In our increasingly interconnected world, the potential for emerging infectious diseases (EIDs) to spread globally is of paramount concern. Travel bans-herein defined as the complete restriction of ...travel from at least one geographic region to at least one other international geographic region-are a potential policy solution to control the global spread of disease. The social, economic, and health-related consequences of travel bans, as well as the available evidence on the effectiveness of travel restrictions in preventing the global spread of influenza, have been previously described. However, the effectiveness of travel bans in reducing the spread of noninfluenza EIDs, characterized by different rates and modes of transmission, is less well understood. This study employs an integrative review approach to summarize the minimal evidence on effectiveness of travel bans to decrease the spread of severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome (MERS), Ebola virus disease (EVD), and Zika virus disease (ZVD). We describe and qualify the evidence presented in six modeling studies that assess the effectiveness of travel bans in controlling these noninfluenza EID events. We conclude that there is an urgent need for additional research to inform policy decisions on the use of travel bans and other control measures to control noninfluenza EIDs in advance of the next outbreak.
Abstract
Extreme smoke events from wildland fires are increasing in frequency and intensity across the country. Risk communication around wildland and prescribed fires is an essential component of ...both smoke-readiness and resilience. To date, little research has been conducted on how smoke exposure risks can be communicated effectively, especially within the context of rural and tribal communities, who experience a disproportionate burden of smoke risks and impacts. This qualitative study analyzed how tribal and non-tribal communities in the Okanogan River Airshed Emphasis Area (ORAEA) receive and share information about smoke exposure to highlight gaps and communication opportunities for smoke risk communication. The ORAEA is a region of north-central Washington that is frequently blanketed with smoke year-round from wildland fire in the summer, prescribed fire in the fall and spring, and wood burning stoves in the winter. This study was the result of a partnership between the Okanogan River Airshed Partnership, the Natural Resource Division for the Confederated Tribes of the Colville Reservation, the Colville Environmental Trust Air Quality Program, and the University of Washington. The study team conducted seventeen key informant interviews and six focus groups to identify community perceptions of smoke exposure and describe its impact. A thematic analysis of interview and focus group data identified five themes around wildfire smoke risk communication: (1) perception of the health risks of smoke; (2) current ways of sharing information about smoke; (3) trusted sources of information; (4) gaps and communication opportunities; and (5) perceptions of prescribed fire. Based on these themes, we developed a set of six recommended actions. To create effective smoke risk communication that may be applicable to smoke-impacted regions across the country, messaging must address barriers to action, be rooted in community perceptions of risk, and be delivered through trusted channels.
The increased number of catastrophic disasters in the United States in recent decades has been accompanied by consequences of climate change, including rising sea levels, floods, storms, extreme ...temperatures, drought, and wildfires. Climate change and extreme events are interrelated, and climate change is likely to lead to more frequent and severe hazards. Hazard mitigation offers tools to address the hazards that are influenced by climate change and minimize community-level exposure or vulnerability. State Hazard Mitigation Officers in the 56 U.S. states, territories, and the District of Columbia involved in FEMA’s Hazard Mitigation Grant Program were surveyed to assess the extent to which climate change has been integrated into State Hazard Mitigation Plans (SHMPs) and the barriers and facilitators to such climate change integration. The majority of responding states reported integration of climate change into SHMPs, and increased climate change projection evidence was commonly cited as a driver of such integration. However, lack of funding and competing hazard mitigation priorities were the most commonly reported barriers to integration. Political prioritization was reported as both a barrier to and facilitator of integration. There is an ongoing need to effectively translate climate change research to practitioners to support evidence-based hazard mitigation policy and practice.
This study examines the attitudinal impact of an Extended Parallel Process Model (EPPM)-based training curriculum on local public health department (LHD) workers' willingness to respond to ...representative public health emergency scenarios. Data are from 71 U.S. LHDs in urban and rural settings across nine states. The study explores changes in response willingness and EPPM threat and efficacy appraisals between randomly assigned control versus intervention health departments, at baseline and 1 week post curriculum, through an EPPM-based survey/resurvey design. Levels of response willingness and emergency response-related attitudes/beliefs are measured. Analyses focus on two scenario categories that have appeared on a U.S. government list of scenarios of significant concern: a weather-related emergency and a radiological "dirty" bomb event (U.S. Department of Homeland Security, 2007). The greatest impact from the training intervention on response willingness was observed among LHD workers who had low levels of EPPM-related threat and efficacy perceptions at baseline. Self-efficacy and response efficacy and response willingness increased in intervention LHDs for both scenarios, with greater response willingness increases observed for the radiological "dirty" bomb terrorism scenario. Findings indicate the importance of building efficacy versus enhancing threat perceptions as a path toward greater response willingness, and suggest the potential applicability of such curricular interventions for boosting emergency response willingness among other cadres of health providers.
