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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Climate Change".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 45771

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Dr. Kimberley Shoaf

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Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, United States
Interests: Casualty Modelling; Health System Coordination in Disaster; Public Health Workforce; Disasters; Humanitarian Crises; Public Health Leadership

Special Issue Information

Dear Colleagues,

The likelihood of disasters and catastrophic events is increasing worldwide. This is a result of many factors, including climate change and population movement. Climate change is impacting our world, bringing with it an increase in disasters related to extreme weather, droughts, rising sea levels, and wildfires. Furthermore, as populations continue to move to urban areas, and as the urban areas grow, they are increasingly intersecting with hazard prone areas (such as coastal areas and the interface with wildlands). At the same time, health care and public health systems are increasingly complex and facing economic challenges.

This special issue seeks articles that address the public health effects of disasters and the actions that public health agencies and society as a whole can take to address the current and future risks. Articles may address a number of topics including: health impacts of disasters; public health and health care systems’ response to disasters; population use of self-protective actions; organization of the health system for response and recovery; modelling of health impacts from disasters as a result of climate change.

Dr. Kimberley Shoaf
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Disasters
Health Impacts
Casualty Modelling
Response Coordination
Health Capacity and Capabilities
Earthquake
Severe Weather
Humanitarian Crises

Published Papers (13 papers)

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Research

15 pages, 2397 KiB

Open AccessArticle

Post-Traumatic Stress Disorder after the 6.1 Magnitude Earthquake in Piura, Peru: A Cross-Sectional Study

by Mario J. Valladares-Garrido, Luis E. Zapata-Castro, C. Ichiro Peralta, Abigaíl García-Vicente, David Astudillo-Rueda, Darwin A. León-Figueroa and Cristian Díaz-Vélez

Int. J. Environ. Res. Public Health 2022, 19(17), 11035; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191711035 - 03 Sep 2022

Cited by 2 | Viewed by 2312

Abstract

In Peru, major disasters like the 2007 Pisco earthquake have produced high rates of post-traumatic stress. However, evidence is still needed to strengthen interventions. In 2021, a major earthquake struck Piura, in northern Peru. In this context, we aimed to assess the prevalence of PTSD and its associated factors. A cross-sectional study was conducted during August–September 2021 in people who experienced the 6.1 Piura earthquake on 30 July 2021. The questionnaire included the PCL-C, CD-RISC, ISI, HFIAS, and additional demographic data. Generalized linear models were used. The prevalence of PTSD was 20.3%. Household income was between PEN 2001 and 3000 (PR = 4.26, 95% CI: 1.08–16.75), smoking (PR = 2.49, 95% CI: 1.03–6.01), experience of a nervous breakdown (PR = 1.83, 95% CI: 1.09–3.09), moderate food insecurity (PR = 2.91, 95% CI: 1.10–7.73), and severe insomnia (PR = 8.25, 95% CI: 2.22–30.71) increased the prevalence of PTSD. One out of five individuals experienced post-traumatic stress symptoms after the 2021 earthquake in Piura, which varies depending on socioeconomic, psychosocial, and individual factors. Further research should strengthen these findings to ensure a fair and early mental health intervention against new seismic events in this and other Peruvian regions. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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16 pages, 2232 KiB

Open AccessArticle

Environmental Stressors Suffered by Women with Gynecological Cancers in the Aftermath of Hurricanes Irma and María in Puerto Rico

by Pablo A. Méndez-Lázaro, Yanina M. Bernhardt, William A. Calo, Andrea M. Pacheco Díaz, Sandra I. García-Camacho, Mirza Rivera-Lugo, Edna Acosta-Pérez, Naydi Pérez and Ana P. Ortiz-Martínez

Int. J. Environ. Res. Public Health 2021, 18(21), 11183; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182111183 - 25 Oct 2021

Cited by 9 | Viewed by 3110

Abstract

Background: Hurricanes are the immediate ways that people experience climate impacts in the Caribbean. These events affect socio-ecological systems and lead to major disruptions in the healthcare system, having effects on health outcomes. In September 2017, Puerto Rico (PR) and the United States Virgin Islands (USVI) experienced one of the most catastrophic hurricane seasons in recent history (Hurricane Irma was a Category 5 and Hurricane María was a Category 4 when they hit PR). Objective: This study examines environmental stressors experienced by women with gynecologic (GYN) cancers from PR and USVI who received oncologic cancer care in PR, in the aftermath of the hurricanes. Methods: A descriptive qualitative study design was used to obtain rich information for understanding the context, barriers, knowledge, perspectives, risks, vulnerabilities, and attitudes associated to these hurricanes. We performed focus groups among GYN cancer patients (n = 24) and key-informant interviews (n = 21) among health-care providers and administrators. Interviews were conducted from December 2018–April 2019. Results: Environmental health stressors such as lack of water, heat and uncomfortable temperatures, air pollution (air quality), noise pollution, mosquitos, and rats ranked in the top concerns among cancer patients and key-informants. Conclusions: These findings are relevant to cancer patients, decision-makers, and health providers facing extreme events and disasters in the Caribbean. Identifying environmental secondary stressors and the most relevant cascading effects is useful for decision-makers so that they may address and mitigate the effects of hurricanes on public health and cancer care. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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10 pages, 303 KiB

