve all actors in chemical safety, including the citizens, to (i) identify societal challenges and needs; (ii) set research priorities that address those needs; (iii) ensure that HBM4EU activities are legitimate and credible; (iv) implement procedures that are transparent and accountable; (v) generate benefits for the society; and (vi) disseminate HBM4EU results. Strategies engaging those actors prove to enable a more effective risk governance, a greater acceptance by the public towards human biomonitoring, and, at the same time, bring citizen perspectives into public health policy developments [ 31 , 32 ]. This encourages continuous (health) literacy actions (providing fact sheets, tailor made information) targeted to citizens with different backgrounds in an inclusive, easily accessible approach. In line with efforts to engage citizens in the initiative, surveys of European citizens were conducted within the HBM4EU, to inform the prioritization process (i.e., identification of relevant substances and their health effects following chemical exposure should be addressed), which serves as a basis for the work undertaken under the project. Despite this initial effort to gather some input from non-specialists in chemical exposure, numerous questions regarding European citizens’ perceptions, concerns and beliefs on chemical exposure and safety, as well as on HBM (i.e., HBM literacy) remain unexplored. Evidence from related fields demonstrate that citizens’ engagement in sensitive questions that directly or indirectly affect them is crucial to support decision making and to avoid distrust in the authorities [ 33 , 34 ]. Considering this, this paper describes the results of four focus groups Int. J. Environ. Res. Public Health 2021,18, 1532 3 of 17 organized within the HBM4EU framework in four European countries, Austria, Portugal, Ireland, and the United Kingdom (UK). The objectives of this study were to gather further understanding on (i) citizens’ perception of chemical exposure in their daily lives and HBM; (ii) their concerns regarding exposure to chemical substances; (iii) beliefs towards chemical exposure and safety, as well as regarding HBM. Altogether, the results from each of the four group discussions are valuable contributions to support the design, implementation, and communication of future HBM actions, as well as to bridge the gap between science and citizens. 2. Materials and Methods This is a cross-sectional observational qualitative study, with data collected through semi-structured focus groups conducted in four European countries: Austria, Portugal, Ireland, and the UK. In each country, one focus group composed of citizens was moderated by HBM4EU partners. Data collection took place in Austria (February 2018), Portugal (May 2019), Ireland (September 2019), and the UK (October 2019). A qualitative approach using focus groups was employed to provide an in-depth understanding of citizen’s knowledge, beliefs, and attitudes in terms of chemical exposure [ 35 ]. It was felt that a quantitative approach would lose depth and meaning, and may omit key issues of relevance to policy makers. This is also particularly appropriate, as there have been few qualitative studies of human biomonitoring. Focus groups can provide richer information about the knowledge, attitudes, and experiences of the participants. They obtain information from the interactions with and between the participants. Their intent is “not to infer but to understand, not to generalize but determine the range, and not to make statements about the population but to provide insights about how people in the groups perceive a situation” [36], (p. 66). Theoretical saturation is under discussion with four focus groups undertaken; similar thoughts from different focus groups do reflect that some common concerns are crosssectional to different countries. Apart from the topic(s) under discussion, intensive phases of interaction indicate that the topics are key and relevant for the participants in the group discussion [37]. 2.1. Participants: Sampling and Inclusion/Exclusion Criteria Participant recruitment followed a purposive sampling (non-random, conceptually driven) in each of the four countries. Eligible participants were adult citizens (18+ years old), both sexes. An effort was made to ensure heterogeneity regarding age, educational level, urban/rural residence, and professional background, in order to gather different perspectives about the topics under discussion. Citizens were excluded from participating in focus groups if they could not master the language that the focus group was conducted in (German, English, or Portuguese, according to the country). This was also the case if participants were not able to provide written consent to participate in the focus group. Participants were invited to take part in the focus groups through different ways, according to the country. Selection from a panel of citizens