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Communication Inequalities During Public HealthDisasters: Katrina's WakeKalahn Alexandra Taylor-Clark a , Kasisomayajula Viswanath b & Robert J. Blendon ca Economic Studies , Brookings Institutionb Harvard School of Public Health and Dana-Farber Cancer Institutec Harvard School of Public Health and The Kennedy School of GovernmentPublished online: 10 May 2010.

To cite this article: Kalahn Alexandra Taylor-Clark , Kasisomayajula Viswanath & Robert J. Blendon (2010)Communication Inequalities During Public Health Disasters: Katrina's Wake, Health Communication, 25:3, 221-229, DOI:10.1080/10410231003698895

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Health Communication, 25: 221–229, 2010Copyright © Taylor & Francis Group, LLCISSN: 1041-0236 print / 1532-7027 onlineDOI: 10.1080/10410231003698895

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Communication Inequalities During Public Health Disasters: Katrina’s Wake

Communication Inequalities and Hurricane Katrina Kalahn Alexandra Taylor-ClarkEconomic Studies

Brookings Institution

Kasisomayajula ViswanathHarvard School of Public Health and

Dana-Farber Cancer Institute

Robert J. BlendonHarvard School of Public Health and The Kennedy School of Government

We evaluate effects of low socioeconomic position (SEP) and social networks among BlackHurricane Katrina victims on access to and processing of evacuation orders, and abilities toevacuate before the storm hit. We also explore whether SEP, moderating conditions, andcommunication outcomes affected risk perceptions of the storm’s severity and compliancewith evacuation orders. We conducted stepwise logistic regression analyses using survey datacollected in September 2005 among Black respondents in shelters throughout Houston, TX.Having few social networks, being unemployed, and being of younger age were significantlyassociated with having heard evacuation orders and whether victims’ perceived having heardclear orders. This study provides implications for targeted public health emergencycampaigns and future research to understand the effects of sociodemographic influences oncommunication inequalities and public health preparedness.

The fault lines of American society, as much as the failingsof its infrastructure, are shamefully on display in theaftermath of Hurricane Katrina. Race, class, age, and(dis)ability are now at the heart of the public debate aboutvulnerability, preparedness, and emergency response.(Enarson, 2006, p. 1)

On August 29, 2005, the United States and the worldwatched gripping television and Internet coverage ofHurricane Katrina and its aftermath. More than 1,836 peo-ple died in Katrina, and as of 2006, more than 100 moreremain missing, while tens of thousands have been uprootedfrom their homes and neighborhoods (Louisiana Depart-ment of Health and Hospitals, 2006). Much conjecture stirsas to why some of Katrina’s victims remained in their

homes while the category 5 hurricane ravaged their sur-roundings, yet few in the American public really compre-hended the experiences of the most vulnerable victims. Tobe sure, media images of grieving pet owners (Goldiner,2006; Shaffer, 2005) skewed the landscape on which tounderstand the “irrational” behaviors of the victims whostayed in their homes during the storm. Yet, as weeks pro-gressed, the American public witnessed anecdotes and mediareports exposing how socioeconomic vulnerabilities andracial discrimination disproportionately weakened impover-ished Black American victims’ abilities to cope with thedisaster. Indeed, economic and social vulnerability createbarriers to appropriately prepare for and respond to disasterthreats (Blaikie, Cannon, Davis, & Wisner, 1994; Bolin &Klenow, 1988; Boyce, 2000; Lynn, 2005; Morrow, 1999).

