Clinical Associate Professor of Social and Behavioral Sciences
Dr. David Abramson is a Clinical Associate Professor at NYU’s School of Global Public Health and the director of the research program on Population Impact, Recovery and Resilience (PiR2). His research employs a social ecological framework to examine the health consequences of disasters, individual and community resilience, and long-term recovery from acute collective stressors. His work has focused on population health consequences, interactions of complex systems, and risk communication strategies associated with hurricanes Katrina and Sandy, the Joplin tornado, the Deepwater Horizon oil spill, H1N1, and Zika, among other natural, technological, and man-made disasters. Before joining NYU’s faculty, Dr. Abramson was the Deputy Director at Columbia University’s National Center for Disaster Preparedness at the Earth Institute.
In 2005 Dr. Abramson launched the Gulf Coast Child and Family Health study, an ongoing longitudinal cohort study of over 1,000 randomly sampled Katrina survivors in Louisiana and Mississippi, which is presently a core research project in the NIH-funded Katrina@10 Program (P01HD082032, NICHD). After Superstorm Sandy he partnered with colleagues at Rutgers University, Columbia University, and the University of Colorado to conduct the Sandy Child and Family Health study, an observational cohort study modeled on the Katrina study. More recently, he was funded by the National Science Foundation and the Robert Wood Johnson Foundation to study the risk salience of an evolving threat, the Zika virus, among the US population in general and among women of child-bearing age. In addition, Dr. Abramson serves on two National Academies of Medicine panels, the Standing Committee on Medical and Public Health Research During Large-Scale Emergency Events, and the Committee on Evidence-Based Practices for Public Health Emergency Preparedness and Response.
Prior to entering the field of public health, Dr. Abramson spent a decade as a national magazine journalist, having worked at or written for such publications as Rolling Stone, Esquire, and Outside magazines, and was a nationally-certified paramedic. He has a PhD in sociomedical sciences, with a sub-specialization in political science, and an MPH, both from Columbia University.
BA, English (High Honors), Queens College, New York, NYMPH, Sociomedical Sciences, Columbia University, New York, NYPhD, Sociomedical Sciences/Political Science, Columbia University, New York, NY
Columbia University Alumni Association Scholarship (2003)Eugene Litwak Prize for best doctoral dissertation proposal, Mailman School of Public Health (2002)Columbia University School of Public Health Alumni Association Scholarship Award (1982)Nyack Hospital Paramedic Program Valedictorian (1989)
Community HealthDisaster HealthDisaster Impact and RecoveryEnvironmental InterventionsPopulation HealthPublic Health SystemsSocial BehaviorsSocial Determinants of Health
From information to intervention: connecting risk communication to individual health behavior and community-level health interventions during the 2016 Zika outbreakPiltch-Loeb, R., & Abramson, D.
Journal titleJournal of Risk Research
Page(s)978-993AbstractEmerging disease threats are on the rise. Risk communication in an emerging threat is used by public health officials to reach the population in a timely and effective manner. However, limited research has drawn on data gathered during an emerging threat to understand how risk communication shapes intervention perceptions. This analysis examines the relationship between risk communication, especially where information comes from, and receptivity to individual-level and community-level health interventions in an emerging threat using evidence from the 2016 rise of Zika. Data comes from a repeat cross-sectional survey conducted three times in 2016, representative of the United States population. Drawing on leading theories of risk communication, a structural model (SEM) is used to measure the relationships of interest. Two distinct SEMs are used to compare and contrast the relationship between source of information and individual health behavior change and community-level health interventions while also exploring the role of knowledge, perceived risk, and demographics. Results of both direct and indirect SEM pathways show different sources of information may be more effective in promoting particular interventions. Promoting community-level interventions can be accomplished through dissemination of information in print news to increase knowledge and ultimately receptivity. However, there is a far more complex relationship between risk communication and personal intervention receptivity. With a more nuanced understanding of the way information from a particular source effects intervention receptivity, communicators can reach the public more effectively to limit the consequences of an emerging public health threat.
Information-Accessing behavior during zika virus outbreak, United States, 2016Piltch-Loeb, R., & Abramson, D.
Journal titleEmerging Infectious Diseases
Page(s)2290-2292AbstractWe used latent class analysis to examine Zika virus-related information-accessing behavior of US residents during the 2016 international outbreak. We characterized 3 classes of information-accessing behavior patterns: universalists, media seekers, and passive recipients. Understanding these patterns is crucial to planning risk communication during an emerging health threat.
