Environmental Risks Perception Among Citizens Living Near Industrial Plants: A Cross-Sectional Study

The present work is a cross-sectional study aimed at assessing the risk perception and evaluating the community outrage linked to environmental factors among a self-selected sample of citizens living in an area characterized by the presence of industrial structures of high emotional impact. An anonymous questionnaire was administered to the population by publishing a Google form URL code in local and regional newspapers and via social media. The resulting data were entered on Excel and analyzed. Qualitative variables were summarized with absolute and relative (percentage) frequencies. The results showed that the event that causes the greatest worry was air pollution, with 92.6% of the respondents stating that they perceived the problem as “very” or “quite” worrying. Furthermore, all the health problems investigated in relation to environmental quality aroused concern among the interviewees, with 93.1% believing there was a cause-effect relationship between environmental quality and health. Overall, as other studies had previously underlined, the survey shows that the perceived risks are not always in line with the real ones, Thus, it is imperative to articulate interventions aimed at offering the population objective tools to enable them to interpret the risks themselves. In this regard, a fundamental role is played by adequate communication between the competent bodies and political decision-makers and the population.


Introduction
The relationship between environment and health is of extreme relevance in Public Health. According to the World Health Organization (WHO) [1], 23% of all deaths globally are attributable to environmental factors, and several diseases could be avoided if we lived in healthier environments. In particular, according to the European Environmental Agency [2], poor air quality causes 6.5 million premature deaths worldwide, 620,000 of which are in the WHO European Region. Indeed, the European Environment Agency [3] also certifies that noise and air pollution continue to have a serious impact on the health of the population, and human activities (mainly the key sectors of industry, energy, transport, agriculture) are a source of strong environmental pressure [4][5][6][7].
The growing awareness of the health impacts caused by the alteration of environmental conditions by anthropic activities, such as industrial expansion near urban areas, atmospheric pollution, and climate change, plays a key role in the judgment and acceptability of the risks related to environmental Owing to its insularity, the region lends itself very well to observational investigations and represents an excellent test case in relation to the reported social dynamics. In fact, the island has already proven to be well suited to epidemiological studies as it preserves the region from interferences caused by territorial contiguity. As such, it can act as an excellent exercise for the reported social and epidemiological dynamics.
In particular, the present study was conducted in the Marghine area, a historical region in central Sardinia which covers an area of 475.42 km 2 and includes 10 municipalities: Birori, Bolotana, Borore, Bortigali, Dualchi, Lei, Macomer, Noragugume, Silanus, and Sindia [31][32][33][34]. Figure 1 shows the study area's territorial framework and the population of each municipality in 2018, the year in which observation was carried out, whereas Table 2      As shown in Figure 2, several industrial plants (mostly dedicated to the management of solid waste from the entire Region) are situated in Marghine, located near urban areas, in particular in the Municipality of Macomer, the main town in the area, with a population of 10,019 in 2018. As shown in Figure 2, several industrial plants (mostly dedicated to the management of solid waste from the entire Region) are situated in Marghine, located near urban areas, in particular in the Municipality of Macomer, the main town in the area, with a population of 10,019 in 2018.    [35,36].
In the same industrial zone there is also a purifier that treats the waste water from the waste-toenergy process [36][37][38]. Finally, the production cycle also includes the management of the controlled landfill, again serving the Tossilo plant, located in Monte-Muradu, in the area north of Macomer.
Although the area is heavily industrialized, the official data published by the health authority and the Environmental Protection Agency have always highlighted parameter values that comply with the regulatory limits, the absence of pollution from the environmental matrices, and excluded an excesses of pathologies in the area of study [39-41].   [35,36].

Survey Method
In the same industrial zone there is also a purifier that treats the waste water from the waste-to-energy process [36][37][38]. Finally, the production cycle also includes the management of the controlled landfill, again serving the Tossilo plant, located in Monte-Muradu, in the area north of Macomer.
Although the area is heavily industrialized, the official data published by the health authority and the Environmental Protection Agency have always highlighted parameter values that comply with the regulatory limits, the absence of pollution from the environmental matrices, and excluded an excesses of pathologies in the area of study [39-41].

