Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-30 (of 35 Records) |
Query Trace: Schnall A [original query] |
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Evaluating an equity-focused approach to assess climate resilience and disaster priorities through a community survey
Lovell S , Vickery J , López P , Rodríguez AJ , Cummings BJ , Moloney K , Berman J , Bostrom A , Isaksen TB , Estrada E , Hartwell C , Kohler P , Kramer CB , Patel R , Schnall AH , Smith MH , Errett NA . PLoS One 2024 19 (6) e0302106 As the Duwamish Valley community in Seattle, Washington, U.S.A. and other environmental justice communities nationally contend with growing risks from climate change, there have been calls for a more community-centered approach to understanding impacts and priorities to inform resilience planning. To engage community members and identify climate justice and resilience priorities, a partnership of community leaders, government-based practitioners, and academics co-produced a survey instrument and collected data from the community using the Seattle Assessment for Public Health Emergency Response (SASPER), an approach adapted from the Centers for Disease Control and Prevention's Community Assessment for Public Health Emergency Response (CASPER). In addition, we conducted a process and outcome project evaluation using quantitative survey data collected from volunteers and qualitative semi-structured interviews with project team members. In October and November 2022, teams of volunteers from partner organizations collected 162 surveys from households in the Duwamish Valley. Poor air quality, extreme heat, and wildfires were among the highest reported hazards of concern. Most Duwamish Valley households agreed or strongly agreed that their neighborhood has a strong sense of community (64%) and that they have people nearby to call when they need help (69%). Forty-seven percent of households indicated willingness to get involved with resilience planning, and 62% of households said that they would use a Resilience Hub during an emergency. Survey volunteers evaluated their participation positively, with over 85% agreeing or strongly agreeing that they learned new skills, were prepared for the survey, and would participate in future assessments. The evaluation interviews underscored that while the SASPER may have demonstrated feasibility in a pre-disaster phase, CASPER may not meet all community/partner needs in the immediate disaster response phase because of its lack of focus on equity and logistical requirements. Future research should focus on identifying less resource intensive data collection approaches that maintain the rigor and reputation of CASPER while enabling a focus on equity. |
Identifying key factors to prep initiation and persistence among YMSM through focus groups and surveys in two high-priority settings
D'Avanzo P , Shourya S , Brin M , Kaw S , Kay E , Batey DS , Radix A , Belkind U , Tanner M , Galindo CA , Ferrara S , Ott C , Ozoria Ramirez S , Schnall R . AIDS Educ Prev 2024 36 (1) 33-47 Cisgender men are diagnosed with HIV at a rate four times greater than cisgender women, with 71% of infections attributed to male-male sexual contact. Despite expanding accessibility, pre-exposure prophylaxis (PrEP) for HIV prevention is initiated by only 30% of people with PrEP indications. Five focus groups with 42 young men who have sex with men from New York and Alabama were conducted to identify key factors to PrEP initiation and persistence. Thirty focus group participants completed a survey on demographics, PrEP choices and health care attitudes. Findings suggest provider competency significantly influences PrEP use due to stigmatization in medical settings. Participants noted benefits of PrEP including HIV protection and sexual empowerment, yet barriers like cost and side effects were prevalent. Our findings outline barriers and facilitators to PrEP use among young men who have sex with men in two high priority settings that will inform PrEP care updates in participating clinics. |
Mortality surveillance during Winter Storm Uri, United States - 2021
Hanchey A , Jiva S , Bayleyegn T , Schnall A . Disaster Med Public Health Prep 2023 17 e530 OBJECTIVE: On February 12, 2021, Winter Storm Uri hit the United States. To understand the disaster-related causes and circumstances of death, the Centers for Disease Control and Prevention (CDC) activated media mortality surveillance. METHODS: The team searched the internet daily for key terms related to Uri and compiled the information into a standardized media mortality surveillance database to conduct descriptive statistics. RESULTS: Between February 12 and March 2, 2021, the accessed media reported 136 Uri-related deaths from nine states. Most decedents were male (39%) and adults (62.5%). Exposure to extreme temperatures (47.1%) was the most common cause of death. Among indirect deaths, motor vehicle collision (12.5%), and carbon monoxide poisoning (7.4%) represented the top two circumstances. CONCLUSION: This was the first time CDC activated media mortality surveillance for a winter storm. Media mortality surveillance is useful in assessing the impact of a disaster and provides timely data for an all-hazards response approach. |
Monitoring trends in lacrimator exposures using the National Poison Data System: 2000-2021
