title: Determinants of emergency response willingness in the local public health workforce by jurisdictional and scenario patterns: a cross-sectional survey.
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.
authors.affiliation: Johns Hopkins Preparedness and Emergency Response Research Center, 615 North Wolfe Street, Room E7537, Baltimore, MD 21205, USA. dbarnett@jhsph.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Barnett
authors.forename: Carol B
authors.initials: CB
authors.lastname: Thompson
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Errett
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Semon
authors.forename: Marilyn K
authors.initials: MK
authors.lastname: Anderson
authors.forename: Justin L
authors.initials: JL
authors.lastname: Ferrell
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Freiheit
authors.forename: Robert
authors.initials: R
authors.lastname: Hudson
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Koch
authors.forename: Mary
authors.initials: M
authors.lastname: McKee
authors.forename: Alvaro
authors.initials: A
authors.lastname: Mejia-Echeverry
authors.forename: James
authors.initials: J
authors.lastname: Spitzer
authors.forename: Ran D
authors.initials: RD
authors.lastname: Balicer
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Links
mesh_terms: D000328:Adult; D000881:Anthrax / Q000517:prevention & control / Q000523:psychology; D001291:Attitude of Health Personnel; D023482:Bioterrorism / Q000517:prevention & control / Q000523:psychology; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks / Q000517:prevention & control; D060731:Emergency Responders / Q000523:psychology* / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control / Q000523:psychology; D019570:Inhalation Exposure / Q000517:prevention & control; D009111:Local Government; D008297:Male; D008875:Middle Aged; D011361:Professional Competence / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011594:Psychometrics; D015980:Public Health Practice / Q000706:statistics & numerical data*; D012307:Risk Factors; D019035:Rural Health Services; D023481:Terrorism / Q000517:prevention & control / Q000523:psychology; D014481:United States; D019037:Urban Health Services; D000078329:Workforce