Theory based approaches to understanding

This article was downloaded by: [Michigan State University] On: 28 July 2010 Access details: Access Details: [subscription number 918013331] Publisher Taylor & Francis Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 3741 Mortimer Street, London W1T 3JH, UK Journal of Health Communication Publication details, including instructions for authors and subscription information: http://www.informaworld.com/smpp/title~content=t713666566 Theory-Based Approaches to Understanding Public Emergency Preparedness: Implications for Effective Health and Risk Communication Hye-Jin Paeka; Karen Hilyardb; Vicki Freimuthc; J Kevin Barged; Michele Mindline a Department of Advertising, Public Relations, & Retailing, College of Communications Arts & Sciences, Michigan State University, East Lansing, Michigan, USA b School of Advertising & Public Relations, College of Communication and Information, University of Tennessee, Knoxville, Tennessee, USA c Department of Speech Communication and the Grady School of Journalism and Mass Communication, University of Georgia, Athens, Georgia, USA d Department of Communication, Texas A&M University, College Station, Texas, USA e Georgia Division of Public Health, Atlanta, Georgia, USA Online publication date: 21 June 2010 To cite this Article Paek, Hye-Jin , Hilyard, Karen , Freimuth, Vicki , Barge, J Kevin and Mindlin, Michele(2010) 'Theory- Based Approaches to Understanding Public Emergency Preparedness: Implications for Effective Health and Risk Communication', Journal of Health Communication, 15: 4, 428 — 444 To link to this Article: DOI: 10.1080/10810731003753083 URL: http://dx.doi.org/10.1080/10810731003753083 PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material Journal of Health Communication, 15:428–444, 2010 Copyright # Taylor & Francis Group, LLC ISSN: 1081-0730 print=1087-0415 online DOI: 10.1080/10810731003753083 Theory-Based Approaches to Understanding Public Emergency Preparedness: Implications for Effective Health and Risk Communication HYE-JIN PAEK Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Department of Advertising, Public Relations, & Retailing, College of Communications Arts & Sciences, Michigan State University, East Lansing, Michigan, USA KAREN HILYARD School of Advertising & Public Relations, College of Communication and Information, University of Tennessee, Knoxville, Tennessee, USA VICKI FREIMUTH Department of Speech Communication and the Grady School of Journalism and Mass Communication, University of Georgia, Athens, Georgia, USA J KEVIN BARGE Department of Communication, Texas A&M University, College Station, Texas, USA MICHELE MINDLIN Georgia Division of Public Health, Atlanta, Georgia, USA Recent natural and human-caused disasters have awakened public health officials to the importance of emergency preparedness Guided by health behavior and media effects theories, the analysis of a statewide survey in Georgia reveals that self-efficacy, subjective norm, and emergency news exposure are positively associated with the respondents’ possession of emergency items and their stages of emergency preparedness Practical implications suggest less focus on demographics as the sole predictor of emergency preparedness and more comprehensive measures of This research is a part of emergency and disaster preparedness project, supported by the Georgia Department of Human Resources–Public Health Division, with funds from the U.S Department of Health and Human Services, Centers for Disease Control and Prevention An earlier version of this article was presented at the 2008 National Communication Annual Convention in San Diego, CA, November 21–24 Address correspondence to Hye-Jin Paek, Department of Advertising, Public Relations, & Retailing, College of Communication Arts & Science, Michigan State University, 320 CAS, East Lansing, MI 48824, USA E-mail: paekh@msu.edu 428 Public Emergency Preparedness 429 Downloaded By: [Michigan State University] At: 00:40 28 July 2010 preparedness, including both a person’s cognitive stage of preparedness and checklists of emergency items on hand We highlight the utility of theory-based approaches for understanding and predicting public emergency preparedness as a way to enable more effective health and risk communication Following a series of natural and human-caused disasters ranging from Hurricane Katrina to 9=11 to epidemic disease outbreaks such as West Nile virus and avian flu, the public’s level of emergency preparedness is capturing the attention of public health officials, risk communicators, and academicians The Federal Emergency Management Agency (2007) has allocated more than $16 billion for state and local government initiatives to prepare for terrorism and more than $7 billion to prepare the nation for pandemic flu (Morse, Garwin, & Olsiewski, 2006) and established new protocols such as the National Incident Management System (NIMS) to enhance government response to disaster Despite the intense interest in emergency planning and preparedness, relatively little is known about the determinants of the public’s level of emergency preparedness beyond demographic characteristics This study explores the extent to which three key predictors—efficacy, perceived norm, and attention to emergency-related news media—are related to levels of emergency preparedness Drawing on literature from social psychology, persuasion, public health, and mass communication, we highlight the theoretical rationale for selecting these three predictors Our analysis of a statewide emergency preparedness survey provides several practical implications for public health officials and risk communication practitioners when designing messages to promote emergency preparedness Emergency Preparedness as a Critical Public Health and Safety Issue Emergency preparedness refers to the capability of individuals, as well as public health and risk organizations and communities, ‘‘to prevent, protect against, quickly respond to, and recover from emergencies’’ (Nelson, Lurie, Wasserman, & Zakowski, 2007, p S9) The term ‘‘emergency’’ connotes the sense of a sudden and unexpected onset of a disaster, but it also can be applied to other situations, which may not reach the level of ‘‘disaster.’’ From a public health perspective, emergencies tend to be characterized by disruptions in essential services, such as utilities, transportation, and food supply; the potential damage or destruction of dwellings and businesses; and the need for evacuation or rescue Although many different checklists exist to help citizens prepare, the most common emergencies such as fires, floods, hurricanes, and earthquakes require a similar set of supplies; human-caused emergencies such as terrorism and industrial accidents often build on the same lists Accordingly, we take this broader conception of emergency and consider preparedness as a coordinated and continuous process of planning to take corrective action (Nelson et al., 2007) The majority of research related to emergency management deals with response rather than preparation (McEntire & Myers, 2004) Studies of emergency preparedness behavior among the public primarily have been confined to descriptive statistics of degrees of preparedness or to scrutinizing government actions, with little attention being paid to predictors other than demographic characteristics Also absent in the research is any examination of preparedness campaigns within the context of a continuum or staged process—a critical oversight, given that being prepared for an Downloaded By: [Michigan State University] At: 00:40 28 July 2010 430 H.-J Paek et al emergency is not an all-or-nothing proposition, but a process in which people may adopt recommended precautions incrementally Existing literature reveals that Americans generally are not well prepared for emergencies, although there are some differences in preparedness levels among particular demographic groups (Eisenman et al., 2006; Enarson, 1998; Fothergill & Peek, 2004) For example, in a February 2007 poll, the American Public Health Association (2007) found that 23% of the public had taken no steps to prepare for an emergency; 27% claimed to be prepared, but only half that group had a 3-day supply of food, water, and medicine First aid kits and cash on hand also were lacking, but even low- or no-cost preparations were overlooked, such as planning how to communicate with family members in an emergency Other nationwide polls found similar results, with about 23–28% of respondents not prepared at all (e.g., American Red Cross and the Council for Excellence in Government, 2007; Harris Interactive, 2007) Generally, it is the poor, the elderly, and households headed by women that are believed to be the least likely to be prepared for emergencies (American Red Cross, 2007; Morrow, 1999) Post-Hurricane Katrina studies have examined demographic differences in perceptions of community preparedness and the ability of the government to respond to disasters, but the same data not exist with regard to individual or household preparedness (Perry & Lindell, 2003; Sattler, Kaiser, & Hittner, 2000; Tierney, Lindell, & Perry, 2001) It seems that personal vulnerability and resilience also contribute to individual variance in preparedness Other influences on preparedness, however, appear counterintuitive For example, awareness of risk is not associated with increased levels of preparedness A 2002 poll of more than 8,000 residents of Los Angeles County showed that despite high perceived risk in which 60% believed a terrorist attack was likely within the next year, only 37% had emergency supplies or plans As might be expected, young people and single people were found to be the least prepared One unexpected finding was that the disabled, African Americans, and residents born outside the United States tended to be prepared better than other groups (Eisenman et al., 2006) This contrasts with conventional wisdom that these populations are inherently more vulnerable to emergencies due to language barriers or lack of resources, indicating a need for further research Lessons Learned from the Past Studies: Toward Theory-Based Understanding and Prediction Inherent in many of the typical preparedness surveys such as those detailed above are two measures of emergency preparedness: One is defined by a checklist of how many items have been gathered or plans made; and another describes the cognitive process behind preparedness behavior, including reflexive perceptions of preparedness There are both practical and theoretical reasons to discern two types of emergency preparedness Practically, the first measure (counting the number of emergency items) has been employed as an indicator of preparedness by many public health organizations (e.g., American Red Cross, King County Office of Emergency Management) This measure does not capture whether people own certain emergency items coincidentally or whether they deliberately have collected these items to prepare for an emergency As a result, a measure of how mindful people are of planning for emergencies may better describe, explain, and predict the public’s level of Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Public Emergency Preparedness 431 emergency preparedness The utility of measuring the respondent’s self-appraisal of deliberate planning and preparation is also supported by the Transtheoretical Model (TTM) The TTM posits that people change their behavior through stages of action (Glanz, 1997; Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992) The number of stages of action has changed over time and may vary across health contexts, but most research incorporates some version of the following five stages: (1) precontemplation—the stage where people have no intention to change behavior in the near future; (2) contemplation—where people are aware that a problem exists and are seriously thinking about overcoming it, but they have not yet made a commitment to take an action; (3) preparation—where people intend to take action and have started to make some changes; (4) action—where individuals modify their behavior or environment to overcome problems and reach certain goals; and (5) maintenance—in which people maintain behavior changes for at least months or more (Prochaska & DiClemente, 1983) The TTM suggests that communication messages should be different for people in different stages of change For example, action-oriented messages may be quite effective with individuals who are in the decision or action stages, but these same campaigns may be ineffective with individuals in precontemplation or contemplation stages These individuals may not yet be aware of a need to prepare, or they may not yet be persuaded of the urgency or efficacy of preparation (Prochaska et al., 1992) Research has shown the importance of targeting each stage in the process to produce incremental change Even moving just one stage initially, for example, from precontemplation to contemplation or contemplation to preparation can double the chance of an individual’s likelihood of getting to the action stage within months or in the ‘‘near future’’ (Prochaska & Norcross, 2001) The model successfully has been applied to many health contexts including smoking and drug cessation, weight control, condom use, and mammography screening (Prochaska et al., 1994) In this study, we apply the TTM in two ways First, we use the stages-ofchange model to construct the dependent variable measuring the stage of emergency preparedness actions This allows us to examine the degrees by which people consider, learn, prepare, maintain, and update emergency supplies and plans It makes sense to examine behavior as it is associated with these stages, because response to emergency preparedness campaigns often is incremental or graduated in nature, a phenomenon similar to that documented in literature from many disciplines (Marcus et al., 1992; Nigg et al., 1999; Prochaska & DiClemente, 1983) Second, we use the TTM to examine some of the key theoretical concepts or determinants that are related to both the number of emergency items that individuals have and the individual’s stage of emergency preparedness Three important theoretical determinants are identified in the TTM that cut across several theories of behavioral change (see Slater, 1999): (1) self-efficacy; (2) normative influence; and (3) media effects Efficacy Hypothesis In order to take action, a person must first recognize the existence of the problem and a need to improve the situation (also see Situational Theory in public relations literature; Grunig & Hunt, 1984) Second, the person must take into account any Downloaded By: [Michigan State University] At: 00:40 28 July 2010 432 H.