Hurricane Harvey Registry Initial Report February 2019 Share your Harvey experience at HarveyRegistry.rice.edu HURRICANE HARVEY REGISTRY Share your Harvey experience at HarveyRegistry.rice.edu This report was prepared by the Children’s Environmental Health Initiative (CEHI) at Rice University. February, 2019. Calculations, including maps and summary statistics, were based exclusively on data available in the registry. Respondents who did not answer a question were excluded from any analysis involving that question. All maps displayed in this report aggregate data to a sufficient scale to protect the confidentiality of the Hurricane Harvey Registry respondents. Table of Contents  2 Message from Project Leaders  3 Project Summary  4 Community Outreach  5 Hurricane Harvey Registrants  6 Displacement  7 Debris  8 Physical Health 10 Mental Health 12 Next Steps 13 Hurricane Harvey Registry Team 15 Our Partners 16 References Hurricane Harvey Registry Initial Report 1 Message from Project Leaders W hen Hurricane Harvey hit, our community responded with courage, commitment, and compassion. As we realized the scope and scale of Harvey’s impact, it became clear that we needed a systematic way to identify and track the long-term health and housing impacts of the storm. Out of this need, the Hurricane Harvey Registry was born. Since launching in April 2018, the Hurricane Harvey Registry has been asking residents to share their Harvey experience. More than 13,000 individual registrants, capturing the living environments of over 39,000 residents, spanning 13 counties, have reflected on how Harvey impacted their physical health, mental health, property, financial security, and many other aspects of their life. In this document, we report on the 9,798 people who had registered by January 2, 2019. We are honored by the support this collaboration has received. With transparency and openness to the communities we serve, we are committed to moving the entire region forward through innovative public health solutions. We want to especially thank each and every one of the registrants; your willingness to engage with us as citizen-scientists is part of what makes our community so special. This initial report serves as an update on our journey thus far, but our work is far from over. We will continue to enroll community members in the registry so that we can better capture the range of experiences throughout the region. We are working hard to make sure that every single neighborhood, city, and county has a voice. We ask that you help uplift the voices of your own community by spreading the word to your neighbors, friends, community groups, churches, and coworkers about the Hurricane Harvey Registry. Together, we can ensure that those same qualities of courage, commitment, and compassion shape our long-term recovery from Harvey. Sincerely, Mary Beth Bess, RN, MSN, FNP-BC, Chambers County Health Department Elena Craft, PhD, Environmental Defense Fund Mary DesVignes-Kendrick, MD, Fort Bend County Health & Human Services Richard McBrayer, Victoria Office of Emergency Management Marie Lynn Miranda, PhD, Children’s Environmental Health Initiative, Rice University Umair A. Shah, MD, MPH, Harris County Public Health Alicia Williams, MPH, CIC, Montgomery County Public Health District Stephen L. Williams, MEd, MPA, Houston Health Department 2 HarveyRegistry.rice.edu Project Summary I n August 2017, Hurricane Harvey, one of the most destructive storms in our nation’s history, made landfall. Unprecedented rain from the storm dumped trillions of gallons of water on the region. Ten counties were declared disaster areas. More than 10,000 rescue missions were conducted, $125 billion worth of damage was reported, and over 700,000 residents registered for Federal Emergency Management Agency assistance. These figures are moving, but do not capture the full range of experiences throughout Southeast Texas. From Houston to Bay City, from Fort Bend County to Galveston County, individuals and communities have been forever changed. While some high-level statistics about Hurricane Harvey’s impact are known, there remain significant gaps in understanding the full impact of Harvey on residents, especially regarding the storm’s effects on health. In Houston alone, over one quarter of homes were damaged or destroyed by