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There is an urgent need for strategies to reduce the negative impacts of a warming climate on human health. Cooling urban neighborhoods by planting trees and vegetation and increasing albedo of roofs, pavements, and walls can mitigate urban heat. We used synoptic climatology to examine how different tree cover and albedo scenarios would affect heat-related morbidity in Los Angeles, CA, USA, as measured by emergency room (ER) visits. We classified daily meteorological data for historical summer heat events into discrete air mass types. We analyzed those classifications against historical ER visit data to determine both heat-related and excess morbidity. We used the Weather Research and Forecasting model to examine the impacts of varied tree cover and albedo scenarios on meteorological outcomes and used these results with standardized morbidity data algorithms to estimate potential reductions in ER visits. We tested three urban modification scenarios of low, medium, and high increases of tree cover and albedo and compared these against baseline conditions. We found that avoiding 25% to 50% of ER visits during heat events would be a common outcome if the urban environment had more tree cover and higher albedo, with the greatest benefits occurring under heat events that are moderate and those that are particularly hot and dry. We conducted these analyses at the county level and compared results to a heat-vulnerable, working-class Los Angeles community with a high concentration of people of color, and found that reductions in the rate of ER visits would be even greater at the community level compared to the county.

Introduction. Several frameworks exist to measure vulnerability to extreme heat events using a health equity approach, but little evidence validates these measures and their applications. We investigated the degree to which social vulnerability measures and their constituent elements correlate with excess emergency room visits as an outcome measure. Methods. The relationship between six commonly used social vulnerability indicators and measured excess emergency room visit rates (processed by including heat-related illnesses and all-internal causes diagnosis, with considerations for age and heat days) was tested through geospatial analytics and statistical regressions, for both California and Los Angeles County. Results. The vulnerability indicators and the outcome measure were significantly positively associated at the census tract-level but weaker (∼0.2 rs) at the scale of California and stronger (∼0.6 rs) at the scale of Los Angeles County. Hazard-specific vulnerability indicators showed stronger relationships with outcome measures regardless of scale. A Poisson regression model showed a significant inter-county variation, indicating the importance of localized assessments for equitable environmental policies. Conclusion. The findings identify communities that are overburdened by heat and pollution and highlight the need for use of both social vulnerability and indicators of adverse outcomes from excessive heat. Patterns are found across all measures that suggest that populations facing accessibility barriers may be less likely to visit emergency rooms. This suggestion needs to be tested in other environmental settings to draw broader conclusions but has direct implications for environmental scientists and mitigation planners who use these methods.

BackgroundThe ongoing COVID-19 pandemic has led to an increase in anxiety, depression, posttraumatic stress disorder, and psychological stress experienced by the general public in various degrees worldwide. However, effective, tailored mental health services and interventions cannot be achieved until we understand the patterns of mental health issues emerging after a public health crisis, especially in the context of the rapid transmission of COVID-19. Understanding the public's emotions and needs and their distribution attributes are therefore critical for creating appropriate public policies and eventually responding to the health crisis effectively, efficiently, and equitably. ObjectiveThis study aims to detect the temporal patterns in emotional fluctuation, significant events during the COVID-19 pandemic that affected emotional changes and variations, and hourly variations of emotions within a single day by analyzing data from the Chinese social media platform Weibo. MethodsBased on a longitudinal dataset of 816,556 posts published by 27,912 Weibo users in Wuhan, China, from December 31, 2019, to April 31, 2020, we processed general sentiment inclination rating and the type of sentiments of Weibo posts by using pandas and SnowNLP Python libraries. We also grouped the publication times into 5 time groups to measure changes in netizens’ sentiments during different periods in a single day. ResultsOverall, negative emotions such as surprise, fear, and anger were the most salient emotions detected on Weibo. These emotions were triggered by certain milestone events such as the confirmation of human-to-human transmission of COVID-19. Emotions varied within a day. Although all emotions were more prevalent in the afternoon and night, fear and anger were more dominant in the morning and afternoon, whereas depression was more salient during the night. ConclusionsVarious milestone events during the COVID-19 pandemic were the primary events that ignited netizens’ emotions. In addition, Weibo users’ emotions varied within a day. Our findings provide insights into providing better-tailored mental health services and interventions.

