Public Perceptions of the Threat of Avian Influenza in

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					Public Perceptions of the Threat of Avian
   Influenza in the U.S. Food Supply


                             William K. Hallman
                               Sarah C. Condry
                                   Miranda Vata
                                   Cara L. Cuite
                                           Food Policy Institute
                    Rutgers, The State University of New Jersey
                             ASB III, New Brunswick, NJ 08901
Results from a national survey

• Basic Methodology – Telephone Interviews
  • CATI
    • Average length ~ 21 minutes
  • Data Collection
    • May 3, 2006 – June 5, 2006
  • Sample
    • Used Random Digit Dialing
    • 1,131 American Adults in final sample
            Sampling error: 2.9%
            Cooperation rate: 60%
    • 48% Male, 52% Female
       • Data weighted using appropriate U.S. census weights for gender,
         age, race, ethnicity, and education
  • Longitudinal design – ability to follow-up
Overview

• Funding through the USDA, CSREES
 • 3 – year grant ($2 million) focusing on food
   biosecurity
   • National Integrated Food Safety Initiative Grant
• Supplemental funding through the N.J.
 Agricultural Experiment Station
Important distinctions

• Avian influenza in birds vs. people
• Highly pathogenic vs. low path
  • H5N1 vs. other strains
• Transmission:
  • Bird to bird
  • Bird to human
     •   Contact with live birds
     •   Contact with raw meat
     •   Eating poultry products
         •   Properly vs. inadequately cooked
  • Human to human
     •   Close contact required
     •   Easily transmissible (pandemic)
Important distinctions

• Avian influenza in birds vs. people
• Highly pathogenic vs. low path
  • H5N1 vs. other strains
• Transmission:
  • Bird to bird
  • Bird to human
     •   Contact with live birds
     •   Contact with raw meat
     •   Eating poultry products
         •   Properly vs. inadequately cooked
  • Human to human
     •   Close contact required
     •   Easily transmissible (pandemic)
Most have heard of avian influenza

• Most Americans           How much would you say you have heard or read
                           about the „bird flu‟?
    (93%) say they
    have heard of
    avian influenza or
    “bird flu”.                      7%
                                                              A Great Deal
    • 44% „a great deal‟                     27%              A Lot
                               17%
         or „a lot‟                                           Some
                                                              A Little
                                                              Nothing
                                             17%
                                  32%




N=1200
 AI is a topic of conversation

 • Nearly three                                                     How often would you say you‟ve talked with others
                                                                    about the bird flu?
        quarters (71%)
        say they have                                                                        5%
        talked about AI
        with others
        • Nearly one quarter                                                    19%
                                                                                                  29%*
                                                                                                          Never
              (24%) say they                                                                              Once or twice
              have done so                                                                                A few times
                                                                                                          Occasionally
              occasionally or                                                 21%                         Frequently
              frequently                                                                      26%




* Includes the 4% of respondents who say they have heard nothing and know nothing about AI
Most say they don’t know much

• Most Americans                 How much would you say you know about about
                                 the „bird flu‟?
    say they don‟t
                                              4%
    know much about
    of avian influenza
    • About half (52%)                   9%        16%
                                                                   Nothing
         say they know
                                                                   A Little
         „little‟ or „nothing‟                                     Some
                                      35%                          A Lot
                                                   36%
                                                                   A Great Deal




N=1200
And overall, they’re right

• On average, Americans were able to correctly
  answer only about 59% of a series of 22 objective
  knowledge questions about AI and food
  • (M=13.03, SD=3.82). Mdn= 13.00
    • Questions related to:
      • Current cases in
         Wild birds, production birds, humans
      • Transmission of the AI virus
         From non-human sources
      • Prevention of infection
         Cooking, freezing, visual inspection, etc.
What do people know about the
        spread of AI?
Most know about human cases

