Michele M. Wood

Weathering the Storm: The Impact of Hurricanes on Physical and Mental Health

The authors briefly review the deaths, injuries, and diseases attributed to hurricanes that made landfall in the United States prior to Hurricane Katrina; recent hurricane evacuation studies and their potential for reducing death, injury, and disease; information available to date about mortality, injury, and disease attributed to Hurricane Katrina; and psychological distress attributable to hurricanes. Drowning in salt water caused by storm surges has been reduced over the past thirty years, while deaths caused by fresh water (inland) flooding and wind have remained steady. Well-planned evacuations of coastal areas can reduce death and injury associated with hurricanes. Hurricane Katrina provides an example of what happens when evacuation is not handled appropriately. Preliminary data indicate that vulnerable elderly people were substantially overrepresented among the dead and that evacuees represent a population potentially predisposed to a high level of psychological distress, exacerbated by severe disaster exposure, lack of economic and social resources, and an inadequate government response.

The Reliability and Validity of Drug Users' Self Reports of Amphetamine Use Among Primarily Heroin and Cocaine Users

Relatively few studies have addressed the psychometric properties of self-report measures of amphetamine use. This study examines the reliability and validity of the Risk Behavior Assessments (RBA) lifetime and recent amphetamine-use questions. To evaluate validity, 4027 out-of-treatment primarily cocaine and heroin users provided urine samples that were compared to self-report data; to evaluate reliability, 218 completed the RBA at two time points, 48h apart. In the overall sample, self-reports demonstrated moderately high validity, with a 95% accuracy rate (kappa=.54). When analysis was restricted to recent amphetamine users validity was slightly lower (71.5% accuracy; kappa=.41). Test-retest data indicated good reliability for self-reports of ever having used amphetamine (kappa=.79), and amphetamine use in the past 30 days (.75<r<.91). Out-of-treatment drug users provided accurate self-reports of amphetamine use. Reliable and valid measures are essential for describing and predicting trends in amphetamine use, evaluating the effectiveness of interventions, and developing policies and programs.

Prevalence of affirmative responses to questions of food insecurity: International Polar Year Inuit Health Survey, 2007-2008

Objectives. Assess the prevalence of food insecurity by region among Inuit households in the Canadian Arctic. Study design. A community-participatory, cross-sectional Inuit health survey conducted through face-to-face interviews. Methods. A quantitative household food security questionnaire was conducted with a random sample of 2,595 self-identified Inuit adults aged 18 years and older, from 36 communities located in 3 jurisdictions (Inuvialuit Settlement Region; Nunavut; Nunatsiavut Region) during the period from 2007 to 2008. Weighted prevalence of levels of adult and household food insecurity was calculated. Results. Differences in the prevalence of household food insecurity were noted by region, with Nunavut having the highest prevalence of food insecurity (68.8%), significantly higher than that observed in Inuvialuit Settlement Region (43.3%) and Nunatsiavut Region (45.7%) (p≤0.01). Adults living in households rated as severely food insecure reported times in the past year when they or other adults in the household had skipped meals (88.6%), gone hungry (76.9%) or not eaten for a whole day (58.2%). Adults living in households rated as moderately food insecure reported times in the past year when they worried that food would run out (86.5%) and when the food did not last and there was no money to buy more (87.8%). Conclusions. A high level of food insecurity was reported among Inuit adults residing in the Canadian Arctic, particularly for Nunavut. Immediate action and meaningful interventions are needed to mitigate the negative health impacts of food insecurity and ensure a healthy Inuit population.

Convergent and discriminant validity of three measures of stage of change.

The University of Rhode Island Change Assessment (E. A. McConnaughy, J. O. Prochaska, & W. F. Velicer, 1983), the Stages of Change Readiness and Treatment Eagerness Scale (W. R. Miller & J. S. Tonigan, 1996), and the Readiness to Change Questionnaire (S. Rollnick, N. Heather, R. Gold, & W. Hall, 1992) are commonly used multidimensional measures of stage of change. The authors examined the convergent and discriminant validity of drug-use versions of these 3 measures through multitrait-multimethod analysis in a population of indigent, out-of-treatment drug users (N = 377). Agreement in stage-of-change assignment and the relationship between stage of change and drug-use behaviors were also examined. Confirmatory factor analysis suggests that the Stages of Change Readiness and Treatment Eagerness Scale may have questionable convergent validity with the University of Rhode Island Change Assessment and Readiness to Change Questionnaire. There was moderate agreement in stage assignment. Analysis of behavior did provide some support for the construct validity of the measures. The results suggest that these drug-use stage-of-change measures may not be equivalent.

Inuit housing and homelessness: results from the International Polar Year Inuit Health Survey 2007-2008.

Objectives. Evaluate housing characteristics across Inuit regions in Canada that participated in the 2007–2008 International Polar Year (IPY) Inuit Health Survey. Study design. A cross-sectional Inuit Health Survey. Methods. Housing characteristics were ascertained as part of the IPY Inuit Health Survey through interviews conducted in 33 coastal and 3 inland communities, representing all communities in the Inuvialuit Settlement Region (ISR) of NWT, Nunavut and Nunatsiavut of northern Labrador. Variable descriptive statistics were weighted and presented by region and by whether children were present or not in each household. Results. A total of 2,796 Inuit households were approached, of which 68% participated (n=1,901 households). In ISR and Nunavut, approximately 20% of homes provided shelter to the homeless compared to 12% in Nunatsiavut (p≤0.05). The prevalence of public housing and household crowding also varied by region, with Nunavut having a statistically significantly higher prevalence of crowding (30%) than Nunatsiavut (12%) and ISR (12%). Household crowding was more prevalent among homes with children. Overall, 40% of homes were in need of major repairs and problems with mould were reported in 20% of households. Conclusions. Adequate shelter is a basic human need and an essential foundation for thriving population health. The results indicate that improvements in housing indicators are needed. Of utmost concern is the high prevalence of overcrowding in Inuit homes with children, which poses potential consequences for children’s health and well-being. Further, the high percentage of homes providing shelter to the homeless suggests that hidden homelessness needs to be addressed by further research and program implementation.

The Study of Mobile Public Warning Messages: A Research Review and Agenda

In 2011, the U.S. Federal Emergency Management Agency (FEMA) began authorizing emergency management officials to broadcast Wireless Emergency Alerts (WEAs) to cellular phones and other mobile devices to help notify people of imminent hazards. WEAs are 90-characters long, geographically targeted emergency messages sent by government alerting authorities through the nations mobile telecommunications networks, which, for the first time, allow officials to directly notify at-risk publics where they live and work. The use of WEAs has outpaced investigation of their benefits, limitations, and actual and potential consequences. To address this critical gap in scholarship and public understanding, we integrate literature from the fields of public warning, instructional crisis communication, and mobile health communication. Combining these literatures, we outline a theoretical and applied communication research agenda for public warning messages delivered over mobile devices.

Reliability of Arrest and Incarceration Questions on the Risk Behavior Assessment

We examined 48-hour test-retest reliability of the arrest and incarceration questions on the Risk Behavior Assessment (RBA; National Institute on Drug Abuse, 1993). Participants were 229 street-drug users recruited in 11 cities throughout the United States. Results revealed that lifetime arrest and incarceration items demonstrated good to excellent reliability. The 30-day arrest and incarceration items provided such poor reliabilities that they would yield unreliable data with limited research or clinical use. Future research needs to identify alternative items that can yield reliable data regarding recent arrest history; until then, it is recommended that the recent arrest items be used with caution.

Who Prepares for Terrorism

The National Survey of Disaster Experiences and Preparedness (NSDEP) examined whether households in the United States have engaged in proactive preparedness and avoidance activities since September 11, 2001, and whether the activities reported were done because of terrorism, natural disasters, other reasons, or any combination of reasons. Reported activities were examined by geographic area of exposure to or threat of 9/11, gender, race/ethnic identification, and income. The sample was drawn using random-digit-dialing (RDD) supplemented with surname lists. Data were collected between April 13, 2007, and February 13, 2008. Few households did preparedness and avoidance activities exclusively because of concerns about terrorism. Rather decisions were motivated by a combination of reasons. Residents of New York City and Washington, DC, men, and high-income respondents reported more preparedness activities, whereas low-income respondents, African Americans, and Hispanics reported more avoidance activities.

Understanding the Influence of Loneliness on HIV Risk Behavior in Young Men Who Have Sex with Men

In this study we used grounded theory methodology to understand the influence of loneliness in YMSM in terms of HIV risk behavior. Twenty-two YMSM, 18–29 years of age, of HIV-negative/unknown status were interviewed. Results indicated that loneliness is defined in two ways: emotional and social. A cyclical pattern emerged that included negative symptoms, “self-treatment” of loneliness through drug use and sex, temporary relief, remorse related to engaging in HIV risk behaviors, negative self-image, and ultimately the reemergence of initial loneliness symptoms. Results suggest that loneliness in YMSM plays a greater role in HIV-related behavior than previously understood. A preliminary explanatory model, implications, and directions for future research are discussed.

Efficacy and Effectiveness Issues in the NIDA Cooperative Agreement: Interventions for Out-of-Treatment Drug Users

This paper examines the Cooperative Agreement (CA) HIV intervention studies for active drug users, sponsored by the National Institute on Drug Abuse, in terms of the constructs of prevention efficacy and effectiveness. A rationale is presented for conservatively interpreting outcome findings of these studies as indicative of intervention efficacy, as opposed to effectiveness. It is argued that the CA studies fall more within the domain of efficacy owing to the high degree of control and optimization that occurred with respect to intervention recruitment, participation, process monitoring, and staff training. Because the interventions were implemented and evaluated in community-based, noninstitutional settings with many real-world constraints, it is suggested that minimal shrinkage of their effects would occur if they were implemented in uncontrolled community settings. The relationship of intervention structure, content, process, dose, and participant characteristics to intervention efficacy is reviewed and discussed, both in general terms and with reference to the CA studies.