Physical and mental health consequences of Katrina on Vietnamese immigrants in New Orleans: a pre- and post-disaster assessment

Cumulative disaster exposure and hypertension among mothers who survived Hurricane Katrina

As climate change intensifies, hurricanes and weather-related disasters have been increasingly frequent and severe, impacting regions like the U.S. Gulf Coast with repeated hurricanes. While acute and short-term health impacts are well-described, impacts on longer-term and chronic conditions such as hypertension remain underexplored. This study examines the association between repeated hurricane exposure and hypertension risk in survivors. We used data from the Resilience in Survivors of Katrina project, a longitudinal (2003-2018) cohort of predominantly Black, low-income mothers affected by Hurricane Katrina. A sample of 505 women who were not hypertensive pre-Katrina was analyzed. Cumulative exposure was defined as the number of hurricanes experienced post-Katrina, assessed at several survey waves over 12 years. Logistic regression estimated associations between hurricane exposure and hypertension in 2016-18, with mediation analyses exploring the indirect effect via psychological distress (PD). In adjusted models, exposure to two hurricanes was associated with a 61% increase in hypertension odds (OR = 1.61, 95% CI: 1.00, 2.63) and exposure to three or more with 87% increased odds (OR = 1.87, 95% CI: 1.01, 3.47), relative to exposure to only one hurricane. The indirect effect from hurricane exposure to hypertension via PD was statically significant (95% CI: 1.01, 1.09). Findings highlight a novel link between cumulative disaster exposure and hypertension, with PD as a potential mediator. This suggests that repeated exposure to hurricanes not only impacts mental health but may also contribute to adverse physical health outcomes. Addressing both mental and physical health in disaster response, especially for vulnerable populations, is crucial.

Impact of Hurricanes and Floodings on Mental Health Outcomes Within the United States: A Systematic Review and Meta-Analysis

OBJECTIVE

Given the US population concentration near coastal areas and increased flooding due to climate change, public health professionals must recognize the psychological burden resulting from exposure to natural hazards.

METHODS

We performed a systematic search of databases to identify articles with a clearly defined comparison group consisting of either pre-exposure measurements in a disaster-exposed population or disaster-unexposed controls, and assessment of mental health, including but not limited to, depression, post-traumatic stress (PTS), and anxiety.

RESULTS

Twenty-five studies, with a combined total of n =616 657 people were included in a systematic review, and 11 studies with a total of 2012 people were included in a meta-analysis of 3 mental health outcomes. Meta-analytic findings included a positive association between disaster exposure and PTS (n = 5, g = 0.44, 95% CI 0.04, 0.85), as well as depression (n = 9, g = 0.28, 95% CI 0.04, 0.53), and no meaningful effect size in studies assessing anxiety (n = 6, g = 0.05 95% CI -0.30, 0.19).

CONCLUSIONS

Hurricanes and flooding were consistently associated with increased depression and PTS in studies with comparison groups representing individuals unaffected by hazards.

Disaster preparedness among Asian, Pacific Islander, and Desi American communities

Disaster experiences and explorations of preparedness among Asian, Pacific Islander, and Desi Americans (APIDA) in the United States are often overlooked owing to their relatively smaller population share. APIDA are not homogenous, and their disaster experiences warrant further examination. This paper does so by investigating disaster preparedness using disaggregated information about APIDA. The study utilises nationally representative data from the 2017 American Housing Survey, analysing sociodemographic covariates. The disaster preparedness score among APIDA communities was approximately 4.81 on a zero to nine scale. APIDA renters and non-US citizens were less prepared than homeowners and US citizens. Among subgroups, Korean, Chinese, and Vietnamese respondents who were non-US citizens were less prepared than those who were US citizens. Marital status was significantly and positively associated with preparedness among Indians, Japanese, Vietnamese, and multiracial respondents. The findings underscore the importance of data disaggregation and tailored preparedness information and resources to address specific challenges APIDA communities face instead of a one-size-fits-all approach.

