Terrorism_Public perceptions_ANZJPH_2009_33_4

2009 vol. 33 no. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 339© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia

Public perceptions of the threat of terrorist attack in

Australia and anticipated compliance behaviours

Abstract

Objective: To determine the perceived

threat of terrorist attack in Australia and

preparedness to comply with public safety

directives.

Methods: A representative sample

of 2,081 adults completed terrorism

perception questions as part of the New

South Wales Population Health Survey.

Results: Overall, 30.3% thought a terrorist

attack in Australia was highly likely,

42.5% were concerned that self or family

would be directly affected and 26.4% had

changed the way they lived due to potential

terrorist attacks. Respondents who spoke a

language other than English at home were

2.47 times (Odds Ratios (OR=2.47, 95%

CI:1.58-3.64, p<0.001) more likely to be

concerned self or family would be affected

and 2.88 times (OR=2.88, 95% CI:1.95-

4.25, p<0.001) more likely to have changed

the way they lived due to the possibility of

terrorism. Those with high psychological

distress perceived higher terrorism

likelihood and greater concern that self or

family would be directly affected (OR=1.84,

95% CI:1.05-3.22, p=0.034). Evacuation

willingness was high overall but those with

poor self-rated health were significantly

less willing to leave their homes during a

terrorism emergency.

Conclusion: Despite not having

experienced recent terrorism within

Australia, perceived likelihood of an attack

was higher than in comparable western

countries. Marginalisation of migrant

groups associated with perceived terrorism

threat may be evident in the current

findings.

Implications: This baseline data will be

useful to monitor changes in population

perceptions over time and determine

the impact of education and other

preparedness initiatives.

Key words: terrorism, threat perception,

risk perception, evacuation, ethnicity,

psychological distress.

Aust N Z Public Health. 2009; 33:339-46

doi: 10.1111/j.1753-6405.2009.00405.x

Garry Stevens, Melanie TaylorSchool of Medicine, University of Western Sydney, New South Wales

Margo BarrCentre for Epidemiology and Research, New South Wales Department of Health

Louisa JormSchool of Medicine, University of Western Sydney, New South Wales

Michael Giffin, Ray FergusonCentre for Epidemiology and Research, New South Wales Department of Health

Kingsley Agho and Beverley RaphaelSchool of Medicine, University of Western Sydney, New South Wales

If a terrorist attack should occur, it is

essential that public health authorities

are prepared to act. Understanding how

the public perceives the threat of a terrorist

attack, and is likely to respond, is integral to

incident preparedness and planning.1-2

Studies following large-scale terrorist

attacks show that the perceived risk of further

attacks is linked with changes in behaviour,

such as restricting travel, avoiding places of

perceived high risk and increased substance

use.3-5 There is evidence that some of these

changes will persist in the medium term and be

associated with negative health and economic

outcomes.6-8 There is also evidence that some

of these population impacts may be mitigated

through public information campaigns and

other preparedness initiatives.5

Information is also emerging from

populations that have not experienced a

major attack but are at risk of such events.9-

11 In one Canadian study, only 20% of the

population thought a terrorist attack was

extremely or very likely to occur. Perceived

threat to themselves as individuals was

even lower. Most respondents worried little

Submitted: August 2008 Revision requested: February 2009 Accepted: April 2009Correspondence to:Garry Stevens, Senior Research Fellow, School of Medicine, University of Western Sydney, Building EV, Parramatta Campus, Locked Bag 1797, Penrith NSW DC1797. Fax: (02) 9685 9554; e-mail: [email protected]

about terrorism; preparatory behaviours

were consistent with these perceptions,

with less than 5% establishing a family

emergency plan for terrorism or avoiding

public places of perceived risk. While

specific preparedness was low, there was

high willingness to follow public safety

directives during such incidents.9

Australia, like Canada, is a country that has

experienced little terrorism within its borders.

