Risk Perceptions of Swine Influenza Virus Infection Among At-risk Populations: Observation from Rural Hubei Province (China) and Rural North Carolina (the United States)

Abstract

Background: Swine Influenza (SI) not only increases the burden of disease in pigs worldwide, but also presents a serious challenge for public health, especially for China and the United States. Although swine influenza viruses (SIVs) are not generally transmitted from pigs to humans, sporadic human infection cases do occur and this phenomenon appears to be increasing in recent years. Additionally, there is mounting evidence that swine workers and residents who live near areas with a high density of pig farms are at more risk for being infected with SIVs than is the general public. Thus, to help them prevent future SIV infection in humans, there is a need to understand their current risk perception and their responses to precautionary methods. This study measures the risk perception among at-risk populations in rural areas in Hubei (China) and North Carolina (the U.S.A.) and examines the association between those risk perceptions and their responses to precautionary methods. Methods: A cross-sectional, quantitative method study was conducted in four rural counties of Hubei province and one rural county of North Carolina. Four rural counties in Hubei were selected because many of residents are pig farmers with backyard-sized pig farms. One rural county in North Carolina was selected because it is a residential area with a high density of industrial hog operations (IHOs). A total of 67 face-to-face questionnaire interviews in Chinese were conducted among participants in Hubei counties, while 33 face-to-face questionnaire interviews in English or Spanish were conducted among participants in North Carolina. All participants completed the same questionnaire that assessed their risk perception of swine influenza virus infection and responses to precautionary behavior. The measure of risk perception in this study is focused upon perceived likelihood and susceptibility of SIVs infections. Results: In terms of perceived likelihood of SIVs infection, only 23.9% of respondents in the Hubei study part thought SIVs infection among swine workers was likely or strongly likely to occur in China and 20.9% of them thought this was likely or strongly likely to occur in Hubei. Additionally, overall 27.3% of respondents in North Carolina study part thought SIVs infection among swine workers was likely or strongly likely to occur in the United States and 39.4% of them thought this was likely or strongly likely to occur in North Carolina. In terms of perceived personal susceptibility of SIVs infections, the majority of respondents (80.6%) in the Hubei study thought they were at low risk, but most respondents in North Carolina (66.7%) perceived themselves to be at moderate risk. Furthermore, results showed that 16.4% of respondents in Hubei and more than half (60.6%) of respondents in North Carolina took no precautionary methods after touching pigs. In addition, considering the larger sample size in the Hubei part of the study, we further conducted single and multiple regression analysis to see the determinants of risk perceptions as well as the association between risk perceptions and intensity of precautionary methods. Results showed that female respondents and younger respondents were more likely to have higher risk perceptions. In addition, people who had high levels of risk perceptions were also more likely to take more precautionary measures.Conclusions: This study provided evidence for the following conclusions: 1) Most pig farmers in the rural Hubei study, despite had relatively low-risk perceptions, were still willing to use at least one precautionary method; and 2) Although participants in rural North Carolina had relatively high-risk perceptions, more than half of them still thought it was not necessary to take precautionary measures. In addition, further multiple regression analysis of data in the Hubei study also indicated that risk perceptions are significantly associated with gender and age, and the intensity of precautionary methods may be influenced by risk perceptions. These results carry important policy implications about the need to better educate at-risk populations about their risk of SIV infection and to promote appropriate precautionary methods for future disease prevention.