Kimberley Shoaf

Objective: To characterize morbidity, health care-seeking, and medication-related needs among survivors of Hurricane Katrina. Methods: We used a two-stage sampling method to survey and interview 210 Hurricane Katrina survivors in Louisiana from 2006 to 2007. Interviews assessed injury, illness, environmental exposures, disaster-related damage, medication use, and health care-seeking behavior. Descriptive statistics were calculated. Results: Nearly 25% of respondents reported direct contact with hurricane-related floodwater. Nearly all experienced substantial property damage; wind (75.6%) and floodwater (67.5%) were the most common causes of damage. Before Hurricane Katrina, 70% of respondents reported good/excellent health; afterward, 35% reported worse health. Physical injury was reported by 17% of participants, emotional injury by 85%, and illness by 32%. Among those reporting injury/illness, 64% sought care for physical injuries, 21% for emotional injuries, and 63% for illnesses. Medication provision was common among those receiving care (70%-88%). Notably, 47% of respondents reported using at least one medication before the disaster, and 42% were unable to identify the specific medication they were taking. Conclusions: Hurricane-related morbidity extends beyond health care system encounters and is likely underestimated by facility-based surveillance alone. Medication continuity and health care access represent important but understudied dimensions of disaster-related morbidity that remain relevant in contemporary disaster preparedness and response efforts.

Infectious disease dynamics is a growing, interdisciplinary field that aims to advance the understanding of how infectious diseases spread and how to control them. Most trainees enter the field through established disciplines and assemble ad hoc training and experience in infectious disease dynamics. As such, expectations for doctoral training remain largely implicit and highly variable across institutions. Other fields have formalized training expectations though defined training competencies, which promote transparency and alignment across institutions without prescribing specific approaches to training or research. In this paper, we set out to define the core competencies that characterize doctoral-level expertise in infectious disease dynamics. We assembled a team of seven people at the University of Utah and drafted a competency set. We then validated the competency set with experts in the field using an e-Delphi process. We did not restrict participation by location, job title, or sector. We set an a priori threshold for consensus to 70% and sent out two rounds of surveys to experts, asking them to rank the competencies by order of importance. Our team initially generated a list of 13 proposed Cross-cutting, 24 Applied Modeling, 17 Data Science, and 16 Theory competencies. After completing two rounds of validation, we validated two tracks comprised of 7 Cross-cutting, 10 Applied Modeling, and 12 Theory competencies. This study represents the first structured effort to define doctoral-level competencies in infectious disease that can help guide curriculum development, comprehensive exam preparation, and trainee evaluation, while also supporting alignment between academic training and workforce needs.

The purpose of this population-based study is to examine the impact of COVID-19 and its long-term outcomes on US-born and people born outside the US in the state of Utah. Using the Utah Population Database, people born outside the US who were Utah residents alive on January 2020 were matched to US born Utah residents by age and sex. Demographics were compared using Chi-square test, and we examined COVID-19 outcomes using a conditional logistic regression model adjusting for race, ethnicity, Charlson Comorbidity Index, and socioeconomic factors. The final analysis included 475,582 individuals. Among US-born patients, 76.4% were non-Hispanic White and 9% were Hispanic/Latino. Among foreign-born individuals, 18.2% were non-Hispanic White and 50.1% were Hispanic/Latino origin. People born outside the US were less likely to be admitted to an ICU with a COVID diagnosis compared to those born in the US [OR = 0.85, 95% CI: 0.76–0.94]. In comparison to US-born individuals, Utah residents born outside the US had a 21% lower likelihood of all-cause mortality compared to US-born Utah residents [OR = 0.79, (0.74, 0.84)]. This is the first complete state-based analysis of Utah residents’ COVID-19 outcomes and demonstrates the migrant mortality advantage that has been previously described in literature.

