Associations between mindfulness and mental health after collective trauma: results from a longitudinal, representative, probability-based survey

BACKGROUND/OBJECTIVES

Trait mindfulness (TM) may protect against post-trauma mental health ailments and related impairment. Few studies have evaluated this association in the context of collective traumas using representative samples or longitudinal designs.

DESIGN/METHOD

We explored relationships between TM and collective trauma-related outcomes in a prospective, representative, probability-based sample of 1846 U.S. Gulf Coast residents repeatedly exposed to catastrophic hurricanes, assessed twice during the COVID-19 outbreak (Wave 1: 5/14/20-5/27/20; Wave 2: 12/21/21-1/11/22). Generalized estimating equations examined longitudinal relationships between TM, COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment; ordinary least squares regression analyses examined the cross-sectional association between TM and COVID-19-related posttraumatic stress symptoms (PTSS) at Wave 1. Event-related stressor exposure was explored as a moderator.

RESULTS

In covariate-adjusted models including pre-event mental health ailments and demographics, TM was negatively associated with COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment over time; in cross-sectional analyses, TM was negatively associated with COVID-19-related PTSS. TM moderated the relationship between COVID-19 secondary stressor exposure (e.g., lost job/wages) and both global distress and functional impairment over time.

CONCLUSIONS

Results suggest TM may buffer adverse psychosocial outcomes following collective trauma, with some evidence TM may protect against negative effects of secondary stressor exposure.

Severe hurricanes increase recruitment and gene flow in the clonal sponge Aplysina cauliformis

Upright branching sponges, such as Aplysina cauliformis, provide critical three-dimensional habitat for other organisms and assist in stabilizing coral reef substrata, but are highly susceptible to breakage during storms. Breakage can increase sponge fragmentation, contributing to population clonality and inbreeding. Conversely, storms could provide opportunities for new genotypes to enter populations via larval recruitment, resulting in greater genetic diversity in locations with frequent storms. The unprecedented occurrence of two Category 5 hurricanes in close succession during 2017 in the U.S. Virgin Islands (USVI) provided a unique opportunity to evaluate whether recolonization of newly available substrata on coral reefs was due to local (e.g. re-growth of remnants, fragmentation, larval recruitment) or remote (e.g. larval transport and immigration) sponge genotypes. We sampled A. cauliformis adults and juveniles from four reefs around St. Thomas and two in St. Croix (USVI). Using a 2bRAD protocol, all samples were genotyped for single-nucleotide polymorphisms (SNPs). Results showed that these major storm events favoured sponge larval recruitment but did not increase the genetic diversity of A. cauliformis populations. Recolonization of substratum post-storms via clonality was lower (15%) than expected and instead was mainly due to sexual reproduction (85%) via local larval recruitment. Storms did enhance gene flow among and within reef sites located south of St. Thomas and north of St. Croix. Therefore, populations of clonal marine species with low pelagic dispersion, such as A. cauliformis, may benefit from increased frequency and magnitude of hurricanes for the maintenance of genetic diversity and to combat inbreeding, enhancing the resilience of Caribbean sponge communities to extreme storm events.

Hurricanes pose a substantial risk to New England forest carbon stocks

Nature-based climate solutions (NCS) are championed as a primary tool to mitigate climate change, especially in forested regions capable of storing and sequestering vast amounts of carbon. New England is one of the most heavily forested regions in the United States (>75% forested by land area), and forest carbon is a significant component of climate mitigation policies. Large infrequent disturbances, such as hurricanes, are a major source of uncertainty and risk for policies relying on forest carbon for climate mitigation, especially as climate change is projected to alter the intensity and extent of hurricanes. To date, most research into disturbance impacts on forest carbon stocks has focused on fire. Here, we show that a single hurricane in the region can down between 121 and 250 MMTCO2e or 4.6%-9.4% of the total aboveground forest carbon, much greater than the carbon sequestered annually by New England's forests (16 MMTCO2e year-1). However, emissions from hurricanes are not instantaneous; it takes approximately 19 years for downed carbon to become a net emission and 100 years for 90% of the downed carbon to be emitted. Reconstructing hurricanes with the HURRECON and EXPOS models across a range of historical and projected wind speeds, we find that an 8% and 16% increase in hurricane wind speeds leads to a 10.7- and 24.8-fold increase in the extent of high-severity damaged areas (widespread tree mortality). Increased wind speed also leads to unprecedented geographical shifts in damage, both inland and northward, into heavily forested regions traditionally less affected by hurricanes. Given that a single hurricane can emit the equivalent of 10+ years of carbon sequestered by forests in New England, the status of these forests as a durable carbon sink is uncertain. Understanding the risks to forest carbon stocks from disturbances is necessary for decision-makers relying on forests as a NCS.

Exposure of protected areas in Central America to extreme weather events

Central America and the Caribbean are regularly battered by megadroughts, heavy rainfall, heat waves, and tropical cyclones. Although 21st-century climate change is expected to increase the frequency, intensity, and duration of these extreme weather events (EWEs), their incidence in regional protected areas (PAs) remains poorly explored. We examined historical and projected EWEs across the region based on 32 metrics that describe distinct dimensions (i.e., intensity, duration, and frequency) of heat waves, cyclones, droughts, and rainfall and compared trends in PAs with trends in unprotected lands. From the early 21st century onward, exposure to EWEs increased across the region, and PAs were predicted to be more exposed to climate extremes than unprotected areas (as shown by autoregressive model coefficients at p < 0.05 significance level). This was particularly true for heat waves, which were projected to have a significantly higher average (tested by Wilcoxon tests at p < 0.01) intensity and duration, and tropical cyclones, which affected PAs more severely in carbon-intensive scenarios. PAs were also predicted to be significantly less exposed to droughts and heavy rainfall than unprotected areas (tested by Wilcoxon tests at p < 0.01). However, droughts that could threaten connectivity between PAs are increasingly common in this region. We estimated that approximately 65% of the study area will experience at least one drought episode that is more intense and longer lasting than previous droughts. Collectively, our results highlight that new conservation strategies adapted to threats associated with EWEs need to be tailored and implemented promptly. Unless urgent action is taken, significant damage may be inflicted on the unique biodiversity of the region.

Catastrophic storms, forest disturbance, and the natural history of Swainson's warbler

The core breeding range of Swainson's warbler (Limnothlypis swainsonii) overlaps a zone of exceptionally high tornado frequency in southeastern North America. The importance of tornadoes in creating breeding habitat for this globally rare warbler and other disturbance-dependent species has been largely overlooked. This paper estimates tornado frequency (1950-2021) and forest disturbance in the 240 counties and parishes in which breeding was documented from 1988 to 2014. The frequency of destructive tornadoes (EF1-EF5) varied 6-fold across the breeding range with a peak in the Gulf Coast states. Counties from east Texas to Alabama experienced the lowest median return interval of 5.4 years per 1000 km2, resulting in approximately 2477 ha of forest damage per 1000 km2 per century, based on current forestland cover. Tornadoes were significantly less frequent north and east of the core breeding range, with return intervals increasing to 9.1 years per 1000 km2 for breeding counties on the Atlantic coastal plain, 10.2 years per 1000 km2 in the Ozark Mountains, and 32.3 years per 1000 km2 in the Appalachian Mountains. Breeding counties within 150 km of the coastline from east Texas to North Carolina are also subjected to the highest frequency of hurricanes in the Western Hemisphere. Hurricanes often cause massive forest damage but archived meteorological and forestry data are insufficient to estimate the aggregate extent of forest disturbance in breeding counties. Nevertheless, the combined impact of tornadoes and hurricanes in the pre-Anthropogenic era was likely sufficient to produce a dynamic mosaic of early-successional forest crucial for the breeding ecology of Swainson's warbler. To ensure the long-term survival of this rare warbler, it is advisable to develop habitat management plans that incorporate remote sensing data on early-successional forest generated by catastrophic storms as well as anthropogenic activities.

