Ncdp2011 Lecturev3
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This document discusses research on disparities in disaster preparedness and lessons learned. It describes a framework for identifying, understanding, and reducing preparedness disparities. It also summarizes a study on evacuation decision making among low-income urban minorities during Hurricane Katrina, finding that social networks influenced decisions both positively and negatively. Finally, it outlines a culturally-targeted community-based program called PREP to promote preparedness among low-income Latinos in Los Angeles.
Ncdp2011 Lecturev3
- 1. From Disparities Research to Disparities Interventions in Disaster Preparedness Lessons Learned and Thoughts About the Future David P. Eisenman, MD MSHS Associate Professor of Medicine David Geffen School of Medicine at UCLA
- 3. Mentors and Colleagues Steve Asch, MD, MPH Linda Bourque, PhD Jonathan Fielding, MD, MBA, MPH Lillian Gelberg, MD, MSHS Deborah Glik, ScD Dennis Mileti, PhD Martin Shapiro MD, PhD
- 4. Framework for eliminating disparities DETECTING UNDERSTANDING REDUCING Identify which Determine why Identify how disparities disparities occur disparities can be exist eliminated Kilbourne, et al. AJPH, 2006.
- 5. Framework for eliminating disparities DETECTING UNDERSTANDING REDUCING Identify which Determine why Identify how disparities disparities occur disparities can be exist eliminated Before: More likely to be under-prepared During: More likely to experience loss, injury, disease and death After: More likely to experience slower response and recovery Graham, Office of Minority Health’s Agenda to Integrate Racial and Ethnic Communities into Emergency Preparedness” presented at Public Health Preparedness Summit, 2009
- 6. Research Gaps Survey research or case studies focused mainly on disparities between broad majority versus minority groups. Factors that cause disparities less understood – Contextual factors? – Barriers and promoters? Few outcome studies, fewer using prospective designs or theory-based interventions.
- 7. Lessons Learned… Vulnerable populations want to get prepared. Social networks influence disaster behaviors, for better and for worse. Culturally targeted programs can improve preparedness… …but only so much. Why?
- 8. How would vulnerable groups prepare after September 11th? Protection Action Decision Model (Lindell & Perry); Extended Parallel Process Model (Witte) – Address how we process threats and taking protective actions – Link self-appraisal of personal vulnerability to protective actions. Threat severity (how severe will the effects be?); susceptibility (how likely it will happen to me?) Response efficacy (will recommended actions help me?); Self-efficacy
- 9. RDD telephone survey of the non-institutionalized adult population in Los Angeles County; 6 languages: English, Spanish, Chinese (Mandarin & Cantonese), Korean & Vietnamese Over sampled Asian and African Americans 59% cooperation rate “In the past year, has anyone in your household done any of the following in response to the possibility of terrorism: 1) purchased or maintained emergency supplies of food, water or clothing? 2) Developed an emergency plan for you and your family?”
- 11. Implications Vulnerable groups (ethnic minorities, disabled, immigrants) amenable to improving preparedness. Tailored and targeted programs may work for diverse population segments of Los Angeles
- 12. Literature on increased protective behaviors among minority groups Eisenman, et al., AJPH, 2009 Uscher-Pines L, Am J Prev Med, 2009 Page, L., et al., Biosecur Bioterror, 2008 Rubin, GJ., et al., BMJ 2008
- 14. Reasons for non-evacuation Little known about low-income, urban, minority communities Transportation, shelter, historical experience cited in surveys Decision-making is multifactorial and socially embedded; surveys don’t address this. Qualitative research is needed
- 15. Purpose To study the experience of Hurricane Katrina evacuees to understand evacuation decision- making in impoverished, urban, mainly minority communities. Participants describe factors affecting evacuation that are more complex than previously reported, interacted with one another, and were socially influenced. Eisenman, et al., AJPH, 2007
- 16. Quick response research Mon Tues Wed Thurs Fri Aug 29 30 31 Sept 1 2 Katrina NOLA Astrodome Houston landfall evacuated opens shelters house 27K Eisenman camping trip 5 6 7 8 9 Labor Day NSF grant IRB Work in Recruitment submitted; fly shelter clinic; begins to Houston IRB approval
- 18. Major Themes: Social network Transportation Trust Risk Shelter perception Message Money, jobs, understanding property Health
- 19. Transportation I mean, if you've got 20 people trying to get in one car it's not going to happen. So some people, you just stay because you have to.
- 20. Shelter Really truly, we had cars, but we didn't know anybody to go to. They said go to Texas but I didn't know anybody in Texas.
- 21. Health I could have made it on my own, but it was just my aunt and my uncle. Every few steps he made…she forgot his walker…every few steps he made he was falling down.
- 22. Social networks My plans were to leave. Unfortunately we received a call and we had to come back home. My mother-in-law had called for us to come back…. You know when they get a certain age they get confused. My mother-in-law wouldn't leave the house. My husband wouldn't leave her and I'm not going to leave him.
- 23. Social networks Like my Mom said, she's been through Betsy, Camille, all the hurricanes, the major hurricanes and she just wasn't evacuating. So I wasn't going to leave my Mom to stay there by herself. I had a 90 year old mother that I was taking care of and she would not leave that house for hell or high water.