However, in recent years Australians have been

affected by large-scale terrorist attacks within

the region, including bombings in Bali in

2002 and 2005, and the 2005 Jakarta bombing

presumed to have targeted the Australian

Embassy. Australians were also among those

killed in the Mumbai attacks of 2008. In

this environment of increasing international

threat, there is a need for planning to protect

public health and safety should terrorist

attacks occur within Australia.12

Disaster planning requires information about

community perceptions of risk, associated

behaviours and information about vulnerable

sub-populations.13 Researchers and planners

stress the importance of developing specific

Article Threats to health

340 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2009 vol. 33 no. 4© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia

Stevens et al. Article

measures of risk perception, and their behavioural correlates, as an

integral part of disaster planning.14 Such instruments can support

the establishment of baseline data against which the trajectory of

psychosocial recovery can be measured. They can also be used to

monitor other shifts in community perceptions over time, including

the effectiveness of risk communication strategies and education

programs. For these reasons, the relative absence of baseline data has

been cited as a significant impediment to disaster planning.14-15

The aim of this paper is to determine perceptions of the threat

of terrorist attack in Australia and preparedness to comply with

evacuation directives in the event of such incidents. A further aim of

the wider study has been to establish a surveillance tool and source of

baseline data to allow ongoing monitoring of terrorism risk perception

and behavioural correlates within the Australian population.

MethodsQuestion design

A literature search was conducted to identify existing tools for

collecting information on perceptions of terrorist attack with the

underlying themes of likelihood, effect on family (vulnerability and

risk), life changes and compliance with government authorities.

The primary reference was a study by Canadian researchers on

anticipated public response to terrorism.9-10 Questions on threat

likelihood, effect on family and behavioural compliance were

adapted, with permission, by subject matter experts and survey

methodologists. Each proposed question was considered for

clarity, ease of administration and possible biases. A set of five

questions was developed for field-testing as well as the additional

open question “Do you have any comments that you would like to

make on any of the questions or any other issues?”

Field testingThe terrorist attack questions were field tested for test–retest

reliability using the protocol of the New South Wales Health

Survey Program.16 A detailed description of its application in this

study is presented elsewhere.17 Data manipulation and analysis

were conducted using SAS Version. 9.2.16 Kappa values for the

indicators derived from the questions ranged between 0.27 and

0.64 in the second field test. There were low rates of ‘don’t know’

responses (0.0–3.9%) and refusal (0.0–0.5%).

Table 1: Prevalence estimates for each question by response category including don’t know and refused.

Question Response % 95% LCI 95% UCI

How likely do you think it is that a terrorist attack will occur in Australia? Not at all 8.8 7.0 10.6

A little 23.1 20.4 25.8

Moderately 33.6 30.7 36.5

Very 21.5 19.0 23.9

Extremely 8.9 7.2 10.6

Don’t know 3.4 2.2 4.6

Refused 0.7 0.3 1.2

If a terrorist attack happened in Australia, how concerned would you Not at all 10.6 8.8 12.5

be that you or your family would be directly affected by it? A little 22.4 19.7 25.0


Very 24.3 21.8 26.9

Extremely 18.2 15.7 20.6

Don’t know 2.1 1.3 3.0

Refused 0.7 0.3 1.2

How much have you changed the way you live your life because of the Not at all 71.4 68.6 74.2

possibility of a terrorist attack? A little 14.7 12.4 16.9


Very 2.9 1.9 4.0

Extremely 1.1 0.6 1.7

Don’t know 1.6 0.9 2.3

Refused 0.7 0.2 1.1

In case of an emergency situation such as a terrorist attack, how willing Not at all 6.3 4.8 7.9

would you be to evacuate your home? A little 7.0 5.2 8.8


Very 31.3 28.4 34.3

Extremely 33.9 31.0 36.8

Don’t know 2.4 1.6 3.2

Refused 0.8 0.3 1.2

How willing would you be to evacuate your workplace or a public facility? Not at all 1.8 1.1 2.5

A little 3.8 2.6 5.0


Very 34.5 31.6 37.5

Extremely 48.8 45.7 51.8

Don’t know 1.5 0.9 2.0 Refused 0.8 0.3 1.2

Source: New South Wales Health Survey Program. Sydney: New South Wales Department of Health, 2008.


