Learning to coexist with wildfire.

The impacts of escalating wildfire in many regions - the lives and homes lost, the expense of suppression and the damage to ecosystem services - necessitate a more sustainable coexistence with wildfire. Climate change and continued development on fire-prone landscapes will only compound current problems. Emerging strategies for managing ecosystems and mitigating risks to human communities provide some hope, although greater recognition of their inherent variation and links is crucial. Without a more integrated framework, fire will never operate as a natural ecosystem process, and the impact on society will continue to grow. A more coordinated approach to risk management and land-use planning in these coupled systems is needed.

Integrating Subjective and Objective Dimensions of Resilience in Fire-Prone Landscapes.

Resilience has become a common goal for science-based natural resource management, particularly in the context of changing climate and disturbance regimes. Integrating varying perspectives and definitions of resilience is a complex and often unrecognized challenge to applying resilience concepts to social-ecological systems (SESs) management. Using wildfire as an example, we develop a framework to expose and separate two important dimensions of resilience: the inherent properties that maintain structure, function, or states of an SES and the human perceptions of desirable or valued components of an SES. In doing so, the framework distinguishes between value-free and human-derived, value-explicit dimensions of resilience. Four archetypal scenarios highlight that ecological resilience and human values do not always align and that recognizing and anticipating potential misalignment is critical for developing effective management goals. Our framework clarifies existing resilience theory, connects literature across disciplines, and facilitates use of the resilience concept in research and land-management applications.

Should I Stay or Should I Go Now? Or Should I Wait and See? Influences on Wildfire Evacuation Decisions.

As climate change has contributed to longer fire seasons and populations living in fire-prone ecosystems increase, wildfires have begun to affect a growing number of people. As a result, interest in understanding the wildfire evacuation decision process has increased. Of particular interest is understanding why some people leave early, some choose to stay and defend their homes, and others wait to assess conditions before making a final decision. Individuals who tend to wait and see are of particular concern given the dangers of late evacuation. To understand what factors might influence different decisions, we surveyed homeowners in three areas in the United States that recently experienced a wildfire. The Protective Action Decision Model was used to identify a suite of factors previously identified as potentially relevant to evacuation decisions. Our results indicate that different beliefs about the efficacy of a particular response or action (evacuating or staying to defend), differences in risk attitudes, and emphasis on different cues to act (e.g., official warnings, environmental cues) are key factors underlying different responses. Further, latent class analysis indicates there are two general classes of individuals: those inclined to evacuate and those inclined to stay, and that a substantial portion of each class falls into the wait and see category.

Collaborative implementation for ecological restoration on US Public Lands: implications for legal context, accountability, and adaptive management.

The Collaborative Forest Landscape Restoration Program (CFLRP), established in 2009, encourages collaborative landscape scale ecosystem restoration efforts on United States Forest Service (USFS) lands. Although the USFS employees have experience engaging in collaborative planning, CFLRP requires collaboration in implementation, a domain where little prior experience can be drawn on for guidance. The purpose of this research is to identify the ways in which CFLRP's collaborative participants and agency personnel conceptualize how stakeholders can contribute to implementation on landscape scale restoration projects, and to build theory on dynamics of collaborative implementation in environmental management. This research uses a grounded theory methodology to explore collaborative implementation from the perspectives and experiences of participants in landscapes selected as part of the CFLRP in 2010. Interviewees characterized collaborative implementation as encompassing three different types of activities: prioritization, enhancing treatments, and multiparty monitoring. The paper describes examples of activities in each of these categories and then identifies ways in which collaborative implementation in the context of CFLRP (1) is both hindered and enabled by overlapping legal mandates about agency collaboration, (2) creates opportunities for expanded accountability through informal and relational means, and, (3) creates feedback loops at multiple temporal and spatial scales through which monitoring information, prioritization, and implementation actions shape restoration work both within and across projects throughout the landscape creating more robust opportunities for adaptive management.

Public acceptance of wildland fire and fuel management: panel responses in seven locations.

