Factors Associated with Hurricane Preparedness: Results of a Pre-Hurricane Assessment
Survey Report: Dr3-2-3252:2008/5/1
Factors Associated with Hurricane Preparedness: Results of a Pre-Hurricane Assessment Jennifer Horney1 , Cynthia Snider2 , Sandra Malone3 , Laura Gammons3 , and Steve Ramsey4 1 North
Carolina Center for Public Health Preparedness, University of North Carolina at Chapel Hill School of Public Health Campus Box # 8165, 400 Roberson Street Chapel Hill, NC 27599, USA E-mail:
[email protected] 2 University of North Carolina at Chapel Hill School of Public Health Campus Box # 7435 Chapel Hill, NC 27599, USA E-mail:
[email protected] 3 Carteret County Health Department 3820 Bridges Street, Morehead City, NC 28557, USA E-mail: sandram,
[email protected] 4 Public Health Regional Surveillance Team 5, 1203 Maple Street, Greensboro, NC 27405, USA E-mail:
[email protected] [Received October 17, 2007; accepted November 19, 2007]
Previous studies of hurricane preparedness have generally used indirect measures to ascertain household preparedness, including time intervals between preparation and hurricane landfall and past evacuation. This study sought to directly measure hurricane preparedness by asking residents of a high-risk coastal North Carolina county to report whether their household had an evacuation plan and a disaster supply kit with at least 3 days of food and water for each family member and pet as recommended by the American Red Cross. The survey was conducted six weeks prior to the start of the 2007 Atlantic hurricane season. Past hurricane experience increased the likelihood of a household having a disaster supply kit. However, living in multi-unit housing or a mobile home significantly decreased the likelihood of having a disaster supply kit. Past hurricane experience, past evacuation experience and anticipated evacuation under a mandatory evacuation order were important factors related to a household having an evacuation plan. Residence in a designated flood zone, demographic characteristics of the household, pet ownership, and perceived risk were not significantly related to preparedness. Public health and emergency management officials should work together to determine effective interventions that can improve personal preparedness based on factors other than personal hurricane experience. Keywords: hurricanes, disaster preparedness, evacuation
1. Introduction Since 1993, Carteret County, North Carolina, has suffered 20 fatalities and more than $1.8 billion in property damage due to hurricanes and tropical storms [1]. In Journal of Disaster Research Vol.3 No.2, 2008
Fig. 1. Map of Carteret County, North Carolina.
2007, Carteret County, located on the central North Carolina coast (Fig. 1), had the highest forecasted probability of experiencing hurricane-force winds of any US County at 22.4 percent [2]. The county has become increasingly urbanized with higher population densities and a total population that grew from 52,556 in 1990 to 63,584 in 2006 [3]. The number of housing units has more than doubled from 21,238 in 1990 to 44,109 in 2006 with a concurrent increase in coastal property values from a median home value from $73,000 to $124,000 [4]. This growth in population and development leaves Carteret County residents at risk for repeated hurricane related injuries and property damage. Evacuation of residents prior to hurricane landfall is one way public authorities try to reduce hurricane related morbidity and mortality. Preparation, along with perceptions of vulnerability and the risk level of the area, have been reported as keys to successful evacuation during a hurricane [5–7]. But do we really understand what goes into preparation? Previous studies have measured preparation as the duration of time spent by households preparing for an evacuation, with longer preparation predictive of evacuation [8]. This measure is potentially misleading because shorter prepa1
Horney, J. et al.
ration time could also lead to successful evacuation. A better measure of preparedness would be a direct measurement of household preparedness. The American Red Cross provides guidance on hurricane preparedness, with 1) the availability of a disaster supply kit and 2) a hurricane evacuation plan being key components of hurricane preparedness. To understand factors that may be associated with these two measurements of hurricane preparedness, investigators conducted a survey of households in Carteret County using two-stage stratified random sampling. In addition to previously identified demographic and vulnerability variables, residence in designated flood zones was collected to examine any association with hurricane preparedness.
