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Background App‐based drivers face work disruptions and infection risk during a pandemic due to the nature of their work, interactions with the public, and lack of workplace protections. Limited occupational health research has focused on their experiences. Methods We surveyed 100 app‐based drivers in Seattle, WA to assess risk perceptions, supports, and controls received from the company that employs them, sources of trust, stress, job satisfaction, COVID‐19 infection status, and how the pandemic had changed their work hours. Data were summarized descriptively and with simple regression models. We complemented this with qualitative interviews to better understand controls and policies enacted during COVID‐19, and barriers and facilitators to their implementation. Results Drivers expressed very high levels of concern for exposure and infection (86%–97% were “very concerned” for all scenarios). Only 31% of drivers reported receiving an appropriate mask from the company for which they drive. Stress (assessed via PSS‐4) was significantly higher in drivers who reported having had COVID‐19, and also significantly higher in respondents with lower reported job satisfaction. Informants frequently identified supports such as unemployment benefits and peer outreach among the driver community as ways to ensure that drivers could access available benefits during COVID‐19. Conclusions App‐based drivers received few protections from the company that employed them, and had high fear of exposure and infection at work. There is increased need for health‐supportive policies and protections for app‐based drivers. The most effective occupational and public health regulations would cover employees who may not have a traditional employer–employee relationship.

State statutory laws serve as a vital tool for public health entities to assist communities with recovery from disasters. However, no systematic assessment has examined the content of state law addressing disaster recovery or explored if and how the public health role is discussed in state law addressing disaster recovery. This study examined public health-related requirements, authorities, and activities in state disaster recovery laws. Nexis Uni, a legal database, was used to identify codified state statutory laws that authorize or require specific state or local public health entity actions, or set conditions where public health entity actions could be authorized/required, related to disaster recovery planning, implementation, or evaluation (ie, health disaster recovery laws). Disaster recovery laws were reviewed and coded to identify health-related requirements, authorities, and activities planned for recovery. Most states (n = 47) have disaster recovery laws, and 17 states were found to have 30 codified statutory health disaster recovery laws. Half (n = 15) of identified laws require a public health liaison to or representation on a recovery committee or other organization/body working on recovery planning or implementation activities. State disaster recovery laws have limited public health requirements, authorities, and activities. Further research is needed to assess the potential public health benefits of components of state law supporting public health involvement in disaster recovery. The development and dissemination of best practices or model laws and tools to provide opportunities for public health actors to inform recovery decision making may enhance the potential for health promotion during disaster recovery.

The national response to the coronavirus disease 2019 (COVID-19) pandemic has highlighted critical weaknesses in domestic health care and public health emergency preparedness, despite nearly 2 decades of federal funding for multiple programs designed to encourage cross-cutting collaboration in emergency response. Health-care coalitions (HCCs), which are funded through the Hospital Preparedness Program, were first piloted in 2007 and have been continuously funded nationwide since 2012 to support broad collaborations across public health, emergency management, emergency medical services, and the emergency response arms of the health-care system within a geographical area. This commentary provides a SWOT (strengths, weaknesses, opportunities, and threats) analysis to summarize the strengths, weaknesses, opportunities, and threats related to the current HCC model against the backdrop of COVID-19. We close with concrete recommendations for better leveraging the HCC model for improved health-care system readiness. These include better evaluating the role of HCCs and their members (including the responsibility of the HCC to better communicate and align with other sectors), reconsidering the existing framework for HCC administration, increasing incentives for meaningful community participation in HCC preparedness, and supporting next-generation development of health-care preparedness systems for future pandemics.