Changes in Breastfeeding and Related Maternity Care Practices After Hurricanes Irma and Maria in Puerto Rico

Background: Breastfeeding is recommended globally for most infants, especially during and after natural disasters when risk of adverse outcomes increases because of unsanitary conditions and lack of potable water. Materials and Methods: Using 2017-2019 data from Puerto Rico's Pregnancy Risk Assessment Monitoring System for 2,448 respondents with a recent live birth, we classified respondents into 4 hurricane exposure time periods based on infant birth month and year relative to when Hurricanes Irma and Maria occurred: (1) prehurricane; (2) acute hurricane; (3) posthurricane, early recovery; and (4) posthurricane, long-term recovery. We examined the association between maternity care practices during delivery hospitalization and exclusive breastfeeding at 3 months overall and stratified by time period. We also examined the associations between each maternity care practice and exclusive breastfeeding separately by time period. Results: Exclusive breastfeeding at 3 months was higher during the acute hurricane time period (adjusted prevalence ratio [aPR]: 1.43, 95% confidence interval: 1.09-1.87) than the prehurricane time period. Supportive maternity care practices were positively associated with exclusively breastfeeding, and practices that are risk factors for discontinuing breastfeeding were negatively associated with exclusive breastfeeding. Breastfeeding in the first hour (aPR range: 1.51-1.92) and rooming-in (aPR range: 1.50-2.58) were positively associated with exclusive breastfeeding across all time periods, except the prehurricane time period. Receipt of a gift pack with formula was negatively associated with exclusive breastfeeding (aPR range: 0.22-0.54) across all time periods. Conclusions: Maternity care practices during delivery hospitalization may influence breastfeeding behaviors and can improve breastfeeding during and after natural disasters. Strategies to maintain and improve these practices can be further supported during and after natural disasters.

Hurricane disturbance drives trophic changes in neotropical mountain stream food webs

Food webs are complex ecological networks that reveal species interactions and energy flow in ecosystems. Prevailing ecological knowledge on forested streams suggests that their food webs are based on allochthonous carbon, driven by a constant supply of organic matter from adjacent vegetation and limited primary production due to low light conditions. Extreme climatic disturbances can disrupt these natural ecosystem dynamics by altering resource availability, which leads to changes in food web structure and functioning. Here, we quantify the response of stream food webs to two major hurricanes (Irma and María, Category 5 and 4, respectively) that struck Puerto Rico in September 2017. Within two tropical forested streams (first and second order), we collected ecosystem and food web data 6 months prior to the hurricanes and 2, 9, and 18 months afterward. We assessed the structural (e.g., canopy) and hydrological (e.g., discharge) characteristics of the ecosystem and monitored changes in basal resources (i.e., algae, biofilm, and leaf litter), consumers (e.g., aquatic invertebrates, riparian consumers), and applied Layman's community-wide metrics using the isotopic composition of 13 C and 15 N. Continuous stream discharge measurements indicated that the hurricanes did not cause an extreme hydrological event. However, the sixfold increase in canopy openness and associated changes in litter input appeared to trigger an increase in primary production. These food webs were primarily based on terrestrially derived carbon before the hurricanes, but most taxa (including Atya and Xiphocaris shrimp, the consumers with highest biomass) shifted their food source to autochthonous carbon within 2 months of the hurricanes. We also found evidence that the hurricanes dramatically altered the structure of the food web, resulting in shorter (i.e., smaller food-chain length), narrower (i.e., lower diversity of carbon sources) food webs, as well as increased trophic species packing. This study demonstrates how hurricane disturbance can alter stream food webs, changing the trophic base from allochthonous to autochthonous resources via changes in the physical environment (i.e., canopy defoliation). As hurricanes become more frequent and severe due to climate change, our findings greatly contribute to our understanding of the mechanisms that maintain forested stream trophic interactions amidst global change.

Disaster solidarity and survivor ethics: a case study of Hurricane María in Puerto Rico

Liminal periods of disaster solidarity in the aftermath of disaster are a common experience of many survivors. These periods have a specifically ethical component in that people spontaneously engage in collective, altruistic action and magnanimously expand their ethical focus beyond normative social distinctions and hierarchies. Inevitably, however, such solidarity seems to wane, and people return to pre-disaster patterns of interaction. Nevertheless, some individuals move beyond opportune acts of assistance to more extensive reorganisations of their lives during the recovery period and reshape their ethical commitments in new and durable directions. These individuals help make visible marginalised 'others' and draw collaborators to share new ethical visions. Based on observational and interview data collected after Hurricane María (2017) in a mountainous Puerto Rican municipality and employing the framework of virtue ethics, this paper examines the differential effects of disaster solidarity on survivors' ethical responses and the different contributions these make to society.

Pregnant Women's Experiences During and After Hurricanes Irma and Maria, Pregnancy Risk Assessment Monitoring System, Puerto Rico, 2018

OBJECTIVE

Exposure to natural disasters during and after pregnancy may increase adverse mental health outcomes. Hurricanes Irma and Maria struck Puerto Rico in September 2017. Our objectives were to understand hurricane-related experiences, maternal health concerns, and the impact of hurricane experiences on postpartum depressive symptoms (PDS).

METHODS

We used data from the 2018 Pregnancy Risk Assessment Monitoring System to describe differences in maternal hurricane experiences among women who were pregnant during and after the 2017 hurricanes. We assessed maternal concerns and PDS. We estimated adjusted prevalence ratios (aPRs) and 95% CIs for the associations between hurricane experiences and PDS.

RESULTS

The most frequently reported hurricane experiences were losing power for ≥1 week (97%) and feeling unsafe due to lack of order/security (70%). Almost 30% of women who were pregnant during the hurricanes reported missing prenatal care. PDS were reported by 13% of women. Most hurricane experiences were associated with an increased prevalence of PDS. Feeling unsafe (aPR = 2.4; 95% CI, 1.2-4.9) and having difficulty getting food (aPR = 2.1; 95% CI, 1.1-4.1) had the strongest associations.

CONCLUSIONS

Most women who were pregnant during or after hurricanes Irma and Maria struck Puerto Rico reported negative hurricane experiences, and most experiences were associated with an increased prevalence of PDS. Understanding the experiences of pregnant women during and after disasters and identifying risks for adverse mental health outcomes after pregnancy are important to inform emergency preparedness and prenatal and postpartum care.

Rent affordability after hurricanes: Longitudinal evidence from US coastal states

Climate change is expected to increase the frequency and intensity of natural hazards such as hurricanes. With a severe shortage of affordable housing in the United States, renters may be uniquely vulnerable to disaster-related housing disruptions due to increased hazard exposure, physical vulnerability of structures, and socioeconomic disadvantage. In this work, we construct a panel dataset consisting of housing, socioeconomic, and hurricane disaster data from counties in 19 states across the East and Gulf Coasts of the United States from 2009 to 2018 to investigate how the frequency and intensity of a hurricane correspond to changes in median rent and housing affordability (the interaction between rent prices and income) over time. Using a two-stage least square random-effects regression model, we find that more intense prior-year hurricanes correspond to increases in median rents via declines in housing availability. The relationship between hurricanes and rent affordability is more complex, though the occurrence of a hurricane in a given year or the previous year reduces affordable rental housing, especially for counties with higher percentages of renters and people of color. Our results highlight the multiple challenges that renters are likely to face following a hurricane, and we emphasize that disaster recovery in short- and medium-term should focus on providing safe, stable, and affordable rental housing assistance.

