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The Effectiveness of Disaster Risk Communication: A Systematic Review of Intervention )] TJ ET BT 26.250 639.438 Td /F1 9.8 Tf [(Studies. PLOS Currents Disasters. 2014 Aug 22 . Edition 1. doi: 10.1371/currents.dis.349062e0db1048bb9fc3a3fa67d8a4f8.)] TJ ET q 15.000 31.315 577.500 605.741 re W n 0.271 0.267 0.267 rg BT 26.250 610.335 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 590.381 Td /F1 9.8 Tf [(Introduction: A disaster is a serious disruption to the functioning of a community that exceeds its capacity to cope within its own )] TJ ET BT 26.250 578.476 Td /F1 9.8 Tf [(resources. Risk communication in disasters aims to prevent and mitigate harm from disasters, prepare the population before a )] TJ ET BT 26.250 566.571 Td /F1 9.8 Tf [(disaster, disseminate information during disasters and aid subsequent recovery. The aim of this systematic review is to identify, )] TJ ET BT 26.250 554.667 Td /F1 9.8 Tf [(appraise and synthesise the findings of studies of the effects of risk communication interventions during four stages of the )] TJ ET BT 26.250 542.762 Td /F1 9.8 Tf [(disaster cycle.)] TJ ET BT 26.250 530.857 Td /F1 9.8 Tf [(Methods: We searched the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycInfo, Sociological )] TJ ET BT 26.250 518.952 Td /F1 9.8 Tf [(Abstracts, Web of Science and grey literature sources for randomised trials, cluster randomised trials, controlled and )] TJ ET BT 26.250 507.048 Td /F1 9.8 Tf [(uncontrolled before and after studies, interrupted time series studies and qualitative studies of any method of disaster risk )] TJ ET BT 26.250 495.143 Td /F1 9.8 Tf [(communication to at-risk populations. Outcome criteria were disaster-related knowledge and behaviour, and health outcomes.)] TJ ET BT 26.250 483.238 Td /F1 9.8 Tf [(Results: Searches yielded 5,224 unique articles, of which 100 were judged to be potentially relevant. Twenty-five studies met )] TJ ET BT 26.250 471.333 Td /F1 9.8 Tf [(the inclusion criteria, and two additional studies were identified from other searching. The studies evaluated interventions in all )] TJ ET BT 26.250 459.429 Td /F1 9.8 Tf [(four stages of the disaster cycle, included a variety of man-made, natural and infectious disease disasters, and were conducted )] TJ ET BT 26.250 447.524 Td /F1 9.8 Tf [(in many disparate settings. Only one randomised trial and one cluster randomised trial were identified, with less robust designs )] TJ ET BT 26.250 435.619 Td /F1 9.8 Tf [(used in the other studies. Several studies reported improvements in disaster-related knowledge and behaviour.)] TJ ET BT 26.250 423.714 Td /F1 9.8 Tf [(Discussion: We identified and appraised intervention studies of disaster risk communication and present an overview of the )] TJ ET BT 26.250 411.810 Td /F1 9.8 Tf [(contemporary literature. Most studies used non-randomised designs that make interpretation challenging. We do not make )] TJ ET BT 26.250 399.905 Td /F1 9.8 Tf [(specific recommendations for practice but highlight the need for high-quality randomised trials and appropriately-analysed )] TJ ET BT 26.250 388.000 Td /F1 9.8 Tf [(cluster randomised trials in the field of disaster risk communication where these can be conducted within an appropriate )] TJ ET BT 26.250 376.095 Td /F1 9.8 Tf [(research ethics framework.)] TJ ET BT 26.250 339.493 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 319.539 Td /F1 9.8 Tf [(Salary and fees for DTB were paid by the Public Health Agency \(Northern Ireland\))] TJ ET BT 26.250 290.436 Td /F4 12.0 Tf [(Introduction)] TJ ET BT 26.250 270.482 Td /F1 9.8 Tf [(A disaster is a serious disruption of the functioning of a community or a society involving widespread human, material, )] TJ ET BT 26.250 258.577 Td /F1 9.8 Tf [(economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its )] TJ ET BT 26.250 246.672 Td /F1 9.8 Tf [(own resources.)] TJ ET 0.267 0.267 0.267 rg BT 95.602 248.180 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 100.420 246.672 Td /F1 9.8 Tf [( Four stages of a disaster cycle have been identified: Mitigation and prevention, preparedness, response, and )] TJ ET BT 26.250 234.768 Td /F1 9.8 Tf [(recovery.)] TJ ET 0.267 0.267 0.267 rg BT 66.342 236.275 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 71.161 238.656 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 73.570 236.275 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 78.389 234.768 Td /F1 9.8 Tf [( Communication between authorities and the public about disasters occurs in all stages of the cycle, with different )] TJ ET BT 26.250 222.863 Td /F1 9.8 Tf [(aims at each stage. Communication is a potentially valuable way of avoiding and reducing harm caused by disasters.)] TJ ET BT 26.250 203.458 Td /F1 9.8 Tf [(Risk communication aims to provide the public with information about the effects of an event, and how actions may affect the )] TJ ET BT 26.250 191.553 Td /F1 9.8 Tf [(outcome of the event.)] TJ ET 0.267 0.267 0.267 rg BT 120.016 193.061 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 124.834 191.553 Td /F1 9.8 Tf [( Crisis and Emergency Risk Communication \(CERC\) is the use of risk communication in emergencies to )] TJ ET BT 26.250 179.649 Td /F1 9.8 Tf [(inform the public about an event or issue to empower members of a community to protect themselves.)] TJ ET 0.267 0.267 0.267 rg BT 465.721 181.156 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 470.540 179.649 Td /F1 9.8 Tf [( In this review, we focus )] TJ ET BT 26.250 167.744 Td /F1 9.8 Tf [(on CERC in the context of disasters, at all stages of the disaster cycle. Risk communication in disasters has historically been a )] TJ ET BT 26.250 155.839 Td /F1 9.8 Tf [(one-way transfer of information from authorities to the public, rather than an interactive flow of information.)] TJ ET 0.267 0.267 0.267 rg BT 483.613 157.346 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 488.431 155.839 Td /F1 9.8 Tf [( Disaster risk )] TJ ET BT 26.250 143.934 Td /F1 9.8 Tf [(communication may take place through many different channels, including some that have been recently developed or )] TJ ET BT 26.250 132.030 Td /F1 9.8 Tf [(expanded. Potential channels of communication include face-to face conversations, telephone calls, group meetings, mass )] TJ ET BT 26.250 120.125 Td /F1 9.8 Tf [(media such as television, tailored mass media such as reverse 911 services and interactive social media such as Twitter.)] TJ ET BT 26.250 100.720 Td /F1 9.8 Tf [(The effectiveness of risk communication interventions could be evaluated by assessing many possible outcomes. We chose to )] TJ ET BT 26.250 88.815 Td /F1 9.8 Tf [(focus on knowledge, behaviour and incidence of health outcomes \(e.g. injuries, deaths\), which are particularly likely to be )] TJ ET BT 26.250 76.911 Td /F1 9.8 Tf [(measured and reported, and also might be considered the most important outcomes.)] TJ ET BT 26.250 57.506 Td /F1 9.8 Tf [(As well as seeking to estimate the effects of different types of disaster risk communication, we aim to identify gaps in knowledge )] TJ ET BT 26.250 45.601 Td /F1 9.8 Tf [(or evidence that would benefit from future research. Lastly, we aim to identify lessons from the literature that will help inform the )] TJ ET Q q 15.000 684.354 577.500 53.646 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Effectiveness of Disaster Risk Communication: A )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Systematic Review of Intervention Studies)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 675.088 Td /F3 9.8 Tf [(August 22, 2014)] TJ ET BT 83.523 675.088 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 88.398 675.088 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 663.247 Td /F1 9.8 Tf [(Declan T Bradley)] TJ ET 0.271 0.267 0.267 rg BT 101.023 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 106.444 663.247 Td /F1 9.8 Tf [(Marie McFarland)] TJ ET 0.271 0.267 0.267 rg BT 179.579 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 185.000 663.247 Td /F1 9.8 Tf [(Mike Clarke)] TJ ET 0.271 0.267 0.267 rg BT 26.250 651.342 Td /F1 9.8 Tf [(Bradley DT, McFarland M, Clarke M. The Effectiveness of Disaster Risk Communication: A Systematic Review of Intervention )] TJ ET BT 26.250 639.438 Td /F1 9.8 Tf [(Studies. PLOS Currents Disasters. 2014 Aug 22 . Edition 1. doi: 10.1371/currents.dis.349062e0db1048bb9fc3a3fa67d8a4f8.)] TJ ET q 15.000 31.315 577.500 605.741 re W n 0.271 0.267 0.267 rg BT 26.250 610.335 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 590.381 Td /F1 9.8 Tf [(Introduction: A disaster is a serious disruption to the functioning of a community that exceeds its capacity to cope within its own )] TJ ET BT 26.250 578.476 Td /F1 9.8 Tf [(resources. Risk communication in disasters aims to prevent and mitigate harm from disasters, prepare the population before a )] TJ ET BT 26.250 566.571 Td /F1 9.8 Tf [(disaster, disseminate information during disasters and aid subsequent recovery. The aim of this systematic review is to identify, )] TJ ET BT 26.250 554.667 Td /F1 9.8 Tf [(appraise and synthesise the findings of studies of the effects of risk communication interventions during four stages of the )] TJ ET BT 26.250 542.762 Td /F1 9.8 Tf [(disaster cycle.)] TJ ET BT 26.250 530.857 Td /F1 9.8 Tf [(Methods: We searched the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycInfo, Sociological )] TJ ET BT 26.250 518.952 Td /F1 9.8 Tf [(Abstracts, Web of Science and grey literature sources for randomised trials, cluster randomised trials, controlled and )] TJ ET BT 26.250 507.048 Td /F1 9.8 Tf [(uncontrolled before and after studies, interrupted time series studies and qualitative studies of any method of disaster risk )] TJ ET BT 26.250 495.143 Td /F1 9.8 Tf [(communication to at-risk populations. Outcome criteria were disaster-related knowledge and behaviour, and health outcomes.)] TJ ET BT 26.250 483.238 Td /F1 9.8 Tf [(Results: Searches yielded 5,224 unique articles, of which 100 were judged to be potentially relevant. Twenty-five studies met )] TJ ET BT 26.250 471.333 Td /F1 9.8 Tf [(the inclusion criteria, and two additional studies were identified from other searching. The studies evaluated interventions in all )] TJ ET BT 26.250 459.429 Td /F1 9.8 Tf [(four stages of the disaster cycle, included a variety of man-made, natural and infectious disease disasters, and were conducted )] TJ ET BT 26.250 447.524 Td /F1 9.8 Tf [(in many disparate settings. Only one randomised trial and one cluster randomised trial were identified, with less robust designs )] TJ ET BT 26.250 435.619 Td /F1 9.8 Tf [(used in the other studies. Several studies reported improvements in disaster-related knowledge and behaviour.)] TJ ET BT 26.250 423.714 Td /F1 9.8 Tf [(Discussion: We identified and appraised intervention studies of disaster risk communication and present an overview of the )] TJ ET BT 26.250 411.810 Td /F1 9.8 Tf [(contemporary literature. Most studies used non-randomised designs that make interpretation challenging. We do not make )] TJ ET BT 26.250 399.905 Td /F1 9.8 Tf [(specific recommendations for practice but highlight the need for high-quality randomised trials and appropriately-analysed )] TJ ET BT 26.250 388.000 Td /F1 9.8 Tf [(cluster randomised trials in the field of disaster risk communication where these can be conducted within an appropriate )] TJ ET BT 26.250 376.095 Td /F1 9.8 Tf [(research ethics framework.)] TJ ET BT 26.250 339.493 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 319.539 Td /F1 9.8 Tf [(Salary and fees for DTB were paid by the Public Health Agency \(Northern Ireland\))] TJ ET BT 26.250 290.436 Td /F4 12.0 Tf [(Introduction)] TJ ET BT 26.250 270.482 Td /F1 9.8 Tf [(A disaster is a serious disruption of the functioning of a community or a society involving widespread human, material, )] TJ ET BT 26.250 258.577 Td /F1 9.8 Tf [(economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its )] TJ ET BT 26.250 246.672 Td /F1 9.8 Tf [(own resources.)] TJ ET 0.267 0.267 0.267 rg BT 95.602 248.180 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 100.420 246.672 Td /F1 9.8 Tf [( Four stages of a disaster cycle have been identified: Mitigation and prevention, preparedness, response, and )] TJ ET BT 26.250 234.768 Td /F1 9.8 Tf [(recovery.)] TJ ET 0.267 0.267 0.267 rg BT 66.342 236.275 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 71.161 238.656 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 73.570 236.275 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 78.389 234.768 Td /F1 9.8 Tf [( Communication between authorities and the public about disasters occurs in all stages of the cycle, with different )] TJ ET BT 26.250 222.863 Td /F1 9.8 Tf [(aims at each stage. Communication is a potentially valuable way of avoiding and reducing harm caused by disasters.)] TJ ET BT 26.250 203.458 Td /F1 9.8 Tf [(Risk communication aims to provide the public with information about the effects of an event, and how actions may affect the )] TJ ET BT 26.250 191.553 Td /F1 9.8 Tf [(outcome of the event.)] TJ ET 0.267 0.267 0.267 rg BT 120.016 193.061 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 124.834 191.553 Td /F1 9.8 Tf [( Crisis and Emergency Risk Communication \(CERC\) is the use of risk communication in emergencies to )] TJ ET BT 26.250 179.649 Td /F1 9.8 Tf [(inform the public about an event or issue to empower members of a community to protect themselves.)] TJ ET 0.267 0.267 0.267 rg BT 465.721 181.156 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 470.540 179.649 Td /F1 9.8 Tf [( In this review, we focus )] TJ ET BT 26.250 167.744 Td /F1 9.8 Tf [(on CERC in the context of disasters, at all stages of the disaster cycle. Risk communication in disasters has historically been a )] TJ ET BT 26.250 155.839 Td /F1 9.8 Tf [(one-way transfer of information from authorities to the public, rather than an interactive flow of information.)] TJ ET 0.267 0.267 0.267 rg BT 483.613 157.346 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 488.431 155.839 Td /F1 9.8 Tf [( Disaster risk )] TJ ET BT 26.250 143.934 Td /F1 9.8 Tf [(communication may take place through many different channels, including some that have been recently developed or )] TJ ET BT 26.250 132.030 Td /F1 9.8 Tf [(expanded. Potential channels of communication include face-to face conversations, telephone calls, group meetings, mass )] TJ ET BT 26.250 120.125 Td /F1 9.8 Tf [(media such as television, tailored mass media such as reverse 911 services and interactive social media such as Twitter.)] TJ ET BT 26.250 100.720 Td /F1 9.8 Tf [(The effectiveness of risk communication interventions could be evaluated by assessing many possible outcomes. We chose to )] TJ ET BT 26.250 88.815 Td /F1 9.8 Tf [(focus on knowledge, behaviour and incidence of health outcomes \(e.g. injuries, deaths\), which are particularly likely to be )] TJ ET BT 26.250 76.911 Td /F1 9.8 Tf [(measured and reported, and also might be considered the most important outcomes.)] TJ ET BT 26.250 57.506 Td /F1 9.8 Tf [(As well as seeking to estimate the effects of different types of disaster risk communication, we aim to identify gaps in knowledge )] TJ ET BT 26.250 45.601 Td /F1 9.8 Tf [(or evidence that would benefit from future research. Lastly, we aim to identify lessons from the literature that will help inform the )] TJ ET Q q 15.000 684.354 577.500 53.646 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Effectiveness of Disaster Risk Communication: A )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Systematic Review of Intervention Studies)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 675.088 Td /F3 9.8 Tf [(August 22, 2014)] TJ ET BT 83.523 675.088 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 88.398 675.088 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 663.247 Td /F1 9.8 Tf [(Declan T Bradley)] TJ ET 0.271 0.267 0.267 rg BT 101.023 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 106.444 663.247 Td /F1 9.8 Tf [(Marie McFarland)] TJ ET 0.271 0.267 0.267 rg BT 179.579 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 185.000 663.247 Td /F1 9.8 Tf [(Mike Clarke)] TJ ET 0.271 0.267 0.267 rg BT 26.250 651.342 Td /F1 9.8 Tf [(Bradley DT, McFarland M, Clarke M. The Effectiveness of Disaster Risk Communication: A Systematic Review of Intervention )] TJ ET BT 26.250 639.438 Td /F1 9.8 Tf [(Studies. PLOS Currents Disasters. 2014 Aug 22 . Edition 1. doi: 10.1371/currents.dis.349062e0db1048bb9fc3a3fa67d8a4f8.)] TJ ET q 15.000 31.315 577.500 605.741 re W n 0.271 0.267 0.267 rg BT 26.250 610.335 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 590.381 Td /F1 9.8 Tf [(Introduction: A disaster is a serious disruption to the functioning of a community that exceeds its capacity to cope within its own )] TJ ET BT 26.250 578.476 Td /F1 9.8 Tf [(resources. Risk communication in disasters aims to prevent and mitigate harm from disasters, prepare the population before a )] TJ ET BT 26.250 566.571 Td /F1 9.8 Tf [(disaster, disseminate information during disasters and aid subsequent recovery. The aim of this systematic review is to identify, )] TJ ET BT 26.250 554.667 Td /F1 9.8 Tf [(appraise and synthesise the findings of studies of the effects of risk communication interventions during four stages of the )] TJ ET BT 26.250 542.762 Td /F1 9.8 Tf [(disaster cycle.)] TJ ET BT 26.250 530.857 Td /F1 9.8 Tf [(Methods: We searched the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycInfo, Sociological )] TJ ET BT 26.250 518.952 Td /F1 9.8 Tf [(Abstracts, Web of Science and grey literature sources for randomised trials, cluster randomised trials, controlled and )] TJ ET BT 26.250 507.048 Td /F1 9.8 Tf [(uncontrolled before and after studies, interrupted time series studies and qualitative studies of any method of disaster risk )] TJ ET BT 26.250 495.143 Td /F1 9.8 Tf [(communication to at-risk populations. Outcome criteria were disaster-related knowledge and behaviour, and health outcomes.)] TJ ET BT 26.250 483.238 Td /F1 9.8 Tf [(Results: Searches yielded 5,224 unique articles, of which 100 were judged to be potentially relevant. Twenty-five studies met )] TJ ET BT 26.250 471.333 Td /F1 9.8 Tf [(the inclusion criteria, and two additional studies were identified from other searching. The studies evaluated interventions in all )] TJ ET BT 26.250 459.429 Td /F1 9.8 Tf [(four stages of the disaster cycle, included a variety of man-made, natural and infectious disease disasters, and were conducted )] TJ ET BT 26.250 447.524 Td /F1 9.8 Tf [(in many disparate settings. Only one randomised trial and one cluster randomised trial were identified, with less robust designs )] TJ ET BT 26.250 435.619 Td /F1 9.8 Tf [(used in the other studies. Several studies reported improvements in disaster-related knowledge and behaviour.)] TJ ET BT 26.250 423.714 Td /F1 9.8 Tf [(Discussion: We identified and appraised intervention studies of disaster risk communication and present an overview of the )] TJ ET BT 26.250 411.810 Td /F1 9.8 Tf [(contemporary literature. Most studies used non-randomised designs that make interpretation challenging. We do not make )] TJ ET BT 26.250 399.905 Td /F1 9.8 Tf [(specific recommendations for practice but highlight the need for high-quality randomised trials and appropriately-analysed )] TJ ET BT 26.250 388.000 Td /F1 9.8 Tf [(cluster randomised trials in the field of disaster risk communication where these can be conducted within an appropriate )] TJ ET BT 26.250 376.095 Td /F1 9.8 Tf [(research ethics framework.)] TJ ET BT 26.250 339.493 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 319.539 Td /F1 9.8 Tf [(Salary and fees for DTB were paid by the Public Health Agency \(Northern Ireland\))] TJ ET BT 26.250 290.436 Td /F4 12.0 Tf [(Introduction)] TJ ET BT 26.250 270.482 Td /F1 9.8 Tf [(A disaster is a serious disruption of the functioning of a community or a society involving widespread human, material, )] TJ ET BT 26.250 258.577 Td /F1 9.8 Tf [(economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its )] TJ ET BT 26.250 246.672 Td /F1 9.8 Tf [(own resources.)] TJ ET 0.267 0.267 0.267 rg BT 95.602 248.180 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 100.420 246.672 Td /F1 9.8 Tf [( Four stages of a disaster cycle have been identified: Mitigation and prevention, preparedness, response, and )] TJ ET BT 26.250 234.768 Td /F1 9.8 Tf [(recovery.)] TJ ET 0.267 0.267 0.267 rg BT 66.342 236.275 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 71.161 238.656 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 73.570 236.275 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 78.389 234.768 Td /F1 9.8 Tf [( Communication between authorities and the public about disasters occurs in all stages of the cycle, with different )] TJ ET BT 26.250 222.863 Td /F1 9.8 Tf [(aims at each stage. Communication is a potentially valuable way of avoiding and reducing harm caused by disasters.)] TJ ET BT 26.250 203.458 Td /F1 9.8 Tf [(Risk communication aims to provide the public with information about the effects of an event, and how actions may affect the )] TJ ET BT 26.250 191.553 Td /F1 9.8 Tf [(outcome of the event.)] TJ ET 0.267 0.267 0.267 rg BT 120.016 193.061 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 124.834 191.553 Td /F1 9.8 Tf [( Crisis and Emergency Risk Communication \(CERC\) is the use of risk communication in emergencies to )] TJ ET BT 26.250 179.649 Td /F1 9.8 Tf [(inform the public about an event or issue to empower members of a community to protect themselves.)] TJ ET 0.267 0.267 0.267 rg BT 465.721 181.156 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 470.540 179.649 Td /F1 9.8 Tf [( In this review, we focus )] TJ ET BT 26.250 167.744 Td /F1 9.8 Tf [(on CERC in the context of disasters, at all stages of the disaster cycle. Risk communication in disasters has historically been a )] TJ ET BT 26.250 155.839 Td /F1 9.8 Tf [(one-way transfer of information from authorities to the public, rather than an interactive flow of information.)] TJ ET 0.267 0.267 0.267 rg BT 483.613 157.346 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 488.431 155.839 Td /F1 9.8 Tf [( Disaster risk )] TJ ET BT 26.250 143.934 Td /F1 9.8 Tf [(communication may take place through many different channels, including some that have been recently developed or )] TJ ET BT 26.250 132.030 Td /F1 9.8 Tf [(expanded. Potential channels of communication include face-to face conversations, telephone calls, group meetings, mass )] TJ ET BT 26.250 120.125 Td /F1 9.8 Tf [(media such as television, tailored mass media such as reverse 911 services and interactive social media such as Twitter.)] TJ ET BT 26.250 100.720 Td /F1 9.8 Tf [(The effectiveness of risk communication interventions could be evaluated by assessing many possible outcomes. We chose to )] TJ ET BT 26.250 88.815 Td /F1 9.8 Tf [(focus on knowledge, behaviour and incidence of health outcomes \(e.g. injuries, deaths\), which are particularly likely to be )] TJ ET BT 26.250 76.911 Td /F1 9.8 Tf [(measured and reported, and also might be considered the most important outcomes.)] TJ ET BT 26.250 57.506 Td /F1 9.8 Tf [(As well as seeking to estimate the effects of different types of disaster risk communication, we aim to identify gaps in knowledge )] TJ ET BT 26.250 45.601 Td /F1 9.8 Tf [(or evidence that would benefit from future research. 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22834 >> stream 0.271 0.267 0.267 rg q 15.000 24.611 577.500 752.389 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(design of future research.)] TJ ET BT 26.250 730.874 Td /F4 12.0 Tf [(Methods)] TJ ET BT 26.250 710.919 Td /F4 9.8 Tf [(Protocol and registration)] TJ ET BT 26.250 691.515 Td /F1 9.8 Tf [(This project was undertaken as part of one authors Masters in Public Health degree \(DTB\) and was not externally registered in )] TJ ET BT 26.250 679.610 Td /F1 9.8 Tf [(advance. The review is reported according to the PRISMA statement \(PRISMA checklist is shown in Appendix 1\).)] TJ ET BT 26.250 660.205 Td /F4 9.8 Tf [(Eligibility criteria and outcomes)] TJ ET BT 26.250 640.800 Td /F1 9.8 Tf [(The following intervention study types were included: Randomised trials, cluster randomised trials, quasi-randomised trials, )] TJ ET BT 26.250 628.896 Td /F1 9.8 Tf [(controlled before-and-after studies, uncontrolled before-and-after studies, post-intervention only studies if the pre-intervention )] TJ ET BT 26.250 616.991 Td /F1 9.8 Tf [(state could reasonably be assumed, interrupted time series and qualitative research.)] TJ ET BT 26.250 597.586 Td /F1 9.8 Tf [(The populations included were people or communities, before, during or following a disaster, who were at risk of being affected )] TJ ET BT 26.250 585.681 Td /F1 9.8 Tf [(by a public health problem. Groups of people considered more vulnerable to disasters because of their language or other )] TJ ET BT 26.250 573.777 Td /F1 9.8 Tf [(characteristics \(e.g. disability\) were included in the review. Communications must have been made from public authorities to )] TJ ET BT 26.250 561.872 Td /F1 9.8 Tf [(communities or populations. Studies of communication with or between groups of professionals involved in disaster response )] TJ ET BT 26.250 549.967 Td /F1 9.8 Tf [(were excluded from the review.)] TJ ET BT 26.250 530.562 Td /F1 9.8 Tf [(The interventions included were face-to-face, television, radio, Internet or telephone communication, or any other method of risk )] TJ ET BT 26.250 518.658 Td /F1 9.8 Tf [(communication aimed at informing the public about a potential disaster situation to enable people to make informed choices that )] TJ ET BT 26.250 506.753 Td /F1 9.8 Tf [(benefit their health on or after 1 January 2000. Risk communication interventions were aimed at producing desired knowledge, )] TJ ET BT 26.250 494.848 Td /F1 9.8 Tf [(behavioural or health outcomes. This time limit was chosen because of recent development in electronic communications.)] TJ ET BT 26.250 475.443 Td /F1 9.8 Tf [(The United Nations International Strategy for Disaster Reduction definition of disaster was adhered to.)] TJ ET 0.267 0.267 0.267 rg BT 465.741 476.951 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 470.560 475.443 Td /F1 9.8 Tf [( The HIV pandemic was )] TJ ET BT 26.250 463.539 Td /F1 9.8 Tf [(excluded from this review because an extensive body of literature exists for this specific topic, which has been reviewed several )] TJ ET BT 26.250 451.634 Td /F1 9.8 Tf [(times in recent years. If it was not clear from the article whether a study took place in the context of a disaster or if the )] TJ ET BT 26.250 439.729 Td /F1 9.8 Tf [(intervention was not described in sufficient detail to be assessed, the study was categorised as unclear.)] TJ ET BT 26.250 420.324 Td /F1 9.8 Tf [(The outcomes included in this review were: 1. Incidence of health-related events related to the disaster/possible disaster; 2. )] TJ ET BT 26.250 408.420 Td /F1 9.8 Tf [(Health-related behaviour \(self-reported or observed\) relating to the disaster/possible disaster; 3. Health-related knowledge )] TJ ET BT 26.250 396.515 Td /F1 9.8 Tf [(about the disaster/possible disaster.)] TJ ET BT 26.250 377.110 Td /F4 9.8 Tf [(Information Sources)] TJ ET BT 26.250 357.705 Td /F1 9.8 Tf [(We searched the following databases: Cochrane Central Register of Controlled Trials \(CENTRAL; 2000 to present\); Embase )] TJ ET BT 26.250 345.801 Td /F1 9.8 Tf [(\(Ovid, 2000 to present\); MEDLINE \(Ovid, 2000 to present\); PsycInfo \(Ovid, 2000 to present\); Sociological Abstracts \(Proquest, )] TJ ET BT 26.250 333.896 Td /F1 9.8 Tf [(2000 to present\) and Web of Science \(Web of Knowledge, 2000 to present\). These online databases were searched for relevant )] TJ ET BT 26.250 321.991 Td /F1 9.8 Tf [(articles on 18 June 2013. Searches were not limited by language or country of origin but were limited to manuscripts published )] TJ ET BT 26.250 310.086 Td /F1 9.8 Tf [(on or after 1 of January 2000. The search strategy was constructed from a combination of disaster-related search terms and )] TJ ET BT 26.250 298.182 Td /F1 9.8 Tf [(communication-related search terms. Outcomes were not specified in the search in order to avoid excluding relevant studies. )] TJ ET BT 26.250 286.277 Td /F1 9.8 Tf [(Database selection and the principles of the search strategy were discussed with a subject librarian.)] TJ ET BT 26.250 266.872 Td /F1 9.8 Tf [(Full search strategy for all databases is shown in Appendix 2.)] TJ ET BT 26.250 247.467 Td /F1 9.8 Tf [(Further articles were identified from references of potentially relevant studies. The websites of the Centers for Disease Control )] TJ ET BT 26.250 235.563 Td /F1 9.8 Tf [(and Prevention, Public Health England, European Centre for Disease Control, the World Health Organisation, The United )] TJ ET BT 26.250 223.658 Td /F1 9.8 Tf [(Nations Office for Disaster Risk Reduction and the World Bank were searched for documents relevant to disaster )] TJ ET BT 26.250 211.753 Td /F1 9.8 Tf [(communication. The New York Academy of Medicines Grey Literature Report was also searched for disaster communication.)] TJ ET BT 26.250 192.348 Td /F4 9.8 Tf [(Data collection and assessment)] TJ ET BT 26.250 172.944 Td /F1 9.8 Tf [(Search results were merged and duplicates removed. Two reviewers \(DTB and MM\) independently read the retrieved titles and )] TJ ET BT 26.250 161.039 Td /F1 9.8 Tf [(abstracts and assessed them for relevance. Reports identified as potentially relevant by either reviewer were retrieved in full )] TJ ET BT 26.250 149.134 Td /F1 9.8 Tf [(and independently assessed for inclusion by two reviewers \(DTB and MM\), with a discussion to resolve discordances. )] TJ ET BT 26.250 137.229 Td /F1 9.8 Tf [(Published data were extracted by one reviewer \(DTB\) using a standardised form. No unpublished data were sought.)] TJ ET BT 26.250 117.825 Td /F1 9.8 Tf [(Data Items collected were: Disaster cycle phase \(mitigation, preparedness, response or recovery\); Disaster type \(infectious )] TJ ET BT 26.250 105.920 Td /F1 9.8 Tf [(disease, natural or man-made\); Study type; Geographical setting; Population characteristics and numbers; Randomisation )] TJ ET BT 26.250 94.015 Td /F1 9.8 Tf [(method if applicable; Allocation method if applicable; Blinding; Attrition if applicable; Details of intervention; Outcomes reported; )] TJ ET BT 26.250 82.110 Td /F1 9.8 Tf [(Results.)] TJ ET BT 26.250 62.706 Td /F1 9.8 Tf [(Study-level assessment for bias was performed with the Cochrane Collaborations Assessment for bias tool. The tool was not )] TJ ET BT 26.250 50.801 Td /F1 9.8 Tf [(ideally suited to the non-randomised studies. The assessment tool was used to catalogue the characteristics of the study )] TJ ET BT 26.250 38.896 Td /F1 9.8 Tf [(without attempting to make an overall summary categorisation of study bias as their very diverse natures, contexts and methods )] TJ ET Q q 15.000 24.611 577.500 752.389 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(design of future research.)] TJ ET BT 26.250 730.874 Td /F4 12.0 Tf [(Methods)] TJ ET BT 26.250 710.919 Td /F4 9.8 Tf [(Protocol and registration)] TJ ET BT 26.250 691.515 Td /F1 9.8 Tf [(This project was undertaken as part of one authors Masters in Public Health degree \(DTB\) and was not externally registered in )] TJ ET BT 26.250 679.610 Td /F1 9.8 Tf [(advance. The review is reported according to the PRISMA statement \(PRISMA checklist is shown in Appendix 1\).)] TJ ET BT 26.250 660.205 Td /F4 9.8 Tf [(Eligibility criteria and outcomes)] TJ ET BT 26.250 640.800 Td /F1 9.8 Tf [(The following intervention study types were included: Randomised trials, cluster randomised trials, quasi-randomised trials, )] TJ ET BT 26.250 628.896 Td /F1 9.8 Tf [(controlled before-and-after studies, uncontrolled before-and-after studies, post-intervention only studies if the pre-intervention )] TJ ET BT 26.250 616.991 Td /F1 9.8 Tf [(state could reasonably be assumed, interrupted time series and qualitative research.)] TJ ET BT 26.250 597.586 Td /F1 9.8 Tf [(The populations included were people or communities, before, during or following a disaster, who were at risk of being affected )] TJ ET BT 26.250 585.681 Td /F1 9.8 Tf [(by a public health problem. Groups of people considered more vulnerable to disasters because of their language or other )] TJ ET BT 26.250 573.777 Td /F1 9.8 Tf [(characteristics \(e.g. disability\) were included in the review. Communications must have been made from public authorities to )] TJ ET BT 26.250 561.872 Td /F1 9.8 Tf [(communities or populations. Studies of communication with or between groups of professionals involved in disaster response )] TJ ET BT 26.250 549.967 Td /F1 9.8 Tf [(were excluded from the review.)] TJ ET BT 26.250 530.562 Td /F1 9.8 Tf [(The interventions included were face-to-face, television, radio, Internet or telephone communication, or any other method of risk )] TJ ET BT 26.250 518.658 Td /F1 9.8 Tf [(communication aimed at informing the public about a potential disaster situation to enable people to make informed choices that )] TJ ET BT 26.250 506.753 Td /F1 9.8 Tf [(benefit their health on or after 1 January 2000. Risk communication interventions were aimed at producing desired knowledge, )] TJ ET BT 26.250 494.848 Td /F1 9.8 Tf [(behavioural or health outcomes. This time limit was chosen because of recent development in electronic communications.)] TJ ET BT 26.250 475.443 Td /F1 9.8 Tf [(The United Nations International Strategy for Disaster Reduction definition of disaster was adhered to.)] TJ ET 0.267 0.267 0.267 rg BT 465.741 476.951 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 470.560 475.443 Td /F1 9.8 Tf [( The HIV pandemic was )] TJ ET BT 26.250 463.539 Td /F1 9.8 Tf [(excluded from this review because an extensive body of literature exists for this specific topic, which has been reviewed several )] TJ ET BT 26.250 451.634 Td /F1 9.8 Tf [(times in recent years. If it was not clear from the article whether a study took place in the context of a disaster or if the )] TJ ET BT 26.250 439.729 Td /F1 9.8 Tf [(intervention was not described in sufficient detail to be assessed, the study was categorised as unclear.)] TJ ET BT 26.250 420.324 Td /F1 9.8 Tf [(The outcomes included in this review were: 1. Incidence of health-related events related to the disaster/possible disaster; 2. )] TJ ET BT 26.250 408.420 Td /F1 9.8 Tf [(Health-related behaviour \(self-reported or observed\) relating to the disaster/possible disaster; 3. Health-related knowledge )] TJ ET BT 26.250 396.515 Td /F1 9.8 Tf [(about the disaster/possible disaster.)] TJ ET BT 26.250 377.110 Td /F4 9.8 Tf [(Information Sources)] TJ ET BT 26.250 357.705 Td /F1 9.8 Tf [(We searched the following databases: Cochrane Central Register of Controlled Trials \(CENTRAL; 2000 to present\); Embase )] TJ ET BT 26.250 345.801 Td /F1 9.8 Tf [(\(Ovid, 2000 to present\); MEDLINE \(Ovid, 2000 to present\); PsycInfo \(Ovid, 2000 to present\); Sociological Abstracts \(Proquest, )] TJ ET BT 26.250 333.896 Td /F1 9.8 Tf [(2000 to present\) and Web of Science \(Web of Knowledge, 2000 to present\). These online databases were searched for relevant )] TJ ET BT 26.250 321.991 Td /F1 9.8 Tf [(articles on 18 June 2013. Searches were not limited by language or country of origin but were limited to manuscripts published )] TJ ET BT 26.250 310.086 Td /F1 9.8 Tf [(on or after 1 of January 2000. The search strategy was constructed from a combination of disaster-related search terms and )] TJ ET BT 26.250 298.182 Td /F1 9.8 Tf [(communication-related search terms. Outcomes were not specified in the search in order to avoid excluding relevant studies. )] TJ ET BT 26.250 286.277 Td /F1 9.8 Tf [(Database selection and the principles of the search strategy were discussed with a subject librarian.)] TJ ET BT 26.250 266.872 Td /F1 9.8 Tf [(Full search strategy for all databases is shown in Appendix 2.)] TJ ET BT 26.250 247.467 Td /F1 9.8 Tf [(Further articles were identified from references of potentially relevant studies. The websites of the Centers for Disease Control )] TJ ET BT 26.250 235.563 Td /F1 9.8 Tf [(and Prevention, Public Health England, European Centre for Disease Control, the World Health Organisation, The United )] TJ ET BT 26.250 223.658 Td /F1 9.8 Tf [(Nations Office for Disaster Risk Reduction and the World Bank were searched for documents relevant to disaster )] TJ ET BT 26.250 211.753 Td /F1 9.8 Tf [(communication. The New York Academy of Medicines Grey Literature Report was also searched for disaster communication.)] TJ ET BT 26.250 192.348 Td /F4 9.8 Tf [(Data collection and assessment)] TJ ET BT 26.250 172.944 Td /F1 9.8 Tf [(Search results were merged and duplicates removed. Two reviewers \(DTB and MM\) independently read the retrieved titles and )] TJ ET BT 26.250 161.039 Td /F1 9.8 Tf [(abstracts and assessed them for relevance. Reports identified as potentially relevant by either reviewer were retrieved in full )] TJ ET BT 26.250 149.134 Td /F1 9.8 Tf [(and independently assessed for inclusion by two reviewers \(DTB and MM\), with a discussion to resolve discordances. )] TJ ET BT 26.250 137.229 Td /F1 9.8 Tf [(Published data were extracted by one reviewer \(DTB\) using a standardised form. No unpublished data were sought.)] TJ ET BT 26.250 117.825 Td /F1 9.8 Tf [(Data Items collected were: Disaster cycle phase \(mitigation, preparedness, response or recovery\); Disaster type \(infectious )] TJ ET BT 26.250 105.920 Td /F1 9.8 Tf [(disease, natural or man-made\); Study type; Geographical setting; Population characteristics and numbers; Randomisation )] TJ ET BT 26.250 94.015 Td /F1 9.8 Tf [(method if applicable; Allocation method if applicable; Blinding; Attrition if applicable; Details of intervention; Outcomes reported; )] TJ ET BT 26.250 82.110 Td /F1 9.8 Tf [(Results.)] TJ ET BT 26.250 62.706 Td /F1 9.8 Tf [(Study-level assessment for bias was performed with the Cochrane Collaborations Assessment for bias tool. The tool was not )] TJ ET BT 26.250 50.801 Td /F1 9.8 Tf [(ideally suited to the non-randomised studies. The assessment tool was used to catalogue the characteristics of the study )] TJ ET BT 26.250 38.896 Td /F1 9.8 Tf [(without attempting to make an overall summary categorisation of study bias as their very diverse natures, contexts and methods )] TJ ET Q q 15.000 24.611 577.500 752.389 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(design of future research.)] TJ ET BT 26.250 730.874 Td /F4 12.0 Tf [(Methods)] TJ ET BT 26.250 710.919 Td /F4 9.8 Tf [(Protocol and registration)] TJ ET BT 26.250 691.515 Td /F1 9.8 Tf [(This project was undertaken as part of one authors Masters in Public Health degree \(DTB\) and was not externally registered in )] TJ ET BT 26.250 679.610 Td /F1 9.8 Tf [(advance. The review is reported according to the PRISMA statement \(PRISMA checklist is shown in Appendix 1\).)] TJ ET BT 26.250 660.205 Td /F4 9.8 Tf [(Eligibility criteria and outcomes)] TJ ET BT 26.250 640.800 Td /F1 9.8 Tf [(The following intervention study types were included: Randomised trials, cluster randomised trials, quasi-randomised trials, )] TJ ET BT 26.250 628.896 Td /F1 9.8 Tf [(controlled before-and-after studies, uncontrolled before-and-after studies, post-intervention only studies if the pre-intervention )] TJ ET BT 26.250 616.991 Td /F1 9.8 Tf [(state could reasonably be assumed, interrupted time series and qualitative research.)] TJ ET BT 26.250 597.586 Td /F1 9.8 Tf [(The populations included were people or communities, before, during or following a disaster, who were at risk of being affected )] TJ ET BT 26.250 585.681 Td /F1 9.8 Tf [(by a public health problem. Groups of people considered more vulnerable to disasters because of their language or other )] TJ ET BT 26.250 573.777 Td /F1 9.8 Tf [(characteristics \(e.g. disability\) were included in the review. Communications must have been made from public authorities to )] TJ ET BT 26.250 561.872 Td /F1 9.8 Tf [(communities or populations. Studies of communication with or between groups of professionals involved in disaster response )] TJ ET BT 26.250 549.967 Td /F1 9.8 Tf [(were excluded from the review.)] TJ ET BT 26.250 530.562 Td /F1 9.8 Tf [(The interventions included were face-to-face, television, radio, Internet or telephone communication, or any other method of risk )] TJ ET BT 26.250 518.658 Td /F1 9.8 Tf [(communication aimed at informing the public about a potential disaster situation to enable people to make informed choices that )] TJ ET BT 26.250 506.753 Td /F1 9.8 Tf [(benefit their health on or after 1 January 2000. Risk communication interventions were aimed at producing desired knowledge, )] TJ ET BT 26.250 494.848 Td /F1 9.8 Tf [(behavioural or health outcomes. This time limit was chosen because of recent development in electronic communications.)] TJ ET BT 26.250 475.443 Td /F1 9.8 Tf [(The United Nations International Strategy for Disaster Reduction definition of disaster was adhered to.)] TJ ET 0.267 0.267 0.267 rg BT 465.741 476.951 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 470.560 475.443 Td /F1 9.8 Tf [( The HIV pandemic was )] TJ ET BT 26.250 463.539 Td /F1 9.8 Tf [(excluded from this review because an extensive body of literature exists for this specific topic, which has been reviewed several )] TJ ET BT 26.250 451.634 Td /F1 9.8 Tf [(times in recent years. If it was not clear from the article whether a study took place in the context of a disaster or if the )] TJ ET BT 26.250 439.729 Td /F1 9.8 Tf [(intervention was not described in sufficient detail to be assessed, the study was categorised as unclear.)] TJ ET BT 26.250 420.324 Td /F1 9.8 Tf [(The outcomes included in this review were: 1. Incidence of health-related events related to the disaster/possible disaster; 2. )] TJ ET BT 26.250 408.420 Td /F1 9.8 Tf [(Health-related behaviour \(self-reported or observed\) relating to the disaster/possible disaster; 3. Health-related knowledge )] TJ ET BT 26.250 396.515 Td /F1 9.8 Tf [(about the disaster/possible disaster.)] TJ ET BT 26.250 377.110 Td /F4 9.8 Tf [(Information Sources)] TJ ET BT 26.250 357.705 Td /F1 9.8 Tf [(We searched the following databases: Cochrane Central Register of Controlled Trials \(CENTRAL; 2000 to present\); Embase )] TJ ET BT 26.250 345.801 Td /F1 9.8 Tf [(\(Ovid, 2000 to present\); MEDLINE \(Ovid, 2000 to present\); PsycInfo \(Ovid, 2000 to present\); Sociological Abstracts \(Proquest, )] TJ ET BT 26.250 333.896 Td /F1 9.8 Tf [(2000 to present\) and Web of Science \(Web of Knowledge, 2000 to present\). These online databases were searched for relevant )] TJ ET BT 26.250 321.991 Td /F1 9.8 Tf [(articles on 18 June 2013. Searches were not limited by language or country of origin but were limited to manuscripts published )] TJ ET BT 26.250 310.086 Td /F1 9.8 Tf [(on or after 1 of January 2000. The search strategy was constructed from a combination of disaster-related search terms and )] TJ ET BT 26.250 298.182 Td /F1 9.8 Tf [(communication-related search terms. Outcomes were not specified in the search in order to avoid excluding relevant studies. )] TJ ET BT 26.250 286.277 Td /F1 9.8 Tf [(Database selection and the principles of the search strategy were discussed with a subject librarian.)] TJ ET BT 26.250 266.872 Td /F1 9.8 Tf [(Full search strategy for all databases is shown in Appendix 2.)] TJ ET BT 26.250 247.467 Td /F1 9.8 Tf [(Further articles were identified from references of potentially relevant studies. The websites of the Centers for Disease Control )] TJ ET BT 26.250 235.563 Td /F1 9.8 Tf [(and Prevention, Public Health England, European Centre for Disease Control, the World Health Organisation, The United )] TJ ET BT 26.250 223.658 Td /F1 9.8 Tf [(Nations Office for Disaster Risk Reduction and the World Bank were searched for documents relevant to disaster )] TJ ET BT 26.250 211.753 Td /F1 9.8 Tf [(communication. The New York Academy of Medicines Grey Literature Report was also searched for disaster communication.)] TJ ET BT 26.250 192.348 Td /F4 9.8 Tf [(Data collection and assessment)] TJ ET BT 26.250 172.944 Td /F1 9.8 Tf [(Search results were merged and duplicates removed. Two reviewers \(DTB and MM\) independently read the retrieved titles and )] TJ ET BT 26.250 161.039 Td /F1 9.8 Tf [(abstracts and assessed them for relevance. Reports identified as potentially relevant by either reviewer were retrieved in full )] TJ ET BT 26.250 149.134 Td /F1 9.8 Tf [(and independently assessed for inclusion by two reviewers \(DTB and MM\), with a discussion to resolve discordances. )] TJ ET BT 26.250 137.229 Td /F1 9.8 Tf [(Published data were extracted by one reviewer \(DTB\) using a standardised form. No unpublished data were sought.)] TJ ET BT 26.250 117.825 Td /F1 9.8 Tf [(Data Items collected were: Disaster cycle phase \(mitigation, preparedness, response or recovery\); Disaster type \(infectious )] TJ ET BT 26.250 105.920 Td /F1 9.8 Tf [(disease, natural or man-made\); Study type; Geographical setting; Population characteristics and numbers; Randomisation )] TJ ET BT 26.250 94.015 Td /F1 9.8 Tf [(method if applicable; Allocation method if applicable; Blinding; Attrition if applicable; Details of intervention; Outcomes reported; )] TJ ET BT 26.250 82.110 Td /F1 9.8 Tf [(Results.)] TJ ET BT 26.250 62.706 Td /F1 9.8 Tf [(Study-level assessment for bias was performed with the Cochrane Collaborations Assessment for bias tool. The tool was not )] TJ ET BT 26.250 50.801 Td /F1 9.8 Tf [(ideally suited to the non-randomised studies. The assessment tool was used to catalogue the characteristics of the study )] TJ ET BT 26.250 38.896 Td /F1 9.8 Tf [(without attempting to make an overall summary categorisation of study bias as their very diverse natures, contexts and methods )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(2)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 88 0 obj << /Type /Annot /Subtype /Link /A 89 0 R /Border [0 0 0] /H /I /Rect [ 465.7410 476.1489 470.5597 484.9672 ] >> endobj 89 0 obj << /Type /Action >> endobj 90 0 obj << /Type /Annot /Subtype /Link /A 91 0 R /Border [0 0 0] /H /I /Rect [ 465.7410 476.1489 470.5597 484.9672 ] >> endobj 91 0 obj << /Type /Action >> endobj 92 0 obj << /Type /Annot /Subtype /Link /A 93 0 R /Border [0 0 0] /H /I /Rect [ 465.7410 476.1489 470.5597 484.9672 ] >> endobj 93 0 obj << /Type /Action >> endobj 94 0 obj << /Type /Page /Parent 3 0 R /Annots [ 96 0 R 100 0 R 104 0 R 106 0 R 108 0 R 112 0 R 116 0 R 118 0 R 120 0 R 124 0 R 128 0 R 130 0 R ] /Contents 95 0 R >> endobj 95 0 obj << /Length 10078 >> stream 0.271 0.267 0.267 rg q 15.000 24.231 577.500 752.769 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(made most studies not directly comparable, even in terms of bias.)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(All relevant knowledge, behaviour and incidence outcomes were included in the review in the manner that they were originally )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(reported. Due to the disparate nature of the studies, no formal assessment of risk of bias across studies was considered. No )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(additional analyses were performed.)] TJ ET BT 26.250 687.659 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 667.705 Td /F4 9.8 Tf [(Study selection)] TJ ET BT 26.250 648.300 Td /F1 9.8 Tf [(The electronic searches yielded 5,224 unique articles. Of these, 100 were judged to be potentially relevant by at least one )] TJ ET BT 26.250 636.396 Td /F1 9.8 Tf [(reviewer and were obtained in full. Of these 100 articles, 25 were judged to meet the inclusion criteria, and for a further six )] TJ ET BT 26.250 624.491 Td /F1 9.8 Tf [(studies were judged not to clearly meet the inclusion criteria due to insufficient information. Two additional studies were found )] TJ ET BT 26.250 612.586 Td /F1 9.8 Tf [(from references of other papers, and one additional paper providing extra information about an already included study was also )] TJ ET BT 26.250 600.681 Td /F1 9.8 Tf [(identified \(Figure 1\). Full study characteristics and assessment for bias for included reports are shown in Appendix 3, references )] TJ ET BT 26.250 588.777 Td /F1 9.8 Tf [(to excluded studies with reasons for exclusion are shown in Appendix 4 and references to studies for which an assessment )] TJ ET BT 26.250 576.872 Td /F1 9.8 Tf [(could not be made are shown in Appendix 5.)] TJ ET 0.965 0.965 0.965 rg 26.250 377.100 555.000 189.891 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 566.991 m 581.250 566.991 l 581.250 566.241 l 26.250 566.241 l f 26.250 377.100 m 581.250 377.100 l 581.250 377.850 l 26.250 377.850 l f q 225.000 0 0 123.750 35.250 433.491 cm /I4 Do Q q 35.250 388.350 537.000 39.141 re W n 0.271 0.267 0.267 rg BT 35.250 417.967 Td /F4 9.8 Tf [(Fig. 1: Review Flowchart)] TJ ET BT 35.250 398.597 Td /F1 9.8 Tf [(Flowchart showing results of systematic review process.)] TJ ET Q BT 26.250 360.076 Td /F4 9.8 Tf [(Study Characteristics)] TJ ET 0.965 0.965 0.965 rg 26.250 55.540 555.000 294.655 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 350.195 m 581.250 350.195 l 581.250 349.445 l 26.250 349.445 l f 26.250 55.540 m 581.250 55.540 l 581.250 56.290 l 26.250 56.290 l f q 225.000 0 0 249.750 35.250 90.695 cm /I6 Do Q q 35.250 66.790 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 75.171 Td /F4 9.8 Tf [(Fig. 2: Summary characteristics of included studies)] TJ ET Q BT 26.250 38.517 Td /F1 9.8 Tf [(Summary characteristics of the studies are shown \(Figure 2\). One study took place in Australia,)] TJ ET 0.267 0.267 0.267 rg BT 436.988 40.024 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 441.807 38.517 Td /F1 9.8 Tf [( one in Canada,)] TJ ET 0.267 0.267 0.267 rg BT 510.642 40.024 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 515.461 38.517 Td /F1 9.8 Tf [( two in the )] TJ ET Q q 15.000 24.231 577.500 752.769 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(made most studies not directly comparable, even in terms of bias.)