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Objectives: Hurricane Ida delivered record rainfall to the northeast, resulting in 11 deaths in New York City. We review these deaths, identify risk factors, and discuss solutions to prevent recurrence., Methods: Deaths were confirmed by multiple sources. Locations of the deceased were obtained from obituaries and plotted on the NYC.gov flood-hazard map. Risk factor information of the decedents was collected when available. Current emergency response plans and mitigation efforts were identified on the NYC.gov officially sanctioned website., Results: All descendants resided in basement apartments. None of the deaths occurred in a location previously designated a "flood risk zone." While a flash flood emergency was issued during Hurricane Ida, guidance was not provided during the emergency. Flooding was compounded by the city's aging infrastructure and lack of green space., Conclusions: Aging infrastructure, lack of pre-notification, illegal basement apartments, and lack of a planned response all appear to have played a role in these 11 deaths.

Natural disasters trigger complex chains of events within human societies 1 . Immediate deaths and damage are directly observed after a disaster and are widely studied, but delayed downstream outcomes, indirectly caused by the disaster, are difficult to trace back to the initial event 1,2 . Tropical cyclones (TCs)-that is, hurricanes and tropical storms-are widespread globally and have lasting economic impacts 3-5 , but their full health impact remains unknown. Here we conduct a large-scale evaluation of long-term effects of TCs on human mortality in the contiguous United States (CONUS) for all TCs between 1930 and 2015. We observe a robust increase in excess mortality that persists for 15 years after each geophysical event. We estimate that the average TC generates 7,000-11,000 excess deaths, exceeding the average of 24 immediate deaths reported in government statistics 6,7 . Tracking the effects of 501 historical storms, we compute that the TC climate of CONUS imposes an undocumented mortality burden that explains a substantial fraction of the higher mortality rates along the Atlantic coast and is equal to roughly 3.2-5.1% of all deaths. These findings suggest that the TC climate, previously thought to be unimportant for broader public health outcomes, is a meaningful underlying driver for the distribution of mortality risk in CONUS, especially among infants (less than 1 year of age), people 1-44 years of age, and the Black population. Understanding why TCs induce this excess mortality is likely to yield substantial health benefits., (© 2024. The Author(s).)

Introduction: Puerto Rico is a territory of the United States, making Puerto Ricans vulnerable to damaging colonial policy. The purpose of this article is to utilize the socioecological model (SEM) to evaluate how the Jones Act impacted Puerto Rico after Hurricane María, examining colonialist policy as a social determinant of health (SDOH) in Puerto Rico., Methods: Levels of the SEM used in this examination included: individual , institutional , community , policy , and context., Results: Evaluation of the Jones Act using the model demonstrated relationships between all socioecological levels. The Jones Act caused delays and increased prices for goods needed to rebuild community utility infrastructure, which led to extended closures of institutions like workplaces, schools, and hospitals, and ultimately contributed to increased acute and chronic physical and mental illness among Puerto Ricans., Discussion: This evaluation establishes that colonialist policy negatively impacts the health of Puerto Ricans, positioning colonialism as an SDOH., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Patients undergoing maintenance hemodialysis face heightened vulnerability during disasters like tropical cyclones, yet there is sparse research on their treatment-related challenges and countermeasures. This scoping review aims to highlight the issues maintenance hemodialysis patients encounter following tropical cyclones., Methods: A systematic scoping review of 19 articles from 2000 to 2023 was conducted, evaluating eligibility against predefined criteria., Results: Hemodialysis patients encounter substantial challenges during and after tropical cyclones in the United States, Puerto Rico, Australia, and Taiwan. Thematic analysis identified 3 themes related to "challenges" (Hemodialysis health-related challenges, socially relevant challenges, and challenges of management inefficiencies). "Recommendations" comprised 4 themes and 4 phases across the "mitigation phase" (fortifying healthcare infrastructure and mobilizing community-focused risk mitigation initiatives), "preparedness" (emergency plan development, training, and patient education), "response" (activation of emergency plans and providing emergency healthcare services), and "recovery" (intersectoral collaboration for recovery and rebuilding)., Conclusion: This scoping review underscores challenges confronted by patients undergoing maintenance hemodialysis post-tropical cyclones, highlighting the urgent need for targeted strategies to ensure the continuity of dialysis care during and after such disasters.

5wPatients with end stage kidney disease (ESKD) who receive in-center hemodialysis are disproportionately vulnerable to extreme weather events, including hurricanes and heat waves, that may disrupt access to healthcare providers, and life-sustaining treatments. This current era of climate-driven compounding disasters is progressively elevating the level of threat to the health and well-being of patients with ESKD. This analysis brings together multi-disciplinary expertise to explore the contours of this increasingly complex risk landscape. Despite the challenges, important advances have been made for safeguarding this medically high-risk patient population. Hemodialysis services providers have devised innovative systems for preparing their patients and sustaining, or rapidly reestablishing, hemodialysis services in the aftermath of a disaster, and maintaining open lines of communication with their caseloads of ESKD patients throughout all phases of the event. A description of lessons learned along the path towards improved patient support in disasters, is provided. The article concludes with a detailed case example, describing dialysis providers' effective response throughout Hurricane Ian's passage across the State of Florida in 2022. Based on lessons learned, this analysis outlines strategies for protecting patients with ESKD that may be adapted for future climate-potentiated disaster scenarios.

Objective: Cancer patients are among the most vulnerable populations during and after a disaster. We evaluated the impact of treatment interruption on the survival of women with gynecologic cancer in Puerto Rico following Hurricanes Irma and María., Methods: A retrospective cohort study among a clinic-based sample of women with gynecological cancer diagnosed between January 2016 and September 2017 (n = 112) was done. Women were followed from their diagnosis until December 2019, to assess vital status. Kaplan-Meier survival curves and Cox proportional hazards models were performed., Results: Mean age was 56 (± 12.3) years; corpus uteri (58.9%) was the most common gynecologic cancer. Predominant treatments were surgery (91.1%) and chemotherapy (44.6%). Overall, 75.9% were receiving treatment before the hurricanes, 16.1% experienced treatment interruptions, and 8.9% died during the follow-up period. Factors associated with treatment interruption in bivariate analysis included younger age (≤55 years), having regional/distant disease, and receiving > 1 cancer treatment ( P < 0.05). Crude analysis revealed an increased risk of death among women with treatment interruption (HR: 3.88, 95% CI: 1.09-13.77), persisting after adjusting for age and cancer stage (HR: 2.49, 95% CI: 0.69-9.01)., Conclusions: Findings underscore the detrimental impact of treatment interruption on cancer survival in the aftermath of hurricanes, emphasizing the need for emergency response plans for this vulnerable population.