Open AccessArticle

Are We Ready to Build Back “Healthier?” An Exploratory Analysis of U.S. State-Level Disaster Recovery Plans

by Mallory Kennedy, Shannon A. Gonick and Nicole A. Errett

Int. J. Environ. Res. Public Health 2021, 18(15), 8003; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18158003 - 28 Jul 2021

Cited by 6 | Viewed by 3134

Abstract

As communities recover from disasters, it is crucial to understand the extent to which states are prepared to support the recovery of health systems and services. This need has been emphasized by the United States’ experience with COVID-19. This study sought to assess public health activities in state disaster recovery implementation plans. In this exploratory, descriptive study, state-wide disaster recovery implementation plans were collected from emergency management agency websites and verified (n = 33). We reviewed and coded the recovery plans to identify health-related activities. While 70% and 64% of reviewed plans included activities to address short-term healthcare and behavioral health needs, respectively, one-third or less of the plans included activities to address long-term healthcare and behavioral health needs. Further, plans have limited descriptions of health-related data collection, analysis, or data-driven processes. Additional evidence-informed public health requirements and activities are needed in disaster recovery implementation plans. State disaster recovery plans would benefit from additional description of public health roles, responsibilities, and activities, as well as additional plans for collecting and analyzing public health data to drive recovery decision making and activities. Plans should include approaches for ongoing evaluation of recovery activities. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

17 pages, 666 KiB

Open AccessArticle

Effects of Hurricane Michael on Access to Care for Pregnant Women and Associated Pregnancy Outcomes

by Ke Pan, Leslie Beitsch, Elaina Gonsoroski, Samendra P. Sherchan, Christopher K. Uejio, Maureen Y. Lichtveld and Emily W. Harville

Int. J. Environ. Res. Public Health 2021, 18(2), 390; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020390 - 06 Jan 2021

Cited by 14 | Viewed by 2650

Abstract

Background: Disasters are associated with worse perinatal outcomes, perhaps due to inadequate prenatal care (PNC). Methods: Using 2017–2019 Florida vital statistics, we compared PNC use before and after Hurricane Michael. We categorized counties as most affected (Area A) or less affected (Area B and C). We examined whether Michael’s effects on perinatal outcomes varied by maternity care availability and used the Baron and Kenny method to assess whether delayed PNC initiation mediated perinatal outcomes. Log-binomial regression and semi-parametric linear regression were used, controlling for maternal and ZIP code tabulation area characteristics. Results: Compared to the one-year period pre-Michael, the week of the first PNC was later in all areas in the one-year period post-Michael, with the largest change in Area A (adjusted difference 0.112, 95% CI: 0.055–0.169), where women were less likely to receive PNC overall (aRR = 0.994, 95% CI = 0.990–0.998) and more likely to have inadequate PNC (aRR = 1.193, 95% CI = 1.127–1.264). Michael’s effects on perinatal outcomes did not vary significantly by maternity care availability within Area A. Delayed PNC initiation appeared to mediate an increased risk in small for gestational age (SGA) births after Michael. Conclusion: Women in Area A initiated PNC later and had a higher likelihood of inadequate PNC. Delayed PNC initiation may partially explain increased risk of SGA. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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16 pages, 2531 KiB

Open AccessArticle

Food Insecurity in the Post-Hurricane Harvey Setting: Risks and Resources in the Midst of Uncertainty

by Kevin M. Fitzpatrick, Don E. Willis, Matthew L. Spialek and Emily English

Int. J. Environ. Res. Public Health 2020, 17(22), 8424; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228424 - 13 Nov 2020

