Motivation AMR is one of the most serious threats to both animal and - - PowerPoint PPT Presentation

Information Avoidance: Does

Ignorance Keep Us Uniformed About Antimicrobial Resistance?

• Dr. Kate Brooks

kbrooks4@unl.edu

• Dr. Imran Meerza, Dr. Chris Gustafson, Dr. Emie Yiannaka

We gratefully acknowledge the support of the UNL IANR ARD and US MARC Research Collaborations program

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• AMR is one of the most serious threats to both animal and human

healthcare systems and the global economy.

• The estimated annual direct cost of AMR to the U.S. healthcare system is

approximately $20 billion, with additional indirect costs as high as $35 billion per year. Around 2 million people are infected with AMR bacteria each year in the U.S. resulting in 23,000 deaths.

• Educating the public about AMR related issues is a priority for the World

Health Organization.

• However, little is known about the public’s knowledge of, and attitudes

towards, the use of antimicrobials in livestock production and AMR.

Motivation

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• 1. Examine the public’s knowledge of, attitudes towards, and acceptance of

the use of antimicrobials in livestock production as well as their understanding of, and attitudes towards, AMR.

• Which factors affect acceptance of antimicrobial use in livestock

production? We distinguish between use intended to promote growth and to prevent, control and treat disease. 2. Assess how subjective (self-assessed) and objective (measured) knowledge of AMR and use of antimicrobials in livestock production relate to information avoidance behavior.

Research Objectives

Information Avoidance: Does Ignorance Keep Us Uniformed About Antimicrobial Resistance? | NIAA 9th Annual Antibiotic Symposium 4

• Conducted in May & June 2018.
• Administered by IRi, a leading online survey firm.
• A random sample of 1,030 U.S. residents, representative of the U.S.

population, participated in the survey.

• The online survey was divided into two sections to address the two

broad study objectives.

Survey

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• Level of acceptance of antibiotic use.
• To treat infections in food animals.
• To control infections in food animals.
• To prevent infections in food animals.
• To promote growth in food animals.
• 5 point scale 1=total unacceptable to 5=perfectly

acceptable

Consumer acceptance of antibiotic use in livestock production

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Acceptance of Use of Antibiotics in Food Animals 1) Please mark the level of acceptance you feel consumers would have for the use of antibiotics to

treat infections in food animals

• a. Unacceptable
• b. Neither acceptable nor unacceptable
• c. Acceptable

2) Please mark the level of acceptance you feel consumers would have for the use of antibiotics to

prevent infections in food animals

• a. Unacceptable
• b. Neither acceptable nor unacceptable
• c. Acceptable

3) Please mark the level of acceptance you feel consumers would have for the use of antibiotics to

control the spread of an illness among food animals.

• a. Unacceptable
• b. Neither acceptable nor unacceptable
• c. Acceptable

4) Please mark the level of acceptance you feel consumers would have for the use of antibiotics to

promote growth in food animals

• a. Unacceptable
• b. Neither acceptable nor unacceptable
• c. Acceptable

SLIDO Questions

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Acceptance of Antibiotic Use in Food Animals

11% 15% 29% 58% 28% 32% 35% 28% 61% 54% 36% 14% 0% 10% 20% 30% 40% 50% 60% 70% Treat infections Control infections Prevent infections Promote growth Percentage Unacceptable Neutral Acceptable

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• Econometric Model:
• Assess level of acceptance of 4 reasons of antibiotic use
• Dependent Variables:
• To prevent, control and treat disease and to promote growth
• Independent variables:
• Subjective & objective knowledge, consumption behavior, WTP for food

safety attributes, personal antibiotic use history, attitudes towards animal welfare & AMR, and demographic characteristics

Factors Impacting Acceptance of Antibiotic Use in Food Animals

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• Self-assessed knowledge:
• 4 point scale from “no knowledge” to “a great deal of knowledge”
• How much do you know about the following?
• 1. Use of antibiotics in livestock production
• 2. Antibiotic resistance in humans
• 3. Drug resistance
• 4. Antibiotic resistance in animals
• 5. Antibiotic resistant bacteria
• 6. Superbugs

Subjective Knowledge of Antibiotic use and AMR

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SLIDO Question – Subjective Knowledge

Subjective & Objective Knowledge 1) What percentage of consumers, do you believe, rated themselves as having no knowledge or little knowledge about AMR and antibiotic use in livestock production?

