Assessing the Emergency Response Role of Community-Based Organizations (CBOs) Serving People with Disabilities and Older Adults in Puerto Rico Post-Hurricane María and during the COVID-19 Pandemic

In Puerto Rico, a host of factors makes the role of community-based organizations (CBOs) critically important in emergency preparedness and response (EPR) and disability-inclusive disaster risk reduction (DiDRR) addressing the needs of people with disabilities and older adults. The territory has been the site of recurring hurricanes, earthquakes, medical crises, and human-made disasters. Political, social, and economic problems unique to the archipelago have historically limited the preparedness and response capacity of governmental authorities, especially for its most at-risk populations. In a context of severe constraints on government resources, CBOs are positioned to play an outsized role in providing services for disabled and older adults before, during, and after emergencies. This study assesses the emergency preparedness and response capacity of CBOs (n = 22) for addressing the needs of people with disabilities and the elderly. Semi-structured, largely closed-ended interviews were conducted in Spanish with key informants at Puerto Rican CBOs. The interviews included questions about emergency preparedness and response training, as well as organizational capacity during COVID-19 and post-Hurricane María. This study posits that conditions in Puerto Rico place CBOs at the forefront of critical responsibilities including emergency preparedness and response, warranting assessment of their practices and resources to assist them in fulfilling their mission

Criena Fitzgerald. Turning men into stone: a social and medical history of silicosis in Western Australia 1890-1970. Carlisle, Western Australia: Hesperian Press; 2016, 252 p. ISBN 978-0-85905-635-9

Obra ressenyada: Criena FITZGERALD, Turning men into stone: a social and medical history of silicosis in Western Australia 1890-1970. Carlisle, Western Australia: Hesperian Press, 2016

Addressing Disparities in Emergency Communication with the Deaf and Hard-of-Hearing: Cultural Competence and Preparedness for First Responders

It is critically important to foster a resilient Deaf and hard-of-hearing (Deaf/HH) population empowered to act in a pre-event phase before and respond during and after critical large-scale public health emergencies. Standard all-hazards emergency preparedness risk & response communication efforts don't always reach people with barriers relating to literacy, language, culture or disability. This is a significant problem given that there is a growing body of evidence of higher risk during disasters for injury, death, property loss for 32 million Deaf/HH Americans and for 90 million Americans with low-literacy skills. It is beneficial to use a participatory, community-directed approach to improve all-hazards preparedness capacity for the Deaf/HH. This dissertation is in a three-paper format. Part I, a literature review, systematically examines all-hazards emergency communication access for the Deaf/HH during large-scale disasters with an eye towards maximizing emergency preparedness capacity within the Deaf community. The literature review does not simply examine lessons learned from any access issues that have been documented in previous disasters but also reviews the peer reviewed and gray literature (non-peer-reviewed literature, often non-published reports) to determine the need for interventions or systemic change on a policy-level. By identifying the scope and magnitude of the problem, this literature review is a stepping stone for Parts II and III, which aim to develop best practices for educational outreach and training for first responders. Part II is a program evaluation utilizing mixed methods of a training program for law enforcement officers at the scene of domestic violence (DV) emergencies involving the Deaf/HH. A program evaluation of cultural competency training for the Deaf/HH has never been published, to my knowledge, despite several available trainings for first responders or medical professionals and students nationally (Appendix 1). Once trainings are developed, standardized and shown to be beneficial, they can be distributed to Deaf/HH audiences and/or first responders, which can sustain longer-term development efforts that might mitigate the impact of future emergencies or improve the quality of life/infrastructure on broader levels. Part III is a qualitative exploration of barriers, attitudes, perceptions, and knowledge of law enforcement and first responders regarding working with the Deaf/HH in an emergency. Specific abstracts for each Part can be found in the corresponding section. The closing section provides a summary of policy and legislative developments on a national level that are informed by Deaf/HH experts in emergency communication; these developments have implications for further research and practice to address disparities in emergency preparedness communication for the Deaf/HH

Addressing Disparities in Emergency Communication with the Deaf and Hard-of-Hearing: Cultural Competence and Preparedness for First Responders