Threats to health Public perceptions of threat of terrorist attack

The surveyThe New South Wales Adult Population Health Survey is a

continuous telephone survey of the health of the state population

using the in-house CATI facility of the New South Wales

Department of Health.16

The terrorist attack question module was administered as part of

the survey between 22 January and 31 March, 2007. The terrorist

attack questions were submitted to the ethics committees of the

NSW Population Health and Health Services and the University of

Western Sydney, for approval prior to use. The survey also included

other modules on health behaviours, health status (including

psychological distress, using the Kessler K10 measure, and self-

rated health status) and access to health services, as well as the

demographics of respondents and households. As field test data

had indicated high assumed knowledge regarding the concept of

terrorism and presumptions this typically involved bombings or

shootings (i.e. ‘conventional’ terrorism), a specific definition of

terrorism was not outlined in the preamble. The target population

for the survey was all state residents living in households with

private telephones. Up to seven calls were made to establish initial

contact with a household and five calls were made in order to

contact a selected respondent.

Response categories were dichotomised into indicators of

interest and responses of ‘don’t know’ or ‘refused’ were excluded.

For the hypothetical questions (i.e. likelihood of a terrorist attack

in Australia, concern that self or family would be directly affected,

willingness to comply with evacuation of home, willingness

to comply with evacuation of workplace or public facility) the

responses of extremely likely and very likely were combined

into the indicator of interest. For the non-hypothetical question

“changed the way you live because of the possibility of a terrorist

attack”, the responses ‘a little’, ‘moderately’, ‘very much’ and

‘extremely’ were combined into the indicator of interest: that is,

changed way of living.

The survey data were weighted to adjust for probability of selection

and for differing non-response rates among males and females and

different age groups.17 Data were manipulated and analysed using

SAS version 9.2.16 The SURVEYFREQ procedure in SAS was used

to calculate point estimates and 95% confidence intervals.

Odds ratios were calculated as described by Bland.18 All

calculations were performed using the ‘SVY’ commands of Stata

version 9.2 (Stata Corp, College Station, TX, USA), which allowed

for adjustments for sampling weights.

ResultsIn total 2,081 state residents aged 16 years and over completed

the module on terrorist attack. The overall response rate was

65%. The demographics of the weighted survey population were

comparable with the Australian Bureau of Statistics 2006 Census.19

These comparisons are reported elsewhere.20

Overall, 30.3% of the population thought a terrorist attack was

extremely or very likely, 42.5% were extremely or very concerned

that they or their family would be affected by a terrorist attack

and 26.4% had made some (small to extreme) level of change

to the way they lived their life because of the possibility of an

attack. Table 1 shows the prevalence estimates for all of the survey

questions by response category.

Table 2 presents prevalence estimates for the likelihood, concern

and changed way of living variables by demographic and socio-

economic characteristics, and the indicators of level of psychological

distress and general self-rated health status. When these variables

were combined, the greatest proportion of the population (37.0%)

thought a terrorist attack was unlikely to occur, were not concerned

that they or family members would be directly affected and had not

changed the way they lived their life because of the possibility of a

terrorist attack. Less than 1 in 10 people (9.0%) thought a terrorist

attack was likely, were concerned that they or family members

would be directly affected and had made changes to the way they

lived their life due to the prospect of an attack.

The results of univariate analyses identified a number of

statistically significant factors associated with threat likelihood,

concern and changed way of living (see Table 2). For the latter

variable, a sensitivity analysis comparing the current indicator

(‘a little’, ‘moderately’, ‘very’ and ‘extremely’) and the more

conservative indicator (‘moderately’, ‘very’ and ‘extremely’)

showed that the association did not change for the co-variates and

therefore the current indicator was retained for the analysis.