Importance: Evacuation has been found to be associated with adverse outcomes among nursing home residents during hurricanes, but the outcomes for assisted living (AL) residents remain unknown., Objective: To examine the association between evacuation and health care outcomes (ie, emergency department visits, hospitalizations, mortality, and nursing home visits) among Florida AL residents exposed to Hurricane Irma., Design, Setting, and Participants: Retrospective cohort study using 2017 Medicare claims data. Participants were a cohort of Florida AL residents who were aged 65 years or older, enrolled in Medicare fee-for-service, and resided in 9-digit zip codes corresponding to US assisted living communities with 25 or more beds on September 10, 2017, the day of Hurricane Irma's landfall. Propensity score matching was used to match evacuated residents to those that sheltered-in-place based on resident and AL characteristics. Data were analyzed from September 2022 to February 2024., Exposure: Whether the AL community evacuated or sheltered-in-place before Hurricane Irma made landfall., Main Outcomes and Measures: Thirty- and 90-day emergency department visits, hospitalizations, mortality, and nursing home admissions., Results: The study cohort included 25 130 Florida AL residents (mean [SD] age 81 [9] years); 3402 (13.5%) evacuated and 21 728 (86.5%) did not evacuate. The evacuated group had 2223 women (65.3%), and the group that sheltered-in-place had 14 556 women (67.0%). In the evacuated group, 42 residents (1.2%) were Black, 93 (2.7%) were Hispanic, and 3225 (94.8%) were White. In the group that sheltered in place, 490 residents (2.3%) were Black, 707 (3.3%) were Hispanic, and 20 212 (93.0%) were White. After 1:4 propensity score matching, when compared with sheltering-in-place, evacuation was associated with a 16% greater odds of emergency department visits (adjusted odds ratio [AOR], 1.16; 95% CI, 1.01-1.33; P = .04) and 51% greater odds of nursing home visits (AOR, 1.51; 95% CI, 1.14-2.00; P = .01) within 30 days of Hurricane Irma's landfall. Hospitalization and mortality did not vary significantly by evacuation status within 30 or 90 days after the landfall date., Conclusions and Relevance: In this cohort study of Florida AL residents, there was an increased risk of nursing home and emergency department visits within 30 days of Hurricane Irma's landfall among residents from communities that evacuated before the storm when compared with residents from communities that sheltered-in-place. The stress and disruption caused by evacuation may yield poorer immediate health outcomes after a major storm for AL residents. Therefore, the potential benefits and harms of evacuating vs sheltering-in-place must be carefully considered when developing emergency planning and response.

Tropical cyclones have far-reaching impacts on livelihoods and population health that often persist years after the event 1-4 . Characterizing the demographic and socioeconomic profile and the vulnerabilities of exposed populations is essential to assess health and other risks associated with future tropical cyclone events 5 . Estimates of exposure to tropical cyclones are often regional rather than global 6 and do not consider population vulnerabilities 7 . Here we combine spatially resolved annual demographic estimates with tropical cyclone wind fields estimates to construct a global profile of the populations exposed to tropical cyclones between 2002 and 2019. We find that approximately 560 million people are exposed yearly and that the number of people exposed has increased across all cyclone intensities over the study period. The age distribution of those exposed has shifted away from children (less than 5 years old) and towards older people (more than 60 years old) in recent years compared with the early 2000s. Populations exposed to tropical cyclones are more socioeconomically deprived than those unexposed within the same country, and this relationship is more pronounced for people exposed to higher-intensity storms. By characterizing the patterns and vulnerabilities of exposed populations, our results can help identify mitigation strategies and assess the global burden and future risks of tropical cyclones., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Intense tropical cyclones (TCs), which often peak in autumn 1,2 , have destructive impacts on life and property 3-5 , making it crucial to determine whether any changes in intense TCs are likely to occur. Here, we identify a significant seasonal advance of intense TCs since the 1980s in most tropical oceans, with earlier-shifting rates of 3.7 and 3.2 days per decade for the Northern and Southern Hemispheres, respectively. This seasonal advance of intense TCs is closely related to the seasonal advance of rapid intensification events, favoured by the observed earlier onset of favourable oceanic conditions. Using simulations from multiple global climate models, large ensembles and individual forcing experiments, the earlier onset of favourable oceanic conditions is detectable and primarily driven by greenhouse gas forcing. The seasonal advance of intense TCs will increase the likelihood of intersecting with other extreme rainfall events, which usually peak in summer 6,7 , thereby leading to disproportionate impacts., (© 2023. The Author(s).)

Importance: Hurricanes and flooding can interrupt health care utilization. Understanding the magnitude and duration of interruptions, as well as how they vary according to hazard exposure, race, and income, are important for identifying populations in need of greater retention in care., Objective: To determine how the differential exposure to Hurricane Harvey in August 2017 is associated with changes in utilization of Veterans Health Administration health care., Design, Setting, and Participants: This is a retrospective cohort analysis of primary care practitioner (PCP) visits, emergency department visits, and inpatient admissions in the Veterans Health Administration among Texas veterans residing in counties impacted by Hurricane Harvey from 2016 to 2018. Data analysis was performed from September 2020 to May 2021., Exposures: Residential flooding after Hurricane Harvey., Main Outcomes and Measures: Interrupted time series analysis measured changes in health care utilization over time, stratified by residential flood exposure, race, and income., Results: Of the 99 858 patients in the cohort, 89 931 (90.06%) were male, and their median (range) age was 58 (21 to 102) years. Compared with veterans in nonflooded areas, veterans living in flooded areas were more likely to be Black (24 715 veterans [33.80%] vs 4237 veterans [15.85%]) and low-income (14 895 veterans [20.37%] vs 4853 veterans [18.15%]). Rates of PCP visits decreased by 49.78% (95% CI, -64.52% to -35.15%) for veterans in flooded areas and by 45.89% (95% CI, -61.93% to -29.91%) for veterans in nonflooded areas and did not rebound until more than 8 weeks after the hurricane. Rates of PCP visits in flooded areas remained lower than expected for 11 weeks among White veterans (-6.99%; 95% CI, -14.36% to 0.81%) and for 13 weeks among racial minority veterans (-7.22%; 95% CI, -14.11% to 0.30%). Low-income veterans, regardless of flood status, experienced greater suppression of PCP visits in the 8 weeks following the hurricane (-13.72%; 95% CI, -20.51% to -6.68%) compared with their wealthier counterparts (-9.63%; 95% CI, -16.74% to -2.26%)., Conclusions and Relevance: These findings suggest that flood disasters such as Hurricane Harvey may be associated with declines in health care utilization that differ according to flood status, race, and income strata. Patients most exposed to the disaster also had the greatest delay or nonreceipt of care.