Nogee D , Therriault C , Yeh M , Kieszak S , Schnall A , Brown K , Bronstein A , Chang A , Svendsen E . Clin Toxicol (Phila) 2023 61 (7) 1-8 CONTEXT: Lacrimators are used by individuals for personal defense and by police for crowd control during periods of civil unrest. Increased public awareness about their use has raised concerns about their application and safety. OBJECTIVE: To characterize patterns of lacrimator exposures in the United States, we describe temporal trends of calls to poison centers by demographics, substances, medical outcomes, exposure sites, and scenarios. METHODS: A retrospective data analysis was performed for all single-substance lacrimator exposures in the United States reported to the National Poison Data System between 2000 and 2021. Descriptive analyses were performed to examine demographic characteristics, geographic distribution, product types and medical outcomes associated with lacrimator exposures. RESULTS: A total of 107,149 lacrimator exposure calls were identified. There was an overall decrease in calls per year, from 6,521 calls in 2000 to 2,520 in 2020, followed by an increase to 3,311 calls in 2021. A declining trend was observed independent of total poison center call volume. Oleoresin capsicum was the most commonly reported substance (81,990, 76.5%). Individuals ages 19 years and younger accounted for 62% of calls, but adults ages 20 and over were more likely to develop major clinical effects (odds ratio 3.03; 95% confidence interval 1.91-4.81; P < 0.0001). The most common exposure site was "own residence," followed by schools. School exposures accounted for 15.8% of exposures in children ages 6-12 years and 37.7% in adolescents. Among calls with documented scenarios, 19.7% involved unintentional exposures due to children accessing lacrimators. CONCLUSION: Lacrimator exposure calls to United States poison centers decreased from 2000 to 2021. Most calls pertain to oleoresin capsicum and individuals ages 19 and younger. Improper storage allowing children to have access to these chemicals, is a common scenario. Public safety interventions such as education about safe storage and use of lacrimators, improved product design, or regulatory changes may prevent unintentional exposures. |
The 2017 Hurricane Public Health Responses: Case Studies Illustrating the Role of Centers for Disease Control and Prevention's Public Health Emergency Preparedness Program - Erratum
Martinez D , Landon KA , McDermott W , Roth J , Schnall AH , Talbert TP , Mainzer HM . Disaster Med Public Health Prep 2020 17 e8 In the original publication of this article, the title | was incorrect, and the key words were left out. The | article has since been corrected. | The publisher apologizes for the error. |
Characterizing household emergency preparedness levels for natural disasters during the COVID-19 pandemic: United States, 2020-2021
Schnall AH , Kieszak S , Heiman HJ , Bayleyegn T , Daniel J , Hanchey A , Stauber C . J Emerg Manag 2023 21 (7) 51-69 Introduction: It is vital that households are prepared for a natural disaster to help mitigate potential negative impacts. Our goal was to characterize United States household preparedness on a national level to guide next steps to better prepare for and respond to disasters during the COVID-19 pandemic. Methods: We added 10 questions to the existing Porter Novelli's ConsumerStyles surveys in fall 2020 (N = 4,548) and spring 2021 (N = 6,455) to examine factors that contribute to overall household preparedness levels. Results: Being married (odds ratio (OR), 1.2), having children in the home (OR, 1.5), and having a household income of $150,000 or more (OR, 1.2) are all associated with increased preparedness levels. Those in the Northeast are least likely to be prepared (OR, 0.8). Persons living in mobile homes, Recreational Vehicles, boats, or vans are half as likely to have preparedness plans compared to those living in single family homes (OR, 0.6). Conclusions: As a nation, there is much work to be done in terms of preparedness to reach performance measure targets of 80 percent. These data can help inform response planning and the updating of communication resources such as websites, fact sheets, and other materials to reach a wide audience of disaster epidemiologists, emergency managers, and the public. © 2023 Weston Medical Publishing. All rights reserved. |
Characterizing emergency supply kit possession in the United States during the COVID-19 pandemic - 2020-2021.
Schnall AH , Kieszak S , Hanchey A , Heiman H , Bayleyegn T , Daniel J , Stauber C . Disaster Med Public Health Prep 2022 17 1-29 BACKGROUND: In the immediate aftermath of a disaster, household members may experience lack of support services and isolation from one another. To address this, a common recommendation is to promote preparedness through the preparation of an emergency supply kit (ESK). The goal was to characterize ESK possession on a national level to help the Centers for Disease Control and Prevention (CDC) guide next steps to better prepare for and respond to disasters and emergencies at the community level. METHODS: The authors analyzed data collected through Porter Novelli's ConsumerStyles surveys in Fall 2020 (n=3,625) and Spring 2021 (n=6,455). RESULTS: ESK ownership is lacking. Overall, while most respondents believed that an ESK would help their chance of survival, only a third have one. Age, gender, education level, and region of the country were significant predictors of kit ownership in a multivariate model. In addition, there was a significant association between level of preparedness and ESK ownership. CONCLUSIONS: These data are an essential starting point in characterizing ESK ownership and can be used to help tailor public messaging, inform work with partners to increase ESK ownership, and guide future research. |
Tracking hurricane-related deaths in the contiguous United States using media reports from 2012 to 2020
Williams S , Jiva S , Hanchey A , Suárez-Soto RJ , Bayleyegn T , Schnall AH . Disaster Med Public Health Prep 2022 17 1-6 Heavy rainfall, storm surges, and tornadoes are hazards associated with hurricanes that can cause property damages and loss of life. Disaster-related mortality surveillance encounters challenges, such as timely reporting of mortality data. This review demonstrates how tracking hurricane-related deaths using online media reports (eg, news media articles, press releases, social media posts) can enhance mortality surveillance during a response. The Centers for Disease Control and Prevention used online media reports from 2012 to 2020 to characterize hurricane-related deaths from 10 hurricanes that were declared major disasters and the flooding related to Hurricane Joaquin in the contiguous United States. Media reports showed that drowning (n = 139), blunt force trauma (n = 89), and carbon monoxide poisoning (n = 58) were the primary causes of death. Online media and social media reports are not official records. However, media mortality surveillance is useful for hurricane responses to target messaging and current incident decision-making. |
Accuracy of Case-Based Seroprevalence of SARS-CoV-2 Antibodies in Maricopa County, Arizona.
