Deborah C. Glik

Variations in disaster preparedness by mental health, perceived general health, and disability status.

OBJECTIVES Chronic medical and mental illness and disability increase vulnerability to disasters. National efforts have focused on preparing people with disabilities, and studies find them to be increasingly prepared, but less is known about people with chronic mental and medical illnesses. We examined the relation between health status (mental health, perceived general health, and disability) and disaster preparedness (home disaster supplies and family communication plan). METHODS A random-digit-dial telephone survey of the Los Angeles County population was conducted October 2004 to January 2005 in 6 languages. Separate multivariate regressions modeled determinants of disaster preparedness, adjusting for sociodemographic covariates then sociodemographic variables and health status variables. RESULTS Only 40.7% of people who rated their health as fair/poor have disaster supplies compared with 53.1% of those who rate their health as excellent (P < 0.001). Only 34.8% of people who rated their health as fair/poor have an emergency plan compared with 44.8% of those who rate their health as excellent (P < 0.01). Only 29.5% of people who have a serious mental illness have disaster supplies compared with 49.2% of those who do not have a serious mental illness (P < 0.001). People with fair/poor health remained less likely to have disaster supplies (adjusted odds ratio [AOR] 0.69, 95% confidence interval [CI] 0.50-0.96) and less likely to have an emergency plan (AOR 0.68, 95% CI 0.51-0.92) compared with those who rate their health as excellent, after adjusting for the sociodemographic covariates. People with serious mental illness remained less likely to have disaster supplies after adjusting for the sociodemographic covariates (AOR 0.67, 95% CI 0.48-0.93). Disability status was not associated with lower rates of disaster supplies or emergency communication plans in bivariate or multivariate analyses. Finally, adjusting for the sociodemographic and other health variables, people with fair/poor health remained less likely to have an emergency plan (AOR 0.66, 95% CI 0.48-0.92) and people with serious mental illness remained less likely to have disaster supplies (AOR 0.67, 95% CI 0.47-0.95). CONCLUSIONS People who report fair/poor general health and probable serious mental illness are less likely to report household disaster preparedness and an emergency communication plan. Our results could add to our understanding of why people with preexisting health problems suffer disproportionately from disasters. Public health may consider collaborating with community partners and health services providers to improve preparedness among people with chronic illness and people who are mentally ill.

Communicating with the public about emerging health threats: lessons from the Pre-Event Message Development Project.

OBJECTIVES We sought to better understand the challenges of communicating with the public about emerging health threats, particularly threats involving toxic chemicals, biological agents, and radioactive materials. METHODS At the request of the Centers for Disease Control and Prevention, we formed an interdisciplinary consortium of investigative teams from 4 schools of public health. Over 2 years, the investigative teams conducted 79 focus group interviews with 884 participants and individual cognitive response interviews with 129 respondents, for a total sample of 1013 individuals. The investigative teams systematically compared their results with other published research in public health, risk communication, and emergency preparedness. RESULTS We found limited public understanding of emerging biological, chemical, and radioactive materials threats and of the differences between them; demand for concrete, accurate, and consistent information about actions needed for protection of self and family; active information seeking from media, local authorities, and selected national sources; and areas in which current emergency messaging can be improved. CONCLUSIONS The public will respond to a threat situation by seeking protective information and taking self-protective action, underlining the critical role of effective communication in public health emergencies.

Youth Performing Arts Entertainment-Education for HIV/AIDS Prevention and Health Promotion: Practice and Research

Entertainment-education approaches to health promotion and disease prevention are a popular method for many interventions that target adolescents and young adults. This article documents how this approach is used to educate and influence young people about HIV/AIDS, other sexually transmitted diseases (STDs), and other health issues in the United States. A review of the literature is followed by a two-phase descriptive study of American youth performing arts entertainment-education programs. First, a quantitative survey was conducted among youth performing arts participants who were attending a national conference on the subject. This was followed by a qualitative survey among adult and youth conference attendees from established HIV/AIDS prevention youth performing arts programs. These two approaches provided detailed insight into the characteristics, approaches, and frameworks used to create, implement, and evaluate these entertainment-education efforts. Nine domains that define the effects and effectiveness of youth HIV prevention entertainment-education interventions are identified and described, including those related to performances, intervention management, and audiences. Given the importance of evaluation for the success and effectiveness of intervention programs, these domains are used to construct a framework for entertainment-education research and evaluation efforts.

Malaria treatment practices among mothers in Guinea.

A survey of mothers of young children in Guinea, West Africa (June-July 1988) suggests that individual, sociocultural, and structural factors influence the use of antimalarials for episodes of fever presumed to be malaria. A survey of 243 mothers was carried out in eight different sites (four urban and four rural) in two regions of the country. Among mothers interviewed, use of Western antimalarials for infants and children with fever was acceptable, but access to treatment was problematic. Mothers interviewed were less likely to use antimalarials during pregnancy, partly because of certain misconceptions about their effects and lack of access to the medication. Despite programmatic efforts to promote practices of presumptive treatment of fever among young children and chemoprophylaxis during pregnancy among mothers in towns and villages surveyed, variables associated with low use of antimalarials by mothers and their young children reflect important barriers to the implementation of child survival initiatives.

They Blew the Levee: Distrust of Authorities Among Hurricane Katrina Evacuees

O August 29th, 2005, Hurricane Katrina made landfall just east of New Orleans, Louisiana. That night and the next day, levees in New Orleans collapsed, resulting in flooding of 80% of the city, with water levels reaching to the rooftops in many areas.1 Despite strong evacuation warnings, followed by a mandatory evacuation order,2 over 100,000 greater New Orleans residents failed to evacuate prior to the hurricane’s landfall.3 Distrust of authorities, among numerous other factors,4–5 seems likely to have played a role in New Orleans residents’ reactions to evacuation warnings and public health authorities’ advice. Prior to the hurricane, 72% of New Orleans residents were of minority race or ethnicity6 and there is a long history of minority groups in the United States distrusting the medical and public health leadership.7–9 Furthermore, distrust of authorities among New Orleans’ impoverished residents is rooted in local history. In 1927, The Great Mississippi Flood was threatening to destroy New Orleans, including its crucial downtown regional financial institutions. To avert the threat, and in part to stabilize the financial markets, it was decided to perform a controlled break of the New Orleans levees, thereby selectively flooding poor areas and saving financial institutions.10 This event lives on in the memories and oral history of the residents of the deliberately flooded areas.11 Faced with the knowledge that distrust hampers the success of recommended evacuations and other disaster responses, disaster and public health officials must

Terrorism-Related Fear and Avoidance Behavior in a Multiethnic Urban Population

OBJECTIVES We sought to determine whether groups traditionally most vulnerable to disasters would be more likely than would be others to perceive population-level risk as high (as measured by the estimated color-coded alert level) would worry more about terrorism, and would avoid activities because of terrorism concerns. METHODS We conducted a random digit dial survey of the Los Angeles County population October 2004 through January 2005 in 6 languages. We asked respondents what color alert level the country was under, how often they worry about terrorist attacks, and how often they avoid activities because of terrorism. Multivariate regression modeled correlates of worry and avoidance, including mental illness, disability, demographic factors, and estimated color-coded alert level. RESULTS Persons who are mentally ill, those who are disabled, African Americans, Latinos, Chinese Americans, Korean Americans, and non-US citizens were more likely to perceive population-level risk as high, as measured by the estimated color-coded alert level. These groups also reported more worry and avoidance behaviors because of concerns about terrorism. CONCLUSIONS Vulnerable populations experience a disproportionate burden of the psychosocial impact of terrorism threats and our national response. Further studies should investigate the specific behaviors affected and further elucidate disparities in the disaster burden associated with terrorism and terrorism policies.

Media Literacy and Public Health Integrating Theory, Research, and Practice for Tobacco Control

The influence of mass media on the culture and health-related behaviors of youth has prompted health education and health promotion practitioners and researchers to turn toward media literacy approaches. In this article, development, implementation, and evaluation of a media literacy curriculum for tobacco control for high school students are discussed. Various theories from the field of public health are used to frame practice and research issues. A quasi-experimental research design was used to assess changes in tobacco-related knowledge, attitudes, and behaviors among students exposed to the curriculum. This type of evaluation approach has become de rigueur for assessing school-based curricula in both educational and public health fields.

Health-related Quality of Life Trajectories of Methamphetamine-Dependent Individuals as a Function of Treatment Completion and Continued Care Over a 1-Year Period

This study applies a chronic illness framework to evaluate treatment outcomes among individuals dependent on methamphetamine (MA). Using growth curve modeling, health-related quality of life (HRQOL) trajectories of MA-dependent individuals (N = 723) were examined over a 1-year period. Results show greater improvements in mental HRQOL trajectories as a function of treatment completion and continued care, although fairly static trajectories in physical health status. Other factors affecting HRQOL trajectories included gender, psychosocial functioning, drug use severity, and health impairment. Results extend research on treatment evaluations for MA dependence, highlighting the importance of continued service utilization for improved quality of life outcomes.

Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health

The opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. We review scientific evidence from promising interventions focused on the social determinants of health and discuss how such interventions can improve population health and reduce health disparities. We found sufficient evidence of successful outcomes to support disparity-reducing policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. Cost-effectiveness evaluations show that these interventions lead to long-term societal savings, but the interventions require more routine attention to cost considerations. We discuss challenges to implementation, including the need for long-term financing to scale up effective interventions for implementation at the local, state, and national levels.

Fetal Alcohol Syndrome Prevention Using Community-Based Narrowcasting Campaigns

Preventing fetal alcohol syndrome (FAS) by encouraging pregnant women to abstain from drinking alcohol competes with commercial alcohol marketing. Two FAS-prevention campaigns using a narrowcast approach among young women of childbearing age in two disadvantaged Southern California communities are compared. The design, implementation process, and degree to which campaigns reached the priority populations are the focus of this article. Formative research shows that young women in disadvantaged communities receive mixed messages about dangers of drinking during pregnancy. A social norms approach using positive role models was the most acceptable message strategy based on materials pretesting. Differences in campaign implementation and distribution strategies between communities were documented through program monitoring. Survey research indicated the more viable messaging and implementation strategies. Findings show that low-cost community campaigns are feasible; however, variations in messaging, distribution strategies, and saturation levels determine whether such campaigns succeed or fail to reach priority populations.