Hurricanes affect diversification among individual life courses of a primate population

Extreme climatic events may influence individual-level variability in phenotypes, survival and reproduction, and thereby drive the pace of evolution. Climate models predict increases in the frequency of intense hurricanes, but no study has measured their impact on individual life courses within animal populations. We used 45 years of demographic data of rhesus macaques to quantify the influence of major hurricanes on reproductive life courses using multiple metrics of dynamic heterogeneity accounting for life course variability and life-history trait variances. To reduce intraspecific competition, individuals may explore new reproductive stages during years of major hurricanes, resulting in higher temporal variation in reproductive trajectories. Alternatively, individuals may opt for a single optimal life-history strategy due to trade-offs between survival and reproduction. Our results show that heterogeneity in reproductive life courses increased by 4% during years of major hurricanes, despite a 2% reduction in the asymptotic growth rate due to an average decrease in mean fertility and survival by that is, shortened life courses and reduced reproductive output. In agreement with this, the population is expected to achieve stable population dynamics faster after being perturbed by a hurricane (ρ = 1.512 ; 95% CI: 1.488, 1.538), relative to ordinary yearsρ = 1.482 ; 1.475 , 1.490 . Our work suggests that natural disasters force individuals into new demographic roles to potentially reduce competition during unfavourable environments where mean reproduction and survival are compromised. Variance in lifetime reproductive success and longevity are differently affected by hurricanes, and such variability is mostly driven by survival.

Fear Language in a Warning Is Beneficial to Risk Perception in Lower-Risk Situations

OBJECTIVE

The goal was to examine the effectiveness of fear language in the protective action recommendation of an emergency warning, which instructs people how to prepare and stay safe.

BACKGROUND

Past work is limited because it has focused on describing the severity of the weather crisis, not improving the recommendation. Likewise, other research has examined fear appeals that overemphasize death, which leads to poor risk perceptions.

METHOD

In Experiment 1, the presence of fear language and second-person personal pronouns (i.e., "you") in a recommendation was manipulated. Experiment 2 examined how fear language and a hurricane changing in intensity influenced risk perceptions across three decision points.

RESULTS

Experiment 1 suggested that fear language was more influential than a pronoun on risk perceptions. Experiment 2 suggested that fear language in a protective action recommendation was most impactful in the case of a hurricane decreasing in intensity.

CONCLUSION

Protective action recommendations with fear language influence risk perceptions and behaviors. The magnitude of this influence is dependent on how people have categorized the hurricane (i.e., low vs. high risk).

APPLICATION

These results demonstrate that fear appeals in hurricane warnings can be useful, especially in cases when a low to medium risk event is still extremely dangerous. Likewise, these results demonstrate a need for caution, as fear appeals are not a "one size-fits-all" approach to increasing risk perceptions and should be used thoughtfully. Recommendations of when to use fear appeals in protective action recommendations are provided based on the present data.

Diagnosis Codes for Mold Infections and Mold Exposure Before and After Hurricane Harvey Among a Commercially Insured Population-Houston, Texas, 2016-2018

OBJECTIVE

Indoor mold after flooding poses health risks, including rare but serious invasive mold infections. The purpose of this study was to evaluate use of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes for mold infection and mold exposure in Houston, Texas, during the year before and the year after Hurricane Harvey.

METHODS

This study used data from MarketScan, a large health insurance claims database.

RESULTS

The incidence of invasive mold infections remained unchanged in the year after Hurricane Harvey; however, the incidence of diagnosis codes for mold exposure nearly doubled compared with the year before the hurricane (6.3 vs 11.0 per 100 000 enrollees, rate ratio: 1.7, 95% confidence interval 1.0-3.1).

CONCLUSIONS

Diagnosis codes alone may not be sufficiently sensitive to detect changes in invasive mold infection rates within this population and time frame, demonstrating the need for more comprehensive studies.

Healthcare and Social Organizations' Disaster Preparedness, Response, and Recovery Experience: Lessons Learned From Hurricanes Irma and Maria

BACKGROUND

Healthcare and social organizations (HSOs) are first respondents after natural disasters. Hence, their preparedness and resilience are critical components for addressing future disasters. However, little is known about HSOs' experiences prior to, during, and after hurricanes.

OBJECTIVE

To describe preparedness, response, and recovery experiences from hurricanes Irma/ Maria among HSOs in Puerto Rico and the US Virgin Islands.

METHODS

Using a convenience sample, semi-structured interviews were conducted with 52 key-informants. Content analysis for common and recurring themes and patterns was performed by HSO type.

RESULTS

Most HSOs (80.8%) had a preparedness plan and 55.8% responded providing emergency supplies. HSOs' human resources (61.2%) was the main recovery facilitator/ enabler, while 36.5% identified the lack of economic resources and the lack of an integrated emergency plan as the top barriers. The main lesson learned include understanding the need to make improvements to their emergency preparedness plans (56.3%), and to establish an integrated/ centralized plan between relevant parties.

CONCLUSION

Lessons learned after hurricanes allowed HSOs to identify gaps and opportunities to become more resilient. Infrastructure capacity, human resources, communication systems, and economic support, as well as training, partnerships, and new policies should be defined, revised, and/ or integrated into the HSOs' preparedness plans to mitigate the impact of future disasters.

Marshes and Mangroves as Nature-Based Coastal Storm Buffers

Tidal marshes and mangroves are increasingly valued for nature-based mitigation of coastal storm impacts, such as flooding and shoreline erosion hazards, which are growing due to global change. As this review highlights, however, hazard mitigation by tidal wetlands is limited to certain conditions, and not all hazards are equally reduced. Tidal wetlands are effective in attenuating short-period storm-induced waves, but long-period storm surges, which elevate sea levels up to several meters for up to more than a day, are attenuated less effectively, or in some cases not at all, depending on storm conditions, wetland properties, and larger-scale coastal landscape geometry. Wetlands often limit erosion, but storm damage to vegetation (especially mangrove trees) can be substantial, and recovery may take several years. Longer-term wetland persistence can be compromised when combined with other stressors, such as climate change and human disturbances. Due to these uncertainties, nature-based coastal defense projects need to adopt adaptive management strategies.

Official sources, news outlets, or search engines? Rumour validation on social media during Hurricanes Harvey and Irma

This study, based on data collected from a representative sample of adults in the United States, explores the social cognitive variables that motivated Americans to validate rumours on social media about Hurricanes Harvey and Irma, both of which struck in August/September 2017. The results indicate that risk perception and negative emotions are positively related to systematic processing of relevant risk information, and that systematic processing is significantly related to rumour validation through search engines such as Google. In contrast, trust in information about the hurricane is significantly related to validation through official sources, such as FEMA (Federal Emergency Management Agency), and major news outlets such as The New York Times. Trust in information is also significantly related to systematic processing of risk information. The findings of this study suggest that ordinary citizens may be motivated to validate rumours on social media, which is an increasingly important issue in contemporary societies.

