Avian influenza risk perception, Europe and Asia.During autumn 2005, we conducted 3,436 interviews in European and Asian countries. We found risk perceptions of avian influenza avian influenza: see influenza. to be at an intermediate level and beliefs of efficacy to be slightly lower. Risk perceptions were higher in Asia than Europe; efficacy beliefs were lower in Europe than in Asia. ********** The possibility of an influenza pandemic
n. Any of three viruses of the genus Influenzavirus designated type A, type B, and type C, that cause influenza and influenzalike infections. with the avian avian /avi·an/ (a´ve-an) of or pertaining to birds. a·vi·an adj. Of, relating to, or characteristic of birds. H5N1 virus could result in a virus capable of human-to-human transmission and the start of a new pandemic pandemic /pan·dem·ic/ (pan-dem´ik) 1. a widespread epidemic of a disease. 2. widely epidemic. pan·dem·ic adj. Epidemic over a wide geographic area. n. . Despite extensive media attention for avian influenza, knowledge about risk perception of AI is scarce. We therefore explored the conditions for effective nonmedical interventions. If an influenza pandemic occurs, public health authorities will be dependent on the willingness and ability of the public to adhere to adhere to verb 1. follow, keep, maintain, respect, observe, be true, fulfil, obey, heed, keep to, abide by, be loyal, mind, be constant, be faithful 2. recommendations regarding personal hygiene personal hygiene person n → Körperhygiene f , vaccination and prophylaxis prophylaxis (prō'fĭlăk`sĭs), measures designed to prevent the occurrence of disease or its dissemination. Some examples of prophylaxis are immunization against serious diseases such as smallpox or diphtheria; quarantine to confine , quarantine, travel restrictions, or closing of public buildings (2,3). Adherence, however, cannot be assumed. Evaluation of the outbreak of H7N7 AI in the Netherlands in 2003 showed that adherence to antiviral therapy This article is about the biomedical journal. For therapy with antiviral agents, see antiviral drug. Antiviral Therapy is an academic journal published by International Medical Press, London, UK (a subsidiary of MediTech Media). and behavioral measures, such as wearing face masks and goggles goggles, n the protective eyewear worn by dental personnel and patients during dental procedures. goggles see periocular leukotrichia. , was low (4). Our ability to promote health-protective behavioral change depends on our knowledge of determinants of such behavior (5). The protection motivation theory posits that health-protective actions are influenced by risk perceptions (6-8). Risk perceptions are defined by the perceived seriousness of a health threat and perceived personal vulnerability. However, the protection motivation theory explicitly states that higher risk perceptions will only predict protective behavior when people believe that effective protective actions are available (response efficacy) and that they have the ability to engage in such protective actions (self-efficacy). The Study We investigated risk perceptions and efficacy beliefs related to AI of a random sample of persons in 8 areas. Random digital dialing was used to select the samples, and data were collected by using computer-assisted telephone interviewing. Interviews were conducted from September 20 through November 22, 2005, in 5 European countries (Denmark, the Netherlands, United Kingdom, Spain, and Poland) and 3 East Asian areas (Singapore; Guangdong Province Noun 1. Guangdong province - a province in southern China Guangdong, Kwangtung , People's Republic People's Republic n. A political organization founded and controlled by a national Communist party. of China; and Hong Kong Hong Kong (hŏng kŏng), Mandarin Xianggang, special administrative region of China, formerly a British crown colony (2005 est. pop. 6,899,000), land area 422 sq mi (1,092 sq km), adjacent to Guangdong prov. , Special Administrative Region A special administrative region may be:
Severe acute respiratory syndrome (SARS) is the first emergent and highly transmissible viral disease to appear during the twenty-first century. (SARS) (9). Respondents first received a brief explanation of AI. In line with the protection motivation theory (8), a measure of risk perception was constructed by multiplication of seriousness (scale 1-10) and vulnerability (scale 1-5). To make the scores comparable, the seriousness score was first divided by 2. To normalize normalize to convert a set of data by, for example, converting them to logarithms or reciprocals so that their previous non-normal distribution is converted to a normal one. the skewed distribution Skewed distribution Probability distribution in which an unequal number of observations lie below (negative skew) or above (positive skew) the mean. of the new variable, a square-root transformation was performed, which resulted in a measure of risk perception on a scale from 1 (low) to 5 (high). A total of 3,436 respondents were interviewed; participation rates varied from 12.9% in Asia to 81.1% in Poland. Most respondents were female (Table 1). European respondents were significantly older than Asian respondents (mean age 47 and 39 years, respectively, range 18-75 years, t = 16.2; degrees of freedom [df] = 3,351; p<0.001). Overall, 45% of respondents thought they were likely or very likely to become infected with AI if an outbreak occurred in their country. This perception varied from 32% in Denmark and Singapore to 61% in Poland and Spain. Risk perception scores varied significantly across countries; the highest mean score was in Poland and the lowest was in Denmark (Table 2). Higher scores were observed in Europe than in Asia (t = 5.2; df = 3,250; p<0.001), and differences between individual countries within Europe were significant. Multivariate analysis multivariate analysis, n a statistical approach used to evaluate multiple variables. multivariate analysis, n a set of techniques used when variation in several variables has to be studied simultaneously. showed that country, sex, and age group remained independent significant factors and showed a significant interaction between country and sex and between country and age group (Figure). In all countries, except Singapore, risk perception was higher among women than men, but this difference was smaller in Asian than in European countries. The effects of age also varied by country; mean risk perception levels were higher in older age groups in Europe but not in Asia. [FIGURE OMITTED] Response efficacy and self-efficacy also varied across countries; levels were highest in China and lowest in the Netherlands (Table 2). Mean response efficacy and self efficacy were significantly higher in Asia than in Europe (response efficacy t = -14; df = 2,868; p<0.001; self-efficacy t = -20; df = 2,701; p<0.001). Response and self-efficacy were inversely associated with risk perception (p = 0.013 and p<0.001, respectively). Multivariate analysis also showed that country, but not sex or age, was significantly associated with response efficacy. Country, sex, and age group were all significantly associated with self-efficacy. Self-efficacy levels were lower for women compared with men and for the youngest age group compared with older respondents. Risk perception and efficacy levels before and after the introduction of avian influenza in Europe did not differ significantly. Conclusions Our study showed that risk perceptions for AI appear to be at an intermediate level and that efficacy beliefs are slightly lower. Both differ according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. country or region. No evidence was found that the introduction of AI in Europe in October 2005 influenced perceptions of risk or efficacy. Fielding et al. have reported on risk perception of Al in Hong Kong with a focus on live chicken sales (10). Although our results are difficult to compare with theirs, our study appears to indicate a higher feeling of vulnerability, with 41.8% of Hong Kong respondents thinking it likely or very likely that they would become infected with influenza during an outbreak. Takeuchi's interviews on food safety practices of consumers in Thailand found high levels of knowledge of AI but lower levels of risk perception and behavior change Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness. (11). If we compare our results with those from several studies on perception of risk for SARS, we find that perception of risk for SARS in some of the Asian countries was relatively low compared with that in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. (12). In the Netherlands, however, perception of risk for SARS was low, whereas our present study indicates that