from previous qualitative studies followed by invitation via email (Portugal), invitation via email and through online posts on institutional homepages or social media accounts of the HBM4EU institutions (Ireland and Austria), invitation via citizen pool from occasional citizen dialogues and through snowball principle (Austria), invitation from a long standing people panel (UK) facilitated by Public Health England (PHE), and invitation from advertisements posted in public/community buildings within the adjacent geographical area of the focus group venue (Ireland). Sample size ranged between seven (UK) and fourteen (Austria) participants. A total of four focus groups were undertaken. This provided sufficient data to analyse themes. A review of 40 focus group studies [ 38 ] found that 80% of all themes could be identified within 2–3 focus groups and 90% by 3–6 focus groups. Int. J. Environ. Res. Public Health 2021,18, 1532 4 of 17 2.2. Setting, Procedures and Instruments of Data Collection Focus groups took place within the facilities of the research units or local institutions. A moderator and a co-moderator, both experienced in these types of group discussions, conducted the focus groups. The co-moderator assumed a less active role in the discussion and was mainly responsible for introducing topics not covered by the moderator and for taking field notes. The session started with the moderator seeking consent to audio record the discussion, followed by an overview of the main sections to be discussed (Table 1) and a five-minute introduction to the HBM4U project. Part of the focus group topic guide involved participants having to imagine that they were in the year 2023. This was used to encourage discussion on potential changes and impacts that the HBM4U project may have had, and the best way to disseminate information. The moderators assumed a nondirective semi-structured approach, proposing the topics for discussion and promoting group interaction. The topic guide questions were flexible in terms of order and depth of discussion, so national teams could reorganize the discussion to reflect local needs. The duration of the focus groups was variable and ranged from one to three hours (full session). Participants were given light refreshments during the sessions, which also contributed to “break the ice” and promote group interaction. Table 1. Guidelines for conducting the focus group: relevant topics to be covered. 1 Introduction on human biomonitoring - Pre-knowledge on human biomonitoring - Relation to the topic - Special interest on human biomonitoring studies/previous participation 2 Human biomonitoring now: exposure to chemical substances in our daily lives - Substances of concern - Assessment of chemical exposure - Health problems related to chemical exposure - Relevance of Human biomonitoring results and the Human biomonitoring (HBM) initiative for everyday life - If applicable, areas and reasons of relevance 3 Thought experiment: human biomonitoring project—the future - Expectation regarding the results: content - Expectations regarding the results: impact (e.g., policy making) 4 Prospective future: results of the human biomonitoring project - Perception of achieved results and applicability of the results - Who receives information about the project’s results and how (i.e., communication channels) - Preferred communication channel to obtain information about the project The full sessions were audiotaped and fully transcribed. The transcript and text material were rechecked prior and during the coding process by at least two experienced researchers (transcripts of FG and code list can be found in Supplementary Material). 2.3. Data Analysis Content analysis was independently undertaken by two researchers of the study team, per country, following grounded theory principles [ 39 , 40 ]. Each researcher independently read the transcripts, noting key words or phrases (open coding). These were used to construct a coding framework of similar categories. The coding framework was triangulated for interpretative validity [ 41 ] by the moderators and co-moderators of the focus groups. Conceptual triangulation was enhanced by a review of the literature. The coding framework was then used to identify key themes emerging from the data gathered in the group discussions. Further interpretative and significance validity was assured by Int. J. Environ. Res. Public Health 2021,18, 1532 5 of 17 providing open access to the anonymized corpus (enclosed raw text data of transcripts is provided as Supplementary Material). 