terrorism_public perceptions_anzjph_2009_33_4
TRANSCRIPT
2009 vol. 33 no. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 339© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia
Public perceptions of the threat of terrorist attack in
Australia and anticipated compliance behaviours
Abstract
Objective: To determine the perceived
threat of terrorist attack in Australia and
preparedness to comply with public safety
directives.
Methods: A representative sample
of 2,081 adults completed terrorism
perception questions as part of the New
South Wales Population Health Survey.
Results: Overall, 30.3% thought a terrorist
attack in Australia was highly likely,
42.5% were concerned that self or family
would be directly affected and 26.4% had
changed the way they lived due to potential
terrorist attacks. Respondents who spoke a
language other than English at home were
2.47 times (Odds Ratios (OR=2.47, 95%
CI:1.58-3.64, p<0.001) more likely to be
concerned self or family would be affected
and 2.88 times (OR=2.88, 95% CI:1.95-
4.25, p<0.001) more likely to have changed
the way they lived due to the possibility of
terrorism. Those with high psychological
distress perceived higher terrorism
likelihood and greater concern that self or
family would be directly affected (OR=1.84,
95% CI:1.05-3.22, p=0.034). Evacuation
willingness was high overall but those with
poor self-rated health were significantly
less willing to leave their homes during a
terrorism emergency.
Conclusion: Despite not having
experienced recent terrorism within
Australia, perceived likelihood of an attack
was higher than in comparable western
countries. Marginalisation of migrant
groups associated with perceived terrorism
threat may be evident in the current
findings.
Implications: This baseline data will be
useful to monitor changes in population
perceptions over time and determine
the impact of education and other
preparedness initiatives.
Key words: terrorism, threat perception,
risk perception, evacuation, ethnicity,
psychological distress.
Aust N Z Public Health. 2009; 33:339-46
doi: 10.1111/j.1753-6405.2009.00405.x
Garry Stevens, Melanie TaylorSchool of Medicine, University of Western Sydney, New South Wales
Margo BarrCentre for Epidemiology and Research, New South Wales Department of Health
Louisa JormSchool of Medicine, University of Western Sydney, New South Wales
Michael Giffin, Ray FergusonCentre for Epidemiology and Research, New South Wales Department of Health
Kingsley Agho and Beverley RaphaelSchool of Medicine, University of Western Sydney, New South Wales
If a terrorist attack should occur, it is
essential that public health authorities
are prepared to act. Understanding how
the public perceives the threat of a terrorist
attack, and is likely to respond, is integral to
incident preparedness and planning.1-2
Studies following large-scale terrorist
attacks show that the perceived risk of further
attacks is linked with changes in behaviour,
such as restricting travel, avoiding places of
perceived high risk and increased substance
use.3-5 There is evidence that some of these
changes will persist in the medium term and be
associated with negative health and economic
outcomes.6-8 There is also evidence that some
of these population impacts may be mitigated
through public information campaigns and
other preparedness initiatives.5
Information is also emerging from
populations that have not experienced a
major attack but are at risk of such events.9-
11 In one Canadian study, only 20% of the
population thought a terrorist attack was
extremely or very likely to occur. Perceived
threat to themselves as individuals was
even lower. Most respondents worried little
Submitted: August 2008 Revision requested: February 2009 Accepted: April 2009Correspondence to:Garry Stevens, Senior Research Fellow, School of Medicine, University of Western Sydney, Building EV, Parramatta Campus, Locked Bag 1797, Penrith NSW DC1797. Fax: (02) 9685 9554; e-mail: [email protected]
about terrorism; preparatory behaviours
were consistent with these perceptions,
with less than 5% establishing a family
emergency plan for terrorism or avoiding
public places of perceived risk. While
specific preparedness was low, there was
high willingness to follow public safety
directives during such incidents.9
Australia, like Canada, is a country that has
experienced little terrorism within its borders.
However, in recent years Australians have been
affected by large-scale terrorist attacks within
the region, including bombings in Bali in
2002 and 2005, and the 2005 Jakarta bombing
presumed to have targeted the Australian
Embassy. Australians were also among those
killed in the Mumbai attacks of 2008. In
this environment of increasing international
threat, there is a need for planning to protect
public health and safety should terrorist
attacks occur within Australia.12
Disaster planning requires information about
community perceptions of risk, associated
behaviours and information about vulnerable
sub-populations.13 Researchers and planners
stress the importance of developing specific
Article Threats to health
340 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2009 vol. 33 no. 4© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia
Stevens et al. Article
measures of risk perception, and their behavioural correlates, as an
integral part of disaster planning.14 Such instruments can support
the establishment of baseline data against which the trajectory of
psychosocial recovery can be measured. They can also be used to
monitor other shifts in community perceptions over time, including
the effectiveness of risk communication strategies and education
programs. For these reasons, the relative absence of baseline data has
been cited as a significant impediment to disaster planning.14-15
The aim of this paper is to determine perceptions of the threat
of terrorist attack in Australia and preparedness to comply with
evacuation directives in the event of such incidents. A further aim of
the wider study has been to establish a surveillance tool and source of
baseline data to allow ongoing monitoring of terrorism risk perception
and behavioural correlates within the Australian population.
MethodsQuestion design
A literature search was conducted to identify existing tools for
collecting information on perceptions of terrorist attack with the
underlying themes of likelihood, effect on family (vulnerability and
risk), life changes and compliance with government authorities.
The primary reference was a study by Canadian researchers on
anticipated public response to terrorism.9-10 Questions on threat
likelihood, effect on family and behavioural compliance were
adapted, with permission, by subject matter experts and survey
methodologists. Each proposed question was considered for
clarity, ease of administration and possible biases. A set of five
questions was developed for field-testing as well as the additional
open question “Do you have any comments that you would like to
make on any of the questions or any other issues?”
