Health agencies working with the homebound play a vital role in bolstering a community’s resiliency by improving the preparedness of this vulnerable population. Nevertheless, this role is one for which agencies lack training and resources, which leaves many homebound at heightened risk. This study examined the utility of an evidence-based Disaster Preparedness Toolkit in Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs.

We conducted an online survey of all VHA HBPC program managers (N=77/146; 53% response rate).

Respondents with fewer years with the HBPC program rated the toolkit as being more helpful (P<0.05). Of those who implemented their program’s disaster protocol most frequently, two-thirds strongly agreed that the toolkit was relevant. Conversely, of those who implemented their disaster protocols very infrequently or never, 23% strongly agreed that the topics covered in the toolkit were relevant to their work (P<0.05).

This toolkit helps support programs as they fulfill their preparedness requirements, especially practitioners who are new to their position in HBPC. Programs that implement disaster protocols infrequently may require additional efforts to increase understanding of the toolkit’s utility. Engaging all members of the team with their diverse clinical expertise could strengthen a patient’s personal preparedness plan. (Disaster Med Public Health Preparedness. 2017;11:56–63)

The aim of this study was to determine the level of coronavirus disease 2019 (COVID-19) risk perceptions in Indonesia and characterize predictors of perceptions.

An online cross-sectional study was conducted. A questionnaire assessed perceived risk and collected independent variables, including sociodemographic data. A multivariable linear regression model was used to characterize the relationship between independent variables and perceived risk.

We included 1379 respondents in the final analysis with the mean and median of perceived risk score was 19.21% and 10.0%, respectively. Respondents aged between 21 and 30 years had the highest perceived risk, and those who were unmarried had 4.3% higher perceived risk compared with those who were married. Compared with the lowest monthly income group, those making Indonesian Rupiah (IDR) 6-10 million and more than IDR 10 million a month believed they had 4.2% and 8.8% higher risk, respectively. Citizens who lived in cities and health-care workers also had a higher perceived risk compared with those in the rural areas and non–health-care workers, respectively.

Perceived risk of COVID-19 in Indonesia is relatively low, and this could hamper the adoption of preventive measures of COVID-19. Efforts to increase the awareness and perceived risk are important to prevent the pandemic from escalating.

Hurricane Sandy's October 29, 2012 arrival in New York City caused flooding, power disruption, and population displacement. Infectious disease risk may have been affected by floodwater exposure, residence in emergency shelters, overcrowding, and lack of refrigeration or heating. For 42 reportable diseases that could have been affected by hurricane-related exposures, we developed methods to assess whether hurricane-affected areas had higher disease incidence than other areas of NYC.

We identified post-hurricane cases as confirmed, probable, or suspected cases with onset or diagnosis between October 30 and November 26 that were reported via routine passive surveillance. Pre-hurricane cases for the same 4-week period were identified in 5 prior years, 2007–2011. Cases were geocoded to the census tract of residence. Using data compiled by the NYC Office of Emergency Management, we determined (1) the proportion of the population in each census tract living in a flooded block and (2) the subset of flooded tracts severely “impacted”, e.g., by prolonged service outages or physical damage. A separate multivariable regression model was constructed for each disease, modeling the outcome of case counts using a negative binomial distribution. Independent variables were: neighborhood poverty; whether cases were pre- or post-hurricane (time); the proportion of the population flooded in impacted and not impacted tracts; and interaction terms between the flood/impact variables and time. Models used repeated measures to adjust for correlated observations from the same tract and an offset term of the log of the population size. Sensitivity analyses assessed the effects of case count fluctuations and accounted for variations in reporting volume by using an offset term of the log of total cases.

Only legionellosis was statistically significantly associated with increased occurrence in flooded/impacted areas post-hurricane, adjusting for baseline differences (P = .04). However, there was only 1 legionellosis case post-hurricane in a flooded/impacted area.

Hurricane Sandy did not appear to elevate reportable disease incidence in NYC. Defining and acquiring reliable data and meta-data regarding hurricane-affected areas was a challenge in the weeks post-storm. Relevant metrics could be developed during disaster preparedness planning. These methods to detect excess disease can be adapted for future emergencies. (Disaster Med Public Health Preparedness. 2013;7:513-521)

This investigation assessed changes in utilization of inpatient, outpatient, emergency department, and pharmacy services in the aftermath of Hurricane Sandy in 8 counties in New York affected by the storm.