-J Paek et al constraints that might limit their control over the situation This idea is closely related to perceived self-efficacy, which has been defined in Social Cognitive Theory (SCT; Bandura, 1997) and others (Witte, 1992) as an individual’s belief that he or she is capable of executing a particular behavior.1 The Extended Parallel Process Model (EPPM; Witte, 1992) and Protection Motivation Theory (Rogers, 1983) also propose that people must have the confidence to undertake the recommended behaviors Finally, the Theory of Planned Behavior (TPB; Ajzen, 1985) also notes the significant role of perceived behavioral control in predicting behavioral intention Similar to self-efficacy, perceived behavioral control is defined as an individual’s perceptions of his or her ability or feelings of self-efficacy to perform a behavior Numerous studies have tested and confirmed that self-efficacy is a significant predictor of behavior or behavior change in various health and risk contexts (Glanz et al., 2002; Maddux, 1991) Based on conceptual and empirical support from SCT, EPPM, and TPB, we offer the following hypothesis: H1 Self-efficacy is positively related to emergency preparedness Normative Influence Hypothesis Although self-efficacy serves as an internal driving force to make people adopt a recommended risk reduction behavior (like emergency preparedness), people also often follow what is acceptable in society and among their significant others The idea of normative influence is reflected most prominently in the Theory of Reasoned Action (TRA)=Theory of Planned Behavior (TPB; Ajzen, 1985; Fishbein & Ajzen, 1975) Both theories explain how behavior is influenced by the interplay among beliefs, attitudes, and behavioral intentions That is, behavior is dependent on intention, which is determined by an individual’s attitude (i.e., beliefs and values about the outcome of the behavior) and subjective norm (i.e., a belief about how one’s significant others think she or he should engage in the behavior) Although attitudes may best explain behavioral intention, subjective norm also has been found to explain behavioral intention to a significant extent (Gottlieb, Gingiss, & Weinstein, 1992) While the subjective norm identified in TRA and TPB is limited in scope to a person’s ‘‘significant others’’ (e.g., parents, close friends, spouses, children), another line of normative influence literature embraces perceived norm in broader terms: an individual’s perception about what most people or what is typical or normal (also called descriptive norm by Cialdini, Reno, & Kallgren, 1990) Whether subjective norm or perceived norm, the idea behind this normative influence is that people are influenced by what others think and how others behave (Paek & Gunther, 2007) Guided by the normative influence literature, varying levels of emergency preparedness among individuals are likely tied to their perception of what their SCT proposes causal, triadic interactions among the environment (both social and physical), people (and their intrinsic cognitive, affective, and biological traits), and the behavior (Bandura, 1997) In this theory, self-efficacy is critical to performing a particular behavior successfully (Glanz, Rimer, & Lewis, 2002) Public Emergency Preparedness 433 significant others approve of or what a majority of Americans think and Thus, this study proposes the following normative influence hypothesis: H2 Subjective norm (H2–1) and perceived norm (H2–2) are positively related to emergency preparedness Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Media Effects Hypothesis People can learn from the news media about current disasters and emergencies and how to prepare for them First, one of the main functions of media, ‘‘surveillance,’’ is the watchdog function to keep people informed of what is happening in the environment and aware of threats or dangers With media monitoring the world and gathering and summarizing important information, people can go about their daily lives, knowing they will be alerted when something relevant or dangerous needs their attention (Perse, 2001) Second, through agenda setting and priming, the media play a key role not only in making certain issues more salient (McCombs & Reynolds, 2002) but also in altering criteria for evaluating political leaders and government policies (Iyengar, 1991) Third, media expand the boundary of an individual’s experiences, allowing them to vicariously experience various human-caused and natural emergencies such as Hurricane Katrina, 9=11, and anthrax (Mutz, 1998) The vicarious experience idea also is supported by the SCT, which posits that people observe and learn from role models and respond to an environment, in this case provided by media (Bandura, 1994) Studies of disaster news have examined its functions in communicating warnings and directives to individuals directly affected, as well as the policy implications, educational potential, and emotional impact of coverage on a wider audience (Garner & Huff, 1997; Keselman, Slaughter, & Patel, 2005) While emergency-related news may make disaster more salient to the public, coverage that emphasizes the random nature of disaster may result in higher levels of fatalistic thinking (McClure, Sutton, & Sibley, 2007; Tierney et al., 2001) Therefore, the third hypothesis explores the relationship between attention to the emergency-related news and preparedness behavior: H3 Exposure to emergency-related media news is positively related to emergency preparedness Methods Data The study analyzed a state-representative telephone survey of 1,302 adult respondents age 18 and older conducted in the state of Georgia in July 2006 Georgia may be an ideal microcosm for the study of emergencies and disasters in general, because it experiences the same disasters that many other states do, yet there is no single overwhelming threat like earthquakes or hurricanes that might dominate residents’ thoughts While many areas of Georgia are rural, Atlanta is the ninth largest metropolitan statistical area in the United States The city’s size and the presence of institutions such as the Centers for Disease Control and Prevention (CDC) and 434 H.