Jehn M , Pandit U , Sabin S , Tompkins C , White J , Kaleta E , Dale AP , Ross HM , MacMcCullough J , Pepin S , Kenny K , Sanborn H , Heywood N , Schnall AH , Lant T , Sunenshine R . Am J Public Health 2022 112 (1) 38-42 We conducted a community seroprevalence survey in Arizona, from September 12 to October 1, 2020, to determine the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We used the seroprevalence estimate to predict SARS-CoV-2 infections in the jurisdiction by applying the adjusted seroprevalence to the county's population. The estimated community seroprevalence of SARS-CoV-2 infections was 4.3 times greater (95% confidence interval=2.2, 7.5) than the number of reported cases. Field surveys with representative sampling provide data that may help fill in gaps in traditional public health reporting. (Am J Public Health. 2022;112(1):38-42. https://doi.org/10.2105/AJPH.2021.306568). |
Notes from the Field: Deaths related to Hurricane Ida reported by media - nine states, August 29-September 9, 2021
Hanchey A , Schnall A , Bayleyegn T , Jiva S , Khan A , Siegel V , Funk R , Svendsen E . MMWR Morb Mortal Wkly Rep 2021 70 (39) 1385-1386 On August 29, 2021, Hurricane Ida made landfall near Port Fourchon, Louisiana, as a Category 4 hurricane with sustained winds of 150 mph, causing life-threatening storm surges, wind damage, heavy rainfall, and power outages that affected approximately one million homes and businesses along the U.S. Gulf Coast (1,2). The storm then traveled Northeast as a tropical depression, causing flash flooding, tornadoes, and power outages, before exiting offshore.During Hurricane Ida’s widespread geographic impact, collection and analysis of timely data were necessary to understand regional differences, such as causes and circumstances of death, and to guide public health messaging to promote action (3). In response to the disaster, CDC’s Epidemiology Surveillance Task Force† (Epi/Surv Task Force) activated media mortality surveillance to track online reports of deaths related to Hurricane Ida using standardized key search terms from an internal standard operating procedure that outlines surveillance protocol. Team members compiled and coded the information from identified sources (e.g., news media articles, press releases, and social media posts) into a database, analyzed the compiled data, and shared results with emergency response leadership and health communicators to provide situational awareness and guide messaging © 2021. MMWR Recommendations and Reports. All rights reserved. |
Community Assessment for Mental and Physical Health Effects After Hurricane Irma - Florida Keys, May 2019
Torres-Mendoza Y , Kerr A , Schnall AH , Blackmore C , Hartley SD . MMWR Morb Mortal Wkly Rep 2021 70 (26) 937-941 Disasters can adversely affect population health, resulting in increased need for health services. Hurricane Irma made landfall in the Florida Keys (Monroe County) as a Category 4 hurricane on September 10, 2017. The hurricane caused substantial damage to 65% of homes and resulted in 40 persons injured and 17 deaths from hurricane-related causes.* During 2018, the county suicide rate increased to 34.9 per 100,000 population from the 5-year (2013-2017) average of 25.2 per 100,000 population (1). In May 2019, 20 months after the hurricane, the Florida Department of Health (FDOH) conducted a modified Community Assessment for Public Health Emergency Response (CASPER) to assess the community's mental, physical, and economic health and develop public health interventions to decrease the suicide rate. A consenting adult member from 231 households was interviewed, and a weighted cluster analysis was conducted to estimate the number and percentage of households throughout the Florida Keys with a particular response, as well as the number and percentage of persons at risk for suicide. During the 20 months since Hurricane Irma, 17% of households reported a need for a mental health care provider; 37.9% of these did not receive those services. A modified CASPER was used to calculate population estimates of suicide risk in an area of high landfall for hurricanes; estimated population suicide risk was 7.3%. Respondents reported worsening of respiratory conditions (17.7%), anxiety (17.0%), and depression (11.3%). Emergency preparedness plans should consider strengthening mental health service delivery after a hurricane, particularly during the long-term recovery phase. |
Safe Use and Storage of Cleaners, Disinfectants, and Hand Sanitizers: Knowledge, Attitudes, and Practices among U.S. Adults during the COVID-19 Pandemic, May 2020.
Gharpure R , Miller GF , Hunter CM , Schnall AH , Kunz J , Garcia-Williams AG . Am J Trop Med Hyg 2020 104 (2) 496-501 Cleaning and disinfection of frequently touched surfaces and frequent hand hygiene are recommended measures to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. Since the onset of the COVID-19 pandemic, poison center calls regarding exposures to cleaners, disinfectants, and hand sanitizers have increased as compared with prior years, indicating a need to evaluate household safety precautions. An opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020. Survey items evaluated knowledge regarding use and storage of cleaners, disinfectants, and hand sanitizers; attitudes about household cleaning and disinfection; and safety precautions practiced during the prior month. We assigned a knowledge score to each respondent to quantify knowledge of safety precautions and calculated median scores by demographic characteristics and attitudes. We identified gaps in knowledge regarding safe use and storage of cleaners, disinfectants, and hand sanitizers; the overall median knowledge score was 5.17 (95% CI: 4.85-5.50; maximum 9.00). Knowledge scores were lower among younger than older age-groups and among black non-Hispanic and Hispanic respondents compared with white non-Hispanic respondents. A greater proportion of respondents expressed knowledge of safety precautions than the proportion who engaged in these precautions. Tailored communication strategies should be used to reach populations with lower knowledge of cleaning and disinfection safety. In addition, as knowledge alone did not shape individual engagement in safety precautions, health promotion campaigns may specifically emphasize the health risks of unsafe use and storage of cleaners, disinfectants, and hand sanitizers to address risk perception. |
Estimated Community Seroprevalence of SARS-CoV-2 Antibodies - Two Georgia Counties, April 28-May 3, 2020.