The magnitude, timing, and etiology of morbidity associated with tropical cyclones remains incompletely quantified. We examined the relative change in cause-specific emergency department (ED) visits among residents of New York City during and after Hurricane Sandy, a tropical cyclone that affected the northeastern United States in October 2012. We used quasi-Poisson constrained distributed lag models to compare the number of ED visits on and after Hurricane Sandy with all other days, 2005-2014, adjusting for temporal trends. Among residents aged ≥65 years, Hurricane Sandy was associated with a higher rate of ED visits due to injuries and poisoning (relative risk (RR) = 1.19, 95% confidence interval (CI): 1.10, 1.28), respiratory disease (RR = 1.35, 95% CI: 1.21, 1.49), cardiovascular disease (RR = 1.10, 95% CI: 1.02, 1.19), renal disease (RR = 1.44, 95% CI: 1.22, 1.72), and skin and soft tissue infections (RR = 1.20, 95% CI: 1.03, 1.39) in the first week following the storm. Among adults aged 18-64 years, Hurricane Sandy was associated with a higher rate of ED visits for renal disease (RR = 2.15, 95% CI: 1.79, 2.59). Among those aged 0-17 years, the storm was associated with lower rates of ED visits for up to 3 weeks. These results suggest that tropical cyclones might result in increased health-care utilization due to a wide range of causes, particularly among older adults., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In September 2017, Hurricane Maria made landfall across the Caribbean region as a category 4 storm. In the aftermath, many residents of Puerto Rico were without power or clean running water for nearly a year. Using both English and Spanish tweets from September 16 to October 15 2017, we investigate discussion of Maria both on and off the island, constructing a proxy for the temporal network of communication between victims of the hurricane and others. We use information theoretic tools to compare the lexical divergence of different subgroups within the network. Lastly, we quantify temporal changes in user prominence throughout the event. We find at the global level that Spanish tweets more often contained messages of hope and a focus on those helping. At the local level, we find that information propagating among Puerto Ricans most often originated from sources local to the island, such as journalists and politicians. Critically, content from these accounts overshadows content from celebrities, global news networks, and the like for the large majority of the time period studied. Our findings reveal insight into ways social media campaigns could be deployed to disseminate relief information during similar events in the future., Competing Interests: The authors have declared that no competing interests exist.

We study collective attention paid towards hurricanes through the lens of n-grams on Twitter, a social media platform with global reach. Using hurricane name mentions as a proxy for awareness, we find that the exogenous temporal dynamics are remarkably similar across storms, but that overall collective attention varies widely even among storms causing comparable deaths and damage. We construct 'hurricane attention maps' and observe that hurricanes causing deaths on (or economic damage to) the continental United States generate substantially more attention in English language tweets than those that do not. We find that a hurricane's Saffir-Simpson wind scale category assignment is strongly associated with the amount of attention it receives. Higher category storms receive higher proportional increases of attention per proportional increases in number of deaths or dollars of damage, than lower category storms. The most damaging and deadly storms of the 2010s, Hurricanes Harvey and Maria, generated the most attention and were remembered the longest, respectively. On average, a category 5 storm receives 4.6 times more attention than a category 1 storm causing the same number of deaths and economic damage., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Author DRD’s commercial affiliation with paid employment. Additionally, we have received funding from a commerical source: Massachusetts Mutual Life Insurance Company and Google. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The impact and lessons learned from Hurricane Katrina and the Gulf Oil Spill are described as an example of work done reflecting best practices and theory to gain a better understanding of risk and resilience for children and families. Hurricane Katrina, described as the worst natural disaster in the US history, resulted in traumatic separations of children and families and devastation of communities and schools. The impact was greater on families with fewer resources before the hurricane who were provided limited support to return and rebuild. Insufficient community support and economic resources contributed to prolonged traumatiaation and slow recovery. Many were still recovering from Hurricane Katrina when impacted by the Gulf Oil Spill. For families with multigenerational ties to the fishing and oil industries, the Gulf Oil Spill resulted in both cumulative trauma and increased risk. In implementing the behavioural health response, much was learned about promotive and protective factors for individual and community resilience. Services provided following the disasters were based on precepts of individual, family, and community resilience. To enhance recovery and support resilience, the development of regional coalitions across at risk areas provides important coordination before disasters occur for better preparation and response., (© 2020 International Union of Psychological Science.)

Natural disturbances are an important driver of population dynamics. Because it is difficult to observe wildlife during these events, our understanding of the strategies that species use to survive these disturbances is limited. On October 10, 2018, Hurricane Michael made landfall on Florida's northwest coast. Using satellite and acoustic telemetry, we documented movements of 6 individual turtles: one loggerhead sea turtle, one Kemp's ridley sea turtle, three green sea turtles and one diamondback terrapin, in a coastal bay located less than 30 km from hurricane landfall. Post-storm survival was confirmed for all but the Kemp's ridley; the final condition of that individual remains unknown. No obvious movements were observed for the remaining turtles however the loggerhead used a larger home range in the week after the storm. This study highlights the resiliency of turtles in response to extreme weather conditions. However, long-term impacts to these species from habitat changes post-hurricane are unknown.

Objectives. To examine how physical health symptoms developed and resolved in response to Hurricane Katrina. Methods. We used data from a 2003 to 2018 study of young, low-income mothers who were living in New Orleans, Louisiana, when Hurricane Katrina struck in 2005 (n = 276). We fit logistic regressions to model the odds of first reporting or "developing" headaches or migraines, back problems, and digestive problems, and of experiencing remission or "recovery" from previously reported symptoms, across surveys. Results. The prevalence of each symptom increased after Hurricane Katrina, but the odds of developing symptoms shortly before versus after the storm were comparable. The number of traumatic experiences endured during Hurricane Katrina increased the odds of developing back and digestive problems just after the hurricane. Headaches or migraines and back problems that developed shortly after Hurricane Katrina were more likely to resolve than those that developed just before the storm. Conclusions. While traumatic experiences endured in disasters such as Hurricane Katrina appear to prompt the development of new physical symptoms, disaster-induced symptoms may be less likely to persist or become chronic than those emerging for other reasons.

