Browsing by Subject "Disasters"
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Item Comorbidity of PTSD, Major Depression, and Substance Use Disorder among Adolescent Victims of the Spring 2011 Tornadoes in Alabama and Joplin, Missouri(Taylor & Francis, 2015) Adams, Zachary W.; Danielson, Carla Kmett; Sumner, Jennifer A.; McCauley, Jenna L.; Cohen, Joseph R.; Ruggiero, Kenneth J.; Psychiatry, School of MedicineObjective: The purpose of this study was twofold: (1) to estimate the prevalence of comorbid posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance use disorder (SUD); and (2) to identify risk factors for patterns of comorbidity among adolescents affected by disasters. Method: A population-based sample of 2,000 adolescents (51% female; 71% Caucasian, 26% African American) aged 12 to 17 years (M = 14.5, SD = 1.7) and their parents was recruited from communities affected by the spring 2011 tornadoes in Alabama and Joplin, Missouri. Participants completed structured telephone interviews assessing demographic characteristics, impact of disaster, prior trauma history, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), symptoms of posttraumatic stress disorder (PTSD) and major depressive episode (MDE), and substance use disorder (SUD) symptoms. Prevalence estimates were calculated for PTSD + MDE, PTSD + SUD, MDE + SUD, and PTSD + MDE + SUD. Hierarchical logistic regression was used to identify risk factors for each comorbidity profile. Results: Overall prevalence since the tornado was 3.7% for PTSD + MDE, 1.1% for PTSD + SUD, 1.0% for MDE + SUD, and 0.7% for PTSD + MDE + SUD. Girls were significantly more likely than boys to meet criteria for PTSD + MDE and MDE + SUD (ps < .05). Female gender, exposure to prior traumatic events, and persistent loss of services were significant risk factors for patterns of comorbidity. Parental injury was associated with elevated risk for PTSD + MDE. Adolescents should be evaluated for comorbid problems, including SUD, following disasters so that appropriate referrals to evidence-based treatments can be made. Conclusions: Results suggest that screening procedures to identify adolescents at risk for comorbid disorders should assess demographic characteristics (gender), impact of the disaster on the family, and adolescents' prior history of stressful events.Item Digging through disaster rubble in search of the determinants of organizational mitigation and preparedness(DOI: 10.2202/1944-4079.1005, 2010-07) Sadiq, Abdul-AkeemDisaster researchers have established the determinants of mitigation and preparedness at the household level of analysis. However, at the organizational level, there is limited research and no theory to guide research on the determinants of mitigation and preparedness. The research question is “what are the determinants of mitigation and preparedness at the organizational level?” The data come from a survey of 227 organizations in Memphis, Tennessee. This study uses Tobit regression technique to identify the determinants and finds that organizational size and concern over disaster impact are strong positive determinants of mitigation and preparedness in organizations. In addition, there is a significant and nonlinear relationship between organizational obstacle and mitigation and preparedness activities. This study concludes with policy implications and recommendations for future studies.Item Elucidating Dimensions of Posttraumatic Stress Symptoms and their Functional Correlates in Disaster-Exposed Adolescents(Elsevier, 2014) Sumner, Jennifer A.; Pietrzak, Robert H.; Danielson, Carla Kmett; Adams, Zachary W.; Ruggiero, Kenneth J.; Psychiatry, School of MedicineThe aim of this study was to elucidate the dimensional structure of posttraumatic stress disorder (PTSD) and potential moderators and functional correlates of this structure in disaster-affected adolescents. A population-based sample of 2000 adolescents aged 12-17 years (M = 14.5 years; 51% female) completed interviews on post-tornado PTSD symptoms, substance use, and parent-adolescent conflict between 4 and 13 months (M = 8.8, SD = 2.6) after tornado exposure. Confirmatory factor analyses revealed that all models fit well but a 5-factor dysphoric arousal model provided a statistically significantly better representation of adolescent PTSD symptoms compared to 4-factor dysphoria and emotional numbing models. There was evidence of measurement invariance of the dysphoric arousal model across gender and age, although girls and older adolescents aged 15-17 years had higher mean scores than boys and younger adolescents aged 12-14 years, respectively, on some PTSD dimensions. Differential magnitudes of association between PTSD symptom dimensions and functional correlates were observed, with emotional numbing symptoms most strongly positively associated with problematic substance use since the tornado, and dysphoric arousal symptoms most strongly positively associated with parent-adolescent conflict; both correlations were significantly larger than the corresponding correlations with anxious arousal. Taken together, these results suggest that the dimensional structure of tornado-related PTSD symptomatology in adolescents is optimally characterized by five separate clusters of re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal symptoms, which showed unique associations with functional correlates. Findings emphasize that PTSD in disaster-exposed adolescents is not best conceptualized as a homogenous construct and highlight potential differential targets for post-disaster assessment and intervention.Item Emergency preparedness is a healthcare issue: COVID-19 pandemic's influence on attitudes and behaviors among a national sample of parents(Elsevier, 2023) Glauberman, Gary; Zimet, Gregory; Michel, Alexandra; Fontenot, Holly B.; Pediatrics, School of MedicineBackground: Improving household emergency preparedness (EP) is a public health priority, yet little is known about what influence the COVID-19 pandemic had on