2. Methods The Carteret County Health Department (CCHD), the Carteret County Department of Planning, North Carolina Public Health Regional Surveillance Team 5 (PHRST 5), and the North Carolina Center for Public Health Preparedness (NCCPHP) conducted a pre-hurricane assessment of Carteret County households from April 12-14, 2007. Flood zones in Carteret County were classified according to the updated 2003 Flood Insurance Rate Maps (FIRMs) [9]. Five flood zone designations were used: VE, AO, AE, Shaded X, and AEFW. VE zones correspond to areas with a 1% annual chance of coastal flooding with an additional hazard associated with storm waves while AO zones correspond to the 1% annual chance floodplains for shallow flooding and AE zones correspond to the 1% annual chance floodplains. Shaded X zones correspond to the 0.2% annual chance flood, including areas of 1% annual chance flood with average depths of less than one foot or with drainage areas less than one square mile. Finally, AEFW zones correspond to land designated as nondevelopable flood zones. Non-flood zones are areas where there is less than 1% annual chance flood and flood insurance purchase is not required. Census blocks were categorized by flood zone based on the flood zone designation of the block’s physical center (Fig. 2). According to the updated FIRMs, 1,476 (54.4%) of Carteret County’s 2,727 census blocks were in flood zones; 128 (8.6%) were VE, 4 (0.1%) were AO, 999 (67.4%) were AE, 349 (23.5%) were Shaded X, and 3 (0.1%) were AEFW. The remaining 1,244 (45.6%) census blocks were not located in flood zones. Census blocks designated as AO and AEFW flood zones were excluded from the study due to insufficient number of households. To ensure each flood zone was represented in the study, census blocks were first stratified by flood zones. Census blocks in each stratum were randomly selected based on probability proportionate to population size. Within each census block, 7 households were randomly selected using a survey site selection toolkit developed by the North Carolina Division of Public Health in ESRI ArcMap 9.2 (Redlands, CA) (Fig. 3). Using GPS-equipped Trimble Recon Field Data Collectors, interview teams were routed 2
to each location with a map generated by ESRI ArcPad 6.0.3 Street Map USA. Interviews were conducted with one resident of the selected household and data were electronically recorded at the time of interview. To measure preparedness, respondents were asked whether their household had 1) an evacuation plan for their household and 2) a disaster supply kit that included at least 3 days of food and water for each household member as recommended by the American Red Cross [10]. Information collected from households on factors previously identified to be associated with preparedness included type of dwelling, composition of household (e.g elderly (adults 65 years) or young children (children 2 years)), pet in the home, perception of hurricane threats (e.g. flooding, storm surge, and wind), number of hurricanes experienced, past evacuation, and intended evacuation from a future hurricane under voluntary or mandatory evacuation order. All data were downloaded from the Field Data Collectors into a laptop computer in Microsoft Excel 2003 format (Redmond, WA). Data were imported in SAS 9.1 (Cary, NC) for data analysis. To identify factors for inclusion in multivariate modeling, bivariate analyses were performed to identify any statistically significant association (p0.05) between factors of interest and 1) disaster supply kit and 2) evacuation plan. For multilevel exposures, reference categories were selected either because it was previously identified (or perceived) to be the lowest risk level or for stability in estimation. Crude prevalence ratios (PR) and 95% confidence intervals (CI) were estimated. Multivariate binomial regression was used to adjust for potential confounding. Model convergence and predicated probabilities between the values of 0 and 1 were verified. Effect measure modification was not assessed. Adjusted PR and 95% CI were calculated. Confidence limit ratios (CLR) were calculated for adjusted PR, with a value of 1.00 used as the criteria for assessing precision.
3. Results Interviews were completed for 251 households in 36 census blocks across Carteret County. Thirty-three percent (n=84) of the interviews were conducted with households located in VE zones. The remaining interviews were evenly distributed among the other flood zones and non-flood zone: 56 (22%) in AE zones, 57 (23%) in Shaded X zones and 54 (22%) in the non-flood zone.
