Hurricane Harvey and Greater Houston households: comparing pre-event preparedness with post-event health effects, event exposures, and recovery

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.

A longitudinal investigation of risk perceptions and adaptation behavior in the US Gulf Coast

Climate change is occurring more rapidly than expected, requiring that people quickly and continually adapt to reduce human suffering. The reality is that climate change-related threats are unpredictable; thus, adaptive behavior must be continually performed even when threat saliency decreases (e.g. time has passed since climate-hazard exposure). Climate change-related threats are also intensifying; thus, new or more adaptive behaviors must be performed over time. Given the need to sustain climate change-related adaptation even when threat saliency decreases, it becomes essential to better understand how the relationship between risk perceptions and adaptation co-evolve over time. In this study, we present results from a probability-based representative sample of 2,774 Texas and Florida residents prospectively surveyed 5 times (2017-2022) in the presence and absence of exposure to tropical cyclones, a climate change-related threat. Distinct trajectories of personal risk perceptions emerged, with higher and more variable risk perceptions among the less educated and those living in Florida. Importantly, as tropical cyclone adaptation behaviors increased, personal risk perceptions decreased over time, particularly in the absence of storms, while future tropical cyclone risk perceptions remained constant. In sum, adapting occurs in response to current risk but may inhibit future action despite increasing future tropical cyclone risks. Our results suggest that programs and policies encouraging proactive adaptation investment may be warranted.

Geospatial analytics of driving mechanism of land subsidence in Gulf Coast of Texas, United States

Land subsidence has been an ongoing issue for over a century along the Gulf Coast of Texas in the United States. This study assesses and models the factors contributing to land subsidence covering fifty-six (56) counties along the Gulf of Mexico coastline from Louisiana to the border of Mexico, approximately 300,000 km2. Geospatial statistical techniques and regression models were employed to investigate and predict the fundamental causes of land subsidence by integrating multiple datasets such as Global Navigation Satellite System (GNSS) (147 stations), groundwater extraction (78,420 wells), hydrocarbon production (84,424 wells), precipitation, and population growth. In the last two decades, the overall population rose by 33 % and the compound annual population growth rate increased from 2.08 to 4.10 % in Montgomery, Waller, Fort Bend, and Chambers counties. Emerging hotspot analysis reveals that the groundwater level is persistently declining and the regression model (R2 = 0.92) tested over Harris County predicts that the population growth significantly contributes to land subsidence in this region. The groundwater withdrawal rate is increased from 23 to 96.6 billion gallons in Harris, Montgomery, and Fort Bend counties in the last two decades. A prolonged drought from 2010 to 2015 due to low precipitation affected all fifty-six counties. Oil production increased eightfold and a high extraction rate of 19.5 to 40.1 million bbl/yr of oil in Karnes County was recorded within the last 20 years. The regression model (R2 = 0.73) over this county suggests that oil extraction is a primary contributing factor to the observed subsidence. Although the gas extraction rates for all counties are decreasing over time, some counties in the southern part of the Gulf Coast Aquifer show relatively higher extraction rates. For the first time, this research determines that all fifty-six counties along the Gulf Coast of Texas are undergoing land subsidence and experiencing high population growth, groundwater withdrawal, and hydrocarbon extraction.

Anticipating older populations' health risk exacerbated by compound disasters based on mortality caused by heart diseases and strokes

The health of older populations in the Southeastern U.S. receives threats from recurrent tropical cyclones and extreme heat, which may exacerbate the mortality caused by heart diseases and strokes. Such threats can escalate when these extremes form compound disasters, which may be more frequent under climate change. However, a paucity of empirical evidence exists concerning the health threats of compound disasters, and anticipations regarding the health risks of older populations under future compound disaster scenarios are lacking. Focusing on Florida, which has 67 counties and the second-largest proportion of older populations among U.S. states, we calibrate Poisson regression models to explore older populations' mortality caused by heart diseases and strokes under single and compound disasters. The models are utilized to estimate the mortality across future disaster scenarios, the changing climate, and the growing population. We identify that under multiple hurricanes or heat, current-month hurricanes or heat can affect mortality more heavily than previous-month hurricanes or heat. Under future scenarios, co-occurring hurricanes and extreme heat can exacerbate the mortality more severely than other disaster scenarios. The same types of compound disasters can coincide with an average of 20.5% higher mortality under RCP8.5-SSP5 than under RCP4.5-SSP2. We assess older populations' future health risks, alerting health agencies to enhance preparedness for future "worst-case" scenarios of compound disasters and proactively adapt to climate change.

