Assessing the Relationship Between Social Vulnerability and Community Resilience to Hazards

Examining social vulnerability to multi-hazards in North-Western Himalayas, India

The enhancing risk from human action and multi-hazard interaction has substantially complicated the hazard-society relationship. The underlying vulnerabilities are crucial in predicting the probable impact to be caused by multi-hazards. Thus, the evaluation of social vulnerability is decisive in inferring the driving factor and preparing for mitigation strategies. The Himalayan landscape is prone to multiple hazards as well as possesses a multitude of vulnerabilities owing to changing human landscape. Thus, an attempt has been made to inquire into the underlying socioeconomic factors enhancing the susceptibility of the region to multi-hazards. The social vulnerability index (SVIent) has been introduced, consisting of 13 indicators and 33 variables. The variables have been standardized using the maximum and minimum normalization method and the relative importance for each indicator has been determined using Shannon entropy methods to compute SVIent. The findings revealed that female population, population above 60 years old, net irrigated area, migrant population, dilapidated house, nonworkers, bank, and nonworkers seeking jobs were found to be relatively significant contributors to the vulnerability. The western part of the study area was classified as the highly vulnerable category (SVI > 0.40628), attributed to high dependence, and higher share of unemployed workers and high poverty. The SVIent was shown to have positive correlation between unemployment, socioeconomic status, migration, dependency, and household structure significant at two-tailed test. The study's impact can be found in influencing the decision of policymakers and stakeholders in framing the mitigation strategies and policy documents.

A Research Note on Community Resilience Estimates: New U.S. Census Bureau Data With an Application to Excess Deaths From COVID-19

In this research note, we describe the results of the first validation study of the U.S. Census Bureau's new Community Resilience Estimates (CRE), which uses Census microdata to develop a tract-level vulnerability index for the United States. By employing administrative microdata to link Social Security Administration mortality records to CRE, we show that CRE quartiles provide more stable predictions of COVID-19 excess deaths than single demographic categorizations such as race or age, as well as other vulnerability measures including the U.S. Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) and the Federal Emergency Management Agency's National Risk Index (NRI). We also use machine learning techniques to show that CRE provides more predictive power of COVID-19 excess deaths than standard socioeconomic predictors of vulnerability such as poverty and unemployment, as well as SVI and NRI. We find that a 10-percentage-point increase in a key CRE risk measure is associated with one additional death per neighborhood during the initial outbreak of COVID-19 in the United States. We conclude that, compared with alternative measures, CRE provides a more accurate predictor of community vulnerability to a disaster such as a pandemic.

Identifying and assessing corporate employment variables that influence community resilience: A novel model

Quantifying the concept of disaster resilience on a local level is becoming more critical as vulnerable communities face more frequent and intense disasters due to climate change. In the United States (US), corporations are often evaluated using social justice or environmental sustainability matrices for financial investment consideration. However, there are few tools available to measure a corporation's contribution to disaster resilience on a local level. This study includes a focused literature review of employment variables that contribute to community resilience and a national survey that asked US emergency managers to rank the variables they believe have the greatest influence on individual resilience. A novel corporate community resilience model that ranks corporate contributions to disaster resilience in the communities where they operate was developed and then tested against data from five employment sectors from the same area. This model can be used by stakeholders to better understand how corporations can most efficiently contribute to county- and subcounty-level disaster resilience. The metrics used in this study are universal and translative, and thus, the development of this resilience model has global disaster resilience implications.

Understanding the spatial disparity in socio-economic recovery of coastal communities following typhoon disasters

The increasing risk of climate change in the Anthropocene underscores the importance and urgency of enhancing resilience to climate-related disasters. However, the assessment of resilience to disasters with traditional statistical data is spatially inexplicit and timeliness inadequate, and the determinants of resilience remain unclear. In this study, we employed spatially detailed daily nighttime light images to assess socio-economic disturbance and track near real-time recovery of coastal communities in Southeast China following super typhoon Meranti. Furthermore, we constructed a "exposure-sensitivity-adaptive capacity" framework to explore the role of key factors in shaping spatiotemporal patterns of recovery. Our case study showed a significant spatial disparity in socio-economic recovery in the post-typhoon period. Low-urbanized areas recovered relatively rapidly with the weakest socio-economic disturbance they suffered, and middle-urbanized areas experienced the slowest recovery despite the disruption being moderate. Remarkably, high-urbanized areas were the most severely impacted by the typhoon but recovered fast. The exposure to hazard, socio-economic sensitivity, and adaptive capacity in communities explained well the spatial disparity of resilience to the typhoon. Maximum wind speed, percentage of the elderly, and percentage of low-income population significantly negatively correlated with resilience, whereas commercial activity intensity, spatial accessibility of hospitals, drainage capacity, and percentage of green open space showed significantly positive relationships with resilience. Notably, the effects of key factors on resilience were spatially heterogeneous. For instance, maximum wind speed exhibited the strongest influence on resilience in middle-urbanized areas, while the effect of commercial activity intensity was most pronounced in low-urbanized areas. Conversely, spatial accessibility of hospitals and drainage capacity showed the strongest influence in high-urbanized areas. Our study highlights the necessity of linking post-disaster recovery with intensity of hazard, socio-economic sensitivity, and adaptive capacity to understand community resilience for better disaster risk reduction.

The Impact of Social Vulnerability on Substance Use Detection Practices in Pregnancy

This study aimed to synthesize current literature regarding the impact of social vulnerability on pregnancy-related substance use detection in the United States and highlight disparities in substance use detection practices. Clinicaltrials.gov, Google Scholar, PubMed (includes MEDLINE), and Cochrane Library databases were searched using the following Medical Subject Headings (MeSH): (["pregnancy" or "prenatal"] AND ["substance use screening" or "urine toxicology testing" or "toxicology testing" or "urine drug screening" or "CRAFFT" or "4P's" or "4P's Plus" or "NIDA Quick Screen" or "DAST-10" or "SURP-P" or "WIDUS"], AND ("bias" or "disparities" or "social vulnerability"]). The search included systematic reviews, prospective and retrospective studies, randomized controlled trials, case studies, and qualitative and quantitative research from January 2014 through November 2023. Selected literature was limited to studies published in English, which included a study population of either pregnant individuals or pregnancy health care providers in the United States, and that were focused on inequities in pregnancy substance use detection. Using Covidence, three authors screened abstracts, and two screened full articles for inclusion. The included studies were evaluated for quality of evidence using the mixed methods appraisal tool. The search yielded 4,188 manuscripts; 37 were eligible for full review. A total of 18 manuscripts were included based on the relevancy of the topic. The most common social vulnerability domain identified was minority status (17/18), followed by socioeconomic status (11/18), household characteristics (8/18), and housing type (1/18). Social vulnerability plays a role in substance use detection among pregnant individuals. Most notably, race and ethnicity, age, and public insurance lead to increased rates of detection, though most individual factors need to be studied in greater depth. This study was registered with PROSPERO (PROSPERO ID CRD42022352598), the International Prospective Register of Systematic Reviews. KEY POINTS: · Socially vulnerable pregnant individuals are more likely to receive substance use screening or urine toxicology testing.. · Race, ethnicity, age, and insurance influence substance use detection disparities.. · More research is needed to understand how other characteristics influence disparities in substance use detection..

