Multi-scalar and multi-dimensional conceptions of social capital and mental health impacts after disaster: the case of Hurricane Harvey.

While much research investigates how social capital relates to mental health after disasters, less work employs a multi-scalar, multi-dimensional social capital framework. This study applies such a construct to an analysis of novel survey data of approximately 1,000 rural and urban Texans after Hurricane Harvey struck the United States in August 2017. On the individual level, it finds that greater social support is linked to fewer mental health impacts, but that greater civic and organisational engagement is connected to greater mental health impacts. At the community level, it finds that neither a density of bridging social capital organisations nor of bonding social capital organisations is associated with poorer mental health, although a greater number of bonding organisations is related to negative mental health impacts on rural residents. The paper concludes by focusing on how individual and community social capital relationships with mental health are contingent on measurement, scale, and rural or urban location.

A Mixed-Methods Approach to the Development of a Disaster Food Security Framework.

BACKGROUND: Limited research on food systems and food insecurity (FI) following disasters finds contextual differences in post-disaster food systems that shape dimensions of FI. Measurement limitations make it difficult to address FI and develop effective practices for disaster-affected communities. OBJECTIVE: To develop, validate, and test a Disaster Food Security Framework (DFSF). DESIGN: Mixed-methods approach was used, including in-depth interviews to understand lived experiences during disasters; expert panel input to validate DFSF designed using responses from in-depth interviews; and quantitative testing of robustness of DFSF using the coronavirus disease 2019 pandemic as a disaster example. PARTICIPANTS AND SETTING: The in-depth interviews included participants from Vermont (n = 5), North Carolina (n = 3), and Oklahoma (n = 2) who had been living in those states during Hurricane Irene (2011), Hurricane Florence (2018), the Moore tornadoes (2013), and coronavirus disease 2019 pandemic (2020). The expert panel consisted of researchers and practitioners from different US geographical regions and food-related disciplines (n = 18). For the quantitative testing survey, data from 4 US states (New York, New Mexico, Vermont, and Maryland; n = 3,228) from the National Food Access and COVID Research Team was used. MAIN OUTCOME MEASURES: The outcomes from the in-depth interviews were dimensions of disaster FI, those from the expert panel was a content validity ratio, and those from the quantitative testing was the number of items and components to be included. ANALYSES PERFORMED: Inductive and deductive reasoning were using when reporting on the in-depth interviews and expert panel results, including frequencies. The quantitative testing was conducted using multiple correspondence analysis. RESULTS: The in-depth interviews revealed four dimensions of FI: availability (supply and donation), accessibility (economic, physical, and social), acceptability (preference and health), and agency (infrastructure and self-efficacy). The panel of experts reported high content validity for the DFSF and its dimensions (content validity ratio >0.42), thus giving higher credibility to the DFSF. Multiple correspondence analysis performed on 25 food-related variables identified one component with 13 indicators representing three of the four dimensions: availability, acceptability, and accessibility, but not agency.

Differences in Household Preparedness and Adaptation for COVID-19.

OBJECTIVE: To quantify differences in preparedness for and adaptations to COVID-19 in a cohort sample of New York City residents. METHODS: A proportional quota sample (n = 1020) of individuals residing in New York City during the COVID-19 pandemic participated in a Qualtrics web survey. Quotas were set for age, sex, race, and income to mirror the population of New York City based on the 2018 American Community Survey. RESULTS: Low self-efficacy, low social support, and low sense of community increased the odds of securing provisions to prepare for COVID-19. Being an essential worker, poor mental health, and having children in the household reduced the likelihood of engaging in preparedness practices. Essential workers and individuals with probable serious mental illness were less likely to report preparedness planning for the pandemic. CONCLUSIONS: The findings contribute to evolving theories of preparedness. There are differences across the sample in preparedness types, and different kinds of preparedness are associated with different household characteristics. Findings suggest that public officials and others concerned with population wellbeing might productively turn attention to education and outreach activities indexed to these characteristics.