Media exposure, threat processing, and mitigation behaviors in Gulf Coast residents facing the co-occurring threats of COVID-19 and hurricanes

The 2020 hurricane season threatened millions of Americans concurrently grappling with COVID-19. Processes guiding individual-level mitigation for these conceptually distinct threats, one novel and chronic (COVID-19), the other familiar and episodic (hurricanes), are unknown. Theories of health protective behaviors suggest that inputs from external stimuli (e.g., traditional and social media) lead to threat processing, including perceived efficacy (self- and response) and perceived threat (susceptibility and severity), guiding mitigation behavior. We surveyed a representative sample of Florida and Texas residents (N = 1846) between April 14, 2020 and April 27, 2020; many had previous hurricane exposure; all were previously assessed between September 8, 2017 and September 11, 2017. Using preregistered analyses, two generalized structural equation models tested direct and indirect effects of media exposure (traditional media, social media) on self-reported (1) COVID-19 mitigation (handwashing, mask-wearing, social distancing) and (2) hurricane mitigation (preparation behaviors), as mediated through perceived efficacy (self- and response) and perceived threat (susceptibility and severity). Self-efficacy and response efficacy were associated with social distancing (p = .002), handwashing, mask-wearing, and hurricane preparation (ps < 0.001). Perceived susceptibility was positively associated with social distancing (p = 0.017) and hurricane preparation (p < 0.001). Perceived severity was positively associated with social distancing (p < 0.001). Traditional media exhibited indirect effects on COVID-19 mitigation through increased response efficacy (ps < 0.05), and to a lesser extent self-efficacy (p < 0.05), and on hurricane preparation through increased self-efficacy and response efficacy and perceived susceptibility (ps < 0.05). Social media did not exhibit indirect effects on COVID-19 or hurricane mitigation. Communications targeting efficacy and susceptibility may encourage mitigation behavior; research should explore how social media campaigns can more effectively target threat processing, guiding protective actions.

Flood Risk to Hospitals on the United States Atlantic and Gulf Coasts From Hurricanes and Sea Level Rise

Hurricanes have caused major healthcare system disruptions. No systematic assessment of hurricane risk to United States hospital-based healthcare delivery has been performed. Here, we show that 25 of 78 metropolitan statistical areas (MSAs) on the United States Atlantic and Gulf Coasts have half or more of their hospitals at risk of flooding from relatively weak hurricanes. 0.82 m of sea level rise expected within this century from climate change increases the odds of hospital flooding 22%. Furthermore, in 18 MSAs at least half of the roads within 1.6 km of hospitals were at risk of flooding from a category 2 storm. These findings identify previously undescribed risks to hospital-based care delivery in Atlantic and Gulf Coast communities. They suggest that lower intensity hurricanes can have outsized impacts on healthcare access, particularly in places where per capita bed availability is low.

Observational Verification of the Cumulative Resilience Screening Index (CRSI) Using Hurricanes, Inland Floods, and Wildfires From 2016 to 2019

Users can apply three processes to develop confidence in decision-making tools like models and indices-validation, verification, and observation. The utility of the Cumulative Resilience Screening Index (CRSI) was demonstrated by combining the processes of verification and observation using real-world natural hazard events (i.e., hurricanes, inland flooding, and wildfires). The ability of CRSI to determine the counties most vulnerable to hazards and least likely to recover quickly from natural hazards is demonstrated using these natural hazard events from outside the original index construction data set. Using Hurricane Harvey and Hurricane Michael, the counties in Texas and Florida/Georgia, respectively, experiencing the most damage and the most extended recovery intervals were determined accurately. Similarly, the most vulnerable and least recoverable counties were correctly identified as those associated with the Great Louisiana Flood of 2016. Finally, three different types of wildfires in California were examined to determine the likelihood of recovery and the strength of pre-event planning. All models and indices developed for use by decision-makers should consider undertaking this verification or a similar validation operation to enhance user confidence.

Assessing the Feasibility and Effectiveness of a Linkage Into Mental Health Care Program for Adults Affected by Hurricane Sandy

OBJECTIVE

Research indicates that greater exposure to Hurricane Sandy is associated with increased mental health difficulties. This study examined whether Project Restoration, a program that linked adults into mental health care (L2C), was effective in reducing post-Sandy mental health difficulties as compared to a cohort of adults matched on mental health difficulties that were not linked into post-Sandy mental health care.

METHODS

Project Restoration participants (n = 52) with elevated self-reported mental health difficulties had the option to enroll into L2C. Project LIGHT (n = 63) used similar methodologies but did not have a L2C component and served as the matched control group.

RESULTS

Multivariable modeling showed significant decreases in all mental health difficulties except for depression in the Project Restoration group, whereas there were no significant decreases in LIGHT. The decrease in anxiety from baseline to follow-up was significantly greater for Project Restoration as compared to LIGHT.

CONCLUSION

Findings confirm the powerful impact community outreach and treatment have on reducing mental health difficulties after a disaster.

Hurricanes and Mortality among Patients Receiving Dialysis

BACKGROUND

Hurricanes are severe weather events that can disrupt power, water, and transportation systems. These disruptions may be deadly for patients requiring maintenance dialysis. We hypothesized that the mortality risk among patients requiring maintenance dialysis would be increased in the 30 days after a hurricane.

METHODS

Patients registered as requiring maintenance dialysis in the United States Renal Data System who initiated treatment between January 1, 1997 and December 31, 2017 in one of 108 hurricane-afflicted counties were followed from dialysis initiation until transplantation, dialysis discontinuation, a move to a nonafflicted county, or death. Hurricane exposure was determined as a tropical cyclone event with peak local wind speeds ≥64 knots in the county of a patient's residence. The risk of death after the hurricane was estimated using time-varying Cox proportional hazards models.

RESULTS

The median age of the 187,388 patients was 65 years (IQR, 53-75) and 43.7% were female. There were 27 hurricanes and 105,398 deaths in 529,339 person-years of follow-up on dialysis. In total, 29,849 patients were exposed to at least one hurricane. Hurricane exposure was associated with a significantly higher mortality after adjusting for demographic and socioeconomic covariates (hazard ratio, 1.13; 95% confidence interval, 1.05 to 1.22). The association persisted when adjusting for seasonality.

CONCLUSIONS

Patients requiring maintenance dialysis have a higher mortality risk in the 30 days after a hurricane.

Disaster preparedness in assisted reproductive technology

The American Society for Reproductive Medicine compels centers providing reproductive medicine care to develop and implement an emergency preparedness plan in the event of a disaster. Reproductive care is vulnerable to disruptions in energy, transportation, and supply chains as well as may have potential destructive impacts on infrastructure. With the relentless progression of events related to climate change, centers can expect a growing number of such disruptive events and must prepare to deal with them. This article provides a case study of the impact of Hurricane Sandy on one center in New York City and proposes recommendations for future preparedness and mitigation.

No evidence of predicted phenotypic changes after hurricane disturbance in a shade-specialist Caribbean anole

Extreme climatic events (ECEs) such as hurricanes have been hypothesized to be a major driving force of natural selection. Recent studies argue that, following strong hurricane disturbance, Anolis lizards in the Caribbean undergo selection for traits such as longer forelimbs or smaller body sizes that improve their clinging ability to their substrates increasing their chances of surviving hurricane wind gusts. Some authors challenge the generalization of this hypothesis arguing that other mechanisms may explain these phenotypic changes or that they may not necessarily be generalizable across systems. To address this issue, we compared body size and relative forelimb length of Anolis gundlachi, a trunk-ground anole living in closed-canopy forests in Puerto Rico, before, four months after, and 15 months after Hurricanes Irma and Maria in 2017. Overall, our results show no clear evidence of a temporal decrease in body size or increase forelimb length (relative to body size) challenging the generalizability of the clinging ability hypothesis. Understanding how animals adapt to ECE is an emerging field. Still, we are quickly learning that this process is complex and nuanced.

