"They blew the levee": distrust of authorities among Hurricane Katrina evacuees

Framing the meaning of COVID-19 and the psychological responses to it: Insights gleaned from selected theoretical approaches

This viewpoint article reviews theoretical approaches that are relevant to studying COVID-19 and the psychological reactions to it. We suggest that the published research can be viewed from four major theoretical perspectives: as a stress situation, traumatic event, shared reality/shared trauma, and loss and grief situation. We detail the terms and the main theory/ies underlying each approach and suggest how COVID-19 characteristics and the its' psychological consequences may be conceptualized in accordance with each approach. Additionally, we discuss the challenges and facets of each theoretical conceptualization that should be addressed in further research, and the necessity of exploring implications for practice.

Frontline love: Romantic partners of frontline doctors and nurses during the New York City COVID-19 outbreak

Objective

This qualitative study's aim was to learn how the spouses and romantic partners of frontline doctors and nurses dealt with the acute stress of the outbreak; the kinds of support they provided when the frontliners had to navigate COVID-19 at their hospitals; and, according to their perceptions, how this crisis impacted their relationship.

Background

This study focused on the partners of frontliners working in hospitals during the crisis of the coronavirus outbreak in New York City (NYC)-one of the earliest epicenters of the COVID-19 pandemic in the United States. This study expanded upon the Family Stress Model-which examines how economic problems can affect marital quality and stability.

Method

Interviews were conducted with 29 partners of frontliners who had been treating COVID-19 patients in NYC hospitals during the pandemic outbreak from February 29 to June 1, 2020. Partners were recruited via snowball sampling, interviewed via Zoom or telephone, and results were analyzed using thematic content analysis.

Results

The following themes were found in the narratives: The burden of running the home independently; providing various kinds of support (concrete, emotional, and refraining from sexual and physical closeness); and the effects of the pandemic on the relationship via writing a will and discussing the possibility of death, the lack of relationship-ending threats, and emerging from the crisis with a strengthened relationship.

Conclusion

The pandemic crisis unified the partners and frontliners, even in the face of multiple stressors.

Tweeting Jokes, Tweeting Hope: Humor Practices during the 2014 Ebola Outbreak

In this article, we examine how humor practices on Twitter resist dominant emotion norms during an emerging disease outbreak. Humor may seem frivolous or irreverent but can constitute a powerful practice for channeling and managing difficult emotions - like anxiety and fear - during an outbreak. We find that the use of AAVE (African-American Vernacular English) and Black cultural references were widespread in Ebola-related tweets using humor. Together these communicative practices constitute Black Twitter. Humor can signal membership in Black culture while also performing and managing specific emotions in relation to epidemic risk in online spaces. Humor practices on Black Twitter were more likely to reimagine social connections despite the risks posed by the epidemic, whereas mainstream forms of humor emphasized retreat and self-isolation in response to an epidemic threat. These findings center the agency and creativity of this influential digital community while showing the variability of communication practices among a group facing disproportionate vulnerability to outbreaks and public health threats. The implications for public health messaging are discussed.

Can Comorbidity Data Explain Cross-State and Cross-National Difference in COVID-19 Death Rates?

Many efforts to predict the impact of COVID-19 on hospitalization, intensive care unit (ICU) utilization, and mortality rely on age and comorbidities. These predictions are foundational to learning, policymaking, and planning for the pandemic, and therefore understanding the relationship between age, comorbidities, and health outcomes is critical to assessing and managing public health risks. From a US government database of 1.4 million patient records collected in May 2020, we extracted the relationships between age and number of comorbidities at the individual level to predict the likelihood of hospitalization, admission to intensive care, and death. We then applied the relationships to each US state and a selection of different countries in order to see whether they predicted observed outcome rates. We found that age and comorbidity data within these geographical regions do not explain much of the international or within-country variation in hospitalization, ICU admission, or death. Identifying alternative explanations for the limited predictive power of comorbidities and age at the population level should be considered for future research.