Experiences of Veterans, Caregivers, and VA Home-Based Care Providers before, during, and Post-Hurricane Ian

On 28 September 2022, Hurricane Ian pummeled parts of south Florida. Disaster and climate change research has shown that disasters exacerbate inequalities, especially amongst older and physically vulnerable people. Florida has a large population of Veterans managing multiple chronic health conditions and receiving long-term care in-home from Veterans Health Administration (VA) programs, including Home Based Primary Care and Medical Foster Home. To describe how VA staff provided high quality care during and after the hurricane, and how Veterans and caregivers accessed needed healthcare and supports post-hurricane, we conducted a site visit to Lee County, Florida area in May 2023, conducting N = 25 interviews with VA staff, Veterans, and caregivers. Findings from qualitative thematic analysis showed that while some Veterans and caregivers experienced significant challenges during and after the hurricane, including displacement and difficulty accessing oxygen, they felt highly supported by VA care teams. Staff efforts post-hurricane focused on improving care coordination in anticipation of future disasters, especially around communicating with Veterans and their caregivers, and a VA workgroup formed to implement changes. As climate change causes more severe hazard events, lessons learned from this project can better support healthcare staff, older adults, and their caregivers before and after major disasters.

A Neighborhood-level analysis of mental health distress and income inequality as quasi-longitudinal risk of reported COVID-19 infection and mortality outcomes in Chicago

Extant literature investigates the impact of COVID-19 on mental health outcomes, however there is a paucity of work examining mental health distress as a risk factor for COVID-19 outcomes. While systemic variables like income inequality relate to both mental health and COVID-19, more work is needed to test theoretically informed models including such variables. Using a social-ecological framework, we aimed to address these gaps in the literature by conducting a neighborhood-level analysis of potential mental health distress and systemic- (income inequality) level predictors of reported COVID-19 infection and mortality over time in Chicago. Neighborhood-level comparisons revealed differences in mental health distress, income inequality, and reported COVID-19 mortality, but not reported COVID-19 infection. Specifically, Westside and Southside neighborhoods generally reported higher levels of mental health distress and greater concentration of poverty. The Central neighborhood showed a decline in reported mortality rates over time. Multi-level negative binomial models established that Zip-codes with greater mental health distress were at increased reported COVID-19 infection risk, yet lower mortality risk; Zip-codes with more poverty were at increased reported COVID-19 infection risk, yet lower mortality risk; and Zip-codes with the highest percentage of People of Color were at decreased risk of reported COVID-19 mortality. Taken together, these findings substantiate Chicago neighborhood-level disparities in mental health distress, income inequality, and reported COVID-19 mortality; identify unique differential associations of mental health distress and income inequality to reported COVID-19 infection and reported mortality risk; and, offer an alternative lens towards understanding COVID-19 outcomes in terms of race/ethnicity.

Examining racial and social vulnerability disparities in the outpatient treatment of uncomplicated cystitis at a Southern California Academic Hospital

Racially and ethnically minoritized (REM) patients are disproportionately impacted by infectious diseases. In our study, REM patients were more likely to receive care for urinary tract infections in the emergency department or urgent care, were younger, and were more likely to have higher social vulnerability.

Risk Factors for Intimate Partner Violence in the Context of Disasters: A Systematic Review

Women are at increased risk for experiencing intimate partner violence (IPV) in the context of disasters. However, the factors that increase this risk are not well understood. The purpose of the current study was to systematically review the literature on IPV in the context of disasters. The first aim was to identify risk factors predicting women's exposure to IPV. The second aim was to identify disaster-specific risk factors for IPV. The third aim was to construct a social ecological framework of risk factors for IPV in disasters at the individual, relationship/household, community, and structural levels. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA; Moher et al., 2009). Articles were identified using keywords in seven ProQuest databases. Of the 67 articles identified for full-text review, 24 were eligible for inclusion. Studies were evaluated based on critical appraisal of methodology using an adapted version of the Mixed Methods Appraisals Tool (MMAT; Hong et al., 2018). Findings suggest that disasters give rise to unique risk factors across social ecologies which interact with pre-existing characteristics of social vulnerability to increase women's risk of IPV. Findings inform violence prevention strategies within the context of disaster response and therefore have implications for research, policy, and practice.

Disaster exposure and patterns of disaster preparedness: A multilevel social vulnerability and engagement perspective

This study examined how community vulnerabilities contextualized the impact of exposure to five major disasters in 2017 on individuals' disaster preparedness. We pooled two panels of the Federal Emergency Management Agency (FEMA)'s National Household Survey in 2017 (pre-disaster) and 2018 (post-disaster) and further merged the data with 15 Centers for Disease Control and Prevention Social Vulnerability Index factors to examine the moderating impact of county-level vulnerabilities. Latent class analysis was used to identify patterns of disaster preparedness based on six preparedness items defined by FEMA with a total of 10,045 individuals. Three groups were identified and named basic preparedness (BP) group, high preparedness: socially engaged (HP-SE) group, and high preparedness: advanced socially engaged (HP-ASE) group. A working sample with a smaller sample size was constructed to include 2,179 individuals from 92 counties with disaster declarations of Hurricane Harvey, Hurricane Irma, Hurricane Maria, Hurricane Nate, and California Wildfires in 2017. Multinomial logistic regression indicated that post-disaster respondents were more likely to be in the HP-SE relative to the BP group. Two-level multinomial logistic regression showed that post-disaster respondents in communities with higher percentages of single-parent households and those of no vehicles were less likely to be in the HP-SE vs. the BP group. Post-disaster respondents in communities with higher percentages of unemployment, no high school diploma, and occupied housing units with more people than rooms were less likely to be in the HP-ASE vs. the BP group. Post-disaster respondents in communities with higher percentages of older adults and mobile homes were more likely to be in the HP-SE vs. the BP group. The findings also highlighted the importance of social engagement in disaster preparedness disparities and the need for community-level intervention to promote individuals' disaster preparedness.

Measuring resilience and stress during pregnancy and its relation to vulnerability and pregnancy outcomes in a nulliparous cohort study

BACKGROUND

Resilience reflects coping with pregnancy-specific stress, including physiological adaptations of the maternal organism or factors arising from the socioeconomic context, such as low income, domestic violence, drug and alcohol use, lack of a support network and other vulnerability characteristics. Resilience is a dynamic characteristic that should be comparatively evaluated within a specific context; its association with perceived stress and social vulnerability during pregnancy is still not fully understood. This study aimed at exploring maternal resilience, perceived stress and social vulnerability during pregnancy and its associated factors and outcomes.

METHODS

Prospective multicenter cohort study of nulliparous women in Brazil determining resilience (Resilience Scale; RS) and stress (Perceived Stress Scale; PSS) at 28 weeks of gestation (± 1 week). Resilience and stress scores were compared according to sociodemographic characteristics related to maternal/perinatal outcomes and social vulnerability, defined as having low level of education, being adolescent, without a partner or ethnicity other than white.

RESULTS

We included 383 women who completed the RS and PSS instruments. Most women showed low resilience scores (median: 124.0; IQR 98-143). Women with a low resilience score (RS < 125) were more likely from the Northeast region, adolescents, other than whites, did not study or work, had a low level of education, low family income and received public antenatal care. Higher scores of perceived stress were shown in the Northeast, other than whites, at low levels of education, low annual family income and public antenatal care. Pregnant women with low resilience scores (n = 198) had higher perceived stress scores (median = 28) and at least one vulnerability criterion (n = 181; 91.4%).

CONCLUSION

Our results reinforce the role of resilience in protecting women from vulnerability and perceived stress. It may prevent complications and build a positive experience during pregnancy.

A neighborhood-level analysis of association between social vulnerability and COVID-19 in ahvaz, Iran

Social vulnerability and society's resilience are two concepts frequently used to examine the capacity of social systems to prepare, absorb, and adapt to environmental hazards and shocks. With the emergence of the COVID-19 pandemic, the role of social vulnerability in dealing with risks has gained renewed attention. Assessing social vulnerability can help managers and planners prioritize budgets, develop prevention programs, and enhance risk preparedness. This study aimed to determine the association between social vulnerability and COVID-19 in the neighborhoods of Ahvaz, Iran. To assess the social vulnerability of Ahvaz neighborhoods, decision-making techniques (best-worst method and weighted aggregated sum product assessment method) and geographic information systems were applied. Moreover, to investigate the relationship between social vulnerability and COVID-19 cases, the Pearson correlation test was used. The results showed that the '20-meteri shahrdari' neighborhood has the highest level of social vulnerability, and the lowest level of social vulnerability among the neighborhoods of Ahvaz belongs to the neighborhood of 'Shahrak Naft'. There is a low inverse association between the integrated index of social vulnerability and the incidence of COVID-19 per 1000 people in Ahvaz. By revealing the most important details at the neighborhood level and levels of vulnerability, the results can inform effective planning actions at the neighborhood level.

