Differences Between Florida and the Rest of the United States in Response to Local Transmission of the Zika Virus: Implications for Future Communication Campaigns

Trade-offs versus reassurance: framing competing risks in the 2016 Zika outbreak

Environmental threats increasingly entail important risks from government responses. In considering the risks of a new vector-borne disease, for example, decision-makers must also grapple with potential risks from responses such as the aerial spraying of pesticides. In communicating about these complex risks, public officials often choose different "frames" that promote different conceptualizations of the issue. Yet prior research has paid limited attention to how public officials frame the related risks of the environmental threat and the public response. This paper starts to fill that gap by conducting a content analysis of statements by public officials regarding risks from the threat of a local outbreak of the Zika virus in South Florida in 2016, as well as risks from the response of aerial pesticide spraying. Based on limited prior research, we hypothesize that public officials are likely to have adopted a "risk maximization" frame that stressed the high risks from exposure to Zika, but a "risk trade-off" frame when discussing aerial spraying. In actuality, we find that officials strongly favored a "reassurance" frame that downplayed both types of risks. Based on this analysis, we suggest framing strategies for disease outbreaks and other threats with potentially risky government responses may vary significantly depending on local contexts and that the South Florida experience was a missed opportunity to test the strategy of trade-off framing.

Can a COVID-19 vaccine live up to Americans' expectations? A conjoint analysis of how vaccine characteristics influence vaccination intentions

OBJECTIVE

A vaccine for the novel coronavirus (COVID-19) could prove critical in establishing herd immunity. While past work has documented the prevalence and correlates of vaccine refusal, I assess how a less explored topic -- properties of vaccines themselves (e.g., national origin, efficacy, risk of side effects) -- might influence vaccination intentions. This information can help public health officials preempt differential intentions to vaccinate, and inform health communication campaigns that encourage vaccine uptake.

RATIONALE

Previous research suggests that Americans should be more likely to intend to vaccinate if presented with a US-made vaccine that carries a low risk of minor side effects, is highly effective, is administered in just one dose, and has spent significant time in development.

METHODS

I administered a conjoint experiment (N = 5940 trials) in a demographically representative survey (N = 990) of US adults to assess how variation in vaccine properties influence self-reported public vaccination intentions.

RESULTS

I find that respondents prefer vaccines that are US-made, over 90% effective, and carry a less than 1% risk of minor side effects. This is potentially problematic, as some leading vaccine candidates are produced outside the US, and/or may be more likely to produce minor side effects than respondents would otherwise prefer. Worryingly, intended vaccine refusal rates exceed 30% for a vaccine meeting these optimal characteristics. Encouragingly, though, Americans show no clear preference for vaccines administered in one dose, or developed in under a year, and do not appear to draw a distinction between weakened viral vs. mRNA-based vaccines.

CONCLUSION

Americans' preferences for a novel coronavirus vaccine may be at odds with the vaccine that ultimately hits the market, posing both policy and health communication challenges for vaccination uptake.

Communicating the risk of contracting Zika virus to low income underserved pregnant Latinas: A clinic-based study

OBJECTIVE

Frequent travel between the Southern border states in the USA, Mexico, and Latin American countries increases the risk of the Zika virus (ZIKV) spread. Patient education on virus transmission is fundamental in decreasing the number of imported cases, particularly among pregnant women.

METHODS

The study used cross-sectional methodology to investigate information sources and knowledge concerning the ZIKV virus among 300 under-served pregnant Latinas recruited from prenatal care clinics in the North Texas region. Bivariate and multiple logistic regression models were used to investigate associations between the primary outcomes and patient characteristics.

RESULTS

Physicians, nurses, and families are the major sources for pregnancy information, while media/internet (65%) and physician/nurse (33%) are the main sources for ZIKV information. Less than one-half of the mothers reported that their physician/nurse did not discuss safe sexual practices or inquired about their sexual practices. A considerable proportion of women from the community clinic were neither warned nor queried about travel to ZIKV risk countries. There is an overall understanding of Zika virus transmission, symptoms, complications, and recommended guidelines. Younger age and single mother status are risk factors for lack of ZIKV knowledge. Foreign-born mothers are 2.5-3.0 times more likely to have knowledge on disease transmission, symptoms, and microcephaly condition. While, younger mothers (18-24) are less likely to have knowledge of ZIKV infection symptoms (fever, rash and pink eye) and transmission of infection via unprotected sexual (vaginal, anal, or oral) behavior, compared to older mothers.