-J Paek et al Cable News Network (CNN) make it a possible terrorist target, and its importance as a travel hub makes it a potential vector for disease A professional research firm was employed to conduct the 15-minute telephone survey, collected through a stratified, list-assisted, random digit-dialing (RDD) sampling method among the state’s general population.2 The CASRO response rate was 40.5%.3 Compared with the 2006 census data, the sample appeared to slightly overrepresent females (62%), Whites (69.6%), older citizens (M ¼ 48.59, SD ¼ 15.53), and the better-educated (M ¼ 5.06—some college education, SD ¼ 1.02) Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Measures The variables used in the present analysis can be categorized into five groups, with one group serving as criterion variables and the four other groups serving as independent variables: (1) criterion variables; (a) the number of emergency items and (b) stage of emergency preparedness; (2) control variables: (a) demographics (gender, race, age, and the number of children at home), (b) social structural variables (social status, home ownership), (c) residential area, and (d) past experience; and (3) main predictors: (a) respondents’ own beliefs and perceptions—self-efficacy, subjective norm, and perceived norm regarding emergency preparedness; and (b) exposure to emergency-related media news Question items were drawn from existing literature and modified to fit the study context Appendix A reports the individual question items used to operationalize the variables Table reports descriptive statistics for all the variables used in the study The number of emergency items was measured by counting the number of actual emergency supplies people possessed The survey asked a series of ‘‘yes’’ or ‘‘no’’ questions about specific preparedness behaviors and supplies The question items were drawn from other emergency preparedness programs (e.g., King County Office of Emergency Management; American Red Cross) and confirmed by public health officials Due to the limited time of a telephone interview, the Computer-Aided-Telephone-Interview (CATI) system randomly divided the sample into two groups (N ¼ 654 and 648), each of which was asked either 10 Using a multistage sampling method, all possible telephone numbers were divided into blocks that were defined by the last two digits of a 10-digit phone number Strict procedures were implemented to improve response rate and to ensure that the hard-to-reach respondents had a chance to be interviewed, including the following: (1) a requirement of distributing call attempts by each interviewer at different times across different days; and (2) strict call-back rules stipulating that a number could not be abandoned unless it had been verified as being invalid or attempted at least 25 times Within each household, the interviewer randomly selected the adult in the household who most recently celebrated a birthday in order to randomize within-household selection and to prevent bias associated with only speaking to the person who answers the telephone The survey was composed of two sections: (a) one about emergency preparedness in general; and (b) the other soliciting citizens’ knowledge and perceptions of avian flu and pandemic flu The present analysis is based on the first section of the survey, where respondents were asked about their media use and attention related to emergency news, their perceptions and self-reported knowledge about emergency preparedness, various emergency supplies that they currently owned, and their stages of emergency preparedness The CASRO rate is a formula suggested by the Council of American Survey Research Organizations (CASRO) and is largely used in nationwide and statewide surveys (e.g., Behavioral Risk Factor Surveillance System) Similar to American Association for Public Opinion Research (AAPOR) response rate formula 3, the CASRO rate was calculated as the number of interviews divided by the number of known and unknown eligible cases Public Emergency Preparedness 435 Table Descriptive statistics (N ¼ 1,302) Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Variables Dependent variables The number of emergency items Stage of emergency preparedness Control variables Femalea Whitesa Age Social status Number of children at home Home ownershipa Urban residencea Past experiencea Beliefs & perceptions Self-efficacy Subjective norm Perceived norm Media use & attention Media attention Mean SD 5.51 2.37 2.37 1.45 62.0 (%) 69.6 (%) 48.59 4.26 78 77.1 (%) 44.8 (%) 33.3 (%) – – 15.53 1.11 1.17 – – – 3.27 3.10 2.34 72 78 71 3.43 63 a Gender and race were measured with dummy variables with female (male ¼ 0) and White being (other races ¼ 0) Homeownership, urban residence, and past experience are measured with binary scale of yes or no The numeric values reported are percentages or 11 of the 21 questions Among these items, one item, ‘‘Extra supplies for pet,’’ was eliminated from the final analysis since it could not be applied to all participants, especially those without pets (21.5% of respondents) The ‘‘yes’’ responses then were summed to create a measure of the number of emergency items owned by individuals (range ¼ 0–10) To measure stage of emergency preparedness, the authors adopted the five stages of action developed and tested by Prochaska and his associates (1983, 1992, 1994, 1997, 2001) and modified them to fit the emergency preparedness context Those who answered ‘‘no’’ for the first question (‘‘Have you thought about planning for emergencies at all?’’) were considered to be in the pre contemplation stage; those who answered ‘‘yes’’ for the first question but answered ‘‘no’’ for the second question (‘‘Have you tried to learn or find more information about how to prepare for emergencies?’’) were placed in the contemplation stage; and so on, with the following questions corresponding similarly to the other three stages (i.e., two ‘‘yes’’ answers followed by ‘‘no’’ to ‘‘Have you taken any action to gather supplies or make a plan for emergencies?’’ was classified as preparation; ‘‘no’’ to ‘‘Have you updated your emergency plans or restocked your supplies for emergencies in the past months?’’ was considered action and ‘‘yes’’ considered indicative of the maintenance stage.) The stage of emergency preparedness measure was a 5-point ordinal scale The correlation between the two dependent variables, number of emergency items, and stage of emergency preparedness was 57, indicating a moderate association Downloaded By: [Michigan State University] At: 00:40 28 July 2010 436 H.