The univariate analysis indicated that young people (16-24

years) were significantly less likely to report high terrorism

likelihood compared to all other age categories. Those with no

formal qualifications were 2.09 times (Odds Ratios (OR=2.09,

95% CI:1.32-3.31, p=0.002) more likely to think that a terrorist

attack was very or extremely likely compared to those with a

university degree or equivalent and women were significantly

more likely (OR =1.54, 95% CI:1.20-1.99, p=0.001) to be very

or extremely concerned for themselves or family members in the

event of an attack.

Those who spoke a language other than English at home were

2.47 times (OR=2.47, 95% CI=1.58-3.64, p<0.001) more likely

to be concerned for self or family and 2.88 times (OR=2.88, 95%

CI:1.95-4.26, p<0.001) more likely to have made changes in living

due to the risk of terrorism attack. When these indicators were

combined, those with high psychological distress were found to

perceive higher terrorism likelihood and to have greater concern

that they or family members would be directly affected (OR=1.84,

95% CI:05-3.22, p=0.034).

Table 3 shows the prevalence estimates for willingness to

evacuate home, workplace/public facility, and both home and

workplace/public facility, by demographic characteristics and the

indicators psychological distress and health status. Table 3 also

shows combined indicators of evacuation willingness for those

concerned about self and family and who also thought a terrorist

attack was likely. Overall, if an emergency such as a terrorist attack

were to occur, the majority of the population would be willing to

evacuate their home (67.4%), their workplace or a public facility

(85.2%), or both location types (65.8%). Conversely, 12.5% would

be willing to evacuate neither of these locations. Fewer than 20%


Stevens et al. ArticleTa

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No

32.5

1.

00

49.3

1.

00

26.7

1.

00

22.4

1.

00

10.8

1.

00

Ye

s 31

.7

0.94

0.

72,1

.22

0.63

41

.3

0.71

0.

55,0

.91

0.01

26

.9

1.02

0.

77,1

.35

0.90

17

.7

0.71

0.

52,0

.96

0.03

8.

4 0.

74

0.47

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6 0.

19


would be willing to evacuate their workplace or a public facility

but not their home, whereas far fewer (1.9%) would be willing to

evacuate their home but not their workplace or public facility.

Univariate analyses of evacuation intentions, also presented in

Table 3, indicated that females were 1.45 times (OR=1.45, 95%

CI:1.11-1.89, p=0.007) more willing to evacuate their homes than

males, employed Australians were 1.37 times (OR=1.37, 95%

CI:1.06-1.79, p=0.018) more willing to evacuate their homes

than those unemployed and respondents with poor self-rated

health were significantly less willing (OR=0.63, 95% CI: 0.42-

0.96, p=0.032) to evacuate their homes than those with good or

excellent self-rated health.

With regard to evacuation of work/public facilities, females were

1.62 times (OR1.62, 95% CI:1.14-2.32, =0.008) more willing

than males, people with children were 1.84 times (OR=1.84, 95%

CI:1.10-3.05, p=0.019) more willing than those without children

and those with higher household incomes ($A80,000 and over)

were 2.57 times (OR=2.57. 95% CI:1.48-4.44, p=0.001) more

willing than those with lower incomes.

DiscussionAlmost one-third of the population perceive a high likelihood

of terrorist attack within Australia, with a greater proportion

expressing high levels of concern that they, or a family member,

could be directly affected should a terrorist attack occur. More

than one-quarter had made some level of accommodation in the

way they live due to this possibility. In the context of an immediate

threat, the majority of the population would be willing to follow

public safety directives to evacuate homes, workplaces and public

facilities should a terrorist attack occur.