 • Most (87%) knew
   that people had
   been infected
   with AI in some
   places around
   the world
  • Only 5% said that
    people hadn‟t been
    infected
  • 8% said they didn‟t
    know
One-fifth believe human AI cases are already
in the U.S.
• 19% believe
 incorrectly, that
 people in the U.S.
 have already been
 infected with AI
   • 19% said they didn‟t know
   • Only 62% correctly
     reported than no one in the
     U.S. has been infected
     with AI
Most know about AI cases in wild birds and
poultry

• 73% knew that chickens
  had been infected with
  H5N1 around the world
     •   20% said they didn‟t know
     •   Only 7% said no chickens
         had been infected
• 66% knew that wild birds
  had been infected in some
  places around the world
     •   23% said they didn‟t know
     •   11% said no wild birds had
         been infected
Only two-thirds are aware that we do not import
much chicken from other countries
              Much of the Chicken in U.S. Grocery Stores is
                    Imported from Other Countries

                                   Percent
             True        16

            False                   65



  Definitely true    9

      Likely true    7

     Likely false        19

  Definitely false            46                  Less than one-half

     Don't know          19                       One in five don‟t know
A minority believe AI is already in birds in
the U.S.
• 10% say that chickens in
  the U.S. have been infected
  with H5N1
  • Nearly one-third (31%) were
     not sure
     •   Only 59% say no H5N1 in
         chickens in the U.S.

• One-in-six (17%) say that
  wild birds in the U.S. have
  been infected with H5N1
  • More than one-third (35%)
     were not sure
     •   Only 48% say no H5N1 in
         wild birds in U.S.
What do people know about AI
 transmission and poultry?
About one in ten think that it is easy to see if a live
bird is infected with AI
                It is Easy to Tell When Live Chickens are
               Infected with Bird Flu by Looking at Them

                                      Percent


              Agree        12

           Disagree                        69



     Strongly Agree    4                             One in twenty-five
   Somewhat Agree      8

 Somewhat Disagree              23

   Strongly Disagree                 46

         Don't know         19
But one-quarter think it is easy see if a raw chicken
is infected
       When Raw Chicken is Infected with Bird Flu, Safety
   Inspectors Can Visibly See that It Should Not Be Consumed.

                                      Percent


              Agree         25                  One-quarter

           Disagree                     59



     Strongly Agree    13

   Somewhat Agree      12

 Somewhat Disagree      19

   Strongly Disagree             40

         Don't know    16
Two-thirds believe the virus is present in the
uncooked meat of infected birds
              The Bird Flu Virus is Present in the Uncooked
                       Meat of an Infected Chicken

                                        Percent

             True                        64

            False        13



  Definitely true                  43               4 in 10 think it is
                                                    definitely true
      Likely true            21

     Likely false    4

  Definitely false       9

     Don't know               23
Two-thirds aware that freezing does not kill the
virus
                  Freezing Chicken Kills the Bird Flu Virus


                                        Percent

             True    8

            False                       62



  Definitely true    4

      Likely true    4

     Likely false        18
                                                      Only 4 in 10
  Definitely false                 44
                                                      think it definitely
     Don't know               30                      false
Only four-in-ten believe that proper cooking kills
the virus
                      Cooking Chicken to Recommended
                     Temperatures Kills the Bird Flu Virus

                                          Percent
                                                     Only 4 in 10 think
             True                    42              proper cooking kills
            False              27                    the virus


  Definitely true          23

      Likely true         19

     Likely false     9

  Definitely false        18
                                                    Nearly one-third
     Don't know                 31
                                                    don‟t know
Who is least likely to believe cooking kills the
virus?
• Women
      •   F (1,1145) =19.107, p=0.001
• Those with less education
  •   Those with H.S. diploma or less answer incorrect more often than those with
      4 year college degree or more
      •   F (2,1142) =3.224, p=0.012
• Those with less objective knowledge
      •   r (1146)= -0.292, t = -109.944, p=0.001
      •   B =0.833, [CI=0.802, 0.865], p=0.001, R2=0.12
• Those with higher perceived risk
      •   r (1146)=0.249, t = -106.244, p=0.001
      •   B =3.315 [CI=2.488, 4.416], p=0.001, R2=0.08,
• No differences in geographic region, age, income, or
  race
      How can people become sick with AI?