Objective: Previous studies have demonstrated that stress and sleep are bidirectional and perseverative cognition (ie, worry and rumination) is a key cognitive mechanism in this relationship. The goal of our study was to examine the relationships between stress and sleep, and test whether physical activity moderates the stress-sleep link. Methods: Participants aged 18 and above were recruited from May 2020 to November 2021 and completed questionnaires and 7 days of twice daily text-based surveys, morning and evening. Morning text-based surveys assessed evening/overnight perseverative cognition and sleep, and evening surveys assessed daily stress ratings. Habitual physical activity was measured by the International Physical Activity Questionnaire. Analyses were conducted using bivariate multilevel autoregressive modeling (ML-VAR), a discrete-time structural equation model (SEM), to test relationships between repeated daily measures of sleep (duration/efficiency), stress, and preservative cognition, which were adjusted for age, sex, and race/ethnicity. Results: We obtained data from 155 participants (age M =42, SD=15, 82 f) over 1009 days. In the models, 95% credibility intervals for both stress (95% CI=−0.7, −0.1) and perseverative cognition (95% CI=−13.3, −6) showed they predicted shorter sleep duration during the corresponding night. Perseverative cognition had a stronger relationship with sleep duration than stress, but did not mediate its relationship. Participants with higher habitual MVPA had a weaker relationship between stress and sleep duration (95% CI=<0.001, 0.015). Perseverative cognition also predicted lower sleep efficiency that night (95% CI=−0.024, −0.006). There were no significant mediators or moderators in models of sleep efficiency. Conclusions: Results demonstrated that stress and perseverative cognition had a stronger impact on sleep at night than the opposite direction. In addition, results highlight the importance of physical activity in mitigating the deleterious effects of stress.

Infectious disease modeling and forecasting tools are crucial for outbreak management. However, variability exists in the capacity of state and local health departments to effectively utilize these tools, influenced by factors such as infrastructure, funding, staff capacity, and data access. This study aims to identify the current priorities, needs, and capacities of state and local public health departments regarding infectious disease modeling and forecasting tools. Key informant interviews were conducted with epidemiologists, informaticists, and leadership across state and local health departments from Montana, Utah, and Washington. Thematic coding and axial coding were used for thematic analysis. Three themes emerged: (1) models and tools must be adaptable based on the jurisdiction type (rural, urban, state); (2) building trust in models and tools is an important precursor to adoption; and (3) there are concerns about the availability and quality of data. This study highlights the need for adaptable modeling tools that are tailored to specific public health jurisdictions. Building trust in modeling and forecasting tools and addressing data quality issues are essential for successful tool implementation and adoption across diverse public health settings.

Purpose: Anxiety, insomnia, and physical activity (PA) are interrelated, but the bi-directional relationships between these three variables are not well understood. Less is known of these relationships in settings of disrupted daily activities and acute stress. This study aimed to characterize and examine relationships between insomnia, anxiety, and PA throughout the first year of the COVID-19 pandemic, when many lifestyle behaviors were disrupted. Methods: Participants comprised a convenience sample of 204 adults (55.4% female; 43.85 ± 15.85 years old) who completed the Generalized Anxiety Disorder Questionnaire (GAD-7), Insomnia Severity Index (ISI), and the International Physical Activity Questionnaire (IPAQ) at three time points through the first year of the COVID-19 pandemic. A cross-lagged panel model was used to evaluate these variables’ concurrent, autoregressive, and cross-lagged relationships across time. Follow-up dynamic panel modeling using maximum likelihood and structural equation modeling was employed. Results: Approximately 64% of participants reported their work/occupation as affected by the pandemic. At baseline, associations between anxiety and insomnia were observed (β-coefficient: 15.87; p < 0.001). Insomnia was a positive future predictor of anxiety (ISI time point 2: 7.9 ± 5.6 points; GAD-7 at time point 3: 4.1 ± 4.2 points; β-coefficient: 0.16; p < 0.01). No associations were observed between PA and anxiety or insomnia (all p > 0.05). Conclusions: Insomnia and anxiety were interrelated, and effects were cross-lagged. These data can inform future work focused on improving anxiety in settings of acute stress and disruptions to daily life, such as changes in occupational structure and stability. Specifically, targeting sleep parameters may be of interest to elicit downstream positive health behaviors.

Objectives: Determine the economic cost or benefit of expanding electronic case reporting (eCR) for 29 reportable conditions beyond the initial eCR implementation for COVID-19 at an academic health center. Materials and methods: The return on investment (ROI) framework was used to quantify the economic impact of the expansion of eCR from the perspective of an academic health system over a 5-year time horizon. Sensitivity analyses were performed to assess key factors such as personnel cost, inflation, and number of expanded conditions. Results: The total implementation costs for the implementation year were estimated to be $5031.46. The 5-year ROI for the expansion of eCR for the 29 conditions is expected to be 142% (net present value of savings: $7166). Based on the annual ROI, estimates suggest that the savings from the expansion of eCR will cover implementation costs in approximately 4.8 years. All sensitivity analyses yielded a strong ROI for the expansion of eCR. Discussion and conclusion: Our findings suggest a strong ROI for the expansion of eCR at UHealth, with the most significant cost savings observed implementing eCR for all reportable conditions. An early effort to ensure data quality is recommended to expedite the transition from parallel reporting to production to improve the ROI for healthcare organizations. This study demonstrates a positive ROI for the expansion of eCR to additional reportable conditions beyond COVID-19 in an academic health setting, such as UHealth. While this evaluation focuses on the 5-year time horizon, the potential benefit could extend further.

