Exposure to the Indian Ocean Tsunami shapes the HPA-axis resulting in HPA "burnout" 14 years later.

Despite significant research on the effects of stress on the hypothalamic-pituitary-adrenal (HPA) axis, questions remain regarding long-term impacts of large-scale stressors. Leveraging data on exposure to an unanticipated major natural disaster, the 2004 Indian Ocean tsunami, we provide causal evidence of its imprint on hair cortisol levels fourteen years later. Data are drawn from the Study of the Tsunami Aftermath and Recovery, a population-representative longitudinal study of tsunami survivors who were living along the coast of Aceh, Indonesia, when the tsunami hit. Annual rounds of data, collected before, the year after and 2 y after the disaster provide detailed information about tsunami exposures and self-reported symptoms of post-traumatic stress. Hair samples collected 14 y after the tsunami from a sample of adult participants provide measures of cortisol levels, integrated over several months. Hair cortisol concentrations are substantially and significantly lower among females who were living, at the time of the tsunami, in communities directly damaged by the tsunami, in comparison with similar females living in other, nearby communities. Differences among males are small and not significant. Cortisol concentrations are lowest among those females living in damaged communities who reported elevated post-traumatic stress symptoms persistently for two years after the tsunami, indicating that the negative effects of exposure were largest for them. Low cortisol is also associated with contemporaneous reports of poor self-rated general and psychosocial health. Taken together, the evidence points to dysregulation in the HPA axis and "burnout" among these females fourteen years after exposure to the disaster.

Do Adverse Childhood Experiences Modify the Association Between Disaster-Related Trauma and Cognitive Disability?

Identifying subpopulations that are particularly vulnerable to long-term adverse health consequences of disaster-related trauma is needed. We examined whether adverse childhood experiences (ACEs) potentiate the association between disaster-related trauma and subsequent cognitive disability among older adult disaster survivors. Data were from a prospective cohort study of older adults who survived the 2011 Great East Japan Earthquake. The baseline survey pre-dated the disaster by 7 months. We included participants who completed follow-up surveys (2013 and 2016) and did not have a cognitive disability before the disaster (n = 602). Disaster-related traumas (i.e., home loss, loss of friends or pets) and ACEs were retrospectively assessed in 2013. Cognitive disability levels in 2016 were objectively assessed. After adjusting for pre-disaster characteristics using a machine learning-based estimation approach, home loss (0.19, 95% confidence interval (CI): 0.09, 0.28) was, on average, associated with greater cognitive disability. Among individuals with ACEs, home loss was associated with even higher cognitive disability levels (0.64, 95% CI: 0.24, 1.03). Losses of friends (0.18, 95% CI: 0.05, 0.32) and pets (0.13, 95% CI: 0.02, 0.25) were associated with higher cognitive disability levels only among those with ACEs. Our findings suggest that individuals with a history of ACEs may be particularly vulnerable to adverse health consequences related to disasters.

Floods and cause-specific mortality in the UK: a nested case-control study.

BACKGROUND: Floods are the most frequent weather-related disaster, causing significant health impacts worldwide. Limited studies have examined the long-term consequences of flooding exposure. METHODS: Flood data were retrieved from the Dartmouth Flood Observatory and linked with health data from 499,487 UK Biobank participants. To calculate the annual cumulative flooding exposure, we multiplied the duration and severity of each flood event and then summed these values for each year. We conducted a nested case-control analysis to evaluate the long-term effect of flooding exposure on all-cause and cause-specific mortality. Each case was matched with eight controls. Flooding exposure was modelled using a distributed lag non-linear model to capture its nonlinear and lagged effects. RESULTS: The risk of all-cause mortality increased by 6.7% (odds ratio (OR): 1.067, 95% confidence interval (CI): 1.063-1.071) for every unit increase in flood index after confounders had been controlled for. The mortality risk from neurological and mental diseases was negligible in the current year, but strongest in the lag years 3 and 4. By contrast, the risk of mortality from suicide was the strongest in the current year (OR: 1.018, 95% CI: 1.008-1.028), and attenuated to lag year 5. Participants with higher levels of education and household income had a higher estimated risk of death from most causes whereas the risk of suicide-related mortality was higher among participants who were obese, had lower household income, engaged in less physical activity, were non-moderate alcohol consumers, and those living in more deprived areas. CONCLUSIONS: Long-term exposure to floods is associated with an increased risk of mortality. The health consequences of flooding exposure would vary across different periods after the event, with different profiles of vulnerable populations identified for different causes of death. These findings contribute to a better understanding of the long-term impacts of flooding exposure.