To date, there have not been recent substantial acts of terrorism

within Australia. Our findings indicate a lower level of terrorism

risk perception than that observed in countries such as the US and

UK where significant terrorist events have occurred.3,5 However,

the level of perceived risk within the Australian population is

notably higher than in comparable western countries that have

not experienced recent attacks. Although comparisons with other

studies are difficult to make, only 20% of Canadians perceived

a high likelihood of domestic terrorism compared with 30.3%

of Australians. Possible reasons for this may include Australia’s

regional exposure to terrorism, such as the Bali bombings in

2002 and 2005. These and associated events such as the naming

of Australia as a specific target by terrorist organisations such as

Al-Qaeda are likely to have increased the awareness of Australians

to such threats domestically.12

Concurrent high concern and changed way of living were noted

among those born outside Australia and/or who spoke a language

other than English in the home. Given that these groups did not

perceive a higher likelihood that an attack would occur, these

results may reflect a perceived ‘secondary’ threat from within

the wider population. There is broad evidence that heightened

community threat perception is associated with increased

ethnocentrism and xenophobia.21 In terrorism affected countries,

Tabl

e 2

con

tinu

ed: P

reva

len

ce a

nd

Odd

s R

atio

s (9

5% c

on

fid

ence

inte

rval

s) o

f ter

rori

st a

ttac

k lik

ely,

co

nce

rn fo

r se

lf/fa

mily

, ch

ang

ed w

ay o

f liv

ing

an

d c

om

bin

ed in

dic

tors

.In

dep

end

ent

Terr

ori

st a

ttac

k lik

ely

Co

nce

rned

sel

f o

r fa

mily

C

han

ged

way

of

livin

g d

ue

Terr

ori

st a

ttac

k lik

ely

and

Te

rro

rist

att

ack

likel

y an

d

vari

able

dir

ectl

y af

fect

ed

to p

oss

ibili

ty o

f te

rro

rism

co

nce

rned

for

self

/fam

ily

con

cern

ed a

nd

ch

ang

ed

w

ay o

f liv

ing

W

eig

hte

d O

R

95%

CI

P

Wei

gh

ted

OR

95

% C

I P

W

eig

hte

d

OR

95

% C

I P

W

eig

hte

d O

R

95%

CI

P

Wei

gh

ted

OR

95

% C

I P

(%)

valu

e (%

)

va

lue

(%)

valu

e (%

)

va

lue

(%)

valu

e

Ho

use

ho

ld in

com

e (b

efo

re t

ax)

<

$20k

34

.5

1.00

47

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1.00

27

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21

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1.00

9.

2 1.

00

$2

0-40

k 39

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1.24

0.

84,1

.84

0.28

49

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1.09

0.

73,1

.61

0.68

25

.8

0.92

0.

57,1

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0.74

26

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1.33

0.

85,2

.07

0.21

14

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1.67

0.

90,3

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0.10

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60k

33.7

0.

96

0.63

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87

41.7

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79

0.52

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0 0.

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31.8

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24

0.76

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1 0.

39

19.5

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89

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9 0.

66

9.5

1.12

0.

52,2

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0.77

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30.9

0.

85

0.51

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1 0.

53

44.2

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87

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2 0.

59

22.1

0.

75

0.43

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3 0.

33

22.7

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10

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29.1

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78

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35.2

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60

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12.3

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Hea

lth

sel

f-ra

ted

as

go

od

Ye

s 33

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1.00

43

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26

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1.00

18

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1.00

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3 1.

00

N

o 35

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1.08

0.

71,1

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0.73

50

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1.34

0.

89,2

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0.19

25

.9

0.98

0.

61,1

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0.95

26

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1.61

0.

99,2

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0.06

13

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1.79

0.

88,3

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0.11

Mar

ital

sta

tus

M

arrie

d 34

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1.00

42

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1.00

27

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1.00

18

.9

1.00

8.

6 1.

00

W

idow

ed

32.9

0.

92

0.63

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5 0.

68

54.2

1.

59

1.12

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4 0.

01

26.6

0.

93

0.62

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0 0.

73

24.8

1.

42

0.93

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7 0.

10

11.2

1.

35

0.71

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8 0.

36S

epar

ated

/div

orce

d 43

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1.43

0.

99,2

.06

0.06

44

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1.06

0.

74,1

.51

0.74

30

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0.

75,1

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0.56

22

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1.26

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83,1

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0.26

8.

1 1.

07

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,2.0

5 0.

84N

ever

mar

ried

21.6

0.

