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1.  Serious Emotion Disturbance among Youth Exposed to Hurricane Katrina Two Years Post-Disaster 
Objective
To estimate the prevalence of serious emotional disturbance (SED) among children and adolescents exposed to Hurricane Katrina along with the associations of SED with hurricane-related stressors, socio-demographics, and family factors 18–27 months following the hurricane.
Method
A probability sample of pre-hurricane residents of areas affected by Hurricane Katrina was administered a telephone survey. Respondents provided information on up to two of their children (n=797) aged 4–17. The survey assessed hurricane-related stressors and lifetime history of psychopathology in respondents, screened for 12-month SED in respondents’ children using the Strengths and Difficulties Questionnaire (SDQ), and determined whether children’s emotional and behavioral problems were attributable to Hurricane Katrina.
Results
The estimated prevalence of SED was 14.9%, and 9.3% of youth were estimated to have SED that is directly attributable to Hurricane Katrina. Stress exposure was associated strongly with SED, and 20.3% of youth with high stress exposure had hurricane-attributable SED. Death of a loved one had the strongest association with SED among pre-hurricane residents of New Orleans, whereas exposure to physical adversity had the strongest association in the remainder of the sample. Among children with stress exposure, parental psychopathology and poverty were associated with SED.
Conclusions
The prevalence of SED among youth exposed to Hurricane Katrina remains high 18–27 months after the storm, suggesting a substantial need for mental health treatment resources in the hurricane-affected areas. Youth who were exposed to hurricane-related stressors, have a family history of psychopathology, and have lower family incomes are at greatest risk for long-term psychiatric impairment.
doi:10.1097/CHI.0b013e3181b76697
PMCID: PMC3992889  PMID: 19797983
Hurricane Katrina; SED; natural disaster; child mental health
2.  Five Years Later: Recovery from Post Traumatic Stress and Psychological Distress Among Low-Income Mothers Affected by Hurricane Katrina 
Social science & medicine (1982)  2011;74(2):150-157.
Hurricane Katrina, which struck the Gulf Coast of the United States in August 2005, exposed area residents to trauma and extensive property loss. However, little is known about the long-run effects of the hurricane on the mental health of those who were exposed. This study documents long-run changes in mental health among a particularly vulnerable group—low income mothers—from before to after the hurricane, and identifies factors that are associated with different recovery trajectories. Longitudinal surveys of 532 low-income mothers from New Orleans were conducted approximately one year before, 7 to 19 months after, and 43 to 54 months after Hurricane Katrina. The surveys collected information on mental health, social support, earnings and hurricane experiences. We document changes in post-traumatic stress symptoms (PTSS), as measured by the Impact of Event Scale-Revised, and symptoms of psychological distress (PD), as measured by the K6 scale. We find that although PTSS has declined over time after the hurricane, it remained high 43 to 54 months later. PD also declined, but did not return to pre-hurricane levels. At both time periods, psychological distress before the hurricane, hurricane-related home damage, and exposure to traumatic events were associated with PTSS that co-occurred with PD. Hurricane-related home damage and traumatic events were associated with PTSS without PD. Home damage was an especially important predictor of chronic PTSS, with and without PD. Most hurricane stressors did not have strong associations with PD alone over the short or long run. Over the long run, higher earnings were protective against PD, and greater social support was protective against PTSS. These results indicate that mental health problems, particularly PTSS alone or in co-occurrence with PD, among Hurricane Katrina survivors remain a concern, especially for those who experienced hurricane-related trauma and had poor mental health or low socioeconomic status before the hurricane.
doi:10.1016/j.socscimed.2011.10.004
PMCID: PMC3286602  PMID: 22137245
Mental health; natural disasters; Hurricane Katrina; USA; women
3.  The Relationship between Mold Exposure and Allergic Response in Post-Katrina New Orleans 
Journal of Allergy  2010;2010:510380.
Objectives. The study's objective was to examine the relation between mold/dampness exposure and mold sensitization among residents of Greater New Orleans following Hurricane Katrina. Methods. Patients were recruited from the Allergy Clinic of a major medical facility. Any patient receiving a skin prick test for one of 24 molds between December 1, 2005 and December 31, 2008 was eligible for the study. Exposure was assessed using standardized questionnaires. Positive mold reactivity was defined as a wheal diameter >3 mm to any mold genera. Results. Approximately 57% of participants tested positive to any indoor allergen, 10% to any mold. Over half of respondents had significant home damage, 34% reported dampness/mold in their home, half engaged in renovation, and one-third lived in a home undergoing renovation. Despite extensive exposure, and multiple measures of exposure, we found no relationship between mold/dampness exposure and sensitivity to mold allergens. Conclusions. These results along with results of earlier research indicate no excess risk of adverse respiratory effects for residents living in New Orleans after the devastation of Hurricane Katrina.
doi:10.1155/2010/510380
PMCID: PMC2948940  PMID: 20948880
4.  Symptoms of Posttraumatic Stress Disorder in a New Orleans Workforce Following Hurricane Katrina 
Journal of Urban Health   2007;84(2):142-152.