Impact of extreme weather events on mental health in South and Southeast Asia: A two decades of systematic review of observational studies.

Extreme weather events in South and Southeast Asia exert profound psychosocial impacts, amplifying the prevalence of mental illness. Despite their substantial consequences, there is a dearth of research and representation in the current literature. We conducted a systematic review of observational studies published between January 1, 2000, and January 20, 2024, to examine the impact of extreme weather events on the mental health of the South and Southeast Asian population. Quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale (NOS) quality appraisal checklist. The search retrieved 70 studies that met the inclusion criteria and were included in our review. Most were from India (n = 22), and most used a cross-sectional study design (n = 55). Poor mental health outcomes were associated with six types of extreme weather events: floods, storm surges, typhoons, cyclones, extreme heat, and riverbank erosion. Most studies (n = 41) reported short-term outcome measurements. Findings included outcomes with predictable symptomatology, including post-traumatic stress disorder, depression, anxiety, general psychological distress, emotional distress and suicide. Limited studies on long-term effects showed higher mental disorders after floods and typhoons, while cyclone-exposed individuals had more short-term distress. Notably, the review identified over 50 risk factors influencing mental health outcomes, categorized into six classes: demographic, economic, health, disaster exposure, psychological, and community factors. However, the quantitative evidence linking extreme weather events to mental health was limited due to a lack of longitudinal data, lack of control groups, and the absence of objective exposure measurements. The review found some compelling evidence linking extreme weather events to adverse mental health in the South and Southeast Asia region. Future research should focus on longitudinal study design to identify the specific stressors and climatic factors influencing the relationship between climate extremes and mental health in this region.

An enhanced drought forecasting in coastal arid regions using deep learning approach with evaporation index.

Coastal arid regions are similar to deserts, where it receives significantly less rainfall, less than 10 cm. Perhaps the world's worst natural disaster, coastal area droughts, can only be detected using reliable monitoring systems. Creating a reliable drought forecast model and figuring out how well various models can analyze drought factors in coastal arid regions are two of the biggest obstacles in this field. Different time-series methods and machine-learning models have traditionally been utilized in forecasting strategies. Deep learning is promising when describing the complex interplay between coastal drought and its contributing variables. Considering the possibility of enhancing our understanding of drought features, applying deep learning approaches has yet to be tried widely. The current investigation employs a deep learning strategy. Coastal Drought indices are commonly used to comprehend the situation better; hence the Standard Precipitation Evaporation Index (SPEI) was used since it incorporates temperatures and precipitation into its computation. An integrated coastal drought monitoring model was presented and validated using convolutional long short-term memory with self-attention (SA-CLSTM). The Climatic Research Unit (CRU) dataset, which spans 1901-2018, was mined for the drought index and predictor data. To learn how LSTM forecasting could enhance drought forecasting, we analyzed the findings regarding numerous drought parameters (drought severity, drought category, or geographic variation). The model's ability to predict drought intensity was assessed using the Coefficient of Determination (R2), the Root Mean Square Error (RMSE), and the Mean Absolute Error (MAE). Both the SPEI 1 and SPEI 3 examples had R2 values more than 0.99 for the model. The range of predicted outcomes for each drought group was analyzed using a multi-class Receiver Operating Characteristic based Area under Curves (ROC-AUC) method. The research showed that the AUC for SPEI 1 was 0.99 and for SPEI 3, 0.99. The study's results indicate progress over machine learning models for one month in advance, accounting for various drought conditions. This work's findings may be used to mitigate drought, and additional improvement can be achieved by testing other models.

Exposure to earthquakes and development of ischemic heart disease.