Heat exposure poses health risks that disproportionately burden disadvantaged communities. Trees protect against heat, but significant barriers exist to growing robust urban forests. In drier climates, complex logistics of watering during a multi-year establishment period pose a challenge because street trees are typically unirrigated and funding for maintenance is generally unavailable. This study tested the impacts of varying theory-guided community engagement approaches on beliefs, attitudes, knowledge, and behaviors related to foster street tree stewardship and individual-level heat mitigation actions in 116 households in Los Angeles County, USA. We tested a control intervention against experimental messaging focused on either public health or environmental health, and also segmented participants by the degree of prior household engagement with a local tree planting group. Outcomes measured were soil moisture, tree health, and survey responses indicating benefits and barriers related to tree stewardship. Results indicate that intervention messages had limited effect on these outcomes, and that level of engagement by the tree planting group was a stronger predictor of tree stewardship. We also found that tree stewardship correlated positively to heat protection measures, suggesting that environmental engagement may be an effective portal to reducing heat risk.

There is a pressing need for strategies to prevent the heat-health impacts of climate change. Cooling urban areas through adding trees and vegetation and increasing solar reflectance of roofs and pavements with higher albedo surface materials are recommended strategies for mitigating the urban heat island. We quantified how various tree cover and albedo scenarios would impact heat-related mortality, temperature, humidity, and oppressive air masses in Los Angeles, California, and quantified the number of years that climate change-induced warming could be delayed in Los Angeles if interventions were implemented. Using synoptic climatology, we used meteorological data for historical summer heat waves, classifying days into discrete air mass types. We analyzed those data against historical mortality data to determine excess heat-related mortality. We then used the Weather Research and Forecasting model to explore the effects that tree cover and albedo scenarios would have, correlating the resultant meteorological data with standardized mortality data algorithms to quantify potential reductions in mortality. We found that roughly one in four lives currently lost during heat waves could be saved. We also found that climate change-induced warming could be delayed approximately 40-70 years under business-as-usual and moderate mitigation scenarios, respectively.

BackgroundEpidemics of COVID-19 in student populations at universities were a key concern for the 2020-2021 school year. The University of California (UC) System developed a set of recommendations to reduce campus infection rates. SARS-CoV-2 test results are summarized for the ten UC campuses during the Fall 2020 term.MethodsUC mitigation efforts included protocols for the arrival of students living on-campus students, non-pharmaceutical interventions, daily symptom monitoring, symptomatic testing, asymptomatic surveillance testing, isolation and quarantine protocols, student ambassador programs for health education, campus health and safety pledges, and lowered density of on-campus student housing. We used data from UC campuses, the UC Health-California Department of Public Health Data Modeling Consortium, and the U.S. Census to estimate the proportion of each campus' student populations that tested positive for SARS-CoV-2 and compared it to the fraction individuals aged 20-29 years who tested positive in their respective counties.ResultsSARS-CoV-2 cases in campus populations were generally low in September and October 2020, but increased in November and especially December, and were highest in early to mid-January 2021, mirroring case trajectories in their respective counties. Many students were infected during the Thanksgiving and winter holiday recesses and were detected as cases upon returning to campus. The proportion of students who tested positive for SARS-CoV-2 during Fall 2020 ranged from 1.2% to 5.2% for students living on campus and was similar to students living off campus. For most UC campuses the proportion of students testing positive was lower than that for the 20-29-year-old population in which campuses were located.ConclusionsThe layered mitigation approach used on UC campuses, informed by public health science and augmented perhaps by a more compliant population, likely minimized campus transmission and outbreaks and limited transmission to surrounding communities. University policies that include these mitigation efforts in Fall 2020 along with SARS-CoV-2 vaccination, may alleviate some local concerns about college students returning to communities and facilitate resumption of normal campus operations and in-person instruction.

