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Key Points Question What characteristics are IMPORTANCE Since the terrorist attacks on September 11, 2001, the US government has promoted associated with resource- and action- household disaster preparedness, but preparedness remains low. based disaster preparedness among US households? OBJECTIVE To identify disparities in disaster preparedness among US households. Findings In this cross-sectional study using nationally representative survey DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from a nationally data from 16 725 US households, 68.9% representative sample of US households from the 2017 American Housing Survey’s topical section on of households fulfilled at least half of preparedness to assess associations of disaster preparedness with households’ socioeconomic recommended preparedness items, but characteristics, composition, and region. Logistic regressions were used to assess associations of households were more likely to fulfill household characteristics with overall preparedness, resource- and action-based preparedness, and resource- than action-based items. specific preparedness items. Data analyses were completed on March 27, 2020. Fulfillment of specific resource- or action-based items differed EXPOSURES Combined household income, head of household’s education level, race/ethnicity, substantially by household marital status of head of household, head of household aged 65 years or older, presence of children characteristics. or a household member with a disability, and region. Meaning These findings suggest that MAIN OUTCOMES AND MEASURES Nine actionable preparedness items, such as having an because households may treat emergency carry-on kit (resource), food and water stockpiles (resource), and alternative preparedness items differently, targeted communication plans and meeting locations (action). Items were summed for the measures of strategies are needed to promote overall, resource-based, and action-based preparedness, with preparedness defined as meeting at preparedness across communities, and least half of the criteria. risk communication should emphasize the importance of both resource- and RESULTS Among 16 725 included households, 9103 household heads were men (54.4%), 11 687 action-based preparedness. were married (69.9%), and 10 749 (66.1%) had some college education or higher. In all, 1969 household heads (11.8%) were black, while 2696 were Hispanic/Latino (16.1%); 3579 household Supplemental content heads (21.4%) were 65 years or older. A total of 7163 households (42.8%) included children, and 3533 households (21.2%) included a person with a disability. Households were more likely to fulfill at least Author affiliations and article information are listed at the end of this article. half of the criteria for resource-based preparedness (10 950 households [65.5%]) than for action- based preparedness (6876 households [41.1%]). Wealthy households and those with household heads aged 65 years or older were more likely to fulfill at least half of resource-based items (wealthy households: adjusted odds ratio [aOR] by logged income, 1.18 [95% CI, 1.13-1.22]; household heads age 65 years: aOR, 1.42 [95% CI, 1.29-1.55) but less likely to fulfill action-based items (wealthy households: aOR: 0.96 [95% CI, 0.93-0.99]; household heads age 65 years: aOR, 0.92 [95% CI, 0.84-0.99]). Households with black household heads were more likely to fulfill items directly related to emergencies (carry-on emergency kit: aOR, 1.26 [95% CI, 1.14-1.39]; alternative communication plan: aOR, 1.55 [95% CI, 1.39-1.72]; alternative meeting location: aOR, 1.18 [95% CI, 1.07-1.31]) but less likely to fulfill resource-based items (at least half of resource items: aOR, 0.89 [95% CI, 0.80-0.99]). (continued) Open Access. This is an open access article distributed under the terms of the CC-BY License. JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 1/12 JAMA Network Open | Public Health US Households’ Disaster Preparedness and Socioeconomic Characteristics, Composition, and Region Abstract (continued) CONCLUSIONS AND RELEVANCE These findings suggest that types of preparedness vary by household characteristics. Targeted strategies are needed to promote preparedness across communities. JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 Introduction Since the terrorist attacks of September 11, 2001, the Federal Emergency Management Agency, the Centers for Disease Control and Prevention, and state and local governments have promoted household disaster preparedness, with a message of being informed, making plans, and having 1-3 emergency kits. Climate change and extreme weather events have numerous effects on population health, making household preparedness important beyond terrorist attacks. Despite these efforts, studies have consistently found that US households are not ready for emergencies, there have been no significant improvements in preparedness, and the proportion of people fulfilling 5,6 some actions, such as having a communication plan, has decreased. Even when individuals claim to be prepared, often they are not. The Centers for Disease Control and Prevention estimates that nearly 50% of US households do not have resources or plans in the event of emergency. In a separate study, the Federal Emergency Management Agency found that 70% of survey respondents completed at least 1 mitigation action but only 25% of respondents completed 2 mitigation actions. Although individuals may consider preparedness actions, their actions may be insufficient. High socioeconomic status has been consistently found to be associated with preparedness, but there are conflicting findings regarding other demographic characteristics. Higher socioeconomic 5,8-11 status increases households’ odds of being prepared, and the likelihood of evacuating when 12,13 required. However, results for racial and ethnic minority households are contradictory: some 14,15 studies have found that these groups encounter more challenges to being prepared, while others have found that they are more likely to have emergency plans and supplies. Results also differ among households with individuals with disabilities, with some studies reporting that these 17,18 households are less likely to be prepared and others reporting that they have higher odds of 16,19 having an alternative meeting location. A limitation of these studies is that they only analyzed a few specific preparedness items, such as complying with mandatory evacuations, or examined 6,8,11,16 emergency supplies and emergency plans in general. In this study, we used a nationally representative sample from the 2017 American Housing Survey to identify factors associated with household emergency preparedness and whether they differ by type of preparedness. We differentiated resource- vs action-based preparedness. Resource- based items are material or financial resources, such as food and water stockpiles, an electric generator, or having financial resources for evacuation. Action-based preparedness items are activities that enhance households’ preparedness through coordination actions, such as having an alternative communication plan or meeting location. These items do not rely on material resources and thus are less likely to have economic limitations for fulfillment. Previous studies have identified factors associated with some preparedness actions; however, to our knowledge, no study has analyzed extensively their associations with different levels and types of disaster 5,9-11,16,18,20-23 preparedness. Taking this granular approach to examining preparedness is important because the relative importance of items may vary across disasters. For example, having emergency preparedness kits, financial resources, food stockpiles, and communication plans are important for responding to the novel