BACKGROUND: The evidence regarding the effect of earthquake exposure on the development of cardiovascular diseases is limited. This study evaluated the association between the 2016 Gyeongju earthquake, which had a magnitude of 5.8, and over 600 subsequent aftershocks occurring within a year in Korea, with the development of ischemic heart disease (IHD) among residents of Gyeongju. METHODS: Ten years (2010-2019) of medical records from a randomly selected cohort of residents (n = 540,858) in Gyeongju and 3 control cities were acquired from the national health insurance service. Employing difference-in-difference and meta-analyses, the risks of IHD development of Gyeongju residents before (reference: Sep 2014 to Aug 2015; period 1: Sep 2015 to Aug 2016) and after (period 2: Sep 2016 to Aug 2017; period 3: Sep 2017 to Aug 2018; period 4: Sep 2018 to Aug 2019) the earthquake were estimated. RESULTS: The monthly average incidence of IHD in Gyeongju was 39.5 persons (per 1,000,000) for reference period and 38.4 persons for period 1. However, the number increased to 58.5 persons in period 2, and 49.8 persons in period 3, following the earthquake. The relative risk (RR) [with a 95% confidence interval] of developing IHD among Gyeongju residents increased by 1.58 times (1.43, 1.73) in period 2, 1.33 times (1.21, 1.46) in period 3, and 1.15 times (1.04, 1.27) in period 4, in comparison to both the control cities and the pre-earthquake reference period. The increase in RR was particularly noticeable among women, adults aged 25-44, and individuals with lower incomes. CONCLUSIONS: The major earthquake in Korea was associated with an increase in the development of IHD among local residents. Individuals exposed to earthquakes may benefit from cardiovascular health surveillance.

The impact of the 2021 flood on the outpatient care in the North Rhine region, Germany: a cross-sectional study.

BACKGROUND: In the summer of 2021, heavy precipitation led to extreme flooding across Western Europe. In Germany, North Rhine-Westphalia and Rhineland-Palatinate were particularly affected. More than 180 people lost their lives, and over 700 were left injured and traumatized. In the North Rhine district alone, more than 120 practices were only able to operate to a limited extent or had to close their practices completely. The aim of this study was to assess the impact of the 2021 flood on the outpatient care in the North Rhine region. METHODS: The cross-sectional study was conducted in January 2022 in practices affected by the flood in the North Rhine region. For this purpose, 210 affected practices were identified using a list of the Association of Statutory Health Insurance Physicians for North Rhine (KVNO) and via telephone and/or e-mail. These practices were forwarded a questionnaire that addressed, among other things, the local accessibility of the practices before and after the flood, possibilities of patient care in different premises and received support. RESULTS: A total of 103 practices (49.1%) returned the completed questionnaire, of which 1/4 were general practitioners. 97% of the practices reported power failure, more than 50% water supply damage and nearly 40% the loss of patient records. 76% of the participating practices stated that they needed to close their practice at least temporarily. 30 doctors took up patient care in alternative premises. The average number of patients seen by doctors per week before the flood was 206.5. In the first week working in alternative premises, doctors saw an average of 66.2 patients (-50.3%). Especially elderly/geriatric patients and patients with disabilities were identified as particularly vulnerable in terms of access to health care after the flood. CONCLUSIONS: The flood had a significant negative impact on outpatient care. We determined not only a high number of closed practices and a large decrease in patient numbers but also differences in patient care assessment depending on the type of alternative premises. To address outpatient care disruptions after extreme weather events more effectively, appropriate measures should be implemented pre-emptively.

Evaluation of the demographic characteristics and general health status of earthquake survivors affected by the 2023 Kahramanmaras earthquake; a section from Gaziantep Nurdagi district.