Purpose: The purpose of the current study was to examine the association between social cohesion and two domains of quality of life (QOL) among individuals affected by Hurricane Ike, which made landfall on September 13, 2008. Psychosocial and physical QOL were measured using the Short form of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF; Endicottn et al. in Psychopharmacol Bull 29: 321-326, 1993)., Methods: The participants were 658 survivors who participated in the Galveston Bay Recovery Study (GBRS; National Center for Disaster Mental Health Research, Galea, and Norris in Galveston Bay Recovery Study, 2008-2010, Inter-university Consortium for Political and Social Research [distributor], Ann Arbor, MI, https://doi.org/10.3886/ICPSR34801.v1 , 2016). Assessments were conducted at approximately 3, 6, and 15 months after the disaster. Longitudinal structural equation modeling was conducted to examine the association between social cohesion and both psychosocial and physical QOL at 6 and 15 months after the hurricane., Results: The results revealed no significant association between social cohesion and physical QOL at either 6 or 15 months. Furthermore, no association was found between social cohesion and psychosocial QOL at 6 months. However, there was a significant positive association between social cohesion and psychosocial QOL at 15 months, even after controlling for the previous levels of posttraumatic stress and demographic variables., Conclusion: The current study highlights a potential effect of social cohesion on QOL, specifically the psychosocial domain, which may manifest after 6 months among survivors of a hurricane. The current results also suggest the importance of long-term programs and interventions to help survivors adjust after experiences of disaster.

Food insecurity is of heightened concern during and after natural disasters; higher prevalence is typically reported in post-disaster settings. The current study examines food insecurity prevalence and specific risk/resource variables that may act as barriers or advantages in accessing food in such a setting. Using a modified quota sample ( n = 316), Hurricane Harvey survivors participated in face-to-face interviews and/or online surveys that assessed health, social and household factors, and sociodemographic characteristics. Using logistic regression analyses we find that social vulnerabilities, circumstantial risk, and social and psychological resources are important in determining the odds of food insecurity. Hispanic and/or Nonwhite survivors, renters, and those persons displaced during the natural disaster have higher food insecurity odds. Survivors with stronger social ties, higher levels of mastery, and a greater sense of connectedness to their community are found to have lower food insecurity odds. A more nuanced analysis of circumstantial risk finds that while the independent effects of displacement and home ownership are important, so too is the intersection of these two factors, with displaced-renters experiencing significantly higher odds than any other residence and displacement combinations, and particularly those who are homeowners not displaced during the disaster. Strategies for addressing differential risks, as well as practical approaches for implementation and education programming related to disaster recovery, are discussed.

Objectives. To review the trends in pregnancy outcomes after Hurricane Katrina and assess effects of the disaster on research and public health related to pregnant women. Methods. We reexamined the 2004-2006 vital statistics data from Alabama, Louisiana, and Mississippi, assessing what the risk of adverse pregnancy outcomes in the population would have been under varying risk scenarios. Results. We saw a reduction in number of births as well as in low birth weight and preterm birth. If the number of births had stayed constant and the relative higher risk in the "missing" births had been between 17% and 100%, the storm would have been associated with an increased risk instead of a decrease. Because the relative decline in births was larger in Black women, the higher risk in the "missing" births required to create a significant increase associated with the storm was generally not as great as for White women. Conclusions. Higher exposure to Katrina may have produced a reduction in births among high-risk women in the region rather than increasing adverse outcomes among those who did give birth.

The co-occurrence of the 2020 Atlantic hurricane season and the ongoing coronavirus disease 2019 (COVID-19) pandemic creates complex dilemmas for protecting populations from these intersecting threats. Climate change is likely contributing to stronger, wetter, slower-moving, and more dangerous hurricanes. Climate-driven hazards underscore the imperative for timely warning, evacuation, and sheltering of storm-threatened populations - proven life-saving protective measures that gather evacuees together inside durable, enclosed spaces when a hurricane approaches. Meanwhile, the rapid acquisition of scientific knowledge regarding how COVID-19 spreads has guided mass anti-contagion strategies, including lockdowns, sheltering at home, physical distancing, donning personal protective equipment, conscientious handwashing, and hygiene practices. These life-saving strategies, credited with preventing millions of COVID-19 cases, separate and move people apart. Enforcement coupled with fear of contracting COVID-19 have motivated high levels of adherence to these stringent regulations. How will populations react when warned to shelter from an oncoming Atlantic hurricane while COVID-19 is actively circulating in the community? Emergency managers, health care providers, and public health preparedness professionals must create viable solutions to confront these potential scenarios: elevated rates of hurricane-related injury and mortality among persons who refuse to evacuate due to fear of COVID-19, and the resurgence of COVID-19 cases among hurricane evacuees who shelter together.

Objectives: Although research shows that public health is substantially affected during and after disasters, few studies have examined the health effects of Hurricane Harvey, which made landfall on the Texas coast in August 2017. We assessed disparities in physical health, mental health, and health care access after Hurricane Harvey among residents of the Houston-The Woodlands-Sugar Land, Texas, metropolitan statistical area (ie, Houston MSA)., Methods: We used structured survey data collected through telephone and online surveys from a population-based random sample of Houston MSA residents (n = 403) collected from November 29, 2017, through January 6, 2018. We used descriptive statistics to describe the prevalence of physical health/mental health and health care access outcomes and multivariable generalized linear models to assess disparities (eg, based on race/ethnicity, socioeconomic status, disability) in health outcomes., Results: Physical health problems disproportionately affected persons who did not evacuate (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.19-0.87). Non-Hispanic black persons were more likely than non-Hispanic white persons to have posttraumatic stress (OR = 5.03; 95% CI, 1.90-13.10), as were persons in households that experienced job loss post-Harvey (vs did not experience job loss post-Harvey; OR = 2.89; 95% CI, 1.14-7.32) and older persons (OR = 1.04; 95% CI, 1.01-1.06). Health care access was constrained for persons whose households lost jobs post-Harvey (vs did not lose jobs post-Harvey; OR = 2.73; 95% CI, 1.29-5.78) and for persons with disabilities (vs without disabilities; OR = 3.19; 95% CI, 1.37-7.45)., Conclusions: Our findings underscore the need to plan for and ameliorate public health disparities resulting from climate change-related disasters, which are expected to occur with increased frequency and magnitude.

