The Impact of Anthrax Attacks on the American Public

Robert J. Blendon, ScD, John M. Benson, MA, Catherine M. DesRoches, DrPH, William E. Pollard, PhD, Claudia Parvanta, PhD, Melissa J. Herrmann, MA

In This Article

Abstract and Introduction

Context: Incidents involving anthrax (Bacillus anthracis) through the mail in 4 metropolitan areas have raised concerns about the public's response nationally and locally.
Objective: To examine public response to these incidents and what it reveals about the demand placed on health professionals and public health officials nationally, in affected areas, and by affected people.
Design: Random-digit-dialed telephone surveys of samples of households nationally and in 3 specific metropolitan areas where cases of anthrax were reported: the District of Columbia; Trenton/Princeton, New Jersey; and Boca Raton, Florida.
Outcome measures: Respondents were asked a series of questions measuring their level of concern and their behavior in response to threats of anthrax and potential bioterrorist acts.
Results: The lives of a large share of people were affected in 3 metropolitan areas where anthrax incidents occurred. Residents of those 3 areas and people there who were affected by the incidents expressed a higher level of concern and took more precautions handling their mail. However, these incidents did not lead to great demands on the health system.
Conclusions: The incidents of anthrax created anxieties, especially in areas where incidents occurred. There was some increased demand on the health system, but the demands were not large-scale. In the event of a major outbreak of disease, most Americans will rely heavily on their own physician for advice. Both national and local systems of population-based information gathering about the public's response to bioterrorist attacks are needed.

Starting less than 1 month after the September 11, 2001, attacks on the World Trade Center and the Pentagon, the United States experienced a series of attacks involving anthrax in the mail. Twenty-two cases of anthrax were reported, mainly in 4 metropolitan areas: New York, NY, Washington, DC, Trenton/Princeton, NJ, and Boca Raton, FL.[1] These cases resulted in 5 deaths.

In order to provide an adequate capacity for dealing with current and possible future incidents of anthrax or threats of bioterrorism, health professionals and public health officials need to know the demands these events placed on the health system. One important way to measure demand is to examine the public's response, their concerns, and behavior. Several surveys conducted during October and November 2001 examined how Americans nationwide were responding to reports of anthrax.[2,3,4,5,6,7,8,9,10]

However, because public response is likely to be different and the level of demand higher in areas where the cases were reported, there is also a need to know how the residents of affected areas and particularly those individuals affected by the incidents were responding. In order to examine this issue, we conducted surveys of the public in 3 metropolitan areas where cases of anthrax had been reported. Simultaneously, we conducted a national survey with exactly the same measures.

The survey results reported here address 3 main questions: (1) How, nearly 2 months after the first cases were reported, were adults nationwide responding to the anthrax incidents? (2) How were residents of 3 areas where cases of anthrax had been reported responding? (3) In areas where cases of anthrax had been reported, were those directly or indirectly affected responding differently from unaffected residents of those areas?


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