While much effort is focused on addressing the physical(social and economic) barriers that Hurricane Katrina vic-tims faced (Elliott & Pais, 2006; Park & Miller, 2006), few

Correspondence should be addressed to Kalahn Alexandra Taylor-Clark, Economic Studies, Brookings Institution, Suite 600, 1775 MassachusettsAvenue, Washington, DC 20036. E-mail: ktclark@brookings.edu

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222 TAYLOR-CLARK, VISWANATH, AND BLENDON

studies have focused on how and whether communicationfactors affected people’s abilities to appropriately respondto the disaster (Brodie, Weltzien, Altman, Blendon, &Benson, 2006; Eisenman, Cordasco, Asch, Golden, & Glik,2007; Spence, Lachlan, Burke, & Seeger, 2007; Spence,Lachlan, & Griffin, 2007). While it is widely believed thatcommunication plays an important role in disasters, little isunderstood on how social determinants, such as socioeco-nomic position, may influence access to and the capacity to acton the information in the context of disasters, a relationshipthat is widely documented in the literature (Viswanath,2006; Viswanath & Finnegan, 1996). The goal of this paperis to focus specifically on examining how social determi-nants, such as socioeconomic position, are related to pre-paredness communication outcomes such as accessing andunderstanding evacuation information and evacuationbehaviors during an emergency.

PUBLIC RESPONSE TO PUBLIC HEALTH RISKS

Risk communication researchers argue that in order to fullymitigate risks associated with public health threats, scien-tists and officials must evaluate the epidemiological profileof a threat as well as the public’s perceptions of andresponse to that threat (Lachlan & Spence, 2007; Sandman,1991). Perceptions of health risks can affect the public’sability to prevent and respond appropriately to threats(Lachlan & Spence, 2007). Public perceptions of risk andvulnerability, however, can be influenced by socioeconomicposition (SEP) and demographic position of those affected(Covello, 2003; Sandman, 1991). Indeed, historic accountsdetail how misinformed risk perceptions among socioeco-nomically vulnerable groups have led to mass panic andpublic flight (John, 1995), changes in economic or consum-erist behavior (Blendon, Benson, DesRoches, Raleigh, &Taylor-Clark, 2004), and stigmatization of the affected groups(Nelkin, 1991), among others. As evidenced by Katrina,inaction or quiescence—perhaps among the most deadlyresponses to public health threats—may also leave low-SEPand racial/ethnic minorities particularly susceptible to risks.We argue that communication is one way to mitigate misin-formed risk perceptions and inappropriate behavioralresponses to public health and medical emergency threats.

COMMUNICATION INEQUALITIES AND PUBLIC HEALTH THREATS

The thesis that effective communication may lead to moreaccurate perceptions of risk is based on the assumption thatpeople access the relevant information, understand it, andact on it. Students of communication, however, have longargued that vulnerability stemming from differential socio-economic positions manifests in the form of inequitable

access and exposure to relevant information, which maydirectly or indirectly influence health-related outcomes,including risk perceptions (Viswanath, 2006). The earliestmanifestation of this proposition was documented in thewidely studied knowledge gap hypothesis, which positedthat increasing flow of information into a social system islikely to be acquired at a faster rate by members of higherSEP groups compared to members of lower SEP groups,thereby widening gaps in knowledge between them(Tichenor, Donohue, & Olien, 1980; Viswanath & Finnegan,1996). More recently, this was expanded to include otherdimensions of inequalities including accessing, understand-ing, and acting on information stemming from differentialsocioeconomic positions (Viswanath, 2006). In sum, socialgroups’ (in)abilities to acquire, understand, and act onwidely distributed health and emergency information areshaped by their socioeconomic position, which may lead tomisinformed risk perceptions among vulnerable groups.

A limited literature documents sociodemographic differ-ences in communication outcomes and disaster preparednessby age (Bolin, 1986), race/ethnicity (Blanchard-Boehm, 1997;Dash, Peacock, & Morrow, 1997; Fothergill, Maestas, &Darlington, 1999; Perry, Lindell, & Greene, 1982; Perry &Nelson, 1991) gender (Blanchard-Boehm, 1997; Dash, Peacock,& Morrow, 1997), and socioeconomic position (Anderson,1996; Bolton, Liebow, & Olson, 1993; Hooke & Rogers,2005). In 1991, Lave and Lave interviewed people living inthree U.S. communities that had been flooded in that year.They found that although most people had little knowledgeof the cause of floods or what could be done to prevent flooddamage, people who were employed and better educatedknew more and were more likely to have flood insurance(Lave & Lave, 1991). With greater knowledge about how toprepare for flood threats, people with higher socioeconomicpositions were better able to secure against financial losses,which in turn may have helped them cope with the disaster.