Tracking Hurricane-Related Deaths in the Contiguous United States Using Media Reports From 2012 to 2020

Heavy rainfall, storm surges, and tornadoes are hazards associated with hurricanes that can cause property damages and loss of life. Disaster-related mortality surveillance encounters challenges, such as timely reporting of mortality data. This review demonstrates how tracking hurricane-related deaths using online media reports (eg, news media articles, press releases, social media posts) can enhance mortality surveillance during a response. The Centers for Disease Control and Prevention used online media reports from 2012 to 2020 to characterize hurricane-related deaths from 10 hurricanes that were declared major disasters and the flooding related to Hurricane Joaquin in the contiguous United States. Media reports showed that drowning (n = 139), blunt force trauma (n = 89), and carbon monoxide poisoning (n = 58) were the primary causes of death. Online media and social media reports are not official records. However, media mortality surveillance is useful for hurricane responses to target messaging and current incident decision-making.

Coastal Microbial Communities Disrupted During the 2018 Hurricane Season in Outer Banks, North Carolina

Hurricane frequencies and intensities are expected to increase under warming climate scenarios, increasing potential to disrupt microbial communities from steady-state conditions and alter ecosystem function. This study shows the impact of hurricane season on microbial community dynamics within the barrier island system of Outer Banks, North Carolina. We found that the passage of two sequential energetic hurricanes in 2018 (Florence and Michael) were correlated with shifts in total and active (DNA and RNA) portions of bacterial communities but not in archaeal communities, and within surface waters but not within the sediment. These microbial community shifts were distinct from non-hurricane season conditions, suggesting significant implications for nutrient cycling in nearshore and offshore environments. Hurricane-influenced marine sites in the coastal North Atlantic region had lower microbial community evenness and Shannon diversity, in addition to increased relative abundance of copiotrophic microbes compared to non-hurricane conditions. The abundance of functional genes associated with carbon and nitrogen cycling pathways were also correlated with the storm season, potentially shifting microbial communities at offshore sites from autotroph-dominated to heterotroph-dominated and leading to impacts on local carbon budgets. Understanding the geographic- and system-dependent responses of coastal microbial communities to extreme storm disturbances is critical for predicting impacts to nutrient cycling and ecosystem stability in current and future climate scenarios.

The Impact of Natural Disasters on Maternal Health: Hurricanes Irma and María in Puerto Rico

The PROTECT research Center funded by the NIH's National Institute of Environmental Health Sciences (NIEHS) Superfund Research Program was launched in 2010 to explore the impact of exposure to pollutants on the high rate of premature births in Puerto Rico. In September 2017, Hurricanes Irma and María devastated the archipelago, which caused: collapse of the electrical system, collapse of the communication system, limited access to clean water, food, gas, and health services, destruction of public (e.g., hospitals) and private property (e.g., houses) and more than 4500 deaths. Pregnant and postpartum individuals are especially vulnerable to natural disasters. They face difficulty obtaining adequate pre- and post-natal care, are exposed to increased risk of miscarriage, premature delivery, and giving birth to low birth weight babies during and after disasters and are also more likely to suffer physical and mental health problems compared to the general population during and after disasters. A face-to-face questionnaire was administered to PROTECT participants who were pregnant during hurricanes Irma or Maria or who became pregnant shortly after in order to identify hurricane-related sources of stress and other adverse effects. This paper is based on the answers to the open-ended question at the end of the questionnaire where participants were asked to share their experiences during and after the hurricanes. Among the 375 participants who completed the survey, 76 answers to the open-ended question were considered due to data saturation. The answers to the open-ended question were transcribed into a document in order to facilitate the coding process. The transcribed text was analyzed first to identify emerging categories and then coded to identify common themes as well as divergence among participants. The following themes were identified: pregnancy and birth challenges, lack of access to basic services, housing conditions, stressful working conditions, concerns about health, concerns about their children, and positive or protective aspects. The results indicate how the disruption in access to basic services has a unique impact on the physical and mental health of pregnant and post-partum women in an emergency situation. These findings point to the potential benefit of developing specific protocols designed for emergency preparedness aimed at this population, which can inform healthcare providers and community organizations in case of future events.

Throwing caution to the wind: How hurricanes affect COVID-19 spread

This study exploits the pathway of Hurricane Laura to assess its impact on the spread of COVID-19. Using US hospital data on confirmed and suspected adult COVID-19 cases, we find average daily cases per week rose by more than 12% primarily in tropical storm-affected counties in subsequent weeks. We suspect the key mechanisms involve constraints on social distancing for two reasons. First, there is significant evidence of storm-induced mobility. Second, lower income areas endured higher growth in hospital cases during the post-hurricane period. These findings provide crucial insights for policy-makers when designing natural disaster protocols to adjust for potential respiratory viral illnesses.

Dialysis Care for US Military Veterans in Puerto Rico during the 2017 Atlantic Hurricane Season

OBJECTIVES

Patients with end stage kidney disease (ESKD) are at higher risk for increased mortality and morbidity due to disaster-related disruptions to care. We examine effects of Hurricanes Irma and Maria on access to dialysis care for US Department of Veterans Affairs (VA) ESKD patients in Puerto Rico.

METHODS

A retrospective, longitudinal cohort study was conducted among VA patients with at least 1 dialysis-related encounter between September 6, 2016, and September 5, 2018. The annual number of dialysis encounters, visits to an emergency department (ED), and the number of deaths pre- and post-hurricanes were compared. A random effects logistic regression model for correlated binary outcomes was fitted for predictors of mortality. Chi-square tests were for differences between pre- and post-hurricane visits.

RESULTS

The number of ED visits increased in post-hurricane period (1172 [5.7%] to 1195 [6.6%]; P < 0.001). ESKD-related ED visits increased from 200 (0.9%) to 227 (1.3%) (P < 0.05). Increase in mortality was associated with age (OR = 1.66; CI: 1.23-2.17), heart failure (OR = 2.07; CI: 1.26-3.40), chronic pulmonary disease (OR = 3.26; CI: 1.28-8.28), and sepsis (OR = 3.16; CI: 1.89-5.29).

CONCLUSIONS

There was an increase in dialysis services at the San Juan VA Medical Center post-Irma/Maria, and access to dialysis care at the non-VA clinics was limited. The role of VA dialysis centers in providing care during disasters warrants further investigation.

Trends in carbon monoxide poisoning deaths in high frequency hurricane states from 2014-19: the need for prevention intervention strategies

INTRODUCTION

Hurricanes often result in power outages, which increase generator usage and carbon monoxide (CO) deaths. We aim to identify states with the highest frequency of hurricanes and evaluate the number of unintentional CO poisoning deaths by region, age, race and metropolitan distribution.

METHODS

The number of hurricanes was determined using the FEMA database, and the number of unintentional CO poisoning deaths was determined using the CDC WONDER database from 2014-19. Hurricane-associated consumer outages were obtained from the Department of Energy.

RESULTS

The number of unintentional CO poisoning deaths was as follows: Florida, South Carolina, North Carolina, Georgia and Alabama. Adults displayed a significantly higher number of unintentional CO poisoning deaths than pediatrics (P < 0.001). The total number of unintentional CO poisoning deaths was highest in the White population (P < 0.001); however, unintentional CO poisoning death rates were nearly two times higher among Black population in adults (0.5 versus 0.3) and pediatrics (0.2 versus 0.1). Medium metropolitan areas exhibited significantly more unintentional CO poisoning deaths (P < 0.001).

CONCLUSIONS

Hurricanes and unintentional CO poisoning deaths were most common in Florida. Death rates were higher among Black individuals. Medium metropolitan areas displayed significantly more unintentional CO poisoning deaths than all other areas.