2.4. Ethical Issues Prior to taking part in the focus groups, all participants signed an informed consent form. Within that, it was explained that participation was voluntary, that they could withdraw at any time and that all data collected were anonymous and confidential. The focus group moderator also sought consent to audio record the discussion and asked for participants’ permission to take photographs during the group discussion. The conduct of the focus groups in HBM4EU was approved by the project management board. Adherence to rules of the GDPR (General Data Protection Regulation) was assured by the project teams carrying out the focus groups in accordance with national policy. In all focus groups, citizens gave informed consent through a declaration of consent on data protection of the affected persons (according to Art 6 Para 1 lit a GDPR) Citizen Workshop on HumanBiomonitoring in the EU. Additionally, in Portugal, positive approval for conduction of the focus group was obtained by the Ethics Committee of the Centro Académico de Medicina de Lisboa (Reference 306/19). Ethics committee approval was not required in the other three countries. 3. Results Sample characterisation, by country, in terms of sociodemographic variables, is provided in Table 2. Table 2. Sample characterisation by country. Portugal Ireland United Kingdom Austria Gender Male 5 (50.0%) 5 (45.5%) 3 (43%) 7 (50% Female 5 (50.0%) 6 (54.5%) 4 (57%) 7 (50%) Age Age range (24–63) (18–74) (52–72) (20–72) Mean age ±SD 46.6 ±14.6 Age cohorts were recorded 64.0 ±6.9 41.3 ±4.6 Education University degree (8), Secondary education (1), primary education (1) Third education level (9), secondary education (2) Professional background was recorded University degree (9), secondary education (5) Previous knowledge about HBM Participants claimed lack of information on the topic Few participants were previously exposed to the topic, either through the media or at work Knowledge mainly claimed on media consumption (TV documentaries, movies) Almost half of citizens with professional or educational background on the topic, all claimed interest on this 3.1. Citizens’ Perceptions and Concerns about Chemical Risks and Their Impact on Human Health In the following section, specific statements of participants are cited and discussed in relation to current challenges in risk assessment and management. Participants were concerned about the health risks associated to the exposure to a variety of chemicals, namely through various sources of exposure they are exposed to in their daily lives and via consumer products and food. Few participants named specific chemical substances; asbestos and phthalates were mentioned in the Portuguese focus group, whereas diesel fumes were referred to in the Irish focus group. Some participants expressed their general concern about polluted water and industry-related air pollution (visible steam). “It’s those things that the plastics we use in our daily life have . . . the leaching into the beverages we drink, the food we eat, the food we heat in the microwave, Int. J. Environ. Res. Public Health 2021,18, 1532 6 of 17 inside of plastic boxes, all those contacts we made, as stated before, also through the clothes we wear, what we touch, and the effects even to our offspring” (Portugal, male, lines 108–114). “ . . . we often walk Sandymount Strand with our dog and there is a non-ending plume of what is supposed to be steam coming from it; but what’s in steam? But I presume that EPA are monitoring that.” (Ireland, male, lines 31–33). In one focus group, participants identified main exposure pathways to chemicals (e.g., outdoor air, food, drinking water, and clothes) and established a link between exposure pathways and different sources of pollution. For example, car exhaust emissions and car brake dust were linked to chemical exposure through outdoor air. Pesticides used in crops and flavourings, preservatives, and colour additives used in soft drinks production were linked to chemical exposure through food; environmental reservoirs of antibiotic resistant microorganisms and industrial wastewater discharges were linked to chemical exposure through drinking water. Two groups mentioned mixtures of chemical substances and interactions between these substances: “ . . . you know I used shampoo this morning, and I have a toothpaste which I believe is better than the fluoride ones, but how do I know is there something still in that toothpaste that is not good, and I tried to have as little as possible in terms of makeup, and you know, I am using really good pure baby-type creams and things like that, but what about all the stuff I do not know about.” (Ireland, female, lines 17–22). “ . . . was mentioning about things in combination as well. Mercury with other exposures seems to have more of an effect. How can this be monitored? What do we do about mixtures.” (UK, male, part 2, lines 255–256). Some participants in another focus group identified the “chain of effects” of the human influence on the whole ecosystem: “One of the one of the things that I think goes on in research that you do is you look at single chemicals. And one of the things that I think perhaps isn’t looked at enough is the cocktail of chemicals that we’re absorbing. Because we seem to have a lot more