52

0.36

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4 <

0.01

43

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1.03

0.

75,1

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0.85

23

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0.

55,1

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0.25

15

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0.

53,1

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7.

8 0.

91

0.50

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4 0.

75

Not

es: P

sych

olog

ical

dis

tres

s w

as m

easu

red

usin

g th

e K

10. V

alue

s ra

nge

from

10-

50, w

ith ‘h

igh’

psy

chol

ogic

al d

istr

ess

cons

ider

ed a

s be

ing ≥2

2. S

ourc

e: N

ew S

outh

Wal

es H

ealth

Sur

vey

Pro

gram

. Syd

ney:

New

Sou

th W

ales

D

epar

tmen

t of H

ealth

, 200

8.



Table 3: Prevalence and Odds Ratios (95% confidence intervals) of willingness to evacuate home, willingness to evacuate office/public facility and combined indicator.

Independent variable Willing to evacuate home Willing to evacuate Willing to evaluate home and office/public facility office/public facility Weighted OR 95% CI Pvalue Weighted OR 95% CI Pvalue Weighted OR 95% CI Pvalue (%) (%) (%)

NSW population 67.4 - - - 85.2 - - - 65.8 - - -

Gender

Male 63.4 1.00 82.2 1.00 62.2 1.00

Female 71.5 1.45 1.11,1.89 0.01 88.3 1.62 1.14,2.32 0.01 69.3 1.37 1.06,1.79 0.02

Location

Urban 66.3 1.00 84.4 1.00 64.6 1.00

Rural 69.7 1.17 0.91,1.50 0.22 86.9 1.22 0.88,1.69 0.26 68.3 1.18 0.93,1.51 0.18

High psychological distress (≥22) No 68.5 1.00 86.7 1.00 67.4 1.00

Yes 70.0 1.07 0.65,1.76 0.76 80.1 0.61 0.33,1.12 0.11 66.3 0.95 0.59,1.54 0.85

Age

16-24 66.1 1.00 80.0 1.00 63.0 1.00

25-34 69.2 1.15 0.65,2.06 0.63 88.4 1.91 0.89,4.07 0.10 67.6 1.27 0.72,2.24 0.40

35-44 68.9 1.14 0.65,1.99 0.66 89.1 2.05 0.89,4.70 0.09 67.4 1.26 0.73,2.18 0.40

45-54 73.2 1.40 0.84,2.33 0.20 86.6 1.62 0.85,3.08 0.14 72.4 1.52 0.92,2.50 0.10

55-64 65.8 0.99 0.60,1.63 0.96 87.1 1.68 0.88,3.20 0.12 65.0 1.10 0.67,1.80 0.70

65-74 61.6 0.82 0.50,1.34 0.43 81.0 1.06 0.59,1.92 0.85 59.5 0.86 0.53,1.38 0.53

75+ 54.1 0.60 0.36,1.03 0.06 73.7 0.70 0.38,1.30 0.26 52.0 0.62 0.37,1.04 0.07

Children in household No 64.9 1.00 82.6 1.00 63.3 1.00

Yes 71.6 1.36 0.99,1.88 0.06 89.7 1.84 1.10,3.05 0.02 69.9 1.40 1.02,1.92 0.04

Born in Australia No 70.0 1.00 82.3 1.00 67.8 1.00

Yes 66.5 0.85 0.62,1.18 0.33 86.2 1.34 0.89,2.01 0.16 65.1 0.90 0.66,1.23 0.51

Speak language other than English No 67.0 1.00 86.4 1.00 65.5 1.00

Yes 69.4 1.12 0.73,1.71 0.61 78.9 0.59 0.36,0.96 0.03 67.1 1.07 0.71,1.60 0.75

Living alone No 67.7 1.00 85.5 1.00 66.0 1.00

Yes 65.3 0.90 0.70,1.16 0.42 82.9 0.82 0.59,1.15 0.25 63.7 0.87 0.68,1.12 0.28

Highest formal qualification University degree/ 70.7 1.00 88.9 1.00 70.0 1.00 equivalent

