COMMUNITY ASSESSMENT POPULATION SURVEY (CAPS)

Transcription

1 COMMUNITY ASSESSMENT POPULATION SURVEY (CAPS) Communications During the West Virginia Water Crisis: A survey of the population David Latif, PhD, MBA University of Charleston School of Pharmacy Rahul Gupta, MD, MPH, FACP Kanawha-Charleston Health Department Elena Savoia, MD MPH Co-Principal Investigator, Preparedness & Emergency Response Research Center Deputy Director, Preparedness & Emergency Response Learning Center Harvard School of Public Health, Boston, MA

2 COMMUNITY ASSESSMENT POPULATION SURVEY (CAPS) Rahul Gupta, MD, MPH, FACP Health Officer/Executive Director, Kanawha-Charleston Health Department Adjunct Associate Professor, University of Charleston School of Pharmacy Clinical Assistant Professor, West Virginia University School of Medicine David Latif, PhD, MBA Professor and Chair Dept. of Pharmaceutical and Administrative Sciences University of Charleston School of Pharmacy

3 Purpose To characterize the impacted population in Kanawha County, WV in terms of the public health emergency response related to WV Elk River Chemical spill of January 9, 2014 and the ensuing water crisis. To understand the physical, psychosocial, economic and communication related impacts of the large-scale drinking water chemical contamination incident in the impacted population in Kanawha County, WV.

4 Methods Design: Cross-sectional population survey Setting: Kanawha County, WV Participants: Impacted Households Measurements: Randomized telephone sampling methodology was utilized to identify potential respondents and administer the telephone survey. Rigorous survey methodology utilized to develop, test, and administer the 75-item questionnaire, by trained interviewers. Approval: Institutional Review Board of University of Charleston approved current research as exempt.

5 Methods contd Surveys conducted April 3-8, Three lists of random telephone numbers in Kanawha county consisting of 4,000 land line numbers and 2,000 cellular phone numbers. Disconnected, non-working numbers and fax machines were identified as calls were made. Duplicate numbers were eliminated. Excluding 412 ineligible individuals and 335 refusals, there were 499 respondents, for a response rate of 59.8%. Data was analyzed using statistical software (SAS).

6 Study Limitations Our Sample and Size Population representation and generalizability Non-response Bias Recall Bias Association v. Cause and Effect Unable to measure incidence Preliminary results

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8 AGE OF RESPONDENTS 65 or older 43.17% years old 16.06% AGE OF HOUSEHOLD MEMBERS years old 40.76% 0 12 Persons <1 years old in household Persons 1-17 years of age in household Persons years of age in household Persons over 65 years of age in household GENDER % 67.34% RACE White 91.77% Other 1.81% African American 5.02% Refused Male Female Native American 0.4

9 EDUCATION College Graduate (2-4 year) 36.77% 45% 4 35% EMPLOYMENT 25% High School 48.28% Some grade school 7.47% Post graduate education 7.47% 15% 5% INCOME RESIDENCE 25% 15% 5% Own 80.97% Rent 14.98% Other 4.05%

10 When did someone in your household first learn about the chemical in the Elk River? % % 4.62% 2.61% January 9, 2014 January 10, 2014 Later Don't know

11 How did your household first learn about the chemical spill? 6 5 4

12 How many gallons of purchased water did you have on hand when you first heard of the chemical spill? 35% 25% 15% 5% <1 gallon 1-2 gallons 3-5 gallons >5 gallons Don't know

13 Used public water supply during the time that the do not use order was in effect for your household (other than flushing the toilet or trying to put out a fire) % 7 Don't know, % No, 76.71% Yes, 23.09% % 43.97% 40.52% 29.31% 42.24% 27.59% 23.28% 5.17%

14 After the chemical spill, did anyone in your household try to get another source of water that was not part of the public water supply? No 8.03% Don't know Yes 91.77%

15 Did anyone in your household need to travel outside of the affected area to try to get water during the do not use order? Yes No

16 Economic Impact Business owners surveyed who replied business were closed as a result of the chemical spill Extra household expense* % % 25% Yes No 15% Respondents told not to come to work 5% < $100 $ $ >$500 Don't know/don't remember *Water, childcare, food, and other costs related to the crisis Yes No

17 After the chemical spill, did anyone in your household have any illness that they felt was related to the spill? No 66.87% Don't know 1. What type of symptoms did you or your household members have? 7 When did the symptoms start? Yes 31.93% % 4 35% 25% 15% 5% Before the do not use order During the do not use order After the do not use order was lifted

18 Did you or a member of the household seek medical attention or advice because of these symptoms during the days after the chemical spill? Where did they seek medical attention? 8 7 Internet source 2.5 Other source Poison control center 7.5 Admitted to hospital 7.5 Primary Care Physician 45.0 Yes No Emergency Room 27.5 Urgent Care 25.0

19 Was there anyone in the household who was ill with symptoms related to the water who did NOT seek medical attention or advice? No insurance 1. Why didn t they seek medical attention or advice? 4 Lack of transportation 2.41% Concerned about the cost 4.82% Did not feel ill enough to seek medical attention Other 18.07% 67.47% Yes No

20 Psychological Distress During the 30 Days After Emergency Began and the Past 30 days WORRIED STRESSED During Now During Now DEPRESSED ANGRY During Now During Now

21 Respondents' Rating of Trustworthiness of Information, by Information Source 4 35% 25% 15% 5% A B C D E F Don't know/don't remember Feds State WV American Water Local

22 Respondents' Rating of Information being Clear and Understandable, by Information Source 35% 25% 15% 5% A B C D E F Don't know/don't remember Federal State WV American Water Local

23 Respondents' Rating of Information being Helpful, by Information Source 35% 25% 15% 5% A B C D E F Don't know/don't remember Feds State WV American Water Local

