K. Hilyard - Academia.edu (original) (raw)
Papers by K. Hilyard
Journal of Health Communication, 2013
Distrust of the government often stands in the way of cooperation with public health recommendati... more Distrust of the government often stands in the way of cooperation with public health recommendations in a crisis. The purpose of this paper is to describe the public's trust in government recommendations during the early stages of the H1N1 pandemic and identify factors that might account for these trust levels. We surveyed 1543 respondents about their experiences and attitudes related to H1N1 influenza between June 3, 2009 and July 6, 2009, during the first wave of the pandemic using the Knowledge Networks (KN) online panel. This panel is representative of the US population, and uses a combination of random-digit dial and addressbased probability sampling frames covering 99% of the US household population to recruit participants. To ensure participation of low-income individuals and those without Internet access, KN provides hardware and access to the Internet if needed. Measures included standard demographics, a trust scale, trust ratings for individual spokespersons, involvement with H1N1, experience with H1N1, and past discrimination in health care. We found that trust of government was low (2.3 out of 4) and varied across demographic groups. Blacks and Hispanics reported higher trust in government than did Whites. Of the spokespersons included, personal health professionals received the highest trust ratings and religious leaders the lowest. Attitudinal and experience variables predicted trust better than demographic characteristics. Closely following the news about the flu virus, having some self-reported knowledge about H1N1, self-reporting of local cases and previously experiencing discrimination were the significant attitudinal and experience predictors of trust. Using a second longitudinal survey, trust in the early stages of the pandemic did predict vaccine acceptance later but only for white, non-Hispanic individuals. During a public health emergency, it is critical that risk communication messages convince the public to cooperate quickly with governmental directives such as to boil water, shelter
Disaster medicine and public health preparedness, 2015
The Centers for Disease Control and Prevention estimated that up to 88 million H1N1 influenza cas... more The Centers for Disease Control and Prevention estimated that up to 88 million H1N1 influenza cases, 398,000 hospitalizations, and up to 18,050 related deaths, including significant racial and ethnic disparities, occurred between April 2009 and March 13, 2010. The Food and Drug Administration (FDA) approved emergency use authorizations (EUAs), which allowed the distribution of unapproved drugs or the off-label use of approved drugs. In late 2009, peramivir was granted an EUA for patients with severe disease. This study examined factors associated with willingness to take peramivir. In 2010 we conducted a nationally representative survey with 2079 respondents randomly drawn from the Knowledge Networks research panel. Our completion rate was 56%. Respondents received information about peramivir from a fact sheet and then answered questions about their willingness to take the drug. Overall, 48% of participants indicated that they would probably or definitely take peramivir. Seventy-nin...
Journal of Human Lactation, 2014
Background: African American women have the lowest breastfeeding rates among all racial/ethnic gr... more Background: African American women have the lowest breastfeeding rates among all racial/ethnic groups in the United States. Peer counseling is an effective intervention in improving breastfeeding in this population. However, little is known on peer counselors’ perceptions of breastfeeding in African American women. Objective: As part of a larger qualitative study, the goal of this study was to understand the contextual factors influencing breastfeeding decisions of low-income African American women from the perspective of breastfeeding peer counselors (PCs). Methods: Three focus groups were conducted with 23 PCs from the Women, Infants, and Children program in a southeastern state. All focus group discussions were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Bronfenbrenner’s socioecological model was used to group categories into themes. Results: Of the sample, 47.8% were African American, 78.2% were married, and 56.5% had some college education....
Health Promotion Practice, 2008
To better inform public health officials during a flu pandemic, this study analyzes a representat... more To better inform public health officials during a flu pandemic, this study analyzes a representative statewide telephone survey among 1,602 adults to examine knowledge and perceptions about a flu pandemic, trust in government, and support for government actions in a flu pandemic. The findings show citizens do not understand what avian/bird flu is and how it evolves into a pandemic. They also seem to have divergent perceptions regarding the susceptibility and severity of a flu pandemic. More than half of the respondents trust the government to handle a flu pandemic and show strong support for many proposed government actions in a pandemic, except for offering non—fully approved drugs. The findings suggest public health and risk communicators should reinforce support for controversial actions through trust building and personalization of risks rather than mere education or publicity. Public education and engagement should also begin pre-pandemic and continue throughout all phases of t...
