Health Concerns of Women and Infants in Times of Natural Disasters: Lessons Learned from Hurricane Katrina

Pregnant women and infants have unique health concerns in the aftermath of a natural disaster such as Hurricane Katrina. Although exact numbers are lacking, we estimate that approximately 56,000 pregnant women and 75,000 infants were directly affected by the hurricane. Disruptions in the supply of clean water for drinking and bathing, inadequate access to safe food, exposure to environmental toxins, interruption of health care, crowded conditions in shelters, and disruption of public health and clinical care infrastructure posed threats to these vulnerable populations. This report cites the example of Hurricane Katrina to focus on the needs of pregnant women and infants during times of natural disasters and provides considerations for those who plan for the response to these events.     

Disaster mythology and fact: Hurricane Katrina and social attachment

Misconceptions about disasters and their social and health consequences remain prevalent despite considerable research evidence to the contrary. Eight such myths and their factual counterparts were reviewed in a classic report on the public health impact of disasters by Claude de Ville de Goyet entitled, The Role of WHO in Disaster Management: Relief, Rehabilitation, and Reconstruction (Geneva, World Health Organization, 1991), and two additional myths and facts were added by Pan American Health Organization. In this article, we reconsider these myths and facts in relation to Hurricane Katrina, with particular emphasis on psychosocial needs and behaviors, based on data gleaned from scientific sources as well as printed and electronic media reports. The review suggests that preparedness plans for disasters involving forced mass evacuation and resettlement should place a high priority on keeping families together--and even entire neighborhoods, where possible--so as to preserve the familiar and thereby minimize the adverse effects of separation and major dislocation on mental and physical health.     

Environmental lead after Hurricane Katrina: implications for future populations

Background: As a result of Hurricane Katrina, > 100,000 homes were destroyed or damaged and a significant amount of sediment was deposited throughout the city of New Orleans, Louisiana. Researchers have identified the potential for increased lead hazards from environmental lead contamination of soils.Objectives: We assessed the distribution of residential soil and dust lead 2 years poststorm and compared soil lead before and after the storm.Methods: We conducted a cross-sectional study in New Orleans in which households were selected by stratified random sampling. A standard residential questionnaire was administered, and lead testing was performed for both the interior and exterior of homes. Logistic regression was used to identify significant predictors of interior and exterior lead levels in excess of allowable levels.Results: One hundred nine households were enrolled; 61% had at least one lead measurement above federal standards. Of homes with bare soil, 47% had elevated lead and 27% had levels exceeding 1,200 ppm. Housing age was associated with soil lead, and housing age and soil lead were associated with interior lead. Race, income, and ownership status were not significantly associated with either interior or exterior lead levels. The median soil lead level of 560 ppm was significantly higher than the median level of samples collected before Hurricane Katrina.Conclusions: The high prevalence (61%) of lead above recommended levels in soil and dust samples in and around residences raises concern about potential health risks to the New Orleans population, most notably children. Steps should be taken to mitigate the risk of exposure to lead-contaminated soil and dust. Further research is needed to quantify the possible contribution of reconstruction activities to environmental lead levels.     

Evaluating a Media Campaign That Targeted PTSD After Hurricane Katrina

This study evaluates a media campaign that targeted posttraumatic stress disorder (PTSD) in New Orleans following Hurricane Katrina. Evaluation data come from telephone survey interviews of African Americans (N = 968), who were the target audience of the media campaign. Ordinary Least Squares (OLS) regression indicates over-time improvements in campaign attention, PTSD beliefs, and PTSD preventive behaviors, whereas PTSD remained constant. Structural equation modeling offers support for a multistep model in which campaign attention influences PTSD beliefs, which influence PTSD preventive behaviors, which, in turn, influence PTSD. There is one across-step path from campaign attention directly to PTSD preventive behaviors. These two sets of findings signify the media campaign's positive role in influencing beliefs and preventive behaviors. Although PTSD remained unchanged, the improvements in PTSD beliefs and preventive behaviors may have been a means to subsequent abatement in PTSD.     

