A National Survey of Adults

Public Attitudes Regarding Pandemic Influenza

Jim Wolf, DirectorSurvey Research Center at IUPUI

July 14, 2008

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Acknowledgments:

• Indiana State Department of Health

• Centers for Disease Control and Prevention

• Indiana University School of Medicine Center for Bioethics

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Background:

• Health officials throughout the country must develop policies to address emergency needs that will occur during an influenza pandemic

• Many questions began to emerge regarding the ethical implications of some of these policies

• This study was designed to begin understanding how the public will react

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Purpose of the study is to estimate:

• Public perception of priorities

• Likelihood of compliance with recommendations

• Likely sources of assistance and information

• Potential barriers to compliance

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Survey results:

• Random sample of 625 adults in U.S.• 26% response rate• Telephone interviews conducted in May and

June 2008• Sampling error no greater than +/- 4%• Average interview lasted about 11 minutes

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Respondent Demographics

49.1 50.9

13.9

34.9 32.6

18.6

79.6

5.6 6.8 7.9

010203040

5060708090

Pe

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nt

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Quarantine: Who can stay home 7+ days?

• Potential problems for:

• Employed people• Those in poor health• The elderly• Those with children

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Potential Drawbacks to Full Compliance

50.2

11.5

38.3 34.1 33.0

70.9

16.6 12.5

01020304050607080

Pe

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nt

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Policies: “How much do you approve…”• The State will identify healthcare workers who will be

required to work during a pandemic. • The State will not allow health care organizations to fire

employees who stay home during the epidemic.• The State will require employers to provide all supplies

necessary to protect medical personnel expected to interact with patients

• Priority for scarce medical equipment, like respirators, will be given to patients who are most likely to get well rather than other criteria (age, dependents, etc.)

• The State will request all hospitals to adopt same priorities

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% Approval for Selected Policies

53.8

42.2

61.3

57.9

43.6

16.8

33.7

24.1

30.3

53.7

0 10 20 30 40 50 60 70 80 90 100

Equipment priority to thehealthiest

Prohibit the firing of "no-shows"

Require all hosp to followsame priorities

Require selected HCW toreport to work

Require hospitals to provideprotective equip

Percent

Approve Strongly approve

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“Strongly Approve” Policies, by Type

0 10 20 30 40 50 60

Equipment priority to thehealthiest

Require selected HCW toreport to work

Require all hosp to followsame priorities

Prohibit the firing of "no-shows"

Require hospitals to provideprotective equipment

Percent

All Infirm 55 and over Kids

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Priority of Importance for Health Officials (Scale of 1=Lowest to 10=Highest)

• Treat everyone as equally as possible• Protect the health of the greatest number of people• Give priority to sick and frail people in getting

assistance• Aim to preserve essential community services like

electricity and law enforcement• Do not interfere with the civil liberties or freedoms of

people in your community

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Average Priority Importance, by Type

0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00

Protect civil liberties andfreedom

Priority to sick and frail

Treat everyone equally

Preserve essentialcommunity svcs

Protect the health of greatestnumber

All Infirm 55 and over Kids

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“If asked by State, would you stay home 7-14 days…”• To take care of members of your household at home

if they become sick• If you were sick with pandemic influenza

• Is there someone who could care for you at home?

• If you might have been exposed to pandemic influenza

• If pandemic influenza was in your community

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Compliance and Home Care, by Type

0 10 20 30 40 50 60 70 80 90 100

Someone to care for you

Care for others in home

Stay home if infection incommunity

Stay home if possiblyinfected

Stay home if infected

Percent

All Infirm 55 and over Kids

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“How likely is the following to be a problem if you had to stay home 7-14 days?”• Access to health care or prescription medications• Potential loss of pay or other financial problems• Generally have a hard time staying home that long• If applicable:

• Potential job loss• Access to baby formula, diapers, or other infant supplies • Problems with childcare • Proper care for disabled person • Proper care for elderly person

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“Very likely” Problems, by Type

0 5 10 15 20 25 30 35 40 45

Baby formula, diapers

Childcare

Lose job

Caring for elderly at home

Have a hard time

Get health care or meds

Caring for disabled at home

Lose pay/money problems

Percent

All Infirm 55 and over Kids

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“How likely is it that you would agree to the following for one month:”• Avoid going to public events (movies, sports, concerts)• Avoid going to malls and department stores• Postpone family events such as weddings, or funerals• Avoid air travel• Limit your use of public transportation, buses and trains• Cancel doctor or hospital appointments that are not critical• Reduce contact with people outside your own household• Avoid going to church or religious services

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“Very likely” Compliance, by Type

0 10 20 30 40 50 60 70 80 90 100

Family gatherings

People other than HH members

Church, religious svcs

Non-critical medical appts

Public entertainment venues

Malls, dept stores

Buses and trains

Air travel

Percent

All Infirm 55 and over Kids

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“How much help would you expect from each of the following sources:”• Government agencies• Voluntary agencies• Community groups• Church groups• Family• Friends• Neighbors

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“A lot” of Help Expected, by Type

0 10 20 30 40 50 60

Community groups

Voluntary agencies

Government agencies

Church groups

Neighbors

Friends

Family

Percent

All Infirm 55 and over Kids

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“How much confidence would you have in getting information about the pandemic from:”• State public health officials• Reporters at newspapers, magazines, TV or radio• Your doctor or other health care professional• Religious leaders in your community• The governor of your state

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“A lot” of Trust in Information, by Type

0 10 20 30 40 50 60 70 80

Media reporters

Religious leaders incommunity

State Governor

State public health officials

Personal doctor

Percent

All Infirm 55 and over Kids

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Questions asked only of employed:

• If state officials said stay home, but employer said come to work, would you stay home or go to work?

• If state officials requested closure, do you think your workplace would shut down, or would it stay open?

• Would you be able to work from home for a month? • If you had to stay away from work, would you still

get paid or not, or don’t you know?

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Workplace Compliance, by Type

0 10 20 30 40 50 60 70 80

Could work from home for amonth

Would still get paid

Employer would close

Stay home, even if employerrequested

Percent

All Infirm 55 and over Kids

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Conclusions• Public generally supports state policies taking firm action in times

of medical crisis• Nearly equal importance given to giving priority to the sickest

giving priority to helping the greatest number (need for public education)

• Nearly all would stay home if requested by state health officials• Nearly all would avoid public transportation, shopping and

entertainment venues; less so for more personal gatherings (church, family members)

• High likelihood of financial problems for 25-30%, especially for those with children, if in-home quarantine lasted 7-14 days

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Conclusions (cont’d)• People overwhelmingly report they would rely on family and friends

for help• They have far more trust in their doctor for information during a

pandemic than more formal channels• Most of those employed feel they would stay home, even if their

employer requested they show up for work.• Most also reported their employer would probably not close

voluntarily, nor would employees get paid if they stayed home• Older citizens, those with health problems and with children at

home report a variety of problematic issues, but generally reflect the population as a whole.

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Questions?

• Please email Jim Wolf: jamwolf@iupui.edu