-J Paek et al Self-efficacy was measured with a single item, ‘‘How confident are you about your own ability to manage an emergency?’’ with a 4-point scale ranging from ‘‘not at all confident (1)’’ to ‘‘very much confident (4).’’ Subjective norm was measured with a single item, ‘‘To what extent most of your family or friends think you personally should prepare for an emergency?’’ with a 4-point scale ranging from ‘‘not at all (1)’’ to ‘‘very much (4).’’ Perceived norm was measured with a one-item question, ‘‘How well prepared you think most people in the U.S are for an emergency?’’ with a 4-point scale ranging from ‘‘not at all prepared (1)’’ to ‘‘very much prepared (4).’’ To measure media use, participants were asked about the amount of attention they paid to emergency preparedness news using a 4-point scale (1¼‘‘no attention at all,’’ to ¼ ‘‘very close attention’’) The Exploratory Factor Analysis (EFA) result shows that the four items clearly constituted one factor explaining 59.8% of the total variance (Cronbach’s alpha ¼ 76) The four items were averaged to create an index of attention to emergency news, with a higher score indicating a higher level of attention For control variables, guided by existing risk communication literature (e.g., Griffin & Dunwoody, 2000), the authors included gender, age, race (White as a dummy variable), number of children at home, social status, home ownership, residential area (i.e., urban=rural), and past experiences with various emergency situations (see Paek, Yoon, & Shah, 2005; Tierney et al., 2001, for the relevant rationales) For social status, an averaging index of education and income was created (6-point scale), because the two variables often represent individuals’ socioeconomic status and are highly correlated (inter-item correlation ¼ 50; see Griffin & Dunwoody, 2000, for the same measure) Analytic Strategy First, the variables were evaluated to see if they violated normality assumptions that might threaten the results Diagnostic statistics using skewness and kurtosis showed that the normality assumption was not violated Second, two hierarchical multiple regression models were computed to assess the predictive value of all the variables on the two dependent variables, the number of emergency items and stage of emergency preparedness In the regression models, predictors were entered in the following order: control variables (demographics, social structural variables, and past experience), respondents’ own beliefs and perceptions, and then media attention variables (see Table 2) Although the stage of emergency preparedness is measured with an ordinal scale (that is not truly an interval scale), the diagnostic statistics indicate normal distributions without any outliers or truncation of the data Ordinary least squares (OLS) regression was used because it yields results similar to those from ordinal techniques such as probit or logit models but allows clearer interpretations (Fox, 1991; Knoke & Bohrnstedt, 1994) Results H1 Efficacy Hypothesis Hypothesis predicted that the more confident people are about their ability to prepare for an emergency, the more likely they will have emergency items and the higher Public Emergency Preparedness 437 Table Hierarchical multiple regression analysis The number of emergency items owned Beta finalb Beta finalb À.062à 025 042 059à À.029 108à À.053 211ÃÃà À.033 À.005 010 008 À.030 084Ãà À.019 117ÃÃà 059ÃÃà 031 067à 110ÃÃà 085Ãà À.012 104ÃÃà À.027 244ÃÃà 067à 029 100ÃÃà 038 026 049 002 167ÃÃà 082ÃÃà 401ÃÃà 301ÃÃà 102ÃÃà 320ÃÃà 187ÃÃà 061à 176ÃÃà 336ÃÃà 263ÃÃà 051 265ÃÃà 164ÃÃà 019 120Ãà 145ÃÃà 101ÃÃà 009ÃÃà 244ÃÃà 145ÃÃà 078Ãà 007Ãà 210ÃÃà Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Variables Control variables Female Whites Age Social status Number of children at home Home ownership Urban residence Past experience DR2 Beliefs & perceptions Self-efficacy Subjective norm Perceived norm DR2 Media use & attention Media attention DR2 Total R2 Stage of emergency preparedness a Pearson correlation coefficient Betas are taken from the final equation with all the predictors entered à p 05, Ãà p 01, ÃÃà p 001; All betas are standardized regression coefficients Missing values were treated with pairwise solution b their stage of emergency preparedness will be Our results support this hypothesis Self-efficacy was strongly and positively associated with the two dependent variables Confidence in the ability to handle emergencies was associated with greater likelihood of preparing emergency supplies (b ¼ 320, p < 001) and engaging in a higher stage of emergency preparedness (b ¼ 265, p < 001) H2 Normative Influence Hypothesis Hypothesis predicted that the more their significant others think they should prepare for emergencies (subjective norm; H2–1) and that the more people perceive others are well prepared (perceived norm; H2–2), the more likely they will have emergency items and rate themselves as being in a higher stage of emergency preparedness Subjective norm was significantly and positively associated with the two dependent variables of emergency preparedness The more people thought their significant others such as parents and friends believed they should prepare for an emergency, the more likely they were to perform emergency planning (e.g., safely store important documents, put together an emergency kit for the car) and gather supplies (e.g., a flashlight, lantern or candles, a first aid kit; b ¼ 187, p < 001) They 438 H.-J Paek et al were also in a higher stage of emergency preparedness (b ¼ 164, p < 001) By contrast, the respondents’ perception that average Americans were well prepared was positively related to the number of emergency items (b ¼ 061, p < 05), but not to the stage of emergency preparedness (b ¼ 019, p ¼ ns) Even at a bivariate level, perceived norm was only marginally significantly related to the stage of emergency preparedness (r ¼ 051, p ¼ 068) and became nonsignificant when the other predictors were controlled in the model Downloaded By: [Michigan State University] At: 00:40 28 July 2010 H3 Media Effects Hypothesis Last, Hypotheses predicted that the more people are exposed to emergency-related news in media, the more likely they will have emergency items and rate themselves as being in a stage of emergency preparedness This hypothesis was strongly supported The more attentive people were to news about various emergencies delivered by television, radio, newspaper, and the Internet, the more likely they were to have emergency items (b ¼ 101, p < 001) and to engage in a higher stage of preparation actions (b ¼ 078, p < 01) Although the variance explained by the media exposure variable was small, it significantly contributed to the regression models (DR2 ¼ 009 for the number of emergency items model and