Lisa M. Gargano

Natural and man-made disasters are occurring more frequently, making household emergency preparedness essential for an effective response. Enrollees of the World Trade Center Health Registry have been found to be less prepared than the US national average despite their prior disaster exposure. The purpose of this study was to evaluate and compare the effectiveness of two interventions—a mailed brochure and a structured phone call—for increasing emergency preparedness knowledge among this population. We conducted a two-arm parallel group trial between February 2019 and August 2020. Participants were Registry enrollees who completed the Wave 4 Registry (2015–2016) survey, whose primary language was English or Spanish, who lived in New York City, and who did not report being a rescue and recovery worker affiliated with FDNY or NYPD. Enrollees were randomized to receive either a brochure by mail summarizing the components of emergency preparedness or a 15 min phone call describing the same. The primary outcome measure was the number of “yes” responses to the ten-item CDC CASPER emergency preparedness questionnaire, measured at baseline and post-intervention. Enrollees were sequentially alternatively assigned to either the brochure or phone call groups. In total, 705 enrollees were assigned to the brochure (n = 353) or phone call (n = 352) groups, and a total of 702 enrollees were analyzed. The Incident Rate Ratio (IRR) for the effect of time was 1.17 (95% CI = (1.14, 1.20)) and for intervention was 1.00 (95% CI = (0.95, 1.05)) Both the brochure and phone call interventions improved knowledge of emergency preparedness from baseline to post-intervention assessment, and to the same extent.

The September 11th World Trade Center (WTC) disaster resulted in an elevated prevalence of Post-Traumatic Stress Disorder (PTSD) among those directly exposed, yet lower than expected rates of mental health treatment seeking and high levels of reported perceived unmet mental healthcare need were observed in this population in the years following. Self-efficacy, an individual’s self-perception of their ability to succeed in specific situations or accomplish a task or goal, may in part explain this discrepancy; however, little is known about its interplay with the help-seeking behaviors of disaster-exposed populations. We used WTC Health Registry data (n = 11,851) to describe the relationship between self-efficacy and three outcomes related to help-seeking behavior: (1) seeking mental health treatment, (2) perceived unmet mental health care needs, and (3) satisfaction with mental health treatment. Multinomial logistic regression models were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CI). We found a dose-response relationship between self-efficacy score and mental health help-seeking: for every one unit increase in self-efficacy score, we observed a 6% increase in the odds of having treatment 4 to 12 months ago (OR = 1.06, CI: 1.03–1.09), a 7% increase in the odds of having had treatment 1 to 2 years ago (OR = 1.07, CI: 1.04, 1.09), and a 10% increase in the odds of having sought treatment 2 or more years ago (OR = 1.10, CI: 1.08, 1.12) compared to those who had sought treatment more recently. An understanding of individual self-efficacy may help improve post-disaster mental health treatment in order to provide more tailored and helpful care.