Adverse Effects of the Deepwater Horizon oil spill Amid Cumulative Disasters: A Qualitative Analysis of the Experiences of Children and Families

Limited research has examined the ramifications of the Deepwater Horizon oil spill (DHOS) on children and their families. This study builds on secondary data analysis and representative survey findings from the multi-method, multi-phase Gulf Coast Population Impact (GCPI) project. Specifically, this phase of the GCPI research draws on in-depth, semi-structured interview and focus group data to illuminate the social conditions that influenced poor child health outcomes in the aftermath of the DHOS and amid other disasters. These qualitative data were collected two years after the spill with caregivers, teachers, faith- and community-based leaders in five highly impacted Gulf Coast communities. Exploratory qualitative analysis revealed that children were affected by the DHOS and other related challenges through exposure to familial stress emerging from livelihood disruptions. Such disruptions were the result of ongoing poverty, damage to the fishing industry, and exposure to cumulative and compounding environmental disasters. In cases of severe familial stress, children may have experienced toxic stress because of caregivers' displaced distress; ambiguous loss through caregivers' physical and/or emotional absence; and the children's recognition of their families' dire financial situations. Toxic stress was most often expressed through acute and chronic physiological, emotional, and behavioral health challenges. This study expands current understandings of the impact of technological disasters and cumulative environmental disasters on children and families. It underscores the importance of investing in harm prevention strategies to reduce threats to the health and wellbeing of young people living in ecologically and socioeconomically insecure environments prone to intensifying technological and climate-fueled disasters.

Factors Associated With Poor Health Outcomes Among Vietnamese Americans After Hurricane Harvey, Houston, Texas, 2018-2019

OBJECTIVE

Immigrants typically experience poor health outcomes after disasters but are often excluded in disaster studies. We assessed physical and mental health outcomes among Houston-area Vietnamese American residents after Hurricane Harvey and hurricane-related characteristics associated with poor health outcomes.

METHODS

We conducted in-person structured surveys among 120 Vietnamese Americans from November 2018 through February 2019. We used the physical and mental component scores of the 12-Item Short-Form Health Survey to assess health outcomes. We used descriptive statistics for health outcomes and hurricane-related effects and examined the associations between hurricane-related characteristics and health outcomes.

RESULTS

Overall mean (95% CI) physical and mental component scores were 39.8 (29.7-49.9) and 32.6 (27.6-37.6), respectively. The odds of poor physical health poststorm were significantly higher among participants reporting ≥5 versus <5 depressive symptoms (odds ratio [OR] = 3.04; 95% CI, 1.11-8.29; P = .03) and significantly lower among participants with versus without health insurance (OR = 0.25; 95% CI, 0.09-0.71; P = .01). The odds of experiencing poor mental health more than a year after the hurricane were significantly higher among those sustaining versus not sustaining a serious injury/illness because of the hurricane (OR = 3.34; 95% CI, 1.12-9.94; P = .03) and among those who were married/partnered versus not married/partnered (OR = 4.16; 95% CI, 1.32-13.07; P = .02). Receiving versus not receiving free health care services after the hurricane and having high versus low levels of acculturation protected against poor mental health (P < .05 for both).

CONCLUSIONS

Our findings highlight the inequalities of postdisaster health outcomes in this immigrant population and emphasize the need for improved disaster recovery programs that account for these factors.

Social support and community embeddedness protect against post-disaster depression among immigrants: a Vietnamese American case study

Immigrants often face increased vulnerabilities to disaster-related poor health and recovery, compared to mainstream populations. Little is known about Hurricane Harvey's impacts among the storm affected area's large Vietnamese American population. Our study documented diverse psychological experiences and recovery challenges 1 year post-storm among a sample of 120 Vietnamese Americans residing in the Houston, Texas area. Using linear regression modeling, we examined the association between social support and depressive symptom development among these storm-affected Vietnamese Americans. Social support encapsulating both social embeddedness and perceived support was measured by the Louisville Social Support Scale and depressive symptom development was measured by 18 items that assessed emotional distress. These items included loss of appetite, loss of concentration, exposure to persistent pain, and the exhibition of hopelessness, tiredness, sadness, frustration, discouragement, desperation, exhaustion, disgraced, anger, and craziness. We found adverse post-disaster health outcomes, as well as potential avenues to mitigate them, that should be taken into consideration in the design and implementation of inclusive disaster programs. A high level of social support lowered depressive symptomology among Vietnamese Americans post-Hurricane Harvey, even when accounting for Hurricane Harvey-related home damages and injuries/illness. The negative association between social support and depressive symptom development remained after accounting for both post-storm self-rated mental and physical health. Our results suggested that public health practitioners and emergency management entities should prioritize social support resources to foster mental well-being after hurricanes among Vietnamese Americans as future hurricanes are expected to be stronger and more prevalent along the United States Gulf Coast.

