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Large-scale damage to the power infrastructure from hurricanes and high-wind events can have devastating ripple effects on infrastructure, the broader economy, households, communities, and regions. Using Hurricane Irma’s impact on Florida as a case study, we examined: (1) differences in electric power outages and restoration rates between urban and rural counties; (2) the duration of electric power outages in counties exposed to tropical storm force winds versus hurricane Category 1 force winds; and (3) the relationship between the duration of power outage and socioeconomic vulnerability. We used power outage data for the period September 9, 2017–September 29, 2017. At the peak of the power outages following Hurricane Irma, over 36% of all accounts in Florida were without electricity. We found that the rural counties, predominantly served by rural electric cooperatives and municipally owned utilities, experienced longer power outages and much slower and uneven restoration times. Results of three spatial lag models show that large percentages of customers served by rural electric cooperatives and municipally owned utilities were a strong predictor of the duration of extended power outages. There was also a strong positive association across all three models between power outage duration and urban/rural county designation. Finally, there is positive spatial dependence between power outages and several social vulnerability indicators. Three socioeconomic variables found to be statistically significant highlight three different aspects of vulnerability to power outages: minority groups, population with sensory, physical and mental disability, and economic vulnerability expressed as unemployment rate. The findings from our study have broader planning and policy relevance beyond our case study area, and highlight the need for additional research to deepen our understanding of how power restoration after hurricanes contributes to and is impacted by the socioeconomic vulnerabilities of communities.

Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory. The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.

To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability. Adults (ages 18-64) who participated in the Behavioral Risk Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009). The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was used to adjust for potential confounders (age, sex and race) and to evaluate whether there was an independent effect of ACEs on work inability after adding other important predictors (support, education, health) to the model. ACEs were highly prevalent with almost 75% of the sample reporting at least one ACE category and over 25% having a high ACE burden (4 or more categories). ACEs were strongly associated with functional support. Participants experiencing a high ACE burden had a higher adjusted odds ratio (OR) [95% confidence interval] of 1.9 [1.5-2.4] of work inability (reference: zero ACEs). Good functional support (adjusted OR 0.52 [0.42-0.63]) and structural support (adjusted OR 0.48 [0.41-0.56]) were protective against work inability. After adding education and health to the model, ACEs no longer appeared to have an independent effect. Structural support remained highly protective, but functional support only appeared to be protective in those with good physical health. ACEs are highly prevalent in working-age US adults with a disability, particularly young adults. ACEs are associated with decreased support, lower educational attainment and worse adult health. Health care providers are encouraged to screen for ACEs. Addressing the effects of ACEs on health and support, in addition to education and retraining, may increase ability to work in those with a disability.

Disaster exposure is associated with the development of posttraumatic stress (PTS) symptoms in youths. However, little is known about how to predict which youths will develop chronic PTS symptoms after disaster exposure. To evaluate PTS symptom trajectories among youths after 4 major US hurricanes and assess factors associated with those trajectories. This cohort study used integrative data analysis to combine data from 4 studies of youths' responses to natural disasters (hurricanes Andrew [1992], Charley [2004], Ike [2005], and Katrina [2008]) at time points ranging from 3 to 26 months after the disasters. Those studies recruited and surveyed youths aged 6 to 16 years at schools via convenience sampling of schools near the path of destruction for each hurricane. This study was conducted from August 2017 to August 2020, and pooled data were analyzed from February 2019 to October 2020. Experience of a natural disaster during the ages of 6 to 16 years. Posttraumatic stress symptoms were assessed using the University of California, Los Angeles, Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) and the UCLA PTSD-RI-Revised. Latent class growth analyses were used to evaluate the youths' PTS symptom trajectories and associated factors. Among 1707 youths included in the study, the mean (SD) age was 9.61 (1.60) years, 922 (54%) were female, and 785 (46%) self-identified as White non-Hispanic. Four PTS symptom trajectories were identified: chronic (171 participants [10%]), recovery (393 [23%]), moderate-stable (563 [33%]), and low-decreasing (580 [34%]). Older youths were less likely to be in the chronic group; compared with the chronic group, each 1-year increase in age was associated with increased odds of being in the other groups (recovery: odds ratio [OR], 1.78 [95% CI, 1.29-2.48]; moderate-stable: OR, 1.94 [95% CI, 1.43-2.62]; and low-decreasing: OR, 2.71 [95% CI, 1.99-3.71]). Compared with males, females had higher odds of being in the chronic group than in any other group (recovery group: OR, 0.48 [95% CI, 0.26-0.91]; moderate-stable group: OR, 0.37 [95% CI, 0.21-0.64]; and low-decreasing group: OR, 0.25 [95% CI, 0.14-0.44]). In this cohort study, few youths reported chronic distress, and trajectories among most youths reflected recovery or low-decreasing PTS symptoms. Older age and identification as male were factors associated with decreased odds of a chronic trajectory. Youths with chronic or moderate-stable trajectories may benefit from intervention.

Context. Pediatricians working toward health equity require health care delivery mechanisms that take on dual roles: mitigating the health effects of a maladaptive social ecosystem while simultaneously working to improve the ecosystem itself. School-based health centers (SBHCs) perform these dual roles by providing medical, mental/behavioral, dental, and vision care directly in schools where young people spend the majority of their time, maximizing their opportunity to learn and grow. Evidence Acquisition. Databases were searched extensively for research studies published between January 2000 and December 2018. Evidence Synthesis. The authors began with 3 recent high-impact reviews that covered SBHC history, health outcomes, cost-benefit, and impact on health equity. Informed by these articles, the authors organized the evidence into 4 broad categories of impact: Financial, Physical Health (including medical, vision, and dental), Mental Health, and Educational Outcomes. Using these 4 categories, the authors then performed a robust literature search using PubMed for studies that fit into these themes. Conclusions. SBHCs increase access to health services for children, families, and communities, which ultimately leads to positive short- and long-term outcomes in service of a broad range of stakeholders. Educational impact requires further attention on both outcomes and methodological approaches. Three current public health topics of importance were identified that SBHCs might be well-suited to address: Youth Gun Violence, Adverse Childhood Experiences, and the Health of American Indian/Alaskan Native communities in the United States.