Extreme climate events such as droughts, cold snaps, and hurricanes can be powerful agents of natural selection, producing acute selective pressures very different from the everyday pressures acting on organisms. However, it remains unknown whether these infrequent but severe disruptions are quickly erased by quotidian selective forces, or whether they have the potential to durably shape biodiversity patterns across regions and clades. Here, we show that hurricanes have enduring evolutionary impacts on the morphology of anoles, a diverse Neotropical lizard clade. We first demonstrate a transgenerational effect of extreme selection on toepad area for two populations struck by hurricanes in 2017. Given this short-term effect of hurricanes, we then asked whether populations and species that more frequently experienced hurricanes have larger toepads. Using 70 y of historical hurricane data, we demonstrate that, indeed, toepad area positively correlates with hurricane activity for both 12 island populations of Anolis sagrei and 188 Anolis species throughout the Neotropics. Extreme climate events are intensifying due to climate change and may represent overlooked drivers of biogeographic and large-scale biodiversity patterns., Competing Interests: The authors declare no competing interest.

Considering the impact of events such as natural disasters on disease risk is important. For this study, we examined temporal trends in multiple cancers available via Louisiana SEER data to understand how event impacts differ in timing and strength by cancer type. The specific event of interest for these Louisiana residents diagnosed with lung and bronchus, prostate, breast, colorectal, leukemia, or ovarian cancer in during the years 2000-2013 was Hurricane Katrina (August 2005). The results across multiple cancers showed similarities among trends, both spatial and temporal. With these results in mind, direct action could be made with the aim of improving survival after detrimental events or in detected Louisiana parishes with worse than average survival., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

This study analyses the effects of exposure to tropical storms and hurricanes during pregnancy on children's anthropometric measures taken within the first five years of life. We merge destruction indexes calculated at the district level with 13 yearly rounds of household level surveys from Jamaica. The empirical strategy exploits variation arising from the storms' timing and intensity across different cohorts within the same district. The findings rule out medium-to-large overall adverse effects of tropical storms. However, when expectant mothers living in coastal-rural areas are affected by the cumulative destruction of two hurricanes, their children experience negative impacts on both weight-for-age and weight-for-height measures., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: Hurricanes have increased in severity over the past 35 years, and climate change has led to an increased frequency of catastrophic flooding. The impact of floods on emergency department (ED) operations and patient health has not been well studied. We sought to detail challenges and lessons learned from the severe weather event caused by Hurricane Harvey in Houston, Texas, in August 2017., Methods: This report combines narrative data from interviews with retrospective data on patient volumes, mode of arrival, and ED lengths of stay (LOS). We compared the five-week peri-storm period for the 2017 hurricane to similar periods in 2015 and 2016., Results: For five days, flooding limited access to the hospital, with a consequent negative impact on provider staffing availability, disposition and transfer processes, and resource consumption. Interruption of patient transfer capabilities threatened patient safety, but flexibility of operations prevented poor outcomes. The total ED patient census for the study period decreased in 2017 (7062 patients) compared to 2015 (7665 patients) and 2016 (7770) patients). Over the five-week study period, the arrival-by-ambulance rate was 12.45% in 2017 compared to 10.1% in 2016 (p < 0.0001) and 13.7% in 2015 (p < 0.0001). The median ED length of stay (LOS) in minutes for admitted patients was 976 minutes in 2015 (p < 0.0001) compared to 723 minutes in 2016 and 591 in 2017 (p < 0.0001). For discharged patients, median ED LOS was 336 minutes in 2016 compared to 356 in 2015 (p < 0.0001) and 261 in 2017 (p < 0.0001). Median boarding time for admitted ED patients was 284 minutes in 2016 compared to 470 in 2015 (p < 0.0001) and 234.5 in 2017 (p < 0.001). Water damage resulted in a loss of 133 of 179 inpatient beds (74%). Rapid and dynamic ED process changes were made to share ED beds with admitted patients and to maximize transfers post-flooding to decrease ED boarding times., Conclusion: A number of pre-storm preparations could have allowed for smoother and safer ride-out functioning for both hospital personnel and patients. These measures include surplus provisioning of staff and supplies to account for limited facility access. During a disaster, innovative flexibility of both ED and hospital operations may be critical when disposition and transfer capibilities or bedding capacity are compromised.

On September 20, 2017, Hurricane Maria made landfall on Puerto Rico as a category 4 storm, resulting in serious widespread impact across the island, including communication and power outages, water systems impairment, and damage to life-saving infrastructure. In collaboration with the Puerto Rico Department of Health, the Public Health Branch (PHB), operating under the Department of Health and Human Services Incident Response Coordination Team, was tasked with completing assessments of health-care facilities in Puerto Rico to determine infrastructure capabilities and post-hurricane capacity. Additionally, in response to significant data entry and presentation needs, the PHB leadership worked with the Puerto Rico Planning Board to develop and test a new app-based infrastructure capacity assessment tool. Assessments of hospitals were initiated September 28, 2017, and completed November 10, 2017 (n = 64 hospitals, 97%). Assessments of health-care centers were initiated on October 7, 2017, with 186 health-care centers (87%) assessed through November 18, 2017. All hospitals had working communications; however, 9% (n = 17) of health-care centers reported no communication capabilities. For the health-care centers, 114 (61%) reported they were operational but had sustainment needs. In conclusion, health-care facility assessments indicated structural damage issues and operational capacity decreases, while health-care centers reported loss of communication capabilities post-Hurricane Maria.