Field testingThe terrorist attack questions were field tested for test–retest
reliability using the protocol of the New South Wales Health
Survey Program.16 A detailed description of its application in this
study is presented elsewhere.17 Data manipulation and analysis
were conducted using SAS Version. 9.2.16 Kappa values for the
indicators derived from the questions ranged between 0.27 and
0.64 in the second field test. There were low rates of ‘don’t know’
responses (0.0–3.9%) and refusal (0.0–0.5%).
Table 1: Prevalence estimates for each question by response category including don’t know and refused.
Question Response % 95% LCI 95% UCI
How likely do you think it is that a terrorist attack will occur in Australia? Not at all 8.8 7.0 10.6
A little 23.1 20.4 25.8
Moderately 33.6 30.7 36.5
Very 21.5 19.0 23.9
Extremely 8.9 7.2 10.6
Don’t know 3.4 2.2 4.6
Refused 0.7 0.3 1.2
If a terrorist attack happened in Australia, how concerned would you Not at all 10.6 8.8 12.5
be that you or your family would be directly affected by it? A little 22.4 19.7 25.0
Moderately 21.7 19.1 24.2
Very 24.3 21.8 26.9
Extremely 18.2 15.7 20.6
Don’t know 2.1 1.3 3.0
Refused 0.7 0.3 1.2
How much have you changed the way you live your life because of the Not at all 71.4 68.6 74.2
possibility of a terrorist attack? A little 14.7 12.4 16.9
Moderately 7.6 5.9 9.4
Very 2.9 1.9 4.0
Extremely 1.1 0.6 1.7
Don’t know 1.6 0.9 2.3
Refused 0.7 0.2 1.1
In case of an emergency situation such as a terrorist attack, how willing Not at all 6.3 4.8 7.9
would you be to evacuate your home? A little 7.0 5.2 8.8
Moderately 18.2 15.9 20.6
Very 31.3 28.4 34.3
Extremely 33.9 31.0 36.8
Don’t know 2.4 1.6 3.2
Refused 0.8 0.3 1.2
How willing would you be to evacuate your workplace or a public facility? Not at all 1.8 1.1 2.5
A little 3.8 2.6 5.0
Moderately 8.9 6.9 10.9
Very 34.5 31.6 37.5
Extremely 48.8 45.7 51.8
Don’t know 1.5 0.9 2.0 Refused 0.8 0.3 1.2
Source: New South Wales Health Survey Program. Sydney: New South Wales Department of Health, 2008.
2009 vol. 33 no. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 341© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia
Threats to health Public perceptions of threat of terrorist attack
The surveyThe New South Wales Adult Population Health Survey is a
continuous telephone survey of the health of the state population
using the in-house CATI facility of the New South Wales
Department of Health.16
The terrorist attack question module was administered as part of
the survey between 22 January and 31 March, 2007. The terrorist
attack questions were submitted to the ethics committees of the
NSW Population Health and Health Services and the University of
Western Sydney, for approval prior to use. The survey also included
other modules on health behaviours, health status (including
psychological distress, using the Kessler K10 measure, and self-
rated health status) and access to health services, as well as the
demographics of respondents and households. As field test data
had indicated high assumed knowledge regarding the concept of
terrorism and presumptions this typically involved bombings or
shootings (i.e. ‘conventional’ terrorism), a specific definition of
terrorism was not outlined in the preamble. The target population
for the survey was all state residents living in households with
private telephones. Up to seven calls were made to establish initial
contact with a household and five calls were made in order to
contact a selected respondent.
Response categories were dichotomised into indicators of
interest and responses of ‘don’t know’ or ‘refused’ were excluded.
For the hypothetical questions (i.e. likelihood of a terrorist attack
in Australia, concern that self or family would be directly affected,
willingness to comply with evacuation of home, willingness
to comply with evacuation of workplace or public facility) the
responses of extremely likely and very likely were combined
into the indicator of interest. For the non-hypothetical question
“changed the way you live because of the possibility of a terrorist
attack”, the responses ‘a little’, ‘moderately’, ‘very much’ and
‘extremely’ were combined into the indicator of interest: that is,
changed way of living.
The survey data were weighted to adjust for probability of selection
and for differing non-response rates among males and females and
different age groups.17 Data were manipulated and analysed using
SAS version 9.2.16 The SURVEYFREQ procedure in SAS was used
to calculate point estimates and 95% confidence intervals.
Odds ratios were calculated as described by Bland.18 All
calculations were performed using the ‘SVY’ commands of Stata
version 9.2 (Stata Corp, College Station, TX, USA), which allowed
for adjustments for sampling weights.
ResultsIn total 2,081 state residents aged 16 years and over completed
the module on terrorist attack. The overall response rate was
65%. The demographics of the weighted survey population were
comparable with the Australian Bureau of Statistics 2006 Census.19
These comparisons are reported elsewhere.20
Overall, 30.3% of the population thought a terrorist attack was
extremely or very likely, 42.5% were extremely or very concerned
that they or their family would be affected by a terrorist attack
and 26.4% had made some (small to extreme) level of change
to the way they lived their life because of the possibility of an
attack. Table 1 shows the prevalence estimates for all of the survey
questions by response category.
Table 2 presents prevalence estimates for the likelihood, concern
and changed way of living variables by demographic and socio-
economic characteristics, and the indicators of level of psychological
distress and general self-rated health status. When these variables
were combined, the greatest proportion of the population (37.0%)
thought a terrorist attack was unlikely to occur, were not concerned
that they or family members would be directly affected and had not
changed the way they lived their life because of the possibility of a
terrorist attack. Less than 1 in 10 people (9.0%) thought a terrorist
attack was likely, were concerned that they or family members
would be directly affected and had made changes to the way they
lived their life due to the prospect of an attack.
The results of univariate analyses identified a number of
statistically significant factors associated with threat likelihood,
concern and changed way of living (see Table 2). For the latter
variable, a sensitivity analysis comparing the current indicator
(‘a little’, ‘moderately’, ‘very’ and ‘extremely’) and the more
conservative indicator (‘moderately’, ‘very’ and ‘extremely’)
showed that the association did not change for the co-variates and
therefore the current indicator was retained for the analysis.