24 Percent of Respondents Key Question Responses: Raw vs. 5 45% 4 35% 25% 15% 5% Adjusted to Population* Used water DNU Drank water DNU HH member ill Trust Fed "F" *Weighted to the age-sex distribution of Kanawha County (2010 census) Raw Weighted

25 Is your household currently using the water? How are you using the water? Do you use it to Showering or bathing 96.36% Washing Dishes 86.94% For pets 39.19% Watering plants 43.47% Drinking 36.19% 4 Yes No Refused Washing clothes 95.5 Cooking 50.96% Brushing teeth 62. Handwashing 85.87% All subgroups had significant non-drinking rates

26 Do you believe the water is safe? Yes No Refused Don't know Before the Spill After the "Do not use" order was lifted

27 Related Ongoing Needs or Concerns Over 1/3 or 37.8% of the respondents said yes to above and had comments in following categories: 6/10 respondents were concerned about either water quality or the water company including filter changes. 1/4 respondents criticized the timeliness, accuracy, or truthfulness of information received, or expressed distrust. 1/5 respondents were concerned about the health effects, illness, or safety. 1/8 respondents were concerned about the personal/community economic costs. 1/8 respondents raised the question of how to prevent future events, or suggested more regulation.

28 In general, illness was associated with lower levels of trust, and a higher psychological distress. Respondents who did not find federal information trustworthy exhibited almost three times the risk of having a household member with an illness they felt was related to the spill compared to those with high levels of trust. This increased to four times in case of WVAWC. Similarly, respondents who stated being worried during emergency were almost five times more likely to have a household member with an illness. Associations were statistically significant and demonstrated a strong effect even after adjusting for household size.

29 Water Safety and Illness are the major issues moving forward Respondents who think the water is safe now are more than four times as likely to drink it as those who don t. Respondents who had a household illness they think was related to the water are half as likely to be drinking it now as those who did not.

30 Acknowledgements The study was funded with support of the Kanawha- Charleston Board of Health. In-kind support was provided by several partners. We would like to thank the following for ongoing partnerships: Dr. Elena Savoia and her team, HSPH Dr. Roxy Silver and her team, Univ of Ca Irvine Dr. Charles Engel, RAND Our presentation as well as the views and discussions expressed are solely those of the presenters, and do not necessarily represent the views of any partner organizations.

31 Communications during the West Virginia Water Crisis: A survey of the population Elena Savoia, MD MPH Co-Principal Investigator Preparedness & Emergency Response Research Center Deputy Director Preparedness & Emergency Response Learning Center Harvard School of Public Health, Boston, MA Harvard School of Public Health

32 Harvard Public Health Emergency Preparedness Centers lamps.sph.harvard.edu Harvard School of Public Health

33 Similar studies conducted by our Center 2009 H1N1 PANDEMIC May 2010 Boston Water Emergency Picture from boston.com Harvard School of Public Health

34 THE SURVEY IN WEST VIRGINIA When? February Where? Entire state How? Existing online survey panels Harvard School of Public Health

35 Population characteristics adjusted for sample weights Variable Gender Male Female Age Total sample n (%) total n= (47.4) 244 (52.6) 76 (16.5) 113 (24.4) 133 (28.6) 141 (30.5) Living in the affected counties n (%) Total n= (44.6) 71 (55.4) 16 (12.6) 35 (26.9) 41 (31.5) 37 (29) Living outside the affected counties n (%) Total n= (48.3) 173 (51.7) 59 (17.7) 79 (23.6) 92 (27.7) 103 (31) Education < High school High school Some college Bachelor or more 33 (7.2) 221 (47.7) 104 (22.5) 104 (22.6) 7 (5.2) 47 (36.4) 38 (29.6) 37 (28.8) 26 (7.9) 172 (51.5) 67 ( (20.5) Income <$15,000 $15,000-$34,999 $35,000-$59,999 $60,000-$100,000 >$100, (14.9) 88 (19.7) 108 (24.1) 123 (27.4) 62 (13.9) 18 (14.5) 27 (21.3) 27 (26.8) 33 (33) 21 (21.1) 49 (15.1) 62 (19.1) 81 (25.1) 90 (27.8) 42 (12.9) Harvard School of Public Health

36 What did we ask? How and when did people know about the crisis? What did they know? What did they do? What do they think? 592 COMPLETED SURVEY OUT OF 690: REPONSE RATE 86% Harvard School of Public Health

37 How and when did people know about the crisis? 7 out 10 people heard about the emergency from the local T.V. and got the information the same day the emergency occurred on January 9 th. Harvard School of Public Health

38 What did they know? In the affected counties 8 people out of 10 knew what to do avoid tap water and use bottled water for drinking, cooking and bathing. Harvard School of Public Health

39 What did they do? In the nine affected counties 7 people out of 10 followed the recommended behaviors. Picture from Wikipedia Harvard School of Public Health

40 In general, do you think there is too much, too little, or about the right amount of government regulation on the environment? Too much Right amount Too little Do not know In the affected counties: 7 people out of 10 think that there is too little regulation. Even outside the affected areas, half the sample thinks there is too little regulation. Harvard School of Public Health

41 Acknowledgements We gratefully acknowledge funding support from the U.S. Centers for Disease Control and Prevention (CDC) supplement to grant number 1U90TP (Preparedness and Emergency Response Research Center) and grant number 1U90TP (Preparedness and Emergency Response Learning Center). The content of this presentation as well as the views and discussions expressed are solely those of the presenter, and do not necessarily represent the views of any partner organizations, the CDC or the U.S. Department of Health and Human Services nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. Harvard School of Public Health

42 THANK YOU. Please write your questions on the index card provided and pass forward.