The Humans in Human Ecology: Studying Society & West Nile Virus

1. The Humans in Human Ecology: Studying Society & West Nile Virus Emily Zielinski Gutierrez, CDC/Division of Vector-Borne Infectious Diseases Mary Hayden, University of Colorado at Colorado Springs NISSC

2. HumanEcology & Vector-borne Disease • People shape local ecology and thus influence vector ecology • Land use and sanitary conditions (trash, breeding sites) • Control of water resources • Human patterns and choices affect exposure to vectors • Housing characteristics • Outdoor activities (work & recreation) • Use of prevention measures

3. Data on Human Behavior • Land/water use analysis, GIS • Mapping of housing characteristics • Surveys to quantify behavior • Interviews and focus groups to characterize/describe behavior

4. Qualitative Data Often “words” Inductive Not intended to be generalizable Identify concepts, issues How? Why? Subjective Quantitative Data Often “numbers” Deductive Usually generalizable Identify frequency/magnitude What? How many? “Objective” (but…) Qualitative/Quantitative Methods

5. Qualitative and Quantitative Methods • Both “scientific,” though from varied disciplines • Role of researcher can vary • level of involvement, interaction • Ultimately depends on the question(s) you are trying to answer • Ideally function as complementary approaches to analysis • Resources • Qualitative MAY be quicker, cheaper and administratively easier (IRB, OMB) – rapid assessment

6. Methods – WNV focal areas • Community discussion groups (e.g. focus groups) • Louisiana (2002), Colorado (2003), Illinois (2003), California/Mexico border (2004) • Demographically diverse populations • Focus groups were segmented by age, language, ethnicity/race, and geographic location. • Interviews transcribed and content analysis conducted to define major themes and interactions

7. Data Collection • Topics covered: • concern/risk perception vis-à-vis WNV, mosquitoes • attitudes towards mosquitoes, repellent, and mosquito control • information sources • protective actions (repellent, protective clothing, screening) • housing & lifestyle (e.g., time spent outdoors)

8. Synthesis Risk perception was affected by locally- and individually-defined “intensity of WNV transmission” Factors defining local intensity of transmission include: • personal knowledge about disease • type and credibility of information sources • local government intervention • perception of local ecology

9. Need for New Models • Few models of health behavior adequately account for role of local ecology in shaping people’s risk perception

10. Personal knowledge about disease Information Sources Actions of local government Local ecology Locally-defined intensity of transmission

11. Intense WNV Human Disease 2002 & 2003 ME WA VT MT ND MN NH OR NY MA WI ID SD RI Population perceives limited mosquito infestation Limited experience w/ & some resistance to mosquito control Risk perception linked to info from community groups WY MI PA NJ CT IA NE OH DE IN NV IL UT WV VA CO CA KS MO MD KY NC TN OK AZ SC NM AR GA AL MS TX LA FL Long history of mosquito infestations and nuisance Experience with and general support for mosquito control as a public service Risk perception linked to info from community groups Includes Fever and neuroinvasive disease as reported to CDC > 200 human cases 2003 > 200 human cases 2002 > 200 human cases both years

12. Risk: personal knowledge of disease • Knowing some who was ill • Increased recognition of WNV Fever cases during 2003*, more residents knew of someone infected • Concern about severity of Fever • Not the same impact as ND, but people missed school, work, described prolonged headache ache and fatigue • “No one told us it was going to be this bad.”

13. Defining Risk: Local Ecology • “No mosquitoes here”: West • Public lack recent history of dealing with mosquitoes as a nuisance or comparisons to Midwest/elsewhere • We have a drought, how can we have mosquitoes? • “We’ve always had mosquitoes…”: South • Home as “Safe Zone” • Forget repellent in the backyard… disinclination to regard home as dangerous • “Most of us [retirees] who are living here are so happy to be in this particular environment that we think we’ve got it made and… we’re kind of invulnerable to any sort of thing.”

14. Defining Risk: perception of ecology/local geography • “Hyper-localization” of risk • Individuals try to quantify exactly where and when the risk exists • We know that (on the whole) Americans have poor geography skills • People try to downgrade their risk – e.g. that dead bird was 3 blocks from here… • “We hear about the deaths… I wish they would go into a bit more history [of where they were bit.]”

15. Defining risk: people look at what government is doing • Mosquito control actions can create controversy. • The decision to declare a public health emergency also was noted as influencing people’s concern over the issue. • Can long-term mosquito abatement lead to complacency (and no repellent use) among citizens? • Local gov’t actions can serve as trigger for citizens

16. Social Factors Potentially Influencing WNV Risk • Community Level: • History/use of mosquito abatement • Irrigation practices • Land Use (farming, golf courses…) • Presence of household breeding (trash collection, tire laws, gardening practices) • Regional adaptation to climate

17. Social Factors Potentially Influencing WNV Risk • Household/Personal Level • Presence/lack of air conditioning (vs. swamp coolers vs. fans vs. none) • Style of housing (open vs. closed) • Type of work (e.g. ag workers, landscaping) • Recreation choices (gardening, golf) • Willingness to engage in repellent use, control of breeding sites • May depend on experience with other public health progs, risk perception…

18. Recommendations • Short-term: • Educate citizens on local ecology • Help people interpret data through mapping • Housing adaptations, target certain populations with education on risk mitigation • Long-term: • Examine factors that influence mosquito breeding & resistance to control (household and ag irrigation, ag use of pesticides) • Work toward policy changes