The univariate analysis indicated that young people (16-24
years) were significantly less likely to report high terrorism
likelihood compared to all other age categories. Those with no
formal qualifications were 2.09 times (Odds Ratios (OR=2.09,
95% CI:1.32-3.31, p=0.002) more likely to think that a terrorist
attack was very or extremely likely compared to those with a
university degree or equivalent and women were significantly
more likely (OR =1.54, 95% CI:1.20-1.99, p=0.001) to be very
or extremely concerned for themselves or family members in the
event of an attack.
Those who spoke a language other than English at home were
2.47 times (OR=2.47, 95% CI=1.58-3.64, p<0.001) more likely
to be concerned for self or family and 2.88 times (OR=2.88, 95%
CI:1.95-4.26, p<0.001) more likely to have made changes in living
due to the risk of terrorism attack. When these indicators were
combined, those with high psychological distress were found to
perceive higher terrorism likelihood and to have greater concern
that they or family members would be directly affected (OR=1.84,
95% CI:05-3.22, p=0.034).
Table 3 shows the prevalence estimates for willingness to
evacuate home, workplace/public facility, and both home and
workplace/public facility, by demographic characteristics and the
indicators psychological distress and health status. Table 3 also
shows combined indicators of evacuation willingness for those
concerned about self and family and who also thought a terrorist
attack was likely. Overall, if an emergency such as a terrorist attack
were to occur, the majority of the population would be willing to
evacuate their home (67.4%), their workplace or a public facility
(85.2%), or both location types (65.8%). Conversely, 12.5% would
be willing to evacuate neither of these locations. Fewer than 20%
342 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2009 vol. 33 no. 4© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia
Stevens et al. ArticleTa
ble
2: P
reva
len
ce a
nd
Od
ds
Rat
ios
(95%
co
nfi
den
ce in
terv
als)
of
terr
ori
st a
ttac
k lik
ely,
co
nce
rn fo
r se
lf/f
amily
, ch
ang
ed w
ay o
f liv
ing
an
d c
om
bin
ed in
dic
tors
.In
dep
end
ent
Terr
ori
st a
ttac
k lik
ely
Co
nce
rned
sel
f o
r fa
mily
C
han
ged
way
of
livin
g d
ue
Terr
ori
st a
ttac
k lik
ely
and
Te
rro
rist
att
ack
likel
y an
d
vari
able
dir
ectl
y af
fect
ed
to p
oss
ibili
ty o
f te
rro
rism
co
nce
rned
for
self
/fam
ily
con
cern
ed a
nd
ch
ang
ed
w
ay o
f liv
ing
W
eig
hte
d
OR
95
% C
I P
W
eig
hte
d
OR
95
% C
I P
W
eig
hte
d
OR
95
% C
I P
W
eig
hte
d
OR
95
% C
I P
W
eig
hte
d
OR
95
% C
I P
(%)
valu
e (%
)
va
lue
(%)
valu
e (%
)
va
lue
(%)
valu
e
NS
W p
op
’n
31.6
-
- -
43.7
-
- -
27.0
-
- -
18.9
-
- -
9.0
- -
-G
end
er
M
ale
30.8
1.
00
38.5
1.
00
24.7
1.
00
16.8
1.
00
7.9
1.00
Fem
ale
32.5
1.
08
0.83
,1.4
1 0.
55
49.1
1.
54
1.20
,1.9
9 <
0.01
29
.3
1.26
0.
94,1
.69
0.12
21
.1
1.35
0.
98,1
.86
0.07
10
.1
1.31
0.
82,2
.10
0.26
Lo
cati
on
Urb
an
31.2
1.
00
45.7
1.
00
29.2
1.
00
19.1
1.
00
9.7
1.00
Rur
al
32.5
1.
06
0.83
,1.3
6 0.
64
39.5
0.
78
0.61
,0.9
8 0.
04
22.1
0.
69
0.52
,0.9
0 0.
01
18.4
0.
94
0.71
,1.2
5 0.
66
7.4
0.76
0.
51,1
.14
0.19
Hig
h p
sych
olo
gic
al d
istr
ess
(≥22
)
N
o 29
.9
1.00
45
.2
1.00
25
.1
1.00
17
.3
1.00
7.
7 1.
00
Ye
s 40
.0
1.55
0.
95,2
.53
0.08
52
.1
1.31
0.
82,2
.09
0.25
30
.9
1.33
0.
79,2
.25
0.28
27
.9
1.84
1.
05,3
.22
0.03
13
.9
1.98
0.
93,4
.22
0.08
Ag
e
16-2
4 17
.4
1.00
39
.5
1.00
27
.9
1.00
14
.1
1.00
7.
6 1.
00
25
-34
30.5
2.
09
1.12
,3.9
0 0.
02
51.1
1.
60
0.93
,2.7
8 0.
09
26.1
0.
91
0.49
,1.6
9 0.
77
22.3
1.
76
0.87
,3.5
8 0.
12
12.2
1.
71
0.67
,4.3
6 0.
2635
-44
34.1
2.
46
1.36
,4.4
6 <
0.01
32
.6
0.74
0.
44,1
.26
0.27
28
.7
1.04
0.
57,1
.88
0.90
13
.0
0.98
0.
48,2
.01
0.97
7.
4 1.
05
0.40
,2.7
5 0.
9245
-54
36.4
2.
72
1.55
,4.7
6 <
0.01
45
.0
1.25
0.
77,2
.04
0.37
31
.7
1.20
0.
69,2
.07
0.52
21
.3
1.77
0.
93,3
.36
0.08
9.
7 1.
33
0.55
,3.1
7 0.
5655
-64
35.3
2.
59
1.49
,4.5
0 0.
01
44.6
1.
23
0.76
,2.0
0 0.
39
25.4
0.
88
0.51
,1.5
2 0.