it is high for influenza (9). The lower level of risk perception for AI in Asia may be related to the proximity to the current outbreak and the experience with the SARS epidemic. These experiences may have resulted in the notion that new epidemics of infectious diseases can be controlled. Also, despite the fact that the first cases of H5N1 influenza among humans in Asia were reported in 2003, a larger outbreak did not ensue. Accordingly, risk perception research has shown that the public may be more optimistic when familiar risks are perceived to be largely under volitional vo·li·tion n. 1. The act or an instance of making a conscious choice or decision. 2. A conscious choice or decision. 3. The power or faculty of choosing; the will. control (13,14). Our study has several implications for public health policy and research. Although in all countries an influenza pandemic is perceived as a real risk, the level of self-efficacy appears to be rather low. When developing preparedness plans for an influenza pandemic, specific attention should therefore be paid to risk communication and how perceived self-efficacy can be increased; otherwise, adherence to preventive measures may be low. This work was done as part of SARSControl: Effective and Acceptable Strategies for the Control of SARS and New Emerging Infections in China and Europe, a European Commission European Commission, branch of the governing body of the European Union (EU) invested with executive and some legislative powers. Located in Brussels, Belgium, it was founded in 1967 when the three treaty organizations comprising what was then the European Community project funded within the Sixth Framework Programme The Sixth Framework Programme (abbreviated FP6) was the Framework Programme for Research and Technological Development from 2002 till 2006 set up by the European Union (EU) in order to fund and promote European research and technological development. , Thematic Priority Scientific Support to Policies, contract no. SP22-CT-2004-003824. References (1.) World Health Organization. Cumulative number of confirmed human cases of avian influenza A/(H5N 1) reported to WHO [cited 2006 Aug 23]. Available from http://www.who.int/csr/disease/ avian_influenza/country/cases_table_2006_08_21/en/index.html (2.) World Health Organization Writing Group. Nonpharmaceutical interventions for pandemic influenza, international measures. Emerg Infect Dis [serial on the Internet]. 2006 Jan [cited 2006 Feb 14]. Available from http://www.cdc.gov/ncidod/EID/vol12no01/051370.htm (3.) World Health Organization Writing Group. Nonpharmaceutical interventions for pandemic influenza, national and community measures. Emerg Infect Dis [serial on the Internet]. 2006 Jan [cited 2006 Feb 14]. Available from http://www.cdc.gov/ncidod/EID/ vol 12no01/05-1371.htm (4.) Bosman A, Du Ry van Beest Holle M, Conyn-van Spaendonck MAE (1) (Metropolitan Area Exchange) Originally known as Metropolitan Area Ethernets, MAEs are junction points on the Internet where data is exchanged between carriers. See IXP and NAP. , Koopmans MPG. Compliance among poultry workers to infection control measures during a large epizootic ep·i·zo·ot·ic adj. Affecting a large number of animals at the same time within a particular region or geographic area. Used of a disease. ep of avian influenza in commercial poultry farms in the Netherlands [in Dutch]. In: Bosman A. Mulder YM, De Leeuw JRJ JRJ James R. Johnson & Associates, Inc. , Meijer A, Du Ry van Beest Holle M, Kamst RA, et al., editors. Avian flu avian flu: see influenza. epidemic 2003: public health consequences. Bilthoven: National Institute for Public Health and the Environment (RIVM RIVM Rijksinstituut voor Volksgezondheid en Milieu ) and Institute for Psychotrauma; 2004. p. 183-91. (5.) Green LW, Kreuter MW. Health promotion planning, an educational and ecological approach. 3rd ed. Mountain View (CA): Mayfield Publishing Company; 1999. (6.) Weinstein ND. The precaution adoption process. Health Psychol. 1988;7:355-86. (7.) Sjoberg L. Factors in risk perception. Risk Anal. 2000;20:1-11. (8.) Rogers RW. Cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation. In: Cacioppo J, Petty R, editors. Social psychophysiology psychophysiology /psy·cho·phys·i·ol·o·gy/ (-fiz?e-ol´ah-je) physiologic psychology. psy·cho·phys·i·ol·o·gy n. The study of correlations between the mind, behavior, and bodily mechanisms. . New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Guilford Press; 1983. (9.) Brug J, Aro AR, Oenema A, de Zwart O, Richardus JH, Bishop GD. SARS risk perception, knowledge, precautions, and information sources, the Netherlands. Emerg Infect Dis [serial on the Internet]. 