stuff that’s going on. And the, it’s actually how, how, what, what can be done about that, for example . . . ” (UK, female, part 1, lines 577–581). “ . . . when you get in things that are coming in . . . outside the EU, for example, from South America, taking the example of grapes. What? How do we know they’re not filled with pesticides?” (UK, female, part 1, lines 610–611). Indirect exposure from using products that were in contact with potentially hazardous substances at any stage of the production chain was also an expressed concern. For example, Irish and UK citizens were concerned about the use of pesticides to protect crops from pests, especially in the case of fruit production: “but if you cut an apple from the shop in half, it stays perfect, so what is making that stay perfect, there something, you know, whereas when they just pick it off the tree with no pesticides or anything, it would start, the minute you cut it, it would start to go brown, but when you buy them, they don’t, they stay like that.” (Ireland, female, lines 57–61). A UK citizen mentioned farm animals and the use of antibiotics and antibiotic resistance: “ . . . factory farmed animals are routinely fed antibiotics as a prophylactic, rather than actually to treat condition and those antibiotics, presumably and I’m saying presumably because of, I don’t know, got access to research, but they’re in the meat and therefore when we eat that meat we’re taking in antibiotic.” (UK, female, part 1, lines 584–587). Int. J. Environ. Res. Public Health 2021,18, 1532 7 of 17 A Portuguese participant mentioned the irrigation of agricultural fields using potentially contaminated water from the rivers that is captured through artisanal boreholes: “My main concern is not so much about direct consumption, which I believe is well regulated and well controlled, but it is much more about indirect consumption, that is, water that is used to irrigate the crops we later eat and that is not so scrutinised, it is often taken directly from the river or another watercourse ( . . . ah . . . ) and also in Portugal, the percentage of people who still only use water pumped from artisanal boreholes is higher than expected.” (Portugal, male, lines 270–276). Although participants generally expressed some concern in terms of exposure to environmental pollution, some participants pointed out that it is important to avoid alarmism, as this can be equally harmful to health. According to them, it is important to establish trust in the governing authorities instead: “Because it makes us worried and when we are worried, we live less. I guess.” (Portugal, male, line 139). “I always guide myself by the way I trust or not in the authorities that regulate it.” (Portugal, male, lines 231–232). 3.2. Communicating Information about Chemical Exposure Participants in the four focus groups acknowledged the key role of communication in empowering citizens to take action. It empowers future consumers’ decision-making and opens possibilities for them to put pressure on regulatory authorities. The depth of the discussion on communication of information on chemical exposure and HBM varied across groups, with some participants referring to generic types of communication (such as websites, articles in newspapers) whereas others mentioned specific types of communication. “We would need a database available to the public, one we can gather more information from. What is happening? What is it about a certain substance? What does it do [ . . . ] with a certain chemical? Empowerment!” (Austria, female, lines 282–284). Anecdotal evidence of citizen empowerment after transparency in information communication was provided by a Portuguese participant: “We had phenomena like the history of mad cow’s disease, etc., if it weren’t for public pressure, maybe we still ate contaminated beef today, wouldn’t we?” (Portugal, male, lines 785–787). A model of the communication process in HBM involving science, decision makers, and citizens emerged from the Portuguese focus group. Participants mentioned that science produces information that is used to support decisions by policy makers, ultimately leading to action. Interestingly, national authorities, such as the Portuguese Environment Agency, were not identified as being part of this communication process. The role of lobbying in the prioritisation process of political action offered some concern to the Portuguese participants in the group discussion, as well as the role of citizens, who were considered as passive receptors of political decisions that, according to them, follows a top-down approach. Overall, Portuguese participants in the focus group felt that communicating scientific results was a very important component of the “communication triangle of science” (Figure 1). Disseminating information to the public may contribute to increased citizen engagement, which in turn may empower them to put pressure on politicians