Medium-Term Post-Katrina Health Sequelae Son Chae Kim PhD, RN Quynh Bui Gredig MSN, RN Ruth L. Plumb MSN, RN Larry Rankin PhD, RN Barbara Taylor PhD, RN.

Medium-Term Post-Katrina Medium-Term Post-Katrina Health SequelaeHealth Sequelae

Son Chae Kim PhD, RNSon Chae Kim PhD, RNQuynh Bui Gredig MSN, RNQuynh Bui Gredig MSN, RN

Ruth L. Plumb MSN, RN Ruth L. Plumb MSN, RN Larry Rankin PhD, RNLarry Rankin PhD, RN

Barbara Taylor PhD, RNBarbara Taylor PhD, RN

Pre-KatrinaPre-Katrina

High poverty levels: High poverty levels: 22ndnd worse state worse state

12% unemployment rate:12% unemployment rate: Twice national averageTwice national average

21% receive food stamps:21% receive food stamps: Three times national average (Three times national average (Louisiana Department Louisiana Department

of Health and Hospitals, 2005)of Health and Hospitals, 2005)

20% of Jefferson Parish eligible for Medicaid20% of Jefferson Parish eligible for Medicaid

Hurricane KatrinaHurricane Katrina

August 29, 2005August 29, 2005

The Christian Science Monitor, The Christian Science Monitor, http://www.csmonitor.com/slideshows/katrina2/slide3.html

Hurricane RitaHurricane Rita

September 24, 2005September 24, 2005

Wikimedia Commons, Wikimedia Commons, http://commons.wikimedia.org/wiki/Image:Hurricane_Rita_200509240900-3-Day_Cone.gif

Wikipedia, Wikipedia, http://en.wikipedia.org/wiki/Hurricane_Katrina

BackgroundBackgroundShort-term Post-KatrinaShort-term Post-Katrina

2 weeks post-Katrina: (Millin, et al. 2006)2 weeks post-Katrina: (Millin, et al. 2006) >40% clinic visits for chronic illness management>40% clinic visits for chronic illness management

4 -8 Months Post-Katrina: (Weisler, et al., 2006)4 -8 Months Post-Katrina: (Weisler, et al., 2006) Suicide rates Suicide rates ↑↑ X 3 X 3 Murder rates Murder rates ↑ ↑ 37% over pre-Katrina rates 37% over pre-Katrina rates

1 Year Post-Katrina: (Lambrew & Shalala, 2006)1 Year Post-Katrina: (Lambrew & Shalala, 2006) Many hospitals remained closed, including Charity Many hospitals remained closed, including Charity

hospitalhospital

PurposePurpose

To describe medium-term effects on living To describe medium-term effects on living environment, health status & healthcare environment, health status & healthcare accessaccess

To assess medium-term mental and physical To assess medium-term mental and physical health 15 months post-Katrinahealth 15 months post-Katrina

To determine demographic, social & To determine demographic, social & environmental factors that predict poor environmental factors that predict poor mental & physical healthmental & physical health

Method Method

Study Design: Cross sectional surveyStudy Design: Cross sectional survey Sampling: A convenience sample (Sampling: A convenience sample (NN=222) =222)

Inclusion Criteria: age 18yrs or older, currently Inclusion Criteria: age 18yrs or older, currently living or working in the area, able to speak and living or working in the area, able to speak and understand English.understand English.

Study Duration: December 16 -18, 2006Study Duration: December 16 -18, 2006

MethodMethod

Questionnaire: survey items were selected Questionnaire: survey items were selected Behavioral risk Factor Surveillance System Behavioral risk Factor Surveillance System

(BRFSS)(BRFSS) MMWR Morbidity and Mortality Weekly ReportMMWR Morbidity and Mortality Weekly Report United States Department of AgricultureUnited States Department of Agriculture Previous reports on disaster-related studiesPrevious reports on disaster-related studies

MethodMethod

Approved by PLNU IRBApproved by PLNU IRB Data collectionData collection

Data collector trainingData collector training 6 teams of faculty, MSN, & BSN students6 teams of faculty, MSN, & BSN students Door-to-door survey & Health FairDoor-to-door survey & Health Fair

Structured Interview ProcessStructured Interview Process

Data Analysis:Data Analysis: Descriptive StatisticsDescriptive Statistics Multivariate Logistic RegressionMultivariate Logistic Regression

Participants CharacteristicsParticipants CharacteristicsParticipants Characteristics (N=222)

0% 20% 40% 60% 80% 100%

35-64 y/o

Not Married

Black

Female

Post HS ed.

Unemployed

Descriptive StatisticsDescriptive Statistics

Living Environment 27% living below poverty line 15% difficulty accessing clean drinking water 26% eating less than they should due to lack

of money 23% feeling unsafe from crime

Descriptive StatisticsDescriptive Statistics

Healthcare AccessHealthcare Access

Sources of Health Care Service

0%10%20%30%

40%50%60%

Physician's Office Hospital or ER No Source ofHealthcare

Per

cen

t o

f R

esp

on

den

ts

Pre-Katrina

15 Moths Post-Katrina

Source of Health Care Coverage

0%10%20%30%40%50%

PrivateInsurance

GovernmentAid

No Source ofCoverage

Not Sure

Per

cen

t o

f R

esp

on

den

ts

Pre-Katrina

15 Months Post-Katrina

Healthcare StatusHealthcare Status

Mental and Physical Health Diagnoses (N=222)

DiagnosesPre-Katrina

n (%)Post-Katrina

n (%)Totaln (%)

Depression 18 (8) 29 (13) 47 (21)