Identifying Optimal Locations for Potential Temporary Community Clinics During Public Health Emergencies

OBJECTIVES

This article argues that community healthcare clinics managed by dedicated medical professionals who are familiar with the special needs of the local community may serve as effective alternatives to centralized hospitals and medical facilities, which may be disconnected from these local communities.

BACKGROUND

The literature indicates that socioeconomic factors that affect an individual's ability to seek medical help when needed can cause vulnerability to public health emergencies. These factors include belonging to lower income populations, being African American, being dependent due to age (below 18 or above 65) or disability, being an immigrant, English-language ability, access to transportation means, and the strength of an individual's social network.

METHOD

This study aims at developing a multifaceted methodology to identify optimal locations for deployment of temporary healthcare clinics to address health disparity issues among socially vulnerable populations, especially during pandemics and public health crises. This case study looks at the Health Enterprise Zone (HEZ) in Baltimore and ranks Census tracts based on their vulnerability, using two novel health vulnerability indices and considering their locations.

RESULTS

Using the proposed methodology, the optimal tracts within the HEZ are identified as potential locations for deploying temporary healthcare clinics.

CONCLUSION

The analysis of vulnerabilities to public health emergencies based on socioeconomic factors can assist in identifying potential locations for setting up temporary healthcare clinics with the goal of assisting socially vulnerable populations during outbreaks and pandemics.

A county-level analysis of association between social vulnerability and COVID-19 cases in Khuzestan Province, Iran

Social vulnerability is related to the differential abilities of socio-economic groups to withstand and respond to the adverse impacts of hazards and stressors. COVID-19, as a human risk, is influenced by and contributes to social vulnerability. The purpose of this study was to examine the association between social vulnerability and the prevalence of COVID-19 infection in the counties of Khuzestan province, Iran. To determine the social vulnerability of the counties in the Khuzestan province, decision-making techniques and geographic information systems were employed. Also, the Pearson correlation was used to examine the relationship between the two variables. The findings indicate that Ahvaz county and the province's northeastern counties have the highest levels of social vulnerability. There was no significant link between the social vulnerability index of the counties and the rate of COVID-19 cases (per 1000 persons). We argue that all counties in the province should implement and pursue COVID-19 control programs and policies. This is particularly essential for counties with greater rates of social vulnerability and COVID-19 cases.

Measuring Community Resilience and Its Determinants: Relocated Vulnerable Community in Western China

With the full implementation of poverty alleviation resettlement (PAR), the restoration and improvement of the comprehensive living standards of relocated households have received increasing attention from policy researchers. The measurement of resilience and its determinants provides new ideas for PAR at the community level. This article proposes a method for examining community resilience in the context of PAR through a survey of 459 relocated households in western China and uses regression analysis to identify the determinants of community resilience. The results showed that the four dimensions of community resilience, in descending order, included: environmental resilience, economic resilience, management resilience, and social resilience. Income level and livelihood diversification were positively correlated with the community resilience index. Relocation time, relocation type, and resettlement mode were all essential determinants of the community resilience of relocated households. Finally, some suggestions were put forward, such as the need to build an interpersonal relationship network, guide pure farmers and non-farmers to transform into diversified livelihood households, and formulate a unified community action plan and interest protection mechanism so as to provide a reference for decision-making among managers to make decisions.

Social Vulnerability and COVID-19 Vaccine in Spain

Different analyses show that the design of vaccination policies should especially protect the most vulnerable social groups, since the level of acceptance is determined by the population's knowledge, attitude and concerns about the safety and efficacy of vaccines. The objective of this work will be to detect the most socially vulnerable groups with respect to COVID-19 and to analyze the factors that influence predisposition to vaccination. This is a cross-sectional study using data from the Centro de Investigaciones Sociológicas (CIS) on the Effects and Consequences of Coronavirus (Study 3346 of December 2021). Sociodemographic variables (sex, age, employment status, studies and subjective class identification) were extracted, as well as the answers to the questions indicating the attitude towards vaccination, corresponding to questions 7,8,10 and 11 of the study. The most vulnerable group was lower class women (self-perceived), under 45 years of age with lower educational level, unemployed or performing unpaid work in the home. Most of them are not predisposed to vaccinate only because of the obligation to do so, mainly due to lack of belief in the power and efficacy of vaccines, as well as fear of health risks/collateral side effects. The lower vaccine uptake in this vulnerable population group may be due to a lack of awareness and lower trust in the authorities, as well as the benefits of the vaccine, which could be related to a lack of policy targeting the most socially vulnerable populations.

Degree and direction of overlap between social vulnerability and community resilience measurements

An ongoing debate in academic and practitioner communities, centers on the measurement similarities and differences between social vulnerability and community resilience. More specifically, many see social vulnerability and community resilience measurements as conceptually and empirically the same. Only through a critical and comparative assessment can we ascertain the extent to which these measurement schemas empirically relate to one another. This paper uses two well-known indices—the social vulnerability index (SoVI) and the Baseline Resilience Indicators for Communities (BRIC) to address the topic. The paper employs spatio-temporal correlations to test for differences or divergence (negative associations) and similarities or convergence (positive associations), and the degree of overlap. These tests use continental U.S. counties, two timeframes (2010 and 2015), and two case study sub-regions (to identify changes in measurement associations going from national to regional scales given the place-based nature of each index). Geospatial analytics indicate a divergence with little overlap between SoVI and BRIC measurements, based on low negative correlation coefficients (around 30%) for both time periods. There is some spatial variability in measurement overlap, but less than 2% of counties show hot spot clustering of correlations of more than 50% in either year. The strongest overlap and divergence in both years occurs in few counties in California, Arizona, and Maine. The degree of overlap in measurements at the regional scale is greater in the Gulf Region (39%) than in the Southeast Atlantic region (21% in 2010; 28% in 2015) suggesting more homogeneity in Gulf Coast counties based on population and place characteristics. However, in both study areas SoVI and BRIC measurements are negatively associated. Given their inclusion in the National Risk Index, both social vulnerability and resilience metrics are needed to interpret the local community capacities in natural hazards risk planning, as a vulnerable community could be highly resilient or vice versa.

Exploring spatial distribution of social vulnerability and its relationship with the Coronavirus disease 2019: the Capital region of South Korea

Background & objective

The ongoing coronavirus disease 2019 (COVID-19) pandemic continues to cause death and socioeconomic problems worldwide. This study examined the spatial distribution of social vulnerability to COVID-19 and its relationship with the number of confirmed COVID-19 cases in 2020, focusing on the Capital region of South Korea.

Methods

A traditional social vulnerability index (SVI), healthy SVI, and the difference of each SVI were constructed in 2015 and 2019. The traditional SVI was constructed across five domains: age, socioeconomic disadvantage, housing, income, and environment. The healthy SVI domains were: prevention, health-related habits, chronic disease, healthcare infrastructure, and mortality. The spatial distribution of the traditional SVI, healthy SVI, and confirmed cases of COVID-19 was explored using ArcGIS 10.5. Pearson correlation was used to identify the relationship between confirmed COVID-19 cases and the two SVIs and their changes between 2015 and 2019. Four multiple linear regression models were used to identify the impact of the changes of the two SVIs on the confirmed COVID-19 cases for the three episodes and total period with control of population using STATA/MP 16.1.