BACKGROUND: An earthquake with a magnitude of 7.7 occurred in Pazarcik District of Turkey at 04.17 on February 6, 2023 and another earthquake of 7.6 occurred at 13.24 on the same day. This is the second largest earthquake to have occurred in Turkey. The aim of this study is to investigate the earthquake-related level of knowledge, attitudes and behaviours, general health and psychological status of survivors who were affected by the 2023 Kahramanmaras Earthquake and who were living in Nurdagi District of Gaziantep after the earthquake. METHODS: Data of 2317 individuals older than 18 years of age who were living in earthquake neighbourhoods, tents and containers in Nurdagi District of Gaziantep were examined. Variables were evaluated to find out the demographic characteristics and general health status of earthquake victims. General Health Questionnaire (GHQ-12) was used to find out psychological states of earthquake victims. RESULTS: The rate of injuries was 14.2% and leg and foot injuries were the most common with 44.2%. The relationship between injury status; and age, marital status, and being trapped under debris was revealed (p < 0.05). Mean GHQ-12 score of the survivors was 3.81 ± 2.81 and 51.9% experienced psychological distress. In the evaluation with logistic regression, it was found that female gender, being injured in the earthquake, loss of first degree and second degree relatives (with a higher rate in loss of first degree relative), having a severely damaged -to be demolished house and having a completely destroyed house were correlated with higher level of psychological distress (p < 0.05). CONCLUSION: General characteristics, injury prevalence and affecting factors of earthquake survivors were evaluated in the present study. Psychological distress was found in victims. For this reason, providing protective and assistive services to fight the destructive effects of earthquake is vital. Accordingly, increasing the awareness of people residing in earthquake zones regarding earthquakes is exceptionally important.

Predictors of individual mental health and psychological resilience after Australia's 2019-2020 bushfires.

AIMS: We assessed the mental health effects of Australia's 2019-2020 bushfires 12-18 months later, predicting psychological distress and positive psychological outcomes from bushfire exposure and a range of demographic variables, and seeking insights to enhance disaster preparedness and resilience planning for different profiles of people. METHODS: We surveyed 3083 bushfire-affected and non-affected Australian residents about their experiences of bushfire, COVID-19, psychological distress (depression, anxiety, stress, post-traumatic stress disorder) and positive psychological outcomes (resilient coping, wellbeing). RESULTS: We found high rates of distress across all participants, exacerbated by severity of bushfire exposure. For people who were bushfire-affected, being older, having less financial stress, and having no or fewer pre-existing mental disorders predicted both lower distress and higher positive outcomes. Being male or having less income loss also predicted positive outcomes. Severity of exposure, higher education and higher COVID-19-related stressors predicted both higher distress and higher positive outcomes. Pre-existing physical health diagnosis and previous bushfire experience did not significantly predict distress or positive outcomes. RECOMMENDATIONS: To promote disaster resilience, we recommend investment in mental health, particularly for younger adults and for those in rural and remote areas. We also recommend investment in mechanisms to protect against financial distress and the development of a broader definition of bushfire-related impacts than is currently used to capture brushfires' far-reaching effects.

'School-based screen-and-treat': An effective blueprint for expediating access to care in children experiencing PTSD following disasters.

OBJECTIVES: While 5%-10% of children exposed to natural disasters develop PTSD, few children access support. This paper reports on the proactive 'screen-and-treat' approach deployed following devastating floods in Queensland, Australia, in 2011 and presents results for children in the Lockyer Valley (the most impacted community). DESIGN: Open treatment study (2011-2012) within a government-funded post-disaster service response. METHODS: One hundred and fifty children (7-12 years) completed pencil-and-paper screening (PTSD, anxiety and depression) at school. Eighty children endorsing either clinical levels of PTSD, or moderate levels of PTSD and clinical levels of either anxiety or depression, and their parents, completed a structured diagnostic interview. Forty-eight children were offered a free trauma-focused CBT intervention. The parents of 19 children accepted this offer. Most clinicians were clinical psychology trainees from local universities. All measures were repeated at post-treatment, 6- and 12-month follow-up. Note: The term 'parents' is used to refer to the wide variety of people serving as a child's primary caregiver. RESULTS: Pre-treatment, all children met diagnostic criteria for full (N = 17) or sub-clinical PTSD. By post-treatment, 10.5% met criteria for PTSD, with 0% meeting criteria at the 12-month follow-up. The incidence of anxiety and depressive disorders also reduced significantly. There were no differences in outcomes for children seen by trainees compared to experienced clinicians. CONCLUSIONS: A school-based screen-and-treat approach offers potential as a means of identifying and treating children following natural disaster exposure. However, engagement of families at the outset, and when offering intervention was challenging. Postgraduate trainees represent an effective potential workforce in a post-disaster environment.

Six-year follow-up study of residential displacement and health outcomes following the 2011 Japan Earthquake and Tsunami.