Quantifying Disaster Impacts on Local Public Health Agency's Leadership, Staffing, and Provision of Essential Public Health Services.

OBJECTIVE: The objective of this study is to assess the impact that natural disaster response has on local health departments' (LHD) ability to continue to provide essential public health services. METHODS: A web-based survey was sent to all North Carolina Local Health Directors. The survey asked respondents to report on LHD functioning following Hurricanes Florence (2018) and Dorian (2019). RESULTS: After Hurricane Florence, the positions who most frequently had regular duties postponed or interrupted were leadership (15 of 48; 31.3%), and professional staff (e.g., nursing and epidemiology: 11 of 48; 22.9%). Staffing shelters for all phases - from disaster response through long-term recovery - was identified as a burden by LHDs, particularly for nursing staff. Approximately 66.6% of LHD jurisdictions opened an Emergency Operations Center (EOC) or activated Incident Command System in response to both hurricanes. If an EOC was activated, the LHD was statistically, significantly more likely to report that normal duties had been interrupted across every domain assessed. CONCLUSIONS: The ability of LHDs to perform regular activities and provide essential public health services is impacted by their obligations to support disaster response. Better metrics are needed to measure the impacts to estimate indirect public health impacts of disasters.

Diaper Need During the COVID-19 Pandemic Associated with Poverty, Food Insecurity, and Chronic Illness: An Analysis of a Representative State Sample of Caretakers with Young Children.

Objectives: Diaper need is an important form of material hardship for families with young children. This study quantified diaper need during the COVID-19 pandemic and examined factors associated with diaper need. Methods: Using a representative statewide sample of adults in Massachusetts, diaper need was assessed during the COVID-19 pandemic among respondents with at least one child 0-4 years of age in diapers (n=353). Bivariate tests examined associations between diaper need and individual and household factors. Multivariable regression was used to examine associations between diaper need and demographic factors, job loss, and mental health during the pandemic. Results: More than one in three respondents reported diaper need (36.0%). Demographic factors associated with diaper need were age <25 years, Latino ethnicity, having less than a high school degree, unemployment before the pandemic, household income <$50,000, household food insecurity, or having a household member with a chronic disease. Diaper need was higher among respondents who utilized a nutrition assistance program or a food pantry during the pandemic. In multivariable analyses considering job loss and mental health during the pandemic, diaper need was associated with household income <$50,000 (odds ratio [OR] 3.61; confidence interval [95% CI] 1.40-9.26) and a chronic disease diagnosis within the household (OR 4.26; 95% CI 1.77-10.29). Conclusions: This study indicates a level of diaper need similar to what was documented before the COVID-19 pandemic despite federal stimulus payments and increased distributions by local diaper banks. The findings identify groups at increased risk and suggest opportunities to reach those at risk through food assistance programs.

Racial/Ethnic Disparities in Food Pantry Use and Barriers in Massachusetts during the First Year of the COVID-19 Pandemic.

This study sought to describe racial disparities in food insecurity, food pantry use, and barriers to and experiences with food pantries during the first year of the COVID-19 pandemic. We surveyed 2928 adults in Massachusetts regarding food access in the year before and during the first year of the pandemic. Weighted multivariable logistic regression models assessed racial differences in barriers to and experiences with pantry use during the pandemic. Black and Latino adults experienced the highest prevalence of food insecurity and pantry use. Additionally, Black and Latino adults reported more barriers to, but less stigma around, pantry use compared to White adults. Latino adults were less likely to know about pantry hours/locations and encounter staff who spoke their language. Black and Latino adults were also more likely to find pantry hours/locations inconvenient and have difficulty with transportation. The COVID-19 pandemic resulted in increased food insecurity, and food access inequities persisted. Programmatic policies to improve pantry access in communities of color could include increasing the hours/days that pantries are open, increasing bilingual staff, providing transportation or delivery, and creating multilingual public awareness campaigns on how to locate pantries.

