Health problems among low-income parents in the aftermath of Hurricane Katrina.

Hurricane Katrina made landfall in New Orleans on August 29, 2005, and led to disproportionate damage in low-income, non-Hispanic Black communities (e.g., Logan, 2006), due in part to housing that was less able to withstand disaster and greater proximity to levees that were in disrepair and that breached in the days following the storm (Ruscher, 2006). Moreover, the existing evacuation policies relied on private means of transportation that were less available to low-income, non-Hispanic Blacks than to their counterparts (Lavelle & Feagin, 2006). Consequently, low-income, non-Hispanic Blacks were more likely to stay in New Orleans, increasing their risk of exposure to deprivation, violence, and other hardships during the storm and its aftermath (Elliot & Pais, 2006). The psychological consequences of the hurricane have been well documented. Studies have shown elevated rates of general psychological distress, depression, and posttraumatic stress in the aftermath of Hurricane Katrina (e.g., Galea et al., 2007), and especially high levels among female, non-Hispanic Black, and low-income survivors (e.g., Elliot & Pais, 2006; Rhodes, Chan, Paxson, Waters, & Fussell, 2010). Less is known, however, about how the hurricane affected survivors’ physical health, including rates of common stress-related symptoms, such as frequent headaches or migraines, back pain, and digestive problems. Although most disaster research has focused on their psychological consequences, there is some evidence that disasters may also compromise physical health. A large study from the Netherlands, for example, found that survivors of a fireworks disaster reported higher levels of a variety of general health problems than the general Dutch population (van Kamp et al., 2006). By tracking survivors and nonexposed participants over multiple data points, studies have found that the declines in health go beyond what would be expected over time (e.g., Deeg, Huizink, Comij, & Smid, 2005). One factor that appears to account for variation in postdisaster health is exposure severity. In general, survivors who endure more severe exposure (e.g., greater property damage, bereavement, injuries) have been found to have worse postdisaster health (e.g., Dirkzwager, Grievink, Van Der Valden, & Yzermans, 2006). Persistent postdisaster stressors, such as disruptions in employment and relocation, have also been investigated, although the limited findings to date have been inconsistent (Uscher-Pines, 2009). The role of exposure in determining the health outcomes of Hurricane Katrina survivors specifically remains unclear. One study of 303 residents of FEMA trailers in the aftermath of Hurricane Katrina found that poorer health was associated with postdisaster loss of employment and residential instability (Lu, 2011). In contrast, a smaller study of Hurricane Katrina survivors (N = 128) found that property damage and level of employment were not significant predictors of physical health (Vu & VanLandingham, 2012). It is also likely that psychological functioning contributes to postdisaster health outcomes. A long history of research has focused on the interplay of physical and mental health in nondisaster contexts (World Health Organization, 2004). For example, in a large-scale study of New Yorkers across 33 communities (N = 10,000), researchers found that those who reported significant levels of emotional distress were three time more likely to suffer from poor health than other participants (McVeigh, Mostashari, & Wunsch-Hitzig, 2003). Other research has highlighted the role of psychological distress and specific health conditions, including migraine headaches, back pain, and digestive problems (e.g., Currie & Wang, 2005; Modgill, Jette, Wang, Becker, & Patten, 2012; Mussell et al., 2008). In studies of disaster survivors specifically, higher psychological distress, depression, and posttraumatic stress have been significantly associated with poorer physical health, controlling for disaster exposure (e.g., Polusny et al., 2008; Ruggiero et al., 2009). Predisaster mental health appears to be especially important in shaping postdisaster physical health outcomes. Drawing on data from electronic medical records, researchers in the Netherlands documented significant associations between predisaster mental health problems and increases in general health problems, unexplained physical symptoms (e.g., tiredness, headaches, abdominal pain), and chronic diseases (den Ouden, Dirkzwager, & Yzermans, 2005; Dirkzwager et al., 2006). A related study found that, 2 1/2 years after the disaster, predisaster mental health problems to be a stronger predictor of physical health symptoms than disaster exposure, suggesting that predisaster psychological functioning may be of particular importance in predicting the longer-term adjustment to disasters (Soeteman et al., 2006). Given the associations between predisaster mental health and postdisaster physical health, it is unfortunate that few studies include predisaster data. A 2002 review of the literature found that fewer than 5% of extant studies included predisaster assessments (Norris et al., 2002). A number of studies since this review have included predisaster data, including the medical record studies from the Netherlands mentioned above as well as a handful of investigations with predisaster self-report data. For example, in a sample of adolescents exposed to the 2010 Nashville floods, Felton, Cole, and Martin (2013) found that predisaster depressive symptoms and rumination were significant predictors of postdisaster depressive symptoms. In a study of male veterans who survived Hurricane Katrina, Tharp et al. (2011) found that those who were exposed to predisaster violence had increased odds of experiencing violence exposure during the hurricane, as well as posttraumatic stress disorder, panic, and generalized anxiety disorder 2 years thereafter. Finally, in a study of adolescents exposed to Hurricane Katrina, Weems et al. (2007) found that predisaster trait anxiety and negative affect were associated with postdisaster posttraumatic stress. Despite these and other notable exceptions, a lack of predisaster data remains the norm, and no studies to our knowledge have included predisaster self-report data on physical health conditions. The lack of predisaster is understandable given logistical and practical considerations. The period between which a hurricane is identified and when it makes landfall is brief, making it difficult, if not impossible, for researchers to mobilize predisaster data collection. Other forms of natural disasters, including tornados and hurricanes, offer even less time to prepare, further decreasing the feasibility of collecting data prior to their occurrence. Researchers could follow participants from studies in progress prior to disasters, yet such studies might not have measures relevant to postdisaster responses. Even if ongoing studies do have relevant measures, participants might not have been asked for consent to be contacted for further studies and researchers therefore might not collect postdisaster data for ethical reasons. Although the lack of predisaster data is understandable, in the absence of such data, it is difficult to discern the extent to which postdisaster elevations in health problems are due to preexisting health or mental health conditions or to the impact of the disaster and its aftermath. Moreover, as noted above, the few studies that do include predisaster data generally have not measured physical health when exploring the impact of disaster exposure on later adjustment. One cross-sectional study had Hurricane Katrina survivors (n = 222) retrospectively report on whether they had been diagnosed with a variety of health conditions prior to the hurricane, and found that recollections of predisaster arthritis, asthma, and hypertension were significantly associated with poorer postdisaster health (only predisaster arthritis was significant in a multivariate model; Kim, Plumb, Gredig, Rankin, & Taylor, 2008). Postdisaster physical and psychological functioning could have biased participants’ retrospective reports, however, and the study did not look at changes in specific health conditions. Likewise, in the absence of multiple waves of postdisaster data, it is difficult to decipher whether survivors’ initial health difficulties linger or return to predisaster levels in the years following the event. Previous studies in the aftermath of other disasters have produced mixed findings about whether postdisaster declines in health persist over time. One study (Dorn, Yzermans, Spreeuwenberg, Schilder, & van der Zee, 2008) found that adolescent survivors of a mass burn incident had larger increases in respiratory and musculoskeletal problems than nonexposed participants in the first year postdisaster, but not 2, 3, or 4 years postdisaster study. In contrast, a study of older adults in the Netherlands found that disaster exposure was associated with declines in self-reported functional ability 4 years postdisaster (Deeg et al., 2005). These studies highlight both the importance of following disaster survivors beyond the short-term aftermath and the importance of participant age in determining health outcomes.