Adverse Health Outcomes Following Hurricane Harvey: A Comparison of Remotely-Sensed and Self-Reported Flood Exposure Estimates

Remotely sensed inundation may help to rapidly identify areas in need of aid during and following floods. Here we evaluate the utility of daily remotely sensed flood inundation measures and estimate their congruence with self-reported home flooding and health outcomes collected via the Texas Flood Registry (TFR) following Hurricane Harvey. Daily flood inundation for 14 days following the landfall of Hurricane Harvey was acquired from FloodScan. Flood exposure, including number of days flooded and flood depth was assigned to geocoded home addresses of TFR respondents (N = 18,920 from 47 counties). Discordance between remotely-sensed flooding and self-reported home flooding was measured. Modified Poisson regression models were implemented to estimate risk ratios (RRs) for adverse health outcomes following flood exposure, controlling for potential individual level confounders. Respondents whose home was in a flooded area based on remotely-sensed data were more likely to report injury (RR = 1.5, 95% CI: 1.27-1.77), concentration problems (1.36, 95% CI: 1.25-1.49), skin rash (1.31, 95% CI: 1.15-1.48), illness (1.29, 95% CI: 1.17-1.43), headaches (1.09, 95% CI: 1.03-1.16), and runny nose (1.07, 95% CI: 1.03-1.11) compared to respondents whose home was not flooded. Effect sizes were larger when exposure was estimated using respondent-reported home flooding. Near-real time remote sensing-based flood products may help to prioritize areas in need of assistance when on the ground measures are not accessible.

Resident perceptions of the short- and long-term impacts of Hurricane Harvey

Severe storms and flooding events are expected to increase in frequency and severity, with lasting economic, social, and psychological impacts on communities in post-disaster recovery. In the first mixed methods study to focus on the experiences of Houstonians during Hurricane Harvey, which resulted in unprecedented and widespread flooding and billions of dollars in damage, we conducted five focus groups from four neighborhoods almost two years after Harvey made landfall. Our purpose was to understand how residents withstood and recovered from flooding-related stressors, what the major sources of support were and what long-term issues they were still dealing with. Residents relied on their families, friends, and neighborhood networks offline and online to seek important information about the storm and coordinate rescue efforts. They turned to their friends and neighbors for help with cleaning their homes and received support and donations from church and volunteer groups, while in one neighborhood residents organized themselves and coordinated aid and clean-up activities. Contrasting with this initial surge of social support that was perceived as overwhelmingly positive, the process of applying for federal aid was confusing, and residents reported continued stress and mental health strain. The experiences of Houston residents echo those of Hurricanes Katrina and Sandy survivors, particularly when seeking federal assistance, an experience that continued to exacerbate post-disaster stress. Enhanced state and local disaster response mechanisms, as well engaged partnerships between community stakeholders, academics and policy makers have the potential to improve community resilience, particularly in the natural and industrial disaster-prone greater Houston area.

Perceptions, knowledge, and communication preferences about indoor mold and its health implications among persons affected by Hurricane Harvey: a focus group analysis

Background

Among people affected by Hurricane Harvey, we assessed experiences and perceptions (e.g., knowledge, attitudes, and practices) regarding mold and its impact on health and elicited participants’ opinions about how to improve public health messaging about indoor mold after a large flooding event.

Methods

Houston Health Department conducted four focus groups with 31 Houston metropolitan area residents during January to March 2020, using a semi-structured discussion guide and federal communication materials about indoor mold. Drawing from a theoretical framework analysis, transcripts were grouped into relevant themes using inductive and deductive coding.

Results

Hurricane Harvey had a large impact on participants’ living standards, and widespread financial barriers to remediation led to long-term mold exposure for many participants. Knowledge about mold’s impact on health and proper mold clean-up practices varied, and clean-up behaviors did not commonly align with federal guidance. Participants generally preferred traditional forms of outreach, such as in-person, radio, and television announcements, to communicate public health messaging.

Conclusions

More strategic dissemination of expanded public health educational materials about proper mold clean-up practices and the health risks of mold exposure following flooding events is needed.