Primary and Secondary Health Impacts of COVID-19 among Minority Individuals in New York State.

In addition to the direct health impacts of COVID-19, the pandemic disrupted economic, educational, healthcare, and social systems in the US. This cross-sectional study examined the primary and secondary impacts of the COVID-19 pandemic among low-income and minority groups in New York State using the social determinants of health framework. New Yorkers were recruited to complete a web-based survey through Qualtrics. The survey took place in May and June 2020 and asked respondents about COVID-19 health impacts, risk factors, and concerns. Chi-square analysis examined the health effects experienced by race and ethnicity, and significant results were analyzed in a series of logistic regression models. Results showed disparities in the primary and secondary impacts of COVID-19. The majority of differences were reported between Hispanic and white respondents. The largest differences, in terms of magnitude, were reported between other or multiracial respondents and white respondents. Given the disproportionate burden of COVID-19 on minority populations, improved policies and programs to address impacts on lower-paying essential jobs and service positions could reduce exposure risks and improve safety for minority populations. Future research can identify the long-term health consequences of the pandemic on the social determinants of health among populations most at risk.

Food Access Worries, Food Assistance Use, Purchasing Behavior, and Food Insecurity Among New Yorkers During COVID-19.

The coronavirus disease of 2019 (COVID-19) disrupted health, economy, and food systems across the United States. This cross-sectional study examined the relationship between food access worries, food assistance use, and purchasing behaviors and food insecurity during COVID-19 among residents of New York State. New Yorkers were recruited to complete a web-based survey through Qualtrics. The survey took place in the summer and fall of 2020 and asked respondents about food access worries, food assistance use, food insecurity, and food purchasing behaviors. Chi-square analysis examined the relationships between food concerns, food assistance use, purchasing behaviors, and demographic characteristics by reported food insecurity, and significant results were analyzed in a series of logistic regression models. Results showed that higher food worries, Supplemental Nutrition Assistance Program (SNAP) use, reported food assistance and delivery as food sources, and self-reported Hispanic ethnicity were associated with a higher likelihood of experiencing food insecurity. Future research is needed to assess the ongoing impacts of the pandemic on food access and food insecurity, particularly among underserved groups. Measures that provide additional money for food and improved food access can alleviate barriers to accessing enough healthy food at this time.

Impact of Employment, Essential Work, and Risk Factors on Food Access during the COVID-19 Pandemic in New York State.

The COVID-19 pandemic disrupted food systems and the economy in the U.S. and abroad. This cross-sectional study examined the direct and indirect impacts of COVID-19 on food access among low-income and Black, Indigenous, and people of color (BIPOC) in New York State. New York residents were recruited to complete a web-based survey through Qualtrics. The survey took place in May and June 2020 and asked participants about COVID-19 health impacts, risk factors, and food access. Chi-square analysis examined issues with food access experienced by demographic characteristics, work disruptions, health impacts, and household risk for contracting the virus and experiencing severe illness, and significant results were analyzed in a series of logistic regression models. After accounting for covariates, Hispanic respondents, those with likely Major Depressive Disorder, and essential workers were more likely to experience worse food access during COVID-19. Improved policies and services to address impacts on vulnerable populations such as BIPOC, those suffering from mental health disorders, and workers in lower-paying essential jobs can reduce the risk of food access issues at this time. Future research can identify how food access issues during the pandemic influenced diet quality, chronic disease risk and infection, and persistence of food access issues.

Bowling Together: Community Social Institutions Protective Against Poor Child Mental Health.