Hypertension 88 (40) 10 (5) 98 (44)

Arthritis 55 (25) 5 (2) 60 (27)

Diabetes Mellitus 24 (11) 3 (1) 27 (12)

Angina 14 (6) 12 (5) 26 (12)

Asthma 22 (10) 2 (1) 24 (11)

Frequency of Poor Mental Frequency of Poor Mental Health DaysHealth Days

0%

10%

20%

30%

40%

50%

60%

0 1-7 8-14 15-21 22-29 30

No. of Poor Mental Health Days

% o

f R

es

po

nd

en

ts

Multivariate Logistic Regression Multivariate Logistic Regression Model Predicting ≥ 1 Day of Poor Model Predicting ≥ 1 Day of Poor

Mental Health Mental Health

Odds Ratio 95% CI p Pre-Katrina depression 19.1 2.1 – 172 0.009 Post-Katrina depression 7.2 1.8 – 29.0 0.005 ≥ 1 Day of poor physical health during the past month

5.6

2.7 – 11.0

< 0.001

Feel unsafe from crime 4.3 1.7 – 11.0 0.002 Female gender 2.6 1.3 – 5.3 0.009

Frequency of Poor Physical Frequency of Poor Physical Health DaysHealth Days

0%

10%

20%

30%

40%

50%

60%

0 1-7 8-14 15-21 22-29 30

No. of Poor Physical Health Days

% o

f R

es

po

nd

en

ts

Multivariate Logistic Regression Multivariate Logistic Regression Model Predicting ≥ 1 Day of Poor Model Predicting ≥ 1 Day of Poor

Physical Health (Physical Health (NN=198)=198)

Odds Ratio 95% CI p ≥ 1 Day of poor mental health during the past month

3.9

2.0 - 7.5

< 0.001

Lack of money for food 2.7 1.2 – 6.0 0.017 Pre-Katrina arthritis 2.6 1.2 – 5.7 0.019

ConclusionsConclusions

Fifteen months post-Katrina, the experience continues to affect the mental and physical health of New Orleans residents.

The rebuilding and reestablishment of basic needs and of accessible healthcare are continuing needs.

RecommendationsRecommendations

Ongoing community assessments to identify issues with healthcare access and health related needs.

Partnering of the public health system and local communities to identify program development opportunities and interventions.

ReferencesReferences

Brodie M, Weltzien E, Altman D, Blendon RJ & Benson JM (2006): Brodie M, Weltzien E, Altman D, Blendon RJ & Benson JM (2006): Experiences of hurricane Katrina evacuees in Houston shelters: Experiences of hurricane Katrina evacuees in Houston shelters: implications for future planning. implications for future planning. American Journal of Public HealthAmerican Journal of Public Health 9696, , 1402-1408.1402-1408.

Centers for Disease Control and Prevention (2006): Assessment of health-Centers for Disease Control and Prevention (2006): Assessment of health-related needs after Hurricanes Katrina and Rita--Orleans and Jefferson related needs after Hurricanes Katrina and Rita--Orleans and Jefferson Parishes, New Orleans area, Louisiana, October 17-22, 2005. Parishes, New Orleans area, Louisiana, October 17-22, 2005. MMWR MMWR Morbidity Mortality Weekly Report Morbidity Mortality Weekly Report 5555,, 38-41. 38-41.

Lambrew JM & Shalala DE (2006): Federal health policy response to Lambrew JM & Shalala DE (2006): Federal health policy response to Hurricane Katrina: what it was and what it could have been. Hurricane Katrina: what it was and what it could have been. Journal of the Journal of the American Medical AssociationAmerican Medical Association 296 296, 1394-1397., 1394-1397.

Louisiana Department of Health and Hospitals, Office of Public Health, Policy, Louisiana Department of Health and Hospitals, Office of Public Health, Policy, Planning, and Evaluation Section. (2005). Planning, and Evaluation Section. (2005). 2005 Parish health profiles: A 2005 Parish health profiles: A tool for community health planning.tool for community health planning. Retrieved May 14, 2007 from Retrieved May 14, 2007 from http://www.dhh.louisiana.gov/OPH/PHP%202005/Data/Jefferson/index.hthttp://www.dhh.louisiana.gov/OPH/PHP%202005/Data/Jefferson/index.htmm

ReferencesReferences

Millin MG, Jenkins JL & Kirsch T (2006): A comparative analysis of two Millin MG, Jenkins JL & Kirsch T (2006): A comparative analysis of two external health care disaster responses following Hurricane Katrina. external health care disaster responses following Hurricane Katrina. Prehospital Emergency CarePrehospital Emergency Care 1010, 451-456., 451-456.

Mills MA, Edmondson D & Park CL (2007): Trauma and stress response Mills MA, Edmondson D & Park CL (2007): Trauma and stress response among Hurricane Katrina evacuees. among Hurricane Katrina evacuees. American Journal of Public HealthAmerican Journal of Public Health 97 Suppl 197 Suppl 1, S116-123., S116-123.

Weisler RH, Barbee JGt & Townsend MH (2006): Mental health and Weisler RH, Barbee JGt & Townsend MH (2006): Mental health and recovery in the Gulf Coast after Hurricanes Katrina and Rita. recovery in the Gulf Coast after Hurricanes Katrina and Rita. Journal of Journal of the American Medical Association the American Medical Association 296296, 585-588., 585-588.

Walker, B. & Warren, R. (2007). Katrina perspectives. Walker, B. & Warren, R. (2007). Katrina perspectives. Journal of Health Journal of Health Care for the Poor and Underserved. Care for the Poor and Underserved. 18:233-240.18:233-240.