Disaster-zone research needs a code of conduct

Mental models for inclusive, socially-just disaster planning: a multi-community study in Saint Martin after Hurricane Irma

Local perspectives provide different insights into disaster planning and response as compared to those of experts. Eliciting them, however, can be challenging, particularly for marginalised groups whose viewpoints have historically been excluded from planning processes. Fuzzy cognitive mapping (FCM) provides a semi-quantitative approach to representing the collective understanding or 'mental models' of diverse individuals and communities. This study involved 23 FCM interviews across three neighbourhoods of Saint Martin to comprehend: (i) how individuals' mental models of Hurricane Irma (2017) differ based on their context; (ii) how aligned mental models are with policy and planning documents; and (iii) the implications for the inclusiveness and representativeness of disaster response policies. It found that the residents of different neighbourhoods provided unique insights into the factors driving the social-ecological system, and that official policies aligned closely with priorities. The paper argues that the inclusion of the perspectives of different groups in disaster recovery is essential for an equitable process.

Health Disparities in the Aftermath of Flood Events: A Review of Physical and Mental Health Outcomes with Methodological Considerations in the USA

PURPOSE OF REVIEW

This review applies an environmental justice perspective to synthesize knowledge of flood-related health disparities across demographic groups in the USA. The primary aim is to examine differential impacts on physical and mental health outcomes while also assessing methodological considerations such as flood exposure metrics, baseline health metrics, and community engagement.

RECENT FINDINGS

In our review (n = 27), 65% and 72% of studies identified racial, ethnic, or socio-economic disparities in physical and mental health outcomes post-flooding, respectively. The majority of racial/ethnic disparities were based on Black race, while most socio-economic disparities were based on lower household income. Forty-two percent of studies lacked flood exposure metrics, but often identified disparities. Common flood exposure metrics included self-reported flooding, flood risk models, and satellite-based observations. Seventy percent of studies lacked baseline health measurements or suitable alternatives, and only 19% incorporated community engagement into their research design. The literature consistently finds that both physical and mental health burdens following flooding are unequally shared across racial, ethnic, and socio-economic groups. These findings emphasize the need for disaster risk reduction policies that address underlying vulnerabilities to flooding, unequal exposure to flooding, and progressive funding for recovery efforts. Findings also underscore the importance of methodological enhancements to facilitate precise assessments of flood exposure and health outcomes.

Shifting terrains: Understanding residential contaminants after flood disasters

Flood disasters can induce the mass transport of soils and sediments. This has the potential to distribute contaminants and present novel combinations to new locations - including residential neighborhoods. Even when soil contaminants cannot be directly attributed to the disaster, data on bacterial and heavy metal(loids) can facilitate an environmentally just recovery by enabling reconstruction decisions that fill data gaps to minimize future exposure. These data-gathering interventions may be especially useful in poor, rural, and racially diverse communities where there is a high probability of exposure to multiple hazards and a potential dependency on the financial resources of disaster aid as a means of reducing chronic exposures to other environmental pollutants. At the same time, entering these post-disasters spaces is ethically complex. To acknowledge this complexity, we pilot a framework for work that gathers social-ecological hazard information while retaining a fair-minded approach to transdisciplinary work. Assembled a transdisciplinary team to recruit participants from 90 households subjected to flooding in the southeastern US. Participating households agreed to interviews to elicit flood experience and environmental health concerns, soil sampling for fecal bacteria (E. coli) and soil sampling for selected heavy metals and metalloids (Pb, As, Cd) at their flooded residence. Soil sampling found a wide range of E. coli concentrations in soil (0.4-1115.7 CFU/ dry gram). Heavy metal(loid)s were detected at most residences (As 97.9 %; Ca 25.5 %; Pb 100 %). Individually, heavy metal(loid) concentrations did not exceed regulatory thresholds. Hazard, risk, and mitigation concerns expressed during interviews reveal that integrated human-nature concepts complicate common understandings of how hazard perceptibility (smell, sight, touch, and information) affects research-action spaces. Qualitative analysis of interviews and field notes revealed that soil-related hazards addressed by our biophysical protocols were less salient than changes with direct causal associations with flooding. We conclude by discussing the potential for the social-ecological hazard information that is fair-minded and transdisciplinary (SHIFT) framework to advance environmentally just approaches to research-action spaces after disasters.