coronavirus pandemic owing to temporary shelter in place restrictions and associated economic loss, whereas water stockpiles, electronic generators, an alternative meeting point, and a vehicle available for evacuation are relevant to responding to a natural disaster. JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 2/12 JAMA Network Open | Public Health US Households’ Disaster Preparedness and Socioeconomic Characteristics, Composition, and Region Methods Study Overview and Data Sources Our cross-sectional study used household-level data from the nationally representative 2017 American Housing Survey (AHS), the most recent wave. The public use file microdata are available for direct public download on the US Census Bureau website. The AHS website includes the complete codebook and the interview script with details on participant consent, including the survey purpose and confidentiality assurances. Following the American Association for Public Opinion Research (AAPOR) reporting guideline, the survey website also contains details on accuracy, recruitment, and historical changes to questionnaires. We received an exemption from institutional review board review and informed consent from the University at Albany because this is a secondary data analysis. We tested the associations of overall disaster preparedness and different types of preparedness with households’ socioeconomic characteristics, composition, and region. Although 66 752 housing units were included in the 2017 AHS, our analysis includes 33 474 occupied housing units included in the survey’s topical section on emergency and disaster preparedness. Households included in our sample responded to all 9 questions on emergency and disaster preparedness used as our outcome measures. eTable 1 in the Supplement compares demographic characteristics of survey participants included and excluded from our study. Variables The survey contains 12 preparedness items; following past studies, we analyze the 9 items that are actionable by household members. eTable 2 in the Supplement lists all survey questions, defining each included resource-based item (ie, vehicle available for evacuation, food stockpiles, financial resource for evacuation, water stockpiles, carry-on emergency preparedness kit, and electric generator) and action-based item (ie, plan with financial information, separate evacuation meeting point, and alternative communication plan). The 3 excluded items are not readily actionable: assistance needed to evacuate or shelter pets, home has a tornado safe room or shelter, and whether a disaster in the past 2 years required the household or landlord to make extensive home repairs. Consistent with previous studies, the values for all 9 items were summed for our measure of overall preparedness, coded as a binomial indicator for which preparedness was defined as meeting 17,18,20 more than half of the criteria. For the resource- and action-based preparedness measures, the 9 items were first classified by type of preparedness and then summed within each group. Households were classified as prepared if they fulfilled at least half of the items. We selected that cutoff because it was a midpoint to distinguish levels of preparedness, having all regressions in the same logistic format allows for an easier interpretation, and sensitivity analyses using ordinary least squares on a continuous 0 to 9 outcome and a multinomial logit for low, medium, and high levels of preparedness yielded similar findings (eTable 3 in the Supplement). We did not weight preparedness items differently in our indices because their comparative importance and effectiveness has not been 20,27 demonstrated. The independent variables were socioeconomic factors previously identified as influencing household or individual disaster preparedness and region. Included socioeconomic measures were combined household income (log-transformed) and the head of household’s education 6,9,11,16,18,21,22,28 level. To assess whether the income relationship was curvilinear, we also examined income as quadratic and as quintiles, and results were similar (eTable 4 in the Supplement). Included household composition measures were race/ethnicity (black and Hispanic/Latino), woman head of household, whether the head of the household was married, whether the household included an individual with a disability, whether the head of the household was 65 years or older, and the 14-19,22,23,29,30 presence of children younger than 18 years. Race and ethnicity were self-reported by respondents using the standard Census definitions, and for black race we included those self- disclosing as their primary identity. We focus on heads of households 65 years or older because older populations are commonly identified as being at higher risk, and this cutoff is consistent with past JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 3/12 JAMA Network Open | Public Health US Households’ Disaster Preparedness and Socioeconomic Characteristics, Composition, and Region 17,20,31 studies. The household’s geographical region was operationalized as 3 dummy variables for 5,6,22 Northeast, Midwest, and West regions, with the South region as the reference. Urbanicity was not included owing to its unavailability in the public use file. There was low correlation among all independent variables, reducing multicollinearity concerns with the adjusted models. Statistical Analysis Three logistic regression models tested the associations of household characteristics with fulfilling at least half of the items for overall preparedness, resource-based preparedness, and action-based preparedness. Additionally, 9 logistic regression models examined the associations of household- level characteristics with each preparedness item as dependent variables to assess consistency in the statistical significance and direction of the household characteristics across preparedness items. We report 95% CIs rather than P values owing to the large number of associations considered. All statistical analyses were conducted using SAS statistical software version 9.4 (SAS Institute). We did not use the survey weights because our study sample was restricted to individuals who answered all 9 preparedness questions. Qualitative conclusions from frequencies and regressions using a logistic regression weighting to adjust for nonresponse were similar (eTables 5, 6, 7, and 8 in the Supplement). Data analyses were completed on March 27, 2020. Results Of 33 474 households that received the 2017 AHS disaster preparedness module, 16 725 households responded to all preparedness questions and were included in our sample (50.0% participation rate). Self-reported characteristics of household heads included 9103 (54.4%) men, 11 687 household heads (69.9%) were married, 1969 were black (11.8%), 2696 (16.1%) were Hispanic/Latino, 3579 (21.4%) were aged 65 years or older, and 11 049 (66.1%) had some college or higher education (Table 1). Household characteristics included 7163 households (42.8%) with children and 3533 households (21.2%) with a person with a disability. Median (interquartile range) annual household income was $76 400 ($40 700-$128 100). Households fulfilled a variable number of preparedness items (Figure). More than two-thirds of households (11 522 households [68.9%]) met the criteria for overall preparedness, defined as meeting at least half of the criteria, with approximately half of households (9009 households [53.9%]) meeting 4, 5, or 6 items. Only 579 households (3.5%) met all 9 items. However, preparedness differed by type of action. A total of 10 950 households (65.5%) fulfilled at least half of resource-based preparedness items, while 6876 households (41.1%) fulfilled at least half of action- based preparedness items. Most households had food stockpiles (14 018 households [83.8%]), vehicles available for evacuation (16 087 