DR2 ¼ 007 for the stage of emergency preparedness model) Overall, the two regression models, respectively, accounted for more than 24% and 21% of total variance explained in the two dependent variables Discussion This study explored three promising theoretical concepts (i.e., self-efficacy, subjective and perceived norm) and media exposure as critical determinants of the public’s emergency preparedness Two emergency preparedness variables were constructed, one for the number of emergency items that individuals actually possessed and the other for stage of emergency preparedness based on the TTM The findings suggest that, in general, only about half the respondents tended to prepare with specific emergency supplies, consistent with the Readiness Quotient Public Opinion Survey that reported a less-than-desired level of emergency preparedness (American Red Cross, 2007) The finding may imply that the public is not clear about what to prepare other than basic emergency kits, or some emergency items (e.g., flashlight, first aid kit) may be more easily purchased and prepared, while others (e.g., dust mask, generator) may not Measuring level of emergency preparedness using the number of emergency items, however, may not capture the deliberate intention to prepare better Employing the stage of emergency preparedness guided by TTM may provide a more nuanced and alternative way of assessing the public’s emergency preparedness Indeed, the stage of emergency preparedness shows a somewhat different picture from the number of emergency items that the respondents actually own The data show that more than half of the respondents have taken some action related to emergency preparedness (action: 24.0%) or updated their emergency plans, restocked emergency supplies, or both activities in the past months (maintenance: 30.5%) About one-third of the respondents however, said that they have either not thought about preparing for emergencies at all or have thought about it but have not sought more information about how to prepare Given that consideration or information seeking is a necessary step for Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Public Emergency Preparedness 439 an individual to engage in actual emergency preparation behaviors (Prochaska et al., 1992, 1994), these pre-contemplative individuals may constitute a much different audience than those who are at later stages of action Beyond the description of how well people are prepared, the main focus was to identify predictors of emergency preparedness The data demonstrate that most of the theoretical concepts tested in this study contribute to predicting respondents’ possession of emergency items and stage of emergency preparedness but with some different patterns: subjective norm was strongly related to both dependent variables, but perceived norm was related only to possession of emergency items, not stage of preparedness This reflects the relatively stronger predictive value of subjective norm over perceived norm documented in empirical studies (Campo et al., 2003) and the tendency to follow reference group or in-group norms rather than nonreference or out-group norms (Hyman, 1968; Sherif & Sherif, 1964) The nonsignificant association between perceived norm and stage of emergency preparedness in our study may be due to the referent (i.e., people in the United States) that was provided to participants in the survey question According to the peer proximity and social distance premises, people seemed more influenced by perception of ‘‘others’’ who are more similar to themselves in terms of demographic and psychographic characteristics (Paek & Gunther, 2007) The results may have been different if we used more similar and closer others, such as residents of the same state or even the same neighborhood Future research should investigate this possibility in various emergency contexts Last, attention to media news about emergencies such as human-caused and natural disasters and pandemic flu seems to play a significantly positive role in emergency preparedness It may imply that news media can inform and educate the public about what should be prepared for emergencies (Bryant & Thompson, 2002; Perse, 2001) Media also can play an agenda-setting role, alerting the public to the importance of emergency preparedness (McCombs & Reynolds, 2002), which makes it critical that public health and risk communication practitioners sustain media interest in this topic Limitations First, some of the single-item measures may lack reliability, and an important direction for future research will be developing and testing more robust measures of the most important variables in an emergency preparedness context Second, although Georgia experiences many types of natural disasters (tornadoes, hurricanes, flooding, wildfires), it is not as disaster prone as states such as those in tornado alley, near earthquake faults, or on the hurricane-prone Gulf Coast; therefore, our results may not be generalizable to those areas Third, due to the nature of the cross-sectional data, all the findings should be interpreted as correlation rather than causation For example, those who pay the most attention to news coverage of emergencies may be a self-selecting group who already think or worry more about emergencies Regarding self-efficacy, people may feel more confident about their ability to handle emergencies because they have done more preparation, rather than the other way around, although literature has shown self-efficacy is an important precursor to behavior change (Kvalem & Træen, 2000; Schwarzer & Fuchs, 1995; Stuart, Borland, & McMurray, 1994) Last, regarding normative influence, people who are prepared with more emergency 440 H.-J Paek et al supplies may perceive that average Americans are better prepared accordingly (this argument is also related to false consensus effect; Prentice & Miller, 1993) More rigorous evidence of a causal relationship is beyond the data, but it should be pursued in future studies using longitudinal data Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Implications First, public information campaigns focusing on increasing individuals’ perceptions of self-efficacy or subjective norm may be an effective approach for improving the public emergency preparedness (e.g., ‘‘What will your friends do=your family want in an emergency?’’) Second, campaigns should be focused on more than simply gathering emergency supplies; increasing the stage of preparation should also be a critical goal For example, this study demonstrated that the effects of perceived norm on the two dependent variables could diverge Some demographic characteristics also predicted differently the two types of emergency preparedness measures (see Table 2) From a pragmatic point of view, differences may appear in real preparedness between someone who happens to