Studies examining the long-term health consequences of residential displacement following large-scale disasters remain sparse. Following the 2011 Japan Earthquake and Tsunami, victims who lost their homes were resettled by two primary means: 1) group relocation to public housing or 2) individual relocation, in which victims moved into public housing by lottery or arranged for their own accommodation. Little is known about how the specific method of residential relocation affects survivors' health. We examined the association between residential relocation and long-term changes in mental and physical well-being. Our baseline assessment predated the disaster by 7 mo. Two follow-up surveys were conducted ∼2.5 y and 5.5 y after the disaster to ascertain the long-term association between housing arrangement and health status. Group relocation was associated with increased body mass index and depressive symptoms at 2.5-y follow-up but was no longer significantly associated with these outcomes at 5.5-y follow-up. Individual relocation at each follow-up survey was associated with lower instrumental activities of daily living as well as higher risk of cognitive impairment. Our findings underscore the potential complexity of long-term outcomes associated with residential displacement, indicating both positive and negative impacts on mental versus physical dimensions of health.

An integrated approach to analyze equitable access to food stores under disasters from human mobility patterns.

Limited access to food stores is often linked to higher health risks and lower community resilience. Socially vulnerable populations experience persistent disparities in equitable food store access. However, little research has been done to examine how people's access to food stores is affected by natural disasters. Previous studies mainly focus on examining potential access using the travel distance to the nearest food store, which often falls short of capturing the actual access of people. Therefore, to fill this gap, this paper incorporates human mobility patterns into the measure of actual access, leveraging large-scale mobile phone data. Specifically, we propose a novel enhanced two-step floating catchment area method with travel preferences (E2SFCA-TP) to measure accessibility, which extends the traditional E2SFCA model by integrating actual human mobility behaviors. We then analyze people's actual access to grocery and convenience stores across both space and time under the devastating winter storm Uri in Harris County, Texas. Our results highlight the value of using human mobility patterns to better reflect people's actual access behaviors. The proposed E2SFCA-TP measure is more capable of capturing mobility variations in people's access, compared with the traditional E2SFCA measure. This paper provides insights into food store access across space and time, which could aid decision making in resource allocation to enhance accessibility and mitigate the risk of food insecurity in underserved areas.

Meta-analyses of motivational factors of response to natural disaster.

Response behavior of individuals is of critical importance to decrease chances of injury and death as well as ameliorate costs in property and infrastructure damage in natural disasters. Plenty of studies have examined which factors motivate individuals to respond to natural disasters. However, a systematic overview of the key motivating factors of various response behaviors is lacking. This study conducts a series of meta-analyses using data of 53,713 samples from 87 studies (77 papers) conducted in 27 different countries and regions to examine how 17 motivational factors were associated with individuals' response to natural disasters. The results indicate self-efficacy, outcome efficacy, attitudes, subjective norms, and information acquisition show the strongest effects on response behavior. Contrarily, the impact of negative affects like fear, depression, and anxiety on victims is minimal, despite the common assumption that they are significant related to response behaviour. In addition, current studies have disproportionally focused on studying risk perception, experience and information acquisition, earthquake and hurricane, and evacuation and preparation, while attention given to other types of motivational factors, disasters and response behaviors is lacking.

Experiences of nursing students providing support in disaster areas: A qualitative study.

This study was conducted as a qualitative inquiry to deeply explore the thoughts and experiences of nursing students involved in support activities in disaster areas. It was conducted as a qualitative study. Data for the study were collected through face-to-face interviews or video conferencing using a Personal Information Form and a Semi-Structured Interview Form created by the researcher. Data analysis was conducted using the MAXQDA software. The population of this qualitative study consisted of nursing students actively involved in support activities in 11 provinces affected by the magnitude of 7.7 earthquake centered in Kahramanmaras/Turkey. The sample of the study comprised nursing students who responded to our call shared with nursing student groups and met the inclusion criteria. Through qualitative analysis, three themes were identified: initial emotions experienced during the earthquake, difficulties faced during the earthquake process, and emotions following the earthquake experience. Students participating in support activities in the earthquake-affected region provided explanations regarding their emotions, encountered ethical dilemmas, infrastructure issues, as well as deficiencies in organization and education.