• a. Less than 25%
• b. 25% - 49%
• c. 50% - 75%
• d. Over 75%

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Subjective Knowledge Question

36% 22% 30% 51% 30% 38% 38% 35% 34% 28% 33% 32% 20% 31% 26% 17% 27% 23% 6% 12% 10% 5% 10% 7% 0% 10% 20% 30% 40% 50% 60% Use of antibiotics in livestock production Antibiotic resistance in humans Drug resistance Antibiotic resistance in animals Antibiotic-resistant bacteria Superbugs Percentage No knowledge Little knowledge Moderate knowledge A great deal of knowledge

On average, 67% self-identified with little or no knowledge of AMR & antibiotic use in livestock production.

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Antibiotic use in livestock production:

• 1. Antibiotics are common drugs useful in treating bacterial infections in humans
• 2. Antibiotics are common drugs useful in treating viral infections in humans.
• 3. Antibiotics are common drugs useful in treating any kind of pain or inflammation.
• 4. Antibiotics are common drugs useful in treating bacterial infections in food animals.
• 5. Antibiotics are common drugs useful in treating viral infections in food animals.

AMR:

• 6. Antibiotic resistance occurs when bacteria become resistant to antibiotics and antibiotics no longer

work as well.

• 7. Overuse and misuse of antibiotics accelerate antibiotic resistance.
• 8. The overuse and misuse of antibiotics in animals do not cause antibiotic resistance in humans

because the antibiotics that are used to treat animals are different than those used to treat humans.

• 9. Antibiotic resistance existed before human development of antibiotics.

10.Antibiotic resistance has been found in every environment studied, including many not impacted by food animal or human antibiotic use.

Objective Knowledge of Antibiotic use and AMR

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SLIDO Question – Objective Knowledge

2) What do you believe is the average score of consumer’s actual measured knowledge of AMR and antibiotic use in livestock production?

• a. Less than 25%
• b. 25% - 49%
• c. 50% - 75%
• d. Over 75%

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Objective Knowledge

Correct Answer % of participants answering correctly Antibiotic use in livestock production: Antibiotics are common drugs useful in treating bacterial infections in humans True 75% Antibiotics are common drugs useful in treating viral infections in humans. False 41% Antibiotics are common drugs useful in treating any kind of pain or inflammation. False 53% Antibiotics are common drugs useful in treating bacterial infections in food animals. True 49% Antibiotics are common drugs useful in treating viral infections in food animals. False 31% AMR: Antibiotic resistance occurs when bacteria become resistant to antibiotics and antibiotics no longer work as well. True 69% Overuse and misuse of antibiotics accelerate antibiotic resistance. True 70% The overuse and misuse of antibiotics in animals do not cause antibiotic resistance in humans because the antibiotics that are used to treat animals are different than those used to treat humans. False 29% Antibiotic resistance existed before human development of antibiotics. True 19% Antibiotic resistance has been found in every environment studied, including many not impacted by food animal or human antibiotic use. True 31%

Average score = 40%

Antibiotics are common drugs useful in treating bacterial infections in humans True 75% Overuse and misuse of antibiotics accelerate antibiotic resistance. True 70% Antibiotic resistance existed before human development of antibiotics. True 19%

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Subjective and Objective Knowledge of AMR

25% 42% 27% 6% 28% 37% 31% 4% 0% 10% 20% 30% 40% 50% No Knowledge Little Knowledge Moderate Knowledge A Great Deal of Knowledge Percentage

Knowledge of antibiotic use and AMR

Subjective (self-assessed) Knowledge Objective Knowledge 0.2 0.4 0.6 0.8 1 1 2 3 4 Objective knowledge Subjective knowledge

Positi tive r rel elati tionship b between sub ubjecti tive a and nd o

• bjecti

tive kn knowledge of antibioti tic u use and AM AMR

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Descriptive Statistics of Control Variables

Level of Concern (1= not at all concerned to 5 = extremely concerned)

3.65 3.46 3.45 3.38 3.19 3.06 2.89 0.5 1 1.5 2 2.5 3 3.5 4 Use of antibiotics to promote animal growth in food animals Use of the same antibiotics in humans and food animals contributing to antibiotic resistance in humans Use of antibiotics in food animal production contributing to antibiotic resistance Use of any antibiotics to treat humans contributing to antibiotic resistance in humans Use of antibiotics to prevent infections in food animals Use of antibiotics to control the spread of an illness among food animals Use of antibiotics to treat infections in food animals Level of Concern

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• Key Results
• The greater the objective knowledge of antibiotic use and AMR
• More likely to accept antibiotic use to treat & control disease
• Less likely to accept antibiotic use to prevent disease & promote growth
• Those with high level of concern about AMR & antibiotic use in livestock

production were less likely to accept antibiotic use in food animals.