The Epidemiology and Geographic Patterns of Natural Disaster and Extreme Weather Mortality by Race and Ethnicity, United States, 1999-2018

OBJECTIVES

The adverse effects that racial and ethnic minority groups experience before, during, and after disaster events are of public health concern. The objective of this study was to examine disparities in the epidemiologic and geographic patterns of natural disaster and extreme weather mortality by race and ethnicity.

METHODS

We used mortality data from the Centers for Disease Control and Prevention from January 1, 1999, through December 31, 2018. We defined natural disaster and extreme weather mortality based on International Classification of Diseases, 10th Revision codes X30-X39. We calculated age-adjusted mortality rates by race, ethnicity, and hazard type, and we calculated age-adjusted mortality rate ratios by race, ethnicity, and state. We used geographic mapping to examine age-adjusted mortality rate ratios by race, ethnicity, and state.

RESULTS

Natural disasters and extreme weather caused 27 335 deaths in the United States during 1999-2018. Although non-Hispanic White people represented 68% of total natural disaster and extreme weather mortality, the mortality rate per 100 000 population among non-Hispanic Black people was 1.87 times higher (0.71) and among non-Hispanic American Indian/Alaska Native people was 7.34 times higher (2.79) than among non-Hispanic White people (0.38). For all racial and ethnic groups, exposure to extreme heat and cold were the 2 greatest causes of natural disaster and extreme weather mortality. Racial and ethnic disparities in natural disaster and extreme weather mortality were highest in the South, Southwest, Mountain West, and Upper Midwest.

CONCLUSIONS

Racial and ethnic minority populations have a greater likelihood of mortality from natural disaster or extreme weather events than non-Hispanic White people. Our study strengthens the current knowledge base on these disparities and may inform and improve disaster preparedness and response efforts.

Disaster differentially affects underserved communities

Patients with barriers to care, including poverty and language barriers, often live in lower-cost, disaster-prone areas. Partnering with community clinics enables allergists to reach underserved patients.

Trajectories of Depressive Symptoms Experienced by Older People: Effects of Time, Hurricane Sandy, and the Great Recession

OBJECTIVES

To examine depressive symptom trajectories as a function of time and exposure to Hurricane Sandy, accounting for the effects of the Great Recession.

METHODS

We analyzed 6 waves of data from a 12-year panel using latent class growth models and multinomial logistic regression.

RESULTS

We identified 4 groups of people experiencing different trajectories of depressive symptoms. The groups differed on baseline characteristics (gender, age, education, income, race), history of diagnosed depression, and initial level of depressive symptoms. The group with the highest levels of depressive symptoms reported greater levels of peri-traumatic stress exposure to Hurricane Sandy.

DISCUSSION

Depressive symptoms increased as a function of the Great Recession, but exposure to Hurricane Sandy was not associated with subsequent increases in depressive symptoms for any of the 4 groups. People who consistently experienced high levels of depressive symptoms over time reported the highest levels of peri-traumatic stress during Hurricane Sandy. Findings highlight the importance of accounting for historical trends when studying the effects of disaster, identify people likely to be at risk during a disaster, and provide novel information about the causal relationship between exposure to disaster and depressive symptoms.

