Facilitated Look-Back Analysis of Public Health Emergencies to Enhance Preparedness: A Brief Report of a Chemical Spill in Charleston, West Virginia.

To demonstrate how public health emergency systems can use health systems tools to analyze and learn from critical incidents, we employed a facilitated look-back approach to review the public response to a chemical spill in Charleston, West Virginia. We reviewed official reports, news articles, and other documents; conducted in-person interviews with key public health and emergency response officials and local community stakeholders; and organized a facilitated look-back meeting to identify root causes of the problems that were encountered. The primary response challenges were (1) public distrust stemming from scientific uncertainty about potential harms of chemicals involved in the spill and how this uncertainty was communicated and (2) communication within the public health system, broadly defined. We found that to address inherent uncertainty, health officials should acknowledge uncertainty and tell the public what is known and unknown, and what they are doing to get more information.

Persistent Distress after Water Contamination.

Background: A chemical spill contaminated the public water supply of Charleston, West Virginia in January 2014 for at least a week. Psychological distress is common after disasters. Methods: We surveyed the exposed population to assess psychological distress during and three months after the incident. We inquired about stressors that might predict distress, adequacy of communication from public officials, and use of the water supply and perceptions of its safety three months after the incident. Results: Twenty six percent of interviewees had persistent symptoms of distress. Female sex, negative household experiences during the episode (especially having someone sick), and poor perception of communication increased odds of persistent distress. Households of respondents without persistent distress were significantly more likely to report drinking tap water (RR=1.95) than those with persistent distress. Conclusions: Distress in Charleston area residents persisted and may have resulted in continuing mistrust of the water supply.

Public response to the 2014 chemical spill in West Virginia: knowledge, opinions and behaviours.

BACKGROUND: On January 9(th) 2014, a faulty storage tank leaked 10,000 gal of an industrial coal processing liquid into the Elk River in West Virginia (WV), contaminating the drinking water of the nine counties collectively known as the Kanawha Valley. The aim of this study was to 1) explore how and when people obtained information about the water contamination and 2) understand how individual and social factors such as socio-demographic characteristics, timing of information, trust in government, and risk perception influenced compliance with recommended behaviours and the public's views on the need for environmental regulations. METHODS: Between February 7-26, 2014, a survey was conducted of adult residents of West Virginia including geographic areas affected and non-affected by the chemical spill. The total population-based sample size was 690 and the survey was administered online. Descriptive statistics and multivariate statistical models were created to determine what factors influenced compliance and public opinions. RESULTS: Findings from this study show that, during the 2014 West Virginia water crisis, information about water contamination spread quickly, as 73 % of survey respondents across the state and 89 % within the affected counties reported they heard about the incident the same day it occurred. Most people received the information promptly, understood what happened, and understood what to do to prevent exposure to the contaminant. The majority of respondents living in affected counties (70 %) followed the recommended behaviours. Among participants who voiced an opinion on the role of government in environmental regulations, the majority of respondents (54 %) reported there is "too little regulation." CONCLUSION: Data from this study show that a higher perception of risk and timely receipt of information are associated with compliance with recommended behaviours, underlying the importance of releasing information to the public as quickly as possible during a crisis. This study also highlights the importance of coordinating risk communication activities beyond the area of the incident to assure public understanding of what measures are recommended, which are not and where.

Correction: Self-Reported Household Impacts of Large-Scale Chemical Contamination of the Public Water Supply, Charleston, West Virginia, USA.

[This corrects the article DOI: 10.1371/journal.pone.0126744.].

Self-reported household impacts of large-scale chemical contamination of the public water supply, Charleston, West Virginia, USA.

A January 2014 industrial accident contaminated the public water supply of approximately 300,000 homes in and near Charleston, West Virginia (USA) with low levels of a strongly-smelling substance consisting principally of 4-methylcyclohexane methanol (MCHM). The ensuing state of emergency closed schools and businesses. Hundreds of people sought medical care for symptoms they related to the incident. We surveyed 498 households by telephone to assess the episode's health and economic impact as well as public perception of risk communication by responsible officials. Thirty two percent of households (159/498) reported someone with illness believed to be related to the chemical spill, chiefly dermatological or gastrointestinal symptoms. Respondents experienced more frequent symptoms of psychological distress during and within 30 days of the emergency than 90 days later. Sixty-seven respondent households (13%) had someone miss work because of the crisis, missing a median of 3 days of work. Of 443 households reporting extra expenses due to the crisis, 46% spent less than $100, while 10% spent over $500 (estimated average about $206). More than 80% (401/485) households learned of the spill the same day it occurred. More than 2/3 of households complied fully with "do not use" orders that were issued; only 8% reported drinking water against advice. Household assessments of official communications varied by source, with local officials receiving an average "B" rating, whereas some federal and water company communication received a "D" grade. More than 90% of households obtained safe water from distribution centers or stores during the emergency. We conclude that the spill had major economic impact with substantial numbers of individuals reporting incident-related illnesses and psychological distress. Authorities were successful supplying emergency drinking water, but less so with risk communication.

Comprehensive tobacco control policies in West Virginia--going from intersection to integration.

INTRODUCTION: Currently, there exists a sufficient robust evidence base for effective tobacco control interventions. Yet, despite this progress, we as a nation and state are not currently on track to achieve the Healthy People 2020 objective to reduce cigarette smoking among adults to 12 percent or less by the year 2020. We examine state selected specific data and make recommendations on initiating an approach to policy that may lead us to further integrate tobacco control programs in West Virginia at a community level. METHODS: We utilized the publicly available data to compare the historical performance of West Virginia with its select neighboring states (Ohio, Kentucky, Tennessee, Virginia, and Pennsylvania) in the areas of daily adult smoking rates, productivity losses, smoking-attributable mortality and per pack state cigarette taxes. RESULTS: West Virginia's adult daily smoking rates have not declined in proportion when compared with the rest of the nation or even surrounding states. We have suffered more dollars in productivity lost per person, and higher smoking-attributable mortality while having one of the lowest state taxes on a pack of cigarettes. CONCLUSION: Whereas research has well documented the effectiveness of laws and policies in a comprehensive tobacco control effort to protect the public from smoking related morbidity and mortality, as a state, we must begin to understand that the individual components of the comprehensive program are most effective when they work together at community levels to produce the synergistic effects. Therefore we strongly recommend our state legislature and policy makers consider tobacco control funding mechanisms that promote such integrated strategies at the local community level.