Weather-related disasters pose significant risks to youth mental health. Exposure to multiple disasters is becoming more common; however, the effects of such exposure remain understudied. This study demonstrates the application of integrative data approaches and FAIR (Findable, Accessible, Interoperable, Reusable) data principles to evaluate the relationship between cumulative disaster exposure and youth depression and suicidality in the United States, taking into account contextual factors across levels of social ecology. We combined data from five public sources, including the Youth Risk Behavior Surveillance System (YRBS), Federal Emergency Management Agency (FEMA), United States Census Bureau, Center for Homeland Defense and Security School Shooting Safety Compendium, and Global Terrorism Database. The integrative dataset included 415,701 youth from 37 districts across the United States who completed the YRBS between 1999 and 2021. The YRBS served as the core dataset. This data note highlights strategies for harmonizing diverse data formats, addressing geographic and temporal inconsistencies, and validating integrated datasets. Automated data cleaning and visualization techniques enhance accuracy and efficiency. Planning for sensitivity analyses before data cleaning is recommended to improve the data integration process and enhance the robustness of findings. This integrative approach demonstrates how leveraging FAIR principles can advance trauma research by facilitating large-scale analyses of complex public health questions. The methods provide a replicable framework for examining population-level impacts of phenomena and highlight opportunities for expanding trauma research.

The COVID-19 pandemic is a disaster event. Exposure to stressors during and after disaster events is associated with negative mental health symptoms. To inform targeted COVID-19 recovery efforts, data are needed to understand which stressors play a key role in this relationship. Cross-sectional survey data (demographics, impacts of COVID-19, social determinants of health, depression, and anxiety) were collected online from adults living in New York state between May and June 2020. Differences in the proportion of stressors (COVID-19 and social determinants) experienced by race/ethnicity were assessed using chi-square analyses. Logistic regression was used to assess which factors were associated with increased odds of depression and anxiety. A majority ( = 258, 62.2%) of the 415 respondents reported being directly impacted by the pandemic. Non-white respondents reported a significantly larger proportion of stressors compared to white respondents. Under half of respondents reported depression ( = 171, 41.2%) and anxiety ( = 164, 39.5%). Healthcare and food concerns were associated with increased odds of depression and anxiety, and economic concerns were associated with increased odds of anxiety. Findings underscore the need to respond to the COVID-19 mental health crisis by addressing social determinants of health.

Background: Children are a vulnerable population following a natural disaster, due to their age and dependence on adults. The primary presenting problem children report after disasters is posttraumatic stress symptoms (PTSS). Prior research suggests that PTSS is inversely related to social support, which is often disrupted after a disaster. Objective: This study examined the relationship between social support (from parents, teachers, and peers) and PTSS in children affected by Hurricane Katrina. The research contributes to the literature by examining the mechanisms that drive this relationship over time. Methods: In this study, 426 children were followed over four timepoints, beginning 3-7 months after Hurricane Katrina and concluding 25-27 months post-hurricane. Three path models analysed the relationship between social support (from parents, teachers, and peers, measured by the Social Support Scale for Children) and PTSS (measured by the UCLA PTSD Reaction Index). Covariates included child age, minority status, gender, perceived life threat, and actual life threat. Nonsignificant paths were trimmed from the final models. Global fit indices were examined to determine model fit. Results: In the parent and peer social support models, PTSS exhibited statistically significant effects on social support from one wave to the next. In the teacher model, this was only true between Waves 2 and 3. Social support showed a statistically significant effect on PTSS between Wave 2 and Wave 3 in the peer model (standardized estimate = −0.26, p < .0001). No paths from social support to PTSS were significant in the parent and teacher models. Conclusion: Findings support a social selection model in which PTSS undermine social support, particularly in the first two years post-disaster. If these findings are replicated, this suggests that, in cases of limited funding, PTSS should be prioritized, given their cascading effects on social support.

College students are a unique population occupying a distinct life-course and transition period between adolescence and adulthood. Although not monolithic in experiences, knowledge, and demographics, this diverse population is particularly susceptible to immediate, short-term, mid-term, and long-term disaster impacts. Recently, disaster research focusing on college students has rightly focused on the ongoing COVID-19 pandemic. Although the pandemic was a public health disaster interrupting social, developmental, and educational processes for students on a global scale, the climate crisis and related environmental disasters continuously threaten college students’ individual development, health, and well-being. Thus, it is critical to understand current knowledge focusing on environmental disasters and college students in order to determine future research needs. This article used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach to examine research on college students and disasters over the past ten years (2014–2023). We identified 67 articles, which we analyzed through a mixed methods approach, including descriptive statistics and thematic analysis. Results indicate that disaster impacts on college students are an understudied topic in the social sciences, especially in an era of more-frequent and -intense environmental hazards. Our findings demonstrate a need to engage college students in disaster research worldwide so that trade schools, colleges, and universities can collaborate with policymakers to build this unique and disproportionately impacted population’s capacity to mitigate against, respond to, and recover from environmental hazards in an ever-changing climate.