Results

Confirmed COVID-19 cases were concentrated in a specific area of the Capital region. The traditional SVI was more vulnerable in the outer regions of the Capital region, and some central, western, and eastern areas reflected an increase in vulnerability. Healthy SVI was more vulnerable in the northern part of the Capital region, and increase in vulnerability showed in some central areas above Seoul. By multiple regression with the population controlled, the difference of the traditional SVI between 2015 and 2019 showed a positive relationship with the confirmed COVID-19 cases in all models at a significance level of 0.05, and the 2019 integrated SVI showed a negative relationship with confirmed COVID-19 cases in all models.

Conclusions

The results of this study showed that the confirmed COVID-19 cases are associated with increased traditional SVI vulnerability between 2015 and 2019 and have a high positive relationship with the spread of COVID-19. Policy efforts are needed to reduce confirmed COVID-19 cases among the vulnerable in regions with relatively increased traditional SVI.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14212-7.

Societal vulnerability in the context of population aging-Perceptions of healthcare students' in Saudi Arabia

Background and objective

Healthcare professionals have an important role in increasing awareness and protecting populations from natural disasters. This study aimed to assess the perception of healthcare students toward societal vulnerability in the context of population aging.

Methods

This is a cross-sectional questionnaire-based study conducted among students from two different health colleges over 4 months from February to May 2021. Descriptive analysis was used to assess the perception, and inferential testing was used to assess the various association of knowledge toward societal vulnerability using SPSS.

Results

The majority of respondents were male (69.2%), between 20 and 24 years of age (91.2%), and studying for a nursing degree (76.6%). Only 4.7% had previously completed a previous degree. The mean score of perceptions on the Aging and Disaster Vulnerability Scale among nursing students was 42.5 ± 10.3 (0-65) while for paramedicine 48.1 ± 9.7 (0-65). Similarly, the mean score among male students was 44.1 ±10.5. The mean PADVS total score for the cohort was 43.8 (SD = 10.5). The mean PADVS total score for nursing students was significantly lower than paramedic students (42.5 vs. 48.1; p < 0.001). There was no correlation between PADVS total score and gender, age, area of residence, or previous degree.

Conclusion

Our results indicate that Saudi healthcare students perceive older adults are somewhat vulnerable to disasters with significant differences between nursing and paramedic students. Furthermore, we suggest informing emergency services disaster response planning processes about educational intervention to overcome disasters in Saudi Arabia and other countries.

Gray Measure and Spatial Distribution Exploration of Local Emergency Resilience on Compound Disasters

The complexity and uncertainty of compound disasters highlight the significance of local emergency resilience. This paper puts forward a framework, including the Projection Pursuit Model based on Real-coded Accelerating Genetic Algorithm and the Moran's Index (Moran's I), to measure the local emergency resilience and analyze its spatial distribution. An empirical test is conducted with the case of Hubei Province, China. The results show that: (1) the measurement indices related to infrastructure, material reserves, and resource allocation have a larger weight, while those related to personnel and their practice have a smaller weight. (2) The measurement value of local emergency resilience of sub-provincial regions in Hubei Province is vital in the eastern and weak in the western, and there are apparent east-west segmentation and north-south aggregation characteristics. (3) Although the sub-provincial regions do not show significant spatial correlation, the eastern regions centered on Wuhan are negatively correlated, and the western regions are positively correlated. Furthermore, this study provides theories and methods for local emergency resilience evaluation and spatial correlation exploration, and it has specific guidance recommendations for optimizing local emergency management resource allocation and improving local emergency resilience.

Assessing inequities underlying racial disparities of COVID-19 mortality in Louisiana parishes

High COVID-19 mortality among Black communities heightened the pandemic's devastation. In the state of Louisiana, the racial disparity associated with COVID-19 mortality was significant; Black Americans accounted for 50% of known COVID-19-related deaths while representing only 32% of the state's population. In this paper, we argue that structural racism resulted in a synergistic framework of cumulatively negative determinants of health that ultimately affected COVID-19 deaths in Louisiana Black communities. We identify the spatial distribution of social, environmental, and economic stressors across Louisiana parishes using hot spot analysis to develop aggregate stressors. Further, we examine the correlation between stressors, cumulative health risks, COVID-19 mortality, and the size of Black populations throughout Louisiana. We hypothesized that parishes with larger Black populations (percentages) would have larger stressor values and higher cumulative health risks as well as increased COVID-19 mortality rates. Our results suggest two categories of parishes. The first group has moderate levels of aggregate stress, high population densities, predominately Black populations, and high COVID-19 mortality. The second group of parishes has high aggregate stress, lower population densities, predominantly Black populations, and initially low COVID-19 mortality that increased over time. Our results suggest that structural racism and inequities led to severe disparities in initial COVID-19 effects among highly populated Black Louisiana communities and that as the virus moved into less densely populated Black communities, similar trends emerged.

Solidarity, not charity: Learning the lessons of the COVID-19 pandemic to reconceptualise the radicality of mutual aid

The COVID-19 pandemic has significantly ruptured our global society. We have seen health care systems, governments and commerce buckle under the strain of disease, lockdowns and unrest, but the rupture has also created space for radical (and anarchist) politics of mutual aid, as societal organising principles, to move into a more prominent position (and offers potential for this shift to remain after the crisis has subsided). However, in the short time since mutual aid has been thrust into the limelight, we have seen a multiplicity and spectrum of geographies, applications and approaches. Indeed, we have also seen its appropriation by government(s) that takes advantage of mutual aid's rallying cry of "solidarity not charity"; absolving the state's responsibilities to sufficiently fund social welfare when good neighbours will do it for free. In this paper we map out how mutual aid has been enacted during the COVID-19 pandemic by charity, contributory and radical groups to address specific and novel forms of vulnerabilities, and the opportunities and challenges this offers for the future. In particular we highlight potential tensions between the enacting of mutual aid practices and the political activism (or not) of the mutual aid actors. Our contribution is to reconceptualise mutual aid to (i) show where the real "mutualism" of mutual aid is, and (ii) create a better understanding of how mutual aid can be mobilised in future emergencies which will inevitably arise in the current climate emergency.

Socio-demographic backwardness in cyclone prone coastal villages: An Insight from Indian Sundarban

The capability to design for, respond to, and recover from natural hazards is much influenced by demographic and socio-economic vulnerability of the region. Triggering effect of cyclone induced multi-hazards in the coastal areas of West Bengal, India makes the life and livelihood of people miserable. Very recent cyclones, like, Fani, Bulbul, Amphan and Yaas make people much more susceptible to hazard with the evil impact of on-going pandemic. According to IPCC, sensitivity and adaptive capacity analysis at micro level is taking much importance to address the readiness situation of the region. In this backdrop, the study aims to assess and map the level of demographic and socio-economic backwardness at village level for Kakdwip coastal area under coastal West Bengal, India. Applying principal component analysis we have tried to find out the level of demographic and socio-economic backwardness at different geographical locations (categorise as inland, riverine/ estuarine, coastal and island). The final findings suggest that backwardness is more prevalent in the southern part of the research region, with island and riverine/ estuary villages being particularly vulnerable. When the results have tries to find out the triggering factors at different geographical locations, female and child population, land holdings and earning of household came as the dominant factors for such higher degree of backwardness. These findings, when combined with micro level assessments, could help village administrators, planners and policymakers, and emergency managers design more effective and spatially tailored backwardness management plans.