It is critically important to foster a resilient Deaf and hard-of-hearing (Deaf/HH) population empowered to act in a pre-event phase before and respond during and after critical large-scale public health emergencies. Standard all-hazards emergency preparedness risk & response communication efforts don't always reach people with barriers relating to literacy, language, culture or disability. This is a significant problem given that there is a growing body of evidence of higher risk during disasters for injury, death, property loss for 32 million Deaf/HH Americans and for 90 million Americans with low-literacy skills. It is beneficial to use a participatory, community-directed approach to improve all-hazards preparedness capacity for the Deaf/HH. This dissertation is in a three-paper format. Part I, a literature review, systematically examines all-hazards emergency communication access for the Deaf/HH during large-scale disasters with an eye towards maximizing emergency preparedness capacity within the Deaf community. The literature review does not simply examine lessons learned from any access issues that have been documented in previous disasters but also reviews the peer reviewed and gray literature (non-peer-reviewed literature, often non-published reports) to determine the need for interventions or systemic change on a policy-level. By identifying the scope and magnitude of the problem, this literature review is a stepping stone for Parts II and III, which aim to develop best practices for educational outreach and training for first responders. Part II is a program evaluation utilizing mixed methods of a training program for law enforcement officers at the scene of domestic violence (DV) emergencies involving the Deaf/HH. A program evaluation of cultural competency training for the Deaf/HH has never been published, to my knowledge, despite several available trainings for first responders or medical professionals and students nationally (Appendix 1). Once trainings are developed, standardized and shown to be beneficial, they can be distributed to Deaf/HH audiences and/or first responders, which can sustain longer-term development efforts that might mitigate the impact of future emergencies or improve the quality of life/infrastructure on broader levels. Part III is a qualitative exploration of barriers, attitudes, perceptions, and knowledge of law enforcement and first responders regarding working with the Deaf/HH in an emergency. Specific abstracts for each Part can be found in the corresponding section. The closing section provides a summary of policy and legislative developments on a national level that are informed by Deaf/HH experts in emergency communication; these developments have implications for further research and practice to address disparities in emergency preparedness communication for the Deaf/HH

Deaf patient-provider communication and lung cancer screening: Health Information National Trends survey in American Sign Language (HINTS-ASL).

OBJECTIVE:To assess whether mode of communication and patient centered communication (PCC) with physicians were associated with the likelihood of deaf smokers inquiring about lung cancer screening. METHODS:An accessible health survey including questions about PCC, modes of communication, smoking status and lung cancer screening was administered in American Sign Language (HINTS-ASL) to a nationwide sample of deaf adults from February to August 2017. Of 703 deaf adults who answered the lung screening question, 188 were 55-80 years old. RESULTS:The odds ratio of asking about a lung cancer screening test was higher for people with lung disease or used ASL (directly or through an interpreter) to communicate with their physicians. PCC was not associated with asking about a lung cancer screening test. CONCLUSION:Current or former smokers who are deaf and use ASL are at greater risk for poorer health outcomes if they do not have accessible communication with their physicians. PRACTICE IMPLICATIONS:Optimal language access through interpreters or directly in ASL is critical when discussing smoking cessation or lung cancer screening tests. Counseling and shared decision-making will help improve high-risk deaf patients' understanding and decision-making about lung cancer screening

Deaf and Hard-of-Hearing Learners in Emergency Medicine

Approximately 23% of Americans over age 12 have some level of hearing loss. 1 Emergency departments can reduce healthcare barriers for deaf and hard-of-hearing (DHoH) patients through improved patient-physician communication. DHoH students, once they become physicians, may provide one mechanism for reducing existing healthcare disparities and communication barriers for DHoH patients, and may be more adept with patients facing other communication barriers. A renewed interest in disability access and a commitment to social justice has increased efforts toward the inclusion of individuals with disabilities in medical education and training. Despite this increased interest and a growing number of DHoH students entering medical education, DHoH students continue to be dissuaded from specialty careers such as emergency medicine (EM) over concerns regarding effective communication and ability. Given the academic medicine communities’ commitment to diversity, a recounting of the successful inclusion of DHoH students in EM can benefit medical education and practice. In this account, the authors reflect on the successful experiences of a visiting DHoH medical student in an academic EM rotation at a Level I trauma hospital that serves a diverse population, and they identify the potential challenges for DHoH students in an EM setting, offer solutions including reasonable accommodations, and provide commentary on the legal requirements for providing full and equal access for DHoH students. We secured permission from the student to share the contents of this article prior to publication

Deaf and Hard of Hearing Learners in Emergency Medicine

Approximately 23% of Americans over age 12 have some level of hearing loss.1 Emergency departments can reduce healthcare barriers for deaf and hard-of-hearing (DHoH) patients through improved patient-physician communication. DHoH students, once they become physicians, may provide one mechanism for reducing existing healthcare disparities and communication barriers for DHoH patients, and may be more adept with patients facing other communication barriers. A renewed interest in disability access and a commitment to social justice has increased efforts toward the inclusion of individuals with disabilities in medical education and training. Despite this increased interest and a growing number of DHoH students entering medical education, DHoH students continue to be dissuaded from specialty careers such as emergency medicine (EM) over concerns regarding effective communication and ability. Given the academic medicine communities’ commitment to diversity, a recounting of the successful inclusion of DHoH students in EM can benefit medical education and practice.In this account, the authors reflect on the successful experiences of a visiting DHoH medical student in an academic EM rotation at a Level I trauma hospital that serves a diverse population, and they identify the potential challenges for DHoH students in an EM setting, offer solutions including reasonable accommodations, and provide commentary on the legal requirements for providing full and equal access for DHoH students. We secured permission from the student to share the contents of this article prior to publication. 