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(All relevant knowledge, behaviour and incidence outcomes were included in the review in the manner that they were originally )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(reported. Due to the disparate nature of the studies, no formal assessment of risk of bias across studies was considered. No )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(additional analyses were performed.)] TJ ET BT 26.250 687.659 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 667.705 Td /F4 9.8 Tf [(Study selection)] TJ ET BT 26.250 648.300 Td /F1 9.8 Tf [(The electronic searches yielded 5,224 unique articles. Of these, 100 were judged to be potentially relevant by at least one )] TJ ET BT 26.250 636.396 Td /F1 9.8 Tf [(reviewer and were obtained in full. Of these 100 articles, 25 were judged to meet the inclusion criteria, and for a further six )] TJ ET BT 26.250 624.491 Td /F1 9.8 Tf [(studies were judged not to clearly meet the inclusion criteria due to insufficient information. Two additional studies were found )] TJ ET BT 26.250 612.586 Td /F1 9.8 Tf [(from references of other papers, and one additional paper providing extra information about an already included study was also )] TJ ET BT 26.250 600.681 Td /F1 9.8 Tf [(identified \(Figure 1\). Full study characteristics and assessment for bias for included reports are shown in Appendix 3, references )] TJ ET BT 26.250 588.777 Td /F1 9.8 Tf [(to excluded studies with reasons for exclusion are shown in Appendix 4 and references to studies for which an assessment )] TJ ET BT 26.250 576.872 Td /F1 9.8 Tf [(could not be made are shown in Appendix 5.)] TJ ET 0.965 0.965 0.965 rg 26.250 377.100 555.000 189.891 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 566.991 m 581.250 566.991 l 581.250 566.241 l 26.250 566.241 l f 26.250 377.100 m 581.250 377.100 l 581.250 377.850 l 26.250 377.850 l f q 225.000 0 0 123.750 35.250 433.491 cm /I8 Do Q q 35.250 388.350 537.000 39.141 re W n 0.271 0.267 0.267 rg BT 35.250 417.967 Td /F4 9.8 Tf [(Fig. 1: Review Flowchart)] TJ ET BT 35.250 398.597 Td /F1 9.8 Tf [(Flowchart showing results of systematic review process.)] TJ ET Q BT 26.250 360.076 Td /F4 9.8 Tf [(Study Characteristics)] TJ ET 0.965 0.965 0.965 rg 26.250 55.540 555.000 294.655 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 350.195 m 581.250 350.195 l 581.250 349.445 l 26.250 349.445 l f 26.250 55.540 m 581.250 55.540 l 581.250 56.290 l 26.250 56.290 l f q 225.000 0 0 249.750 35.250 90.695 cm /I10 Do Q q 35.250 66.790 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 75.171 Td /F4 9.8 Tf [(Fig. 2: Summary characteristics of included studies)] TJ ET Q BT 26.250 38.517 Td /F1 9.8 Tf [(Summary characteristics of the studies are shown \(Figure 2\). One study took place in Australia,)] TJ ET 0.267 0.267 0.267 rg BT 436.988 40.024 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 441.807 38.517 Td /F1 9.8 Tf [( one in Canada,)] TJ ET 0.267 0.267 0.267 rg BT 510.642 40.024 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 515.461 38.517 Td /F1 9.8 Tf [( two in the )] TJ ET Q q 15.000 24.231 577.500 752.769 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(made most studies not directly comparable, even in terms of bias.)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(All relevant knowledge, behaviour and incidence outcomes were included in the review in the manner that they were originally )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(reported. Due to the disparate nature of the studies, no formal assessment of risk of bias across studies was considered. No )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(additional analyses were performed.)] TJ ET BT 26.250 687.659 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 667.705 Td /F4 9.8 Tf [(Study selection)] TJ ET BT 26.250 648.300 Td /F1 9.8 Tf [(The electronic searches yielded 5,224 unique articles. Of these, 100 were judged to be potentially relevant by at least one )] TJ ET BT 26.250 636.396 Td /F1 9.8 Tf [(reviewer and were obtained in full. Of these 100 articles, 25 were judged to meet the inclusion criteria, and for a further six )] TJ ET BT 26.250 624.491 Td /F1 9.8 Tf [(studies were judged not to clearly meet the inclusion criteria due to insufficient information. Two additional studies were found )] TJ ET BT 26.250 612.586 Td /F1 9.8 Tf [(from references of other papers, and one additional paper providing extra information about an already included study was also )] TJ ET BT 26.250 600.681 Td /F1 9.8 Tf [(identified \(Figure 1\). Full study characteristics and assessment for bias for included reports are shown in Appendix 3, references )] TJ ET BT 26.250 588.777 Td /F1 9.8 Tf [(to excluded studies with reasons for exclusion are shown in Appendix 4 and references to studies for which an assessment )] TJ ET BT 26.250 576.872 Td /F1 9.8 Tf [(could not be made are shown in Appendix 5.)] TJ ET 0.965 0.965 0.965 rg 26.250 377.100 555.000 189.891 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 566.991 m 581.250 566.991 l 581.250 566.241 l 26.250 566.241 l f 26.250 377.100 m 581.250 377.100 l 581.250 377.850 l 26.250 377.850 l f q 225.000 0 0 123.750 35.250 433.491 cm /I12 Do Q q 35.250 388.350 537.000 39.141 re W n 0.271 0.267 0.267 rg BT 35.250 417.967 Td /F4 9.8 Tf [(Fig. 1: Review Flowchart)] TJ ET BT 35.250 398.597 Td /F1 9.8 Tf [(Flowchart showing results of systematic review process.)] TJ ET Q BT 26.250 360.076 Td /F4 9.8 Tf [(Study Characteristics)] TJ ET 0.965 0.965 0.965 rg 26.250 55.540 555.000 294.655 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 350.195 m 581.250 350.195 l 581.250 349.445 l 26.250 349.445 l f 26.250 55.540 m 581.250 55.540 l 581.250 56.290 l 26.250 56.290 l f q 225.000 0 0 249.750 35.250 90.695 cm /I14 Do Q q 35.250 66.790 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 75.171 Td /F4 9.8 Tf [(Fig. 2: Summary characteristics of included studies)] TJ ET Q BT 26.250 38.517 Td /F1 9.8 Tf [(Summary characteristics of the studies are shown \(Figure 2\). One study took place in Australia,)] TJ ET 0.267 0.267 0.267 rg BT 436.988 40.024 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 441.807 38.517 Td /F1 9.8 Tf [( one in Canada,)] TJ ET 0.267 0.267 0.267 rg BT 510.642 40.024 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 515.461 38.517 Td /F1 9.8 Tf [( two in the )] TJ ET Q q 225.000 0 0 123.750 35.250 433.491 cm /I16 Do Q q 225.000 0 0 249.750 35.250 90.695 cm /I18 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(3)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 96 0 obj << /Type /Annot /Subtype /Link /A 97 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 433.4910 260.2500 557.2410 ] >> endobj 97 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2014/05/bradley-flowchart-with-arrows.png) >> endobj 98 0 obj << /Type /XObject /Subtype /Image /Width 300 /Height 165 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 300 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 359>> stream xA 0 =fy9뀟\z endstream endobj 99 0 obj << /Type /XObject /Subtype /Image /Width 300 /Height 165 /SMask 98 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 300 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 27025>> stream xw\u'zv=9<` 2$HT"M[dd{%~޷~Z,J"E1 @$ 09ni A>rp_sNշQ,C؂?r^TdEM^=/Jƿ CINw@EnfšXL:N Ci8Pr#@QϴMk";yesmeE(OGtQJ&NO'B>xw}r TO_ Jό}vOPQLĕl! 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c%ũOF.]ݻurM%դ+4a()UƮ ɩȗ2t*/7^;WOtZ4 왙 'X5)).n$ӧ>ZX;w؋{jc$R3#8E#.Rn DD«lt ML,/,WVVnme=/.n.e&)05v%2Tk޸Mr*a m$S++ee2ҒoTצ fq9SK K N)5!iQ޶8&T\_V*iz# *b}}sK#c2TBr:U w{}%ڥىťrw45DdX(ד(l0,;56lsy-SӋKK+21IpB3]ngcw{Wǝli_ܲ -Fз'&mKsdbfii1kn- fHLN/-/ u7gp\ ^+PtPDH'n'̀ ucR\K3 _y۶ncSTܶi4.M--|9]u;fh{mu]cڶ*U"/_Xr٘h,:,gXؗkx\csK ˢ =u{ P;RtPgQQ5ZyֆR@K|3d:mPeUͥ6CK vTڶflxZJű{* G'kح_{5샪rd|(D%S>lc[VA:8KuEt~ɶE{S}B?g?PLMen@\j LwxT%Ȟ]SVE}Mun\k0*T\AMF)S|ulYe52D#&k;RQYn*+c+V[__ EJ* jͭm;mY!HNwg?n+*Xι횙ml@teRTD {o45zك%ejđKl￙DTVTc|hsW^{'`MUJj,Mҹs3A9Q)X)n@s #L1;h?|ê{}RFa+@&Ebfg[4sm:?ٓ!HKmusssCWO\ٿ r MUZۨB )Ep%E e&)&cbe (} !,Y]]γm R#J'hÞ͌d_eNQ*mx*K##Eˋ]O!E wZl^R It]d8tDMJSK!wNݕ-Ϝt_?qQdgWndxpz7gl_${-D㓳<9ӟܘ]Gt:; qfPgd>i?u:o^~kG]2|ͱY=23<<\t&:5w>z{p" !Z${ҙ~c,Go2Qz>+DʏlT>U?I[оtw5ٽ*: 4 rDe]TT9.z _X4jo]әj0u/p3+X&G\ژ>OjsAdtksM)4*/MG1TE2|ep?[_| {U/~aa۲Ry+o,.U8EIy/?Oc>4azc{O>`u 6?)mRM՟[oDrsւF&}H=`:ozWGF LAPykok`!PMכϥp*0wXlqgUC @Qk4{_ڣTe] F:G D8W)jJUj-TG2LZA0]8{= zG5`wS<<-`T@ EEWST*qM\Bu7n峇M\' ;7_Nޞ\YY*Z5)qee 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445 0 R 447 0 R 449 0 R 451 0 R 453 0 R 455 0 R 457 0 R 459 0 R 461 0 R 463 0 R 465 0 R 467 0 R 469 0 R 471 0 R 473 0 R 475 0 R 477 0 R 479 0 R 481 0 R 483 0 R 485 0 R 487 0 R 489 0 R 491 0 R 493 0 R 495 0 R 497 0 R 499 0 R 501 0 R 503 0 R 505 0 R 507 0 R 509 0 R 511 0 R 513 0 R 515 0 R 517 0 R 519 0 R 521 0 R 523 0 R 525 0 R 527 0 R 529 0 R 531 0 R 533 0 R 535 0 R 537 0 R 539 0 R 541 0 R 543 0 R 545 0 R 547 0 R 549 0 R 551 0 R 553 0 R 555 0 R 557 0 R 559 0 R 561 0 R 563 0 R 565 0 R 567 0 R 569 0 R 571 0 R 573 0 R 575 0 R 577 0 R 579 0 R 581 0 R 583 0 R 585 0 R 587 0 R 589 0 R 591 0 R 593 0 R 595 0 R 597 0 R 599 0 R 601 0 R 603 0 R 605 0 R 607 0 R 609 0 R 611 0 R 613 0 R 615 0 R 617 0 R 619 0 R 621 0 R 623 0 R 625 0 R 627 0 R 629 0 R 631 0 R 633 0 R 635 0 R 637 0 R 639 0 R 641 0 R 643 0 R 645 0 R 647 0 R 649 0 R 651 0 R 653 0 R 655 0 R 657 0 R 659 0 R 661 0 R 663 0 R 665 0 R 667 0 R 669 0 R 671 0 R 673 0 R 675 0 R 677 0 R 679 0 R 681 0 R 683 0 R 685 0 R 687 0 R 689 0 R ] /Contents 137 0 R >> endobj 137 0 obj << /Length 59515 >> stream 0.271 0.267 0.267 rg q 15.000 23.301 577.500 753.699 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(United Kingdom)] TJ ET 0.267 0.267 0.267 rg BT 95.612 768.983 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 100.430 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 102.840 768.983 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 107.658 767.476 Td /F1 9.8 Tf [( and ten in the United States of America.)] TJ ET 0.267 0.267 0.267 rg BT 282.710 768.983 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 292.347 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 294.756 768.983 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 304.394 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 306.803 768.983 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 316.440 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 318.850 768.983 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 328.487 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 330.896 768.983 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 340.534 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 342.943 768.983 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 352.580 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 354.990 768.983 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 364.627 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 367.036 768.983 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 376.674 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 379.083 768.983 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 388.720 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 391.130 768.983 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 400.767 767.476 Td /F1 9.8 Tf [( One was conducted in Hong Kong,)] TJ ET 0.267 0.267 0.267 rg BT 554.144 768.983 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 26.250 755.571 Td /F1 9.8 Tf [(one in Thailand,)] TJ ET 0.267 0.267 0.267 rg BT 95.621 757.079 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 105.259 755.571 Td /F1 9.8 Tf [( one in Taiwan,)] TJ ET 0.267 0.267 0.267 rg BT 171.373 757.079 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 181.011 755.571 Td /F1 9.8 Tf [( one in Singapore,)] TJ ET 0.267 0.267 0.267 rg BT 260.142 757.079 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 269.779 755.571 Td /F1 9.8 Tf [(one in Japan,)] TJ ET 0.267 0.267 0.267 rg BT 328.318 757.079 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 337.955 755.571 Td /F1 9.8 Tf [( and one in China.)] TJ ET 0.267 0.267 0.267 rg BT 417.086 757.079 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 426.724 755.571 Td /F1 9.8 Tf [( One study took place in Egypt,)] TJ ET 0.267 0.267 0.267 rg BT 561.673 757.079 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 26.250 743.667 Td /F1 9.8 Tf [(one in Iran,)] TJ ET 0.267 0.267 0.267 rg BT 75.029 745.174 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 84.667 743.667 Td /F1 9.8 Tf [( one in Republic of the Congo,)] TJ ET 0.267 0.267 0.267 rg BT 215.824 745.174 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 225.461 743.667 Td /F1 9.8 Tf [( one in Mauritius,)] TJ ET 0.267 0.267 0.267 rg BT 299.697 745.174 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 309.335 743.667 Td /F1 9.8 Tf [( one in India,)] TJ ET 0.267 0.267 0.267 rg BT 365.163 745.174 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 374.801 743.667 Td /F1 9.8 Tf [( one in Haiti)] TJ ET 0.267 0.267 0.267 rg BT 426.281 745.174 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 435.918 743.667 Td /F1 9.8 Tf [( and one took place on two )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(Caribbean islands: St. Vincent and the Grenadines, and Turks and Caicos Islands.)] TJ ET 0.267 0.267 0.267 rg BT 381.755 733.269 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 26.250 712.357 Td /F1 9.8 Tf [(Two studies focused on general disaster preparedness,)] TJ ET 0.267 0.267 0.267 rg BT 265.778 713.864 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 275.416 716.245 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 277.825 713.864 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 287.462 712.357 Td /F1 9.8 Tf [( one focused on five natural hazards,)] TJ ET 0.267 0.267 0.267 rg BT 447.343 713.864 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 456.980 712.357 Td /F1 9.8 Tf [( two on hurricanes only,)] TJ ET 0.267 0.267 0.267 rg BT 559.940 713.864 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 569.577 716.245 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 26.250 701.960 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 35.887 700.452 Td /F1 9.8 Tf [( one on a cyclone,)] TJ ET 0.267 0.267 0.267 rg BT 115.018 701.960 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 124.656 700.452 Td /F1 9.8 Tf [( one on floods only,)] TJ ET 0.267 0.267 0.267 rg BT 209.208 701.960 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 218.845 700.452 Td /F1 9.8 Tf [( two on wildfires,)] TJ ET 0.267 0.267 0.267 rg BT 290.907 701.960 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 300.545 704.341 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 302.954 701.960 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 312.591 700.452 Td /F1 9.8 Tf [( one on earthquakes)] TJ ET 0.267 0.267 0.267 rg BT 401.482 701.960 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 411.119 700.452 Td /F1 9.8 Tf [( and one on a terrorist attack.)] TJ ET 0.267 0.267 0.267 rg BT 537.938 701.960 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 547.575 700.452 Td /F1 9.8 Tf [( Four )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(studies dealt with water supply disasters.)] TJ ET 0.267 0.267 0.267 rg BT 202.900 690.055 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 207.719 692.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 210.129 690.055 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 219.766 692.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 222.175 690.055 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 231.813 692.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 234.222 690.055 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 243.859 688.548 Td /F1 9.8 Tf [( One dealt with radiation.)] TJ ET 0.267 0.267 0.267 rg BT 351.704 690.055 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 361.341 688.548 Td /F1 9.8 Tf [( The remaining studies focused on infectious )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(disease disasters: Three studied pandemic influenza,)] TJ ET 0.267 0.267 0.267 rg BT 256.019 678.150 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 260.837 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 263.246 678.150 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 268.065 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 270.475 678.150 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 280.112 676.643 Td /F1 9.8 Tf [( three focused on the SARS epidemic,)] TJ ET 0.267 0.267 0.267 rg BT 445.404 678.150 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 455.041 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 457.450 678.150 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 467.088 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 469.497 678.150 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 479.134 676.643 Td /F1 9.8 Tf [( one on an outbreak of )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(avian influenza,)] TJ ET 0.267 0.267 0.267 rg BT 93.993 666.245 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 103.630 664.738 Td /F1 9.8 Tf [( one on an epidemic of acute haemorrhagic conjunctivitis,)] TJ ET 0.267 0.267 0.267 rg BT 351.826 666.245 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 361.464 664.738 Td /F1 9.8 Tf [( one followed an outbreak of monkeypox)] TJ ET 0.267 0.267 0.267 rg BT 536.515 666.245 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 546.153 664.738 Td /F1 9.8 Tf [( and )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(one dealt with an outbreak of meningococcal disease.)] TJ ET 0.267 0.267 0.267 rg BT 258.202 654.341 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 633.429 Td /F1 9.8 Tf [(There were several different types of communication method used in these studies. Mitigation and preparedness interventions )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(used face-to-face group participation and education in eight studies,)] TJ ET 0.267 0.267 0.267 rg BT 318.906 623.031 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 323.725 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 326.134 623.031 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 330.953 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 333.362 623.031 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 342.999 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 345.409 623.031 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 355.046 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 357.455 623.031 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 367.093 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 369.502 623.031 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 379.139 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 381.549 623.031 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 391.186 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 393.595 623.031 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 403.233 621.524 Td /F1 9.8 Tf [( one of which included the use of a )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(specially designed board game.)] TJ ET 0.267 0.267 0.267 rg BT 163.355 611.126 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 172.992 609.619 Td /F1 9.8 Tf [( Two early warning alerts used several communication channels)] TJ ET 0.267 0.267 0.267 rg BT 449.336 611.126 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 458.973 613.507 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 461.383 611.126 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 471.020 609.619 Td /F1 9.8 Tf [( and another used )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(Reverse-911.)] TJ ET 0.267 0.267 0.267 rg BT 84.769 599.222 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 94.407 597.714 Td /F1 9.8 Tf [( Mitigation and preparedness studies that did not use face-to-face communication used a telephone intervention,)] TJ ET 0.267 0.267 0.267 rg BT 26.250 587.317 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 31.069 585.810 Td /F1 9.8 Tf [( and a computer game.)] TJ ET 0.267 0.267 0.267 rg BT 131.328 587.317 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 140.965 585.810 Td /F1 9.8 Tf [( The response phase interventions were multi-channel information campaigns \(with different methods )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(and balance of methods between studies\))] TJ ET 0.267 0.267 0.267 rg BT 206.722 575.412 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 211.541 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 213.951 575.412 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 218.769 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 221.179 575.412 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 230.816 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 233.225 575.412 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 242.863 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 245.272 575.412 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 254.909 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 257.319 575.412 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 266.956 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 269.365 575.412 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 279.003 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 281.412 575.412 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 291.049 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 293.459 575.412 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 303.096 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 305.505 575.412 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 315.143 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 317.552 575.412 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 327.189 573.905 Td /F1 9.8 Tf [( and a school-based participatory intensive education )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(programme.)] TJ ET 0.267 0.267 0.267 rg BT 78.803 563.507 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 88.440 562.000 Td /F1 9.8 Tf [( The three recovery phase interventions used media campaigns to encourage members of the public to access )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(telephone help lines for mental health problems and to undertake healthy behaviours following disasters.)] TJ ET 0.267 0.267 0.267 rg BT 476.593 551.603 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 486.230 553.984 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 488.639 551.603 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 498.277 553.984 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 500.686 551.603 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 26.250 530.691 Td /F1 9.8 Tf [(The objectives of the interventions were to improve the health knowledge and behaviour in relation to disasters, and to decrease )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(the incidence of negative health events. The studies were chosen on that basis, and several studies reported additional )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(outcomes that were outside the scope of this review. The knowledge, behaviour and incidence outcomes are described in detail )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(in Appendix 3 \(characteristics and results of included studies\).)] TJ ET BT 26.250 458.374 Td /F4 12.0 Tf [(Results of Individual Studies)] TJ ET BT 26.250 438.420 Td /F4 9.8 Tf [(1 Effect of Risk Communication Interventions to Promote Disaster Mitigation and Preparedness)] TJ ET BT 26.250 419.015 Td /F4 9.8 Tf [(1.1 Communication to Promote Mitigation and Preparedness for Infectious Disease Disasters)] TJ ET BT 26.250 399.610 Td /F4 9.8 Tf [(1.1.1 Setting)] TJ ET BT 26.250 380.205 Td /F1 9.8 Tf [(Two studies for pandemic influenza took place in high-income countries \(Canada)] TJ ET 0.267 0.267 0.267 rg BT 374.686 381.713 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 379.504 380.205 Td /F1 9.8 Tf [( and Australia)] TJ ET 0.267 0.267 0.267 rg BT 439.116 381.713 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 443.935 380.205 Td /F1 9.8 Tf [(\), and one study for )] TJ ET BT 26.250 368.301 Td /F1 9.8 Tf [(monkeypox took place in a low-income country \(Republic of the Congo\).)] TJ ET 0.267 0.267 0.267 rg BT 336.748 369.808 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 346.386 368.301 Td /F1 9.8 Tf [( Both studies of interventions for pandemic influenza )] TJ ET BT 26.250 356.396 Td /F1 9.8 Tf [(took place in 2008, before the 2009 H1N1 pandemic. The study of an intervention for monkeypox took place in 2009, six years )] TJ ET BT 26.250 344.491 Td /F1 9.8 Tf [(after an outbreak in Republic of the Congo, and subsequent to a serological survey that suggested that past infection was )] TJ ET BT 26.250 332.586 Td /F1 9.8 Tf [(widespread. Monkeypox is a potentially fatal disease that is related to smallpox, incidence of which is thought to have increased )] TJ ET BT 26.250 320.682 Td /F1 9.8 Tf [(following the discontinuation of the smallpox vaccine in 1980.)] TJ ET 0.267 0.267 0.267 rg BT 289.627 322.189 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 301.277 Td /F4 9.8 Tf [(1.1.2 Participants)] TJ ET BT 26.250 281.872 Td /F1 9.8 Tf [(The Australian study by Eastwood )] TJ ET BT 176.361 281.872 Td /F5 9.8 Tf [(et al.)] TJ ET BT 197.499 281.872 Td /F1 9.8 Tf [( of a pandemic influenza mitigation intervention included 1,166 individuals \(62% female\) )] TJ ET BT 26.250 269.967 Td /F1 9.8 Tf [(who were contacted by telephone \(58% response rate\).)] TJ ET 0.267 0.267 0.267 rg BT 265.242 271.475 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 270.061 269.967 Td /F1 9.8 Tf [( Dumais et al. reported an educational intervention in a class of 35 )] TJ ET BT 26.250 258.063 Td /F1 9.8 Tf [(female year 10 students in a private school in Canada.)] TJ ET 0.267 0.267 0.267 rg BT 261.449 259.570 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 266.268 258.063 Td /F1 9.8 Tf [( The intervention in Republic of the Congo was delivered on a much )] TJ ET BT 26.250 246.158 Td /F1 9.8 Tf [(greater scale: approximately 23,860 people in 16 towns and villages received the intervention over a period of 90 days.)] TJ ET 0.267 0.267 0.267 rg BT 538.379 247.665 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 234.253 Td /F1 9.8 Tf [(Evaluation was by a survey of 271 people \(57% male; mean age 33 years\) before and after the intervention.)] TJ ET 0.267 0.267 0.267 rg BT 491.237 235.760 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 214.848 Td /F4 9.8 Tf [(1.1.3 Description of Interventions)] TJ ET BT 26.250 195.444 Td /F1 9.8 Tf [(The Eastwood et al. intervention for pandemic influenza was a simple telephone conversation, with a researcher delivering a )] TJ ET BT 26.250 183.539 Td /F1 9.8 Tf [(short script explaining the nature and effects of an influenza pandemic.)] TJ ET 0.267 0.267 0.267 rg BT 331.366 185.046 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 336.185 183.539 Td /F1 9.8 Tf [( The Dumais )] TJ ET BT 394.159 183.539 Td /F5 9.8 Tf [(et al.)] TJ ET BT 415.297 183.539 Td /F1 9.8 Tf [( intervention was developed by )] TJ ET BT 26.250 171.634 Td /F1 9.8 Tf [(conducting a pre-intervention survey of students understanding of viruses and forming an education programme based on )] TJ ET BT 26.250 159.729 Td /F1 9.8 Tf [(revealed insufficiencies.)] TJ ET 0.267 0.267 0.267 rg BT 129.746 161.237 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 134.565 159.729 Td /F1 9.8 Tf [( The intervention took place in an 80 minute session involving a lecture and discussion, and addressed )] TJ ET BT 26.250 147.825 Td /F1 9.8 Tf [(shortfalls in knowledge about virus biology. The aim of this intervention was to improve understanding of viruses to facilitate )] TJ ET BT 26.250 135.920 Td /F1 9.8 Tf [(response to risk communication about pandemic and epidemic influenza. The Roess )] TJ ET BT 393.113 135.920 Td /F5 9.8 Tf [(et al.)] TJ ET BT 414.251 135.920 Td /F1 9.8 Tf [( intervention was an outreach )] TJ ET BT 26.250 124.015 Td /F1 9.8 Tf [(education programme in villages in the Republic of Congo.)] TJ ET 0.267 0.267 0.267 rg BT 278.775 125.522 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 288.412 124.015 Td /F1 9.8 Tf [( Small group sessions were conducted using two specially made )] TJ ET BT 26.250 112.110 Td /F1 9.8 Tf [(educational videos and discussions about monkeypox in each village.)] TJ ET BT 26.250 92.706 Td /F4 9.8 Tf [(1.1.4 Results)] TJ ET BT 26.250 73.301 Td /F1 9.8 Tf [(All three studies were uncontrolled before and after studies. The Eastwood et al. study of pandemic influenza revealed that the )] TJ ET BT 26.250 61.396 Td /F1 9.8 Tf [(Australian public reported themselves to be largely willing to comply with the public health measures proposed, such as self-)] TJ ET BT 26.250 49.491 Td /F1 9.8 Tf [(quarantine and social distancing. Following the information intervention, they were even more likely to report their willingness to )] TJ ET BT 26.250 37.587 Td /F1 9.8 Tf [(self-isolate \(94.1% before to 97.5% after\), avoid public events \(94.2% to 98.3%\) and postpone gatherings \(90.7% to 97.2%\).)] TJ ET 0.267 0.267 0.267 rg BT 560.609 39.094 Td /F4 8.7 Tf [(6)] TJ ET Q q 15.000 23.301 577.500 753.699 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(United Kingdom)] TJ ET 0.267 0.267 0.267 rg BT 95.612 768.983 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 100.430 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 102.840 768.983 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 107.658 767.476 Td /F1 9.8 Tf [( and ten in the United States of America.)] TJ ET 0.267 0.267 0.267 rg BT 282.710 768.983 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 292.347 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 294.756 768.983 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 304.394 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 306.803 768.983 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 316.440 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 318.850 768.983 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 328.487 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 330.896 768.983 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 340.534 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 342.943 768.983 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 352.580 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 354.990 768.983 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 364.627 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 367.036 768.983 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 376.674 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 379.083 768.983 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 388.720 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 391.130 768.983 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 400.767 767.476 Td /F1 9.8 Tf [( One was conducted in Hong Kong,)] TJ ET 0.267 0.267 0.267 rg BT 554.144 768.983 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 26.250 755.571 Td /F1 9.8 Tf [(one in Thailand,)] TJ ET 0.267 0.267 0.267 rg BT 95.621 757.079 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 105.259 755.571 Td /F1 9.8 Tf [( one in Taiwan,)] TJ ET 0.267 0.267 0.267 rg BT 171.373 757.079 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 181.011 755.571 Td /F1 9.8 Tf [( one in Singapore,)] TJ ET 0.267 0.267 0.267 rg BT 260.142 757.079 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 269.779 755.571 Td /F1 9.8 Tf [(one in Japan,)] TJ ET 0.267 0.267 0.267 rg BT 328.318 757.079 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 337.955 755.571 Td /F1 9.8 Tf [( and one in China.)] TJ ET 0.267 0.267 0.267 rg BT 417.086 757.079 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 426.724 755.571 Td /F1 9.8 Tf [( One study took place in Egypt,)] TJ ET 0.267 0.267 0.267 rg BT 561.673 757.079 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 26.250 743.667 Td /F1 9.8 Tf [(one in Iran,)] TJ ET 0.267 0.267 0.267 rg BT 75.029 745.174 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 84.667 743.667 Td /F1 9.8 Tf [( one in Republic of the Congo,)] TJ ET 0.267 0.267 0.267 rg BT 215.824 745.174 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 225.461 743.667 Td /F1 9.8 Tf [( one in Mauritius,)] TJ ET 0.267 0.267 0.267 rg BT 299.697 745.174 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 309.335 743.667 Td /F1 9.8 Tf [( one in India,)] TJ ET 0.267 0.267 0.267 rg BT 365.163 745.174 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 374.801 743.667 Td /F1 9.8 Tf [( one in Haiti)] TJ ET 0.267 0.267 0.267 rg BT 426.281 745.174 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 435.918 743.667 Td /F1 9.8 Tf [( and one took place on two )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(Caribbean islands: St. Vincent and the Grenadines, and Turks and Caicos Islands.)] TJ ET 0.267 0.267 0.267 rg BT 381.755 733.269 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 26.250 712.357 Td /F1 9.8 Tf [(Two studies focused on general disaster preparedness,)] TJ ET 0.267 0.267 0.267 rg BT 265.778 713.864 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 275.416 716.245 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 277.825 713.864 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 287.462 712.357 Td /F1 9.8 Tf [( one focused on five natural hazards,)] TJ ET 0.267 0.267 0.267 rg BT 447.343 713.864 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 456.980 712.357 Td /F1 9.8 Tf [( two on hurricanes only,)] TJ ET 0.267 0.267 0.267 rg BT 559.940 713.864 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 569.577 716.245 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 26.250 701.960 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 35.887 700.452 Td /F1 9.8 Tf [( one on a cyclone,)] TJ ET 0.267 0.267 0.267 rg BT 115.018 701.960 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 124.656 700.452 Td /F1 9.8 Tf [( one on floods only,)] TJ ET 0.267 0.267 0.267 rg BT 209.208 701.960 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 218.845 700.452 Td /F1 9.8 Tf [( two on wildfires,)] TJ ET 0.267 0.267 0.267 rg BT 290.907 701.960 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 300.545 704.341 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 302.954 701.960 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 312.591 700.452 Td /F1 9.8 Tf [( one on earthquakes)] TJ ET 0.267 0.267 0.267 rg BT 401.482 701.960 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 411.119 700.452 Td /F1 9.8 Tf [( and one on a terrorist attack.)] TJ ET 0.267 0.267 0.267 rg BT 537.938 701.960 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 547.575 700.452 Td /F1 9.8 Tf [( Four )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(studies dealt with water supply disasters.)] TJ ET 0.267 0.267 0.267 rg BT 202.900 690.055 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 207.719 692.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 210.129 690.055 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 219.766 692.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 222.175 690.055 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 231.813 692.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 234.222 690.055 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 243.859 688.548 Td /F1 9.8 Tf [( One dealt with radiation.)] TJ ET 0.267 0.267 0.267 rg BT 351.704 690.055 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 361.341 688.548 Td /F1 9.8 Tf [( The remaining studies focused on infectious )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(disease disasters: Three studied pandemic influenza,)] TJ ET 0.267 0.267 0.267 rg BT 256.019 678.150 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 260.837 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 263.246 678.150 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 268.065 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 270.475 678.150 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 280.112 676.643 Td /F1 9.8 Tf [( three focused on the SARS epidemic,)] TJ ET 0.267 0.267 0.267 rg BT 445.404 678.150 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 455.041 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 457.450 678.150 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 467.088 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 469.497 678.150 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 479.134 676.643 Td /F1 9.8 Tf [( one on an outbreak of )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(avian influenza,)] TJ ET 0.267 0.267 0.267 rg BT 93.993 666.245 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 103.630 664.738 Td /F1 9.8 Tf [( one on an epidemic of acute haemorrhagic conjunctivitis,)] TJ ET 0.267 0.267 0.267 rg BT 351.826 666.245 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 361.464 664.738 Td /F1 9.8 Tf [( one followed an outbreak of monkeypox)] TJ ET 0.267 0.267 0.267 rg BT 536.515 666.245 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 546.153 664.738 Td /F1 9.8 Tf [( and )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(one dealt with an outbreak of meningococcal disease.)] TJ ET 0.267 0.267 0.267 rg BT 258.202 654.341 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 633.429 Td /F1 9.8 Tf [(There were several different types of communication method used in these studies. Mitigation and preparedness interventions )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(used face-to-face group participation and education in eight studies,)] TJ ET 0.267 0.267 0.267 rg BT 318.906 623.031 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 323.725 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 326.134 623.031 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 330.953 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 333.362 623.031 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 342.999 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 345.409 623.031 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 355.046 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 357.455 623.031 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 367.093 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 369.502 623.031 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 379.139 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 381.549 623.031 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 391.186 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 393.595 623.031 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 403.233 621.524 Td /F1 9.8 Tf [( one of which included the use of a )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(specially designed board game.)] TJ ET 0.267 0.267 0.267 rg BT 163.355 611.126 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 172.992 609.619 Td /F1 9.8 Tf [( Two early warning alerts used several communication channels)] TJ ET 0.267 0.267 0.267 rg BT 449.336 611.126 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 458.973 613.507 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 461.383 611.126 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 471.020 609.619 Td /F1 9.8 Tf [( and another used )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(Reverse-911.)] TJ ET 0.267 0.267 0.267 rg BT 84.769 599.222 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 94.407 597.714 Td /F1 9.8 Tf [( Mitigation and preparedness studies that did not use face-to-face communication used a telephone intervention,)] TJ ET 0.267 0.267 0.267 rg BT 26.250 587.317 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 31.069 585.810 Td /F1 9.8 Tf [( and a computer game.)] TJ ET 0.267 0.267 0.267 rg BT 131.328 587.317 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 140.965 585.810 Td /F1 9.8 Tf [( The response phase interventions were multi-channel information campaigns \(with different methods )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(and balance of methods between studies\))] TJ ET 0.267 0.267 0.267 rg BT 206.722 575.412 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 211.541 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 213.951 575.412 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 218.769 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 221.179 575.412 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 230.816 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 233.225 575.412 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 242.863 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 245.272 575.412 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 254.909 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 257.319 575.412 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 266.956 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 269.365 575.412 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 279.003 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 281.412 575.412 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 291.049 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 293.459 575.412 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 303.096 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 305.505 575.412 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 315.143 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 317.552 575.412 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 327.189 573.905 Td /F1 9.8 Tf [( and a school-based participatory intensive education )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(programme.)] TJ ET 0.267 0.267 0.267 rg BT 78.803 563.507 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 88.440 562.000 Td /F1 9.8 Tf [( The three recovery phase interventions used media campaigns to encourage members of the public to access )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(telephone help lines for mental health problems and to undertake healthy behaviours following disasters.)] TJ ET 0.267 0.267 0.267 rg BT 476.593 551.603 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 486.230 553.984 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 488.639 551.603 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 498.277 553.984 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 500.686 551.603 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 26.250 530.691 Td /F1 9.8 Tf [(The objectives of the interventions were to improve the health knowledge and behaviour in relation to disasters, and to decrease )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(the incidence of negative health events. The studies were chosen on that basis, and several studies reported additional )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(outcomes that were outside the scope of this review. The knowledge, behaviour and incidence outcomes are described in detail )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(in Appendix 3 \(characteristics and results of included studies\).)] TJ ET BT 26.250 458.374 Td /F4 12.0 Tf [(Results of Individual Studies)] TJ ET BT 26.250 438.420 Td /F4 9.8 Tf [(1 Effect of Risk Communication Interventions to Promote Disaster Mitigation and Preparedness)] TJ ET BT 26.250 419.015 Td /F4 9.8 Tf [(1.1 Communication to Promote Mitigation and Preparedness for Infectious Disease Disasters)] TJ ET BT 26.250 399.610 Td /F4 9.8 Tf [(1.1.1 Setting)] TJ ET BT 26.250 380.205 Td /F1 9.8 Tf [(Two studies for pandemic influenza took place in high-income countries \(Canada)] TJ ET 0.267 0.267 0.267 rg BT 374.686 381.713 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 379.504 380.205 Td /F1 9.8 Tf [( and Australia)] TJ ET 0.267 0.267 0.267 rg BT 439.116 381.713 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 443.935 380.205 Td /F1 9.8 Tf [(\), and one study for )] TJ ET BT 26.250 368.301 Td /F1 9.8 Tf [(monkeypox took place in a low-income country \(Republic of the Congo\).)] TJ ET 0.267 0.267 0.267 rg BT 336.748 369.808 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 346.386 368.301 Td /F1 9.8 Tf [( Both studies of interventions for pandemic influenza )] TJ ET BT 26.250 356.396 Td /F1 9.8 Tf [(took place in 2008, before the 2009 H1N1 pandemic. The study of an intervention for monkeypox took place in 2009, six years )] TJ ET BT 26.250 344.491 Td /F1 9.8 Tf [(after an outbreak in Republic of the Congo, and subsequent to a serological survey that suggested that past infection was )] TJ ET BT 26.250 332.586 Td /F1 9.8 Tf [(widespread. Monkeypox is a potentially fatal disease that is related to smallpox, incidence of which is thought to have increased )] TJ ET BT 26.250 320.682 Td /F1 9.8 Tf [(following the discontinuation of the smallpox vaccine in 1980.)] TJ ET 0.267 0.267 0.267 rg BT 289.627 322.189 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 301.277 Td /F4 9.8 Tf [(1.1.2 Participants)] TJ ET BT 26.250 281.872 Td /F1 9.8 Tf [(The Australian study by Eastwood )] TJ ET BT 176.361 281.872 Td /F5 9.8 Tf [(et al.)] TJ ET BT 197.499 281.872 Td /F1 9.8 Tf [( of a pandemic influenza mitigation intervention included 1,166 individuals \(62% female\) )] TJ ET BT 26.250 269.967 Td /F1 9.8 Tf [(who were contacted by telephone \(58% response rate\).)] TJ ET 0.267 0.267 0.267 rg BT 265.242 271.475 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 270.061 269.967 Td /F1 9.8 Tf [( Dumais et al. reported an educational intervention in a class of 35 )] TJ ET BT 26.250 258.063 Td /F1 9.8 Tf [(female year 10 students in a private school in Canada.)] TJ ET 0.267 0.267 0.267 rg BT 261.449 259.570 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 266.268 258.063 Td /F1 9.8 Tf [( The intervention in Republic of the Congo was delivered on a much )] TJ ET BT 26.250 246.158 Td /F1 9.8 Tf [(greater scale: approximately 23,860 people in 16 towns and villages received the intervention over a period of 90 days.)] TJ ET 0.267 0.267 0.267 rg BT 538.379 247.665 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 234.253 Td /F1 9.8 Tf [(Evaluation was by a survey of 271 people \(57% male; mean age 33 years\) before and after the intervention.)] TJ ET 0.267 0.267 0.267 rg BT 491.237 235.760 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 214.848 Td /F4 9.8 Tf [(1.1.3 Description of Interventions)] TJ ET BT 26.250 195.444 Td /F1 9.8 Tf [(The Eastwood et al. intervention for pandemic influenza was a simple telephone conversation, with a researcher delivering a )] TJ ET BT 26.250 183.539 Td /F1 9.8 Tf [(short script explaining the nature and effects of an influenza pandemic.)] TJ ET 0.267 0.267 0.267 rg BT 331.366 185.046 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 336.185 183.539 Td /F1 9.8 Tf [( The Dumais )] TJ ET BT 394.159 183.539 Td /F5 9.8 Tf [(et al.)] TJ ET BT 415.297 183.539 Td /F1 9.8 Tf [( intervention was developed by )] TJ ET BT 26.250 171.634 Td /F1 9.8 Tf [(conducting a pre-intervention survey of students understanding of viruses and forming an education programme based on )] TJ ET BT 26.250 159.729 Td /F1 9.8 Tf [(revealed insufficiencies.)] TJ ET 0.267 0.267 0.267 rg BT 129.746 161.237 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 134.565 159.729 Td /F1 9.8 Tf [( The intervention took place in an 80 minute session involving a lecture and discussion, and addressed )] TJ ET BT 26.250 147.825 Td /F1 9.8 Tf [(shortfalls in knowledge about virus biology. The aim of this intervention was to improve understanding of viruses to facilitate )] TJ ET BT 26.250 135.920 Td /F1 9.8 Tf [(response to risk communication about pandemic and epidemic influenza. The Roess )] TJ ET BT 393.113 135.920 Td /F5 9.8 Tf [(et al.)] TJ ET BT 414.251 135.920 Td /F1 9.8 Tf [( intervention was an outreach )] TJ ET BT 26.250 124.015 Td /F1 9.8 Tf [(education programme in villages in the Republic of Congo.)] TJ ET 0.267 0.267 0.267 rg BT 278.775 125.522 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 288.412 124.015 Td /F1 9.8 Tf [( Small group sessions were conducted using two specially made )] TJ ET BT 26.250 112.110 Td /F1 9.8 Tf [(educational videos and discussions about monkeypox in each village.)] TJ ET BT 26.250 92.706 Td /F4 9.8 Tf [(1.1.4 Results)] TJ ET BT 26.250 73.301 Td /F1 9.8 Tf [(All three studies were uncontrolled before and after studies. The Eastwood et al. study of pandemic influenza revealed that the )] TJ ET BT 26.250 61.396 Td /F1 9.8 Tf [(Australian public reported themselves to be largely willing to comply with the public health measures proposed, such as self-)] TJ ET BT 26.250 49.491 Td /F1 9.8 Tf [(quarantine and social distancing. Following the information intervention, they were even more likely to report their willingness to )] TJ ET BT 26.250 37.587 Td /F1 9.8 Tf [(self-isolate \(94.1% before to 97.5% after\), avoid public events \(94.2% to 98.3%\) and postpone gatherings \(90.7% to 97.2%\).)] TJ ET 0.267 0.267 0.267 rg BT 560.609 39.094 Td /F4 8.7 Tf [(6)] TJ ET Q q 15.000 23.301 577.500 753.699 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(United Kingdom)] TJ ET 0.267 0.267 0.267 rg BT 95.612 768.983 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 100.430 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 102.840 768.983 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 107.658 767.476 Td /F1 9.8 Tf [( and ten in the United States of America.)] TJ ET 0.267 0.267 0.267 rg BT 282.710 768.983 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 292.347 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 294.756 768.983 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 304.394 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 306.803 768.983 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 316.440 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 318.850 768.983 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 328.487 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 330.896 768.983 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 340.534 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 342.943 768.983 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 352.580 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 354.990 768.983 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 364.627 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 367.036 768.983 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 376.674 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 379.083 768.983 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 388.720 771.364 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 391.130 768.983 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 400.767 767.476 Td /F1 9.8 Tf [( One was conducted in Hong Kong,)] TJ ET 0.267 0.267 0.267 rg BT 554.144 768.983 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 26.250 755.571 Td /F1 9.8 Tf [(one in Thailand,)] TJ ET 0.267 0.267 0.267 rg BT 95.621 757.079 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 105.259 755.571 Td /F1 9.8 Tf [( one in Taiwan,)] TJ ET 0.267 0.267 0.267 rg BT 171.373 757.079 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 181.011 755.571 Td /F1 9.8 Tf [( one in Singapore,)] TJ ET 0.267 0.267 0.267 rg BT 260.142 757.079 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 269.779 755.571 Td /F1 9.8 Tf [(one in Japan,)] TJ ET 0.267 0.267 0.267 rg BT 328.318 757.079 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 337.955 755.571 Td /F1 9.8 Tf [( and one in China.)] TJ ET 0.267 0.267 0.267 rg BT 417.086 757.079 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 426.724 755.571 Td /F1 9.8 Tf [( One study took place in Egypt,)] TJ ET 0.267 0.267 0.267 rg BT 561.673 757.079 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 26.250 743.667 Td /F1 9.8 Tf [(one in Iran,)] TJ ET 0.267 0.267 0.267 rg BT 75.029 745.174 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 84.667 743.667 Td /F1 9.8 Tf [( one in Republic of the Congo,)] TJ ET 0.267 0.267 0.267 rg BT 215.824 745.174 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 225.461 743.667 Td /F1 9.8 Tf [( one in Mauritius,)] TJ ET 0.267 0.267 0.267 rg BT 299.697 745.174 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 309.335 743.667 Td /F1 9.8 Tf [( one in India,)] TJ ET 0.267 0.267 0.267 rg BT 365.163 745.174 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 374.801 743.667 Td /F1 9.8 Tf [( one in Haiti)] TJ ET 0.267 0.267 0.267 rg BT 426.281 745.174 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 435.918 743.667 Td /F1 9.8 Tf [( and one took place on two )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(Caribbean islands: St. Vincent and the Grenadines, and Turks and Caicos Islands.)] TJ ET 0.267 0.267 0.267 rg BT 381.755 733.269 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 26.250 712.357 Td /F1 9.8 Tf [(Two studies focused on general disaster preparedness,)] TJ ET 0.267 0.267 0.267 rg BT 265.778 713.864 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 275.416 716.245 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 277.825 713.864 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 287.462 712.357 Td /F1 9.8 Tf [( one focused on five natural hazards,)] TJ ET 0.267 0.267 0.267 rg BT 447.343 713.864 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 456.980 712.357 Td /F1 9.8 Tf [( two on hurricanes only,)] TJ ET 0.267 0.267 0.267 rg BT 559.940 713.864 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 569.577 716.245 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 26.250 701.960 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 35.887 700.452 Td /F1 9.8 Tf [( one on a cyclone,)] TJ ET 0.267 0.267 0.267 rg BT 115.018 701.960 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 124.656 700.452 Td /F1 9.8 Tf [( one on floods only,)] TJ ET 0.267 0.267 0.267 rg BT 209.208 701.960 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 218.845 700.452 Td /F1 9.8 Tf [( two on wildfires,)] TJ ET 0.267 0.267 0.267 rg BT 290.907 701.960 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 300.545 704.341 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 302.954 701.960 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 312.591 700.452 Td /F1 9.8 Tf [( one on earthquakes)] TJ ET 0.267 0.267 0.267 rg BT 401.482 701.960 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 411.119 700.452 Td /F1 9.8 Tf [( and one on a terrorist attack.)] TJ ET 0.267 0.267 0.267 rg BT 537.938 701.960 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 547.575 700.452 Td /F1 9.8 Tf [( Four )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(studies dealt with water supply disasters.)] TJ ET 0.267 0.267 0.267 rg BT 202.900 690.055 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 207.719 692.