Cross-Sectional Psychological and Demographic Associations of Zika Knowledge and Conspiracy Beliefs Before and After Local Zika TransmissionPiltch-Loeb, R., Zikmund-Fisher, B. J., Shaffer, V. A., Scherer, L. D., Knaus, M., Fagerlin, A., Abramson, D. M., & Scherer, A. M.
Journal titleRisk Analysis
Page(s)2683-2693AbstractPerceptions of infectious diseases are important predictors of whether people engage in disease-specific preventive behaviors. Having accurate beliefs about a given infectious disease has been found to be a necessary condition for engaging in appropriate preventive behaviors during an infectious disease outbreak, while endorsing conspiracy beliefs can inhibit preventive behaviors. Despite their seemingly opposing natures, knowledge and conspiracy beliefs may share some of the same psychological motivations, including a relationship with perceived risk and self-efficacy (i.e., control). The 2015–2016 Zika epidemic provided an opportunity to explore this. The current research provides some exploratory tests of this topic derived from two studies with similar measures, but different primary outcomes: one study that included knowledge of Zika as a key outcome and one that included conspiracy beliefs about Zika as a key outcome. Both studies involved cross-sectional data collections that occurred during the same two periods of the Zika outbreak: one data collection prior to the first cases of local Zika transmission in the United States (March–May 2016) and one just after the first cases of local transmission (July–August). Using ordinal logistic and linear regression analyses of data from two time points in both studies, the authors show an increase in relationship strength between greater perceived risk and self-efficacy with both increased knowledge and increased conspiracy beliefs after local Zika transmission in the United States. Although these results highlight that similar psychological motivations may lead to Zika knowledge and conspiracy beliefs, there was a divergence in demographic association.
Housing Transitions and Recovery of Older Adults following Hurricane SandyMerdjanoff, A. A., Piltch-Loeb, R., Friedman, S., & Abramson, D. M.
Journal titleJournals of Gerontology - Series B Psychological Sciences and Social Sciences
Page(s)1041-1052AbstractObjectives: This study explores the effects of social and environmental disruption on emergency housing transitions among older adults following Hurricane Sandy. It is based upon the Sandy Child and Family Health (S-CAFH) Study, an observational cohort of 1,000 randomly sampled New Jersey residents living in the nine counties most affected by Sandy. Methods: This analysis examines the post-Sandy housing transitions and recovery of the young-old (55-64), mid-old (65-74), and old-old (75+) compared with younger adults (19-54). We consider length of displacement, number of places stayed after Sandy, the housing host (i.e., family only, friends only, or multi-host), and self-reported recovery. Results: Among all age groups, the old-old (75+) reported the highest rates of housing damage and were more likely to stay in one place besides their home, as well as stay with family rather than by themselves after the storm. Despite this disruption, the old-old were most likely to have recovered from Hurricane Sandy. Discussion: Findings suggest that the old-old were more resilient to Hurricane Sandy than younger age groups. Understanding the unique post-disaster housing needs of older adults can help identify critical points of intervention for their post-disaster recovery.
Hurricanes and healthcare: A case report on the influences of Hurricane Maria and managed Medicare in treating a Puerto Rican residentMellgard, G., Abramson, D., Okamura, C., & Weerahandi, H.
Journal titleBMC health services research
Issue1AbstractBackground: While Medicare is a federal health insurance program, managed Medicare limits access to healthcare services to networks within states or territories. However, if a natural disaster requires evacuation, displaced patients are at risk of losing coverage for their benefits. Previous literature has discussed the quality of managed Medicare plans within Puerto Rico but has not addressed the adequacy of this coverage if residents are displaced to the continental United States. We explore Hurricane Maria's impact on a resident of Puerto Rico with chronic health problems, and the challenges he faces seeking healthcare in New York. Case presentation: A 59-year-old male with a history of diabetes mellitus type II, coronary artery disease, peripheral vascular disease status post right foot amputation, and end-stage kidney disease on hemodialysis was admitted in October of 2017 for chest pain and swelling of legs for 5 days. The patient had missed his last three dialysis sessions after Hurricane Maria forced him to leave Puerto Rico. In examining this patient's treatment, we observe the effect of Hurricane Maria on the medical management of Puerto Rican residents and identify challenges managed Medicare may pose to patients who cross state or territory lines. Conclusions: We employ this patient's narrative to frame a larger discussion of Puerto Rican managed Medicare and provide additional recommendations for healthcare providers. Moreover, we consider this case in the context of disaster-related continuity of care for patients with complex medical conditions or treatment regimens. To address the gaps in the care of these patients, this article proposes (1) developing system-based approaches for screening displaced patients, (2) increasing the awareness of Special Enrollment Periods related to Medicare among healthcare providers, and (3) creating policy solutions to assure access to care for patients with complex medical conditions.