Qualitative studies show ethnic and socioeconomic dif-ferences in minority communities’ abilities to act on disas-ter warnings, and differences in preferred disaster messageforms (Perry, Lindell, & Greene, 1982; Tierney, Lindell, &Perry, 2001). These studies show that racial/ethnic minorityand low-SEP groups will have more difficulty accessingeffective and usable information during natural disasters.For example, one study revealed that although racial minor-ity victims of Hurricane Katrina were more likely than theirWhite counterparts to have sought information about evacu-ation, they were less likely to evacuate before the storm hit(Spence, Lachlan, & Griffin, 2007). Another study showedthat Mexican and Black communities are more likely thanWhite communities to prefer local television as an informa-tion channel on environmental hazards because they lackaccess to cable networks (Perry & Nelson, 1991). In fact,access to cable TV services is associated with higher educa-tion and incomes (Viswanath, 2006). Another study foundthat due to hearing impairments, older people may be more

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vulnerable to information processing barriers, such as hav-ing difficulty in understanding emergency orders (Fernandez,Byard, Lin, Benson, & Barbera, 2002).

Qualitative research documenting Hurricane Katrina vic-tims’ experiences during the storm indicated that strong tiesto extended family, friends, and community groups affectedseveral factors associated with evacuation, including trans-portation, access to shelters, and perceptions of evacuationmessages. The authors concluded that social ties may havefacilitated or hindered evacuation behaviors (Eisenman,Cordasco, Asch, Golden, & Glik, 2007). “Linking” socialcapital, a concept that “ties individuals and groups with largersocial institutions,” may assist in mobilizing or preventingcommunities to act in prescribed ways during a public healthemergency (Kawachi, Kim, Coutts, & Subramanian, 2004).Social capital is engendered by communication and may alsoplay an important role in affecting communication outcomesfor sociodemographically vulnerable groups by serving as asource of information, support, and facilitator of action(Beaudoin, 2007; Viswanath, 2008). Thus, understandinghow engagement with social networks may affect commu-nication outcomes will help communicators to address thefoundations of communication inequalities during disasters.

CONCEPTUAL MODEL AND HYPOTHESES

Evaluations of the direct effects of social determinants andcommunication factors on knowledge, risk perceptions, andaction during emergencies can be instructive, yet they donot tell us how these factors, relative to one another, affectsocioeconomically vulnerable groups’ abilities to act in pre-scribed ways (Brashers, Neidig, & Haas, 2000; Eisenmanet al., 2004; Fischer, 1995; Glass, 2001; Spence et al., 2006;Tierney, Lindell, & Perry, 2001). Few have explored therelative effects of social determinants on the communica-tion outcomes that are instrumental in determining publicrisk perceptions and actions during public health threats(Perry & Nelson, 1991). In this paper, we draw from,though we do not directly test, the structural influencemodel (SIM) of health communication, which argues thatcommunication factors such as access to and understanding ofinformation are influenced by social determinants, and ine-qualities in access and understanding, in turn, may explainoutcomes in health (Kontos, Bennett, & Viswanath, 2007;Taylor-Clark, Koh, & Viswanath, 2007; Viswanath, 2006).

Based on the foregoing review, our research questionswere: (a) How do social determinants such as socioeco-nomic position (SEP) influence disaster-related communi-cation outcomes such as access to and processing ofevacuation information, as well as acting on evacuationorders, and (b) how do social determinants and communica-tion factors relate to risk perceptions among Black AmericanKatrina shelter victims who did not leave before the stormhit (i.e., did not utilize the evacuation orders)?

