1 figure, 2 tables omitted
During August 13, 2004–September 25, 2004, Florida experienced
four major hurricanes: Charley and Frances (both Category (4) and Ivan and
Jeanne (both Category 3).* An estimated 20% of homes throughout Florida were
damaged by these hurricanes,1 and 124 persons
died.2 In October 2004, the Florida Department
of Health (FDOH) added 30 questions to the Behavioral Risk Factor Surveillance
System (BRFSS) survey to assess the impact of the hurricanes on state residents.
This report summarizes the results of that survey, which indicated that 48.7%
of Florida residents had no evacuation plan before any of the hurricanes,
portable generators were used in 17.5% of homes after electric power outages,
and residents of counties not in the direct paths† of the four hurricanes
had consequences similar to those who lived in the direct paths of the hurricanes
(e.g., physical injuries, barriers to medical treatment, and loss of work
days). Public health officials should consider the needs of residents both
in and not in the direct paths of hurricanes in their preparedness planning.
BRFSS is a state-based, random-digit–dialed telephone survey of
the noninstitutionalized U.S. population aged ≥18 years.3 During
November-December 2004, interviews were conducted with 1,706 Florida residents.
Among the participants, 919 (53.9%) lived in the 41 counties in the direct
path of at least one of the four hurricanes, and 787 (46.1%) lived in the
26 counties not in the direct paths of the hurricanes; participants represented
all 67 counties in Florida. Chi-square tests were used to examine differences
in prevalence between those living in the two groups of counties. Response
rate was 42.5%; data were weighted by sex, age, and race/ethnicity to represent
characteristics of the 2000 Florida population,4,5 with
the weighted result that 52.5% of participants were women, 69.0% were white,‡
and 62.3% had at least some college education.
Overall, 51.3% of Florida residents reported having evacuation plans
before the hurricanes; results were similar for residents of counties in the
direct paths of hurricanes (53.5%) and those not in the direct paths of hurricanes
(48.5%). More than one third (37.9%) of Floridians living in the direct paths
evacuated their homes for at least one hurricane, compared with 26.7% of those
not in the hurricane paths. Among the 67 counties in Florida, 44 (65.7%) ordered
mandatory evacuations for at least one hurricane; an additional 15 counties
ordered voluntary evacuations for at least one hurricane. Evacuation orders
varied; for example, during Hurricane Charley, Hillsborough County had a countywide
mandatory evacuation order, whereas neighboring Pinellas County had a mandatory
evacuation order for nursing homes only.
Environmental concerns associated with hurricanes cited as most important
by all respondents were drinking water quality (50.9%), sewage disposal (13.2%),
and food protection (11.8%). No statistically significant differences were
observed between residents living in counties in or not in the direct paths
of the hurricanes. Overall, 17.5% of occupied Florida residences used a portable,
gasoline-powered generator for electric power after hurricanes; no significant
difference was observed between persons living in counties in or not in the
direct paths of the hurricanes (19.3% versus 15.3%). Among persons using generators,
4.6% reported operating them inside a home or garage (1.8% in the hurricane
paths and 8.9% not in the hurricane paths, respectively).
Among all respondents, 51.4% reported some damage to their homes, including
43.3% of those who were not living in counties in the direct paths of the
hurricanes. Severe or catastrophic damage was reported by 10.2% of persons
in the hurricane paths and 6.0% not in the hurricane paths. Among the 850
survey participants who reported being employed or self-employed and who responded
to questions about employment after the hurricanes, 45.8% missed work, lost
their jobs, or both because of the hurricanes, and 39.2% were out of work
for more than 5 days. Among those in the hurricane paths, 47.2% missed work,
lost their jobs, or both, and 39.5% missed more than 5 days of work. Among
Floridians not in the hurricane paths, 44.1% missed work, lost their jobs,
or both, and 38.8% missed more than 5 days of work.
Physical injuries caused by the hurricanes were reported by 4.6% of
persons in the hurricane paths and 3.8% not in the hurricane paths. Among
persons with health conditions such as diabetes, asthma, or cardiovascular
disease, 5.4% reported their conditions were made worse as a result of the
hurricanes, including 6.4% in the hurricane paths and 4.1% not in the hurricane
paths. Among those who said their health conditions were made worse by the
hurricanes, 13.6% reported being prevented or delayed by the hurricanes from
obtaining medication, and 9.0% reported barriers to accessing essential medical
equipment (e.g., dialysis or oxygen). Persons living in counties in the hurricane
paths were more likely (12.7%) to report difficulty in accessing essential
medical equipment than persons not in the hurricane paths (1.9%).
