Key words: decision-making, health behaviour, smoking behaviour, e-cigarette use, childhood vaccination

"Next to Best Health Decisions; Exploring two cases: smoking behavior and childhood vaccination"

Next to best health options are – from a public health and scientific point of view – less harmful than the unrecommended health option, but not less harmful compared to the recommended health option. In this thesis, smoking behaviour and childhood vaccination were explored because an increase in the next to best health decisions was observed. With a combination of qualitative and quantitative studies, the thesis explored which socio-cognitive factors are related to decision regarding smoking behaviour and childhood vaccination and whether these decisions adhered to the criteria of informed decision-making. Similar socio-cognitive factors were reported to be imported in decisions about smoking behaviour and childhood vaccination, such as knowledge, perceived risks, trust in information, attitudes, social norms, and deliberation. Other factors mentioned were product characteristics related to e-cigarette use, and anticipated regret among parents related to their decision about childhood vaccination. The results indicate that overall decisions about smoking behaviour and childhood vaccination did not adhere to at least one of the criteria of informed decision-making. With regard to communicating about best and other options, it is important to articulate clearly which particular goals public health experts want to achieve. They may consider it their goal to provide scientific information without providing advice or decisional support. Another goal may be to facilitate informed decision-making even though the consequence of this may be that more people will choose an unrecommended option, thereby increasing public health risks. Alternatively, public health experts may choose to take a more directive approach to get as many people as possible to choose the recommended health option to increase public health gain.