Katrina: A Case Study

Transcription

1 Katrina: A Case Study David Abramson, PhD MPH Disaster Research Response Workshop IOM Forum on Medical and Public Health Preparedness June 23, 2014

2 MOST OF THE AREA WILL BE UNINHABITABLE FOR WEEKS... PERHAPS LONGER HUMAN SUFFERING INCREDIBLE BY MODERN STANDARDS. -- National Weather Service report Slidell, Louisiana August 28, 2005

3 Columbia University National Center for Disaster Preparedness

4

5

6 Columbia University National Center for Disaster Preparedness Flood of New Orleans

7 Columbia University National Center for Disaster Preparedness

8 Columbia University National Center for Disaster Preparedness

9 Columbia University National Center for Disaster Preparedness

10 Columbia University National Center for Disaster Preparedness

11 Voices of Katrina 11

12 Columbia University National Center for Disaster Preparedness

13 Columbia University National Center for Disaster Preparedness

14 Columbia University National Center for Disaster Preparedness Arabi, Louisiana, May

15 Research Landscape, Review of NIH and NSF grants awarded in 2005 and Search terms: Katrina OR Disaster Population research, human subjects research Does NOT capture all PHS grants or intramural work, but provides a snapshot of the extramural research program 15

16 Katrina Funding: NIH and NSF, # grants Total $ Mean award ($) As % of total budget NIH 11 $3.2 million $292,000.01% NSF 54 $5.7 million $106,000.10% NSF structural advantages NIH: only NIMH and NIDA Impact of Katrina on high-risk behaviors 1. Rapid funding mechanisms (at least 10 under $50k discretionary cap Disruption and reformulation of illicit drug markets for program officers) Disaster mental health research 2. Program officers experienced in disaster research 3. Well-organized extra-mural research community NSF: 9 sections, 25 program officers 4. Established high-impact academic journals Social behavior, organizational behavior and network emergence, 5. Social science disciplinary alignment risk communication, decision-making, vulnerability, role and reach of informal networks, psychological consequences, etc.

17 Rapid Research Reviewed the Katrina Bookshelf, compendium of research organized by the Social Science Research Council (editors Kai Erickson and Lori Peek) Restricted search to research that began in AND that published in academic or grey literature by 2007 Not a complete accounting, but illustrative

18 HURRICANE KATRINA RESEARCH (2005-) September 2005 October 2005 November 2005 December 2005 January February March April May June July August September Qualitative/Key Informant = Survey = Mixed Methods = LA = Blue LA & MS = Green TX = Purple Other = Yellow

19 HURRICANE KATRINA RESEARCH (2005-) September 2005 October 2005 November 2005 December 2005 January February March April May June July August September Qualitative/Key Informant = Survey = Mixed Methods = LA = Blue LA & MS = Green TX = Purple Other = Yellow

20 HURRICANE KATRINA RESEARCH (2005-) September 2005 October 2005 November 2005 December 2005 January February March April May June July August September Qualitative/Key Informant = Survey = Mixed Methods = LA = Blue LA & MS = Green TX = Purple Other = Yellow

21 HURRICANE KATRINA RESEARCH (2005-) September 2005 October 2005 November 2005 December 2005 January February March April May June July August September Qualitative/Key Informant = Survey = Mixed Methods = LA = Blue LA & MS = Green TX = Purple Other = Yellow

22 HURRICANE KATRINA RESEARCH (2005-) Gulf Coast Child & Family Health Study September 2005 October 2005 November 2005 December 2005 January February March April May June July August September Qualitative/Key Informant = Survey = Mixed Methods = LA = Blue LA & MS = Green TX = Purple Other = Yellow

23

24 The Challenges Access to sample frame data (aggregate emergency housing sites) Access to trailer parks and hotels Research infrastructure and workforce IRB Time and the problem of ephemeral data

25 Sample frame + Access issues 1. Who has most current list? 2. Will they share the list? 3. Can the research team gain access at multiple public and private sites?