65
19.7
1.
60
0.87
,2.9
4 0.
13
8.1
1.10
0.
48,2
.52
0.81
65-7
4
33.6
2.
40
1.37
, 4.1
8 <
0.01
51
.7
1.64
1.
02,2
.66
0.04
23
.8
0.80
0.
46,1
.39
0.42
24
.0
1.99
1.
06,3
.72
0.03
10
.4
1.42
0.
60,3
.39
0.43
75+
36
.2
2.69
1.
47,4
.93
<0.
01
52.9
1.
72
1.02
,2.9
1 0.
04
14.3
0.
43
0.23
,0.8
1 0.
01
24.9
2.
36
1.19
,4.6
7 0.
01
5.9
0.71
0.
25,2
.03
0.52
Ch
ildre
n in
ho
use
ho
ld
No
29.7
1.
00
45.7
1.
00
26.3
1.
00
19.1
1.
00
8.7
1.00
Yes
33.3
1.
13
0.84
,1.5
1 0.
43
40.1
0.
79
0.60
,1.0
6 0.
12
30.4
1.
31
0.96
,1.7
8 0.
09
17.8
0.
91
0.64
,1.3
0 0.
61
9.9
1.27
0.
78,2
.08
0.34
Bo
rn in
Au
stra
lia
N
o 32
.4
1.00
50
.4
1.00
36
.0
1.00
20
.1
1.00
10
.5
1.00
Yes
31.3
0.
94
0.68
,1.2
9 0.
70
41.3
0.
69
0.52
,0.9
3 0.
02
23.8
0.
56
0.40
,0.7
7 <
0.01
18
.4
0.90
0.
61, 1
.33
0.61
8.
4 0.
83
0.48
,1.4
5 0.
52S
pea
k la
ng
uag
e o
ther
th
an E
ng
lish
at
ho
me
No
32.1
1.
00
40.1
1.
00
23.2
1.
00
17.8
1.
00
8.0
1.00
Yes
29.1
0.
87
0.56
,1.3
4 0.
53
62.4
2.
47
1.68
,3.6
4 <
0.01
46
.5
2.88
1.
95,4
.26
<0.
01
24.8
1.
45
0.90
,2.3
3 0.
12
14.3
1.
77
0.94
,3.3
3 0.
08L
ivin
g a
lon
e
No
31.2
1.
00
43.4
1.
00
27.9
1.
00
18.5
1.
00
9.2
1.00
Yes
35.0
1.
18
0.92
,1.5
3 0.
19
46.1
1.
12
0.88
,1.4
2 0.
38
19.5
0.
62
0.47
,0.8
4 <
0.01
21
.6
1.21
0.
90,1
.62
0.20
6.
9 0.
71
0.46
,1.1
2 0.
14H
igh
est
form
al q
ual
ifica
tio
n
Uni
vers
ity
27.4
1.
00
35.3
1.
00
24.3
1.
00
11.5
1.
00
5.6
1.00
de
gree
/equ
ival
ent
TAF
E
34.9
1.
43
0.97
,2.1
0 0.
07
41.0
1.
28
0.89
,1.8
4 0.
19
26.6
1.
13
0.74
,1.7
1 0.
58
17.4
1.
61
0.96
,2.6
9 0.
01
7.9
1.44
0.
66,3
.14
0.36
ce
rtifi
cate
/Dip
lom
aH
igh
scho
ol
25.8
0.
92
0.60
,1.4
3 0.
72
44.0
1.
44
0.95
,2.1
8 0.
09
28.9
1.
27
0.80
,2.0
1 0.
31
17.6
1.
63
0.95
,2.8
0 0.
08
7.1
1.28
0.
57,2
.85
0.55
ce
rtifi
cate
Sch
ool c
ertifi
cate
35
.2
1.44
0.
99, 2
.08
0.05
52
.1
1.99
1.
41,2
.82
<0.
01
28.4
1.
24
0.84
,1.8
3 0.
29
26.7
2.
68
1.68
,4.2
7 <
0.01
13
.4
2.53
1.
32,4
.87
0.01
Non
e 44
.5
2.09
1.
32,3
.31
<0.
01
62.9
2.
92
1.87
,4.5
8 <
0.01
32
.2
1.43
0.
87,2
.36
0.16
37
.3
4.52
2.
63,7
.75
<0.
01
18.1
3.
46
1.58
,7.6
0 <
0.01
Em
plo
yed
No
32.5
1.
00
49.3
1.
00
26.7
1.
00
22.4
1.
00
10.8
1.
00
Ye
s 31
.7
0.94
0.
72,1
.22
0.63
41
.3
0.71
0.
55,0
.91
0.01
26
.9
1.02
0.
77,1
.35
0.90
17
.7
0.71
0.
52,0
.96
0.03
8.
4 0.
74
0.47
,1.1
6 0.
19
2009 vol. 33 no. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 343© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia
would be willing to evacuate their workplace or a public facility
but not their home, whereas far fewer (1.9%) would be willing to
evacuate their home but not their workplace or public facility.
Univariate analyses of evacuation intentions, also presented in
Table 3, indicated that females were 1.45 times (OR=1.45, 95%
CI:1.11-1.89, p=0.007) more willing to evacuate their homes than
males, employed Australians were 1.37 times (OR=1.37, 95%
CI:1.06-1.79, p=0.018) more willing to evacuate their homes
than those unemployed and respondents with poor self-rated
health were significantly less willing (OR=0.63, 95% CI: 0.42-
0.96, p=0.032) to evacuate their homes than those with good or
excellent self-rated health.
With regard to evacuation of work/public facilities, females were
1.62 times (OR1.62, 95% CI:1.14-2.32, =0.008) more willing
than males, people with children were 1.84 times (OR=1.84, 95%
CI:1.10-3.05, p=0.019) more willing than those without children
and those with higher household incomes ($A80,000 and over)
were 2.57 times (OR=2.57. 95% CI:1.48-4.44, p=0.001) more
willing than those with lower incomes.