Objective: Survivors of natural disasters are at risk for mental health sequela, including deficits in neurocognitive functioning. This study explores links between hurricane exposure and resulting psychiatric symptoms and deficits in cognitive processing, attention, learning, and memory., Methods: Relocated Katrina survivors and demographically matched controls completed neurocognitive tests assessing processing speed (Trail Making Test, Part A), mental flexibility (Trail Making Test, Part B), sustained attention (Conner's Continuous Performance Test), and learning and memory (Rey Auditory-Verbal Learning Test). PTSD (Clinician-Administered PTSD Scale) and depressive symptoms (BDI- II) were also measured., Results: Survivors had more PTSD and depression symptoms and weaker performance in cognitive processing, mental flexibility, and sustained attention, but not memory and learning compared to controls. When controlling for depression and PTSD symptoms (analysis of covariances), only CPT-II response time remained significantly different for survivors, so that sustained attention deficits were independent of emotional symptoms., Conclusion: Survivors had more psychiatric symptoms and neurocognitive dysfunctions than controls in most assessed measures. Our study had mixed results in identifying cognitive deficits related to psychopathology. Results suggest that disaster survivors, even those without psychopathology, should be assessed for cognitive issues that may affect their ability to process post-disaster instructions and access assistance in recovery efforts.

Objective: When 2017 Hurricane Harvey struck the coastline of Texas on August 25, 2017, it resulted in 88 fatalities and more than US $125 billion in damage to infrastructure. The floods associated with the storm created a toxic mix of chemicals, sewage and other biohazards, and over 6 million cubic meters of garbage in Houston alone. The level of biohazard exposure and injuries from trauma among persons residing in affected areas was widespread and likely contributed to increases in emergency department (ED) visits in Houston and cities receiving hurricane evacuees. We investigated medical surge resulting from these evacuations in Dallas-Fort Worth (DFW) metroplex EDs., Methods: We used data sourced from the North Texas Syndromic Surveillance Region 2/3 in ESSENCE to investigate ED visit surge following the storm in DFW hospitals because this area received evacuees from the 60 counties with disaster declarations due to the storm. We used the interrupted time series (ITS) analysis to estimate the magnitude and duration of the ED surge. ITS was applied to all ED visits in DFW and visits made by patients residing in any of the 60 counties with disaster declarations due to the storm. The DFW metropolitan statistical area included 55 hospitals. Time series analyses examined data from March 1, 2017-January 6, 2018 with focus on the storm impact period, August 14-September 15, 2017. Data from before, during, and after the storm were visualized spatially and temporally to characterize magnitude, duration, and spatial variation of medical surge attributable to Hurricane Harvey., Results: During the study period overall, ED visits in the DFW area rose immediately by about 11% (95% CI: 9%, 13%), amounting to ~16 500 excess total visits before returning to the baseline on September 21, 2017. Visits by patients identified as residing in disaster declaration counties to DFW hospitals rose immediately by 127% (95% CI: 125%, 129%), amounting to 654 excess visits by September 29, 2017, when visits returned to the baseline. A spatial analysis revealed that evacuated patients were strongly clustered (Moran's I = 0.35, P < 0.0001) among 5 of the counties with disaster declarations in the 11-day window during the storm surge., Conclusions: The observed increase in ED visits in DFW due to Hurricane Harvey and ensuing evacuation was significant. Anticipating medical surge following large-scale hurricanes is critical for community preparedness planning. Coordinated planning across stakeholders is necessary to safeguard the population and for a skillful response to medical surge needs. Plans that address hurricane response, in particular, should have contingencies for support beyond the expected disaster areas.

The United States (US) and Caribbean regions remain vulnerable to the impact of severe tropical storms, hurricanes, and typhoons. In 2017, a series of hurricanes posed threats to residents living in inland and coastal communities as well as on islands isolated from the US mainland. Harvey, Irma, Jose, and Maria caused catastrophic infrastructure damage, resulting in a loss of electrical power and communications due to damaged or downed utility poles, cell towers, and transmission lines. Critical services were inoperable for many months. Emergency managers are public officials who are accountable to both political leaders and the citizens. During disaster events, emergency managers must prioritize areas of effort, manage personnel, and communicate with stakeholders to address critical infrastructure interdependences. Essential lifeline services (eg, energy and communications) were inoperable for many months, which led to increased attention from policy-makers, media, and the public.

Objective: The aim of this study was to describe individuals seeking care for injury at a major emergency department (ED) in southern Puerto Rico in the months after Hurricane Maria on September 20, 2017., Methods: After informed consent, we used a modified version of the Natural Disaster Morbidity Surveillance Form to determine why patients were visiting the ED during October 16, 2017-March 28, 2018. We analyzed visits where injury was reported as the primary reason for visit and whether it was hurricane-related., Results: Among 5 116 patients, 573 (11%) reported injury as the primary reason for a visit. Of these, 10% were hurricane-related visits. The most common types of injuries were abrasions, lacerations, and cuts (43% of all injury visits and 50% of hurricane-related visits). The most common mechanisms of injury were falls, slips, trips (268, 47%), and being hit by/or against an object (88, 15%). Most injury visits occurred during the first 3 months after the hurricane., Conclusions: Surveillance after Hurricane Maria identified injury as the reason for a visit for about 1 in 10 patients visiting the ED, providing evidence on the patterns of injuries in the months following a hurricane. Public health and emergency providers can use this information to anticipate health care needs after a disaster.

Objective: Hurricane Harvey, which made landfall in Texas on August 24, 2017, caused catastrophic damage that resulted in the closure of many schools and school districts across 4 states. We evaluated the underlying reasons and characteristics of the unplanned school closures to gain insight on how communities may cope with recommended preemptive closures as an intervention for pandemic influenza., Methods: Information was extracted from news articles, school websites, and Twitter and Facebook posts previously collected through daily systematic searches of Google, Google News, and Lexis-Nexis. This information was sorted into predefined categories describing the characteristics that may be associated with unplanned school closures that occur during a natural disaster., Results: Across Texas, Louisiana, Kentucky, and Tennessee, there were 3026 unplanned closures. Sixty-three percent of the closures occurred in Texas. The main reasons for the closures were flooding, power outages, and structural damage. The closed schools in Texas were sometimes used as shelters or as locations for providing food or other resources., Conclusion: School closures associated with Hurricane Harvey were attributed to both the effects of the hurricane and use for resource allocation. These findings can help inform preparedness planning and response for future hurricane seasons and other large-scale emergencies.