大理州疾控机构应对突发公共卫生事件和重大自然灾害卫生应急准备现状分析和建议

目的提高大理州疾病预防控制机构应对突发公共卫生事件和重大自然灾害调查和处置能力,最大限度地降低突发公共卫生事件和重大自然灾害的危害。方法根据《中华人民共和国传染病防治法》、《突发公共卫生事件应急条例》等国家卫生法律法规,结合大理州疾病预防控制机构现状和州情,反思作者先后参加了2003年"非典"防治,多起重大食物中毒处置和"5.12"汶川大地震后的卫生防疫等实际工作中,今后大理州如何更好地提高应对突发公共卫生事件和重大自然灾害调查和处置能力,并提出合理化建议。结果大理州卫生应急预案体系不够健全,没有从州政府的层面制定《大理州突发事件应急总预案》,如发生突发公共卫生事件和重大自然灾害时,还要花时间协调各部门一起应对;各种预案较多且分散;没有统一管理的各类专业人员齐备的应急队伍;近年来较少组织卫生应急演练,实战能力有待提高,队员野外生存能力差。结论大理州要进一步建立健全卫生应急预案体系,收集或制定卫生应急规范,从州政府的层面制定《大理州突发事件应急总预案》;要按照"平战结合、因地制宜、分类管理、分级负责、统一管理、协调运转"的原则,建立一只卫生应急队伍;完善应急队伍的应急装备和做好应急物资储备。     

Hurricane Katrina: more lessons learned

In August of 2007, the author testified as the medical expert witness on behalf of the State of Louisiana in the St. Rita's Nursing Home criminal case. Thirty-five residents drowned as floodwaters swept over the nursing home during Hurricane Katrina. For nursing home owners, administrators, and medical staff leadership, there are additional lessons to be learned from this catastrophe.     

Hurricane Katrina: addictive behavior trends and predictors

Objective

Post-disaster trends in alcohol consumption and cigarette smoking, as well as their predictors, were identified.

Methods

Data from cross-sectional and panel surveys of African American adults in New Orleans, Louisiana, were used from before (2004: n=1,867; 2005: n=879) and after (2006a: n=500; 2006b: n=500) Hurricane Katrina.

Results

Alcohol consumption increased significantly from pre- to post-Hurricane Katrina, while cigarette smoking remained constant. In 2006, posttraumatic stress disorder (PTSD) was associated with cigarette smoking, whereas “news attention” and “provided social support” were inversely associated with cigarette smoking. “News attention” was also inversely associated with cigarette smoking frequency, while “neighborliness” was associated with alcohol consumption. In addition, the effects of PTSD on alcohol consumption were moderated by “neighborliness.”