- 24. The influence of social networks: conclusions and recommendations Demonstrates interactions between factors influencing evacuation – Counterpart to Drabek’s finding “ families move as units and remain together, even at the cost of overriding dissenting opinions.” Broad networks hindered and facilitated evacuation – Stretched limited resources – Obligations to extended family, especially elderly who resisted evacuation or were frail, inhibited individuals and nuclear families Disaster research and policy must address social units not just individuals.
- 26. •Programa para Responder a Emergencias con Preparación. •A culturally-targeted, community-based program to promote disaster preparedness among low income Latinos •UCLA, Coalition for Community Health (CCH), Los Angeles County Department of Public Health
- 27. Preparedness in Los Angeles is low... Family Emergency Plan 39.3% 3 Days Food/Water 82.0% Battery-Powered Radio 93.6% First Aid Kit 70.8% Flashlight 76.2% Spare Batteries 77.4% 30% 40% 50% 60% 70% 80% 90% 100% * While most residents have each item, only 45% have all 5 items; <40% have plan.
- 28. Latinos less likely to have supplies (OR=0.73) and Spanish speakers less likely to have emergency plan (OR=0.61)* 60% 56.4% 47.4% 47.5% 42.5% 45% 41.8% 40.8% 38.8% White Latino Africa American 32.2% APIs - Chinese 30% APIs - Korean 22.5% 16.8% 15% Disaster Supplies Emergency Plan * Controlled for age, gender, income, education, community, country of origin, health.
- 29. Promotora Local lay community residents trained in basic health promotion skills working with fellow community members who are under-served by the health care system. Use their cultural knowledge, social networks, and leadership role in the community to model behavior, overcome barriers, and create change. Provide connections between community and health care system including informal counseling, service assistance, education. Improved health care access, prenatal care, health behaviors. Not previously used in U.S. disaster preparedness
- 30. PREP logic model PREP CAB Focus CAB Interven New Groups tion behavior CBPR CBPR CBPR CBPR CBPR HBM PADM HBM PADM SI
- 31. “Disaster Kit” Only half heard of term “disaster kit” or “emergency kit” – What's the difference between a disaster kit and a first aid kit? – Storage, like when we buy something we say this is for storage – Emergency things Eisenman, et al., JHCPU, 2009
- 33. Communication Plan For most very fuzzy having the means to get communications from others during a disaster – A portable radio. – If there is no electricity you can’t ever charge your cell phone. – a little book with all the emergency phone numbers – walkie talkies Kind of like an emergency exit.
- 35. PREP Experiment: Overview Randomized, longitudinal two-group cohort design of a culturally-tailored, disaster preparedness program – ‘high-intensity’ vs ‘low-intensity’ groups Latino immigrant adults living in Los Angeles County, recruited using Respondent Driven Sampling – Eligibility: Latino, adult, domiciled in Los Angeles, 1 adult per household Baseline and 3-months post-intervention telephone assessments.
- 36. Theoretical Model Demographic Milling/norms H1: Disaster supplies Culture/Beliefs: Perceived benefits H2: Communication (fatalism, locus of plan responsibility, Perceived literacy) barriers Self-efficacy
- 37. Media Culturally tailored brochure Laminated shopping card Pre-printed/perforated communication cards
- 38. Platica Small group discussion, 1 hour Led by a trained promotora Held at community site. + Media materials N=25
- 39. Respondent Driven Sampling A type of chain referral sampling method that uses social network theory to gather a sample representative of the target “hidden” population. 7 seeds – Recruitment instructions, 4 coupons with unique codes, 5$ per eligible recruit – All persons who called the study number and presented a valid coupon were assessed for eligibility.
- 41. RDS results
- 42. Eisenman, et al., Am J Prev Med, 2009
- 43. Summary Culturally tailored materials did very well, often doubling proportions of preparedness. Significantly greater proportion of participants in the platica arm reported increases in important outcomes.
- 44. Improving Communication Plans Nationally, fewer people have plans than supplies, even after media campaigns. Platicas led more participants to develop a written plan than media Is this due to social interaction resolving participants’ ambiguities? – Emergency communication plan requires discussion and agreement – Promotoras suited for clarifying uncertainties and misunderstandings
- 45. Perceived benefit of a plan Responses to Pre- Post- “Having a plan for ….is helpful.” Strongly 32 (17%) 79 (42.3%) disagree Mildly agree 3 (1.6%) 6 (3.2%) Neither agree 4 (2.1%) 1 (0.5%) or disagree Mildly agree 20 (10.7%) 9 (4.8%) Strongly agree 128 (68.5%) 92 (49%)
- 46. Emergency Plan perceived benefit of a plan Confusion and fuzzy understanding – Do we need different plans for different emergencies? For different times of the day and week? Doesn’t it matter what the authorities say during the emergency? Is text better than telephone?
- 47. Emergency Plan Family emergency planning cannot totally be done in the family vacuum “Species-level” changes in communication Are we dubious about the benefit of a plan?
- 55. Emergency Medication Supply Did not improve in PREP People in poor physical or mental health are less likely to be prepared. – Eisenman, DMPHP, 2009. Inflexible drug-dispensing policies prevent the public from building reserves – Carameli and Eisenman DMPHP, 2010.
- 56. “The fact that every family’s plan involves other parts of the community is why I strongly believe that there needs to be one day in the year dedicated to the emergency planning process. If we as a nation feel it is really important for the public to develop emergency plans, it would be far more effective if everyone was doing that at the same time — rather than asking individuals to do it on their own so the planning can be integrated.” John Solomon, incaseofemergencyblog.com, 9/13/10
- 57. Thank you