to take effective actions that shall be oriented to meet citizens’ needs. Ultimately, this contributes to reduce mistrust in politicians. “First, reach the public and then the public put pressure on the politicians.” (Portugal, male, lines 1025–1026). Int. J. Environ. Res. Public Health 2021,18, 1532 8 of 17 Figure 1. Model of information flow and communication of HBM knowledge (communication from media and science, information from other sources, and education from the context, all together seems to affect, at different levels, citizen perceptions on the health impact of chemical exposure. The asterisks indicate critical points related to the way information is emitted or received by the stakeholders. Continuous lines represent that information or actions flows in closed circuits, i.e., not taken into consideration citizens perceptions or needs. Dotted lines indicate an open flow of information to which citizens are exposed to. The thickness of these lines is related to the level of influence on citizens’ perceptions and attitudes. Therefore, the context (subjectively understood here as the combination of individual, social, and place attributes) seems to have more influence than other sources of information (e.g., social media), media, and science communication) (empirical data driven model: citizen perspective). Threats to transparent and credible scientific data communication were also discussed. Participants in one of the group discussions stressed that scientific information should be communicated using credible sources, such as science experts. This was an important step to provide “certainty” and to protect citizens and public opinion from “fake news”. The environmental campaign led by Greta Thunberg was given as an example of an approach emphasising the importance of science and the need to “listen to the scientists”. Participants in the UK focus group identified the need for executive and government agencies to produce detailed, focused, and tailored information to be delivered to the citizens. Some participants expressed their opinion that citizens should have “a right” to receive information when adverse human health effects are detected from chemicals to which they are directly or indirectly exposed to. A list compiled by medically trained individuals, providing information about hazardous and less harmful chemicals (e.g., products where the chemicals can be found, risks to particular groups), should be produced and delivered to the general population. “Public Health, I think has a high priority for most people. Not just their own personal health, but the health of the population at large. For all sorts of reasons, I think it’s a good thing that people are more aware than was the case in my Int. J. Environ. Res. Public Health 2021,18, 1532 9 of 17 parents’ generation, or even my grandparents’ generation, they simply weren’t aware of these issues. (UK, male, part 2, lines 722–725). “ . . . the public, I think, are becoming more and more aware of pollution, and heavy chemicals in water and food and plastic in the ocean, and all of these kinds of things. And what we need, I believe, is a guide from government or from executive agencies, or maybe both about a broad ballpark area where we can look for more information on these topics, and perhaps specific websites, and where we can find answers to questions. So I think the objective communication in this realm is to make the public more aware. And more aware in a more focused, targeted way than government is generally very good at so that we can begin to ask the right questions of people like you (PHE scientists).” (UK; male, part1, lines 481–491). “I believe we need to lead from medical practitioners, people with medically trained who can say there’s a whole load of chemicals in the air in the soil, we eat them, breath them, drink them, many of them are not dangerous, but some are and here’s a list of them.” (UK, male, part 1, lines 705–707). One person stressed that there was a need to build-up trust and confidence in government organisations. Several others felt that information should be provided by nongovernmental organisations. One focus group highlighted the importance of an independent “watchdog” organisation that had authority: “So, if we have governments looking to independent bodies like an independent water authority, you know, that is monitoring waters, water pollution levels.” (Ireland, male, lines 362–364). The need for the HBM4EU project to provide information, namely evidence on health effects from chemical exposure, in a user-friendly format, easily understandable by the general citizen, was stressed by the participants in the Irish focus group. One participant, holding a Master’s degree in biochemistry, commented that some information provided, e.g., on a chemical safety data sheet he had seen, was “totally unintelligible.” A different participant stressed that it would be important for this project to turn “scientific knowledge into understanding”. “ . . . we are going to have it in language a five-year-old can understand.” (Ireland, male, lines 289–290). 