A Bitter Pill to Swallow: Nonadherence With Prophylactic Antibiotics During the Anthrax Attacks and the Role of Private Physicians

Bradley D. Stein; Terri L. Tanielian; Gery W. Ryan; Hilary J. Rhodes; Shalanda D. Young; Janice C. Blanchard


Biosecur Bioterror. 2004;2(3) 

In This Article


We used flyers and e-mail to recruit 54 individuals who had worked at the BPF or the HSOB during October 2001. Individuals were eligible if officials had advised them to take at least 60 days of antibiotic prophylaxis. We screened individuals to obtain a final study sample in which approximately half of BPF and HSOB participants were nonadherent with the recommended 60 days of antibiotics prophylaxis. Brentwood postal workers were paid $50 for their participation; HSOB staff were not compensated because Senate Ethics Rules prohibit such payment. RAND's Human Subjects Protection Committee approved all study procedures.

We conducted 1-hour, semi-structured interviews between February and July of 2003 using well-established procedures.[9,10,11] Using open-ended questions, we asked participants how they learned about their potential exposure to anthrax, how they assessed their personal risk from anthrax, what actions they took to protect their health over the subsequent weeks and months, and how they perceived the pros and cons of following the recommendations of public health officials. We sought clarification or elaboration of responses as required, probing specifically to learn how participants reached decisions and what source and type of information participants used. Interviews were audiotaped and transcribed. Interviewers also recorded their own personal notes and observations immediately after each interview.

Drawing on the literature on risk perception and decision- making, we identified major themes, including adherence to public health recommendations, perceptions of the official response to the crisis, individuals' perceptions of risk to their well-being, sources and types of information used to make adherence decisions, and perceptions of public health recommendations. Trained coders reviewed transcripts using qualitative software (Atlas.ti. In.4.1 ed., Scientific Software Development, Federal Republic of Germany) to mark sections of text for each major theme. Next, quotes pertaining to each major theme were pasted on index cards with participant characteristics (e.g., adherence status, gender, population, etc.) noted on the back. A multidisciplinary research team that included the principal authors (BS, TT, GR, HR) sorted the cards into subthemes based on their similarity. This is a standard technique for identifying themes and subthemes that emerge from data.[12,13]


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