 9%              Eating Undercooked Infected Chicken                       4- -5                             47                                  31               13



                     Contact with Feces from Infected Birds                 4- -3                            45                                 31                17



                        Touching Live Infected Birds                10-         -7                      41                                 29               13



24%          Touching Raw Infected Chicken                    13-          -11                     30                           29                    17



                         From Infected People                 18-               -9                 32                       21                   20


                                                                                                                                                                 42% said
39% Eating Cooked Infected Chicken                   23-                  -16                 19                  15                 27
                                                                                                                                                                 Proper
                                                                                                                                                                 Cooking
  Eating Eggs from Infected Chicken                  23-                  -16            12             15                      34                               Kills the
                                                                                                                                                                 Virus

               Mosquito Bites                  32-                        -16            14              15                23


              (75)               (50)                 (25)                           0                        25                      50                   75                100


                                        Likely False         Definitely False             Definitely True              Likely True         Don't Know
Who knows the most about AI & food?

• Men
       •   F (1,1145)=10.137, p=0.001
• Those with more education
   •   Those with H.S. diploma or less answer fewer correctly than those who
       attended some college or more
   •   Those who attended some college answer fewer than those who attended
       grad school
       •   F (4,1142)=14.485, p=0.001
• Those with higher incomes
   •   Main differences: those earning $35,000 or less answer fewer correctly than
       those groups over $50,000
       •   F (8,1048)=6.568, p=0.001
• Whites
   •   Blacks and those in other racial categories answer fewer correctly than
       whites
       •   F (2,1103)=9.119, p=0.001
• No differences in geographic region or age
Greater objective knowledge

• Americans with higher objective knowledge also
  reported:
  • Higher self-reported knowledge
    • r (1146)=0.392, p=0.001
  • Increased awareness of avian influenza in general
    • r (1147)=0.351, p=0.001
  • Increased frequency of discussions with others
    • r (1147)=0.330, p=0.001
  • Lower perceptions of risk
    • r (1147)= -0.184, p=0.001
  • Reduced perceptions of other Americans‟ likelihoods of
    infection
    • r (1089)= -0.082, p=0.001
Greater objective knowledge

• Increased objective knowledge was NOT
 associated with:
 • Perceptions of one‟s own likelihood of infection
   • r (1092)= -0.004, p=0.903
 • Worry about infection with AI
   • r (1141)= 0.004, p=0.883
What do people believe about
      the risks of AI?
      Most aren’t worried about risk of infection
      • Americans report their worry about risk of infection with AI to be low
            (M=2.84, SD=2.90). Mdn= 2
            •      28% report being “not at all worried” about becoming infected

Percent

30

25

20

 15

 10

  5

  0
      Not at all    1      2      3      4     5      6      7     8      9   Extremely Don't
      worried                                                                  worried  know
     Most believe that others are at greater risk of infection

      •       Americans report their risk of infection with AI in the next year as low
                  • (M=2.60, SD=2.51) Mdn= 2
              • 26% report having “no risk at all” of becoming infected
      •       Yet, they say other Americans are at significantly higher risk
                  • (M=4.11, SD=2.51)1 Mdn= 4
Percent
              • Only 7% report other Americans have “no risk at all” of becoming infected
30

25

20

15

10

 5

 0
     No risk          1          2   3   4        5         6          7   8   9      An      Don't
      at all                                                                       absolute   know
                                                                                     risk
                                             Your Risk   Others Risk

      1   t(1061)=-20.672, p<0.001
        But, they see AI in chicken as more risky

 The risk of getting sick with bird flu from eating chicken is
 increasing.
                               (7)             (21)                (14)                23                                   35


 Chickens infected with the bird flu in the U.S. food supply could
 kill many people in a short period of time.
                                         (5)           (15)          (11)                        36                                        33


 Getting sick with bird flu from eating chicken is a risk that could
 threaten future generations of people.
                                       (6)            (15)          (12)                         35                                    32