TAFE certificate/Diploma 67.7 0.87 0.59,1.29 0.49 87.0 0.83 0.45,1.53 0.56 66.7 0.85 0.58,1.26 0.42

High school certificate 63.5 0.72 0.46,1.12 0.15 83.2 0.61 0.32,1.17 0.14 63.0 0.68 0.44,1.05 0.08

School certificate 66.0 0.81 0.55,1.18 0.26 80.9 0.53 0.30,0.92 0.02 61.8 0.69 0.47,0.99 0.05

None 62.9 0.76 0.47,1.22 0.25 81.3 0.57 0.30,1.07 0.08 60.3 0.68 0.43,1.09 0.11

Work (paid or unpaid) No 62.7 1.00 80.7 1.00 60.3 1.00

Yes 70.5 1.37 1.06,1.79 0.02 89.0 1.68 1.17,2.42 0.01 69.4 1.46 1.12,1.89 0.01

Household income (before tax) <$20k 61.0 1.00 77.2 1.00 60.0 1.00

$20-40k 70.4 1.52 1.01,2.27 0.04 84.4 1.60 0.97,2.65 0.07 68.1 1.41 0.95,2.11 0.09

$40-60k 66.7 1.28 0.82,1.99 0.28 87.6 2.08 1.18,3.67 0.01 64.3 1.23 0.80,1.89 0.35

$60-80k 62.1 1.04 0.62,1.76 0.87 88.5 2.27 0.80,6.47 0.12 61.7 1.14 0.68,1.92 0.62

>$80k 70.7 1.54 1.03,2.29 0.03 89.7 2.57 1.48,4.44 <0.01 70.7 1.68 1.13,2.49 0.01

Health self-rated as good Yes 69.6 1.00 85.6 1.00 68.1 1.00

No 59.1 0.63 0.42,0.96 0.03 79.7 0.66 0.39,1.12 0.12 57.5 0.65 0.43,0.98 0.04

Marital status Married 68.3 1.00 86.2 1.00 66.5 1.00

Widowed 59.0 0.67 0.47,0.96 0.03 81.7 0.72 0.45,1.16 0.17 54.9 0.61 0.43,0.88 0.01

Separated/divorced 70.9 1.13 0.77,1.66 0.54 89.3 1.34 0.77,2.34 0.30 69.0 1.12 0.77,1.64 0.55Never married 65.8 0.89 0.64,1.25 0.51 82.5 0.76 0.49,1.18 0.22 62.5 0.84 0.60,1.17 0.30

Notes: Psychological distress was measured using the K10. Values range from 10-50, with ‘high’ psychological distress considered as being ≥22. Source: New South Wales Health Survey Program. Sydney: New South Wales Department of Health, 2008.



culture, appearance and religion have been found to be strong

predictors of high terrorism-related distress and appear to reflect

increased stigmatising of these groups.5 Further studies are needed

to explore the possible reasons for this in the Australian context.

While the Australian government has produced recent population-

level information campaigns to address terrorism concerns, the

current results highlight potential vulnerabilities in these sub-

populations and a possible need for tailored risk communication

to address unease in these groups.

There is evidence that mental health factors such as stressful life

events and exposure to trauma are associated with increased fear

of terrorism. In this study, those with high levels of psychological

distress where almost twice as likely to perceive high terrorism

likelihood and greater concern that they or a family member

would directly affected. This is consistent with recent data from

the Australian Unity Wellbeing Index, which showed that those

with the highest ratings of perceived terrorism likelihood also had

significantly lower levels of personal wellbeing compared to the

population average.22 There is evidence from the therapeutic field

that those with greater risk appraisal and vigilance tendencies are

at greater risk of negative mood states.1,23 The findings occurred

in the absence of specific domestic terrorist incidents and suggest

increased vulnerability may exist even with the general threat of

terrorism. Recent practices in Australia such as the issuing of

national terror alerts may have adverse impacts on this sub-group

that may warrant further examination.22

The findings regarding willingness to evacuate were quite

emphatic and indicate high levels of intent where the specific

threat also appears to be high. The proportion of people with

low willingness to evacuate based on terrorism threat (12%) was

found to be about half the ‘non-compliance’ rate observed during

mandatory natural disaster evacuations.24 Little is known about the

observed lower willingness of those with poor self-rated health.

