The effects of cumulative natural disaster exposure on adolescent psychological distress.

Natural disasters are becoming more frequent and destructive due to climate change and have been shown to be associated with a variety of adverse mental health outcomes in children and adolescents. This study utilizes data from three cohort studies of Hurricane Katrina survivors-including low-income mothers from New Orleans; displaced and highly impacted families from Louisiana and Mississippi; and Vietnamese immigrants in New Orleans-to examine the relationship between cumulative natural disaster exposure and adolescent psychological distress approximately 13 years after Katrina. Among 648 respondents with children ages 10-17, 112 (17.2%) reported that their child had exhibited one or more symptoms of psychological distress in the past month. Overall, respondents had experienced an average of 0.6 (SD 1.0) natural disasters following Hurricane Katrina. Each additional natural disaster experienced by the respondent was associated with 1.41 (95% CI 1.05, 1.88) greater odds of his or child experiencing psychological distress in the past month. This relationship was not significantly moderated by any measures of family resilience or vulnerability, nor by race/ethnicity or socioeconomic status, although family functioning, parental coping, and caregiver mental health were independently associated with adolescent psychological distress. The results of this analysis suggest that natural disasters have cumulative, detrimental impacts on adolescent mental health.

Disparities in health care among Vietnamese New Orleanians and the impacts of Hurricane Katrina.

This paper examines the use of routine health care and disparities by socio-economic status among Vietnamese New Orleanians. It also assesses how these differences may have changed as the result of Hurricane Katrina, which struck the Gulf Coast in late summer 2005, devastating the infrastructure of the health care system of New Orleans. Data for this study come from a panel of Vietnamese New Orleanians who were interviewed in 2005, just weeks before the hurricane, and followed up twice near the disaster's anniversary in 2006 and 2007. Findings show a steep declining trend in routine health care after the hurricane, compared to 2005. Marked differences in health care were already apparent in 2005 (before Katrina) between education levels, home ownership, and health insurance coverage. These differences were significantly reduced one year after the hurricane. We argue, however, that the reduction in disparities was not due to improved health care services or improved health care practice. Instead, it was likely due to the influx of free health care services that were provided to meet urgent needs of hurricane survivors while the area's infrastructure was devastated. By 2007, these free health care services were no longer widely available. Routine health visits dropped further and the temporary reduction in disparities disappeared. The paper also underlines ongoing shortages of essential health care services for Vietnamese New Orleanians. Efforts need to ensure that all members of this community receive the full array of comprehensive and culturally-appropriate health care as they continue to rebuild from the Katrina disaster.

Effect of family planning services on modern contraceptive method continuation in Vietnam.

Access to and quality of services have increasingly been the focus of family planning programme managers, implementers and researchers in the developing world. In Vietnam, a country characterized by recent significant achievements in family planning, not much is known about the linkages between service accessibility and quality and contraceptive behaviour. Data for this study come from the Vietnam 1997 Demographic and Health Survey, with individual contraceptive use information recorded in the calendar section. Measures of access to and quality of services come from the Community/Health Facility Questionnaire, with key informant interviews and facility visits. The study focuses on the effects of the outreach programme and commune health centres on contraceptive method discontinuation for three modern, temporary methods: the IUD, oral pills and condoms. Longer travel time to commune health centres is found to be associated with significantly increased risks of first- and all-method discontinuation for any reason, while residence in communities with higher quality health centres is associated with significantly lower risks of method discontinuation. Access to and quality of the outreach programme are, in contrast, not significant determinants of method discontinuation for any reason. Similar results are found for first- and all-method discontinuation for service-related reasons. The effects of programmatic factors are more pronounced among older women and during the first three months of method use. This study provides evidence for the importance of family planning services for contraceptive method continuation in Vietnam. The results also highlight the need for a thorough evaluation of the family planning outreach programme in terms of its facilitation of women's continued use of contraception.

Impact of an entertainment-education television drama on health knowledge and behavior in Bangladesh: an application of propensity score matching.

Shabuj Chaya is a weekly television drama broadcast during a 13-week period in Bangladesh in 2000. It used an entertainment-education format to increase health knowledge and to promote visits to health clinic and modern contraceptive use. The purpose of this article is to demonstrate how a relatively new statistical technique, propensity score matching in conjunction with structural equation modeling, can be used to obtain an unbiased estimate of changes in health outcomes that can be attributed to exposure to the drama. The analysis is conducted with data from an after-only, cross-sectional survey of 4,492 men and women from the intended audience. The results from propensity score matching approximate what would be expected from a randomized control group design.