摘要：Objectives. We surveyed how many US residents engaged in 6 preparedness activities and measured the relationship between engagement and personal experience in hazard events, flashbulb memories of major events, self-reliance, and other indicators of a conservative philosophy. Methods. We used random digit dialing for national landline (75%) and cell phone (25%) surveys of 1930 US residents from July 6, 2011, to September 9, 2011; 1080 of the sample lived near 6 US Department of Energy nuclear waste management facilities and 850 were a national random sample. Results. The median respondent engaged in 3 of the 6 activities; those who disproportionately engaged in 4 or more had experienced a hazard event, had distressing and strong flashbulb memories of major hazard events, and had strong feelings about the need for greater self-reliance. The results for the national and US Department of Energy site–specific surveys were almost identical. Conclusions. A cadre of US residents are disproportionately engaged in disaster preparedness, and they typically have stronger negative memories of past disasters and tend to be self-reliant. How their efforts can or should be integrated into local preparedness efforts is unclear. Preparedness has been an important subject in the American Journal of Public Health, including in an electronic journal supplement in 2007. 1–5 Much of the literature, with some important exceptions, 1,3 has been about defining preparedness and the public health system’s capacity. Much less attention has been devoted to the public’s preparedness. The message from the literature is that much of the public is not ready to respond to serious events. 6–10 Why do so many not have a fire extinguisher, not have a communication plan with loved ones in the case of an event, not have a food supply set aside, and not have taken other steps that would increase their probability of survival in a serious event? Our focus in this article was on identifying those individuals who are most prepared and comparing their attributes with those who are less prepared. Using survey responses collected in 2011, our purpose was to answer 2 questions: What proportion of US respondents have engaged in preparedness actions ranging from knowing how to use a fire extinguisher to predetermining a place to meet if a hazardous event occurs? What factors are most strongly associated with taking multiple preparedness actions? Several key elements of the preparedness literature guided this research. Defining “preparedness” was one. Bourque et al. 10 used National Survey of Disaster Experiences and Preparedness data that included developing emergency plans, stockpiling supplies, purchasing things to be safer, learning how to get information, duplicating documents, and becoming more vigilant. They also examined avoidance activities, such as reducing airplane, train, and public transportation use; avoiding some cities, tall buildings, and national landmarks, and changing mail-handling practices. They found that 94% of respondents engaged in 1 or more of the 6 proactive activities, 84% reported that they became more vigilant, 32% had an emergency plan, 37% had stockpiled supplies, and 60% had learned how to get information. The median response was to have engaged in 3 of 6 activities. Residents of New York City and Washington, DC; men; and high-income respondents reported more preparedness activities. The authors concluded that US households are “remarkably unprepared for disasters and emergencies, including terrorism,” 10 (p402) a common conclusion in the literature. 6–15 Why are so few people prepared? One explanation is people are bombarded with so much information, including information about risks that seem more likely and threatening than a tornado or terrorist attack. 16 Second, preparedness is not clearly defined in ways that lead them to take action. 2,5,17 For some, preparedness might be learning how to access the latest information, but for others preparedness might mean leaving and knowing where to go before any warnings. Third, people may become numb to the threat if they have been warned and asked to move too many times and no threat materialized. Some may have already taken action and become less worried about the threat. 18 Given many people’s lack of engagement, researchers have been developing conceptual models to predict preparedness, 19–22 and these models were the basis for our research design, including such factors as personal experience in a disaster, strong emotions about disasters, trust in authority, self-efficacy, optimistic bias, psychological distance from the issue, and demographic attributes. 23–38 This literature suggests that preparedness is a deliberative action requiring strong reasons to participate because the events are low probability and most people do not believe they will be affected. We expected, first, that personal experience with a hazard event that left strong distressing memories, such as horror and fear, is strong motivation for preparedness. Our second expectation was that deeply embedded memories of major national or international disasters drive preparedness because these events were so shocking, salient, and consequential that they left so-called “flashbulb” memories, which are detailed recollections about the event, including where the respondent was and what he or she was doing during the event. 39–47 Indeed, deeply embedded memories can be used as one diagnostic to predict posttraumatic stress after wars, the 9/11 terrorist attacks, earthquakes, and hurricanes, even among those with Alzheimer’s disease. 42–47 Hence, we expected personal experience in events, emotional reactions to those events, and flashbulb memories of some of the worst events in recent history to be the strongest correlates of preparedness. We expected that although strong negative memories and personal experiences would be signal events, they would not lead everyone to prepare for low-probability hazard events. Those who took action would tend to assert conservative values that emphasize self-help, lack of trust in authority to protect them, and a resistance to immediately agreeing with government-initiated policy proposals. In addition, we expected demographic attributes, as well as respondents’ location, to influence the results. Overall, our key expectation was focused on strong negative memories and personal experiences; secondarily, we focused on the role of self-reliance, demographic attributes, and location.
