Shannon Grabich

Adaptive Planning for Disaster Recovery and Resiliency: An Evaluation of 87 Local Recovery Plans in Eight States

Problem, research strategy and findings: A pre-disaster recovery plan that considers how a community should be redeveloped is a logical first step to support resiliency during high uncertainty and rapid change, yet limited attention has been given to recovery plans. In this study, we evaluate local disaster recovery planning in eight southeastern states and find that such planning receives limited public support: Less than one-third of vulnerable local jurisdictions had a recovery plan, and those plans received low plan quality scores. Unfunded state mandates produce weaker plans than plans in other states without mandates. We find that a collaborative network of stakeholders initially intent on reordering priorities results in stronger plans. Takeaway for practice: Local recovery planning should be designed to operate under conditions of high uncertainty. Local jurisdictions can choose plan design options that reflect how they build capability for recovery planning: 1) standalone community-wide recovery plan; 2) comprehensive land use plan; 3) emergency management plan; and 4) small area recovery plan. Because recovery planning lacks a public constituency, and is new to most local jurisdictions, the stand-alone community-wide recovery plan design option is the most effective at building local commitment. This option involves a plan-making process that concentrates time, effort, and resources focused on a building a network of stakeholders who likely have the greatest responsibility in rebuilding efforts because they care most about the impacts of a disaster.

County‐level cumulative environmental quality associated with cancer incidence

Individual environmental exposures are associated with cancer development; however, environmental exposures occur simultaneously. The Environmental Quality Index (EQI) is a county‐level measure of cumulative environmental exposures that occur in 5 domains.

Measuring participation by socially vulnerable groups in hazard mitigation planning, Bertie County, North Carolina

In accordance with the Disaster Mitigation Act, most US counties have a hazard mitigation plan (HMP) to reduce future disaster losses. HMPs are important as they can be used to proactively assess risk, direct future development, raise awareness and build consensus. Using a population-based sample, we interviewed residents of Bertie County, NC, about their awareness of and participation in the HMP process to determine if demographics, social vulnerability or hazard vulnerability were associated with increased awareness or participation. We also assessed whether these factors were associated with knowledge of policy changes and investments that were adopted in the HMP. Overall, the unemployed were the only group less likely to report awareness of or participation in HMP development. African-Americans, mobile home residents, the poor, short-term residents and those with less disaster experience were less likely to be aware of policies and investments prioritised in the HMP. Targeted efforts to increase awareness could potentially improve disaster outcomes among vulnerable populations.

Capacity for Stakeholder Participation in Recovery Planning

Abstract It is generally accepted that meaningful participation by a representative, well-informed public contributes to a better plan. We surveyed the lead official responsible for the development of recovery plans in a sample of US Atlantic and Gulf Coast counties to determine capacity for stakeholder participation. We report on a variety of engagement techniques that were positively associated with an increase in participation in recovery plan development. We also link increased participation with better plan quality scores in plan quality principles. Investing human and fiscal resources in participation can increase involvement in the planning process and improve recovery plan quality.

Disaster impacts on cost and utilization of Medicare

BackgroundTo estimate changes in the cost and utilization of Medicare among beneficiaries over age 65 who have been impacted by a natural disaster, we merged publically available county-level Medicare claims for the years 2008–2012 with Federal Emergency Management Agency (FEMA) data related to disasters in each U.S. County from 2007 to 2012.MethodsFixed-effects generalized linear models were used to calculate change in per capita costs standardized by region and utilization per 1000 beneficiaries at the county level. Aggregate county demographic characteristics of Medicare participants were included as predictors of change in county-level utilization and cost. FEMA data was used to determine counties that experienced no, some, high, and extreme hazard exposure. FEMA data was merged with claims data to create a balanced panel dataset from 2008 to 2012.ResultsIn general, both cost and utilization of Medicare services were higher in counties with more hazard exposure. However, utilization of home health services was lower in counties with more hazard exposure.ConclusionsAdditional research using individual-level data is needed to address limitations and determine the impacts of the substitution of services (e.g., inpatient rehabilitation for home health) that may be occurring in disaster affected areas during the post-disaster period.

Impact of hurricane exposure on reproductive health outcomes, Florida, 2004

OBJECTIVE Prenatal hurricane exposure may be an increasingly important contributor to poor reproductive health outcomes. In the current literature, mixed associations have been suggested between hurricane exposure and reproductive health outcomes. This may be due, in part, to residual confounding. We assessed the association between hurricane exposure and reproductive health outcomes by using a difference-in-difference analysis technique to control for confounding in a cohort of Florida pregnancies. METHODS We implemented a difference-in-difference analysis to evaluate hurricane weather and reproductive health outcomes including low birth weight, fetal death, and birth rate. The study population for analysis included all Florida pregnancies conceived before or during the 2003 and 2004 hurricane season. Reproductive health data were extracted from vital statistics records from the Florida Department of Health. In 2004, 4 hurricanes (Charley, Frances, Ivan, and Jeanne) made landfall in rapid succession; whereas in 2003, no hurricanes made landfall in Florida. RESULTS Overall models using the difference-in-difference analysis showed no association between exposure to hurricane weather and reproductive health. CONCLUSIONS The inconsistency of the literature on hurricane exposure and reproductive health may be in part due to biases inherent in pre-post or regression-based county-level comparisons. We found no associations between hurricane exposure and reproductive health. (Disaster Med Public Health Preparedness. 2017;11:407-411).

Quantifying the Health Impacts of Disasterson Medicare Beneficiaries

The growing Medicare population remains disproportionately vulnerable to health effects from natural disasters. While case studies have characterized impacts of individual disasters, comparative data using common measurements over time and across locations are not available. County-level Medicare claims for beneficiaries in the 48 contiguous U.S. States for 2008-2012 were merged with Federal Emergency Management Agency data for each U.S. county from 2007-2012 to create a balanced panel dataset. To estimate average annual within-county change in the percent of Medicare beneficiaries with health conditions, exposure to a disaster declaration and a hazard factor variable were compared using fixed-effects regression models adjusted for Medicaid eligibility and beneficiary age, gender, and race. Using the disaster declaration exposure we found significant negative (diabetes, high cholesterol) changes for counties with declared disasters. Using the hazard exposure factor variable resulted in significant positive (heart attack, diabetes, arthritis) and negative (diabetes, high cholesterol) changes in disaster exposed counties. Associations between disaster exposure and health outcomes among Medicare beneficiaries are mixed and should be explored further. This can inform the development of innovative and timely pre-disaster interventions, as well as contribute to enhanced disaster resilience among beneficiaries and the Medicare system.