Wildland fire affects both public and private resources throughout the United States. A century of fire suppression has contributed to changing ecological conditions and accumulated fuel loads. Managers have used a variety of approaches to address these conditions and reduce the likelihood of wildland fires that may result in adverse ecological impacts and threaten communities. Public acceptance is a critical component of developing and implementing successful management programs. This study examines the factors that influence citizen support for agency fuel reduction treatments over time-particularly prescribed fire and mechanical vegetation removal. This paper presents findings from a longitudinal study examining resident beliefs and attitudes regarding fire management and fuels treatments in seven states: Arizona, Colorado, Oregon, Utah, Michigan, Minnesota, and Wisconsin. The study was implemented in two phases over a 6-year period using mail surveys to residents of communities adjacent to federal lands in each location. Questions replicated measures from the original project as well as some new items to allow a more in-depth analysis of key concepts. The study design enables comparisons over time as well as between locations. We also assess the factors that influence acceptance of both prescribed fire and mechanical vegetation removal. Findings demonstrate a relative stability of attitudes toward fuels management approaches over time and suggest that this acceptance is strongly influenced by confidence in resource managers and beliefs that the treatments would result in positive outcomes.

Outreach programs, peer pressure, and common sense: what motivates homeowners to mitigate wildfire risk?

In recent years, altered forest conditions, climate change, and the increasing numbers of homes built in fire prone areas has meant that wildfires are affecting more people. An important part of minimizing the potential negative impacts of wildfire is engaging homeowners in mitigating the fire hazard on their land. It is therefore important to understand what makes homeowners more or less willing to take action. The research presented here comes from a study that interviewed a total of 198 homeowners in six communities in the western United States about the activities they had undertaken to mitigate their fire risk, the factors that contributed to their decisions, and their future intentions. The current paper reports on findings from the first half of the longitudinal study, after 3 years we will return to interview the current homeowner on the same properties to assess maintenance actions and facilitating and limiting factors. Overall we found a body of individuals who understand the fire risk, are taking numerous mitigation actions, and think that these actions have reduced their risk. These homeowners typically did not expect the government to do it for them: they wanted information about what to do and, in some cases, assistance with the work, but saw taking care of their property primarily as their responsibility. Responses also show that key information sources and motivating factors vary by location and that it is not inherently necessary to have relationships between community members to create defensible space.

The impact of breast cancer-related lymphedema on rural and small-town Survivors' return-to-work and quality of life: A multiple-case study.

BACKGROUND: Breast cancer-related lymphedema (BCRL) is a lifelong condition. Millions who develop breast cancer are younger than retirement age and at a lifetime risk for developing BCRL. Rural and small-town survivors may face unique challenges in terms of access to health care and BCRL/survivorship resources. This multiple-case study describes how BCRL influences the work experiences and quality of life (QoL) of survivors living in rural and small towns in Missouri. METHODS AND MATERIALS: Thirteen survivors from rural and small towns in Missouri completed semi-structured interviews and a standardized QoL instrument. Cases were analyzed using in-vivo and open-coding techniques and constant cross-case comparative methods. Twelve of the 13 participants' data are synthesized into themes to represent an illustrative case. The 13th case is presented as a contradictory (rival) case. RESULTS: Four themes are represented within the illustrative case - multiple medical encounters; the development of self-care routines; the reciprocity of work/live activities, triggers, and adjustments; and rural/small-town cultural impact. Upon BCRL diagnosis, survivors received intensive treatments, eventually establishing self-care routines. Survivors identified strategies for working around their BCRL when completing work and home responsibilities. The contradictory (rival) case was more recently diagnosed and, as such, had not established self-care and coping mechanisms in the same way. CONCLUSIONS AND IMPLICATIONS: Survivors alleviate BCRL symptoms and improve their QoL by establishing self-care strategies. This provides guidance for client-centered survivorship care-planning and occupational rehabilitation of rural survivors with BCRL. This study provides the foundation for developing information for rural survivors that supports mental preparation and coping skills for BCRL self-management.

Identification of patients at increased risk for colorectal cancer in an open access endoscopy center.

