Threatened by the mosquito-borne Zika virus in 2016, Florida residents felt more susceptible than others in the United States to getting the virus, were more knowledgeable about it, and were more likely to support taking community action against it.

Floridians were nearly twice as likely as non-Floridians to say they took steps to protect themselves from Zika. Whether or not they felt personally susceptible to getting the virus, Floridians reported acting in greater numbers than their non-Florida counterparts.

Even so, fewer than half of Floridians said they actually did take preventive measures.

A new study comparing the response to the Zika outbreak of adults in Florida with those living elsewhere in the United States suggests that more community-level education may be needed to trigger a broader response to a public health threat such as Zika.

"People need to understand that by protecting themselves from the virus, they're protecting everyone from the virus," said lead author Kenneth M. Winneg, the managing director of survey research at the Annenberg Public Policy Center of the University of Pennsylvania. "It's not enough to have the people who are most at risk protecting themselves. You need the entire community involved."

The study, published recently in the journal Risk Analysis, was conducted by researchers at the Annenberg Public Policy Center (APPC) and the Centers for Disease Control and Prevention (CDC). The study was based on nationally representative surveys by APPC of more than 12,000 U.S. adults, with an oversample of Florida residents, taken August 8 to October 3, 2016. The Annenberg Science Knowledge (ASK) surveys were conducted after the Florida Department of Health identified the first locally transmitted cases of Zika infection in the United States in Miami-Dade and Broward Counties.

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'Unprecedented challenges to public health'

Most people who are infected with Zika do not show symptoms. For those who do, the symptoms are usually mild and gone within a week.

Nonetheless, the researchers say that Zika virus infection poses "unprecedented challenges to public health" as the first mosquito-borne illness that causes birth defects in infants through perinatal transmission and as the first mosquito-borne illness to be sexually transmitted.

Because the Zika virus can be passed to a fetus, pregnant women are especially at risk. Zika can cause microcephaly and other severe fetal brain defects, according to the CDC. Guillain-Barré syndrome, which has symptoms of muscle weakness and sometimes paralysis, usually for weeks or months, is also strongly associated with Zika, the CDC says.

Floridians more active against Zika

In a number of ways, the study found that Floridians were more informed about Zika, more approving of control measures, and more active in taking steps to protect themselves:

Floridians were more than twice as likely as non-Floridians to express at least moderate feelings of susceptibility or being at risk of infection by Zika in the next six months (37 percent vs. 16 percent);

Floridians were slightly more likely than non-Floridians to know that Zika is transmitted by mosquitoes (84 percent vs. 82 percent) and by sexual transmission (66 percent vs. 61 percent) and to know that coughing and sneezing is not a means of transmission (67 percent vs. 64 percent);

Floridians were more likely than non-Floridians to know that Zika doesn't always produce noticeable symptoms (55 percent vs. 50 percent) and to know that a severe birth defect was a consequence for babies born to infected mothers (76 percent vs. 71 percent);

Floridians were more supportive than non-Floridians of aerial spraying (74 percent vs. 67 percent), ground spraying (87 percent vs. 80 percent) and using genetically modified mosquitoes to control Zika (62 percent vs. 58 percent);

Floridians were almost twice as likely as non-Floridians (45 percent vs. 26 percent) to say that they had taken steps in the prior three months to protect themselves from Zika;

More Floridians who felt at risk of Zika reported taking action to protect themselves than non-Floridians who felt at risk (58 percent vs. 41 percent). And a greater number of Floridians reported taking action than non-Floridians despite not feeling susceptible (38 percent vs. 22 percent).

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Wider response needed to Zika virus

Although more than 8 in 10 Floridians knew about Zika and knew that mosquitoes were a likely form of transmission, more than half of Floridians (55 percent) took no preventive action. Even Florida households with a member who was at risk of an adverse pregnancy outcome did not take any more action than comparable non-Florida households.

Over the eight weeks of the Zika study, Floridians did not report significant increases in knowledge, susceptibility or preventive strategies, the researchers found. To overcome such inertia, future efforts to combat Zika may need more outreach to communicate the severe risks to community members such as microcephaly and Guillain-Barré syndrome, researchers said.

In addition, they said that people needed to be educated to understand the wider community implications of their action or inaction.

"Many people may not have expected the symptoms to be personally harmful, and this might have reduced the response to Zika," said co-author Dan Romer, APPC's research director. "But people need to know how important it is to get rid of standing water, put up screens, and use insect repellent -- the steps necessary to combat the ability of mosquitoes to transmit the infection. You need a larger community response to prevent the spread of a new transmissible infection like Zika."

"Differences Between Florida and the Rest of the United States in Response to Local Transmission of the Zika Virus: Implications for Future Communication Campaigns," was published in May in Risk Analysis.

In addition to Winneg and Romer, the authors of the study are Jo Ellen Stryker of the CDC and Kathleen Hall Jamieson, director of APPC.

The Annenberg Public Policy Center was established in 1993 to educate the public and policy makers about the media's role in advancing public understanding of political, health, and science issues at the local, state and federal levels.