Cited by 10 | Viewed by 2449

Abstract

Food insecurity is of heightened concern during and after natural disasters; higher prevalence is typically reported in post-disaster settings. The current study examines food insecurity prevalence and specific risk/resource variables that may act as barriers or advantages in accessing food in such a setting. Using a modified quota sample (n = 316), Hurricane Harvey survivors participated in face-to-face interviews and/or online surveys that assessed health, social and household factors, and sociodemographic characteristics. Using logistic regression analyses we find that social vulnerabilities, circumstantial risk, and social and psychological resources are important in determining the odds of food insecurity. Hispanic and/or Nonwhite survivors, renters, and those persons displaced during the natural disaster have higher food insecurity odds. Survivors with stronger social ties, higher levels of mastery, and a greater sense of connectedness to their community are found to have lower food insecurity odds. A more nuanced analysis of circumstantial risk finds that while the independent effects of displacement and home ownership are important, so too is the intersection of these two factors, with displaced-renters experiencing significantly higher odds than any other residence and displacement combinations, and particularly those who are homeowners not displaced during the disaster. Strategies for addressing differential risks, as well as practical approaches for implementation and education programming related to disaster recovery, are discussed. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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11 pages, 767 KiB

Open AccessArticle

Developing an Environmental Health Sciences COVID-19 Research Agenda: Results from the NIEHS Disaster Research Response (DR2) Work Group’s Modified Delphi Method

by Nicole A. Errett, Marilyn Howarth, Kimberley Shoaf, Megan Couture, Steven Ramsey, Richard Rosselli, Sara Webb, April Bennett and Aubrey Miller

Int. J. Environ. Res. Public Health 2020, 17(18), 6842; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17186842 - 19 Sep 2020

Cited by 7 | Viewed by 3816

Abstract

Leveraging the community of practice recently established through the U.S. National Institute of Environmental Health Sciences (NIEHS) Disaster Research Response (DR2) working group, we used a modified Delphi method to identify and prioritize environmental health sciences Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and associated Coronavirus Disease 2019 (COVID-19) research questions. Twenty-six individuals with broad expertise across a variety of environmental health sciences subdisciplines were selected to participate among 45 self-nominees. In Round 1, panelists submitted research questions and brief justifications. In Round 2, panelists rated the priority of each question on a nine-point Likert scale. Responses were trichotomized into priority categories (low priority; medium priority; and high priority). A research question was determined to meet consensus if at least 69.2% of panelists rated it within the same priority category. Research needs that did not meet consensus in round 2 were redistributed for re-rating. Fourteen questions met consensus as high priority in round 2, and an additional 14 questions met consensus as high priority in round 3. We discuss the impact and limitations of using this approach to identify and prioritize research questions in the context of a disaster response. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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18 pages, 3092 KiB

Open AccessArticle

What Protective Health Measures Are Americans Taking in Response to COVID-19? Results from the COVID Impact Survey

by Fares Qeadan, Nana Akofua Mensah, Benjamin Tingey, Rona Bern, Tracy Rees, Sharon Talboys, Tejinder Pal Singh, Steven Lacey and Kimberley Shoaf

Int. J. Environ. Res. Public Health 2020, 17(17), 6295; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176295 - 29 Aug 2020

Cited by 36 | Viewed by 6217

Abstract

With the emergence of the novel SARS-CoV-2 and the disease it causes; COVID-19, compliance with/adherence to protective measures is needed. Information is needed on which measures are, or are not, being undertaken. Data collected from the COVID Impact Survey, conducted by the non-partisan and objective research organization NORC at the University of Chicago on April, May, and June of 2020, were analyzed through weighted Quasi-Poisson regression modeling to determine the association of demographics, socioeconomics, and health conditions with protective health measures taken at the individual level in response to COVID-19. The three surveys included data from 18 regional areas including 10 states (CA, CO, FL, LA, MN, MO, MT, NY, OR, and TX) and 8 Metropolitan Statistical Areas (Atlanta, GA; Baltimore, MD; Birmingham, AL; Chicago, IL; Cleveland and Columbus, OH; Phoenix, AZ; and Pittsburgh, PA). Individuals with higher incomes, insurance, higher education levels, large household size, age 60+, females, minorities, those who have asthma, have hypertension, overweight or obese, and those who suffer from mental health issues during the pandemic were significantly more likely to report taking precautionary protective measures relative to their counterparts. Protective measures for the three subgroups with a known relationship to COVID-19 (positive for COVID-19, knowing an individual with COVID-19, and knowing someone who had died from COVID-19) were strongly associated with the protective health measures of washing hands, avoiding public places, and canceling social engagements. This study provides first baseline data on the response to the national COVID-19 pandemic at the individual level in the US. The found heterogeneity in the response to this pandemic by different variables can inform future research and interventions to reduce exposure to the novel SARS-CoV-2 virus. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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12 pages, 930 KiB

Open AccessArticle

Evaluation of Sleep Quality in a Disaster Evacuee Environment

by Hitomi Ogata, Momoko Kayaba, Miki Kaneko, Keiko Ogawa and Ken Kiyono

Int. J. Environ. Res. Public Health 2020, 17(12), 4252; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124252 - 15 Jun 2020