Physical Health Symptoms and Hurricane Katrina: Individual Trajectories of Development and Recovery More Than a Decade After the Storm

Objectives. To examine how physical health symptoms developed and resolved in response to Hurricane Katrina.Methods. We used data from a 2003 to 2018 study of young, low-income mothers who were living in New Orleans, Louisiana, when Hurricane Katrina struck in 2005 (n = 276). We fit logistic regressions to model the odds of first reporting or "developing" headaches or migraines, back problems, and digestive problems, and of experiencing remission or "recovery" from previously reported symptoms, across surveys.Results. The prevalence of each symptom increased after Hurricane Katrina, but the odds of developing symptoms shortly before versus after the storm were comparable. The number of traumatic experiences endured during Hurricane Katrina increased the odds of developing back and digestive problems just after the hurricane. Headaches or migraines and back problems that developed shortly after Hurricane Katrina were more likely to resolve than those that developed just before the storm.Conclusions. While traumatic experiences endured in disasters such as Hurricane Katrina appear to prompt the development of new physical symptoms, disaster-induced symptoms may be less likely to persist or become chronic than those emerging for other reasons.

Mental Illness Public Stigma and Generational Differences Among Vietnamese Americans

Public stigma is one barrier to accessing behavioral health care among Vietnamese Americans. To explore and identify features of culture and acculturation that influence behavioral health-related stigma, six focus groups were conducted with Vietnamese American participants in three generational groups and eleven key informant interviews were conducted with Vietnamese community leaders, traditional healers, and behavioral health professionals. Data were analyzed using Link and Phelan's (Annu Rev Sociol 27(1):363-385, 2001) work on stigma as an organizing theoretical framework. Findings underline several key cultural and generational factors that intersect to affect perceptions, beliefs, and stigma about mental health treatment. In particular, participants in the youngest groups highlighted that while they recognized the value of mental health services, they felt culturally limited in their access. This appeared to be closely related to intergenerational communication about mental health. The findings suggest avenues for further research as well as interventions to increase mental health treatment access and adherence.

A modified Community Assessment for Public Health Emergency Response (CASPER) four months after Hurricane Sandy

This study sought to assess access to utilities, basic needs, financial burden, and perceived safety among households in the Rockaway Peninsula of New York City, United States, four months after Hurricane Sandy struck in 2012. A modified cluster survey design was used to select households for inclusion in the study. Survey content was created using the Community Assessment for Public Health Emergency Response (CASPER) toolkit, gathering relevant data on access to food and water, basic utilities, financial burden, household demographics, and safety. Four months after Sandy, electricity and heat had been restored to all households. However, around one-third of them still had difficulty in obtaining food, and about one-half believed that their neighborhood was unsafe. One-quarter had problems in acquiring prescription medications, and approximately one-half reported anxiety. While basic utilities were almost entirely restored, there were ongoing challenges in Rockaway four months after Sandy, relating to financial hardship, food insecurity, healthcare, and psychologic distress.

Psychological distress and psychiatric disorder after natural disasters: systematic review and meta-analysis

BACKGROUND

Natural disasters are increasing in frequency and severity. They cause widespread hardship and are associated with detrimental effects on mental health.AimsOur aim is to provide the best estimate of the effects of natural disasters on mental health through a systematic review and meta-analysis of the rates of psychological distress and psychiatric disorder after natural disasters.

METHOD

This systematic review and meta-analysis is limited to studies that met predetermined quality criteria. We required included studies to make comparisons with pre-disaster or non-disaster exposed controls, and sample representative populations. Key studies were identified through a comprehensive search of PubMed, EMBASE and PsycINFO from 1980 to 3 March 2017. Random effects meta-analyses were performed for studies that reported key outcomes with appropriate statistics.

RESULTS

Forty-one studies were identified by the literature search, of which 27 contributed to the meta-analyses. Continuous measures of psychological distress were increased after natural disasters (combined standardised mean difference 0.63, 95% CI 0.27-0.98, P = 0.005). Psychiatric disorders were also increased (combined odds ratio 1.84, 95% CI 1.43-2.38, P < 0.001). Rates of post-traumatic stress disorder and depression were significantly increased after disasters. Findings for anxiety and alcohol misuse/dependence were not significant. High rates of heterogeneity suggest that disaster-specific factors and, to a lesser degree, methodological factors contribute to the variance between studies.

CONCLUSIONS

Increased rates of psychological distress and psychiatric disorders follow natural disasters. High levels of heterogeneity between studies suggest that disaster variables and post-disaster response have the potential to mitigate adverse effects.Declaration of interestNone.