GOALS: To determine whether patients referred for open access endoscopy (OAE) are being appropriately identified as "increased risk" or "average risk" for colorectal cancer (CRC) by referring physicians. BACKGROUND: OAE allows nongastroenterologists to schedule elective endoscopies without prior consultation with a gastroenterologist. It is unknown how accurately referring physicians identify CRC risk of such patients. METHODS: We retrospectively reviewed the records of outpatients referred to a single OAE center for screening or surveillance colonoscopy from July 1, 2001 to November 8, 2002. Before colonoscopy, a 3-question tool was used to stratify each patient as average risk or increased risk for CRC. CRC risk assessment was compared with the referring physician's indication for colonoscopy. Chi-square testing was used to compare the incidence of neoplastic polyps between average risk and increased risk patients. RESULTS: Two hundred eighty-eight patients met inclusion criteria. Referring physicians accurately identified 61% of 126 increased risk patients, including 13 of 19 patients (68%) with a personal history of CRC, 29 of 61 patients (48%) with a family history of CRC, 47 of 61 patients (77%) with a personal history of colonic polyps, and 0 of 8 patients (0%) who met clinical criteria for hereditary nonpolyposis colorectal cancer. Adenomatous polyps were found in 24% of average risk patients compared with 41% of increased risk patients (P<0.01). CONCLUSIONS: In an OAE system, referring physicians often fail to correctly identify patients at increased risk for CRC. Our 3-question tool for risk assessment helps to better identify patients at increased risk of CRC and can be used by gastroenterologists to stratify patients referred for OAE.

An Ecosystems and Vulnerable Populations Perspective on Solastalgia and Psychological Distress After a Wildfire.

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

Effect of genetic cancer risk assessment on surgical decisions at breast cancer diagnosis.

HYPOTHESIS: Breast cancer gene (BRCA) mutation status affects patients' surgical decisions when genetic cancer risk assessment is offered at the time of breast cancer diagnosis, prior to definitive treatment. PATIENTS AND INTERVENTIONS: Outcomes following genetic cancer risk assessment were studied for women newly diagnosed as having breast cancer who were prospectively enrolled in an institutional review board-approved hereditary cancer registry during a 1-year sampling frame. BRCA gene analysis was offered to subjects with a calculated mutation probability of 10% or higher. Review of medical records and telephone survey were used to document surgical treatment decisions following genetic cancer risk assessment. RESULTS: Thirty-seven of 233 women in the registry were enrolled at the time of a breast cancer diagnosis. The interval from diagnosis to genetic cancer risk assessment ranged from 3 to 60 days. The mean calculated probability of a BRCA gene mutation was 21% across the cohort. Two women were not tested because of low prior probabilities of mutation detection, and 3 declined owing to intercurrent psychological stressors. Of the remaining 32 patients, no BRCA gene mutation was detected in 22 (69%), 3 (9%) were found to carry a variant of uncertain significance, and 7 (22%) had a deleterious mutation. All 7 subjects with a deleterious mutation opted for bilateral mastectomy, whereas 20 of 22 patients with negative test results chose stage-appropriate treatment (P<.001). CONCLUSIONS: Genetic cancer risk assessment at the time of breast cancer diagnosis significantly affected women's treatment decisions. Although need and feasibility are demonstrated, the logistics of genetic cancer risk assessment during breast cancer diagnosis prove challenging.

Racial and gender disparities in hereditary colorectal cancer risk assessment: the role of family history.

BACKGROUND: In this study, we aimed to examine racial/ethnic and gender differences in self-reported family cancer history knowledge in patients at high risk for hereditary colon cancer syndromes. METHODS: We performed retrospective analysis of all referrals to the University of Chicago High Risk Colon Cancer Clinic between 1995 and 2003. RESULTS: We found hereditary nonpolyposis colorectal cancer and familial adenomatous polyposis in 17% and 9% of Whites, respectively, and 6% and 0% of Blacks, respectively. Unknown paternal history was found in 6.5% of Whites and 18.9% of Blacks (23% men, 11% women). CONCLUSIONS: Blacks and men had significantly decreased rates of paternal history cancer knowledge.