floodwater.1 Harvey’s broader impact on housing in the region can also be examined by the extraordinary number of residents who were displaced from their homes—many, for months on end. There are numerous chemical production and storage facilities including chemical plants, Superfund sites, and refineries in the greater Houston area, and the extent of air, soil, and water contamination has yet to be assessed. Receding flood waters likely resulted in widespread mold and bacterial contamination in residential and commercial structures. How did exposure to environmental contaminants and psychological stressors impact the mental and physical health of individuals and communities in the region? What health and housing risks can government officials better address in preparation for fu- Hurricane Harvey Registry Initial Report ture storms? While many of these questions typically go unanswered in the aftermath of natural disasters, these questions continue to inspire our work. With the initial idea for the registry born immediately after Harvey made landfall, the Hurricane Harvey Registry was officially launched in April 2018 with the objective of establishing a baseline understanding of the environmental health risks from the storm. Led by Chambers County, the Environmental Defense Fund, Fort Bend County, Harris County Public Health, Houston Health Department, Montgomery County, Rice University’s Children’s Environmental Health Initiative, and Victoria County, we continue to focus on documenting how the storm affected health in our communities, shaping public health solutions and better preparing the region for future weather disasters. Since Harvey, many residents are working to recover. We work diligently to identify and connect residents to resources that will help support these recovery needs. Ultimately, we recognize that this region has not fully recovered until we all have recovered. We are extremely excited to share this preliminary report with those who have registered, those who have not, and those looking for insight into Harvey’s long-term impact. We continue to recruit new registrants to engage the region as we work with partners to use information from the registry to build a more resilient community. Please visit HarveyRegistry.rice.edu to enroll in the registry and to learn more about insights the registry is providing. 3 Community Outreach T he Hurricane Harvey Registry team is committed to building meaningful relationships, earning trust, and remaining visible in communities throughout the region. In our efforts to build meaningful relationships, we engage public officials (city council members, neighborhood leaders, school districts, and other government leaders), local nonprofit organizations (BakerRipley, the Sierra Club, Interfaith Ministries, and others), churches, businesses, and a vast array of community stakeholders. These community-based relationships allow us to extend our reach and give us a better understanding of community needs. The Hurricane Harvey Registry seeks to inspire and earn the trust of residents throughout the region. We are deeply committed to data privacy and security. At the same time, we work diligently to remain transparent with the public about our findings. 4 In addition to our ongoing community stakeholder recruitment efforts, we have a dedicated team committed to listening and responding to residents at a local level. We interact with community members at large scale events (from public health fair events to Houston Rockets games) and grassroots community meetings. We also lead canvassing and door-to-door outreach efforts to reach and inform residents. We welcome the opportunity to visit with your local community group, church, school, library, community center, or other gathering spot. To arrange such a visit, please email us at HarveyRegistry@rice.edu. HarveyRegistry.rice.edu Hurricane Harvey Registrants 9,798 registrants as of Jan 2, 2019 Over 29,000 residents across the region captured On average, there are 3 people per household represented in the registry. Home Flooded Home Damaged Vehicle Damage Electricity Loss Income Loss 44% 55% 34% 43% 41% Number of respondents per 20 square mile hexagon Hurricane Harvey Registry Initial Report 5 Displacement R esearch studies have linked housing displacement to poor mental health