While school-based comprehensive sex education (CSE) is effective in HIV prevention among young people ages 10–24 years, Ghana’s national sexual and reproductive health education policy promotes abstinence. Meanwhile, the Ministry of Health’s HIV prevention programs provide more comprehensive school-based education. This qualitative study evaluated the HIV/AIDS education program in the Lower Manya Krobo Municipality to assess the perspectives of students and educators in 10 schools on school-based sexual and reproductive health programs, including HIV/AIDS education and conflicting HIV/AIDS sex education policies. HIV prevalence in the Lower Manya Krobo Municipality of Ghana was more than twice the national average at 5.64% in 2018, and prevalence among youth in the municipality aged 15–24 was the highest in the nation at 0.8%. Educators have mixed feelings regarding abstinence-based and CSE approaches. However, students generally endorse abstinence and describe the limitations of condom use. Ambiguity in overarching policies is identified as a factor that could influence the orientation of school-based health educators, create disharmony in sex education interventions, introduce confusing sex education messages to young people, and create a potentially narrow curriculum that limits the gamut of HIV/AIDS sex education to exclude young people’s risky sexual behaviours and diverse teaching and implementation strategies. Policies and the scope of sex education should be realigned to ensure the transparent implementation of HIV/AIDS sex education programs in Ghana.

The COVID-19 pandemic has changed routines and habits, raising stress and anxiety levels of individuals worldwide. The goal of this qualitative study was to advance the understanding of how pandemic-related changes affected sleep, diet, physical activity (PA), and stress among adults. We conducted semi-structured, qualitative interviews with 185 participants and selected 33 interviews from a represented sample based on age, race, and gender for coding and analysis of themes. After coding for thematic analysis, results demonstrated four primary themes: sleep, diet, PA, and stress. Sleep sub-themes such as poorer sleep quality were reported by 36% of our participants, and 12% reported increased an frequency of vivid dreams and nightmares. PA was decreased in 52% of our participants, while 33% experienced an increase and 15% experienced no change in PA. Participants also reported having an improved diet, mostly among women. Stress was elevated in 79% of our participants and was more likely to be discussed by women. Many participants reported how stress was involved in precipitating health behavior change, especially for sleep. Increased stress was also linked to elevated anxiety and depression among participants. The results of this qualitative study demonstrate how managing stress could have a beneficial effect on promoting health behaviors and mental health during the COVID-19 pandemic and beyond.

Focus Previous Next Chapter 4: Disaster Risk Assessment Add to Favorites Download PDF Cite Close Cite this chapter BibTeX RIS Close Permissions Share Close Share this chapter Copy link Share via email Share via: Close table of contents Contents Search Search Copyright Dedication Contributors Preface Acknowledgments Introduction Part I: Fundamentals of Public Health Emergency Preparedness Chapter 1: What is Emergency Preparedness? Chapter 2: Community Preparedness Chapter 3: All-Hazards Preparedness Design Chapter 4: Disaster Risk Assessment Chapter 5: Emergency Operations Plans Part II: Lessons Learned From Actual Incidents Chapter 6: Hurricane Disasters as a Public Health Problem Chapter 7: Tornadoes and Related Public Health Risks Chapter 8: Earthquakes Chapter 9: Wildfires Chapter 10: Extreme Heat Events and Public Health Chapter 11: Public Health Response to Bioterrorism Chapter 12: Chemical Disasters and Public Health Effects Chapter 13: Nuclear Detonation as a Public Health Threat Chapter 14: Disease Outbreaks and Pandemics Chapter 15: Water Supply Hazards and Public Health Part III: Special Considerations Chapter 16: Public Health Law Chapter 17: Access and Functional Needs Chapter 18: Children and Disasters Chapter 19: Evolving and Emerging Threats Chapter 20: Going Forward Epilogue Glossary The 10 Essential Public Health Services CEPH Foundational Competencies DOI: 10.1891/9780826149039.0004 Authors Shoaf, Kimberley