3.1. Disaster Supply Kit Overall, 207 (82%) of 251 households indicated they were responsible for their own food, water, and shelter in the 3 days following a hurricane, although only 109 (44%) of 248 households reported having a disaster supply kit that included a 3 day supply of food and water. When compared to households residing in single family homes, households residing in mobile homes or multiple unit homes were 0.59 (95% CI:0.36-0.97) and 0.67 (95% CI: 0.44-1.00) times as likely to have a disaster supply Journal of Disaster Research Vol.3 No.2, 2008
Factors Associated with Hurricane Preparedness: Results of a Pre-Hurricane Assessment
Fig. 2. Map of Carteret County, North Carolina, with Census Blocks stratified by flood zone (n=2727).
Fig. 3. Map of Carteret County, North Carolina, with interview locations.
kit, respectively (Table 1). A statistically significant association between the availability of a disaster supply kit and the reported number of hurricanes experienced by the household was also observed. Variables included in the multivariate model were type of dwelling and the number of hurricanes experienced (Table 2). When compared to those living in single family homes, households residing in mobiles homes were 0.58 times (95% CI: 0.36-0.95) and households in multi-unit homes were 0.73 times (95% CI: 0.50-1.08) as likely to have a disaster supply kit in the home, adjusted for number of hurricanes experienced. After adjusting for type of Journal of Disaster Research Vol.3 No.2, 2008
dwelling, the number of hurricanes experienced appeared to be significantly associated with the availability of a disaster supply kit but this association was only observed in select categories.
3.2. Evacuation Plan A total of 128 (51%) of the 251 households indicated they had an evacuation plan. The number of hurricanes experienced in the past was associated with having an evacuation plan in the home when households that experienced 7-9 hurricanes were compared to households that had experienced 10 or more, yet this association was 3
Horney, J. et al.
Table 1. Distribution, Crude Prevalence Ratios (PR), and 95% Confidence Intervals (CI) for factors potentially associated with the availability of a disaster supply kit among select households in Carteret County, North Carolina 2007 . Variable Description
Supply Kit (N=109) n (%)
No Supply Kit (N=139) n (%)
PR
95% CI
No Flooding Shaded X AE VE
23 31 23 32
21.10 28.44 21.10 29.36
31 26 33 49
22.30 18.71 23.74 35.25
1.00 1.28 0.96 0.93
0.86-1.89 0.62-1.50 0.62-1.40
Single Family Home Multi-unit Homes Mobile Home
79 18 12
72.48 16.51 11.01
76 35 28
54.68 25.18 20.14
1.00 0.67 0.59
0.44-1.00 0.36-0.97
101 5 3
92.66 4.59 2.75
126 10 3
90.65 7.19 2.16
1.00 0.74
0.36-1.56
No Yes
76 33
69.72 30.28
88 51
63.31 36.69
1.00 0.85
0.62-1.16
No Yes Missing
37 72 0
33.94 66.06
51 82 6
36.69 58.99 4.32
1.00 1.11
0.83-1.50
10+ 7-9 4-6 1-3 0
60 15 23 9 2
55.05 13.76 21.10 8.26 1.83
50 29 23 26 11
35.97 20.86 16.55 18.71 7.91
1.00 0.63 0.92 0.47 0.28
0.40-0.98 0.66-1.28 0.26-0.85 0.08-1.02
No Yes Missing
55 54 0
50.46 49.54
79 57 3
56.83 41.01 2.16
1.00 1.19
0.90-1.57
Other Flooding Storm Surge Wind Don’t Know or Missing
31 26 16 27 9
28.44 23.85 14.68 24.77 8.26
29 34 21 43 12
20.86 24.46 15.11 30.94 8.63
1.00 0.84 0.84 0.75
0.57-1.22 0.54-1.30 0.51-1.10
Flood Zone
Type of Dwelling
Children 2 years in Household
Adults Age
No Yes Missing
65 years in Household
Pet in Household
Hurricanes Experienced
Ever Evacuated in the Past
Greatest Perceived Risk
3
households had missing information on the availability of a disaster supply kit in the home. Table 2. Adjusted Prevalence Ratios (PR) and 95% Confidence Intervals (CI) for factors associated with the availability of a disaster supply kit among select households in Carteret County, North Carolina 2007*. Variable Description
Supply Kit (N=109) n
No Supply Kit (N=139) n
PR
95% CI
CLR
Single Family Home Multi-unit Homes Mobile Home
79 18 12
76 35 28
1.00 0.73 0.58
0.50-1.08 0.36-0.95
2.16 2.64
10+ 7-9 4-6 1-3 0
60 15 23 9 2
50 29 23 26 11
1.00 0.62 0.96 0.50 0.29
0.40-0.97 0.70-1.33 0.28-0.91 0.08-1.04
2.43 1.90 3.25 13.00
Type of Dwelling
Hurricanes Experienced
3
households had missing information on the availability of a disaster supply kit in the home.