Impact of the Great East Japan Earthquake followed by the nuclear power plant accident on the nursing students' academic progress in Soma, Fukushima, Japan: a retrospective cohort study with questionnaire survey.

BACKGROUND: The Great East Japan Earthquake and the subsequent Fukushima nuclear power plant accident in 2011 posed significant challenges to the educational sector, particularly affecting nursing students in the disaster area. However, to the best of our knowledge, there are no reports on the effects of the natural disaster coupled with the nuclear accident on the nursing students. Therefore, this study aimed to determine the impact of the Fukushima disasters on rate of academic failure events in nursing education. METHODS: A retrospective cohort approach was conducted, focusing on 677 students from Soma Nursing School admitted between 2001 and 2017. Four failure events-failure to pass the national examination, student retention, suspension, and withdrawal from school-were compared between three time periods: pre-disaster, early peri-disaster, and later peri-disaster. This analysis was followed by a questionnaire survey among the students and an interview with faculty members to gain further insights. RESULTS: Of the student cohort, 17% had at least one failure event. Students in the later peri-disaster phase faced an elevated failure rate at 29%. Variables such as being male, admission during later peri-disaster period, and local pre-admission residence played a significant role in these failure events in multivariate logistic regression analysis (adjusted odds ratio [95% confidence interval, p value]; 2.63 [1.49-4.64, < 0.001], 3.207 [2.00-5.15, < 0.001], and 1.84 [1.12-3.02, 0.02], respectively). CONCLUSIONS: This study highlights the impact of the Great East Japan Earthquake and the following nuclear accident on nursing education. The elevated failure rates in the later peri-disaster period emphasize the challenges posed by continuing disaster phases. Thus, there is a need for intensified and tailored strategies in nursing education in disaster-affected regions.

Enhancing natural disaster analysis and waste classification: a novel VGG-FL approach.

The study of natural disasters is a crucial field that involves analyzing the occurrence, impact, and aftermath of various natural hazards that can cause significant harm to communities and the environment. Efficient waste management and environmental protection require proper classification of waste. Analyzing natural disasters and categorizing waste can be a time-consuming task, and conventional methods often struggle with it. However, a new approach called Visual Geometry Group with Federated Learning (VGG-FL) has been introduced to address these challenges. This methodology uses the golden search optimization (GSO) algorithm for feature selection and leverages VGG with federated learning for feature extraction and classification. To test the effectiveness of this method, a disaster image dataset was used to train the VGG-FL model. The results showed that the VGG-FL model attained exceptional accuracy in discerning and categorizing various disaster scenarios. The waste classification dataset simultaneously trains the VGG-FL model to categorize waste based on its characteristics and potential hazards. To measure the model's performance, several evaluation metrics such as accuracy, specificity, precision, F1-score, and recall are utilized to assess the effectiveness of the proposed VGG-FL method. These results are then compared with existing methodologies. The VGG-FL method performs exceptionally well, achieving 98.52% accuracy, 97.48% precision, 97.83% recall, 97.58% F1-score, and 97.12% specificity. These experimental findings demonstrate the efficacy of the VGG-FL method in analyzing natural disasters and classifying waste materials.

Young people's experiences of the Northern Rivers 2017 flood and its effects on their mental health.

OBJECTIVE: To explore young people's (YP) experiences of catastrophic flooding in the Northern Rivers area of northern NSW in 2017 and its effect on their mental health. DESIGN: Content analysis of free-text survey responses (written responses to open questions, rather than selecting a response option). SETTING: Northern Rivers NSW. PARTICIPANTS: YP aged 16-25 years who were Northern Rivers residents at the time of the 2017 flood. RESULTS: YP found their flood experience to be novel and challenging. They expressed worry, distress, anxiety, and worsened pre-existing mental health issues as a result of the flood. YP reported a number of primary stressors (inadequate preparedness, warning and support during the flood) and secondary stressors (loss/damage of property and possessions, financial strain and disruptions to daily life) which potentially contributed to poor mental health. Some YP reported positive outcomes from their flood experience, notably increased community connectedness and personal resilience. However, they also expressed concern for the future, particularly potential reoccurrence of extreme floods as well as climate change. YP conveyed a desire for better community involvement to improve preparedness for future floods and a clear motivation to take action on climate change. CONCLUSION: The flood was a challenging experience for YP which was commonly described as negatively affecting their mental health. Understanding what YP view as significant events or issues arising from their personal flood experience may help target support mechanisms and services to maintain their mental. More focus on community-based initiatives to improve disaster preparedness can support mental health in YP.