Utilizing Population Distribution Patterns for Disaster Vulnerability Assessment: Case of Foreign Residents in the Tokyo Metropolitan Area of Japan

Foreign residents in Japan are amongst the vulnerable groups at risk to disasters in the country. Improvement is crucial in meeting Japan’s vison of zero casualties in major disaster events. If the case of the 2005 Hurricane Katrina is to offer an insight into migrants’ characteristics in mega-disaster situations, then a broader analysis of vulnerabilities is needed to avoid mass casualties should the anticipated megathrust earthquake occur. Hence, this study analyzes the vulnerabilities of foreign residents by utilizing their spatial distribution attributes in the Tokyo metropolitan area. This study uses multiple approaches that combine geographic information systems to analyze secondary and primary datasets. The results reveal that foreign nationals are spatially clustered in some parts of the metropolis, especially within a 7 km radius of Minato city. The densities in these areas alter the earthquake community vulnerability levels from 1.23% to 2.8% and from 5.42% to 13.46%, respectively. Although only 11% of foreign residents are prepared for any disaster, there is a high sense of interaction amongst them and Japanese nationals, which almost eliminates isolation within communities. This study therefore proposes the utilization of some of these attributes in mobilizing specifically targeted evacuation procedures, management of evacuation centers, and disaster risk information dissemination.

Exploring changes in cigar smoking patterns and motivations to quit cigars among black young adults in the time of COVID-19

INTRODUCTION

The COVID-19 pandemic has disproportionately impacted the Black/African American communities in the U.S. The objective of this study is to understand the change in cigar smoking patterns and motivations to quit cigars during the COVID-19 pandemic among Black young adult cigar smokers.

METHODS

During May-June 2020, in-depth telephone interviews were conducted to investigate cigar (i.e., large cigars, cigarillos, filtered cigars, and blunts) smoking behaviors during the pandemic among self-identified, non-Hispanic Black/African American young adult cigar smokers (n = 40; ages 21-29). Interviews were audio-recorded, transcribed verbatim, and coded separately by three coders. Thematic analysis was used to assess thematic patterns arising from the interviews.

RESULTS

Most participants reported smoking cigarillos and blunts in higher frequency and quantity to cope with COVID-19-induced stress, anxiety, loneliness, and boredom due to economic losses and physical isolation. Some also reported contextual changes in cigarillo and blunt smoking, including smoking around the clock, smoking immediately after waking up, and smoking an entire cigarillo or blunt in one setting. Very few participants reported motivations to quit cigars during the pandemic. Perceiving higher risks of progressed COVID-19 outcomes did not prompt participants' increased motivations for quitting cigars.

CONCLUSIONS

Black young adults in this study increasingly smoked cigarillos and blunts during the COVID-19 pandemic, mainly attributed to daily life stressors. Participants did not have increased motivations for quitting cigars to reduce COVID-19-related risks. Promoting contextually appropriate healthy coping and cigar smoking cessation may minimize COVID-19-related health consequences of cigar smoking and reduce health disparities among Black young adults.

Examining harmful algal blooms through a disaster risk management lens: A case study of the 2015 U.S. West Coast domoic acid event

The human dimensions of harmful algal blooms (HABs) are becoming increasingly apparent as they grow in frequency and magnitude in some regions of the world under changing ocean conditions. One such region is the U.S. West Coast, where HABs of toxigenic species of Pseudo-nitzschia have been found to coincide with or closely follow periods of warming. In 2015, the region experienced a massive HAB of Pseudo-nitzschia that was associated with the 2014-16 Northeast Pacific marine heatwave. The HAB event delayed the opening of the lucrative commercial Dungeness crab fishery for up to 5 months and closed the popular recreational razor clam fishery, resulting in fishery failures and disaster declarations and causing significant sociocultural and economic impacts to coastal communities. Here, management actions are examined that were taken by federal and state government agencies and responses of coastal residents to this extreme HAB event using a disaster risk management framework consisting of four phases: 1) prediction and early warning, 2) event response, 3) recovery and reconstruction, and 4) mitigation and prevention. Clear differences in management actions at the state level were evident in California, Oregon, and Washington during every phase, producing vastly different perceptions of management by coastal residents. A history of trusted relationships and coordination among agencies and with the fishing industry in Washington State was associated with more transparent and accepted management responses. The examination found that additional education, outreach, and trust-building exercises would provide benefits to communities affected by extreme HAB events. Our findings contribute to an understanding of climate change adaptation in coastal communities dependent on fishery resources.