Objectives: Hurricane Harvey left a path of destruction in its wake, resulting in over 100 deaths and damaging critical infrastructure. During a disaster, public health surveillance is necessary to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The Centers for Disease Control and Prevention (CDC) and American Red Cross collaborate on shelter surveillance to monitor the health of the sheltered population and help guide response efforts., Methods: We analyzed data collected from 24 Red Cross shelters between August 25, 2017, and September 14, 2017. We described the aggregate morbidity data collected during Harvey compared with previous hurricanes (Gustav, Ike, and Sandy)., Results: Over one-third (38%) of reasons for visit were for health care maintenance; 33% for acute illnesses, which includes respiratory conditions, gastrointestinal symptoms, and pain; 19% for exacerbation of chronic disease; 7% for mental health; and 4% for injury. The Red Cross treated 41% of clients within the shelters; however, reporting of disposition was often missed. These results are comparable to previous hurricanes., Conclusion: The capacity of Red Cross shelter staff to address the acute health needs of shelter residents is a critical resource for local public health agencies overwhelmed by the disaster. However, there remains room for improvement because reporting remained inconsistent.

Objective: Syndromic surveillance has been useful for routine surveillance on a variety of health outcomes and for informing situational awareness during public health emergencies. Following the landfall of Hurricane Maria in 2017, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented an enhanced syndromic surveillance system to characterize related emergency department (ED) visits., Methods: ED visits with any mention of specific key words ("Puerto," "Rico," "hurricane," "Maria") in the ED chief complaint or Puerto Rico patient home Zip Code were identified from the DOHMH syndromic surveillance system in the 8-week window leading up to and following landfall. Visit volume comparisons pre- and post-Hurricane Maria were performed using Fisher's exact test., Results: Analyses identified an overall increase in NYC ED utilization relating to Puerto Rico following Hurricane Maria landfall. In particular, there was a small but significant increase in visits involving a medication refill or essential medical equipment. Visits for other outcomes, such as mental illness, also increased, but the differences were not statistically significant., Conclusions: Gaining this situational awareness of medical service use was informative following Hurricane Maria, and, following any natural disaster, the same surveillance methods could be easily established to aid an effective emergency response.

Objective: Describe the lived experience of a grassroots, non-governmental disaster medical team (DMT) through a research lens and share practical lessons learned, based on the DMT's experience to support and inform future response teams., Methods: Forty-five days after Hurricane Maria, a non-governmental DMT provided primary medical care via community based pop-up clinics and home visitations in 5 different areas of Puerto Rico. Observational data, photo images, and debriefing notes were collected and documented in the response team's daily activity log. Field notes were coded using a descriptive coding method and then categorized into 2 domains specific to public health and medical diagnosis., Results: Medical aid was provided to nearly 300 (N = 296) residents. Field note observations identified exhaustion related to living conditions and the exacerbation of underlying conditions such as reactive airway diseases, diabetes, hypertension, and depression due to the compounding effects of multiple post-disaster triggers. During home visitations, feelings of sadness and helplessness were identified secondary to natural disaster trauma and current living conditions., Conclusion: Our non-governmental DMT displayed similar characteristics demonstrated by federal DMTs post natural disaster. A number of strategic lessons learned emerged from the public health intervention important to future non-governmental DMTs.

The 2017 Atlantic hurricane season was especially memorable for 3 major hurricanes-Harvey, Irma, and Maria-that devastated population centers across Texas, Florida, and Puerto Rico, respectively. Each storm had unique hazard properties that posed distinctive challenges for persons living with type 1 diabetes (T1D). Diabetes care specialists and educators took on leadership roles for coordinating care and establishing insulin supply lifelines for people with T1D living in the hardest-hit neighborhoods affected by these extreme storms. Strategies and resources were customized for each population. Diabetes specialists strategized to provide mutual support and shared insulins and supplies across sites.

This statement responds to the public health challenges in Puerto Rico in the wake of Hurricane Maria during September 2017. As a result of Maria, and to a certain extent Hurricane Irma, the territory sustained unprecedented damage. We call for a mid- and long-term public health response and research to assess the long-term impacts of high-impact weather events, such as Maria's effects on Puerto Rico, including impacts on vulnerable populations' environmental health and well-being.

Objective: To determine the extent of service disruption among home health agencies impacted by Hurricane Harvey., Methods: Structured interviews with optional open-ended questions were conducted with home health agencies in and around Houston, Texas. A random sample of 277 agencies was selected and contacted via telephone during the study period, from February to May of 2018., Results: Only 45% of 122 participating agencies indicated that their offices were open during Hurricane Harvey, and three-fourths reported that home visits were disrupted. The length of disruption varied: 7% reported a disruption of 1 day or less and 46% indicated a disruption of 1 week or longer. Disruption occurred even though nearly all (99%) of the agencies had-and close to all (92%) of them activated-an emergency preparedness plan., Conclusions: Although most of the participating home health agencies activated their emergency preparedness plan, significant disruption in home health services occurred. While agencies are required to have clear, detailed plans in place, gaps in effective implementation of emergency preparedness plans remain.

In 2017, Cuba was pummeled by Hurricane Irma, one of the strongest and most devastating Atlantic basin hurricanes in history. Twelve of Cuba's 15 provinces and 90 percent of the population were affected, and there was island-wide loss of electrical power. Despite the significant damage, ongoing economic hardships, and the political realities that required Cuba to handle the situation without response support from other nations, Cuba's recovery was swift and effective. Cuba's disaster self-sufficiency and timely response to Hurricane Irma was grounded on 5 decades of disaster planning coupled with ongoing evolution of disaster risk reduction and management strategies. While the central command center, with local dispatch response teams, and mandated citizen engagement are features unique to Cuba's political structure, in this study, we highlight 5 defining attributes of Cuba's hurricane response that can constructively inform the actions of other island and coastal nations vulnerable to Atlantic tropical cyclones. These attributes are: (1) actively learning and incorporating lessons from past disaster events, (2) integrating healthcare and public health professionals on the frontlines of disaster response, (3) proactively engaging the public in disaster preparedness, (4) incorporating technology into disaster risk reduction, and (5) infusing science into risk planning. In terms of hurricane response, as a geopolitically isolated nation, Cuba has experienced particular urgency when it comes to protecting the population and creating resilient infrastructure that can be rapidly reactivated after the onslaught of storms of ever-increasing intensity. This includes planning for worsening future disaster scenarios based on a clear-eyed appreciation of the realities of climate change.