Research conducted in the context of a disaster or public health emergency is essential to improve knowledge about its short- and long-term health consequences, as well as the implementation and effectiveness of response and recovery strategies. Integrated approaches to conducting Disaster Research Response (DR2) can answer scientific questions, while also providing attendant value for operational response and recovery. Here, we propose a Concept of Operations (CONOPS) template to guide the collaborative development and implementation of DR2 among academic public health and public health agencies, informed by previous literature, semi-structured interviews with disaster researchers from academic public health across the United States, and discussion groups with public health practitioners. The proposed CONOPS outlines actionable strategies to address DR2 issues before, during, and after disasters for public health scholars and practitioners who seek to operationalize or enhance their DR2 programs. Additional financial and human resources will be necessary to promote widespread implementation of collaborative DR2 programs.

Looming climate change health impacts among rural communities will require a robust health system response. To reduce health inequities and promote climate justice, rural local health departments (LHDs) must be adequately resourced and supported to engage in climate change mitigation and adaptation policy and program development and implementation. In the United States, small local tax bases, overreliance on revenue from fee-based services, and limited federal funding to support climate change and health programming, have left rural LHDs with limited and inflexible human, financial, and political capital to support engagement in local climate change activities. Because of the urgent demands stemming from climate change, additional investments and supports are needed to rapidly build the capacity and capability of rural LHDs. Federal and state approaches to public health funding should consider the unique climate change and health risks of rural communities. Further, cross-jurisdictional shared service arrangements and state-level support to build rural LHDs’ technical capacity, and research on local impacts and culturally appropriate solutions, must be prioritized.

As communities recover from disasters, it is crucial to understand the extent to which states are prepared to support the recovery of health systems and services. This need has been emphasized by the United States’ experience with COVID-19. This study sought to assess public health activities in state disaster recovery implementation plans. In this exploratory, descriptive study, state-wide disaster recovery implementation plans were collected from emergency management agency websites and verified (n = 33). We reviewed and coded the recovery plans to identify health-related activities. While 70% and 64% of reviewed plans included activities to address short-term healthcare and behavioral health needs, respectively, one-third or less of the plans included activities to address long-term healthcare and behavioral health needs. Further, plans have limited descriptions of health-related data collection, analysis, or data-driven processes. Additional evidence-informed public health requirements and activities are needed in disaster recovery implementation plans. State disaster recovery plans would benefit from additional description of public health roles, responsibilities, and activities, as well as additional plans for collecting and analyzing public health data to drive recovery decision making and activities. Plans should include approaches for ongoing evaluation of recovery activities.

CONTEXT Wildfire events are increasing in prevalence and intensity in the Pacific Northwest. Effective communication of health risks and actions to reduce exposure to wildfire smoke is imperative. OBJECTIVE We assessed the content of wildfire smoke risk messages from government organizations and mainstream media during a major wildfire smoke event in August 2018. DESIGN We conducted a content analysis of wildfire smoke risk information communicated by local and state government organizations and the mainstream media. SETTING Eight Washington State counties during a statewide wildfire smoke event in August 2018. MAIN OUTCOME MEASURE Leveraging the Extended Parallel Process Model and information in the existing literature on wildfire smoke and health, we assessed messages for the presence of information regarding health risk, personal interventions, administrative interventions, vulnerable populations, and trusted sources of information. Summary statistics were calculated to identify common messages about recommended interventions, vulnerable populations cited, and trusted sources of public health information. RESULTS Of the 273 identified government and media messages on wildfire smoke, the majority (71% and 66%) contained information about health risks. However, only 46% and 33% of government and media messages contained information about personal interventions to reduce risk, and 37% and 14% of government and media messages contained information about administrative interventions to reduce risk. Less than half of government and media messages (28% and 31%) contained information specific to vulnerable populations, and 58% and 46% of government and media messages contained any reference to a trusted source of information. CONCLUSIONS While information about wildfire smoke and health risks was communicated during Washington's August 2018 wildfire smoke event, there remains considerable opportunity to include additional information about interventions, vulnerable populations, and trusted sources of information. We recommend several opportunities to improve and evaluate risk communication and risk reduction before, during, and after future wildfire smoke events.