While some attention has been given to understandinginterracial differences in communication inequality, little isunderstood about how gender, age, socioeconomic position,and social networks play a role in exacerbating communica-tion inequalities within racial minority groups. Further,social and residential isolation may render some racialminority groups, including Black Americans, particularlyvulnerable to disaster threats. This data set provides us witha unique opportunity to test the question.

Building on previous literature, we are guided by thefollowing hypotheses:

Hypothesis 1: Lower socioeconomic position is likely to besignificantly associated with lower access toinformation about evacuation and with lowerunderstanding of the evacuation orders.

Hypothesis 2: Those from lower socioeconomic position,and who had lower access to and understand-ing of evacuation orders, will be more likelyto have lower risk perceptions, that is, to haveunderestimated the hurricane’s severity.

Hypothesis 3: Lower SEP, sociodemographic vulnerability(i.e., being a woman, older), fewer social net-works, and lower access to and understandingof information will be significantly associ-ated with acting (or not acting) on informa-tion (i.e., not having left before the storm hit).

METHODS

Data Collection

The survey instrument was jointly designed by theWashington Post, the Kaiser Family Foundation, and theHarvard School of Public Health. It was conducted betweenSeptember 10 and September 12, 2005, approximately2 weeks after the storm hit, with 680 randomly selectedrespondents 18 years or older who were evacuated toHouston from the Gulf Coast after Hurricane Katrina. Forthe current analysis, the sample was stratified by racebecause we had a unique opportunity to analyze BlackAmerican victims’ responses (91% of total responses),which equaled 621 total responses analyzed.

Sample and Survey Questionnaire

The full sample included 439 respondents from the HoustonReliant Park complex (i.e., the Astrodome and ReliantCenter), 152 from the George R. Brown Convention Center,and 12 whose location was not recorded. The sample alsoincluded 77 respondents from 5 of the 14 smaller Red Crossshelters established in the greater Houston area.

Interviews were distributed across shelters in proportionto best estimates of the actual shelter populations, whichtotaled more than 8,000 during the interviewing period.

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224 TAYLOR-CLARK, VISWANATH, AND BLENDON

This number represented approximately 30% of the esti-mated 27,100 evacuees residing in the main Houston shel-ters sites at the peak of occupancy.

The survey’s overall margin of sampling error was ±4percentage points. Interviews were administered face-to-faceby 28 Houston-based interviewers supervised by Interna-tional Communications Research and staff of the KaiserFamily Foundation. Interviewers explained to respondentsthat their ability to receive Red Cross aid was not related totheir participation in the survey. Interviewers excluded chil-dren under 18 from the counting cycle.

The survey was intended to cover the population hardesthit by the hurricane: those who were still in shelters afterone week, who had to rely on government help to evacuate,and who did not have access to their own housing.

Measures

Independent Variables

The independent variables included measures of socio-economic position (SEP) as well as sociodemographics. Weused the following variables as indicators of SEP: educa-tion, wealth, and employment. Sociodemographic measuresincluded age and gender. In addition, we also measuredwhether respondents were connected to social networks.

Education. We divided education into five categories:no education; grades 1–8; high school graduate or GED;some college or associate’s degree; and college degree +(reference category, ref.).

Wealth. Studies increasingly document wealth as aproxy measure for socioeconomic position (Kawachi &Kennedy, 1997). Wealth was measured by two variables..The first was home ownership, which was divided into fourcategories: home owned by self/family; renting house/apartment; living in a facility; and others (i.e., living some-where else, don’t know, refused). A second indicatormeasured whether the respondents did or did not have achecking or savings account that the person could access.

Employment status. As stated in the introduction, casestudies illustrate that employment status is significantly associ-ated with public preparedness for health threats (i.e., pur-chasing flood insurance) (Lave & Lave, 1991). Employmentalso provides access to peer networks, facilitating informationflow. We categorized employment status into three categories:unemployed (ref.); employed part-time; and employed full-time.

Gender. Gender was dichotomized into men (ref.) andwomen.

Age. Age (years) was divided into the following cate-gories: 18–35 (ref.); 36–45; 46–65; and 65+.