On August 29, 2005, Hurricane Katrina made landfall resulting in catastrophic damage and flooding to New Orleans, LA, and the Gulf Coast, which may have had significant mental health effects on the population. To determine rates and predictors of symptoms consistent with a diagnosis of posttraumatic stress disorder (PTSD) in New Orleans residents following Hurricane Katrina, we conducted a web-based survey 6 months after Hurricane Katrina made landfall. Participants included 1,542 employees from the largest employer in New Orleans. The prevalence of PTSD symptoms was 19.2%. Predictors of PTSD symptoms in a multivariate-adjusted regression model included female sex, non-black race, knowing someone who died in the storm, not having property insurance, having had a longer evacuation, a much longer work commute compared to before Hurricane Katrina, and currently living in a newly purchased or rented house or in a temporary trailer. Despite universal health coverage and the benefits of an employee assistance program for all employees, only 28.5% of those with PTSD symptoms had talked to a health professional about the events of Hurricane Katrina or issues encountered since the storm. A significant burden of PTSD symptoms was present 6 months following Hurricane Katrina among a large group of adults who had returned to work in New Orleans. Given their key role in the economic redevelopment of the region, there is a tremendous need to identify those in the workforce with symptoms consistent with PTSD and to enhance treatment options. The strong relationship between displacement from ones’ pre-Katrina residence and symptoms of PTSD suggests a need to focus resource utilization and interventions on individuals living in temporary housing.
doi:10.1007/s11524-006-9147-1
PMCID: PMC2231633  PMID: 17226081
Hurricane Katrina; Natural disaster; Posttraumatic stress disorder; Risk factors.
5.  DRUG MARKET RECONSTITUTION AFTER HURRICANE KATRINA: LESSONS FOR LOCAL DRUG ABUSE CONTROL INITIATIVES 
Hurricane Katrina accomplished what no law enforcement initiative could ever achieve: It completely eradicated the New Orleans drug market. However, Katrina did little to eliminate the demand for drugs. This article documents the process of the drug market reconstitution that occurred 2005–2008 based on in-depth interviews and focus groups with predominately low-income drug users and sellers. Before Katrina, the drug market was largely characterized by socially-bonded participants involved with corporate style distribution. After Katrina, a violent freelance market emerged. The conclusion draws recommendations for law enforcement for dealing with drug markets after a major disaster.
This article uses New Orleans as a case study to chart the process of drug market reconstitution following an extreme disaster, namely Hurricane Katrina. On August 29, 2005, Hurricane Katrina made landfall and engulfed the New Orleans area, overwhelming levees and causing extensive flooding and destruction across the city. The storm generated 30- to 40-foot waves, which demolished many cities and small towns in Southern Mississippi and Alabama and caused considerable wind damage further inland. Although the hurricane eye missed central New Orleans by about 30 miles, the wave action in Lake Pontchartrain caused several levees to break and flood most of eastern New Orleans, which was under sea level. The storm had an impact on practically all New Orleans residents and almost destroyed New Orleans (Cooper & Block, 2006; Levitt & Whitaker, 2009; Lee, 2006).
Our research focused on the impact of this storm on the drug markets in New Orleans. Katrina destroyed the physical environment and organizational structure that sustained the drug trade, yet drug use and sales did not disappear. During and soon after the storm, improvised sales and distribution organizations provided a wide range of illicit drugs to users (see Dunlap, Johnson, Kotarba, & Fackler, 2009; Dunlap & Golub, 2010; Dunlap, Johnson & Morse, 2007). This article examines the next historical period, the continuation of drug use among those returning to New Orleans and the rebuilding of drug market structures. The analysis provides a short review of drug markets before Katrina. Our main focus is the reconstitution process during the three years following the disaster. We pay special attention to street-level dealers and the end users’ lived experiences in primarily poorer neighborhoods, illustrating elements of continuity and change as various actors reconstituted New Orleans’ drug market.
doi:10.3818/JRP.13.1.2011.23
PMCID: PMC3349334  PMID: 22582027
6.  Environmental Lead after Hurricane Katrina: Implications for Future Populations 
Environmental Health Perspectives  2011;120(2):180-184.
Background: As a result of Hurricane Katrina, > 100,000 homes were destroyed or damaged and a significant amount of sediment was deposited throughout the city of New Orleans, Louisiana. Researchers have identified the potential for increased lead hazards from environmental lead contamination of soils.
Objectives: We assessed the distribution of residential soil and dust lead 2 years poststorm and compared soil lead before and after the storm.
Methods: We conducted a cross-sectional study in New Orleans in which households were selected by stratified random sampling. A standard residential questionnaire was administered, and lead testing was performed for both the interior and exterior of homes. Logistic regression was used to identify significant predictors of interior and exterior lead levels in excess of allowable levels.
Results: One hundred nine households were enrolled; 61% had at least one lead measurement above federal standards. Of homes with bare soil, 47% had elevated lead and 27% had levels exceeding 1,200 ppm. Housing age was associated with soil lead, and housing age and soil lead were associated with interior lead. Race, income, and ownership status were not significantly associated with either interior or exterior lead levels. The median soil lead level of 560 ppm was significantly higher than the median level of samples collected before Hurricane Katrina.
Conclusions: The high prevalence (61%) of lead above recommended levels in soil and dust samples in and around residences raises concern about potential health risks to the New Orleans population, most notably children. Steps should be taken to mitigate the risk of exposure to lead-contaminated soil and dust. Further research is needed to quantify the possible contribution of reconstruction activities to environmental lead levels.
doi:10.1289/ehp.1103774
PMCID: PMC3279443  PMID: 22052045
children’s health; environmental exposures; housing; lead exposure; soil pollutants
7.  Trends in Serious Emotional Disturbance among Youths Exposed to Hurricane Katrina 
Objective
To examine patterns and predictors of trends in DSM-IV serious emotional disturbance (SED) among youths exposed to Hurricane Katrina.