Health Promotion Practice, 2008
This article describes the design, implementation, and evaluation of a simulation of risk communi... more This article describes the design, implementation, and evaluation of a simulation of risk communication in the first hours of a pandemic. The simulation design was based on Crisis and Emergency Risk Communication principles espoused by the Centers for Disease Control and Prevention, as well as the collective experience of the authors. Over 4 hours, 17 local health district risk communicators in Georgia responded to a scenario in which every community in the state had teenagers infected with avian flu after returning from an international conference. The evaluation revealed that local risk communicators had much greater difficulty following risk communication principles under the time pressures of a realistic and stressful event than they did in a tabletop exercise. Strengths and weaknesses of the performance of the local risk communicators are identified in addition to lessons learned about the design and implementation of a risk communication simulation.
Health Education & Behavior, 2012
Research on influenza vaccine uptake has focused largely on intrapersonal determinants (perceived... more Research on influenza vaccine uptake has focused largely on intrapersonal determinants (perceived risk, past vaccine acceptance, perceived vaccine safety) and on physician recommendation. The authors used a social ecological framework to examine influenza vaccine uptake during the 2009 H1N1 pandemic. Surveying an adult population ( n = 2,079) in January 2010 with significant oversamples of Blacks and Hispanics, this study found that 18.4% (95% confidence interval = 15.6-21.5) had gotten the 2009 H1N1 vaccine. Variables at each level of the social ecological model were significant predictors of uptake as well as of intent to get the vaccine. The intrapersonal level explained 53%, the interpersonal explained 47%, the institutional level explained 34%, and the policy and community levels each explained 8% of the variance associated with vaccine uptake. The levels together explained 65% of the variance, suggesting that interventions targeting multiple levels of the framework would be mo...
Health Education & Behavior, 2013
Although designated as a high-risk group during the 2009-2010 H1N1 pandemic, only about 40% of U.... more Although designated as a high-risk group during the 2009-2010 H1N1 pandemic, only about 40% of U.S. children received the vaccine, a relatively low percentage compared with high-risk groups in seasonal influenza, such as the elderly, whose vaccine rates typically top 70%. To better understand parental decision making and predictors of acceptance of the H1N1 vaccine, we examined data from a representative national sample of parents ( n = 684), using the health belief model as a framework. The most important predictors of vaccine acceptance were “cues to action” at multiple levels, from intrapersonal to mass communication, including the influence of friends, family, the media, and modeling by the Obama family; costs and benefits and self-efficacy were also significant predictors of vaccine acceptance. Higher perceived levels of H1N1 risk were not associated with vaccine uptake. Results suggest that traditional measures of perceived risk may not account for the cost–benefit analysis in...
ABSTRACT Objectives: We examined what factors are associated with support for probable government... more ABSTRACT Objectives: We examined what factors are associated with support for probable government actions in a flu pandemic. Method: We analyzed a cross-sectional survey of 1,602 Georgia residents collected in summer 2006. The dependent variable was support for ten probable government actions (e.g., school and border closing, quarantining, rationing, not-fully approved vaccine provision). Independent variables include demographics (race, gender, age, income, education level, home ownership, and residence), psychological variables (perceived severity and susceptibility of pandemic flu), conservatism, religiousness, knowledge about bird flu/pandemic flu, and an index of trust in government. Result: Despite a high level of support for most government actions, many Georgian respondents did not favor public health officials providing people vaccines or drugs that were not fully approved. Our hierarchical regression models indicate that trust in government seems to be the most significant and consistent predictor of support for government actions. In addition, African American respondents are less likely to support the government's actions than the other racial groups. Implications/Conclusion: Governmental risk communicators need to build an understanding of investigational new drugs prior to any need to use them on a large scale. They also should reinforce support for other controversial actions while recognizing that some of this support may erode when it impacts everyday life. Every effort should be made to build trust in government, especially in groups such as African Americans whose mistrust has deep historical roots that have been intensified following Hurricane Katrina.