Development of a Biomarker-Based Diagnostic Algorithm for Posttraumatic Syndrome after Physical Injury: Design of the BioPTS Study

Severe physical injury is a leading cause of posttraumatic syndrome (PTS). This is to develop a biomarker-based diagnostic algorithm for posttraumatic syndrome (BioPTS) study. This is a 2-year longitudinal cohort study assessing patients who were hospitalized beginning in 2015 at Chonnam National University Hospital in Gwangju, Korea, after experiencing severe physical injuries. Baseline evaluations were made during the acute phase (within 1 month) of the physical injury and included extensive information on sociodemographic and clinical variables as well as a list of biomarkers. All participants will be followed up for 2 years, and the diagnostic and predictive validities of various biomarkers for PTS will be estimated. The BioPTS study will develop the most accurate models for the diagnosis and prediction of PTS, and will contribute to existing research regarding the complex relationships between severe physical injury and psychological issues.

Cross-Sectional Data Within 1 Year of the Fukushima Meltdown: Effect-Size of Predictors for Depression

This cross-sectional study investigates effect sizes of depression predictors in a community close to the Fukushima, Japan nuclear reactor damaged by the 11 March, 2011 earthquake and tsunami. Subjects volunteered for assessment between December, 2011 and March, 2012. Of 466 individuals (351 female, mean age 60.4 year, SD = 14.0), 23 % of the female participants and 17 % of the male participants could be diagnosed with depression. The strongest predictors were house damage, age, income reduction, home water incursion, and casualty acquaintance. Education level, location during disaster, and workplace damage proved non-significant. The high number of retired/unemployed in the sample may have influenced outcome. Results suggest sampling influences the applicability of Conservation of Resources model to a disaster event.

A meta-analysis of risk factors for depression in adults and children after natural disasters

Background

A number of studies have shown a range of negative psychological symptoms (e.g. depression) after exposure to natural disasters. The aim of this study was to determine risk factors for depression in both children and adults who have survived natural disasters.

Methods

Four electronic databases (PubMed, Embase, Web of Science, and PsychInfo) were used to search for observational studies (case–control, cross-sectional, and cohort studies) about depression following natural disasters. The literature search, study selection, and data extraction were conducted independently by two authors. Thirty-one articles were included in the study, of which twenty included adult participants and eleven included child participants. Summary estimates were obtained using random-effects models. Subgroup analysis, sensitivity analysis, and publication bias tests were performed on the data.

Results

The prevalence of depression after natural disasters ranged from 5.8% to 54.0% in adults and from 7.5% to 44.8% in children. We found a number of risk factors for depression after exposure to natural disasters. For adults, the significant predictors were being female ;not married;holding religious beliefs; having poor education; prior trauma; experiencing fear, injury, or bereavement during the disaster; or losing employment or property, suffering house damage as a result of the disaster. For children, the significant predictors were prior trauma; being trapped during the disaster; experiencing injury, fear, or bereavement during the disaster; witnessing injury/death during the disaster; or having poor social support.

Conclusions

The current analysis provides evidence of risk factors for depression in survivors of natural disasters. Further research is necessary to design interventions to improve the mental health of survivors of natural disasters.

Military service, exposure to trauma, and health in older adulthood: an analysis of northern Vietnamese survivors of the Vietnam War

OBJECTIVES

We sought to better understand the association between early life exposure to war and trauma and older adult health status in a developing setting.

METHODS

We analyzed data of 405 Vietnamese men and women in 1 northern Vietnam commune who entered early adulthood during the Vietnam War and who are now entering late adulthood (i.e., ages 55 years and older in 2010).

RESULTS

The toll of war's trauma in the aging northern Vietnamese population was perceptible in the association between exposure to war trauma and various measures of physical health, including negative self-reported health and somatic symptoms. Killing another person and being exposed to toxic substances in warfare was especially detrimental to health in older adulthood. War traumas were likely implicated more strongly as determinants of late adulthood health in men than in women. The weak association between trauma exposure and reported depressive symptoms raised questions about measuring mental health.