Effects of Urban Landscape and Sociodemographic Characteristics on Heat-Related Health Using Emergency Medical Service Incidents

It is well known that extremely hot weather causes heat-related health issues. Health problems, especially in urban areas, are becoming increasingly important due to urban heat island effect. Understanding the impact of neighborhood characteristics is important for research into the relationship between thermal environment and human health. The objectives of this study were to explore the urban landscape and sociodemographic characteristics affecting heat-related health and identify spatial inequalities for vulnerable groups. A total of 27,807 heat-related EMS incidents were used at the census block group level (N = 285). We used land cover database and Landsat satellite images for urban landscape variables and used 2019 U.S. Census data for sociodemographic variables. Negative binomial regression was used to identify the neighborhood variables associated with the heat-related EMS incidents in each block group. Heat-related health has been alleviated in block groups with high green areas. However, the negative effects of thermal environments on human health were higher in areas with a high percentage of impervious surface, over 65 years, non-white people, no high school diploma, or unemployment. The results indicate that heat-related health problems can be addressed through prevention strategies for block group variables. Local intervention efforts to solve health issues should be targeted at more vulnerable areas and groups.

Assessing Community Disaster Resilience in Flood-Prone Areas of Bangladesh: From a Gender Lens

The main purpose of this study was to assess the level of community flood resilience with a special focus on gender. A gender perspective ensures the representation of diversified voices in the study. From concept development to data representation, all the steps were completed ensuring gender-based inclusion. Both quantitative and qualitative approaches were used to conduct the study. A total of 402 responses were analyzed as the sample. A linear structured questionnaire was developed by using a five-point Likert scale to collect quantitative data. As part of the qualitative tool, in-depth observation was used in the study. The study found that female members of the community lag in terms of disaster resilience comparing to their male counterparts. The scores in different components of resilience assessment framework indicate that there are gaps in terms of level of resilience from the gender perspective. The same disaster can create a disproportionate level of impact on women and men due to an unequal level of resilience. The study indicates that assessing community disaster resilience and introducing resilience enhancement interventions should focus on a gender-based approach.

Social vulnerability and county stay-at-home behavior during COVID-19 stay-at-home orders, United States, April 7-April 20, 2020

PURPOSE

Early COVID-19 mitigation relied on people staying home except for essential trips. The ability to stay home may differ by sociodemographic factors. We analyzed how factors related to social vulnerability impact a community's ability to stay home during a stay-at-home order.

METHODS

Using generalized, linear mixed models stratified by stay-at-home order (mandatory or not mandatory), we analyzed county-level stay-at-home behavior (inferred from mobile devices) during a period when a majority of United States counties had stay-at-home orders (April 7-April 20, 2020) with the Centers for Disease Control and Prevention Social Vulnerability Index (CDC SVI).

RESULTS

Counties with higher percentages of single-parent households, mobile homes, and persons with lower educational attainment were associated with lower stay-at-home behavior compared with counties with lower respective percentages. Counties with higher unemployment, higher percentages of limited-English-language speakers, and more multi-unit housing were associated with increases in stay-at-home behavior compared with counties with lower respective percentages. Stronger effects were found in counties with mandatory orders.

CONCLUSIONS

Sociodemographic factors impact a community's ability to stay home during COVID-19 stay-at-home orders. Communities with higher social vulnerability may have more essential workers without work-from-home options or fewer resources to stay home for extended periods, which may increase risk for COVID-19. Results are useful for tailoring messaging, COVID-19 vaccine delivery, and public health responses to future outbreaks.

Social vulnerability and the impact of policy responses to COVID-19 on disabled people

In this paper, we propose a conceptual framework for understanding the impact of the policy responses to COVID-19 on disabled people. These responses have overwhelmingly focused on individual vulnerability, which has been used as a justification for removing or restricting rights. This suggests the need to shift the attention towards the social determinants of disabled people's vulnerability. We do this by bringing literature on social vulnerability in disaster risk management or 'disaster studies' in contact with key concepts in disability studies such as the social model of disability, independent living, intersectionality, and biopower. Empirically, we draw on the findings of the global COVID-19 Disability Rights Monitor (www.covid-drm.org), as well as on reports from academic journals, civil society publications, and internet blogs. We put the proposed conceptual framework to work by developing a critical analysis of COVID-19 policies in three interrelated areas-institutional treatment and confinement of disabled people, intersectional harms, and access to health care. Our conclusion links this analysis with strategies to address disabled people's social vulnerability in post-pandemic reconstruction efforts. We make a case for policies that address the social, economic, and environmental conditions that disproportionately expose disabled people to natural disasters and hazards.

Rethinking the design of resilience and adaptation indicators supporting coastal communities

As resilience and adaptation considerations become mainstreamed into public policy, there is an overarching desire to measure and quantify metrics and indicators that seek to evaluate the efficiency, effectiveness, and justness associated with outcomes of such processes. While much research has sought to develop specific indicators that may serve as proxies for these considerations, less research has focused on those normative aspects of indicator design that support a variety of goals associated with the accuracy, reproducibility, proxy value and multi-stakeholder translation of indicators, among various other goals and values. This perspective article sets forth a range of potential considerations that may be useful for those who seek to design and develop novel resilience and adaptation indicators ("RAIs"). These considerations are explored through a range of hypothetical examples that may be applicable to coastal communities that seek to address the practical challenges facing the design, execution, management and modification of RAIs.

Social Vulnerability Indices as a Risk Factor for Heart Failure Readmissions

Objectives: The objective of our study was to use the parameters of social vulnerability index (SVI) to observe their association with the 30-day hospital readmissions in the heart failure population.Methods: Data required for analysis were extracted from the electronic medical record. The geographic SVI data was then merged with the clinical data. Qualitative variables and reported as frequency and quantitative variables and reported as the mean ± standard deviation. Variables from univariate analysis with a P value of ≤ 0.10 were evaluated using multivariate logistic regression with stepwise backward variable selection and receiver operating curve (ROC) analysis.Results: The odds ratio of readmission predicted by HOSPITAL score was 1.137 (P value = 0.004, 95% CI = 1.041-1.241). SVI parameter recording disability showed odds ratio of 1.521 (P value = 0.006, 95% CI = 1.125-2.058) and SVI parameter tracking vehicle ownership showed odds ratio of 15.355 (P value = 0.014, 95% CI = 1.755 - 134.383). The ROCs were generated for three scenarios: (i) HOSPITAL score only which had area under the curve (AUC) of 0.702 (P value = 0.015), (ii) SVI indicators tracking vehicle ownership and disability resulted in the AUC of 0.589 (P value = 0.016), and (iii) all of the above combined increased the AUC increased to 0.718 (P value = 0.015).Conclusions: Two social parameters (limited vehicle access and prevalence of disability) from the SVI showed a strong association with 30-day hospital readmissions.

Spatial Disparities of COVID-19 Cases and Fatalities in United States Counties

This paper examines the spatial and temporal trends in county-level COVID-19 cases and fatalities in the United States during the first year of the pandemic (January 2020–January 2021). Statistical and geospatial analyses highlight greater impacts in the Great Plains, Southwestern and Southern regions based on cases and fatalities per 100,000 population. Significant case and fatality spatial clusters were most prevalent between November 2020 and January 2021. Distinct urban–rural differences in COVID-19 experiences uncovered higher rural cases and fatalities per 100,000 population and fewer government mitigation actions enacted in rural counties. High levels of social vulnerability and the absence of mitigation policies were significantly associated with higher fatalities, while existing community resilience had more influential spatial explanatory power. Using differences in percentage unemployment changes between 2019 and 2020 as a proxy for pre-emergent recovery revealed urban counties were hit harder in the early months of the pandemic, corresponding with imposed government mitigation policies. This longitudinal, place-based study confirms some early urban–rural patterns initially observed in the pandemic, as well as the disparate COVID-19 experiences among socially vulnerable populations. The results are critical in identifying geographic disparities in COVID-19 exposures and outcomes and providing the evidentiary basis for targeting pandemic recovery.