DiscussionAlmost one-third of the population perceive a high likelihood
of terrorist attack within Australia, with a greater proportion
expressing high levels of concern that they, or a family member,
could be directly affected should a terrorist attack occur. More
than one-quarter had made some level of accommodation in the
way they live due to this possibility. In the context of an immediate
threat, the majority of the population would be willing to follow
public safety directives to evacuate homes, workplaces and public
facilities should a terrorist attack occur.
To date, there have not been recent substantial acts of terrorism
within Australia. Our findings indicate a lower level of terrorism
risk perception than that observed in countries such as the US and
UK where significant terrorist events have occurred.3,5 However,
the level of perceived risk within the Australian population is
notably higher than in comparable western countries that have
not experienced recent attacks. Although comparisons with other
studies are difficult to make, only 20% of Canadians perceived
a high likelihood of domestic terrorism compared with 30.3%
of Australians. Possible reasons for this may include Australia’s
regional exposure to terrorism, such as the Bali bombings in
2002 and 2005. These and associated events such as the naming
of Australia as a specific target by terrorist organisations such as
Al-Qaeda are likely to have increased the awareness of Australians
to such threats domestically.12
Concurrent high concern and changed way of living were noted
among those born outside Australia and/or who spoke a language
other than English in the home. Given that these groups did not
perceive a higher likelihood that an attack would occur, these
results may reflect a perceived ‘secondary’ threat from within
the wider population. There is broad evidence that heightened
community threat perception is associated with increased
ethnocentrism and xenophobia.21 In terrorism affected countries,
Tabl
e 2
con
tinu
ed: P
reva
len
ce a
nd
Odd
s R
atio
s (9
5% c
on
fid
ence
inte
rval
s) o
f ter
rori
st a
ttac
k lik
ely,
co
nce
rn fo
r se
lf/fa
mily
, ch
ang
ed w
ay o
f liv
ing
an
d c
om
bin
ed in
dic
tors
.In
dep
end
ent
Terr
ori
st a
ttac
k lik
ely
Co
nce
rned
sel
f o
r fa
mily
C
han
ged
way
of
livin
g d
ue
Terr
ori
st a
ttac
k lik
ely
and
Te
rro
rist
att
ack
likel
y an
d
vari
able
dir
ectl
y af
fect
ed
to p
oss
ibili
ty o
f te
rro
rism
co
nce
rned
for
self
/fam
ily
con
cern
ed a
nd
ch
ang
ed
w
ay o
f liv
ing
W
eig
hte
d O
R
95%
CI
P
Wei
gh
ted
OR
95
% C
I P
W
eig
hte
d
OR
95
% C
I P
W
eig
hte
d O
R
95%
CI
P
Wei
gh
ted
OR
95
% C
I P
(%)
valu
e (%
)
va
lue
(%)
valu
e (%
)
va
lue
(%)
valu
e
Ho
use
ho
ld in
com
e (b
efo
re t
ax)
<
$20k
34
.5
1.00
47
.6
1.00
27
.4
1.00
21
.9
1.00
9.
2 1.
00
$2
0-40
k 39
.5
1.24
0.
84,1
.84
0.28
49
.7
1.09
0.
73,1
.61
0.68
25
.8
0.92
0.
57,1
.48
0.74
26
.5
1.33
0.
85,2
.07
0.21
14
.1
1.67
0.
90,3
.10
0.10
$40-
60k
33.7
0.
96
0.63
,1.4
8 0.
87
41.7
0.
79
0.52
,1.2
0 0.
27
31.8
1.
24
0.76
,2.0
1 0.
39
19.5
0.
89
0.53
,1.4
9 0.
66
9.5
1.12
0.
52,2
.39
0.77
$60-
80k
30.9
0.
85
0.51
,1.4
1 0.
53
44.2
0.
87
0.54
,1.4
2 0.
59
22.1
0.
75
0.43
,1.3
3 0.
33
22.7
1.
10
0.61
,1.9
9 0.
75
9.6
1.17
0.
52,2
.65
0.70
>$8
0k
29.1
0.
78
0.53
,1.1
4 0.
20
35.2
0.
60
0.41
,0.8
7 0.
01
28.0
1.
03
0.66
,1.6
1 0.
89
12.3
0.
52
0.32
,0.8
4 0.
01
5.6
0.63
0.
31,1
.29
0.21
Hea
lth
sel
f-ra
ted
as
go
od
Ye
s 33
.4
1.00
43
.4
1.00
26
.2
1.00
18
.3
1.00
8.
3 1.
00
N
o 35
.1
1.08
0.
71,1
.65
0.73
50
.6
1.34
0.
89,2
.01
0.19
25
.9
0.98
0.
61,1
.58
0.95
26
.0
1.61
0.
99,2
.62
0.06
13
.8
1.79
0.
88,3
.63
0.11
Mar
ital
sta
tus
M
arrie
d 34
.7
1.00
42
.8
1.00
27
.9
1.00
18
.9
1.00
8.
6 1.
00
W
idow
ed
32.9
0.
92
0.63
,1.3
5 0.
68
54.2
1.
59
1.12
,2.2
4 0.
01
26.6
0.
93
0.62
,1.4
0 0.
73
24.8
1.
42
0.93
,2.1
7 0.
10
11.2
1.
35
0.71
,2.5
8 0.
36S
epar
ated
/div
orce
d 43
.2
1.43
0.
99,2
.06
0.06
44
.2
1.06
0.
74,1
.51
0.74
30
.5
1.13
0.
75,1
.70
0.56
22
.6
1.26
0.
83,1
.91
0.26
8.
1 1.
07
0.56
,2.0
5 0.
84N
ever
mar
ried
21.6
0.
52
0.36
,0.7
4 <
0.01
43
.5
1.03
0.
75,1
.42
0.85
23
.7
0.80
0.
55,1
.17
0.25
15
.9
0.81
0.