CONCLUSIONS

Interventions are needed to heighten the knowledge of ZIKV, particularly among women of reproductive age and their male partners in the community health care setting. Our study underscores the need for health care providers to be trained in delivering messages to enhance risk perception during health emergencies to vulnerable and underserved families (lower economic background, language ability, and culture). During health emergencies, clinics must disseminate crucial information via multi modalities to ensure messages reach the targeted patients.

How Localized Outbreaks and Changes in Media Coverage Affect Zika Attitudes in National and Local Contexts

Public opinion researchers often find changing attitudes about pressing public health issues to be a difficult task and even when attitudes do change, behaviors often do not. However, salient real-world events have the ability to bring public health crises to the fore in unique ways. To assess the impact of localized public health events on individuals' self-reported behavior, this paper examines Floridians' intentions to take preventative measures against the Zika virus before and after the first locally transmit- ted case of Zika emerged in Florida. We find that local and national media coverage of Zika increased significantly following its first transmission in the U.S. Critically, we also find that Floridians surveyed after this increase in media coverage were more likely to pay attention to Zika-related news, and self-report intentions to take protective action against the virus. These results suggest that behavioral intentions can shift as health threats become more proximate.

Uncertainties, Fear and Stigma: Perceptions of Zika Virus among Pregnant Women in Spain

Similar to other epidemics, knowledge about Zika virus (ZIKV) relies upon information often coming from outside the health system. This study aimed to explore views, perceptions and attitudes towards ZIKV among migrant women from Central and South America, diagnosed with ZIKV infection during pregnancy, and to comprehend healthcare professionals’ perceptions of ZIKV. An exploratory qualitative study, based on phenomenology and grounded theory, was conducted in Barcelona, Spain. Data were collected through in-depth and paired interviews with women diagnosed with ZIKV infection during pregnancy, and semi-structured interviews with healthcare professionals. Women showed good level of awareness of ZIKV, despite some knowledge gaps. The most consulted source of information about ZIKV was the Internet. Women expressed they suffered from anxiety and depression due to potential effects of ZIKV on their babies. They conveyed their sources of support came primarily from their partners and relatives, as well as healthcare professionals. This study stresses the dramatic health, social and emotional burden that the epidemic imposed on migrant women infected with ZIKV during pregnancy. These results may help guide psychosocial support and health measures for pregnant women and their children as part of the public health emergency response in emergent epidemics.

Infectious disease, public health, and politics: United States response to Ebola and Zika

Politics, rather than disease characteristics, complicated the United States response to Ebola virus disease and Zika virus. We analyze how media and political elites shaped public opinion of the two outbreaks. We conducted a retrospective analysis of media coverage, Congressional floor speech, and public opinion polls to explain elite cueing and public perceptions of Ebola and Zika. We find evidence of elite cueing by Congress and the media on public opinion. Public opinion of both disease outbreaks initially followed partisan patterns. However, while Ebola public opinion remained partisan, ultimately, opinion emerged of a bipartisan nature for Zika, mirroring elite framing. Public health officials should be aware of how elite cueing shapes policy and prioritizes partisan strategies. Politics and public opinion can focus attention on or away from infectious disease; it can also undermine public health responses by biasing the public's view of a diseases' relative risk.