not observed for households that experienced fewer hurricanes (Table 3) . Households that reported evacuating in the past were 1.49 (95% CI: 1.17-1.90) times as likely to have an evacuation plan compared to those who had never evacuated. Although a household’s willingness to 4
evacuate under a voluntary evacuation was not associated with having an evacuation plan, a household’s willingness to follow a mandatory evacuation order was significantly associated with the availability of a plan. The number of hurricanes experienced, past evacuaJournal of Disaster Research Vol.3 No.2, 2008
Factors Associated with Hurricane Preparedness: Results of a Pre-Hurricane Assessment
Table 3. Distribution, Crude Prevalence Ratios (PR), and 95% Confidence Intervals (CI) for factors potentially associated with the availability of an evacuation plan among select households in Carteret County, North Carolina 2007. Variable Description
Evacuation Plan (N=128) n (%)
No Evacuation Plan (N=123) n (%)
PR
95% CI
No Flooding Shaded X AE VE
26 32 22 48
20.31 25.00 17.19 37.50
28 25 34 36
22.76 20.33 27.64 29.27
1.00 1.17 0.82 1.19
0.81-1.67 0.53-1.25 0.85-1.66
Single Family Home Multi-unit Homes Mobile Home
79 31 18
61.72 24.22 14.06
79 22 22
64.23 17.89 17.89
1.00 1.17 0.90
0.89-1.54 0.62-1.31
121 5 2
94.53 3.91 1.56
109 10 4
88.62 8.31 3.25
1.00 0.63
0.31-1.31
No Yes
86 42
67.19 32.81
81 42
65.85 34.15
1.00 0.97
0.75-1.26
No Yes Missing
48 80 0
37.50 62.50
41 76 6
33.33 61.79 4.88
1.00 0.95
0.74-1.22
10+ 7-9 4-6 1-3 0
57 31 19 18 3
44.53 24.22 14.84 14.06 2.34
54 13 27 18 11
43.90 10.57 21.95 14.63 8.94
1.00 1.37 0.80 0.97 0.42
1.05-1.79 0.55-1.19 0.67-1.41 0.15-1.16
No Yes Missing
57 70 1
44.53 54.69 0.78
79 42 2
64.23 34.15 1.63
1.00 1.49
1.17-1.90
No Yes Missing
25 86 17
19.53 67.19 13.28
35 76 12
28.46 61.79 9.76
1.00 1.27
0.91-1.78
No Yes Missing
7 115 6
5.47 89.84 4.69
22 97 4
17.89 78.86 3.25
1.00 2.25
1.17-4.33
31 32 22 30 13
24.22 25.00 17.19 23.44 10.16
31 29 15 40 8
25.20 23.58 12.20 32.52 6.50
1.00 1.05 1.19 0.86
0.74-1.48 0.83-1.71 0.59-1.24
Flood Zone
Type of Dwelling
Children 2 years in Household
Adults Age
No Yes Missing
65 years in Household
Pet in Household
Hurricanes Experienced
Past Evacuation
Evacuate - Voluntary Order
Evacuate - Mandatory Order
Greatest Perceived Risk Other Flooding Storm Surge Wind Don’t Know or Missing
tion, and mandatory evacuation order were included in multivariate modeling (Table 4). Adjusting for past evacuation and mandatory evacuation order, households that had experienced 7-9 hurricanes were 1.33 times (95% CI: 1.04-1.71) as likely to have an evacuation plan when compared to those who had experienced 10 or more hurricanes. This association was not observed in households that experienced fewer hurricanes. Availability of an evacuation plan was significantly associated with households that indicated they would evacuate under mandatory orders when compared to households that indicated they would not evacuate after adjusting for number of hurricanes experienced and past evacuation history. The observed crude association between past evacuation and an evacuation plan was no longer significant in the multivariate model once adjusted for potential confounders.