Biggs HM , Harris JB , Breakwell L , Dahlgren FS , Abedi GR , Szablewski CM , Drobeniuc J , Bustamante ND , Almendares O , Schnall AH , Gilani Z , Smith T , Gieraltowski L , Johnson JA , Bajema KL , McDavid K , Schafer IJ , Sullivan V , Punkova L , Tejada-Strop A , Amiling R , Mattison CP , Cortese MM , Ford SE , Paxton LA , Drenzek C , Tate JE , CDC Field Surveyor Team , Brown Nicole , Chang Karen T , Deputy Nicholas P , Desamu-Thorpe Rodel , Gorishek Chase , Hanchey Arianna , Melgar Michael , Monroe Benjamin P , Nielsen Carrie F , Pellegrini Gerald JJr , Shamout Mays , Tison Laura I , Vagi Sara , Zacks Rachael . MMWR Morb Mortal Wkly Rep 2020 69 (29) 965-970 Transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is ongoing in many communities throughout the United States. Although case-based and syndromic surveillance are critical for monitoring the pandemic, these systems rely on persons obtaining testing or reporting a COVID-19-like illness. Using serologic tests to detect the presence of SARS-CoV-2 antibodies is an adjunctive strategy that estimates the prevalence of past infection in a population. During April 28-May 3, 2020, coinciding with the end of a statewide shelter-in-place order, CDC and the Georgia Department of Public Health conducted a serologic survey in DeKalb and Fulton counties in metropolitan Atlanta to estimate SARS-CoV-2 seroprevalence in the population. A two-stage cluster sampling design was used to randomly select 30 census blocks in each county, with a target of seven participating households per census block. Weighted estimates were calculated to account for the probability of selection and adjusted for age group, sex, and race/ethnicity. A total of 394 households and 696 persons participated and had a serology result; 19 (2.7%) of 696 persons had SARS-CoV-2 antibodies detected. The estimated weighted seroprevalence across these two metropolitan Atlanta counties was 2.5% (95% confidence interval [CI] = 1.4-4.5). Non-Hispanic black participants more commonly had SARS-CoV-2 antibodies than did participants of other racial/ethnic groups (p<0.01). Among persons with SARS-CoV-2 antibodies, 13 (weighted % = 49.9; 95% CI = 24.4-75.5) reported a COVID-19-compatible illness,* six (weighted % = 28.2; 95% CI = 11.9-53.3) sought medical care for a COVID-19-compatible illness, and five (weighted % = 15.7; 95% CI = 5.1-39.4) had been tested for SARS-CoV-2 infection, demonstrating that many of these infections would not have been identified through case-based or syndromic surveillance. The relatively low seroprevalence estimate in this report indicates that most persons in the catchment area had not been infected with SARS-CoV-2 at the time of the survey. Continued preventive measures, including social distancing, consistent and correct use of face coverings, and hand hygiene, remain critical in controlling community spread of SARS-CoV-2. |
Knowledge and Practices Regarding Safe Household Cleaning and Disinfection for COVID-19 Prevention - United States, May 2020.
Gharpure R , Hunter CM , Schnall AH , Barrett CE , Kirby AE , Kunz J , Berling K , Mercante JW , Murphy JL , Garcia-Williams AG . MMWR Morb Mortal Wkly Rep 2020 69 (23) 705-709 A recent report described a sharp increase in calls to poison centers related to exposures to cleaners and disinfectants since the onset of the coronavirus disease 2019 (COVID-19) pandemic (1). However, data describing cleaning and disinfection practices within household settings in the United States are limited, particularly concerning those practices intended to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. To provide contextual and behavioral insight into the reported increase in poison center calls and to inform timely and relevant prevention strategies, an opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020 to characterize knowledge and practices regarding household cleaning and disinfection during the COVID-19 pandemic. Knowledge gaps were identified in several areas, including safe preparation of cleaning and disinfectant solutions, use of recommended personal protective equipment when using cleaners and disinfectants, and safe storage of hand sanitizers, cleaners, and disinfectants. Thirty-nine percent of respondents reported engaging in nonrecommended high-risk practices with the intent of preventing SARS-CoV-2 transmission, such as washing food products with bleach, applying household cleaning or disinfectant products to bare skin, and intentionally inhaling or ingesting these products. Respondents who engaged in high-risk practices more frequently reported an adverse health effect that they believed was a result of using cleaners or disinfectants than did those who did not report engaging in these practices. Public messaging should continue to emphasize evidence-based, safe practices such as hand hygiene and recommended cleaning and disinfection of high-touch surfaces to prevent transmission of SARS-CoV-2 in household settings (2). Messaging should also emphasize avoidance of high-risk practices such as unsafe preparation of cleaning and disinfectant solutions, use of bleach on food products, application of household cleaning and disinfectant products to skin, and inhalation or ingestion of cleaners and disinfectants. |
Serial hurricanes the 2017 hurricane public health responses: Case studies illustrating the role of Centers for Disease Control and Prevention's Public Health Emergency Preparedness Program
Martinez D , Landon KA , McDermott W , Roth J , Schnall AH , Talbert TP , Mainzer HM . Disaster Med Public Health Prep 2020 17 1-5 The Centers for Disease Control and Prevention (CDC), Division of State and Local Readiness (DSLR), Public Health Emergency Preparedness(PHEP) program funds 62 recipients to strengthen capability standards to prepare for and respond to public health emergencies. Recipients use these PHEP resources in addition to CDC's administrative and scientific guidance to support preparedness and response program planning and requirements. It is expected that public health agencies develop and maintain comprehensive emergency preparedness and response plans in preparation for disasters such as hurricanes. The 2017 historic hurricane season highlighted how emergency planning and collaborative operational execution is important for public health agencies to effectively prepare for and respond to both the immediate and long-term population health consequences of these disasters. In 2017, the southeastern United States (US) and US Caribbean territories experienced 3 Category 4 or higher Atlantic hurricanes (Harvey, Irma, and Maria) within a 5-week period. This paper highlights selected case studies that illustrate the contributions and impact of jurisdictional emergency management planning and operational capacity supported by capability standards during the 2017 hurricane season. Although the magnitude of the 2017 hurricanes required public health officials to seek additional assistance, the following case studies describe the use of public health preparedness systems and recovery resources supported by the PHEP program. |
Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 - National Poison Data System, United States, January 1, 2020-March 31, 2020.