Informational Sources, Social Media Use, and Race in Flint, Michigan's Water Crisis

Safe, clean water is necessary for health and wellbeing. Water issues affect minority and vulnerable populations at disproportionate rates, including the poor and racial and ethnic minorities. An investigation of the relationships of race, social media use, and informational sources during the municipal water crisis in Flint, Michigan reflects an instrumental view of communication and uses and gratifications theory in this study. Data from 208 Flint residents in 2016 indicated that African American respondents favored interpersonal networks and resources and were more likely than other racial groups to obtain current information about the water crisis via Instagram. Preferred channels and sources to receive additional crisis information varied on the basis of race.

‘Come Back at Us’: Reflections on Researcher-Community Partnerships during a Post-Oil Spill Gulf Coast Resilience Study

This paper presents findings from eight post-hoc interviews with individuals representing the key community partner organizations that facilitated and hosted data collection for an in-person mixed-methods survey about disaster resilience and preparedness in three communities on the Gulf Coast (U.S.) impacted by the Deepwater Horizon oil spill and numerous disasters from natural hazards. We submit our analysis of these follow-up interviews with community partners as a case study to provide a set of recommendations for future community-engaged research practices, particularly in the field of environmental and disaster resilience. Input from community partners stressed the importance of engaging with local community brokers to enhance trust in research; researcher-partner communication; and researcher interaction with community residents that respects local knowledge and culture. The partners indicated that even communities that have often been the subjects of post-disaster studies are receptive to research participation, especially when the effects of disasters are long-term and ongoing. Recommendations include using research methodologies that are congruent with post-disaster community characteristics such as educational attainment; collaborating with community partners to disseminate research findings; and incorporating theories and practices that center critical reflection and consider power dynamics when working with communities that have experienced disaster and trauma.

Short-term leprosy forecasting from an expert opinion survey

We conducted an expert survey of leprosy (Hansen’s Disease) and neglected tropical disease experts in February 2016. Experts were asked to forecast the next year of reported cases for the world, for the top three countries, and for selected states and territories of India. A total of 103 respondents answered at least one forecasting question. We elicited lower and upper confidence bounds. Comparing these results to regression and exponential smoothing, we found no evidence that any forecasting method outperformed the others. We found evidence that experts who believed it was more likely to achieve global interruption of transmission goals and disability reduction goals had higher error scores for India and Indonesia, but lower for Brazil. Even for a disease whose epidemiology changes on a slow time scale, forecasting exercises such as we conducted are simple and practical. We believe they can be used on a routine basis in public health.

Building community disaster resilience: perspectives from a large urban county department of public health

An emerging approach to public health emergency preparedness and response, community resilience encompasses individual preparedness as well as establishing a supportive social context in communities to withstand and recover from disasters. We examine why building community resilience has become a key component of national policy across multiple federal agencies and discuss the core principles embodied in community resilience theory-specifically, the focus on incorporating equity and social justice considerations in preparedness planning and response. We also examine the challenges of integrating community resilience with traditional public health practices and the importance of developing metrics for evaluation and strategic planning purposes. Using the example of the Los Angeles County Community Disaster Resilience Project, we discuss our experience and perspective from a large urban county to better understand how to implement a community resilience framework in public health practice.

Communication of Urgent Public Health Messages to Urban Populations: Lessons From the Massachusetts Water Main Break

Objective: To study when and how an urgent public health message about a boil-water order reached an urban population after the Massachusetts water main break.

