Studies have shown that differences among individuals and social groups in accessing and using information on health and specific threats have an impact on their knowledge and behaviors. These differences, characterized as communication inequalities, may hamper the strength of a society's response to a public health emergency. Such inequalities not only make vulnerable populations subject to a disproportionate burden of adversity, but also compromise the public health system's efforts to prevent and respond to pandemic influenza outbreaks. We investigated the effect of socioeconomic status (SES) and health communication behaviors (including barriers) on people's knowledge and misconceptions about pandemic influenza A(H1N1) (pH1N1) and adoption of prevention behaviors.
Methods.
The data for this study came from a survey of 1,569 respondents drawn from a nationally representative sample of American adults during pH1N1. We conducted logistic regression analyses when appropriate.
Results.
We found that (1) SES has a significant association with barriers to information access and processing, levels of pH1N1-related knowledge, and misconceptions; (2) levels of pH1N1-related knowledge are associated positively with the adoption of recommended prevention measures and negatively with the adoption of incorrect protective behaviors; and (3) people with higher SES, higher news exposure, and higher levels of pH1N1-related knowledge, as well as those who actively seek information, are less likely than their counterparts to adopt incorrect prevention behaviors.
Conclusion.
Strategic public health communication efforts in public health preparedness and during emergencies should take into account potential communication inequalities and develop campaigns that reach across different social groups.
References
1.
ChanM.Statement to the press: World now at the start of 2009 influenza pandemic. Geneva: World Health Organization; 2009.
TafawaAOViswanathKKawachiIWilliamsDR, Mass media exposure, social stratification, and tobacco consumption among Nigerian adults. Cancer Causes Control2012;23Suppl 1:45–55.
4.
IshikawaYNishiuchiHHayashiHViswanathK.Socioeconomic status and health communication inequalities in Japan: A nationwide cross-sectional survey. PLoS One2012;7:e40664.
5.
ClaymanMLManganelloJAViswanathKHesseBWAroraNK, Providing health messages to Hispanics/Latinos: Understanding the importance of language, trust in health information sources, and media use. J Health Commun2010;15Suppl 3:252–63.
6.
JungMLinLViswanathK.Associations between health communication behaviors, neighborhood social capital, vaccine knowledge, and parents' H1N1 vaccination of their children. Vaccine2013;31:4860–6.
7.
ViswanathKMinskySRamamurthiDKontosE.Communications under uncertainty: Communication behaviors of diverse audiences during the A(H1N1) incidence of spring and summer 2009. Boston: Viswanath Lab, Harvard School of Public Health, and Dana-Farber Cancer Institute; August 2009.
8.
ViswanathKRamanadhanSRKontosEZ, Mass media and population health: A macrosocial view. In: GaleaS, editor. Macrosocial determinants of population health. New York: Springer; 2007. p. 275–94.
9.
AndrulisDPSiddiquiNJGantnerJL, Preparing racially and ethnically diverse communities for public health emergencies. Health Aff (Millwood)2007;26:1269–79.
10.
BlendonRJBensonJMDesrochesCMWeldonKJ, Using opinion surveys to track the public's response to a bioterrorist attack. J Health Commun2003;8Suppl 1:83–92.
11.
Taylor-ClarkKAViswanathKBlendonRJ, Communication inequalities during public health disasters: Katrina's wake. Health Commun2010;25:221–9.
12.
ViswanathK.Public communications and its role in reducing and eliminating health disparities. In: ThomsonGEMitchellFWilliamsMB, editors. Examining the health disparities research plan of the National Institutes of Health: Unfinished business. Washington: Institute of Medicine; 2006. p. 215–53.
13.
ViswanathKAckersonLK, Race, ethnicity, language, social class, and health communication inequalities: A nationally-representative cross-sectional study. PLoS One2011;6:e14550.
14.
SavoiaETestaMAViswanathK.Predictors of knowledge of H1N1 infection and transmission in the U.S. population. BMC Public Health2012;12:328.
15.
CowlingBJNgDMIpDKLiaoQLamWWWuJT, Community psychological and behavioral responses through the first wave of the 2009 influenza A(H1N1) pandemic in Hong Kong. J Infect Dis2010;202:867–76.
16.
GaygisizUGaygisizEOzkanTLajunenT.Individual differences in behavioral reactions to H1N1 during a later stage of the epidemic. J Infect Public Health2012;5:9–21.
17.
LinYHuangLNieSLiuZYuHYanW, Knowledge, attitudes and practices (KAP) related to the pandemic (H1N1) 2009 among Chinese general population: A telephone survey. BMC Infect Dis2011;11:128.
18.
BalkhyHHAbolfotouhMAAl-HathloolRHAl-JumahMA, Awareness, attitudes, and practices related to the swine influenza pandemic among the Saudi public. BMC Infect Dis2010;10:42.
19.
WongLPSamIC, Behavioral responses to the influenza A(H1N1) outbreak in Malaysia. J Behav Med2011;34:23–31.
20.
