Complexity of household emergency preparedness as a public health tool

Household-level preparedness has long been a cornerstone of public preparedness strategies, whether the event planned for is a natural hazard requiring evacuation, such as a hurricane, or a man-made hazard requiring sheltering-in-place, such as a radiological terrorist attack. Local health officials and emergency planners, in particular, regard individual-level preparedness as a critical supplement to organized preparedness activities, since it may relieve the burden on public resources and limit adverse outcomes within a community. Despite persistent efforts on the part of the government and agencies such as the Red Cross, most Americans do not regard themselves as prepared. Unlike seat-belt usage, which has a national uptake of over 75% and is similar to household preparedness as a preventive measure for a low-probability/high-consequence event, citizen preparedness hovers at 30 - 40%. The problem may not be in the dissemination of the preparedness message, but that it is often regarded as a unitary behavior similar to seat belts: they're either on or off, citizens are prepared or not. Using nationally representative survey data collected annually from 2002 through 2006, this presentation will consider preparedness as a complex phenomenon that encompasses behavioral elements (assembling material, planning and exercising response plans), psychological elements (such as self-efficacy, fatalism, risk awareness, self-perception as “helper” “dependent” or “leader”), cognitive elements (awareness of local response structures and agencies, surveillance of potential threats), and attitudinal elements (trust in authority, confidence in government, civic engagement). Approaching preparedness as a complex phenomenon can guide social marketing and health promotion messages, increasing its uptake.