BACKGROUND:Extreme heat is often associated with elevated levels of human mortality, particularly across the mid-latitudes. Los Angeles, CA exhibits a unique, highly variable winter climate, with brief periods of intense heat caused by downsloping winds commonly known as Santa Ana winds. The goal is to determine if Los Angeles County is susceptible to heat-related mortality during the winter season. This is the first study to specifically evaluate heat-related mortality during the winter for a U.S. city. METHODS:Utilizing the Spatial Synoptic Classification system in Los Angeles County from 1979 through 2010, we first relate daily human mortality to synoptic air mass type during the winter season (December, January, February) using Welch's t-tests. However, this methodology is only somewhat effective at controlling for important inter- and intra-annual trends in human mortality unrelated to heat such as influenza outbreaks. As a result, we use distributed lag nonlinear modeling (DLNM) to evaluate if the relative risk of human mortality increases during higher temperatures in Los Angeles, as the DLNM is more effective at controlling for variability at multiple temporal scales within the human mortality dataset. RESULTS:Significantly higher human mortality is uncovered in winter when dry tropical air is present in Los Angeles, particularly among those 65 years and older (p

This manuscript presents the protocol and participatory planning process for implementing the Community Resilience Learning Collaborative and Research Network (C-LEARN) study. C-LEARN is designed to determine how to build a service program and individual client capacity to improve mental health-related quality of life among individuals at risk for depression, with exposure to social risk factors or concerns about environmental hazards in areas of Southern Louisiana at risk for events such as hurricanes and storms. The study uses a Community Partnered Participatory Research (CPPR) framework to incorporate community priorities into study design and implementation. The first phase of C-LEARN is assessment of community priorities, assets, and opportunities for building resilience through key informant interviews and community agency outreach. Findings from this phase will inform the implementation of a two-level (program-level and individual client level) randomized study in up to four South Louisiana communities. Within communities, health and social-community service programs will be randomized to Community Engagement and Planning (CEP) for multi-sector coalition support or Technical Assistance (TA) for individual program support to implement evidence-based and community-prioritized intervention toolkits, including an expanded version of depression collaborative care and resources (referrals, manuals) to address social risk factors such as financial or housing instability and for a community resilience approach to disaster preparedness and response. Within each arm, the study will randomize individual adult clients to one of two mobile applications that provide informational resources on services for depression, social risk factors, and disaster response or also provide psychoeducation on Cognitive Behavioral Therapy to enhance coping with stress and mood. Planned data collection includes baseline, six-month and brief monthly surveys for clients, and baseline and 12-month surveys for administrators and staff.

Heat is a well-recognized hazard for workers in many outdoor settings, yet fewinvestigations have compared the prevalence of outdoor work at the community level and rates of heat-related mortality and morbidity. This analysis examines whether heat-related health outcomes occur more frequently in communities with higher proportions of residents working in construction,agriculture, and other outdoor industries. Using 2005–2010 data from Los Angeles County, California, we analyze associations between community-level rates of deaths, emergency department (ED) visits, and hospitalizations during summer heat events and the prevalence of outdoor work. We findgenerally higher rates of heat-related ED visits and hospitalizations during summer heat events in communities with more residents working outdoors. Specifically, each percentage increase in residents working in construction resulted in an 8.1 percent increase in heat-related ED visits and a 7.9 percent increase in heat-related hospitalizations, while each percentage increase in residents working in agriculture and related sectors resulted in a 10.9 percent increase in heat-related ED visits.The findings suggest that outdoor work may significantly influence the overall burden of heat-related morbidity at the community level. Public health professionals and healthcare providers should recognize work and employment as significant heat risk factors when preparing for and respondingto extreme heat events.

Community resilience has grown in importance in national disaster response and recovery efforts. However, measurement of community resilience, particularly the content and quality of relationships aimed at improving resilience, is lacking. To address this gap, we used a social network survey to measure the number, type, and quality of relationships among organizations participating in 16 coalitions brought together to address community resilience in the Los Angeles Community Disaster Resilience project. These coalitions were randomized to one of two approaches (community resilience or preparedness). Resilience coalitions received training and support to develop these partnerships and implement new activities. Both coalition types received expert facilitation by a public health nurse or community educator. We also measured the activities each coalition engaged in and the extent to which partners participated in these activities at two time points. We found that the community resilience coalitions were initially larger and had lower trust among members than the preparedness communities. Over time, these trust differences dissipated. While both coalitions grew, the resilience community coalitions maintained their size difference throughout the project. We also found differences in the types of activities implemented by the resilience communities; these differences were directly related to the trainings provided. This information is useful to organizations seeking guidance on expanding the network of community-based organizations that participate in community resilience activities.