Hospitalizations for chronic conditions following hurricanes among older adults: A self-controlled case series analysis

BACKGROUND/PURPOSE

Extreme events such as hurricanes adversely impact healthcare systems and the communities they serve. The degree to which hurricanes affect healthcare use among high need groups such as older adults with chronic conditions has not been well examined, nor has the impact of hurricane severity on health outcomes. We characterized hospitalizations among older adults by chronic condition after eight large-scale hurricanes in the United States.

METHODS

Using a combination of administrative healthcare data and the Federal Emergency Management Agency's Disaster Declaration database we conducted a self-controlled case series analysis. We identified Medicare beneficiaries who were exposed to one of eight hurricanes and compared hospitalizations in the 30-days after a hurricane to hospitalizations in the rest of the calendar year of the hurricane. We examined hospitalizations (1) in total, (2) separately for diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) admissions, and (3) by hurricane damage category.

RESULTS

Among all older adults exposed, hospitalizations in the 30-day period after each disaster increased for all three chronic conditions; diabetes (incidence rate ratio [IRR] = 1.06, 95% confidence interval [CI] 1.03, 1.10), COPD (IRR = 1.06, 95% CI 1.04, 1.08), and CHF (IRR = 1.19, 95% CI 1.17, 1.21. In the 30-to-60-day period hospitalizations also increased for each chronic condition; diabetes (IRR = 1.06, 95% CI 1.03, 1.10), COPD (IRR = 1.12, 95% CI 1.10, 1.15), and CHF (IRR = 1.32, 95% CI 1.30, 1.34). Substantial differences in hospitalizations were observed according to individual hurricane and by the chronic disease examined.

CONCLUSION

Exposure to hurricanes is associated with an increase in hospitalizations for chronic conditions across all hurricane damage categories. As disasters are expected to increase in strength and frequency, our results underscore the need for response strategies and health policy planning for healthcare systems designed to address the health needs of older Americans with chronic conditions.

Evolution of Tropical Cyclone Properties Across the Development Cycle of the GISS-E3 Global Climate Model

The next-generation global climate model from the NASA Goddard Institute for Space Studies, GISS-E3, contains many improvements to resolution and physics that allow for improved representation of tropical cyclones (TCs) in the model. This study examines the properties of TCs in two different versions of E3 at different points in its development cycle, run for 20 years at 0.5° resolution, and compares these TCs with observations, the previous generation GISS model, E2, and other climate models. E3 shares many TC biases common to global climate models, such as having too few tropical cyclones, but is much improved from E2. E3 produces strong enough TCs that observation-based wind speed thresholds can now be used to detect and track them, and some storms now reach hurricane intensity; neither of these was true of E2. Model development between the first and second versions of E3 further increased the number and intensity of TCs and reduced TC count biases globally and in most regions. One-year sensitivity tests to changes in various microphysical and dynamical tuning parameters are also examined. Increasing the entrainment rate for the more strongly entraining plume in the convection scheme increases the number of TCs (though also affecting other climate variables, and in some cases increasing biases). Variations in divergence damping did not have a strong effect on simulated TC properties, contrary to expectations based on previous studies. Overall, the improvements in E3 make it more credible for studies of TC activity and its relationship to climate.

Rhesus macaques compensate for reproductive delay following ecological adversity early in life

Adversity early in life can shape the reproductive potential of individuals through negative effects on health and life span. However, long-lived populations with multiple reproductive events may present alternative life history strategies to optimize reproductive schedules and compensate for shorter life spans. Here, we quantify the effects of major hurricanes and density dependence as sources of early-life ecological adversity on Cayo Santiago rhesus macaque female reproduction and decompose their effects onto the mean age-specific fertility, reproductive pace, and lifetime reproductive success (LRS). Females experiencing major hurricanes exhibit a delayed reproductive debut but maintain the pace of reproduction past debut and show a higher mean fertility during prime reproductive ages, relative to unaffected females. Increasing density at birth is associated to a decrease in mean fertility and reproductive pace, but such association is absent at intermediate densities. When combined, our study reveals that hurricanes early in life predict a delay-overshoot pattern in mean age-specific fertility that supports the maintenance of LRS. In contrast to predictive adaptive response models of accelerated reproduction, this long-lived population presents a novel reproductive strategy where females who experience major natural disasters early in life ultimately overcome their initial reproductive penalty with no major negative fitness outcomes. Density presents a more complex relation with reproduction that suggests females experiencing a population regulated at intermediate densities early in life will escape density dependence and show optimized reproductive schedules. Our results support hypotheses about life history trade-offs in which adversity-affected females ensure their future reproductive potential by allocating more energy to growth or maintenance processes at younger adult ages.

Disruptions in Oncology Care Confronted by Patients with Gynecologic Cancer Following Hurricanes Irma and Maria in Puerto Rico

BACKGROUND

In September 2017, hurricanes Irma and Maria affected Puerto Rico (PR) and the US Virgin Islands (USVI), causing major disruptions in basic services and health care. This study documented the stressors and experiences of patients with gynecologic cancer receiving oncology care in PR following these hurricanes.

METHODS

We conducted 4 focus groups (December 2018-April 2019) among women aged ≥21 years from PR who were diagnosed with gynecological cancer between September 2016 and September 2018 (n = 24). Using the same eligibility criteria, we also interviewed patients from the USVI (n = 2) who were treated in PR. We also conducted key-informant interviews with oncology care providers and administrators (n = 23) serving gynecologic cancer patients in PR. Discussions were audio-recorded, transcribed verbatim, and coded to identify emergent themes using a constant comparison method.

RESULTS

Analyses of focus group discussions and interviews allowed us to identify the following emergent themes: 1) disruptions in oncology care were common; 2) communication between oncology providers and patients was challenging before and after the hurricanes hit; 3) patient resilience was key to resume care; and 4) local communities provided much-needed social support and resources.

CONCLUSIONS

This study provides firsthand information about the disruptions in oncology care experienced by and the resiliency of women with gynecologic cancer following hurricanes Irma and Maria. Our findings underscore the need to incorporate oncology care in the preparedness and response plans of communities, health systems, and government agencies to maintain adequate care for cancer patients during and after disasters such as hurricanes.

Resilience of Communities in Puerto Rico Following Hurricane Maria: Community-Based Preparedness and Communication Strategies

OBJECTIVE

This study aimed to examine factors that may have contributed to community disaster resilience following Hurricane Maria in Puerto Rico.

METHODS

In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities (9% of total). Transcripts were deductively and inductively coded and analyzed to identify salient topics and themes, then examined according to strategic themes from the Federal Emergency Management Association's (FEMA) Whole Community Approach.

RESULTS

Municipal preparedness efforts were coordinated, community-based, leveraged community assets, and prioritized vulnerable populations. Strategies included (1) multi-sectoral coordination and strategic personnel allocation; (2) neighborhood leader designation as support contacts; (3) leveraging of community leader expertise and social networks to protect vulnerable residents; (4) Censuses of at-risk groups, health professionals, and first responders; and (5) outreach for risk communication and locally tailored protective measures. In the context of collapsed telecommunications, communities implemented post-disaster strategies to facilitate communication with the Puerto Rican Government, between local first responders, and to keep residents informed, including the use of: (1) police radios; (2) vehicles with loudspeakers; (3) direct interpersonal communication; and (4) solar-powered Internet radio stations.

CONCLUSIONS

Adaptive capacities and actions of Puerto Rican communities exemplify the importance of local solutions in disasters. Expanded research is recommended to better understand contributors to disaster resilience.