Support for vector control strategies in the United States during the Zika outbreak in 2016: The role of risk perception, knowledge, and confidence in governmentPiltch-Loeb, R., Merdjanoff, A. A., Bhanja, A., & Abramson, D. M.
Journal titlePreventive Medicine
Page(s)52-57AbstractLimiting the spread and impact of Zika was a major global priority in 2016, which required a variety of vector control measures. The success of vector control campaigns is varied and often dependent on public or political will. This paper examines the change over time in the United States population's support for vector control and the factors that predicted support for three vector control strategies (i.e., indoor spraying, outdoor spraying, and use of larvacide tablets) during the 2016 Zika outbreak in the United States. Data is from a nationally representative random digit dial sample conducted at three time points in 2016. Bivariate and multivariate regression analyses were used, treating data as a pooled cross-sectional sample. Results show public support for vector control strategies depends on both perceived risk for disease and knowledge of disease characteristics, as well is confidence in government to prevent the threat. Support varied based on vector control method: indoor spraying, aerial spraying, and use of larvacide tables. Results can aide public health officials in implementing effective vector control campaigns depending on the vector control strategy of choice. Results have implications for ways to design effective prevention campaigns in future emerging infectious disease threats.
Application of a Theoretical Model Toward Understanding Continued Food Insecurity Post Hurricane KatrinaClay, L. A., Papas, M. A., Gill, K., & Abramson, D. M.
Journal titleDisaster medicine and public health preparedness
Page(s)47-56AbstractObjective Disaster recovery efforts focus on restoring basic needs to survivors, such as food, water, and shelter. However, long after the immediate recovery phase is over, some individuals will continue to experience unmet needs. Ongoing food insecurity has been identified as a post-disaster problem. There is a paucity of information regarding the factors that might place an individual at risk for continued food insecurity post disaster. Methods Using data from a sample (n=737) of households severely impacted by Hurricane Katrina, we estimated the associations between food insecurity and structural, physical and mental health, and psychosocial factors 5 years after Hurricane Katrina. Logistic regression models were fit and odds ratios (OR) and 95% CI estimated. Results Nearly one-quarter of respondents (23%) reported food insecurity 5 years post Katrina. Marital/partner status (OR: 0.7, CI: 0.42, 0.99), self-efficacy (OR: 0.56, CI: 0.37, 0.84), sense of community (OR: 0.7, CI: 0.44, 0.98), and social support (OR: 0.59, CI: 0.39, 0.89) lowered the odds of food insecurity and explained most of the effects of mental health distress on food insecurity. Social support, self-efficacy, and being partnered were protective against food insecurity. Conclusions Recovery efforts should focus on fostering social-support networks and increased self-efficacy to improve food insecurity post disaster.
Factors associated with continued food insecurity among households recovering from hurricane KatrinaClay, L. A., Papas, M. A., Gill, K. B., & Abramson, D. M.
Journal titleInternational journal of environmental research and public health
Issue8AbstractIn 2010, 14.5% of US households experienced food insecurity, which adversely impacts health. Some groups are at increased risk for food insecurity, such as female-headed households, and those same groups are often also at increased risk for disaster exposure and the negative consequences that come with exposure. Little research has been done on food insecurity post-disaster. The present study investigates long-term food insecurity among households heavily impacted by Hurricane Katrina. A sample of 683 households participating in the Gulf Coast Child and Family Health Study were examined using a generalized estimation model to determine protective and risk factors for food insecurity during long-term recovery. Higher income (Odds Ratio (OR) 0.84, 95% Confidence Interval (CI) 0.77, 0.91), having a partner (OR 0.93; 95% CI 0.89, 0.97), or “other” race were found to be protective against food insecurity over a five-year period following disaster exposure. Low social support (OR 1.14; 95% CI 1.08, 1.20), poor physical health (OR 1.08; 95% CI 1.03, 1.13) or mental health (OR 1.13; 95% CI 1.09, 1.18), and female sex (OR 1.05; 95% CI 1.01, 1.10) were risk factors. Policies and programs that increase access to food supplies among high-risk groups are needed to reduce the negative health impacts of disasters.