Cited by 4 | Viewed by 2503

Abstract

We aimed to evaluate sleep and sleep-related physiological parameters (heart rate variability and glucose dynamics) among evacuees by experimentally recreating the sleep environment of evacuation shelters and cars. Nine healthy young male subjects participated in this study. Two interventions, modeling the sleep environments of evacuation shelters (evacuation shelter trial) and car seats (car trial), were compared with sleep at home (control trial). Physiological data were measured using portable two-channel electroencephalogram and electrooculogram monitoring systems, wearable heart rate sensors, and flash glucose monitors. Wake after sleep onset (WASO) and stage shift were greater in both intervention trials than the control trial, while rapid-eye movement (REM) latency and non-rapid eye movement (NREM) 1 were longer and REM duration was shorter in the evacuation shelter trial than the control trial. Glucose dynamics and power at low frequency (LF.p) of heart rate variability were higher in the car trial than in the control trial. It was confirmed that sleep environment was important to maintain sleep, and affected glucose dynamics and heart rate variability in the experimental situation. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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14 pages, 1094 KiB

Open AccessFeature PaperArticle

Naive Forecast for COVID-19 in Utah Based on the South Korea and Italy Models-the Fluctuation between Two Extremes

by Fares Qeadan, Trenton Honda, Lisa H. Gren, Jennifer Dailey-Provost, L. Scott Benson, James A. VanDerslice, Christina A. Porucznik, A. Blake Waters, Steven Lacey and Kimberley Shoaf

Int. J. Environ. Res. Public Health 2020, 17(8), 2750; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17082750 - 16 Apr 2020

Cited by 18 | Viewed by 6139

Abstract

Differences in jurisdictional public health actions have played a significant role in the relative success of local communities in combating and containing the COVID-19 pandemic. We forecast the possible COVID-19 outbreak in one US state (Utah) by applying empirical data from South Korea and Italy, two countries that implemented disparate public health actions. Forecasts were created by aligning the start of the pandemic in Utah with that in South Korea and Italy, getting a short-run forecast based on actual daily rates of spread, and long-run forecast by employing a log-logistic model with four parameters. Applying the South Korea model, the epidemic peak in Utah is 169 cases/day, with epidemic resolution by the end of May. Applying the Italy model, new cases are forecast to exceed 200/day by mid-April, with the potential for 250 new cases a day at the epidemic peak, with the epidemic continuing through the end of August. We identify a 3-month variation in the likely length of the pandemic, a 1.5-fold difference in the number of daily infections at outbreak peak, and a 3-fold difference in the expected cumulative cases when applying the experience of two developed countries in handling this virus to the Utah context. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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10 pages, 302 KiB

Open AccessFeature PaperArticle

Determinants of Hurricane Evacuation from a Large Representative Sample of the U.S. Gulf Coast

by Ibraheem M. Karaye, Jennifer A. Horney, David P. Retchless and Ashley D. Ross

Int. J. Environ. Res. Public Health 2019, 16(21), 4268; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16214268 - 03 Nov 2019

Cited by 12 | Viewed by 2581

Abstract

Exposure to natural disasters like hurricanes negatively impacts the mental and physical health of populations, and evacuation is an important step taken to prevent these adverse health events. This study uses data from a large representative sample of U.S. Gulf Coast residents to explore the determinants of hurricane evacuation. In December 2017, data were collected from 3030 residents of the U.S. Gulf Coast, including Texas, Louisiana, Mississippi, Alabama, and Florida—2557 of whom reported being impacted during the 2017 hurricane season. Bivariate analyses were conducted using prevalence differences and tested for statistical significance with chi-square tests. Multivariable logistic regression models were fitted to identify factors associated with hurricane evacuation. One-third of the respondents (919 of 2557; 35.9%) evacuated from a hurricane that impacted the U.S. Gulf Coast in 2017. The determinants of hurricane evacuation in this population were: residing in a mobile home, higher perception of storm surge risk, higher perception of wind risk, self-sufficiency, carrying flood insurance, and reliance on media and family for evacuation decisions. These findings may be relevant for reducing the adverse health effects of hurricanes by improving emergency planning and evacuation in this highly vulnerable region. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

10 pages, 2588 KiB

Open AccessArticle

Daily Bicycle and Pedestrian Activity as an Indicator of Disaster Recovery: A Hurricane Harvey Case Study

by Annie Doubleday, Youngjun Choe, Scott Miles and Nicole A. Errett

Int. J. Environ. Res. Public Health 2019, 16(16), 2836; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16162836 - 08 Aug 2019