CONCLUSIONS

Military service and war trauma were important determinants of older adult health beyond the US context, given the widespread waging of war and concentration of recent armed conflicts within developing societies.

Health problems among low-income parents in the aftermath of Hurricane Katrina

OBJECTIVE

Although the mental health consequences of disasters have been well documented, relatively less is known about their effects on survivors' physical health. Disaster studies have also generally lacked predisaster data, limiting researchers' ability to determine whether postdisaster physical health problems were influenced by disaster exposure, or whether they would have emerged even if the disaster had not occurred. The current study aimed to fill this gap.

METHOD

Participants were low-income, primarily non-Hispanic Black mothers (N = 334) who survived Hurricane Katrina and completed 4 survey assessments, 2 predisaster and 2 postdisaster. In each assessment, participants reported on whether they had experienced 3 common health problems (frequent headaches or migraines, back problems, and digestive problems) and completed 2 mental health measure (the K6 scale, the Perceived Stress Scale).

RESULTS

The descriptive results suggested that the hurricane led to at least short-term increases in the 3 health outcomes. Fixed effects modeling was conducted to explore how changes in various predictor variables related to changes in each health condition over the study. Bereavement and increases in psychological distress were significant predictors of increases in health problems.

CONCLUSIONS

Based on these results, further research that explores the processes through which disasters lead to both physical and mental health problems, postdisaster screenings for common health conditions and psychological distress, and interventions that boost survivors' stress management skills are suggested.

Hispanic health disparities after a flood disaster: results of a population-based survey of individuals experiencing home site damage in El Paso (Texas, USA)

In 2006, El Paso County, a predominantly Hispanic urban area, was affected by a flood disaster; 1,500 homes were damaged. We assessed the health impacts of the disaster upon 475 individuals whose homes were flood-damaged using mail survey data and logistic regression. Substantial proportions of individuals had one or more physical (43 %) or mental (18 %) health problem in the four months following the floods; 28 % had one or more injury or acute effect related to post-flood cleanup. Adverse event experiences, older age, and lower socioeconomic status were significantly associated with negative post-flood health outcomes in all three logistic regression models. A lack of access to healthcare, non-US citizenship, and English proficiency were significant predictors of negative outcomes in both the physical and mental health models, while Hispanic ethnicity (physical), native-birth (mental), and more serious home damage (cleanup) were significant predictors in one model each. The disaster had disproportionate negative health impacts on those who were more exposed, poorer, older, and with constrained resource-access. While a lack of US citizenship and Hispanic ethnicity were associated with higher risks, being less acculturated (i.e., English-deficient, foreign-born) may have protected against health impacts.

Disentangling the effects of migration, selection and acculturation on weight and body fat distribution: results from a natural experiment involving Vietnamese Americans, returnees, and never-leavers

We distinguish between selection and true migration effects on weight and body fat for Vietnamese immigrants; and examine the role of acculturation on these outcomes. Data (n = 703) were collected among three population-based samples of working-age Vietnamese immigrants, repatriated emigrants and never-migrated Vietnamese nationals. This allows for a decomposition exercise to separate the effects of migration effects from selection effects on body mass index (BMI) and waist-hip ratio (WHR). Immigrants are more likely to be overweight and to have high WHR, relative to both never-leavers and returnees, a pattern reflecting the importance of migration over selection. Among immigrants, coming to the US at a younger age is associated with higher BMI and WHR levels. And longer length of residence in the US is related to higher BMI. While higher Vietnamese language proficiency is related to a lower BMI level, being bilingual (proficient in both English and Vietnamese) is associated with lower risks for being overweight. The distinct pattern of results suggests that more problematic weight status and fat distribution among Vietnamese immigrants relative to Vietnamese nationals are not artifacts of the types of persons choosing to emigrate, but rather are due to acculturation to American diet and lifestyles. While efforts to promote and maintain traditional patterns of diet and lifestyle are likely to help Vietnamese and other immigrants avoid the perils of American patterns, facilitating a bi-cultural orientation is perhaps the most realistic approach for preserving protective features of the culture of origin with regard to body weight and fat distribution.