Perceived Laws and Infectious Disease Control Measures

Medical College Of Wisconsin, Milwaukee WI

Investigators

Abstract

Historically, US residents have been reluctant to engage in public health infectious disease control measures such as testing, contact tracing, and seeking prompt medical care. Yet the public’s cooperation is essential if public health infectious disease control measures are to succeed. Increasingly, commentators have noted the potential for laws and concerns about laws to deter persons from engaging in communicable disease control measures. This may be especially true for conditions that are shrouded with negative social connotations. Findings from our previous studies, related to largely individual-level public health interventions—specifically use of services for HIV testing, substance use disorders and intimate partner violence—confirm commentators’ concerns (1R01MD011573 PI: Galletly), and our preliminary study of individuals’ legal concerns relevant to widespread infectious disease testing, contact tracing, and treatment (R01MH091875-S1 PI: Galletly) strongly suggest this influence applies to large-scale, population-level disease control efforts as well. The proposed study will extend our research on the influence of actual and, importantly, perceived laws on individuals’ use of HIV prevention services to examine the influence of these on individuals’ ability and willingness to engage in population-level disease control efforts where government direction is more prominent. Specifically, we propose to leverage increased public awareness of public health disease control measures to examine the influence of actual and perceived laws on individuals’ willingness to engage in testing, contact tracing, and prompt treatment as recommended by public health representatives when indicated for tuberculosis and hepatitis C, two conditions with contrasting modes of transmission and social connotations. Our interdisciplinary team of researchers, attorneys, community health workers and public health representatives will collaborate on this mixed-methods, community-engaged study. Formative legal and qualitative inquiry to identify the nature, extent, and influence of legal concerns will inform the development of a de novo measure to be administered to 1200 persons living in two US regions with diverse environments. Participants in rural, suburban, and urban settings will be purposively sampled to further inform analysis of these complex behaviors. Identifying actual and perceived legal barriers to individuals’ engagement in disease control measures can only be useful if results are transferred to practice. We will explore, with public health personnel, how best to support the rapid transfer of findings to practice. Given that US public health departments conduct, finance, or advise virtually all communicable disease control efforts, they are an ideal conduit for this.