Journal of Disaster Research Vol.3 No.2, 2008
4. Discussion Direct measurement of household preparedness indicates associations between preparedness and generally measured demographic and vulnerability factors that differ from the published literature on hurricane evacuation behavior. Demographic and vulnerability factors were generally not significantly related to preparedness in this high-risk county. The number of hurricanes experienced was the only factor significantly related to a household having both a disaster supply kit and an evacuation plan. Type of dwelling was the only other variable related to a household having a disaster supply kit. Intention to evacuate under mandatory evacuation orders was associated with having an evacuation plan in multivariate analysis but past evacuation was no longer associated after adjustment for confounding. However, the borderline lower 5
Horney, J. et al.
Table 4. Adjusted Prevalence Ratios (PR) and 95% Confidence Intervals (CI) for factors associated with the availability of an evacuation plan among select households in Carteret County, North Carolina 2007. Variable Description
Evacuation Plan (N=128) n
No Evacuation Plan (N=123) n
PR
95% CI
CLR
57 31 19 18 3 57 70 7 115
54 13 27 18 11 79 42 22 97
1.00 1.33 0.79 0.97 0.36
1.04-1.71 0.54-1.16 0.67-1.41 0.10-1.27
1.64 2.15 2.10 12.7
1.25
0.98-1.60
1.63
2.28
1.17-4.43
3.79
Hurricanes Experienced
Past Evacuation Mandatory Evacuation
10+ 7-9 4-6 1-3 0 No Yes No Yes
confidence limit and the relative precision of the estimate (CLR=1.63) would suggest past evacuation should be further examined. Although many of the factors we examined only had a small number of respondents (e.g. multilevel response categories), the findings from our analyses point to directions in disaster preparedness research and education that have not been previously pursued. Households residing in flood zones, including the highest risk VE flood zone, were no more likely than those living in non-flood zones to be prepared for a hurricane as measured by having a disaster supply kit or an evacuation plan. This finding, coupled with the fact that only 27% of surveyed households living in the most vulnerable VE and AE flood zones believed storm surge and flooding were important causes of injury or death from hurricanes, provides an opportunity for targeted intervention by authorities. These households are at high risk of personal injury, death, and property damage during a hurricane, and increasing awareness of preparedness and personal vulnerability to storm surge and flooding is clearly needed. Given the devastating impacts of flooding following Hurricane Katrina, efforts have been made to improve flood maps and increase the number of households covered by flood insurance programs. Increases in the numbers of households covered by flood insurance in area affected by Katrina were short-lived, with more than 15% of new policyholders in Louisiana failing to renew their post-Katrina policies in 2007 [11]. Since Hurricane Katrina, only 34% of the National Flood Insurance Program maps have been updated by the Federal Emergency Management Agency [12]. A proposed amendment to the National Flood Insurance Act, which would have required flood insurance even when no loan is involved in property purchase, broadened the number of households and businesses eligible for coverage, increased maximum coverage amounts, and reduced waiting periods failed to become law [13]. Even with improvements in mapping and insurance coverage, approximately 20% of all flood claims come from households in areas of moderate or low risk, who can purchase insurance coverage at lower rates but generally fail to do so unless required [14]. Those living in mobile homes and multi-unit buildings were less likely to have a disaster supply kit. In our study, there was no difference in the proportion of hurricanes ex6
