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Potential Threats of Bioterrorism

Since 2001, the government and the media have periodically alerted the American people to potential threats of bioterrorism. //

Now, a team of researchers at the Albert Einstein College of Medicine of Yeshiva University has found that such messages measurably raise anxiety levels, which could pose adverse health effects.

In their findings reported in the current issue of the International Quarterly of Community Health Education, the researchers suggest that a comprehensive independent review of such messages is long overdue.

“Unlike public health messages that portray dire scenarios to try to scare people into quitting smoking or using seatbelts, similar bioterrorism scenarios do not lead to any measurable beneficial behavior change,” notes senior author Dr. Hillel Cohen, associate professor of epidemiology and population health at Einstein.

He adds, “Public health programs, which these alerts fall under, and other health interventions are typically evaluated by weighing efficacy and safety. If a public health program can induce stress and anxiety in the population, these should be considered potentially adverse effects that need evaluation.”

Dr. Cohen and his collaborators from the Ferkauf Graduate School of Psychology, also of Yeshiva University, conducted their study with volunteers recruited from students enrolled at both Einstein and Ferkauf. Potential participants were asked if they would participate in a research study involving the perception of a public health message and its relation to anxiety.

The 116 participants (26 men and 90 women) randomly received one of two messages: either a potent bioterrorism message portraying a graphic account of a horrific case of bioterrorism, or a message more neutral in tone that presented bioterrorism as a risk that was minor relative to other public health challenges. Those receiving the more potent message became the “experimental” group, while tho se receiving the more neutral message were considered the “control” group.

Anxiety was evaluated at the state and trait scores of the State-Trait Anxiety Inventory (STAI), while the Noncontingent Outcome Instrument also was used to measure pessimism regarding uncontrollable events, in order to identify the potential confounder of a general pessimistic outlook that could affect the STAI scores.

In addition, knowledge of bioterrorism was measured using a general Knowledge Questionnaire designed specifically for the study. Participants underwent all three components of these measures both before and after reading the randomized messages.

While “state anxiety” pre-intervention scores and pre-scores for “trait anxiety” were similar for both groups, “change-in-state” scores were sharply different. “We saw a statistically significant increase in the ‘state anxiety’ levels for the experimental group and a decrease of similar magnitude for the control group,” says Dr. Cohen. “And while there was negligible change in ‘trait scores’ for the control group, we found a significant increase in anxiety in the experimental group.

“Alarms and warnings are purposely constructed to stimulate an arousal response,” notes Dr. Cohen. “It is not surprising that alarms and warnings about potential dangers in general could also elevate anxiety and stress. Public health messages, like those to encourage quitting smoking or not driving after drinking, take advantage of this likely response in order to promote an aversion response to behaviors considered harmful. While risks and benefits are routinely weighed for medications and other health interventions, health related messages are simply assumed to be harmless. Our findings suggest this is not necessarily so. Therefore all health interventions including warnings about potential threats of bioterrorism should be evaluated by weighing the expected benefits against the potential risk of harm.”

He adds, “With smoking, the behavior to be avoided is clear. With bioterrorism, it is not at all clear what behaviors the public is expected to avoid or adopt, or what benefits could be anticipated if behaviors were to change. Therefore, before utilizing this approach to public health in the future, a clearer evaluation of its efficacy and safety should be undertaken. Doing so could prevent potentially harmful warnings that do little more than raise anxiety among the general population without offering a beneficial action for the public to take.”

Dr. Cohen’s collaborators on the study were Dr. Charles Swencionis, associate clinical professor of epidemiology and population health and of psychiatry and behavioral sciences at Einstein, and Dr. Sandra Lightstone, of the Ferkauf School of Psychology.


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