Adverse respiratory symptoms and environmental exposures among children and adolescents following Hurricane Katrina

Objectives

Children and adolescents are especially vulnerable to environmental exposures and their respiratory effects. Following Hurricane Katrina in 2005, residents experienced multiple adverse environmental exposures. We characterized the association between upper respiratory symptoms (URS) and lower respiratory symptoms (LRS) and environmental exposures among children and adolescents affected by Hurricane Katrina.

Methods

We conducted a cross-sectional study following the return of the population to New Orleans after Hurricane Katrina (October 2005 and February 2006) among a convenience sample of children and adolescents attending New Orleans health facilities. We used uni-, bi-, and multivariable analyses to describe participants, exposures, and associations with URS/LRS.

Results

Of 1,243 participants, 47% were Caucasian, 50% were male, and 72% were younger than 11 years of age. Multiple environmental exposures were identified during and after the storm and at current residences: roof/glass/storm damage (50%), outside mold (22%), dust (18%), and flood damage (15%). Self-reported URS and LRS (76% and 36%, respectively) were higher after the hurricane than before the hurricane (22% and 9%, respectively, p<0.0001). Roof/glass/storm damage at home was associated with URS (adjusted odds ratio [AOR] = 1.59, 95% confidence interval [CI] = 1.15, 2.21) and LRS (AOR=1.35, 95% CI 1.01, 1.80), while mold growth at home was associated with LRS (AOR=1.47, 95% CI 1.02, 2.12).

Conclusions

Children and adolescents affected by Hurricane Katrina experienced environmental exposures associated with increased prevalence of reported URS and LRS. Additional research is needed to investigate the long-term health impacts of Hurricane Katrina.Hurricane Katrina, the deadliest hurricane to strike the United States since 1928, made landfall in the U.S. Gulf Coast Region on August 29, 2005.^1,2 Heavy rains, strong winds, and storm surges caused widespread damage in Louisiana, Mississippi, Florida, and Alabama.³ New Orleans, Louisiana, a city largely below sea level, was particularly vulnerable to the hurricane''s destructive force.² Large sections of New Orleans, as well as the surrounding parishes, remained flooded for weeks. As a result, excessive moisture coupled with the area''s humid climate created optimal conditions for mold growth within buildings and on accumulated waste and debris from damaged homes.⁴ Exposure to mold and damp indoor spaces can cause both upper respiratory symptoms (URS) and lower respiratory symptoms (LRS), and can trigger asthma attacks and allergic reactions,^5,6 with increased rates of respiratory symptoms among residents affected by widespread community flooding events.^7–9Following the storm, the Centers for Disease Control and Prevention (CDC) and the Louisiana Department of Health and Hospitals (LDHH) conducted an investigation of post-Katrina homes and found visible mold growth in 46% of inspected residences at levels equal to or above threshold levels associated with URS and LRS in previous studies investigating typical mold-associated symptoms, such as cough; airway hyper-reactivity; influenza-like symptoms; ear, nose, and throat irritation; and decreased lung function. Predominant fungi indoors and outdoors in this post-Katrina study were Aspergillus subspecies (spp.) and Penicillium spp. Measurements of indoor airborne endotoxin levels in households after Hurricane Katrina suggested a 20-fold elevation over levels measured in previous studies (outdoor levels were elevated up to 10-fold). Exposure to (1–>3)-β-D-glucan, a cell-wall component not specific to fungi, which has also been linked to respiratory health effects in previous studies, was also elevated in household measurements following Hurricane Katrina.⁴These findings suggest that residents moving back to the area after Hurricane Katrina were at increased risk of both URS and LRS. Area hospitals reported increased numbers of patients with URS and LRS, with local doctors using the term “Katrina cough” to describe the respiratory symptoms (e.g., cough, congestion, runny nose, sore throat, and sinus headaches) that they believed to be attributed to the hurricane, including mold, dust, and irritating fumes circulating in the area''s atmosphere following Hurricane Katrina.^10,11The LDHH conducted a case-control study to determine if the observed increases in URS and LRS were associated with exposures resulting from the hurricane.¹² The LDHH case-control study found no significant increase in URS and LRS within the New Orleans area when compared with rates in other parts of the state and country, and concluded that the proportions of respiratory conditions observed in New Orleans after the hurricane were similar to national data for the same time period.¹² Limitations of the LDHH case-control study included focusing only on emergency room visits for URS and LRS and not including patients visiting physician''s offices or outpatient departments. At times when several hospitals and medical offices remained closed, excessive waiting hours in emergency rooms may have prevented patients with mild-to-moderate respiratory symptoms from seeking care in acute settings. In addition, the LDHH study focused on adult participants and did not include patients seen for well-visits, in diverse practice settings, or for non-respiratory chief complaints with concurrent respiratory symptoms.As a result of these methodological limitations, associations between repercussions of the storm and URS and LRS may have been underestimated in the LDHH study. While children are a vulnerable population with specific health needs, especially after a natural disaster,¹³ only 26 children and adolescents aged ≤24 years were included in the LDHH case-control study.¹² Children are at an increased risk of developing respiratory conditions after exposure to mold, dust, allergens, and other irritants, including sewage.^10,14–26 The purpose of this period cross-sectional study was to characterize associations between environmental and residential exposures and respiratory symptoms among a convenience sample of children and adolescents who sought care in the New Orleans metropolitan area immediately following Hurricane Katrina.     

Students' experiences and perceived benefits of a sex education curriculum: a qualitative analysis

A qualitative evaluation explored the experiences and perceived benefits of students who participated in an abstinence-plus sex education program at enrollment and conclusion. The sample included 1130 inner-city high school students, 73.7% of whom were Hispanic. Thematic analysis was used to identify main themes in responses made by students to 3 open-ended questions. The most common preparticipation request was for information about sexually transmitted infections. At program conclusion, the most common response theme involved the quality of course delivery. Students indicated that they appreciated the facilitators who allowed open conversations. The implications of these findings to sex education programs are discussed.