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 210.129 690.055 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 219.766 692.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 222.175 690.055 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 231.813 692.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 234.222 690.055 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 243.859 688.548 Td /F1 9.8 Tf [( One dealt with radiation.)] TJ ET 0.267 0.267 0.267 rg BT 351.704 690.055 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 361.341 688.548 Td /F1 9.8 Tf [( The remaining studies focused on infectious )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(disease disasters: Three studied pandemic influenza,)] TJ ET 0.267 0.267 0.267 rg BT 256.019 678.150 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 260.837 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 263.246 678.150 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 268.065 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 270.475 678.150 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 280.112 676.643 Td /F1 9.8 Tf [( three focused on the SARS epidemic,)] TJ ET 0.267 0.267 0.267 rg BT 445.404 678.150 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 455.041 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 457.450 678.150 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 467.088 680.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 469.497 678.150 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 479.134 676.643 Td /F1 9.8 Tf [( one on an outbreak of )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(avian influenza,)] TJ ET 0.267 0.267 0.267 rg BT 93.993 666.245 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 103.630 664.738 Td /F1 9.8 Tf [( one on an epidemic of acute haemorrhagic conjunctivitis,)] TJ ET 0.267 0.267 0.267 rg BT 351.826 666.245 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 361.464 664.738 Td /F1 9.8 Tf [( one followed an outbreak of monkeypox)] TJ ET 0.267 0.267 0.267 rg BT 536.515 666.245 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 546.153 664.738 Td /F1 9.8 Tf [( and )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(one dealt with an outbreak of meningococcal disease.)] TJ ET 0.267 0.267 0.267 rg BT 258.202 654.341 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 633.429 Td /F1 9.8 Tf [(There were several different types of communication method used in these studies. Mitigation and preparedness interventions )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(used face-to-face group participation and education in eight studies,)] TJ ET 0.267 0.267 0.267 rg BT 318.906 623.031 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 323.725 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 326.134 623.031 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 330.953 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 333.362 623.031 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 342.999 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 345.409 623.031 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 355.046 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 357.455 623.031 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 367.093 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 369.502 623.031 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 379.139 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 381.549 623.031 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 391.186 625.412 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 393.595 623.031 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 403.233 621.524 Td /F1 9.8 Tf [( one of which included the use of a )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(specially designed board game.)] TJ ET 0.267 0.267 0.267 rg BT 163.355 611.126 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 172.992 609.619 Td /F1 9.8 Tf [( Two early warning alerts used several communication channels)] TJ ET 0.267 0.267 0.267 rg BT 449.336 611.126 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 458.973 613.507 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 461.383 611.126 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 471.020 609.619 Td /F1 9.8 Tf [( and another used )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(Reverse-911.)] TJ ET 0.267 0.267 0.267 rg BT 84.769 599.222 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 94.407 597.714 Td /F1 9.8 Tf [( Mitigation and preparedness studies that did not use face-to-face communication used a telephone intervention,)] TJ ET 0.267 0.267 0.267 rg BT 26.250 587.317 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 31.069 585.810 Td /F1 9.8 Tf [( and a computer game.)] TJ ET 0.267 0.267 0.267 rg BT 131.328 587.317 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 140.965 585.810 Td /F1 9.8 Tf [( The response phase interventions were multi-channel information campaigns \(with different methods )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(and balance of methods between studies\))] TJ ET 0.267 0.267 0.267 rg BT 206.722 575.412 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 211.541 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 213.951 575.412 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 218.769 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 221.179 575.412 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 230.816 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 233.225 575.412 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 242.863 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 245.272 575.412 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 254.909 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 257.319 575.412 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 266.956 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 269.365 575.412 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 279.003 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 281.412 575.412 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 291.049 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 293.459 575.412 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 303.096 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 305.505 575.412 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 315.143 577.793 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 317.552 575.412 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 327.189 573.905 Td /F1 9.8 Tf [( and a school-based participatory intensive education )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(programme.)] TJ ET 0.267 0.267 0.267 rg BT 78.803 563.507 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 88.440 562.000 Td /F1 9.8 Tf [( The three recovery phase interventions used media campaigns to encourage members of the public to access )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(telephone help lines for mental health problems and to undertake healthy behaviours following disasters.)] TJ ET 0.267 0.267 0.267 rg BT 476.593 551.603 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 486.230 553.984 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 488.639 551.603 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 498.277 553.984 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 500.686 551.603 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 26.250 530.691 Td /F1 9.8 Tf [(The objectives of the interventions were to improve the health knowledge and behaviour in relation to disasters, and to decrease )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(the incidence of negative health events. The studies were chosen on that basis, and several studies reported additional )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(outcomes that were outside the scope of this review. The knowledge, behaviour and incidence outcomes are described in detail )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(in Appendix 3 \(characteristics and results of included studies\).)] TJ ET BT 26.250 458.374 Td /F4 12.0 Tf [(Results of Individual Studies)] TJ ET BT 26.250 438.420 Td /F4 9.8 Tf [(1 Effect of Risk Communication Interventions to Promote Disaster Mitigation and Preparedness)] TJ ET BT 26.250 419.015 Td /F4 9.8 Tf [(1.1 Communication to Promote Mitigation and Preparedness for Infectious Disease Disasters)] TJ ET BT 26.250 399.610 Td /F4 9.8 Tf [(1.1.1 Setting)] TJ ET BT 26.250 380.205 Td /F1 9.8 Tf [(Two studies for pandemic influenza took place in high-income countries \(Canada)] TJ ET 0.267 0.267 0.267 rg BT 374.686 381.713 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 379.504 380.205 Td /F1 9.8 Tf [( and Australia)] TJ ET 0.267 0.267 0.267 rg BT 439.116 381.713 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 443.935 380.205 Td /F1 9.8 Tf [(\), and one study for )] TJ ET BT 26.250 368.301 Td /F1 9.8 Tf [(monkeypox took place in a low-income country \(Republic of the Congo\).)] TJ ET 0.267 0.267 0.267 rg BT 336.748 369.808 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 346.386 368.301 Td /F1 9.8 Tf [( Both studies of interventions for pandemic influenza )] TJ ET BT 26.250 356.396 Td /F1 9.8 Tf [(took place in 2008, before the 2009 H1N1 pandemic. The study of an intervention for monkeypox took place in 2009, six years )] TJ ET BT 26.250 344.491 Td /F1 9.8 Tf [(after an outbreak in Republic of the Congo, and subsequent to a serological survey that suggested that past infection was )] TJ ET BT 26.250 332.586 Td /F1 9.8 Tf [(widespread. Monkeypox is a potentially fatal disease that is related to smallpox, incidence of which is thought to have increased )] TJ ET BT 26.250 320.682 Td /F1 9.8 Tf [(following the discontinuation of the smallpox vaccine in 1980.)] TJ ET 0.267 0.267 0.267 rg BT 289.627 322.189 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 301.277 Td /F4 9.8 Tf [(1.1.2 Participants)] TJ ET BT 26.250 281.872 Td /F1 9.8 Tf [(The Australian study by Eastwood )] TJ ET BT 176.361 281.872 Td /F5 9.8 Tf [(et al.)] TJ ET BT 197.499 281.872 Td /F1 9.8 Tf [( of a pandemic influenza mitigation intervention included 1,166 individuals \(62% female\) )] TJ ET BT 26.250 269.967 Td /F1 9.8 Tf [(who were contacted by telephone \(58% response rate\).)] TJ ET 0.267 0.267 0.267 rg BT 265.242 271.475 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 270.061 269.967 Td /F1 9.8 Tf [( Dumais et al. reported an educational intervention in a class of 35 )] TJ ET BT 26.250 258.063 Td /F1 9.8 Tf [(female year 10 students in a private school in Canada.)] TJ ET 0.267 0.267 0.267 rg BT 261.449 259.570 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 266.268 258.063 Td /F1 9.8 Tf [( The intervention in Republic of the Congo was delivered on a much )] TJ ET BT 26.250 246.158 Td /F1 9.8 Tf [(greater scale: approximately 23,860 people in 16 towns and villages received the intervention over a period of 90 days.)] TJ ET 0.267 0.267 0.267 rg BT 538.379 247.665 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 234.253 Td /F1 9.8 Tf [(Evaluation was by a survey of 271 people \(57% male; mean age 33 years\) before and after the intervention.)] TJ ET 0.267 0.267 0.267 rg BT 491.237 235.760 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 214.848 Td /F4 9.8 Tf [(1.1.3 Description of Interventions)] TJ ET BT 26.250 195.444 Td /F1 9.8 Tf [(The Eastwood et al. intervention for pandemic influenza was a simple telephone conversation, with a researcher delivering a )] TJ ET BT 26.250 183.539 Td /F1 9.8 Tf [(short script explaining the nature and effects of an influenza pandemic.)] TJ ET 0.267 0.267 0.267 rg BT 331.366 185.046 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 336.185 183.539 Td /F1 9.8 Tf [( The Dumais )] TJ ET BT 394.159 183.539 Td /F5 9.8 Tf [(et al.)] TJ ET BT 415.297 183.539 Td /F1 9.8 Tf [( intervention was developed by )] TJ ET BT 26.250 171.634 Td /F1 9.8 Tf [(conducting a pre-intervention survey of students understanding of viruses and forming an education programme based on )] TJ ET BT 26.250 159.729 Td /F1 9.8 Tf [(revealed insufficiencies.)] TJ ET 0.267 0.267 0.267 rg BT 129.746 161.237 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 134.565 159.729 Td /F1 9.8 Tf [( The intervention took place in an 80 minute session involving a lecture and discussion, and addressed )] TJ ET BT 26.250 147.825 Td /F1 9.8 Tf [(shortfalls in knowledge about virus biology. The aim of this intervention was to improve understanding of viruses to facilitate )] TJ ET BT 26.250 135.920 Td /F1 9.8 Tf [(response to risk communication about pandemic and epidemic influenza. The Roess )] TJ ET BT 393.113 135.920 Td /F5 9.8 Tf [(et al.)] TJ ET BT 414.251 135.920 Td /F1 9.8 Tf [( intervention was an outreach )] TJ ET BT 26.250 124.015 Td /F1 9.8 Tf [(education programme in villages in the Republic of Congo.)] TJ ET 0.267 0.267 0.267 rg BT 278.775 125.522 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 288.412 124.015 Td /F1 9.8 Tf [( Small group sessions were conducted using two specially made )] TJ ET BT 26.250 112.110 Td /F1 9.8 Tf [(educational videos and discussions about monkeypox in each village.)] TJ ET BT 26.250 92.706 Td /F4 9.8 Tf [(1.1.4 Results)] TJ ET BT 26.250 73.301 Td /F1 9.8 Tf [(All three studies were uncontrolled before and after studies. The Eastwood et al. study of pandemic influenza revealed that the )] TJ ET BT 26.250 61.396 Td /F1 9.8 Tf [(Australian public reported themselves to be largely willing to comply with the public health measures proposed, such as self-)] TJ ET BT 26.250 49.491 Td /F1 9.8 Tf [(quarantine and social distancing. Following the information intervention, they were even more likely to report their willingness to )] TJ ET BT 26.250 37.587 Td /F1 9.8 Tf [(self-isolate \(94.1% before to 97.5% after\), avoid public events \(94.2% to 98.3%\) and postpone gatherings \(90.7% to 97.2%\).)] TJ ET 0.267 0.267 0.267 rg BT 560.609 39.094 Td /F4 8.7 Tf [(6)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(4)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 138 0 obj << /Type /Font /Subtype /Type1 /Name /F5 /BaseFont /Helvetica-Oblique /Encoding /WinAnsiEncoding >> endobj 139 0 obj << /Type /Annot /Subtype /Link /A 140 0 R /Border [0 0 0] /H /I /Rect [ 95.6115 768.1817 100.4302 777.0000 ] >> endobj 140 0 obj << /Type /Action >> endobj 141 0 obj << /Type /Annot /Subtype /Link /A 142 0 R /Border [0 0 0] /H /I /Rect [ 102.8395 768.1817 107.6582 777.0000 ] >> endobj 142 0 obj << /Type /Action >> endobj 143 0 obj << /Type /Annot /Subtype /Link /A 144 0 R 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442.419 757.079 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 447.238 755.571 Td /F1 9.8 Tf [( Roess )] TJ ET BT 480.290 755.571 Td /F5 9.8 Tf [(et al.)] TJ ET BT 501.428 755.571 Td /F1 9.8 Tf [( analysed their )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(before and after study using paired analyses.)] TJ ET 0.267 0.267 0.267 rg BT 220.811 745.174 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 230.449 743.667 Td /F1 9.8 Tf [( Significant improvements were noted in outcomes related to recognising )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(monkeypox and knowledge of how it is transmitted. The numbers of people who knew at least one symptom increased from )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(49% to 95%, named rash and fever as symptoms increased from 11% to 32%, and knew that the rash occurs on palms and )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(soles increased from 14% to 51%. The numbers of people who knew that the disease could be transmitted by contact with an ill )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(person increased 28% to 58%, by fomites \(2% to 14%\), by contact with an ill animal \(24% to 64%\) and contact with a dead )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(animal \(7% to 19%\). There were significant improvements in four appropriate behavioural actions. Whilst there was a reduction )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(in the number of who would eat or sell found rodent carcasses \(eating, 33% to 16%; selling 7% to 3%\), there was no reduction )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(in the number who would eat or sell primate carcasses \(eat, 11%; sell, 4%\).)] TJ ET 0.267 0.267 0.267 rg BT 351.373 661.841 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 361.011 660.333 Td /F1 9.8 Tf [( The authors noted that the programme had )] TJ ET BT 26.250 648.429 Td /F1 9.8 Tf [(shown effectiveness in increasing knowledge, and might encourage participants to seek healthcare if monkeypox was )] TJ ET BT 26.250 636.524 Td /F1 9.8 Tf [(suspected, but suggested that future strategies should focus on prevention of risk behaviours. The design used in all three )] TJ ET BT 26.250 624.619 Td /F1 9.8 Tf [(infectious disease mitigation or preparedness studies means that inferring causality from the reports is difficult. Alternative )] TJ ET BT 26.250 612.714 Td /F1 9.8 Tf [(explanations for the improvements in knowledge and behaviour include an observer effect, which might influence self-reported )] TJ ET BT 26.250 600.810 Td /F1 9.8 Tf [(behaviour in the study of monkeypox and the Australian study of pandemic influenza.)] TJ ET 0.267 0.267 0.267 rg BT 392.606 602.317 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 26.250 581.405 Td /F4 9.8 Tf [(1.2 Communication to Promote Preparedness for Natural Disasters)] TJ ET BT 26.250 562.000 Td /F4 9.8 Tf [(1.2.1 Setting)] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(Five studies of preparedness for natural disasters were identified. Two studies took place in the USA,)] TJ ET 0.267 0.267 0.267 rg BT 461.938 544.103 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 471.576 546.484 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 473.985 544.103 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 483.623 542.595 Td /F1 9.8 Tf [( one in Japan,)] TJ ET 0.267 0.267 0.267 rg BT 544.872 544.103 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 554.509 542.595 Td /F1 9.8 Tf [( one )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(in Iran)] TJ ET 0.267 0.267 0.267 rg BT 53.345 532.198 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 62.983 530.691 Td /F1 9.8 Tf [( and one on the Carribean islands of St. Vincent and the Grenadines, and Turks and Caicos.)] TJ ET 0.267 0.267 0.267 rg BT 461.319 532.198 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 470.956 530.691 Td /F1 9.8 Tf [( Two studies were )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(aimed at general preparedness,)] TJ ET 0.267 0.267 0.267 rg BT 163.900 520.293 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 173.538 522.674 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 175.947 520.293 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 185.585 518.786 Td /F1 9.8 Tf [( one preparedness for flash floods,)] TJ ET 0.267 0.267 0.267 rg BT 335.705 520.293 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 345.343 518.786 Td /F1 9.8 Tf [( one for earthquakes,)] TJ ET 0.267 0.267 0.267 rg BT 437.480 520.293 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 447.117 518.786 Td /F1 9.8 Tf [( and one for five natural )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(hazards.)] TJ ET 0.267 0.267 0.267 rg BT 63.641 508.388 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 26.250 487.476 Td /F4 9.8 Tf [(1.2.2 Participants)] TJ ET BT 26.250 468.072 Td /F1 9.8 Tf [(Eisenman )] TJ ET BT 72.309 468.072 Td /F5 9.8 Tf [(et al. )] TJ ET BT 96.157 468.072 Td /F1 9.8 Tf [(reported a randomised trial of 231 Latino people who lived in Los Angeles County, California, USA, of whom )] TJ ET BT 26.250 456.167 Td /F1 9.8 Tf [(187 completed the study \(a per protocol analysis was presented; mean age was 37 years; both groups were approximately two )] TJ ET BT 26.250 444.262 Td /F1 9.8 Tf [(thirds female\).)] TJ ET 0.267 0.267 0.267 rg BT 88.016 445.769 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 97.654 444.262 Td /F1 9.8 Tf [( Yasunari et al. reported a cluster non-randomised trial at different hospital sites with 99 primiparous women )] TJ ET BT 26.250 432.357 Td /F1 9.8 Tf [(\(mean age 31 years; mean gestation 22.9 weeks\) in the intervention group \(of 993 who attended these sessions\) and 104 )] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(primiparous women \(mean age 31 years; mean gestational 24.7 weeks\) in the control group \(of 1,010 who attended the control )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(sessions\).)] TJ ET 0.267 0.267 0.267 rg BT 70.135 410.055 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 79.772 408.548 Td /F1 9.8 Tf [( Tanes reported a cluster randomised trial of 250 college students \(62% male\) from a large Midwestern university.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 398.150 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 35.887 400.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 38.297 398.150 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 47.934 396.643 Td /F1 9.8 Tf [( Students selected a time slot to attend for the intervention, and the time slots were randomly assigned to an intervention. )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(Clerveaux )] TJ ET BT 72.845 384.738 Td /F5 9.8 Tf [(et al.)] TJ ET BT 93.983 384.738 Td /F1 9.8 Tf [( conducted an uncontrolled cluster before and after study with 42 grade 5 pupils, with mean age 11 years, from )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(St. Vincent and the Grenadines, and 33 Grade 5 pupils, with mean age 10 years, from Turks and Caicos.)] TJ ET 0.267 0.267 0.267 rg BT 478.221 374.341 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 487.858 372.834 Td /F1 9.8 Tf [( Ardalan conducted )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(a cluster non-randomised trial in two rural flood-prone areas of Golestan Provence, Iran using independent pre- and post-)] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(intervention samples in each area.)] TJ ET 0.267 0.267 0.267 rg BT 174.733 350.531 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 184.370 349.024 Td /F1 9.8 Tf [( The intervention group included 1,163 participants pre-intervention and 1,159 post-)] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(intervention. The control group included 1,200 pre-intervention and 1,210 post-intervention. The mean age for each group was )] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(between 27 and 29 years, and females were slightly more numerous in each group \(52% to 59%\).)] TJ ET 0.267 0.267 0.267 rg BT 447.860 326.722 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 26.250 305.810 Td /F4 9.8 Tf [(1.2.3 Description of Interventions)] TJ ET BT 26.250 286.405 Td /F1 9.8 Tf [(Ardalan )] TJ ET BT 62.559 286.405 Td /F5 9.8 Tf [(et al. )] TJ ET BT 86.407 286.405 Td /F1 9.8 Tf [(used a community participation approach to preparedness and mitigation of flood disasters.)] TJ ET 0.267 0.267 0.267 rg BT 479.840 287.912 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 489.477 286.405 Td /F1 9.8 Tf [( Village disaster )] TJ ET BT 26.250 274.500 Td /F1 9.8 Tf [(teams were developed, were trained, and then conducted training for local people that included identifying areas at risk of )] TJ ET BT 26.250 262.596 Td /F1 9.8 Tf [(flooding, developing personalised plans, developing an early warning system and conducting evacuation exercises over three )] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(months.)] TJ ET 0.267 0.267 0.267 rg BT 60.931 252.198 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 70.568 250.691 Td /F1 9.8 Tf [( Eisenman )] TJ ET BT 119.338 250.691 Td /F5 9.8 Tf [(et al.)] TJ ET BT 140.476 250.691 Td /F1 9.8 Tf [( used a randomised trial to compare small group discussions with community health promotion )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(officers lasting one hour \(high-intensity intervention\) compared to simply receiving written information \(low-intensity intervention\) )] TJ ET BT 26.250 226.881 Td /F1 9.8 Tf [(for Latino residents of Los Angeles County, USA.)] TJ ET 0.267 0.267 0.267 rg BT 238.147 228.389 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 247.784 226.881 Td /F1 9.8 Tf [( A study of pregnant women in Japan offered six 15-minute disaster )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(preparedness classes as part of normal antenatal classes in a cluster non-randomised trial.)] TJ ET 0.267 0.267 0.267 rg BT 419.116 216.484 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 428.754 214.977 Td /F1 9.8 Tf [( Participants in the intervention )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(group were instructed about preparedness, communication and receiving medical attention in disasters. Controls received )] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(normal antenatal care.)] TJ ET 0.267 0.267 0.267 rg BT 123.253 192.674 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 132.890 191.167 Td /F1 9.8 Tf [( Two studies used games to educate participants about disaster preparedness. One used a specially )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(developed board game, the Disaster Awareness Game, to inform school children about disaster preparedness for floods, )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(hurricanes, volcanoes, landslides and mud flows.)] TJ ET 0.267 0.267 0.267 rg BT 238.127 168.865 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 247.765 167.358 Td /F1 9.8 Tf [( The intervention took place over two days and included discussion of the )] TJ ET BT 26.250 155.453 Td /F1 9.8 Tf [(topics raised by the game. Tanes used an existing computer game, Beat the Quake, developed in California, which was )] TJ ET BT 26.250 143.548 Td /F1 9.8 Tf [(designed to educate people about appropriate steps to take in the event of an earthquake.)] TJ ET 0.267 0.267 0.267 rg BT 414.875 145.055 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 424.513 147.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 426.922 145.055 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 26.250 124.143 Td /F4 9.8 Tf [(1.2.4 Results)] TJ ET BT 26.250 104.739 Td /F1 9.8 Tf [(Community flood risk preparedness programme participants were much more likely to have taken the recommended )] TJ ET BT 26.250 92.834 Td /F1 9.8 Tf [(preparedness steps than people who lived in areas without the intervention.)] TJ ET 0.267 0.267 0.267 rg BT 351.959 94.341 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 361.596 92.834 Td /F1 9.8 Tf [( Adjusted odds ratios for the intervention group )] TJ ET BT 26.250 80.929 Td /F1 9.8 Tf [(ranged from 6 to 50 for outcomes such as having a family preparedness meeting, risk mapping, having emergency supplies, )] TJ ET BT 26.250 69.024 Td /F1 9.8 Tf [(having a plan for vulnerable people and having an evacuation drill. Control group odds ratios \(comparing before and after\) for )] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(the same measures ranged from 0.4 to 2.7.)] TJ ET 0.267 0.267 0.267 rg BT 213.216 58.627 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 222.853 57.120 Td /F1 9.8 Tf [( Latino people who took part in a community-based preparedness discussion with )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(a health promoter and people who received written information made significant improvements in disaster preparedness )] TJ ET Q q 15.000 30.929 577.500 746.071 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(Participants in the Canadian study of influenza increased their knowledge scores between a pre- and post-intervention test \(with )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(a significant change in mean score from 0.2 to 1.3, where 2.0 was the maximum possible score\).)] TJ ET 0.267 0.267 0.267 rg BT 442.419 757.079 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 447.238 755.571 Td /F1 9.8 Tf [( Roess )] TJ ET BT 480.290 755.571 Td /F5 9.8 Tf [(et al.)] TJ ET BT 501.428 755.571 Td /F1 9.8 Tf [( analysed their )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(before and after study using paired analyses.)] TJ ET 0.267 0.267 0.267 rg BT 220.811 745.174 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 230.449 743.667 Td /F1 9.8 Tf [( Significant improvements were noted in outcomes related to recognising )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(monkeypox and knowledge of how it is transmitted. The numbers of people who knew at least one symptom increased from )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(49% to 95%, named rash and fever as symptoms increased from 11% to 32%, and knew that the rash occurs on palms and )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(soles increased from 14% to 51%. The numbers of people who knew that the disease could be transmitted by contact with an ill )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(person increased 28% to 58%, by fomites \(2% to 14%\), by contact with an ill animal \(24% to 64%\) and contact with a dead )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(animal \(7% to 19%\). There were significant improvements in four appropriate behavioural actions. Whilst there was a reduction )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(in the number of who would eat or sell found rodent carcasses \(eating, 33% to 16%; selling 7% to 3%\), there was no reduction )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(in the number who would eat or sell primate carcasses \(eat, 11%; sell, 4%\).)] TJ ET 0.267 0.267 0.267 rg BT 351.373 661.841 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 361.011 660.333 Td /F1 9.8 Tf [( The authors noted that the programme had )] TJ ET BT 26.250 648.429 Td /F1 9.8 Tf [(shown effectiveness in increasing knowledge, and might encourage participants to seek healthcare if monkeypox was )] TJ ET BT 26.250 636.524 Td /F1 9.8 Tf [(suspected, but suggested that future strategies should focus on prevention of risk behaviours. The design used in all three )] TJ ET BT 26.250 624.619 Td /F1 9.8 Tf [(infectious disease mitigation or preparedness studies means that inferring causality from the reports is difficult. Alternative )] TJ ET BT 26.250 612.714 Td /F1 9.8 Tf [(explanations for the improvements in knowledge and behaviour include an observer effect, which might influence self-reported )] TJ ET BT 26.250 600.810 Td /F1 9.8 Tf [(behaviour in the study of monkeypox and the Australian study of pandemic influenza.)] TJ ET 0.267 0.267 0.267 rg BT 392.606 602.317 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 26.250 581.405 Td /F4 9.8 Tf [(1.2 Communication to Promote Preparedness for Natural Disasters)] TJ ET BT 26.250 562.000 Td /F4 9.8 Tf [(1.2.1 Setting)] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(Five studies of preparedness for natural disasters were identified. Two studies took place in the USA,)] TJ ET 0.267 0.267 0.267 rg BT 461.938 544.103 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 471.576 546.484 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 473.985 544.103 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 483.623 542.595 Td /F1 9.8 Tf [( one in Japan,)] TJ ET 0.267 0.267 0.267 rg BT 544.872 544.103 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 554.509 542.595 Td /F1 9.8 Tf [( one )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(in Iran)] TJ ET 0.267 0.267 0.267 rg BT 53.345 532.198 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 62.983 530.691 Td /F1 9.8 Tf [( and one on the Carribean islands of St. Vincent and the Grenadines, and Turks and Caicos.)] TJ ET 0.267 0.267 0.267 rg BT 461.319 532.198 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 470.956 530.691 Td /F1 9.8 Tf [( Two studies were )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(aimed at general preparedness,)] TJ ET 0.267 0.267 0.267 rg BT 163.900 520.293 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 173.538 522.674 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 175.947 520.293 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 185.585 518.786 Td /F1 9.8 Tf [( one preparedness for flash floods,)] TJ ET 0.267 0.267 0.267 rg BT 335.705 520.293 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 345.343 518.786 Td /F1 9.8 Tf [( one for earthquakes,)] TJ ET 0.267 0.267 0.267 rg BT 437.480 520.293 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 447.117 518.786 Td /F1 9.8 Tf [( and one for five natural )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(hazards.)] TJ ET 0.267 0.267 0.267 rg BT 63.641 508.388 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 26.250 487.476 Td /F4 9.8 Tf [(1.2.2 Participants)] TJ ET BT 26.250 468.072 Td /F1 9.8 Tf [(Eisenman )] TJ ET BT 72.309 468.072 Td /F5 9.8 Tf [(et al. )] TJ ET BT 96.157 468.072 Td /F1 9.8 Tf [(reported a randomised trial of 231 Latino people who lived in Los Angeles County, California, USA, of whom )] TJ ET BT 26.250 456.167 Td /F1 9.8 Tf [(187 completed the study \(a per protocol analysis was presented; mean age was 37 years; both groups were approximately two )] TJ ET BT 26.250 444.262 Td /F1 9.8 Tf [(thirds female\).)] TJ ET 0.267 0.267 0.267 rg BT 88.016 445.769 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 97.654 444.262 Td /F1 9.8 Tf [( Yasunari et al. reported a cluster non-randomised trial at different hospital sites with 99 primiparous women )] TJ ET BT 26.250 432.357 Td /F1 9.8 Tf [(\(mean age 31 years; mean gestation 22.9 weeks\) in the intervention group \(of 993 who attended these sessions\) and 104 )] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(primiparous women \(mean age 31 years; mean gestational 24.7 weeks\) in the control group \(of 1,010 who attended the control )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(sessions\).)] TJ ET 0.267 0.267 0.267 rg BT 70.135 410.055 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 79.772 408.548 Td /F1 9.8 Tf [( Tanes reported a cluster randomised trial of 250 college students \(62% male\) from a large Midwestern university.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 398.150 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 35.887 400.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 38.297 398.150 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 47.934 396.643 Td /F1 9.8 Tf [( Students selected a time slot to attend for the intervention, and the time slots were randomly assigned to an intervention. )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(Clerveaux )] TJ ET BT 72.845 384.738 Td /F5 9.8 Tf [(et al.)] TJ ET BT 93.983 384.738 Td /F1 9.8 Tf [( conducted an uncontrolled cluster before and after study with 42 grade 5 pupils, with mean age 11 years, from )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(St. Vincent and the Grenadines, and 33 Grade 5 pupils, with mean age 10 years, from Turks and Caicos.)] TJ ET 0.267 0.267 0.267 rg BT 478.221 374.341 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 487.858 372.834 Td /F1 9.8 Tf [( Ardalan conducted )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(a cluster non-randomised trial in two rural flood-prone areas of Golestan Provence, Iran using independent pre- and post-)] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(intervention samples in each area.)] TJ ET 0.267 0.267 0.267 rg BT 174.733 350.531 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 184.370 349.024 Td /F1 9.8 Tf [( The intervention group included 1,163 participants pre-intervention and 1,159 post-)] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(intervention. The control group included 1,200 pre-intervention and 1,210 post-intervention. The mean age for each group was )] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(between 27 and 29 years, and females were slightly more numerous in each group \(52% to 59%\).)] TJ ET 0.267 0.267 0.267 rg BT 447.860 326.722 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 26.250 305.810 Td /F4 9.8 Tf [(1.2.3 Description of Interventions)] TJ ET BT 26.250 286.405 Td /F1 9.8 Tf [(Ardalan )] TJ ET BT 62.559 286.405 Td /F5 9.8 Tf [(et al. )] TJ ET BT 86.407 286.405 Td /F1 9.8 Tf [(used a community participation approach to preparedness and mitigation of flood disasters.)] TJ ET 0.267 0.267 0.267 rg BT 479.840 287.912 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 489.477 286.405 Td /F1 9.8 Tf [( Village disaster )] TJ ET BT 26.250 274.500 Td /F1 9.8 Tf [(teams were developed, were trained, and then conducted training for local people that included identifying areas at risk of )] TJ ET BT 26.250 262.596 Td /F1 9.8 Tf [(flooding, developing personalised plans, developing an early warning system and conducting evacuation exercises over three )] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(months.)] TJ ET 0.267 0.267 0.267 rg BT 60.931 252.198 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 70.568 250.691 Td /F1 9.8 Tf [( Eisenman )] TJ ET BT 119.338 250.691 Td /F5 9.8 Tf [(et al.)] TJ ET BT 140.476 250.691 Td /F1 9.8 Tf [( used a randomised trial to compare small group discussions with community health promotion )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(officers lasting one hour \(high-intensity intervention\) compared to simply receiving written information \(low-intensity intervention\) )] TJ ET BT 26.250 226.881 Td /F1 9.8 Tf [(for Latino residents of Los Angeles County, USA.)] TJ ET 0.267 0.267 0.267 rg BT 238.147 228.389 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 247.784 226.881 Td /F1 9.8 Tf [( A study of pregnant women in Japan offered six 15-minute disaster )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(preparedness classes as part of normal antenatal classes in a cluster non-randomised trial.)] TJ ET 0.267 0.267 0.267 rg BT 419.116 216.484 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 428.754 214.977 Td /F1 9.8 Tf [( Participants in the intervention )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(group were instructed about preparedness, communication and receiving medical attention in disasters. Controls received )] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(normal antenatal care.)] TJ ET 0.267 0.267 0.267 rg BT 123.253 192.674 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 132.890 191.167 Td /F1 9.8 Tf [( Two studies used games to educate participants about disaster preparedness. One used a specially )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(developed board game, the Disaster Awareness Game, to inform school children about disaster preparedness for floods, )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(hurricanes, volcanoes, landslides and mud flows.)] TJ ET 0.267 0.267 0.267 rg BT 238.127 168.865 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 247.765 167.358 Td /F1 9.8 Tf [( The intervention took place over two days and included discussion of the )] TJ ET BT 26.250 155.453 Td /F1 9.8 Tf [(topics raised by the game. Tanes used an existing computer game, Beat the Quake, developed in California, which was )] TJ ET BT 26.250 143.548 Td /F1 9.8 Tf [(designed to educate people about appropriate steps to take in the event of an earthquake.)] TJ ET 0.267 0.267 0.267 rg BT 414.875 145.055 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 424.513 147.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 426.922 145.055 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 26.250 124.143 Td /F4 9.8 Tf [(1.2.4 Results)] TJ ET BT 26.250 104.739 Td /F1 9.8 Tf [(Community flood risk preparedness programme participants were much more likely to have taken the recommended )] TJ ET BT 26.250 92.834 Td /F1 9.8 Tf [(preparedness steps than people who lived in areas without the intervention.)] TJ ET 0.267 0.267 0.267 rg BT 351.959 94.341 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 361.596 92.834 Td /F1 9.8 Tf [( Adjusted odds ratios for the intervention group )] TJ ET BT 26.250 80.929 Td /F1 9.8 Tf [(ranged from 6 to 50 for outcomes such as having a family preparedness meeting, risk mapping, having emergency supplies, )] TJ ET BT 26.250 69.024 Td /F1 9.8 Tf [(having a plan for vulnerable people and having an evacuation drill. Control group odds ratios \(comparing before and after\) for )] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(the same measures ranged from 0.4 to 2.7.)] TJ ET 0.267 0.267 0.267 rg BT 213.216 58.627 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 222.853 57.120 Td /F1 9.8 Tf [( Latino people who took part in a community-based preparedness discussion with )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(a health promoter and people who received written information made significant improvements in disaster preparedness )] TJ ET Q q 15.000 30.929 577.500 746.071 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(Participants in the Canadian study of influenza increased their knowledge scores between a pre- and post-intervention test \(with )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(a significant change in mean score from 0.2 to 1.3, where 2.0 was the maximum possible score\).)] TJ ET 0.267 0.267 0.267 rg BT 442.419 757.079 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 447.238 755.571 Td /F1 9.8 Tf [( Roess )] TJ ET BT 480.290 755.571 Td /F5 9.8 Tf [(et al.)] TJ ET BT 501.428 755.571 Td /F1 9.8 Tf [( analysed their )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(before and after study using paired analyses.)] TJ ET 0.267 0.267 0.267 rg BT 220.811 745.174 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 230.449 743.667 Td /F1 9.8 Tf [( Significant improvements were noted in outcomes related to recognising )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(monkeypox and knowledge of how it is transmitted. The numbers of people who knew at least one symptom increased from )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(49% to 95%, named rash and fever as symptoms increased from 11% to 32%, and knew that the rash occurs on palms and )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(soles increased from 14% to 51%. The numbers of people who knew that the disease could be transmitted by contact with an ill )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(person increased 28% to 58%, by fomites \(2% to 14%\), by contact with an ill animal \(24% to 64%\) and contact with a dead )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(animal \(7% to 19%\). There were significant improvements in four appropriate behavioural actions. Whilst there was a reduction )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(in the number of who would eat or sell found rodent carcasses \(eating, 33% to 16%; selling 7% to 3%\), there was no reduction )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(in the number who would eat or sell primate carcasses \(eat, 11%; sell, 4%\).)] TJ ET 0.267 0.267 0.267 rg BT 351.373 661.841 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 361.011 660.333 Td /F1 9.8 Tf [( The authors noted that the programme had )] TJ ET BT 26.250 648.429 Td /F1 9.8 Tf [(shown effectiveness in increasing knowledge, and might encourage participants to seek healthcare if monkeypox was )] TJ ET BT 26.250 636.524 Td /F1 9.8 Tf [(suspected, but suggested that future strategies should focus on prevention of risk behaviours. The design used in all three )] TJ ET BT 26.250 624.619 Td /F1 9.8 Tf [(infectious disease mitigation or preparedness studies means that inferring causality from the reports is difficult. Alternative )] TJ ET BT 26.250 612.714 Td /F1 9.8 Tf [(explanations for the improvements in knowledge and behaviour include an observer effect, which might influence self-reported )] TJ ET BT 26.250 600.810 Td /F1 9.8 Tf [(behaviour in the study of monkeypox and the Australian study of pandemic influenza.)] TJ ET 0.267 0.267 0.267 rg BT 392.606 602.317 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 26.250 581.405 Td /F4 9.8 Tf [(1.2 Communication to Promote Preparedness for Natural Disasters)] TJ ET BT 26.250 562.000 Td /F4 9.8 Tf [(1.2.1 Setting)] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(Five studies of preparedness for natural disasters were identified. Two studies took place in the USA,)] TJ ET 0.267 0.267 0.267 rg BT 461.938 544.103 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 471.576 546.484 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 473.985 544.103 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 483.623 542.595 Td /F1 9.8 Tf [( one in Japan,)] TJ ET 0.267 0.267 0.267 rg BT 544.872 544.103 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 554.509 542.595 Td /F1 9.8 Tf [( one )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(in Iran)] TJ ET 0.267 0.267 0.267 rg BT 53.345 532.198 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 62.983 530.691 Td /F1 9.8 Tf [( and one on the Carribean islands of St. Vincent and the Grenadines, and Turks and Caicos.)] TJ ET 0.267 0.267 0.267 rg BT 461.319 532.198 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 470.956 530.691 Td /F1 9.8 Tf [( Two studies were )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(aimed at general preparedness,)] TJ ET 0.267 0.267 0.267 rg BT 163.900 520.293 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 173.538 522.674 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 175.947 520.293 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 185.585 518.786 Td /F1 9.8 Tf [( one preparedness for flash floods,)] TJ ET 0.267 0.267 0.267 rg BT 335.705 520.293 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 345.343 518.786 Td /F1 9.8 Tf [( one for earthquakes,)] TJ ET 0.267 0.267 0.267 rg BT 437.480 520.293 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 447.117 518.786 Td /F1 9.8 Tf [( and one for five natural )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(hazards.)] TJ ET 0.267 0.267 0.267 rg BT 63.641 508.388 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 26.250 487.476 Td /F4 9.8 Tf [(1.2.2 Participants)] TJ ET BT 26.250 468.072 Td /F1 9.8 Tf [(Eisenman )] TJ ET BT 72.309 468.072 Td /F5 9.8 Tf [(et al. )] TJ ET BT 96.157 468.072 Td /F1 9.8 Tf [(reported a randomised trial of 231 Latino people who lived in Los Angeles County, California, USA, of whom )] TJ ET BT 26.250 456.167 Td /F1 9.8 Tf [(187 completed the study \(a per protocol analysis was presented; mean age was 37 years; both groups were approximately two )] TJ ET BT 26.250 444.262 Td /F1 9.8 Tf [(thirds female\).)] TJ ET 0.267 0.267 0.267 rg BT 88.016 445.769 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 97.654 444.262 Td /F1 9.8 Tf [( Yasunari et al. reported a cluster non-randomised trial at different hospital sites with 99 primiparous women )] TJ ET BT 26.250 432.357 Td /F1 9.8 Tf [(\(mean age 31 years; mean gestation 22.9 weeks\) in the intervention group \(of 993 who attended these sessions\) and 104 )] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(primiparous women \(mean age 31 years; mean gestational 24.7 weeks\) in the control group \(of 1,010 who attended the control )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(sessions\).)] TJ ET 0.267 0.267 0.267 rg BT 70.135 410.055 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 79.772 408.548 Td /F1 9.8 Tf [( Tanes reported a cluster randomised trial of 250 college students \(62% male\) from a large Midwestern university.