Identifying cognitive, demographic, and environmental factors that influence individuals' knowledge and behaviors regarding West Nile virus in Phoenix, AZ

Despite the region’s arid climate, several disease-transmitting mosquito species have flourished throughout the Phoenix (Arizona) metropolitan area, and the emergence and persistence of West Nile virus (WNv) represents a significant health challenge to residents and local public health professionals. The purpose of this study is to identify cognitive and demographic factors associated with Phoenix-area residents’ knowledge, perceptions, and behaviors related to WNv.

A questionnaire was administered to individuals 18 years and older residing in nine randomly selected neighborhoods (stratified by neighborhood median family income and predominant land cover) throughout the Phoenix area. Five items assessed individuals’ knowledge of mosquito ecology and WNv. Components of the Health Belief Model (susceptibility, severity, benefits, barriers, and self-efficacy) were operationalized in order to assess individuals’ perceptions regarding WNv. Performance of five personal protective behaviors (PPBs) (wearing repellent; remaining indoors during peak mosquito times; wearing long-sleeves/pants; draining standing water; repairing window/door screens) was also assessed. Associations between these factors and individuals’ performance of PPBs, dichotomized as always/often versus less frequently/never, were analyzed using logistic regression.

Two-hundred twelve participants completed the questionnaire (participation rate=69.3%). Of the 212 respondents, 38.7%, 48.6%, and 12.7% were aware that, did not believe that, and were unsure that WNv was locally transmitted, respectively. One hundred forty-nine (70.3%) respondents always/often performed at least one PPB; just 16.5% always/often performed at least three PPBs. The most commonly performed behavior was draining standing water (48.6% of respondents always/often drained standing water); wearing long-sleeves/pants during peak mosquito biting times was least frequently performed (10.4% always/often performed this PPB). In multivariate logistic regression analyses, there is a positive association (OR: 2.83; 95% CI: 1.21-6.62) between individuals’ perceived self-efficacy and always/often performing at least one PPB. Additionally, compared to residents who reside in neighborhoods composed of mixed vegetation and stone/gravel, residents who reside in neighborhoods characterized by lush grass/vegetation have 80% reduced odds (OR: 0.20; 95% CI: 0.05-0.81) of always/often performing at least one PPB.

This study represents the first effort to describe residents’ knowledge and to identify factors positively and negatively associated with performance of PPBs for mosquito-borne disease within the study area. The specific cognitive, demographic, and environmental factors identified in this study can inform future intervention efforts designed to reduce residents’ risk to WNv within the Phoenix metropolitan area.