Background: Over 160 000 children were displaced from their homes after Hurricane Katrina. Tens of thousands of these children experienced the ongoing chaos and uncertainty of displacement and transiency, as well as significant social disruptions in their lives. The objectives of this study were to estimate the long-term mental health effects of such exposure among children, and to elucidate the systemic pathways through which the disaster effect operates.

Methods: The prevalence of serious emotional disturbance was assessed among 283 school-aged children in Louisiana and Mississippi. These children are part of the Gulf Coast Child & Family Health Study, involving a longitudinal cohort of 1079 randomly sampled households in the two states, encompassing a total of 427 children, who have been interviewed in 4 annual waves of data collection since January 2006. The majority of data for this analysis was drawn from the fourth round of data.

Results: Although access to medical care for children has expanded considerably since 2005 in the region affected by Hurricane Katrina, more than 37% of children have received a clinical mental health diagnosis of depression, anxiety, or behavior disorder, according to parent reports. Children exposed to Hurricane Katrina were nearly 5 times as likely as a pre-Katrina cohort to exhibit serious emotional disturbance. Path analyses confirm the roles played by neighborhood social disorder, household stressors, and parental limitations on children's emotional and behavioral functioning.

Conclusions: Children and youth are particularly vulnerable to the effects of disasters. They have limited capacity to independently mobilize resources to help them adapt to stressful postdisaster circumstances, and are instead dependent upon others to make choices that will influence their household, neighborhood, school, and larger social environment. Children's mental health recovery in a postdisaster setting can serve as a bellwether indicator of successful recovery or as a lagging indicator of system dysfunction and failed recovery.

(Disaster Med Public Health Preparedness. 2010;4:S17-S27)

Background: The study was designed to examine the 30- and 90-day mortality and hospitalization rates among nursing facility (NF) residents in the affected areas of Louisiana and Mississippi following Hurricane Katrina and to assess the rate of significant posthurricane functional decline.

Methods: A secondary data analysis was conducted using Medicare claims merged with NF resident data from the Minimum Data Set. Thirty- and 90-day mortality and hospitalization rates for long-stay (>90 days) residents residing in 141 at-risk NFs during Hurricane Katrina were compared to rates for residents residing at the same facilities during the same time period in prior nonhurricane years (2003 and 2004). Functional decline was assessed as a 4+ drop in function using a 28-point Minimum Data Set Activities of Daily Living Scale.

Results: There were statistically significant differences (all P < .0001) in mortality, hospitalization, and functional decline among residents exposed to Hurricane Katrina. At 30 days, the mortality rate was 3.88% among the exposed cohort compared with 2.10% and 2.28% for residents in 2003 and 2004, respectively. The 90-day mortality rate was 9.27% compared with 6.71% and 6.31%, respectively. These mortality differences translated into an additional 148 deaths at 30 days and 230 deaths at 90 days. The 30-day hospitalization rate was 9.87% compared with 7.21% and 7.53%, respectively. The 90-day hospitalization rate was 20.39% compared with 18.61% and 17.82%, respectively. Finally, the rate of significant functional decline among survivors was 6.77% compared with 5.81% in 2003 and 5.10% in 2004.

Conclusions: NF residents experienced a significant increase in mortality, hospitalization, and functional decline during Hurricane Katrina.

(Disaster Med Public Health Preparedness. 2010;4:S28-S32)

Background: The impact of a natural disaster on self-care and health care delivery has been well documented. The objective of the study was to document the recovery pattern from the impact of a natural disaster such as Hurricane Katrina on clinical and biochemical measures of diabetes and its comorbidities.

Methods: Patients were selected from Tulane University Hospital and Clinic, Southeast Louisiana Veterans Health Care System, and the Medical Center of Louisiana at New Orleans. Adults with diabetes and A1c measurement 6 months before (pre-K) Hurricane Katrina (February 28, 2005–August 27, 2005) and 6 to 16 months after (post-K) Katrina (March 1, 2006–December 31, 2006) were identified within the 3 facilities. Follow-up data (January 1, 2007–December 31, 2007) were 1 year after the first post-K visit. The outcome measures were hemoglobin A1c (HbA1c), systolic and diastolic blood pressure (BP), and lipids (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL], triglycerides).

Results: Averaged across the 3 facilities, the parameters significantly different in the follow-up period compared with pre- and post-K were HbA1c (P = .04), HDL, and systolic and diastolic BP (P < .0001). Parameters with significantly different patterns of change in the 3 facilities over time were HbA1c, HDL, systolic and diastolic BP (P < .0001), and low-density lipoprotein (P < .01).

Conclusions: Our results suggest that a variety of clinical and biochemical parameters related to diabetes and its comorbidities affected by natural disaster have varied the rate of recovery to predisaster levels.

(Disaster Med Public Health Preparedness. 2010;4:S33-S38)

Objective: To examine how the demographic and other population changes affected birth and obstetric outcomes in Louisiana, and the effect of the hurricane on racial disparities in these outcomes.

Methods: Vital statistics data were used to compare the incidence of low birth weight (LBW) (<2500 g), preterm birth (PTB) (37 weeks' gestation), cesarean section, and inadequate prenatal care (as measured by the Kotelchuck index), in the 2 years after Katrina compared to the 2 years before, for the state as a whole, region 1 (the area around New Orleans), and Orleans Parish (New Orleans). Logistic models were used to adjust for covariates.