Method
A probability sample of adult pre-hurricane residents of the areas affected by Katrina completed baseline and follow-up telephone surveys 18-27 months post-hurricane and 12-18 months later. Baseline adult respondents residing with children (ages 4-17) provided informant reports about the emotional functioning of these youths (n = 576) with the Strengths and Difficulties Questionnaire (SDQ). The surveys also assessed hurricane-related stressors and ongoing stressors experienced by respondent families.
Results
SED prevalence decreased significantly across survey waves from 15.1% to 11.5%, although even the latter prevalence was considerably higher than the pre-hurricane prevalence of 4.2% estimated in the US National Health Interview Survey. Trends in hurricane-related SED were predicted by both stressors experienced in the hurricane and ongoing stressors, with SED prevalence decreasing significantly only among youths with moderate stress exposure (16.8% vs. 6.5%). SED prevalence did not change significantly between waves among youths with either high stress exposure (30.0% vs. 41.9%) or low stress exposure (3.5% vs. 3.4%). Pre-hurricane functioning did not predict SED persistence among youths with high stress exposure, but did predict SED persistence among youth with low-moderate stress exposure.
Conclusions
The prevalence of SED among youths exposed to Hurricane Katrina remains significantly elevated several years after the storm despite meaningful decrease since baseline. Youths with high stress exposure have the highest risk of long-term hurricane-related SED and consequently represent an important target for mental health intervention.
doi:10.1016/j.jaac.2010.06.012
PMCID: PMC3228600  PMID: 20855044
Hurricane Katrina; SED; natural disaster; child mental health; stress
8.  Sediment from Hurricane Katrina: Potential to Produce Pulmonary Dysfunction in Mice 
On August 29, 2005, Hurricane Katrina made landfall along the Gulf Coast as a Category 3 hurricane. The associated storm surge and heavy rainfall resulted in major flooding throughout the New Orleans area. As the flood waters receded, thick sediment was left covering the ground and coating the interior of homes. This sediment was dispersed into the air and inhaled as dust by returning residents and workers. Our objective in this study was to evaluate the potential pulmonary effects associated with the respirable particulate matter (PM) derived from Hurricane Katrina (HK-PM) in mice. Samples of PM were collected from several locations along the Gulf Coast on September 30 and October 2, 2005 and had a mean aerodynamic diameter ranging from 3-5 μm). Chemical analysis and cytotoxicity assays were performed for all HK-PM samples. A few samples with varying levels of cytotoxicity were chosen for an acute inhalation exposure study. Airborne PM10 levels recorded in the New Orleans area post-Katrina were variable, ranging from 70 μg/m3 in Gentilly to 688 μg/m3 in Lakeview (residential areas). Mice exposed to one of these samples developed significant pulmonary inflammation and airways resistance and hyperresponsiveness to methacholine challenge. These studies demonstrate that dispersion of certain Katrina sediment samples through either natural (e.g., wind) or mechanical (e.g., vehicles) processes promotes airflow obstruction in mice.
PMCID: PMC2596316  PMID: 19079667
Hurricane Katrina; pulmonary dysfunction; respiratory toxicology
9.  Hurricane Katrina’s Impact on the Mental Health of Adolescent Female Offenders 
Anxiety, stress, and coping  2009;22(4):433-448.
Exposure to multiple traumatic events and high rates of mental health problems are common among juvenile offenders. This study draws on Conservation of Resources (COR) stress theory to examine the impact of a specific trauma, Hurricane Katrina, relative to other adverse life events on the mental health of female adolescent offenders in Mississippi. Teenage girls (N = 258, 69% African American) were recruited from 4 juvenile detention centers and the state training school. Participants were interviewed about the occurrence and timing of adverse life events and hurricane-related experiences and completed a self-administered mental health assessment. Hierarchical linear regression models were used to identify predictors of anxiety and depression. Pre-hurricane family stressors, pre-hurricane traumatic events, hurricane-related property damage, and receipt of hurricane-related financial assistance significantly predicted symptoms of anxiety and depression. Findings support COR theory. Family stressors had the greatest influence on symptoms of anxiety and depression, highlighting the need for family-based services that address the multiple, inter-related problems and challenges in the lives of female juvenile offenders.