How the US Population Engaged with and Prioritized Sources of Information about the Emerging Zika Virus in 2016Piltch-Loeb, R., Merdjanoff, A. A., & Abramson, D. M.
Journal titleHealth Security
Page(s)165-177AbstractEmerging disease threats like Zika pose a risk to naïve populations. In comparison to chronic diseases, there is scientific uncertainty surrounding emerging diseases because of the lack of medical and public health information available as the threat emerges. Further complicating this are the multiple, diverse channels through which people get information. This article used bivariate and multivariate analysis to first describe the breadth of information sources individuals accessed about the Zika virus, and then describe individuals' primary sources of information for Zika using a nationally representative pooled cross-sectional data set collected at 3 time points in 2016 (N = 3,698). The analysis also highlights how 3 subgroups - high-education, high-income adults; Hispanic women of childbearing age; and retirees over the age of 65 with less than a high school education - varied in their use of information. Results suggest individuals accessed multiple sources, but TV and radio were the primary sources of Zika information for the public, followed by print news. Demographic variation in primary source of information means public health officials should consider alternative channels to reach target groups in an emerging event. Without an understanding of how information has reached people, and who individuals engaged with regarding that information, public health practitioners are missing a key piece of the puzzle to improving public health campaigns during a future event like Zika. This analysis aims to inform the public health community about the message channels the US population uses during an emerging disease event and the most prevalent channels for different demographic groups, who can be targeted with particular messaging.
Variations in Healthcare Provider Use of Public Health and Other Information Sources by Provider Type and Practice Setting during New York City's Response to the Emerging Threat of Zika Virus Disease, 2016Quinn, C., Poirot, E., Sanders Kim, A., Viswanath, A. L., Patel, S. N., Abramson, D. M., & Piltch-Loeb, R.
Journal titleHealth Security
Page(s)252-261AbstractThe New York City (NYC) Department of Health and Mental Hygiene (DOHMH) used multiple methods to provide guidance to healthcare providers on the management and prevention of Zika virus disease during 2016. To better understand providers' use of information sources related to emerging disease threats, this article describes reported use of information sources by NYC providers to stay informed about Zika, and patterns observed by provider type and practice setting. We sent an electronic survey to all email addresses in the Provider Data Warehouse, a system used to maintain information from state and local health department sources on all prescribing healthcare providers in NYC. The survey asked providers about their use of information sources, including specific information products offered by the NYC DOHMH, to stay informed about Zika during 2016. Trends by provider type and practice setting were described using summary statistics. The survey was sent to 44,455 unique email addresses; nearly 20% (8,711) of the emails were undeliverable. Ultimately, 1,447 (5.8%) eligible providers completed the survey. Most respondents (79%) were physicians. Overall, the most frequently reported source of information from the NYC DOHMH was the NYC Health Alert Network (73%). Providers in private practice reported that they did not use any NYC DOHMH source of information about Zika more frequently than did those working in hospital settings (29% vs 23%); similarly, private practitioners reported that they did not use any other source of information about Zika more frequently than did those working in hospital settings (16% vs 8%). Maintaining timely and accurate databases of healthcare provider contact information is a challenge for local public health agencies. Effective strategies are needed to identify and engage independently practicing healthcare providers to improve communications with all healthcare providers during public health emergencies.
Risk salience of a novel virus: US population risk perception, knowledge, and receptivity to public health interventions regarding the Zika virus prior to local transmissionPiltch-Loeb, R., Abramson, D. M., & Merdjanoff, A. A.