Methods: In-person surveys were conducted in waiting areas of clinics and emergency departments at a large urban safety net hospital within 1 week of the event.

Results: Of 533 respondents, 97% were aware of the order; 34% of those who lived in affected cities or towns were potentially exposed to contaminated water. Among those who were aware, 98% took action. Respondents first received the message through word of mouth (33%), television (25%), cellular telephone calls (20%), landline calls (10%), and other modes of communication (12%). In multivariate analyses, foreign-born respondents and those who lived outside the city of Boston had a higher risk of exposure to contaminated water. New modes (eg, cellular telephones) were used more commonly by females and younger individuals (ages 18 to 34). Individuals who did not speak English at home were more likely to receive the message through their personal networks.

Conclusions: Given the increasing prevalence of cellular telephone use, public officials should encourage residents to register landline and cellular telephone for emergency alerts and must develop creative ways to reach immigrants and non–English-speaking groups quickly via personal networks.

(Disaster Med Public Health Preparedness. 2011;5:235–241)

Return or relocate? An inductive analysis of decision-making in a disaster

This paper proposes an inductive analysis of the decision as to whether to return or to relocate by persons in the State of Louisiana, United States, who evacuated after Hurricanes Katrina and Rita in August and September 2005, respectively. Drawing on interviews with evacuees in these events and extensive fieldwork in the impacted area, the paper seeks to identify the folk dimensions of the decision-making process, assess their arrangements, and situate the process in the larger context of risk and resilience in an advanced society. It suggests that, despite the material and emotional upheaval experienced by affected persons, the decision-making process is a rational endeavour combining a definite set of tightly interconnected factors, involving material dimensions and substantive values that can act in concert or in conflict. In addition, it indicates that there are significant variations by geographic areas, homeownership, and kind of decision. Some theoretical implications, practical measures, and suggestions for future research are examined.

Pandemics and health equity: lessons learned from the H1N1 response in Los Angeles County

BACKGROUND

Pandemic preparedness and response (as with all public health actions) occur within a social, cultural, and historical context of preexisting health disparities and, in some populations, underlying mistrust in government. Almost 200,000 people received H1N1 vaccine at 109 free, public mass vaccination clinics operated by the Los Angeles County Department of Public Health between October 23, 2009, and December 8, 2009. Wide racial/ethnic disparities in vaccination rates were observed with African Americans having the lowest rate followed by whites.

METHODOLOGY/PRINCIPAL FINDINGS

Demographic information, including race/ethnicity, was obtained for 163 087 of the Los Angeles County residents who received vaccine. This information was compared with estimates of the Los Angeles County population distribution by race/ethnicity. Rate ratios of vaccination were as follows: white, reference; African American, 0.5; Asian, 3.2; Hispanic, 1.5; Native American, 1.9; and Pacific Islander, 4.3.

SIGNIFICANCE

Significant political challenges and media coverage focused on equity in vaccination access specifically in the African American population. An important challenge was community-level informal messaging that ran counter to the "official" messages. Finally, we present a partnership strategy, developed in response to the challenges, to improve outreach and build trust and engagement with African Americans in Los Angeles County.

Public response to an anthrax attack: a multiethnic perspective

The 2001 anthrax attacks emphasized the need to develop outreach that would more effectively support racial/ethnic minority populations during a bioterrorism incident. Given the importance of antibiotic prophylaxis in a future anthrax attack, it should be a priority to better support racial/ethnic minorities in mass dispensing programs. To examine the needs and perspectives of racial/ethnic minorities, this study used a nationally representative poll of 1,852 adults, including 1,240 whites, 261 African Americans, and 282 Hispanics. The poll examined public reactions to a ''worst-case scenario'' in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within 48 hours. Findings suggest willingness across all racial/ethnic groups to comply with recommendations to seek prophylaxis at dispensing sites. However, findings also indicate possible barriers for racial/ethnic minorities, including greater concern about pill safety and multiple attacks as well as lesser knowledge about inhalation anthrax. Across all racial/ethnic groups, roughly half would prefer to receive antibiotics at mass dispensing sites rather than through the US Postal Service. People in racial/ethnic minority groups were more likely to say this preference stems from a desire to speak with staff or to exchange medication formulation or type. Findings suggest the need for tailored outreach to racial/ethnic minorities through, for example, emphasis on key messages and enhanced understandability in communications, increased staff for answering questions in relevant dispensing sites, and long-term trust building with racial/ethnic minority communities.