doi:10.1080/10615800802290634
PMCID: PMC2788001  PMID: 19296263
female juvenile offenders; hurricane exposure; family stressors; anxiety; depression
10.  Characterization of Airborne Molds, Endotoxins, and Glucans in Homes in New Orleans after Hurricanes Katrina and Rita▿  
In August and September 2005, Hurricanes Katrina and Rita caused breeches in the New Orleans, LA, levee system, resulting in catastrophic flooding. The city remained flooded for several weeks, leading to extraordinary mold growth in homes. To characterize the potential risks of mold exposures, we measured airborne molds and markers of molds and bacteria in New Orleans area homes. In October 2005, we collected air samples from 5 mildly water-damaged houses, 15 moderately to heavily water-damaged houses, and 11 outdoor locations. The air filters were analyzed for culturable fungi, spores, (1→3,1→6)-β-d-glucans, and endotoxins. Culturable fungi were significantly higher in the moderately/heavily water-damaged houses (geometric mean = 67,000 CFU/m3) than in the mildly water-damaged houses (geometric mean = 3,700 CFU/m3) (P = 0.02). The predominant molds found were Aspergillus niger, Penicillium spp., Trichoderma, and Paecilomyces. The indoor and outdoor geometric means for endotoxins were 22.3 endotoxin units (EU)/m3 and 10.5 EU/m3, respectively, and for (1→3,1→6)-β-d-glucans were 1.7 μg/m3 and 0.9 μg/m3, respectively. In the moderately/heavily water-damaged houses, the geometric means were 31.3 EU/m3 for endotoxins and 1.8 μg/m3 for (1→3,1→6)-β-d-glucans. Molds, endotoxins, and fungal glucans were detected in the environment after Hurricanes Katrina and Rita in New Orleans at concentrations that have been associated with health effects. The species and concentrations were different from those previously reported for non-water-damaged buildings in the southeastern United States.
doi:10.1128/AEM.01973-06
PMCID: PMC1828784  PMID: 17209066
11.  Recovery from PTSD following Hurricane Katrina 
Depression and anxiety  2011;28(6):439-446.
Background
We examined patterns and correlates of speed of recovery of estimated posttraumatic stress disorder (PTSD) among people who developed PTSD in the wake of Hurricane Katrina.
Method
A probability sample of pre-hurricane residents of areas affected by Hurricane Katrina was administered a telephone survey 7-19 months following the hurricane and again 24-27 months post-hurricane. The baseline survey assessed PTSD using a validated screening scale and assessed a number of hypothesized predictors of PTSD recovery that included socio-demographics, pre-hurricane history of psychopathology, hurricane-related stressors, social support, and social competence. Exposure to post-hurricane stressors and course of estimated PTSD were assessed in a follow-up interview.
Results
An estimated 17.1% of respondents had a history of estimated hurricane-related PTSD at baseline and 29.2% by the follow-up survey. Of the respondents who developed estimated hurricane-related PTSD, 39.0% recovered by the time of the follow-up survey with a mean duration of 16.5 months. Predictors of slow recovery included exposure to a life-threatening situation, hurricane-related housing adversity, and high income. Other socio-demographics, history of psychopathology, social support, social competence, and post-hurricane stressors were unrelated to recovery from estimated PTSD.
Conclusions
The majority of adults who developed estimated PTSD after Hurricane Katrina did not recover within 18-27 months. Delayed onset was common. Findings document the importance of initial trauma exposure severity in predicting course of illness and suggest that pre- and post-trauma factors typically associated with course of estimated PTSD did not influence recovery following Hurricane Katrina.
doi:10.1002/da.20790
PMCID: PMC3138333  PMID: 21308887
Disasters; Post-traumatic stress disorders; PTSD; Stressful Events; Time Factors
12.  Implementation of Evidence-based Asthma Interventions in Post-Katrina New Orleans: The Head-off Environmental Asthma in Louisiana (HEAL) Study 
Environmental Health Perspectives  2012;120(11):1607-1612.
Background: Childhood asthma morbidity and mortality in New Orleans, Louisiana, is among the highest in the nation. In August 2005, Hurricane Katrina created an environmental disaster that led to high levels of mold and other allergens and disrupted health care for children with asthma.
Objectives: We implemented a unique hybrid asthma counselor and environmental intervention based on successful National Institutes of Health asthma interventions from the National Cooperative Inner City Asthma (NCICAS) and Inner-City Asthma (ICAS) Studies with the goal of reducing asthma symptoms in New Orleans children after Hurricane Katrina.
Methods: Children (4–12 years old) with moderate-to-severe asthma (n = 182) received asthma counseling and environmental intervention for approximately 1 year. HEAL was evaluated employing several analytical approaches including a pre–post evaluation of symptom changes over the entire year, an analysis of symptoms according to the timing of asthma counselor contact, and a comparison to previous evidence-based interventions.
Results: Asthma symptoms during the previous 2 weeks decreased from 6.5 days at enrollment to 3.6 days at the 12-month symptom assessment (a 45% reduction, p < 0.001), consistent with changes observed after NCICAS and ICAS interventions (35% and 62% reductions in symptom days, respectively). Children whose families had contact with a HEAL asthma counselor by 6 months showed a 4.09-day decrease [95% confidence interval (CI): 3.25 to 4.94-day decrease] in symptom days, compared with a 1.79-day decrease (95% CI: 0.90, 2.67) among those who had not yet seen an asthma counselor (p < 0.001).
Conclusions: The novel combination of evidence-based asthma interventions was associated with improved asthma symptoms among children in post-Katrina New Orleans. Post-intervention changes in symptoms were consistent with previous randomized trials of NCICAS and ICAS interventions.
doi:10.1289/ehp.1104242
PMCID: PMC3556603  PMID: 22894795
asthma case management; asthma counselor; asthma morbidity; environmental intervention; Hurricane Katrina; indoor allergens; mold
13.  Indoor Environmental Exposures for Children with Asthma Enrolled in the HEAL Study, Post-Katrina New Orleans 
Environmental Health Perspectives  2012;120(11):1600-1606.
