Children's Health after the Storms (CHATS)

An in-depth public health study of a hurricane-stricken population

Client
Centers for Disease Control and Prevention (CDC), Federal Emergency Management Agency (FEMA)

Hurricanes Katrina and Rita both struck the Gulf Coast of the United States within a single month during 2005. After the immediate impact of the storms subsided, thousands of residents of Texas, Louisiana, Mississippi, and Alabama faced long-term consequences for their health, safety, and environment.

Among these consequences was an unforeseen hazard. It turned out that the temporary housing units provided by the Federal Emergency Management Agency contained formaldehyde, a probable carcinogen. As physicians began to report an uptick in respiratory ailments among former FEMA trailer residents in the years following Katrina and Rita, the Centers for Disease Control and Prevention investigated. In 2010, the CDC chose RTI to conduct research focused on the health effects of FEMA trailers on children.

Compiling a Robust Health Profile of Hundreds of Children

Children’s Health after the Storms, known as CHATS, was a pilot study of about 400 children from the areas affected by Katrina and Rita. We conducted a comprehensive investigation of the children’s health status and environmental exposures, comparing children who had lived in FEMA housing to those who hadn’t. Our goal was to test the feasibility of a complete study of all children who had lived in FEMA housing.

Our pilot study, which took place in 2012 and 2013, demonstrated that expanding to the full population was feasible. Despite the years that had passed since the storm, we exceeded our client’s requirements for the percentage of people we could locate, enroll in the study, and retain for a follow-up assessment. Although the full study was never funded, our work shows our ability to plan and carry out a complex assessment that combined multiple sources of data to form a complete picture of the health of our target population.

Working with a geographically dispersed population of people who have been through a major natural disaster presents its own challenges. Many of the families we targeted had already been saturated with surveys. We recruited community advisory boards, including members from non-English speaking communities, and reached out at public events to gain public awareness and trust.

A Comprehensive Approach to Data Collection to Understand Health and Exposures

We used several methods to collect our data. We interviewed parents about their children’s health, adding a survey for children over the age of 12. We sent nurses to participants’ homes to collect blood and urine samples, measure children’s breathing capacity, and check other health markers. We sampled the air inside and outside of the children’s homes, and checked their neighborhoods for other sources of contaminants. This multifaceted survey design, created in response to the CDC’s open-ended request, represents our customized approach to answering our clients’ research questions.

CHATS also took advantage of the RTI-designed MicroPEM, a wearable device that monitors personal exposures to airborne particles and pollutants. Since it was first used in 2011, MicroPEM has helped researchers fill in gaps in our understanding of acute and chronic aerosol exposures, which were previously expensive and complex to monitor directly. The children in the CHATS study wore MicroPEM devices over their clothes for the majority of their time for a full week, providing us with air quality and activity measurements. The result was among the most comprehensive lists of environmental exposures of all post-Katrina studies.

An Interdisciplinary Response to Past and Present Environmental Hazards

Of our many projects in environmental health, CHATS stands out for its extensive detail. Our interdisciplinary team planned an ambitious design and executed the outreach, training, and follow-up necessary for the success of an assessment of this depth.

We remain prepared to offer expertise in public health, environmental exposures, survey design, aerosol science, and data analysis to contribute to a sound understanding of the complicated effects of natural disasters.