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 398.150 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 35.887 400.531 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 38.297 398.150 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 47.934 396.643 Td /F1 9.8 Tf [( Students selected a time slot to attend for the intervention, and the time slots were randomly assigned to an intervention. )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(Clerveaux )] TJ ET BT 72.845 384.738 Td /F5 9.8 Tf [(et al.)] TJ ET BT 93.983 384.738 Td /F1 9.8 Tf [( conducted an uncontrolled cluster before and after study with 42 grade 5 pupils, with mean age 11 years, from )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(St. Vincent and the Grenadines, and 33 Grade 5 pupils, with mean age 10 years, from Turks and Caicos.)] TJ ET 0.267 0.267 0.267 rg BT 478.221 374.341 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 487.858 372.834 Td /F1 9.8 Tf [( Ardalan conducted )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(a cluster non-randomised trial in two rural flood-prone areas of Golestan Provence, Iran using independent pre- and post-)] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(intervention samples in each area.)] TJ ET 0.267 0.267 0.267 rg BT 174.733 350.531 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 184.370 349.024 Td /F1 9.8 Tf [( The intervention group included 1,163 participants pre-intervention and 1,159 post-)] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(intervention. The control group included 1,200 pre-intervention and 1,210 post-intervention. The mean age for each group was )] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(between 27 and 29 years, and females were slightly more numerous in each group \(52% to 59%\).)] TJ ET 0.267 0.267 0.267 rg BT 447.860 326.722 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 26.250 305.810 Td /F4 9.8 Tf [(1.2.3 Description of Interventions)] TJ ET BT 26.250 286.405 Td /F1 9.8 Tf [(Ardalan )] TJ ET BT 62.559 286.405 Td /F5 9.8 Tf [(et al. )] TJ ET BT 86.407 286.405 Td /F1 9.8 Tf [(used a community participation approach to preparedness and mitigation of flood disasters.)] TJ ET 0.267 0.267 0.267 rg BT 479.840 287.912 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 489.477 286.405 Td /F1 9.8 Tf [( Village disaster )] TJ ET BT 26.250 274.500 Td /F1 9.8 Tf [(teams were developed, were trained, and then conducted training for local people that included identifying areas at risk of )] TJ ET BT 26.250 262.596 Td /F1 9.8 Tf [(flooding, developing personalised plans, developing an early warning system and conducting evacuation exercises over three )] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(months.)] TJ ET 0.267 0.267 0.267 rg BT 60.931 252.198 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 70.568 250.691 Td /F1 9.8 Tf [( Eisenman )] TJ ET BT 119.338 250.691 Td /F5 9.8 Tf [(et al.)] TJ ET BT 140.476 250.691 Td /F1 9.8 Tf [( used a randomised trial to compare small group discussions with community health promotion )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(officers lasting one hour \(high-intensity intervention\) compared to simply receiving written information \(low-intensity intervention\) )] TJ ET BT 26.250 226.881 Td /F1 9.8 Tf [(for Latino residents of Los Angeles County, USA.)] TJ ET 0.267 0.267 0.267 rg BT 238.147 228.389 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 247.784 226.881 Td /F1 9.8 Tf [( A study of pregnant women in Japan offered six 15-minute disaster )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(preparedness classes as part of normal antenatal classes in a cluster non-randomised trial.)] TJ ET 0.267 0.267 0.267 rg BT 419.116 216.484 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 428.754 214.977 Td /F1 9.8 Tf [( Participants in the intervention )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(group were instructed about preparedness, communication and receiving medical attention in disasters. Controls received )] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(normal antenatal care.)] TJ ET 0.267 0.267 0.267 rg BT 123.253 192.674 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 132.890 191.167 Td /F1 9.8 Tf [( Two studies used games to educate participants about disaster preparedness. One used a specially )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(developed board game, the Disaster Awareness Game, to inform school children about disaster preparedness for floods, )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(hurricanes, volcanoes, landslides and mud flows.)] TJ ET 0.267 0.267 0.267 rg BT 238.127 168.865 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 247.765 167.358 Td /F1 9.8 Tf [( The intervention took place over two days and included discussion of the )] TJ ET BT 26.250 155.453 Td /F1 9.8 Tf [(topics raised by the game. Tanes used an existing computer game, Beat the Quake, developed in California, which was )] TJ ET BT 26.250 143.548 Td /F1 9.8 Tf [(designed to educate people about appropriate steps to take in the event of an earthquake.)] TJ ET 0.267 0.267 0.267 rg BT 414.875 145.055 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 424.513 147.436 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 426.922 145.055 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 26.250 124.143 Td /F4 9.8 Tf [(1.2.4 Results)] TJ ET BT 26.250 104.739 Td /F1 9.8 Tf [(Community flood risk preparedness programme participants were much more likely to have taken the recommended )] TJ ET BT 26.250 92.834 Td /F1 9.8 Tf [(preparedness steps than people who lived in areas without the intervention.)] TJ ET 0.267 0.267 0.267 rg BT 351.959 94.341 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 361.596 92.834 Td /F1 9.8 Tf [( Adjusted odds ratios for the intervention group )] TJ ET BT 26.250 80.929 Td /F1 9.8 Tf [(ranged from 6 to 50 for outcomes such as having a family preparedness meeting, risk mapping, having emergency supplies, )] TJ ET BT 26.250 69.024 Td /F1 9.8 Tf [(having a plan for vulnerable people and having an evacuation drill. Control group odds ratios \(comparing before and after\) for )] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(the same measures ranged from 0.4 to 2.7.)] TJ ET 0.267 0.267 0.267 rg BT 213.216 58.627 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 222.853 57.120 Td /F1 9.8 Tf [( Latino people who took part in a community-based preparedness discussion with )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(a health promoter and people who received written information made significant improvements in disaster preparedness )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(5)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 693 0 obj << /Type /Annot /Subtype /Link /A 694 0 R /Border [0 0 0] /H /I /Rect [ 442.4190 756.2769 447.2377 765.0952 ] >> endobj 694 0 obj << /Type /Action >> endobj 695 0 obj << /Type /Annot /Subtype /Link /A 696 0 R /Border [0 0 0] /H /I /Rect [ 220.8113 744.3722 230.4486 753.1905 ] >> endobj 696 0 obj << /Type /Action 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checklist.)] TJ ET 0.267 0.267 0.267 rg BT 187.730 768.983 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 197.367 767.476 Td /F1 9.8 Tf [( The )] TJ ET BT 219.587 767.476 Td /F5 9.8 Tf [(platica)] TJ ET BT 247.765 767.476 Td /F1 9.8 Tf [( \(discussion\) group was slightly better prepared for ten of 13 measures )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(before the intervention. Overall preparedness score for the written information group increased from 29% to 52%, and for the )] TJ ET BT 26.250 743.667 Td /F5 9.8 Tf [(platica)] TJ ET BT 54.427 743.667 Td /F1 9.8 Tf [( group increased from 38% to 76%.)] TJ ET 0.267 0.267 0.267 rg BT 207.249 745.174 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 216.886 743.667 Td /F1 9.8 Tf [( In the Yasunari )] TJ ET BT 287.886 743.667 Td /F5 9.8 Tf [(et al.)] TJ ET BT 309.024 743.667 Td /F1 9.8 Tf [( study of disaster education with antenatal care, the )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(intervention and control groups both showed non-statistically significant improvements in knowledge on all outcome measures, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(but no direct statistical comparison of the two groups was reported.)] TJ ET 0.267 0.267 0.267 rg BT 315.084 721.364 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 324.721 719.857 Td /F1 9.8 Tf [( The intervention group improved in knowledge of the )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(emergency telephone line \(69.7% to 82.8%\), the disaster message board \(51.5% to 67.7%\), local alternative maternity clinics )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(\(52.5% to 68.7%\), evacuation sites \(47.5% to 67.7%\) and being explain about own health status \(86.9% to 97%\).)] TJ ET 0.267 0.267 0.267 rg BT 512.385 697.555 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 522.022 696.048 Td /F1 9.8 Tf [( They also )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(were more likely to have discussed communication plan with family \(20.2% to 43.4%\), be able to find out family contact methods )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(\(46.5% to 70.7%\), take measures to prevent furniture turning over \(33.3% to 48.5%\) and objects falling \(20.2% to 34.3%\).)] TJ ET 0.267 0.267 0.267 rg BT 549.211 673.745 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 558.848 672.238 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(control group significantly improved in only taking measures to prevent objects falling \(9.6% to 20.2%\).)] TJ ET 0.267 0.267 0.267 rg BT 467.350 661.841 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 476.987 660.333 Td /F1 9.8 Tf [( The inclusion criteria )] TJ ET BT 26.250 648.429 Td /F1 9.8 Tf [(for this study were altered )] TJ ET BT 140.588 648.429 Td /F5 9.8 Tf [(post hoc)] TJ ET BT 177.443 648.429 Td /F1 9.8 Tf [( when it was found that the demographics of the intervention and control groups \(conducted )] TJ ET BT 26.250 636.524 Td /F1 9.8 Tf [(on different hospital sites\) were markedly different.)] TJ ET 0.267 0.267 0.267 rg BT 244.084 638.031 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 253.722 636.524 Td /F1 9.8 Tf [( Both game interventions led to increases in knowledge about hazards. )] TJ ET BT 26.250 624.619 Td /F1 9.8 Tf [(The Disaster Awareness Game, played in schools on Caribbean islands, and supplemented with additional discussion, )] TJ ET BT 26.250 612.714 Td /F1 9.8 Tf [(promoted increases in knowledge about all the natural hazards presented, as well as increases in knowledge about how to )] TJ ET BT 26.250 600.810 Td /F1 9.8 Tf [(prepare, evacuate and recover from disasters. No statistical comparisons were made of the before and after comparisons, )] TJ ET BT 26.250 588.905 Td /F1 9.8 Tf [(however. Among St. Vincent and the Grenadines participants, knowledge \(measured by game score\) of the hazard of flooding )] TJ ET BT 26.250 577.000 Td /F1 9.8 Tf [(increased from 65% to 87%, and hurricanes from 65% to 83%.)] TJ ET 0.267 0.267 0.267 rg BT 296.120 578.507 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 305.758 577.000 Td /F1 9.8 Tf [( Among Turks and Caicos Islands participants, knowledge for )] TJ ET BT 26.250 565.095 Td /F1 9.8 Tf [(the five tested hazards also increased \(floods, 69% to 75%; hurricanes, 75% to 83%; volcano, 54% to 80%; landslide 51% to )] TJ ET BT 26.250 553.191 Td /F1 9.8 Tf [(92%; mudflow 43% to 83%\).)] TJ ET 0.267 0.267 0.267 rg BT 148.720 554.698 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 158.357 553.191 Td /F1 9.8 Tf [( The Beat the Quake game increased knowledge about how to respond to an imminent )] TJ ET BT 26.250 541.286 Td /F1 9.8 Tf [(earthquake according to scores on multiple choice questions, compared to not playing the game.)] TJ ET 0.267 0.267 0.267 rg BT 442.994 542.793 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 452.632 545.174 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 455.041 542.793 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 464.678 541.286 Td /F1 9.8 Tf [( The study evaluated )] TJ ET BT 26.250 529.381 Td /F1 9.8 Tf [(more complex variations of the game involving comparing goal-setting by researchers or participants themselves, but no )] TJ ET BT 26.250 517.476 Td /F1 9.8 Tf [(significant differences between these variations was noted.)] TJ ET 0.267 0.267 0.267 rg BT 280.413 518.984 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 290.050 521.365 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 292.460 518.984 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 26.250 498.072 Td /F4 9.8 Tf [(1.3 Communication to Promote Preparedness for Man-made Disasters)] TJ ET BT 26.250 478.667 Td /F4 9.8 Tf [(1.3.1 Setting)] TJ ET BT 26.250 459.262 Td /F1 9.8 Tf [(One study of communication for preparedness for man-made disasters was found.)] TJ ET 0.267 0.267 0.267 rg BT 381.189 460.769 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 26.250 439.857 Td /F4 9.8 Tf [(1.3.2 Participants)] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(The participants who are relevant to this review were 421 people who attended voluntary clinics to receive potassium iodide \(KI\) )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(prophylaxis and information, and 286 individuals who did not attend these clinics, all of whom lived within 10 km of a nuclear )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(power plant.)] TJ ET 0.267 0.267 0.267 rg BT 79.358 398.150 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 88.996 396.643 Td /F1 9.8 Tf [( The participants had themselves chosen whether to acquire potassium iodide, and therefore the characteristics )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(of the two groups were likely to be systematically different.)] TJ ET BT 26.250 365.334 Td /F4 9.8 Tf [(1.3.3 Description of Interventions)] TJ ET BT 26.250 345.929 Td /F1 9.8 Tf [(The New Jersey Department of Health and Senior Services organised distribution of KI to protect against thyroid cancer in the )] TJ ET BT 26.250 334.024 Td /F1 9.8 Tf [(event of a nuclear or radiation incident. Voluntary clinics offered the pills and information to people within a 10km radius of a )] TJ ET BT 26.250 322.119 Td /F1 9.8 Tf [(nuclear power plant. Information was written at Flesch Kincaid Grade level of 6.5 and pilot tested.)] TJ ET 0.267 0.267 0.267 rg BT 445.149 323.627 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 26.250 302.715 Td /F4 9.8 Tf [(1.3.4 Results)] TJ ET BT 26.250 283.310 Td /F1 9.8 Tf [(Individuals who received KI and information scored an average of 46% on a knowledge test, while those who did not receive KI )] TJ ET BT 26.250 271.405 Td /F1 9.8 Tf [(or information scored an average of 15%.)] TJ ET 0.267 0.267 0.267 rg BT 205.084 272.912 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 214.722 271.405 Td /F1 9.8 Tf [( Due to the fact that the self-selection, it is difficult to evaluate the effect of the )] TJ ET BT 26.250 259.500 Td /F1 9.8 Tf [(intervention, since those with better knowledge of radiation might have been more likely to seek KI, and therefore the )] TJ ET BT 26.250 247.596 Td /F1 9.8 Tf [(intervention group might have had better knowledge anyway.)] TJ ET BT 26.250 228.191 Td /F4 9.8 Tf [(1.4 Communications to Provide Early Warnings of Natural Disasters)] TJ ET BT 26.250 208.786 Td /F4 9.8 Tf [(1.4.1 Setting)] TJ ET BT 26.250 189.381 Td /F1 9.8 Tf [(Three studies evaluated the effect of early warning of impending natural disasters. One evaluated the response to a warning of )] TJ ET BT 26.250 177.477 Td /F1 9.8 Tf [(the Indian Ocean Tsunami on the island of Mauritius,)] TJ ET 0.267 0.267 0.267 rg BT 254.400 178.984 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 264.037 177.477 Td /F1 9.8 Tf [( and the second evaluated the effect of a warning of a cyclone on the )] TJ ET BT 26.250 165.572 Td /F1 9.8 Tf [(east coast of India.)] TJ ET 0.267 0.267 0.267 rg BT 108.091 167.079 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 117.729 165.572 Td /F1 9.8 Tf [( A third study evaluated the response to an evacuation order during a wildfire event in San Diego, )] TJ ET BT 26.250 153.667 Td /F1 9.8 Tf [(California, USA, in 2007.)] TJ ET 0.267 0.267 0.267 rg BT 133.003 155.174 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 26.250 134.262 Td /F4 9.8 Tf [(1.4.2 Participants)] TJ ET BT 26.250 114.858 Td /F1 9.8 Tf [(The survey in Mauritius reached 319 respondents \(including 19 of whom outside the target area; proportion of each gender not )] TJ ET BT 26.250 102.953 Td /F1 9.8 Tf [(reported\) out of 1,484 attempted contacts.)] TJ ET 0.267 0.267 0.267 rg BT 207.815 104.460 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 217.452 102.953 Td /F1 9.8 Tf [( Sharma \(2009\) contacted 44 decision-makers \(59% male\) from individual )] TJ ET BT 26.250 91.048 Td /F1 9.8 Tf [(households in Indian villages that were at risk of harm from a cyclone. Strawderman et al. interviewed 1,020 individuals \(mean )] TJ ET BT 26.250 79.143 Td /F1 9.8 Tf [(age 54 years; 37% male\) who lived in a zone that was evacuated during the San Diego wildfire \(of 12,204 telephone numbers )] TJ ET BT 26.250 67.239 Td /F1 9.8 Tf [(attempted\).)] TJ ET 0.267 0.267 0.267 rg BT 75.566 68.746 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 85.203 71.127 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 87.612 68.746 Td /F4 8.7 Tf [(16)] TJ ET Q q 15.000 37.953 577.500 739.047 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(according to a self-reported checklist.)] TJ ET 0.267 0.267 0.267 rg BT 187.730 768.983 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 197.367 767.476 Td /F1 9.8 Tf [( The )] TJ ET BT 219.587 767.476 Td /F5 9.8 Tf [(platica)] TJ ET BT 247.765 767.476 Td /F1 9.8 Tf [( \(discussion\) group was slightly better prepared for ten of 13 measures )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(before the intervention. Overall preparedness score for the written information group increased from 29% to 52%, and for the )] TJ ET BT 26.250 743.667 Td /F5 9.8 Tf [(platica)] TJ ET BT 54.427 743.667 Td /F1 9.8 Tf [( group increased from 38% to 76%.)] TJ ET 0.267 0.267 0.267 rg BT 207.249 745.174 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 216.886 743.667 Td /F1 9.8 Tf [( In the Yasunari )] TJ ET BT 287.886 743.667 Td /F5 9.8 Tf [(et al.)] TJ ET BT 309.024 743.667 Td /F1 9.8 Tf [( study of disaster education with antenatal care, the )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(intervention and control groups both showed non-statistically significant improvements in knowledge on all outcome measures, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(but no direct statistical comparison of the two groups was reported.)] TJ ET 0.267 0.267 0.267 rg BT 315.084 721.364 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 324.721 719.857 Td /F1 9.8 Tf [( The intervention group improved in knowledge of the )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(emergency telephone line \(69.7% to 82.8%\), the disaster message board \(51.5% to 67.7%\), local alternative maternity clinics )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(\(52.5% to 68.7%\), evacuation sites \(47.5% to 67.7%\) and being explain about own health status \(86.9% to 97%\).)] TJ ET 0.267 0.267 0.267 rg BT 512.385 697.555 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 522.022 696.048 Td /F1 9.8 Tf [( They also )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(were more likely to have discussed communication plan with family \(20.2% to 43.4%\), be able to find out family contact methods )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(\(46.5% to 70.7%\), take measures to prevent furniture turning over \(33.3% to 48.5%\) and objects falling \(20.2% to 34.3%\).)] TJ ET 0.267 0.267 0.267 rg BT 549.211 673.745 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 558.848 672.238 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(control group significantly improved in only taking measures to prevent objects falling \(9.6% to 20.2%\).)] TJ ET 0.267 0.267 0.267 rg BT 467.350 661.841 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 476.987 660.333 Td /F1 9.8 Tf [( The inclusion criteria )] TJ ET BT 26.250 648.429 Td /F1 9.8 Tf [(for this study were altered )] TJ ET BT 140.588 648.429 Td /F5 9.8 Tf [(post hoc)] TJ ET BT 177.443 648.429 Td /F1 9.8 Tf [( when it was found that the demographics of the intervention and control groups \(conducted )] TJ ET BT 26.250 636.524 Td /F1 9.8 Tf [(on different hospital sites\) were markedly different.)] TJ ET 0.267 0.267 0.267 rg BT 244.084 638.031 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 253.722 636.524 Td /F1 9.8 Tf [( Both game interventions led to increases in knowledge about hazards. )] TJ ET BT 26.250 624.619 Td /F1 9.8 Tf [(The Disaster Awareness Game, played in schools on Caribbean islands, and supplemented with additional discussion, )] TJ ET BT 26.250 612.714 Td /F1 9.8 Tf [(promoted increases in knowledge about all the natural hazards presented, as well as increases in knowledge about how to )] TJ ET BT 26.250 600.810 Td /F1 9.8 Tf [(prepare, evacuate and recover from disasters. No statistical comparisons were made of the before and after comparisons, )] TJ ET BT 26.250 588.905 Td /F1 9.8 Tf [(however. Among St. Vincent and the Grenadines participants, knowledge \(measured by game score\) of the hazard of flooding )] TJ ET BT 26.250 577.000 Td /F1 9.8 Tf [(increased from 65% to 87%, and hurricanes from 65% to 83%.)] TJ ET 0.267 0.267 0.267 rg BT 296.120 578.507 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 305.758 577.000 Td /F1 9.8 Tf [( Among Turks and Caicos Islands participants, knowledge for )] TJ ET BT 26.250 565.095 Td /F1 9.8 Tf [(the five tested hazards also increased \(floods, 69% to 75%; hurricanes, 75% to 83%; volcano, 54% to 80%; landslide 51% to )] TJ ET BT 26.250 553.191 Td /F1 9.8 Tf [(92%; mudflow 43% to 83%\).)] TJ ET 0.267 0.267 0.267 rg BT 148.720 554.698 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 158.357 553.191 Td /F1 9.8 Tf [( The Beat the Quake game increased knowledge about how to respond to an imminent )] TJ ET BT 26.250 541.286 Td /F1 9.8 Tf [(earthquake according to scores on multiple choice questions, compared to not playing the game.)] TJ ET 0.267 0.267 0.267 rg BT 442.994 542.793 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 452.632 545.174 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 455.041 542.793 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 464.678 541.286 Td /F1 9.8 Tf [( The study evaluated )] TJ ET BT 26.250 529.381 Td /F1 9.8 Tf [(more complex variations of the game involving comparing goal-setting by researchers or participants themselves, but no )] TJ ET BT 26.250 517.476 Td /F1 9.8 Tf [(significant differences between these variations was noted.)] TJ ET 0.267 0.267 0.267 rg BT 280.413 518.984 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 290.050 521.365 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 292.460 518.984 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 26.250 498.072 Td /F4 9.8 Tf [(1.3 Communication to Promote Preparedness for Man-made Disasters)] TJ ET BT 26.250 478.667 Td /F4 9.8 Tf [(1.3.1 Setting)] TJ ET BT 26.250 459.262 Td /F1 9.8 Tf [(One study of communication for preparedness for man-made disasters was found.)] TJ ET 0.267 0.267 0.267 rg BT 381.189 460.769 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 26.250 439.857 Td /F4 9.8 Tf [(1.3.2 Participants)] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(The participants who are relevant to this review were 421 people who attended voluntary clinics to receive potassium iodide \(KI\) )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(prophylaxis and information, and 286 individuals who did not attend these clinics, all of whom lived within 10 km of a nuclear )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(power plant.)] TJ ET 0.267 0.267 0.267 rg BT 79.358 398.150 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 88.996 396.643 Td /F1 9.8 Tf [( The participants had themselves chosen whether to acquire potassium iodide, and therefore the characteristics )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(of the two groups were likely to be systematically different.)] TJ ET BT 26.250 365.334 Td /F4 9.8 Tf [(1.3.3 Description of Interventions)] TJ ET BT 26.250 345.929 Td /F1 9.8 Tf [(The New Jersey Department of Health and Senior Services organised distribution of KI to protect against thyroid cancer in the )] TJ ET BT 26.250 334.024 Td /F1 9.8 Tf [(event of a nuclear or radiation incident. Voluntary clinics offered the pills and information to people within a 10km radius of a )] TJ ET BT 26.250 322.119 Td /F1 9.8 Tf [(nuclear power plant. Information was written at Flesch Kincaid Grade level of 6.5 and pilot tested.)] TJ ET 0.267 0.267 0.267 rg BT 445.149 323.627 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 26.250 302.715 Td /F4 9.8 Tf [(1.3.4 Results)] TJ ET BT 26.250 283.310 Td /F1 9.8 Tf [(Individuals who received KI and information scored an average of 46% on a knowledge test, while those who did not receive KI )] TJ ET BT 26.250 271.405 Td /F1 9.8 Tf [(or information scored an average of 15%.)] TJ ET 0.267 0.267 0.267 rg BT 205.084 272.912 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 214.722 271.405 Td /F1 9.8 Tf [( Due to the fact that the self-selection, it is difficult to evaluate the effect of the )] TJ ET BT 26.250 259.500 Td /F1 9.8 Tf [(intervention, since those with better knowledge of radiation might have been more likely to seek KI, and therefore the )] TJ ET BT 26.250 247.596 Td /F1 9.8 Tf [(intervention group might have had better knowledge anyway.)] TJ ET BT 26.250 228.191 Td /F4 9.8 Tf [(1.4 Communications to Provide Early Warnings of Natural Disasters)] TJ ET BT 26.250 208.786 Td /F4 9.8 Tf [(1.4.1 Setting)] TJ ET BT 26.250 189.381 Td /F1 9.8 Tf [(Three studies evaluated the effect of early warning of impending natural disasters. One evaluated the response to a warning of )] TJ ET BT 26.250 177.477 Td /F1 9.8 Tf [(the Indian Ocean Tsunami on the island of Mauritius,)] TJ ET 0.267 0.267 0.267 rg BT 254.400 178.984 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 264.037 177.477 Td /F1 9.8 Tf [( and the second evaluated the effect of a warning of a cyclone on the )] TJ ET BT 26.250 165.572 Td /F1 9.8 Tf [(east coast of India.)] TJ ET 0.267 0.267 0.267 rg BT 108.091 167.079 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 117.729 165.572 Td /F1 9.8 Tf [( A third study evaluated the response to an evacuation order during a wildfire event in San Diego, )] TJ ET BT 26.250 153.667 Td /F1 9.8 Tf [(California, USA, in 2007.)] TJ ET 0.267 0.267 0.267 rg BT 133.003 155.174 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 26.250 134.262 Td /F4 9.8 Tf [(1.4.2 Participants)] TJ ET BT 26.250 114.858 Td /F1 9.8 Tf [(The survey in Mauritius reached 319 respondents \(including 19 of whom outside the target area; proportion of each gender not )] TJ ET BT 26.250 102.953 Td /F1 9.8 Tf [(reported\) out of 1,484 attempted contacts.)] TJ ET 0.267 0.267 0.267 rg BT 207.815 104.460 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 217.452 102.953 Td /F1 9.8 Tf [( Sharma \(2009\) contacted 44 decision-makers \(59% male\) from individual )] TJ ET BT 26.250 91.048 Td /F1 9.8 Tf [(households in Indian villages that were at risk of harm from a cyclone. Strawderman et al. interviewed 1,020 individuals \(mean )] TJ ET BT 26.250 79.143 Td /F1 9.8 Tf [(age 54 years; 37% male\) who lived in a zone that was evacuated during the San Diego wildfire \(of 12,204 telephone numbers )] TJ ET BT 26.250 67.239 Td /F1 9.8 Tf [(attempted\).)] TJ ET 0.267 0.267 0.267 rg BT 75.566 68.746 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 85.203 71.127 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 87.612 68.746 Td /F4 8.7 Tf [(16)] TJ ET Q q 15.000 37.953 577.500 739.047 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(according to a self-reported checklist.)] TJ ET 0.267 0.267 0.267 rg BT 187.730 768.983 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 197.367 767.476 Td /F1 9.8 Tf [( The )] TJ ET BT 219.587 767.476 Td /F5 9.8 Tf [(platica)] TJ ET BT 247.765 767.476 Td /F1 9.8 Tf [( \(discussion\) group was slightly better prepared for ten of 13 measures )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(before the intervention. Overall preparedness score for the written information group increased from 29% to 52%, and for the )] TJ ET BT 26.250 743.667 Td /F5 9.8 Tf [(platica)] TJ ET BT 54.427 743.667 Td /F1 9.8 Tf [( group increased from 38% to 76%.)] TJ ET 0.267 0.267 0.267 rg BT 207.249 745.174 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 216.886 743.667 Td /F1 9.8 Tf [( In the Yasunari )] TJ ET BT 287.886 743.667 Td /F5 9.8 Tf [(et al.)] TJ ET BT 309.024 743.667 Td /F1 9.8 Tf [( study of disaster education with antenatal care, the )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(intervention and control groups both showed non-statistically significant improvements in knowledge on all outcome measures, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(but no direct statistical comparison of the two groups was reported.)] TJ ET 0.267 0.267 0.267 rg BT 315.084 721.364 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 324.721 719.857 Td /F1 9.8 Tf [( The intervention group improved in knowledge of the )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(emergency telephone line \(69.7% to 82.8%\), the disaster message board \(51.5% to 67.7%\), local alternative maternity clinics )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(\(52.5% to 68.7%\), evacuation sites \(47.5% to 67.7%\) and being explain about own health status \(86.9% to 97%\).)] TJ ET 0.267 0.267 0.267 rg BT 512.385 697.555 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 522.022 696.048 Td /F1 9.8 Tf [( They also )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(were more likely to have discussed communication plan with family \(20.2% to 43.4%\), be able to find out family contact methods )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(\(46.5% to 70.7%\), take measures to prevent furniture turning over \(33.3% to 48.5%\) and objects falling \(20.2% to 34.3%\).)] TJ ET 0.267 0.267 0.267 rg BT 549.211 673.745 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 558.848 672.238 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(control group significantly improved in only taking measures to prevent objects falling \(9.6% to 20.2%\).)] TJ ET 0.267 0.267 0.267 rg BT 467.350 661.841 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 476.987 660.333 Td /F1 9.8 Tf [( The inclusion criteria )] TJ ET BT 26.250 648.429 Td /F1 9.8 Tf [(for this study were altered )] TJ ET BT 140.588 648.429 Td /F5 9.8 Tf [(post hoc)] TJ ET BT 177.443 648.429 Td /F1 9.8 Tf [( when it was found that the demographics of the intervention and control groups \(conducted )] TJ ET BT 26.250 636.524 Td /F1 9.8 Tf [(on different hospital sites\) were markedly different.)] TJ ET 0.267 0.267 0.267 rg BT 244.084 638.031 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 253.722 636.524 Td /F1 9.8 Tf [( Both game interventions led to increases in knowledge about hazards. )] TJ ET BT 26.250 624.619 Td /F1 9.8 Tf [(The Disaster Awareness Game, played in schools on Caribbean islands, and supplemented with additional discussion, )] TJ ET BT 26.250 612.714 Td /F1 9.8 Tf [(promoted increases in knowledge about all the natural hazards presented, as well as increases in knowledge about how to )] TJ ET BT 26.250 600.810 Td /F1 9.8 Tf [(prepare, evacuate and recover from disasters. No statistical comparisons were made of the before and after comparisons, )] TJ ET BT 26.250 588.905 Td /F1 9.8 Tf [(however. Among St. Vincent and the Grenadines participants, knowledge \(measured by game score\) of the hazard of flooding )] TJ ET BT 26.250 577.000 Td /F1 9.8 Tf [(increased from 65% to 87%, and hurricanes from 65% to 83%.)] TJ ET 0.267 0.267 0.267 rg BT 296.120 578.507 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 305.758 577.000 Td /F1 9.8 Tf [( Among Turks and Caicos Islands participants, knowledge for )] TJ ET BT 26.250 565.095 Td /F1 9.8 Tf [(the five tested hazards also increased \(floods, 69% to 75%; hurricanes, 75% to 83%; volcano, 54% to 80%; landslide 51% to )] TJ ET BT 26.250 553.191 Td /F1 9.8 Tf [(92%; mudflow 43% to 83%\).)] TJ ET 0.267 0.267 0.267 rg BT 148.720 554.698 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 158.357 553.191 Td /F1 9.8 Tf [( The Beat the Quake game increased knowledge about how to respond to an imminent )] TJ ET BT 26.250 541.286 Td /F1 9.8 Tf [(earthquake according to scores on multiple choice questions, compared to not playing the game.)] TJ ET 0.267 0.267 0.267 rg BT 442.994 542.793 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 452.632 545.174 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 455.041 542.793 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 464.678 541.286 Td /F1 9.8 Tf [( The study evaluated )] TJ ET BT 26.250 529.381 Td /F1 9.8 Tf [(more complex variations of the game involving comparing goal-setting by researchers or participants themselves, but no )] TJ ET BT 26.250 517.476 Td /F1 9.8 Tf [(significant differences between these variations was noted.)] TJ ET 0.267 0.267 0.267 rg BT 280.413 518.984 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 290.050 521.365 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 292.460 518.984 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 26.250 498.072 Td /F4 9.8 Tf [(1.3 Communication to Promote Preparedness for Man-made Disasters)] TJ ET BT 26.250 478.667 Td /F4 9.8 Tf [(1.3.1 Setting)] TJ ET BT 26.250 459.262 Td /F1 9.8 Tf [(One study of communication for preparedness for man-made disasters was found.)] TJ ET 0.267 0.267 0.267 rg BT 381.189 460.769 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 26.250 439.857 Td /F4 9.8 Tf [(1.3.2 Participants)] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(The participants who are relevant to this review were 421 people who attended voluntary clinics to receive potassium iodide \(KI\) )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(prophylaxis and information, and 286 individuals who did not attend these clinics, all of whom lived within 10 km of a nuclear )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(power plant.)] TJ ET 0.267 0.267 0.267 rg BT 79.358 398.150 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 88.996 396.643 Td /F1 9.8 Tf [( The participants had themselves chosen whether to acquire potassium iodide, and therefore the characteristics )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(of the two groups were likely to be systematically different.)] TJ ET BT 26.250 365.334 Td /F4 9.8 Tf [(1.3.3 Description of Interventions)] TJ ET BT 26.250 345.929 Td /F1 9.8 Tf [(The New Jersey Department of Health and Senior Services organised distribution of KI to protect against thyroid cancer in the )] TJ ET BT 26.250 334.024 Td /F1 9.8 Tf [(event of a nuclear or radiation incident. Voluntary clinics offered the pills and information to people within a 10km radius of a )] TJ ET BT 26.250 322.119 Td /F1 9.8 Tf [(nuclear power plant. Information was written at Flesch Kincaid Grade level of 6.5 and pilot tested.)] TJ ET 0.267 0.267 0.267 rg BT 445.149 323.627 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 26.250 302.715 Td /F4 9.8 Tf [(1.3.4 Results)] TJ ET BT 26.250 283.310 Td /F1 9.8 Tf [(Individuals who received KI and information scored an average of 46% on a knowledge test, while those who did not receive KI )] TJ ET BT 26.250 271.405 Td /F1 9.8 Tf [(or information scored an average of 15%.)] TJ ET 0.267 0.267 0.267 rg BT 205.084 272.912 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 214.722 271.405 Td /F1 9.8 Tf [( Due to the fact that the self-selection, it is difficult to evaluate the effect of the )] TJ ET BT 26.250 259.500 Td /F1 9.8 Tf [(intervention, since those with better knowledge of radiation might have been more likely to seek KI, and therefore the )] TJ ET BT 26.250 247.596 Td /F1 9.8 Tf [(intervention group might have had better knowledge anyway.)] TJ ET BT 26.250 228.191 Td /F4 9.8 Tf [(1.4 Communications to Provide Early Warnings of Natural Disasters)] TJ ET BT 26.250 208.786 Td /F4 9.8 Tf [(1.4.1 Setting)] TJ ET BT 26.250 189.381 Td /F1 9.8 Tf [(Three studies evaluated the effect of early warning of impending natural disasters. 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that the tsunami effects were already being observed.)] TJ ET 0.267 0.267 0.267 rg BT 388.794 725.769 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 398.431 724.262 Td /F1 9.8 Tf [( This included the meteorological service )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(contacting police, coastguard, local radio and television channels and directly phoning hotels to warn them of the imminent )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(danger. Perry reported that the information issued may have understated the necessary action required by individuals.)] TJ ET 0.267 0.267 0.267 rg BT 535.112 701.960 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 26.250 688.548 Td /F1 9.8 Tf [(Sharma et al. presented a study of the publics response to a warning of a cyclone on the east coast of India that occurred in )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(December 2003.)] TJ ET 0.267 0.267 0.267 rg BT 98.322 678.150 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 107.959 676.643 Td /F1 9.8 Tf [( The intervention was a technical report warning of the impending cyclone and the likely effects. This was )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(disseminated from national to local level through several layers of government, translated into local languages at district level )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(and locally disseminated orally. The warning itself covered a large geographic area and did not advise on whether evacuation )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(was necessary. The decision to advise people whether to evacuate was made by administrators at a district level in light of the )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(information provided. Strawderman et al. sought to evaluate a recently-installed public address system called Reverse 911, )] TJ ET BT 26.250 617.119 Td /F1 9.8 Tf [(which automatically dials all telephone numbers in a specified area and delivers a recorded emergency message.)] TJ ET 0.267 0.267 0.267 rg BT 514.491 618.626 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 524.128 617.119 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 605.214 Td /F1 9.8 Tf [(warning messages were also spread through television, radio, interpersonal communication and police.)] TJ ET 0.267 0.267 0.267 rg BT 470.596 606.722 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 26.250 585.810 Td /F4 9.8 Tf [(1.4.4 Results)] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(Perry reported that the Mauritius Meteorological Service learned of the tsunami just over two hours before its first effects )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(reached the island.)] TJ ET 0.267 0.267 0.267 rg BT 108.628 556.007 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 118.265 554.500 Td /F1 9.8 Tf [( At the onset of the wave effects, 10% of people knew about the expected tsunami, and by the time the )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(effects finished, approximately three hours later, only 42% knew about the warning. Upon hearing of it, most people continued )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(their normal business \(64%\), while only 25% took action to protect themselves and 15% did the opposite of what was advised )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(and went to watch the waves at the coast.)] TJ ET 0.267 0.267 0.267 rg BT 207.268 520.293 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 216.906 518.786 Td /F1 9.8 Tf [( In the study of a cyclone in India 345 of the villagers reported that they evacuated )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(voluntarily, 20% were forced to evacuate and 46% did not evacuate.)] TJ ET 0.267 0.267 0.267 rg BT 324.317 508.388 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 333.955 506.881 Td /F1 9.8 Tf [( In the San Diego wildfire, 53% of residents in the )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(evacuation zone received the Reverse 911 evacuation message, and 80% who received it evacuated, including 100% of those )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(for whom evacuation was judged necessary.)] TJ ET 0.267 0.267 0.267 rg BT 218.081 484.579 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 227.719 483.072 Td /F1 9.8 Tf [( However, only 66% of those who received it reported the message to be the )] TJ ET BT 26.250 471.167 Td /F1 9.8 Tf [(reason why they evacuated. Some people who did not need to evacuate did so anyway because of the message.)] TJ ET 0.267 0.267 0.267 rg BT 514.023 472.674 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 523.660 471.167 Td /F1 9.8 Tf [( Information )] TJ ET BT 26.250 459.262 Td /F1 9.8 Tf [(acquired through the Internet had the highest correct rejection rate, and the lowest false alarm rate, suggesting that residents )] TJ ET BT 26.250 447.357 Td /F1 9.8 Tf [(were able to judge their own situation most accurately using it as a source.)] TJ ET 0.267 0.267 0.267 rg BT 347.600 448.865 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 357.238 447.357 Td /F1 9.8 Tf [( In the Mauritian tsunami study and the Indian )] TJ ET BT 26.250 435.453 Td /F1 9.8 Tf [(cyclone study there was a low level of compliance with the advice to take protective action against the imminent natural )] TJ ET BT 26.250 423.548 Td /F1 9.8 Tf [(hazards. Factors relating to personal circumstances, beliefs and attitudes, societal response, and the characteristics of the )] TJ ET BT 26.250 411.643 Td /F1 9.8 Tf [(authorities may have influenced whether individuals chose to evacuate.)] TJ ET 0.267 0.267 0.267 rg BT 333.521 413.150 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 343.159 411.643 Td /F1 9.8 Tf [( In the San Diego wildfire, 69% of people in the )] TJ ET BT 26.250 399.738 Td /F1 9.8 Tf [(evacuation zone did evacuate, which is much higher than in the other two studies.)] TJ ET 0.267 0.267 0.267 rg BT 379.054 401.246 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 388.691 399.738 Td /F1 9.8 Tf [( This may relate to the characteristics of the )] TJ ET BT 26.250 387.834 Td /F1 9.8 Tf [(disaster \(fire\), the setting \(rural USA\), the communication methods, or the society. The Reverse 911 alert was relatively widely )] TJ ET BT 26.250 375.929 Td /F1 9.8 Tf [(received and acted upon by a majority of recipients. Use of the Internet allowed people to make even more personalised )] TJ ET BT 26.250 364.024 Td /F1 9.8 Tf [(decisions.)] TJ ET 0.267 0.267 0.267 rg BT 69.599 365.531 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 79.236 364.024 Td /F1 9.8 Tf [( The studies were all conceived retrospectively and relied on recall by participants. Some studies also assessed )] TJ ET BT 26.250 352.119 Td /F1 9.8 Tf [(aetiological factors, and though the studies focused on the intervention of the evacuation warnings, they were not under the )] TJ ET BT 26.250 340.215 Td /F1 9.8 Tf [(control of the researchers. It is difficult to assess the effectiveness of early warning information whenever it is not necessarily )] TJ ET BT 26.250 328.310 Td /F1 9.8 Tf [(correct to attribute all subsequent evacuations to the warning, since some may occur independently of warnings.)] TJ ET BT 26.250 308.905 Td /F4 9.8 Tf [(2 Effect of Risk Communication Interventions to Improve Disaster Response)] TJ ET BT 26.250 289.500 Td /F4 9.8 Tf [(2.1 Communication to Promote Response to Infectious Disease Disasters)] TJ ET BT 26.250 270.096 Td /F4 9.8 Tf [(2.1.1 Setting)] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(Seven studies of communication interventions during infectious disease disasters were identified. One was in the UK,)] TJ ET 0.267 0.267 0.267 rg BT 531.300 252.198 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 536.119 250.691 Td /F1 9.8 Tf [( one was )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(in Egypt,)] TJ ET 0.267 0.267 0.267 rg BT 64.187 240.293 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 73.825 238.786 Td /F1 9.8 Tf [( and five were in Asian countries: one in each of China,)] TJ ET 0.267 0.267 0.267 rg BT 311.734 240.293 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 321.372 238.786 Td /F1 9.8 Tf [( Thailand,)] TJ ET 0.267 0.267 0.267 rg BT 364.184 240.293 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 373.821 238.786 Td /F1 9.8 Tf [( Taiwan,)] TJ ET 0.267 0.267 0.267 rg BT 410.667 240.293 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 420.304 238.786 Td /F1 9.8 Tf [( Singapore)] TJ ET 0.267 0.267 0.267 rg BT 467.455 240.293 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 477.092 238.786 Td /F1 9.8 Tf [( and Hong Kong.)] TJ ET 0.267 0.267 0.267 rg BT 550.266 240.293 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 26.250 226.881 Td /F1 9.8 Tf [(Three studies took place in the context of the SARS epidemic,)] TJ ET 0.267 0.267 0.267 rg BT 293.966 228.389 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 303.603 230.770 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 306.012 228.389 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 315.650 230.770 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 318.059 228.389 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 327.696 226.881 Td /F1 9.8 Tf [( one during the 2009-2010 influenza pandemic,)] TJ ET 0.267 0.267 0.267 rg BT 531.481 228.389 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 541.118 226.881 Td /F1 9.8 Tf [( one )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(during an avian influenza outbreak,)] TJ ET 0.267 0.267 0.267 rg BT 177.999 216.484 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 187.636 214.977 Td /F1 9.8 Tf [( one involved an epidemic of viral conjunctivitis)] TJ ET 0.267 0.267 0.267 rg BT 389.754 216.484 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 399.391 214.977 Td /F1 9.8 Tf [( and one was set during a small outbreak )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(of meningococcal disease in a school.)] TJ ET 0.267 0.267 0.267 rg BT 190.450 204.579 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 183.667 Td /F4 9.8 Tf [(2.1.2 Participants)] TJ ET BT 26.250 164.262 Td /F1 9.8 Tf [(Farahat et al. studied 420 school pupils \(mean age 16 years; 46% male\) during the influenza pandemic.)] TJ ET 0.267 0.267 0.267 rg BT 472.800 165.770 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 482.437 164.262 Td /F1 9.8 Tf [( Olsen )] TJ ET BT 513.325 164.262 Td /F5 9.8 Tf [(et al. )] TJ ET BT 537.174 164.262 Td /F1 9.8 Tf [(reported )] TJ ET BT 26.250 152.358 Td /F1 9.8 Tf [(a study of 200 participants \(median age 50 years; 72% female\) during an avian influenza outbreak in Nakhon Phanom, Thailand.