Chickens infected with bird flu in the U.S. food supply would
cause a global catastrophe.
                               (6)             (20)                (15)                     30                                   29



 Getting sick with bird flu from eating chicken is a new
 type of risk for me.
                                             (4)      (12)          (13)                              40                                        31




                   (50)                        (25)                         0                              25                         50             75

                                               Strongly Disagree   Somewhat Disagree    Strongly Agree          Somewhat Agree   Don't know
Most see infection with AI from chicken as a
risk
• Series of 17 questions related to their
  perceptions of risk of:
    • Avian influenza in the food supply
    • Exposure to AI
    • The consequences of infection with avian influenza
        • Personal consequences
        • Global consequences
  • Americans rated the risks associated with AI a
    2.40 (out of 4)
    •   (M=2.40, SD=0.43) Mdn= 2.41
Who reports most perceived risk?
• Women
  • F (1,1145)=26.059, p=0.001
• Americans with lower incomes
  • Main differences: those earning $35,000 or less
    answer fewer correctly than those groups over
    $50,000
    • F (8,1048)=6.198, p=0.001
• Non-whites
  • Blacks and those in other racial categories report
    greater risk than whites
    • F (2,1103)=16.118, p=0.001
• No differences in geographic region or age
Increased perceived risk

• Americans with higher perceived risk also reported:
  • Increased worried about infection
    • r (1141)= 0.455, p=0.001
  • Greater perceived risk of one‟s own likelihood of infection
    • r (1092)= 0.292, p=0.001
  • Greater perceived risk of other Americans‟ likelihoods of
    infection
    • r (1089)= 0.408, p=0.001
  • Less objective knowledge
    • r (1147)= -0.184, p=0.001
  • Less self-reported knowledge
    • r (1146)= -0.213, p=0.001
  • Less self-reported awareness
    • r (1147)= -0.187, p=0.001
What are people doing now?
Most continue to eat chicken
                        • 94% say they currently
                          eat chicken
                          • Only 1% say they don‟t eat
                            chicken because of the
                            risks of AI
                          • Only 5% say they eating
                            less chicken because of AI
         Most believe that chicken in the U.S. is safe to eat


       • Thinking about the bird flu . . . how safe would you
          say it is to eat:

Completely 10
Safe         9
             8
             7
             6
             5
             4
             3
             2
             1
Completely   0
Unsafe           Cooked to   Home cooked Certified AI-   Familiar   Organic         Frozen   Canned soup   Vaccinated   Irradiated   Fast food
                   165*                      Free         brand

                                                                      Mean Safety
What would people do?
   Consumer response and reaction to AI in the
   European Union
• Across the EU:                                                70%

    •    One in five citizens reported                          60%
         reducing their consumption
         of poultry                                             50%
    • Reductions ranged from
      5% in the U.K. to 70% in                                  40%

      Turkey
                                                                30%
         •     Largest decreases in
               poultry consumption were
               in countries directly affected                   20%
               by the virus
• Self–reports of reductions                                     10%

    in consumption appear                                         0%
                                                                       Turkey Greece                                H
                                                                                          Italy Romania FranceGermany ungary U.K.
    related to actual declines
                                                                                % Decrease in poultry sales
    in sales of poultry                                                         % respondents that replied they eat less poultry*



 * Results from the Special Eurobarometer 257, Wave 65.2, TNS Opinion and Social, European Commission, June 2006
        What if US chickens were infected?
        • After reassurance that NO H5N1 has been found in the U.S.
             • How likely would you be to eat chicken if it was found in the U.S.?

             • If chicken in the U.S. was infected:
                  •    39% report they „definitely would NOT eat‟ chicken
Definitely would eat       10
                            9
                            8
                            7
                            6
                            5
                            4
                            3
                            2
                            1
Definitely would NOT eat    0
                                    39%
                                Chickens- U.S.
      How close does AI have to come to the U.S.?