perienced by type of dwelling (χ 2 8d f = 8.47, p =0.39), leading us to conclude that cost may be a barrier to having a disaster supply kit. Plans to build a disaster supply kit over a period of weeks, such as those suggested by the American Red Cross, and partnerships with local merchants to offer disaster supply kit supplies at reduced prices, could increase the percentage of residents living in mobile homes and multi-unit buildings who have kits. These results indicate challenges for local health department and emergency management officials to improve hurricane preparedness by increasing the number of households having a disaster supply kit or an evacuation plan in ways that do not rely on residents’ past hurricane experience. Interventions that may target newer residents, such as educational materials included in new resident welcome packets, should include information about hurricane preparedness. Improved public understanding of the severity of situations under which a mandatory evacuation order may be issued could encourage more residents to have a plan prior to order issuance. Also, improved awareness of the dangers of storm surge and flooding, even for those living in moderate and low risk areas, is essential to protect lives and property.
4.1. Limitations The use of the physical center of a census block for the block-wide flood zone designation may have introduced misclassification bias. If more than one flood zone was present in a census block, a household could have been misclassified with a stronger, or weaker, flood zone designation. The potential for bias would be larger in the more rural areas of the county where census blocks are geographically larger. Interviewers did not confirm whether respondents were aware of the flood zone in which their property was located. Since flood insurance is required by lenders, any homeowner with a mortgage would be aware of the flood zone designation of their property. Updates to the Flood Insurance Rate Maps for North Carolina were completed in 2003, and at the time, many residents of the region were made aware of the flood zone designation of their property. Ensuring representation of all flood zones may have introduced selection bias. The highest proportion (33%) Journal of Disaster Research Vol.3 No.2, 2008
Factors Associated with Hurricane Preparedness: Results of a Pre-Hurricane Assessment
of interviewed households resided in the VE flood zone which constituted only 8.6% of all 1,476 census blocks located in flood zones. Generalizability of study findings may also be limited since only 1.3% of 2,727 census blocks were represented in the study. However, precision would have been increased over the typical 30x7 two-stage cluster sampling design due to the inclusion of six additional clusters. Surveys which ask questions about anticipated evacuation behavior may overestimate actual evacuation at the time of a storm, particularly in the wake of the active Atlantic hurricane seasons of 2004 and 2005. Due to the nature of this analysis, we did not use the reported anticipated evacuation behavior in this report. However, reporting bias may have occurred if respondents felt they should report positively on hurricane preparation and evacuation to the interviewer; self-reported answers were not confirmed by the interviewers.
[11] Louisiana Department of Insurance, “Insurance Commissioner Donelon to Discuss Storm Awareness in Lafayette,” August 1, 2007. Available at: http://www.ldi.state.la.us/public affairs/Press Releases/2007 Press Releases/8-1-07%20Commissioner%20Donelon%20to%20discuss %20storm%20awareness%20in%20Lafayette.htm. Accessed November 2, 2007. [12] US Government Accountability Office, “Federal Emergency Management Agency: Ongoing Challenges Facing the National Flood Insurance Program,” October 2, 2007. Available at: http://www.gao.gov/htext/d08118t.html. Accessed November 2, 2007. [13] GovTrack.us, “H.R. 4973 – 109th Congress: Flood Insurance Reform and Modernization Act of 2006,” 2007. Available at: http://www.govtrack.us/congress/bill.xpd?bill=h109-4973. Accessed November 2, 2007. [14] Louisiana Department of Insurance, “Insurance Commissioner Donelon to Discuss Storm Awareness in Lafayette,” August 1, 2007. Available at: http://www.ldi.state.la.us/public affairs/Press Releases/2007 Press Releases/8-1-07%20Commissioner%20Don elon%20to%20discuss%20storm%20awareness%20in%20Lafaye tte.htm. Accessed November 2, 2007.