families' EP. This study aimed to explore current EP attitudes and behaviors. Methods: We conducted online focus groups in Winter 2022 with a nationwide sample of parents of adolescents. We held six 90-min focus groups of 9-15 participants using a semi-structured interview script that elicited parental knowledge and attitudes related to household EP. Two researchers conducted qualitative content analysis on focus group transcripts. First-level coding within and across scripts was used to identify broad categories or themes regarding EP. The process was reviewed continuously to verify data and coding procedures. Three investigators independently verified the final themes that emerged. Results: Participants (N = 64) were mostly female (n = 54, 84.3%), white (n = 46, 71.9%), and college-educated (n = 49, 76.6%). Major themes included: 1) Expanded awareness and behavioral change related to EP due to the COVID-19 pandemic, 2) Reconceptualization of planning for family health as part of EP, 3) Changing perspectives related to vaccination as a component of EP, and 4) Perspectives related to discussing EP with their health care provider. Conclusions: EP was described as a healthcare issue and healthcare providers were identified as trusted sources of EP information. Interventions to support providers' ability to assist with individual EP health action plans, including discussing vaccination as part of preparedness are needed.Item FEMA versus local governments: Influence and reliance in disaster preparedness(Springer, 2016) Sadiq, Abdul-Akeem; Tharp, Kevin; Graham, John D.; School of Public and Environmental Affairs, IUPUIThis study uses an experimental approach to examine whether disaster information sourced to the Federal Emergency Management Agency (FEMA) influences intentions to adopt hazard adjustments. Survey questions are also used to determine whether individuals rely more on FEMA or local governments when preparing for disasters. Using an online sample of 2008 US employees, the results indicate that information sourced to FEMA is no more influential than information sourced to local governments and that individuals rely less on FEMA than on local agencies during disaster preparedness. These results have significant implications for practice and future research on natural hazard preparedness.Item Fukushima after the Great East Japan Earthquake: lessons for developing responsive and resilient health systems(Edinburgh University Global Health Society, 2017-06) Fukuma, Shingo; Ahmed, Shahira; Goto, Rei; Inui, Thomas S.; Atun, Rifat; Fukuhara, Shunichi; Medicine, School of MedicineBACKGROUND: On 11 March 2011, the Great East Japan Earthquake, followed by a tsunami and nuclear-reactor meltdowns, produced one of the most severe disasters in the history of Japan. The adverse impact of this 'triple disaster' on the health of local populations and the health system was substantial. In this study we examine population-level health indicator changes that accompanied the disaster, and discuss options for re-designing Fukushima's health system, and by extension that of Japan, to enhance its responsiveness and resilience to current and future shocks. METHODS: We used country-level (Japan-average) or prefecture-level data (2005-2014) available from the portal site of Official Statistics of Japan for Fukushima, Miyagi, and Iwate, the prefectures that were most affected by the disaster, to compare trends before (2005-2010) and after (2011-2014) the 'disaster'. We made time-trend line plots to describe changes over time in age-adjusted cause-specific mortality rates in each prefecture. FINDINGS: All three prefectures, and in particular Fukushima, had lower socio-economic indicators, an older population, lower productivity and gross domestic product per capita, and less higher-level industry than the Japan average. All three prefectures were 'medically underserved', with fewer physicians, nurses, ambulance calls and clinics per 100 000 residents than the Japan average. Even before the disaster, age-adjusted all-cause mortality in Fukushima was in general higher than the national rates. After the triple disaster we found that the mortality rate due to myocardial infarction increased substantially in Fukushima while it decreased nationwide. Compared to Japan average, spikes in mortality due to lung disease (all three prefectures), stroke (Iwate and Miyagi), and all-cause mortality (Miyagi and Fukushima) were also observed post-disaster. The cause-specific mortality rate from cancer followed similar trends in all three prefectures to those in Japan as a whole. Although we found a sharp rise in ambulance calls in Iwate and Miyagi, we did not see such a rise in Fukushima: a finding which may indicate limited responsiveness to acute demand because of pre-existing restricted capacity in emergency ambulance services. CONCLUSIONS: We analyze changes in indicators of health and health systems infrastructure in Fukushima before and five years following the disaster, and explored health systems' strengths and vulnerabilities. Spikes in mortality rates for selected non-infectious conditions common among older individuals were observed compared to the national trends. The results suggest that poorer reserves in the health care delivery system in Fukushima limited its capacity to effectively meet sudden unexpected increases in demand generated by the disaster.Item Haiti’s Emergency Management: A Case of Regional Support, Challenges, Opportunities, and Recommendations for the Future(FEMA, U.S. Department of Homeland Security: http://training.fema.gov/EMIWeb/edu/CompEmMgmtBookProject.asp, 2012) Fordyce, Erin; Sadiq, Abdul-Akeem; Chikoto, Grace L.As one of the poorest nations in the Western Hemisphere (with over 70 percent of the population living on less than $2 a day) (Grunewald et al. 2010), one wonders about the state of the Haitian Emergency Management System prior to the 2010 earthquake. Clearly, Haiti has been an economically-challenged nation for decades and its