have some emergency supplies on hand and an individual who has gathered them purposefully; there are further real differences between the individual whose supplies and plans are out of date (possible even for someone in the ‘‘action’’ stage) and those who recently have restocked pantries and updated phone lists or knowledge of evacuation routes (those in the ‘‘maintenance’’ stage) Progression from even one stage to the next is a step in the right direction, but stopping short of the maintenance stage may give both individuals and community organizers a false sense of security Therefore, efforts should be aimed not just at ushering people from contemplation to action, but from action to maintenance This kind of stage-of-action approach to understanding and promoting emergency preparedness may provide more feasible and effective programs to public health and risk communication practitioners References Ajzen, I (1985) From intentions to actions: A theory of planned behavior In J Kuhl & J Beckman (Eds.), Action-control: From cognition to behavior (pp 11–39) Heidelberg: Springer American Public Health Association (2007) National opinion survey to determine levels of preparedness for a public health crisis Washington, DC: Author American Red Cross and the Council for Excellence in Government (2007) Readiness Quotient Public Opinion Survey Washington, DC: Author Bandura, A (1994) Social cognitive theory of mass communication In J B D Zillmann (Ed.), Media effects: Advances in theory and research (pp 121–153) Hillsdale, NJ: Lawrence Erlbaum Bandura, A (1997) Self-efficacy: The exercise of control New York: W.H Freeman Bryant, J., & Thomson, S (2002) Fundamentals of media effects Boston: McGraw Hill Campo, S., Brossard, D., Frazer, M S., Marchell, T., Lewis, D., & Talbot, J (2003) Are social norms campaigns really magic bullets? Assessing the effects of students’ misperceptions on drinking behavior Health Communication, 15, 481–497 Cialdini, R B., Reno, R R., & Kallgren, C A (1990) A focus theory of normative conduct: Recycling the concept of norms to reduce littering in public places Journal of Personality and Social Psychology, 58, 1015–1026 Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Public Emergency Preparedness 441 Eisenman, D P., Wold, C (2007) Fielding, J., Long, A., Setodji, C., Hickey, S., et al (2006) Differences in individual-level terrorism preparedness in Los Angeles County American Journal of Preventive Medicine, 30(1), 1–6 Enarson, E (1998) Through women’s eyes: A gendered research agenda for disaster social science Disasters, 22(2), 157–173 Federal Emergency Management Agency (2007) Welcome to the National Integration Center (NIC) Incident Management Systems Division Retrieved January 16, 2008, from http:// www.fema.gov/emergency/nims/ Fishbein, M., & Ajzen, I (1975) Belief, attitude, intention, and behavior: An introduction to theory and research Reading, MA: Addison-Wesley Fothergill, A., & Peek, L A (2004) Poverty and disasters in the United States: A review of recent sociological findings Natural Hazards, 32(1), 89–110 Fox, J (1991) Regression diagnostics New York: Sage Publications Garner, A C., & Huff, W A K (1997) The wreck of Amtrak’s Sunset Limited: News coverage of a mass transport disaster Disasters, 21(1), 4–19 Glanz, K (1997) Behavioral research contributions and needs in cancer prevention and control: Dietary change Preventive Medicine, 26(5), S43–S55 Glanz, K., Rimer, B K., & Lewis, F M (2002) Health behavior and health education: Theory, research and practice San Francisco: Wiley & Sons Gottlieb, N H., Gingiss, P L., & Weinstein, R P (1992) Attitudes, subjective norms and models of use for smokeless tobacco among college athletes—implications for prevention and cessation programming Health Education Research, 7(3), 359–368 Griffin, R J., & Dunwoody, S (2000) The relation of communication to risk judgment and preventive behavior related to lead in tap water Health Communication, 12(1), 81–81 Grunig, J E., & Hunt, T (1984) Managing public relations New York: Rinehart and Wilson Harris Interactive (2007) Harris Poll #54 Rochester, NY: Author Conducted April 10–16, 2007 Hyman, H H (1968) Readings in reference group theory and research New York: Free Press Iyengar, S (1991) Is anyone responsible? How television frames political issues Chicago: University of Chicago Press Keselman, A., Slaughter, L., & Patel, V L (2005) Toward a framework for understanding lay public’s comprehension of disaster and bioterrorism information Journal of Biomedical Informatics, 38(4), 331–344 Knoke, D., & Bohrnstedt, G W (1994) Statistics for social data analysis Itasca, IL: Peacock Publishers Kvalem, I L., & Træen, B (2000) Self-efficacy, scripts of love and intention to use condoms among Norwegian adolescents Journal of Youth and Adolescence, 29, 337–353 Maddux, J E (1991) Self-efficacy In C R Snyder & D R Forsyth (Eds.), Handbook of social and clinical psychology: The health perspective (pp 57–78) New York: Pergamon Press Marcus, B H., Banspach, S W., Lefebvre, R C., Rossi, J S., Carleton, R A., & Abrams, D B (1992) Using the stages of change model to increase the adoption of physical activity among community participants American Journal of Health Promotion, 6, 424–429 McClure, J., Sutton, R M., & Sibley, C G (2007) Listening to reporters or engineers? How instance-based messages about building design affect earthquake fatalism Journal of Applied Social Psychology, 37(9), 1956–1973 McCombs, M E., & Reynolds, A (2002) News influence on our pictures of the world In J Bryant & D Zillmann (Eds.), Media effects: Advances in theory and research (pp 1–18) Mahwah, NJ: Lawrence Erlbaum McEntire, D A., & Myers, A (2004) Preparing communities for disasters: Issues and processes for government readiness Disaster Prevention and Management, 13(2), 140–152 Downloaded By: [Michigan State University] At: 00:40 28 July 2010 442 H.-J Paek et al Morrow, B H (1999) Identifying and mapping community vulnerability Disasters, 23(1), Morse, S S., Garwin, R L., & Olsiewski, P J (2006) Public health: Next flu pandemic: What to until the vaccine arrives? Science, 314(5801), 929 Mutz, D C (1998) Impersonal influence: How perceptions of mass collectives affect political attitudes Cambridge: Cambridge University Press Nelson, C., Lurie, N., Wasserman, J., & Zakowski, S (2007) Conceptualizing and defining public health emergency preparedness American Journal of Public Health, 97, S9–S11 Nigg, C R., Burbank, P M., Padula, C., Dufresne, R., Rossi, J S., Velicer, W F., et al (1999) Stages of change across ten health risk behaviors for older adults Gerontologist, 39, 473–482 Paek, H.-J., & Gunther, A C (2007) How peer proximity moderates indirect media influence on adolescent smoking Communication Research, 34, 407–432 Paek, H.