Social networks. Social links can have direct effectson communication outcomes and mobilization processes

during public health emergencies, whereby strong ties mayprovide the necessary information and support to help indi-viduals prepare for and respond to threats, while weaker tiesmay allow the flow of new information (Viswanath,Ramanadhan, & Kontos, 2007). Ties, in general, rely oncommunications and allow for the flow of information. Wetested whether a proxy for social ties, having family orfriends to stay with, was associated with communication andrisk perception outcomes. We dichotomized the variable“Do you have friends or family to stay with until you getback on your feet?” into two categories: yes (ref.) and no.

Dependent Variables

Communication outcomes. We measured three com-munication outcome variables that have shown to producehealth inequalities among vulnerable populations (Viswanath,2006). We measured respondents’ abilities to access, process(understand), and utilize information to prepare for and respondto public health threats. (1) We divided the access variable “Didyou hear the evacuation orders?” into two categories: not heard(ref.) and heard. (2) We categorized the information-processingvariable “Were the orders that you heard clear?” into two cate-gories: not clear (ref.) and clear. This variable was dependent onhaving heard the evacuation order. (3) Finally, we assessedinformation utilization by dichotomizing the variable “Did youevacuate before the storm hit?” into no (ref.) and yes.

Risk perception outcomes. Risk communication lit-erature delineates several factors that affect public percep-tions of risk, which have an impact on the overall hazardassociated with public health threats (Sandman, 1991).Risk perceptions were measured by asking them to react tothe statement “Thought the storm would not be that bad,” andthe response was dichotomized into “Yes, reason that theydid not leave,” or “No, not a reason that they did not leave.”

ANALYSES

We examined responses from 621 Black respondents. Wereported descriptive statistics of the study population. We usedstepwise logistic regression to investigate how low SEP andother sociodemographic characteristics affect communica-tion inequalities and risk perceptions about disaster threats.

Model 1—Communication Outcomes

Three stepwise logistic regressions regressed (a) informationaccess (having heard evacuation order) and (b) (among thosewho heard orders) processing (having heard clear instructions)on SEP, sociodemographic, and social network characteristics(i.e., education, wealth, employment, age, gender, and havingsocial networks). Next, we conducted two logistic regressionsto assess whether the aforementioned SEP, sociodemographicand social network characteristics, and communication factors

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COMMUNICATION INEQUALITIES AND HURRICANE KATRINA 225

of access and understanding were associated with informationutilization—evacuating before the storm hit.

Model 2—Risk Perception

Finally, we regressed thinking the storm would not be that badas a major reason for not evacuating before the storm hit onSEP, sociodemographic and social network information access,and information-processing variables to test whether com-munication outcomes affected respondents’ perceptions of risk.

RESULTS

A majority of respondents rented their homes prior to thestorm (64%), had high school degrees or less (78%), did nothave a checking or savings account (69%), and more than80% did not have any social networks, such as friends orfamily to stay with until they got back on their feet.Although one-third were not at all employed prior to thestorm, a majority (68%) worked either part- or full-time. Thesample was relatively well distributed by age and gender.

More than one-fourth, 27%, of these respondents did nothear the evacuation orders at all, while another 25% saidthat the orders that they heard were unclear. Sixty-two per-cent of respondents said that they did not evacuate beforethe storm hit (Table 1).

Access to and Understanding of Evacuation Messages

We posited that lower SEP would be significantly associ-ated with lower likelihood of hearing and understanding theevacuation orders. Data in the first column of Table 2 revealthat among all SEP indictors, people who were notemployed at all were significantly less likely than werethose who were employed full-time before the storm to haveheard the evacuation orders. People who do not have familyand friends, that is, had no social networks to rely on, weresignificantly less likely than those who were part of a net-work to have heard the evacuation orders. Other indicatorsof SEP such as education and wealth were not significant.

The results in the third column of Table 2 suggest thatonly having a bank or savings account and age were associ-ated with likelihood of understanding of the evacuationorders. People who did not have a checking or savingsaccount were significantly more likely to say that the ordersthat they heard were unclear. Younger people (18–24 years)were significantly more likely than those who were 56+ tosay that the orders that they heard were unclear.

Risk Perception

Our second hypothesis proposed that those from lowersocioeconomic position, and who had lower access to and

understanding of evacuation orders, would be more likely tohave lower risk perceptions, that is, to have underestimated thehurricane’s severity. The data in Table 3 indicate that ageand homeownership were two significant predictors ofwhether respondents underestimated the storm’s severity. Peo-ple who owned homes and people over the age of 55 weremore likely to underestimate the severity of the storm whencompared to renters and people ages 35–45, after controllingfor other factors. Communication variables were not signifi-cantly associated in influencing these respondents’ risk percep-tions of the storm’s severity, after controlling for other factors.

Utilization of Evacuation Messages

Our third and final hypothesis was that socioeconomic posi-tion, sociodemographics, social networks, and communica-tion factors of access and understanding would be related to

TABLE 1 Descriptive Statistics

ParameterTotal sample (Black), N = 621: n (valid %)

Home ownershipOwned 205 (33%)Rented 396 (64%)

Last grade completed in schoolNone, 1–8 26 (4%)High school (incomplete) 154 (25%)High school graduate/GED 303 (49%)Some college/vocational school 94 (15%)College graduate/postgraduate 32 (6%)

Do you have a savings or checking accountYes 189 (32%)No 411 (69%)

Friends or relatives to move in with until backon feet

Yes 118 (20%)No 478 (80%)

Employment statusFull time 316 (52%)Part time 97 (16%)Not at all 199 (33%)

Age (years)18–24 100 (17%)25–34 100 (17%)35–45 152 (25%)46–55 148 (25%)56+ 104 (17%)

GenderMen 303 (49%)Women 313 (51%)

Access and processing evacuation ordersYes, heard orders and they were clear 285 (49%)Yes, heard orders and they were unclear 145 (25%)No, did not hear evacuation orders 158 (27%)

Communication utilization—evacuate before storm hit

Yes 230 (38%)No 374 (62%)

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226 TAYLOR-CLARK, VISWANATH, AND BLENDON

acting on information or not. The extreme right column inTable 2 shows whether the respondents were able to utilizethe evacuation orders. As predicted, homeownership,gender, and information access were significant predictorsof whether they evacuated or not. Not having heard theevacuation orders was the most significant predictor of nothaving left before the storm hit, after controlling for othersocioeconomic characteristics. In addition, renters andwomen were significantly more likely to have left beforethe storm hit than homeowners or men.

In summary, the indicators of “wealth”—home owner-ship, having a bank account, employment—and social net-works, were significantly associated with whetherrespondents heard the evacuation orders (“access”), whetherthe orders were clear (“understanding/processing”), andwhether they used the orders to evacuate (“utilization”).

DISCUSSION

In general, our data show that even among a fairly raciallyand socioeconomically homogeneous group, (a) certain

indicators of SEP still matter in accessing, understanding(processing), and acting on emergency information. Forexample, we found that being employed is related to hearingabout the evacuation orders and having a bank account isrelated to understanding the evacuation orders; (b) anotherindicator of SEP, home ownership, is related to perceptionsof risk from the storm and acting on information, in thisevacuation; (c) social networks are an important determi-nant of hearing the evacuation orders; and (d) last, vulnera-bilities such as age and gender are also associated withhearing and understanding the evacuation messages.

What our findings reinforce is the importance of socialdeterminants, particularly socioeconomic position, in influ-encing reception to disaster communications. While a num-ber of studies have documented impact of disasters onvulnerable populations, our data offer a plausible mecha-nism that could potentially explain this relationship byshowing that even in a seemingly homogeneous group,Black Americans, some indicators of SEP matter.

The literature on social determinants in health has dis-cussed at length the role of social networks (Berkman &Kawachi, 2000; Kawachi, Subramanian, & Kim, 2008).