Journal titlePloS one
Issue12AbstractBackground As the incidence of Zika infection accelerated in Central and South American countries from November 2015 through April 2016, U.S. public health officials developed vector control and risk communication strategies to address mosquito-borne and sexual modes of transmission. This study reports upon U.S. perceptions of the Zika virus prior to domestic transmission, and analyzes the association of socio-economic, political, knowledge and risk factors with population receptivity to selected behavioral, environmental, and clinical intervention strategies. Methods A representative sample of 1,233 U.S. residents was drawn from address-based telephone and mobile phone lists, including an oversample of 208 women of child-bearing age living in five U.S. southern states. Data were collected between April and June, 2016, and weighted to represent U.S. population distributions. Results Overall, 78% of the U.S. population was aware of Zika prior to domestic transmission. Those unaware of the novel virus were more likely to be younger, lower income, and of Hispanic ethnicity. Among those aware of Zika, over half would delay pregnancy for a year or more in response to public health warnings; approximately one third agreed with a possible vector-control strategy of targeted indoor spraying by the government; and nearly two-thirds agreed that the government should make pregnancy-termination services available to women who learn their fetus had a Zika-related birth defect. Receptivity to these public health interventions varied by age, risk perception, and knowledge of the virus. Conclusion Risk salience and population receptivity to public health interventions targeting a novel virus can be conditioned on pre-existing characteristics in the event of an emerging infectious disease. Risk communicators should consider targeted strategies to encourage adoption of behavioral, environmental, and clinical interventions.
Social capital, neighborhood disorder, and disaster recoveryClay, L., Papas, M., Abramson, D., & Kendra, J.
Journal titleJournal of Emergency Management
Page(s)233-246AbstractObjective: This study examined social institutions as a contextual factor that may influence perceptions of neighborhood physical and social disorder during disaster recovery. Design: The study used descriptive statistics and fit logistic regression models. Setting and Participants: Participants in this study (n = 772) were recruited from temporary housing in Louisiana and Mississippi as part of the Gulf Coast Child and Family Health Study, a longitudinal study of households heavily impacted by Hurricane Katrina. Community data were obtained from the Dun and Bradstreet Million Dollar Database and the American Community Survey. Outcome measure(s): Social disorder was assessed by asking respondents how concerned they are about issues such as being robbed or walking alone at night. Physical disorder was assessed by asking about problems experienced in the last month such as broken or missing windows and presence of mice or rats. Results: Greater income (β = -0.17, SE = 0.07), housing stability (β = -0.16, SE = 0.07), social support (β = -0.09, SE = 0.04), and home ownership (β = -0.10, SE = 0.05) were associated with lower social disorder and a larger male population at the community level was associated with greater social disorder (β = 0.00, SE = 0.00). Greater social support (β = -0.11, SE = 0.04), housing stability (β = -0.15, SE = 0.06), and higher income (β = -0.10, SE = 0.07) were associated with lower physical disorder. Conclusions: Longitudinal research is needed to understand the direction of influence between neighborhood factors and to household ability to provide for basic needs postdisaster. The findings also highlight the need for further research on postdisaster male behavior.
The Women and Their Children's Health (WaTCH) study: Methods and design of a prospective cohort study in Louisiana to examine the health effects from the BP oil spillPeters, E. S., Rung, A. L., Bronson, M. H., Brashear, M. M., Peres, L. C., Gaston, S., Sullivan, S. M., Peak, K., Abramson, D. M., Fontham, E. T., Harrington, D., Oral, E., & Trapido, E. J.
Journal titleBMJ open
Issue7AbstractPurpose The Deepwater Horizon Oil Spill is the largest marine oil spill in US history. Few studies have evaluated the potential health effects of this spill on the Gulf Coast community. The Women and Their Children's Health (WaTCH) study is a prospective cohort designed to investigate the midterm to long-term physical, mental and behavioural health effects of exposure to the oil spill. Participants Women were recruited by telephone from pre-existing lists of individuals and households using an address-based sampling frame between 2012 and 2014. Baseline interviews obtained information on oil spill exposure, demographics, physical and mental health, and health behaviours. Women were also asked to provide a household roster, from which a child between 10 and 17 years was randomly selected and recruited into a child substudy. Telephone respondents were invited to participate in a home visit in which blood samples, anthropometrics and neighbourhood characteristics were measured. A follow-up interview was completed between 2014 and 2016. Findings to date 2852 women completed the baseline interview, 1231 of whom participated in the home visit, and 628 children participated in the child's health substudy. The follow-up interview successfully reinterviewed 2030 women and 454 children. Future plans WaTCH continues to conduct follow-up surveys, with a third wave of interviews planned in 2017. Also, we are looking to enhance the collection of spatially related environmental data to facilitate assessment of health risks in the study population. In addition, opportunities to participate in behavioural interventions for subsets of the cohort have been initiated. There are ongoing studies that examine the relationship between genetic and immunological markers with mental health.