Extreme events, educational aspirations, and long-term outcomes.

The 2004 Indian Ocean tsunami was an extremely destructive event in Aceh, Indonesia, killing over 160,000 people and destroying infrastructure, homes, and livelihoods over miles of coastline. In its immediate aftermath, affected populations faced a daunting array of challenges. At the population level, questions of how the disaster affected children's and parents' aspirations for education and whether it permanently disrupted schooling progression are critical in understanding how shocks affect human capital in the short and long term. We use longitudinal data from the Study of the Tsunami Aftermath and Recovery (STAR) to examine how disaster exposure affects educational aspirations and eventual attainment. We find that damage to one's community depresses aspirations in the short term but that this weakens with time. With respect to educational attainment 15 years after the event, children's aspirations, parents' education, and family socioeconomic status are more important determinants of whether children complete high school and go on to tertiary schooling than disaster exposure. While these results likely reflect, at least in part, the successful post-tsunami reconstruction program, they also establish enormous resilience among survivors who bore the brunt of the tsunami.

Uncovering Heterogeneous Associations Between Disaster-Related Trauma and Subsequent Functional Limitations: A Machine-Learning Approach.

This study examined heterogeneity in the association between disaster-related home loss and functional limitations of older adults, and identified characteristics of vulnerable subpopulations. Data were from a prospective cohort study of Japanese older survivors of the 2011 Japan Earthquake. Complete home loss was objectively assessed. Outcomes in 2013 (n = 3,350) and 2016 (n = 2,664) included certified physical disability levels, self-reported activities of daily living, and instrumental activities of daily living. We estimated population average associations between home loss and functional limitations via targeted maximum likelihood estimation with SuperLearning and its heterogeneity via the generalized random forest algorithm. We adjusted for 55 characteristics of survivors from the baseline survey conducted 7 months before the disaster. While home loss was consistently associated with increased functional limitations on average, there was evidence of effect heterogeneity for all outcomes. Comparing the most and least vulnerable groups, the most vulnerable group tended to be older, not married, living alone, and not working, with preexisting health problems before the disaster. Individuals who were less educated but had higher income also appeared vulnerable for some outcomes. Our inductive approach for effect heterogeneity using machine learning algorithm uncovered large and complex heterogeneity in postdisaster functional limitations among Japanese older survivors.

Hurricane Florence and suicide mortality in North Carolina: a controlled interrupted time-series analysis.

BACKGROUND: Natural disasters are associated with increased mental health disorders and suicidal ideation; however, associations with suicide deaths are not well understood. We explored how Hurricane Florence, which made landfall in September 2018, may have impacted suicide deaths in North Carolina (NC). METHODS: We used publicly available NC death records data to estimate associations between Hurricane Florence and monthly suicide death rates using a controlled, interrupted time series analysis. Hurricane exposure was determined by using county-level support designations from the Federal Emergency Management Agency. We examined effect modification by sex, age group, and race/ethnicity. RESULTS: 8363 suicide deaths occurred between January 2014 and December 2019. The overall suicide death rate in NC between 2014 and 2019 was 15.53 per 100 000 person-years (95% CI 15.20 to 15.87). Post-Hurricane, there was a small, immediate increase in the suicide death rate among exposed counties (0.89/100 000 PY; 95% CI -2.69 to 4.48). Comparing exposed and unexposed counties, there was no sustained post-Hurricane Florence change in suicide death rate trends (0.02/100 000 PY per month; 95% CI -0.33 to 0.38). Relative to 2018, NC experienced a statewide decline in suicides in 2019. An immediate increase in suicide deaths in Hurricane-affected counties versus Hurricane-unaffected counties was observed among women, people under age 65 and non-Hispanic black individuals, but there was no sustained change in the months after Hurricane Florence. CONCLUSIONS: Although results did not indicate a strong post-Hurricane Florence impact on suicide rates, subgroup analysis suggests differential impacts of Hurricane Florence on several groups, warranting future follow-up.