53,1
.23
0.32
7.
8 0.
91
0.50
,1.6
4 0.
75
Not
es: P
sych
olog
ical
dis
tres
s w
as m
easu
red
usin
g th
e K
10. V
alue
s ra
nge
from
10-
50, w
ith ‘h
igh’
psy
chol
ogic
al d
istr
ess
cons
ider
ed a
s be
ing ≥2
2. S
ourc
e: N
ew S
outh
Wal
es H
ealth
Sur
vey
Pro
gram
. Syd
ney:
New
Sou
th W
ales
D
epar
tmen
t of H
ealth
, 200
8.
Threats to health Public perceptions of threat of terrorist attack
344 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2009 vol. 33 no. 4© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia
Table 3: Prevalence and Odds Ratios (95% confidence intervals) of willingness to evacuate home, willingness to evacuate office/public facility and combined indicator.
Independent variable Willing to evacuate home Willing to evacuate Willing to evaluate home and office/public facility office/public facility Weighted OR 95% CI Pvalue Weighted OR 95% CI Pvalue Weighted OR 95% CI Pvalue (%) (%) (%)
NSW population 67.4 - - - 85.2 - - - 65.8 - - -
Gender
Male 63.4 1.00 82.2 1.00 62.2 1.00
Female 71.5 1.45 1.11,1.89 0.01 88.3 1.62 1.14,2.32 0.01 69.3 1.37 1.06,1.79 0.02
Location
Urban 66.3 1.00 84.4 1.00 64.6 1.00
Rural 69.7 1.17 0.91,1.50 0.22 86.9 1.22 0.88,1.69 0.26 68.3 1.18 0.93,1.51 0.18
High psychological distress (≥22) No 68.5 1.00 86.7 1.00 67.4 1.00
Yes 70.0 1.07 0.65,1.76 0.76 80.1 0.61 0.33,1.12 0.11 66.3 0.95 0.59,1.54 0.85
Age
16-24 66.1 1.00 80.0 1.00 63.0 1.00
25-34 69.2 1.15 0.65,2.06 0.63 88.4 1.91 0.89,4.07 0.10 67.6 1.27 0.72,2.24 0.40
35-44 68.9 1.14 0.65,1.99 0.66 89.1 2.05 0.89,4.70 0.09 67.4 1.26 0.73,2.18 0.40
45-54 73.2 1.40 0.84,2.33 0.20 86.6 1.62 0.85,3.08 0.14 72.4 1.52 0.92,2.50 0.10
55-64 65.8 0.99 0.60,1.63 0.96 87.1 1.68 0.88,3.20 0.12 65.0 1.10 0.67,1.80 0.70
65-74 61.6 0.82 0.50,1.34 0.43 81.0 1.06 0.59,1.92 0.85 59.5 0.86 0.53,1.38 0.53
75+ 54.1 0.60 0.36,1.03 0.06 73.7 0.70 0.38,1.30 0.26 52.0 0.62 0.37,1.04 0.07
Children in household No 64.9 1.00 82.6 1.00 63.3 1.00
Yes 71.6 1.36 0.99,1.88 0.06 89.7 1.84 1.10,3.05 0.02 69.9 1.40 1.02,1.92 0.04
Born in Australia No 70.0 1.00 82.3 1.00 67.8 1.00
Yes 66.5 0.85 0.62,1.18 0.33 86.2 1.34 0.89,2.01 0.16 65.1 0.90 0.66,1.23 0.51
Speak language other than English No 67.0 1.00 86.4 1.00 65.5 1.00
Yes 69.4 1.12 0.73,1.71 0.61 78.9 0.59 0.36,0.96 0.03 67.1 1.07 0.71,1.60 0.75
Living alone No 67.7 1.00 85.5 1.00 66.0 1.00
Yes 65.3 0.90 0.70,1.16 0.42 82.9 0.82 0.59,1.15 0.25 63.7 0.87 0.68,1.12 0.28
Highest formal qualification University degree/ 70.7 1.00 88.9 1.00 70.0 1.00 equivalent
TAFE certificate/Diploma 67.7 0.87 0.59,1.29 0.49 87.0 0.83 0.45,1.53 0.56 66.7 0.85 0.58,1.26 0.42
High school certificate 63.5 0.72 0.46,1.12 0.15 83.2 0.61 0.32,1.17 0.14 63.0 0.68 0.44,1.05 0.08
School certificate 66.0 0.81 0.55,1.18 0.26 80.9 0.53 0.30,0.92 0.02 61.8 0.69 0.47,0.99 0.05
None 62.9 0.76 0.47,1.22 0.25 81.3 0.57 0.30,1.07 0.08 60.3 0.68 0.43,1.09 0.11
Work (paid or unpaid) No 62.7 1.00 80.7 1.00 60.3 1.00
Yes 70.5 1.37 1.06,1.79 0.02 89.0 1.68 1.17,2.42 0.01 69.4 1.46 1.12,1.89 0.01
Household income (before tax) <$20k 61.0 1.00 77.2 1.00 60.0 1.00
$20-40k 70.4 1.52 1.01,2.27 0.04 84.4 1.60 0.97,2.65 0.07 68.1 1.41 0.95,2.11 0.09
$40-60k 66.7 1.28 0.82,1.99 0.28 87.6 2.08 1.18,3.67 0.01 64.3 1.23 0.80,1.89 0.35
$60-80k 62.1 1.04 0.62,1.76 0.87 88.5 2.27 0.80,6.47 0.12 61.7 1.14 0.68,1.92 0.62
>$80k 70.7 1.54 1.03,2.29 0.03 89.7 2.57 1.48,4.44 <0.01 70.7 1.68 1.13,2.49 0.01
Health self-rated as good Yes 69.6 1.00 85.6 1.00 68.1 1.00
No 59.1 0.63 0.42,0.96 0.03 79.7 0.66 0.39,1.12 0.12 57.5 0.65 0.43,0.98 0.04
Marital status Married 68.3 1.00 86.2 1.00 66.5 1.00
Widowed 59.0 0.67 0.47,0.96 0.03 81.7 0.72 0.45,1.16 0.17 54.9 0.61 0.43,0.88 0.01
Separated/divorced 70.9 1.13 0.77,1.66 0.54 89.3 1.34 0.77,2.34 0.30 69.0 1.12 0.77,1.64 0.55Never married 65.8 0.89 0.64,1.25 0.51 82.5 0.76 0.49,1.18 0.22 62.5 0.84 0.60,1.17 0.30
Notes: Psychological distress was measured using the K10. Values range from 10-50, with ‘high’ psychological distress considered as being ≥22. Source: New South Wales Health Survey Program. Sydney: New South Wales Department of Health, 2008.