Developing sugar-sweetened beverage warning labels for young adults

ObjectiveThere is a lack of qualitative research developing sugar-sweetened beverage (SSB) warning labels with their intended end users. We sought to identify promising SSB warning elements for improving label effectiveness and for future testing in policy and institutional settings.DesignMixed methods design using ten focus groups, a design task and a survey. The design task was used to generate ideas for an icon that would dissuade SSB consumption. The survey and focus group guide assessed participant perceptions of SSB warning label mock-ups of text (loss frame, gain frame and loss frame with attribution), colour and icon options.SettingThree large public universities in California from February to March 2018.ParticipantsYoung adult SSB consumers (n 86) enrolled in one of three diverse California public universities.ResultsParticipants perceived the following elements as most effective for reducing SSB consumption: loss-frame text with attribution to a credible source, yellow and red colour for label background and an image or icon to accompany the text. Preferred images included sugar near or inside of an SSB, intuitive shapes like a triangle with exclamation mark or octagon and a visual indicator of SSB sugar content compared with recommended limits. Support was high for using SSB warning labels in university cafeterias and on bottles/cans.ConclusionsLoss-frame text with a credible source, yellow or red label colour and icons could potentially enhance effectiveness of SSB warning labels and warrant further testing

Responding to the deaf in disasters: establishing the need for systematic training for state-level emergency management agencies and community organizations

Abstract Background Deaf and hard-of-hearing (Deaf/HH) individuals have been underserved before and during emergencies. This paper will assess Deaf/HH related emergency preparedness training needs for state emergency management agencies and deaf-serving community-based organizations (CBOs). Methods Four approaches were used: 1) a literature review; 2) results from 50 key informant (KI) interviews from state and territorial-level emergency management and public health agencies; 3) results from 14 KI interviews with deaf-serving CBOs in the San Francisco Bay Area; and 4) a pilot program evaluation of an emergency responder training serving the Deaf/HH in one urban community. Results Results from literature review and state and territorial level KIs indicate that there is a substantive gap in emergency preparedness training on serving Deaf/HH provided by state agencies. In addition, local KI interviews with 14 deaf-serving CBOs found gaps in training within deaf-serving CBOs. These gaps have implications for preparing for and responding to all-hazards emergencies including weather-related or earthquake-related natural disasters, terrorist attacks, and nuclear-chemical disasters. Conclusion Emergency preparedness trainings specific to responding to or promoting preparedness of the Deaf/HH is rare, even for state agency personnel, and frequently lack standardization, evaluation, or institutionalization in emergency management infrastructure. This has significant policy and research implications. Similarly, CBOs are not adequately trained to serve the needs of their constituents

Assessment of State- and Territorial-Level Preparedness Capacity for Serving Deaf and Hard-of-Hearing Populations in Disasters

ObjectivesSubstantial evidence exists that emergency preparedness and response efforts are not effectively reaching populations with functional and access needs, especially barriers related to literacy, language, culture, or disabilities. More than 36 million Americans are Deaf or hard of hearing (Deaf/HH). These groups experienced higher risks of injury, death, and property loss in recent disasters than the general public. We conducted a participatory research study to examine national recommendations on preparedness communication for the Deaf/HH.MethodsWe assessed whether previous recommendations regarding the Deaf/HH have been incorporated into state- and territorial-level emergency operations plans (EOPs), interviewed state- and territorial-level preparedness directors about capacity to serve the Deaf/HH, and proposed strategies to benefit Deaf/HH populations during emergencies. We analyzed 55 EOPs and 50 key informant (KI) interviews with state directors.ResultsFifty-five percent of EOPs mentioned vulnerable populations; however, only 31% specifically mentioned Deaf/HH populations in their plan. Study findings indicated significant relationships among the following factors: a state-level KI's familiarity with communication issues for the Deaf/HH, making relay calls (i.e., calls to services to relay communication between Deaf and hearing people), and whether the KI's department provides trainings about serving Deaf/HH populations in emergencies. We found significant associations between a state's percentage of Deaf/HH individuals and a KI's familiarity with Deaf/HH communication issues and provision by government of any disability services to Deaf/HH populations in emergencies. Further, we found significant relationships between KIs attending training on serving the Deaf/HH and familiarity with Deaf/HH communication issues, including how to make relay calls.ConclusionThis study provides new knowledge that can help emergency agencies improve their preparedness training, planning, and capacity to serve Deaf/HH populations in emergencies