Crisis Decision-Making during Hurricane Sandy: An Analysis of Established and Emergent Disaster Response Behaviors in the New York Metro AreaChandler, T., Abramson, D. M., Panigrahi, B., Schlegelmilch, J., & Frye, N.
Journal titleDisaster medicine and public health preparedness
Page(s)436-442AbstractObjective This collective case study examined how and why specific organizational decision-making processes transpired at 2 large suburban county health departments in lower New York State during their response to Hurricane Sandy in 2012. The study also examined the relationships that the agencies developed with other emerging and established organizations within their respective health systems. Methods In investigating these themes, the authors conducted in-depth, one-on-one interviews with 30 senior-level public health staff and first responders; reviewed documentation; and moderated 2 focus group discussions with 17 participants. Results Although a natural hazard such as a hurricane was not an unexpected event for these health departments, they nevertheless confronted a number of unforeseen challenges during the response phase: prolonged loss of power and fuel, limited situational awareness of the depth and breadth of the storm's impact among disaster-exposed populations, and coordination problems with a number of organizations that emerged in response to the disaster. Conclusions Public health staff had few plans or protocols to guide them and often found themselves improvising and problem-solving with new organizations in the context of an overburdened health care system.
ForewordFothergill, A., Peek, L. A., Abramson, D., & Redlener, I. In Children of Katrina (First).
The Medical Home and Care Coordination in Disaster Recovery: Hypothesis for Interventions and ResearchKanter, R. K., Abramson, D. M., Redlener, I., & Gracy, D.
Journal titleDisaster medicine and public health preparedness
Page(s)337-343AbstractIn postdisaster settings, health care providers encounter secondary surges of unmet primary care and mental health needs that evolve throughout disaster recovery phases. Whatever a community's predisaster adequacy of health care, postdisaster gaps are similar to those of any underserved region. We hypothesize that existing practice and evidence supporting medical homes and care coordination in primary care for the underserved provide a favorable model for improving health in disrupted communities. Elements of medical home services can be offered by local or temporary providers from outside the region, working out of mobile clinics early in disaster recovery. As repairs and reconstruction proceed, local services are restored over weeks or years. Throughout recovery, major tasks include identifying high-risk patients relative to the disaster and underlying health conditions, assisting displaced families as they transition through housing locations, and tracking their evolving access to health care and community services as they are restored. Postdisaster sources of financial assistance for the disaster-exposed population are often temporary and evolving, requiring up-to-date information to cover costs of care until stable services and insurance coverage are restored. Evidence to support disaster recovery health care improvement will require research funding and metrics on structures, processes, and outcomes of the disaster recovery medical home and care coordination, based on adaptation of standard validated methods to crisis environments.
Preparedness and emergency response research centers: Early returns on investment in evidence-based public health systems researchQari, S. H., Abramson, D. M., Kushma, J. A., & Halverson, P. K.
Journal titlePublic Health Reports
School interventions after the Joplin tornadoKanter, R. K., & Abramson, D.
Journal titlePrehospital and Disaster Medicine
Page(s)214-217AbstractBackground/Objective To qualitatively describe interventions by schools to meet children's needs after the May 2011 Joplin, Missouri tornado. Methods Qualitative exploratory study conducted six months after the tornado. Key informant interviews with school staff (teachers, psychologists, guidance counselor, nurse, principal), public health official, and physicians. Report After the tornado, school staff immediately worked to contact every enrolled child to provide assistance and coordinate recovery services. Despite severe damage to half of the city's schools, the decision was made to reopen schools at the earliest possible time to provide a safe, reassuring environment and additional services. An expanded summer school session emphasized child safety and emotional wellbeing. The 2011-2012 school year began on time, less than three months after the disaster, using temporary facilities. Displaced children were bused to their usual schools regardless of their new temporary residence locations. In just-in-time training sessions, teachers developed strategies to support students and staff experiencing anxiety or depression. Certified counselors conducted school-based, small-group counseling for students. Selective referrals were made to community mental health providers for children with greatest needs. Conclusions Evidence from Joplin adds to a small body of empirical experience demonstrating the important contribution of schools to postdisaster community recovery. Despite timely and proactive services, many families and children struggled after the tornado. Improvements in the effectiveness of postdisaster interventions at schools will follow from future scientific evidence on optimal approaches.