households [96.2%]), and financial resources for evacuation (13 505 households [80.8%]). More than half of the households reported having water stockpiles (10 000 households [59.8%]) and carry-on emergency preparedness kits (9166 households [54.8%]), but a minority of households reported having electric generators (3167 households [18.9%]). Fulfilling action-based preparedness items was less common. Although 13 800 households (82.5%) had a plan with their financial information, only 6381 households (27.9%) had alternative communication plans and 6381 households (38.2%) had separate evacuation meeting points. Correlations for fulfillment of items is presented in eTable 9 in the Supplement. In the adjusted models, household member characteristics and region were significantly associated with preparedness (Table 2). There was higher overall preparedness among households whose heads were married (adjusted odds ratio [aOR], 1.47 [95% CI, 1.36-1.60]), 65 years or older (aOR, 1.26 [95% CI, 1.15-1.39]), and with higher levels of education (compared with less than high school degree, high school degree: aOR, 1.35 [95% CI, 1.19-1.52]; some college: aOR, 1.39 [95% CI, 1.23-1.56]; some graduate education: aOR, 1.11 [95% CI, 0.96-1.28]) and among households with higher logged income (aOR, 1.13 [95% CI, 1.09-1.18]). Compared with households in the South, households in all other regions were less likely to meet criteria for overall preparedness (Northeast: JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 4/12 JAMA Network Open | Public Health US Households’ Disaster Preparedness and Socioeconomic Characteristics, Composition, and Region aOR, 0.77 [95% CI, 0.70-0.85]; West: aOR, 0.87 [95% CI, 0.80-0.95]; Midwest: aOR, 0.83 [95% CI, 0.76-0.91]). There was lower overall preparedness among woman-headed households (aOR, 0.89 [95% CI, 0.83-0.96]), households with children (aOR, 0.87 [95% CI, 0.81-0.94]), and households with a person with a disability (aOR, 0.86 [95% CI, 0.79-0.94]). There were differences in preparedness for resource- vs action-based items (Table 2). Households with higher logged incomes were more likely to fulfill at least half of resource-based items (aOR, 1.18 [95% CI, 1.13-1.22]) but less likely to fulfill at least half of action-based items (aOR, 0.96 [95% CI, 0.93-0.99]). Households whose head was black (aOR, 0.89 [95% CI, 0.80-0.99]) and households with children (aOR, 0.75 [95% CI, 0.70-0.80]) were less likely to fulfill the resource- based preparedness criterion but more likely to fulfill the action-based preparedness criterion (black household head: aOR, 1.25 [95% CI, 1.13-1.38]; households with children: aOR, 1.24 [95% CI, Table 1. Household Characteristics and Fulfillment of Preparedness Items Characteristic No. (%) Head of household Men 9103 (54.4) Married 11 687 (69.9) Race/ethnicity Black 1969 (11.8) Hispanic/Latino 2696 (16.1) Age ≥65 y 3579 (21.4) Education level No high school degree 1772 (10.6) High school degree 3904 (23.3) Some college 8497 (50.8) Some graduate education 2552 (15.3) Household Combined income, median (IQR), $ 76 400 (40 700-128 100) Presence of children 7163 (42.8) Presence of a person with a disability 3533 (21.2) Census region South 6469 (38.7) Northeast 2445 (14.6) West 4568 (27.3) Midwest 3243 (19.4) Preparedness Resource-based items Vehicle available for evacuation 16 087 (96.2) Food stockpile 14 018 (83.8) Financial resources for evacuation 13 505 (80.8) Water stockpile 10 000 (59.8) Carry-on emergency preparedness kit 9166 (54.8) Electric generator 3167 (18.9) Action-based items Plan with financial information 13 800 (82.5) Separate evacuation meeting point 6381 (38.2) Alternative communication plan 4670 (27.9) Fulfillment of preparedness criteria Overall 11 522 (68.9) Resource-based 10 950 (65.5) Action-based 6876 (41.1) Abbreviation: IQR, interquartile range. Preparedness is defined as meeting at least half of the items in that category. JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 5/12 JAMA Network Open | Public Health US Households’ Disaster Preparedness and Socioeconomic Characteristics, Composition, and Region 1.16-1.33]). Woman-headed households (aOR, 0.85 [95% CI, 0.80-0.91]) and households with a person with a disability (aOR, 0.83 [95% CI, 0.76-0.90]) were less likely to fulfill at least half of resource-based items, but these characteristics were not associated with fulfilling at least half of action-based preparedness items. Table 3 and Table 4 present the adjusted models for the adjusted odds of fulfilling specific resource- and action-based preparedness items. Many findings are consistent with the results from the aggregate preparedness measures in Table 2. For example, woman-headed households had lower preparedness on half of individual resource-based items, including having an electric generator (aOR, 0.89 [95% CI, 0.82-0.97]), a carry-on emergency kit (aOR, 0.88 [95% CI, 0.82-0.94]), and financial resources for evacuation (aOR, 0.73 [95% CI, 0.66-0.80]). Married household heads were more likely to fulfill each resource-based item (food stockpile: aOR, 1.20 [95% CI, 1.09-1.31]; water Figure. Distribution of US households' Fulfillment of Preparedness Items Bars indicate percentage of households fulfilling that 0 1 2 3 4 5 6 7 8 9 number of items and the orange line, cumulative Preparedness items fulfilled, No. percentage. Table 2. Logistic Regression of Adjusted Odds of Preparedness Among US Households Stratified by Type of Preparedness Preparedness, aOR (95% CI) Characteristic Overall Resource-based Action-based Head of household Woman 0.89 (0.83-0.96) 0.85 (0.80-0.91) 0.96 (0.90-1.03) Married 1.47 (1.36-1.59) 1.54 (1.43-1.66) 1.22 (1.14-1.32) Race/ethnicity Black 0.99 (0.89-1.10) 0.89 (0.80-0.99) 1.25 (1.13-1.38) Hispanic/Latino 0.88 (0.80-0.97) 0.92 (0.84-1.01) 0.95 (0.87-1.04) Age ≥65 y 1.26 (1.15-1.39) 1.42 (1.29-1.55) 0.92 (0.84-0.99) Education level No diploma 1 [Reference] 1 [Reference] 1 [Reference] High school diploma 1.35 (1.19-1.52) 1.26 (1.12-1.42) 1.18 (1.04-1.33) Some college 1.39 (1.23-1.56) 1.28 (1.14-1.43) 1.18 (1.06-1.33) Some graduate education 1.11 (0.96-1.28) 1.09 (0.87-1.16) 1.07 (0.93-1.23) Household Combined income, logged 1.13 (1.09-1.18) 1.18 (1.13-1.22) 0.96 (0.93-0.99) Presence of children 0.87 (0.81-0.94) 0.75 (0.70-0.80) 1.24 (1.16-1.33) Presence of a person with a disability 0.86 (0.79-0.94) 0.83 (0.76-0.90) 1.04 (0.96-1.23) Location South 1 [Reference] 1 [Reference] 1 [Reference] Northeast 0.77 (0.70-0.85) 0.84 (0.76-0.93) 0.76 (0.69-0.84) Abbreviation: aOR, adjusted odds ratio. West 0.87 (0.80-0.95) 0.95 (0.88-1.04) 0.92 (0.85-0.99) Preparedness is defined by fulfilling at least half Midwest 0.83 (0.76-0.91) 0.81 (0.74-0.90) 0.81 (0.74-0.89) of items. JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 6/12 Households, % JAMA Network Open | Public Health US Households’ Disaster Preparedness and Socioeconomic Characteristics, Composition, and Region stockpile: aOR, 1.27 [95% CI, 1.18-1.37]; electric generator: aOR, 1.88 [95% CI, 1.69-2.08]; carry-on emergency kit: aOR, 1.20 [95% CI, 1.12-1.29]; financial resources for evacuation: aOR, 1.71 [95% CI, 1.55-1.88]; evacuation vehicle: aOR, 2.04 [95% CI, 1.70-2.46]) and action-based item (communication plan: aOR, 1.13 [95% CI, 1.04-1.23]; meeting location: aOR, 1.20 [95% CI, 1.11-1.30; plan with financial information: aOR, 1.26 [95% CI, 1.15-1.38]). However, there were differences in the associations between household demographic characteristics and the likelihood of fulfilling items reflecting financial security more generally (eg, financial resources for an evacuation) or was exclusive to emergencies. Households with heads who were black were more likely to fulfill specific resource- and action-based items that were related to emergencies but did not require substantial resources (water stockpile: aOR, 1.18 [95% CI, 1.07-1.31]; carry-on emergency kit: aOR, 1.26 [95% CI, 1.14-1.39]; alternative communication plan: aOR, 1.55 [95% CI, 1.39-1.72]; alternative meeting location: aOR, 1.18 [95% CI, 1.07-1.31]) but less likely to fulfill items requiring large investments or financial stability (food stockpile: aOR, 0.76 [95% CI, 0.66-0.86]; electric generator: aOR, 0.57 [95% CI, 0.49-0.67]; financial resources for evacuation: aOR, 0.54 [95% CI, 0.48-0.61]; evacuation vehicle: aOR, 0.41 [95% CI, 0.33-0.50]). Households whose heads were Hispanic/Latino had a similar pattern of lower preparedness on specific items requiring substantial resources (food stockpile: aOR, 0.68 [95% CI, 0.61-0.76]; electric generator: aOR, 0.64 [95% CI, 0.56-0.74]; financial resources: aOR, 0.66 [95% CI, 0.59-0.74]; evacuation vehicle: aOR, 0.57 [95% CI, 0.46-0.70]), but they were more likely to have a water stockpile (aOR, 1.45 [95% CI, 1.31-1.59]) and alternative communication plan (aOR, 1.12 [95% CI, 1.02-1.24]). Households with higher incomes were more likely to fulfill preparedness items requiring resources and reflecting financial stability (food stockpile: aOR, 1.09 [95% CI, 1.04-1.14]; electric generator: aOR, 1.19 [95% CI, 1.13-1.25]; financial resources for evacuation: aOR, 2.02 [95% CI, 1.92-2.13]; evacuation vehicle: aOR, 1.44 [95% CI, 1.34-1.55]; plan with financial information: aOR, 1.21 [95% CI, 1.16-1.27]), but they were less likely to have an alternative communication plan (aOR, 0.89 ([95% CI, 0.86-0.93]) or alternative meeting location (aOR, 0.96 Table 3. Logistic Regression of Adjusted Odds of Fulfillment of Resource-Based Preparedness Items Among US Households aOR (95% CI) Stockpile Financial resources Characteristic Food Water Electric generator Carry-on emergency kit for evacuation Evacuation vehicle Head of household Woman 0.99 (0.91-1.08) 0.95 (0.89-1.02) 0.89 (0.82-0.97) 0.88 (0.82-0.94) 0.73 (0.66-0.80) 0.95 (0.79-1.14) Married 1.20 (1.09-1.31) 1.27 (1.18-1.37) 1.88 (1.69-2.08) 1.20 (1.12-1.29) 1.71 (1.55-1.88) 2.04 (1.70-2.46) Race/ethnicity Black 0.76 (0.66-0.86) 1.18 (1.07-1.31) 0.57 (0.49-0.67) 1.26 (1.14-1.39) 0.54 (0.48-0.61) 0.41 (0.33-0.50) Hispanic/Latino 0.68 (0.61-0.76) 1.45 (1.31-1.59) 0.64 (0.56-0.74) 0.97 (0.89-1.06) 0.66 (0.59-0.74) 0.57 (0.46-0.70) Age ≥65 y 1.38 (1.22-1.56) 1.27 (1.17-1.39) 1.16 (1.05-1.29) 1.02 (0.94-1.11) 2.35 (2.05-2.69) 1.15 (0.92-1.44) Education level No diploma 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] High school diploma 1.26 (1.08-1.46) 0.88 (0.78-0.99) 1.12 (0.96-1.31) 1.15 (1.02-1.29) 1.64 (1.43-1.88) 1.66 (1.31-2.11) Some college 1.23 (1.06-1.41) 0.80 (0.71-0.90) 0.91 (0.78-1.07) 1.10 (0.98-1.23) 2.56 (2.24-2.93) 2.03 (1.61-2.56) Some graduate education 1.13 (0.94-1.34) 0.64 (0.55-0.74) 0.59 (0.49-0.71) 0.96 (0.83-1.10) 7.04 (5.51-8.99) 2.34 (1.61-3.40) Household Combined income, logged 1.09 (1.04-1.14) 0.97 (0.93-1.00) 1.19 (1.13-1.25) 1.01 (0.97-1.05) 2.02 (1.92-2.13) 1.44 (1.34-1.55) Presence of children 0.92 (0.84-1.00) 0.72 (0.67-0.77) 0.74 (0.68-0.81) 0.92 (0.86-0.98) 0.68 (0.62-0.75) 1.06 (0.88-1.27) Presence of a person 0.98 (0.88-1.10) 0.88 (0.81-0.95) 1.23 (1.11-1.36) 0.92 (0.85-1.00) 0.55 (0.49-0.61) 0.59 (0.49-0.71) with a disability Location South 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] Northeast 0.99 (0.87-1.13) 0.92 (0.83-1.01) 1.04 (0.92-1.17) 0.68 (0.62-0.75) 1.09 (0.95-1.26) 0.42 (0.33-0.52) West 0.82 (0.74-0.91) 1.16 (1.07-1.26) 0.65 (0.59-0.73) 0.96 (0.88-1.04) 1.07 (0.95-1.20) 0.89 (0.71-1.12) Midwest 1.03 (0.92-1.17) 0.81 (0.74-0.89) 1.03 (0.93-1.15) 0.66 (0.60-0.72) 1.03 (0.91-1.16) 1.00 (0.77-1.29) Abbreviation: aOR, adjusted odds ratio. JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 7/12 JAMA Network Open | Public Health US Households’ Disaster Preparedness and Socioeconomic Characteristics, Composition, and Region [95% CI, 0.93-0.99]). Households whose heads had higher levels of education had increased odds of having financial resources for evacuation (high school diploma: aOR, 1.64 [95% CI, 1.43-1.88]; some college: aOR, 2.56 [95% CI, 2.24-2.93); some graduate education: aOR, 7.04 [95% CI, 5.51-8.99]), an evacuation vehicle (high school diploma: aOR, 1.66 [95% CI, 1.31-2.11]; some college: aOR, 2.03 [95% CI, 1.61-2.56]; some graduate education: aOR, 2.34 [95% CI, 1.61-3.40]), and a financial plan (high school diploma: aOR, 1.50 [95% CI, 1.31-1.72]; some college: aOR, 1.81 [95% CI, 1.59-2.06]; some graduate education: aOR, 1.79 [95% CI, 1.50-2.12]), but increasing levels of education were associated with decreasing odds of having a water stockpile (high school diploma: aOR, 0.88 [95% CI, 0.78-0.99]; some college: aOR, 0.80 [95% CI, 0.71-0.90]; some graduate education: aOR, 0.64 [95% CI, 0.55-0.74]). Discussion This cross-sectional study used recent nationally representative survey data to test the associations of household characteristics (ie, socioeconomic characteristics, composition, and region) with disaster preparedness (ie, overall preparedness, resource- and action-based preparedness, and specific preparedness items). Separating these items allows for a more nuanced understanding of which households are the highest risk for different types of disasters. Most households in our sample had some level of preparedness, but they were more likely to meet at least half of resource-based items (65.5% of households) than at least half of action-based items (41.1% of households). Types of preparedness varied by household characteristics; for example, wealthier households and those with adults 65 years or older were more likely to meet resource-based items but less likely to meet action-based items, households with children were generally less prepared but more likely to have an alternative meeting location, and households with black household heads were more likely to meet Table 4. Logistic Regression of Adjusted Odds of Fulfillment of Action-Based Preparedness Items Among US Households aOR (95% CI) Alternative Alternative meeting Plan with financial Characteristic communication plan location information Head of household Female 0.96 (0.89-1.03) 0.97 (0.91-1.03) 0.93 (0.85-1.01) Married 1.13 (1.04-1.23) 1.20 (1.11-1.30) 1.26 (1.15-1.38) Race/ethnicity Black 1.55 (1.39-1.72) 1.18 (1.07-1.31) 0.98 (0.86-1.12) Hispanic/Latino 1.12 (1.02-1.24) 0.92 (0.84-1.01) 0.72 (0.65-0.81) Age ≥65 y 0.91 (0.83-1.00) 0.85 (0.78-0.93) 1.10 (0.99-1.23) Education level No diploma 1 [Reference] 1 [Reference] 1 [Reference] High school diploma 1.12 (0.99-1.28) 1.16 (1.03-1.31) 1.50 (1.31-1.72) Some college 1.01 (0.89-1.15) 1.18 (1.05-1.33) 1.81 (1.59-2.06) Some graduate education 0.96 (0.83-1.12) 1.05 (0.91-1.20) 1.79 (1.50-2.12) Household Combined income, logged 0.89 (0.86-0.93) 0.96 (0.93-0.99) 1.21 (1.16-1.27) Presence of children 1.08 (1.00-1.16) 1.28 (1.19-1.37) 0.94 (0.86-1.03) Presence of a person with a disability 1.01 (0.92-1.10) 1.04 (0.96-1.13) 0.82 (0.74-0.91) Location South 1 [Reference] 1 [Reference] 1 [Reference] Northeast 0.77 (0.69-0.85) 0.81 (0.73-0.89) 0.70 (0.62-0.79) West 1.07 (0.98-1.16) 0.96 (0.88-1.04) 0.69 (0.62-0.77) Midwest 0.76 (0.68-0.83) 0.93 (0.85-1.02) 0.76 (0.67-0.85) Abbreviation: aOR, adjusted odds ratio. JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 8/12 JAMA Network Open | Public Health US Households’ Disaster Preparedness and Socioeconomic Characteristics, Composition, and Region items directly related to emergencies but less likely to meet resource-based items that require large financial investments or financial stability. Our study adds to the findings of prior studies on the determinants of preparedness and resilience by categorizing preparedness items as resource- or action-based preparedness. For example, a key finding of our study is that households with higher combined income had higher odds of having resource-based preparedness that requires