3.3. Barriers to Reduce Pollution Levels Pollution was identified by the participants in the focus groups as one important pathway of exposure to chemicals. As such, the discussion not only focused upon concerns about health effects after exposure to sources of pollution (see Section 3.1 Citizens’ perceptions and concerns about environmental risks and their impact on human health), but also several barriers that prevent active action to reduce pollution levels. Different expectations from different stakeholders were emphasised across focus groups as a main potential barrier to reduce pollution levels that could be surpassed if the stakeholders engage in a collaborative effort at many different levels. The government was pointed out by some participants as a barrier, because they would protect the industry over citizens’ interests. The rationale was that the industry sector creates jobs and contributes to the economical wealth of the country. As such, measures aimed at reducing pollution levels mainly target the consumer and less is required in this realm from private companies. The role of “lobbyism” and the industry sector’s own agenda and interests in shaping political decisions was referred in two out of the four focus groups by some of the participants. Additional industry-related barriers were identified by the participants: Aggressive marketing strategies were mentioned as contributing to an overload of messages that makes it harder to distinguish relevant and credible information about hazardous substances. Constant product innovation by industry in highly industrialised areas of the Int. J. Environ. Res. Public Health 2021,18, 1532 16 of 17 27. Jansen, T.; Claassen, L.; van Kamp, I.; Timmermans, D. ‘All chemical substances are harmful.’ public appraisal of uncertain risks of food additives and contaminants. Food Chem. Toxicol. 2020,136, 110959. [CrossRef] 28. Papadopoli, R.; Nobile, C.G.A.; Trovato, A.; Pileggi, C.; Pavia, M. Chemical risk and safety awareness, perception, and practices among research laboratories workers in Italy. J. Occup. Med. Toxicol. 2020,15, 1–11. [CrossRef] 29. Ferguson, A.; del Donno, C.; Obeng-Gyasi, E.; Mena, K.D.; Altomare, T.K.; Guerrero, R.; Gidley, M.L.; Montas, L.; Solo-Gabriele, H.M. Children Exposure-Related Behavior Patterns and Risk Perception Associated with Recreational Beach Use. Int. J. Environ. Res. Public Heal. 2019,16, 2783. [CrossRef] 30. David, M.; Schwedler, G.; Reiber, L.; Tolonen, H.; Andersson, A.-M.; López, M.E.; Joas, A.; Schöpel, M.; Polcher, A.; KolossaGehring, M. Learning from previous work and finding synergies in the domains of public and environmental health: EU-funded projects BRIDGE Health and HBM4EU. Arch. Public Heal. 2020,78, 1–13. [CrossRef] 31. Keune, H.; Morrens, B.; Croes, K.; Colles, A.; Koppen, G.; Springael, J.; Loots, I.; van Campenhout, K.; Chovanova, H.; Schoeters, G.; et al. Opening the research agenda for selection of hot spots for human biomonitoring research in Belgium: A participatory research project. Environ. Heal. 2010,9, 33. [CrossRef] 32. Keune, H.; Morrens, B.; Loots, I. Risk communication and human biomonitoring: Which practical lessons from the Belgian experience are of use for the EU perspective? Environ. Heal. 2008,7, S11. [CrossRef] 33. Brouwer, R.; van der Wielen, P.W.J.J.; Schriks, M.; Claassen, M.; Frijns, J. Public Participation in Science: The Future and Value of Citizen Science in the Drinking Water Research. Water 2018,10, 284. [CrossRef] 34. Silva, S.; Machado, H. Trust, morality and altruism in the donation of biological material: The case of Portugal. New Genet. Soc. 2009,28, 103–118. [CrossRef] 35. Morgan, D. The Focus Group Guidebook; SAGE Publications: Thousand Oaks, CA, USA, 1998; ISBN 9780761908180. 36. Richard, A.K.; Casey, M.A. Focus Groups: A Practical Guide for Applied Research, 5th ed.; SAGE Publications: Thousand Oaks, CA, USA, 2014; ISBN 978-1-4833-6524-4. 37. McQuarrie, E.F.; Krueger, R.A. Focus Groups: A Practical Guide for Applied Research. J. Mark. Res. 1989,26, 371. [CrossRef] 38. Guest, G.; Namey, E.; McKenna, K. How Many Focus Groups Are Enough? Building an Evidence Base for Nonprobability Sample Sizes. Field Methods 2016,29, 3–22. [CrossRef] 39. Charmaz, K.C. Constructing Grounded Theory: A Practical Guide through Qualitative Analysis; SAGE Publications: London, UK, 2006. 40. Burnard, P.; Gill, P.; Stewart, K.; Treasure, E.T.; Chadwick, B.L. Analysing and presenting qualitative data. Br. Dent. J. 2008 ,204, 429–432. [CrossRef] 41. McLeod, J. Qualitative Research in Counselling and Psychotherapy; Indian Institute of Management: Kozhikode, India, 2001. 