A National Survey of Adults Public Attitudes Regarding Pandemic Influenza Jim Wolf, Director Survey Research Center at IUPUI July 14, 2008

2 Acknowledgments: Indiana State Department of Health Centers for Disease Control and Prevention Indiana University School of Medicine Center for Bioethics

3 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

4 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

5 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

6 Respondent Demographics

7 Quarantine: Who can stay home 7+ days? Potential problems for: Employed people Those in poor health The elderly Those with children

8 Potential Drawbacks to Full Compliance

9 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

10 % Approval for Selected Policies

11 “Strongly Approve” Policies, by Type

12 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

13 Average Priority Importance, by Type

14 “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

15 Compliance and Home Care, by Type

16 “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

17 “Very likely” Problems, by Type

18 “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

19 “Very likely” Compliance, by Type

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

21 “A lot” of Help Expected, by Type

22 “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

23 “A lot” of Trust in Information, by Type

24 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?

25 Workplace Compliance, by Type

26 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

27 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.

28 Questions? Please Jim Wolf: