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The Effects of Hurricane and Tornado Disasters on Pregnancy Outcomes Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 The ffecE ts of Hurricane and Tornado Disasters on Pregnancy Outcomes Kenneth E. Christopher Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Public Health Education and Promotion Commons, and the Women's Studies Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Kenneth E. Christopher has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Joseph Robare, Committee Chairperson, Public Health Faculty Dr. Kiara Spooner, Committee Member, Public Health Faculty Dr. Daniel Okenu, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract The Effects of Hurricane and Tornado Disasters on Pregnancy Outcomes by Kenneth E. Christopher MPH, George Mason University, 2012 MA, Marymount University, 1994 MEd, University of West Florida, 1993 MS, University of West Florida, 1992 BS, Park College, 1990 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University February 2017 Abstract Maternal prenatal exposure to hurricanes and tornadoes could contribute to an increased risk for adverse birth outcomes. Little is known about the effects of Hurricane Katrina of August 2005, on pregnancy outcomes in Mississippi. Additionally, little is known about the influence of the April 2011 Alabama tornado disaster on births in that state. The purpose of this study was to bridge this knowledge gap by examining the relationship between maternal prenatal exposure to these storms and adverse infant health outcomes. The theoretical framework guiding this retrospective, cross-sectional study was the life course approach. Data for this investigation included 2,000 records drawn from the Linked Infant Births and Deaths registers. Chi-square and logistic regression analyses were performed. Results indicated hurricane exposure was not a predictor of preterm birth (OR = .723, 95% CI = [.452, 1.16]; p = 1.76) or low birth weight (OR = .608, 95% CI = [.329-1.13]; p = .113). However, an association was observed between tornado exposure and preterm birth (OR = 1.68, 95% CI = [1.19-2.39]; p = < 0.05) and low birthweight (OR = 1.91, 95% CI = [1.27-2.87]; p = < 0.05). Findings suggest pregnant women are vulnerable to natural disaster storms, and are at risk for adverse pregnancy outcomes. The implications for social change include informing preparedness efforts to reduce vulnerability to increased pregnancy risk factors and adverse birth outcomes, consequential to hurricane and tornado disasters. The Effects of Hurricane and Tornado Disasters on Pregnancy Outcomes by Kenneth E. Christopher MPH, George Mason University, 2012 MA, Marymount University, 1994 MEd, University of West Florida, 1993 MS, University of West Florida, 1992 BS, Park College, 1990 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University February 2017 Dedication This dissertation is dedicated to my loving family. To the memory of my grandmother, Beatrice Athill Christopher; my father, Arthur Christopher; my aunt Elizabeth Krigger; my cousins, Cashena Benjamin; Maurice and Marion Sadio; Venetta Brathwaite; and Eric V. Krigger, Jr., who collectively, did more than just facilitate my intellectual development. Each provided an exemplary path for me to follow as a civic- minded individual; established high academic standards; challenged me to think critically; and ensured I had a good foundation to negotiate the challenges of this world. To the memory of my cousin Neville Sadio, who left us way too soon! To my Mother, Ernestine Christopher, who raised me to love, honor and obey my Creator, and to follow my dreams. To my brothers Arthur Viera; Charles, Athill, and Glen Christopher; my sisters, Jacinth Gilbert, Jackie Christopher, Karen McColley, Janet Lomax, and Dr. Juleen Christopher, who have always encouraged me. To my cousins, Denise Medley, and Hildred and Philip Mills, who have been a constant source of inspiration and has encouraged me to complete my doctorate degree. To my friend and mentor, Robert “Bob” Miller, who saw something in me and reminded me that I was born with a purpose and needed to find my focus, and fulfill my purpose. Finally, to all my friends, especially Kristine Cintron and Selgui Choi, and many others who were always there for me. Acknowledgments First and foremost, I give thanks to God almighty, the Creator of the heavens and the earth; for giving me the endurance, strength, and grace to endure this arduous journey. I would like to thank my committee chair, Dr. Joseph Robare, for his support and guidance. My special thanks to my second committee member, Dr. Kiara Spooner; and my University Research Reviewer, Dr. Daniel Okenu, for their methodical, scholarly inputs, and reassuring feedback. My deepest gratitude is extended to Dr. Panagiota Kitsantas for introducing me to maternal and fetal health, and for being the epitome of a stellar mentor, colleague, and friend. I am thankful for my fellow Walden doctoral colleagues, Dr. Rebeka Doyle, and Aretha Townsend, whose routine telephone calls were a source of inspiration. I am indebted to numerous individuals who fostered my growth personally and professionally. Specifically, the Honorable Bent Lawaetz; Dr. Randall “Doc” James; Charles Roper; Robert “Bob” Jones; and Ms. Susanna Pringle. I am indebted to Margaret L. Copeman for introducing me to public health, and my cousin Wayne Chardon for sustaining my interest in this humble profession. Finally, I owe my deepest gratitude to my wife, Lissette Christopher; my daughter, Kaycee Christopher, my son, Alex Smith; my sister, Dr. Juleen Christopher; and cousins, Dr. Deborah Ellis, and Dr. Migdalia Brathwaite, who supported me throughout this process. I owe my achievements to all of my family members. Their constant prayers and continued support is the cornerstone of my success! Table of Contents List of Tables .......................................................................................................................v List of Figures .................................................................................................................... vi Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background ....................................................................................................................6 Problem Statement .........................................................................................................9 Purpose of Study ..........................................................................................................11 Research Questions and Hypotheses ...........................................................................11 Theoretical Framework ................................................................................................13 Nature of the Study ......................................................................................................16 Definitions....................................................................................................................19 Assumptions .................................................................................................................22 Scope and Delimitations ..............................................................................................23 Limitations ...................................................................................................................25 Significance of Study ...................................................................................................28 Summary ......................................................................................................................31 Chapter 2: Literature Review .............................................................................................33 Introduction ..................................................................................................................33 Literature Search Strategy ............................................................................................35 Theoretical Foundation ................................................................................................37 Hurricane and Tornado Natural Disasters ....................................................................41 i Hurricanes ............................................................................................................. 43 Tornadoes .............................................................................................................. 50 Hurricane and Tornado Studies Related to Key Variables ..........................................60
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