Government health measures in a pandemic are effective only with strong support and compliance fr... more Government health measures in a pandemic are effective only with strong support and compliance from the public. A survey of 1,583 US adults early in the 2009 H1N1 (swine influenza) pandemic shows surprisingly mixed support for possible government efforts to control the spread of the disease, with strong support for more extreme measures such as closing borders and weak support for more basic, and potentially more effective, policies such as encouraging sick people to stay home from work. The results highlight challenges that public health officials and policy makers must address in formulating strategies to respond to a pandemic before a more severe outbreak occurs. Although far smaller and less severe than other influenza pandemics of the past century, 1 the 2009 H1N1 (swine flu) pandemic and the virus that caused it remain a concern for public health officials for three reasons. First, unlike typical influenza outbreaks, H1N1 caused proportionally more hospitalizations and deaths among those under age sixty-five, 1 and certain groups, such as people with obesity, appeared to be at risk for severe complications not previously seen in influenza. 2 Second, the World Health Organization (WHO) believes that H1N1 could mutate into a more dangerous form, 3 such as the 1918 avian flu that killed fifty million people, many of whom were ages 20-40 and were previously healthy. 4 And third, although the H1N1 pandemic turned out not to be severe, public health officials discovered problems with their initial efforts to mitigate the spread of the disease and increase public support for those efforts. Greater public awareness of flu pandemics as a result of the H1N1 outbreak provided a unique opportunity to evaluate strategies that officials might use in a more severe pandemic. We began a longitudinal assessment of public support for government action just after the virus emerged in Mexico and in several areas in the United States. That was early in the outbreak, before the development of a vaccine, the identification of groups that should
Journal of Health Communication, 2014
Distrust of the government often stands in the way of cooperation with public health recommendati... more Distrust of the government often stands in the way of cooperation with public health recommendations in a crisis. The purpose of this article is to describe the public's trust in government recommendations during the early stages of the H1N1 pandemic and to identify factors that might account for these trust levels. The authors surveyed 1,543 respondents about their experiences and attitudes related to H1N1 influenza between June 3, 2009, and July 6, 2009, during the first wave of the pandemic using the Knowledge Networks online panel. This panel is representative of the U.S. population and uses a combination of random digit dialing and address-based probability sampling frames covering 99% of the U.S. household population to recruit participants. To ensure participation of low-income individuals and those without Internet access, Knowledge Networks provides hardware and access to the Internet if needed. Measures included standard demographics, a trust scale, trust ratings for individual spokespersons, involvement with H1N1, experience with H1N1, and past discrimination in health care. The authors found that trust of government was low (2.3 out of 4) and varied across demographic groups. Blacks and Hispanics reported higher trust in government than did Whites. Of the spokespersons included, personal health professionals received the highest trust ratings and religious leaders the lowest. Attitudinal and experience variables predicted trust better than demographic
Journal of Health Communication, 2013
Distrust of the government often stands in the way of cooperation with public health recommendati... more Distrust of the government often stands in the way of cooperation with public health recommendations in a crisis. The purpose of this paper is to describe the public's trust in government recommendations during the early stages of the H1N1 pandemic and identify factors that might account for these trust levels. We surveyed 1543 respondents about their experiences and attitudes related to H1N1 influenza between June 3, 2009 and July 6, 2009, during the first wave of the pandemic using the Knowledge Networks (KN) online panel. This panel is representative of the US population, and uses a combination of random-digit dial and addressbased probability sampling frames covering 99% of the US household population to recruit participants. To ensure participation of low-income individuals and those without Internet access, KN provides hardware and access to the Internet if needed. Measures included standard demographics, a trust scale, trust ratings for individual spokespersons, involvement with H1N1, experience with H1N1, and past discrimination in health care. We found that trust of government was low (2.3 out of 4) and varied across demographic groups. Blacks and Hispanics reported higher trust in government than did Whites. Of the spokespersons included, personal health professionals received the highest trust ratings and religious leaders the lowest. Attitudinal and experience variables predicted trust better than demographic characteristics. Closely following the news about the flu virus, having some self-reported knowledge about H1N1, self-reporting of local cases and previously experiencing discrimination were the significant attitudinal and experience predictors of trust. Using a second longitudinal survey, trust in the early stages of the pandemic did predict vaccine acceptance later but only for white, non-Hispanic individuals. During a public health emergency, it is critical that risk communication messages convince the public to cooperate quickly with governmental directives such as to boil water, shelter
Disaster medicine and public health preparedness, 2015
The Centers for Disease Control and Prevention estimated that up to 88 million H1N1 influenza cas... more The Centers for Disease Control and Prevention estimated that up to 88 million H1N1 influenza cases, 398,000 hospitalizations, and up to 18,050 related deaths, including significant racial and ethnic disparities, occurred between April 2009 and March 13, 2010. The Food and Drug Administration (FDA) approved emergency use authorizations (EUAs), which allowed the distribution of unapproved drugs or the off-label use of approved drugs. In late 2009, peramivir was granted an EUA for patients with severe disease. This study examined factors associated with willingness to take peramivir. In 2010 we conducted a nationally representative survey with 2079 respondents randomly drawn from the Knowledge Networks research panel. Our completion rate was 56%. Respondents received information about peramivir from a fact sheet and then answered questions about their willingness to take the drug. Overall, 48% of participants indicated that they would probably or definitely take peramivir. Seventy-nin...