Cited by 8 | Viewed by 3262

Abstract

Changes in levels and patterns of physical activity might be a mechanism to assess and inform disaster recovery through the lens of wellbeing. However, few studies have examined disaster impacts on physical activity or the potential for physical activity to serve as an indicator of disaster recovery. In this exploratory study, we examined daily bicycle and pedestrian counts from four public bicycle/pedestrian trails in Houston, before and after Hurricane Harvey landfall, to assess if physical activity returned to pre-Harvey levels. An interrupted time series analysis was conducted to examine the immediate impact of Harvey landfall on physical activity; t-tests were performed to assess if trail usage returned to pre-Harvey levels. Hurricane Harvey was found to have a significant negative impact on daily pedestrian and bicycle counts for three of the four trails. Daily pedestrian and bicycle counts were found to return to pre-Harvey or higher levels at 6 weeks post-landfall at all locations studied. We discuss the potential for further research to examine the trends, feasibility, validity, and limitations of using bicycle and pedestrian use levels as a proxy for disaster recovery and wellbeing among affected populations. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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13 pages, 1299 KiB

Open AccessArticle

Hospitalization Rates for Respiratory Diseases After L’Aquila Earthquake

by Francesco D’Aloisio, Pierpaolo Vittorini, Anna Rita Giuliani, Maria Scatigna, Jacopo Del Papa, Mario Muselli, Giorgio Baccari and Leila Fabiani

Int. J. Environ. Res. Public Health 2019, 16(12), 2109; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16122109 - 14 Jun 2019

Cited by 9 | Viewed by 2700

Abstract

The study aims to investigate the impact of the earthquake on public health, in terms of hospitalizations for respiratory diseases in the Abruzzo region, focusing on the area damaged by the earthquake “Crater”. We collected data of hospitalizations of residents in Abruzzo between 2009 and 2015. Hospital Discharge Records (HDRs) with a primary diagnosis of respiratory disease were included and divided into pneumonia, Chronic Obstructive Pulmonary Disease (COPD), and respiratory insufficiency. Absolute frequencies and standardized hospitalization rates were calculated to perform both a short-term and a medium-long term analysis. A linear regression was performed using standardized hospitalization rates and the time. A total of 108.669 respiratory-related records were collected and the most frequent subgroup was respiratory insufficiency. Standardized Hospitalization Rates (SHRs) for respiratory diseases resulted higher in the non-Crater than Crater area, but the short-term analysis showed a significant increase in hospitalizations for pneumonia and respiratory insufficiency in the Crater area. The medium-long term analysis reported a significant difference on the slope decrease of hospitalizations for acute and chronic respiratory diseases in the Crater versus the non-Crater area. The earthquake may have played a triggering role in the increased detection of respiratory diseases. A temporal relationship between the quake and an increase in admissions was found although it is not yet possible to detect a direct cause-effect relationship. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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15 pages, 306 KiB

Open AccessArticle

Investigating the Aftershock of a Disaster: A Study of Health Service Utilization and Mental Health Symptoms in Post-Earthquake Nepal

by Tara Powell, Shang-Ju Li, Yuan Hsiao, Chloe Ettari, Anish Bhandari, Anne Peterson and Niva Shakya

Int. J. Environ. Res. Public Health 2019, 16(8), 1369; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16081369 - 16 Apr 2019

Cited by 8 | Viewed by 3501

Abstract

Background: In 2015, a 7.8 magnitude earthquake struck Nepal, causing unprecedented damage and loss in the mountain and hill regions of central Nepal. The aim of this study was to investigate the association between healthcare access and utilization, and post-disaster mental health symptoms. Methods: A cross-sectional study conducted with 750 disaster-affected individuals in six districts in central Nepal 15 months post-earthquake. Anxiety and depression were measured through the Depression, Anxiety and Stress Scale (DASS-21). Healthcare utilization questions examined types of healthcare in the communities, utilization, and approachability of care providers. Univariate analyses, ANOVAs and Tobit regression were used. Results: Depression and anxiety symptoms were significantly higher for females and individuals between 40–50 years old. Those who utilized a district hospital had the lowest anxiety and depression scores. Participants who indicated medical shops were the most important source of health-related information had more anxiety and depression than those who used other services. Higher quality of healthcare was significantly associated with fewer anxiety and depressive symptoms. Conclusions: Mental health symptoms can last long after a disaster occurs. Access to quality mental health care in the primary health care settings is critical to help individuals and communities recover immediately and during the long-term recovery. Full article

(This article belongs to the Special Issue Disasters and Their Consequences for Public Health)

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