and have shown it is a barrier to long-term recovery.2, 3 Evidence-based interventions and policies can help reduce hurricane-related housing instability.4 If you left your home, where did you go? Left Home 20 Weeks 46% Respondents who reported having to leave their home were displaced for an average of 20 weeks before moving back home. Lived with family 59% Lived in hotel 14% Lived in apartment 9% Other 18% Percent of respondents who left home by Zip Code Tabulation Area 6 HarveyRegistry.rice.edu Debris D ebris that comes in contact with flood waters are a public health threat due to chemical contaminants released by the flood. Older homes often contain higher levels of toxins, leaving residents more vulnerable to health effects caused by chemicals like lead, asbestos, and arsenic. 5, 6 Trash on Block 65% 7 Weeks On average, it took approximately seven weeks for piles of trash to be cleared. Percent of respondents with trash on their block in the aftermath of Harvey by Zip Code Tabulation Area Hurricane Harvey Registry Initial Report 7 Physical Health R esearch shows people who experience flooding or had contact with floodwaters are at risk for exposure to sewage, toxic chemicals, and other hazardous substances. 7–9 Physical injuries commonly occur during clean-up where lack of knowledge or lack of proper cleaning materials and protective gear increase health risks, resulting from exposure to debris and harmful toxics.10 Exposure to mold and bacteria during clean-up have been linked to new and worsening respiratory conditions including cough, difficult or labored breathing, sinus symptoms, asthma, and pneumonia.7 Runny Nose Problems Concentrating Headaches/ Migraines Shortness of Breath Skin Rash 50% 23% 26% 20% 10% Percent of respondents who reported headache by Zip Code Tabulation Area 8 HarveyRegistry.rice.edu Reporting of symptoms, by whether or not respondent reported home flooding No Flooding Runny Nose Home Flooded 51% 49% Problems Concentrating 34% Headaches/ Migraines 66% 46% Shortness of Breath 54% 45% 55% Skin Rash 36% 3000 2000 1000 64% 0 1000 2000 3000 Number of Respondents Reporting of symptoms, by whether or not respondent reported living at home during clean up Not Present in Home Runny Nose Present in Home 39% 61% Problems Concentrating 41% Headaches/ Migraines 59% 37% Shortness of Breath 63% 39% Skin Rash 61% 43% 1500 1000 500 57% 0 500 1000 1500 2000 Number of Respondents Hurricane Harvey Registry Initial Report 9 Mental Health P revious studies of hurricane survivors have shown that property loss and damage are associated with poor mental health. Sociodemographic factors including unemployment, hurricane-related physical illness and injury, and hurricane-related housing insecurity have also been linked to mental health problems.11 Psychological reactions to natural disasters occur in waves of emotional highs and lows that take place well beyond the one-year anniversary of an event. Investigators have noted increases in mental conditions including post-traumatic stress disorder, several months or years after a hurricane occurs.12 Identifying high risk populations and persistent stressors of people who lived through Harvey will help develop evidence-based prevention strategies for future disasters. 13, 14 Percent of respondents reporting “sometimes” or “often” to having mental health difficulties 59% I thought about it when I didn’t mean to. I avoided letting myself get upset when I thought about it or was reminded of it. 53% Pictures about it popped into my mind. 52% Other things kept making me think about it. 52% 50% I had waves of strong feelings about it. Any reminder brought back feelings about it. 44% I had trouble falling asleep or staying asleep because of pictures or thoughts about it that came into my mind. 37% 35% I tried not to think about it. 33% My feelings about it were kind of numb. 32% I was aware that I still had a lot of feelings about it, but I didn’t deal with them. 31% I tried to remove it from memory. 