Background: Rain and flooding from Hurricane Katrina resulted in widespread growth of mold and bacteria and production of allergens in New Orleans, Louisiana, which may have led to increased exposures and morbidity in children with asthma.
Objectives: The goal of the Head-off Environmental Asthma in Louisiana (HEAL) study was to characterize post-Katrina exposures to mold and allergens in children with asthma.
Methods: The homes of 182 children with asthma in New Orleans and surrounding parishes were evaluated by visual inspection, temperature and moisture measurements, and air and dust sampling. Air was collected using vacuum-pump spore traps and analyzed for > 30 mold taxa using bright field microscopy. Dust was collected from the children’s beds and bedroom floors and analyzed for mouse (Mus m 1), dust mite (Der p 1), cockroach (Bla g 1), and mold (Alternaria mix) allergens using ELISA.
Results: More than half (62%) of the children were living in homes that had been damaged by rain, flooding, or both. Geometric mean indoor and outdoor airborne mold levels were 501 and 3,958 spores/m3, respectively. Alternaria antigen was detected in dust from 98% of homes, with 58% having concentrations > 10 µg/g. Mus m 1, Der p 1, and Bla g 1 were detected in 60%, 35%, and 20% of homes, respectively, at low mean concentrations.
Conclusions: Except for Alternaria antigen in dust, concentrations of airborne mold (ratio of indoor to outdoor mold) and dust allergens in the homes of HEAL children were lower than measurements found in other studies, possibly because of extensive post-Katrina mold remediation and renovations, or because children moved into cleaner homes upon returning to New Orleans.
doi:10.1289/ehp.1104840
PMCID: PMC3556612  PMID: 22894816
allergens; asthma; endotoxin; environmental remediation; glucan; Hurricane Katrina; mold
14.  Exposure to Hurricane Katrina, Post-Traumatic Stress Disorder and Birth Outcomes 
Background
Little is known about the effects of natural disasters on pregnancy outcomes. We studied mental health and birth outcomes among women exposed to Hurricane Katrina.
Methods
We collected data prospectively from a cohort of 301 women from New Orleans and Baton Rouge. Pregnant women were interviewed during pregnancy about their experiences during the hurricane, as well as whether they had experienced symptoms of post-traumatic stress disorder (PTSD) and/or depression. High hurricane exposure was defined as having three or more of the eight severe hurricane experiences, such as feeling that one's life was in danger, walking through floodwaters, or having a loved one die.
Results
The frequency of low birth weight was higher in women with high hurricane exposure (14.0%) than women without high hurricane exposure (4.7%), with an adjusted odds ratio (aOR): 3.3; 95% confidence interval (CI): 1.13−9.89; p<0.01. The frequency of preterm birth was higher in women with high hurricane exposure (14.0%) than women without high hurricane exposure (6.3%), with aOR: 2.3; 95% CI: 0.82−6.38; p>0.05. There were no significant differences in the frequency of low birth weight or preterm birth between women with PTSD or depression and women without PTSD or depression (p>0.05).
Conclusions
Women who had high hurricane exposure were at an increased risk of having low birth weight infants. Rather than a general exposure to disaster, exposure to specific severe disaster events and the intensity of the disaster experience may be better predictors of poor pregnancy outcomes. To prevent poor pregnancy outcomes during and after disasters, future disaster preparedness may need to include the planning of earlier evacuation of pregnant women to minimize their exposure to severe disaster events.
doi:10.1097/MAJ.0b013e318180f21c
PMCID: PMC2635112  PMID: 18703903
Depression; disaster; low birth weight; post-traumatic stress disorder; pregnancy
15.  Interaction Between Genetic Variants and Exposure to Hurricane Katrina on Post-Traumatic Stress and Post-Traumatic Growth: A Prospective Analysis of Low Income Adults 
Journal of affective disorders  2013;0:10.1016/j.jad.2013.09.018.
Background
There is considerable variation in psychological reactions to natural disasters, with responses ranging from relatively mild and transitory symptoms to severe and persistent posttraumatic stress (PTS). Some survivors also report post-traumatic growth (PTG), or positive psychological changes due to the experience and processing of the disaster and its aftermath. Gene-environment interaction (GxE) studies could offer new insight into the factors underlying variability in post-disaster psychological responses. However, few studies have explored GxE in a disaster context.
Methods
We examined whether ten common variants in seven genes (BDNF, CACNA1C, CRHR1, FKBP5, OXTR, RGS2, SLC6A4) modified associations between Hurricane Katrina exposure and PTS and PTG. Data were from a prospective study of 205 low-income non-Hispanic Black parents residing in New Orleans prior to and following Hurricane Katrina.
Results
We found a significant association (after correction) between RGS2 (rs4606; p=0.0044) and PTG, which was mainly driven by a cross-over GxE (p=0.006), rather than a main genetic effect (p=0.071). The G (minor allele) was associated with lower PTG scores for low levels of Hurricane exposure and higher PTG scores for moderate and high levels of exposure. We also found a nominally significant association between variation in FKBP5 (rs1306780, p=0.0113) and PTG, though this result did not survive correction for multiple testing.
Limitations
Although the inclusion of low-income non-Hispanic Black parents allowed us to examine GxE among a highly vulnerable group, our findings may not generalize to other populations or groups experiencing other natural disasters. Moreover, not all participants invited to participate in the genetic study provided saliva.
