Adoption of Preventive Behaviors in Response to the 2009 H1N1 Influenza Pandemic

A Multiethnic Perspective

Gillian K. SteelFisher; Robert J. Blendon; Minah Kang; Johanna R. M. Ward; Emily B. Kahn; Kathryn E.W. Maddox; Keri M. Lubell; Myra Tucker; Eran N. Ben-Porath

Disclosures

Influenza Resp Viruses. 2015;9(3):131-142. 

In This Article

Abstract and Introduction

Abstract

Background As public health leaders prepare for possible future influenza pandemics, the rapid spread of 2009 H1N1 influenza highlights the need to focus on measures the public can adopt to help slow disease transmission. Such measures may relate to hygiene (e.g., hand washing), social distancing (e.g., avoiding places where many people gather), and pharmaceutical interventions (e.g., vaccination). Given the disproportionate impact of public health emergencies on minority communities in the United States, it is important to understand whether there are differences in acceptance across racial/ethnic groups that could lead to targeted and more effective policies and communications.

Objectives This study explores racial/ethnic differences in the adoption of preventive behaviors during the 2009 H1N1 influenza pandemic.

Patients/Methods Data are from a national telephone poll conducted March 17 to April 11, 2010, among a representative sample of 1123 white, 330 African American, 317 Hispanic, 268 Asian, and 262 American Indian/Alaska Native adults in the USA.

Results People in at least one racial/ethnic minority group were more likely than whites to adopt several behaviors related to hygiene, social distancing, and healthcare access, including increased hand washing and talking with a healthcare provider (P-values <0·05). Exceptions included avoiding others with influenza-like illnesses and receiving 2009 H1N1 and seasonal influenza vaccinations. After we controlled the data for socioeconomic status, demographic factors, healthcare access, and illness- and vaccine-related attitudes, nearly all racial/ethnic differences in behaviors persisted.

Conclusions Minority groups appear to be receptive to several preventive behaviors, but barriers to vaccination are more pervasive.

Introduction

As a novel influenza A virus (H1N1) spread to more than 74 countries between March and mid-June, 2009, the World Health Organization declared a global pandemic.[1] As public health leaders prepare for future influenza pandemics, the rapid spread of 2009 H1N1 influenza highlights the need to focus on measures that members of the public can adopt to help slow disease transmission. Influenza mitigation efforts have included practices related to hygiene (e.g., hand washing), social distancing (e.g., avoiding places where many people gather), and pharmaceutical interventions (e.g., vaccination).[2–7] Increasing public acceptance of these preventive behaviors during a pandemic is a crucial goal for preparedness planning. Given the disproportionate impact of public health emergencies on minority communities in the United States,[8–10] it is important to understand whether there are differences in acceptance across different racial/ethnic groups that could lead to targeted and more effective policies and communications across populations.

Evidence about racial/ethnic differences in behavioral responses to influenza, whether 2009 H1N1 or seasonal, is limited. Studies in the United States have focused primarily on vaccination uptake rather than use of antiviral medications, hand hygiene and respiratory etiquette practices, or social distancing behaviors.[11] In most studies, vaccination rates for 2009 H1N1 or seasonal influenza appear to be higher among whites than African Americans or Hispanics, but few studies include discussion of American Indians/Alaska Natives or Asians.[11–14] There is relatively little study of the reasons underlying differences in behavior related to 2009 H1N1 influenza. Available data suggest that reasons may be similar to those that pertain to differences in seasonal influenza vaccination rates,[15] including those related to socioeconomic status, demographics, access to healthcare services, and attitudes (toward the vaccine, providers, and the illness).[12–17]

The limited data available on non-vaccine behaviors come from polling literature. Results from a poll regarding the American public's response to a hypothetical influenza pandemic suggest that African Americans may be less likely than whites to adopt financially burdensome social distancing behaviors, such as staying home from work for relatively long periods of time (e.g., 1 month).[18] When considering less financially burdensome behaviors, however, African Americans are more likely to adopt them. Data from a poll on avian influenza suggest that racial/ethnic minorities are more concerned than whites about this illness and predict they would be more likely to take basic preventive actions, including washing hands more often, if avian influenza were detected in the USA population (R.J. Blendon, unpub. data). One might find similar racial/ethnic differences in non-vaccine behaviors for other infectious illnesses, like 2009 H1N1 influenza, but no related studies yet exist.

In this study, we used national polling data to explore racial/ethnic differences in the adoption of preventive behaviors related to hygiene, social distancing, and health care among adults in the United States during the 2009 H1N1 influenza pandemic. We also explored whether behavioral differences could be attributed to differences in socioeconomic status, demographic factors, access to healthcare services, or attitudes. Unlike many previous studies in the area of pandemic preparedness, this study assesses practices among American Indians/Alaska Natives and Asians, in addition to African Americans, Hispanics, and whites.

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