Social capital is widely recognized as health bolstering and more recently as playing a central role in family and community disaster response and recovery. Community social institutions may be considered a critical mechanism for the development of social capital, as they provide opportunities for community members to interact to build the networks and relationships that are necessary for taking collective action. In particular, social institutions may have a pivotal role to play in supporting children's health and welfare postdisaster. Community social institutions such as membership, civic, and religious organizations are community resources that stimulate learning and foster healthy child development. This study explores communities impacted by Hurricane Katrina and the Deepwater Horizon Oil Spill (DWHOS). Social institutions data were paired with household interviews from the Women and Their Children's Health Study (n = 521) to explore whether the density and type of community social institutions in the community were associated with child mental health outcomes. Multilevel logistic regression models examining the role of social institutions, household characteristics, maternal characteristics, and child-specific factors in child mental health showed that for each additional prosocial institution established in the community during recovery from Hurricane Katrina, respondents were 21% less likely to report a child mental health diagnosis (odds ratio 0.79; 95% confidence interval 0.63-0.98). These findings highlight the potential of investment in social institutions in communities to bolster resilience and foster meaningful recovery.

Capturing Disruptions to Food Availability After Disasters: Assessing the Food Environment Following Hurricanes Florence and María.

OBJECTIVE: The aim of this study was to describe the results of food environment assessments completed after Hurricane Florence in North Carolina (2018) and Hurricane María in Puerto Rico (2017), and provide recommendations for assessing disaster food environments. METHODS: Adapted structured observation protocols were used to conduct rapid assessments of the availability, price, and quality of specific foods in retail markets. RESULTS: In both settings, unhealthful food items (soda, chips, fruit-flavored drinks) and milk were widely available and at lower prices than domestic averages. The adapted instrument in Puerto Rico allowed for documentation of greater availability of canned items compared with fresh or frozen foods. In both settings, researchers noted the inability of the instrument to document items that are important to assess postdisaster: ready-to-heat and ready-to-eat foods; food preparation facilities and supplies; hygiene supplies; and empty shelf-space. CONCLUSIONS: The instruments, despite their limitations, were able to capture food availability issues in postdisaster environments. Future instrument adaptation is necessary to capture availability of all major food groups, healthful and unhealthful options, shelf-stable, ready-to-eat, and ready-to-heat foods versus other formats (fresh, frozen), and cooking and hygiene supplies.

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. OBJECTIVE: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. METHODS: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. RESULTS: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. CONCLUSIONS: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

Factors Associated with Food Insecurity Following Hurricane Harvey in Texas.

Food insecurity prevalence among disaster-affected households has been found to be higher than state prevalence in non-disaster times. This study applies a socio-ecological model of post-disaster food insecurity to a nested quota sample (n = 1002) recruited for a web survey from 41 Texas counties affected by Hurricane Harvey 12-15 months post-event. This analysis identifies risk and protective factors for food insecurity. Chi-square analysis was used to examine independent associations between individual, household, and social factors with food insecurity. A multivariate logistic model was fitted and adjusted odds ratios are reported. Economic instability (adjusted odds ratio (OR) 2.43; 95% Confidence Interval (CI) 1.73, 3.41), relocation due to Hurricane Harvey (OR 1.89; CI 1.15, 3.09), major home damage (OR 2.11; CI 1.12, 3.98), non-white race - black (OR 1.79; CI 1.01, 3.18), Hispanic (OR 1.67; CI 1.09, 2.54), other race (OR 4.39; CI 1.96, 9.82) - and community-based organization assistance (1.99; 1.11, 3.58) were risk factors while older age (45-64 years: 0.49; 0.32, 0.73; 65+ years 0.40; 0.22, 0.75), better physical health (0.46; 0.29, 0.71), better mental health (0.46; 0.32, 0.67), and high social support (0.37; 0.25, 0.55) were protective against food insecurity. Disaster policies and programs should address the disproportionate burden on households that relocate or have health conditions. Fostering social support networks, especially among relocated populations, may improve disaster health outcomes.

Does Preparedness Matter? The Influence of Household Preparedness on Disaster Outcomes During Superstorm Sandy.

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

Application of a Theoretical Model Toward Understanding Continued Food Insecurity Post Hurricane Katrina.

OBJECTIVE: 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. (Disaster Med Public Health Preparedness. 2018;12:47-56).

Factors Associated with Continued Food Insecurity among Households Recovering from Hurricane Katrina.

In 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.