30% I had dreams about it. 28% I stayed away from reminders of it. 26% I tried not to talk a bout it. I felt as if it hadn't happened or it wasn’t real. 23% 0 10 20 30 40 50 % of Respondents 10 HarveyRegistry.rice.edu “I tried not to think about it.” “I had waves of strong feelings about it.” Often Often Often 19.6% Rarely 17.6% 21.1% 16.3% 55% Home 45% Home Damaged not Damaged Sometimes 29.3% 66.9% Not At All 33.2% Rarely 50.8% Not At All 21.0% Not At All Not At All “I thought about it when I didn’t mean to.” “Other things kept making me think about it.” Often Often Often 13.9% 40.4% Often 32.4% Sometimes 55% Home 45% Home 18.7% Damaged not Damaged 39.5% 12.4% 11.5% Sometimes 24.7% 27.9% Rarely Rarely 55% Home 45% Home Damaged not Damaged 15.2% Sometimes 33.9% Sometimes 11.8% 14.3% 5.6% 29.6% 34.5% Rarely 13.2% Sometimes Often Sometimes Rarely Sometimes 33.3% 55% Home 45% Home 17.0% Damaged not Damaged Rarely 46.8% 15.5% Not At All Rarely Not At All 18.8% 13.3% Not At All Not At All “I was aware that I still had a lot of feelings about it, but I didn’t deal with them.” Often Often 20.7% 25.4% 20.1% Rarely 10.6% 14.2% 4.0% Sometimes Rarely Sometimes 55% Home 45% Home Damaged not Damaged 71.2% Not At All 33.8% Not At All Hurricane Harvey Registry Initial Report 11 Next Steps T he Hurricane Harvey Registry team is committed to working actively to connect registrants with pertinent long-term recovery resources. The data we are collecting works to improve and design intervention programs and inform municipal governments about improvements needed in current recovery strategies. Exposure to mold can result in allergies, respiratory symptoms, and other adverse health effects. Many families are still working to return to homes that were severely damaged. Some families continue to live in homes with mold or other harmful environmental contaminants. Hurricane Harvey collaborators are committed to addressing these areas of need through targeted intervention programs. to anxiety, persistent headaches, and other mental health related symptoms. Mental health resource allocation and service delivery must be improved throughout the region. The Hurricane Harvey Registry team is committed to laying the foundation for this improvement by highlighting Harvey’s true impact on mental health throughout the region. Asthma impacts over 1 million individuals in Texas alone.15 It is extremely important that residents throughout the region have access to services that adequately address asthma triggers in their environment. Since Harvey, air quality has become an even greater concern. The Hurricane Harvey Registry will help the region better understand and identify gaps in air quality regulations currently in place. We will also be able to better support advocacy and intervention efforts aimed at addressing asthma within the state. Ultimately, understanding the needs of millions of residents across dozens of counties can be difficult. When natural disasters strike, resource allocation and long-term recovery across a region is of utmost concern. The Harvey Registry hopes to better inform and support ongoing recovery projects with vital input from residents. Whether it be mobile health clinic programs, mold remediation programs, or free food and vaccine programs, the Hurricane Harvey Registry is working to lay the foundation for a healthy, efficient, and equitable recovery. Mental health services remain a significant area of need for the entire region. Oftentimes, in the aftermath of traumatic stress, it can take months for mental health conditions to manifest. Many residents have reported anxiety, problems concentrating, persistent headaches, and other symptoms associated with the mental health impact of Hurricane Harvey. Factors like long-term displacement, financial challenges, and adverse health effects can all contribute We’ve come a long way but our work is far from over. We need your help to make sure that every community throughout the region is well represented. If you have not registered already, please make sure to visit HarveyRegistry.rice.edu. If you have friends, family, or neighbors in the region who have not registered, please make sure to share the link with them. 12 HarveyRegistry.rice.edu Hurricane Harvey Registry Team Chambers County Health Department Mary Beth Bess Kevin Crump Health Services Director Public Health Emergency Preparedness Coordinator Environmental Defense Fund Elena Craft Matt Tresaugue Senior Director Communications Manager Fort Bend County Health & Human Services M. desVignes-Kendrick David Olinger Director Public Health Preparedness Coordinator Harris County Public Health