                               How likely would you be to eat chicken if AI was found in. . .
Definitely would eat   10
                           9
                           8        5%             7%               10%                            15%
                                                                                    16%                      26%
                           7
                           6
                           5
                           4
                           3
                           2
                           1                       32%
                                   39%                              23%             20%            15%        8%
Definitely would NOT eat   0
                                Chickens- U.S.   Humans- U.S.   Wild Birds- U.S. Mexico- Chicken   Canada-   England-
                                                                                                   Chicken   Chicken



                                         39%
                                                         Mean Likelihood of Eating
Most say they would purchase other products


     If Chicken was Infected with Bird Flu in the U.S., I Would
             Buy Other Food Products as Substitutes

                                Percent


             Agree                        85

          Disagree        13



     Strongly Agree                 64                  Two Thirds
   Somewhat Agree          21

 Somewhat Disagree     7

  Strongly Disagree   6

        Don't know 2
     Most chicken products would be rejected

     • Products currently being viewed as safe doesn‟t
            ensure likelihood of people eating them if AI is found
            in the U.S.
10
9
8
7
6
5
4
3
2
 1
0
     Certified AI-   Cooked to    Home    Vaccinated   Familiar     Canned soup     Organic   Frozen   Irradiated   Fast food   Cooked
         Free           165      cooked                 brand                                                                    eggs*

                                                                  Mean Likelihood
                                                                  Mean Safety


       * Cooked eggs equivalent to cooked to 165°
Who reports being least likely to eat chicken if AI is in the
U.S.?

• Most significant:
  • Those with higher perceptions of risk
        •   B = -0.462, p=0.001, R2=0.21

  • Those who are more worried about becoming infected
        •   B = -0.262, p=0.001, R2=0.07

• Less significant:
  • Those who perceive a greater personal likelihood of infection
        •   B = -0.142, p=0.001, R2=0.02

  • Those who perceive a greater likelihood of infection for other
    Americans
        •   B = -0.213, p=0.001, R2=0.04

  • Those incorrect that cooking kills the virus
        •   B = 0.176, p=0.001, R2=0.03
Who is least likely to eat chicken if AI is in the U.S.?

• Less significant:
  • Women less likely
      •   B = -0.163, p=0.001, R2=0.26
  • Those with less education less likely
      •   B = 0.127, p=0.001, R2=0.02
  • Non-whites less likely
      •   B = -0.100, p=0.001, R2=0.01
• Not significant:
  •   Overall objective knowledge
  •   Age
  •   Geographic region
  •   Income
What would people do after
       recovery?
What if no other chicken became infected?


• Those who reported that they would be relatively
        unlikely to eat chicken1 in the event that AI were
        found in chickens on U.S. farms were told:
        • while still “imaging that avian influenza had been
          found in chickens in the U.S., [to] please imagine that
          you later heard the USDA had done an investigation,
          and found that no chickens with avian influenza had
          entered the food supply and no other chickens had
          become infected.”



1less   than or equal to 4 (n=700)
If you were told it was safe, would you eat
chicken?
• Even after safety reassurances Americans report
        their likelihood of eating chicken again to be
        moderately low
          • (M=4.46, SD= 3.18) Mdn= 5.00
        • But, significantly higher than it was initially1
          • (M=3.10, SD= 3.26) Mdn= 2.00
        • Especially for those that said they were relatively unlikely to eat it2
          • (M=0.98, SD= 1.36) Mdn= 0.00
• One-fifth (19%) said they “definitely would NOT eat”
        chicken again.
        • Only 10% reported that they “definitely WOULD eat” chicken
              again

1   t(699)=-29.191, p<0.001
2   Ratings of 4 or less out of 10
How long would it take for you to start eating it
again?

