Objectives. We studied the experience of Hurricane Katrina evacuees to better understand factors influencing evacuation decisions in impoverished, mainly minority communities that were most severely affected by the disaster.Methods. We performed qualitative interviews with 58 randomly selected evacuees living in Houston’s major evacuation centers from September 9 to 12, 2005. Transcripts were content analyzed using grounded theory methodology.Results. Participants were mainly African American, had low incomes, and were from New Orleans. Participants’ strong ties to extended family, friends, and community groups influenced other factors affecting evacuation, including transportation, access to shelter, and perception of evacuation messages. These social connections cut both ways, which facilitated and hindered evacuation decisions.Conclusions. Effective disaster plans must account for the specific obstacles encountered by vulnerable and minority communities. Removing the more apparent obstacles of shelter and transportation will likely be insufficient for improving disaster plans for impoverished, minority communities. The important influence of extended families and social networks demand better community-based communication and preparation strategies.

Research from JAMA — Mental Health and Health-Related Quality of Life Among Adult Latino Primary Care Patients Living in the United States With Previous Exposure to Political Violence — ContextAlthough political violence continues in parts of Central America, South America, and Mexico, little is known about its relationship to the health of Latino immigrants living in the United States.ObjectiveTo determine (1) rates of exposure to political violence among Latino adult primary care patients who have immigrated to the United States from Central America, South America, and Mexico and its impact on mental health and health-related quality of life and (2) frequency of disclosure of political violence to primary care clinicians.Design, Setting, and ParticipantsTwo-stage cluster design survey of a systematic sample of Latino immigrant adults in 3 community-based primary care clinics in Los Angeles, conducted from July 2001 to February 2002.Main Outcome MeasuresReports of exposure to political violence in home country before immigrating to the United States and communication with clinicians about political violence; self-reported measures of health-related quality of life using the Medical Outcomes Study Short Form 36 (MOS SF-36); symptoms of depression, anxiety, and alcohol disorders using the Primary Care Evaluation of Mental Disorders (PRIME-MD); and symptoms of posttraumatic stress disorder (PTSD) using the PTSD Checklist–Civilian Version (PCL-C).ResultsA total of 638 (69%) of 919 eligible patients participated. The nonresponse rates did not differ by age, sex, recruitment sites, or clinic sessions. In weighted analyses, 54% of participants reported political violence experiences in their home countries, including 8% who reported torture. Of those exposed to political violence, 36% had symptoms of depression and 18% had symptoms of PTSD vs 20% and 8%, respectively, among those not exposed to political violence. Controlling for age, sex, country, years lived in the United States, acculturation, income, health insurance status, and recruitment site in a subsample of 512 participants (56%), those who reported political violence exposure were more likely to meet symptom criteria for PTSD (adjusted odds ratio [AOR], 3.4; 95% confidence interval [CI], 1.4-8.4) and to have symptoms of depression (AOR, 2.8; 95% CI, 1.4-5.4) and symptoms of panic disorder (AOR, 4.8; 95% CI, 1.6-14.4) than participants not reporting political violence. Those exposed to political violence reported more chronic pain and role limitations due to physical problems, as well as worse physical functioning and lower perceptions of general health than those who were not exposed to political violence. Only 3% of the 267 patients who had experienced political violence reported ever telling a clinician about it after immigrating; none reported their current physician asking about political violence.ConclusionLatino immigrants in primary care in Los Angeles have a high prevalence of exposure to political violence before immigrating to the United States and associated impairments in mental health and health-related quality of life.

Objectives:Chronic medical and mental illness and disability increase vulnerability to disasters. National efforts have focused on preparing people with disabilities, and studies find them to be increasingly prepared, but less is known about people with chronic mental and medical illnesses. We examined the relation between health status (mental health, perceived general health, and disability) and disaster preparedness (home disaster supplies and family communication plan).Methods:A random-digit-dial telephone survey of the Los Angeles County population was conducted October 2004 to January 2005 in 6 languages. Separate multivariate regressions modeled determinants of disaster preparedness, adjusting for sociodemographic covariates then sociodemographic variables and health status variables.Results:Only 40.7% of people who rated their health as fair/poor have disaster supplies compared with 53.1% of those who rate their health as excellent (P< 0.001). Only 34.8% of people who rated their health as fair/poor have an emergency plan compared with 44.8% of those who rate their health as excellent (P< 0.01). Only 29.5% of people who have a serious mental illness have disaster supplies compared with 49.2% of those who do not have a serious mental illness (P< 0.001). People with fair/poor health remained less likely to have disaster supplies (adjusted odds ratio [AOR] 0.69, 95% confidence interval [CI] 0.50–0.96) and less likely to have an emergency plan (AOR 0.68, 95% CI 0.51–0.92) compared with those who rate their health as excellent, after adjusting for the sociodemographic covariates. People with serious mental illness remained less likely to have disaster supplies after adjusting for the sociodemographic covariates (AOR 0.67, 95% CI 0.48–0.93). Disability status was not associated with lower rates of disaster supplies or emergency communication plans in bivariate or multivariate analyses. Finally, adjusting for the sociodemographic and other health variables, people with fair/poor health remained less likely to have an emergency plan (AOR 0.66, 95% CI 0.48–0.92) and people with serious mental illness remained less likely to have disaster supplies (AOR 0.67, 95% CI 0.47–0.95).Conclusions:People who report fair/poor general health and probable serious mental illness are less likely to report household disaster preparedness and an emergency communication plan. Our results could add to our understanding of why people with preexisting health problems suffer disproportionately from disasters. Public health may consider collaborating with community partners and health services providers to improve preparedness among people with chronic illness and people who are mentally ill. (Disaster Med Public Health Preparedness. 2009;3:33–41)

Background: Smoke from wildfires is a growing public health risk due to the enormous amount of smoke-related pollution that is produced and can travel thousands of kilometers from its source. While many studies have documented the physical health harms of wildfire smoke, less is known about the effects on mental health and well-being. Understanding the effects of wildfire smoke on mental health and well-being is crucial as the world enters a time in which wildfire smoke events become more frequent and severe. We conducted a scoping review of the existing information on wildfire smoke’s impact on mental health and well-being and developed a model for understanding the pathways in which wildfire smoke may contribute to mental health distress. Methods: We conducted searches using PubMed, Medline, Embase, Google, Scopus, and ProQuest for 1990–2022. These searches yielded 200 articles. Sixteen publications met inclusion criteria following screening and eligibility assessment. Three more publications from the bibliographies of these articles were included for a total of 19 publications. Results: Our review suggests that exposure to wildfire smoke may have mental health impacts, particularly in episodes of chronic and persistent smoke events, but the evidence is inconsistent and limited. Qualitative studies disclose a wider range of impacts across multiple mental health and well-being domains. The potential pathways connecting wildfire smoke with mental health and well-being operate at multiple interacting levels including individual, social and community networks, living and working conditions, and ecological levels. Conclusions: Priorities for future research include: 1) applying more rigorous methods; 2) differentiating between mental illness and emotional well-being; 3) studying chronic, persistent or repeated smoke events; 4) identifying the contextual factors that set the stage for mental health and well-being effects, and 5) identifying the causal processes that link wildfire smoke to mental health and well-being effects. The pathways model can serve as a basis for further research and knowledge synthesis on this topic. Also, it helps public health, community mental health, and emergency management practitioners mitigate the mental health and well-being harms of wildfire smoke.