Survey Method
An anonymous questionnaire was built, tested, adjusted, and validated through a pilot study, carried out on a convenience sample of 20 experts in Public Health (data not published). The internal consistency was assessed with Cronbach's alpha test.
The questionnaire consisted of 14 close-ended questions divided into two areas of investigation: 6 personal data questions; 8 questions related to health concerns and risk perception. To complete the questionnaire it was required to answer each question. Only one question (item no. 13) allowed for more than one answer.
The questionnaire was administered by publishing a Google form URL code in the local and regional newspapers (i.e., "Il Marghine" and "La Nuova Sardegna"), and via social media (i.e., Facebook public profiles of the same newspapers). The questionnaire was to be completed in the period between 1st September 2018 and 31st December 2018. The full questionnaire is shown in Tables 2 and 3 (Results Section): Table 2 reports 6 questions related to the respondents' general information; Table 3 shows 8 questions (numbers 7 to 14) related to health concerns and risk perceptions, together with their close-ended answers. Questions and answers are reported in the first and second columns of the tables, respectively.

Statistical Analysis
Data were entered on Excel (Microsoft Office, Microsoft Corporation, Redmond, WA, USA) and analyzed using the STATA software 16 (StatCorp., Austin, TX, USA). Qualitative variables were summarized with absolute and relative (percentage) frequencies.
The differences between mean values for quantitative variables were tested applying the Student t-test, whereas for proportions, Z test was applied. The independence for qualitative variables was tested applying the X 2 test. In order to evaluate the equality of distributions, Kolgomorov Smirnov test for two samples was performed. A p-value less than 0.05 was considered statistically significant.

General Information
With regard to the internal consistency, the questionnaire showed a Cronbach's alpha reliability test global value of 0.9044, which highlights a very good internal consistency. No missing data were managed.
During the observation period, 651 residents in the study area voluntarily answered the questionnaire. The respondents' general information related to the first six questions is shown in Table 3.
Of the 651 respondents, 500 were from Macomer, whereas 151 lived in the other municipalities in Marghine. As regards the age and gender of the respondents, the average age was 38.7 years (±13.8), without statistically significant differences between gender, and more than half of the self-selected sample were between 18 and 39 years old. As regards the equality of the distribution by age groups, no differences were observed between genders (combined Kolmogorov-Smirnoff K-S = 0.05; p = 0.82). Moreover, 64.4% were female.
As regards marital status, most of the respondents were unmarried, and this percentage was in line with that of the general population (45.3% and 45.0%, respectively). All age groups had at least one respondent.
Over 80% of the sample interviewed had a high school diploma or a university degree, while more than half said they were in employment. Finally, 89.9% of the respondents had resided in the study area for over 10 years.