large investments or financial stability, but we found no evidence of among these households of differences in fulfilling resource-based items specific to emergencies and lower odds of having action-based preparedness. Households with children were less likely to fulfill resource-based preparedness items and more likely to fulfill action- based preparedness items. These households may have had less disposable income available for resource-based items, but having an alternative communication plan and an alternative meeting location may have been a spillover effect from managing households with children where these may be school requirements. Another striking change in the direction of the association by type of preparedness occurred among black households. These households had lower odds of fulfilling at least half of resource-based preparedness items but increased odds of fulfilling at least half of action- based preparedness items. The shifts in the direction of the association were more evident when considering each individual preparedness item, with differences in these households’ odds of fulfilling resource-based items requiring larger financial investments (eg, electric generators, financial resources evacuation, and evacuation vehicle) vs resource-based items that are specific to emergency preparedness (eg, water stockpiles and carry-on emergency kits). Previous studies analyzing the associations of household socioeconomic characteristics with disaster preparedness are contradictory at times. Our approach to classify items into resource- vs action-based measures might explain how different studies could be reaching conflicting conclusions. Previous studies have consistently found that determinants of higher socioeconomic 6,9-11 6,8,12 status, such as higher levels of income or education, are positively associated with disaster preparedness. Our findings are consistent with these results. However, our study found that more financially secure households had reduced odds of having action-based disaster preparedness items that require coordination among household members and had a similar likelihood of having emergency supplies, such as water stockpiles and carry-on emergency kits. This suggests that while households’ financial stability may reduce the effect of a disaster, these households may face bigger challenges if disasters hit while they are away from home. As they may require assistance during emergencies, households with persons with disabilities may be at increased risk. We found that this population was overall less prepared, particularly in their limited fulfillment of resource-based items, such as water stockpiles, financial resources for evacuation, and access to evacuation vehicles. We found no evidence of a positive association among 16,19 these households with having an alternative meeting location, as previous studies have shown. Nevertheless, identifying the challenges this specific population faces when it comes to evacuation capability is critical to plan emergency response actions. There are a few possible explanations to support these findings. First, households may have different perceptions of which preparedness items are relevant or have varying capacities to be prepared in different areas. For example, lower-income households or those with children may have fewer liquid assets to purchase resource-based items, and higher-income households may underestimate their likelihood of being affected by a disaster and the importance of action-based items. Second, while it is promising that many households met several of the recommended preparedness actions, the items frequently met are not exclusive to disaster preparedness. Having stockpiles available, evacuation vehicles, or financial resources for evacuation may not be the result of explicit disaster preparedness actions but evidence of general consumption patterns. If households are only preparing for the critical first 72 hours, we would expect to find that food and water stockpiles had similar association with household-level factors, but this was not the case. For example, the associations of racial/ethnic minority populations with their likelihoods of fulfilling food and water stockpiles were significant but in opposite directions. Our finding that households with JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 9/12 JAMA Network Open | Public Health US Households’ Disaster Preparedness and Socioeconomic Characteristics, Composition, and Region children had a positive association with action-based preparedness despite having lower resource- based preparedness may indicate a spillover effect from school-based requirements. While we cannot confirm this, it may be a starting point to explore the influence schools may have in promoting disaster and emergency preparedness. There are several policy and practice implications to our findings. Previous studies have 12,19 identified an opportunity to modify existing risk communication messages and promote 12,16,18 education campaigns. Our findings suggest that targeting specific populations and contexts, such as households with children or adjusting messaging for different cultural backgrounds, may be more effective at promoting action, particularly on items that are disaster-specific and unrelated to general consumption and saving patterns. Second, it is important to further study why individuals choose to fulfill some items but not others, such as the role of resource constraints, general awareness, or perceived likelihood of experiencing a disaster. Third, the finding that households with children were more likely to fulfill action-based items suggests that other government programs could integrate preparedness. For example, Medicare and Medicaid have emergency preparedness requirements established for health care practitioners and some specific groups of beneficiaries, such as individuals with disabilities. There is an opportunity to expand these efforts. Limitations Our study has several limitations. First, conducting a causal or longitudinal analysis was not possible because the data are cross-sectional and the disaster preparedness module changes across the American Household Survey’s data collection cycles. Second, our study sample only includes households that responded to all disaster preparedness questions in the survey. The study sample may be biased toward individuals who are more aware of preparedness actions, thereby overestimating the proportion of US residents who fulfill preparedness items. When we compared the study sample with all survey respondents, respondents who completed all emergency preparedness questions and were thus included in our study were wealthier and more likely to be married and have children. Our population estimates of the proportion of US households that are prepared are likely an overestimate, and it is more appropriate to focus on the adjusted models comparing the household-level predictors of preparedness rather than on absolute levels of preparedness. Additionally, further qualitative research is needed to understand the rationale behind fulfilling each preparedness item or why individuals appear to perceive them differently. Conclusions The findings of this cross-sectional study suggest that the variations in the direction of the associations of household socioeconomic characteristics and resource- and action-based preparedness may indicate that households treat preparedness items differently, such as food and water stockpiles vs having an alternative communication plan. This suggests that households may have different perceptions of which preparedness items are critical or have different capacities to be prepared in different areas depending on the resources and coordination required. As the effects of man-made and natural disasters increase, individuals’ disaster preparedness as a mean of