2004 Aug [cited 2006 Feb 14]. Available from http://www.cdc.gov/ncidod/EID/vol10no8/04-0283.htm (10.) Fielding R, Lam WWT WWT Wastewater Treatment WWT What Was That? WWT Warioware Touched (Nintendo DS game) WWT Warioware Twisted! (Game Boy Advance game) WWT What a Waste of Time WWT World's Worst Tourist WWT Wall Wash Test , Ho EYY, Lam TH, Hedley AJ, Leung GM. Avian influenza risk perception, Hong Kong. Emerg Infect Dis [serial on the Internet]. 2005 May [cited 2006 Feb 14]. Available from http://www.cdc.gov/ncidod/EID/vol11no05/04-1225.htm (11.) Takeuchi M. Avian influenza risk communication, Thailand [letter]. Emerg Infect Dis [serial on the Internet]. 2006 Jul [cited 2006 22 August]. Available from http://www.cdc.gov/ncidod/EID/voll2 no07/06-0277.htm (12.) Blendon RJ, Benson JM, DesRoches CM, Raleigh E, Taylor-Clark K. The public's response to severe acute respiratory syndrome in Toronto and the United States. Clin Infect Dis. 2004;38:925-31. (13.) Pidgeon NF, Kasperson R, Slovic P. The social amplification of risk and risk communication. Cambridge, UK: Cambridge University Press Cambridge University Press (known colloquially as CUP) is a publisher given a Royal Charter by Henry VIII in 1534, and one of the two privileged presses (the other being Oxford University Press). ; 2003. (14.) Poortinga W, Bickerstaff K, Langford I, Niewohner J, Pidgeon N. The British 2001 foot and mouth crisis: a comparative study of public risk perceptions, trust and beliefs about government policy in two communities. Journal of Risk Research. 2004;7:73-90. Address for correspondence: Onno de Zwart, Municipal Public Health Service Rotterdam Area, Division of Infectious Disease Infectious disease A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. Control, PO Box 70032, 3000 LP Rotterdam, the Netherlands; email: dezwarto@ggd. rotterdam.nl Onno de Zwart, * Irene K. Veldhuijzen, * Gillian Elam, ([dagger]) Arja R. Aro, ([double dagger double dagger n. A reference mark (  ) used in printing and writing. Also called diesis.Noun 1. ]) Thomas Abraham, ([section]) George D. Bishop, ([paragraph]) Jan Hendrik Richardus, # and Johannes Brug # * Municipal Public Health Service, Rotterdam, the Netherlands; [dagger] Health Protection Agency--Centre for Infections, London, United Kingdom; ([double dagger]) University of Southern Denmark As a national institution the University of Southern Denmark (SDU) comprises five faculties – Humanities, Science, Engineering, Social Sciences and Health Sciences totaling 32 departments, 11 research centers and a university library. , Esbjerg, Denmark; ([section]) University of Hong Kong The University of Hong Kong (commonly abbreviated as HKU, pronounced as "Hong Kong U") is the oldest tertiary institution in Hong Kong. Its motto is "Sapientia et Virtus" in Latin, and " , Hong Kong Special Administrative Region, People's Republic of China; ([paragraph]) National University of Singapore The National University of Singapore (Abbreviation: NUS) is Singapore's oldest university. It is the largest university in the country in terms of student enrollment and curriculum offered. , Singapore; and # Erasmus University Erasmus University Rotterdam is a university in the Netherlands, located in Rotterdam. The university is named after Desiderius Erasmus Roterodamus, a 15th century humanist and theologian. Medical Center Rotterdam, Rotterdam, the Netherlands Mr de Zwart is head of the Division of Infectious Diseases Control of the Municipal Public Health Service Rotterdam Area and PhD candidate at the Department of Public Health, Erasmus University Medical Center Rotterdam. His research interests focus on risk perception and communication in relation to infectious diseases and development and evaluation of preventive interventions for HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. , sexually transmitted infections, and viral hepatitis viral hepatitis n. Any of various forms of hepatitis caused by a virus. viral hepatitis, n an inflammatory condition of the liver, caused by the hepatitis viruses: A, B, C, delta, E, F, G, or H. .