Descriptive Analysis
The results of the descriptive analysis are shown in Table 4 (questions 7 to 14). As regards the respondents' perception in relation to the environmental problems reported in question 7, the results are shown graphically in Figure 3.   In particular, the interviewees showed quite a high level of concern regarding all the environmental problems investigated. As the graphic shows, the events that cause the greatest worry are air pollution, with 95.3%, and hazardous waste, with 92.7% of the respondents stating that they perceived the problem as "very" or "quite" worrying, respectively. These latter two figures (air pollution and hazardous waste) seem to significantly differ between genders, with a concern proportion, from quite to very high, of 91.8% vs. 97.1% and 88.8% vs. 95.0%, for males and females, respectively. Statistically significant differences for the same two figures were also observed among age groups (p < 0.001). In particular, the concern seems to grow according to age, ranging from 75.0% in <18 years old to 98.4% in 60-69 years old. In particular, the interviewees showed quite a high level of concern regarding all the environmental problems investigated. As the graphic shows, the events that cause the greatest worry are air pollution, with 95.3%, and hazardous waste, with 92.7% of the respondents stating that they perceived the problem as "very" or "quite" worrying, respectively. These latter two figures (air pollution and hazardous waste) seem to significantly differ between genders, with a concern proportion, from quite to very high, of 91.8% vs. 97.1% and 88.8% vs. 95.0%, for males and females, respectively. Statistically significant differences for the same two figures were also observed among age groups (p < 0.001). In particular, the concern seems to grow according to age, ranging from 75.0% in <18 years old to 98.4% in 60-69 years old.
The answers to question 8 are shown in Figure 4. In particular, the interviewees showed quite a high level of concern regarding all the environmental problems investigated. As the graphic shows, the events that cause the greatest worry are air pollution, with 95.3%, and hazardous waste, with 92.7% of the respondents stating that they perceived the problem as "very" or "quite" worrying, respectively. These latter two figures (air pollution and hazardous waste) seem to significantly differ between genders, with a concern proportion, from quite to very high, of 91.8% vs. 97.1% and 88.8% vs. 95.0%, for males and females, respectively. Statistically significant differences for the same two figures were also observed among age groups (p < 0.001). In particular, the concern seems to grow according to age, ranging from 75.0% in <18 years old to 98.4% in 60-69 years old.
The answers to question 8 are shown in Figure 4.   The events that respondents found less likely are war, terrorism, nuclear risk, and addiction, while diseases were considered to be the most likely event. Figure 5 shows the results of the answers given to question no. 9, concerning worries about one's own health regarding environmental determinants.
As the figures show, all the health problems investigated in relation to environmental quality aroused concern among the interviewees, in particular tumors and (temporary or permanent) damage to the respiratory tract, without statistically significant differences between gender and age groups.
Finally, the results of the questionnaire show that 93.1% believed there was a cause-effect relationship between environmental quality and health (question no. 10), 60.3% believed that the environmental situation in the area was serious (question no. 11) and 63% believed that citizens do not have an influential role in decisions made by the municipal administration (question no. 12).

Information Sources
Question number 13 revealed the respondents' main sources of information (more than one answer was allowed) and the answers are shown in Figure 6.
As can be seen from the graph, the Internet was found to be the most widely used source of information, as opposed to consulting political decision-makers, Municipalities, and the Regional Agency for Environmental Protection Agency (ARPAS).
Finally, question number 14 highlighted the willingness of over 40% of the interviewees to relocate away from their place of residence.
The events that respondents found less likely are war, terrorism, nuclear risk, and addiction, while diseases were considered to be the most likely event. Figure 5 shows the results of the answers given to question no. 9, concerning worries about one's own health regarding environmental determinants. As the figures show, all the health problems investigated in relation to environmental quality aroused concern among the interviewees, in particular tumors and (temporary or permanent) damage to the respiratory tract, without statistically significant differences between gender and age groups.
Finally, the results of the questionnaire show that 93.1% believed there was a cause-effect relationship between environmental quality and health (question no. 10), 60.3% believed that the environmental situation in the area was serious (question no. 11) and 63% believed that citizens do not have an influential role in decisions made by the municipal administration (question no. 12).

Information Sources
Question number 13 revealed the respondents' main sources of information (more than one answer was allowed) and the answers are shown in Figure 6.  As can be seen from the graph, the Internet was found to be the most widely used source of information, as opposed to consulting political decision-makers, Municipalities, and the Regional Agency for Environmental Protection Agency (ARPAS).
Finally, question number 14 highlighted the willingness of over 40% of the interviewees to relocate away from their place of residence.

Discussion
The survey enabled an evaluation of environmental risk perception in a self-selected sample of a population living near industrial plants with a high emotional impact. The strengths and weaknesses presented in the study are discussed in this section.
During the observation period, 651 people responded to the survey, with female respondents more numerous. This figure is attributable to the fact that in the Region, and in the area subject to observation, the female population outnumbers the male. Furthermore, as is known, the female population is more sensitive than the male to environmental issues. For this reason, the greater frequency of female respondents is in line with what has been reported in other similar surveys [42].
Of the 651 respondents, 500 claimed to reside in Macomer. This, on the one hand, is attributable to the fact that the Municipality counted almost a half of the population of the entire area observed at the time of the investigation; on the other, the fact that the main industrial plants in the area (i.e.,