Conclusions
To our knowledge, this is the first study to identify GxE in the context of post-traumatic growth. Future studies are needed to clarify the role of GxE in PTS and PTG and post-disaster psychological responses, especially among vulnerable populations.
doi:10.1016/j.jad.2013.09.018
PMCID: PMC3873605  PMID: 24161451
Genes; Adversity; Hurricane; Post-traumatic stress; Post-traumatic growth; resilience
16.  Cohort Study of Medication Adherence in Older Adults (CoSMO): Extended effects of Hurricane Katrina on medication adherence among older adults 
Background
Previous research indicates that many patients with hypertension ran out of medications and had difficulties getting refills immediately after Hurricane Katrina. The extended effect of Hurricane Katrina on antihypertensive medication adherence is not well characterized.
Methods
Data were analyzed for 2194 participants who completed the baseline survey for the Cohort Study of Medication Adherence among Older Adults between August 2006 and September 2007. Based on pre-Katrina zip codes, the study population was categorized into high and low affected areas. Low medication adherence was defined as a score less than 6 on the 8-item Morisky Medication Adherence Scale.
Results
Prevalence of low adherence was similar among participants living in high and low affected areas. Low medication adherence was similar for participants with greater than or less than 25% of the residence damaged by Hurricane Katrina and for participants with and without symptoms of post-traumatic stress disorder. In high affected areas, non-significant associations were present for those who had moved since the storm and those with a friend or immediate family member who had died in the month following the storm. These factors were not associated with low medication adherence in low affected areas. In both high and low affected areas, lower scores on the hurricane coping self-efficacy scale were associated with low medication adherence (p <0.05).
Conclusions
The effect of Hurricane Katrina on patient adherence to antihypertensive medication was limited in the second year following the storm. Intrinsic patient factors, such as low coping self-efficacy, remain important factors associated with low adherence.
doi:10.1097/MAJ.0b013e318180f175
PMCID: PMC2561294  PMID: 18703902
medication adherence; hypertension; Hurricane Katrina
17.  Quality of Life in Hypertensive Clinic Patients Following Hurricane Katrina 
The Ochsner Journal  2011;11(3):226-231.
Background
The purpose of this study was to assess quality of life among hypertensive patients in the year following Hurricane Katrina.
Methods
Hypertensive patients (n  =  211) in a multispecialty group practice in New Orleans completed validated surveys during the year after Hurricane Katrina. We assessed patients' demographics, quality of life (Medical Outcomes Study 36), hurricane coping self-efficacy, property damage, stress, and changes in distance from and visits with family and friends.
Results
The mean age of participants was 63.5 years, 45.0% were men, 70.6% were white, 89.5% had graduated from high school, and 68.3% were married. Mean quality of life scores (standard deviation) were physical functioning 64.6 (30.0), role physical 60.0 (42.8), bodily pain 59.9 (24.3), general health 60.4 (20.5), vitality 53.6 (26.5), social functioning 74.5 (28.1), role emotional 67.8 (41.1), and mental 72.3 (22.0). After adjustment for age, gender, and race, lower coping self-efficacy, more damage to their residence, higher levels of stress after the storm, increased distance from family and friends, and decreased visits with family and friends were associated with lower quality of life. Personal and financial losses were identified as the most common cause of postdisaster stress, reported by 29.6% of participants.
Conclusions
Storm-related factors were associated with lower quality of life in adult patients with hypertension after Hurricane Katrina. Providers managing hypertensive patients in disaster-prone areas may want to consider these factors in identifying patients at risk for lower quality of life following catastrophes.
PMCID: PMC3179189  PMID: 21960755
Disasters; Hurricane Katrina; hypertension; quality of life; Short Form 36
18.  Race, socioeconomic status, and return migration to New Orleans after Hurricane Katrina 
Population and environment  2010;31(1-3):20-42.
Hurricane Katrina struck New Orleans on the 29th of August 2005 and displaced virtually the entire population of the city. Soon after, observers predicted the city would become whiter and wealthier as a result of selective return migration, although challenges related to sampling and data collection in a post-disaster environment have hampered evaluation of these hypotheses. In this article, we investigate return to the city by displaced residents over a period of approximately 14 months following the storm, describing overall return rates and examining differences in return rates by race and socioeconomic status. We use unique data from a representative sample of pre-Katrina New Orleans residents collected in the Displaced New Orleans Residents Pilot Survey. We find that black residents returned to the city at a much slower pace than white residents even after controlling for socioeconomic status and demographic characteristics. However, the racial disparity disappears after controlling for housing damage. We conclude that blacks tended to live in areas that experienced greater flooding and hence suffered more severe housing damage which, in turn, led to their delayed return to the city. The full-scale survey of displaced residents being fielded in 2009–2010 will show whether the repopulation of the city was selective over a longer period.
doi:10.1007/s11111-009-0092-2
PMCID: PMC2862006  PMID: 20440381
Race; Socioeconomic status; Migration; New Orleans; Hurricane Katrina; Environment; Natural hazards
19.  Exposure to Hurricane-Related Stressors and Mental Illness After Hurricane Katrina 
Archives of general psychiatry  2007;64(12):1427-1434.
Context:
Uncertainty exists about the prevalence, severity, and correlates of mental disorders among people exposed to Hurricane Katrina.
