Trust influences response to public health messages during a bioterrorist event.

This study builds on recent work describing African Americans' low trust in public health regarding terrorism preparedness by identifying the specific components of trust (fiduciary responsibility, honesty, competency, consistency, faith) that may influence community response to a bioterrorist attack. We used qualitative analysis of data from 75 African American adults living in Los Angeles County who participated in focus group discussions. Groups were stratified by socioeconomic status (SES; up to vs. above 200% of federal poverty guidelines) and age (18-39 years old vs. 40-65 years old). Discussions elicited reactions to information presented in escalating stages of a bioterrorism scenario. The scenario mimicked the events and public health decisions that might occur under such a scenario. Honesty and consistency of information from public health officials were the components most frequently identified as determining trust or distrust. Patterns of trust varied according to the scenario stage; honesty was most important upon initially hearing of a public health crisis, whereas fiduciary responsibility and consistency were important upon confirmation of a smallpox outbreak and the ensuing public health response. Findings can help public health officials design communications that address distrust and enhance trust during a bioterrorist event.