TABLE 2 Logistic Regressions of Communication Outcomes on SEP and Sociodemographics (Black Americans Only)

Did you hear evacuationorders? (n = 552), Yes = 0,

No = 1,

Were the orders that you heardclear? (n = 392), Yes = 0,

No = 1,

Did you leave before the stormhit? (n = 522), Yes = 0,

No = 1,Parameter OR (95% CI) OR (95% CI) OR (95% CI)

Home ownership (rented) p ≤ .201 p ≤ .707 p ≤ .003Owned 1.120 (0.730–1.720) 0.862 (0.534–1.389) 0.499 (0.328–0.757)**Education (college grad/

postgrad)p ≤ .164 p ≤ .366 p. ≤ 390

None (grades 1–8) 2.208 (0.480–10.158) 9.214 (0.919–92.333) 0.274 (0.070–1.071)High school incomplete 2.843 (0.876–9.226) 8.387 (1.033–68.067) 0.564 (0.202–1.571)High school grad/GED 1.734 (0.555–5.421) 7.633 (0.979–59.536) 0.629 (0.241–1.638)Some college/vocational

school1.549 (0.454–5.287) 6.557 (0.795–54.074) 0.511 (0.181–1.443)

Do not have a savings account 0.807 (0.515–1.264) 1.864 (1.100–3.156)* 1.316 (0.841–2.059)Employment (not at all) p ≤ .044 p ≤ .615 p ≤ .947(1) (Full-time) 0.548 (0.341–.879)* 0.824 (0.478–1.421) 0.984 (0.604–1.605)(2) (Part-time) 0.725 (0.397–1.322) 1.103 (0.563–2.160) 0.903 (0.480–1.699)Gender (1 = female) 1.080 (0.716–1.631) 0.720 (0.456–1.137) 0.586 (0.389–0.884)*Do not have family/friends 2.451 (1.337–4.491)** 1.156 (.652–2.048) 1.158 (0.691–1.939)Age (years) (56+) p ≤ .098 p ≤ .042 p ≤ .39418–24 1.632 (0.774–3.440) 2.101 (1.006–4.391)* .776 (0.380–1.584)25–34 1.662 (0.786–3.514) 1.402 (0.645–3.050) .675 (0.328–1.391)35–45 2.563 (1.304–5.037)** 1.187 (0.572–2.464) 0.518 (0.269–0.997)46–55 1.913 (0.969–3.777) 0.731 (0.354–1.506) 0.695 (0.366–1.320)Communication outcomes

(no, did not hear)p ≤ .000

Yes, heard orders and they were clear

0.119 (0.067–.211)**

Yes, heard orders and they were unclear

0.368 (0.193–.702)**

R–squared value 0.093 0.102 0.248

*indicates significance at p ≤ .05 level of significance. **indicates significance at p ≤ .01 level of significance.

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Social networks, such as having family or friends, also playan important role in exposing people to messages aboutofficial orders, as is evident from the employment variable,which could be a proxy for SEP, but also for social net-works. Although we might hypothesize that those who donot have work might be more likely to hear evacuationorders through mass media, channels of information or offi-cial protocol at job sites may have a positive impact oninformation access. Indeed, being employed means that col-leagues could serve as another information resource.

Using trusted sources of disaster information for unem-ployed and socially isolated groups will be particularlyimportant in effectively disseminating key risk messagesand public health recommendations (Vanderford, Nasoff,Telfer, & Bonzo, 2007). Future research should identifyeffective channels of information dissemination among thesevulnerable groups. Some qualitative research on publichealth and disaster communication in Black American com-munities suggests that while churches and other religiousvenues may be important sources of shelter and refuge dur-ing disasters, Black communities may be less trusting ofsome information on public health threats disseminatedthrough these channels and more trusting of local health andpolicy officials (Taylor, Taylor-Clark, Torres, & Russell,2007). Future official communication might also carefully

consider how to incorporate local leaders and stakeholdersin the process of information dissemination (Lichterman,2000; Wray, Rivers, Whitworth, Jupka, & Clements, 2006).

