Using Short-Duration Opinion Surveys to Track the Public’s Response to an H1N1 Outbreak Robert J. Blendon, Sc.D. Harvard Opinion Research Program Harvard School of Public Health Harvard Kennedy School of Government Presented at NPHIC, October 19, 2009 Funded as part of a cooperative agreement between HSPH/National Preparedness Leadership Institute and the CDC

Harvard Opinion Research Program’s Focus on Public Health Emergencies Baseline Polls on Possible Public Response to Threats Crisis Polls during Threat (2-5 day results) Crisis Aftermath Polls (impact of events and communications) Analysis of Historic Polling Data for Trends/Perceptions AIDS – J. Osborn, “What ever happened to AIDS?” what some people consider to be panic flight is a RATIONAL response given the information the people have on the threat and risks Knowledge is a huge factor – saw this especially with AIDS. A 1985 ABC/WP survey found that 36% of the public believed that AIDS was just as contagious or more contagious as the common cold. These beliefs led to controversies over HIV positive children in school.

Understanding the Public’s Response to H1N1 Knowledge and Concern Level of concern Awareness of alerts and advisories Beliefs about threats Beliefs about prevention or treatment Response to Public Health Emergencies Following recommendations Other non-recommended behavior Support for public health policies Experiencing serious problems Information-seeking Behavior Sources of information sought Trust in spokespeople Usefulness of information Rating of authorities’ response AIDS – J. Osborn, “What ever happened to AIDS?” what some people consider to be panic flight is a RATIONAL response given the information the people have on the threat and risks Knowledge is a huge factor – saw this especially with AIDS. A 1985 ABC/WP survey found that 36% of the public believed that AIDS was just as contagious or more contagious as the common cold. These beliefs led to controversies over HIV positive children in school.

Concerns about H1N1/Swine Flu Among Hispanics and White Non-Hispanics % saying concerned they or an immediate family member may get sick from H1N1/swine flu in the next 12 months Concerned Not concerned Harvard Opinion Research Program, Harvard School of Public Health, May 5-6, 2009.

% saying they/member of household Steps Taken in Response to Outbreak Among Hispanics and White Non-Hispanics % saying they/member of household Washed hands or used hand sanitizer more frequently Avoided places where many people are gathered together, like sporting events, malls, or public transportation Avoided Mexican restaurants or grocery stores Avoided people you think may have recently visited Mexico Talked with your doctor about health issues related to swine flu Worn a face mask Harvard Opinion Research Program, Harvard School of Public Health, May 5-6, 2009.

% saying in response to reports of H1N1/swine flu, have personally… Steps Taken to Avoid Contact with Others, Among Hispanics and White Non-Hispanics % saying in response to reports of H1N1/swine flu, have personally… Taken any steps to avoid being near someone who has flu-like symptoms Stopped shaking hands with people Stopped hugging/kissing close friends/relatives Harvard Opinion Research Program, Harvard School of Public Health, May 5-6, 2009.

H1N1 Vaccine and the Public

Methods Summary Telephone poll Conducted September 14-20, 2009 Nationally representative random sample of adults in the United States 1,042 respondents—includes 357 parents Data weighted to match U.S. Census on: gender, age, race, education, region, and number adults in household 8

Americans’ Views of the Likelihood of a Major Outbreak of Influenza A – H1N1 % saying they think widespread cases with people getting very sick are… Very likely Somewhat likely Not too likely Not at all likely Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009; May 5-6, 2009. .