Defining, collecting, and sharing perishable disaster data

Researchers across disciplines have long sought to collect 'perishable data' in the context of disasters. Yet, this data type is neither consistently defined nor discussed in specific detail in the literature. To address this gap, this paper defines perishable data and provides guidance on ways to improve both how it is collected and shared. Here, perishable data is conceptualised as highly transient data that may degrade in quality, be irrevocably altered, or be permanently lost if not gathered soon after it is generated. Perishable data may include ephemeral information that must be collected to characterise pre-existing hazardous conditions, near-miss events, actual disasters, and longer-term recovery processes. This data may need to be gathered at multiple points in time across varying geographic scales to accurately characterise exposure, susceptibility to harm, or coping capacity. The paper considers ethical and logistical challenges and discusses opportunities to advance equitable perishable data collection and dissemination.

Maternal stress and hair cortisol among pregnant women following hurricane Florence

Natural disasters represent major stressors, resulting in psychological distress and physiological responses such as increased cortisol. During pregnancy, this impacts not only maternal well-being, but also fetal development. In 2018, Hurricane Florence caused extensive damage across the eastern United States. Studies indicated that compared to married pregnant women, unmarried pregnant women had higher risk of distress. Here we assess hair cortisol among a subsample of participants, and variations based on marital status.

METHODS

We analyzed multiple stress measures among 37 participants who were pregnant during Hurricane Florence. We used questionnaires modeled on previous studies to assess hardship associated with the hurricane, psychological distress, sociodemographic characteristics, social support, and food security. We analyzed cortisol concentrations in proximal and distal hair sections, representing stress around the time of the disaster (distal) and 3-4 months following the disaster (proximal). We used linear regression to test relationships between hair cortisol and self-report stress measures, and variations based on marital status.

RESULTS

Self-report measures of distress and hardship were similar among married and unmarried participants. Mean cortisol levels in distal and proximal sections were higher among unmarried participants. Controlling for confounding variables, hardship was not associated with hair cortisol. Distress predicted cortisol in distal sections (β = .482, p = .018), with a trend for proximal sections (β = .368, p = .055). Marital status was a significant predictor of distal (β = .388, p = .027) and proximal (β = .333, p = .047) hair cortisol, explaining 8.6%-11.7% of unique variance.

CONCLUSIONS

Preexisting and intersecting risk factors likely place unmarried pregnant individuals at risk of stress during and following a disaster.

"Go with the Flo": Conducting rapid research on prenatal stress following Hurricane Florence as participant observers

In this article, we explore the challenges of conceptualizing, designing, and establishing a rapid research agenda as a local researcher following a disaster. We share what we learned while developing and implementing this rapid study and explore the challenges shaped by time pressures, our local context, and resource availability. We identify four core challenges, experienced conducting rapid research, and provide suggestions to overcome these challenges. Our goal is to provide insight to undergraduates, graduate students, and professionals who are considering rapid research inside or outside their own communities.

Young people's perspectives of thyroid cancer screening and its harms after the nuclear accident in Fukushima Prefecture: a questionnaire survey indicating opt-out screening strategy of the thyroid examination as an ethical issue

Background

Overdiagnosis of thyroid cancer has become a major global medical issue. Ultrasound-based thyroid cancer screening has promoted overdiagnosis, and recently international recommendations state that it should not be conducted, even after a nuclear accident. The Fukushima thyroid cancer screening program was initiated in 2011 as a health policy after the nuclear accident. The risk of radiation-induced thyroid cancer was unlikely given the low radiation levels, but the thyroid cancer screening program has continued at 2-year intervals with a relatively high participation rate and is now in its fifth round. It is therefore crucial to clarify whether those targeted for screening understand the disadvantages of screening, and to identify factors that influenced their decision to participate.

Methods

We conducted an anonymous mail-based questionnaire among young people from Fukushima Prefecture (subjects) and a neighboring prefecture that was not targeted for screening (non-subjects). We asked them about the significance of the thyroid cancer screening in Fukushima Prefecture, their reasons for accepting or refusing screening, their perception of the harms of screening, and their opinions on thyroid examination at school. We compared the results of the questionnaire between subjects and non-subjects and between examinees (who were screened) and non-examinees (who declined screening).

Results

Only 16.5% of respondents were aware of the harms associated with thyroid cancer screening, with most perceiving that the benefits outweighed the harms. Comparison of subjects’ and non-subjects’ responses showed there were no significant differences between the two groups. Among subjects, there were also no differences in responses between examinees and non-examinees. The most common reason for participation in screening was that the screening was conducted in schools and perceived as obligatory.

