PC3053: Characterizing Disparities in Pediatric Household Preparedness for Wildfire Disasters

Background: Climate change has increased the threat of more frequent, destructive wildfires. Wildfires disproportionately affect minority and low socioeconomic communities and increase respiratory morbidity, especially in children. Though health disparities among minority children are likely to be compounded during wildfires, limited studies describe this phenomenon. This study aims to characterize disparities in pediatric household preparedness for wildfire disasters and identify targeted education and dissemination strategies for this population.

Methods: Data were obtained using a novel questionnaire and semi-structured interview administered in real-time to English or Spanish-speaking caregivers (n=70) presenting to a Pediatric Emergency Department in Southern California that serves large minority populations and patients in high-risk wildfire zones. Each investigation tool was reviewed by subject matter experts and piloted with real patients for content, comprehension, and literacy before data gathering. Logistic regression models and Fisher’s exact test were used to assess the crude association between household/child demographics, socioeconomic factors and the following outcomes:
[1] Resource-Based Preparedness (RBP: summation of thirteen material-related questions);
[2] Action-Based Preparedness (ABP: summation of five action-related questions);
[3] Overall Preparedness (OP: summation [1] and [2]); and
[4] Preferred dissemination mode and format for wildfire preparedness education.
A household was considered to be prepared if 50% or more criteria were reported.

Results: Overall 71.6% of households reported OP, but were more likely to have RBP (80.9%) than ABP (25%) [Table 1]. Households were less likely to have preparedness if they reported a yearly income less than $75,000 (OP $30K to $49,999: odds ratio (OR) 0.04 [95% confidence interval (CI): 0, 0.97]), less than college level education (ABP high school or less: 0.17 [0.03, 0.8]), or young age (ABP: 0.06 [0.01, 0.54]) compared to 50 years and older, but not all results were significant. Caregivers had higher odds of being prepared if a household had two children (OP: 3.95 [1.03, 15.37]), a child with seasonal allergies (RBP: 5.50 [1.24, 24.35]; OP 4.79 [1.43, 16.08]), or reported air quality was important for child health (RBP: 5.42 [1.15, 25.59]). All households with homeowners insurance reported RBP (p.001), and 85.2% reported OP (p=0.04) [Table 2]. In households reporting a lack of homeowners insurance, 90% did not have ABP (p=0.001). All households with a child with a chronic disease or prescription medication endorsed RBP (p=0.006 and p.0016, respectively) and OP (p=0.0003 and p< 0.0001, respectively). Participants preferred email (55.6%) or phone application alerts (26.4%) and written language (44.4%) or videos (37.5%) for preferred formats for dissemination of wildfire preparedness information.

Conclusion: Pediatric wildfire preparedness represents a clear and identifiable environmental health disparities problem. Further studies are needed to create targeted strategies with standardized wildfire preparedness.