Americans’ Concerns That They or Someone in Their Family May Get Sick from Influenza A – H1N1 During Next 12 Months Concerned Not concerned Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

Americans’ Views of Public Health Officials’ Concerns about a Possible Outbreak of Influenza A-H1N1 Justified Overblown Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

Americans’ Attitudes about Getting the H1N1 Vaccine Adults absolutely certain will get for themselves Parents absolutely certain will get for their children Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

Not Absolutely Certain They Will Get Vaccine Includes those not sure, plan to get vaccine but may change mind, do not plan to get vaccine but will get if outbreak becomes severe, or absolutely certain NOT to get vaccine Gender * Men Women Age ** 18-29 30-49 ** 50-64 ** 65+ Income <$25,000 *** $25,000-50,000 *** $50,000-75,000 >$75,000 Education High school graduate or less **** Some college College graduate * Statistically significantly different than women ** Statistically significantly different than 65+ age group *** Statistically significantly different than <$25,000 **** Statistically significantly different than high school graduate or less/college graduate 13 Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

Parents Not Absolutely Certain They Will Get Vaccine for Their Children Includes those not sure, plan to get vaccine but may change mind, do not plan to get vaccine but will get if outbreak becomes severe, or absolutely certain NOT to get vaccine Racial/Ethnic Groups African American Hispanic * White Income <$25,000 ** >$25,000 ** >$75,000 Education High school graduate or less *** Some college *** College graduate * Statistically significantly different than Hispanic ** Statistically significantly different than <$25,000 *** Statistically significantly different than those with high school diploma or less 14 Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

Major Reasons Adults Will Not/Are Not Sure/May Change Their Mind About Getting H1N1 Vaccine % Who Said Was Major Reason Concern about side effects Don’t think at risk for serious case Can get medication to treat H1N1 Concern about getting H1N1 from vaccine Getting vaccine would be too expensive Concern about getting another serious illness from vaccine Don’t trust public health officials to provide correct information about vaccine safety Don’t think vaccine would be effective Don’t like shots/injections Plan on getting seasonal flu vaccine and believe will protect against H1N1 too Healthcare provider said should not get the vaccine Too hard to get to location for vaccine Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

Citing Concern about Safety of Vaccine Among those who say they will NOT get the vaccine Race African American * Hispanic White Age 18-29 ** 30-49 50-64 ** 65+ Income <$25,000 *** >$25,000 >$75,000 Education **** High school graduate or less **** Some college College graduate Metro Status ***** Urban Suburban Rural * Statistically significantly different than whites ** Statistically significantly different than 18-29 *** Statistically significantly different than >$25,000, >$75,000 **** Statistically significantly different than college graduates ***** Statistically significantly different than suburban 16 Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

Major Reasons Parents Will Not/Are Not Sure/May Change Their Mind About Getting H1N1 Vaccine % Parents Who Said Was Major Reason Concern about side effects Concern about child getting another serious illness from vaccine Don’t trust public health officials to provide correct info about vaccine safety Don’t think child at risk for serious case Concern about child getting H1N1 from vaccine Don’t think vaccine would be effective Child doesn’t like shots/injections Getting vaccine would be too expensive Plan on getting seasonal flu vaccine for child and believe will protect against H1N1 too Healthcare provider told you not to get it for child Too hard to get to location for vaccine Child is less than 6 months old and cannot get vaccine Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

American Public Views: Safety of H1N1 vs. Seasonal Flu Vaccine Very Safe Generally for Most People to Take Very Safe for Children 6 Months to 2 Years to Take Very Safe for Pregnant Women to Take Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

Parents’ Attitudes about What Would Make Them More or Less Likely to Get H1N1 Vaccine for Their Children More likely Makes no difference Less likely Vaccine contains small amount of mercury, aka thimerosal Makes no difference Less likely More likely Vaccine can be taken as a nasal spray rather than shot Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

Americans’ Trust in Groups Giving Advice about H1N1 Vaccine % saying trust a great deal Your personal doctor Your child’s pediatrician The Centers for Disease Control (CDC) The American Medical Association (AMA) Friends or family members employed in the field of health care The Surgeon General The Department of Health and Human Services (HHS) The Food and Drug Administration (FDA) The Department of Homeland Security (DHS) Websites from other health organizations, like WebMD Harvard Opinion Research Program, Harvard School of Public Health, September 14-20, 2009.

Public Support for Government’s Swine Flu Policy October 19761 March 19772 1 Roper Organization poll, October 1976. 2 Harris poll, March 1977.