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Supplemental Material, sj-pdf-1-ahp-10.1177_08901171211041424 for Parental Education and Child Physical Health Following the BP Deepwater Horizon Oil Spill by Samuel Stroope, Rhiannon A. Kroeger, Tim Slack, Kathryn Sweet Keating, Jaishree Beedasy, Thomas Chandler, Jonathan J. Sury and Jeremy Brooks in American Journal of Health Promotion

This report is one of the four-part 2015 Briefing Report Series of the Sandy Child and Family Health (S-CAFH) Study. Reports in the series describe the impact of Hurricane Sandy on several key aspects of New Jersey resident’s lives. The impact a disaster has on the health of a population can be described as having a “dose-response” relationship: the larger the “dose” of the disaster, the greater the health impact or “response” among those individuals and communities exposed. This PERSON Briefing Report describes the impact of Hurricane Sandy (the dose) on the health and well-being of adults and children exposed to the storm (the response). Data for the report are drawn from the baseline survey of the Sandy Child and Family Health (S-CAFH) Study, an observational cohort study of nearly 1,000 randomly-selected New Jersey residents who were living in areas of the state exposed to the storm in 2012. Participants in the study represent over 1 million people living in Sandy’s “Disaster Footprint,” the hurricane-exposed portions of the state. This report describes and examines several critical aspects of individual health and well-being that may be associated with the storm, including:1. Physical health of adults;2. Psychological and emotional health of adults;3. Social and economic health of adults;4. Health and well-being of children; and5. The association between disaster exposure and individual outcomes.This Briefing Report measures dose in terms of the hurricane’s impact on the lives of New Jersey residents living across nine counties most exposed to the storm: Was a member of the household killed or injured in the storm? Was a pet lost in the storm? Was a vehicle destroyed in the storm? Did a member of the household come into contact with floodwaters, debris, or mold? Was the home slightly or moderately damaged by the storm, or did it sustain major structural damage? The response includes the incidence of health conditions such as asthma, the emergence of mental health distress, increases in risk behaviors such as smoking and alcohol consumption, and rising economic constraints on individuals and households struggling to recover from the storm. From among the many findings in this report, several stand out: Housing damage can be a risk factor for poor health that has an effect on people’s lives remarkably similar to the effect of poverty. Within the Disaster Footprint, those individuals living in homes that sustained major structural damage, regardless and independent of their household’s income level, expressed health problems that were often mirror images of those who lived in deep poverty, with household incomes less than $20,000 a year; Implications: More refined physical and mental health screening should be considered for residents whose homes have experienced substantial damage, and additional surveillance efforts undertaken to follow residents of significantly damaged homes and to provide ongoing access to physical and mental health services; Some toxins had “double-barreled effects”: exposure to mold was associated with both clinically-diagnosed asthma and with mental health distress. Adults who were exposed were 2.5 times as likely as those not exposed to mold to be diagnosed with asthma after the storm, and were twice as likely to report mental health distress;- Implications: Mold mitigation efforts should include components of psychological first aid in order to identify residents at risk for mental health problems, and provide referral mechanisms for those residents who meet the threshold established by New Jersey Hope and Healing. Similarly, disaster case management and psychological first aid programs should inquire about mold and housing damage as potential indicators or risk factors for mental health distress; Children living in homes that experienced minor damage were at particularly high risk for psychological and emotional issues. Children living in homes with minor damage were over four times as likely to be sad or depressed, and over twice as likely to have problems sleeping since the storm as were children from homes with no damage. These levels of emotional and mental distress amongst children in homes with minor damage were higher even than those reported by children living in homes with major structural damage; - Implications: The pediatric and social services communities should be particularly attentive to children’s living environments, and consider homes with minor damage (which, according to FEMA definitions, may be uninhabitable for a short period of time) as significant risk factors in children’s lives. Moreover, housing assistance programs should work to accelerate repairs and restorations for households with children and consider existing gaps in restoration programs that may not allow for complete repairs.As an analysis of population health following Hurricane Sandy, this PERSON Report reflects some of the devastating and potentially enduring effects that storms of this magnitude can exert on a population.

This report is one of the four-part 2015 Briefing Report Series of the Sandy Child and Family Health (S-CAFH) Study. Reports in the series describe the impact of Hurricane Sandy on several key aspects of New Jersey resident’s lives. This Place Report focuses on the decisions and actions related to evacuation, housing, community, and restoration and repair. It documents the storm’s impact on PLACE in New Jersey residents’ lives, with a particular emphasis on Sandy’s effect on people’s homes and housing decisions. Any effort to facilitate good decision-making on the part of New Jersey residents, whether it involves evacuation decisions, restoration decisions, or financial decisions, should be predicated on timely and targeted messaging. It provides data on the decisions and actions that residents adopted in the face of the impending storm and throughout the recovery period. This information should help inform officials and stakeholders as they develop even more effective communication campaigns.Assuring safe and stable housing is one of the most important individual and collective goals after a catastrophic disaster. Individuals and families rely upon homes for shelter, sanctuary, and often as a significant economic asset; in turn, communities rely upon a strong housing base as a means of maintaining or enhancing political strength and community resilience, as well as serving as linchpins for social and economic growth. While many residents in New Jersey’s Disaster Footprint are making substantial progress in rebuilding their homes and communities, there are clearly still pockets of damage and disruption, even two and a half years after the storm.

In 2012, with funding from the Baton Rouge Area Foundation, the National Center for Disaster Preparedness (NCDP) at Columbia University, in partnership with the Children’s Health Fund, launched a four-state study in order (1) to identify communities of children in the coastal areas of Louisiana, Mississippi, Alabama and Florida who were adversely impacted by the Deepwater Horizon oil spill, (2) to explore the prevalence of physical and mental health effects among these children, and (3) to conduct a preliminary assessment of the health services available to these children and the potential for targeted interventions or health system enhancements. We identified fifteen communities with higher numbers of BP compensation claims submitted by individuals and by businesses, and which also had higher rates of oil washing up on their shores based upon monitoring data collected by the National Oceanic and Atmospheric Administration. Over a span of four and a half months, a field team of six interviewers and two field coordinators completed 1,437 face-to-face household surveys. The parents whom we interviewed reported considerable exposure to the oil spill as well as a number of physical and mental health problems among their children. Over half of the parents interviewed in these highly-impacted communities reported that their children had some type of oil spill-related exposure, whether it was through physical, environmental, or economic factors. One in every five parents said their children had direct contact with the oil; one in four reported smelling strong oil-related odors; and two of every five said their household had lost income or a job since the oil spill. A little over 40% of parents in these high-impact communities reported some type of health effect experienced by their children since the oil spill. 18.1% of the parents said their children had experienced breathing problems after the oil spill, 14.8% noted skin problems, 16.0% reported visual problems and 21.6% mentioned emotional or behavioral problems since the oil spill. In October 2012 our research team traveled to four communities to interview local officials and leaders and conduct in-depth parent focus groups. We selected the four communities based on the household data, where parents had reported significant health effects. Across the four communities, the team heard of significant issues related to children’s health and well-being.