Objective:
To estimate the prevalence and associations between DSM-IV anxiety-mood disorders and hurricane-related stressors separately among prehurricane residents of the New Orleans metropolitan area and the remainder of the areas in Alabama, Louisiana, and Mississippi affected by Katrina.
Design:
Community survey.
Setting and Participants:
A probability sample of 1043 English-speaking prehurricane residents of the areas affected by Hurricane Katrina was administered via telephone survey between January 19 and March 31, 2006. The survey assessed hurricane-related stressors and screened for 30-day DSM-IV anxiety-mood disorders.
Main Outcome Measures:
The K6 screening scale of anxiety-mood disorders and the Trauma Screening Questionnaire scale for posttraumatic stress disorder (PTSD), both calibrated against blinded structured clinical reappraisal interviews to approximate the 30-day prevalence of DSM-IV disorders.
Results:
Prehurricane residents of the New Orleans metropolitan area were estimated to have a 49.1% 30-day prevalence of any DSM-IV anxiety-mood disorder (30.3% estimated prevalence of PTSD) compared with 26.4% (12.5% PTSD) in the remainder of the sample. The vast majority of respondents reported exposure to hurricane-related stressors. Extent of stressor exposure was more strongly related to the outcomes in the New Orleans metropolitan area subsample than the remainder of the sample. The stressors most strongly related to these outcomes were physical illness/injury and physical adversity in the New Orleans metropolitan area subsample and property loss in the remainder of the sample. Sociodemographic correlates were not explained either by differential exposure or reactivity to hurricane-related stressors.
Conclusions:
The high prevalence of DSM-IV anxiety-mood disorders, the strong associations of hurricane-related stressors with these outcomes, and the independence of sociodemographics from stressors argue that the practical problems associated with ongoing stressors are widespread and must be addressed to reduce the prevalence of mental disorders in this population.
doi:10.1001/archpsyc.64.12.1427
PMCID: PMC2174368  PMID: 18056551
20.  Few Associations Found between Mold and Other Allergen Concentrations in the Home versus Skin Sensitivity from Children with Asthma after Hurricane Katrina in the Head-Off Environmental Asthma in Louisiana Study 
Mold and other allergen exposures exacerbate asthma symptoms in sensitized individuals. We evaluated allergen concentrations, skin test sensitivities, and asthma morbidity for 182 children, aged 4–12 years, with moderate to severe asthma, enrolled 18 months after Katrina, from the city of New Orleans and the surrounding parishes that were impacted by the storm, into the Head-off Environmental Asthma in Louisiana (HEAL) observational study. Dust (indoor) and air (indoor and outdoor) samples were collected at baseline of 6 and 12 months. Dust samples were evaluated for dust mite, cockroach, mouse, and Alternaria by immunoassay. Air samples were evaluated for airborne mold spore concentrations. Overall, 89% of the children tested positive to ≥1 indoor allergen, with allergen-specific sensitivities ranging from 18% to 67%. Allergen concentration was associated with skin sensitivity for 1 of 10 environmental triggers analyzed (cat). Asthma symptom days did not differ with skin test sensitivity, and surprisingly, increased symptoms were observed in children whose baseline indoor airborne mold concentrations were below median levels. This association was not observed in follow-up assessments. The lack of relationship among allergen levels (including mold), sensitivities, and asthma symptoms points to the complexity of attempting to assess these associations during rapidly changing social and environmental conditions.
doi:10.1155/2012/427358
PMCID: PMC3523147  PMID: 23304171
21.  A Comparison of the Nursing Home Evacuation Experience between Hurricanes Katrina (2005) and Gustav (2008) 
Background
One of the tragic legacies of Hurricane Katrina was the loss of life among Louisiana (LA) nursing home (NH) residents. Katrina revealed a staggering lack of emergency preparation and understanding of how to safely evacuate frail populations. Three years later, LA braced for Hurricane Gustav, a storm heralded to rival Katrina's power. Though its magnitude of destruction ultimately paled to Katrina, the warnings and predicted path preceding Gustav yielded a process of NH evacuations similar to Katrina. The goal of this paper was to ascertain whether NH administrative directors (ADs) felt more prepared to evacuate before Gustav.
Methods
In 2006, Dosa, et. al. (JAMDA, 3/07), interviewed 20 NH ADs by qualitative telephone survey to evaluate their lessons learned from Katrina. Administrators at these 20 participating nursing homes were contacted and asked to participate in a follow-up survey to compare hurricane preparedness between 2005 and 2008. Specifically, ADs were asked if they evacuated prior to Gustav, their destination, and about logistical issues with evacuation (e.g., transportation, injuries). ADs were asked to rate their confidence with state assistance, hurricane transportation, and evacuation preparedness on a 10-point scale (10=most confident) and compare their preparedness to Katrina.
Results
Sixteen of the 20 NHs that participated in 2006 agreed to be surveyed – 11 of whom held the same position before Katrina. Unlike Katrina, when only 45% evacuated prior to the storm, all 16 NHs evacuated before Gustav. (56% to another NH and 46% to a church, gym, college, or other facility). Overall, ADs rated their confidence in preparedness for Gustav as a mean of 8.3 (range 5 to 10) – compared with a mean of 5.4 (range 3 to 8) for Katrina, a 54% improvement. Of the 11 ADs employed pre-Katrina, 73% reported improved collaboration with the state and 55% noted improved transportation. Nevertheless, seven ADs noted significant logistical problems during evacuation (mostly transportation); four noted resident injuries (two hip fractures, one traumatic fall, and one cerebrovascular accident); and two noted resident post-traumatic stress.