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 141.960 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 35.887 140.453 Td /F1 9.8 Tf [( Three SARS studies took place in Asia. Pang )] TJ ET BT 236.942 140.453 Td /F5 9.8 Tf [(et al. )] TJ ET BT 260.791 140.453 Td /F1 9.8 Tf [(reported outcomes for 1,860 people in China who were hospitalised with )] TJ ET BT 26.250 128.548 Td /F1 9.8 Tf [(SARS infection.)] TJ ET 0.267 0.267 0.267 rg BT 94.529 130.055 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 104.167 128.548 Td /F1 9.8 Tf [( A study by Chan )] TJ ET BT 181.123 128.548 Td /F5 9.8 Tf [(et al. )] TJ ET BT 204.972 128.548 Td /F1 9.8 Tf [(included 122 \(63% female\) people in Hong Kong aged 55 years or over.)] TJ ET 0.267 0.267 0.267 rg BT 514.963 130.055 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 524.601 128.548 Td /F1 9.8 Tf [( The study )] TJ ET BT 26.250 116.643 Td /F1 9.8 Tf [(by Karan )] TJ ET BT 67.980 116.643 Td /F5 9.8 Tf [(et al. )] TJ ET BT 91.828 116.643 Td /F1 9.8 Tf [(included 300 individuals \(51% male\) in Singapore, 61% of whom were aged between 20 and 39 years.)] TJ ET 0.267 0.267 0.267 rg BT 532.957 118.151 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 542.595 116.643 Td /F1 9.8 Tf [( During )] TJ ET BT 26.250 104.739 Td /F1 9.8 Tf [(an outbreak of viral acute haemorrhagic conjunctivitis in Taiwan, comparisons were made between two interventions by )] TJ ET BT 26.250 92.834 Td /F1 9.8 Tf [(directing public health messages at the inhabitants of two affected cities, Taipei \(population 2,632,242\) and Keelung \(population )] TJ ET BT 26.250 80.929 Td /F1 9.8 Tf [(390,084\).)] TJ ET 0.267 0.267 0.267 rg BT 67.444 82.436 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 77.081 80.929 Td /F1 9.8 Tf [( Schoolchildren were the population that was mainly affected \(Taipei City had 277,159 schoolchildren and Keelung )] TJ ET BT 26.250 69.024 Td /F1 9.8 Tf [(City had 41,244\).)] TJ ET 0.267 0.267 0.267 rg BT 100.496 70.532 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 110.134 69.024 Td /F1 9.8 Tf [( During an outbreak of meningococcal disease in a secondary-level school in England, 88 school pupils )] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(\(63% male\) aged 16-17 years were surveyed \(of 198 who were invited\) to investigate their response to the communications.)] TJ ET 0.267 0.267 0.267 rg BT 560.014 58.627 Td /F4 8.7 Tf [(9)] TJ ET Q q 15.000 27.834 577.500 749.166 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F4 9.8 Tf [(1.4.3 Description of interventions)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Perry evaluated the effects of the early warning of the Indian Ocean Tsunami on the inhabitants of Mauritius.)] TJ ET 0.267 0.267 0.267 rg BT 493.402 749.579 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 503.039 748.071 Td /F1 9.8 Tf [( Perry describes )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(how the local authorities learned of the tsunami from international news outlets and began to issue warnings to inhabitants and )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(tourists during the time period that the tsunami effects were already being observed.)] TJ ET 0.267 0.267 0.267 rg BT 388.794 725.769 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 398.431 724.262 Td /F1 9.8 Tf [( This included the meteorological service )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(contacting police, coastguard, local radio and television channels and directly phoning hotels to warn them of the imminent )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(danger. Perry reported that the information issued may have understated the necessary action required by individuals.)] TJ ET 0.267 0.267 0.267 rg BT 535.112 701.960 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 26.250 688.548 Td /F1 9.8 Tf [(Sharma et al. presented a study of the publics response to a warning of a cyclone on the east coast of India that occurred in )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(December 2003.)] TJ ET 0.267 0.267 0.267 rg BT 98.322 678.150 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 107.959 676.643 Td /F1 9.8 Tf [( The intervention was a technical report warning of the impending cyclone and the likely effects. This was )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(disseminated from national to local level through several layers of government, translated into local languages at district level )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(and locally disseminated orally. The warning itself covered a large geographic area and did not advise on whether evacuation )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(was necessary. The decision to advise people whether to evacuate was made by administrators at a district level in light of the )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(information provided. Strawderman et al. sought to evaluate a recently-installed public address system called Reverse 911, )] TJ ET BT 26.250 617.119 Td /F1 9.8 Tf [(which automatically dials all telephone numbers in a specified area and delivers a recorded emergency message.)] TJ ET 0.267 0.267 0.267 rg BT 514.491 618.626 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 524.128 617.119 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 605.214 Td /F1 9.8 Tf [(warning messages were also spread through television, radio, interpersonal communication and police.)] TJ ET 0.267 0.267 0.267 rg BT 470.596 606.722 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 26.250 585.810 Td /F4 9.8 Tf [(1.4.4 Results)] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(Perry reported that the Mauritius Meteorological Service learned of the tsunami just over two hours before its first effects )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(reached the island.)] TJ ET 0.267 0.267 0.267 rg BT 108.628 556.007 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 118.265 554.500 Td /F1 9.8 Tf [( At the onset of the wave effects, 10% of people knew about the expected tsunami, and by the time the )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(effects finished, approximately three hours later, only 42% knew about the warning. Upon hearing of it, most people continued )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(their normal business \(64%\), while only 25% took action to protect themselves and 15% did the opposite of what was advised )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(and went to watch the waves at the coast.)] TJ ET 0.267 0.267 0.267 rg BT 207.268 520.293 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 216.906 518.786 Td /F1 9.8 Tf [( In the study of a cyclone in India 345 of the villagers reported that they evacuated )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(voluntarily, 20% were forced to evacuate and 46% did not evacuate.)] TJ ET 0.267 0.267 0.267 rg BT 324.317 508.388 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 333.955 506.881 Td /F1 9.8 Tf [( In the San Diego wildfire, 53% of residents in the )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(evacuation zone received the Reverse 911 evacuation message, and 80% who received it evacuated, including 100% of those )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(for whom evacuation was judged necessary.)] TJ ET 0.267 0.267 0.267 rg BT 218.081 484.579 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 227.719 483.072 Td /F1 9.8 Tf [( However, only 66% of those who received it reported the message to be the )] TJ ET BT 26.250 471.167 Td /F1 9.8 Tf [(reason why they evacuated. Some people who did not need to evacuate did so anyway because of the message.)] TJ ET 0.267 0.267 0.267 rg BT 514.023 472.674 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 523.660 471.167 Td /F1 9.8 Tf [( Information )] TJ ET BT 26.250 459.262 Td /F1 9.8 Tf [(acquired through the Internet had the highest correct rejection rate, and the lowest false alarm rate, suggesting that residents )] TJ ET BT 26.250 447.357 Td /F1 9.8 Tf [(were able to judge their own situation most accurately using it as a source.)] TJ ET 0.267 0.267 0.267 rg BT 347.600 448.865 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 357.238 447.357 Td /F1 9.8 Tf [( In the Mauritian tsunami study and the Indian )] TJ ET BT 26.250 435.453 Td /F1 9.8 Tf [(cyclone study there was a low level of compliance with the advice to take protective action against the imminent natural )] TJ ET BT 26.250 423.548 Td /F1 9.8 Tf [(hazards. Factors relating to personal circumstances, beliefs and attitudes, societal response, and the characteristics of the )] TJ ET BT 26.250 411.643 Td /F1 9.8 Tf [(authorities may have influenced whether individuals chose to evacuate.)] TJ ET 0.267 0.267 0.267 rg BT 333.521 413.150 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 343.159 411.643 Td /F1 9.8 Tf [( In the San Diego wildfire, 69% of people in the )] TJ ET BT 26.250 399.738 Td /F1 9.8 Tf [(evacuation zone did evacuate, which is much higher than in the other two studies.)] TJ ET 0.267 0.267 0.267 rg BT 379.054 401.246 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 388.691 399.738 Td /F1 9.8 Tf [( This may relate to the characteristics of the )] TJ ET BT 26.250 387.834 Td /F1 9.8 Tf [(disaster \(fire\), the setting \(rural USA\), the communication methods, or the society. The Reverse 911 alert was relatively widely )] TJ ET BT 26.250 375.929 Td /F1 9.8 Tf [(received and acted upon by a majority of recipients. Use of the Internet allowed people to make even more personalised )] TJ ET BT 26.250 364.024 Td /F1 9.8 Tf [(decisions.)] TJ ET 0.267 0.267 0.267 rg BT 69.599 365.531 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 79.236 364.024 Td /F1 9.8 Tf [( The studies were all conceived retrospectively and relied on recall by participants. Some studies also assessed )] TJ ET BT 26.250 352.119 Td /F1 9.8 Tf [(aetiological factors, and though the studies focused on the intervention of the evacuation warnings, they were not under the )] TJ ET BT 26.250 340.215 Td /F1 9.8 Tf [(control of the researchers. It is difficult to assess the effectiveness of early warning information whenever it is not necessarily )] TJ ET BT 26.250 328.310 Td /F1 9.8 Tf [(correct to attribute all subsequent evacuations to the warning, since some may occur independently of warnings.)] TJ ET BT 26.250 308.905 Td /F4 9.8 Tf [(2 Effect of Risk Communication Interventions to Improve Disaster Response)] TJ ET BT 26.250 289.500 Td /F4 9.8 Tf [(2.1 Communication to Promote Response to Infectious Disease Disasters)] TJ ET BT 26.250 270.096 Td /F4 9.8 Tf [(2.1.1 Setting)] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(Seven studies of communication interventions during infectious disease disasters were identified. One was in the UK,)] TJ ET 0.267 0.267 0.267 rg BT 531.300 252.198 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 536.119 250.691 Td /F1 9.8 Tf [( one was )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(in Egypt,)] TJ ET 0.267 0.267 0.267 rg BT 64.187 240.293 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 73.825 238.786 Td /F1 9.8 Tf [( and five were in Asian countries: one in each of China,)] TJ ET 0.267 0.267 0.267 rg BT 311.734 240.293 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 321.372 238.786 Td /F1 9.8 Tf [( Thailand,)] TJ ET 0.267 0.267 0.267 rg BT 364.184 240.293 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 373.821 238.786 Td /F1 9.8 Tf [( Taiwan,)] TJ ET 0.267 0.267 0.267 rg BT 410.667 240.293 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 420.304 238.786 Td /F1 9.8 Tf [( Singapore)] TJ ET 0.267 0.267 0.267 rg BT 467.455 240.293 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 477.092 238.786 Td /F1 9.8 Tf [( and Hong Kong.)] TJ ET 0.267 0.267 0.267 rg BT 550.266 240.293 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 26.250 226.881 Td /F1 9.8 Tf [(Three studies took place in the context of the SARS epidemic,)] TJ ET 0.267 0.267 0.267 rg BT 293.966 228.389 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 303.603 230.770 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 306.012 228.389 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 315.650 230.770 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 318.059 228.389 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 327.696 226.881 Td /F1 9.8 Tf [( one during the 2009-2010 influenza pandemic,)] TJ ET 0.267 0.267 0.267 rg BT 531.481 228.389 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 541.118 226.881 Td /F1 9.8 Tf [( one )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(during an avian influenza outbreak,)] TJ ET 0.267 0.267 0.267 rg BT 177.999 216.484 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 187.636 214.977 Td /F1 9.8 Tf [( one involved an epidemic of viral conjunctivitis)] TJ ET 0.267 0.267 0.267 rg BT 389.754 216.484 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 399.391 214.977 Td /F1 9.8 Tf [( and one was set during a small outbreak )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(of meningococcal disease in a school.)] TJ ET 0.267 0.267 0.267 rg BT 190.450 204.579 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 183.667 Td /F4 9.8 Tf [(2.1.2 Participants)] TJ ET BT 26.250 164.262 Td /F1 9.8 Tf [(Farahat et al. studied 420 school pupils \(mean age 16 years; 46% male\) during the influenza pandemic.)] TJ ET 0.267 0.267 0.267 rg BT 472.800 165.770 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 482.437 164.262 Td /F1 9.8 Tf [( Olsen )] TJ ET BT 513.325 164.262 Td /F5 9.8 Tf [(et al. )] TJ ET BT 537.174 164.262 Td /F1 9.8 Tf [(reported )] TJ ET BT 26.250 152.358 Td /F1 9.8 Tf [(a study of 200 participants \(median age 50 years; 72% female\) during an avian influenza outbreak in Nakhon Phanom, Thailand.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 141.960 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 35.887 140.453 Td /F1 9.8 Tf [( Three SARS studies took place in Asia. Pang )] TJ ET BT 236.942 140.453 Td /F5 9.8 Tf [(et al. )] TJ ET BT 260.791 140.453 Td /F1 9.8 Tf [(reported outcomes for 1,860 people in China who were hospitalised with )] TJ ET BT 26.250 128.548 Td /F1 9.8 Tf [(SARS infection.)] TJ ET 0.267 0.267 0.267 rg BT 94.529 130.055 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 104.167 128.548 Td /F1 9.8 Tf [( A study by Chan )] TJ ET BT 181.123 128.548 Td /F5 9.8 Tf [(et al. )] TJ ET BT 204.972 128.548 Td /F1 9.8 Tf [(included 122 \(63% female\) people in Hong Kong aged 55 years or over.)] TJ ET 0.267 0.267 0.267 rg BT 514.963 130.055 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 524.601 128.548 Td /F1 9.8 Tf [( The study )] TJ ET BT 26.250 116.643 Td /F1 9.8 Tf [(by Karan )] TJ ET BT 67.980 116.643 Td /F5 9.8 Tf [(et al. )] TJ ET BT 91.828 116.643 Td /F1 9.8 Tf [(included 300 individuals \(51% male\) in Singapore, 61% of whom were aged between 20 and 39 years.)] TJ ET 0.267 0.267 0.267 rg BT 532.957 118.151 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 542.595 116.643 Td /F1 9.8 Tf [( During )] TJ ET BT 26.250 104.739 Td /F1 9.8 Tf [(an outbreak of viral acute haemorrhagic conjunctivitis in Taiwan, comparisons were made between two interventions by )] TJ ET BT 26.250 92.834 Td /F1 9.8 Tf [(directing public health messages at the inhabitants of two affected cities, Taipei \(population 2,632,242\) and Keelung \(population )] TJ ET BT 26.250 80.929 Td /F1 9.8 Tf [(390,084\).)] TJ ET 0.267 0.267 0.267 rg BT 67.444 82.436 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 77.081 80.929 Td /F1 9.8 Tf [( Schoolchildren were the population that was mainly affected \(Taipei City had 277,159 schoolchildren and Keelung )] TJ ET BT 26.250 69.024 Td /F1 9.8 Tf [(City had 41,244\).)] TJ ET 0.267 0.267 0.267 rg BT 100.496 70.532 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 110.134 69.024 Td /F1 9.8 Tf [( During an outbreak of meningococcal disease in a secondary-level school in England, 88 school pupils )] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(\(63% male\) aged 16-17 years were surveyed \(of 198 who were invited\) to investigate their response to the communications.)] TJ ET 0.267 0.267 0.267 rg BT 560.014 58.627 Td /F4 8.7 Tf [(9)] TJ ET Q q 15.000 27.834 577.500 749.166 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F4 9.8 Tf [(1.4.3 Description of interventions)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Perry evaluated the effects of the early warning of the Indian Ocean Tsunami on the inhabitants of Mauritius.)] TJ ET 0.267 0.267 0.267 rg BT 493.402 749.579 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 503.039 748.071 Td /F1 9.8 Tf [( Perry describes )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(how the local authorities learned of the tsunami from international news outlets and began to issue warnings to inhabitants and )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(tourists during the time period that the tsunami effects were already being observed.)] TJ ET 0.267 0.267 0.267 rg BT 388.794 725.769 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 398.431 724.262 Td /F1 9.8 Tf [( This included the meteorological service )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(contacting police, coastguard, local radio and television channels and directly phoning hotels to warn them of the imminent )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(danger. Perry reported that the information issued may have understated the necessary action required by individuals.)] TJ ET 0.267 0.267 0.267 rg BT 535.112 701.960 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 26.250 688.548 Td /F1 9.8 Tf [(Sharma et al. presented a study of the publics response to a warning of a cyclone on the east coast of India that occurred in )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(December 2003.)] TJ ET 0.267 0.267 0.267 rg BT 98.322 678.150 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 107.959 676.643 Td /F1 9.8 Tf [( The intervention was a technical report warning of the impending cyclone and the likely effects. This was )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(disseminated from national to local level through several layers of government, translated into local languages at district level )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(and locally disseminated orally. The warning itself covered a large geographic area and did not advise on whether evacuation )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(was necessary. The decision to advise people whether to evacuate was made by administrators at a district level in light of the )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(information provided. Strawderman et al. sought to evaluate a recently-installed public address system called Reverse 911, )] TJ ET BT 26.250 617.119 Td /F1 9.8 Tf [(which automatically dials all telephone numbers in a specified area and delivers a recorded emergency message.)] TJ ET 0.267 0.267 0.267 rg BT 514.491 618.626 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 524.128 617.119 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 605.214 Td /F1 9.8 Tf [(warning messages were also spread through television, radio, interpersonal communication and police.)] TJ ET 0.267 0.267 0.267 rg BT 470.596 606.722 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 26.250 585.810 Td /F4 9.8 Tf [(1.4.4 Results)] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(Perry reported that the Mauritius Meteorological Service learned of the tsunami just over two hours before its first effects )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(reached the island.)] TJ ET 0.267 0.267 0.267 rg BT 108.628 556.007 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 118.265 554.500 Td /F1 9.8 Tf [( At the onset of the wave effects, 10% of people knew about the expected tsunami, and by the time the )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(effects finished, approximately three hours later, only 42% knew about the warning. Upon hearing of it, most people continued )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(their normal business \(64%\), while only 25% took action to protect themselves and 15% did the opposite of what was advised )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(and went to watch the waves at the coast.)] TJ ET 0.267 0.267 0.267 rg BT 207.268 520.293 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 216.906 518.786 Td /F1 9.8 Tf [( In the study of a cyclone in India 345 of the villagers reported that they evacuated )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(voluntarily, 20% were forced to evacuate and 46% did not evacuate.)] TJ ET 0.267 0.267 0.267 rg BT 324.317 508.388 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 333.955 506.881 Td /F1 9.8 Tf [( In the San Diego wildfire, 53% of residents in the )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(evacuation zone received the Reverse 911 evacuation message, and 80% who received it evacuated, including 100% of those )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(for whom evacuation was judged necessary.)] TJ ET 0.267 0.267 0.267 rg BT 218.081 484.579 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 227.719 483.072 Td /F1 9.8 Tf [( However, only 66% of those who received it reported the message to be the )] TJ ET BT 26.250 471.167 Td /F1 9.8 Tf [(reason why they evacuated. Some people who did not need to evacuate did so anyway because of the message.)] TJ ET 0.267 0.267 0.267 rg BT 514.023 472.674 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 523.660 471.167 Td /F1 9.8 Tf [( Information )] TJ ET BT 26.250 459.262 Td /F1 9.8 Tf [(acquired through the Internet had the highest correct rejection rate, and the lowest false alarm rate, suggesting that residents )] TJ ET BT 26.250 447.357 Td /F1 9.8 Tf [(were able to judge their own situation most accurately using it as a source.)] TJ ET 0.267 0.267 0.267 rg BT 347.600 448.865 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 357.238 447.357 Td /F1 9.8 Tf [( In the Mauritian tsunami study and the Indian )] TJ ET BT 26.250 435.453 Td /F1 9.8 Tf [(cyclone study there was a low level of compliance with the advice to take protective action against the imminent natural )] TJ ET BT 26.250 423.548 Td /F1 9.8 Tf [(hazards. Factors relating to personal circumstances, beliefs and attitudes, societal response, and the characteristics of the )] TJ ET BT 26.250 411.643 Td /F1 9.8 Tf [(authorities may have influenced whether individuals chose to evacuate.)] TJ ET 0.267 0.267 0.267 rg BT 333.521 413.150 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 343.159 411.643 Td /F1 9.8 Tf [( In the San Diego wildfire, 69% of people in the )] TJ ET BT 26.250 399.738 Td /F1 9.8 Tf [(evacuation zone did evacuate, which is much higher than in the other two studies.)] TJ ET 0.267 0.267 0.267 rg BT 379.054 401.246 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 388.691 399.738 Td /F1 9.8 Tf [( This may relate to the characteristics of the )] TJ ET BT 26.250 387.834 Td /F1 9.8 Tf [(disaster \(fire\), the setting \(rural USA\), the communication methods, or the society. The Reverse 911 alert was relatively widely )] TJ ET BT 26.250 375.929 Td /F1 9.8 Tf [(received and acted upon by a majority of recipients. Use of the Internet allowed people to make even more personalised )] TJ ET BT 26.250 364.024 Td /F1 9.8 Tf [(decisions.)] TJ ET 0.267 0.267 0.267 rg BT 69.599 365.531 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 79.236 364.024 Td /F1 9.8 Tf [( The studies were all conceived retrospectively and relied on recall by participants. Some studies also assessed )] TJ ET BT 26.250 352.119 Td /F1 9.8 Tf [(aetiological factors, and though the studies focused on the intervention of the evacuation warnings, they were not under the )] TJ ET BT 26.250 340.215 Td /F1 9.8 Tf [(control of the researchers. It is difficult to assess the effectiveness of early warning information whenever it is not necessarily )] TJ ET BT 26.250 328.310 Td /F1 9.8 Tf [(correct to attribute all subsequent evacuations to the warning, since some may occur independently of warnings.)] TJ ET BT 26.250 308.905 Td /F4 9.8 Tf [(2 Effect of Risk Communication Interventions to Improve Disaster Response)] TJ ET BT 26.250 289.500 Td /F4 9.8 Tf [(2.1 Communication to Promote Response to Infectious Disease Disasters)] TJ ET BT 26.250 270.096 Td /F4 9.8 Tf [(2.1.1 Setting)] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(Seven studies of communication interventions during infectious disease disasters were identified. One was in the UK,)] TJ ET 0.267 0.267 0.267 rg BT 531.300 252.198 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 536.119 250.691 Td /F1 9.8 Tf [( one was )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(in Egypt,)] TJ ET 0.267 0.267 0.267 rg BT 64.187 240.293 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 73.825 238.786 Td /F1 9.8 Tf [( and five were in Asian countries: one in each of China,)] TJ ET 0.267 0.267 0.267 rg BT 311.734 240.293 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 321.372 238.786 Td /F1 9.8 Tf [( Thailand,)] TJ ET 0.267 0.267 0.267 rg BT 364.184 240.293 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 373.821 238.786 Td /F1 9.8 Tf [( Taiwan,)] TJ ET 0.267 0.267 0.267 rg BT 410.667 240.293 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 420.304 238.786 Td /F1 9.8 Tf [( Singapore)] TJ ET 0.267 0.267 0.267 rg BT 467.455 240.293 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 477.092 238.786 Td /F1 9.8 Tf [( and Hong Kong.)] TJ ET 0.267 0.267 0.267 rg BT 550.266 240.293 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 26.250 226.881 Td /F1 9.8 Tf [(Three studies took place in the context of the SARS epidemic,)] TJ ET 0.267 0.267 0.267 rg BT 293.966 228.389 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 303.603 230.770 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 306.012 228.389 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 315.650 230.770 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 318.059 228.389 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 327.696 226.881 Td /F1 9.8 Tf [( one during the 2009-2010 influenza pandemic,)] TJ ET 0.267 0.267 0.267 rg BT 531.481 228.389 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 541.118 226.881 Td /F1 9.8 Tf [( one )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(during an avian influenza outbreak,)] TJ ET 0.267 0.267 0.267 rg BT 177.999 216.484 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 187.636 214.977 Td /F1 9.8 Tf [( one involved an epidemic of viral conjunctivitis)] TJ ET 0.267 0.267 0.267 rg BT 389.754 216.484 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 399.391 214.977 Td /F1 9.8 Tf [( and one was set during a small outbreak )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(of meningococcal disease in a school.)] TJ ET 0.267 0.267 0.267 rg BT 190.450 204.579 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 183.667 Td /F4 9.8 Tf [(2.1.2 Participants)] TJ ET BT 26.250 164.262 Td /F1 9.8 Tf [(Farahat et al. studied 420 school pupils \(mean age 16 years; 46% male\) during the influenza pandemic.)] TJ ET 0.267 0.267 0.267 rg BT 472.800 165.770 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 482.437 164.262 Td /F1 9.8 Tf [( Olsen )] TJ ET BT 513.325 164.262 Td /F5 9.8 Tf [(et al. )] TJ ET BT 537.174 164.262 Td /F1 9.8 Tf [(reported )] TJ ET BT 26.250 152.358 Td /F1 9.8 Tf [(a study of 200 participants \(median age 50 years; 72% female\) during an avian influenza outbreak in Nakhon Phanom, Thailand.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 141.960 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 35.887 140.453 Td /F1 9.8 Tf [( Three SARS studies took place in Asia. Pang )] TJ ET BT 236.942 140.453 Td /F5 9.8 Tf [(et al. )] TJ ET BT 260.791 140.453 Td /F1 9.8 Tf [(reported outcomes for 1,860 people in China who were hospitalised with )] TJ ET BT 26.250 128.548 Td /F1 9.8 Tf [(SARS infection.)] TJ ET 0.267 0.267 0.267 rg BT 94.529 130.055 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 104.167 128.548 Td /F1 9.8 Tf [( A study by Chan )] TJ ET BT 181.123 128.548 Td /F5 9.8 Tf [(et al. )] TJ ET BT 204.972 128.548 Td /F1 9.8 Tf [(included 122 \(63% female\) people in Hong Kong aged 55 years or over.)] TJ ET 0.267 0.267 0.267 rg BT 514.963 130.055 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 524.601 128.548 Td /F1 9.8 Tf [( The study )] TJ ET BT 26.250 116.643 Td /F1 9.8 Tf [(by Karan )] TJ ET BT 67.980 116.643 Td /F5 9.8 Tf [(et al. )] TJ ET BT 91.828 116.643 Td /F1 9.8 Tf [(included 300 individuals \(51% male\) in Singapore, 61% of whom were aged between 20 and 39 years.)] TJ ET 0.267 0.267 0.267 rg BT 532.957 118.151 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 542.595 116.643 Td /F1 9.8 Tf [( During )] TJ ET BT 26.250 104.739 Td /F1 9.8 Tf [(an outbreak of viral acute haemorrhagic conjunctivitis in Taiwan, comparisons were made between two interventions by )] TJ ET BT 26.250 92.834 Td /F1 9.8 Tf [(directing public health messages at the inhabitants of two affected cities, Taipei \(population 2,632,242\) and Keelung \(population )] TJ ET BT 26.250 80.929 Td /F1 9.8 Tf [(390,084\).)] TJ ET 0.267 0.267 0.267 rg BT 67.444 82.436 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 77.081 80.929 Td /F1 9.8 Tf [( Schoolchildren were the population that was mainly affected \(Taipei City had 277,159 schoolchildren and Keelung )] TJ ET BT 26.250 69.024 Td /F1 9.8 Tf [(City had 41,244\).)] TJ ET 0.267 0.267 0.267 rg BT 100.496 70.532 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 110.134 69.024 Td /F1 9.8 Tf [( During an outbreak of meningococcal disease in a secondary-level school in England, 88 school pupils )] TJ ET BT 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/Contents 1244 0 R >> endobj 1244 0 obj << /Length 40192 >> stream 0.267 0.267 0.267 rg q 15.000 28.310 577.500 748.690 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F4 9.8 Tf [(2.1.3 Description of Interventions)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(One study used an intensive health education programme consisting of lectures, role-play and group discussion aided by )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(photos, posters, pamphlets and a data show about influenza H1N1 held every other day in schools for two weeks.)] TJ ET 0.267 0.267 0.267 rg BT 520.487 737.674 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 530.125 736.167 Td /F1 9.8 Tf [( During the )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(avian influenza outbreak, a multi-media response was conducted, including a telephone help line with prevention information, a )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(web site, newspaper, radio and television information broadcasts, the distribution of education videos to health officers and a )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(booklet sent directly to members of the public.)] TJ ET 0.267 0.267 0.267 rg BT 224.584 701.960 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 234.222 700.452 Td /F1 9.8 Tf [( During the SARS epidemic in Beijing, the health ministry announced the )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(outbreak in a press conference on 20 April 2003.)] TJ ET 0.267 0.267 0.267 rg BT 236.528 690.055 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 246.166 688.548 Td /F1 9.8 Tf [( Subsequently there were four further ministry press conferences, nine )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(municipal government press conferences, a billboard campaign, bus advertisements, banners, a daily two-hour educational )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(television programme, a telephone help line, 6,672 SARS community seminars and delivery of 8,280,000 copies of educational )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(materials to citizens.)] TJ ET 0.267 0.267 0.267 rg BT 114.566 654.341 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 124.203 652.833 Td /F1 9.8 Tf [( In Hong Kong, Chan et al. conducted a telephone intervention with pre-test and post-test surveys.)] TJ ET 0.267 0.267 0.267 rg BT 547.470 654.341 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 557.107 652.833 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(intervention was delivered by nursing students who were trained to gather information from the participants and deliver a )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(tailored intervention that addressed any of the participants misconceptions or information needs about SARS. Karan et al. )] TJ ET BT 26.250 617.119 Td /F1 9.8 Tf [(sought to evaluate the national public health communication programme in their survey.)] TJ ET 0.267 0.267 0.267 rg BT 403.419 618.626 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 413.056 617.119 Td /F1 9.8 Tf [( A multi-media campaign was )] TJ ET BT 26.250 605.214 Td /F1 9.8 Tf [(conducted that involved press conferences, print and television adverts explaining infection control measures, a dedicated )] TJ ET BT 26.250 593.310 Td /F1 9.8 Tf [(television channel, web site, help lines, and a SARS kit containing a thermometer that was posted to every home. The )] TJ ET BT 26.250 581.405 Td /F1 9.8 Tf [(Singapore response also included fines and imprisonment for individuals who did not comply with quarantine, and fines for )] TJ ET BT 26.250 569.500 Td /F1 9.8 Tf [(some unhygienic behaviours.)] TJ ET 0.267 0.267 0.267 rg BT 152.512 571.007 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 162.150 569.500 Td /F1 9.8 Tf [( In the outbreak of infective haemorrhagic conjunctivitis, in both Taipei and Keelung cities )] TJ ET BT 26.250 557.595 Td /F1 9.8 Tf [(delivered public service messages and health education in schools, ran a telephone help line and provided the media with )] TJ ET BT 26.250 545.691 Td /F1 9.8 Tf [(information.)] TJ ET 0.267 0.267 0.267 rg BT 77.184 547.198 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 86.821 545.691 Td /F1 9.8 Tf [( However, Taipei instigated further steps: On a single day, the Taipei mayor addressed the press, a letter from the )] TJ ET BT 26.250 533.786 Td /F1 9.8 Tf [(department of health was given to children to give to their parents and SMS text messages with information and infection control )] TJ ET BT 26.250 521.881 Td /F1 9.8 Tf [(advice were sent to all 2.2 million Taipei citizens with mobile phones.)] TJ ET 0.267 0.267 0.267 rg BT 322.650 523.388 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 332.287 521.881 Td /F1 9.8 Tf [( The Health Protection Agency \(now Public Health )] TJ ET BT 26.250 509.976 Td /F1 9.8 Tf [(England\) undertook a communication intervention to inform pupils and parents about an outbreak of meningococcal disease )] TJ ET BT 26.250 498.072 Td /F1 9.8 Tf [(and to arrange mass antibiotic prophylaxis for all pupils and staff.)] TJ ET 0.267 0.267 0.267 rg BT 306.416 499.579 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 311.235 498.072 Td /F1 9.8 Tf [( The outbreak became apparent on a Friday afternoon, and )] TJ ET BT 26.250 486.167 Td /F1 9.8 Tf [(the Health Protection Agency \(HPA\) issued letters to parents and released a press statement for radio on the following Monday. )] TJ ET BT 26.250 474.262 Td /F1 9.8 Tf [(The following day, a briefing was held prior to the mass distribution of antibiotics.)] TJ ET 0.267 0.267 0.267 rg BT 373.603 475.769 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 454.857 Td /F4 9.8 Tf [(2.1.4 Results)] TJ ET BT 26.250 435.453 Td /F1 9.8 Tf [(Participants in the school-based intervention by Farahat )] TJ ET BT 269.571 435.453 Td /F5 9.8 Tf [(et al.)] TJ ET BT 290.709 435.453 Td /F1 9.8 Tf [( demonstrated improved knowledge and practice outcomes.)] TJ ET 0.267 0.267 0.267 rg BT 548.655 436.960 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 26.250 423.548 Td /F1 9.8 Tf [(Significant positive changes in knowledge about the cause, source, transmission, symptoms, complications and treatment of )] TJ ET BT 26.250 411.643 Td /F1 9.8 Tf [(pandemic influenza were reported. Positive changes related to self-reported behaviours were also noted for respiratory and )] TJ ET BT 26.250 399.738 Td /F1 9.8 Tf [(hand hygiene, infection control, and self-care. Overall, the proportion with satisfactory knowledge increased from 43% before )] TJ ET BT 26.250 387.834 Td /F1 9.8 Tf [(the intervention to 68% afterwards, and the proportion with good practice rose from 57% to 65%.)] TJ ET 0.267 0.267 0.267 rg BT 441.912 389.341 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 451.549 387.834 Td /F1 9.8 Tf [( Evaluation of the Thailand )] TJ ET BT 26.250 375.929 Td /F1 9.8 Tf [(multi-media response to the avian influenza involved interviewing participants after the events and asking them about their )] TJ ET BT 26.250 364.024 Td /F1 9.8 Tf [(practices before and after the intervention, and as such it may be prone to recall bias. All four knowledge outcomes were )] TJ ET BT 26.250 352.119 Td /F1 9.8 Tf [(significantly improved \(believing that it is safe to touch dead poultry 40% to 14%; that it is safe for children to touch dead poultry )] TJ ET BT 26.250 340.215 Td /F1 9.8 Tf [(23% to 5%; preparing raw poultry with other food 50% to 37%; safe to eat undercooked chicken or eggs 21% to 6%\).)] TJ ET 0.267 0.267 0.267 rg BT 529.175 341.722 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 26.250 328.310 Td /F1 9.8 Tf [(Behavioural practices did not improve to the same extent, with only those touching dead poultry with bare hands dropping from )] TJ ET BT 26.250 316.405 Td /F1 9.8 Tf [(39% to 11%\).)] TJ ET 0.267 0.267 0.267 rg BT 84.779 317.912 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 94.417 316.405 Td /F1 9.8 Tf [( During the SARS epidemic, the median lag time between developing symptoms and hospitalisation in Beijing )] TJ ET BT 26.250 304.500 Td /F1 9.8 Tf [(reduced during the time period of the outbreak from six days between 5 March and 9 April, to five days between 10 April and 20 )] TJ ET BT 26.250 292.596 Td /F1 9.8 Tf [(April, and two days between 21 April and 15 June.)] TJ ET 0.267 0.267 0.267 rg BT 243.031 294.103 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 252.669 292.596 Td /F1 9.8 Tf [( Following the tailored telephone intervention, Chan )] TJ ET BT 477.572 292.596 Td /F5 9.8 Tf [(et al.)] TJ ET BT 498.710 292.596 Td /F1 9.8 Tf [( reported )] TJ ET BT 26.250 280.691 Td /F1 9.8 Tf [(improvements in paired before and after analyses for knowledge about two of five points of knowledge about SARS )] TJ ET BT 26.250 268.786 Td /F1 9.8 Tf [(transmission, but no change for the other three.)] TJ ET 0.267 0.267 0.267 rg BT 231.107 270.293 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 240.745 268.786 Td /F1 9.8 Tf [( For each question, between four and ten people \(out of 122\) answered )] TJ ET BT 26.250 256.881 Td /F1 9.8 Tf [(correctly before the intervention, but incorrectly after it.)] TJ ET 0.267 0.267 0.267 rg BT 261.430 258.389 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 271.067 256.881 Td /F1 9.8 Tf [( For knowledge about transmission by droplets, for example, 62 people )] TJ ET BT 26.250 244.977 Td /F1 9.8 Tf [(answered correctly before and after the intervention and 28 people answered incorrectly beforehand, but correctly afterwards, )] TJ ET BT 26.250 233.072 Td /F1 9.8 Tf [(19 answered incorrectly both times and four answered correctly before, but incorrectly afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 447.284 234.579 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 456.922 233.072 Td /F1 9.8 Tf [( It was notable that for )] TJ ET BT 26.250 221.167 Td /F1 9.8 Tf [(some outcomes \(e.g. for whether animals could transmit SARS\), the vast majority of respondents answered incorrectly before )] TJ ET BT 26.250 209.262 Td /F1 9.8 Tf [(and afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 93.447 210.770 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 103.084 209.262 Td /F1 9.8 Tf [( Unpaired analyses of behavioural outcomes also showed changes, but largely in the opposite direction to that )] TJ ET BT 26.250 197.358 Td /F1 9.8 Tf [(expected. Overall, participants less frequently washed hands with soap or after coughing/sneezing \(reduced from 1.3 to 1.7 on a )] TJ ET BT 26.250 185.453 Td /F1 9.8 Tf [(four point rating scale with 1 = very often and 4 = not at all\), less frequently covered their mouth when coughing/sneezing )] TJ ET BT 26.250 173.548 Td /F1 9.8 Tf [(\(reduced from 1.3 to 1.9\), and were less likely to use a surgical mask \(1.3 to 2.2\).)] TJ ET 0.267 0.267 0.267 rg BT 375.768 175.055 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 385.405 173.548 Td /F1 9.8 Tf [( The authors speculated that this might be )] TJ ET BT 26.250 161.643 Td /F1 9.8 Tf [(because the SARS epidemic was abating at that time, and there may have been less concern by the time of the second survey, )] TJ ET BT 26.250 149.739 Td /F1 9.8 Tf [(one week after the first. It is, however, possible that the intervention had undesirable effects. The interventions content is )] TJ ET BT 26.250 137.834 Td /F1 9.8 Tf [(difficult to appraise because it was non-standardised, being tailored to each individual by the interviewers depending on their )] TJ ET BT 26.250 125.929 Td /F1 9.8 Tf [(apparent knowledge.)] TJ ET 0.267 0.267 0.267 rg BT 116.759 127.436 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 126.397 125.929 Td /F1 9.8 Tf [( The evaluation of Singapores response to SARS compared time points during and after the epidemic. )] TJ ET BT 26.250 114.024 Td /F1 9.8 Tf [(The authors reported that 90% sometimes or always washed their hands regularly during the epidemic, but 80% did so )] TJ ET BT 26.250 102.120 Td /F1 9.8 Tf [(afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 74.474 103.627 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 84.111 102.120 Td /F1 9.8 Tf [( The recommended practice of monitoring ones own temperature daily, which can be assumed to have a zero )] TJ ET BT 26.250 90.215 Td /F1 9.8 Tf [(prevalence prior to the public health campaign, was 85% \(always or sometimes\) during the epidemic and 31% afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 550.790 91.722 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 560.428 90.215 Td /F1 9.8 Tf [( In )] TJ ET BT 26.250 78.310 Td /F1 9.8 Tf [(the mass communication programme aimed at combating further spread of acute haemorrhagic conjunctivitis, school )] TJ ET BT 26.250 66.405 Td /F1 9.8 Tf [(absenteeism and surveillance data were assessed.)] TJ ET 0.267 0.267 0.267 rg BT 246.805 67.913 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 256.442 66.405 Td /F1 9.8 Tf [( School absenteeism for affected pupils, desirable because it prevented )] TJ ET BT 26.250 54.501 Td /F1 9.8 Tf [(further onward transmission of the virus, increased from 10% before the intervention to 62% afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 472.771 56.008 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 482.408 54.501 Td /F1 9.8 Tf [( There was a fall in )] TJ ET BT 26.250 42.596 Td /F1 9.8 Tf [(overall daily incidence from 0.093% to 0.056% following the intervention. The outbreak in Taipei lasted only 13 days, while that )] TJ ET Q q 15.000 28.310 577.500 748.690 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F4 9.8 Tf [(2.1.3 Description of Interventions)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(One study used an intensive health education programme consisting of lectures, role-play and group discussion aided by )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(photos, posters, pamphlets and a data show about influenza H1N1 held every other day in schools for two weeks.)] TJ ET 0.267 0.267 0.267 rg BT 520.487 737.674 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 530.125 736.167 Td /F1 9.8 Tf [( During the )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(avian influenza outbreak, a multi-media response was conducted, including a telephone help line with prevention information, a )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(web site, newspaper, radio and television information broadcasts, the distribution of education videos to health officers and a )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(booklet sent directly to members of the public.)] TJ ET 0.267 0.267 0.267 rg BT 224.584 701.960 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 234.222 700.452 Td /F1 9.8 Tf [( During the SARS epidemic in Beijing, the health ministry announced the )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(outbreak in a press conference on 20 April 2003.)] TJ ET 0.267 0.267 0.267 rg BT 236.528 690.055 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 246.166 688.548 Td /F1 9.8 Tf [( Subsequently there were four further ministry press conferences, nine )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(municipal government press conferences, a billboard campaign, bus advertisements, banners, a daily two-hour educational )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(television programme, a telephone help line, 6,672 SARS community seminars and delivery of 8,280,000 copies of educational )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(materials to citizens.)] TJ ET 0.267 0.267 0.267 rg BT 114.566 654.341 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 124.203 652.833 Td /F1 9.8 Tf [( In Hong Kong, Chan et al. conducted a telephone intervention with pre-test and post-test surveys.)] TJ ET 0.267 0.267 0.267 rg BT 547.470 654.341 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 557.107 652.833 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(intervention was delivered by nursing students who were trained to gather information from the participants and deliver a )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(tailored intervention that addressed any of the participants misconceptions or information needs about SARS. Karan et al. )] TJ ET BT 26.250 617.119 Td /F1 9.8 Tf [(sought to evaluate the national public health communication programme in their survey.)] TJ ET 0.267 0.267 0.267 rg BT 403.419 618.626 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 413.056 617.119 Td /F1 9.8 Tf [( A multi-media campaign was )] TJ ET BT 26.250 605.214 Td /F1 9.8 Tf [(conducted that involved press conferences, print and television adverts explaining infection control measures, a dedicated )] TJ ET BT 26.250 593.310 Td /F1 9.8 Tf [(television channel, web site, help lines, and a SARS kit containing a thermometer that was posted to every home. The )] TJ ET BT 26.250 581.405 Td /F1 9.8 Tf [(Singapore response also included fines and imprisonment for individuals who did not comply with quarantine, and fines for )] TJ ET BT 26.250 569.500 Td /F1 9.8 Tf [(some unhygienic behaviours.)] TJ ET 0.267 0.267 0.267 rg BT 152.512 571.007 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 162.150 569.500 Td /F1 9.8 Tf [( In the outbreak of infective haemorrhagic conjunctivitis, in both Taipei and Keelung cities )] TJ ET BT 26.250 557.595 Td /F1 9.8 Tf [(delivered public service messages and health education in schools, ran a telephone help line and provided the media with )] TJ ET BT 26.250 545.691 Td /F1 9.8 Tf [(information.)] TJ ET 0.267 0.267 0.267 rg BT 77.184 547.198 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 86.821 545.691 Td /F1 9.8 Tf [( However, Taipei instigated further steps: On a single day, the Taipei mayor addressed the press, a letter from the )] TJ ET BT 26.250 533.786 Td /F1 9.8 Tf [(department of health was given to children to give to their parents and SMS text messages with information and infection control )] TJ ET BT 26.250 521.881 Td /F1 9.8 Tf [(advice were sent to all 2.2 million Taipei citizens with mobile phones.)] TJ ET 0.267 0.267 0.267 rg BT 322.650 523.388 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 332.287 521.881 Td /F1 9.8 Tf [( The Health Protection Agency \(now Public Health )] TJ ET BT 26.250 509.976 Td /F1 9.8 Tf [(England\) undertook a communication intervention to inform pupils and parents about an outbreak of meningococcal disease )] TJ ET BT 26.250 498.072 Td /F1 9.8 Tf [(and to arrange mass antibiotic prophylaxis for all pupils and staff.)] TJ ET 0.267 0.267 0.267 rg BT 306.416 499.579 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 311.235 498.072 Td /F1 9.8 Tf [( The outbreak became apparent on a Friday afternoon, and )] TJ ET BT 26.250 486.167 Td /F1 9.8 Tf [(the Health Protection Agency \(HPA\) issued letters to parents and released a press statement for radio on the following Monday. )] TJ ET BT 26.250 474.262 Td /F1 9.8 Tf [(The following day, a briefing was held prior to the mass distribution of antibiotics.)] TJ ET 0.267 0.267 0.267 rg BT 373.603 475.769 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 454.857 Td /F4 9.8 Tf [(2.1.4 Results)] TJ ET BT 26.250 435.453 Td /F1 9.8 Tf [(Participants in the school-based intervention by Farahat )] TJ ET BT 269.571 435.453 Td /F5 9.8 Tf [(et al.)] TJ ET BT 290.709 435.453 Td /F1 9.8 Tf [( demonstrated improved knowledge and practice outcomes.)] TJ ET 0.267 0.267 0.267 rg BT 548.655 436.960 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 26.250 423.548 Td /F1 9.8 Tf [(Significant positive changes in knowledge about the cause, source, transmission, symptoms, complications and treatment of )] TJ ET BT 26.250 411.643 Td /F1 9.8 Tf [(pandemic influenza were reported. Positive changes related to self-reported behaviours were also noted for respiratory and )] TJ ET BT 26.250 399.738 Td /F1 9.8 Tf [(hand hygiene, infection control, and self-care. Overall, the proportion with satisfactory knowledge increased from 43% before )] TJ ET BT 26.250 387.834 Td /F1 9.8 Tf [(the intervention to 68% afterwards, and the proportion with good practice rose from 57% to 65%.)] TJ ET 0.267 0.267 0.267 rg BT 441.912 389.341 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 451.549 387.834 Td /F1 9.8 Tf [( Evaluation of the Thailand )] TJ ET BT 26.250 375.929 Td /F1 9.8 Tf [(multi-media response to the avian influenza involved interviewing participants after the events and asking them about their )] TJ ET BT 26.250 364.024 Td /F1 9.8 Tf [(practices before and after the intervention, and as such it may be prone to recall bias. All four knowledge outcomes were )] TJ ET BT 26.250 352.119 Td /F1 9.8 Tf [(significantly improved \(believing that it is safe to touch dead poultry 40% to 14%; that it is safe for children to touch dead poultry )] TJ ET BT 26.250 340.215 Td /F1 9.8 Tf [(23% to 5%; preparing raw poultry with other food 50% to 37%; safe to eat undercooked chicken or eggs 21% to 6%\).)] TJ ET 0.267 0.267 0.267 rg BT 529.175 341.722 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 26.250 328.310 Td /F1 9.8 Tf [(Behavioural practices did not improve to the same extent, with only those touching dead poultry with bare hands dropping from )] TJ ET BT 26.250 316.405 Td /F1 9.8 Tf [(39% to 11%\).)] TJ ET 0.267 0.267 0.267 rg BT 84.779 317.912 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 94.417 316.405 Td /F1 9.8 Tf [( During the SARS epidemic, the median lag time between developing symptoms and hospitalisation in Beijing )] TJ ET BT 26.250 304.500 Td /F1 9.8 Tf [(reduced during the time period of the outbreak from six days between 5 March and 9 April, to five days between 10 April and 20 )] TJ ET BT 26.250 292.596 Td /F1 9.8 Tf [(April, and two days between 21 April and 15 June.)] TJ ET 0.267 0.267 0.267 rg BT 243.031 294.103 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 252.669 292.596 Td /F1 9.8 Tf [( Following the tailored telephone intervention, Chan )] TJ ET BT 477.572 292.596 Td /F5 9.8 Tf [(et al.)] TJ ET BT 498.710 292.596 Td /F1 9.8 Tf [( reported )] TJ ET BT 26.250 280.691 Td /F1 9.8 Tf [(improvements in paired before and after analyses for knowledge about two of five points of knowledge about SARS )] TJ ET BT 26.250 268.786 Td /F1 9.8 Tf [(transmission, but no change for the other three.)] TJ ET 0.267 0.267 0.267 rg BT 231.107 270.293 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 240.745 268.786 Td /F1 9.8 Tf [( For each question, between four and ten people \(out of 122\) answered )] TJ ET BT 26.250 256.881 Td /F1 9.8 Tf [(correctly before the intervention, but incorrectly after it.)] TJ ET 0.267 0.267 0.267 rg BT 261.430 258.389 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 271.067 256.881 Td /F1 9.8 Tf [( For knowledge about transmission by droplets, for example, 62 people )] TJ ET BT 26.250 244.977 Td /F1 9.8 Tf [(answered correctly before and after the intervention and 28 people answered incorrectly beforehand, but correctly afterwards, )] TJ ET BT 26.250 233.072 Td /F1 9.8 Tf [(19 answered incorrectly both times and four answered correctly before, but incorrectly afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 447.284 234.579 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 456.922 233.072 Td /F1 9.8 Tf [( It was notable that for )] TJ ET BT 26.250 221.167 Td /F1 9.8 Tf [(some outcomes \(e.g. for whether animals could transmit SARS\), the vast majority of respondents answered incorrectly before )] TJ ET BT 26.250 209.262 Td /F1 9.8 Tf [(and afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 93.447 210.770 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 103.084 209.262 Td /F1 9.8 Tf [( Unpaired analyses of behavioural outcomes also showed changes, but largely in the opposite direction to that )] TJ ET BT 26.250 197.358 Td /F1 9.8 Tf [(expected. Overall, participants less frequently washed hands with soap or after coughing/sneezing \(reduced from 1.3 to 1.7 on a )] TJ ET BT 26.250 185.453 Td /F1 9.8 Tf [(four point rating scale with 1 = very often and 4 = not at all\), less frequently covered their mouth when coughing/sneezing )] TJ ET BT 26.250 173.548 Td /F1 9.8 Tf [(\(reduced from 1.3 to 1.9\), and were less likely to use a surgical mask \(1.3 to 2.2\).)] TJ ET 0.267 0.267 0.267 rg BT 375.768 175.055 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 385.405 173.548 Td /F1 9.8 Tf [( The authors speculated that this might be )] TJ ET BT 26.250 161.643 Td /F1 9.8 Tf [(because the SARS epidemic was abating at that time, and there may have been less concern by the time of the second survey, )] TJ ET BT 26.250 149.739 Td /F1 9.8 Tf [(one week after the first. It is, however, possible that the intervention had undesirable effects. The interventions content is )] TJ ET BT 26.250 137.834 Td /F1 9.8 Tf [(difficult to appraise because it was non-standardised, being tailored to each individual by the interviewers depending on their )] TJ ET BT 26.250 125.929 Td /F1 9.8 Tf [(apparent knowledge.)] TJ ET 0.267 0.267 0.267 rg BT 116.759 127.436 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 126.397 125.929 Td /F1 9.8 Tf [( The evaluation of Singapores response to SARS compared time points during and after the epidemic. )] TJ ET BT 26.250 114.024 Td /F1 9.8 Tf [(The authors reported that 90% sometimes or always washed their hands regularly during the epidemic, but 80% did so )] TJ ET BT 26.250 102.120 Td /F1 9.8 Tf [(afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 74.474 103.627 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 84.111 102.120 Td /F1 9.8 Tf [( The recommended practice of monitoring ones own temperature daily, which can be assumed to have a zero )] TJ ET BT 26.250 90.215 Td /F1 9.8 Tf [(prevalence prior to the public health campaign, was 85% \(always or sometimes\) during the epidemic and 31% afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 550.790 91.722 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 560.428 90.215 Td /F1 9.8 Tf [( In )] TJ ET BT 26.250 78.310 Td /F1 9.8 Tf [(the mass communication programme aimed at combating further spread of acute haemorrhagic conjunctivitis, school )] TJ ET BT 26.250 66.405 Td /F1 9.8 Tf [(absenteeism and surveillance data were assessed.)] TJ ET 0.267 0.267 0.267 rg BT 246.805 67.913 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 256.442 66.405 Td /F1 9.8 Tf [( School