Discussion
The survey enabled an evaluation of environmental risk perception in a self-selected sample of a population living near industrial plants with a high emotional impact. The strengths and weaknesses presented in the study are discussed in this section.
During the observation period, 651 people responded to the survey, with female respondents more numerous. This figure is attributable to the fact that in the Region, and in the area subject to observation, the female population outnumbers the male. Furthermore, as is known, the female population is more sensitive than the male to environmental issues. For this reason, the greater frequency of female respondents is in line with what has been reported in other similar surveys [42].
Of the 651 respondents, 500 claimed to reside in Macomer. This, on the one hand, is attributable to the fact that the Municipality counted almost a half of the population of the entire area observed at the time of the investigation; on the other, the fact that the main industrial plants in the area (i.e., waste-to-energy plants, landfills, and purifiers) were in close proximity to the town center could explain the citizens' greater sensitivity toward this investigation.
As far as the self-selected sample's general information is concerned, over half of the respondents were aged between 18 and 39 years, with an average age of 38.7 years. In particular, with regard to the population of Sardinia (average age of 45.9 years), and of Marghine (average age of 47.9 years), the respondents were younger. Nevertheless, approximately 90% of those surveyed said they had lived in the area for more than 10 years. Although, on the one hand, the way the questionnaire was administered may have favored a response by people more inclined toward the use of IT tools, on the other hand, all age groups are represented in the survey.
Another interesting result, in line with what has been described on the international scene, was the link between educational qualifications and perception of environmental risks. Looking at the sample of respondents to the survey, over 80% of them had a high school diploma or university degree. As previously stated by Carducci et al. and by Ozdemir et al. [43,44], subjects with a higher level of education perceive environmental risks to be higher.
In general, there was a clear concern among respondents toward environmental determinants, both in relation to the perception of risks and possible effects on health, with 93.1% of respondents claiming the existence of a clear cause-effect relationship between the state of the environment and health status. Consequently, all of the environmental problems investigated worried the majority of respondents.
In particular, percentages equal to or even greater than 90% were observed in relation to the presence of hazardous industries, particularly landfills and incinerators/waste-to-energy plants. As recently observed by other authors [11,45], these structures play an important role in environmental risk perception in populations exposed to them, and could explain the consequent high level of concern regarding food and aquatic environment pollution, hazardous material transportation, noise, and air pollution, and hazardous waste. As can be expected, these latter are closely related to the presence of industrial plants and may explain the citizens' apprehension about possible industrial catastrophes and long-term damage to health that emerged from this survey. In particular, a very high concern was observed among females and older age groups. These figures confirm the aforementioned statement that females are more sensitive than males to environmental issues. Moreover, it seems interesting to point out the higher concern among older individuals. Considering the younger mean age of our respondents compared to the general population, this aspect could imply that the real concern could be even greater.
Moreover, the self-selected respondents were concerned by severe weather phenomena (44.1%) and fires (45.0%). On the one hand, the catastrophes caused by extreme weather events that have hit Italy [46] and Sardinia [47] in recent years have certainly influenced the current fear of such an event.
On the other hand, the concern about fires is not surprising, given that these events are frequent in the Region [48].
It is also interesting to note two peculiar conditions declared by the interviewees. First, although Sardinia is a region with moderate seismic hazard [49], more than half of the respondents (54.6%) said they were worried by earthquakes. This particular fact could be traced back to the seismic events occurring in Central Italy starting from 2016 [50] which were most likely, according to the dynamics of availability bias, responsible for people's tendency to base their judgments on recent information, forming opinions conditioned by the latest news acquired [51,52].
Second, a factor that caused little concern was terrorism. In this case, contrary to what was described above, a terrorist cell had been uncovered in Macomer shortly before the present investigation [53], proving the gap that can be found in a population between the perception of a risk (outrage) compared to the real danger (hazard) [16,54].
With regard to road or work accidents, however, a mixed feeling of exposure emerged from the investigation. On the one hand, in fact, respondents showed a high perception of the risk inherent in road accidents. In this case, as found in accordance with the investigations proposed by the Italian National Statistics Institute and by Congiu et al. [55,56], this phenomenon not only represents a known public health problem, but is also increasing if we take fragile categories into consideration.
On the other hand, however, the scant perception of the danger inherent in accidents at work could be attributed to the fact that almost 50% of the volunteer participants were unemployed, students, housewives, or occasional workers.
As for the perception of the environmental quality of the area of residence, although the official analyses carried out by the Regional Environmental Protection Agency of Sardinia excluded the presence of pollutants in the environmental matrices at the time of investigation [39], and excessive numbers of disease cases have not been reported by health authorities [41], the concern of respondents is tangible. Nevertheless, a possible determinant of the outrage could be identified in a controversy that arose in the territory understudy at the end of 2015. In fact, at that time the conversion of the incinerator into a waste-to-energy plant had started and an environmentalist association was in opposition to this transformation. This association claimed that there was an excess of pathologies and specific mortality caused by tumors in that territory. The data on which this position were based derived in part from some incorrect health statistics that had been published in that period [57], in part from an incorrect reading and interpretation of available epidemiological data. Not even the subsequent correction and publication of correct data [41,58] was able to quell the controversy and judicial investigations were also initiated which had no effect and the waste-to-energy plant was set up.
Even some time later, the sense of bewilderment so clearly raised by the numerous newspaper articles that appeared in the local media for several months still remains strong. This fact could explain why the concern for an excess of tumors was high in both sexes, without significant differences.
As Jonathan Swift said, "Falsehood flies and truth comes limping after; so that when men come to be undeceived it is too late; the jest is over and the tale has had its effect" [59]. This situation is aggravated by the fact that most respondents (over 60%) believed that citizens do not play an influential role in the decisions made by the municipal administration. In fact, as highlighted by Peter Sandman himself [27] with the aforementioned outrage theory, the perception of a risk increases when the situation that generates it is independent of one's will and is attributable to third parties.
Furthermore, over 40% of respondents declared the will to relocate. This figure appears to be in contrast with the Sardinian people's well-known sense of belonging and attachment to their land, as well as antithetical to the fact that almost 90% of the replies had been residing in the area for more than 10 years. Nevertheless, since the question referring to the will to relocate in relation only to the perceived environmental risks is not explicitly asked, there could be social, economic, and cultural dynamics behind this desire to move away.