Conclusions
NH ADs felt more prepared to evacuate their residents for Gustav, owing partly to improved communication and collaboration with state agencies; however, significant morbidity and logistical problems remain with evacuating frail NH residents before hurricanes.
doi:10.1016/j.jamda.2009.06.010
PMCID: PMC2773652  PMID: 19883887
Hurricane Disasters; Emergency Preparedness; Evacuation
22.  The effect of Hurricane Katrina on the prevalence of health impairments and disability among adults in New Orleans: Differences by age, race, and sex 
We examined the effects of Hurricane Katrina on disability-related measures of health among adults from New Orleans, U.S.A., in the year after the hurricane, with a focus on differences by age, race, and sex. Our analysis used data from the American Community Survey to compare disability rates between the pre-Katrina population of New Orleans with the same population in the year after Katrina (individuals were interviewed for the study even if they relocated away from the city). The comparability between the pre-and post-Katrina samples was enhanced by using propensity weights. We found a significant decline in health for the adult population from New Orleans in the year after the hurricane, with the disability rate rising from 20.6% to 24.6%. This increase in disability reflected a large rise in mental impairments and, to a lesser extent, in physical impairments. These increases were, in turn, concentrated among young and middle-aged black females. Stress-related factors likely explain why young and middle-aged black women experienced worse health outcomes, including living in dwellings and communities that suffered the most damage from the hurricane, household breakup, adverse outcomes for their children, and higher susceptibility.
doi:10.1016/j.socscimed.2012.12.009
PMCID: PMC3640812  PMID: 23321678
U.S.A; Disability; Demographic disparities; Hurricane Katrina; New Orleans; Natural disasters and health
23.  The Psychological Impact From Hurricane Katrina: Effects of Displacement and Trauma Exposure on University Students 
Behavior Therapy  2010;41(3):340-349.
The following study examined the reactions of university students to Hurricane Katrina. A group of 68 New Orleans area students who were displaced from their home universities as a result of the hurricane were matched on race, gender, and age to a sample of 68 students who had been enrolled at Louisiana State University (LSU) prior to the hurricane. All students were enrolled at LSU at the time they participated in an online survey, conducted 3 months following the hurricane. The survey included symptom measures of depression, anxiety, stress, posttraumatic stress disorder (PTSD), and other variables. Results indicated displaced students experienced more trauma exposure and greater subsequent distress, more symptoms of PTSD, and more symptoms of depression. Moreover, traumatic exposure and distress from the traumatic exposure were found to fully mediate depressive symptoms and posttraumatic symptoms in the displaced students.
doi:10.1016/j.beth.2009.09.004
PMCID: PMC3374339  PMID: 20569783
24.  Hurricane Katrina-related maternal stress, maternal mental health, and early infant temperament 
Maternal and child health journal  2009;14(4):511-518.
To investigate temperament in infants whose mothers were exposed to Hurricane Katrina and its aftermath, and to determine if high hurricane exposure is associated with difficult infant temperament. A prospective cohort study of women giving birth in New Orleans and Baton Rouge, LA (n=288) in 2006–2007 was conducted. Questionnaires and interviews assessed the mother’s experiences during the hurricane, living conditions, and psychological symptoms, two months and 12 months postpartum. Infant temperament characteristics were reported by the mother using the activity, adaptability, approach, intensity, and mood scales of the Early Infant and Toddler Temperament Questionnaires, and “difficult temperament” was defined as scoring in the top quartile for three or more of the scales. Logistic regression was used to examine the association between hurricane experience, mental health, and infant temperament. Serious experiences of the hurricane did not strongly increase the risk of difficult infant temperament (association with 3 or more serious experiences of the hurricane: adjusted odds ratio (aOR) 1.50, 95% confidence interval (CI) 0.63–3.58 at 2 months; 0.58, 0.15–2.28 at 12 months). Maternal mental health was associated with report of difficult infant temperament, with women more likely to report having a difficult infant temperament at one year if they had screened positive for PTSD (aOR 1.82, 95% confidence interval (CI) 0.61–5.41), depression, (aOR 3.16, 95% CI 1.22–8.20) or hostility (aOR 2.17, 95% CI 0.81–5.82) at 2 months. Large associations between maternal stress due to a natural disaster and infant temperament were not seen, but maternal mental health was associated with reporting difficult temperament. Further research is needed to determine the effects of maternal exposure to disasters on child temperament, but in order to help babies born in the aftermath of disaster, the focus may need to be on the mother’s mental health.
doi:10.1007/s10995-009-0486-x
PMCID: PMC3472436  PMID: 19554438
infant temperament; natural disaster; postpartum depression; post-traumatic stress disorder
25.  Public health and Hurricane Katrina: lessons learned and what we can do now. 
Keith C. Ferdinand, MD, FACC, presently resides in Atlanta, GA, displaced from his native New Orleans by Hurricane Katrina, September 2005. The hurricane destroyed hiss cardiovascular center and severely damaged his home. In Atlanta, he is director of the Association of Black Cardiologists Hurricane Katrina Relief.
PMCID: PMC2595083  PMID: 16708514

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