absenteeism for affected pupils, desirable because it prevented )] TJ ET BT 26.250 54.501 Td /F1 9.8 Tf [(further onward transmission of the virus, increased from 10% before the intervention to 62% afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 472.771 56.008 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 482.408 54.501 Td /F1 9.8 Tf [( There was a fall in )] TJ ET BT 26.250 42.596 Td /F1 9.8 Tf [(overall daily incidence from 0.093% to 0.056% following the intervention. The outbreak in Taipei lasted only 13 days, while that )] TJ ET Q q 15.000 28.310 577.500 748.690 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F4 9.8 Tf [(2.1.3 Description of Interventions)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(One study used an intensive health education programme consisting of lectures, role-play and group discussion aided by )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(photos, posters, pamphlets and a data show about influenza H1N1 held every other day in schools for two weeks.)] TJ ET 0.267 0.267 0.267 rg BT 520.487 737.674 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 530.125 736.167 Td /F1 9.8 Tf [( During the )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(avian influenza outbreak, a multi-media response was conducted, including a telephone help line with prevention information, a )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(web site, newspaper, radio and television information broadcasts, the distribution of education videos to health officers and a )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(booklet sent directly to members of the public.)] TJ ET 0.267 0.267 0.267 rg BT 224.584 701.960 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 234.222 700.452 Td /F1 9.8 Tf [( During the SARS epidemic in Beijing, the health ministry announced the )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(outbreak in a press conference on 20 April 2003.)] TJ ET 0.267 0.267 0.267 rg BT 236.528 690.055 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 246.166 688.548 Td /F1 9.8 Tf [( Subsequently there were four further ministry press conferences, nine )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(municipal government press conferences, a billboard campaign, bus advertisements, banners, a daily two-hour educational )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(television programme, a telephone help line, 6,672 SARS community seminars and delivery of 8,280,000 copies of educational )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(materials to citizens.)] TJ ET 0.267 0.267 0.267 rg BT 114.566 654.341 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 124.203 652.833 Td /F1 9.8 Tf [( In Hong Kong, Chan et al. conducted a telephone intervention with pre-test and post-test surveys.)] TJ ET 0.267 0.267 0.267 rg BT 547.470 654.341 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 557.107 652.833 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(intervention was delivered by nursing students who were trained to gather information from the participants and deliver a )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(tailored intervention that addressed any of the participants misconceptions or information needs about SARS. Karan et al. )] TJ ET BT 26.250 617.119 Td /F1 9.8 Tf [(sought to evaluate the national public health communication programme in their survey.)] TJ ET 0.267 0.267 0.267 rg BT 403.419 618.626 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 413.056 617.119 Td /F1 9.8 Tf [( A multi-media campaign was )] TJ ET BT 26.250 605.214 Td /F1 9.8 Tf [(conducted that involved press conferences, print and television adverts explaining infection control measures, a dedicated )] TJ ET BT 26.250 593.310 Td /F1 9.8 Tf [(television channel, web site, help lines, and a SARS kit containing a thermometer that was posted to every home. The )] TJ ET BT 26.250 581.405 Td /F1 9.8 Tf [(Singapore response also included fines and imprisonment for individuals who did not comply with quarantine, and fines for )] TJ ET BT 26.250 569.500 Td /F1 9.8 Tf [(some unhygienic behaviours.)] TJ ET 0.267 0.267 0.267 rg BT 152.512 571.007 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 162.150 569.500 Td /F1 9.8 Tf [( In the outbreak of infective haemorrhagic conjunctivitis, in both Taipei and Keelung cities )] TJ ET BT 26.250 557.595 Td /F1 9.8 Tf [(delivered public service messages and health education in schools, ran a telephone help line and provided the media with )] TJ ET BT 26.250 545.691 Td /F1 9.8 Tf [(information.)] TJ ET 0.267 0.267 0.267 rg BT 77.184 547.198 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 86.821 545.691 Td /F1 9.8 Tf [( However, Taipei instigated further steps: On a single day, the Taipei mayor addressed the press, a letter from the )] TJ ET BT 26.250 533.786 Td /F1 9.8 Tf [(department of health was given to children to give to their parents and SMS text messages with information and infection control )] TJ ET BT 26.250 521.881 Td /F1 9.8 Tf [(advice were sent to all 2.2 million Taipei citizens with mobile phones.)] TJ ET 0.267 0.267 0.267 rg BT 322.650 523.388 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 332.287 521.881 Td /F1 9.8 Tf [( The Health Protection Agency \(now Public Health )] TJ ET BT 26.250 509.976 Td /F1 9.8 Tf [(England\) undertook a communication intervention to inform pupils and parents about an outbreak of meningococcal disease )] TJ ET BT 26.250 498.072 Td /F1 9.8 Tf [(and to arrange mass antibiotic prophylaxis for all pupils and staff.)] TJ ET 0.267 0.267 0.267 rg BT 306.416 499.579 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 311.235 498.072 Td /F1 9.8 Tf [( The outbreak became apparent on a Friday afternoon, and )] TJ ET BT 26.250 486.167 Td /F1 9.8 Tf [(the Health Protection Agency \(HPA\) issued letters to parents and released a press statement for radio on the following Monday. )] TJ ET BT 26.250 474.262 Td /F1 9.8 Tf [(The following day, a briefing was held prior to the mass distribution of antibiotics.)] TJ ET 0.267 0.267 0.267 rg BT 373.603 475.769 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 454.857 Td /F4 9.8 Tf [(2.1.4 Results)] TJ ET BT 26.250 435.453 Td /F1 9.8 Tf [(Participants in the school-based intervention by Farahat )] TJ ET BT 269.571 435.453 Td /F5 9.8 Tf [(et al.)] TJ ET BT 290.709 435.453 Td /F1 9.8 Tf [( demonstrated improved knowledge and practice outcomes.)] TJ ET 0.267 0.267 0.267 rg BT 548.655 436.960 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 26.250 423.548 Td /F1 9.8 Tf [(Significant positive changes in knowledge about the cause, source, transmission, symptoms, complications and treatment of )] TJ ET BT 26.250 411.643 Td /F1 9.8 Tf [(pandemic influenza were reported. Positive changes related to self-reported behaviours were also noted for respiratory and )] TJ ET BT 26.250 399.738 Td /F1 9.8 Tf [(hand hygiene, infection control, and self-care. Overall, the proportion with satisfactory knowledge increased from 43% before )] TJ ET BT 26.250 387.834 Td /F1 9.8 Tf [(the intervention to 68% afterwards, and the proportion with good practice rose from 57% to 65%.)] TJ ET 0.267 0.267 0.267 rg BT 441.912 389.341 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 451.549 387.834 Td /F1 9.8 Tf [( Evaluation of the Thailand )] TJ ET BT 26.250 375.929 Td /F1 9.8 Tf [(multi-media response to the avian influenza involved interviewing participants after the events and asking them about their )] TJ ET BT 26.250 364.024 Td /F1 9.8 Tf [(practices before and after the intervention, and as such it may be prone to recall bias. All four knowledge outcomes were )] TJ ET BT 26.250 352.119 Td /F1 9.8 Tf [(significantly improved \(believing that it is safe to touch dead poultry 40% to 14%; that it is safe for children to touch dead poultry )] TJ ET BT 26.250 340.215 Td /F1 9.8 Tf [(23% to 5%; preparing raw poultry with other food 50% to 37%; safe to eat undercooked chicken or eggs 21% to 6%\).)] TJ ET 0.267 0.267 0.267 rg BT 529.175 341.722 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 26.250 328.310 Td /F1 9.8 Tf [(Behavioural practices did not improve to the same extent, with only those touching dead poultry with bare hands dropping from )] TJ ET BT 26.250 316.405 Td /F1 9.8 Tf [(39% to 11%\).)] TJ ET 0.267 0.267 0.267 rg BT 84.779 317.912 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 94.417 316.405 Td /F1 9.8 Tf [( During the SARS epidemic, the median lag time between developing symptoms and hospitalisation in Beijing )] TJ ET BT 26.250 304.500 Td /F1 9.8 Tf [(reduced during the time period of the outbreak from six days between 5 March and 9 April, to five days between 10 April and 20 )] TJ ET BT 26.250 292.596 Td /F1 9.8 Tf [(April, and two days between 21 April and 15 June.)] TJ ET 0.267 0.267 0.267 rg BT 243.031 294.103 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 252.669 292.596 Td /F1 9.8 Tf [( Following the tailored telephone intervention, Chan )] TJ ET BT 477.572 292.596 Td /F5 9.8 Tf [(et al.)] TJ ET BT 498.710 292.596 Td /F1 9.8 Tf [( reported )] TJ ET BT 26.250 280.691 Td /F1 9.8 Tf [(improvements in paired before and after analyses for knowledge about two of five points of knowledge about SARS )] TJ ET BT 26.250 268.786 Td /F1 9.8 Tf [(transmission, but no change for the other three.)] TJ ET 0.267 0.267 0.267 rg BT 231.107 270.293 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 240.745 268.786 Td /F1 9.8 Tf [( For each question, between four and ten people \(out of 122\) answered )] TJ ET BT 26.250 256.881 Td /F1 9.8 Tf [(correctly before the intervention, but incorrectly after it.)] TJ ET 0.267 0.267 0.267 rg BT 261.430 258.389 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 271.067 256.881 Td /F1 9.8 Tf [( For knowledge about transmission by droplets, for example, 62 people )] TJ ET BT 26.250 244.977 Td /F1 9.8 Tf [(answered correctly before and after the intervention and 28 people answered incorrectly beforehand, but correctly afterwards, )] TJ ET BT 26.250 233.072 Td /F1 9.8 Tf [(19 answered incorrectly both times and four answered correctly before, but incorrectly afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 447.284 234.579 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 456.922 233.072 Td /F1 9.8 Tf [( It was notable that for )] TJ ET BT 26.250 221.167 Td /F1 9.8 Tf [(some outcomes \(e.g. for whether animals could transmit SARS\), the vast majority of respondents answered incorrectly before )] TJ ET BT 26.250 209.262 Td /F1 9.8 Tf [(and afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 93.447 210.770 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 103.084 209.262 Td /F1 9.8 Tf [( Unpaired analyses of behavioural outcomes also showed changes, but largely in the opposite direction to that )] TJ ET BT 26.250 197.358 Td /F1 9.8 Tf [(expected. Overall, participants less frequently washed hands with soap or after coughing/sneezing \(reduced from 1.3 to 1.7 on a )] TJ ET BT 26.250 185.453 Td /F1 9.8 Tf [(four point rating scale with 1 = very often and 4 = not at all\), less frequently covered their mouth when coughing/sneezing )] TJ ET BT 26.250 173.548 Td /F1 9.8 Tf [(\(reduced from 1.3 to 1.9\), and were less likely to use a surgical mask \(1.3 to 2.2\).)] TJ ET 0.267 0.267 0.267 rg BT 375.768 175.055 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 385.405 173.548 Td /F1 9.8 Tf [( The authors speculated that this might be )] TJ ET BT 26.250 161.643 Td /F1 9.8 Tf [(because the SARS epidemic was abating at that time, and there may have been less concern by the time of the second survey, )] TJ ET BT 26.250 149.739 Td /F1 9.8 Tf [(one week after the first. It is, however, possible that the intervention had undesirable effects. The interventions content is )] TJ ET BT 26.250 137.834 Td /F1 9.8 Tf [(difficult to appraise because it was non-standardised, being tailored to each individual by the interviewers depending on their )] TJ ET BT 26.250 125.929 Td /F1 9.8 Tf [(apparent knowledge.)] TJ ET 0.267 0.267 0.267 rg BT 116.759 127.436 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 126.397 125.929 Td /F1 9.8 Tf [( The evaluation of Singapores response to SARS compared time points during and after the epidemic. )] TJ ET BT 26.250 114.024 Td /F1 9.8 Tf [(The authors reported that 90% sometimes or always washed their hands regularly during the epidemic, but 80% did so )] TJ ET BT 26.250 102.120 Td /F1 9.8 Tf [(afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 74.474 103.627 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 84.111 102.120 Td /F1 9.8 Tf [( The recommended practice of monitoring ones own temperature daily, which can be assumed to have a zero )] TJ ET BT 26.250 90.215 Td /F1 9.8 Tf [(prevalence prior to the public health campaign, was 85% \(always or sometimes\) during the epidemic and 31% afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 550.790 91.722 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 560.428 90.215 Td /F1 9.8 Tf [( In )] TJ ET BT 26.250 78.310 Td /F1 9.8 Tf [(the mass communication programme aimed at combating further spread of acute haemorrhagic conjunctivitis, school )] TJ ET BT 26.250 66.405 Td /F1 9.8 Tf [(absenteeism and surveillance data were assessed.)] TJ ET 0.267 0.267 0.267 rg BT 246.805 67.913 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 256.442 66.405 Td /F1 9.8 Tf [( School absenteeism for affected pupils, desirable because it prevented )] TJ ET BT 26.250 54.501 Td /F1 9.8 Tf [(further onward transmission of the virus, increased from 10% before the intervention to 62% afterwards.)] TJ ET 0.267 0.267 0.267 rg BT 472.771 56.008 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 482.408 54.501 Td /F1 9.8 Tf [( There was a fall in )] TJ ET BT 26.250 42.596 Td /F1 9.8 Tf [(overall daily incidence from 0.093% to 0.056% following the intervention. 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The crude attack rate in Taipei was 2%, and that in Keelung was 14.9%.)] TJ ET 0.267 0.267 0.267 rg BT 454.392 768.983 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 464.029 767.476 Td /F1 9.8 Tf [( In qualitative responses )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(to the Health Promotion Agencys response to an outbreak of meningococcal disease in a school, many pupils reported that the )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(official communications had been too slow, because interpersonal communication had spread the news over the preceding )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(days, but that this had been accompanied by misinformation and uncertainty.)] TJ ET 0.267 0.267 0.267 rg BT 357.916 733.269 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 362.734 731.762 Td /F1 9.8 Tf [( The report indicates that 74% of school pupils )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(already knew about the meningococcal disease outbreak before information was released by the school and the Health )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(Protection Agency.)] TJ ET 0.267 0.267 0.267 rg BT 108.082 709.460 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 112.900 707.952 Td /F1 9.8 Tf [( The Chan )] TJ ET BT 161.134 707.952 Td /F5 9.8 Tf [(et al.)] TJ ET BT 182.272 707.952 Td /F1 9.8 Tf [( uncontrolled before and after study during the SARS epidemic highlights a problem with )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(uncontrolled studies: protective behaviours became less common during the period of the study, possibly because of a )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(lessening concern about the disease as the outbreak abated.)] TJ ET 0.267 0.267 0.267 rg BT 289.656 685.650 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 299.293 684.143 Td /F1 9.8 Tf [( If the study had taken place earlier in the outbreak, it might )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(have detected increases in protective behaviours as concern was rising, and might have attributed the improvement to the )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(intervention.)] TJ ET BT 26.250 640.929 Td /F4 9.8 Tf [(2.2 Communication to Promote Response to Natural Disasters)] TJ ET BT 26.250 621.524 Td /F4 9.8 Tf [(2.2.1 Setting)] TJ ET BT 26.250 602.119 Td /F1 9.8 Tf [(One study relating to the response to natural disasters was identified,)] TJ ET 0.267 0.267 0.267 rg BT 324.853 603.626 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 334.491 602.119 Td /F1 9.8 Tf [( relating to the wildfire event in San Diego, California, )] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(USA, in 2007 that was also studied by Strawderman et al.,)] TJ ET 0.267 0.267 0.267 rg BT 277.702 591.722 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 287.340 590.214 Td /F1 9.8 Tf [( described above \(Early Warnings\).)] TJ ET BT 26.250 570.810 Td /F4 9.8 Tf [(2.2.2 Participants)] TJ ET BT 26.250 551.405 Td /F1 9.8 Tf [(Sugerman et al. conducted telephone interviews with 1,802 adults \(of 18,687 calls made\).)] TJ ET 0.267 0.267 0.267 rg BT 412.106 552.912 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 421.744 551.405 Td /F1 9.8 Tf [( Ten percent of calls were )] TJ ET BT 26.250 539.500 Td /F1 9.8 Tf [(conducted in Spanish. The most frequent age range was 35-64 years, the study sample was older than the general population, )] TJ ET BT 26.250 527.595 Td /F1 9.8 Tf [(and 50% of the sample were male.)] TJ ET 0.267 0.267 0.267 rg BT 176.361 529.103 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 26.250 508.191 Td /F4 9.8 Tf [(2.2.3 Description of Interventions)] TJ ET BT 26.250 488.786 Td /F1 9.8 Tf [(The health messages promoted by the San Diego County Health and Human Services Agency and American Heart and Lung )] TJ ET BT 26.250 476.881 Td /F1 9.8 Tf [(Association during a three week multi-media campaign that used television, radio, newspapers and the Internet were evaluated.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 466.484 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 35.887 464.976 Td /F1 9.8 Tf [( They advised residents to stay indoors, drive with all windows closed, run air conditioners on recirculate, keep home windows )] TJ ET BT 26.250 453.072 Td /F1 9.8 Tf [(closed, use HEPA air filters, only exercise indoors, wet ash before clean-up, use N95 respirators during clean-up, limit activities )] TJ ET BT 26.250 441.167 Td /F1 9.8 Tf [(to what is absolutely necessary, boil tap water before drinking and drink bottled water.)] TJ ET 0.267 0.267 0.267 rg BT 395.834 442.674 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 26.250 421.762 Td /F4 9.8 Tf [(2.2.4 Results)] TJ ET BT 26.250 402.357 Td /F1 9.8 Tf [(The messages reached 88% of respondents, with television being by far the most common medium \(77%\) followed by radio )] TJ ET BT 26.250 390.453 Td /F1 9.8 Tf [(\(7%\).)] TJ ET 0.267 0.267 0.267 rg BT 49.543 391.960 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 59.180 390.453 Td /F1 9.8 Tf [( Following the warnings, participants spontaneously recalled being told to stay indoors \(68%\), to keep windows closed )] TJ ET BT 26.250 378.548 Td /F1 9.8 Tf [(\(18%\) and only to exercise indoors \(11%\), but eight other messages were recalled by less than 5%.)] TJ ET 0.267 0.267 0.267 rg BT 454.889 380.055 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 464.527 378.548 Td /F1 9.8 Tf [( Fifty-nine percent stayed )] TJ ET BT 26.250 366.643 Td /F1 9.8 Tf [(inside most of the day, 76% kept windows closed, 88% did not participate in outdoor sports, 76% wet ash during cleanup, 16% )] TJ ET BT 26.250 354.738 Td /F1 9.8 Tf [(used home air conditioning, 10% used HEPA air filters and 8% wore a N95 mask.)] TJ ET 0.267 0.267 0.267 rg BT 377.396 356.246 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 387.034 354.738 Td /F1 9.8 Tf [( It is possible, however, that residents might )] TJ ET BT 26.250 342.834 Td /F1 9.8 Tf [(have engaged in some of these precautions independently of the media campaign.)] TJ ET BT 26.250 323.429 Td /F4 9.8 Tf [(2.3 Communication to Promote Response to Water Supply Disasters)] TJ ET BT 26.250 304.024 Td /F4 9.8 Tf [(2.3.1 Setting)] TJ ET BT 26.250 284.619 Td /F1 9.8 Tf [(Four studies of the response to water supply disasters were found: One in Haiti,)] TJ ET 0.267 0.267 0.267 rg BT 369.820 286.127 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 379.458 284.619 Td /F1 9.8 Tf [( one in the UK)] TJ ET 0.267 0.267 0.267 rg BT 441.244 286.127 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 446.062 284.619 Td /F1 9.8 Tf [( and two in the USA.)] TJ ET 0.267 0.267 0.267 rg BT 534.943 286.127 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 544.581 288.508 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 546.990 286.127 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 556.627 284.619 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 272.715 Td /F1 9.8 Tf [(Haiti study followed major flash floods due to Tropical Storm Jeanne.)] TJ ET 0.267 0.267 0.267 rg BT 322.660 274.222 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 332.297 272.715 Td /F1 9.8 Tf [( The study in the UK occurred in the context of major )] TJ ET BT 26.250 260.810 Td /F1 9.8 Tf [(floods in Gloucestershire, England, that caused 140,000 homes to lose their water supply and subsequently be supplied with )] TJ ET BT 26.250 248.905 Td /F1 9.8 Tf [(untreated water.)] TJ ET 0.267 0.267 0.267 rg BT 96.704 250.412 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 101.522 248.905 Td /F1 9.8 Tf [( The two USA studies took place in Boston, Massachusetts, after the collapse of a major water tunnel that )] TJ ET BT 26.250 237.000 Td /F1 9.8 Tf [(carried water to 2 million individuals and residents were supplied with untreated water.)] TJ ET 0.267 0.267 0.267 rg BT 397.433 238.508 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 407.070 240.889 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 409.479 238.508 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 26.250 217.596 Td /F4 9.8 Tf [(2.3.2 Participants)] TJ ET BT 26.250 198.191 Td /F1 9.8 Tf [(The Haitian study interviewed 100 families who had received education and a water purification product following a natural )] TJ ET BT 26.250 186.286 Td /F1 9.8 Tf [(disaster.)] TJ ET 0.267 0.267 0.267 rg BT 63.095 187.793 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 72.733 186.286 Td /F1 9.8 Tf [( Following the water crisis in Gloucestershire, 159 individuals \(of 1,000 invited\) who lost water supply were )] TJ ET BT 26.250 174.381 Td /F1 9.8 Tf [(interviewed \(40% male\).)] TJ ET 0.267 0.267 0.267 rg BT 130.819 175.889 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 135.637 174.381 Td /F1 9.8 Tf [( The sample was slightly older on average than the local census \(at least partly due to the absence of )] TJ ET BT 26.250 162.477 Td /F1 9.8 Tf [(children from the survey\). In Boston, Galarce et al. analysed surveys from 267 people who were affected by the water crisis )] TJ ET BT 26.250 150.572 Td /F1 9.8 Tf [(\(48% male; modal age 30-44 years\).)] TJ ET 0.267 0.267 0.267 rg BT 183.937 152.079 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 193.574 150.572 Td /F1 9.8 Tf [( Participants were recruited from a research database \(78%\) and purposefully recruited )] TJ ET BT 26.250 138.667 Td /F1 9.8 Tf [(from affected areas \(22%\).)] TJ ET 0.267 0.267 0.267 rg BT 141.671 140.174 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 151.308 138.667 Td /F1 9.8 Tf [( Wang et al. surveyed 525 adults \(31% male; modal age 25-34\) who were opportunistically )] TJ ET BT 26.250 126.762 Td /F1 9.8 Tf [(recruited from hospital clinics and waiting rooms.)] TJ ET 0.267 0.267 0.267 rg BT 236.480 128.270 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 26.250 107.358 Td /F4 9.8 Tf [(2.3.3 Description of Interventions)] TJ ET BT 26.250 87.953 Td /F1 9.8 Tf [(In Haiti, community demonstrations were given of how to use PuR, a proprietary water flocculation and purification treatment, )] TJ ET BT 26.250 76.048 Td /F1 9.8 Tf [(three to six weeks after Tropical Storm Jeanne.)] TJ ET 0.267 0.267 0.267 rg BT 229.996 77.555 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 239.633 76.048 Td /F1 9.8 Tf [( The floods compromised and contaminated sources of drinking water. The )] TJ ET BT 26.250 64.143 Td /F1 9.8 Tf [(US Centers for Disease Control and Populations Services International \(PSI\) had collaborated on the development of this )] TJ ET BT 26.250 52.239 Td /F1 9.8 Tf [(product. PSI and the community leaders promoted, distributed and educated about the use of the water purification treatment.)] TJ ET 0.267 0.267 0.267 rg BT 567.658 53.746 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 26.250 40.334 Td /F1 9.8 Tf [(In Gloucestershire, a non-standard, locally produced Do Not Drink notice was delivered to every affected household before )] TJ ET Q q 15.000 26.048 577.500 750.952 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(in Keelung lasted 34 days. The crude attack rate in Taipei was 2%, and that in Keelung was 14.9%.)] TJ ET 0.267 0.267 0.267 rg BT 454.392 768.983 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 464.029 767.476 Td /F1 9.8 Tf [( In qualitative responses )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(to the Health Promotion Agencys response to an outbreak of meningococcal disease in a school, many pupils reported that the )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(official communications had been too slow, because interpersonal communication had spread the news over the preceding )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(days, but that this had been accompanied by misinformation and uncertainty.)] TJ ET 0.267 0.267 0.267 rg BT 357.916 733.269 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 362.734 731.762 Td /F1 9.8 Tf [( The report indicates that 74% of school pupils )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(already knew about the meningococcal disease outbreak before information was released by the school and the Health )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(Protection Agency.)] TJ ET 0.267 0.267 0.267 rg BT 108.082 709.460 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 112.900 707.952 Td /F1 9.8 Tf [( The Chan )] TJ ET BT 161.134 707.952 Td /F5 9.8 Tf [(et al.)] TJ ET BT 182.272 707.952 Td /F1 9.8 Tf [( uncontrolled before and after study during the SARS epidemic highlights a problem with )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(uncontrolled studies: protective behaviours became less common during the period of the study, possibly because of a )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(lessening concern about the disease as the outbreak abated.)] TJ ET 0.267 0.267 0.267 rg BT 289.656 685.650 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 299.293 684.143 Td /F1 9.8 Tf [( If the study had taken place earlier in the outbreak, it might )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(have detected increases in protective behaviours as concern was rising, and might have attributed the improvement to the )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(intervention.)] TJ ET BT 26.250 640.929 Td /F4 9.8 Tf [(2.2 Communication to Promote Response to Natural Disasters)] TJ ET BT 26.250 621.524 Td /F4 9.8 Tf [(2.2.1 Setting)] TJ ET BT 26.250 602.119 Td /F1 9.8 Tf [(One study relating to the response to natural disasters was identified,)] TJ ET 0.267 0.267 0.267 rg BT 324.853 603.626 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 334.491 602.119 Td /F1 9.8 Tf [( relating to the wildfire event in San Diego, California, )] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(USA, in 2007 that was also studied by Strawderman et al.,)] TJ ET 0.267 0.267 0.267 rg BT 277.702 591.722 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 287.340 590.214 Td /F1 9.8 Tf [( described above \(Early Warnings\).)] TJ ET BT 26.250 570.810 Td /F4 9.8 Tf [(2.2.2 Participants)] TJ ET BT 26.250 551.405 Td /F1 9.8 Tf [(Sugerman et al. conducted telephone interviews with 1,802 adults \(of 18,687 calls made\).)] TJ ET 0.267 0.267 0.267 rg BT 412.106 552.912 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 421.744 551.405 Td /F1 9.8 Tf [( Ten percent of calls were )] TJ ET BT 26.250 539.500 Td /F1 9.8 Tf [(conducted in Spanish. The most frequent age range was 35-64 years, the study sample was older than the general population, )] TJ ET BT 26.250 527.595 Td /F1 9.8 Tf [(and 50% of the sample were male.)] TJ ET 0.267 0.267 0.267 rg BT 176.361 529.103 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 26.250 508.191 Td /F4 9.8 Tf [(2.2.3 Description of Interventions)] TJ ET BT 26.250 488.786 Td /F1 9.8 Tf [(The health messages promoted by the San Diego County Health and Human Services Agency and American Heart and Lung )] TJ ET BT 26.250 476.881 Td /F1 9.8 Tf [(Association during a three week multi-media campaign that used television, radio, newspapers and the Internet were evaluated.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 466.484 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 35.887 464.976 Td /F1 9.8 Tf [( They advised residents to stay indoors, drive with all windows closed, run air conditioners on recirculate, keep home windows )] TJ ET BT 26.250 453.072 Td /F1 9.8 Tf [(closed, use HEPA air filters, only exercise indoors, wet ash before clean-up, use N95 respirators during clean-up, limit activities )] TJ ET BT 26.250 441.167 Td /F1 9.8 Tf [(to what is absolutely necessary, boil tap water before drinking and drink bottled water.)] TJ ET 0.267 0.267 0.267 rg BT 395.834 442.674 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 26.250 421.762 Td /F4 9.8 Tf [(2.2.4 Results)] TJ ET BT 26.250 402.357 Td /F1 9.8 Tf [(The messages reached 88% of respondents, with television being by far the most common medium \(77%\) followed by radio )] TJ ET BT 26.250 390.453 Td /F1 9.8 Tf [(\(7%\).)] TJ ET 0.267 0.267 0.267 rg BT 49.543 391.960 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 59.180 390.453 Td /F1 9.8 Tf [( Following the warnings, participants spontaneously recalled being told to stay indoors \(68%\), to keep windows closed )] TJ ET BT 26.250 378.548 Td /F1 9.8 Tf [(\(18%\) and only to exercise indoors \(11%\), but eight other messages were recalled by less than 5%.)] TJ ET 0.267 0.267 0.267 rg BT 454.889 380.055 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 464.527 378.548 Td /F1 9.8 Tf [( Fifty-nine percent stayed )] TJ ET BT 26.250 366.643 Td /F1 9.8 Tf [(inside most of the day, 76% kept windows closed, 88% did not participate in outdoor sports, 76% wet ash during cleanup, 16% )] TJ ET BT 26.250 354.738 Td /F1 9.8 Tf [(used home air conditioning, 10% used HEPA air filters and 8% wore a N95 mask.)] TJ ET 0.267 0.267 0.267 rg BT 377.396 356.246 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 387.034 354.738 Td /F1 9.8 Tf [( It is possible, however, that residents might )] TJ ET BT 26.250 342.834 Td /F1 9.8 Tf [(have engaged in some of these precautions independently of the media campaign.)] TJ ET BT 26.250 323.429 Td /F4 9.8 Tf [(2.3 Communication to Promote Response to Water Supply Disasters)] TJ ET BT 26.250 304.024 Td /F4 9.8 Tf [(2.3.1 Setting)] TJ ET BT 26.250 284.619 Td /F1 9.8 Tf [(Four studies of the response to water supply disasters were found: One in Haiti,)] TJ ET 0.267 0.267 0.267 rg BT 369.820 286.127 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 379.458 284.619 Td /F1 9.8 Tf [( one in the UK)] TJ ET 0.267 0.267 0.267 rg BT 441.244 286.127 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 446.062 284.619 Td /F1 9.8 Tf [( and two in the USA.)] TJ ET 0.267 0.267 0.267 rg BT 534.943 286.127 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 544.581 288.508 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 546.990 286.127 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 556.627 284.619 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 272.715 Td /F1 9.8 Tf [(Haiti study followed major flash floods due to Tropical Storm Jeanne.)] TJ ET 0.267 0.267 0.267 rg BT 322.660 274.222 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 332.297 272.715 Td /F1 9.8 Tf [( The study in the UK occurred in the context of major )] TJ ET BT 26.250 260.810 Td /F1 9.8 Tf [(floods in Gloucestershire, England, that caused 140,000 homes to lose their water supply and subsequently be supplied with )] TJ ET BT 26.250 248.905 Td /F1 9.8 Tf [(untreated water.)] TJ ET 0.267 0.267 0.267 rg BT 96.704 250.412 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 101.522 248.905 Td /F1 9.8 Tf [( The two USA studies took place in Boston, Massachusetts, after the collapse of a major water tunnel that )] TJ ET BT 26.250 237.000 Td /F1 9.8 Tf [(carried water to 2 million individuals and residents were supplied with untreated water.)] TJ ET 0.267 0.267 0.267 rg BT 397.433 238.508 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 407.070 240.889 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 409.479 238.508 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 26.250 217.596 Td /F4 9.8 Tf [(2.3.2 Participants)] TJ ET BT 26.250 198.191 Td /F1 9.8 Tf [(The Haitian study interviewed 100 families who had received education and a water purification product following a natural )] TJ ET BT 26.250 186.286 Td /F1 9.8 Tf [(disaster.)] TJ ET 0.267 0.267 0.267 rg BT 63.095 187.793 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 72.733 186.286 Td /F1 9.8 Tf [( Following the water crisis in Gloucestershire, 159 individuals \(of 1,000 invited\) who lost water supply were )] TJ ET BT 26.250 174.381 Td /F1 9.8 Tf [(interviewed \(40% male\).)] TJ ET 0.267 0.267 0.267 rg BT 130.819 175.889 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 135.637 174.381 Td /F1 9.8 Tf [( The sample was slightly older on average than the local census \(at least partly due to the absence of )] TJ ET BT 26.250 162.477 Td /F1 9.8 Tf [(children from the survey\). In Boston, Galarce et al. analysed surveys from 267 people who were affected by the water crisis )] TJ ET BT 26.250 150.572 Td /F1 9.8 Tf [(\(48% male; modal age 30-44 years\).)] TJ ET 0.267 0.267 0.267 rg BT 183.937 152.079 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 193.574 150.572 Td /F1 9.8 Tf [( Participants were recruited from a research database \(78%\) and purposefully recruited )] TJ ET BT 26.250 138.667 Td /F1 9.8 Tf [(from affected areas \(22%\).)] TJ ET 0.267 0.267 0.267 rg BT 141.671 140.174 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 151.308 138.667 Td /F1 9.8 Tf [( Wang et al. surveyed 525 adults \(31% male; modal age 25-34\) who were opportunistically )] TJ ET BT 26.250 126.762 Td /F1 9.8 Tf [(recruited from hospital clinics and waiting rooms.)] TJ ET 0.267 0.267 0.267 rg BT 236.480 128.270 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 26.250 107.358 Td /F4 9.8 Tf [(2.3.3 Description of Interventions)] TJ ET BT 26.250 87.953 Td /F1 9.8 Tf [(In Haiti, community demonstrations were given of how to use PuR, a proprietary water flocculation and purification treatment, )] TJ ET BT 26.250 76.048 Td /F1 9.8 Tf [(three to six weeks after Tropical Storm Jeanne.)] TJ ET 0.267 0.267 0.267 rg BT 229.996 77.555 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 239.633 76.048 Td /F1 9.8 Tf [( The floods compromised and contaminated sources of drinking water. The )] TJ ET BT 26.250 64.143 Td /F1 9.8 Tf [(US Centers for Disease Control and Populations Services International \(PSI\) had collaborated on the development of this )] TJ ET BT 26.250 52.239 Td /F1 9.8 Tf [(product. PSI and the community leaders promoted, distributed and educated about the use of the water purification treatment.)] TJ ET 0.267 0.267 0.267 rg BT 567.658 53.746 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 26.250 40.334 Td /F1 9.8 Tf [(In Gloucestershire, a non-standard, locally produced Do Not Drink notice was delivered to every affected household before )] TJ ET Q q 15.000 26.048 577.500 750.952 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(in Keelung lasted 34 days. The crude attack rate in Taipei was 2%, and that in Keelung was 14.9%.)] TJ ET 0.267 0.267 0.267 rg BT 454.392 768.983 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 464.029 767.476 Td /F1 9.8 Tf [( In qualitative responses )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(to the Health Promotion Agencys response to an outbreak of meningococcal disease in a school, many pupils reported that the )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(official communications had been too slow, because interpersonal communication had spread the news over the preceding )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(days, but that this had been accompanied by misinformation and uncertainty.)] TJ ET 0.267 0.267 0.267 rg BT 357.916 733.269 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 362.734 731.762 Td /F1 9.8 Tf [( The report indicates that 74% of school pupils )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(already knew about the meningococcal disease outbreak before information was released by the school and the Health )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(Protection Agency.)] TJ ET 0.267 0.267 0.267 rg BT 108.082 709.460 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 112.900 707.952 Td /F1 9.8 Tf [( The Chan )] TJ ET BT 161.134 707.952 Td /F5 9.8 Tf [(et al.)] TJ ET BT 182.272 707.952 Td /F1 9.8 Tf [( uncontrolled before and after study during the SARS epidemic highlights a problem with )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(uncontrolled studies: protective behaviours became less common during the period of the study, possibly because of a )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(lessening concern about the disease as the outbreak abated.)] TJ ET 0.267 0.267 0.267 rg BT 289.656 685.650 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 299.293 684.143 Td /F1 9.8 Tf [( If the study had taken place earlier in the outbreak, it might )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(have detected increases in protective behaviours as concern was rising, and might have attributed the improvement to the )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(intervention.)] TJ ET BT 26.250 640.929 Td /F4 9.8 Tf [(2.2 Communication to Promote Response to Natural Disasters)] TJ ET BT 26.250 621.524 Td /F4 9.8 Tf [(2.2.1 Setting)] TJ ET BT 26.250 602.119 Td /F1 9.8 Tf [(One study relating to the response to natural disasters was identified,)] TJ ET 0.267 0.267 0.267 rg BT 324.853 603.626 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 334.491 602.119 Td /F1 9.8 Tf [( relating to the wildfire event in San Diego, California, )] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(USA, in 2007 that was also studied by Strawderman et al.,)] TJ ET 0.267 0.267 0.267 rg BT 277.702 591.722 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 287.340 590.214 Td /F1 9.8 Tf [( described above \(Early Warnings\).)] TJ ET BT 26.250 570.810 Td /F4 9.8 Tf [(2.2.2 Participants)] TJ ET BT 26.250 551.405 Td /F1 9.8 Tf [(Sugerman et al. conducted telephone interviews with 1,802 adults \(of 18,687 calls made\).)] TJ ET 0.267 0.267 0.267 rg BT 412.106 552.912 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 421.744 551.405 Td /F1 9.8 Tf [( Ten percent of calls were )] TJ ET BT 26.250 539.500 Td /F1 9.8 Tf [(conducted in Spanish. The most frequent age range was 35-64 years, the study sample was older than the general population, )] TJ ET BT 26.250 527.595 Td /F1 9.8 Tf [(and 50% of the sample were male.)] TJ ET 0.267 0.267 0.267 rg BT 176.361 529.103 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 26.250 508.191 Td /F4 9.8 Tf [(2.2.3 Description of Interventions)] TJ ET BT 26.250 488.786 Td /F1 9.8 Tf [(The health messages promoted by the San Diego County Health and Human Services Agency and American Heart and Lung )] TJ ET BT 26.250 476.881 Td /F1 9.8 Tf [(Association during a three week multi-media campaign that used television, radio, newspapers and the Internet were evaluated.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 466.484 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 35.887 464.976 Td /F1 9.8 Tf [( They advised residents to stay indoors, drive with all windows closed, run air conditioners on recirculate, keep home windows )] TJ ET BT 26.250 453.072 Td /F1 9.8 Tf [(closed, use HEPA air filters, only exercise indoors, wet ash before clean-up, use N95 respirators during clean-up, limit activities )] TJ ET BT 26.250 441.167 Td /F1 9.8 Tf [(to what is absolutely necessary, boil tap water before drinking and drink bottled water.)] TJ ET 0.267 0.267 0.267 rg BT 395.834 442.674 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 26.250 421.762 Td /F4 9.8 Tf [(2.2.4 Results)] TJ ET BT 26.250 402.357 Td /F1 9.8 Tf [(The messages reached 88% of respondents, with television being by far the most common medium \(77%\) followed by radio )] TJ ET BT 26.250 390.453 Td /F1 9.8 Tf [(\(7%\).)] TJ ET 0.267 0.267 0.267 rg BT 49.543 391.960 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 59.180 390.453 Td /F1 9.8 Tf [( Following the warnings, participants spontaneously recalled being told to stay indoors \(68%\), to keep windows closed )] TJ ET BT 26.250 378.548 Td /F1 9.8 Tf [(\(18%\) and only to exercise indoors \(11%\), but eight other messages were recalled by less than 5%.)] TJ ET 0.267 0.267 0.267 rg BT 454.889 380.055 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 464.527 378.548 Td /F1 9.8 Tf [( Fifty-nine percent stayed )] TJ ET BT 26.250 366.643 Td /F1 9.8 Tf [(inside most of the day, 76% kept windows closed, 88% did not participate in outdoor sports, 76% wet ash during cleanup, 16% )] TJ ET BT 26.250 354.738 Td /F1 9.8 Tf [(used home air conditioning, 10% used HEPA air filters and 8% wore a N95 mask.)] TJ ET 0.267 0.267 0.267 rg BT 377.396 356.246 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 387.034 354.738 Td /F1 9.8 Tf [( It is possible, however, that residents might )] TJ ET BT 26.250 342.834 Td /F1 9.8 Tf [(have engaged in some of these precautions independently of the media campaign.)] TJ ET BT 26.250 323.429 Td /F4 9.8 Tf [(2.3 Communication to Promote Response to Water Supply Disasters)] TJ ET BT 26.250 304.024 Td /F4 9.8 Tf [(2.3.1 Setting)] TJ ET BT 26.250 284.619 Td /F1 9.8 Tf [(Four studies of the response to water supply disasters were found: One in Haiti,)] TJ ET 0.267 0.267 0.267 rg BT 369.820 286.127 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 379.458 284.619 Td /F1 9.8 Tf [( one in the UK)] TJ ET 0.267 0.267 0.267 rg BT 441.244 286.127 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 446.062 284.619 Td /F1 9.8 Tf [( and two in the USA.)] TJ ET 0.267 0.267 0.267 rg BT 534.943 286.127 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 544.581 288.508 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 546.990 286.127 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 556.627 284.619 Td /F1 9.8 Tf [( The )] TJ ET BT 26.250 272.715 Td /F1 9.8 Tf [(Haiti study followed major flash floods due to Tropical Storm Jeanne.)] TJ ET 0.267 0.267 0.267 rg BT 322.660 274.222 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 332.297 272.715 Td /F1 9.8 Tf [( The study in the UK occurred in the context of major )] TJ ET BT 26.250 260.810 Td /F1 9.8 Tf [(floods in Gloucestershire, England, that caused 140,000 homes to lose their water supply and subsequently be supplied with )] TJ ET BT 26.250 248.905 Td /F1 9.8 Tf [(untreated water.)] TJ ET 0.267 0.267 0.267 rg BT 96.704 250.412 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 101.522 248.905 Td /F1 9.8 Tf [( The two USA studies took place in Boston, Massachusetts, after the collapse of a major water tunnel that )] TJ ET BT 26.250 237.000 Td /F1 9.8 Tf [(carried water to 2 million individuals and residents were supplied with untreated water.)] TJ ET 0.267 0.267 0.267 rg BT 397.433 238.508 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 407.070 240.889 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 409.479 238.508 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 26.250 217.596 Td /F4 9.8 Tf [(2.3.2 Participants)] TJ ET BT 26.250 198.191 Td /F1 9.8 Tf [(The Haitian study interviewed 100 families who had received education and a water purification product following a natural )] TJ ET BT 26.250 186.286 Td /F1 9.8 Tf [(disaster.)] TJ ET 0.267 0.267 0.267 rg BT 63.095 187.793 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 72.733 186.286 Td /F1 9.8 Tf [( Following the water crisis in Gloucestershire, 159 individuals \(of 1,000 invited\) who lost water supply were )] TJ ET BT 26.250 174.381 Td /F1 9.8 Tf [(interviewed \(40% male\).)] TJ ET 0.267 0.267 0.267 rg BT 130.819 175.889 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 135.637 174.381 Td /F1 9.8 Tf [( The sample was slightly older on average than the local census \(at least partly due to the absence of )] TJ ET BT 26.250 162.477 Td /F1 9.8 Tf [(children from the survey\). In Boston, Galarce et al. analysed surveys from 267 people who were affected by the water crisis )] TJ ET BT 26.250 150.572 Td /F1 9.8 Tf [(\(48% male; modal age 30-44 years\).)] TJ ET 0.267 0.267 0.267 rg BT 183.937 152.079 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 193.574 150.572 Td /F1 9.8 Tf [( Participants were recruited from a research database \(78%\) and purposefully recruited )] TJ ET BT 26.250 138.667 Td /F1 9.8 Tf [(from affected areas \(22%\).)] TJ ET 0.267 0.267 0.267 rg BT 141.671 140.174 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 151.308 138.667 Td /F1 9.8 Tf [( Wang et al. surveyed 525 adults \(31% male; modal age 25-34\) who were opportunistically )] TJ ET BT 26.250 126.762 Td /F1 9.8 Tf [(recruited from hospital clinics and waiting rooms.)] TJ ET 0.267 0.267 0.267 rg BT 236.480 128.270 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 26.250 107.358 Td /F4 9.8 Tf [(2.3.3 Description of Interventions)] TJ ET BT 26.250 87.953 Td /F1 9.8 Tf [(In Haiti, community demonstrations were given of how to use PuR, a proprietary water flocculation and purification treatment, )] TJ ET BT 26.250 76.048 Td /F1 9.8 Tf [(three to six weeks after Tropical Storm Jeanne.)] TJ ET 0.267 0.267 0.267 rg BT 229.996 77.555 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 239.633 76.048 Td /F1 9.8 Tf [( The floods compromised and contaminated sources of drinking water. 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ET BT 26.250 755.571 Td /F1 9.8 Tf [(changing advice to Boil Water was also delivered. Finally, a Water Safe notice was issued. The local authorities )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(communicated primarily through these notices, but local media also disseminated information.)] TJ ET 0.267 0.267 0.267 rg BT 430.485 745.174 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 435.304 743.667 Td /F1 9.8 Tf [( Galarce )] TJ ET BT 474.859 743.667 Td /F5 9.8 Tf [(et al.)] TJ ET BT 495.997 743.667 Td /F1 9.8 Tf [( described the )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(issuing of a boil water notice by the Water Authority and dissemination by the Mayors office, Boston Public Health Commission, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(schools, businesses, faith-based organisations, police, newscasters, the Centers for Disease Control and Prevention Health )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(Alert Network, reverse 911 systems, phone calls, the Internet, by vehicles with bullhorns and by other emergency management )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(systems.)] TJ ET 0.267 0.267 0.267 rg BT 64.714 697.555 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 74.351 696.048 Td /F1 9.8 Tf [( The extent to which each was used was not described. Wang et al. investigated the same event and issuing of a boil )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(water notice, but did not describe its dissemination.)] TJ ET 0.267 0.267 0.267 rg BT 246.805 685.650 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 26.250 664.738 Td /F4 9.8 Tf [(2.3.4 Results)] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(Thirty-seven of the 100 Haitian families reported treating their drinking water before the floods. Following the flood and )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(intervention, 58 used the product while other families used a variety of other reliable and unreliable methods.)] TJ ET 0.267 0.267 0.267 rg BT 493.928 634.936 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 503.566 633.429 Td /F1 9.8 Tf [( Knowledge )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(about how to use the treatment was high: only two opened the packet using their teeth, 83 knew how much water to mix a )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(sachet with, 88 knew how long to mix for, 79 knew how long to let the water stand for and 80 knew to put the flocculated waste )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(in the latrine.)] TJ ET 0.267 0.267 0.267 rg BT 82.069 599.222 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 91.706 597.714 Td /F1 9.8 Tf [( Seventy eight answered all questions correctly. Use of the water treatment was not well sustained, however. )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(Only 22 families had PuR-treated water at the time of the interview, and only a few had used it often during the few weeks )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(between distribution and survey. The authors suggested that this may have been because sample sachets were distributed )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(without households knowing how to access further supplies.)] TJ ET 0.267 0.267 0.267 rg BT 284.742 563.507 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 294.379 562.000 Td /F1 9.8 Tf [( In the Gloucestershire water crisis, 89% received advice about )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(the do not drink notice, 71% about the boil water notice and 88% about the water safe notice.)] TJ ET 0.267 0.267 0.267 rg BT 440.303 551.603 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 445.122 550.095 Td /F1 9.8 Tf [( However, only 42% used the )] TJ ET BT 26.250 538.191 Td /F1 9.8 Tf [(delivered notice for information during the do not drink stage, 36% used it during the boil water stage and 35% used it when )] TJ ET BT 26.250 526.286 Td /F1 9.8 Tf [(the water safe stage was reached. Local radio was more widely used at all stages. Questioning about respondents knowledge )] TJ ET BT 26.250 514.381 Td /F1 9.8 Tf [(revealed misunderstandings: Knowledge of the correct action during both the do not drink and boil water stages was low \(23% )] TJ ET BT 26.250 502.476 Td /F1 9.8 Tf [(and 27%\). Compliance with the advice was not complete, and some people who did avoid drinking tap water continued to use it )] TJ ET BT 26.250 490.572 Td /F1 9.8 Tf [(for brushing teeth and preparing food, which was against the advice. During the do not drink stage, 9% of people drank un-)] TJ ET BT 26.250 478.667 Td /F1 9.8 Tf [(boiled tap water, 16% brushed teeth with it and 21% prepared food with it. Many people used boiled water against advice during )] TJ ET BT 26.250 466.762 Td /F1 9.8 Tf [(the do not drink notice for food preparation \(47%\), to brush teeth \(38%\) and to drink \(hot, 42%; cold 21%\). When the advice )] TJ ET BT 26.250 454.857 Td /F1 9.8 Tf [(was changed to boil water, 42% prepared food with, 38% brushed teeth with, and 29% drank un-boiled water.)] TJ ET 0.267 0.267 0.267 rg BT 502.070 456.365 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 506.888 454.857 Td /F1 9.8 Tf [( In the Boston )] TJ ET BT 26.250 442.953 Td /F1 9.8 Tf [(water crisis, Galarce et al. found that 12.5% of people drank un-boiled tap water, 78% of respondents followed the advice to )] TJ ET BT 26.250 431.048 Td /F1 9.8 Tf [(flush the cold water tap for 1 minute following the resolution of the water problem, and 59% of respondents flushed the warm tap )] TJ ET BT 26.250 419.143 Td /F1 9.8 Tf [(for 15 minutes.)] TJ ET 0.267 0.267 0.267 rg BT 90.737 420.