Assessment of an evacuation shelter program for people with access and functional needs in Monroe County, Florida during Hurricane Irma

This case study presents an evaluation framework to assess the facilitating and constraining factors that influenced the emergency response, operation, and management of a Special Needs Shelter Program in Monroe County, Florida during Hurricane Irma in 2017. A qualitative analysis of key documents and discussions with agencies directly involved in the Monroe County Special Needs Shelter Program was used to assess four major emergency response processes: notifications and communications, evacuation and transportation, sheltering, and interagency coordination. A critical cross-cutting theme emerged, which was a lack of a common definition for populations with "special needs" across different agencies resulting in uncertainties about who should be admitted to the Special Needs Shelter and have access to their services. We generate public health and emergency management lessons to inform future adaptation, preparedness, and response plans to extreme weather events for populations with access and functional needs in Monroe County and Florida's coastal communities more broadly.

Using GIS to Understand the Influence of Hurricane Harvey on Spatial Access to Primary Care

Hurricanes can have a significant impact on the functioning and capacity of healthcare systems. However, little work has been done to understand the extent to which hurricanes influence local residents' spatial access to healthcare. Our study evaluates the change in spatial access to primary care physicians (PCPs) between 2016 and 2018 (i.e., before and after Hurricane Harvey) in Harris County, Texas. We used an enhanced 2-step floating catchment area (E2SFCA) method to measure spatial access to PCPs at the census tract level. The results show that, despite an increased supply of PCPs across the county, most census tracts, especially those in the northern and eastern fringe areas, experienced decreased access during this period as measured by the spatial access ratio (SPAR). We explain this decline in SPAR by the shift in the spatial distribution of PCPs to the central areas of Harris County from the fringe areas after Harvey. We also examined the socio-demographic impact in the SPAR change and found little variation in change among different socio-demographic groups. Therefore, public health professionals and disaster managers may use our spatial access measure to highlight the geographic disparities in healthcare systems. In addition, we recommend considering other social and institutional dimensions of access, such as users' needs, preferences, resource capacity, mobility options, and quality of healthcare services, in building a resilient and inclusive post-hurricane healthcare system.

Multi-scalar and multi-dimensional conceptions of social capital and mental health impacts after disaster: the case of Hurricane Harvey

While much research investigates how social capital relates to mental health after disasters, less work employs a multi-scalar, multi-dimensional social capital framework. This study applies such a construct to an analysis of novel survey data of approximately 1,000 rural and urban Texans after Hurricane Harvey struck the United States in August 2017. On the individual level, it finds that greater social support is linked to fewer mental health impacts, but that greater civic and organisational engagement is connected to greater mental health impacts. At the community level, it finds that neither a density of bridging social capital organisations nor of bonding social capital organisations is associated with poorer mental health, although a greater number of bonding organisations is related to negative mental health impacts on rural residents. The paper concludes by focusing on how individual and community social capital relationships with mental health are contingent on measurement, scale, and rural or urban location.

Climate change is impacting mental health in North America: A systematic scoping review of the hazards, exposures, vulnerabilities, risks and responses

As climate change progresses, it is crucial that researchers and policymakers understand the ways in which climate-mental health risks arise through interactions between climate hazards, human exposure and social vulnerabilities across time and location. This scoping review systematically examined the nature, range and extent of published research in North America that investigates climate-mental health interactions. Five electronic databases were searched and two independent reviewers applied pre-determined criteria to assess the eligibility of articles identified in the search. Eighty-nine articles were determined to be relevant and underwent data extraction and analysis. The published literature reported on numerous exposure pathways through which acute and chronic climate hazards interacted with social vulnerabilities to increase mental health risks, including wellbeing, trauma, anxiety, depression, suicide and substance use. This review also highlights important gaps within the North American climate-mental health evidence base, including minimal research conducted in Mexico, as well as a lack of studies investigating climate-mental health adaptation strategies and projected future mental health risks. Further research should support effective preparation for and adaptation to the current and future mental health impacts of climate change. Such strategies could reduce health risks and the long-term mental health impacts that individuals and communities experience in a changing climate.

