The objective of this study was to assess recovery of Aransas County, Texas households 2 years after Category 4 Hurricane Harvey made landfall.

A 2-stage cluster sampling method used to conduct a Community Assessment for Public Health Emergency Response (CASPER) on May 3 - 4 and May 18 - 19, 2019. A household-based survey was administered through face-to-face interviews, selected through systematic random sampling using weighted analysis of the county population. Field teams collected 175 surveys (83.3% completion rate).

Approximately 57% households experienced repairable damage, 23% had destroyed homes, and 19% had minimal damage. 38% stated having ‘no need,’ 18% needed financial assistance, 16% needed household repairs, and over 8% had behavioral health needs. 17% experiencing a behavioral health concern were seeking services. Of the 35% of households who did not seek services, 14% felt there was no need, and 4% were not aware of the resources available.

Households reported high levels of preparedness, but gaps remain in evacuation intention and behavioral health care access. CASPERs are effective in assessing long-term recovery of communities impacted by major disasters.

Disasters may have major impacts to mental health and to the utilization of mental health services (MHS). Moreover, these effects may be worsened by the preclusion of access to basic services following the event. The aim of this study is to evaluate the utilization of public MHS by the population that suffered water supply interruption following the Mariana Dam Failure in Brazil, 2015.

We conducted an Interrupted Time Series analyzing secondary health data from the municipalities that faced water supply interruption, comparing it to data from the other municipalities of Minas Gerais state.

We found a higher immediate (RR: 1.78; 95% CI: 1.25–2.53) and gradual (RR: 1.05; 95% CI: 1.03–1.06) change in the rate of mental health visits (MHV) in the affected population following the event, whereas there was an immediate fall (RR: 0.41; 95% CI: 0.29–0.59) followed by a higher gradual increase (RR: 1.04; 95% CI: 1.02–1.06) in the rate of hospital admissions (HA) in the affected population.

The results suggest that there was an increase in the utilization of public MHS by the population that suffered water supply interruption following the disaster.

Previous research suggests that people with asthma may experience a worsening of symptoms following hurricanes due to changes in environmental exposures, discontinuity in chronic disease management, and stress. The objective of this study was to estimate changes in asthma-related emergency department (ED) visits in North Carolina following Hurricane Irene, which made landfall in August 2011.

Changes in asthma-related ED visits in September to December of 2010 and 2011 were examined using data from the Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases. A Poisson generalized linear model was used to estimate the association between Federal Emergency Management Agency disaster declarations following Hurricane Irene and county-level asthma-related ED visits controlling for month, year, and county.

Following Hurricane Irene, disaster declarations were made for 38 of 100 counties in North Carolina. In September 2010, the rate of asthma-related ED visits for North Carolina was 6 per 10,000 person-months. In September 2011, rates of asthma-related ED visits were similar in counties with and without disaster declarations (7 and 5 per 10,000 person-months, respectively). When adjusting for covariates, there was little or no difference in the rate of asthma ED visits before and after the hurricane between counties with and without a disaster declaration (rate ratio {RR} [95% confidence interval {CI}] = 1.02[0.97, 1.08]).

Although risk factors for asthma exacerbations increase following hurricanes, these results found little evidence of an increase in asthma-related ED visits in North Carolina following Hurricane Irene.

This study evaluated the relationships between the occurrence of recent and recurring natural disasters on the incidence of acute and chronic health outcomes at the census tract level in 500 cities across the United States between 2001 and 2015.

Using the Centers for Disease Control and Prevention (CDC) 500 cities data set, the CDC Social Vulnerability Index, and the US Small Business Administration (SBA) Disaster Loan Database, we modeled the incidence of self-reported, poor mental and physical health, or a clinical diagnosis of high blood pressure or asthma in census tracts (N = 27 204 tracts in 500 cities) that had experienced recent or recurring natural disasters while controlling for social and environmental risk factors.

Communities that experienced a natural disaster in the previous 5 years compared to those that had not had a higher incidence of poor mental health (RR: 1.02, 95% CI: 1.01-1.02), poor physical health (RR: 1.03, 95% CI: 1.02-1.04), high blood pressure (RR: 1.04, 95% CI: 1.02-1.05), and asthma (RR: 1.01, 95% CI: 1.01-1.02). The incidence of these poor health outcomes increased 1-2% with each additional year that a community experienced a disaster.

Prevention and preparedness plans that work to build resilience in communities before disasters should focus on closing the gap in environmental and social determinants that have been linked with disproportionate health burdens and slow recovery post-disaster.