Fear of crime has been associated with mental health outcomes. Yet, causal relationships have not been established. We examined the relationship between fear and mental health while accounting for potential endogeneity. A sample of 2329 adolescents from the Project on Human Development in Chicago Neighborhoods dataset was analyzed to assess the effect of fear of neighborhood violent crime on anxiety/depression. Instrumental variable (IV) methods were used to address endogeneity. There is evidence that the estimated effect of fear on depressive symptoms does not suffer from endogeneity bias in single-equation models. Adolescents who were more fearful had higher anxiety/depression scores. In adjusted analyses, for each one unit increase in fear (in this case, a move from one level of fear to the next), anxiety/depression scores increased by 1.32 points. There is support for the hypothesis that fear of neighborhood violent crime caused an increase in anxiety/depression scores among adolescents. Many programs address exposure to violence as a potential cause of depression, however few address the fear of violent victimization as a cause. Interventions and services should address fear as a root cause of anxiety/depression among adolescents.

Access to air conditioned space is critical for protecting urban populations from the adverse effects of heat exposure. Yet there remains fairly limited knowledge of the penetration of private (home air conditioning) and distribution of public (cooling centers and commercial space) cooled space across cities. Furthermore, the deployment of government-sponsored cooling centers is likely to be inadequately informed with respect to the location of existing cooling resources (residential air conditioning and air conditioned public space), raising questions of the equitability of access to heat refuges. We explore the distribution of private and public cooling resources and access inequities at the household level in two major US urban areas: Los Angeles County, California and Maricopa County, Arizona (whose county seat is Phoenix). We evaluate the presence of in-home air conditioning and develop a walking-based accessibility measure to air conditioned public space using a combined cumulative opportunities-gravity approach. We find significant variations in the distribution of residential air conditioning across both regions which are largely attributable to building age and inter/intra-regional climate differences. There are also regional disparities in walkable access to public cooled space. At average walking speeds, we find that official cooling centers are only accessible to a small fraction of households (3% in Los Angeles, 2% in Maricopa) while a significantly higher number of households (80% in Los Angeles, 39% in Maricopa) have access to at least one other type of public cooling resource such as a library or commercial establishment. Aggregated to a neighborhood level, we find that there are areas within each region where access to cooled space (either public or private) is limited which may increase heat-related health risks.

Background: In 2008, the Southern California Earthquake Center in collaboration with the U.S. Geological Survey Earthquake Hazards Program launched the first annual Great ShakeOut, the largest earthquake preparedness drill in the history of the United States. Materials and Methods: We collected online survey data from 2052 campaign registrants to assess how people participated, whether audience segments shared behavioral patterns, and whether these segments were associated with five social cognitive factors targeted by the ShakeOut campaign. Results: Participants clustered into four behavioral patterns. The Minimal cluster had low participation in all activities (range: 0-39% participation). The Basic Drill cluster only participated in the drop, cover and hold drill (100% participation). The Community-Oriented cluster, involved in the drill (100%) and other interpersonal activities including attending disaster planning meetings (74%), was positively associated with interpersonal communication (β = 0.169), self-efficacy (β = 0.118), outcome efficacy (β = 0.110), and knowledge about disaster preparedness (β = 0.151). The Interactive and Games cluster, which participated in the drill (79%) and two online earthquake preparedness games (53% and 75%), was positively associated with all five social cognitive factors studied. Conclusions: Our results support audience segmentation approaches to engaging the public, which address the strengths and weaknesses of different segments. Offering games may help "gamers" gain competencies required to prepare for disasters. Targeting the highly active Community-Oriented cluster for leadership roles could help build community resilience by encouraging others to become more involved in disaster planning. We propose that the days of single, national education campaigns without local variation should end.

Community resilience is a key concept in the National Health Security Strategy that emphasizes development of multi-sector partnerships and equity through community engagement. Here, we describe the advancement of CR principles through community participatory methods in the Los Angeles County Community Disaster Resilience (LACCDR) initiative. LACCDR, an initiative led by the Los Angeles County Department of Public Health with academic partners, randomized 16 community coalitions to implement either an Enhanced Standard Preparedness or Community Resilience approach over 24 months. Facilitated by a public health nurse or community educator, coalitions comprised government agencies, community-focused organizations and community members. We used thematic analysis of data from focus groups (n = 5) and interviews (n = 6 coalition members; n = 16 facilitators) to compare coalitions' strategies for operationalizing community resilience levers of change (engagement, partnership, self-sufficiency, education). We find that strategies that included bidirectional learning helped coalitions understand and adopt resilience principles. Strategies that operationalized community resilience levers in mutually reinforcing ways (e.g., disseminating information while strengthening partnerships) also secured commitment to resilience principles. We review additional challenges and successes in achieving cross-sector collaboration and engaging at-risk groups in the resilience versus preparedness coalitions. The LACCDR example can inform strategies for uptake and implementation of community resilience and uptake of the resilience concept and methods.