Journal of Human Lactation, 2014
Background: African American women have the lowest breastfeeding rates among all racial/ethnic gr... more Background: African American women have the lowest breastfeeding rates among all racial/ethnic groups in the United States. Peer counseling is an effective intervention in improving breastfeeding in this population. However, little is known on peer counselors’ perceptions of breastfeeding in African American women. Objective: As part of a larger qualitative study, the goal of this study was to understand the contextual factors influencing breastfeeding decisions of low-income African American women from the perspective of breastfeeding peer counselors (PCs). Methods: Three focus groups were conducted with 23 PCs from the Women, Infants, and Children program in a southeastern state. All focus group discussions were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Bronfenbrenner’s socioecological model was used to group categories into themes. Results: Of the sample, 47.8% were African American, 78.2% were married, and 56.5% had some college education....
Health Promotion Practice, 2008
To better inform public health officials during a flu pandemic, this study analyzes a representat... more To better inform public health officials during a flu pandemic, this study analyzes a representative statewide telephone survey among 1,602 adults to examine knowledge and perceptions about a flu pandemic, trust in government, and support for government actions in a flu pandemic. The findings show citizens do not understand what avian/bird flu is and how it evolves into a pandemic. They also seem to have divergent perceptions regarding the susceptibility and severity of a flu pandemic. More than half of the respondents trust the government to handle a flu pandemic and show strong support for many proposed government actions in a pandemic, except for offering non—fully approved drugs. The findings suggest public health and risk communicators should reinforce support for controversial actions through trust building and personalization of risks rather than mere education or publicity. Public education and engagement should also begin pre-pandemic and continue throughout all phases of t...
Health Promotion Practice, 2008
This article describes the design, implementation, and evaluation of a simulation of risk communi... more This article describes the design, implementation, and evaluation of a simulation of risk communication in the first hours of a pandemic. The simulation design was based on Crisis and Emergency Risk Communication principles espoused by the Centers for Disease Control and Prevention, as well as the collective experience of the authors. Over 4 hours, 17 local health district risk communicators in Georgia responded to a scenario in which every community in the state had teenagers infected with avian flu after returning from an international conference. The evaluation revealed that local risk communicators had much greater difficulty following risk communication principles under the time pressures of a realistic and stressful event than they did in a tabletop exercise. Strengths and weaknesses of the performance of the local risk communicators are identified in addition to lessons learned about the design and implementation of a risk communication simulation.
Health Education & Behavior, 2012
Research on influenza vaccine uptake has focused largely on intrapersonal determinants (perceived... more Research on influenza vaccine uptake has focused largely on intrapersonal determinants (perceived risk, past vaccine acceptance, perceived vaccine safety) and on physician recommendation. The authors used a social ecological framework to examine influenza vaccine uptake during the 2009 H1N1 pandemic. Surveying an adult population ( n = 2,079) in January 2010 with significant oversamples of Blacks and Hispanics, this study found that 18.4% (95% confidence interval = 15.6-21.5) had gotten the 2009 H1N1 vaccine. Variables at each level of the social ecological model were significant predictors of uptake as well as of intent to get the vaccine. The intrapersonal level explained 53%, the interpersonal explained 47%, the institutional level explained 34%, and the policy and community levels each explained 8% of the variance associated with vaccine uptake. The levels together explained 65% of the variance, suggesting that interventions targeting multiple levels of the framework would be mo...
Health Education & Behavior, 2013
Although designated as a high-risk group during the 2009-2010 H1N1 pandemic, only about 40% of U.... more Although designated as a high-risk group during the 2009-2010 H1N1 pandemic, only about 40% of U.S. children received the vaccine, a relatively low percentage compared with high-risk groups in seasonal influenza, such as the elderly, whose vaccine rates typically top 70%. To better understand parental decision making and predictors of acceptance of the H1N1 vaccine, we examined data from a representative national sample of parents ( n = 684), using the health belief model as a framework. The most important predictors of vaccine acceptance were “cues to action” at multiple levels, from intrapersonal to mass communication, including the influence of friends, family, the media, and modeling by the Obama family; costs and benefits and self-efficacy were also significant predictors of vaccine acceptance. Higher perceived levels of H1N1 risk were not associated with vaccine uptake. Results suggest that traditional measures of perceived risk may not account for the cost–benefit analysis in...