A system dynamics approach for understanding community resilience to disaster risk

The Western Cape is a dynamic province that is disaster-prone, particularly the vulnerable urban communities in and around its environs. Such communities are more vulnerable to wildfire, flooding, pandemic, natural and human-made hazards because of poverty and, consequently, poor living conditions such as overcrowding and non-understanding of community resilience. The inability of these communities to understand community resilience and withstand adversities affects the sustainability of initiatives to develop them. This study aims to identify the mechanisms influencing the level of understanding of community resilience in a vulnerable community and to contribute to the understanding of community resilience to disaster risk. Fieldwork was conducted in an informal settlement in South Africa. The research study was conducted in two cycles of data collection and analysis. Data in the form of observation notes, document analysis and interviews were analysed using grounded-theory principles. Ten inter-related variables or mechanisms emerged from the analysis. The theoretical model consists of four reinforcing (R) feedback loops (R1, R2, R3 and R4), respectively, which explain how the understanding of community resilience in the informal settlement maps on to the relative achievement systems archetype. Negative reinforcing behaviour would explain the lack of understanding of community resilience, while positive reinforcing behaviour indicates how an understanding of community resilience develops. In addition, the variable with the leverage to improve the mechanisms influencing the understanding of community resilience was found to be the 'level of public education and awareness'. The theory of how these variables behave in context was represented as a qualitative system dynamics model.

Alleviating Environmental Health Disparities Through Community Science and Data Integration

Environmental contamination is a fundamental determinant of health and well-being, and when the environment is compromised, vulnerabilities are generated. The complex challenges associated with environmental health and food security are influenced by current and emerging political, social, economic, and environmental contexts. To solve these “wicked” dilemmas, disparate public health surveillance efforts are conducted by local, state, and federal agencies. More recently, citizen/community science (CS) monitoring efforts are providing site-specific data. One of the biggest challenges in using these government datasets, let alone incorporating CS data, for a holistic assessment of environmental exposure is data management and interoperability. To facilitate a more holistic perspective and approach to solution generation, we have developed a method to provide a common data model that will allow environmental health researchers working at different scales and research domains to exchange data and ask new questions. We anticipate that this method will help to address environmental health disparities, which are unjust and avoidable, while ensuring CS datasets are ethically integrated to achieve environmental justice. Specifically, we used a transdisciplinary research framework to develop a methodology to integrate CS data with existing governmental environmental monitoring and social attribute data (vulnerability and resilience variables) that span across 10 different federal and state agencies. A key challenge in integrating such different datasets is the lack of widely adopted ontologies for vulnerability and resiliency factors. In addition to following the best practice of submitting new term requests to existing ontologies to fill gaps, we have also created an application ontology, the Superfund Research Project Data Interface Ontology (SRPDIO).

Capturing Disruptions to Food Availability After Disasters: Assessing the Food Environment Following Hurricanes Florence and María

OBJECTIVE

The aim of this study was to describe the results of food environment assessments completed after Hurricane Florence in North Carolina (2018) and Hurricane María in Puerto Rico (2017), and provide recommendations for assessing disaster food environments.

METHODS

Adapted structured observation protocols were used to conduct rapid assessments of the availability, price, and quality of specific foods in retail markets.

RESULTS

In both settings, unhealthful food items (soda, chips, fruit-flavored drinks) and milk were widely available and at lower prices than domestic averages. The adapted instrument in Puerto Rico allowed for documentation of greater availability of canned items compared with fresh or frozen foods. In both settings, researchers noted the inability of the instrument to document items that are important to assess postdisaster: ready-to-heat and ready-to-eat foods; food preparation facilities and supplies; hygiene supplies; and empty shelf-space.

CONCLUSIONS

The instruments, despite their limitations, were able to capture food availability issues in postdisaster environments. Future instrument adaptation is necessary to capture availability of all major food groups, healthful and unhealthful options, shelf-stable, ready-to-eat, and ready-to-heat foods versus other formats (fresh, frozen), and cooking and hygiene supplies.

Developing indices to identify hotspots of skin cancer vulnerability among the Non-Hispanic White population in the United States

PURPOSE

Skin cancer is the most common, yet oftentimes preventable, cancer type in the United States. Exposure to ultraviolet radiation from sunlight is the most prominent environmental risk factor for skin cancer. Besides environmental exposure, demographic characteristics such as race, age, and socioeconomic status may make some groups more vulnerable. An exploratory spatial clustering method is described for identifying clusters of vulnerability to skin cancer incidence and mortality based on composite indices, which combine data from environmental and demographic risk factors.

METHODS

Based on county-level ultraviolet data and demographic risk factors, two vulnerability indices for skin cancer were generated using an additive percentile rank approach. With these indices, univariate local Moran's I spatial autocorrelation identified significant clusters, or hotspots, of neighboring counties with high overall vulnerability indices. Clusters were identified separately for skin cancer incidence and mortality.

RESULTS

Counties with high vulnerabilities were spatially distributed across the United States in a pattern that generally increased to the South and West. Clusters of counties with high skin cancer incidence vulnerability were mostly observed in Utah and Colorado, even with highly conservative levels of significance. Meanwhile, clusters for skin cancer mortality vulnerability were observed in southern Alabama and west Florida as well as across north Alabama, north Georgia and up through the Tennessee-North Carolina area.

CONCLUSIONS

Future skin cancer research and screening initiatives may use these innovative composite vulnerability indices and identified clusters to better target resources based on anticipated risk from underlying demographic and environmental factors.

Resilience Perception of a Mining Town in Eastern Amazonia: A Case Study of Canaã Dos Carajás, Brazil

The ability of communities to react to risks and disturbances is for their balance, development, and sustainability. The concept of resilience provides a way to think about policies and actions for future changes in socioeconomic and ecological-environmental systems. This paper analyzes, in the context of mining, the perception of the resilience of Canaã dos Carajás population in Pará State, Brazilian Amazon. The methodology involved face-to-face interviews based on a structured questionnaire conducted on a sample of 140 residents stratified from 11 social actors in the Canaã community. This approach allowed the evaluation of resilience perception using 26 interview statements derived from six resilience theories. Our multivariate analysis found that the level of residents' perception of resilience was reasonable (with an average score of 3.04 ± 0.22 using a Likert scale, with a Cronbach's alpha of 0.788). The interviewees pointed out one positive and five negative factors that influenced the level of resilience in Canaã. According to residents' perceptions, the resilience of Canaã dos Carajás was moderate but could have been improved with more economic diversification, more infrastructure, and less inequality in access to services and participation in decision-making. The considered most relevant themes were problems caused by mining in the municipality, quality of life issues, difficulties dealing with change after the arrival of mining, and economic problems. This study contributes to the literature because it used theories as a conceptual orientation for the development of a resilience scale to measure resilience at the community level in the context of large-scale mining.

The CHASMS conceptual model of cascading disasters and social vulnerability: The COVID-19 case example

Complex environmental, economic, and social conditions in the places we live provide strong cues to our longevity, livelihood, and well-being. Although often distinct and evolving relatively independently, health disparity, social vulnerability and environmental justice research and practice intertwine and inform one another. Together, they increasingly provide evidence of how social processes intensify disasters almost predictably giving rise to inequitable disruptions and consequences. The domino and cumulative effects of cascading disasters invariably reveal inequities through differential impacts and recovery opportunities across communities and subgroups of people. Not only do cascading disasters reveal and produce inequitable effects, the cascade itself can emerge out of compounded nested social structures. Drawing on, and integrating, theory and practice from social vulnerability, health inequity, and environmental justice, this paper presents a comprehensive conceptual model of cascading disasters that offers a people-centric lens. The CHASMS conceptual model (Cascading Hazards to disAsters that are Socially constructed eMerging out of Social Vulnerability) interrogates the tension between local communities and the larger structural forces that produce social inequities at multiple levels, capturing how those inequities lead to cascading disasters. We apply the model to COVID-19 as an illustration of how underlying inequities give rise to foreseeable inequitable outcomes, emphasizing the U.S. experience. We offer Kenya and Puerto Rico as examples of cumulative effects and possible cascades when responding to other events in the shadow of COVID-19. COVID-19 has vividly exposed the dynamic, complex, and intense relevance of placing social conditions and structures at the forefront of cascading disaster inquiry and practice. The intensity of social disruption and the continuation of the pandemic will, no doubt, perpetuate and magnify chasms of injustice.