Conclusions

In the wake of Hurricane Katrina, there were complex predictive processes of addictive behaviors involving PTSD, news information, and social capital-related measures.As forms of self-medication,¹ cigarette smoking and alcohol consumption tend to increase following traumatic events.^2–8 In such contexts, a common risk factor for these two addictive behaviors is posttraumatic stress disorder (PTSD).^3,7,8 In the broader scope of traumatic events, PTSD has also been linked with cigarette smoking^9–12 and alcohol consumption.^13,14 In disasters and other stressful situations, people tend to turn to cigarettes and alcohol to escape from or diminish strain and anxiety. The processes by which stressful events influence cigarette smoking and alcohol consumption are complex, with research indicating the effects of PTSD on increased alcohol consumption, but not increased cigarette smoking and other forms of tobacco consumption.^1,15This study explored such processes in the context of Hurricane Katrina, considering the effects of PTSD on addictive behaviors, as well as the effects of people''s access to social resources and news information. Hurricane Katrina provides a novel and compelling environment for the study of the predictive factors of addictive behaviors. By many standards the worst natural disaster in U.S. history, Hurricane Katrina breached levees in the New Orleans area, submerged 80% of the city, triggered the largest ever displacement of a U.S. population, and caused an estimated $100 billion in damages and more than 1,000 human deaths.^16,17 Additional effects of the hurricane on mental health have been demonstrated. For instance, 31% of adults in affected regions,¹⁸ as well as 44% of adult caregivers in trailers and hotel rooms,¹⁹ reported psychological distress, and 46% of hurricane shelter residents reported depression.²⁰ Finally, 19% of employees from the largest employer in New Orleans met the criteria for PTSD.²¹Despite the magnitude of the hurricane and its effects, no published studies have assessed the related roles of PTSD, social capital, and communication patterns in predicting addictive behaviors, such as cigarette smoking and alcohol consumption. To fill this gap in the literature, this study had three specific aims. First, it examined trends in cigarette smoking and alcohol consumption from pre- to post-Hurricane Katrina. Second, it tested the roles of PTSD, social capital-related measures, and communication patterns in predicting cigarette smoking and alcohol consumption in the aftermath of Hurricane Katrina. Third, in building upon the previous aim, it assessed whether social capital-related measures and communication patterns moderate the influence of PTSD on cigarette smoking and alcohol consumption.In disaster contexts, social capital and communication patterns may serve as preventive factors of addictive behaviors. Specifically, people who have access to information and social resources may be less likely to smoke cigarettes and drink alcohol. Social capital can be defined as intangible social resources that result from social relationships that can, in turn, be accessed and mobilized to achieve beneficial outcomes.^22,23 There is growing empirical evidence for how people''s social capital helps them achieve improvements in health status²⁴ and preventive behaviors, while avoiding health-risk behaviors.^25–27Particular to cigarette smoking and alcohol consumption in a disaster context, it can be theorized that (1) people with higher levels of social capital have lower levels of cigarette smoking and alcohol consumption; and (2) social capital may moderate the effects of a disaster, including PTSD, on cigarette smoking and alcohol consumption. Such beneficial effects of social capital can function in terms of the diffusion of knowledge, maintenance of norms pertinent to health behaviors, promotion of access to services and amenities, and development of social support and mutual respect.²⁸ Pertinent empirical research has demonstrated that social capital is inversely associated with cigarette smoking^29–31 and, in using panel data, that smokers are more likely to cease cigarette smoking if they participate socially.³² Additionally, in terms of alcohol consumption, research has demonstrated inverse associations between social capital and various alcohol consumption measures, including binge drinking, frequent drunkenness, and alcohol abuse.^33–35The second potential preventive factor, communication patterns, involves how people use news media health and safety information. Research has found that the diffusion of news information is associated with improved health behaviors.³⁶ The related benefits of using news information have been demonstrated in disaster settings,³⁷ including Hurricane Katrina.^20,38 Communication patterns, in this regard, can help people turn back or mitigate health threats. Specifically, news use can help people develop knowledge, as well as attitudes and behaviors. Particular to cigarette smoking and alcohol consumption in a disaster context, it can be theorized that (1) people with higher levels of heath and safety news attention have lower levels of cigarette smoking and alcohol consumption; and (2) health and safety news attention may moderate the effects of a disaster, including PTSD, on cigarette smoking and alcohol consumption.To assess levels of cigarette smoking and alcohol consumption before Hurricane Katrina, data from cross-sectional survey interviews of African Americans in New Orleans from 2004 (n=1,867) and 2005 (n=879) were used. To assess levels of cigarette smoking and alcohol consumption after Hurricane Katrina, as well as their predictors, panel survey data from interviews of African Americans in New Orleans at two points in time in 2006 (n=500) were used. Two aspects of this study are noteworthy. First, while most previous research in this area has relied on cross-sectional data, this study employed a mix of cross-sectional and panel data, the latter of which help strengthen inferences of causation.³⁹ Second, this study focused on a poor and underserved population—African Americans in New Orleans—who bore the brunt of Hurricane Katrina⁴⁰ and have only limited access to traditional resources, such as income and education.⁴¹