Objectives. To develop a set of indicators to guide and monitor climate change adaptation in US state and local health departments. Methods. We performed a narrative review of literature on indicators of climate change adaptation and public health service capacity, mapped the findings onto activities grouped by the Centers for Disease Control and Prevention’s Ten Essential Services, and drafted potential indicators to discuss with practitioners. We then refined the indicators after key informant interviews with 17 health department officials in the US Pacific Northwest in fall 2018. Results. Informants identified a need for clarity regarding state and local public health’s role in climate change adaptation, integration of adaptation into existing programs, and strengthening of communication, partnerships, and response capacity to increase resilience. We propose a set of climate change indicators applicable for state and local health departments. Conclusions. With additional context-specific refinement, the proposed indicators can aid agencies in tracking adaptation efforts. The generalizability, robustness, and relevance of the proposed indicators should be explored in other settings with a broader set of stakeholders.

Context Social media is becoming increasingly integrated into disaster response communication strategies of public health and emergency response agencies. Objective We sought to assess the content, accessibility, and dissemination of social media communications made by government agencies during a disaster response. Design A cross-sectional analysis of social media posts made by federal, state, and local government, public health and emergency management agencies before, during, and after the 2016 Louisiana floods was conducted to determine their content, accessibility, and dissemination by level of government and time relative to disaster onset. Setting Facebook and/or Twitter posts made by public agencies involved in the response to the 2016 Louisiana Flooding events (FEMA Disaster Declaration [DR-4277]) published between August 4 and September 16, 2016, publicly available online between February 21 and March 31, 2017, were included in the analysis. Main outcome measure Content: The text of each post was assessed to determine whether it contained information on provision of situational awareness; addressing misconception, actionable requests; mental, behavioral, and emotional support; and/or recovery and rebuilding resources. Accessibility: A Flesh-Kincaid grade level of each post was calculated, and information on post language, originality, hyperlinks, visuals, videos, or hash tag was recorded. Dissemination: The average number of reacts/likes, shares/retweets, and comments per post was calculated. Results Most posts contained information related to situational awareness and recovery resources. There was an increase in messages during the first week of the disaster at all levels. Few posts were made in languages other than English. Compared with state and federal posts, local Facebook posts averaged fewer reacts, comments, and shares throughout the analysis period. Conclusions Government agencies may maximize the use of social media platforms for disaster communications by establishing their social media network in advance of a disaster and by applying established guidelines on disaster social media use.

Introduction Climate change is leading to increasingly severe wildfires across the United States. Over the past several years, these events have led to extreme, persistent smoke events in several urban areas across the western U.S. However, the health impacts of smoke events on urban communities are not well understood. Impacts to physical activity, including active transportation, may be a useful proxy to understand physical and mental health effects of these events. We aimed to examine the impact of wildfire smoke events, determined by fine particulate matter concentrations and administrative reporting, on physical activity, measured by pedestrian and bicycle counts at eight city counters in Seattle, WA, USA. Methods We assessed for differences in daily average bicycle and pedestrian counts between pre-, during- and post-wildfire smoke periods for two wildfire smoke events in Seattle in the summers of 2017 and 2018. Results The 2018 wildfire smoke event significantly decreased daily average bicycle counts by 14.6–36.0% across the 8 counters, and 31.7%–45.2% across the two pedestrian counters. There were no significant changes in use during the 2017 event, with the exception of a significant decrease in counts at one pedestrian counter. Conclusions Urban physical activity and active transportation may be significantly impacted by future wildfire smoke events, with cascading public health consequences. Differences in impacts across the 2017 and 2018 events may be related to increased intensity of smoke, and/or to enhanced public health messaging by state and local agencies. Additional research is needed to better understand the impact of wildfire smoke on physical activity in urban communities, and to assess and inform public health risk communication campaigns to change behavior during these events.