Risk screening methods for extreme heat: Implications for equity-oriented adaptation

Morbidity and mortality impacts of extreme heat amplified by climate change will be unequally distributed among communities given pre-existing differences in socioeconomic, health, and environmental conditions. Many governments are interested in adaptation policies that target those especially vulnerable to the risks, but there are important questions about how to effectively identify and support communities most in need of heat adaptations. Here, we use an equity-oriented adaptation program from the state of California as a case study to evaluate the implications of the currently used environmental justice index (CalEnviroScreen 3.0) for the identification of socially vulnerable communities with climate change adaptation needs. As CalEnviroScreen is geared towards air and water pollution, we assess how community heat risks and adaptation needs would be evaluated differently under two more adaptation-relevant vulnerability indices: the Social Vulnerability Index and the Heat-Health Action Index. Our analysis considers communities at the census tract scale, as well as the patterns emerging at the regional scale. Using the current index, the state designates 25% of its census tracts as “disadvantaged” communities eligible for special adaptation funds. However, an additional 12.6% of the state’s communities could be considered vulnerable if the two other indices were considered instead. Only 13.4% of communities are vulnerable across all three vulnerability indices studied. Choice of vulnerability index shapes statewide trends in extreme heat risk and is linked to a community’s likelihood of receiving heat-related California Climate Investments (CCI) projects. Tracts that are vulnerable under the current pollution-focused index, but not under the heat-health specific index, received four times the number of heat-related interventions as tracts vulnerable under the reverse scenario. This study demonstrates important nuances relevant to implementing equity-oriented adaptation and explores the challenges, trade-offs, and opportunities in quantifying vulnerability.

Social Vulnerability and Racial Inequality in COVID-19 Deaths in Chicago

Although the current COVID-19 crisis is felt globally, at the local level, COVID-19 has disproportionately affected poor, highly segregated African American communities in Chicago. To understand the emerging pattern of racial inequality in the effects of COVID-19, we examined the relative burden of social vulnerability and health risk factors. We found significant spatial clusters of social vulnerability and risk factors, both of which are significantly associated with the increased COVID-19-related death rate. We also found that a higher percentage of African Americans was associated with increased levels of social vulnerability and risk factors. In addition, the proportion of African American residents has an independent effect on the COVID-19 death rate. We argue that existing inequity is often highlighted in emergency conditions. The disproportionate effects of COVID-19 in African American communities are a reflection of racial inequality and social exclusion that existed before the COVID-19 crisis.

Gunshot wound incidence as a persistent, tragic symptom of area deprivation

BACKGROUND

More than 30,000 Americans die every year of firearm-related injuries. Gun violence is frequently addressed by law enforcement and policing, as opposed to public health interventions that might address poverty or deprivation. Our goal was to evaluate the past 20 years of gunshot wound injury demographics seen at our level I academic trauma center and create a risk map model correlating gunshot wound incidence with area deprivation.

METHODS

Patients admitted for gunshot wound-related injuries between 1996 and 2017 were identified using our trauma registry. Demographic and injury data were extracted and analyzed. Multivariable logistic regression models were created to identify predictors of mortality. Geographic information system mapping of incident location and home address was completed to identify zip code hot spots of high gunshot wound incidence. Area Deprivation Indices, which reflect local income or poverty, housing, education, and employment were used as a marker of relative economic disadvantage. Spearman rank correlation was used to determine the relationship between Area Deprivation Indices score and gunshot wound rate.

RESULTS

A total of 2,413 patients with gunshot wounds were evaluated. The cohort had a mean age of 28.8 ± 11.5 and was 89.6% male. Mean Injury Severity Score was 11 ± 12.5. gunshot wounds were most frequently a result of assault (91.1%), followed by unintentional injury (3.4%). Geographic information systems mapping revealed significant clustering of gunshot wounds. The areas with highest per capita incidence of gunshot wounds was strongly correlated with Area Deprivation Indices (0.594, P < .001).

CONCLUSION

Geographic regions of known lower socioeconomic resources have higher incidence of gunshot wounds in our community. Both Area Deprivation Indices and gunshot wound incidents in these distressed communities remained unchanged throughout the past 20 years, despite law enforcement crime suppression efforts. Gunshot wounds appear to be a symptom of area deprivation, similar to failing schools and poor health outcomes. Efforts to decrease poverty and community capacity-building may help alleviate this area deprivation.

Community Susceptibility and Resiliency to COVID-19 Across the Rural-Urban Continuum in the United States

Purpose

This study creates a COVID‐19 susceptibility scale at the county level, describes its components, and then assesses the health and socioeconomic resiliency of susceptible places across the rural‐urban continuum.

Methods

Factor analysis grouped 11 indicators into 7 distinct susceptibility factors for 3,079 counties in the conterminous United States. Unconditional mean differences are assessed using a multivariate general linear model. Data from 2018 are primarily taken from the US Census Bureau and CDC.

Results

About 33% of rural counties are highly susceptible to COVID‐19, driven by older and health‐compromised populations, and care facilities for the elderly. Major vulnerabilities in rural counties include fewer physicians, lack of mental health services, higher disability, and more uninsured. Poor Internet access limits telemedicine. Lack of social capital and social services may hinder local pandemic recovery. Meat processing facilities drive risk in micropolitan counties. Although metropolitan counties are less susceptible due to healthier and younger populations, about 6% are at risk due to community spread from dense populations. Metropolitan vulnerabilities include minorities at higher health and diabetes risk, language barriers, being a transportation hub that helps spread infection, and acute housing distress.

Conclusions

There is an immediate need to know specific types of susceptibilities and vulnerabilities ahead of time to allow local and state health officials to plan and allocate resources accordingly. In rural areas it is essential to shelter‐in‐place vulnerable populations, whereas in large metropolitan areas general closure orders are needed to stop community spread. Pandemic response plans should address vulnerabilities.

Social Vulnerability and Racial Inequality in COVID-19 Deaths in Chicago

Although the current COVID-19 crisis is felt globally, at the local level, COVID-19 has disproportionately affected poor, highly segregated African American communities in Chicago. To understand the emerging pattern of racial inequality in the effects of COVID-19, we examined the relative burden of social vulnerability and health risk factors. We found significant spatial clusters of social vulnerability and risk factors, both of which are significantly associated with the increased COVID-19-related death rate. We also found that a higher percentage of African Americans was associated with increased levels of social vulnerability and risk factors. In addition, the proportion of African American residents has an independent effect on the COVID-19 death rate. We argue that existing inequity is often highlighted in emergency conditions. The disproportionate effects of COVID-19 in African American communities are a reflection of racial inequality and social exclusion that existed before the COVID-19 crisis.

Hybrid Resiliency-Stressor Conceptual Framework for Informing Decision Support Tools and Addressing Environmental Injustice and Health Inequities

While structural factors may drive health inequities, certain health-promoting attributes of one's "place" known as salutogens may further moderate the cumulative impacts of exposures to socio-environmental stressors that behave as pathogens. Understanding the synergistic relationship between socio-environmental stressors and resilience factors is a critical component in reducing health inequities; however, the catalyst for this concept relies on community-engaged research approaches to ultimately strengthen resiliency and promote health. Furthermore, this concept has not been fully integrated into environmental justice and cumulative risk assessment screening tools designed to identify geospatial variability in environmental factors that may be associated with health inequities. As a result, we propose a hybrid resiliency-stressor conceptual framework to inform the development of environmental justice and cumulative risk assessment screening tools that can detect environmental inequities and opportunities for resilience in vulnerable populations. We explore the relationship between actual exposures to socio-environmental stressors, perceptions of stressors, and one's physiological and psychological stress response to environmental stimuli, which collectively may perpetuate health inequities by increasing allostatic load and initiating disease onset. This comprehensive framework expands the scope of existing screening tools to inform action-based solutions that rely on community-engaged research efforts to increase resiliency and promote positive health outcomes.

