Household Preparedness for Public Health Emergencies — 14 States, 2006–2010

Weekly
September 14, 2012 / 61(36);713-719

Populations affected by disaster increase the demand on emergency response and public health systems and on acute care hospitals, often causing disruptions of services (1). Household preparedness measures, such as having a 3-day supply of food, water, and medication and a written household evacuation plan, can improve a population's ability to cope with service disruption, decreasing the number of persons who might otherwise overwhelm emergency services and health-care systems (2). To estimate current levels of self-reported household preparedness by state and sociodemographic characteristics, CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) survey data collected in 14 states during 2006–2010. The results of this analysis indicated that an estimated 94.8% of households had a working battery-operated flashlight, 89.7% had a 3-day supply of medications for everyone who required them, 82.9% had a 3-day supply of food, 77.7% had a working battery-operated radio, 53.6% had a 3-day supply of water, and 21.1% had a written evacuation plan. Non-English speaking and minority respondents, particularly Hispanics, were less likely to report household preparedness for an emergency or disaster, suggesting that more outreach activities should be directed toward these populations.
BRFSS is a state-based, random-digit–dialed telephone survey of the noninstitutionalized U.S. civilian population aged ≥18 years.* The survey collects information on health risk behaviors, preventive health practices, health-care access, and disease status. The General Preparedness module was included in BRFSS surveys conducted by 14 states during 2006–2010. Two states, Nebraska and Montana, collected data for multiple years. Comparison of data collected by these two states showed no significant increases or decreases in preparedness measures over time. Therefore, data for Nebraska and Montana were combined across years. Significance of differences between percentages was determined by chi-square test (p<0 .05=".05" p="p"> During 2006–2010, preparedness data were collected (with Council of American Survey and Research Organizations response rates indicated) from the following states: 2006, Connecticut (44.3%), Montana (54.8%), Nevada (50.1%), and Tennessee (56.7%); 2007, Delaware (43.2%), Louisiana (41.0%), Maryland (31.4%), Nebraska (65.4%), and New Hampshire (37.7%); 2008, Georgia (55.1%), Montana (48.3%), Nebraska (65.5%), New York (40.0%), and Pennsylvania (45.6%); 2009, Mississippi (49.3%); and 2010, Montana (65.4%) and North Carolina (41.1%).
Household disaster preparedness measures, as defined by the BRFSS questionnaire, included the following items: having 3-day supplies of food, prescription medications, and water, a written evacuation plan, a working battery-powered radio, and a working battery-powered flashlight. Respondents were asked the following six questions: 1) "Does your household have a 3-day supply of nonperishable food for everyone who lives there? By nonperishable we mean food that does not require refrigeration or cooking." 2) "Does your household have a 3-day supply of water for everyone who lives there? A 3-day supply of water is 1 gallon of water per person per day." 3) "Does your household have a 3-day supply of prescription medications for each person in your household who takes prescription medications?" 4) "Does your household have a working battery-operated radio and working batteries for use if the electricity is out?" 5) "Does your household have a working flashlight and working batteries for use if the electricity is out?" 6) "Does your household have a written evacuation plan for how you will leave your home in case of a large-scale disaster or emergency that requires evacuation?"
Overall, an estimated 94.8% of households had a working battery-operated flashlight, 89.7% had a 3-day supply of medications for everyone who required them, 82.9% had a 3-day supply of food, 77.7% had a working battery-operated radio, 53.6% had a 3-day supply of water, and 21.1% had a written evacuation plan (Table 1). With the exception of having a 3-day supply of medication and a written evacuation plan, which were not significantly different by sex, men were significantly more likely than women to report their households were prepared. Significant differences ranged from 1.6 percentage points (95.6% compared with 94.0%) for having a working, battery-powered flashlight to 6.9 percentage points (57.2% compared with 50.3%) for having a 3-day supply of water (Table 1). By race/ethnicity, Hispanics were significantly less likely than all other race/ethnicities to have a 3-day supply of food (75.0%), a 3-day supply of medication (69.0%), and a working battery-operated radio (67.1%), and flashlight (84.4%). In general, as the age of respondents increased, reported household preparedness increased. With the exceptions of having a 3-day supply of water and a written evacuation plan, persons with a high school diploma were more likely to indicate preparedness than those with less than a high school diploma. With the exception of having a written evacuation plan, which was most prevalent among respondents who were unable to work, in general, retired respondents were most likely to indicate that their household was prepared.
Respondents who requested that the survey be conducted in Spanish (68.2%) were less likely to report their households had a 3-day supply of food than those administered the survey in English (83.2%) (Figure). A similar pattern was observed for having a 3-day supply of medication (Spanish, 51.7%; English, 90.6%), a working battery-operated radio (Spanish, 56.5%; English, 78.1%), and a working battery-operated flashlight (Spanish, 74.7%; English, 95.2%). However, respondents who requested the survey be conducted in Spanish were significantly more likely to report their households had a 3-day supply of water (Spanish, 64.5%; English, 53.6%) and were as likely as those interviewed in English to report that the household had a written evacuation plan (Spanish, 25.6%; English, 20.6%; p=0.066).
By state, Montana respondents were most likely (88.1%) and Nevada respondents were least likely (78.5%) to report their household had a 3-day supply of food (Table 2). Pennsylvania respondents were most likely (93.7%) and Nevada respondents were least likely (80.7%) to report a 3-day supply of medication. Louisiana respondents were most likely (67.1%) and Nebraska respondents were least likely (45.5%) to report a 3-day supply of water. Louisiana respondents were most likely (54.0%) and Pennsylvania respondents were least likely (15.0%) to have a written evacuation plan. Louisiana respondents were most likely (85.2%) and Nevada respondents were least likely (72.3%) to report a working battery-powered radio. New Hampshire respondents were most likely (97.2%) and New York respondents were least likely (93.4%) to report a working battery-powered flashlight.