Table 1. Distribution of general characteristics of the study
population, by country or region, September 20-November 22, 2005 *
No. (%)
Characteristic DNK POL NLD UK
Total 463 488 400 401
(14) (14) (12) (12)
Sex
Male 40 39 42 41
Female 60 61 58 59
Age group, y
18-30 13 18 10 13
31-44 31 31 31 35
45-60 36 32 37 31
61-75 20 19 24 21
Area
City 26 21 9 20
Town 38 25 37 45
Village/ 37 54 55 36
countryside
Education
Primary or less 17 8 5 2
Low 31 22 28 20
Intermediate 38 43 35 35
High 13 28 32 43
No. (%)
Characteristic ESP CHN HKG SGP
Total 425 404 396 426
(12) (12) (12) (13)
Sex
Male 41 47 44 43
Female 59 53 56 57
Age group, y
18-30 17 43 27 35
31-44 34 34 35 31
45-60 32 19 27 20
61-75 17 4 12 14
Area
City 45 86 90 81
Town 42 9 4 16
Village/ 13 4 6 2
countryside
Education
Primary or less 22 4 13 3
Low 9 19 20 11
Intermediate 31 35 32 38
High 38 42 35 48
No. (%)
Characteristic Europe Asia Total
Total 2,177 1,226 3,403
(64) (36) (100)
Sex
Male 40 45 42
Female 60 55 58
Age group, y
18-30 14 35 22
31-44 32 33 33
45-60 33 22 29
61-75 20 10 16
Area
City 24 86 46
Town 37 10 27
Village/ 39 4 26
countryside
Education
Primary or less 11 7 9
Low 22 16 20
Intermediate 37 35 36
High 30 42 34
* DNK, Denmark; POL, Poland; NLD, the Netherlands; UK, United
Kingdom; ESP, Spain, CHN, China; HKG, Hong Kong; SGP, Singapore.
Table 2. Perceived risk perception and efficacy beliefs with regard
to a potential influenza outbreak, September 20-November 22, 2005 *
Mean score
(95% CI)
Scale 1-10
Country or
region Seriousness
DNK 6.08 (5.83-6.33)
POL 7.49 (7.29-7.70)
NLD 7.67 (7.48-7.87)
UK 7.38 (7.16-7.61)
ESP 6.76 (6.53-6.99)
CHN 6.58 (6.33-6.82)
HKG 7.02 (6.81-7.23)
SGP 6.63 (6.35-6.91)
Europe ([double dagger]) 7.06 (6.96-7.16)
Asia 6.74 (6.60-6.88)
Total 6.95 (6.86-7.03)
Mean score (95% CI)
Scale 1-5
Country or Risk perception
region Vulnerability ([dagger])
DNK 2.82 (2.71-2.92) 2.73 (2.65-2.81)
POL 3.43 (3.31-3.54) 3.48 (3.39-3.57)
NLD 3.17 (3.07-3.27) 3.40 (3.32-3.48)
UK 2.93 (2.81-3.05) 3.17 (3.07-3.26)
ESP 3.43 (3.32-3.53) 3.29 (3.20-3.37)
CHN 2.88 (2.76-2.99) 2.94 (2.85-3.04)
HKG 3.33 (3.23-3.42) 3.33 (3.25-3.40)
SGP 2.70 (2.57-2.83) 2.82 (2.71-2.93)
Europe ([double dagger]) 3.16 (3.11-3.21) 3.21 (3.17-3.25)
Asia 2.97 (2.90-3.03) 3.03 (2.97-3.08)
Total 3.09 (3.05-3.13) 3.14 (3.11-3.17)
Mean score (95% CI)
Scale 1-5
Country or
region Response efficacy Self-efficacy
DNK 2.32 (2.23-2.41) 2.15 (2.06-2.24)
POL 2.55 (2.46-2.64) 2.06 (1.96-2.16)
NLD 2.25 (2.14-2.35) 1.74 (1.66-1.83)
UK 2.41 (2.32-2.51) 2.03 (1.93-2.12)
ESP 2.75 (2.65-2.85) 2.26 (2.15-2.36)
CHN 2.99 (2.92-3.06) 2.90 (2.82-2.99)
HKG 2.95 (2.87-3.03) 2.64 (2.55-2.73)
SGP 2.81 (2.71-2.91) 2.70 (2.61-2.80)
Europe ([double dagger]) 2.46 (2.41-2.50) 2.05 (2.01-2.10)
Asia 2.92 (2.87-2.96) 2.75 (2.69-2.80)
Total 2.63 (2.59-2.66) 2.31 (2.27-2.34)
* CI, confidence interval; DNK, Denmark; POL, Poland; NLD, the
Netherlands; UK, United Kingdom; ESP, Spain; CHN, China; HKG,
Hong Kong; SGP, Singapore.
([dagger]) Square root of the multiplication of seriousness divided
by 2 and vulnerability.
([double dagger]) Differences in mean scores between Europe and Asia
are significant for all measures (p<0.001).
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