• With safety assurances (from a relatively trusted
       source)
        • Americans report it would take an average of 144 days
          (nearly 5 months) for them to start eating chicken
          again (SD=337.67) Mdn= 42 (6 weeks).
             • Resumption timelines ranged from 1 day to 10 years*
        • 20% reported they would never eat chicken again




*   1 case of “20 years” or 7300 days considered “never” for analyses
Differences in likelihood of eating
• What are the differences between those who likely would and
     likely would not eat if AI was U.S.?1
     • Gender
             •     Women are 1.780 times more likely than men to rate a 4 or less if AI in U.S.
                   •     [CI=1.385, 2.288]
     • Race
             •     Non-whites are 1.596 times more likely than whites to rate a 4 or less if AI in
                   U.S.
                   •     [CI=1.093, 2.331]
     •       Education
             •     Those with H.S. diploma and those with some college are 1.945 and 1.547
                   times more likely (respectively) than those with a graduate degree
                   •     [CI= 1.324, 2.858; CI=1.048,2.282]
     •       Increased perception of risk
             •     Those with perception of risk substantially increased odds of reporting a rating
                   of 4 or less
                   •     [B=8.930, CI=6.269, 12.722].



1 Those   that said less than or equal to 4 (n=700)
Who reports being least likely to eat again?

• Those with greater perceptions of risk
    •   B = -0.204, p=0.001, R2=0.04
• Those who are more worried about becoming
  infected
    •   B = -0.192, p=0.001, R2=0.04
• Those who perceive a increased personal
  likelihood of infection
    •   B = -0.151, p=0.001, R2=0.02
• Those who perceive a increased likelihood of
  infection for other Americans
    •   B = -0.131, p=0.001, R2=0.02
What isn’t important

• Not significant:
  •   Overall objective knowledge
  •   Awareness that cooking kills the virus
  •   Education
  •   Gender
  •   Age
  •   Income
  •   Geographic region
  •   Race
      How much do you trust advice on AI from. . .

      • Americans report the highest levels in trust in U.S.
           and international „health protection‟ agencies.


Complete Trust     10
                   9
                   8
                   7
                   6
                   5
                   4
                   3
                   2
                    1
 No Trust at all   0
                        CDC   WHO   USDA   FDA   Chicken Homeland Chicken News   Bush Supermarkets
                                                 Farmers Security Processors
How does this affect consumption?

• Americans who would be most likely to resume
  consumption would be:
  • Those who have more trust in these groups overall
    •   B = 0.332, p=0.001, R2=0.11
• Specifically:
    • Those who have more trust in government/ health agencies
        •   B = 0.311, p=0.001, R2=0.10
    • Those who have more trust in the USDA, specifically
        •   B = 0.309, p=0.001, R2=0.09
    • Those who have more trust in industry
        •   B = 0.306, p=0.001, R2=0.09

    • Trust in media is significant but accounts for less than 1% and
      inverse direction when compared to government and industry
Conclusions
• Avian Influenza is on the national agenda
  • Most Americans:
     •   Have heard about it
     •   Have talked about it
     •   Don‟t know much
• Most are aware of AI in people, birds, poultry globally
  • Many are confused about the status of AI in the U.S.
• Most see their current risks as low and aren‟t worried
  about AI
  • They see the current supply of chicken products as relatively safe
  • They continue to eat chicken
• Most see greater risks of AI specific to the food supply
  • Risk of infection from eating poultry increasing
  • Personal control versus global catastrophe
Conclusions

• We have work to do on key messages
 • Most believe it possible to become infected
   through:
   • Contact with infected birds
   • Eating undercooked chicken
 • Many do not believe that proper cooking kills the
   virus
 • Many think that infected poultry meat is easy to
   spot
Conclusions

• The belief that others are at greater risk
  (optimistic bias) may be a problem:
  • In getting messages across
  • In influencing perceived susceptibility
  • In persuading appropriate behaviors
Conclusions

• If AI emerges in the US
  • Poultry sales will suffer
  • Most will substitute other food products

• AI doesn‟t have to come to the U.S. for people to
  say they will stop eating chicken.

• Even after reassurances it will take many months for
  the industry to recover

• Messages even from trusted organizations may not
  be sufficient to restore confidence
For more information:


William K. Hallman, PhD
Director
hallman@aesop.rutgers.edu

Sarah C. Condry
Research Analyst
condry@aesop.rutgers.edu

Food Policy Institute
Rutgers University
New Brunswick, NJ 08901-8520
(732) 932-1966 x 3103
www.foodpolicyinstitute.org