Chang A , Schnall AH , Law R , Bronstein AC , Marraffa JM , Spiller HA , Hays HL , Funk AR , Mercurio-Zappala M , Calello DP , Aleguas A , Borys DJ , Boehmer T , Svendsen E . MMWR Morb Mortal Wkly Rep 2020 69 (16) 496-498 On January 19, 2020, the state of Washington reported the first U.S. laboratory-confirmed case of coronavirus disease 2019 (COVID-19) caused by infection with SARS-CoV-2 (1). As of April 19, a total of 720,630 COVID-19 cases and 37,202 associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and four U.S. territories (2). CDC recommends, with precautions, the proper cleaning and disinfection of high-touch surfaces to help mitigate the transmission of SARS-CoV-2 (3). To assess whether there might be a possible association between COVID-19 cleaning recommendations from public health agencies and the media and the number of chemical exposures reported to the National Poison Data System (NPDS), CDC and the American Association of Poison Control Centers surveillance team compared the number of exposures reported for the period January-March 2020 with the number of reports during the same 3-month period in 2018 and 2019. Fifty-five poison centers in the United States provide free, 24-hour professional advice and medical management information regarding exposures to poisons, chemicals, drugs, and medications. Call data from poison centers are uploaded in near real-time to NPDS. During January-March 2020, poison centers received 45,550 exposure calls related to cleaners (28,158) and disinfectants (17,392), representing overall increases of 20.4% and 16.4% from January-March 2019 (37,822) and January-March 2018 (39,122), respectively. Although NPDS data do not provide information showing a definite link between exposures and COVID-19 cleaning efforts, there appears to be a clear temporal association with increased use of these products. |
Community Assessments for Public Health Emergency Response (CASPERs) - US Virgin Islands, 2017-2018
Schnall AH , Wolkin AF , Roth JJ , Ellis EM . Am J Public Health 2019 109 S303-s308 Objectives. To assess preparedness levels of communities to help public health and others plan for disasters or emergencies and tailor messaging to increase community preparedness.Methods. US Virgin Islands Department of Health conducted a Community Assessment for Public Health Emergency Response (CASPER) in June 2017, 2 hurricane response CASPERs in November 2017, and a recovery CASPER in February 2018. CASPER is a 2-stage cluster sampling method designed to provide household-based information about a community's needs in a timely, inexpensive, and representative manner.Results. Roughly the same amount of households reported having a 3-day supply of food and water before and 3 months after the hurricanes. During the response, approximately a third of households resupplied between 3 and 6 days and an additional approximately 40% between days 7 and 14.Conclusions. On the basis of the CASPERs, we were able to track whether households had an emergency preparedness kit, whether they used it during the storms (and what was missing), and if they resupplied their kit in recovery.Public Health Implications. CASPER is a promising tool to measure community preparedness to help state, local, tribal, and territorial jurisdictions plan for disasters or emergencies. |
Disaster-related shelter surveillance during the Hurricane Harvey response - Texas 2017
Schnall AH , Hanchey A , Nakata N , Wang A , Jeddy Z , Alva H , Tan C , Boehmer T , Bayleyegn T , Casey-Lockyer M . Disaster Med Public Health Prep 2019 14 (1) 1-7 OBJECTIVES: Hurricane Harvey left a path of destruction in its wake, resulting in over 100 deaths and damaging critical infrastructure. During a disaster, public health surveillance is necessary to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The Centers for Disease Control and Prevention (CDC) and American Red Cross collaborate on shelter surveillance to monitor the health of the sheltered population and help guide response efforts. METHODS: We analyzed data collected from 24 Red Cross shelters between August 25, 2017, and September 14, 2017. We described the aggregate morbidity data collected during Harvey compared with previous hurricanes (Gustav, Ike, and Sandy). RESULTS: Over one-third (38%) of reasons for visit were for health care maintenance; 33% for acute illnesses, which includes respiratory conditions, gastrointestinal symptoms, and pain; 19% for exacerbation of chronic disease; 7% for mental health; and 4% for injury. The Red Cross treated 41% of clients within the shelters; however, reporting of disposition was often missed. These results are comparable to previous hurricanes. CONCLUSION: The capacity of Red Cross shelter staff to address the acute health needs of shelter residents is a critical resource for local public health agencies overwhelmed by the disaster. However, there remains room for improvement because reporting remained inconsistent. |
Community assessments for mosquito prevention and control experiences, attitudes, and practices - U.S. Virgin Islands, 2017 and 2018
Seger KR , Roth JJr , Schnall AH , Ellis BR , Ellis EM . MMWR Morb Mortal Wkly Rep 2019 68 (22) 500-504 Aedes aegypti, the mosquito that carries dengue, chikungunya, and Zika viruses, is present throughout the U.S. Virgin Islands (USVI). To reduce mosquitoborne disease transmission, the USVI Department of Health (VIDOH) is responsible for integrated mosquito management. During January 2016-January 2018, USVI experienced its first Zika outbreak, with most cases reported during January-December 2016, as well as two Category 5 hurricanes (Irma on St. Thomas/St. John on September 6, 2017, and Maria on St. Croix on September 19, 2017). The hurricanes severely damaged mosquito protection-related building structures (e.g., screens, roofs) and infrastructure (e.g., electricity, air conditioning) and might have created an environment more conducive to mosquito breeding. VIDOH, with requested technical assistance from CDC, conducted three Community Assessments for Public Health Emergency Response (CASPERs) to provide rapid community information at the household level. The three CASPERs were conducted to inform 1) the Zika outbreak response, 2) the hurricane response, and 3) the hurricane recovery. The CASPERs assessed mosquito prevention and control-related experiences, attitudes, and practices; household and environmental conditions associated with mosquito breeding, prevention, and control; and other nonmosquito-related information to inform outbreak and disaster response planning. Approximately 40% of households were very concerned about contracting Zika virus during the Zika outbreak and hurricane responses. Environmental conditions were reported to become more favorable for mosquito breeding between the Zika outbreak and hurricane response. Between 75%-80% of the community supported mosquito-spraying in all assessments. VIDOH used these data to support real-time outbreak and hurricane response planning. Mosquito prevention and control community assessments can provide rapid, actionable information to advise both mosquito education and control and emergency response and recovery efforts. The CASPER design can be used by vector control programs to enhance routine and response operations. |
Disaster-related surveillance among US Virgin Islands (USVI) shelters during the hurricanes Irma and Maria response