mitigating the effect of emergencies and large-scale disasters are critical to improving the overall emergency response. ARTICLE INFORMATION Accepted for Publication: March 30, 2020. Published: April 27, 2020. doi:10.1001/jamanetworkopen.2020.6881 Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Zamboni LM et al. JAMA Network Open. JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 10/12 JAMA Network Open | Public Health US Households’ Disaster Preparedness and Socioeconomic Characteristics, Composition, and Region Corresponding Author: Lucila M. Zamboni, PhD, MPP, Center for Policy Research, Rockefeller College of Public Affairs and Policy, University at Albany-State University of New York, 1400 Washington Ave, Milne Hall, Albany, NY 12222 (lzamboni@albany.edu). Author Affiliations: Center for Policy Research, Rockefeller College of Public Affairs and Policy, University at Albany-State University of New York, Albany (Zamboni); Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany-State University of New York, Albany (Martin). Author Contributions: Dr Zamboni had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Both authors. Acquisition, analysis, or interpretation of data: Both authors. Drafting of the manuscript: Zamboni. Critical revision of the manuscript for important intellectual content: Both authors. Statistical analysis: Both authors. Supervision: Martin. Conflict of Interest Disclosures: None reported. Additional Contributions: Patricia Strach, PhD (Rockefeller Institute of Government and Department of Political Science, University at Albany, Albany, New York), and Brian Nussbaum, PhD (Homeland Security and Cybersecurity, University at Albany College of Emergency Preparedness, Albany, New York), provided comments on early versions of this article. They were not compensated for this contribution. REFERENCES 1. US Centers for Disease Control and Prevention. Zombie preparedness: poster. Accessed December 22, 2019. https://www.cdc.gov/cpr/zombie/posters.htm 2. US Federal Emergency Response Agency. Building a supply kit for your family. Accessed December 21, 2019. https:// www.fema.gov/disaster/4085/updates/building-supply-kit-your-family 3. New York State Department of Homeland Security and Emergency Services. Be prepared. Accessed December 21, 2019. https://prepare.ny.gov/be-prepared 4. 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Centers for Medicare & Medicaid Services, US Department of Health and Human Services. Medicare and Medicaid programs: emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers: final rule. Fed Regist. 2016;81(180):63859-64044. SUPPLEMENT. eTable 1. Comparison of Full American Household Survey Sample With the Study Population eTable 2. Survey Questions for 9 Household Preparedness Items eTable 3. Sensitivity Analysis on Overall Preparedness With OLS Specification (Continuous Outcome) and Multinomial Logistic Specification (3-Level Outcome) eTable 4. Sensitivity Analysis of Alternative Methods to Specify Income eTable 5. Household Characteristics and Fulfillment of Resource- and Action-Based Preparedness Items Using Logistic Regression Weighting for Nonresponse eTable 6. Logistic Regression of Adjusted Odds of Overall, Resource-Based, and Action-Based Preparedness Using Logistic Regression Weighting for Nonresponse eTable 7. Logistic Regression of Adjusted Odds of Fulfillment of Resource-Based Preparedness Items Using Logistic Regression Weighting for Nonresponse eTable 8. Logistic Regression of Adjusted Odds of Fulfillment of Action-Based Preparedness Items Using Logistic Regression Weighting for Nonresponse eTable 9. Correlations Among Fulfillment of Specific Preparedness Items JAMA Network Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 (Reprinted) April 27, 2020 12/12 Supplementary Online Content Zamboni LM, Martin EG. Association of US socioeconomic characteristics, composition, and region. JAMA Netw Open. 2020;3(4):e206881. doi:10.1001/jamanetworkopen.2020.6881 eTable 1. Comparison of Full American Household Survey Sample With the Study Population eTable 2. Survey Questions for 9 Household Preparedness Items eTable 3. Sensitivity Analysis on Overall Preparedness With OLS Specification (Continuous Outcome) and Multinomial Logistic Specification (3-Level Outcome) eTable 4. Sensitivity Analysis of Alternative Methods to Specify Income eTable 5. Household Characteristics and Fulfillment of Resource- and Action-Based Preparedness Items Using Logistic Regression Weighting for Nonresponse eTable 6. Logistic Regression of Adjusted Odds of Overall, Resource-Based, and Action-Based Preparedness Using Logistic Regression Weighting for Nonresponse eTable 7. Logistic Regression of Adjusted Odds of Fulfillment of Resource-Based Preparedness Items Using Logistic Regression Weighting for Nonresponse eTable 8. Logistic Regression of Adjusted Odds of Fulfillment of Action-Based Preparedness Items Using Logistic Regression Weighting for Nonresponse eTable 9. Correlations Among Fulfillment of Specific Preparedness Items This supplementary material has been provided by the authors to give readers additional information about their work. © 2020 Zamboni LM et al. JAMA Network Open. eTable 1. Comparison of Full American Household Survey Sample With the Study Population American Study Excluded Household Household Characteristic Sample Sample Survey (N = 16,725) (N = 16,749) (N = 33,474) Demographic characteristics of the head of the household Female, N (%) 7,622 (45.6) 6,740 (54.6) 14,362 (49.4) Married, N (%) 11,687 (69.9) 2,373 (19.2) 14,060 (48.4) Black, N (%) 1,969 (11.8) 2,354 (19.1) 4,323 (14.9) Hispanic/Latino, N (%) 2,696 (16.1) 1,848 (15.0) 4,544 (15.6) years, N (%) 3,579 (21.4) 3,898 (23.3) 7,477 (22.3) Education of the head of the household No high school degree, N (%) 1,772 (10.6) 1,722 (14.0) 3,494 (12.0) High school degree, N (%) 3,904 (23.3) 2,987 (24.2) 6,891 (23.7) Some college degree, N (%) 8,497 (50.8) 6,154 (49.9) 14,651 (50.4) Some graduate degree, N (%) 2,552 (15.3) 1,482 (12.0) 4,034 (13.9) Additional household characteristics Combined household income ($), Median 76,500 35,000 55,600 (IQR) (76,500) (51,320) (76,680) Household has children age <18 years, N (%) 7,163 (42.8) 1,717 (13.9) 8,880 (30.6) Household has a person with a disability, N (%) 3,533 (21.2) 2,931 (25.4) 6,464 (22.9) Census region South, N (%) 6,469 (38.7) 6,559 (39.2) 13,028 (38.9) Northeast, N (%) 2,445 (14.6) 2,643 (15.8) 5,088 (15.2) West, N (%) 4,568 (27.3) 4,538 (27.1) 9,106 (27.2) Midwest, N (%) 3,243 (19.4) 3,009 (18.0) 6252 (18.7) Notes: The American Housing Survey included 66,752 housing units, of which 33,474 responded to the topical section on emergency and disaster preparedness. The study sample comprises the housing units that responded to the nine questions on specific preparedness items used for the outcome measures. © 2020 Zamboni LM et al. JAMA Network Open. eTable 2. Survey Questions for 9 Household Preparedness Items Preparedness Item American Housing Survey 2017 Question Food stockpiles Does your household have available non-perishable food for 3 days? Water stockpiles Does household have available at least 3 gallons or 24 bottles of water per person? Electric generator Do you have a generator to provide electricity in case there is a power outage? Carry-on emergency Does your household have emergency supplies readily available to preparedness kit take with you if you have to evacuate your home? Financial resources for If you had to evacuate from your town or city to a safe place at evacuation least 50 miles away, do you have the financial resources, in terms of savings or available credit card balances, to meet expenses of up to $2,000? Vehicle available for If you had to evacuate from your town or city to a safe place at evacuation least 50 miles away do you have enough reliable vehicles to carry all of your