MITIGATING HEALTH DISPARITIES AMONG FLOOD SURVIVORS: THE CASE OF EASTERN KENTUCKY

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: ACTIVE
• Funding Source: AFRI COMPETITIVE GRANT
• Reporting Frequency: Annual
• Accession No.: 1029729
• Grant No.: 2023-68016-38953
• Cumulative Award Amt.: $300,000.00
• Proposal No.: 2022-11054
• Project Start Date: Feb 15, 2023
• Project End Date: Oct 14, 2025
• Grant Year: 2023
• Program Code: [A1712]- Rapid Response to Extreme Weather Events Across Food and Agricultural Systems

Recipient Organization
KENTUCKY STATE UNIVERSITY
(N/A)
FRANKFORT,KY 40601

Performing Department
(N/A)

Non Technical Summary
This one-year integrated proposal helps Kentucky State University (KSU), and The Extension Disaster Education Network (EDEN) to address the mental health needs of underserved populations affected by the Eastern Kentucky flood. The primary focus will be on addressing the needs of Eastern Kentucky flood survivors in the following counties: Breathitt, Clay, Floyd, Letcher, and Perry. These counties have high African American population of underserved individuals and families. This project aims to alleviate the impacts of the Eastern Kentucky floods on mental and physical health of low-income people and racial/ethnic minorities. The project will meet its goals/aims by incorporating the following objectives: (1) Identify existing care providers and other health resources available in the affected counties as well as provide immediate disaster relief for the flood survivors by working with local well-known advocates and activists within the community. (2) Assess the level of usage of these resources among the flood survivors by incorporating pre-post surveys. (3) Measure short-term impacts of the floods on the mental and physical health of the affected populations by incorporating pre-post surveys and other available data. (4) Provide training for the flood survivors on the importance of their mental and physical health after a disaster by incorporating best practices. (5) Obtain data for additional research and extension applications for use in securing the stability of the resulting outcomes, and (6) To identify existing care providers and other health resources available in the affected counties as well as providing immediate disaster relief for the flood survivors.

Animal Health Component

90%

Research Effort Categories

Basic

10%

Applied

90%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
723	0430	3070	70%
608	0420	3100	30%

Knowledge Area
608 - Community Resource Planning and Development; 723 - Hazards to Human Health and Safety;

Subject Of Investigation
0420 - Weather; 0430 - Climate;

Field Of Science
3070 - Psychology; 3100 - Management;

Keywords

eastern kentucky

disaster relief

flooding

health equity

mental health

Goals / Objectives
The overarching goal of this proposal is to provide immediate (and potentially future) disaster relief services for minority, underserved, and often disenfranchised survivors of the 2022 Eastern Kentucky Flood. The goal of this proposal is consistent with the mission, vision, and strategic plan of the College of Agriculture, Community, and the Sciences at Kentucky State University (KSU). This includes a mission of expanding cultural diversity, as well as establishing innovative teaching, extension, and research to deliver stakeholder-oriented programs leading to collaborations with other institutions. To achieve the goal of this integrated research and extension proposal, we want to fulfill the following objectives:(1) Identify existing care providers and other health resources available in the affected counties as well as providing immediate disaster relief for the flood survivors by working with local well-known advocates and activists within the community. However, in addition, our goal is to build sustainable, permanent sites in the counties to subsequently address trauma, trust, and other mental health issues within the higher-minority populated Eastern Kentucky counties.(2) Assess the level of usage of these resources among the flood survivors by incorporating pre and post surveys.(3) Measure the short-term impacts of the floods on the mental and physical health of the affected populations by incorporating pre and post surveys and other available data.(4) Provide best-practices training for the flood survivors emphasizing the importance of their mental and physical health after a disaster.(5) Secure stability in these minority, underserved, and disenfranchised populations, obtain quantitative and qualitative data for additional research and extension funding applications, and aid in developing additional programs to further mitigate health disparities among minority, underserved, and disenfranchised populations in times of disaster.