Schnall AH , Roth JJ , Ekpo LL , Guendel I , Davis M , Ellis EM . Disaster Med Public Health Prep 2019 13 (1) 38-43 OBJECTIVES: Two Category 5 storms, Hurricane Irma and Hurricane Maria, hit the U.S. Virgin Islands (USVI) within 13 days of each other in September 2017. These storms caused catastrophic damage across the territory, including widespread loss of power, destruction of homes, and devastation of critical infrastructure. During large scale disasters such as Hurricanes Irma and Maria, public health surveillance is an important tool to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The USVI Department of Health (DoH) partnered with shelter staff volunteers to monitor the health of the sheltered population and help guide response efforts. METHODS: Shelter volunteers collect data on the American Red Cross Aggregate Morbidity Report form that tallies the number of client visits at a shelter's health services every 24 hours. Morbidity data were collected at all 5 shelters on St. Thomas and St. Croix between September and October 2017. This article describes the health surveillance data collected in response to Hurricanes Irma and Maria. RESULTS: Following Hurricanes Irma and Maria, 1130 health-related client visits were reported, accounting for 1655 reasons for the visits (each client may have more than 1 reason for a single visit). Only 1 shelter reported data daily. Over half of visits (51.2%) were for health care management; 17.7% for acute illnesses, which include respiratory conditions, gastrointestinal symptoms, and pain; 14.6% for exacerbation of chronic disease; 9.8% for mental health; and 6.7% for injury. Shelter volunteers treated many clients within the shelters; however, reporting of the disposition (eg, referred to physician, pharmacist) was often missed (78.1%). CONCLUSION: Shelter surveillance is an efficient means of quickly identifying and characterizing health issues and concerns in sheltered populations following disasters, allowing for the development of evidence-based strategies to address identified needs. When incorporated into broader surveillance strategies using multiple data sources, shelter data can enable disaster epidemiologists to paint a more comprehensive picture of community health, thereby planning and responding to health issues both within and outside of shelters. The findings from this report illustrated that managing chronic conditions presented a more notable resource demand than acute injuries and illnesses. Although there remains room for improvement because reporting was inconsistent throughout the response, the capacity of shelter staff to address the health needs of shelter residents and the ability to monitor the health needs in the sheltered population were critical resources for the USVI DoH overwhelmed by the disaster. (Disaster Med Public Health Preparedness. 2019;13:38-43). |
Addressing community needs during the hurricane response and recovery efforts through Community Assessments for Public Health Emergency Response (CASPER)-United States Virgin Islands, 2017-2018
Schnall AH , Roth JJ , Ellis B , Seger K , Davis M , Ellis EM . Disaster Med Public Health Prep 2019 13 (1) 53-62 OBJECTIVES: Two category 5 storms hit the US Virgin Islands (USVI) within 13 days of each other in September 2017. This caused an almost complete loss of power and devastated critical infrastructure such as the hospitals and airports METHODS: The USVI Department of Health conducted 2 response Community Assessments for Public Health Emergency Response (CASPERs) in November 2017 and a recovery CASPER in February 2018. CASPER is a 2-stage cluster sampling method designed to provide household-based information about a community's needs in a timely, inexpensive, and representative manner. RESULTS: Almost 70% of homes were damaged or destroyed, 81.2% of homes still needed repair, and 10.4% of respondents felt their home was unsafe to live in approximately 5 months after the storms. Eighteen percent of individual respondents indicated that their mental health was "not good" for 14 or more days in the past month, a significant increase from 2016. CONCLUSION: The CASPERs helped characterize the status and needs of residents after the devastating hurricanes and illustrate the evolving needs of the community and the progression of the recovery process. CASPER findings were shared with response and recovery partners to promote data-driven recovery efforts, improve the efficiency of the current response and recovery efforts, and strengthen emergency preparedness in USVI. (Disaster Med Public Health Preparedness. 2019;13:53-62). |
Getting the message out: Social media and word-of-mouth as effective communication methods during emergencies
Wolkin AF , Schnall AH , Nakata NK , Ellis EM . Prehosp Disaster Med 2018 34 (1) 1-6 Effective communication is a critical part of managing an emergency. During an emergency, the ways in which health agencies normally communicate warnings may not reach all of the intended audience. Not all communities are the same, and households within communities are diverse. Because different communities prefer different communication methods, community leaders and emergency planners need to know their communities' preferred methods for seeking information about an emergency. This descriptive report explores findings from previous community assessments that have collected information on communication preferences, including television (TV), social media, and word-of-mouth (WoM) delivery methods. Data were analyzed from 12 Community Assessments for Public Health Emergency Response (CASPERs) conducted from 2014-2017 that included questions regarding primary and trusted communication sources. A CASPER is a rapid needs assessment designed to gather household-based information from a community. In 75.0% of the CASPERs, households reported TV as their primary source of information for specific emergency events (range = 24.0%-83.1%). Households reporting social media as their primary source of information differed widely across CASPERs (3.2%-41.8%). In five of the CASPERs, nearly one-half of households reported WoM as their primary source of information. These CASPERs were conducted in response to a specific emergency (ie, chemical spill, harmful algal bloom, hurricane, and flood). The CASPERs conducted as part of a preparedness activity had lower percentages of households reporting WoM as their primary source of information (8.3%-10.4%). The findings in this report demonstrate the need for emergency plans to include hybrid communication models, combining traditional methods with newer technologies to reach the broadest audience. Although TV was the most commonly reported preferred source of information, segments of the population relied on social media and WoM messaging. By using multiple methods for risk communication, emergency planners are more likely to reach the whole community and engage vulnerable populations that might not have access to, trust in, or understanding of traditional news sources. Multiple communication channels that include user-generated content, such as social media and WoM, can increase the timeliness of messaging and provide community members with message confirmation from sources they trust encouraging them to take protective public health actions.Wolkin AF, Schnall AH, Nakata NK, Ellis EM. Getting the message out: social media and word-of-mouth as effective communication methods during emergencies. |