• Those who believed that antibiotic use improves (reduces) animal welfare were

more (less) likely to accept antibiotic use in food animals.

• Female participants and participants who were highly concerned about AMR

were less likely to accept any form of antibiotic use in livestock production.

Factors Impacting Acceptance of Antibiotic Use in Food Animals

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Assessing the role of subjective and objective knowledge in AMR information avoidance behavior.

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Video Selection Length: 3 mins 35 secs Antimicrobial Resistance: The Role of Food and Agriculture https://youtu.be/d3YXW_gWNz4 Nature White Noise: Rain and Thunderstorm Sounds for Relaxation

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SLIDO Questions

Video Questions 1) Please select one of the following two videos. a.Antimicrobial Resistance: The Role of Food and Agriculture b.Nature White Noise: Rain and Thunderstorm Sounds for Relaxation 2) What percentage of consumers, do you believe, chose to avoid obtaining information on AMR and instead watched the white noise video? a.Less than 25% b.25% - 49% c.50% - 75% d.Over 75% 3) Which of the following statements do you believe is the top reason as to why consumers chose to not watch the Antimicrobial Resistance Video: a.I know enough about antimicrobial resistance. b.I believe that antimicrobial resistance is not a problem. c.I trust that the government will take care of antimicrobial resistance. d.I trust that the livestock and poultry industry will take care of antimicrobial resistance. e.Watching a video is not going to change my views on antimicrobial resistance.

• f. I would rather not know more about antimicrobial resistance because there is nothing I can do about it.

g.There are more important issues than antimicrobial resistance. h.I fear that knowing more about antimicrobial resistance will make me feel anxious.

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~40% of respondents avoided AMR video

15.3 21.6 9.0 20.6 31.8 13.0 12.5 5.3 6.5 5 10 15 20 25 30 35

Other Scared of knowing about AMR More important issues than AMR Nothing I can do Watching video won't change my existing view I trust that food industry will take care of AMR I trust that govt. will take care of AMR AMR is not a problem Enough knowledge about AMR

Percentage

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• Information is valuable & improves decision-making.
• Rational agents don’t avoid valid information.
• Unless ignorance is a strategic behavior.
• Consumers value & seek information and willing to pay for even useless

information (Eliaz & Schotter, 2007).

• Growing literature that people avoid information even when information is

free and could improve decision-making (Golman et. al 2017).

Information & Economics

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• A situation in which people choose not to obtain information that is

available and free.

• Previous literature on information avoidance shows responses to potentially

uncomfortable information is highly variable

• Objective: Examine the role of consumers’ subjective and objective

knowledge of AMR and antibiotic use in livestock production on the decision to access or avoid information related to AMR.

Information Avoidance

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Subjective and Objective Knowledge of AMR

25% 42% 27% 6% 28% 37% 31% 4% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% No Knowledge Little Knowledge Moderate Knowledge A Great Deal of Knowledge Percentage

Knowledge of antibiotic use and AMR

Subjective (self-assessed) Knowledge Objective Knowledge 0.2 0.4 0.6 0.8 1 1 2 3 4 Objective knowledge Subjective knowledge

Pos

• sitiv

itive r rela latio ionship ip b betw tween su subjectiv ive an and

• bje

jective kn knowle ledge of

• f an

antib tibio iotic tic u use se an and A AMR

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Independent variables Marginal Effects Participants’ Knowledge of AMR & Antibiotic Use in Livestock production No or little subjective knowledge (1,0) (two categories: no or little know=1, otherwise 0) Objective knowledge Control Variables (i.e., consumption habit, WTP premium for food safety attributes, level of concern about AMR, belief, history of antibiotic use, preference, views on animal welfare, and demographic characteristics) 0.080** (0.035)

• 0.271*** (0.062)

X

• Note: *** significant at 1% and ** significant at 5%.

Role of Subjective and Objective Knowledge

Table 1: Logit Model- Dependent variable- Dummy (1 if avoid AMR information; 0 otherwise)

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• Participants re-answered 4 questions related to

perceptions and understanding of AMR after videos

• 631 out of 1030 respondents chose to watch AMR

video

• Panel Data Analysis (Random Effects)

Effects of Information on Perceptions & Understanding of AMR

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Perceptions and Understanding of AMR

3.54 3.65 3.89 2.66 3.92 4.00 4.18 2.26 0.5 1 1.5 2 2.5 3 3.5 4 4.5 AMR is one of the biggest problems the world faces Widespread use of antibiotics in animal feed can lead to antibiotics polluting the environment through agricultural runoff Widespread use of antibiotics creates new resistant bacteria that cause illness that antibiotics cannot cure Use of antibiotics in food animals does not cause AMR that could affect humans Level of Agreement Level of agreement before AMR video Level of agreement after AMR video