Above- and Below-Ground Carbon Storage of Hydrologically Altered Mangrove Wetlands in Puerto Rico after a Hurricane

Mangrove wetlands are important ecosystems, yet human development coupled with climate change threatens mangroves and their large carbon stores. This study seeks to understand the soil carbon dynamics in hydrologically altered mangrove swamps by studying aboveground biomass estimates and belowground soil carbon concentrations in mangrove swamps with high, medium, and low levels of disturbance in Cataño, Jobos Bay, and Vieques, Puerto Rico. All three sites were affected by hurricane María in 2017, one year prior to the study. As a result of being hit by the Saffir-Simpson category 4 hurricane, the low-disturbance site had almost no living mangroves left during sampling. There was no correlation between level of hydrologic alteration and carbon storage, rather different patterns emerged for each of the three sites. At the highly disturbed location, belowground carbon mass averaged 0.048± 0.001 g-C cm⁻³ which increased with increased aboveground biomass. At the moderately disturbed location, belowground carbon mass averaged 0.047 ± 0.003 g-C cm⁻³ and corresponded to distance from open water. At the low-disturbed location, organic carbon was consistent between all sites and inorganic carbon concentrations controlled total carbon mass which averaged 0.048 ± 0.002 g-C cm⁻³. These results suggest that mangroves are adaptive and resilient and have the potential to retain their carbon storage capacities despite hydrologic alterations, but mass carbon storage within mangrove forests can be spatially variable in hydrologically altered conditions.

Comparing Primary Health-Care Service Delivery Disruptions Across Disasters

OBJECTIVE

The aim of this study was to compare primary care appointment disruptions around Hurricanes Ike (2008) and Harvey (2017) and identify patterns that indicate differing continuity of primary care or care systems across events.

METHODS

Primary care appointment records covering 5 wk before and after each storm were identified for Veterans Health Affairs (VA) facilities in the greater Houston and surrounding areas and a comparison group of VA facilities located elsewhere. Appointment disposition percentages were compared within and across storm events to assess care disruptions.

RESULTS

For Hurricane Harvey, 14% of primary care appointments were completed during the week of landfall (vs 33% for Hurricane Ike and 69% in comparison clinics), and 49% were completed the following week (vs 58% for Hurricane Ike and 71% for comparison clinics). By the second week after Hurricane Ike and third week after Harvey, the scheduled appointment completion percentage returned to prestorm levels of approximately 60%.

CONCLUSIONS

There were greater and more persistent care disruptions for Hurricane Harvey relative to Hurricane Ike. As catastrophic emergencies including major natural disasters and infectious disease pandemics become a more recognized threat to primary and preventive care delivery, health-care systems should consider implementing strategies to monitor and ensure primary care appointment continuity.

Alcohol and other substance use by faculty, staff, and students in a university community during two hurricanes: Lessons for preventing risky misuse

Communities commonly warn against heavy alcohol and other substance use during natural disasters like hurricanes, because such use may produce risk for individuals and communities, with studies showing deleterious effects persisting months or even years. Examining patterns and emotional correlates of use in the immediate presence of hurricanes may identify useful risk prevention targets. We assessed self-reported substance use and emotions in a university community (faculty, staff, and students) having the unlucky fate of experiencing hurricanes in early September 2 years in a row. Participants (403 in 2018, 76.0% female; M age 28.82; SD = 12.36 and 292 in 2019, 72.6% female; M age 30.63; SD = 13.96) reported typical weekly substance use and emotions and then the same data during each hurricane day. Results showed elevated use of alcohol, caffeine and tobacco before and during each hurricane, but a rapid drop-off of alcohol and caffeine (but not tobacco) use immediately after-although anxiety remained high. Findings are interpreted using both tension-reduction and stress-coping models and suggestions are made for future risk mitigation.

Preparing end-stage heart failure patients and care providers in the era of climate change-driven hurricanes

Patients with end-stage congestive heart failure are at elevated risk for harm when extreme storms threaten and strike their communities. Individuals with compromised heart function require customized hurricane protection and preparedness approaches. We provide mitigation strategies for providers and their teams, as well as the patients themselves to ensure their safety and uninterrupted access to healthcare resources and quality care during hurricane impact and in the aftermath.

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.

Information needs and priority use cases of population health researchers to improve preparedness for future hurricanes and floods

OBJECTIVE

Information gaps that accompany hurricanes and floods limit researchers' ability to determine the impact of disasters on population health. Defining key use cases for sharing complex disaster data with research communities and facilitators, and barriers to doing so are key to promoting population health research for disaster recovery.

MATERIALS AND METHODS

We conducted a mixed-methods needs assessment with 15 population health researchers using interviews and card sorting. Interviews examined researchers' information needs by soliciting barriers and facilitators in the context of their expertise and research practices. Card sorting ranked priority use cases for disaster preparedness.

RESULTS

Seven barriers and 6 facilitators emerged from interviews. Barriers to collaborative research included process limitations, collaboration dynamics, and perception of research importance. Barriers to data and technology adoption included data gaps, limitations in information quality, transparency issues, and difficulty to learn. Facilitators to collaborative research included collaborative engagement and human resource processes. Facilitators to data and technology adoption included situation awareness, data quality considerations, adopting community standards, and attractive to learn. Card sorting prioritized 15 use cases and identified 30 additional information needs for population health research in disaster preparedness.

CONCLUSIONS

Population health researchers experience barriers to collaboration and adoption of data and technology that contribute to information gaps and limit disaster preparedness. The priority use cases we identified can help address information gaps by informing the design of supportive research tools and practices for disaster preparedness. Supportive tools should include information on data collection practices, quality assurance, and education resources usable during failures in electric or telecommunications systems.

Impact of Hurricanes on Children With Asthma: A Systematic Literature Review

Following hurricanes, there can be increases in exacerbations of chronic diseases, such as asthma. Asthma is common among children, and many asthma exacerbations can be prevented. This systematic literature review assessed literature describing the impact of hurricanes on children with asthma in the United States. Medline, Embase, Global Health, PubMed, and Scopus databases were searched for peer-reviewed, English-language articles published January 1990 to June 2019 that described the effect of a hurricane on children with asthma. This search identified 212 articles; 8 met inclusion criteria. All 8 were related to Hurricane Katrina, but research questions and study design varied. Articles included information on asthma after hurricanes from cross-sectional surveys, retrospective chart review, and objective clinical testing. Four articles described discontinuity in health insurance, asthma-related health care, or asthma medication use; and 3 articles examined the relationship between mold exposure and asthma symptoms and reported varying results. The eighth study quantified the burden of asthma among people visiting mobile medical units but did not describe factors associated with asthma symptoms. These results highlight opportunities for future research (eg, on more recent hurricanes) and disaster preparedness planning (eg, strategies to prevent health-care discontinuity among children with asthma).

Burkholderia pseudomallei in Soil, US Virgin Islands, 2019

The distribution of Burkholderia pseudomallei in the Caribbean is poorly understood. We isolated B. pseudomallei from US Virgin Islands soil. The soil isolate was genetically similar to other isolates from the Caribbean, suggesting that B. pseudomallei might have been introduced to the islands multiple times through severe weather events.

Understanding Associations Between Hurricane Harvey Exposure and Mental Health Symptoms Among Greater Houston-Area Residents

OBJECTIVE

Hurricane Harvey made landfall on August 25, 2017 and resulted in widespread flooding in Houston and the surrounding areas. This study aimed to explore the associations between exposure to Hurricane Harvey and various mental health symptoms.