5. Conclusion Community education about the importance of personal preparedness in the mitigation of the risks of hurricanes remains a key role of the health department and emergency management officials. Education to increase awareness about the effects of past hurricanes is important, even among members of the community who have not experienced previous hurricanes or participated in previous evacuations. This study indicates that “learning from experience” is valuable. However, the challenge for public health and emergency management officials is to communicate the importance of preparedness without having to rely on experience as the teacher. References: [1] Carteret County Planning Department, “Mitigation Plan for Carteret County, North Carolina,” 2006. Available at: http://www.co.carteret.nc.us/departments/planning/2006/Mitigation PlanCarteret.pdf. Accessed August 24, 2007. [2] University of Central Florida, “Hurricane Risks Higher than Usual for Most of US Coasts,” 2007. Available at: http://news.ucf.edu/UCFnews/index?page=article&id=0024004102 c4c1d99011146fc1c320060e2. Accessed September 17, 2007. [3] U.S. Census Bureau, “State and County Quick Facts,” 2007. Available at: http://quickfacts.census.gov/qfd/states/37/37031lk.html. Accessed September 19, 2007. [4] U.S. Census Bureau, “State and County Quick Facts,” 2008. Available at: http://quickfacts.census.gov/qfd/states/37/37031lk.html. Accessed September 17, 2007. [5] N. Dash and H. Gladwin, “Evacuation Decision Making and Behavioral Responses: Individual and household,” Natural Hazards Review (in press).
Name: Jennifer A. Horney
Affiliation: NC Center for Public Health Preparedness, University of North Carolina at Chapel Hill School of Public Health
Address: CB #8165, Chapel Hill, NC 27599
Brief Career: 2002-03 Resource Development Manager, IntraHealth International 2004-06 Adjunct Clinical Instructor, Public Health Leadership Program and Health Policy and Administration, UNC School of Public Health 2003-present Assistant Project Director, NC Center for Public Health Preparedness
Selected Publications:
¯ L. K. Alexander, J. W. Wallace, R. A. Wilfert, and J. Horney, “Development of a training web site for public health preparedness continuing education,” Journal of Interactive Instructional Development, Vol.20, No.1, pp. 28-38, 2008. ¯ L. Alexander, K. Dail, M. Davis, J. W. Wallace, J. Horney, J. M. Maillard, and P. D. M. MacDonald, “Partnering to meet training needs: A communicable disease continuing education course for public health nurses,” Accepted for publication by Public Health Reports. ¯ J. Horney and P. D. M. MacDonald, “Academic public health community responds to hurricanes: A history of the University of North Carolina School of Public Health response and new infrastructure 1999-2005,” Public Health Reports, Vol.112, pp. 270-276, 2007.
Academic Societies & Scientific Organizations: ¯ American Public Heath Association ¯ Delta Omega Public Health Honor Society
[6] E. Baker, “Hurricane Evacuation Behavior,” International Journal of Mass Emergencies and Disasters, Vol.9, pp. 287-310, 1991. [7] J. Riad, F. Norris, and R. Ruback, “Predicting Evacuation in Two Major Disasters: Risk Perception, Social Influence, and Access to Resources,” Journal of Applied Social Psychology, Vol.29, pp. 918934, 1999. [8] Dash and Gladwin. [9] Carteret County Board of Commissioners, “Minutes of the Regular Session,” June 17, 2003. Available at: http://www.co.carteret.nc.us/pdfs/06-16-03minutes.pdf. Accessed August 24, 2007. [10] American Red Cross, “Prepare at Home,” 2007. Available at: http://www.redcross.org/services/prepare/0,1082,0 91 ,00.html. Accessed June 27, 2007.
Journal of Disaster Research Vol.3 No.2, 2008
7