Scale of 1 = strongly disagree to 5= strongly agree)

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Effects of Information on Perceptions & Understanding of AMR Based on Knowledge

Independent variables Marginal Effects Information (1,0) Participants’ Knowledge of AMR & Antibiotic Use in Livestock production Little or no subjective knowledge (1,0) Little or no subjective knowledge x information Objective knowledge Objective knowledge x information Control Variables (i.e., consumption habit, WTP premium for food safety attributes, level of concern about AMR, belief, history of antibiotic use, preference, views on animal welfare, and demographic characteristics) 0.322***

• 0.162***

0.197*** 0.848***

• 0.213***

X

Note: *** significant at 1% and ** significant at 5%.

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• Participants with higher objective knowledge are more

likely to accept antibiotic use to treat and control disease but less likely to accept antibiotic use to prevent disease and promote growth.

• Positive relationship between participants' subjective and
• bjective knowledge of AMR and antibiotic use.
• Respondents with little or no knowledge of AMR were more

likely to avoid AMR information compared to more knowledgeable respondents.

• Of participants who chose to watch the AMR video, those

with little or no knowledge changed their views the most.

Overall, Key Results

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• How to encourage willfully uniformed individuals to

access information about AMR?

• Examine provision of different forms of AMR

information (statistical vs. “story-based”) by different information sources (e.g., NGOs, gov’t institutions, activists).

• Consumer WTP for animal products associated with

AMR-risk reducing practices/labels.

• Balanced responsible practices

Future Research

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Three questions:

• The use of antibiotics to (treat illness, prevent illness, or

promote growth) in food animals is:

• Prohibited
• Allowed and regulated
• Allowed and unregulated
• I do not know

Participants Understanding of Antibiotic Use in Food Animals

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Four Questions:

• What do you believe is the percentage of food animals that

are given antibiotics (to treat an illness, prevent an illness, promote growth)?

• More than 80%
• 61 - 80%
• 41 - 60%
• 21 - 40%
• Less than 21% but greater than zero
• Zero
• I do not know

Participants Understanding of Antibiotic Use in Food Animals

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Questions/Comments?

Kate Brooks kbrooks4@unl.edu

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Acceptance of Use of Antibiotics in Food Animals

3.69% 6.21% 13.98% 38.16% 7.09% 8.35% 15.34% 19.81% 28.06% 31.65% 34.56% 27.96% 33.40% 34.17% 23.69% 10.10% 27.77% 19.61% 12.43% 3.98% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% Treat infections Control infections Prevent infections Promote growth Totally unacceptable Somewhat unacceptable Neither acceptable nor unacceptable Somewhat acceptable Perfectly acceptable

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Variables es Descrip iption ion Mean ( (S.D .D.) .) Willingness t to p pay a premium for p product attributes 1= strongly disagree to 5= strongly agree Products that are produced under strict animal welfare standards 3.55 (1.07) Meat from animals not treated with antibiotics to promote growth 3.38 (1.01) Perceptions a and u understa tanding o

• f A

AMR Level of agreement with the statement, 1= strongly disagree to 5= strongly agree Antibiotic resistance is one of the biggest problems the world faces 3.42 (1.01) Antibiotic resistance is an issue that could affect me or my family 3.91 (0.92) Widespread use of antibiotics in animal feed can lead to antibiotics polluting the environment through agricultural runoff 3.55 (0.88) Widespread use of antibiotics creates new resistant bacteria that cause illness that antibiotics cannot cure 3.77 (0.89) Use of antibiotics in food animals does not cause AMR that could affect humans 2.77 (0.99) Anim imal w l welfare Level of agreement with the statement, 1= strongly disagree to 5= strongly agree Use of antibiotics to treat an illness in food animals improves animal welfare 3.39 (0.96) Use of antibiotics in food animal production reduces animal welfare 3.23 (0.98) Food safety is strongly dependent on the care provided to food animals 4.00 (0.87)

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Variables es Descrip iption ion Me Mean n (S.D .D.) .) Frequency o

• f Meat a

and f fish c consumption 1= never consume to 5= daily consumption Beef 3.50 (0.94) Chicken 3.81 (0.80) Fish 3.11 (1.03) Pork 3.10 (1.02) Hi History o

• f a

f antibioti tics u use Treated with antibiotics in previous year 1= yes; 0= no 42% Antibiotic treatment didn’t work-own Treated with an antibiotic that didn’t work, 1= yes; 0= no 27% Antibiotic treatment didn’t work - family 23%