Hurricane Michael made landfall in Florida's northwest Gulf Coast on October 10, 2018, causing massive destruction. It was the first Category 5 storm in recorded history to make landfall in the northeast Gulf Coast and the third most destructive hurricane to hit the continental United States. The health care infrastructure collapsed due to the severe damage to two main acute care hospitals, several heath care facilities, and clinics, resulting in large staff layoffs with many physicians relocating out of the area due to lack or support. With many schools and business destroyed, nearly 3,000 children left the school system along with their families. Ultimately, there were not enough living spaces for first responders and recovery crews, so posthurricane recovery efforts were gravely affected. Here are the stories of four nurse practitioners (NPs) who stepped up and recreated themselves to provide needed health care to several communities ravaged by Hurricane Michael. NPs, as skilled and trusted health care providers, are well-prepared to address the pressing life-threatening needs often associated with disasters such as hurricanes, thus ultimately making a difference in health outcomes in affected communities. It is a testimony for NPs across the state of Florida to be able to practice to their full extent of their education and preparation.

In August 2017, Hurricane Harvey struck the US Gulf Coast and caused more than US $125 billion in damages in Texas. The loss of lives and the economic damages resulted in an outpouring of support for the recovery efforts in the form of federal assistance and private donations. The latter has supported more creative approaches to recovery. Organizations that normally would not receive funding were able to obtain resources to use in novel manners. Using the framework of Dynes typology to identify groups and their respective structures and tasks, this report from the field analyzes Hurricane Harvey and the financial support mechanisms used to support recovery efforts in Texas, what organizations were funded to do, and where they fit into Dynes typology. The authors close by noting the importance of these emerging organizations and the need to support diversity in funding disaster response and recovery efforts beyond large nonprofit organizations.

Objectives: The aim of this study was to analyze pharmacy functionality, or the volume of operational pharmacies, among areas in North Carolina and South Carolina affected by Hurricane Florence., Methods: Using geographic information system software and data from the Federal Emergency Management Agency and Healthcare Ready, we computed, mapped, and analyzed pharmacy functionality measures for the period of September 12, 2018, through September 20, 2018, among counties in North Carolina and South Carolina to examine health-care-related disaster readiness for and response to Hurricane Florence., Results: In the Hurricane Florence-impacted region, counties located along the coast had the most suboptimal pharmacy functionality, whereas counties located more centrally within North Carolina and South Carolina had more optimal pharmacy functionality throughout the disaster. Generally, functionality was high at Hurricane Florence's landfall on September 14, 2018, for which operating pharmacy capacity was reported at 85% in North Carolina and 88% in South Carolina. Both states had the lowest functionality on September 16, 2018, at 71% for North Carolina and 62% for South Carolina., Conclusions: During the Hurricane Florence event, suboptimal pharmacy functionality was detected for coastal areas and during the disaster response period. Hurricane readiness plans and infrastructure strengthening should be emphasized for community pharmacies in hurricane-prone areas.

Objective: Using validated psychological assessment instruments, this study examined the psychological distress associated with potential language barriers experienced by over 135 000 Puerto Rican residents who either temporarily or permanently migrated to the continental United States with the landfall of Hurricane Maria in 2017., Methods: Participants were Puerto Rican residents (n = 107) who remained in Puerto Rico (control) or left the island for at least 3 months because of Hurricane Maria (migrants). Participants completed an online survey in their preferred language (Spanish or English), which assessed self-reported English language proficiency, Kessler Psychological Distress Scale (K6), Posttraumatic Stress Disorder Checklist for DSM 5, Patient Health Questionnaire 9-item depression scale, and the Generalized Anxiety Disorder 7-item scale. It was hypothesized that migrants with lower self-reported English proficiency would have comparatively higher indices of post-disaster distress than those with a higher proficiency., Results: Dividing the migrant group by preferred language for questionnaire completion, the Fisher's exact test showed significant differences in prevalence of severe mental distress, as defined by K6 scores above 13, between the Spanish-preferring migrants (30.4%), English-preferring migrants (0%), and controls (9.6%)., Conclusion: Our results support a possible correlation between decreased language proficiency in post-disaster migrants and a higher risk factor for severe mental distress.

Meteorological and even human-made disasters are increasing every year in frequency and magnitude. The passage of a disaster affects a society without distinction, but groups with social vulnerability (low socioeconomic status, chronic medical, or psychological conditions, limited access to resources) face the most significant impact. As a result, psychological and behavioral symptoms (eg, depression and anxiety) can ensue, making the immediate response of mental health services crucial. Secondary data from a database of a temporary healthcare unit were analyzed. A total of 54 records were reviewed to collect information; univariate and bivariate analyses were done. The purpose of this article is to present our experience regarding the incorporation of a mental health services model, with its respective benefits and challenges, into a temporary healthcare unit, after Hurricane Maria in 2017.

Objective: The aim of this study is to determine the response of home-based primary care programs to the fall 2017 Atlantic hurricane season., Methods: This study examines the experiences of 9 Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs in their responses to Hurricanes Harvey, Irma, and Maria. Thirty-four phone interviews with HBPC leadership and staff were conducted from April to July 2018., Results: The total census of impacted HBPC programs was 3118. No program reported loss of life due to these hurricanes. Early preparedness was key to an effective program response. Response included prompt tracking of the patients. In the most affected areas, respondents noted limited resources to support basic patient needs., Conclusions: Medically complex patients served by programs such as the VHA's HBPC program represent a subset of the population, yet they have an outsized impact on health care resources that could be exacerbated by inadequate disaster preparedness. HBPC programs serve a unique role in supporting the "older old." They are tasked with supporting disaster preparedness activities of patients. Understanding what is involved in actualizing their requirements shows communities how to effectively engage with these programs.

Objectives: This study empirically examines preparedness with a kit, medication, and a disaster plan on disaster outcomes including perceived recovery, property damage, and use of medical or mental health services., Methods: Using a cross-sectional, retrospective study design, 1114 households in New York City were interviewed 21-34 months following Super Storm Sandy. Bivariate associations were examined and logistic regression models fit to predict the odds of disaster outcomes given the level of preparedness., Results: Respondents with an evacuation plan were more likely to report not being recovered (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.5-3.8), property damage (OR = 1.4; 95% CI: 1.1-1.9), and use of medical services (OR = 2.3; 95% CI: 1.1-4.5). Respondents reporting a supply of prescription medication were more likely to report using mental health (OR = 3.5; 95% CI: 1.2-9.8) and medical services (OR = 2.3; 95% CI: 1.1-4.8)., Conclusions: Having a kit, plan, and medication did not reduce risk of adverse outcomes in Superstorm Sandy in this sample. Disaster managers should consider the lack of evidence for preparedness when making public education and resource allocation decisions. Additional research is needed to identify preparedness measures that lead to better outcomes for more efficient and effective response and recovery.