-J., Yoon, S., & Shah, D V (2005) Local news, social integration, and community participation: hierarchical linear modeling of contextual and cross-level effects Journalism & Mass Communication Quarterly, 82, 587–606 Perry, R W., & Lindell, M K (2003) Preparedness for emergency response: Guidelines for the emergency planning process Disasters, 27, 336–350 Perse, E M (2001) Media effects and society New York: Lawrence Erlbaum Prentice, D A., & Miller, D T (1993) Pluralistic ignorance and alcohol use on campus: Some consequences of misperceiving the social norm Journal of Personality and Social Psychology, 64, 243–256 Prochaska, J O., & DiClemente, C C (1983) Stages and processes of self-change of smoking: Toward an integrative model of change Journal of Consulting and Clinical Psychology, 51, 390–395 Prochaska, J O., DiClemente, C C., & Norcross, J C (1992) In search of how people change: Applications to addictive behaviors American Psychologist, 47, 1102–1114 Prochaska, J O., & Norcross, J C (2001) Stages of change Psychotherapy, 38, 443–448 Prochaska, J O., & Velicer, W F (1997) The transtheoretical model of health behavior change American Journal of Health Promotion, 97(12), 38–48 Prochaska, J O., Velicer, W F., Rossi, J S., Goldstein, M G., Marcus, B H., Rakowski, W., et al (1994) Stages of change and decisional balance for 12 problem behaviors Health Psychology, 13(1), 39–46 Rogers, R W (1983) Cognitive and psychological processes in fear appeals and attitude change New York: Guilford Sattler, D N., Kaiser, C F., & Hittner, J B (2000) Disaster preparedness: Relationships among prior experience, personal characteristics, and distress Journal of Applied Social Psychology, 30, 1396–1420 Schwarzer, R., & Fuchs, R (1995) Changing risk behaviors and adopting health behaviors: The role of self-efficacy beliefs New York: Cambridge University Press Sherif, M., & Sherif, C W (1964) Reference groups: Exploration into conformity and deviation of adolescents New York: Harper Slater, M D (1999) Integrating application of media effects, persuasion, and behavior change theories to communication campaigns: A stages-of-change framework Health Communication, 11, 335–354 Stuart, K., Borland, R., & McMurray, N (1994) Self-efficacy, health locus of control, and smoking cessation Addictive Behaviors, 19(1), 1–12 Tierney, K J., Lindell, M K., & Perry, R W (2001) Facing the unexpected disaster preparedness and response in the United States Washington, DC: Joseph Henry Press Witte, K (1992) Putting the fear back into fear appeals—The Extended Parallel Process Model Communication Monographs, 59, 329–349 Public Emergency Preparedness 443 Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Appendix A Question wordings and measures The number of emergency items Please tell me if anyone in your household has stocked your house with any of the following supplies to prepare for an emergency Please answer yes or no [FORM A] (a) A flashlight, lantern, or candles? (b) A battery-powered or hand-crank radio? (c) At least days of water and nonperishable food? (d) Dust masks? (e) Extra supplies for pet? [FORM B] (a) A store of batteries? (b) A first aid kit? (c) A generator? (d) Extra cash? Please tell me if anyone in your household has performed any of the following activities to prepare for an emergency Please answer yes or no [FORM A] (a) Safely stored important documents? (b) Set aside extra prescription medications or copies of prescriptions? (c) Discussed or located utility shut-offs? (d) Put together an emergency kit for the car? (e) Located a shelter that you can go to? (f) Made a list of important contact phone numbers and given it to family members? [FORM B] (a) Taken first aid or CPR classes? (b) Developed a home escape plan? (c) Conducted an evacuation or fire drill? (d) Found out designated evacuation routes from your community? (e) Arranged a family meeting place or reconnection plan? (f) Maintained at least 1=4 tank of gas in all vehicles at all times? Media use (4-point scale with ‘‘1’’ indicating ‘‘no attention at all’’ and ‘‘4’’ indicating ‘‘very close attention’’): ‘‘How much attention you pay to stories related to an emergency ’’ (1) when you watch TV news, (2) when listening to radio news, (3) when using the Internet, and (4) when reading the newspaper? Definitions of emergency were provided as follows: By ‘‘emergency,’’ I mean a serious situation that affects many people in a community and requires immediate action These emergencies can include natural disasters like hurricanes and tornados, man-made events like terrorism and chemical spills, and infectious disease outbreaks like SARS and pandemic flu Education: Education level was measured with the 6-point ordinal scale: (1) Less than kindergarten, (2) Grades through 8, (3) Grades through 11, (4) Grade 12 or GED (High school graduate), (5) Some college or technical school, (6) College years or more (College graduate) (M ¼ 5.06, SD ¼ 1.02) 444 H.-J Paek et al Income: What was your total household income (before taxes) in 2005, last year? I don’t need an exact figure, just an approximate category, so could you tell me whether your total family income for last year was 02 03 04 05 More than $25,000? IF NO, CIRCLE ! [01] Less than $25,000 (IF YES) More than $50,000? (IF YES) More than $75,000? (IF YES) More than $100,000? Downloaded By: [Michigan State University] At: 00:40 28 July 2010 Past experiences about risks: ‘‘Have you ever been involved in a large-scale emergency such as natural disasters like hurricane or flood, man-made disasters like a chemical spill or an explosion, or a big infectious disease outbreak?’’ (yes or no) Number of Children at Home: How many children under age 18 you live with in your household? Number of people [RANGE: 1–97] 98 DON’T KNOW 99 REFUSED Home ownership: Do you rent or own the place where you currently live? (1) Rent, (2) Own (created as a dummy variable) Residential area: The variable was not asked but measured with whether or not area of the respondents live in the Metropolitan Statistical Area (labeled as urban) or Micropolitan Statistical Area (labeled as rural) based on the zipcode they provided Metropolitan and micropolitan statistical areas are defined by the U.S Office of Management and Budget (OMB) and are the result of the application of published standards to Census Bureau data The standards for defining the areas are reviewed and revised once every 10 years, prior to each decennial census Generally, the areas are redefined using the most recent set of standards following each decennial census Between censuses, the definitions are updated annually to reflect the most recent Census Bureau population estimates Areas based on the 2000 standards and Census 2000 data were defined in June of 2003 The current definitions are as of December 2005 (http://www.census.gov/population/www/estimates/metrodef.html—last updated August 23, 2006) View publication stats