METHODS

Self-reported demographics, hurricane exposure, and mental health symptomatology were obtained from residents of the greater Houston area through convenience sampling for a pilot study, 5 months after the storm from January 25-29, 2018 (N = 161).

RESULTS

Increased hurricane exposure score was significantly associated with increased odds for probable depression, probable anxiety, and probable posttraumatic stress disorder after adjusting for other factors associated with mental health. No significant associations were found between demographic characteristics and risk of mental health difficulties.

CONCLUSIONS

Mental health difficulties associated with exposure to Hurricane Harvey were still present 5 months after the storm. Future disaster response programs should focus on providing long-term mental health services to hurricane survivors.

Assessing Characteristics of Unplanned School Closures that Occurred in the United States in Response to Hurricane Harvey in 2017

OBJECTIVE

Hurricane Harvey, which made landfall in Texas on August 24, 2017, caused catastrophic damage that resulted in the closure of many schools and school districts across 4 states. We evaluated the underlying reasons and characteristics of the unplanned school closures to gain insight on how communities may cope with recommended preemptive closures as an intervention for pandemic influenza.

METHODS

Information was extracted from news articles, school websites, and Twitter and Facebook posts previously collected through daily systematic searches of Google, Google News, and Lexis-Nexis. This information was sorted into predefined categories describing the characteristics that may be associated with unplanned school closures that occur during a natural disaster.

RESULTS

Across Texas, Louisiana, Kentucky, and Tennessee, there were 3026 unplanned closures. Sixty-three percent of the closures occurred in Texas. The main reasons for the closures were flooding, power outages, and structural damage. The closed schools in Texas were sometimes used as shelters or as locations for providing food or other resources.

CONCLUSION

School closures associated with Hurricane Harvey were attributed to both the effects of the hurricane and use for resource allocation. These findings can help inform preparedness planning and response for future hurricane seasons and other large-scale emergencies.

Humanitarian aid and local power structures: lessons from Haiti's 'shadow disaster'

This paper investigates the confluence of humanitarian aid, centralisation, and politics. The 7.0 magnitude earthquake in Haiti on 12 January 2010 led to more than USD 16 billion in pledges. By contrast, Hurricane Matthew, which made landfall in Haiti on 4 October 2016, stayed in the shadows, attracting about one per cent of the amount. While the earthquake exhibited one face of centralisation, the Category 4 storm laid bare rural vulnerabilities shaped by postcolonial state neglect, and reinforced by the influx of non-governmental organisations in the 'Republic of Port-au-Prince'. The study draws on data from four case studies in two departments to illuminate the legacies of hyper-centralisation in Haiti. Compounding matters, Matthew struck in the middle of an extended election that the international community attempted to control again. The paper argues that disaster assistance and politics are uncomfortably close, while reflecting on the momentary decentralisation of aid after the hurricane and its effectiveness.

Tropical understory herbaceous community responds more strongly to hurricane disturbance than to experimental warming

The effects of climate change on tropical forests may have global consequences due to the forests' high biodiversity and major role in the global carbon cycle. In this study, we document the effects of experimental warming on the abundance and composition of a tropical forest floor herbaceous plant community in the Luquillo Experimental Forest, Puerto Rico. This study was conducted within Tropical Responses to Altered Climate Experiment (TRACE) plots, which use infrared heaters under free-air, open-field conditions, to warm understory vegetation and soils + 4°C above nearby control plots. Hurricanes Irma and María damaged the heating infrastructure in the second year of warming, therefore, the study included one pretreatment year, one year of warming, and one year of hurricane response with no warming. We measured percent leaf cover of individual herbaceous species, fern population dynamics, and species richness and diversity within three warmed and three control plots. Results showed that one year of experimental warming did not significantly affect the cover of individual herbaceous species, fern population dynamics, species richness, or species diversity. In contrast, herbaceous cover increased from 20% to 70%, bare ground decreased from 70% to 6%, and species composition shifted pre to posthurricane. The negligible effects of warming may have been due to the short duration of the warming treatment or an understory that is somewhat resistant to higher temperatures. Our results suggest that climate extremes that are predicted to increase with climate change, such as hurricanes and droughts, may cause more abrupt changes in tropical forest understories than longer-term sustained warming.

Hurricane-induced demographic changes in a non-human primate population

Major disturbance events can have large impacts on the demography and dynamics of animal populations. Hurricanes are one example of an extreme climatic event, predicted to increase in frequency due to climate change, and thus expected to be a considerable threat to population viability. However, little is understood about the underlying demographic mechanisms shaping population response following these extreme disturbances. Here, we analyse 45 years of the most comprehensive free-ranging non-human primate demographic dataset to determine the effects of major hurricanes on the variability and maintenance of long-term population fitness. For this, we use individual-level data to build matrix population models and perform perturbation analyses. Despite reductions in population growth rate mediated through reduced fertility, our study reveals a demographic buffering during hurricane years. As long as survival does not decrease, our study shows that hurricanes do not result in detrimental effects at the population level, demonstrating the unbalanced contribution of survival and fertility to population fitness in long-lived animal populations.

Disaster Vector Control in Mississippi After Hurricane Katrina: Lessons Learned

Hurricane Katrina devastated the Mississippi Gulf Coast on August 29, 2005, causing an ecological disaster. Mississippi State Department of Health (MSDH) entomologists established a vector control program in affected areas with the following objectives: 1) helping local vector control agencies reestablish services, 2) performing mosquito surveillance, and 3) establishing mosquito larviciding and adulticiding where necessary. The MSDH personnel also helped write Action Request Forms requesting assistance from the Federal Emergency Management Agency (FEMA) for increased ground spraying in the 6 lower counties. Mosquito surveillance was conducted daily for 2 wk after the storm, then weekly for another month. Sanitation lagged, with people using makeshift latrines or simply piles of rubbish for bathrooms. Filth flies contaminated food and food surfaces. Responders lived in tent cities, many allowing filth fly access. Approximately 2 wk after hurricane landfall, due to increasing mosquito numbers, MSDH entomologists requested FEMA for an aerial spraying of insecticide to reduce nuisance mosquito biting in the area. A private vendor made 1 application of naled (Dibrom®) insecticide in the 3 coastal counties, yielding over 90% control in entire counties in 1 night. No complaints or medical or environmental problems from the increased ground spraying and aerial spraying were reported. Overall, important lessons in disaster vector control were learned, including how to work effectively with Centers for Disease Control, FEMA, and the US Public Health Service personnel, how to manage the public relations/educational aspects, and how to avoid or mitigate political interference in the disaster response.

Temporal and Spatial Impacts of Hurricane Damage on West Nile Virus Transmission and Human Risk

Hurricanes have profound impacts on zoonotic pathogen ecosystems that exhibit spatial and temporal waves in both distance from and time since the event. Wind, rain, and storm surge directly affect mosquito vectors and animal hosts of these pathogens. In this analysis, we apply a West Nile virus transmission model parameterized for the Northern coast of the Gulf of Mexico to explore the effect of event timing of hurricane landfall, time since the event, and damage extent on human West Nile virus neuro-invasive disease (WNV-NID) risk. Early-season hurricanes, which make landfall prior to the peak of baseline WNV transmission activity, increase the average total WNV-infectious mosquitoes for the year by 7.8% and human WNV-NID incidence by 94.3% across all areas with hurricane damage. The indirect effects on human exposure to mosquito bites in the immediate aftermath and long-term recovery from the event have strong impacts on the risk of infection. The resultant interactive direct and indirect storm effects on the pathogen system are spatially and temporally heterogenous among the generalized time and space categories modeled.