Umair A. Shah Eric Bakota Executive Director Public Health Analyst Houston Health Department Stephen Williams Loren Raun Director Chief Environmental Science Officer Scott Packard Chief Communications Officer Hurricane Harvey Registry Initial Report 13 Hurricane Harvey Registry Team Montgomery County Public Health District Alicia Williams Director Victoria Office of Emergency Management Richard McBrayer Jena West Emergency Management Coordinator Public Health Emergency Preparedness Coordinator Children’s Environmental Health Initiative at Rice University 14 Marie Lynn Miranda Hien Le Director and Rice University Howard R. Hughes Provost Business Systems Analyst Rashida Callender Joshua Tootoo Associate in Research Director of Training and Geospatial Sciences Joally Canales Claire Osgood Community Outreach Coordinator Data Manager Justin Onwenu Max Grossman Community Outreach Coordinator Research Scientist Jocelyn Hwang Kathy Ensor GIS Technician Rice University Director of Kinder Institute Urban Data Platform Ruiyang Li Nathan Cook GIS Technical Team Leader Rice University Director of Government Relations HarveyRegistry.rice.edu Our Partners We’d like to thank the following media and community partners who shared their expertise and helped our team develop meaningful relationships throughout the region. Hurricane Harvey Registry Initial Report 15 References 1. City of Houston Housing and Community Development Department. City of Houston Local Housing Needs Assessment: Hurricane Harvey Housing Recovery. https:// houstontx.gov/housing/Draft_Local_Housing_Needs_ Assessment_v2.pdf 2. Fussell E, Lowe SR. The impact of housing displacement on the mental health of low-income parents after Hurricane Katrina. Social Science & Medicine. 2014; 113: 137 – 144. 3. Galea S, Brewin CR, Gruber M, et al. Exposure to hurricanerelated stressors and mental illness after Hurricane Katrina. Arch Gen Psychiatry. 2007;64(12):1427-1434. 4. Kloos B, Flory K, Hankin BL, et al. Investigating the roles of neighborhood environments and housing-based social support in the relocation of persons made homeless by Hurricane Katrina. J Prev Interv Community. 2009; 37(2): 143-154. 5. Dubey B, Solo-Gabriele HM, Townsend TG. Quantities of Arsenic-Treated Wood in Demolition Debris Generated by Hurricane Katrina. Environ Sci Technol. 2007; 41(5): 1533-1536. 6. Ravikrishna R, Lee H, Mbuligwe S, et al. Air quality during demolition and recovery activities in post-Katrina New Orleans. Environmental Toxicology and Chemistry. 2010; 29(7): 1438-1444. 7. Rando RJ, Lefante JJ, Freyder LM, Jones RN. Respiratory health effects associated with restoration work in postHurricane Katrina New Orleans. J Environ Public Health. 2012; 2012: 462478 16 8. Saulnier DD, Ribacke KB, von Schreeb J. No calm after the storm: A systematic review of human health following flood and storm disasters. Prehosp Disaster Med. 2017; 32(5):568-579. 9. Shultz JM, Galea S. Mitigating the Mental and Physical Health Consequences of Hurricane Harvey. JAMA. 2017;318(15):1437-1438 10. Reible D. Hurricane Katrina: Environmental hazards in the disaster area. Cityscape. 2007; 9(3): 53- 68. 11. Galea S, Brewin CR, Gruber M, et al. Exposure to hurricanerelated stressors and mental illness after Hurricane Katrina. Arch Gen Psychiatry. 2007;64(12):1427-1434. 12. Kessler, RC, Galea K, Gruber MJ, et al. Trends in mental illness and suicidality after Hurricane Katrina. Molecular Psychiatry. 2008; 13: 374-384. 13. Neria Y, Shultz JM. Mental health effects of Hurricane Sandy: characteristics, potential aftermath, and response. JAMA. 2012;308(24):2571-2572. 14. Ruggiero KJ, Gros K, McCauley JL, et al. Mental health outcomes among adults in Galveston and Chambers counties after Hurricane Ike. Disaster Med Public Health Prep. 2012; 6(1): 26-32. 15. Centers for Disease Control and Prevention. Asthma in Texas. https://www.cdc.gov/asthma/stateprofiles/Asthma_ in_TX.pdf HarveyRegistry.rice.edu HARVEY REGISTRY HELPING STORM VICTIMS Hurricane Harvey Registry Initial Report HURRICANE HARVEY REGISTRY Share your Harvey experience at HarveyRegistry.rice.edu 6100 Main Street MS-460 • Houston, TX 77005 Email: HarveyRegistry@rice.edu The Hurricane Harvey Registry is funded by the Environmental Defense Fund, the Cullen Trust for Healthcare, and the National Institutes of Health.