Conclusions

These results highlighted a serious ethical issue in that school-based screening leads to making young people think that it is mandatory screening in an opt-out and default setting manner, with a lack of knowledge about the disadvantages of screening. Based on the autonomy of the subjects and the ethical principle of the post-disaster, surveys after a nuclear disaster should be conducted in an opt-in style without an opt-out style such as school-based screening.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09341-6.

Building Resilience in Qualitative Research: Challenges and Opportunities in Times of Crisis

The COVID-19 pandemic has significantly impacted qualitative researchers, especially those whose research involves face-to-face interactions with the community in the field. Implementing various mitigation measures to prevent the spread of COVID-19 entailed modifying, postponing and/or cancelling many research projects. Based on the attributes of the COVID-19 pandemic, which are unpredictable and pose serious threats, developing a highly structured and tested data collection approach that can reflect experiences and social realities from 'below' during a crisis is necessary. As the latest global crisis marker of this millennium, the extent of the impact of the COVID-19 pandemic on the knowledge production process in marginalised indigenous communities is largely unknown. This study contributes to the debate on how to ensure qualitative research methods possess the flexibility and adaptability to study such communities during a crisis.

PhotoKwento: co-constructing women's narratives of disaster recovery

A recent appraisal of disaster studies undertaken over the past 40 years draws attention to the urgency of advancing different epistemologies that reflect local realities of disaster experiences and of developing appropriate instruments with which to do so. This paper argues that feminist methods and perspectives can contribute greatly to this important endeavour of promoting epistemic diversity in research on disasters, advancing approaches that engender the co-construction of knowledge, and consequently challenging the 'hegemonic' (and often gender-blind) narratives that dominate disaster studies today. Specifically, the paper makes a case for a feminist photo-based approach that I designed (PhotoKwento) to examine women's experiences of disaster recovery in Tacloban City, Philippines. It demonstrates how the technique fosters engaged research relationships and participatory knowledge construction practices pertaining to disaster experiences. In addition, it highlights the potential of PhotoKwento to embody the qualities of research that are necessary for the progress of disaster studies 'from below'.

An ethical dimension to accident management and health surveillance

Many radiation protection actions carry a multitude of direct and indirect consequences that can impact on the welfare of affected populations. Health surveillance raises ethical challenges linked to privacy and data protection, as well as questions about the net benefit of screening. The SHAMISEN project recognized these issues and developed specific recommendations to highlight ethical challenges. Following a brief overview of ethical issues related to accident management, this paper presents the SHAMISEN recommendations: R1 The fundamental ethical principle of doing more good than harm should be central to accident management; and R4 Ensure that health surveillance respects the autonomy and dignity of affected populations, and is sensitive to any inequity in the distribution of risks and impacts. While a holistic approach to accident management means that decisions will be complicated by different values, perceptions and uncertainties about outcomes, addressing ethical issues could help ensure that the assumptions and potential conflicts behind eventual decisions are as transparent as possible.

A scoping review of recommendations in the English language on conducting research with trauma-exposed populations since publication of the Belmont report; thematic review of existing recommendations on research with trauma-exposed populations

OBJECTIVE

To identify recommendations for conducting public health research with trauma-exposed populations.

METHODS

Researchers searched Embase, PubMed, Scopus, Web of Science, Open Grey, and Google Scholar for recommendations. Trauma that causes psychological impact was our exposure of interest and we excluded clinical articles on treating physical trauma. We reviewed titles and abstracts of 8,070 articles and full text of 300 articles. We analyzed recommendations with thematic analysis, generated questions from the existing pool of recommendations, and then summarized select gaps.

RESULTS

We abstracted recommendations from 145 articles in five categories: community benefit, participant benefit, safety, researcher well-being, and recommendations for conduct of trauma research.

CONCLUSIONS

Gold standards to guide the conduct of trauma-informed public health research do not yet exist. The literature suggests participation in trauma research is not inherently harmful, and current recommendations concern using research to benefit communities and participants, protecting participants and researchers from harm, and improving professional practice. As public health researchers increasingly analyze trauma as a determinant of health, gold standards for the conduct of trauma-informed public health research would be appropriate and timely.

Getting Interdisciplinary Teams into the Field: Institutional Review Board Preapproval and Multi-Institution Authorization Agreements for Rapid Response Disaster Research

This article describes an interdisciplinary community resilience research project and presents a case study that supports bringing researchers together before a disaster to develop plans, procedures, and preapproved Institutional Review Board (IRB) protocols. In addition, this article explains how researchers from various academic institutions and their federal agency partners can effectively collaborate by creating an IRB Authorization Agreement (IAA). Such preparations can support interdisciplinary rapid response disaster fieldwork that is timely, ethically informed, and scientifically rigorous. This fieldwork preplanning process can also advance interdisciplinary team formation and data collection efforts over the long term.