Results: After adjustment, rates of LBW rose for the state, but preterm birth did not. In region 1 and Orleans Parish, rates of LBW and PTB remained constant or fell. These patterns were all strongest in African American women. Rates of cesarean section and inadequate prenatal care rose. Racial disparities in birth outcomes remained constant or were reduced.

Conclusions: Although risk of LBW/PTB remained higher in African Americans, the storm does not appear to have exacerbated health disparities, nor did population shifts explain the changes in birth and obstetric outcomes.

(Disaster Med Public Health Preparedness. 2010;4:S39-S45)

Background: Disaster recovery is a complex phenomenon. Too often, recovery is measured in singular fashion, such as quantifying rebuilt infrastructure or lifelines, without taking in to account the affected population's individual and community recovery. A comprehensive framework is needed that encompasses a much broader and far-reaching construct with multiple underlying dimensions and numerous causal pathways; without the consideration of a comprehensive framework that investigates relationships between these factors, an accurate measurement of recovery may not be valid. This study proposes a model that encapsulates these ideas into a single framework, the Socio-Ecological Model of Recovery.

Methods: Using confirmatory factor analysis, an operational measure of recovery was developed and validated using the five measures of housing stability, economic stability, physical health, mental health, and social role adaptation. The data were drawn from a sample of displaced households following Hurricane Katrina. Measures of psychological strength, risk, disaster exposure, neighborhood contextual effects, and formal and informal help were modeled to examine their direct and indirect effects on recovery using a structural equation model.

Findings: All five elements of the recovery measure were positively correlated with a latent measure of recovery, although mental health and social role adaptation displayed the strongest associations. An individual's psychological strength had the greatest association with positive recovery, followed by having a household income greater than $20 000 and having informal social support. Those factors most strongly associated with an absence of recovery included the time displaced since the hurricane, being disabled, and living in a community with substantial social disorder.

Discussion: The socio-ecological framework provides a robust means for measuring recovery, and for testing those factors associated with the presence or absence of recovery.

(Disaster Med Public Health Preparedness. 2010;4:S46-S54)

Background: We examined the relation of sleep disturbance and arousal to work performance, mental and physical health, and day-to-day functioning in Florida Department of Health (FDOH) employees 9 months after the 2004 Florida hurricane season.

Methods: FDOH employees were contacted via e-mail 9 months after the 2004 hurricanes. Participants (N = 2249) completed electronic questionnaires including measures of sleep disturbance, arousal, work performance, physical health, mental health, day-to-day function, hurricane injury, and work demand.

Results: More than 18% of FDOH employees reported ≥25% reduced work performance and 11% to 15.3% reported ≥7 “bad” mental or physical health days in the past month. Sleep disturbance and elevated arousal were strongly associated with impaired work performance (odds ratios [ORs] 3.33 and 3.34, respectively), “bad” mental health (ORs 3.01 and 3.64), “bad” physical health (ORs 3.21 and 2.01), and limited day-to-day function (ORs 4.71 and 2.32), even after adjusting for sex, race, age, education, and marital status.

Conclusions: Among public health workers exposed to the 2004 hurricanes, sleep disturbance and arousal were associated with personal and work impairment. Future research should continue to examine the effect of repeated exposure to disasters in first responders.

(Disaster Med Public Health Preparedness. 2010;4:S55-S62)

Objectives: Children may experience psychological, physical, and educational vulnerability as the result of a disaster. Of these 3 vulnerability types, educational vulnerability has received the most limited scholarly attention. The 2 primary objectives of this research are to describe what forms of educational support displaced children said that they needed after Hurricane Katrina and to identify who or what facilitated children's educational recovery.

Methods: This article draws on data gathered through participant observation and interviews with 40 African American children between the ages of 7 and 18 years who relocated to Colorado with their families after Hurricane Katrina.

Results: In the first year following Hurricane Katrina, more than 75% of the children in the sample experienced a decline in grades. In subsequent years, the children reported greater satisfaction with their schools in Colorado and their overall educational experience. The children identified their teachers, peers, and educational institutions as playing the most significant role in their recovery.

Conclusion: Through offering a child-centric perspective, this study expands prior research on postdisaster educational recovery.

(Disaster Med Public Health Preparedness. 2010;4:S63-S70)

When it struck the US Gulf Coast in 2005, Hurricane Katrina severely disrupted many graduate medical education residency/fellowship programs in the region and the training of hundreds of residents/fellows. Despite the work of the Accreditation Council for Graduate Medical Education in responding to this natural disaster and facilitating communication and transfer of residents/fellows to other unaffected training programs, the storm exposed the gaps in the existing system. Subsequently, the Accreditation Council for Graduate Medical Education, with the aid of its member organizations, including the American Medical Association, developed a new disaster recovery plan to allow for a more rapid, effective response to future catastrophic events. These policies were instrumental in the rapid relocation of 597 residents/fellows from the University of Texas Medical Branch at Galveston after the landfall of Hurricane Ike in September 2008. As a further accommodation to affected trainees, medical certification boards should be as flexible as possible in waiving continuity requirements in the event of a disaster that affects residency/fellowship programs.

(Disaster Med Public Health Preparedness. 2010;4:S71-S74)