The Resilience Activation Framework: a Conceptual Model of How Access to Social Resources Promotes Adaptation and Rapid Recovery in Post-disaster SettingsAbramson, D. M., Grattan, L. M., Mayer, B., Colten, C. E., Arosemena, F. A., Bedimo-Rung, A., & Lichtveld, M.
Journal titleJournal of Behavioral Health Services and Research
Page(s)42-57AbstractA number of governmental agencies have called for enhancing citizens’ resilience as a means of preparing populations in advance of disasters, and as a counterbalance to social and individual vulnerabilities. This increasing scholarly, policy, and programmatic interest in promoting individual and communal resilience presents a challenge to the research and practice communities: to develop a translational framework that can accommodate multidisciplinary scientific perspectives into a single, applied model. The Resilience Activation Framework provides a basis for testing how access to social resources, such as formal and informal social support and help, promotes positive adaptation or reduced psychopathology among individuals and communities exposed to the acute collective stressors associated with disasters, whether human-made, natural, or technological in origin. Articulating the mechanisms by which access to social resources activate and sustain resilience capacities for optimal mental health outcomes post-disaster can lead to the development of effective preventive and early intervention programs.
The Science and Practice of Resilience Interventions for Children Exposed to DisastersFailed generating bibliography.
Hurricane Sandy: Lessons learned, againAbramson, D. M., & Redlener, I.
Journal titleDisaster medicine and public health preparedness
Measuring the impact of hurricane katrina on access to a personal healthcare provider: The use of the national survey of children's health for an external comparison groupStehling-Ariza, T., Park, Y. S., Sury, J. J., & Abramson, D.
Journal titleMaternal and Child Health Journal
Page(s)170-177AbstractThis paper examined the effect of Hurricane Katrina on children's access to personal healthcare providers and evaluated the use of propensity scoremethods to compare a nationally representative sample of children, as a proxy for an unexposed group, with a smaller exposed sample. 2007 data from the Gulf Coast Child and Family Health (G-CAFH) Study, a longitudinal cohort of households displaced or greatly impacted by Hurricane Katrina, were matched with 2007 National Survey of Children's Health (NSCH) data using propensity score techniques. Propensity scores were created using poverty level, household educational attainment, and race/ethnicity, with and without the addition of child age and gender. The outcome was defined as having a personal healthcare provider. Additional confounders (household structure, neighborhood safety, health and insurance status)were also examined. All covariates except gender differed significantly between the exposed (G-CAFH) and unexposed (NSCH) samples. Fewer G-CAFH children had a personal healthcare provider (65 %) compared to those from NSCH (90 %). Adjusting for all covariates, the propensity score analysis showed exposed children were 20 %less likely to have a personal healthcare provider compared to unexposed children in the US (OR = 0.80, 95 % CI 0.76, 0.84), whereas the logistic regression analysis estimated a stronger effect (OR = 0.28, 95 % CI 0.21, 0.39). Two years after Hurricane Katrina, children exposed to the storm had significantly lower odds of having a personal health care provider compared to unexposed children. Propensity score matching techniques may be useful for combining separate data samples when no clear unexposed group exists.
Persistence of mental health needs among children affected by hurricane Katrina in New OrleansOlteanu, A., Arnberger, R., Grant, R., Davis, C., Abramson, D., & Asola, J.
Journal titlePrehospital and Disaster Medicine
Page(s)3-6AbstractBackground: Hurricane Katrina made landfall in August 2005 and destroyed the infrastructure of New Orleans. Mass evacuation ensued. The immediate and long-lasting impact of these events on the mental health of children have been reported in survey research. This study was done to describe the nature of mental health need of children during the four years after Hurricane Katrina using clinical data from a comprehensive healthcare program. Medical and mental health services were delivered on mobile clinics that traveled to medically underserved communities on a regular schedule beginning immediately after the hurricane. Patients were self-selected residents of New Orleans. Most had incomes below the federal poverty level and were severely affected by the hurricane. Methods: Paper charts of pediatric mental health patients were reviewed for visits beginning with the establishment of the mental health program from 01 July 2007 through 30 June 2009 (n = 296). Demographics, referral sources, presenting problems, diagnoses, and qualitative data describing Katrina-related traumatic exposures were abstracted. Psychosocial data were abstracted from medical charts. Data were coded and processed for demographic, referral, and diagnostic trends. Results: Mental health service needs continued unabated throughout this period (two to nearly four years post-event). In 2008, 29% of pediatric primary care patients presented with mental health or developmental/learning problems, including the need for intensive case management. The typical presentation of pediatric mental health patients was a disruptive behavior disorder with an underlying mood or anxiety disorder. Qualitative descriptive data are presented to illustrate the traumatic post-disaster experience of many children. School referrals for mental health evaluation and services were overwhelmingly made for disruptive behavior disorders. Pediatric referrals were more nuanced, reflecting underlying mood and anxiety disorders. Histories indicated that many missed opportunities for earlier identification and intervention. Conclusions: Mental health and case management needs persisted four years after Hurricane Katrina and showed no signs of abating. Many children who received mental health services had shown signs of psychological distress prior to the hurricane, and no causal inferences are drawn between disaster experience and psychiatric disorders. Post-disaster mental health and case management services should remain available for years post-event. To ensure timely identification and intervention of child mental health needs, pediatricians and school officials may need additional training.