There is a paucity of scientific analysis that has examined spatial heterogeneities in the socioeconomic vulnerabilities related to coronavirus disease 2019 (COVID-19) risk and potential mitigation strategies at the sub-national level in India. The present study examined the demographic, socioeconomic, and health system-related vulnerabilities shaping COVID-19 risk across 36 states and union territories in India.

Using secondary data from the Ministry of Health and Family Welfare (MoHFW), Government of India; Census of India, 2011; National Family Health Survey, 2015-16; and various rounds of the National Sample Survey, we examined socioeconomic vulnerabilities associated with COVID-19 risk at the sub-national level in India from March 16, 2020, to May 3, 2020. Descriptive statistics, principal component analysis, and the negative binomial regression model were used to examine the predictors of COVID-19 risk in India.

There persist substantial heterogeneities in the COVID-19 risk across states and union territories in India. The underlying demographic, socioeconomic, and health infrastructure characteristics drive the vulnerabilities related to COVID-19 in India.

This study emphasizes that concerted socially inclusive policy action and sustained livelihood/economic support for the most vulnerable population groups is critical to mitigate the impact of the COVID-19 pandemic in India.

The aim of this study was to (1) assess the long-term mental and behavioral health outcomes of the Deepwater Horizon Oil Spill of residents in the Gulf Coast and to (2) identify populations that may be particularly vulnerable to future disasters.

The Survey of Trauma, Resilience, and Opportunity in Neighborhoods in the Gulf (STRONG) is a population-representative sample of 2520 coastal residents surveyed in Texas, Louisiana, Alabama, Mississippi, and Florida in 2016. We present prevalence estimates for positive screens of depression, anxiety, and alcohol misuse, as well as receipt of health care services. We examine differences in these outcomes across states, affected occupational groups, and demographic groups.

Resource loss attributed to the spill was associated with positive screens for depression and anxiety. Almost 50% of adults screened positive for depression, anxiety, or alcohol misuse, but less than 20% of these currently access mental health care. Black residents were less likely to have health insurance and a usual source of care but were more likely to have visited the emergency room in the past 12 months.

Surveillance data from STRONG can help policy-makers and other stakeholders develop targeted approaches to foster resilience, particularly among vulnerable populations, and thereby mitigate the effects of future disasters.

The objective of this study was to conduct comprehensive analyses of disaster patterns for Germany and France from a pediatric perspective.

An analysis of the Emergency Events Database (EM-DAT), epidemiological database with standard methods of descriptive and comparative statistics respecting the strengthening the reporting of observational studies in epidemiology (STROBE) criteria, was performed.

Between 2006 and 2016, there were 41 and 42 disasters in Germany and France claiming 259 and 4973 lives, respectively. Ages of afflicted individuals were not specified in EM-DAT. In Germany, most events were storms (37%), extreme temperatures (17%), floods (17%), and transport accidents (17%). In France, most events were storms (45%), extreme temperatures (17%), floods (19%), and transport accidents (14%). In Germany, most lives (96) were lost in transport accidents. In France, most casualties were due to the heat waves of 2006 and 2015 (1388 and 3275). Reported event types in Germany and France were similar, but heat waves struck France more significantly than Germany.

Pediatric data are not explicitly captured in EM-DAT, but reported disaster patterns suggest that exposures to heat and cold, storms, trauma, chemicals, water, and infectious agents are possible mechanisms of injury. Age-stratified disaster data are needed to enable a timely, transparent, coordinated, and sustained data-driven approach to pediatric disaster resilience.

Prenatal hurricane exposure may be an increasingly important contributor to poor reproductive health outcomes. In the current literature, mixed associations have been suggested between hurricane exposure and reproductive health outcomes. This may be due, in part, to residual confounding. We assessed the association between hurricane exposure and reproductive health outcomes by using a difference-in-difference analysis technique to control for confounding in a cohort of Florida pregnancies.

We implemented a difference-in-difference analysis to evaluate hurricane weather and reproductive health outcomes including low birth weight, fetal death, and birth rate. The study population for analysis included all Florida pregnancies conceived before or during the 2003 and 2004 hurricane season. Reproductive health data were extracted from vital statistics records from the Florida Department of Health. In 2004, 4 hurricanes (Charley, Frances, Ivan, and Jeanne) made landfall in rapid succession; whereas in 2003, no hurricanes made landfall in Florida.

Overall models using the difference-in-difference analysis showed no association between exposure to hurricane weather and reproductive health.