26 Research infrastructure + workforce Built on long-standing NYC HIV cohort study: data systems, research staff, experience with vulnerable and elusive populations Graduate students from all over (25+, mainly from Columbia University) Common methodology of building and maintaining a longitudinal cohort, using multistage stratified sampling strategies

27 Critical partnerships The Children s Health Fund Coordinated with clinical teams, under umbrella of Operation Assist Sustained and stable funding Mobile health unit as Public Health Field Office Connections with state and local health officials Willingness to improvise Louisiana Department of Health Endorsed study, provided state ID badges for research team, ongoing resource and assistance

28 IRB Defining vulnerability of population Referring subjects to care, identifying crises Endorsement of community or government Attention to safety of field team Adequacy of training and preparation of team Duty to report laws in other states

29 Gulf Coast Child & Family Health Study (G-CAFH): Recruitment 1,079 households in Louisiana and Mississippi recruited within one year of Hurricane Katrina Multi-stage cluster sampling Louisiana: random selection of congregate settings (FEMA trailer parks, FEMA trailers in commercial parks, hotels) Mississippi: random selection of congregate settings (FEMA trailer parks, FEMA trailers in commercial parks), FEMA-designated census blocks (moderately to extensively damaged) Sample representative of 60,000 to 100,000 displaced and/or heavily-impacted Katrina survivors The National Center for Disaster Preparedness

30 G-CAFH Study tracks individual-level measures of recovery among 1,000+ randomly sampled households in LA + MS Housing and relocation status Health status (physical + mental health) Access and use of health services Attitudes & behaviors regarding social institutions (justice, health, faith-based) Personal sense of self-efficacy, resilience, and recovery

31 Relocation of Trailer Park Evacuees 6-12 months post-katrina Trailer park 33% 22 months post-katrina Community 33% 66% Trailer park Trailer population data Cumulative Group sites 22,471 Private sites 109,165 Source: FEMA Gulf Coast Recovery Office

32 Children s Chronic Disease (Gulf Coast data, 22 months post-katrina) NSCH = National Survey of Child Health Asthma Diabetes G-CAFH NSCH G-CAFH NSCH Pre-Katrina Post-Katrina Depression or Anxiety G-CAFH NSCH Behavioral or Conduct G-CAFH NSCH Development al Delay G-CAFH NSCH 0% 5% 10% 15% 20% 25% 30%

33 Mean MCS Score (Standard Deviation) Mental Health (Mississippi, 12 months post) Reasonable MH MH Distress MH Disability Extreme Psychosis FEMA Trailers Private Trailers Impact Areas US Population Wave 2 Mean Baseline Mean MCS = Mental health component summary score, SF12 version 2

34 G-CAFH: Follow-up Respondents interviewed annually Baseline: January & August Wave 2: April-August 2007 Wave 3: June-November 2008 Wave 4: November 2009-April 2010 At last round, 87.6% of eligible respondents found & interviewed 427 households with children enrolled at baseline 194 children from Wave 4 (grades 5-11) used for this analysis The National Center for Disaster Preparedness

35 Kaplan-Meier survival estimate Median days to stable housing = 917 (886, % CI) analysis time

36 Kaplan-Meier survival estimates ChiSq test for equality = 2.91, p = analysis time race = Black race = White

37 Kaplan-Meier survival estimates ChiSq test for equality = 36.69, p < analysis time mcs = Distressed mcs = Healthy

38 Academic Achievement: Age-Appropriate Grade Levels National Center for Education Statistics 1 Gulf Coast Child & Family Health Study 2 Region (year) US South (1999) LA + MS (2008) Total children surveyed, grades 6-12 % one or more years older than appropriate age for grades , % 33.9%

39 Children s mental health Over 160,000 children were displaced from their homes after Katrina for 3 or more months many for months or years Even two years post-katrina, school enrollment in LA and MS was still 55,000 below prehurricane rates The displacement may represent an ongoing exposure to transiency, uncertainty and disrupted social supports

40 Findings on Children s Mental Health Household stressors accounted for the most effect Parents had greatest DIRECT effect Social disorder had substantial and significant effect Prior social adversity had a minimal effect 35% of children had Serious Emotional Disturbance four years after Katrina, a rate nearly five times greater than the norm for comparable pediatric population

41 New York Times April 18, New York Times editorial April 21, Katrina Lessons... The humanitarian emergency that has recently come to light in the Katrina belt should put the federal government on notice that furnishing medical care and rebuilding medical services must be the first priority in disasters like this one. Columbia University National Center for Disaster Preparedness Louisiana Child & Family Health Study

42

43 Scientific ROI (Return on Investment) Gulf Coast Child and Family Health (G-CAFH) Study provided basis for Life Story Project, case-control intervention study of testimony therapy G-CAFH allowed rapid research during Hurricane Gustav G-CAFH cited in National Commission on Children and Disasters report Two doctoral dissertations in progress Foundation for development of Socio-ecological model of individual disaster recovery Served as model for Sandy Child and Family Health Study (S-CAFH), a 1,000-household longitudinal recovery study launched two weeks ago 43