Objective:Disaster research can inform effective, efficient, and evidence-based public health practices and decision making; identify and address knowledge gaps in current disaster preparedness and response efforts; and evaluate disaster response strategies. This study aimed to identify challenges and opportunities experienced by Washington State local health departments (LHDs) regarding engagement in disaster research activities.Methods:An online survey was disseminated to the emergency preparedness representative for the 35 LHDs in Washington State. Survey questions sought to assess familiarity and experience with disaster research, as well as identify facilitators and barriers to their involvement. The survey was first piloted with 7 local and state public health emergency preparedness practitioners.Results:A total of 82.9% of Washington’s 35 LHDs responded to our survey. Only 17.2% of respondents had previous experience with disaster research. Frequently reported barriers to engaging in disaster research included funding availability, competing everyday priorities, staff capacity, and competing priorities during disaster response.Conclusions:These findings can inform efforts to support disaster research partnerships with Washington State LHDs and facilitate future collaboration. Researchers and public health practitioners should develop relationships and work to incorporate disaster research into LHD planning, training, and exercises to foster practice-based disaster research capacity.

Introduction Disaster research response (DR2) is necessary to answer scientific questions about the environmental health impacts of disasters and the effectiveness of response and recovery strategies. This research explores the preparedness and capacity of National Institute of Environmental Health Sciences (NIEHS) P30 Core Centers (CCs) to conduct DR2 and engage with communities in the context of disasters. Methods In early 2018, we conducted an online survey of CC Directors (n = 16, 69.5% response rate) to identify their DR2 relevant scientific assets, capabilities, and activities. Summary statistics were calculated. We also conducted in-depth, semi-structured interviews with 16 (69.5%) CC Community Engagement Core directors to identify facilitators and barriers of DR2 community engagement. Interview notes were coded and thematically analyzed. Results Survey: While 56% of responding CCs reported prior participation in DR2 and preparedness to repurpose funding to support DR2, less than one third reported development of a disaster-specific data collection protocol, deployment plan, or concept of operations plan, participation in an exercise to test DR2 capacity, development of academic partnerships to conduct DR2, development of a process for fast-tracking institutional review board approvals for DR2, or maintenance of formal agreements with state, local, or community-based partner(s). A number of CCs reported developing or considering developing capacity in these areas. Barriers to, and tools and resources to enhance, CC engagement in DR2 were identified. Interviews: Four key components for community engaged DR2 were identified: pre-existing community relationships, responsive research that benefits communities, coordination among researchers, and coordination with community response partners. Several roles for, benefits of, and barriers to Community Engagement Rapid Response Teams (CERRT) were described. Conclusions CCs have significant scientific assets and community partnerships that can be leveraged for DR2; however, additional planning is necessary to ensure that these scientific assets and community partnerships are leveraged when disasters strike. Electronic supplementary material The online version of this article (10.1186/s12940-019-0498-y) contains supplementary material, which is available to authorized users.

Recognizing the public health professional are critical members of interprofessional teams, the Council on Education for Public Health (CEPH) recently added a required Masters of Public Health (MPH) student competency focused on interprofessional education (IPE). A student-centered approach to the design and evaluation of an emergency preparedness-focused curricular program to meet the interprofessional needs of MPH students was used to meet this expectation at the University of Washington. Curriculum design was informed by two 80-minute listening sessions with MPH students to better understand their current interprofessional educational experiences and needs, and how an emergency preparedness-focused two-hour Interprofessional Active Learning Series (iPALS) session could help them develop interprofessional competency. The resultant iPALS session was assessed with a short, paper-based questionnaire. We found MPH students have an interest in participating in IPE, and that all students who participated in the emergency preparedness-focused iPALS session reported significant increases in their interprofessional and disaster response abilities based on their pre- and post-session evaluations. Student-centered IPE curriculum focused on emergency preparedness can enhance the self-reported ability of students across the health sciences to perform on interprofessional teams while engaging in a topic that has relevance to MPH students.