RubinGJPottsHWMichieS.The impact of communications about swine flu (influenza A H1N1) on public responses to the outbreak: Results from 36 national telephone surveys in the UK. Health Technol Assess2010;14:183–266.
21.
MakKKLaiCM, Knowledge, risk perceptions, and preventive precautions among Hong Kong students during the 2009 influenza A (H1N1) pandemic. Am J Infect Control2012;40:273–5.
22.
WongLPSamIC, Factors influencing the uptake of 2009 H1N1 influenza vaccine in a multiethnic Asian population. Vaccine2010;28:4499–505.
23.
ZairinaARNooriahMSYunusAM, Knowledge and practices towards influenza A (H1N1) among adults in three residential areas in Tampin Negeri Sembilan: A cross sectional survey. Med J Malaysia2011;66:207–13.
24.
SavoiaELinLViswanathK.Communications in public health emergency preparedness: A systematic review of the literature. Biosecur Bioterror2013;11:170–84.
25.
GalarceEMMinskySViswanathK.Socioeconomic status, demographics, beliefs and A(H1N1) vaccine uptake in the United States. Vaccine2011;29:528–94.
26.
LiaoQCowlingBLamWTNgMWFieldingR.Situational awareness and health protective responses to pandemic influenza A (H1N1) in Hong Kong: A cross-sectional study. PloS One2010;5:e13350.
ChristensenP.H1N1 fears put graduation tradition on hold. Association of Health Care Journalists 2009 May 5 [cited 2013 Mar 7]. Available from: URL: http://healthjournalism.org/blog/tag/h1n1/page/6.
RebmannTElliottMBSwickZReddickD.US school morbidity and mortality, mandatory vaccination, institution closure, and interventions implemented during the 2009 influenza A H1N1 pandemic. Biosecur Bioterror2013;11:41–8.
34.
MillerJRShortVLWuHMWallerKMeadPKahnE, Use of nonpharmaceutical interventions to reduce transmission of 2009 pandemic influenza A (pH1N1) in Pennsylvania public schools. J Sch Health2013;83:281–9.
35.
MeilickeGRiedmannKBiederbickWMullerUWiererTBartelsC.Hygiene perception changes during the influenza A H1N1 pandemic in Germany: Incorporating the results of two cross-sectional telephone surveys 2008–2009. BMC Public Health2013;13:959.
36.
Garcia-ContinenteXSerralGLopezMJPerezANebotM.Long-term effect of the influenza A/H1N1 pandemic: Attitudes and preventive behaviours one year after the pandemic. Eur J Public Health2013;23:679–81.
37.
CanteyPTChukMGKohlKSHerrmannJWeissPGraffunderCM, Public health emergency preparedness: Lessons learned about monitoring of interventions from the National Association of County and City Health Officials survey of nonpharmaceutical interventions for pandemic H1N1. J Public Health Manag Pract2013;19:70–6.
38.
AgolorySGBarbotOAverhoffFWeissDWilsonEEggerJ, Implementation of non-pharmaceutical interventions by New York City public schools to prevent 2009 influenza A. PLoS One2013;8:e50916.
DhandNKHernandez-JoverMTaylorMHolyoakeP.Public perceptions of the transmission of pandemic influenza A/H1N1 2009 from pigs and pork products in Australia. Prev Vet Med2011;98:165–75.
43.
ScheinRBrulsSBuschVWilsonKHershfieldLKeelanJ.A flu by any other name: Why the World Health Organization should adopt the World Meteorological Association's storm naming system as a model for naming emerging infectious diseases. J Health Commun2012;17:532–45.
44.
VigsøO.Naming is framing: Swine flu, new flu, and A(H1N1). Observatorio J2010;4:229–41.
45.
ViswanathKBreenNMeissnerHMoserRPHesseBSteeleWR, Cancer knowledge and disparities in the information age. J Health Commun2006;11Suppl 1:1–17.
46.
AckersonLKViswanathK.Communication inequalities, social determinants, and intermittent smoking in the 2003 Health Information National Trends Survey. Prev Chronic Dis2009;6:A40.
47.
Census Bureau (US). Current Population Survey 2009 [cited 2010 Jul 20]. Available from: URL: http://www.census.gov/cps.
SavoiaEMassin-ShortSBRoddayAMAaronLAHigdonMAStotoMA, Public health systems research in emergency preparedness: A review of the literature. Am J Prev Med2009;37:150–6.
CantorDCovellJDavisTParkIRizzoL.Health Information National Trends Survey 2005 (HINTS 2005): Final report. Bethesda (MD): National Cancer Institute (US); 2005. Also available from: URL: http://hints.cancer.gov/docs/HINTS_2005_Final_Report.pdf [cited 2014 Jul 20].
54.
CantorDCoaKCrystal-MansourSDavisTDipkoSSigmanR.Health Information National Trends Survey (HINTS) 2007: Final report. Bethesda (MD): National Cancer Institute (US); 2009. Also available from: URL: http://hints.cancer.gov/docs/HINTS2007FinalReport.pdf [cited 2014 Jul 20].
55.
StataCorp. Stata$: Version 11.0. College Station (TX): StataCorp; 2009.