Stevens et al. Article
2009 vol. 33 no. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 345© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia
culture, appearance and religion have been found to be strong
predictors of high terrorism-related distress and appear to reflect
increased stigmatising of these groups.5 Further studies are needed
to explore the possible reasons for this in the Australian context.
While the Australian government has produced recent population-
level information campaigns to address terrorism concerns, the
current results highlight potential vulnerabilities in these sub-
populations and a possible need for tailored risk communication
to address unease in these groups.
There is evidence that mental health factors such as stressful life
events and exposure to trauma are associated with increased fear
of terrorism. In this study, those with high levels of psychological
distress where almost twice as likely to perceive high terrorism
likelihood and greater concern that they or a family member
would directly affected. This is consistent with recent data from
the Australian Unity Wellbeing Index, which showed that those
with the highest ratings of perceived terrorism likelihood also had
significantly lower levels of personal wellbeing compared to the
population average.22 There is evidence from the therapeutic field
that those with greater risk appraisal and vigilance tendencies are
at greater risk of negative mood states.1,23 The findings occurred
in the absence of specific domestic terrorist incidents and suggest
increased vulnerability may exist even with the general threat of
terrorism. Recent practices in Australia such as the issuing of
national terror alerts may have adverse impacts on this sub-group
that may warrant further examination.22
The findings regarding willingness to evacuate were quite
emphatic and indicate high levels of intent where the specific
threat also appears to be high. The proportion of people with
low willingness to evacuate based on terrorism threat (12%) was
found to be about half the ‘non-compliance’ rate observed during
mandatory natural disaster evacuations.24 Little is known about the
observed lower willingness of those with poor self-rated health.
This may reflect lower confidence about receiving or recognising
warnings as well as perceptions about the physical attributes
needed for escape. This finding is consistent with protection
motivation theory which posits that low perceived self-efficacy
reduces the motivation for protective acts even when these actions
are regarded as effective. Proactive disaster planning and education
can potentially overcome these limitations, which highlights the
importance of identifying and engaging these vulnerable groups
early in the process.
LimitationsThere are several limitations of our study. The question “Have
you changed the way you live your life because of the possibility of
a terrorist attack?” was intentionally broad, since current evidence
indicates that where specific incidents have not occurred, preparatory
changes for terrorism are limited and general in focus.9,10 We sought
to determine broader markers of change (experiential as well as
behavioural) that may be sensitive to public health messages or
varied threat status over time. The decision to adopt the full response
set (a little, moderately, very and extremely) as positive indicators
for this question was made on related conceptual grounds: that
is, lower level change reflecting change of some kind. The more
conservative range (very, extremely), produced a response rate
of 4%, which is consistent with the rate of preparatory response
noted in the Lemyre et al. study.9 As anticipated, the broader range
produced a notably higher response rate (27%). This may indicate
that more specific behaviours are being endorsed at the upper end
of the range, with more subtle or even ‘felt’ changes being endorsed
by a larger group at the lower end of the range.
The aim of this paper is to explore population threat perceptions
of terrorist attack in Australia and some anticipated responses
in the acute context. The cross-sectional design of this study
captures only a snapshot view of these frequencies and no firm
conclusions can be made regarding causes. Also, OR’s reported in
this study may lead to bias due to a failure to account for multiple
relationships, which may lead to inflation of type 1 error and the
over interpretation of any apparent positive findings. As this is a
baseline analysis, further studies can examine trends over time
and the consistency of these findings.
It is also important to consider whether recent terrorism
information campaigns significantly affected this baseline data,
which was gathered in early 2007. The ‘Be alert, not alarmed’
campaign was conducted in late 2002 and again, in a modified
form, from July 2005.25 The National Security Hotline was also
launched as part of the initial campaign and has been advertised
periodically. Given that the 2005 campaign ran for a three week
period 18 months prior to the survey, it is unlikely that any
specific shifts in threat perception would have been maintained
so as to have significantly affected the current data. Nonetheless,
it remains possible that the cumulative effects of these public
awareness campaigns have contributed to longitudinal change e.g.
as one significant factor in the rate differences observed between
Australian and Canadian population surveys.
Finally, the questions regarding evacuation only provide a
measure of behavioural intent. While its specific translation to
evacuation compliance is unclear, evidence from experimental
psychology shows that concurrent high intent and high perceived
positive outcomes predict high levels of behavioural translation.26
The data establish high intent, while perceived positive outcomes
in this situation (presumably safety and survival) could reasonably
be assumed based upon these results.
ConclusionPerceived terrorism likelihood and associated concerns were
moderately high, with some groups notably affected. Community
terrorism concerns may have increased ‘out group’ social dynamics
for some ethnic sub-populations and this has implications for the
framing of risk communications. In the context of immediate
threat, the majority of Australians would follow terrorism-related
evacuation directives and at higher rates than is typical of natural
disasters. The study has also established a source of pre-event
baseline data and is one of the few available sources of such
information internationally.
