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Determinants of emergency response willingness in the local public health workforce by jurisdictional and scenario patterns: a cross-sectional survey. BMC Public Health 2012 Mar 07;12:164 PMID: 22397547 PMCID: PMC3362768

Pubmed ID





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.

Author List

Barnett DJ, Thompson CB, Errett NA, Semon NL, Anderson MK, Ferrell JL, Freiheit JM, Hudson R, Koch MM, McKee M, Mejia-Echeverry A, Spitzer J, Balicer RD, Links JM


Jennifer M. Freiheit PhD Adjunct Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin


2-s2.0-84857748822   39 Citations

MESH terms used to index this publication - Major topics in bold

Attitude of Health Personnel
Cluster Analysis
Cross-Sectional Studies
Disease Outbreaks
Emergency Responders
Family Characteristics
Influenza, Human
Inhalation Exposure
Local Government
Middle Aged
Professional Competence
Proportional Hazards Models
Public Health Practice
Risk Factors
Rural Health Services
United States
Urban Health Services
jenkins-FCD Prod-332 f92a19b0ec5e8e1eff783fac390ec127e367c2b5