Understanding of and willingness to comply with recommendations in the event of a “dirty bomb”: Demographic differences in low-literacy urban residents

Potential bioterror events such as "dirty bombs" could have significant public health effects. Little is known, however, about how low literacy populations perceive dirty bombs, their trust in public health or government officials to provide credible information and their willingness to comply with recommended actions. We surveyed 50 low literacy Philadelphia residents (≤ 6 on REALM-R) to assess perceived risks of a dirty bomb and intended behavior should one occur, and whether these perceptions differed by demographic characteristics. Results showed women were significantly more likely than men to trust information sources like the health department (p=.004), Mayor (p=.003), Governor (p=.003), President (p=.017), news media P=.006) and police (p=.034). They were also more likely to believe that the government will provide them with enough information to protect themselves (p=.007), and that the city (p=.004) and federal government (p=.043) will provide them with adequate emergency supplies. Participants aged 50-65 were more likely to believe that the government will provide enough information (p=.019) and participants 65+ were significantly less sure of what a dirty bomb is (p=.04). Whites were significantly more likely to want to know who is responsible for the attack (p=.011) and what the US response is (p=.009), whereas non-whites were more likely to go get their children and family members despite recommendations to stay inside (p= .05). Results indicate that public health recommendations must take into account perception differences by demographic characteristics and messages must be tailored accordingly to ensure compliance during a dirty bomb event.