Land Subsidence in the Texas Coastal Bend: Locations, Rates, Triggers, and Consequences

Land subsidence and sea level rise are well-known, ongoing problems that are negatively impacting the entire Texas coast. Although ground-based monitoring techniques using long-term global navigation satellite systems (GNSS) records provide accurate subsidence rates, they are labor intensive, expensive, time-consuming, and spatially limited. In this study, interferometric synthetic aperture radar (InSAR) data and techniques were used to map the locations and quantify rates of land subsidence in the Texas Coastal Bend region during the period from October 2016 to July 2019. InSAR-derived land subsidence rates were then validated and calibrated against GNSS-derived rates. The factors controlling the observed land subsidence rates and locations were investigated. The consequences of spatial variability in land subsidence rates in Coastal Bend were also examined. The results indicated that: (1) land subsidence rates in the Texas Coastal Bend exhibited spatial variability, (2) InSAR-derived land subsidence rates were consistent with GNSS-derived deformation rates, (3) land subsidence in the Texas Coastal Bend could be attributed mainly to hydrocarbon and groundwater extraction as well as vertical movements along growth faults, and (4) land subsidence increased both flood frequency and severity in the Texas Coastal Bend. Our results provide valuable information regarding not only land deformation rates in the Texas Coastal Bend region, but also the effectiveness of interferometric techniques for other coastal rural areas around the globe.

Toward Resilient Water-Energy-Food Systems under Shocks: Understanding the Impact of Migration, Pandemics, and Natural Disasters

The historic pandemic faced by the international community today boldly demonstrates the complexity and interconnectedness of the resource challenges we must better understand and address in the future. Further complexity is observed when accounting for the impact of compounded shocks related to natural disasters and forced migration around the world. Effectively addressing these challenges requires the development of research that cuts across disciplines and innovates at their interfaces, in order to develop multifaceted solutions that respond to the social, economic, technological, and policy dimensions of these challenges. Water, energy, and food systems are tightly interconnected. They are faced with pressures of varying natures and levels of urgency which need to be better understood, especially as nations work toward achieving the UN 2030 Agenda’s Sustainable Development Goals by 2030. This paper will review existing models and knowledge gaps related to water-energy-food (WEF) nexus models, as well as models for quantifying the impact of migration, pandemics, and natural disasters on this resource nexus. Specifically, this paper will: (1) explore the WEF nexus literature and identify gaps in current assessment tools and models; (2) explore the literature on tools and models for predicting the shocks of migration, natural disasters, and pandemics; (3) identify interconnections between water, energy, and food systems and the identified shocks; (4) develop a common framework that provides a road map for integrating those shocks in WEF nexus analysis; (5) provide recommendations for future research and policies moving forward.

Pediatric Emergency Departments and Urgent Care Visits in Houston after Hurricane Harvey

Introduction

Natural disasters are increasingly common and devastating. It is essential to understand children’s health needs during disasters as they are a particularly vulnerable population. The objective of this study was to evaluate pediatric disease burden after Hurricane Harvey compared to the preceding month and the same period in the previous year to inform pediatric disaster preparedness.

Methods

This was a retrospective cross-sectional study of patients seen at pediatric emergency departments (ED) and urgent care centers (UCC) 30 days before (late summer) and after (early fall) the hurricane and from the same time period in 2016. We collected demographic information and the first five discharge diagnoses from a network of EDs and UCCs affiliated with a quaternary care children’s hospital in Houston, Texas. We calculated the odds of disease outcomes during various timeframes using binary logistic regression modeling.

Results

There were 20,571 (median age: 3.5 years, 48.1% female) and 18,943 (median age: 3.5 years, 47.3% female) patients in 2016 and 2017, respectively. Inpatient admission rates from the ED a month after Harvey were 20.5%, compared to 25.3% in the same period in 2016 (P<0.001). In both years, asthma and other respiratory illnesses increased from late summer to early fall. After controlling for these seasonal trends, the following diseases were more commonly seen after the hurricane: toxicological emergencies (adjusted odds ratio [aOR]: 2.61, 95% [confidence interval] CI, 1.35–5.05); trauma (aOR: 1.42, 95% CI, 1.32–1.53); and dermatological complaints (aOR: 1.34, 95% CI, 1.23–1.46).

Conclusion

We observed increases in rashes, trauma, and toxicological diagnoses in children after a major flood. These findings highlight the need for more medication resources and public health and education measures focused on pediatric disaster preparedness and management.