Medicaid data for enrollees residing in 8 counties in New York were used to obtain aggregated daily counts of claims for 4 service types over immediate, 3-month, and 1-year periods following the storm. Negative binomial regression was used to compare service utilization in the storm year with the 2 prior years, within areas differentially affected by the storm.

Changes in service utilization within areas inside or outside the storm zone were most pronounced over the 1-year effect period. Differences in service utilization by year were the same by storm zone designation over the immediate effect period for all services.

Results are consistent with previous investigations demonstrating that some of the greatest effects of a disaster on health services utilization occur well beyond the initial event. One-year effects, combined with some 3-month effects, suggests that storm recovery, with its effect on health care services utilization, may have followed different paths in areas designated as inside or outside the storm zone. (Disaster Med Public Health Preparedness. 2016;10:472–484)

The aim of this study is to assess prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) in students of Keyano College 18 months after a wildfire and to determine the predictors of likely MDD, GAD, and PTSD in the respondents.

A quantitative cross-sectional survey was used to collect data through self-administered, paper-based questionnaires to determine likely MDD, GAD, and PTSD using the PHQ 9, GAD-7, and the PTSD Checklist for DSM 5, Part 3, respectively. Data were analyzed with SPSS version 20 (IBM Corp, Armonk, NY) using univariate analysis with chi-square tests.

Eighteen months after the wildfire, the 1-month prevalence rates for MDD, GAD, and PTSD among the college students were 23.4%, 18.7%, and 11.0%, respectively. There were statistically significant associations between multiple sociodemographic variables and the likelihood respondents presented with MDD, GAD, and PTSD 18 months after the wildfire. There were also associations between the likely MDD, GAD, and PTSD and abuse/dependence on alcohol and substances in respondents at 18 months.

Our study has established prevalence rates for MDD, GAD, and PTDS among college students 18 months after the Fort McMurray wildfires. Further studies are needed to explore the impact of college-based mental health interventions on the long-term mental health effects of the wildfires.

To demonstrate a spatial epidemiologic approach that could be used in the aftermath of disasters to (1) detect spatial clusters and (2) explore geographic heterogeneity in predictors for mental health and general wellness.

We used a cohort study of Hurricane Ike survivors (n=508) to assess the spatial distribution of postdisaster mental health wellness (most likely resilience trajectory for posttraumatic stress symptoms [PTSS] and depression) and general wellness (most likely resilience trajectory for PTSS, depression, functional impairment, and days of poor health) in Galveston, Texas. We applied the spatial scan statistic (SaTScan) and geographically weighted regression.

We found spatial clusters of high likelihood wellness in areas north of Texas City and spatial concentrations of low likelihood wellness in Galveston Island. Geographic variation was found in predictors of wellness, showing increasing associations with both forms of wellness the closer respondents were located to Galveston City in Galveston Island.

Predictors for postdisaster wellness may manifest differently across geographic space with concentrations of lower likelihood wellness and increased associations with predictors in areas of higher exposure. Our approach could be used to inform geographically targeted interventions to promote mental health and general wellness in disaster-affected communities. (Disaster Med Public Health Preparedness. 2016;10:261–273)

Public education and training that focus on appropriate knowledge, attitudes, and practices have had a crucial role in preparedness. The aim of this study was to assess knowledge, attitudes, and practices of households regarding natural disasters in Shiraz, Iran.

In this cross-sectional descriptive study, we used a stratified random sampling technique. The data collection tool was a self-administered questionnaire, which was completed in through face-to-face interviews. The data were analyzed with the SPSS statistical software package (version 16).

The overall mean scores were 7.3±2.0 for knowledge, 26.3±6.5 for attitudes, and 5.2±2.2 for practices. Mean scores for all 3 factors were higher in women and married participants. In other comparisons, the differences were statistically significant only for the associations between gender and the score for practices. The mean knowledge score was lower in illiterate participants than in other categories of educational status.