Survey on risk perception of radiation following an incident involving a stuck 60Co source in Henan province, China

In July 2009, an incident involving a stuck Co-60 source led hundreds of thousands of people to escape Qi County, Henan Province, China, although no medical or environmental consequences were related to the incident. To investigate knowledge about radiation, public risk-perception of radiation, and evaluation of the official response, a survey was conducted in Qi and Hui County (control). Face-to-face questionnaire interviews were conducted among three groups with different educational backgrounds. In total, 1340 valid questionnaires were collected from people interviewed. Knowledge about radiation was low in all groups in both counties, although knowledge in Qi County was higher than that in Hui County (control). More than 40% respondents supported construction of nuclear power plants (NPPs) in China, while only a few supported constructing NPPs in their vicinity. The main reasons for the mass escape following the incident were assumed to be lack of knowledge about radiation, misinformation, the government's failure to disclose information in time and imitation of group behaviour. Over 60% in Group I and II trusted the local government. About 64% disapproved the response of the Qi County government. After the incident, the population in Qi County still knows little about radiation. Although people trust the government, they are dissatisfied with the response of the local government regarding the incident.

The public health disaster trust scale: validation of a brief measure

CONTEXT

Trust contributes to community resilience by the critical influence it has on the community's responses to public health recommendations before, during, and after disasters. However, trust in public health is a multifactorial concept that has rarely been defined and measured empirically in public health jurisdictional risk assessment surveys. Measuring trust helps public health departments identify and ameliorate a threat to effective risk communications and increase resilience. Such a measure should be brief to be incorporated into assessments conducted by public health departments.

OBJECTIVE

We report on a brief scale of public health disaster-related trust, its psychometric properties, and its validity.

DESIGN

On the basis of a literature review, our conceptual model of public health disaster-related trust and previously conducted focus groups, we postulated that public health disaster-related trust includes 4 major domains: competency, honesty, fairness, and confidentiality.

SETTING

A random-digit-dialed telephone survey of the Los Angeles county population, conducted in 2004-2005 in 6 languages.

PARTICIPANTS

Two thousand five hundred eighty-eight adults aged 18 years and older including oversamples of African Americans and Asian Americans.

MAIN OUTCOME MEASURES

Trust was measured by 4 items scored on a 4-point Likert scale. A summary score from 4 to 16 was constructed.

RESULTS

Scores ranged from 4 to 16 and were normally distributed with a mean of 8.5 (SD 2.7). Cronbach α = 0.79. As hypothesized, scores were lower among racial/ethnic minority populations than whites. Also, trust was associated with lower likelihood of following public health recommendations in a hypothetical disaster and lower likelihood of household disaster preparedness.

CONCLUSIONS

The Public Health Disaster Trust scale may facilitate identifying communities where trust is low and prioritizing them for inclusion in community partnership building efforts under Function 2 of the Centers for Disease Control and Prevention's Public Health Preparedness Capability 1. The scale is brief, reliable, and validated in multiple ethnic populations and languages.

Integrating racially and ethnically diverse communities into planning for disasters: the California experience

OBJECTIVES

Racially/ethnically diverse communities suffer a disproportionate burden of adverse outcomes before, during and after a disaster. Using California as a locus of study, we sought to identify challenges and barriers to meeting the preparedness needs of these communities and highlight promising strategies, gaps in programs, and future priorities.

METHODS

We conducted a literature review, environmental scan of organizational Web sites providing preparedness materials for diverse communities, and key informant interviews with public health and emergency management professionals.