Assessment of behavioral health concerns in the community affected by the Flint Water Crisis - Michigan (USA) 2016
Fortenberry GZ , Reynolds P , Burrer SL , Johnson-Lawrence V , Wang A , Schnall A , Pullins P , Kieszak S , Bayleyegn T , Wolkin A . Prehosp Disaster Med 2018 33 (3) 1-10 OBJECTIVES: The Flint Community Resilience Group (Flint, Michigan USA) and the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) assessed behavioral health concerns among community members to determine the impact of lead contamination of the Flint, Michigan water supply. METHODS: A Community Assessment for Public Health Emergency Response (CASPER) was conducted from May 17 through May 19, 2016 using a multi-stage cluster sampling design to select households and individuals to interview. RESULTS: One-half of households felt overlooked by decision makers. The majority of households self-reported that at least one member experienced more behavioral health concerns than usual. The prevalence of negative quality of life indicators and financial concerns in Flint was higher than previously reported in the Michigan 2012 and 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. CONCLUSIONS: The following can be considered to guide recovery efforts in Flint: identifying additional resources for behavioral health interventions and conducting follow-up behavioral health assessments to evaluate changes in behavioral health concerns over time; considering the impact of household economic factors when implementing behavioral health interventions; and ensuring community involvement and engagement in recovery efforts to ease community stress and anxiety. FortenberryGZ, ReynoldsP, BurrerSL, Johnson-LawrenceV, WangA, SchnallA, PullinsP, KieszakS, BayleyegnT, WolkinA. Assessment of behavioral health concerns in the community affected by the Flint water crisis - Michigan (USA) 2016. |
Community Assessment for Public Health Emergency Response (CASPER): An innovative emergency management tool in the United States
Schnall A , Nakata N , Talbert T , Bayleyegn T , Martinez D , Wolkin A . Am J Public Health 2017 107 S186-s192 OBJECTIVES: To demonstrate how inclusion of the Centers for Disease Control and Prevention's Community Assessment for Public Health Emergency Response (CASPER) as a tool in Public Health Preparedness Capabilities: National Standards for State and Local Planning can increase public health capacity for emergency response. METHODS: We reviewed all domestic CASPER activities (i.e., trainings and assessments) between fiscal years 2012 and 2016. Data from these CASPER activities were compared with respect to differences in geographic distribution, type, actions, efficacy, and usefulness of training. RESULTS: During the study period, the Centers for Disease Control and Prevention conducted 24 domestic in-person CASPER trainings for 1057 staff in 38 states. On average, there was a marked increase in knowledge of CASPER. Ninety-nine CASPERs were conducted in the United States, approximately half of which (53.5%) assessed preparedness; the others were categorized as response or recovery (27.2%) or were unrelated to a disaster (19.2%). CONCLUSIONS: CASPER trainings are successful in increasing disaster epidemiology skills. CASPER can be used by Public Health Emergency Preparedness program awardees to help build and sustain preparedness and response capabilities. |
Characterization of carbon monoxide exposure during Hurricane Sandy and subsequent Nor'easter
Schnall A , Law R , Heinzerling A , Sircar K , Damon S , Yip F , Schier J , Bayleyegn T , Wolkin A . Disaster Med Public Health Prep 2017 11 (5) 1-6 OBJECTIVE: Carbon monoxide (CO) is an odorless, colorless gas produced by fossil fuel combustion. On October 29, 2012, Hurricane Sandy moved ashore near Atlantic City, New Jersey, causing widespread morbidity and mortality, $30 to $50 billion in economic damage, and 8.5 million households to be without power. The combination of power outages and unusually low temperatures led people to use alternate power sources, placing many at risk for CO exposure. METHODS: We examined Hurricane Sandy-related CO exposures from multiple perspectives to help identify risk factors and develop strategies to prevent future exposures. This report combined data from 3 separate sources (health departments, poison centers via the National Poison Data System, and state and local public information officers). RESULTS: Results indicated that the number of CO exposures in the wake of Hurricane Sandy was significantly greater than in previous years. The persons affected were mostly females and those in younger age categories and, despite messaging, most CO exposures occurred from improper generator use. CONCLUSIONS: Our findings emphasize the continued importance of CO-related communication and ongoing surveillance of CO exposures to support public health response and prevention during and after disasters. Additionally, regional poison centers can be a critical resource for potential on-site management, public health promotion, and disaster-related CO exposure surveillance. (Disaster Med Public Health Preparedness. 2017;page 1 of 6). |
A user-centered model for designing consumer mobile health application (apps)
Schnall R , Rojas M , Bakken S , Brown W , Carballo-Dieguez A , Carry M , Gelaude D , Mosley JP , Travers J . J Biomed Inform 2016 60 243-51 BACKGROUND: Mobile technologies are a useful platform for the delivery of health behavior interventions. Yet little work has been done to create a rigorous and standardized process for the design of mobile health (mHealth) apps. This project sought to explore the use of the Information Systems Research (ISR) framework as guide for the design of mHealth apps. METHODS: Our work was guided by the ISR framework which is comprised of 3 cycles: Relevance, Rigor and Design. In the Relevance cycle, we conducted 5 focus groups with 33 targeted end-users. In the Rigor cycle, we performed a review to identify technology-based interventions for meeting the health prevention needs of our target population. In the ISR Design Cycle, we employed usability evaluation methods to iteratively develop and refine mock-ups for a mHealth app. RESULTS: Through an iterative process, we identified barriers and facilitators to the use of mHealth technology for HIV prevention for high-risk MSM, developed 'use cases' and identified relevant functional content and features for inclusion in a design document to guide future app development. Findings from our work support the use of the ISR framework as a guide for designing future mHealth apps. DISCUSSION: Results from this work provide detailed descriptions of the user-centered design and system development and have heuristic value for those venturing into the area of technology-based intervention work. Findings from this study support the use of the ISR framework as a guide for future mobile health (mHealth) app development. CONCLUSION: Use of the ISR framework is a potentially useful approach for the design of a mobile app that incorporates end-users' design preferences. |
Using the information-motivation-behavioral skills model to guide the development of an HIV prevention smartphone application for high-risk MSM