Project Methods
The objectives of this proposal will be partly realized by conducting focus group discussions and surveys in the study area and digitalizing the results. Specific questions that the focus group and survey will aim to answer are: (1) how were the flood survivors affected? (2) Did the flooding have adverse economic impacts (income/cash flow, access to food, employment, etc.) on the flood survivors? (3) Did the flooding affect the general health, mental health, and well-being of the flood survivors? (4) Did the flooding affect the economic and health outcomes of blacks disproportionately?Based on the literature, natural disasters affect the economic and health outcomes of survivors both in the short term and in the long term. To verify this, we will survey flood survivors and compare results from surveys of a comparison group. With the elicited information, we will attempt to estimate the causal impact of the flooding on the flood survivors. In our survey efforts, we will aim to elicit the responses of black flood survivors and compare their responses to the general group of flood survivors. This would allow us to achieve our objective of measuring the impact of flooding on health equity. Through the information retrieved from the survey, we will also test two hypotheses: (1) the flooding negatively impacted the economic and health outcomes of the flood survivors much more than non-flood survivors. (2) The flooding negatively impacted the economic and health outcomes of black flood survivors much more than non-black flood survivors. We will also investigate potential reasons why we believe black flood survivors were disproportionately affected by the floods.Before the survey, we will conduct focus group discussions with the flood survivors to allow the flood survivors to express themselves without being too restricted by the surveys. During the focus group discussions, the project team will gather views that might help with the survey development as well as accurate interpretation of survey results. Data gathered will be used to develop best practice guides and educational programs, and curriculums for post-natural disaster training. Each of the three focus groups surveyed will have up to 10 participants.We will conduct the survey using in-person and virtual interviews following a series of steps. First, the survey will be designed using a template from the Resilience in Survivors of Katrina project and input from the project team. We will aim to survey within three months of receiving the grant award. The randomized survey will be completed within a month, with the expectation that 30 percent will respond positively. Second, we will randomly select the flood survivors. The flood survivors will be identified through the Federal Emergency Management Agency and Kentucky Emergency Management. Our extension associates, contacts, and networks in the affected locations will be utilized for flood victim identification. Prior to conducting the actual survey, we will conduct a pre-test of the survey and ensure that we can follow up with the flood survivors, which would help increase the response rates. The flood survivors that partake in the survey will be provided with a gift card of $50 each as appreciation for their time.To analyze the data collected, we will utilize two empirical methods. We will first use propensity score matching to estimate the causal impacts of the flooding on the flood survivors' economic and health outcomes. We will also utilize descriptive methods such as a test of means to compare the differences between the target groups. Then, we will utilize limited dependent variable (logit or probit) models to understand why black flood survivors are disproportionately affected by the flooding. Data generated will be analyzed using Microsoft excel and Stata.

Progress 02/15/23 to 02/14/24

Outputs
Target Audience:The target audience is survivors of Eastern Kentucky, primarily in the following counties: Breathit, Perry, Letcher, and Knott. This changed from the original target audience, which was2022 Eastern Kentucky Flood survivors within the following counties: Breathitt, Clay, Floyd, Letcher, and Perry - these counties have been chosen because, within the affected area, they have higher underserved minority populations. However, upon further review, we learned that the original population data was skewed in that we based the original on Census data. However, the Census data included incarcerated populations, which did not include the corresponding number of individuals in the general population. Thus, we had to change the counties of interest. Changes/Problems:1. We have encountered several roadblocks that have slowed us down, such as significant changes in staff, leadership, processes, procedures, and policies. 2. We are attempting to pay our primary collaborator for services rendered in Nov and Dec 2023. We were finally able to get an official MOA approved last month. We are now going through the internal process of getting the organization paid. However, our Director of Grants and the Director of Budgeting recently left within the last two months. As a result, the project is paused until payment can be made. 3. We are securing a formal agreement with the University of Florida to provide professional development. Our institution's high turnover rate and transition situation are also causing challenges. What opportunities for training and professional development has the project provided?The project has provided state-of-the-art mental health and physical health disastertraining for 51 participants. We anticipate that within the next few months, we will be able to provide professional development for our professional team (both at KSU and at Kentucky River) in person and virtual Mental Health Training for Providers/Professionals. We are currently finalizing agreements with the University of Florida to provide additional professional development training for the professional teams. Upon finalizing the agreements with the University of Florida, we anticipate that there will be a virtual Mental Health Training for Professionals version for Kentucky River and an in-person version of the Mental Health Training for Professionals for the KSU team. How have the results been disseminated to communities of interest?The current results have been disseminated via the Kentucky River to the communities of interest. Nonetheless, since the project is incomplete, our data is incomplete. Once we finish the project, we plan to provide results via reports and publications. In addition, we plan to disseminate these results to multiple stakeholders within the communities of interest. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period, we plan to provide additional training and professional development for participants and professionals associated with this project. We also plan to secure agreements with the University of Florida for professional development opportunities. We also plan to provide additional services for more participants.

Impacts
What was accomplished under these goals? (1) We have identified existing care providers and provided mental health issues for 51 survivors. The primary care providers that we identified were via the Kentucky River Regional Prevention CenterRegion 12 (Breathitt, Knott, Lee, Leslie, Letcher, Owsley, Perry, & Wolfe Counties). The agency provides holistic services for flood survivors. (2) & (3) We have assessed the level of resource usage by the participating flood survivors through surveys and focus group sessions. Given the transient nature of the population, we were advised that questionnaires and focus group surveys would be a better route than pre-post surveys. With approval from NIFA, we restructured our approach to address these concerns, including suggestions from local officials and experts regarding the transient nature of the population. We are now conducting mental health workshops, providing mental health resources, and conducting focus groups to gather related data. 4) We have provided best-practices training for 51 flood survivors emphasizing the importance of their mental and physical health after a disaster. These interactive workshops included general information and specific information related to resources specific to their particular county residences. 5) We are constantly securing stability by obtaining quantitative and qualitative data for additional research. We obtained qualitative and quantitative data for additional research and extension funding applications during this period. Furthermore, we can develop additional programs to mitigate the disparities in these underserved areas.

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