Social support, fear and willingness to comply with non-pharmaceutical interventions against pandemic influenza among U.S. university students

The relationship between individuals' fear of pandemic influenza and their willingness to comply with non-pharmaceutical interventions (NPIs) is an area of ongoing research. Few studies, however, have examined the role that social support may play in predicting the relationship between these two variables. The goal of this study was therefore to investigate the relationship between social support and (1) fear of pandemic flu and (2) degree of fear required to increase one's willingness to comply with 12 different recommended NPIs. A cross-sectional analysis was performed using data from 966 study participants residing in residence halls of a major U.S. university. Participants' reported fear levels were dichotomized as either afraid or not afraid. Participants' social support was quantified by a validated Social Network Scale, and data were analyzed using generalized estimating equations with Poisson regression to derive prevalence ratios (PR). Results show that there is no significant relationship between social support and fear of pandemic flu (PR=1.01, 95% CI: 0.96, 1.05). However, after adjusting for demographic covariates, individuals with higher levels of social support reported requiring a higher level of fear of pandemic flu in order to be willing to avoid air travel (PR: 0.78, 95% CI: 0.61, 0.99), malls/department stores (PR: 0.68, 95% CI: 0.53, 0.89), and religious services (PR: 0.81, 95% CI: 0.69, 0.95). Overall, these results suggest that compliance with NPIs may vary as a function of the strength of individuals' social networks and level of fear. Further studies are needed to identify whether social support may ultimately alter the course of transmission of pandemic influenza in the community setting.