Lessons learned from conducting disease monitoring in low-dose exposure conditions as a counter-measure after a nuclear disaster

The complex disaster of the Great East Japan Earthquake and the Fukushima nuclear accident caused concern about their various health impacts. Many types of intervention are desired as a countermeasure, depending on the phase of the disaster cycle. The importance of developing and applying codes of conduct has recently been emphasized for post-disaster investigations. Thyroid examination as a type of cancer screening survey was launched from October 2011 after the Fukushima nuclear accident as part of the Fukushima Health Management Survey. In this article, we reviewed the results of three rounds of thyroid examination from 2011 to 2018, and summarized the points to consider in the health survey conducted after the Fukushima nuclear accident. Large-scale mass screening by ultrasound thyroid examination resulted in many cancer diagnoses, >200 cases from a large reservoir of thyroid cancer that goes mainly unnoticed without screening. To prevent the harms of such over-diagnosis, we should be aware of the disadvantage of mass-screening based on the expected natural history of thyroid cancer. A change in strategy from mass-screening to individual monitoring is urgently needed according to international recommendations that are opposed to thyroid ultrasound cancer screening even after a nuclear disaster. To guarantee autonomy and informed choice on post-disaster disease monitoring for residents in a disaster-zone, it is important to set protocol participation and on a voluntary code of conduct basis.

Expected Scopes of Health Emergency and Disaster Risk Management (Health EDRM): Report on the Expert Workshop at the Annual Conference for the Japanese Association for Disaster Medicine 2020

The World Health Organization (WHO) and its partners established the WHO Thematic Platform for Health Emergency and Disaster Risk Management Research Network (HEALTH EDRM RN) in 2016 to respond to the increasing burden of recent health emergencies and disasters. The mission of the HEALTH EDRM RN, whose secretariat is located at the WHO Kobe Centre (WKC), is to promote global research collaboration and strengthen research activities to inform policies and programs by generating new evidence to manage health risks associated with all types of emergencies and disasters. With the strong support and involvement of all WHO regional offices, the HEALTH EDRM RN now works with more than 200 global experts and partners to pursue its mission. The first Core Group Meetings of the HEALTH EDRM RN were held on 17-18 October 2019, and concluded with the HEALTH EDRM RN-activity priorities to (1) promote operational research to better meet the needs of emergency- and disaster-exposed individuals and communities and efforts to translate science to policies and programs and (2) strengthen the research capacity of the Health EDRM community. In collaboration with the Japanese Association for Disaster Medicine, the WKC held a workshop on 21 February 2020, in which 20 Japanese experts from different research fields participated to further discuss these two points. This paper summarizes the discussion at the workshop.

Linking Disaster Risk Reduction and Healthcare in Locations with Limited Accessibility: Challenges and Opportunities of Participatory Research

Disaster risk reduction and healthcare support each other, including the mitigation of further harm after illness or injury. These connections are particularly relevant in locations which have permanent or temporary limited accessibility. In these circumstances, people are required to be self-sufficient in providing emergency and long-term healthcare with limited resources. Planning and preparing to mitigate further harm after illness or injury from disasters (disaster risk reduction) must include people living and working in locations with limited accessibility, meaning that participatory research can be used. The challenges and opportunities of enacting participatory research in such contexts have not been thoroughly examined. The research question of this paper is therefore, "What challenges and opportunities occur when participatory research links disaster risk reduction and healthcare to mitigate illness and injury in locations with limited accessibility?" To answer this research question, the method used is a qualitative evidence synthesis, combined with an overview paper approach. Two principal themes of challenges and opportunities are examined: defining the data and collecting the data. The themes are explored in theory and then through contextual examples. The conclusion is that an overarching challenge is divergent goals of research and actions that, when recognized, lead to opportunities for improved connections between disaster risk reduction and healthcare.

Quality management in humanitarian operations and disaster relief management: a review and future research directions

Quality management has been widely discussed in the literature, and recent special issues on humanitarian supply chains and relief operations have emphasized the increasing importance of quality management in this key emerging area. In this paper, we provide an extensive literature review in the field of quality management in humanitarian operations and disaster relief management. Our comprehensive review, comprising 61 articles published from 2009 to 2018, leads to the identification of enablers (e.g., transparency, policy framework), challenges (e.g., financial services, identity protection), and theory development approaches, as well as numerous research gaps that must be addressed.