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 100.374 419.143 Td /F1 9.8 Tf [( The message successfully reached 89% of the sample on the first day of the crisis.)] TJ ET 0.267 0.267 0.267 rg BT 460.198 420.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 469.835 419.143 Td /F1 9.8 Tf [( The Wang et al. study )] TJ ET BT 26.250 407.238 Td /F1 9.8 Tf [(reported that only 2.4% of their sample drank un-boiled tap water, and their data indicate that 74% of their sample knew about )] TJ ET BT 26.250 395.334 Td /F1 9.8 Tf [(the crisis on the first day.)] TJ ET 0.267 0.267 0.267 rg BT 134.085 396.841 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 143.722 395.334 Td /F1 9.8 Tf [( Their survey reported 47% using bottled and boiled water, 41% using bottled water only and 9.6% )] TJ ET BT 26.250 383.429 Td /F1 9.8 Tf [(using boiled water only.)] TJ ET 0.267 0.267 0.267 rg BT 128.128 384.936 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 137.765 383.429 Td /F1 9.8 Tf [( The study of water treatment in Haiti suggested that all households used some water treatment )] TJ ET BT 26.250 371.524 Td /F1 9.8 Tf [(method following the floods, and that the participants were aware of how to use the water treatment appropriately.)] TJ ET 0.267 0.267 0.267 rg BT 516.158 373.031 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 525.796 371.524 Td /F1 9.8 Tf [( The study )] TJ ET BT 26.250 359.619 Td /F1 9.8 Tf [(did not explicitly explore what happened when PuR water treatment was not being used, so it is not clear whether alternative )] TJ ET BT 26.250 347.715 Td /F1 9.8 Tf [(appropriate methods were being used or whether untreated water was also consumed. The intervention to disseminate )] TJ ET BT 26.250 335.810 Td /F1 9.8 Tf [(information in Boston appears to have been on a larger scale than that used in the Gloucestershire crisis. The study following )] TJ ET BT 26.250 323.905 Td /F1 9.8 Tf [(floods in England demonstrated misunderstandings by those affected and only moderate compliance with the recommended )] TJ ET BT 26.250 312.000 Td /F1 9.8 Tf [(actions.)] TJ ET 0.267 0.267 0.267 rg BT 59.849 313.508 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 64.667 312.000 Td /F1 9.8 Tf [( The USA studies both showed higher compliance with advice, though it is worth noting that the Boston crisis lasted )] TJ ET BT 26.250 300.096 Td /F1 9.8 Tf [(only 4 days, while that in England lasted up to 17 days for some residents.)] TJ ET 0.267 0.267 0.267 rg BT 346.538 301.603 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 351.356 303.984 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 353.766 301.603 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 26.250 280.691 Td /F4 9.8 Tf [(3 Effect of Risk Communication Interventions to Improve Disaster Recovery)] TJ ET BT 26.250 261.286 Td /F4 9.8 Tf [(3.1.1 Setting)] TJ ET BT 26.250 241.881 Td /F1 9.8 Tf [(One study took place following the 11 September 2001 New York terrorist attacks,)] TJ ET 0.267 0.267 0.267 rg BT 380.116 243.389 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 389.754 241.881 Td /F1 9.8 Tf [( and two studies took place following )] TJ ET BT 26.250 229.977 Td /F1 9.8 Tf [(Hurricane Katrina in New Orleans.)] TJ ET 0.267 0.267 0.267 rg BT 174.167 231.484 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 183.805 233.865 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 186.214 231.484 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 26.250 210.572 Td /F4 9.8 Tf [(3.1.2 Participants)] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(Media campaigns were conducted with the populations of New York and New Orleans as their intended audience. The monthly )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(calls to the New York helpline, LifeNet, from November 2000 to December 2002 were enumerated.)] TJ ET 0.267 0.267 0.267 rg BT 451.633 180.770 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 461.270 179.262 Td /F1 9.8 Tf [( Similarly, calls to the New )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(Orleans Crisis Line were counted \(total 29,659 in the study period\).)] TJ ET 0.267 0.267 0.267 rg BT 315.084 168.865 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 324.721 167.358 Td /F1 9.8 Tf [( In the second New Orleans study, 968 adult African )] TJ ET BT 26.250 155.453 Td /F1 9.8 Tf [(Americans were interviewed during and after the media campaign.)] TJ ET 0.267 0.267 0.267 rg BT 312.364 156.960 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 26.250 136.048 Td /F4 9.8 Tf [(3.1.3 Description of Interventions)] TJ ET BT 26.250 116.643 Td /F1 9.8 Tf [(In New York, a mass media campaign was conducted using print, television, radio and other media \(mainly fliers and billboards\) )] TJ ET BT 26.250 104.739 Td /F1 9.8 Tf [(between September 2001 and December 2002 with the aim of informing the citys population of the availability of a help line for )] TJ ET BT 26.250 92.834 Td /F1 9.8 Tf [(mental health problems, which could provide advice and refer callers to medical services where necessary.)] TJ ET 0.267 0.267 0.267 rg BT 486.830 94.341 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 496.468 92.834 Td /F1 9.8 Tf [( In the context of )] TJ ET BT 26.250 80.929 Td /F1 9.8 Tf [(this review, calling the help line was regarded as a behavioural outcome. Following Hurricane Katrina, a media campaign ran for )] TJ ET BT 26.250 69.024 Td /F1 9.8 Tf [(11 weeks in 2006 on four radio stations targeted at African Americans.)] TJ ET 0.267 0.267 0.267 rg BT 329.728 70.532 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 339.366 72.913 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 341.775 70.532 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 351.413 69.024 Td /F1 9.8 Tf [( Messages were broadcast five times each weekday )] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(on four radio channels. Five different messages with a focus on stress and depression were played. The messages promoted )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(preventive behaviours \(normal productive routine, social and physical activity and working to resolve conflicts\), and information )] TJ ET Q q 15.000 30.929 577.500 746.071 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(untreated water was supplied to households, seven days after they lost all water supply.)] TJ ET 0.267 0.267 0.267 rg BT 405.057 768.983 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 409.876 767.476 Td /F1 9.8 Tf [( After a further seven days, a notice )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(changing advice to Boil Water was also delivered. Finally, a Water Safe notice was issued. The local authorities )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(communicated primarily through these notices, but local media also disseminated information.)] TJ ET 0.267 0.267 0.267 rg BT 430.485 745.174 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 435.304 743.667 Td /F1 9.8 Tf [( Galarce )] TJ ET BT 474.859 743.667 Td /F5 9.8 Tf [(et al.)] TJ ET BT 495.997 743.667 Td /F1 9.8 Tf [( described the )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(issuing of a boil water notice by the Water Authority and dissemination by the Mayors office, Boston Public Health Commission, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(schools, businesses, faith-based organisations, police, newscasters, the Centers for Disease Control and Prevention Health )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(Alert Network, reverse 911 systems, phone calls, the Internet, by vehicles with bullhorns and by other emergency management )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(systems.)] TJ ET 0.267 0.267 0.267 rg BT 64.714 697.555 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 74.351 696.048 Td /F1 9.8 Tf [( The extent to which each was used was not described. Wang et al. investigated the same event and issuing of a boil )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(water notice, but did not describe its dissemination.)] TJ ET 0.267 0.267 0.267 rg BT 246.805 685.650 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 26.250 664.738 Td /F4 9.8 Tf [(2.3.4 Results)] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(Thirty-seven of the 100 Haitian families reported treating their drinking water before the floods. Following the flood and )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(intervention, 58 used the product while other families used a variety of other reliable and unreliable methods.)] TJ ET 0.267 0.267 0.267 rg BT 493.928 634.936 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 503.566 633.429 Td /F1 9.8 Tf [( Knowledge )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(about how to use the treatment was high: only two opened the packet using their teeth, 83 knew how much water to mix a )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(sachet with, 88 knew how long to mix for, 79 knew how long to let the water stand for and 80 knew to put the flocculated waste )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(in the latrine.)] TJ ET 0.267 0.267 0.267 rg BT 82.069 599.222 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 91.706 597.714 Td /F1 9.8 Tf [( Seventy eight answered all questions correctly. Use of the water treatment was not well sustained, however. )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(Only 22 families had PuR-treated water at the time of the interview, and only a few had used it often during the few weeks )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(between distribution and survey. The authors suggested that this may have been because sample sachets were distributed )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(without households knowing how to access further supplies.)] TJ ET 0.267 0.267 0.267 rg BT 284.742 563.507 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 294.379 562.000 Td /F1 9.8 Tf [( In the Gloucestershire water crisis, 89% received advice about )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(the do not drink notice, 71% about the boil water notice and 88% about the water safe notice.)] TJ ET 0.267 0.267 0.267 rg BT 440.303 551.603 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 445.122 550.095 Td /F1 9.8 Tf [( However, only 42% used the )] TJ ET BT 26.250 538.191 Td /F1 9.8 Tf [(delivered notice for information during the do not drink stage, 36% used it during the boil water stage and 35% used it when )] TJ ET BT 26.250 526.286 Td /F1 9.8 Tf [(the water safe stage was reached. Local radio was more widely used at all stages. Questioning about respondents knowledge )] TJ ET BT 26.250 514.381 Td /F1 9.8 Tf [(revealed misunderstandings: Knowledge of the correct action during both the do not drink and boil water stages was low \(23% )] TJ ET BT 26.250 502.476 Td /F1 9.8 Tf [(and 27%\). Compliance with the advice was not complete, and some people who did avoid drinking tap water continued to use it )] TJ ET BT 26.250 490.572 Td /F1 9.8 Tf [(for brushing teeth and preparing food, which was against the advice. During the do not drink stage, 9% of people drank un-)] TJ ET BT 26.250 478.667 Td /F1 9.8 Tf [(boiled tap water, 16% brushed teeth with it and 21% prepared food with it. Many people used boiled water against advice during )] TJ ET BT 26.250 466.762 Td /F1 9.8 Tf [(the do not drink notice for food preparation \(47%\), to brush teeth \(38%\) and to drink \(hot, 42%; cold 21%\). When the advice )] TJ ET BT 26.250 454.857 Td /F1 9.8 Tf [(was changed to boil water, 42% prepared food with, 38% brushed teeth with, and 29% drank un-boiled water.)] TJ ET 0.267 0.267 0.267 rg BT 502.070 456.365 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 506.888 454.857 Td /F1 9.8 Tf [( In the Boston )] TJ ET BT 26.250 442.953 Td /F1 9.8 Tf [(water crisis, Galarce et al. found that 12.5% of people drank un-boiled tap water, 78% of respondents followed the advice to )] TJ ET BT 26.250 431.048 Td /F1 9.8 Tf [(flush the cold water tap for 1 minute following the resolution of the water problem, and 59% of respondents flushed the warm tap )] TJ ET BT 26.250 419.143 Td /F1 9.8 Tf [(for 15 minutes.)] TJ ET 0.267 0.267 0.267 rg BT 90.737 420.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 100.374 419.143 Td /F1 9.8 Tf [( The message successfully reached 89% of the sample on the first day of the crisis.)] TJ ET 0.267 0.267 0.267 rg BT 460.198 420.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 469.835 419.143 Td /F1 9.8 Tf [( The Wang et al. study )] TJ ET BT 26.250 407.238 Td /F1 9.8 Tf [(reported that only 2.4% of their sample drank un-boiled tap water, and their data indicate that 74% of their sample knew about )] TJ ET BT 26.250 395.334 Td /F1 9.8 Tf [(the crisis on the first day.)] TJ ET 0.267 0.267 0.267 rg BT 134.085 396.841 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 143.722 395.334 Td /F1 9.8 Tf [( Their survey reported 47% using bottled and boiled water, 41% using bottled water only and 9.6% )] TJ ET BT 26.250 383.429 Td /F1 9.8 Tf [(using boiled water only.)] TJ ET 0.267 0.267 0.267 rg BT 128.128 384.936 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 137.765 383.429 Td /F1 9.8 Tf [( The study of water treatment in Haiti suggested that all households used some water treatment )] TJ ET BT 26.250 371.524 Td /F1 9.8 Tf [(method following the floods, and that the participants were aware of how to use the water treatment appropriately.)] TJ ET 0.267 0.267 0.267 rg BT 516.158 373.031 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 525.796 371.524 Td /F1 9.8 Tf [( The study )] TJ ET BT 26.250 359.619 Td /F1 9.8 Tf [(did not explicitly explore what happened when PuR water treatment was not being used, so it is not clear whether alternative )] TJ ET BT 26.250 347.715 Td /F1 9.8 Tf [(appropriate methods were being used or whether untreated water was also consumed. The intervention to disseminate )] TJ ET BT 26.250 335.810 Td /F1 9.8 Tf [(information in Boston appears to have been on a larger scale than that used in the Gloucestershire crisis. The study following )] TJ ET BT 26.250 323.905 Td /F1 9.8 Tf [(floods in England demonstrated misunderstandings by those affected and only moderate compliance with the recommended )] TJ ET BT 26.250 312.000 Td /F1 9.8 Tf [(actions.)] TJ ET 0.267 0.267 0.267 rg BT 59.849 313.508 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 64.667 312.000 Td /F1 9.8 Tf [( The USA studies both showed higher compliance with advice, though it is worth noting that the Boston crisis lasted )] TJ ET BT 26.250 300.096 Td /F1 9.8 Tf [(only 4 days, while that in England lasted up to 17 days for some residents.)] TJ ET 0.267 0.267 0.267 rg BT 346.538 301.603 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 351.356 303.984 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 353.766 301.603 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 26.250 280.691 Td /F4 9.8 Tf [(3 Effect of Risk Communication Interventions to Improve Disaster Recovery)] TJ ET BT 26.250 261.286 Td /F4 9.8 Tf [(3.1.1 Setting)] TJ ET BT 26.250 241.881 Td /F1 9.8 Tf [(One study took place following the 11 September 2001 New York terrorist attacks,)] TJ ET 0.267 0.267 0.267 rg BT 380.116 243.389 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 389.754 241.881 Td /F1 9.8 Tf [( and two studies took place following )] TJ ET BT 26.250 229.977 Td /F1 9.8 Tf [(Hurricane Katrina in New Orleans.)] TJ ET 0.267 0.267 0.267 rg BT 174.167 231.484 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 183.805 233.865 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 186.214 231.484 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 26.250 210.572 Td /F4 9.8 Tf [(3.1.2 Participants)] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(Media campaigns were conducted with the populations of New York and New Orleans as their intended audience. The monthly )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(calls to the New York helpline, LifeNet, from November 2000 to December 2002 were enumerated.)] TJ ET 0.267 0.267 0.267 rg BT 451.633 180.770 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 461.270 179.262 Td /F1 9.8 Tf [( Similarly, calls to the New )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(Orleans Crisis Line were counted \(total 29,659 in the study period\).)] TJ ET 0.267 0.267 0.267 rg BT 315.084 168.865 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 324.721 167.358 Td /F1 9.8 Tf [( In the second New Orleans study, 968 adult African )] TJ ET BT 26.250 155.453 Td /F1 9.8 Tf [(Americans were interviewed during and after the media campaign.)] TJ ET 0.267 0.267 0.267 rg BT 312.364 156.960 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 26.250 136.048 Td /F4 9.8 Tf [(3.1.3 Description of Interventions)] TJ ET BT 26.250 116.643 Td /F1 9.8 Tf [(In New York, a mass media campaign was conducted using print, television, radio and other media \(mainly fliers and billboards\) )] TJ ET BT 26.250 104.739 Td /F1 9.8 Tf [(between September 2001 and December 2002 with the aim of informing the citys population of the availability of a help line for )] TJ ET BT 26.250 92.834 Td /F1 9.8 Tf [(mental health problems, which could provide advice and refer callers to medical services where necessary.)] TJ ET 0.267 0.267 0.267 rg BT 486.830 94.341 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 496.468 92.834 Td /F1 9.8 Tf [( In the context of )] TJ ET BT 26.250 80.929 Td /F1 9.8 Tf [(this review, calling the help line was regarded as a behavioural outcome. Following Hurricane Katrina, a media campaign ran for )] TJ ET BT 26.250 69.024 Td /F1 9.8 Tf [(11 weeks in 2006 on four radio stations targeted at African Americans.)] TJ ET 0.267 0.267 0.267 rg BT 329.728 70.532 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 339.366 72.913 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 341.775 70.532 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 351.413 69.024 Td /F1 9.8 Tf [( Messages were broadcast five times each weekday )] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(on four radio channels. Five different messages with a focus on stress and depression were played. The messages promoted )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(preventive behaviours \(normal productive routine, social and physical activity and working to resolve conflicts\), and information )] TJ ET Q q 15.000 30.929 577.500 746.071 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(untreated water was supplied to households, seven days after they lost all water supply.)] TJ ET 0.267 0.267 0.267 rg BT 405.057 768.983 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 409.876 767.476 Td /F1 9.8 Tf [( After a further seven days, a notice )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(changing advice to Boil Water was also delivered. Finally, a Water Safe notice was issued. The local authorities )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(communicated primarily through these notices, but local media also disseminated information.)] TJ ET 0.267 0.267 0.267 rg BT 430.485 745.174 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 435.304 743.667 Td /F1 9.8 Tf [( Galarce )] TJ ET BT 474.859 743.667 Td /F5 9.8 Tf [(et al.)] TJ ET BT 495.997 743.667 Td /F1 9.8 Tf [( described the )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(issuing of a boil water notice by the Water Authority and dissemination by the Mayors office, Boston Public Health Commission, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(schools, businesses, faith-based organisations, police, newscasters, the Centers for Disease Control and Prevention Health )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(Alert Network, reverse 911 systems, phone calls, the Internet, by vehicles with bullhorns and by other emergency management )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(systems.)] TJ ET 0.267 0.267 0.267 rg BT 64.714 697.555 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 74.351 696.048 Td /F1 9.8 Tf [( The extent to which each was used was not described. Wang et al. investigated the same event and issuing of a boil )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(water notice, but did not describe its dissemination.)] TJ ET 0.267 0.267 0.267 rg BT 246.805 685.650 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 26.250 664.738 Td /F4 9.8 Tf [(2.3.4 Results)] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(Thirty-seven of the 100 Haitian families reported treating their drinking water before the floods. Following the flood and )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(intervention, 58 used the product while other families used a variety of other reliable and unreliable methods.)] TJ ET 0.267 0.267 0.267 rg BT 493.928 634.936 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 503.566 633.429 Td /F1 9.8 Tf [( Knowledge )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(about how to use the treatment was high: only two opened the packet using their teeth, 83 knew how much water to mix a )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(sachet with, 88 knew how long to mix for, 79 knew how long to let the water stand for and 80 knew to put the flocculated waste )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(in the latrine.)] TJ ET 0.267 0.267 0.267 rg BT 82.069 599.222 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 91.706 597.714 Td /F1 9.8 Tf [( Seventy eight answered all questions correctly. Use of the water treatment was not well sustained, however. )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(Only 22 families had PuR-treated water at the time of the interview, and only a few had used it often during the few weeks )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(between distribution and survey. The authors suggested that this may have been because sample sachets were distributed )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(without households knowing how to access further supplies.)] TJ ET 0.267 0.267 0.267 rg BT 284.742 563.507 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 294.379 562.000 Td /F1 9.8 Tf [( In the Gloucestershire water crisis, 89% received advice about )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(the do not drink notice, 71% about the boil water notice and 88% about the water safe notice.)] TJ ET 0.267 0.267 0.267 rg BT 440.303 551.603 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 445.122 550.095 Td /F1 9.8 Tf [( However, only 42% used the )] TJ ET BT 26.250 538.191 Td /F1 9.8 Tf [(delivered notice for information during the do not drink stage, 36% used it during the boil water stage and 35% used it when )] TJ ET BT 26.250 526.286 Td /F1 9.8 Tf [(the water safe stage was reached. Local radio was more widely used at all stages. Questioning about respondents knowledge )] TJ ET BT 26.250 514.381 Td /F1 9.8 Tf [(revealed misunderstandings: Knowledge of the correct action during both the do not drink and boil water stages was low \(23% )] TJ ET BT 26.250 502.476 Td /F1 9.8 Tf [(and 27%\). Compliance with the advice was not complete, and some people who did avoid drinking tap water continued to use it )] TJ ET BT 26.250 490.572 Td /F1 9.8 Tf [(for brushing teeth and preparing food, which was against the advice. During the do not drink stage, 9% of people drank un-)] TJ ET BT 26.250 478.667 Td /F1 9.8 Tf [(boiled tap water, 16% brushed teeth with it and 21% prepared food with it. Many people used boiled water against advice during )] TJ ET BT 26.250 466.762 Td /F1 9.8 Tf [(the do not drink notice for food preparation \(47%\), to brush teeth \(38%\) and to drink \(hot, 42%; cold 21%\). When the advice )] TJ ET BT 26.250 454.857 Td /F1 9.8 Tf [(was changed to boil water, 42% prepared food with, 38% brushed teeth with, and 29% drank un-boiled water.)] TJ ET 0.267 0.267 0.267 rg BT 502.070 456.365 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 506.888 454.857 Td /F1 9.8 Tf [( In the Boston )] TJ ET BT 26.250 442.953 Td /F1 9.8 Tf [(water crisis, Galarce et al. found that 12.5% of people drank un-boiled tap water, 78% of respondents followed the advice to )] TJ ET BT 26.250 431.048 Td /F1 9.8 Tf [(flush the cold water tap for 1 minute following the resolution of the water problem, and 59% of respondents flushed the warm tap )] TJ ET BT 26.250 419.143 Td /F1 9.8 Tf [(for 15 minutes.)] TJ ET 0.267 0.267 0.267 rg BT 90.737 420.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 100.374 419.143 Td /F1 9.8 Tf [( The message successfully reached 89% of the sample on the first day of the crisis.)] TJ ET 0.267 0.267 0.267 rg BT 460.198 420.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 469.835 419.143 Td /F1 9.8 Tf [( The Wang et al. study )] TJ ET BT 26.250 407.238 Td /F1 9.8 Tf [(reported that only 2.4% of their sample drank un-boiled tap water, and their data indicate that 74% of their sample knew about )] TJ ET BT 26.250 395.334 Td /F1 9.8 Tf [(the crisis on the first day.)] TJ ET 0.267 0.267 0.267 rg BT 134.085 396.841 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 143.722 395.334 Td /F1 9.8 Tf [( Their survey reported 47% using bottled and boiled water, 41% using bottled water only and 9.6% )] TJ ET BT 26.250 383.429 Td /F1 9.8 Tf [(using boiled water only.)] TJ ET 0.267 0.267 0.267 rg BT 128.128 384.936 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 137.765 383.429 Td /F1 9.8 Tf [( The study of water treatment in Haiti suggested that all households used some water treatment )] TJ ET BT 26.250 371.524 Td /F1 9.8 Tf [(method following the floods, and that the participants were aware of how to use the water treatment appropriately.)] TJ ET 0.267 0.267 0.267 rg BT 516.158 373.031 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 525.796 371.524 Td /F1 9.8 Tf [( The study )] TJ ET BT 26.250 359.619 Td /F1 9.8 Tf [(did not explicitly explore what happened when PuR water treatment was not being used, so it is not clear whether alternative )] TJ ET BT 26.250 347.715 Td /F1 9.8 Tf [(appropriate methods were being used or whether untreated water was also consumed. The intervention to disseminate )] TJ ET BT 26.250 335.810 Td /F1 9.8 Tf [(information in Boston appears to have been on a larger scale than that used in the Gloucestershire crisis. The study following )] TJ ET BT 26.250 323.905 Td /F1 9.8 Tf [(floods in England demonstrated misunderstandings by those affected and only moderate compliance with the recommended )] TJ ET BT 26.250 312.000 Td /F1 9.8 Tf [(actions.)] TJ ET 0.267 0.267 0.267 rg BT 59.849 313.508 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 64.667 312.000 Td /F1 9.8 Tf [( The USA studies both showed higher compliance with advice, though it is worth noting that the Boston crisis lasted )] TJ ET BT 26.250 300.096 Td /F1 9.8 Tf [(only 4 days, while that in England lasted up to 17 days for some residents.)] TJ ET 0.267 0.267 0.267 rg BT 346.538 301.603 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 351.356 303.984 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 353.766 301.603 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 26.250 280.691 Td /F4 9.8 Tf [(3 Effect of Risk Communication Interventions to Improve Disaster Recovery)] TJ ET BT 26.250 261.286 Td /F4 9.8 Tf [(3.1.1 Setting)] TJ ET BT 26.250 241.881 Td /F1 9.8 Tf [(One study took place following the 11 September 2001 New York terrorist attacks,)] TJ ET 0.267 0.267 0.267 rg BT 380.116 243.389 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 389.754 241.881 Td /F1 9.8 Tf [( and two studies took place following )] TJ ET BT 26.250 229.977 Td /F1 9.8 Tf [(Hurricane Katrina in New Orleans.)] TJ ET 0.267 0.267 0.267 rg BT 174.167 231.484 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 183.805 233.865 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 186.214 231.484 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 26.250 210.572 Td /F4 9.8 Tf [(3.1.2 Participants)] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(Media campaigns were conducted with the populations of New York and New Orleans as their intended audience. The monthly )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(calls to the New York helpline, LifeNet, from November 2000 to December 2002 were enumerated.)] TJ ET 0.267 0.267 0.267 rg BT 451.633 180.770 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 461.270 179.262 Td /F1 9.8 Tf [( Similarly, calls to the New )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(Orleans Crisis Line were counted \(total 29,659 in the study period\).)] TJ ET 0.267 0.267 0.267 rg BT 315.084 168.865 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 324.721 167.358 Td /F1 9.8 Tf [( In the second New Orleans study, 968 adult African )] TJ ET BT 26.250 155.453 Td /F1 9.8 Tf [(Americans were interviewed during and after the media campaign.)] TJ ET 0.267 0.267 0.267 rg BT 312.364 156.960 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 26.250 136.048 Td /F4 9.8 Tf [(3.1.3 Description of Interventions)] TJ ET BT 26.250 116.643 Td /F1 9.8 Tf [(In New York, a mass media campaign was conducted using print, television, radio and other media \(mainly fliers and billboards\) )] TJ ET BT 26.250 104.739 Td /F1 9.8 Tf [(between September 2001 and December 2002 with the aim of informing the citys population of the availability of a help line for )] TJ ET BT 26.250 92.834 Td /F1 9.8 Tf [(mental health problems, which could provide advice and refer callers to medical services where necessary.)] TJ ET 0.267 0.267 0.267 rg BT 486.830 94.341 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 496.468 92.834 Td /F1 9.8 Tf [( In the context of )] TJ ET BT 26.250 80.929 Td /F1 9.8 Tf [(this review, calling the help line was regarded as a behavioural outcome. Following Hurricane Katrina, a media campaign ran for )] TJ ET BT 26.250 69.024 Td /F1 9.8 Tf [(11 weeks in 2006 on four radio stations targeted at African Americans.)] TJ ET 0.267 0.267 0.267 rg BT 329.728 70.532 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 339.366 72.913 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 341.775 70.532 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 351.413 69.024 Td /F1 9.8 Tf [( Messages were broadcast five times each weekday )] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(on four radio channels. Five different messages with a focus on stress and depression were played. 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A comparison group was made by comparing the number of calls to another phone number for the same help line )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(that was not promoted in the campaign.)] TJ ET BT 26.250 724.262 Td /F4 9.8 Tf [(3.1.4 Results)] TJ ET BT 26.250 704.857 Td /F1 9.8 Tf [(In New York, major increases in advertising activity appeared to be accompanied by increases in call volume to the help line.)] TJ ET 0.267 0.267 0.267 rg BT 563.260 706.364 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 26.250 692.952 Td /F1 9.8 Tf [(Prior to the attacks, between 2,000 and 3,000 calls were made each month. In the month of peak advertising expenditure )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(\(September 2002\), 9,000 calls were made \(though this does coincide with the anniversary of the event\).)] TJ ET 0.267 0.267 0.267 rg BT 472.790 682.555 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 482.428 681.048 Td /F1 9.8 Tf [( Similarly, in New )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(Orleans, the number of calls to the advertised help line increased from a mean of 100 each day, to 125 during the campaign )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(and 134 each day after the campaign.)] TJ ET 0.267 0.267 0.267 rg BT 189.933 658.745 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 199.570 657.238 Td /F1 9.8 Tf [( In the second study of this intervention, no change in combined post-traumatic stress )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(disorder \(PTSD\) understanding, preventive behaviours \(keeping routine, monitoring stress, talking with others, being productive )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(and problem-solving\) or screened incidence \(indicated by avoidance, losing interest, isolation, losing hope, being jumpy and )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(having difficulty sleeping\) was found when comparing surveys taken before and during the campaign. A regression analysis )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(incorporating the date of interview relative to the commencement of the programme showed an increase in PTSD )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(beliefs/understanding and preventive behaviours, but no change in PTSD incidence.)] TJ ET 0.267 0.267 0.267 rg BT 388.813 599.222 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 398.451 597.714 Td /F1 9.8 Tf [( These interventions appear to have been )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(effective at promoting the behaviour of phoning a help line for mental health problems following disasters. The campaign in New )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(Orleans may have improved understanding and knowledge. The lack of change of PTSD incidence may be due to )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(ineffectiveness of the intervention or due to a lack of sufficient time or power to detect any change in incidence.)] TJ ET BT 26.250 542.595 Td /F4 9.8 Tf [(4 Risk of bias in included studies)] TJ ET BT 26.250 523.191 Td /F1 9.8 Tf [(We used the Cochrane risk of bias tool, which is designed for use with randomised control trials. Where a category was not )] TJ ET BT 26.250 511.286 Td /F1 9.8 Tf [(applicable to the study design, Unclear risk was chosen.)] TJ ET BT 26.250 491.881 Td /F4 9.8 Tf [(4.1 Allocation \(selection bias\))] TJ ET BT 26.250 472.476 Td /F1 9.8 Tf [(Only one study was identified that allocated individuals randomly to one of two interventions.)] TJ ET 0.267 0.267 0.267 rg BT 424.021 473.984 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 433.658 472.476 Td /F1 9.8 Tf [( In that study, by Eisenman )] TJ ET BT 553.973 472.476 Td /F5 9.8 Tf [(et al.)] TJ ET BT 575.111 472.476 Td /F1 9.8 Tf [(, )] TJ ET BT 26.250 460.572 Td /F1 9.8 Tf [(the allocation method and concealment were described.)] TJ ET 0.267 0.267 0.267 rg BT 267.406 462.079 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 277.044 460.572 Td /F1 9.8 Tf [( The Tanes )] TJ ET BT 329.070 460.572 Td /F5 9.8 Tf [(Beat the Quake )] TJ ET BT 399.533 460.572 Td /F1 9.8 Tf [(study used an unstated method of )] TJ ET BT 26.250 448.667 Td /F1 9.8 Tf [(randomisation to allocate group time slots, not individuals.)] TJ ET 0.267 0.267 0.267 rg BT 276.065 450.174 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 285.702 452.555 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 288.111 450.174 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 297.749 448.667 Td /F1 9.8 Tf [( It was also not stated whether allocation occurred before or after )] TJ ET BT 26.250 436.762 Td /F1 9.8 Tf [(the time slots had been selected by participants. The randomisation of groups increases the risk of selection bias. Virtually all )] TJ ET BT 26.250 424.857 Td /F1 9.8 Tf [(the other controlled studies compared two different areas, or two groups of areas. Usually this was for practical reasons, and )] TJ ET BT 26.250 412.953 Td /F1 9.8 Tf [(randomisation may not have been possible. For example, Ardalan )] TJ ET BT 312.920 412.953 Td /F5 9.8 Tf [(et al.)] TJ ET BT 334.058 412.953 Td /F1 9.8 Tf [( allocated intervention or control status to 31 villages )] TJ ET BT 26.250 401.048 Td /F1 9.8 Tf [(and later adjusted analyses for possible confounders.)] TJ ET 0.267 0.267 0.267 rg BT 256.574 402.555 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 266.212 401.048 Td /F1 9.8 Tf [( The authors chose the allocations, increasing the risk that any )] TJ ET BT 26.250 389.143 Td /F1 9.8 Tf [(differences in outcome between the intervention and control groups are due to something other than the intervention. Blando )] TJ ET BT 565.503 389.143 Td /F5 9.8 Tf [(et )] TJ ET BT 26.250 377.238 Td /F5 9.8 Tf [(al. )] TJ ET BT 39.257 377.238 Td /F1 9.8 Tf [(studied two groups of people who had themselves chosen whether or not to receive the intervention several years earlier, )] TJ ET BT 26.250 365.334 Td /F1 9.8 Tf [(which presents a high risk of selection bias.)] TJ ET 0.267 0.267 0.267 rg BT 213.743 366.841 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 223.380 365.334 Td /F1 9.8 Tf [( That study does not aim to be a straightforward evaluation of effectiveness, )] TJ ET BT 26.250 353.429 Td /F1 9.8 Tf [(however, and the study should be interpreted in that light.)] TJ ET BT 26.250 334.024 Td /F4 9.8 Tf [(4.2 Blinding \(performance bias and detection bias\))] TJ ET BT 26.250 314.619 Td /F1 9.8 Tf [(Blinding participants to the intervention that they are receiving is generally not possible in for the interventions identified in this )] TJ ET BT 26.250 302.715 Td /F1 9.8 Tf [(review, although Eisenman )] TJ ET BT 146.009 302.715 Td /F5 9.8 Tf [(et al.)] TJ ET BT 167.147 302.715 Td /F1 9.8 Tf [( used interviewers who were blinded to intervention status in their randomised trial.)] TJ ET 0.267 0.267 0.267 rg BT 523.705 304.222 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 533.342 302.715 Td /F1 9.8 Tf [( No other )] TJ ET BT 26.250 290.810 Td /F1 9.8 Tf [(studies mentioned blinding. Outcome assessment in before and after studies, controlled studies and interrupted time series )] TJ ET BT 26.250 278.905 Td /F1 9.8 Tf [(would benefit from being conducted blind to the time point or intervention.)] TJ ET BT 26.250 259.500 Td /F4 9.8 Tf [(4.3 Incomplete outcome data \(attrition bias\))] TJ ET BT 26.250 240.096 Td /F1 9.8 Tf [(The only randomised trial identified in this study had substantial attrition from both groups in the study, particularly from the high-)] TJ ET BT 26.250 228.191 Td /F1 9.8 Tf [(intensity intervention.)] TJ ET 0.267 0.267 0.267 rg BT 117.832 229.698 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 127.469 228.191 Td /F1 9.8 Tf [( This could have affected the final results, since a per protocol analysis was presented. Ardalan )] TJ ET BT 540.411 228.191 Td /F5 9.8 Tf [(et al. )] TJ ET BT 26.250 216.286 Td /F1 9.8 Tf [(sought to avoid attrition by taking a further sample of participants for the post-intervention assessment.)] TJ ET 0.267 0.267 0.267 rg BT 467.915 217.793 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 477.553 216.286 Td /F1 9.8 Tf [( Many studies only )] TJ ET BT 26.250 204.381 Td /F1 9.8 Tf [(conducted one interview with each participant, during which \(if necessary\) they asked participants to recall past as well as )] TJ ET BT 26.250 192.477 Td /F1 9.8 Tf [(present knowledge or behaviours. Whilst avoiding attrition, this does increase risk of recall bias. In other studies, attrition was a )] TJ ET BT 26.250 180.572 Td /F1 9.8 Tf [(significant problem. In the SARS intervention by Chan )] TJ ET BT 261.440 180.572 Td /F5 9.8 Tf [(et al.)] TJ ET BT 282.577 180.572 Td /F1 9.8 Tf [(, for example, one third of participants were lost to follow-up )] TJ ET BT 26.250 168.667 Td /F1 9.8 Tf [(between two interviews.)] TJ ET 0.267 0.267 0.267 rg BT 129.746 170.174 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 139.384 168.667 Td /F1 9.8 Tf [( There was a risk of non-response bias in many of the studies, which was not often addressed. )] TJ ET BT 26.250 156.762 Td /F1 9.8 Tf [(Rundblad et al. and Blando )] TJ ET BT 146.575 156.762 Td /F5 9.8 Tf [(et al.)] TJ ET BT 167.713 156.762 Td /F1 9.8 Tf [( both compared their study groups to the census data for the local population, but even this )] TJ ET BT 26.250 144.858 Td /F1 9.8 Tf [(may not guarantee that people who are recruited are representative of the wider population in other characteristics.)] TJ ET 0.267 0.267 0.267 rg BT 521.570 146.365 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 526.388 148.746 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 528.798 146.365 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 26.250 125.453 Td /F4 9.8 Tf [(4.4 Selective reporting \(reporting bias\))] TJ ET Q q 15.000 36.644 577.500 740.356 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(about an existing telephone help line that provides information and referrals for physician support, counselling and crisis )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(intervention. A comparison group was made by comparing the number of calls to another phone number for the same help line )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(that was not promoted in the campaign.)] TJ ET BT 26.250 724.262 Td /F4 9.8 Tf [(3.1.4 Results)] TJ ET BT 26.250 704.857 Td /F1 9.8 Tf [(In New York, major increases in advertising activity appeared to be accompanied by increases in call volume to the help line.)] TJ ET 0.267 0.267 0.267 rg BT 563.260 706.364 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 26.250 692.952 Td /F1 9.8 Tf [(Prior to the attacks, between 2,000 and 3,000 calls were made each month. In the month of peak advertising expenditure )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(\(September 2002\), 9,000 calls were made \(though this does coincide with the anniversary of the event\).)] TJ ET 0.267 0.267 0.267 rg BT 472.790 682.555 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 482.428 681.048 Td /F1 9.8 Tf [( Similarly, in New )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(Orleans, the number of calls to the advertised help line increased from a mean of 100 each day, to 125 during the campaign )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(and 134 each day after the campaign.)] TJ ET 0.267 0.267 0.267 rg BT 189.933 658.745 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 199.570 657.238 Td /F1 9.8 Tf [( In the second study of this intervention, no change in combined post-traumatic stress )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(disorder \(PTSD\) understanding, preventive behaviours \(keeping routine, monitoring stress, talking with others, being productive )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(and problem-solving\) or screened incidence \(indicated by avoidance, losing interest, isolation, losing hope, being jumpy and )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(having difficulty sleeping\) was found when comparing surveys taken before and during the campaign. A regression analysis )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(incorporating the date of interview relative to the commencement of the programme showed an increase in PTSD )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(beliefs/understanding and preventive behaviours, but no change in PTSD incidence.)] TJ ET 0.267 0.267 0.267 rg BT 388.813 599.222 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 398.451 597.714 Td /F1 9.8 Tf [( These interventions appear to have been )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(effective at promoting the behaviour of phoning a help line for mental health problems following disasters. The campaign in New )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(Orleans may have improved understanding and knowledge. The lack of change of PTSD incidence may be due to )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(ineffectiveness of the intervention or due to a lack of sufficient time or power to detect any change in incidence.)] TJ ET BT 26.250 542.595 Td /F4 9.8 Tf [(4 Risk of bias in included studies)] TJ ET BT 26.250 523.191 Td /F1 9.8 Tf [(We used the Cochrane risk of bias tool, which is designed for use with randomised control trials. Where a category was not )] TJ ET BT 26.250 511.286 Td /F1 9.8 Tf [(applicable to the study design, Unclear risk was chosen.)] TJ ET BT 26.250 491.881 Td /F4 9.8 Tf [(4.1 Allocation \(selection bias\))] TJ ET BT 26.250 472.476 Td /F1 9.8 Tf [(Only one study was identified that allocated individuals randomly to one of two interventions.)] TJ ET 0.267 0.267 0.267 rg BT 424.021 473.984 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 433.658 472.476 Td /F1 9.8 Tf [( In that study, by Eisenman )] TJ ET BT 553.973 472.476 Td /F5 9.8 Tf [(et al.)] TJ ET BT 575.111 472.476 Td /F1 9.8 Tf [(, )] TJ ET BT 26.250 460.572 Td /F1 9.8 Tf [(the allocation method and concealment were described.)] TJ ET 0.267 0.267 0.267 rg BT 267.406 462.079 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 277.044 460.572 Td /F1 9.8 Tf [( The Tanes )] TJ ET BT 329.070 460.572 Td /F5 9.8 Tf [(Beat the Quake )] TJ ET BT 399.533 460.572 Td /F1 9.8 Tf [(study used an unstated method of )] TJ ET BT 26.250 448.667 Td /F1 9.8 Tf [(randomisation to allocate group time slots, not individuals.)] TJ ET 0.267 0.267 0.267 rg BT 276.065 450.174 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 285.702 452.555 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 288.111 450.174 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 297.749 448.667 Td /F1 9.8 Tf [( It was also not stated whether allocation occurred before or after )] TJ ET BT 26.250 436.762 Td /F1 9.8 Tf [(the time slots had been selected by participants. The randomisation of groups increases the risk of selection bias. Virtually all )] TJ ET BT 26.250 424.857 Td /F1 9.8 Tf [(the other controlled studies compared two different areas, or two groups of areas. Usually this was for practical reasons, and )] TJ ET BT 26.250 412.953 Td /F1 9.8 Tf [(randomisation may not have been possible. For example, Ardalan )] TJ ET BT 312.920 412.953 Td /F5 9.8 Tf [(et al.)] TJ ET BT 334.058 412.953 Td /F1 9.8 Tf [( allocated intervention or control status to 31 villages )] TJ ET BT 26.250 401.048 Td /F1 9.8 Tf [(and later adjusted analyses for possible confounders.)] TJ ET 0.267 0.267 0.267 rg BT 256.574 402.555 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 266.212 401.048 Td /F1 9.8 Tf [( The authors chose the allocations, increasing the risk that any )] TJ ET BT 26.250 389.143 Td /F1 9.8 Tf [(differences in outcome between the intervention and control groups are due to something other than the intervention. Blando )] TJ ET BT 565.503 389.143 Td /F5 9.8 Tf [(et )] TJ ET BT 26.250 377.238 Td /F5 9.8 Tf [(al. )] TJ ET BT 39.257 377.238 Td /F1 9.8 Tf [(studied two groups of people who had themselves chosen whether or not to receive the intervention several years earlier, )] TJ ET BT 26.250 365.334 Td /F1 9.8 Tf [(which presents a high risk of selection bias.)] TJ ET 0.267 0.267 0.267 rg BT 213.743 366.841 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 223.380 365.334 Td /F1 9.8 Tf [( That study does not aim to be a straightforward evaluation of effectiveness, )] TJ ET BT 26.250 353.429 Td /F1 9.8 Tf [(however, and the study should be interpreted in that light.)] TJ ET BT 26.250 334.024 Td /F4 9.8 Tf [(4.2 Blinding \(performance bias and detection bias\))] TJ ET BT 26.250 314.619 Td /F1 9.8 Tf [(Blinding participants to the intervention that they are receiving is generally not possible in for the interventions identified in this )] TJ ET BT 26.250 302.715 Td /F1 9.8 Tf [(review, although Eisenman )] TJ ET BT 146.009 302.715 Td /F5 9.8 Tf [(et al.)] TJ ET BT 167.147 302.715 Td /F1 9.8 Tf [( used interviewers who were blinded to intervention status in their randomised trial.)] TJ ET 0.267 0.267 0.267 rg BT 523.705 304.222 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 533.342 302.715 Td /F1 9.8 Tf [( No other )] TJ ET BT 26.250 290.810 Td /F1 9.8 Tf [(studies mentioned blinding. Outcome assessment in before and after studies, controlled studies and interrupted time series )] TJ ET BT 26.250 278.905 Td /F1 9.8 Tf [(would benefit from being conducted blind to the time point or intervention.)] TJ ET BT 26.250 259.500 Td /F4 9.8 Tf [(4.3 Incomplete outcome data \(attrition bias\))] TJ ET BT 26.250 240.096 Td /F1 9.8 Tf [(The only randomised trial identified in this study had substantial attrition from both groups in the study, particularly from the high-)] TJ ET BT 26.250 228.191 Td /F1 9.8 Tf [(intensity intervention.)] TJ ET 0.267 0.267 0.267 rg BT 117.832 229.698 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 127.469 228.191 Td /F1 9.8 Tf [( This could have affected the final results, since a per protocol analysis was presented. Ardalan )] TJ ET BT 540.411 228.191 Td /F5 9.8 Tf [(et al. )] TJ ET BT 26.250 216.286 Td /F1 9.8 Tf [(sought to avoid attrition by taking a further sample of participants for the post-intervention assessment.)] TJ ET 0.267 0.267 0.267 rg BT 467.915 217.793 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 477.553 216.286 Td /F1 9.8 Tf [( Many studies only )] TJ ET BT 26.250 204.381 Td /F1 9.8 Tf [(conducted one interview with each participant, during which \(if necessary\) they asked participants to recall past as well as )] TJ ET BT 26.250 192.477 Td /F1 9.8 Tf [(present knowledge or behaviours. Whilst avoiding attrition, this does increase risk of recall bias. In other studies, attrition was a )] TJ ET BT 26.250 180.572 Td /F1 9.8 Tf [(significant problem. In the SARS intervention by Chan )] TJ ET BT 261.440 180.572 Td /F5 9.8 Tf [(et al.)] TJ ET BT 282.577 180.572 Td /F1 9.8 Tf [(, for example, one third of participants were lost to follow-up )] TJ ET BT 26.250 168.667 Td /F1 9.8 Tf [(between two interviews.)] TJ ET 0.267 0.267 0.267 rg BT 129.746 170.174 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 139.384 168.667 Td /F1 9.8 Tf [( There was a risk of non-response bias in many of the studies, which was not often addressed. )] TJ ET BT 26.250 156.762 Td /F1 9.8 Tf [(Rundblad et al. and Blando )] TJ ET BT 146.575 156.762 Td /F5 9.8 Tf [(et al.)] TJ ET BT 167.713 156.762 Td /F1 9.8 Tf [( both compared their study groups to the census data for the local population, but even this )] TJ ET BT 26.250 144.858 Td /F1 9.8 Tf [(may not guarantee that people who are recruited are representative of the wider population in other characteristics.)] TJ ET 0.267 0.267 0.267 rg BT 521.570 146.365 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 526.388 148.746 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 