42. Exley, K.; Cano, N.; Aerts, D.; Biot, P.; Casteleyn, L.; Kolossa-Gehring, M.; Schwedler, G.; Castaño, A.; Angerer, J.; Koch, H.M.; et al. Communication in a Human biomonitoring study: Focus group work, public engagement and lessons learnt in 17 European countries. Environ. Res. 2015,141, 31–41. [CrossRef] 43. Nelson, J.W.; Scammell, M.K.; Altman, R.G.; Webster, T.F.; Ozonoff, D.M. A New Spin on Research Translation: The Boston Consensus Conference on Human Biomonitoring. Environ. Heal. Perspect. 2009,117, 495–499. [CrossRef] 44. Morello-Frosch, R.; Brody, J.G.; Brown, P.; Altman, R.; Rudel, R.A.; Pérez, C. Toxic ignorance and right-to-know in biomonitoring results communication: A survey of scientists and study participants. Environ. Heal. 2009,8, 6. [CrossRef] 45. Hambach, R.; Mairiaux, P.; François, G.; Braeckman, L.; Balsat, A.; van Hal, G.; Vandoorne, C.; van Royen, P.; van Sprundel, M. Workers’ Perception of Chemical Risks: A Focus Group Study. Risk Anal. 2010,31, 335–342. [CrossRef] 46. Gonzales, M.; King, E.; Bobelu, J.; Ghahate, D.M.; Madrid, T.; Lesansee, S.; Shah, V.O. Perspectives on Biological Monitoring in Environmental Health Research: A Focus Group Study in a Native American Community. Int. J. Environ. Res. Public Heal. 2018, 15, 1129. [CrossRef] 47. Brender, J.D.; Maantay, J.A.; Chakraborty, J. Residential Proximity to Environmental Hazards and Adverse Health Outcomes. Am. J. Public Heal. 2011,101, S37–S52. [CrossRef] 48. EC DG Comm (The European Commission of Bulgaria). Special Barometer 314: Europeans’ Attitudes Toward Chemicals in Consumer Products: Risk Perception of Potential Health Hazards; EC DG Comm: Sofia, Bulgaria, 2009. 49. Löfstedt, R.E. Risk Management in Post-Trust Societies; Palgrave: London, UK, 2005; ISBN 978-1-4039-4978-3. 50. van der Weerd, W.; Timmermans, D.R.; Beaujean, D.J.; Oudhoff, J.; van Steenbergen, J.E. Monitoring the level of government trust, risk perception and intention of the general public to adopt protective measures during the influenza A (H1N1) pandemic in the Netherlands. BMC Public Heal. 2011,11, 575. [CrossRef] 51. Lazarus, J.V.; Ratzan, S.C.; Palayew, A.; Gostin, L.O.; Larson, H.J.; Rabin, K.; Kimball, S.; El-Mohandes, A. A global survey of potential acceptance of a COVID-19 vaccine. Nat. Med. 2020, 1–4. [CrossRef] 52. Renn, O.; Levine, D. Credibility and Trust in Risk Communication: International Perspectives; Springer: Berlin/Heidelberg, Germany, 1991; pp. 175–218. 53. Riley, M.W.; Hovland, C.I.; Janis, I.L.; Kelley, H.H. Communication and Persuasion: Psychological Studies of Opinion Change. Am. Sociol. Rev. 1954,19, 355. [CrossRef] 54. Lee, T.R. Effective communication of information about chemical hazards. Sci. Total. Environ. 1986,51, 149–183. [CrossRef] 55. McCroskey, J.C.; Teven, J.J. Goodwill: A reexamination of the construct and its measurement. Commun. Monogr. 1999 ,66, 90–103. [CrossRef] Int. J. Environ. Res. Public Health 2021,18, 1532 17 of 17 56. Ryu, Y.; Kim, S.; Kim, S. Does Trust Matter? Analyzing the Impact of Trust on the Perceived Risk and Acceptance of Nuclear Power Energy. Sustainability 2018,10, 758. [CrossRef] 57. Williams, D.J.; Noyes, J.M. How does our perception of risk influence decision-making? Implications for the design of risk information. Theor. Issues Ergon. Sci. 2007,8, 1–35. [CrossRef] 58. Rogers, E.; Storey, D. Communication Campaigns. In Handbook of Communication Science; Berger, C., Chaffee, S., Eds.; SAGE: Newbury Park, CA, USA, 1987; pp. 817–846. 59. Maibach, E.; Roser-Renouf, C.; Leiserowitz, A. Communication and Marketing as Climate Change–Intervention Assets. Am. J. Prev. Med. 2008,35, 488–500. [CrossRef] 60. United Nations. Transforming Our World: The 2030 Agenda for Sustainable Development; United Nations: New York, NY, USA, 2015. 61. Fritz, S.; See, L.; Carlson, T.; Haklay, M.; Oliver, J.L.; Fraisl, D.; Mondardini, R.; Brocklehurst, M.; Shanley, L.A.; Schade, S.; et al. Citizen science and the United Nations Sustainable Development Goals. Nat. Sustain. 2019,2, 922–930. [CrossRef] 62. Irwing, A. Citizen Science Comes of Age. Media Nat. 2018,562, 480–482. 63. Landrigan, P.J.; Fuller, R.; Acosta, N.J.; Adeyi, O.; Arnold, R.; Baldé, A.B.; Bertollini, R.; Bose-O’Reilly, S.; Boufford, J.I.; Breysse, P.N.; et al. The Lancet Commission on pollution and health. Lancet 2017,391, 462–512. [CrossRef] 64. Flick, U. An Introduction to Qualitative Research, 6th ed.; SAGE: London, UK, 2018; ISBN 9781526445650. 65. Stalmeijer, R.E.; McNaughton, N.; van Mook, W.N.K.A. Using focus groups in medical education research: AMEE Guide No. 91. Med. Teach. 2014,36, 923–939. [CrossRef] 66. Maione, M.; Mocca, E.; Eisfeld, K.; Kazepov, Y.; Fuzzi, S. Public perception of air pollution sources across Europe. Ambio 2020 , 1–9. [CrossRef] 67. McCright, A.M.; Xiao, C. Gender and Environmental Concern: Insights from Recent Work and for Future Research. Soc. Nat. Resour. 2014,27, 1109–1113. [CrossRef] 68. Silva, D.G.; Pownall, R.A.J. Going green: Does it depend on education, gender or income? Appl. Econ. 2014 ,46, 573–586. [CrossRef]