This may reflect lower confidence about receiving or recognising

warnings as well as perceptions about the physical attributes

needed for escape. This finding is consistent with protection

motivation theory which posits that low perceived self-efficacy

reduces the motivation for protective acts even when these actions

are regarded as effective. Proactive disaster planning and education

can potentially overcome these limitations, which highlights the

importance of identifying and engaging these vulnerable groups

early in the process.

LimitationsThere are several limitations of our study. The question “Have

you changed the way you live your life because of the possibility of

a terrorist attack?” was intentionally broad, since current evidence

indicates that where specific incidents have not occurred, preparatory

changes for terrorism are limited and general in focus.9,10 We sought

to determine broader markers of change (experiential as well as

behavioural) that may be sensitive to public health messages or

varied threat status over time. The decision to adopt the full response

set (a little, moderately, very and extremely) as positive indicators

for this question was made on related conceptual grounds: that

is, lower level change reflecting change of some kind. The more

conservative range (very, extremely), produced a response rate

of 4%, which is consistent with the rate of preparatory response

noted in the Lemyre et al. study.9 As anticipated, the broader range

produced a notably higher response rate (27%). This may indicate

that more specific behaviours are being endorsed at the upper end

of the range, with more subtle or even ‘felt’ changes being endorsed

by a larger group at the lower end of the range.

The aim of this paper is to explore population threat perceptions

of terrorist attack in Australia and some anticipated responses

in the acute context. The cross-sectional design of this study

captures only a snapshot view of these frequencies and no firm

conclusions can be made regarding causes. Also, OR’s reported in

this study may lead to bias due to a failure to account for multiple

relationships, which may lead to inflation of type 1 error and the

over interpretation of any apparent positive findings. As this is a

baseline analysis, further studies can examine trends over time

and the consistency of these findings.

It is also important to consider whether recent terrorism

information campaigns significantly affected this baseline data,

which was gathered in early 2007. The ‘Be alert, not alarmed’

campaign was conducted in late 2002 and again, in a modified

form, from July 2005.25 The National Security Hotline was also

launched as part of the initial campaign and has been advertised

periodically. Given that the 2005 campaign ran for a three week

period 18 months prior to the survey, it is unlikely that any

specific shifts in threat perception would have been maintained

so as to have significantly affected the current data. Nonetheless,

it remains possible that the cumulative effects of these public

awareness campaigns have contributed to longitudinal change e.g.

as one significant factor in the rate differences observed between

Australian and Canadian population surveys.

Finally, the questions regarding evacuation only provide a

measure of behavioural intent. While its specific translation to

evacuation compliance is unclear, evidence from experimental

psychology shows that concurrent high intent and high perceived

positive outcomes predict high levels of behavioural translation.26

The data establish high intent, while perceived positive outcomes

in this situation (presumably safety and survival) could reasonably

be assumed based upon these results.

ConclusionPerceived terrorism likelihood and associated concerns were

moderately high, with some groups notably affected. Community

terrorism concerns may have increased ‘out group’ social dynamics

for some ethnic sub-populations and this has implications for the

framing of risk communications. In the context of immediate

threat, the majority of Australians would follow terrorism-related

evacuation directives and at higher rates than is typical of natural

disasters. The study has also established a source of pre-event

baseline data and is one of the few available sources of such

information internationally.



AcknowledgementsThis study was funded by Emergency Management Australia

and supported by the New South Wales Department of Health. This

analysis is part of the first author’s thesis for a doctoral dissertation

with the College of Health and Science at the University of

Western Sydney. Our thanks to Matthew Gorringe, Centre for

Epidemiology and Research, New South Wales Department

of Health, who assisted with question development and data

collection.

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