528.798 146.365 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 26.250 125.453 Td /F4 9.8 Tf [(4.4 Selective reporting \(reporting bias\))] TJ ET Q q 15.000 36.644 577.500 740.356 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(about an existing telephone help line that provides information and referrals for physician support, counselling and crisis )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(intervention. A comparison group was made by comparing the number of calls to another phone number for the same help line )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(that was not promoted in the campaign.)] TJ ET BT 26.250 724.262 Td /F4 9.8 Tf [(3.1.4 Results)] TJ ET BT 26.250 704.857 Td /F1 9.8 Tf [(In New York, major increases in advertising activity appeared to be accompanied by increases in call volume to the help line.)] TJ ET 0.267 0.267 0.267 rg BT 563.260 706.364 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 26.250 692.952 Td /F1 9.8 Tf [(Prior to the attacks, between 2,000 and 3,000 calls were made each month. In the month of peak advertising expenditure )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(\(September 2002\), 9,000 calls were made \(though this does coincide with the anniversary of the event\).)] TJ ET 0.267 0.267 0.267 rg BT 472.790 682.555 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 482.428 681.048 Td /F1 9.8 Tf [( Similarly, in New )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(Orleans, the number of calls to the advertised help line increased from a mean of 100 each day, to 125 during the campaign )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(and 134 each day after the campaign.)] TJ ET 0.267 0.267 0.267 rg BT 189.933 658.745 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 199.570 657.238 Td /F1 9.8 Tf [( In the second study of this intervention, no change in combined post-traumatic stress )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(disorder \(PTSD\) understanding, preventive behaviours \(keeping routine, monitoring stress, talking with others, being productive )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(and problem-solving\) or screened incidence \(indicated by avoidance, losing interest, isolation, losing hope, being jumpy and )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(having difficulty sleeping\) was found when comparing surveys taken before and during the campaign. A regression analysis )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(incorporating the date of interview relative to the commencement of the programme showed an increase in PTSD )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(beliefs/understanding and preventive behaviours, but no change in PTSD incidence.)] TJ ET 0.267 0.267 0.267 rg BT 388.813 599.222 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 398.451 597.714 Td /F1 9.8 Tf [( These interventions appear to have been )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(effective at promoting the behaviour of phoning a help line for mental health problems following disasters. The campaign in New )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(Orleans may have improved understanding and knowledge. The lack of change of PTSD incidence may be due to )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(ineffectiveness of the intervention or due to a lack of sufficient time or power to detect any change in incidence.)] TJ ET BT 26.250 542.595 Td /F4 9.8 Tf [(4 Risk of bias in included studies)] TJ ET BT 26.250 523.191 Td /F1 9.8 Tf [(We used the Cochrane risk of bias tool, which is designed for use with randomised control trials. Where a category was not )] TJ ET BT 26.250 511.286 Td /F1 9.8 Tf [(applicable to the study design, Unclear risk was chosen.)] TJ ET BT 26.250 491.881 Td /F4 9.8 Tf [(4.1 Allocation \(selection bias\))] TJ ET BT 26.250 472.476 Td /F1 9.8 Tf [(Only one study was identified that allocated individuals randomly to one of two interventions.)] TJ ET 0.267 0.267 0.267 rg BT 424.021 473.984 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 433.658 472.476 Td /F1 9.8 Tf [( In that study, by Eisenman )] TJ ET BT 553.973 472.476 Td /F5 9.8 Tf [(et al.)] TJ ET BT 575.111 472.476 Td /F1 9.8 Tf [(, )] TJ ET BT 26.250 460.572 Td /F1 9.8 Tf [(the allocation method and concealment were described.)] TJ ET 0.267 0.267 0.267 rg BT 267.406 462.079 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 277.044 460.572 Td /F1 9.8 Tf [( The Tanes )] TJ ET BT 329.070 460.572 Td /F5 9.8 Tf [(Beat the Quake )] TJ ET BT 399.533 460.572 Td /F1 9.8 Tf [(study used an unstated method of )] TJ ET BT 26.250 448.667 Td /F1 9.8 Tf [(randomisation to allocate group time slots, not individuals.)] TJ ET 0.267 0.267 0.267 rg BT 276.065 450.174 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 285.702 452.555 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 288.111 450.174 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 297.749 448.667 Td /F1 9.8 Tf [( It was also not stated whether allocation occurred before or after )] TJ ET BT 26.250 436.762 Td /F1 9.8 Tf [(the time slots had been selected by participants. The randomisation of groups increases the risk of selection bias. Virtually all )] TJ ET BT 26.250 424.857 Td /F1 9.8 Tf [(the other controlled studies compared two different areas, or two groups of areas. Usually this was for practical reasons, and )] TJ ET BT 26.250 412.953 Td /F1 9.8 Tf [(randomisation may not have been possible. For example, Ardalan )] TJ ET BT 312.920 412.953 Td /F5 9.8 Tf [(et al.)] TJ ET BT 334.058 412.953 Td /F1 9.8 Tf [( allocated intervention or control status to 31 villages )] TJ ET BT 26.250 401.048 Td /F1 9.8 Tf [(and later adjusted analyses for possible confounders.)] TJ ET 0.267 0.267 0.267 rg BT 256.574 402.555 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 266.212 401.048 Td /F1 9.8 Tf [( The authors chose the allocations, increasing the risk that any )] TJ ET BT 26.250 389.143 Td /F1 9.8 Tf [(differences in outcome between the intervention and control groups are due to something other than the intervention. Blando )] TJ ET BT 565.503 389.143 Td /F5 9.8 Tf [(et )] TJ ET BT 26.250 377.238 Td /F5 9.8 Tf [(al. )] TJ ET BT 39.257 377.238 Td /F1 9.8 Tf [(studied two groups of people who had themselves chosen whether or not to receive the intervention several years earlier, )] TJ ET BT 26.250 365.334 Td /F1 9.8 Tf [(which presents a high risk of selection bias.)] TJ ET 0.267 0.267 0.267 rg BT 213.743 366.841 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 223.380 365.334 Td /F1 9.8 Tf [( That study does not aim to be a straightforward evaluation of effectiveness, )] TJ ET BT 26.250 353.429 Td /F1 9.8 Tf [(however, and the study should be interpreted in that light.)] TJ ET BT 26.250 334.024 Td /F4 9.8 Tf [(4.2 Blinding \(performance bias and detection bias\))] TJ ET BT 26.250 314.619 Td /F1 9.8 Tf [(Blinding participants to the intervention that they are receiving is generally not possible in for the interventions identified in this )] TJ ET BT 26.250 302.715 Td /F1 9.8 Tf [(review, although Eisenman )] TJ ET BT 146.009 302.715 Td /F5 9.8 Tf [(et al.)] TJ ET BT 167.147 302.715 Td /F1 9.8 Tf [( used interviewers who were blinded to intervention status in their randomised trial.)] TJ ET 0.267 0.267 0.267 rg BT 523.705 304.222 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 533.342 302.715 Td /F1 9.8 Tf [( No other )] TJ ET BT 26.250 290.810 Td /F1 9.8 Tf [(studies mentioned blinding. Outcome assessment in before and after studies, controlled studies and interrupted time series )] TJ ET BT 26.250 278.905 Td /F1 9.8 Tf [(would benefit from being conducted blind to the time point or intervention.)] TJ ET BT 26.250 259.500 Td /F4 9.8 Tf [(4.3 Incomplete outcome data \(attrition bias\))] TJ ET BT 26.250 240.096 Td /F1 9.8 Tf [(The only randomised trial identified in this study had substantial attrition from both groups in the study, particularly from the high-)] TJ ET BT 26.250 228.191 Td /F1 9.8 Tf [(intensity intervention.)] TJ ET 0.267 0.267 0.267 rg BT 117.832 229.698 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 127.469 228.191 Td /F1 9.8 Tf [( This could have affected the final results, since a per protocol analysis was presented. Ardalan )] TJ ET BT 540.411 228.191 Td /F5 9.8 Tf [(et al. )] TJ ET BT 26.250 216.286 Td /F1 9.8 Tf [(sought to avoid attrition by taking a further sample of participants for the post-intervention assessment.)] TJ ET 0.267 0.267 0.267 rg BT 467.915 217.793 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 477.553 216.286 Td /F1 9.8 Tf [( Many studies only )] TJ ET BT 26.250 204.381 Td /F1 9.8 Tf [(conducted one interview with each participant, during which \(if necessary\) they asked participants to recall past as well as )] TJ ET BT 26.250 192.477 Td /F1 9.8 Tf [(present knowledge or behaviours. Whilst avoiding attrition, this does increase risk of recall bias. In other studies, attrition was a )] TJ ET BT 26.250 180.572 Td /F1 9.8 Tf [(significant problem. In the SARS intervention by Chan )] TJ ET BT 261.440 180.572 Td /F5 9.8 Tf [(et al.)] TJ ET BT 282.577 180.572 Td /F1 9.8 Tf [(, for example, one third of participants were lost to follow-up )] TJ ET BT 26.250 168.667 Td /F1 9.8 Tf [(between two interviews.)] TJ ET 0.267 0.267 0.267 rg BT 129.746 170.174 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 139.384 168.667 Td /F1 9.8 Tf [( There was a risk of non-response bias in many of the studies, which was not often addressed. )] TJ ET BT 26.250 156.762 Td /F1 9.8 Tf [(Rundblad et al. and Blando )] TJ ET BT 146.575 156.762 Td /F5 9.8 Tf [(et al.)] TJ ET BT 167.713 156.762 Td /F1 9.8 Tf [( both compared their study groups to the census data for the local population, but even this )] TJ ET BT 26.250 144.858 Td /F1 9.8 Tf [(may not guarantee that people who are recruited are representative of the wider population in other characteristics.)] TJ ET 0.267 0.267 0.267 rg BT 521.570 146.365 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 526.388 148.746 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 528.798 146.365 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 26.250 125.453 Td /F4 9.8 Tf [(4.4 Selective reporting \(reporting bias\))] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(11)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 1731 0 obj << /Type /Annot /Subtype /Link /A 1732 0 R /Border [0 0 0] /H /I /Rect [ 563.2605 705.5627 572.8978 714.3810 ] >> endobj 1732 0 obj << /Type /Action >> endobj 1733 0 obj << /Type /Annot /Subtype /Link /A 1734 0 R /Border [0 0 0] /H /I /Rect [ 472.7903 681.7532 482.4276 690.5715 ] >> endobj 1734 0 obj << /Type /Action >> endobj 1735 0 obj << /Type /Annot /Subtype /Link /A 1736 0 R /Border [0 0 0] /H /I /Rect [ 189.9330 657.9437 199.5703 666.7620 ] >> endobj 1736 0 obj << /Type /Action >> endobj 1737 0 obj << /Type /Annot /Subtype /Link /A 1738 0 R /Border [0 0 0] /H /I /Rect [ 388.8135 598.4199 398.4508 607.2382 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0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(Some of the studies \(mainly studies of preparedness\) were clearly designed as prospective intervention studies. Numerous )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(other reports sought to evaluate the response to disasters that had already occurred, in which case hypothesis could be formed )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(cognisant of the general outcome of the interventions. Some of these may still have entailed a prospective collection of data. )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(Others, however, could have generated hypotheses after data were already available. This is particularly possible for research )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(into infectious diseases, given the presence of significant surveillance programmes in some countries. For instance, the use of )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(lag time in the SARS epidemic as an outcome, as reported in Pang et al., might carry some risk of being a )] TJ ET BT 489.570 707.952 Td /F5 9.8 Tf [(post hoc)] TJ ET BT 526.425 707.952 Td /F1 9.8 Tf [( analysis.)] TJ ET 0.267 0.267 0.267 rg BT 567.063 709.460 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 26.250 671.350 Td /F4 12.0 Tf [(Discussion)] TJ ET BT 26.250 651.396 Td /F4 9.8 Tf [(1 Summary of evidence)] TJ ET BT 26.250 631.991 Td /F1 9.8 Tf [(Twenty seven studies of risk communication interventions for the mitigation of, preparedness for, response to, and recovery )] TJ ET BT 26.250 620.086 Td /F1 9.8 Tf [(from disasters were included in this systematic review. The contexts, interventions and outcomes were diverse, and meta-)] TJ ET BT 26.250 608.181 Td /F1 9.8 Tf [(analysis was not appropriate. Some disaster mitigation and preparedness interventions appeared to improve knowledge and )] TJ ET BT 26.250 596.277 Td /F1 9.8 Tf [(behaviour relating to disaster risks. There was little robust evidence of the effectiveness of risk communication for disaster )] TJ ET BT 26.250 584.372 Td /F1 9.8 Tf [(knowledge, behaviour and health outcomes in the response and recovery phases of disasters. One intervention was associated )] TJ ET BT 26.250 572.467 Td /F1 9.8 Tf [(with an undesirable reduction in protective behaviours.)] TJ ET BT 26.250 553.062 Td /F4 9.8 Tf [(1.1 Mitigation and Preparedness Interventions)] TJ ET BT 26.250 533.658 Td /F1 9.8 Tf [(All four trials were found in this category. All mitigation and preparedness studies reported that the interventions that they )] TJ ET BT 26.250 521.753 Td /F1 9.8 Tf [(reported were effective to some extent. Eastwood )] TJ ET BT 243.022 521.753 Td /F5 9.8 Tf [(et al.)] TJ ET BT 264.160 521.753 Td /F1 9.8 Tf [( reported a high level of intended compliance with public health advice )] TJ ET BT 26.250 509.848 Td /F1 9.8 Tf [(before and after an intervention, but did not make statistical comparisons of the changes.)] TJ ET 0.267 0.267 0.267 rg BT 409.406 511.355 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 414.224 509.848 Td /F1 9.8 Tf [( Due to the already high compliance )] TJ ET BT 26.250 497.943 Td /F1 9.8 Tf [(\(over 90% for each measure\), future studies in such contexts would therefore need to be very large to detect significant )] TJ ET BT 26.250 486.039 Td /F1 9.8 Tf [(improvements. Dumais)] TJ ET BT 125.934 486.039 Td /F5 9.8 Tf [( et al.)] TJ ET BT 149.782 486.039 Td /F1 9.8 Tf [( reported significant improvements in knowledge for schoolchildren about influenza, which was )] TJ ET BT 26.250 474.134 Td /F1 9.8 Tf [(intended only to facilitate further health education.)] TJ ET 0.267 0.267 0.267 rg BT 241.413 475.641 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 246.232 474.134 Td /F1 9.8 Tf [( The Roess et al. study of a monkeypox intervention found modest )] TJ ET BT 26.250 462.229 Td /F1 9.8 Tf [(improvement in knowledge outcomes and some behaviours, but did not successfully affect some high risk behaviours.)] TJ ET 0.267 0.267 0.267 rg BT 534.547 463.736 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 450.324 Td /F1 9.8 Tf [(Assessing the longer term effect of the programme is likely to be difficult. Preparedness and mitigation for natural disasters was )] TJ ET BT 26.250 438.420 Td /F1 9.8 Tf [(a relatively well-studied area with several prospective trials. Increased likelihood of behavioural preparedness was shown in )] TJ ET BT 26.250 426.515 Td /F1 9.8 Tf [(controlled studies by Eisenman )] TJ ET BT 163.891 426.515 Td /F5 9.8 Tf [(et al.)] TJ ET BT 185.029 426.515 Td /F1 9.8 Tf [( and Ardalan et al..)] TJ ET 0.267 0.267 0.267 rg BT 266.870 428.022 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 276.508 430.403 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 278.917 428.022 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 288.554 426.515 Td /F1 9.8 Tf [( Games were used by two authors to increase knowledge, with )] TJ ET BT 26.250 414.610 Td /F1 9.8 Tf [(apparent success.)] TJ ET 0.267 0.267 0.267 rg BT 105.371 416.117 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 115.009 418.498 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 117.418 416.117 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 127.055 418.498 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 129.465 416.117 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 139.102 414.610 Td /F1 9.8 Tf [( The effectiveness of the evacuation warnings is difficult to assess because of the many interacting )] TJ ET BT 26.250 402.705 Td /F1 9.8 Tf [(factors in the situations. The Mauritius and India evacuations had relatively low voluntary compliance, whereas the Reverse 911 )] TJ ET BT 26.250 390.801 Td /F1 9.8 Tf [(communication in the San Diego wildfires apparently provided a strong impetus for people to act.)] TJ ET 0.267 0.267 0.267 rg BT 442.975 392.308 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 452.612 394.689 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 455.021 392.308 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 464.659 394.689 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 467.068 392.308 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 476.705 394.689 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 479.115 392.308 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 26.250 371.396 Td /F4 9.8 Tf [(1.2 Response Interventions)] TJ ET BT 26.250 351.991 Td /F1 9.8 Tf [(Few of the response interventions were prospectively planned. The prospectively planned studies by Chan et al. and Farahat )] TJ ET BT 567.092 351.991 Td /F5 9.8 Tf [(et )] TJ ET BT 26.250 340.086 Td /F5 9.8 Tf [(al., )] TJ ET BT 41.967 340.086 Td /F1 9.8 Tf [(though taking place in the context of ongoing disasters, were similar in character to the preparedness interventions for )] TJ ET BT 26.250 328.182 Td /F1 9.8 Tf [(infectious diseases.)] TJ ET 0.267 0.267 0.267 rg BT 111.329 329.689 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 120.966 332.070 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 123.375 329.689 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 133.013 328.182 Td /F1 9.8 Tf [( Farahat et al. demonstrated improvements in knowledge and behaviour over three months, while Chan )] TJ ET BT 26.250 316.277 Td /F5 9.8 Tf [(et al.)] TJ ET BT 47.388 316.277 Td /F1 9.8 Tf [( reported a negative change for behaviour one week after their intervention.)] TJ ET 0.267 0.267 0.267 rg BT 372.560 317.784 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 382.198 320.165 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 384.607 317.784 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 394.244 316.277 Td /F1 9.8 Tf [( Attributing causality in the absence of a )] TJ ET BT 26.250 304.372 Td /F1 9.8 Tf [(control group and in the context of widespread public and media interest in the topic of concern is difficult, and limits the value of )] TJ ET BT 26.250 292.467 Td /F1 9.8 Tf [(these studies. All the other studies attempted to evaluate an ongoing or past risk communication response to a disaster. In )] TJ ET BT 26.250 280.563 Td /F1 9.8 Tf [(these contexts, too, there are many factors that affect interpretation, including many other non-communication interventions that )] TJ ET BT 26.250 268.658 Td /F1 9.8 Tf [(take place concurrently. The studies of the UK and USA water crises demonstrated that the communications to alert the public )] TJ ET BT 26.250 256.753 Td /F1 9.8 Tf [(to the need to take action to avoid using contaminated water were successful in reaching almost all affected, but that in spite of )] TJ ET BT 26.250 244.848 Td /F1 9.8 Tf [(this reach, a significant minority of people either did not understand the advice given or chose not to follow it.)] TJ ET 0.267 0.267 0.267 rg BT 493.938 246.356 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 498.757 248.737 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 501.166 246.356 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 510.803 248.737 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 513.213 246.356 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 522.850 244.848 Td /F1 9.8 Tf [( In Haiti, )] TJ ET BT 26.250 232.944 Td /F1 9.8 Tf [(despite a high level of knowledge, the water treatment was apparently not used all the time.)] TJ ET 0.267 0.267 0.267 rg BT 420.238 234.451 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 429.875 232.944 Td /F1 9.8 Tf [( The factors that affect decisions )] TJ ET BT 26.250 221.039 Td /F1 9.8 Tf [(about whether to comply with the advice may differ between these contexts.)] TJ ET BT 26.250 201.634 Td /F4 9.8 Tf [(1.3 Recovery Interventions)] TJ ET BT 26.250 182.229 Td /F1 9.8 Tf [(Three recovery interventions were found, including two studies of the post-hurricane Katrina response in New Orleans.)] TJ ET 0.267 0.267 0.267 rg BT 536.711 183.737 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 546.349 186.118 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 548.758 183.737 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 558.395 182.229 Td /F1 9.8 Tf [( Use )] TJ ET BT 26.250 170.325 Td /F1 9.8 Tf [(of the mental health help lines in New York and New Orleans increased with promotion.)] TJ ET 0.267 0.267 0.267 rg BT 402.863 171.832 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 412.501 174.213 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 414.910 171.832 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 424.547 174.213 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 426.957 171.832 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 436.594 170.325 Td /F1 9.8 Tf [( Serial surveys of the audience )] TJ ET BT 26.250 158.420 Td /F1 9.8 Tf [(in New Orleans suggested no change in one analysis, and changes in knowledge and behaviour, but not incidence of PTSD in a )] TJ ET BT 26.250 146.515 Td /F1 9.8 Tf [(different analysis.)] TJ ET 0.267 0.267 0.267 rg BT 102.115 148.022 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 111.752 150.403 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 114.161 148.022 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 26.250 127.110 Td /F4 9.8 Tf [(1.4 Disaster-specific Interventions)] TJ ET BT 26.250 107.706 Td /F1 9.8 Tf [(We grouped the disasters primarily by phase and secondly by disaster type. It is possible, however, that there are important )] TJ ET BT 26.250 95.801 Td /F1 9.8 Tf [(lessons for disaster types that transcend phases. We therefore also considered these reports together by disaster type. There )] TJ ET BT 26.250 83.896 Td /F1 9.8 Tf [(were eleven studies related to natural disasters.)] TJ ET 0.267 0.267 0.267 rg BT 232.716 85.403 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 242.353 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 244.763 85.403 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 254.400 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 256.809 85.403 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 266.447 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 268.856 85.403 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 278.493 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 280.903 85.403 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 290.540 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 292.949 85.403 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 302.587 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 304.996 85.403 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 314.633 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 317.043 85.403 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 326.680 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 329.089 85.403 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 338.727 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 341.136 85.403 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 350.773 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 353.183 85.403 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 362.820 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 365.229 85.403 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 374.867 83.896 Td /F1 9.8 Tf [( All five preparedness studies reported that )] TJ ET BT 26.250 71.991 Td /F1 9.8 Tf [(their interventions \(games, interactive discussion groups or teaching\) were effective means of increasing knowledge or )] TJ ET BT 26.250 60.087 Td /F1 9.8 Tf [(preparedness behaviour.)] TJ ET 0.267 0.267 0.267 rg BT 134.095 61.594 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 143.732 63.975 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 146.141 61.594 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 155.779 63.975 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 158.188 61.594 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 167.825 63.975 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 170.235 61.594 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 179.872 63.975 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 182.281 61.594 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 191.919 63.975 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 194.328 61.594 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 203.965 60.087 Td /F1 9.8 Tf [( The only randomised trial identified for this review provided evidence in favour of a )] TJ ET BT 26.250 48.182 Td /F1 9.8 Tf [(health promotion discussion group approach to general disaster preparedness over the simple provision of written information.)] TJ ET 0.267 0.267 0.267 rg BT 569.774 49.689 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 26.250 36.277 Td /F1 9.8 Tf [(In the three early warning studies of natural disasters diverse methods of communication were used. Reverse-911 appeared to )] TJ ET Q q 15.000 21.991 577.500 755.009 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(Some of the studies \(mainly studies of preparedness\) were clearly designed as prospective intervention studies. Numerous )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(other reports sought to evaluate the response to disasters that had already occurred, in which case hypothesis could be formed )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(cognisant of the general outcome of the interventions. Some of these may still have entailed a prospective collection of data. )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(Others, however, could have generated hypotheses after data were already available. This is particularly possible for research )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(into infectious diseases, given the presence of significant surveillance programmes in some countries. For instance, the use of )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(lag time in the SARS epidemic as an outcome, as reported in Pang et al., might carry some risk of being a )] TJ ET BT 489.570 707.952 Td /F5 9.8 Tf [(post hoc)] TJ ET BT 526.425 707.952 Td /F1 9.8 Tf [( analysis.)] TJ ET 0.267 0.267 0.267 rg BT 567.063 709.460 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 26.250 671.350 Td /F4 12.0 Tf [(Discussion)] TJ ET BT 26.250 651.396 Td /F4 9.8 Tf [(1 Summary of evidence)] TJ ET BT 26.250 631.991 Td /F1 9.8 Tf [(Twenty seven studies of risk communication interventions for the mitigation of, preparedness for, response to, and recovery )] TJ ET BT 26.250 620.086 Td /F1 9.8 Tf [(from disasters were included in this systematic review. The contexts, interventions and outcomes were diverse, and meta-)] TJ ET BT 26.250 608.181 Td /F1 9.8 Tf [(analysis was not appropriate. Some disaster mitigation and preparedness interventions appeared to improve knowledge and )] TJ ET BT 26.250 596.277 Td /F1 9.8 Tf [(behaviour relating to disaster risks. There was little robust evidence of the effectiveness of risk communication for disaster )] TJ ET BT 26.250 584.372 Td /F1 9.8 Tf [(knowledge, behaviour and health outcomes in the response and recovery phases of disasters. One intervention was associated )] TJ ET BT 26.250 572.467 Td /F1 9.8 Tf [(with an undesirable reduction in protective behaviours.)] TJ ET BT 26.250 553.062 Td /F4 9.8 Tf [(1.1 Mitigation and Preparedness Interventions)] TJ ET BT 26.250 533.658 Td /F1 9.8 Tf [(All four trials were found in this category. All mitigation and preparedness studies reported that the interventions that they )] TJ ET BT 26.250 521.753 Td /F1 9.8 Tf [(reported were effective to some extent. Eastwood )] TJ ET BT 243.022 521.753 Td /F5 9.8 Tf [(et al.)] TJ ET BT 264.160 521.753 Td /F1 9.8 Tf [( reported a high level of intended compliance with public health advice )] TJ ET BT 26.250 509.848 Td /F1 9.8 Tf [(before and after an intervention, but did not make statistical comparisons of the changes.)] TJ ET 0.267 0.267 0.267 rg BT 409.406 511.355 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 414.224 509.848 Td /F1 9.8 Tf [( Due to the already high compliance )] TJ ET BT 26.250 497.943 Td /F1 9.8 Tf [(\(over 90% for each measure\), future studies in such contexts would therefore need to be very large to detect significant )] TJ ET BT 26.250 486.039 Td /F1 9.8 Tf [(improvements. Dumais)] TJ ET BT 125.934 486.039 Td /F5 9.8 Tf [( et al.)] TJ ET BT 149.782 486.039 Td /F1 9.8 Tf [( reported significant improvements in knowledge for schoolchildren about influenza, which was )] TJ ET BT 26.250 474.134 Td /F1 9.8 Tf [(intended only to facilitate further health education.)] TJ ET 0.267 0.267 0.267 rg BT 241.413 475.641 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 246.232 474.134 Td /F1 9.8 Tf [( The Roess et al. study of a monkeypox intervention found modest )] TJ ET BT 26.250 462.229 Td /F1 9.8 Tf [(improvement in knowledge outcomes and some behaviours, but did not successfully affect some high risk behaviours.)] TJ ET 0.267 0.267 0.267 rg BT 534.547 463.736 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 450.324 Td /F1 9.8 Tf [(Assessing the longer term effect of the programme is likely to be difficult. Preparedness and mitigation for natural disasters was )] TJ ET BT 26.250 438.420 Td /F1 9.8 Tf [(a relatively well-studied area with several prospective trials. Increased likelihood of behavioural preparedness was shown in )] TJ ET BT 26.250 426.515 Td /F1 9.8 Tf [(controlled studies by Eisenman )] TJ ET BT 163.891 426.515 Td /F5 9.8 Tf [(et al.)] TJ ET BT 185.029 426.515 Td /F1 9.8 Tf [( and Ardalan et al..)] TJ ET 0.267 0.267 0.267 rg BT 266.870 428.022 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 276.508 430.403 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 278.917 428.022 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 288.554 426.515 Td /F1 9.8 Tf [( Games were used by two authors to increase knowledge, with )] TJ ET BT 26.250 414.610 Td /F1 9.8 Tf [(apparent success.)] TJ ET 0.267 0.267 0.267 rg BT 105.371 416.117 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 115.009 418.498 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 117.418 416.117 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 127.055 418.498 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 129.465 416.117 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 139.102 414.610 Td /F1 9.8 Tf [( The effectiveness of the evacuation warnings is difficult to assess because of the many interacting )] TJ ET BT 26.250 402.705 Td /F1 9.8 Tf [(factors in the situations. The Mauritius and India evacuations had relatively low voluntary compliance, whereas the Reverse 911 )] TJ ET BT 26.250 390.801 Td /F1 9.8 Tf [(communication in the San Diego wildfires apparently provided a strong impetus for people to act.)] TJ ET 0.267 0.267 0.267 rg BT 442.975 392.308 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 452.612 394.689 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 455.021 392.308 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 464.659 394.689 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 467.068 392.308 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 476.705 394.689 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 479.115 392.308 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 26.250 371.396 Td /F4 9.8 Tf [(1.2 Response Interventions)] TJ ET BT 26.250 351.991 Td /F1 9.8 Tf [(Few of the response interventions were prospectively planned. The prospectively planned studies by Chan et al. and Farahat )] TJ ET BT 567.092 351.991 Td /F5 9.8 Tf [(et )] TJ ET BT 26.250 340.086 Td /F5 9.8 Tf [(al., )] TJ ET BT 41.967 340.086 Td /F1 9.8 Tf [(though taking place in the context of ongoing disasters, were similar in character to the preparedness interventions for )] TJ ET BT 26.250 328.182 Td /F1 9.8 Tf [(infectious diseases.)] TJ ET 0.267 0.267 0.267 rg BT 111.329 329.689 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 120.966 332.070 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 123.375 329.689 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 133.013 328.182 Td /F1 9.8 Tf [( Farahat et al. demonstrated improvements in knowledge and behaviour over three months, while Chan )] TJ ET BT 26.250 316.277 Td /F5 9.8 Tf [(et al.)] TJ ET BT 47.388 316.277 Td /F1 9.8 Tf [( reported a negative change for behaviour one week after their intervention.)] TJ ET 0.267 0.267 0.267 rg BT 372.560 317.784 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 382.198 320.165 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 384.607 317.784 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 394.244 316.277 Td /F1 9.8 Tf [( Attributing causality in the absence of a )] TJ ET BT 26.250 304.372 Td /F1 9.8 Tf [(control group and in the context of widespread public and media interest in the topic of concern is difficult, and limits the value of )] TJ ET BT 26.250 292.467 Td /F1 9.8 Tf [(these studies. All the other studies attempted to evaluate an ongoing or past risk communication response to a disaster. In )] TJ ET BT 26.250 280.563 Td /F1 9.8 Tf [(these contexts, too, there are many factors that affect interpretation, including many other non-communication interventions that )] TJ ET BT 26.250 268.658 Td /F1 9.8 Tf [(take place concurrently. The studies of the UK and USA water crises demonstrated that the communications to alert the public )] TJ ET BT 26.250 256.753 Td /F1 9.8 Tf [(to the need to take action to avoid using contaminated water were successful in reaching almost all affected, but that in spite of )] TJ ET BT 26.250 244.848 Td /F1 9.8 Tf [(this reach, a significant minority of people either did not understand the advice given or chose not to follow it.)] TJ ET 0.267 0.267 0.267 rg BT 493.938 246.356 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 498.757 248.737 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 501.166 246.356 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 510.803 248.737 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 513.213 246.356 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 522.850 244.848 Td /F1 9.8 Tf [( In Haiti, )] TJ ET BT 26.250 232.944 Td /F1 9.8 Tf [(despite a high level of knowledge, the water treatment was apparently not used all the time.)] TJ ET 0.267 0.267 0.267 rg BT 420.238 234.451 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 429.875 232.944 Td /F1 9.8 Tf [( The factors that affect decisions )] TJ ET BT 26.250 221.039 Td /F1 9.8 Tf [(about whether to comply with the advice may differ between these contexts.)] TJ ET BT 26.250 201.634 Td /F4 9.8 Tf [(1.3 Recovery Interventions)] TJ ET BT 26.250 182.229 Td /F1 9.8 Tf [(Three recovery interventions were found, including two studies of the post-hurricane Katrina response in New Orleans.)] TJ ET 0.267 0.267 0.267 rg BT 536.711 183.737 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 546.349 186.118 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 548.758 183.737 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 558.395 182.229 Td /F1 9.8 Tf [( Use )] TJ ET BT 26.250 170.325 Td /F1 9.8 Tf [(of the mental health help lines in New York and New Orleans increased with promotion.)] TJ ET 0.267 0.267 0.267 rg BT 402.863 171.832 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 412.501 174.213 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 414.910 171.832 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 424.547 174.213 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 426.957 171.832 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 436.594 170.325 Td /F1 9.8 Tf [( Serial surveys of the audience )] TJ ET BT 26.250 158.420 Td /F1 9.8 Tf [(in New Orleans suggested no change in one analysis, and changes in knowledge and behaviour, but not incidence of PTSD in a )] TJ ET BT 26.250 146.515 Td /F1 9.8 Tf [(different analysis.)] TJ ET 0.267 0.267 0.267 rg BT 102.115 148.022 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 111.752 150.403 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 114.161 148.022 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 26.250 127.110 Td /F4 9.8 Tf [(1.4 Disaster-specific Interventions)] TJ ET BT 26.250 107.706 Td /F1 9.8 Tf [(We grouped the disasters primarily by phase and secondly by disaster type. It is possible, however, that there are important )] TJ ET BT 26.250 95.801 Td /F1 9.8 Tf [(lessons for disaster types that transcend phases. We therefore also considered these reports together by disaster type. There )] TJ ET BT 26.250 83.896 Td /F1 9.8 Tf [(were eleven studies related to natural disasters.)] TJ ET 0.267 0.267 0.267 rg BT 232.716 85.403 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 242.353 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 244.763 85.403 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 254.400 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 256.809 85.403 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 266.447 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 268.856 85.403 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 278.493 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 280.903 85.403 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 290.540 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 292.949 85.403 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 302.587 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 304.996 85.403 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 314.633 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 317.043 85.403 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 326.680 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 329.089 85.403 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 338.727 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 341.136 85.403 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 350.773 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 353.183 85.403 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 362.820 87.784 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 365.229 85.403 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 374.867 83.896 Td /F1 9.8 Tf [( All five preparedness studies reported that )] TJ ET BT 26.250 71.991 Td /F1 9.8 Tf [(their interventions \(games, interactive discussion groups or teaching\) were effective means of increasing knowledge or )] TJ ET BT 26.250 60.087 Td /F1 9.8 Tf [(preparedness behaviour.)] TJ ET 0.267 0.267 0.267 rg BT 134.095 61.594 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 143.732 63.975 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 146.141 61.594 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 155.779 63.975 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 158.188 61.594 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 167.825 63.975 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 170.235 61.594 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 179.872 63.975 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 182.281 61.594 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 191.919 63.975 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 194.328 61.594 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 203.965 60.087 Td /F1 9.8 Tf [( The only randomised trial identified for this review provided evidence in favour of a )] TJ ET BT 26.250 48.182 Td /F1 9.8 Tf [(health promotion discussion group approach to general disaster preparedness over the simple provision of written information.)] TJ ET 0.267 0.267 0.267 rg BT 569.774 49.689 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 26.250 36.277 Td /F1 9.8 Tf [(In the three early warning studies of natural disasters diverse methods of communication were used. Reverse-911 appeared to )] TJ ET Q q 15.000 21.991 577.500 755.009 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(Some of the studies \(mainly studies of preparedness\) were clearly designed as prospective intervention studies. Numerous )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(other reports sought to evaluate the response to disasters that had already occurred, in which case hypothesis could be formed )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(cognisant of the general outcome of the interventions. Some of these may still have entailed a prospective collection of data. )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(Others, however, could have generated hypotheses after data were already available. This is particularly possible for research )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(into infectious diseases, given the presence of significant surveillance programmes in some countries. For instance, the use of )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(lag time in the SARS epidemic as an outcome, as reported in Pang et al., might carry some risk of being a )] TJ ET BT 489.570 707.952 Td /F5 9.8 Tf [(post hoc)] TJ ET BT 526.425 707.952 Td /F1 9.8 Tf [( analysis.)] TJ ET 0.267 0.267 0.267 rg BT 567.063 709.460 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 26.250 671.350 Td /F4 12.0 Tf [(Discussion)] TJ ET BT 26.250 651.396 Td /F4 9.8 Tf [(1 Summary of evidence)] TJ ET BT 26.250 631.991 Td /F1 9.8 Tf [(Twenty seven studies of risk communication interventions for the mitigation of, preparedness for, response to, and recovery )] TJ ET BT 26.250 620.086 Td /F1 9.8 Tf [(from disasters were included in this systematic review. The contexts, interventions and outcomes were diverse, and meta-)] TJ ET BT 26.250 608.181 Td /F1 9.8 Tf [(analysis was not appropriate. Some disaster mitigation and preparedness interventions appeared to improve knowledge and )] TJ ET BT 26.250 596.277 Td /F1 9.8 Tf [(behaviour relating to disaster risks. There was little robust evidence of the effectiveness of risk communication for disaster )] TJ ET BT 26.250 584.372 Td /F1 9.8 Tf [(knowledge, behaviour and health outcomes in the response and recovery phases of disasters. One intervention was associated )] TJ ET BT 26.250 572.467 Td /F1 9.8 Tf [(with an undesirable reduction in protective behaviours.)] TJ ET BT 26.250 553.062 Td /F4 9.8 Tf [(1.1 Mitigation and Preparedness Interventions)] TJ ET BT 26.250 533.658 Td /F1 9.8 Tf [(All four trials were found in this category. All mitigation and preparedness studies reported that the interventions that they )] TJ ET BT 26.250 521.753 Td /F1 9.8 Tf [(reported were effective to some extent. Eastwood )] TJ ET BT 243.022 521.753 Td /F5 9.8 Tf [(et al.)] TJ ET BT 264.160 521.753 Td /F1 9.8 Tf [( reported a high level of intended compliance with public health advice )] TJ ET BT 26.250 509.848 Td /F1 9.8 Tf [(before and after an intervention, but did not make statistical comparisons of the changes.)] TJ ET 0.267 0.267 0.267 rg BT 409.406 511.355 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 414.224 509.848 Td /F1 9.8 Tf [( Due to the already high compliance )] TJ ET BT 26.250 497.943 Td /F1 9.8 Tf [(\(over 90% for each measure\), future studies in such contexts would therefore need to be very large to detect significant )] TJ ET BT 26.250 486.039 Td /F1 9.8 Tf [(improvements. Dumais)] TJ ET BT 125.934 486.039 Td /F5 9.8 Tf [( et al.)] TJ ET BT 149.782 486.039 Td /F1 9.8 Tf [( reported significant improvements in knowledge for schoolchildren about influenza, which was )] TJ ET BT 26.250 474.134 Td /F1 9.8 Tf [(intended only to facilitate further health education.)] TJ ET 0.267 0.267 0.267 rg BT 241.413 475.641 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 246.232 474.134 Td /F1 9.8 Tf [( The Roess et al. study of a monkeypox intervention found modest )] TJ ET BT 26.250 462.229 Td /F1 9.8 Tf [(improvement in knowledge outcomes and some behaviours, but did not successfully affect some high risk behaviours.)] TJ ET 0.267 0.267 0.267 rg BT 534.547 463.736 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 26.250 450.324 Td /F1 9.8 Tf [(Assessing the longer term effect of the programme is likely to be difficult. Preparedness and mitigation for natural disasters was )] TJ ET BT 26.250 438.420 Td /F1 9.8 Tf [(a relatively well-studied area with several prospective trials. Increased likelihood of behavioural preparedness was shown in )] TJ ET BT 26.250 426.515 Td /F1 9.8 Tf [(controlled studies by Eisenman )] TJ ET BT 163.891 426.515 Td /F5 9.8 Tf [(et al.)] TJ ET BT 185.029 426.515 Td /F1 9.8 Tf [( and Ardalan et al..)] TJ ET 0.267 0.267 0.267 rg BT 266.870 428.022 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 276.508 430.403 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 278.917 428.022 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 288.554 426.515 Td /F1 9.8 Tf [( Games were used by two authors to increase knowledge, with )] TJ ET BT 26.250 414.610 Td /F1 9.8 Tf [(apparent success.)] TJ ET 0.267 0.267 0.267 rg BT 105.371 416.117 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 115.009 418.498 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 117.418 416.117 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 127.055 418.498 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 129.465 416.117 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 139.102 414.610 Td /F1 9.8 Tf [( The effectiveness of the evacuation warnings is difficult to assess because of the many interacting )] TJ ET BT 26.250 402.705 Td /F1 9.8 Tf [(factors in the situations. The Mauritius and India evacuations had relatively low voluntary compliance, whereas the Reverse 911 )] TJ ET BT 26.250 390.801 Td /F1 9.8 Tf [(communication in the San Diego wildfires apparently provided a strong impetus for people to act.)] TJ ET 0.267 0.267 0.267 rg BT 442.975 392.308 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 452.612 394.689 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 455.021 392.308 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 464.659 394.689 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 467.068 392.308 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 476.705 394.689 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 479.115 392.308 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 26.250 371.396 Td /F4 9.8 Tf [(1.2 Response Interventions)] TJ ET BT 26.250 351.991 Td /F1 9.8 Tf [(Few of the response interventions were prospectively planned. The prospectively planned studies by Chan et al. and Farahat )] TJ ET BT 567.092 351.991 Td /F5 9.8 Tf [(et )] TJ ET BT 26.250 340.086 Td /F5 9.8 Tf [(al., )] TJ ET BT 41.967 340.086 Td /F1 9.8 Tf [(though taking place in the context of ongoing disasters, were similar in character to the preparedness interventions for )] TJ ET BT 26.250 328.182 Td /F1 9.8 Tf [(infectious diseases.)] TJ ET 0.267 0.267 0.267 rg BT 111.329 329.689 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 120.966 332.070 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 123.375 329.689 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 133.013 328.182 Td /F1 9.8 Tf [( Farahat et al. demonstrated improvements in knowledge and behaviour over three months, while Chan )] TJ ET BT 26.250 316.277 Td /F5 9.8 Tf [(et al.)] TJ ET BT 47.388 316.277 Td /F1 9.8 Tf [( reported a negative change for behaviour one week after their intervention.)] TJ ET 0.267 0.267 0.267 rg BT 372.560 317.784 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 382.198 320.165 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 384.607 317.784 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 394.244 316.277 Td /F1 9.8 Tf [( Attributing causality in the absence of a )] TJ ET BT 26.250 304.372 Td /F1 9.8 Tf [(control group and in the context of widespread public and media interest in the topic of concern is difficult, and limits the value of )] TJ ET BT 26.250 292.467 Td /F1 9.8 Tf [(these studies. All the other studies attempted to evaluate an ongoing or past risk communication response to a disaster. In )] TJ ET BT 26.250 280.563 Td /F1 9.8 Tf [(these contexts, too, there are many factors that affect interpretation, including many other non-communication interventions that )] TJ ET BT 26.250 268.658 Td /F1 9.8 Tf [(take place concurrently. The studies of the UK and USA water crises demonstrated that the communications to alert the public )] TJ ET BT 26.250 256.753 Td /F1 9.8 Tf [(to the need to take action to avoid using contaminated water were successful in reaching almost all affected, but that in spite of )] TJ ET BT 26.250 244.848 Td /F1 9.8 Tf [(this reach, a significant minority of people either did not understand the advice given or chose not to follow it.)] TJ ET 0.267 0.267 0.267 rg BT 493.938 246.356 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 498.757 248.737 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 501.166 246.356 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 510.803 248.737 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 513.213 246.356 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 522.850 244.848 Td /F1 9.8 Tf [( In Haiti, )] TJ ET BT 26.250 232.944 Td /F1 9.8 Tf [(despite a high level of knowledge, the water treatment was apparently not used all the time.)] TJ ET 0.267 0.267 0.267 rg BT 420.238 234.451 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 429.875 232.944 Td /F1 9.8 Tf [( The factors that affect decisions )] TJ ET BT 26.250 221.039 Td /F1 9.8 Tf [(about whether to comply with the advice may differ between these contexts.)] TJ ET BT 26.250 201.634 Td /F4 9.8 Tf [(1.3 Recovery Interventions)] TJ ET BT 26.250 182.229 Td /F1 9.8 Tf [(Three recovery interventions were found, including two studies of the post-hurricane Katrina response in New Orleans.)] TJ ET 0.267 0.267 0.267 rg BT 536.711 183.737 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 546.349 186.118 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 548.758 183.737 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 558.395 182.229 Td /F1 9.8 Tf [( Use )] TJ ET BT 26.250 170.325 Td /F1 9.8 Tf [(of the mental health help lines in New York and New Orleans increased with promotion.)] TJ ET 0.267 0.267 0.267 rg BT 402.863 171.832 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 412.501 174.213 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 414.910 171.832 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 424.547 174.213 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267