Aliabadi N , Carballo-Dieguez A , Bakken S , Rojas M , Brown W 3rd , Carry M , Mosley JP , Gelaude D , Schnall R . AIDS Educ Prev 2015 27 (6) 522-37 HIV remains a significant public health problem among men who have sex with men (MSM). MSM comprise 2% of the U.S. population, but constitute 56% of persons living with HIV. Mobile health technology is a promising tool for HIV prevention. The purpose of this study was to identify the desired content, features and functions of a mobile application (app) for HIV prevention in high-risk MSM. We conducted five focus group sessions with 33 MSM. Focus group recordings were transcribed and coded using themes informed by the information-motivation-behavioral (IMB) skills model. Participants identified information needs related to HIV prevention: HIV testing and prophylaxis distribution centers, support groups/peers, and HIV/STI disease/treatment information. Areas of motivation to target for the app included: attitudes and intentions. Participants identified behavioral skills to address with an app: using condoms correctly, negotiating safer sex, recognizing signs of HIV/STI. Findings from this work provide insight into the desired content of a mobile app for HIV prevention in high-risk MSM. |
Use of Community Assessments for Public Health Emergency Response (CASPERs) to rapidly assess public health issues - United States, 2003-2012
Bayleyegn TM , Schnall AH , Ballou SG , Zane DF , Burrer SL , Noe RS , Wolkin AF . Prehosp Disaster Med 2015 30 (4) 1-8 INTRODUCTION: Community Assessment for Public Health Emergency Response (CASPER) is an epidemiologic technique designed to provide quick, inexpensive, accurate, and reliable household-based public health information about a community's emergency response needs. The Health Studies Branch at the Centers for Disease Control and Prevention (CDC) provides in-field assistance and technical support to state, local, tribal, and territorial (SLTT) health departments in conducting CASPERs during a disaster response and in non-emergency settings. Data from CASPERs conducted from 2003 through 2012 were reviewed to describe uses of CASPER, ascertain strengths of the CASPER methodology, and highlight significant findings. METHODS: Through an assessment of the CDC's CASPER metadatabase, all CASPERs that involved CDC support performed in US states and territories from 2003 through 2012 were reviewed and compared descriptively for differences in geographic distribution, sampling methodology, mapping tool, assessment settings, and result and action taken by decision makers. RESULTS: For the study period, 53 CASPERs were conducted in 13 states and one US territory. Among the 53 CASPERS, 38 (71.6%) used the traditional 2-stage cluster sampling methodology, 10 (18.8%) used a 3-stage cluster sampling, and two (3.7%) used a simple random sampling methodology. Among the CASPERs, 37 (69.9%) were conducted in response to specific natural or human-induced disasters, including 14 (37.8%) for hurricanes. The remaining 16 (30.1%) CASPERS were conducted in non-disaster settings to assess household preparedness levels or potential effects of a proposed plan or program. The most common recommendations resulting from a disaster-related CASPER were to educate the community on available resources (27; 72.9%) and provide services (18; 48.6%) such as debris removals and refills of medications. In preparedness CASPERs, the most common recommendations were to educate the community in disaster preparedness (5; 31.2%) and to revise or improve preparedness plans (5; 31.2%). Twenty-five (47.1%) CASPERs documented on the report or publications the public health action has taken based on the result or recommendations. Findings from 27 (50.9%) of the CASPERs conducted with CDC assistance were published in peer-reviewed journals or elsewhere. CONCLUSION: The number of CASPERs conducted with CDC assistance has increased and diversified over the past decade. The CASPERs' results and recommendations supported the public health decisions that benefitted the community. Overall, the findings suggest that the CASPER is a useful tool for collecting household-level disaster preparedness and response data and generating information to support public health action. |
The role of applied epidemiology methods in the disaster management cycle
Malilay J , Heumann M , Perrotta D , Wolkin AF , Schnall AH , Podgornik MN , Cruz MA , Horney JA , Zane D , Roisman R , Greenspan JR , Thoroughman D , Anderson HA , Wells EV , Simms EF . Am J Public Health 2014 104 (11) e1-e11 Disaster epidemiology (i.e., applied epidemiology in disaster settings) presents a source of reliable and actionable information for decision-makers and stakeholders in the disaster management cycle. However, epidemiological methods have yet to be routinely integrated into disaster response and fully communicated to response leaders. We present a framework consisting of rapid needs assessments, health surveillance, tracking and registries, and epidemiological investigations, including risk factor and health outcome studies and evaluation of interventions, which can be practiced throughout the cycle. Applying each method can result in actionable information for planners and decision-makers responsible for preparedness, response, and recovery. Disaster epidemiology, once integrated into the disaster management cycle, can provide the evidence base to inform and enhance response capability within the public health infrastructure. |
Using poison center data for postdisaster surveillance
Wolkin A , Schnall AH , Law R , Schier J . Prehosp Disaster Med 2014 29 (5) 1-4 The role of public health surveillance in disaster response continues to expand as timely, accurate information is needed to mitigate the impact of disasters. Health surveillance after a disaster involves the rapid assessment of the distribution and determinants of disaster-related deaths, illnesses, and injuries in the affected population. Public health disaster surveillance is one mechanism that can provide information to identify health problems faced by the affected population, establish priorities for decision makers, and target interventions to meet specific needs. Public health surveillance traditionally relies on a wide variety of data sources and methods. Poison center (PC) data can serve as data sources of chemical exposures and poisonings during a disaster. In the US, a system of 57 regional PCs serves the entire population. Poison centers respond to poison-related questions from the public, health care professionals, and public health agencies. The Centers for Disease Control and Prevention (CDC) uses PC data during disasters for surveillance of disaster-related toxic exposures and associated illnesses to enhance situational awareness during disaster response and recovery. Poison center data can also be leveraged during a disaster by local and state public health to supplement existing surveillance systems. Augmenting traditional surveillance data (ie, emergency room visits and death records) with other data sources, such as PCs, allows for better characterization of disaster-related morbidity and mortality. Poison center data can be used during a disaster to detect outbreaks, monitor trends, track particular exposures, and characterize the epidemiology of the event. This timely and accurate information can be used to inform public health decision making during a disaster and mitigate future disaster-related morbidity and mortality. |
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