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Adherence to Emergency Public Health Measures for Bioevents: Review of US Studies

  • Robyn R. Gershon (a1), Qi Zhi (a2), Alexander F. Chin (a3), Ezinne M. Nwankwo (a4) and Lisa M. Gargano (a5)...


The frequency of bioevents is increasing worldwide. In the United States, as elsewhere, control of contagion may require the cooperation of community members with emergency public health measures. The US general public is largely unfamiliar with these measures, and our understanding of factors that influence behaviors in this context is limited. The few previous reviews of research on this topic focused on non-US samples. For this review, we examined published research on the psychosocial influences of adherence in US sample populations. Of 153 articles identified, only 9 met the inclusion criteria. Adherence behaviors were categorized into 2 groups: self-protective behaviors (personal hygiene, social distancing, face mask use, seeking out health care advice, and vaccination) and protecting others (isolation, temperature screening, and quarantine). A lack of uniformity across studies regarding definitions and measures was noted. Only 5 of the 9 articles reported tests of association between adherence with emergency measures and psychosocial factors; perceived risk and perceived seriousness were found to be significantly associated with adherence or adherence intentions. Although it is well documented that psychosocial factors are important predictors of protective health behaviors in general, this has not been rigorously studied in the context of bioevents. (Disaster Med Public Health Preparedness. 2018;12:528–535)


Corresponding author

Correspondence and reprint requests to Robyn R. Gershon, DrPH, Department of Environmental Health Sciences, College of Global Public Health, New York University, New York, NY 10003. (email:


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