Designing a Model to Display the Relation between Social Vulnerability and Anthropogenic Risk of Wildfires in Galicia, Spain

Since the beginning of the 21st century, most of the forest fires that have occured in Spain have taken place in the northern region of Galicia. This area represents 5.8% of the Spanish territory, but compromises, in certain years, up to 50% of the total number of wildfires. Current research on forest fires is focused mostly on physical or meteorological characteristics, post-fire situations, and their potential destructive capacities (main areas burnt, type of vegetation, economic loses, etc.). However, the academic research to date has not delved into other socioeconomic factors (population structure, density, livestock farms, education, among others), which compromise the existing pre-fire situation in the affected territories, and subsequently reflect the prevailing vulnerability of the population. Indeed, these socioeconomic variables can influence fire occurrence, whether positively or negatively. To fill in this knowledge gap, this article analyzes the relationship between wildfire events and the socioeconomic variables that characterize the Galician municipalities affected. To that effect, first, a thorough examination and selection of the most relevant socioeconomic variables, and their subsequent justification will be carried out. Then, using IBM SPSS statistics 24, a linear regression is executed using the data of wildfires that occurred in Galicia between 2001–2015. The resulting model allows a better knowledge of the importance of the socioeconomic situation in Galician municipalities when wildfires occur. Therefore, this result identifies the existing relationship between the socioeconomic variables and wildfire events, and consequently will help to optimize the interventions that must be done. This may be the best way to carry out prevention actions in order to reduce vulnerability to forest fires.

From Disaster Response to Community Recovery: Nongovernmental Entities, Government, and Public Health

In this article, we examine the role of nongovernmental entities (NGEs; nonprofits, religious groups, and businesses) in disaster response and recovery. Although media reports and the existing scholarly literature focus heavily on the role of governments, NGEs provide critical services related to public safety and public health after disasters. NGEs are crucial because of their ability to quickly provide services, their flexibility, and their unique capacity to reach marginalized populations. To examine the role of NGEs, we surveyed 115 NGEs engaged in disaster response. We also conducted extensive field work, completing 44 hours of semistructured interviews with staff from NGEs and government agencies in postdisaster areas in Texas, Florida, Puerto Rico, Northern California, and Southern California. Finally, we compiled quantitative data on the distribution of nonprofit organizations. We found that, in addition to high levels of variation in NGE resources across counties, NGEs face serious coordination and service delivery problems. Federal funding for expanding the capacity of local Voluntary Organizations Active in Disaster groups, we suggest, would help NGEs and government to coordinate response efforts and ensure that recoveries better address underlying social and economic vulnerabilities.

Health Care Student Perceptions of Societal Vulnerability to Disasters in the Context of Population Aging

OBJECTIVE

This paper reports on undergraduate health care students' perception of societal vulnerability to disasters in the context of population aging. Forecast increases in extreme weather events are likely to have a particularly devastating effect on older members of the community.

METHODS

Undergraduate paramedicine and nursing students were surveyed using the Perceptions of Ageing and Disaster Vulnerability Scale (PADVS) to determine their views on the risks posed to older members of the community by disasters. Data analysis included a comparison of subscales relating to isolation, health system readiness, declining function, and community inclusiveness.

RESULTS

Students reported a moderate level of concern about disaster vulnerability. Students who had previously completed another university degree reported significantly higher levels of concern than those without a prior degree. Australian students reported lower concern about societal vulnerability compared to a previously reported cohort of Japanese students.

CONCLUSION

Our study suggests current education of future health care students does not promote adequate levels of awareness of the health-related challenges posed by disasters, particularly among older members of the community. Without addressing this gap in education, the risk of negative outcomes for both unprepared first responders and older members of the community is significant. (Disaster Med Public Health Prep. 2019;13:449-455).

Community Resilience, Psychological Resilience, and Depressive Symptoms: An Examination of the Mississippi Gulf Coast 10 Years After Hurricane Katrina and 5 Years After the Deepwater Horizon Oil Spill

OBJECTIVE

This study examined the role of community resilience and psychological resilience on depressive symptoms in areas on the Mississippi Gulf Coast that have experienced multiple disasters.

METHODS

Survey administration took place in the spring of 2015 to a spatially stratified, random sample of households. This analysis included a total of 294 subjects who lived in 1 of the 3 counties of the Mississippi Gulf Coast at the time of both Hurricane Katrina in 2005 and the Deepwater Horizon oil spill in 2010. The survey included the Communities Advancing Resilience Toolkit (CART) scale, the Connor-Davidson Resilience Scale (CD-RISC 10), and the Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

There was a significant inverse relationship between psychological resilience and depressive symptoms and a significant positive relationship between community resilience and psychological resilience. The results also revealed that community resilience was indirectly related to depressive symptoms through the mediating variable of psychological resilience.

CONCLUSIONS

These findings highlight the importance of psychological resilience in long-term disaster recovery and imply that long-term recovery efforts should address factors associated with both psychological and community resilience to improve mental health outcomes. (Disaster Med Public Health Preparedness. 2018;12:241-248).

Community Capitals as Community Resilience to Climate Change: Conceptual Connections

In the last few decades, disaster risk reduction programs and climate initiatives across the globe have focused largely on the intimate connections between vulnerability, recovery, adaptation, and coping mechanisms. Recent focus, however, is increasingly paid to community resilience. Community, placed at the intersection between the household and national levels of social organization, is crucial in addressing economic, social, or environmental disturbances disrupting human security. Resilience measures a community’s capability of bouncing back—restoring the original pre-disaster state, as well as bouncing forward—the capacity to cope with emerging post-disaster situations and changes. Both the ‘bouncing back’ and ‘moving forward’ properties of a community are shaped and reshaped by internal and external shocks such as climate threats, the community’s resilience dimensions, and the intensity of economic, social, and other community capitals. This article reviews (1) the concept of resilience in relation to climate change and vulnerability; and (2) emerging perspectives on community-level impacts of climate change, resilience dimensions, and community capitals. It argues that overall resilience of a place-based community is located at the intersection of the community’s resilience dimensions, community capitals, and the level of climate disruptions.

Vulnerability assessment of atmospheric environment driven by human impacts

Atmospheric environment quality worsening is a substantial threat to public health worldwide, and in many places, air pollution due to the intensification of the human activity is increasing dramatically. However, no studies have been investigated the integration of vulnerability assessment and atmospheric environment driven by human impacts. The objective of this study was to identify and prioritize the undesirable environmental changes as an early warning system for environment managers and decision makers in term of human, atmospheric environment, and social economic elements. We conduct a vulnerability assessment method of atmospheric environment associated with human impact, this method integrates spatial context of Geographic Information System (GIS) tool, multi-criteria decision analysis (MCDA) method, ordered weighted averaging (OWA) operators under the Exposure-Sensitivity- Adaptive Capacity (ESA) framework. Decision makers can find out relevant vulnerability assessment results with different vulnerable attitudes. In the Beijing-Tianjin-Hebei (BTH) region, China, we further applied this developed method and proved it to be reliable and consistent with the China Environmental Status Bulletin. Results indicate that the vulnerability of atmospheric environment in the BTH region is not optimistic, and environment managers should do more about air pollution. Thus, the most appropriate strategic decision and development program of city or state can be picked out assisting by the vulnerable results.