Threats to health Public perceptions of threat of terrorist attack
346 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2009 vol. 33 no. 4© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia
AcknowledgementsThis study was funded by Emergency Management Australia
and supported by the New South Wales Department of Health. This
analysis is part of the first author’s thesis for a doctoral dissertation
with the College of Health and Science at the University of
Western Sydney. Our thanks to Matthew Gorringe, Centre for
Epidemiology and Research, New South Wales Department
of Health, who assisted with question development and data
collection.
References1. Maguen S Papa A, Litz BT. Coping with the threat of terrorism: A review.
Anxiety Stress Coping. 2008;21(1):15-35.2. Lemyre L, Lee JEC, Turner MC, Krewski D. Terrorism preparedness in Canada:
A public survey on perceived institutional and individual response to terrorism. International Journal of Emergency Management. 2007;4(2):296–315.
3. Silver RC, Holman EA, McIntosh DN, Poulin M, et al. Nationwide longitudinal study of psychological responses to September 11. JAMA. 2002;288: 1235-44.
4. Huddy L, Feldman S, Capelos T, Provost C. The consequences of terrorism: Disentangling the effects of personal and national threat. Political Psychology. 2002;23(3):485-509.
5. Rubin GJ, Brewin CR, Greenberg N, Simpson J, et al. Psychological and behavioural reactions to the bombings in London on 7 July 2005: Cross sectional survey of a representative sample of Londoners. BMJ. 2005;331:606-12.
6. Rubin GJ, Brewin CR, Greenberg N, Hughes JH, et al. Enduring consequences of terrorism: 7-month follow-up survey of reactions to the bombings in London on 7 July 2005. BMJ. 2007;190:350-6.
7. Vlahov D, Galea S, Resnick H, Ahern J, et al. Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York, residents after the September 11th terrorist attacks. Am J Epidemiol. 2002;155(11):988–96.
8. Gigerenzer G. Out of the frying pan into the fire: Behavioral reactions to terrorist attacks. Risk Anal. 2006;26(2):347-51.
9. Lemyre L, Lee JEC, Krewski D. National Public Survey of Perceived CBRN Terrorism Threat and Preparedness. Ottawa (CAN): Institute of Population Health, University of Ottawa; 2004.
10. Lemyre L, Turner MC, Lee JEC, Krewski D. Public perception of terrorism threats and related information sources in Canada: implications for the management of terrorism risks. Journal of Risk Research. 2006;9(7):755-74.
11. Sjöberg L. The Perceived Risk of Terrorism [SSE–EFI Working Paper Series in Business Administration No 2002:11]. Stockholm (SWE): Centre for Risk Research, Stockholm School of Economics; 2004 [cited 2009 Mar 28]. Available from: http://swoba.hhs.se/
12. Department of Foreign Affairs and Trade [publications page on the Internet]. Canberra (AUST) Commonwealth of Australia; 2004 [cited 2009 Mar 28]. A new kind of foe. In: Transnational Terrorism: The Threat to Australia. Available from: http://www.dfat.gov.au/
13. Stevens G, Agho KE, Taylor B, Barr M, et al. Terrorism in Australia: factors associated with population perceptions of threat and incident-critical behaviours. BMC Public Health [serial on the Internet]. 2009 [cited 2009 Apr 22];9:91. Available from: http://www.biomedcentral.com/1471-2458/9/91
14. Reissman D. New roles for mental and behavioural health experts to enhance emergency preparedness and response readiness. Psychiatry. 2004;67(2):118–22.
15. North CS, Pfefferbaum B, Narayanan P, Thielman S, et al. Comparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City. Br J Psychiatry. 2005;186:487-93.
16. Barr M, Baker D, Gorringe M, Fritsche L. NSW Population Health Survey: Description of Methods [background paper on the Internet]. Sydney (AUST): Centre for Epidemiology and Research, New South Wales Department of Health; 2008 [cited 2009 Mar 28]. Available from: http://www.health.nsw.gov.au/
17. Steel D. NSW Population Health Survey: Review of Weighting Procedures Methods [background paper on the Internet]. Sydney (AUST): Centre for Epidemiology and Research, New South Wales Department of Health; 2008. [cited 2009 Mar 28]. Available from: http://www.health.nsw.gov.au/
18. Bland M. An Introduction to Medical Statistics. 3rd ed. New York (NY): Oxford University Press; 2000.
19. Australian Bureau of Statistics [homepage on the Internet]. Canberra (AUST): ABS; 2006 [cited 2009 Mar 28]. 2006 Census of Population and Housing. Available from: http://www.censusdata.abs.gov.au/
20. Barr M, Raphael B, Taylor M, Stevens G, et al. Pandemic influenza in Australia: Using telephone surveys to measure perceptions of threat and willingness to comply. BMC Infect Dis [serial on the Internet]. 2008 [cited 2009 Mar 28];8:117. Available from:http://www.biomedcentral.com/1471-2334/8/117
21. Schwartz SH, Struch N. Intergroup aggression: its predictors and distinctness from in-group bias. J Pers Soc Psychol. 1989;56:364-73.
22. Cummins RA. Australian Unity Wellbeing Index Survey 19. Part A: The Report [report on the Internet]. Melbourne (AUST): The Australian Centre on Quality of Life, Deakin University; 2008 [cited 2009 Mar 28]. Available from: http://acqol.deakin.edu.au/index_wellbeing/Survey_19_Part_A.pdf
23. Loewenstein GF, Weber EU, Hsee CK, Welch ES. Risk as feelings. Psychol Bull. 2001;127(2):267-86.
24. Kirschenbaum A. Warning and evacuation during a mass disaster: a multivariate decision making model. International Journal of Mass Emergencies and Disasters.1992;10(1):91114.
25. Robertson D. New Anti-terrorism Ads Hit the Airwaves [pm program on the Internet]. Sydney (AUST): ABC Online; 2005 July 14 [cited 2009 Mar 28];18:26:37. Available from: http://www.abc.net.au/pm/content/2005/s1414590.htm
26. Azjen I. The theory of planned behaviour. Organizational Behavior and Human Decision Processes. 1991;50:179–211.
Stevens et al. Article