The leading source of weather-related deaths in the United States is heat, and future projections show that the frequency, duration, and intensity of heat events will increase in the Southwest. Presently, there is a dearth of knowledge about how infrastructure may perform during heat waves or could contribute to social vulnerability. To understand how buildings perform in heat and potentially stress people, indoor air temperature changes when air conditioning is inaccessible are modeled for building archetypes in Los Angeles, California, and Phoenix, Arizona, when air conditioning is inaccessible is estimated. An energy simulation model is used to estimate how quickly indoor air temperature changes when building archetypes are exposed to extreme heat. Building age and geometry (which together determine the building envelope material composition) are found to be the strongest indicators of thermal envelope performance. Older neighborhoods in Los Angeles and Phoenix (often more centrally located in the metropolitan areas) are found to contain the buildings whose interiors warm the fastest, raising particular concern because these regions are also forecast to experience temperature increases. To combat infrastructure vulnerability and provide heat refuge for residents, incentives should be adopted to strategically retrofit buildings where both socially vulnerable populations reside and increasing temperatures are forecast.

In an extreme heat event, people can go to air-conditioned public facilities if residential air-conditioning is not available. Residences that heat slowly may also mitigate health effects, particularly in neighborhoods with social vulnerability. We explored the contributions of social vulnerability and these infrastructures to heat mortality in Maricopa County and whether these relationships are sensitive to temperature. Using Poisson regression modeling with heat-related mortality as the outcome, we assessed the interaction of increasing temperature with social vulnerability, access to publicly available air conditioned space, home air conditioning and the thermal properties of residences. As temperatures increase, mortality from heat-related illness increases less in census tracts with more publicly accessible cooled spaces. Mortality from all internal causes of death did not have this association. Building thermal protection was not associated with mortality. Social vulnerability was still associated with mortality after adjusting for the infrastructure variables. To reduce heat-related mortality, the use of public cooled spaces might be expanded to target the most vulnerable.

Fear of violent crime is common among adolescents in urban settings; however, little is known about individual- and neighborhood-level determinants of fear. A generalized ordered logit model was used to analyze individual- and neighborhood-level variables among 2474 adolescents. Seeing violence significantly reduced the probability of feeling unafraid, as did higher levels of social disorder. The more block faces where police were visible, the higher the probability of feeling unafraid and lower the probability of feeling very afraid. Reducing fear could affect more people than just reducing crime. Fear-reduction strategies should target those most at risk of becoming fearful.

Heat vulnerability of urban populations is becoming a major issue of concern with climate change, particularly in the cities of the Southwest United States. In this article we discuss the importance of understanding coupled social and technical systems, how they constitute one another, and how they form the conditions and circumstances in which people experience heat. We discuss the particular situation of Los Angeles and Maricopa Counties, their urban form and the electric grid. We show how vulnerable populations are created by virtue of the age and construction of buildings, the morphology of roads and distribution of buildings on the landscape. Further, the regulatory infrastructure of electricity generation and distribution also contributes to creating differential vulnerability. We contribute to a better understanding of the importance of sociotechnical systems. Social infrastructure includes codes, conventions, rules and regulations; technical systems are the hard systems of pipes, wires, buildings, roads, and power plants. These interact to create lock-in that is an obstacle to addressing issues such as urban heat stress in a novel and equitable manner.

We studied the relationship between psychological distress and relative resource and risk predictors, including loss of solace from the landscape (solastalgia), one year after the Wallow Fire, in Arizona, United States. Solastalgia refers to the distress caused by damage to the surrounding natural environment and it has not been examined for its relationship to psychological health. Doing so opens avenues of research that inquire into how land management might be able to support improved community resilience and psychological health outcomes after a wildfire. In 2012, we conducted a household survey mailed to all 1387 households in the five communities surrounding the fire. The Kessler Psychological Distress Scale assessed psychological distress. In the multivariate analysis, higher solastalgia score and an adverse financial impact of the fire were associated with clinically significant psychological distress. Annual household income ≥ $80,000 and a higher family functioning score were associated with less psychological distress. Part-time residents were no more likely to have psychological distress than full-time residents. We conclude that dramatic transformation of a landscape by an environmental event such as a wildfire can reduce its value as a source of solace. These results call for novel post-wildfire community recovery interventions that wed forest management and community psychology.

