Disasters, social vulnerability, and evacuation from Hurricane Katrina

David Eisenman, MD MSHS

Division of GIM/HSR

May 5, 2006

Co-authors

• Kristina Cordasco, MD MPH• Steve Asch, MD MPH• Deborah Glik, ScD• Joya Golden, BA

We gratefully acknowledge the participants of this study who were willing to participate during a time of intense personal difficulty. Special thanks to Michele Allen, M.D., M.S. This study was funded by the Quick Response Research program of National Hazards Research and Applications Information Center and Grant No. 1 K01 CD000049-01 from the Centers for Disease Control and Prevention.

Reasons for non-evacuation• Little known about low-

income, urban, minority communities• Transportation, shelter,

historical experience cited in surveys • Decision-making is

multifactorial and socially embedded; surveys don’t address this.• Qualitative research is

needed

Purpose

To study the experience of Hurricane Katrina evacuees to understand evacuation decision-making in impoverished, urban, mainly minority communities.

Participants describe factors affecting evacuation that are more complex than previously reported, interacted with one another, and were socially influenced.

Methods

Study Recruitment

• Adult evacuees residing in major centers• Random selection • September 9-12, 2005

Data Collection

• Semi-structured• Sources and understanding of

information prior to the hurricane• Knowledge, perceptions and resources

that influenced evacuation• Recorded, professionally transcribed

Sample questions

• Were you aware of the recommendations to evacuate?• When did you learn this information?

From what source? • Did you consider leaving? Did you want

to leave? • What made evacuating easy/hard for

you?

Socio-demographic Characteristics of Study Participants (N=58)

New Orleans resident

95%

Gender 52% Male

Ethnicity African American White Latino Asian/PI

81%

10% 5%

3%

Age 18-34 years old 35-54 years old 55-74 years old 75+ years old Missing

16%

46% 31%

5% 2%

Socio-demographic Characteristics of Study Participants (N=58)

Income < $20, 000 $20,000-30,000 30,000 - 40,000 40,000-50,000 50,000 + Refused

50%31%

9%2%5%3%

Education < High School High School > High School

45%40%10%

Data Analysis

• Grounded theory approach• In-vivo & theoretical coding• 2 of 3 ‘coders’ independently applied

codes and resolved differences by consensus• Atlas.ti software

Results

Results: Major Themes

Message Message understandingunderstanding HealthHealth

TransportationTransportation

ShelterShelter

TrustTrust

Money, jobs, Money, jobs, propertypropertyRisk perceptionRisk perception

Social networkSocial network

1194 statements coded

Transportation

• I mean, if you've got 20 people trying to get in one car it's not going to happen. So some people, you just stay because you have to.

Shelter

• Really truly, we had cars, but we didn't know anybody to go to.

• They said go to Texas but I didn't know anybody in Texas.

Money, property, jobs• You have to be able to feed your children when

you leave. You have to be able to have a place to stay, you have to have gas money, you have to have rental car money. I couldn't afford to do that. You need at least $500/$600, and that's the least amount of money.

Discussing clients from HIV/AIDS group home: “We had five of them placed, two of them were

not placed, so that means when we had to evacuate…I had to take them with me.”

Money, property, jobs

• They were already robbing. And my dad, he had to stay behind because we had a lot of tools and belongings there.

Money, property, jobs

• ‘If you don't come around then, you know, I'll just see you when I see you.’…That means when I see you you're going to be fired.

Health

• I could have made it on my own, but it was just my aunt and my uncle. Every few steps he made…she forgot his walker…every few steps he made he was falling down.

Social networks

• I started making phone calls to my children warning them to get out. And after that, my sister, she had called me. So I went to pick her and her children up, and grand children, and we just started driving, heading toward Florida.

Social networks

• “So our clinical manager called back. She says, ‘Stella, the Lord said get out of that house.’ I said, ‘We're on our way out now if you would hang up.’”

Social networks

• My plans were to leave. Unfortunately we received a call and we had to come back home. My mother-in-law had called for us to come back…. You know when they get a certain age they get confused.

Social networks

• Like my Mom said, she's been through Betsy, Camille, all the hurricanes, the major hurricanes and she just wasn't evacuating. So I wasn't going to leave my Mom to stay there by herself.

• I had a 90 year old mother that I was taking care of and she would not leave that house for hell or high water.

Discussion

The influence of social networks: conclusions and recommendations

• Broad networks hindered and facilitated evacuation – Stretched limited resources – Obligations to extended family, especially elderly

who resisted evacuation or were frail, inhibited individuals and nuclear families – Counterpart to Drabek’s finding “ families move as

units and remain together, even at the cost of overriding dissenting opinions.”

• Disaster research and programs must address social units (households, extended families, neighborhoods) and institutions (churches) not just individuals.

Limitations Strengths

• Social response bias

• Specific urban community

• Convenience sample?

• Adds to understanding of the influence of social networks on decisions and behavior

• Evaluating interactions between factors influencing evacuation

• Comparable to concurrent study samples

30

Health

• …because I'm a diabetic and I have to be close by to get to doctors and hospital...

• I no healthy to drive too far.

• I take so much medication by that time I was like groggy

Social networks

• My mother-in-law wouldn't leave the house. My husband wouldn't leave her and I'm not going to leave him.

Risk perception

• I know it’s a flooding city but the street I live on does not flood

Risk perception

• Flooding became dangerous to one person only “when it got up to my neck… I'm an excellent swimmer.”

Risk perception

• The last storm we had there, it was more people got hurt on the highway traveling away from the storm, running out of gas, accidents, than it would have been if they stayed home.

Risk perception

• “I probably would ride another one out….I mean, even though it was a category 5, all it did was tore the roof off my house.”

Trust

• It was from them opening flood gates, telling lies about the levee breaking and stuff...I believe they do these things intentionally...so they can flood out those black neighborhoods.