Our findings showed that the knowledge of households regarding disaster preparedness was encouraging, but that of attitudes and practices might be improved through a greater focus on motivational educational programs and cooperation among the organizations involved in public awareness. (Disaster Med Public Health Preparedness. 2014;0:1–4)

To summarize existing literature on the mental health impact of the Flint Water Crisis.

In March 2020, we searched 5 databases for literature exploring the psychological consequences of the crisis. Main findings were extracted.

132 citations were screened and 11 included in the review. Results suggest a negative psychological effect caused by the water crisis, including anxiety and health worries, exacerbated by lowered trust in public health officials, uncertainty about the long-term impacts of the crisis, financial hardships, stigma, and difficulties seeking help. There was evidence that concerns about tap water continued even after the state of emergency was lifted.

With a possible compound effect to residents of Flint with the recent COVID-19 pandemic, the results highlight the need for more resources for psychological health interventions in Flint as well as a need for local governments and health authorities to regain the trust of those affected by the Flint Water Crisis.

Individuals with disabilities experience more negative outcomes due to natural and manmade disasters and emergencies than do people without disabilities. This vulnerability appears to be due in part to knowledge gaps among public health and safety emergency planning and response personnel (responders). We assessed the effectiveness of an online program to increase emergency responder knowledge about emergency planning and response for individuals with disabilities.

Researchers developed an online course designed to teach public health, emergency planning and management, and other first response personnel about appropriate, efficient, and equitable emergency planning, response, interaction, and communication with children and adults with disabilities before, during, and after disasters or emergencies. Course features included an ongoing storyline, exercises embedded in the form of real-life scenarios, and game-like features such as points and timed segments.

Evaluation measures indicated significant pre- to post-test gains in learner knowledge and simulated applied skills.

An online program using scenarios and simulations is an effective way to make disability-related training available to a wide variety of emergency responders across geographically disparate areas. (Disaster Med Public Health Preparedness. 2014;8:533-540)

Hurricane Sandy made landfall on October 29, 2012, causing a coastal storm surge and extensive flooding, which led to the closure of several health care facilities in New York City (NYC) and prolonged interruptions in service delivery. The impact on mental health–related emergency department (ED) and inpatient hospital service utilization was studied.

Data came from the New York Statewide Planning and Research Cooperative System. We obtained mental health–related data among NYC residents from 2010 to 2013. Patients were grouped into 5 geographic areas, including service areas of closed hospitals, the Hurricane Sandy evaluation zone, and all of NYC. The Farrington method was used to detect increases in ED visits and hospitalizations for the post-Sandy period.

Open hospitals experienced a substantial increase in psychiatric ED visits from patients living in the service areas of closed hospitals. This surge in psychiatric ED visits persisted for 4 to 6 months after Hurricane Sandy. However, the increase in psychiatric hospitalizations was observed for 1 to 3 months.

Several NYC hospitals received a substantially larger number of ED patients from service areas of closed hospitals after Hurricane Sandy, unlike other hospitals that experienced a decrease. Because of potential surges in the number of psychiatric ED visits, resource allocation to hospitals should be considered. (Disaster Med Public Health Preparedness. 2016;10:512–517)

Digital surveillance has shown mixed results as a supplement to traditional surveillance. Google Trends™ (GT) (Google, Mountain View, CA, United States) has been used for digital surveillance of H1N1, Ebola and MERS. We used GT to correlate the information seeking on COVID-19 with number of tests and cases in India.

Data was obtained on daily tests and cases from WHO, ECDC and covid19india.org. We used a comprehensive search strategy to retrieve GT data on COVID-19 related information-seeking behavior in India between January 1 and May 31, 2020 in the form of relative search volume (RSV). We also used time-lag correlation analysis to assess the temporal relationships between RSV and daily new COVID-19 cases and tests.

GT RSV showed high time-lag correlation with both daily reported tests and cases for the terms “COVID 19,” “COVID,” “social distancing,” “soap,” and “lockdown” at the national level. In 5 high-burden states, high correlation was observed for these 5 terms along with “Corona.” Peaks in RSV, both at the national level and in high-burden states corresponded with media coverage or government declarations on the ongoing pandemic.

The correlation observed between GT data and COVID-19 tests/cases in India may be either due to media-coverage-induced curiosity, or health-seeking curiosity.