Obstacles and Facilitators to Evacuation from Hurricane Katrina

1. Obstacles and Facilitators to Evacuation from Hurricane Katrina David Eisenman, MD MSHS AcademyHealth, Annual Research Meeting June 27, 2006 UCLA Division of General Internal Medicine and Health Services Research & RAND Corporation

2. Co-authors • Kristina Cordasco, MD MPH • Steve Asch, MD MPH • Deborah Glik, ScD • Joya Golden, BA

4. Research on minorities and disasters • Surprisingly little known about minority communities and disasters • Studies describe disparities but factors operating within minority groups less understood • Most commonly cited reasons for non-evacuation were transportation & risk perception* • Social psychological theory predicts decision-making is multifactorial and socially embedded • Invites questions about circumstances and relationships of reasons and reasons not included in surveys • Qualitative research provides detailed, in-depth accounting of cultural context, social environment, individual cognition leading to evacuation behavior (*Brodie et al, AJPH 2006)

5. Purpose To study the experience of Hurricane Katrina evacuees to understand evacuation decision-making in impoverished, urban, minority communities. Participants describe factors affecting evacuation that are complex, interacted with one another, and were socially influenced.

6. Methods

7. Study Recruitment • Adult evacuees residing in major centers • Random selection • September 9-12, 2005

9. Data Collection • Semi-structured • Sources and understanding of information prior to the hurricane • Knowledge, perceptions and resources that influenced evacuation • Reflections on factors that might have altered their behavior • Recorded, professionally transcribed

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

11. Results

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

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

14. Shelter Trust Transportation Money, jobs, property Risk perception Message understanding Health Social network Results: Major Themes 1194 statements coded

15. Transportation • One car was not enough if others had evacuated earlier with it or if the family was too large for it • “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.”

16. Shelter • Having extended family outside of New Orleans influenced evacuation • “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.”

17. 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.”

18. 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.”

19. Money, property, jobs • Fear of job loss influenced evacuation • “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.”

20. Health • Health of extended family influenced evacuation • “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.”

21. Social networks • Obstacle or facilitator to evacuation • Overlapped with transportation, shelter, and health themes • “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.”

22. Social networks • Obligations to elderly influenced evacuation • “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.”

23. Discussion

24. The influence of social networks • 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 • Extended families remained together and stayed as units, even at the cost of overriding dissenting opinions

25. Policy and research implications • Disaster research and programs must address social units (households, extended families, neighborhoods) and institutions (churches) not just individuals. • Emergency food and gas vouchers must be provided to urban poor in hazard zones • Need further research on the frequency of threatened job loss as an obstacle; do we need job protection laws?

26. Limitations Strengths • Adds to understanding of the influence of social networks on decisions and behavior • Evaluating interactions between factors influencing evacuation • Sample randomly selected (and similar to concurrent study sample) • Social response bias • Specific urban community • Not representative of all evacuees

27. Funding for this study was provided by the CDC (grant # K01 CD000049-01) & the National Hazards Research and Applications Information Center We gratefully acknowledge the participants who were willing to participate during a time of intense personal difficulty. Special thanks to Michele Allen, M.D., M.S.

28. 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?

29. 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

30. 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.

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

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

33. 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.

34. 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.”

35. 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.