Climate Change and Human Well-Being in the 2020s: Lessons From 2020

Behind the coronavirus headlines the year 2020 set multiple extreme weather records, including unprecedented wildfires in Australia and California, massive flooding in China, and back-to-back hurricanes in Central America. The impacts on the well-being of local populations have been devastating. We reviewed these extreme weather events, together with the year's newly published climate and health science reports, and identified three important themes for building health resilience in the decade ahead: (1) preparing for greater magnitude and intensity of climate hazards, extreme events, and population health impacts; (2) better anticipating cascading and compound impacts on population well-being, particularly for the most vulnerable; and (3) identifying appropriate, effective preparedness tools and strategies. While decarbonizing the economy is the urgent goal to protect both human and planetary health from a changing climate, 2020 demonstrates that recognizing the likely magnitude and complexity of future extreme weather events, and preparing local public health agencies and communities with the knowledge and tools to respond to them, will be essential in this critical decade.

Perspectives on the Health Effects of Hurricanes: A Review and Challenges

Hurricanes are devastating natural disasters which dramatically modify the physical landscape and alter the socio-physical and biochemical characteristics of the environment, thus exposing the affected communities to new environmental stressors, which persist for weeks to months after the hurricane. This paper has three aims. First, it conceptualizes potential direct and indirect health effects of hurricanes and provides an overview of factors that exacerbate the health effects of hurricanes. Second, it summarizes the literature on the health impact of hurricanes. Finally, it examines the time lag between the hurricane (landfall) and the occurrence of diseases. Two major findings emerge from this paper. Hurricanes are shown to cause and exacerbate multiple diseases, and most adverse health impacts peak within six months following hurricanes. However, chronic diseases, including cardiovascular disease and mental disorders, continue to occur for years following the hurricane impact.

Policy brief on climate change and mental health/well-being

Climate change has a significant global impact on individuals' mental health and well-being. However, global health systems are inadequately prepared to address this issue. Studies indicate that climate events such as floods, droughts, tornados, earthquakes, and fires not only exacerbate chronic mental illness, but also impact well-being causing anxiety, stress, and in the worst case, suicide. The World Health Organization estimates that 12.6 million preventable deaths per year can be attributed to environmental factors, all of which are exacerbated by climate change, and an additional 250,000 deaths per year are projected between 2030 and 2050. Nurses must advocate for research, education, and policies that support disaster-resilient infrastructure and human services that allow communities across the globe to effectively mitigate the impact of climate change on human health.

Disparities in Health Effects and Access to Health Care Among Houston Area Residents After Hurricane Harvey

OBJECTIVES

Although research shows that public health is substantially affected during and after disasters, few studies have examined the health effects of Hurricane Harvey, which made landfall on the Texas coast in August 2017. We assessed disparities in physical health, mental health, and health care access after Hurricane Harvey among residents of the Houston-The Woodlands-Sugar Land, Texas, metropolitan statistical area (ie, Houston MSA).

METHODS

We used structured survey data collected through telephone and online surveys from a population-based random sample of Houston MSA residents (n = 403) collected from November 29, 2017, through January 6, 2018. We used descriptive statistics to describe the prevalence of physical health/mental health and health care access outcomes and multivariable generalized linear models to assess disparities (eg, based on race/ethnicity, socioeconomic status, disability) in health outcomes.

RESULTS

Physical health problems disproportionately affected persons who did not evacuate (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.19-0.87). Non-Hispanic black persons were more likely than non-Hispanic white persons to have posttraumatic stress (OR = 5.03; 95% CI, 1.90-13.10), as were persons in households that experienced job loss post-Harvey (vs did not experience job loss post-Harvey; OR = 2.89; 95% CI, 1.14-7.32) and older persons (OR = 1.04; 95% CI, 1.01-1.06). Health care access was constrained for persons whose households lost jobs post-Harvey (vs did not lose jobs post-Harvey; OR = 2.73; 95% CI, 1.29-5.78) and for persons with disabilities (vs without disabilities; OR = 3.19; 95% CI, 1.37-7.45).

CONCLUSIONS

Our findings underscore the need to plan for and ameliorate public health disparities resulting from climate change-related disasters, which are expected to occur with increased frequency and magnitude.