Mosquito feeding - Chris Fifield-Smith flickr

Despite almost nonstop news about Zika, many Americans remain dangerously unaware of how to protect themselves from mosquito marauders. In a new survey just released by FleishmanHillard, conducted for Spectrum Brands Holdings (NYSE: SPB), 22% of participants could not identify even a single active ingredient deemed effective by the CDC, although 79% knew mozzies are the main transmitters of Zika. Equally worrisome, the survey found that “82% mistakenly believe at least one product sold as mosquito repellent but not recommended by the CDC will protect them from mosquitoes.” I would have been in that group.

The survey in June, 2016, involved 1,176 interviews of Americans aged 18 years or older, including 408 women aged 18-44. While only 436 respondents lived in the South, the highest risk area for contracting Zika, dengue, or Chikungunya in the U.S., Sue Jolly, Sr. VP at FleishmanHillard explained that the survey was weighted to match demographics. Participants were selected using an online opt-in panel, so are not generalizable to the population as a whole. It used a “convenience” sample rather than a randomly generated group.

Although most of those surveyed believe they will be bitten by mosquitoes this summer—40% are certain they will be—this does not translate to their taking preventive action. Only 20% say they use a repellent every time they go outside or every time they go out for an extended period. Women of childbearing age didn’t do much better, despite their risk of having a baby born with microcephaly or other birth defects from mosquito-transmitted virus infection.

The survey compared sunscreen use patterns to that of insect repellents. The best news in this survey is that 33% of participants said they use sunscreen regularly, although only 12% thought they were certain to get a sunburn this summer.

So there is quite a disconnect—people are aware they are at higher risk of mosquito bites, yet only 20% use insect repellents regularly. Most people have experienced the pain of sunburn, but not serious illness due to insect-borne disease.

It’s likely that some of this gap can also be explained by the longer efforts at educating about skin cancer, and that more health care providers routinely discuss skin cancer prevention with their patients. For others, the “power of habit” might be important, with seeing the sun, preparing for travel to the beach, or working outside serving as cues, triggering a ritual habit.

Marketing may well contribute to the disconnect in use of repellents vs. sunscreen, too. Sunscreen labels and ads are positive, pitched as beauty products that will keep you young, healthier, and more beautiful. Many of the insect repellents connote danger, with names as “Off” and Repel, and militaristic or hunting allusions.

Knowledge of Zika

As noted above, although most people think they are likely to be bitten by a mosquito—almost a summer rite of passage—they do not see themselves at significant risk of Zika.

While 74% knew that some strains of mosquitoes transmit Zika, less than two-thirds knew that it can be transmitted to the fetus in the womb, and less than 50% knew Zika can be transmitted sexually. This is especially important, given that pregnant women may be more likely to attract mosquitoes given their higher body temperatures and because they exhale more carbon dioxide.

Most also perceive themselves at low risk of becoming infected, and they are confident that they know how to protect themselves against mosquito bites—though many were either wrong about the efficacy of insect repellents, or don’t use them anyway.

Surprisingly, women of childbearing age were no more concerned about Zika than they were about sunburn, although most were aware of possible birth defects.

More than 60% of participants knew that using screens and reducing standing water are very effective at reducing mosquito populations.

Knowledge of insect repellents

Although expressing undue confidence in their ability to choose an effective repellent, many respondents lacked basic knowledge about what repellents are effective. DEET and Citronella had the highest name recognition (65%), but were seen as similarly effective, which is incorrect. Less than 10% had ever even heard of picaridin or IR3535, but ~40% were familiar with oil of eucalyptus. In contrast, 73% of respondents misidentified at least one ingredient not recommended by the CDC for use as a repellent as being effective—especially believing citronella to be far more effective than it is.


Much of the ignorance about effective insect repellents is likely from marketing. I’ve spent hours poring over labels and web sites. It is not easy to understand the differences. We are burdened by “The Paradox of Choice,” becoming overwhelmed and sometimes immobilized by the variety of products.

It’s easy to be attracted to subliminal messaging from packaging, rather than focusing on the details. For example, we have DEET, which looks and sounds more threatening.

OFF! DEET Moquito repellents - Mike Mozart, JeepersMedia, on Flickr CC by 2.0

Or you can choose Cutter natural, which looks soft, and nonthreatening, with it’s gentle green leaves.

Cutter Natural Screen Shot 2016-07-15 at 11.02.07 AM

Who wouldn’t be attracted to the seductive “DEET free,” “Protection for the whole family” with ads that assure effectiveness. (Stay tuned…tomorrow I’ll give you the details comparing these products and tell you which are the most highly rated).

So why are these relatively ineffective products marketed so heavily? The insect repellent industry, with revenue of $168 million and 7-10% annual growth finds it increasingly profitable to target people who want “natural” products.


Despite the steady stream of bad news about Zika, dengue, and Chikungunya, many Americans are dangerously ignorant about how the infection is transmitted as well as the efficacy of insect repellents. Especially given the high stakes of devastating birth defects from Zika, the severity of illness and sequelae from many other mosquito-borne viral infections, the FleishmanHillard survey clearly demonstrates the vast need for education about the efficacy of products that are marketed as insect repellents. This topic is simply too complex and important to rely on people being able to accurately educate themselves, especially in the face of relentless advertising for ineffective “natural” products. Tomorrow, I’ll share what we know about effective repellents.

For more medical/pharma news and perspective, follow me on Twitter @drjudystone or here at Forbes