Americans' Views of Voluntary Protective Actions Against Zika Infection: Conceptual and Measurement Issues

Understanding factors affecting decisions by people to protect themselves, or not, is critical to designing supportive communications. Here, threat, protective-action, and stakeholder perceptions were evaluated for effects on mainland Americans' behavioral intentions regarding Zika in April 2017, as postulated by the Protective Action Decision Model. Although all three perception types (including a novel resource sufficiency measure) affected intentions, these relationships varied widely depending upon the method used to measure adoption of actions (e.g., total count of all behaviors adopted vs. behavior-specific analyses), the behaviors involved, and whether analysis focused on the full sample or only on people who had a reasonable opportunity to enact the behavior or who believed it relevant to their lives. There was a general contrast between mosquito control actions (removal of mosquito breeding areas and pesticide spraying) and travel-related behaviors (avoiding travel to areas of local transmission of the virus, protecting oneself from mosquito bites after potential exposure, and practicing safe sex after potential exposure). Reported action or inaction during the 2016 mosquito season, and stages of behavior change, were both elicited in January-February 2017; both drove intentions in April 2017 for the upcoming season, although direct and indirect effects varied widely. Collectively these findings present theoretical, measurement, and practical implications for understanding, tracking, and promoting voluntary protective actions against hazards.

Does the U.S. public support using gene drives in agriculture? And what do they want to know?

Gene drive development is progressing more rapidly than our understanding of public values toward these technologies. We analyze a statistically representative survey (n = 1018) of U.S. adult attitudes toward agricultural gene drives. When informed about potential risks, benefits, and two previously researched applications, respondents' support/opposition depends heavily (+22%/-19%) on whether spread of drives can be limited, non-native versus native species are targeted (+12%/-9%), or the drive replaces versus suppresses target species (±2%). The one-fifth of respondents seeking out non-GMO-labeled food are more likely to oppose drives, although their support exceeds opposition for limited applications. Over 62% trust U.S. universities and the Department of Agriculture to research gene drives, with the private sector and Department of Defense viewed as more untrustworthy. Uncertain human health and ecological effects are the public's most important concerns to resolve. These findings can inform responsible innovation in gene drive development and risk assessment.

Association between Knowledge of Zika Transmission and Preventative Measures among Latinas of Childbearing Age in Farm-Working Communities in South Florida

Zika infection, an otherwise usually mild disease, is of serious public health concern due to the potential teratogenic effects of the virus. The incidence of Zika infection is difficult to document since it is mostly asymptomatic and detection of those carrying Zika is usually not possible. Currently, there is no vaccine for Zika; therefore, use of personal preventative measures is the only method of avoiding transmission. The aim of this study was to evaluate the association between knowledge of Zika transmission and the use of preventive measures among Latinas of childbearing age who lived in or near farm-working communities in South Florida. A secondary data analysis was performed on a cross-sectional study, sampling 100 Latina women aged 18–50 years. Sixty-nine percent demonstrated a high degree of knowledge of Zika transmission, and 68% were categorized as taking good preventative measures. Women with high knowledge were 5.86 times more likely to take good preventative measures than those with no knowledge (p-value = 0.05). Knowledge was associated with more preventative measures. Therefore, it is essential to further investigate this relationship in order to develop effective public health interventions for this population.

Residential Location and Psychological Distance in Americans' Risk Views and Behavioral Intentions Regarding Zika Virus

Two 2017 experiments with a U.S. national opportunity sample tested effects of location, psychological distance (PD), and exposure to location-related information on Americans' Zika risk views and behavioral intentions. Location-distance from mosquito transmission of the virus in Florida and Texas; residence within states with 100+ Zika infections; residence within potential mosquito vector ranges-had small, inconsistent effects. Hazard proximity weakly enhanced personal risk judgments and concern about Zika transmission locally. It also increased psychological proximity, and intentions of mosquito control, avoiding travel to Zika-infected areas, and practicing safe sex. PD-particularly social and geographical distance, followed by temporal distance, with few effects for uncertainty-modestly and inconsistently decreased risk views and intentions. Exposure to location-related information from the U.S. Centers for Disease Control and Prevention website-naming states with 100+ Zika cases; maps of potential mosquito vector habitat-increased risk views and psychological closeness, but not intentions; maps had slightly stronger if inconsistent effects versus prevalence information. Structural equation modeling (SEM) of a location > PD > risk views > intention path explained modest variance in intentions. This varied in degree and kind (e.g., which location measures were significant) across behaviors, and between pre- and postinformation exposure analyses. These results suggest need for both theoretical and measurement advances regarding effects of location and PD on risk views and behavior. PD mediates location effects on risk views. Online background information, like that used here, will not enhance protective behavior without explicitly focused communication and perhaps higher objective risk.