The inconsistency of the literature on hurricane exposure and reproductive health may be in part due to biases inherent in pre-post or regression-based county-level comparisons. We found no associations between hurricane exposure and reproductive health. (Disaster Med Public Health Preparedness. 2017;11:407–411)

To assess the preparedness of the US mass fatality infrastructure, we developed and tested metrics for 3 components of preparedness: organizational, operational, and resource sharing networks.

In 2014, data were collected from 5 response sectors: medical examiners and coroners, the death care industry, health departments, faith-based organizations, and offices of emergency management. Scores were calculated within and across sectors and a weighted score was developed for the infrastructure.

A total of 879 respondents reported highly variable organizational capabilities: 15% had responded to a mass fatality incident (MFI); 42% reported staff trained for an MFI, but only 27% for an MFI involving hazardous contaminants. Respondents estimated that 75% of their staff would be willing and able to respond, but only 53% if contaminants were involved. Most perceived their organization as somewhat prepared, but 13% indicated “not at all.” Operational capability scores ranged from 33% (death care industry) to 77% (offices of emergency management). Network capability analysis found that only 42% of possible reciprocal relationships between resource-sharing partners were present. The cross-sector composite score was 51%; that is, half the key capabilities for preparedness were in place.

The sectors in the US mass fatality infrastructure report suboptimal capability to respond. National leadership is needed to ensure sector-specific and infrastructure-wide preparedness for a large-scale MFI. (Disaster Med Public Health Preparedness. 2016;10:87–97)

We propose a model of population behavior in the aftermath of disasters.

We conducted a qualitative analysis of an empirical dataset of 339 disasters throughout the world spanning from 1950 to 2005.

We developed a model of population behavior that is based on 2 fundamental assumptions: (i) behavior is predictable and (ii) population behavior will progress sequentially through 5 stages from the moment the hazard begins until is complete.

Understanding the progression of population behavior during a disaster can improve the efficiency and appropriateness of institutional efforts aimed at population preservation after large-scale traumatic events. Additionally, the opportunity for population-level intervention in the aftermath of such events will improve population health. (Disaster Med Public Health Preparedness. 2014;8:497-504)

We examined the association between housing type and household emergency preparedness among households in Oakland County, Michigan.

We used interview data on household emergency preparedness from a cluster design survey in Oakland County, Michigan, in 2012. We compared survey-weighted frequencies of household demographics, medical conditions, and preparedness measures in single-detached homes versus multi-unit dwellings, and determined the unadjusted odds ratios (OR) and the income-level adjusted OR for each preparedness measure.

Households had similar demographics and medical conditions between housing types. Unadjusted ORs were statistically significant for single detached homes having a generator (11.1), back-up heat source (10.9), way to cook without utilities (5.8), carbon monoxide (CO) detector (3.8), copies of important documents (3.4), evacuation routes (3.1), and 3-day supply of water (2.5). Income level adjusted ORs remained statistically significant except for owning a CO detector.

Households in multi-unit dwellings were less likely to have certain recommended emergency plans and supplies compared to those in single detached homes. Further research is required to explore the feasibility, barriers, and alternatives for households in multi-unit dwellings in terms of complying with these measures. (Disaster Med Public Preparedness. 2014;0:1–8)

Valuable trauma-related research may be hindered when the risks of asking participants about traumatic events are not carefully weighed against the benefits of their participation in the research.

The overall aim of our population-based survey was to improve the professional care of suicide-bereaved parents by identifying aspects of care that would be amenable to change. The study population included 666 suicide-bereaved and 377 matched (2:1) non-bereaved parents. In this article we describe the parents' perceptions of their contacts with us as well as their participation in the survey. We also present our ethical-protocol for epidemiological surveys in the aftermath of a traumatic loss.

We were able to contact 1410 of the 1423 eligible parents; eight of these parents expressed resentment towards the contact. Several participants and non-participants described their psychological suffering and received help because of the contact. A total of 666 suicide-bereaved and 377 non-bereaved parents returned the questionnaire. Just two out of the 1043 answered that they might, in the long term, be negatively affected by participation in the study; one was bereaved, the other was not. A significant minority of the parents reported being temporarily negatively affected at the end of their participation, most of them referring to feelings of sadness and painful memories. In parallel, positive experiences were widely expressed and most parents found the study valuable.

Our findings suggest, given that the study design is ethically sound, that suicide-bereaved parents should be included in research since the benefits clearly outweigh the risks.