This study examined coercive conditions experienced by trafficked persons in the context of Biderman's theory of coercion. We conducted semi-structured interviews with 12 adult women trafficked into Los Angeles County, from 10 countries, for domestic work and/or sex work. Participants described health problems they experienced in relation to their trafficking experience and their perceptions of conditions that caused health problems. Utilizing a framework analysis approach, we analyzed themes using Biderman's framework. Participants reported experiencing the range of nonphysical coercive tactics outlined by Biderman, including isolation, monopolization of perception, induced debility or exhaustion, threats, occasional indulgences, demonstration of omnipotence, degradation, and enforcement of trivial demands. Our analysis demonstrates how these coercion tactics reinforced the submission of trafficked persons to their traffickers even in the absence of physical force or restraints. Such psychological abuse creates extreme stress that can lead to acute and chronic, physical and mental health problems.

Public health officials need evidence-based methods for improving community disaster resilience and strategies for measuring results. This methods paper describes how one public health department is addressing this problem. This paper provides a detailed description of the theoretical rationale, intervention design and novel evaluation of the Los Angeles County Community Disaster Resilience Project (LACCDR), a public health program for increasing community disaster resilience. The LACCDR Project utilizes a pretest-posttest method with control group design. Sixteen communities in Los Angeles County were selected and randomly assigned to the experimental community resilience group or the comparison group. Community coalitions in the experimental group receive training from a public health nurse trained in community resilience in a toolkit developed for the project. The toolkit is grounded in theory and uses multiple components to address education, community engagement, community and individual self-sufficiency, and partnerships among community organizations and governmental agencies. The comparison communities receive training in traditional disaster preparedness topics of disaster supplies and emergency communication plans. Outcome indicators include longitudinal changes in inter-organizational linkages among community organizations, community member responses in table-top exercises, and changes in household level community resilience behaviors and attitudes. The LACCDR Project is a significant opportunity and effort to operationalize and meaningfully measure factors and strategies to increase community resilience. This paper is intended to provide public health and academic researchers with new tools to conduct their community resilience programs and evaluation research. Results are not yet available and will be presented in future reports.

Posttraumatic stress disorder (PTSD) is a common problem in primary care. Although effective treatments are available, little is known about whether such treatments are effective within the context of Federally Qualified Health Centers (FQHCs) that serve as national "safety nets" for providing primary care for low income and underinsured patients. The Violence and Stress Assessment (ViStA) study is the first randomized controlled trial (RCT) to test the impact of a care management intervention for treating PTSD in FQHCs. To develop a PTSD management intervention appropriate for lower resource FQHCs and the predominantly Latino patients they serve, formative work was conducted through a collaborative effort between researchers and an FQHC practice-based research network. This article describes how FQHC stakeholders were convened to review, assess, and prioritize evidence-based strategies for addressing patient, clinician, and system-level barriers to care. This multi-component care management intervention incorporates diagnosis with feedback, patient education and activation; navigation and linkage to community resources; clinician education and medication guidance; and structured cross-disciplinary communication and continuity of care, all facilitated by care managers with FQHC experience. We also describe the evaluation design of this five-year RCT and the characteristics of the 404 English or Spanish speaking patients enrolled in the study and randomized to either the intervention or to usual care. Patients are assessed at baseline, six months, and 12 months to examine intervention effectiveness on PTSD, other mental health symptoms, health-related quality-of-life, health care service use; and perceived barriers to care and satisfaction with care.

Only 40-50% of households in the United States are currently disaster prepared. In this intervention study, respondent-driven sampling was used to select a sample (n = 187) of low income, Latino residents of Los Angeles County, randomly assigned into two treatment conditions: (i) household preparedness education received through 'promotora' (community health worker) led small group meetings, and (ii) household preparedness education received through print media. Weinstein's Precaution Adoption Process, a stage model appropriate for risk communication guided the intervention. Outcomes are conceptualized as stages of decision making linked to having disaster supplies and creating a family communication plan. Quantitative results showed a significant shift over time from awareness to action and maintenance stages for disaster communication plans and supplies in both study arms; however, the shift in stage for a communication plan for those in the 'platica' study arm was (P < 0.0001) than for those in the media arm. For changes in stage linked to disaster supplies, people in both media and 'platica' study arms improved at the same rate. Simple media-based communications may be sufficient to encourage disadvantaged households to obtain disaster supplies; however, adoption of the more complex disaster family communication requires interpersonal education.