RESULTS

We identified individual-level barriers to preparing diverse communities such as socioeconomic status, trust, culture, and language, as well as institutional-level barriers faced by organizations such as inadequate support for culturally/linguistically appropriate initiatives. Current programs to address these barriers include language assistance services, community engagement strategies, cross-sector collaboration, and community assessments. Enhancing public-private partnerships, increasing flexibility in allocating funds and improving organizational capacity for diversity initiatives were all identified as additional areas of programmatic need.

CONCLUSIONS

Our study suggests at least four intervention priorities for California and across the United States: engaging diverse communities in all aspects of emergency planning, implementation, and evaluation; mitigating fear and stigma; building organizational cultural competence; and enhancing coordination of information and resources. In addition, this study provides a methodological model for other states seeking to assess their capacity to integrate diverse communities into preparedness planning and response.

Vulnerable Populations: Hurricane Katrina as a Case Study

Mitigating disaster impact requires identifying risk factors. The increased vulnerability of the physically fragile is easily understood. Less obvious are the socio-economic risk factors, especially within relatively affluent societies. Hurricane Katrina demonstrated many of these risks within the United States.These factors include poverty, home ownership, poor English language proficiency, ethnic minorities, immigrant status, and high-density housing. These risk factors must be considered when planning for disaster preparation, mitigation, and response.

Public response to an anthrax attack: reactions to mass prophylaxis in a scenario involving inhalation anthrax from an unidentified source

An attack with Bacillus anthracis ("anthrax") is a known threat to the United States. When weaponized, it can cause inhalation anthrax, the deadliest form of the disease. Due to the rapid course of inhalation anthrax, delays in initiation of antibiotics may decrease survival chances. Because a rapid response would require cooperation from the public, there is a need to understand the public's response to possible mass dispensing programs. To examine the public's response to a mass prophylaxis program, this study used a nationally representative poll of 1,092 adults, supplemented by a targeted focus on 3 metropolitan areas where anthrax attacks occurred in 2001: New York City (n=517), Washington, DC (n=509), and Trenton/Mercer County, NJ (n=507). The poll was built around a "worst-case scenario" in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within a 48-hour period. Findings from this poll provide important signs of public willingness to comply with public health recommendations for obtaining antibiotics from a dispensing site, although they also indicate that public health officials may face several challenges to compliance, including misinformation about the contagiousness of inhalation anthrax; fears about personal safety in crowds; distrust of government agencies to provide sufficient, safe, and effective medicine; and hesitation about ingesting antibiotic pills after receiving them. In general, people living in areas where anthrax attacks occurred in 2001 had responses similar to those of the nation as a whole.

Rapid community participatory assessment of health care in post-storm New Orleans

BACKGROUND

Hurricane Katrina and levee failures disrupted healthcare access for hundreds of thousands of New Orleans residents. Few models exist to explain community stakeholders' priorities for post-disaster recovery while building capacity for response. This project engaged community stakeholders in a rapid, participatory assessment of health priorities 1 year post-disaster, to inform the policy process and build capacity for recovery planning among community members.

METHODS

This project combined community-based participatory research methods and rapid assessment procedures to engage diverse community members in design, conduct, data interpretation, and dissemination of results. Thirty stakeholders in the health and healthcare fields were interviewed in Summer 2006, and four grassroots community discussion groups were held in New Orleans neighborhoods to assess perceptions of the disaster's impacts on healthcare access. Interview transcripts were reviewed in Summer 2006, and themes were elicited using methods rooted in grounded theory. Findings were shared at a public community feedback conference, and recovery-relevant community action steps were set in motion.

RESULTS

Three main themes emerged from the data: (1) healthcare access challenges; (2) unmet needs of specific vulnerable populations; (3) opportunities, resources, and community adaptations to improve healthcare access.

CONCLUSIONS

This rapid, community-based participatory assessment provided new information on diverse community members' concerns and priorities, and it produced a sustainable community-academic partnership dedicated to improving both access to care and the public's health following this major disaster.