Emotional and mental health conditions were assessed during the interviews
to determine whether any resulted from the hurricanes. Among all respondents,
10.7% reported feelings of nervousness, worry, or anxiety at the time of the
interview because of the hurricanes; 6.0% reported feeling sad or having loss
of appetite or difficulty sleeping; and 3.9% reported reduced mental ability
to work or study.
MA Bailey, MSW, R Glover, MS, Y Huang, DrPH, Bur of Epidemiology, Div
of Disease Control, Florida Dept of Health. Div of Adult and Community Health,
National Center for Chronic Disease Prevention and Health Promotion, CDC.
The results of this assessment of the 2004 hurricane season in Florida
underscore the need to improve certain areas of hurricane preparedness planning.
Approximately half (48.7%) of Floridians had no evacuation plan before any
of the hurricanes, including those who resided in counties in the direct path
of a hurricane. Efforts should be increased to educate the public regarding
the need to evacuate residences not only in the direct paths of hurricanes
but also residences away from the direct paths where hazards are posed (e.g.,
Survey results also indicated that portable generators were used for
electric power in an estimated 17.5% of occupied Florida residences. Among
persons using generators, 4.6% reported operating them improperly inside a
home or garage. Surveillance data from this period identified 56 reported
carbon monoxide–exposure incidents, resulting in treatment of 167 persons
and six deaths.6 During the 2004 hurricane
season, FDOH periodically released notices regarding the dangers of carbon
monoxide poisoning, especially involving the use of portable generators. Public
education regarding the proper use of generators and the dangers of carbon
monoxide should be increased to reduce the risk for exposures throughout the
The findings in this report are subject to at least five limitations.
First, the sample size of 1,706 was too small for strata analyses, particularly
regarding difficulties faced by adults with chronic conditions and treatment
sought by those reporting emotional or mental health conditions. Second, the
response rate for the survey was 42.5%. Third, the sample design for the Florida
BRFSS did not provide county-level data to assess local impact of the four
hurricanes. However, other reports have addressed local impact of specific
2004 hurricanes and the needs of target populations, such as older adults.7- 9 Fourth, BRFSS does not
reach residents who are temporarily or permanently without a land-line telephone,
and interviews by cellular telephone are prohibited. Finally, no baseline
data were available to compare the emotional and mental health conditions
reported by survey participants as a result of the hurricanes with their conditions
before the hurricanes.
The findings in this report suggest that BRFSS can be used for rapid
assessment of the impact on the lives of residents and the public health consequences
of hurricanes. Timeliness of implementing such surveys can be critical to
the accurate assessment of conditions directly related to the hurricanes.
Within 30 days after the last Florida hurricane of 2004 (Hurricane Jeanne),
FDOH began collecting these data, which might not have been captured by other
means. Collaboration among state agencies was essential to developing a comprehensive
assessment tool. Hurricane preparedness by FDOH now includes educating residents
about the danger of carbon monoxide poisoning, planning for mosquito control,
and making available a family preparedness guide. Additional information is
available at http://doh.state.fl.us.
The findings in this report are based, in part, on contributions by
the Florida Dept of Children and Families Adult Mental Health Program; Florida
Behavioral Risk Factor Surveillance System Working Group; Bur of Chronic Disease
Prevention and Health Promotion, Div of Environmental Health, Florida Dept
*On the Saffir-Simpson Hurricane Scale, Category 4 hurricanes are those
with wind speeds of 131-155 miles per hour (mph), and Category 3 hurricanes
are those with wind speeds of 111-130 mph.
†Counties in the direct paths were defined as those crossed by
50-mile swaths of the hurricanes, as plotted by FDOH from post-hurricane data
of the National Oceanic and Atmospheric Administration. The 41 counties in
the direct paths of hurricanes were as follows: Alachua, Charlotte, Citrus,
Columbia, Desoto, Dixie, Escambia, Flagler, Gadsden, Gilchrist, Hamilton,
Hardee, Hernando, Highlands, Hillsborough, Indian River, Jefferson, Lafayette,
Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Martin, Okeechobee, Orange,
Osceola, Pasco, Pinellas, Polk, Saint Lucie, Sarasota, Seminole, Sumter, Suwannee,
Taylor, Union, Volusia, and Wakulla. The 26 counties not in the direct paths
of hurricanes were as follows: Baker, Bay, Bradford, Brevard, Broward, Calhoun,
Clay, Collier, Duval, Franklin, Glades, Gulf, Hendry, Holmes, Jackson, Marion,
Miami-Dade, Monroe, Nassau, Okaloosa, Palm Beach, Putnam, Saint Johns, Santa
Rosa, Walton, and Washington.
‡For this report, persons identified as white or black are all
non-Hispanic. Persons identified as Hispanic might be of any race.
Epidemiologic Assessment of the Impact of Four Hurricanes—Florida,
2004. JAMA. 2005;294(12):1484-1485. doi:10.1001/jama.294.12.1484