The authors studied a health promotion program called PM-Prep (Peer-Mentored Prep), which was designed to improve disaster preparedness among adults living independently in the community. PM-Prep consists of four 2-hour classes co-taught by a health educator and peer-mentors. Adults were randomly assigned to an experimental arm or a wait-list control arm. Earthquake safety knowledge and preparedness supplies were assessed prior to the intervention and at 1 month after the intervention (N  =  82). Adults in the experimental arm significantly increased preparedness by 19 percentage points, from 56% to 75% completed (p < .0001), and improved their knowledge by 8 percentage points, from 79% to 87% correct (p  =  .001). This is the first peer-mentored, targeted, and tailored disaster preparedness program tested with this population.

ObjectiveThis study presents reliability and validity findings for the Assessment for Disaster Engagement with Partners Tool (ADEPT), an instrument that can be used to monitor the frequency and nature of collaborative activities between local health departments (LHDs) and community-based organizations (CBOs) and faith-based organizations (FBOs) for disaster preparedness, response, and recovery.MethodsWe used formative research to develop the instrument by ranking LHDs according to their disaster outreach and engagement activities. We validated the scale through a 2011 national survey of disaster preparedness coordinators (n=273) working in LHDs. We reduced the original measure of 25 items to a final measure comprising 15 items with four dimensions: (1) communication outreach and coordination, (2) resource mobilization, (3) organizational capacity building, and (4) partnership development and maintenance. We used internal consistency reliability m correlation and factor analysis to validate the measure.ResultsUsing internal consistency reliability, we found reasonable inter-item reliability for the four hypothesized dimensions (Cronbach's alpha: 0.71-0.88). These four dimensions were confirmed through correlation and factor analysis (Varimax rotation).ConclusionHigher scores on all four dimensions of ADEPT for organizational respondents suggest that more activities were conducted for inter-organizational preparedness in those organizations than in organizations whose respondents had lower scores. This finding implies that organizations with higher ADEPT scores have more active relationships with CBOs/FBOs in the realm of preparedness, a key element for creating community resilience for emergencies and disaster preparedness.

BackgroundRecent US disasters highlight the current imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. We examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves.MethodsA mixed methods design included evaluation of insurance pharmacy benefits, focus group interviews with patients, and key informant interviews with physicians, pharmacists, and insurers.Results and discussionMost prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days. For patients to acquire 14- to 30-day disaster medication reserves, health professionals interviewed supported 60- to 100-day dispensing units. Barriers included restrictive insurance benefits, patients' resistance to mail order, and higher copay-ments. Physicians, pharmacists, and insurers also varied widely in their preparedness planning and collective mutual-aid plans, and most believed pharmacists had the primary responsibility for patients' medication continuity during a disaster.ConclusionsTo strengthen prescription drug continuity in disasters, recommendations include the following: (1) creating flexible drug-dispensing policies to help patients build reserves, (2) training professionals to inform patients about disaster planning, and (3) building collaborative partnerships among system stakeholders.

Public health emergency planners can better perform their mission if they develop and maintain effective relationships with community- and faith-based organizations in their jurisdictions. This qualitative study presents six themes that emerged from 20 key informant interviews representing a wide range of American community- and faith-based organizations across different types of jurisdictions, organizational types, and missions. This research seeks to provide local health department public health emergency planners with tools to assess and improve their inter-organizational community relationships. The themes identified address the importance of community engagement, leadership, intergroup dynamics and communication, and resources. Community- and faith-based organizations perceive that they are underutilized or untapped resources with respect to public health emergencies and disasters. One key reason for this is that many public health departments limit their engagement with community- and faith-based organizations to a one-way "push" model for information dissemination, rather than engaging them in other ways or improving their capacity. Beyond a reprioritization of staff time, few other resources would be required. From the perspective of community- and faith-based organizations, the quality of relationships seems to matter more than discrete resources provided by such ties.