Reported by

Summer D. DeBastiani MPH, Tara W Strine, PhD, Office of Public Health Preparedness and Response, CDC. Corresponding contributor: Summer D. DeBastiani, sdebastiani@cdc.gov, 404-639-3101.

Editorial Note

Similar to previous studies, the findings in this report generally indicate increased levels of disaster and emergency preparedness among men, English-speaking persons, and adults with more education (3,4). Also similar to previous research, this analysis indicates limited evacuation planning among households (3,4). With the notable exception of Louisiana, where in 2007, 2 years after devastating Hurricane Katrina, 54.0% of respondents said they had a written evacuation plan, no state reported a prevalence as high as 35%. Therefore, increased efforts encouraging the adoption of a written household evacuation plan are needed.
Beginning in 2003, the federal government launched two preparedness campaigns for the purpose of increasing household preparedness: Ready.gov and the Citizen Corps (5,6). Both campaigns encourage the general population to prepare for disasters by being informed, assembling an emergency kit, and having a plan (Box). Ready.gov is an Internet-based disaster preparedness initiative, and the Citizen Corps encourages government and community leaders to involve the general population in all-hazards emergency preparedness activities (5,6). The primary method to access preparedness materials and information through these organizations is via predominantly English language websites, creating a possible barrier for non-English speaking adults, persons of low socioeconomic status, and those without Internet access. An increased effort to make household preparedness materials and information more accessible, particularly by those with resource and language barriers, is needed.
The findings in this report are subject to at least five limitations. First, during 2006–2010, BRFSS sampled only households with a landline telephone, thus excluding homes with only cellular telephones. Second, responses were dependent on the participant's understanding of preparedness measures taken in the household; for example, some respondents might not have known that the household had a 3-day supply of food, water, and medications. In addition, respondents were not required to present any evidence that a preparedness measure (e.g., 3-day supply of water or a working flashlight) had been met. Third, the response rates were low; only approximately one of every two persons contacted agreed to participate in the survey. Fourth, several of the questions failed to account for all types of preparedness technology (e.g., hand-cranked flashlights). Finally, the General Preparedness module was only implemented in 14 states during 2006–2010, with only a few states using the module in any given year; therefore, the findings are not generalizable to the U.S. population.
Since the 2001 terrorist attacks, the federal government has increased its emphasis on emergency preparedness, including the response and recovery capabilities of emergency management agencies, hospitals, and public health systems (7). CDC uses preparedness metrics to assess systems, with the findings disseminated to states and used to inform Healthy People 2020 objectives. Outcomes associated with individual household preparedness activities, however, are not similarly assessed or shared (3,8). To help improve household disaster preparedness in the general population and to inform national and state preparedness planning and policy, systematically measured, generalizable state-based household preparedness data are needed (9).

References

Hick JL, Hanfling D, Burstein JL, et al. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med 2004;44:253–61.
Paton D, Johnston DM. Disaster resilience: an integrated approach. Springfield, IL: Charles C. Thomas; 2006:105–6.
Ablah E, Konda K, Kelley CL. Factors predicting individual emergency preparedness: a multi-state analysis of the 2006 BRFSS data. Biosecur Bioterror 2009;7:317–30.
Murphy ST, Cody M, Frank LB, Glik D, Ang A. Predictors of emergency preparedness and compliance. Disaster Med Public Health Prep 2009;7:S1–8.
Federal Emergency Management Agency. Ready. Washington, DC: Federal Emergency Management Agency; 2012. Available at http://www.ready.gov . Accessed September 7, 2012.
Federal Emergency Management Agency. Citizen Corps. Washington, DC: Federal Emergency Management Agency; 2012. Available at http://citizencorps.gov . Accessed September 7, 2012.
CDC. Public health preparedness capabilities: national standards for state and local planning. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. Available at http://www.cdc.gov/phpr/capabilities. Accessed September 7, 2012.
CDC. Public Health Emergency Preparedness Program: budget period 1. Performance measures specifications and implementation guidance. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/phpr/documents/phep+bp1+pm+specifications+and+implementation+guidance_v1_1.pdf . Accessed September 7, 2012.