household members and a small amount of supplies such as clothes and food? Alternative Do the members of your household have a plan for communicating communication plan in the event that cell phone service is disrupted? Separate evacuation If you had to evacuate from your town or city to a safe place at meeting point least 50 miles away for at least two weeks, where would you most likely stay during those two weeks? Plan with financial Would you have access to your vital financial information and information contact numbers if you had to evacuate your home? Source: U.S. Department of Housing and Urban Development and U.S. Census Bureau, American Household Survey 2017 codebook, available at https://www.census.gov/data- tools/demo/codebook/ahs/ahsdict.html (accessed March 24, 2020). © 2020 Zamboni LM et al. JAMA Network Open. eTable 3. Sensitivity Analysis on Overall Preparedness With OLS Specification (Continuous Outcome) and Multinomial Logistic Specification (3-Level Outcome) Logistic Multinomial Regression OLS Regression Household Characteristic Logit Regression aOR (95% CI) beta (se) aOR (95% CI) 0.89 (0.83, 0.96) -0.13 (0.031)** 0.89 (0.81, 0.98) Female head of household 0.81 (0.73, 0.90) Married head of household 1.47 (1.36, 1.59) 0.42099 1.38 (1.25, 1.52) (0.034)** 1.86 (1.67, 2.08) Black head of household 0.99 (0.89, 1.10) -0.032 (0.047) 0.76 (0.66, 0.87) 0.94 (0.80, 1.09) Hispanic/Latino head of household 0.88 (0.80, 0.97) -0.16 (0.043)** 0.73 (0.65, 0.83) 0.74 (0.65, 0.85) Head of household age 65 years 1.26 (1.15, 1.39) 0.18 (0.039)** 1.52 (1.33, 1.73) 1.53 (1.33, 1.76) Head of household with high school 1.35 (1.19, 1.52) 0.34 (0.055)** 1.19 (1.02, 1.39) diploma (reference: no diploma) 1.45 (1.22, 1.72) Head of household with some 1.39 (1.23, 1.56) 0.34 (0.052)** 1.36 (1.17, 1.57) college degree (reference: no 1.53 (1.30, 1.81) diploma) Head of household with some 1.11 (0.96, 1.28) 0.17 (0.063)* 1.37 (1.13, 1.65) graduate degree (reference: no 1.25 (1.01, 1.54) diploma) Combined household income ($, 1.13 (1.09, 1.18) 0.14 (0.016)** 1.29 (1.23, 1.35) logged) 1.27 (1.21, 1.34) Household has children <18 0.87 (0.81, 0.94) -0.15 (0.031)** 0.85 (0.77, 0.93) years 0.78 (0.71, 0.87) Household has a person 0.86 (0.79, 0.94) -0.14 (0.037)** 0.81 (0.73, 0.91) with a disability 0.77 (0.68, 0.87) Northeast location (reference: South) 0.77 (0.70, 0.85) -0.28 (0.044)** 0.92 (0.80, 1.06) 0.69 (0.59, 0.80) West location (reference: South) 0.87 (0.80, 0.95) -0.11 (0.036)* 0.83 (0.74, 0.94) 0.82 (0.72, 0.92) Midwest location (reference: South) 0.83 (0.76, 0.91) -0.24 (0.040)** 0.91 (0.81, 1.04) 0.70 (0.61, 0.81) Notes: N=16,527. For the OLS regression, * P<0.01, ** P<0.001. Outcome is overall preparedness, on a 0 to 9 scale. The logistic regression specification, used in the manuscript, represents fulfilling 5 or more (at least half) of items. The ordinary least squares specification uses overall preparedness as a continuous outcome and includes P-values to denote statistical significance. The multinomial logistic regression examines three categories of preparedness (low (0-3 items), medium (4-6 items), and high (7-9 items)), with low as the reference category. For each coefficient, there are two odds ratios corresponding to level 2 versus level 1 (i.e., medium versus low) and level 3 versus level 1 (i.e., high versus low). Abbreviations: adjusted odds ratio (aOR), confidence interval (CI). © 2020 Zamboni LM et al. JAMA Network Open. eTable 4. Sensitivity Analysis of Alternative Methods to Specify Income Linear Quadratic Quintiles Household Characteristic aOR (95% CI) aOR (95% CI) aOR (95% CI) Female head of household 0.89 (0.83, 0.96) 0.89 (0.83, 0.95) 0.89 (0.83, 0.95) Married head of household 1.47 (1.36, 1.59) 1.47 (1.36, 1.59) 1.47 (1.36, 1.58) Black head of household 0.99 (0.89, 1.10) 0.99 (0.89, 1.10) 0.99 (0.89, 1.10) Hispanic/Latino head of household 0.88 (0.80, 0.97) 0.88 (0.80, 0.97) 0.88 (0.80, 0.98) Head of household age 65 years 1.26 (1.15, 1.39) 1.26 (1.15, 1.39) 1.28 (1.16, 1.40) Head of household with high school 1.35 (1.19, 1.52) 1.35 (1.19, 1.52) 1.34 (1.18, 1.51) diploma (reference: no diploma) Head of household with some 1.39 (1.23, 1.56) 1.39 (1.23, 1.56) 1.37 (1.22, 1.54) college degree (reference: no diploma) Head of household with some 1.11 (0.96, 1.28) 1.10 (0.95, 1.27) 1.10 (0.95, 1.27) graduate degree (reference: no diploma) Combined household income ($, 1.13 (1.09, 1.18) 1.07 (0.81, 1.41) -- logged) Combined household income, -- 1.00 (0.99, 1.02) -- quadratic term ($, logged) Combined household income, -- -- 1.20 (1.08, 1.33) quintile 2 (reference: quintile 1) Combined household income, -- -- 1.29 (1.16, 1.44) quintile 3 (reference: quintile 1) Combined household income, -- -- 1.44 (1.28, 1.61) quintile 4 (reference: quintile 1) Combined household income, -- -- 1.43 (1.27, 1.62) quintile 5 (reference: quintile 1) 0.87 (0.81, 0.94) Household has children <18 0.87 (0.81, 0.94) 0.88 (0.81, 0.94) years Household has a person 0.86 (0.79, 0.94) 0.86 (0.79, 0.94) 0.87 (0.80, 0.94) with a disability Northeast location (reference: South) 0.77 (0.70, 0.85) 0.77 (0.70, 0.85) 0.77 (0.70, 0.85) West location (reference: South) 0.87 (0.80, 0.95) 0.87 (0.80, 0.95) 0.87 (0.80, 0.95) Midwest location (reference: South) 0.83 (0.76, 0.91) 0.83 (0.76, 0.91) 0.83 (0.76, 0.91) Notes: N=16,527. Outcome is fulfilling at least half of the 9 preparedness items (overall preparedness). © 2020 Zamboni LM et al. JAMA Network Open. eTable 5. Household Characteristics and Fulfillment of Resource- and Action-Based Preparedness Items Using Logistic Regression Weighting for Nonresponse Household Characteristic Value Demographic characteristics of the head of household 13,447 (49.4) Female, N (%) 13,773 (50.6) Married, N (%) 4,158 (15.3) Black, N (%) 4,622 (17.0) Hispanic/Latino, N (%) 6,374 (23.4) Age 65 years, N (%) 3,316 (12.2) No high school degree, N (%) 6,535 (24.0) High school degree, N (%) 13,536 (49.8) Some college degree, N (%) 3,822 (14.1) Some graduate degree, N (%) Additional household characteristics 60,000 (80,640) Combined household income ($), Median (interquartile range) 9,087 (33.4) Household has children <18 years, N (%) 5,971 (22.0) Household has a person with a disability, N (%) 10,480 (38.5) Census region: South, N (%) 4,275 (15.7) Census region: Northeast, N (%) 7,567 (27.8) Census region: West, N (%) 4,887 (18.0) Census region: Midwest, N (%) Household availability of resource-based disaster preparedness items 25,712 (94.5) Vehicle available for evacuation, N (%) 22,537 (82.8) Food stockpiles, N (%) 20,640 (75.7) Financial resources for evacuation, N (%) 16,246 (59.7) Water stockpiles, N (%) 14,646 (53.8) Carry-on emergency preparedness kit, N (%) 4,602 (16.9) Electric generator, N (%) Household availability of action-based disaster preparedness items 21,807 (80.1) Plan with financial information, N (%) 9,954 (36.6) Separate evacuation meeting point, N (%) 7,550 (27.8) Alternative communication plan, N (%) Fulfillment of preparedness criteria 17,935 (65.9) Overall preparedness, N (%) 17,054 (62.7) Resource-based preparedness, N (%) 10,718 (39.4) Action-based preparedness, N (%) Notes: N=16,725. For fulfillment of overall preparedness, resource-based items, and action- based items, preparedness is defined as meeting at last half of the items in that category. The study sample is limited to participants who responded to the 9 questions on specific preparedness items. To adjust for possible nonresponse bias, this replicates Table 1 from the manuscript using a logistic regression weighting method. © 2020 Zamboni LM et al. JAMA Network Open. eTable 6. Logistic Regression of Adjusted Odds of Overall, Resource-Based, and Action-Based Preparedness Using Logistic Regression Weighting for Nonresponse Overall Resource-based Action-based Household Characteristic