Disaster recovery provides an opportunity to build healthier and more resilient communities. However, opportunities and challenges encountered by local health departments (LHDs) when integrating health considerations into recovery have yet to be explored. Following Hurricane Harvey, 17 local health and emergency management officials from 10 agencies in impacted Texas, USA jurisdictions were interviewed to describe the types and level of LHD engagement in disaster recovery planning and implementation and the extent to which communities leveraged recovery to build healthier, more resilient communities. Interviews were conducted between December 2017 and January 2018 and focused on if and how their communities were incorporating public health considerations into the visioning, planning, implementation, and assessment phases of disaster recovery. Using a combined inductive and deductive approach, we thematically analyzed interview notes and/or transcripts. LHDs reported varied levels of engagement and participation in activities to support their community&rsquo, s recovery. However, we found that LHDs rarely articulated or informed decision makers about the health impacts of recovery activities undertaken by other sectors. LHDs would benefit from additional resources, support, and technical assistance designed to facilitate working across sectors and building resilience during recovery.

A growing body of literature suggests that restrictive public health measures implemented to control COVID-19 have had negative impacts on physical activity. We examined how Stay Home orders in Houston, New York City, and Seattle impacted outdoor physical activity patterns, measured by daily bicycle and pedestrian count data. We assessed changes in activity levels between the period before and during Stay Home orders. Across all three cities, we found significant changes in bicycle and pedestrian counts from the period before to the period during Stay Home orders. The direction of change varied by location, likely due to differing local contexts and outbreak progression. These results can inform policy around the use of outdoor public infrastructure as the COVID-19 pandemic continues.

ObjectiveWe aimed to quantitatively gauge local public health workers’ perceptions toward disaster recovery role expectations among jurisdictions in New Jersey and Maryland affected by Hurricane Sandy.MethodsAn online survey was made available in 2014 to all employees in 8 Maryland and New Jersey local health departments whose jurisdictions had been impacted by Hurricane Sandy in October 2012. The survey included perceptions of their actual disaster recovery involvement across 3 phases: days to weeks, weeks to months, and months to years. The survey also queried about their perceptions about future involvement and future available support.ResultsSixty-four percent of the 1047 potential staff responded to the survey (n=669). Across the 3 phases, 72% to 74% of the pre-Hurricane Sandy hires knew their roles in disaster recovery, 73% to 75% indicated confidence in their assigned roles (self-efficacy), and 58% to 63% indicated that their participation made a difference (response efficacy). Of the respondents who did not think it likely that they would be asked to participate in future disaster recovery efforts (n=70), 39% indicated a willingness to participate.ConclusionThe marked gaps identified in local public health workers’ awareness of, sense of efficacy toward, and willingness to participate in disaster recovery efforts after Hurricane Sandy represent a significant infrastructural concern of policy and programmatic relevance. (Disaster Med Public Health Preparedness. 2016;10:371–377)

Translation strategies are critical for sharing research with public health practitioners. To disseminate our analyses of legal issues that arise relative to mental and behavioral health during emergencies, we created 10 brief translational tools for members of the public health workforce. In consultation with an interdisciplinary project advisory group (PAG), we identified each tool's topic and format. PAG members reviewed draft and final versions of the tools. We then worked with local health departments throughout the country to distribute the tools along with a brief survey to determine practitioners' perceived utility of the tools. Through survey responses, we learned that practitioners believed the tools provided information that would be useful during the planning, response, and recovery phases of an emergency. This article describes the creation of the PAG, the development of the tools, and lessons learned for those seeking to translate legal and ethical research findings for practitioner audiences.