Conclusions
The present study has evaluated the role of environmental risk perception among a self-selected sample of citizens living in an area where industrial plants with high perceptual and emotional impact are situated. In particular, as other studies had previously underlined, the study shows that the perceived risks are not always in line with the real ones, if we think of how, for example, the respondents answered regarding fear of earthquakes, highly unlikely events in the territory under observation. Thus, it is imperative to articulate interventions that are aimed at offering the population objective tools to enable them to interpret the risks themselves. In this regard, a fundamental role is played by adequate communication between the competent bodies and political decision-makers and the population. Moreover, the study also revealed how the process of participation in decision-making is one of the determining aspects that influences a person's environmental risk perception, and promoting citizens' involvement in decisions can strengthen their sense of belonging, attachment to the territory, and empowerment. In fact, any action on the territory and even more so its protection (and consequently the perception of the risk linked to the action) that does not stem from an involvement of the local community, is in vain, as it is not legitimized by the context [60].
Starting from the results of the survey, although the study is descriptive in nature and, therefore, requires further investigation in order to better understand the dynamics underlying the high outrage found, some practical actions could be implemented. These should not only concern informing and educating citizens, but should also be addressed to Health Authorities and Institutions (Municipalities). In particular, the results of this survey could be very useful for the launch of projects in the area that see the active participation of citizens in decision-making. For this reason, it will be necessary to bring into play multiple professional skills, not only public health professionals and sociologists, but also designers, planners, and urban planners.
In addition, an important role is played by journalists, who are responsible for informing citizens. As known, the mass media are often responsible for riding the wave of news stories that attract the attention of readers as they are fueled by an emotional component [15]. For this reason, it would be appropriate to implement a training project that also involves this category of professionals.
Finally, a reflection in light of the pandemic that the world is currently experiencing opens up interesting prospects for this study. Indeed, it is worth questioning whether the desire to leave the territory studied in this paper is not quenched precisely because low population density is perceived as a less effective medium for the spread of viruses such as SARS-CoV-2, and as such the condition of "urbanity" is not such a great benefit now, nor in the future [61,62].