ABSTRACT Objectives: We examined what factors are associated with support for probable government... more ABSTRACT Objectives: We examined what factors are associated with support for probable government actions in a flu pandemic. Method: We analyzed a cross-sectional survey of 1,602 Georgia residents collected in summer 2006. The dependent variable was support for ten probable government actions (e.g., school and border closing, quarantining, rationing, not-fully approved vaccine provision). Independent variables include demographics (race, gender, age, income, education level, home ownership, and residence), psychological variables (perceived severity and susceptibility of pandemic flu), conservatism, religiousness, knowledge about bird flu/pandemic flu, and an index of trust in government. Result: Despite a high level of support for most government actions, many Georgian respondents did not favor public health officials providing people vaccines or drugs that were not fully approved. Our hierarchical regression models indicate that trust in government seems to be the most significant and consistent predictor of support for government actions. In addition, African American respondents are less likely to support the government's actions than the other racial groups. Implications/Conclusion: Governmental risk communicators need to build an understanding of investigational new drugs prior to any need to use them on a large scale. They also should reinforce support for other controversial actions while recognizing that some of this support may erode when it impacts everyday life. Every effort should be made to build trust in government, especially in groups such as African Americans whose mistrust has deep historical roots that have been intensified following Hurricane Katrina.
Government health measures in a pandemic are effective only with strong support and compliance fr... more Government health measures in a pandemic are effective only with strong support and compliance from the public. A survey of 1,583 US adults early in the 2009 H1N1 (swine influenza) pandemic shows surprisingly mixed support for possible government efforts to control the spread of the disease, with strong support for more extreme measures such as closing borders and weak support for more basic, and potentially more effective, policies such as encouraging sick people to stay home from work. The results highlight challenges that public health officials and policy makers must address in formulating strategies to respond to a pandemic before a more severe outbreak occurs. Although far smaller and less severe than other influenza pandemics of the past century, 1 the 2009 H1N1 (swine flu) pandemic and the virus that caused it remain a concern for public health officials for three reasons. First, unlike typical influenza outbreaks, H1N1 caused proportionally more hospitalizations and deaths among those under age sixty-five, 1 and certain groups, such as people with obesity, appeared to be at risk for severe complications not previously seen in influenza. 2 Second, the World Health Organization (WHO) believes that H1N1 could mutate into a more dangerous form, 3 such as the 1918 avian flu that killed fifty million people, many of whom were ages 20-40 and were previously healthy. 4 And third, although the H1N1 pandemic turned out not to be severe, public health officials discovered problems with their initial efforts to mitigate the spread of the disease and increase public support for those efforts. Greater public awareness of flu pandemics as a result of the H1N1 outbreak provided a unique opportunity to evaluate strategies that officials might use in a more severe pandemic. We began a longitudinal assessment of public support for government action just after the virus emerged in Mexico and in several areas in the United States. That was early in the outbreak, before the development of a vaccine, the identification of groups that should
Journal of Health Communication, 2014
Distrust of the government often stands in the way of cooperation with public health recommendati... more Distrust of the government often stands in the way of cooperation with public health recommendations in a crisis. The purpose of this article is to describe the public's trust in government recommendations during the early stages of the H1N1 pandemic and to identify factors that might account for these trust levels. The authors surveyed 1,543 respondents about their experiences and attitudes related to H1N1 influenza between June 3, 2009, and July 6, 2009, during the first wave of the pandemic using the Knowledge Networks online panel. This panel is representative of the U.S. population and uses a combination of random digit dialing and address-based probability sampling frames covering 99% of the U.S. household population to recruit participants. To ensure participation of low-income individuals and those without Internet access, Knowledge Networks provides hardware and access to the Internet if needed. Measures included standard demographics, a trust scale, trust ratings for individual spokespersons, involvement with H1N1, experience with H1N1, and past discrimination in health care. The authors found that trust of government was low (2.3 out of 4) and varied across demographic groups. Blacks and Hispanics reported higher trust in government than did Whites. Of the spokespersons included, personal health professionals received the highest trust ratings and religious leaders the lowest. Attitudinal and experience variables predicted trust better than demographic