Background: As climate change is expected to result in more frequent, larger fires and associated smoke impacts, creating and sustaining wildfire smoke-resilient communities is an urgent public health priority. Following two summers of persistent and extreme wildfire smoke events in Washington state, the need for additional research on wildfire smoke health impacts, risk communication, and risk reduction, and an associated greater coordination between researcher and practitioner communities, is of paramount importance. Objectives: On 30 October 2018, the University of Washington hosted a Wildfire Smoke Risk Communication Stakeholder Synthesis Symposium in Seattle, Washington. The goals of the symposium were to identify and prioritize practice-based information gaps necessary to promote effective wildfire smoke risk communication and risk reduction across Washington state, foster collaboration among practitioners and academics to address information gaps using research, and provide regional stakeholders with access to the best available health and climate science about current and future wildfire risks. Methods: Seventy-six Washington state practitioners and academics with relevant professional responsibilities or expertise in wildfire smoke and health engaged in small group discussions using the &ldquo, World Caf&eacute, Method&rdquo, to identify practice-relevant research needs related to wildfire smoke and health. Notes from each discussion were coded and qualitatively analyzed using a content analysis approach. Discussion: Washington state&rsquo, s public health and air quality practitioners need additional evidence to communicate and reduce wildfire smoke risk. Exposure, health risk, risk communication, behavior change and interventions, and legal and policy research needs were identified, along with the need to develop research infrastructure to support wildfire smoke and health science. Practice-relevant, collaborative research should be prioritized to address this increasing health threat.

The Extended Parallel Process Model (EPPM) is an established threat- and efficacy-based behavioral framework for understanding health behaviors in the face of uncertain risk. A growing body of research has applied this model to understand these behaviors among the public health workforce. In this manuscript, we aim to explore the application of this framework to the public health workforce, with a novel focus on their confidence in vaccines and perceptions of vaccine injury compensation mechanisms. We characterize specific connections between EPPM’s threat and efficacy dimensions and relevant vaccine policy frameworks and highlight how these connections can usefully inform training interventions for public health workers to enhance their confidence in these vaccine policy measures.

Local health departments play a critical role in short-, intermediate-, and long-term recovery activities after a public health emergency. However, research has not explored attitudinal determinants of health department workers' participation in the recovery phase following a disaster. Accordingly, this qualitative investigation aims to understand perceived facilitators and barriers to performing recovery-related activities following Hurricane Sandy among local health department workers. In January 2014, 2 focus groups were conducted in geographically representative clusters of local health departments affected by Hurricane Sandy (1 cluster in Maryland and 1 cluster in New Jersey). Focus groups were recorded, transcribed verbatim, and analyzed to qualitatively assess attitudes toward Hurricane Sandy recovery activities. This analysis identified 5 major thematic categories as facilitators and barriers to participation in recovery activities: training, safety, family preparedness, policies and planning, and efficacy. Systems that support engagement of health department personnel in recovery activities may endeavor to develop and communicate intra- and interjurisdictional policies that minimize barriers in these areas. Development and implementation of evidence-informed curricular interventions that explain recovery roles may also increase local health department worker motivation to participate in recovery activities.

Objectives: This study evaluated the impact of a novel multimethod curricular intervention using a trainthe-trainer model: the Public Health Infrastructure Training (PHIT). PHIT was designed to 1) modify perceptions of self-efficacy, response efficacy, and threat related to specific hazards and 2) improve the willingness of local health department (LHD) workers to report to duty when called upon. Methods: Between June 2009 and October 2010, eight clusters of US LHDs (n = 49) received PHIT. Two rounds of focus groups at each intervention site were used to evaluate PHIT. The first round of focus groups included separate sessions for trainers and trainees, 3 weeks after PHIT. The second round of focus groups combined trainers and trainees in a single group at each site 6 months following PHIT. During the second focus group round, participants were asked to self-assess their preparedness before and after PHIT implementation. Setting: Focus groups were conducted at eight geographically representative clusters of LHDs. Participants: Focus group participants included PHIT trainers and PHIT trainees within each LHD cluster. Main outcome measure(s): Focus groups were used to assess attitudes toward the curricular intervention and modifications of willingness to respond (WTR) to an emergency; self-efficacy; and response efficacy. Results: Participants reported that despite challenges in administering the training, PHIT was well designed and appropriate for multiple management levels and disciplines. Positive mean changes were observed for all nine self-rated preparedness factors (p < 0.001). The findings show PHIT's benefit in improving self-efficacy and WTR among participants. Conclusions: The PHIT has the potential to enhance emergency response willingness and related self-efficacy among LHD workers.