Preparedness Preparedness Preparedness aOR (95% CI) aOR (95% CI) aOR (95% CI) Female head of household 0.91 (0.87, 0.96) 0.87 (0.82, 0.91) 0.96 (0.91, 1.01) Married head of household 1.55 (1.47, 1.64) 1.67 (1.58, 1.77) 1.26 (1.20, 1.33) Black head of household 0.94 (0.87, 1.01) 0.85 (0.79, 0.92) 1.30 (1.21, 1.40) Hispanic/Latino head of household 0.83 (0.77, 0.89) 0.92 (0.86, 0.99) 0.92 (0.86, 0.99) Head of household age 65 years 1.26 (1.18, 1.34) 1.54 (1.44, 1.65) 0.93 (0.87, 0.99) Head of household with high school 1.18 (1.08, 1.29) 1.28 (1.17, 1.40) 1.04 (0.95, 1.14) diploma (reference: no diploma) Head of household with some 1.23 (1.13, 1.34) 1.31 (1.21, 1.43) 1.03 (0.95, 1.12) college degree (reference: no diploma) Head of household with some 1.01 (0.91, 1.12) 1.09 (0.98, 1.21) 0.94 (0.85, 1.04) graduate degree (reference: no diploma) Combined household income ($, 1.14 (1.12, 1.16) 1.11 (1.09, 1.13) 1.02 (0.99, 1.04) logged) Household has children <18 0.88 (0.83, 0.93) 0.75 (0.71, 0.79) 1.26 (1.19, 1.33) years Household has a person 0.90 (0.84, 0.96) 0.82 (0.77, 0.87) 1.10 (1.04, 1.17) with a disability Northeast location (reference: South) 0.71 (0.65, 0.76) 0.74 (0.69, 0.80) 0.73 (0.67, 0.78) West location (reference: South) 0.89 (0.83, 0.95) 0.95 (0.89, 1.02) 0.92 (0.87, 0.98) Midwest location (reference: South) 0.85 (0.79, 0.91) 0.82 (0.76, 0.88) 0.82 (0.76, 0.88) Notes: N=16,527. Abbreviations: adjusted odds ratio (aOR), confidence interval (CI). Preparedness is defined by fulfilling at least half of items. The study sample is limited to participants who responded to the 9 questions on specific preparedness items. To adjust for possible nonresponse bias, this replicates Table 2 from the manuscript using a logistic regression weighting method. © 2020 Zamboni LM et al. JAMA Network Open. eTable 7: Logistic Regression of Adjusted Odds of Fulfillment of Resource-Based Preparedness Items Using Logistic Regression Weighting for Nonresponse Financial Food Water Electric Carry on Evacuation Household resources Stockpile Stockpile generator emergency kit vehicle Characteristic for evacuation aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) Female head of household 1.07 (1.00, 1.15) 0.95 (0.90, 1.00) 0.82 (0.76, 0.87) 0.90 (0.85, 0.94) 0.73 (0.68, 0.78) 1.06 (0.94, 1.20) Married head of 1.27 (1.18, 1.36) 1.34 (1.27, 1.42) 1.83 (1.70, 1.97) 1.22 (1.16, 1.29) 2.03 (1.89, 2.18) 2.53 (2.21, 2.90) household Black head of household 0.71 (0.65, 0.78) 1.15 (1.07, 1.24) 0.48 (0.43, 0.54) 1.30 (1.21, 1.40) 0.44 (0.40, 0.48) 0.34 (0.30, 0.39) Hispanic/Latino head of 0.66 (0.61, 0.72) 1.48 (1.38, 1.59) 0.63 (0.57, 0.70) 0.98 (0.92, 1.06) 0.62 (0.57, 0.67) 0.49 (0.43, 0.56) household Head of household aged 1.50 (1.38, 1.64) 1.36 (1.27, 1.45) 1.22 (1.13, 1.32) 1.09 (1.02, 1.16) 2.10 (1.92, 2.30) 1.07 (0.94, 1.23) 65 years Head of household with 1.18 (1.06, 1.32) 0.89 (0.81, 0.97) 1.20 (1.06, 1.35) 1.06 (0.97, 1.16) 1.69 (1.53, 1.86) 1.07 (0.94, 1.23) high school diploma (reference: no diploma) Head of household with 1.11 (1.01, 1.24) 0.79 (0.73, 0.86) 1.08 (0.96, 1.22) 0.99 (0.92, 1.08) 2.73 (2.48, 2.99) 2.01 (1.73, 2.33) some college degree (reference: no diploma) Head of household with 0.97 (0.85, 1.10) 0.63 (0.57, 0.70) 0.72 (0.62, 0.83) 0.86 (0.77, 0.95) 10.76 (8.98, 2.32 (1.83, 2.93) some graduate degree 12.88) (reference: no diploma) Combined household 1.06 (1.04, 1.09) 0.97 (0.95, 0.99) 1.10 (1.07, 1.13) 1.05 (1.03, 1.07) 1.46 (1.43, 1.50) 1.20 (1.16, 1.24) income ($, logged) Household has children 0.98 (0.92, 1.06) 0.75 (0.71, 0.79) 0.76 (0.71, 0.83) 0.90 (0.85, 0.95) 0.68 (0.63, 0.73) 1.08 (0.95, 1.23) <18 years Household has a person 1.05 (0.97, 1.14) 0.89 (0.83, 0.94) 1.19 (1.10, 1.29) 0.96 (0.90, 1.02) 0.54 (0.50, 0.58) 0.57 (0.50, 0.64) with a disability © 2020 Zamboni LM et al. JAMA Network Open. Financial Food Water Electric Carry on Evacuation Household resources Stockpile Stockpile generator emergency kit vehicle Characteristic for evacuation aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) Northeast location 0.86 (0.78, 0.95) 0.85 (0.79, 0.91) 1.01 (0.91, 1.11) 0.64 (0.60, 0.69) 1.05 (0.95, 1.15) 0.43 (0.38, 0.50) (reference: South) West location (reference: 0.83 (0.77, 0.90) 1.14 (1.07, 1.21) 0.67 (0.62, 0.73) 0.90 (0.85, 0.96) 1.15 (1.06, 1.25) 0.87 (0.75, 1.01) South) Midwest location 0.99 (0.90, 1.09) 0.81 (0.76, 0.87) 1.05 (0.96, 1.15) 0.66 (0.62, 0.71) 1.07 (0.97, 1.17) 1.10 (0.93, 1.32) (reference: South) Notes: N=16,527. Abbreviations: adjusted odds ratio (aOR), confidence interval (CI). The study sample is limited to participants who responded to the 9 questions on specific preparedness items. To adjust for possible nonresponse bias, this replicates Table 3 from the manuscript using a logistic regression weighting method. © 2020 Zamboni LM et al. JAMA Network Open. eTable 8. Logistic Regression of Adjusted Odds of Fulfillment of Action-Based Preparedness Items Using Logistic Regression Weighting for Nonresponse Alternative Plan with Alternative communication financial Household Characteristic meeting location plan information aOR (95% CI) aOR (95% CI) aOR (95% CI) Female head of household 0.96 (0.90, 1.01) 0.97 (0.92, 1.02) 0.99 (0.92, 1.05) Married head of household 1.18 (1.11, 1.25) 1.23 (1.16, 1.30) 1.25 (1.17, 1.34) Black head of household 1.57 (1.46, 1.70) 1.21 (1.13, 1.31) 0.91 (0.83, 0.99) Hispanic/Latino head of 1.07 (0.99, 1.16) 0.90 (0.84, 0.97) 0.68 (0.62, 0.73) household Head of household age 65 0.90 (0.84, 0.97) 0.84 (0.79, 0.90) 1.17 (1.08, 1.27) years Head of household with high 1.05 (0.96, 1.15 1.04 (0.95, 1.14) 1.22 (1.11, 1.35) school diploma (reference: no diploma) Head of household with some 0.96 (0.88, 1.05) 1.04 (0.96, 1.14) 1.49 (1.35, 1.63) college degree (reference: no diploma) Head of household with some 0.90 (0.80, 1.00) 0.96 (0.86, 1.07) 1.55 (1.37, 1.76) graduate degree (reference: no diploma) Combined household income ($, 0.95 (0.93, 0.97) 1.01 (0.99, 1.03) 1.26 (1.23, 1.29) logged) Household has children <18 1.11 (1.04, 1.18) 1.27 (1.2, 1.34) 0.95 (0.88, 1.02) years Household has a person with a 1.07 (1.00, 1.15) 1.13 (1.07, 1.21) 0.83 (0.77, 0.90) disability Northeast location (reference: 0.76 (0.70, 0.82) 0.73 (0.67, 0.79) 0.77 (0.70, 0.84) South) West location (reference: South) 1.06 (0.99, 1.14) 0.98 (0.92, 1.04) 0.74 (0.69, 0.81) Midwest location (reference: 0.77 (0.71, 0.84) 0.94 (0.88, 1.01) 0.82 (0.75, 0.90) South) Notes: N=16,527. Abbreviations: adjusted odds ratio (aOR), confidence interval (CI). The study sample is limited to participants who responded to the 9 questions on specific preparedness items. To adjust for possible nonresponse bias, this replicates Table 4 from the manuscript using a logistic regression weighting method. © 2020 Zamboni LM et al. JAMA Network Open. eTable 9. Correlations Among Fulfillment of Specific Preparedness Items Item Water Electric Carry on Financial Evacuation Alternative Alternative Plan with stockpile generator emergency resources vehicle communication meeting financial kit for plan location information evacuation Food stockpile 0.273 0.108 0.253 0.144 0.088 0.098 0.118 0.180 Water 0.100 0.347 0.088 0.042 0.225 0.184 0.119 stockpile Electric 0.117 0.119 0.053 0.044 0.061 0.077 generator Carry on 0.111 0.059 0.331 0.305 0.246 emergency kit Financial 0.209 0.032 0.052 0.227 resources for evacuation Evacuation 0.020 0.048 0.106 vehicle Alternative 0.522 0.143 communication plan Alternative 0.160 meeting location Notes: Pearson correlation coefficients. P-values are not provided because with such a large sample, many associations are statistically significant although not meaningful qualitatively. © 2020 Zamboni LM et al. JAMA Network Open.
JAMA Network Open – American Medical Association
Published: Apr 27, 2020
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