Translation strategies are critical for sharing research with public health practitioners. To disseminate our analyses of legal issues that arise relative to mental and behavioral health during ...emergencies, we created 10 brief translational tools for members of the public health workforce. In consultation with an interdisciplinary project advisory group (PAG), we identified each tool's topic and format. PAG members reviewed draft and final versions of the tools. We then worked with local health departments throughout the country to distribute the tools along with a brief survey to determine practitioners' perceived utility of the tools. Through survey responses, we learned that practitioners believed the tools provided information that would be useful during the planning, response, and recovery phases of an emergency. This article describes the creation of the PAG, the development of the tools, and lessons learned for those seeking to translate legal and ethical research findings for practitioner audiences.
The Extended Parallel Process Model (EPPM) is an established threat- and efficacy-based behavioral framework for understanding health behaviors in the face of uncertain risk. A growing body of ...research has applied this model to understand these behaviors among the public health workforce. In this manuscript, we aim to explore the application of this framework to the public health workforce, with a novel focus on their confidence in vaccines and perceptions of vaccine injury compensation mechanisms. We characterize specific connections between EPPM's threat and efficacy dimensions and relevant vaccine policy frameworks and highlight how these connections can usefully inform training interventions for public health workers to enhance their confidence in these vaccine policy measures.
On January 15, 2022, the Hunga-Tonga-Hunga-Ha'apai (Tonga) volcano erupted and triggered a tsunami forecasted to reach North America. This event provided a unique opportunity to investigate risk ...perception and communication among coastal emergency managers and emergency program coordinators (EMs). In response, this research explores 1) how risk can be communicated most effectively and 2) how risk perceptions associated with “distant” tsunami alerts and warnings affect EMs' willingness to issue emergency alerts. A purposive sample of coastal EMs (n = 21) in the U.S. Pacific Northwest participated in semi-structured interviews. Participants represented Tribal, county, state, and federal agencies in Washington, Oregon, and California. Interview transcripts were deductively coded and thematically analyzed. Participants perceived low risk from the Tonga tsunami but took precautionary measures and alerted the public. Participants described how their actions were driven by community characteristics and the anticipated reactions to messaging among residents. Many reported the need to balance notifying the public and avoiding the negative impacts of their messaging (e.g., “crying wolf,” panic, curiosity). The unique nature of the event led to identification of unanticipated facilitators and barriers to decision-making among participants. These findings can inform distant tsunami risk communication and preparedness for coastal communities.
Local health departments play a critical role in short-, intermediate-, and long-term recovery activities after a public health emergency. However, research has not explored attitudinal determinants ...of health department workers' participation in the recovery phase following a disaster. Accordingly, this qualitative investigation aims to understand perceived facilitators and barriers to performing recovery-related activities following Hurricane Sandy among local health department workers. In January 2014, 2 focus groups were conducted in geographically representative clusters of local health departments affected by Hurricane Sandy (1 cluster in Maryland and 1 cluster in New Jersey). Focus groups were recorded, transcribed verbatim, and analyzed to qualitatively assess attitudes toward Hurricane Sandy recovery activities. This analysis identified 5 major thematic categories as facilitators and barriers to participation in recovery activities: training, safety, family preparedness, policies and planning, and efficacy. Systems that support engagement of health department personnel in recovery activities may endeavor to develop and communicate intra- and interjurisdictional policies that minimize barriers in these areas. Development and implementation of evidence-informed curricular interventions that explain recovery roles may also increase local health department worker motivation to participate in recovery activities.
Interlocal collaboration, or collaboration among neighboring independent municipalities, has been generally accepted as an emergency preparedness strategy. In the absence of large-scale disasters, ...emergency preparedness exercises may serve to test the effectiveness of interlocal collaboration on emergency preparedness. However, the use of emergency preparedness exercises to enhance or assess interlocal collaboration, or its impact on preparedness, requires additional empirical exploration.
This exploratory study aims to understand the perspectives of key informants (KIs) with broad knowledge of the history, goals, and implementation of the Urban Area Security Initiative (UASI) program, as well as knowledge of interlocal collaboration exercises conducted as part of the UASI program, about the role of exercises in improving and assessing interlocal collaboration for emergency preparedness.
In early 2014, 28 KIs were interviewed during 24 semistructured interviews. Interviews were recorded and analyzed to identify key themes related to emergency preparedness exercises and the enhancement and assessment of interlocal collaboration.
KIs perceived exercises to enhance interlocal collaboration in preparedness by promoting regional, interlocal: risk assessment; emergency plan testing and operationalization; relationship development; support for regional plans and operational structures; capability delivery practice; best practice sharing across interlocal collaborations; and engagement of elected or senior leadership in interlocal preparedness endeavors. Exercise participants, scenarios, administration, formats, and assessment strategies to promote interlocal collaboration were identified.
Seven distinct mechanisms by which exercises can enhance interlocal collaboration that can be used to guide future research and policy development were identified. The format, scenario, participation, and administration of emergency preparedness exercises can be tailored to enhance collaboration.
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