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Logo of bmcphBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Public Health
 
BMC Public Health. 2012; 12: 164.
Published online 2012 March 7. doi:  10.1186/1471-2458-12-164
PMCID: PMC3362768
Copyright ©2012 Barnett et al; licensee BioMed Central Ltd.
Determinants of emergency response willingness in the local public health workforce by jurisdictional and scenario patterns: a cross-sectional survey
Daniel J Barnett,corresponding author1,2,3 Carol B Thompson,4 Nicole A Errett,5 Natalie L Semon,1,2,3 Marilyn K Anderson,6 Justin L Ferrell,7 Jennifer M Freiheit,8 Robert Hudson,9 Michelle M Koch,10 Mary McKee,11 Alvaro Mejia-Echeverry,12 James Spitzer,13 Ran D Balicer,14,15 and Jonathan M Links1,2,3
1Johns Hopkins Preparedness and Emergency Response Research Center, 615 North Wolfe Street, Room E7537, Baltimore, MD 21205, USA
2Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
3Johns Hopkins Public Health Preparedness Programs, 615 North Wolfe Street, Room E7537, Baltimore, MD 21205, USA
4Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
5Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
6Eastern Idaho Public Health District, 1250 Hollipark Drive, Falls, ID 83401, USA
7Virginia Department of Health-Lord Fairfax Health District, 10 Baker Street, Winchester, VA 22601, USA
8University of Wisconsin-Milwaukee, 1828 East Rusk Avenue, Milwaukee, WI 53207, USA
9Butler County Health Department, 1619 North Main Street, Poplar Bluff, MO 63901, USA
10Meeker County Public Health, 114 N Holcombe Avenue, Suite 250, Litchfield, MN 55355, USA
11Marion County Health Department, 3838 North Rural Street, Indianapolis, IN 46205, USA
12Miami-Dade County Health Department, 8600 NW 17th Street, Suite 200, Doral, FL 33126, USA
13Multnomah County Health Department, 426 SW Stark Street, 7th Floor, Portland, OR 97224, USA
14Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel
15Clalit Research Institute, Clalit Health Services, 101 Arlozorov Street, Tel-Aviv, Israel
corresponding authorCorresponding author.
Daniel J Barnett: dbarnett/at/jhsph.edu; Carol B Thompson: cthompso/at/jhsph.edu; Nicole A Errett: nerrett/at/jhsph.edu; Natalie L Semon: nsemon/at/jhsph.edu; Marilyn K Anderson: manderson/at/phd7.idaho.gov; Justin L Ferrell: justin.ferrell/at/vdh.virginia.gov; Jennifer M Freiheit: jen/at/bvam.co; Robert Hudson: hudsor/at/lpha.mopublic.org; Michelle M Koch: Michelle.Koch/at/co.meeker.mn.us; Mary McKee: mmcKee/at/hhcorp.org; Alvaro Mejia-Echeverry: alvaro_mejia-echeverry/at/doh.state.fl.us; James Spitzer: james.d.spitzer/at/multco.us; Ran D Balicer: rbalicer/at/netvision.net.il; Jonathan M Links: jlinks/at/jhsph.edu
Received October 23, 2011; Accepted March 7, 2012.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
Background
The all-hazards willingness to respond (WTR) of local public health personnel is critical to emergency preparedness. This study applied a threat-and efficacy-centered framework to characterize these workers' scenario and jurisdictional response willingness patterns toward a range of naturally-occurring and terrorism-related emergency scenarios.
Methods
Eight geographically diverse local health department (LHD) clusters (four urban and four rural) across the U.S. were recruited and administered an online survey about response willingness and related attitudes/beliefs toward four different public health emergency scenarios between April 2009 and June 2010 (66% response rate). Responses were dichotomized and analyzed using generalized linear multilevel mixed model analyses that also account for within-cluster and within-LHD correlations.
Results
Comparisons of rural to urban LHD workers showed statistically significant odds ratios (ORs) for WTR context across scenarios ranging from 1.5 to 2.4. When employees over 40 years old were compared to their younger counterparts, the ORs of WTR ranged from 1.27 to 1.58, and when females were compared to males, the ORs of WTR ranged from 0.57 to 0.61. Across the eight clusters, the percentage of workers indicating they would be unwilling to respond regardless of severity ranged from 14-28% for a weather event; 9-27% for pandemic influenza; 30-56% for a radiological 'dirty' bomb event; and 22-48% for an inhalational anthrax bioterrorism event. Efficacy was consistently identified as an important independent predictor of WTR.
Conclusions
Response willingness deficits in the local public health workforce pose a threat to all-hazards response capacity and health security. Local public health agencies and their stakeholders may incorporate key findings, including identified scenario-based willingness gaps and the importance of efficacy, as targets of preparedness curriculum development efforts and policies for enhancing response willingness. Reasons for an increased willingness in rural cohorts compared to urban cohorts should be further investigated in order to understand and develop methods for improving their overall response.
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