protracted poverty level further increases its vulnerability to disasters (PAHO 1994) and impacts its ability to respond and recover effectively when disasters occur. In addition, political instabilities have led to poor economic development opportunities and increased risks. In spite of Haiti’s economic and political challenges, it is possible to gain insight into what the country’s emergency management system looked like before the 2010 earthquake. Haiti had a fledgling national emergency management system in place - one that was heavily supported by both regional and international bodies. The earthquake of January 12, 2010, however, underscores the need for a better disaster reduction and response program, one that would address the underlying and protracted vulnerabilities of Haiti, while ushering in new winds of change that would pump fresh blood into the veins of the emergency management system. This chapter reviews the history of Haiti, including its demography and geography, and examines the hazards and factors contributing to the nation’s vulnerability to disasters. Furthermore, this chapter discusses some past disasters, Haiti’s emergency management system as well as the opportunities and the challenges confronting the system. We conclude by offering some recommendations for improving Haiti’s abilities to deal with disasters.Item A Look at Nigeria’s Bourgeoning Emergency Management System: Challenges, Opportunities, and Recommendations for Improvement(FEMA, U.S. Department of Homeland Security. 2012. Available from: http://training.fema.gov/EMIWeb/edu/CompEmMgmtBookProject.asp, 2012) Sadiq, Abdul-AkeemEmergency management in Nigeria, a country once known as the Giant of Africa, is in its infancy. Although organized responses to disasters date back to the early 1900s when the Fire Brigade was in charge of putting out fires, protecting properties, and helping communities respond to disasters, a comprehensive approach to emergency management only began in 1999. However, since then, Nigeria’s emergency management system has undergone tremendous changes. These include better organizational structure, more funding, curriculum development in emergency management education programs, increased training of emergency personnel, and more collaboration with other countries on emergency management issues. Nevertheless, this bourgeoning disaster management system still has a long way to go and faces innumerable challenges, including poverty, lack of funding for emergency management programs, and marginalization, among many others. This chapter examines the history of Nigeria, including its demography and geography, and takes a look at the factors contributing to vulnerability to disasters and hazards in Nigeria. In addition, this chapter discusses some past disasters as well as the opportunities and the challenges facing Nigeria’s emergency management system. This chapter concludes with recommendations for improving Nigeria’s emergency management system.Item Mental Health Among Adolescents Exposed to a Tornado: The Influence of Social Support and its Interactions with Socio-Demographic Characteristics and Disaster Exposure(Wiley, 2015) Paul, Lisa A.; Felton, Julia W.; Adams, Zachary W.; Welsh, Kyleen; Miller, Stephanie; Ruggiero, Kenneth J.; Psychiatry, School of MedicineApproximately 25% of youths experience a natural disaster and many experience disaster-related distress, including symptoms of posttraumatic stress disorder (PTSD) and depression. This study contributes to the literature by examining PTSD and depressive symptoms among 2,000 adolescents (50.9% female, 70.5% White) assessed after exposure to tornadoes in 2011. The authors hypothesized that greater tornado exposure, female sex, and younger age would be associated with distress, and that social support would interact with these associations. Analyses showed that PTSD symptoms were associated with lower levels of social support (β = -.28, p < .001), greater tornado exposure (β = .14, p < .001), lower household income (β = -.06, p = .013, female sex (β = -.10, p < .001), and older age (β = .07, p = .002), with a 3-way interaction between tornado exposure, sex, and social support (β = -.06, p = .017). For boys, the influence of tornado exposure on PTSD symptoms increased as social support decreased. Regardless of level of tornado exposure, low social support was related to PTSD symptoms for girls; depressive symptom results were similar. These findings were generally consistent with the literature and provide guidance for intervention development focused on strengthening social support at the individual, family, and community levels.Item Obstacles and disaster risk reduction: Survey of Memphis organizations(http://dx.doi.org/10.1061/(ASCE)NH.1527-6996.0000016, 2010-08) Sadiq, Abdul-Akeem; Weible, Christopher M.The disaster management literature is replete with surveys at the community and household levels. However, few exist at the organizational level. This study attempts to fill this void by examining the effect of organizational obstacles on disaster risk reduction. The data come from a survey of 227 organizations in Memphis, Tennessee. This study investigates three obstacles to disaster risk reduction: lack of organizational support, lack of information, and lack of financial resources. The findings show that organizations are more likely to engage in low-effort activities indirectly related to risk reduction and are less likely to engage in high-effort activities directly related to risk reduction. The most important obstacle is lack of information about the frequency of disasters, magnitude of disasters, or organizational benefits of reducing disaster risks. Lack of financial resources and lack of organizational support are sometimes positively associated with risk-reducing activities, suggesting that, when organizations engage in risk-reducing activities, some obstacles become more apparent. The study concludes with implications, limitations, and future research strategies.