Rural and suburban population surge following detonation of an improvised nuclear device: A new model to estimate impactMeit, M., Redlener, I., Briggs, T. W., Kwanisai, M., Culp, D., & Abramson, D. M.
Journal titleDisaster medicine and public health preparedness
Page(s)S143-S150AbstractBackground: The objective of the study was to model urban evacuation into surrounding communities after the detonation of an improvised nuclear device (IND) to assist rural and suburban planners in understanding and effectively planning to address the effects of population surges. Methods: Researchers developed parameters for how far evacuees would travel to escape disasters and factors that would influence choice of destination from studies of historical evacuations, surveys of citizens' evacuation intentions in hypothetical disasters, and semistructured interviews with key informants and emergency preparedness experts. Those parameters became the inputs to a "push-pull" model of how many people would flee in the 4 scenarios and where they would go. Results: The expanded model predicted significant population movements from the New York City borough of Manhattan and counties within 20 km of Manhattan to counties within a 150-mi radius of the assumed IND detonation. It also predicted that even in some communities located far from Manhattan, arriving evacuees would increase the population needing services by 50% to 150%. Conclusions: The results suggest that suburban and rural communities could be overwhelmed by evacuees from their center city following an IND detonation. They also highlight the urgency of educating and communicating with the public about radiation hazards to mitigate panic and hysteria, anticipating the ways in which a mass exodus may disrupt or even cripple rescue and response efforts, and devising creative ways to exercise and drill for an event about which there is great denial and fatalism.
Children as bellwethers of recovery: Dysfunctional systems and the effects of parents, households, and neighborhoods on serious emotional disturbance in children after Hurricane KatrinaAbramson, D. M., Park, Y. S., Stehling-Ariza, T., & Redlener, I.
Journal titleDisaster medicine and public health preparedness
Page(s)S17-S27AbstractBackground: Over 160 000 children were displaced from their homes after Hurricane Katrina. Tens of thousands of these children experienced the ongoing chaos and uncertainty of displacement and transiency, as well as significant social disruptions in their lives. The objectives of this study were to estimate the long-term mental health effects of such exposure among children, and to elucidate the systemic pathways through which the disaster effect operates. Methods: The prevalence of serious emotional disturbance was assessed among 283 school-aged children in Louisiana and Mississippi. These children are part of the Gulf Coast Child & Family Health Study, involving a longitudinal cohort of 1079 randomly sampled households in the two states, encompassing a total of 427 children, who have been interviewed in 4 annual waves of data collection since January 2006. The majority of data for this analysis was drawn from the fourth round of data. Results: Although access to medical care for children has expanded considerably since 2005 in the region affected by Hurricane Katrina, more than 37% of children have received a clinical mental health diagnosis of depression, anxiety, or behavior disorder, according to parent reports. Children exposed to Hurricane Katrina were nearly 5 times as likely as a pre-Katrina cohort to exhibit serious emotional disturbance. Path analyses confirm the roles played by neighborhood social disorder, household stressors, and parental limitations on children's emotional and behavioral functioning. Conclusions: Children and youth are particularly vulnerable to the effects of disasters. They have limited capacity to independently mobilize resources to help them adapt to stressful postdisaster circumstances, and are instead dependent upon others to make choices that will influence their household, neighborhood, school, and larger social environment. Children's mental health recovery in a postdisaster setting can serve as a bellwether indicator of successful recovery or as a lagging indicator of system dysfunction and failed recovery.