This study examines the attitudinal impact of an Extended Parallel Process Model (EPPM)-based training curriculum on local public health department (LHD) workers' willingness to respond to representative public health emergency scenarios. Data are from 71 U.S. LHDs in urban and rural settings across nine states. The study explores changes in response willingness and EPPM threat and efficacy appraisals between randomly assigned control versus intervention health departments, at baseline and 1 week post curriculum, through an EPPM-based survey/resurvey design. Levels of response willingness and emergency response-related attitudes/beliefs are measured. Analyses focus on two scenario categories that have appeared on a U.S. government list of scenarios of significant concern: a weather-related emergency and a radiological "dirty" bomb event (U.S. Department of Homeland Security, 2007). The greatest impact from the training intervention on response willingness was observed among LHD workers who had low levels of EPPM-related threat and efficacy perceptions at baseline. Self-efficacy and response efficacy and response willingness increased in intervention LHDs for both scenarios, with greater response willingness increases observed for the radiological "dirty" bomb terrorism scenario. Findings indicate the importance of building efficacy versus enhancing threat perceptions as a path toward greater response willingness, and suggest the potential applicability of such curricular interventions for boosting emergency response willingness among other cadres of health providers.

The goal of this study was to investigate the willingness of Medical Reserve Corps (MRC) volunteers to participate in public health emergency-related activities by assessing their attitudes and beliefs. MRC volunteers responded to an online survey organized around the Extended Parallel Process Model (EPPM). Respondents reported agreement with attitude/belief statements representing perceived threat, perceived efficacy, and personal/organizational preparedness in 4 scenarios: a weather-related disaster, a pandemic influenza emergency, a radiological ("dirty bomb") emergency, and an inhalational anthrax bioterrorism emergency. Logistic regression analyses were used to evaluate predictors of volunteer response willingness. In 2 response contexts (if asked and regardless of severity), self-reported willingness to respond was higher among those with a high perceived self-efficacy than among those with low perceived self-efficacy. Analyses of the association between attitude/belief statements and the EPPM profiles indicated that, under all 4 scenarios and with few exceptions, those with a perceived high threat/high efficacy EPPM profile had statistically higher odds of agreement with the attitude/belief statements than those with a perceived low threat/low efficacy EPPM profile. The radiological emergency consistently received the lowest agreement rates for the attitude/belief statements and response willingness across scenarios. The findings suggest that enrollment with an MRC unit is not automatically predictive of willingness to respond in these types of scenarios. While MRC volunteers' self-reported willingness to respond was found to differ across scenarios and among different attitude and belief statements, the identification of self-efficacy as the primary predictor of willingness to respond regardless of severity and if asked highlights the critical role of efficacy in an organized volunteer response context.

This study sought to investigate the relationship between psychologically-related attitudes/beliefs toward public health emergency response among local health department (LHD) and hospital workers and their willingness to respond to a pandemic influenza emergency scenario and a radiological 'dirty' bomb scenario, to inform workforce resilience-building interventions. LHD and hospital workers participated in a survey based on an established threat- and efficacy-oriented behavioral model (the extended parallel process model) that focused on collection of the aforementioned attitudes, beliefs, and self-reported response willingness. Odds ratios associating psychologically-related attitudes and beliefs with self-reported response willingness were computed Perceived levels of psychological preparedness and support were shown to impact response willingness, with more pronounced effects in the radiological 'dirty' bomb scenario. Compared to those who did not perceive themselves to be psychologically prepared, those who did perceive themselves as prepared had higher odds of self-reported response willingness. The relationship of these perceptions and self-reported willingness to respond in all contexts, both scenarios, and both cohorts was influenced by perceived self-efficacy andperceived family preparedness.

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.