Although the role of having a savings account was pre-dictable, the fact that the younger age group was lessinformed is an anomalous finding. We hypothesized thatolder people would have more information-processing barri-ers. However, it is possible that “historical memory” of priornatural disasters will moderate the effect of age on increasedprocessing abilities among older victims. Familiarity and his-toric memory of threats have shown to affect public percep-tions of vulnerability to risks (Sandman, 1991), so it ispossible that historic memory of other hurricanes (i.e.,Hurricane Bessie, 1960) may be a factor in better understand-ing official warnings. Although they were not any less likelyto evacuate after controlling for other factors, older peoplewere also more inclined to have underestimated the storm’sseverity, which may be associated with having lived throughprior storms. While some research has identified generaleffects of older age and historical memory on increased hurri-cane preparedness behaviors (Sattler, Kaiser, & Hittner,2000), little has focused on Black American communities’experiences. Future research should disentangle how histori-cal memory of threats plays a role in these communities’perspectives of and responses to disasters.

We also found inconclusive evidence that social determi-nants and communication outcomes had an effect on riskperceptions. That is, although age seemed to play some rolein believing that the storm would not be that bad, we cannotmake any major conclusions about the meaning of thisresult. Future research should test how social determinantsand communication have an effect on people’s views of nat-ural disaster severity.

In this study, exposure to communication messagesseems to play the strongest role in affecting these Hurricanevictims’ abilities to evacuate before the storm hit, after con-trolling for other variables. Although reducing immediatephysical barriers, including transportation issues in under-served communities, plays a substantial role in any publichealth disaster response, our findings urge the need to notonly address physical challenges for vulnerable communi-ties, but also to better understand and reduce the communi-cation barriers that they face.

Research that focuses on media use and communicationoutcomes during disasters will be evermore important as webetter understand the social landscape on which disastersoccur (Greenberg, Hofschire, & Lachlan, 2002). Further,understanding how socioeconomic vulnerabilities affectcommunities’ abilities to access, process, and utilize publichealth information will be imperative to equitably address-ing public health threats. This study showed that evenamong a relatively homogeneous racial and socioeconomicgroup, substantial differences in communication and riskperceptions may occur, leading to differential abilities torespond to disasters. This study also supports calls to

TABLE 3 Logistic Regressions of Risk Perception on SEP,

Sociodemographics, and Communication (Black Americans Only)

Parameter

Did not evacuate because thoughtthe storm would not be that bad (n = 315), 0 = not a reason did

not evacuate, 1 = reason didnot evacuate

Home ownership (rented) p ≤ .137Owned 1.742 (1.004–3.023)*

Education (college grad/postgrad) p ≤ .384None (grades 1–8) 8.133 (0.899–73.600)High school incomplete 5.068 (0.926–27.749)High school grad/GED 4.832 (0.936–24.939)Some college/vocational school 5.254 (0.930–29.691)

Do you have a savings account 0.956 (0.532–1.719)Employment (not at all) p ≤ .222(1) (Full-time) 1.275 (0.694–2.344)(2) (Part-time) 0.638 (0.278–1.465)Gender 1.279 (0.754–2.167)Do you have family/friends 1.428 (0.700–2.913)Age (years) (55+) p ≤ .00918–24 1.023 (0.422–2.478)25–34 0.620 (0.233–1.650)35–45 2.799 (1.228–6.375)*46–54 1.575 (0.709–3.496)Communication outcomes

(no, did not hear)p ≤ .428

Yes, heard orders and they were clear 1.494 (0.802–2.783)Yes, heard orders and they were unclear 1.362 (0.704–2.635)

*indicates significance at p ≤ .05 level of significance.

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228 TAYLOR-CLARK, VISWANATH, AND BLENDON

increase access to effective communication channels inorder to help vulnerable groups comply with official recom-mendations (Lichterman, 2000).

Understanding mass media behaviors before and duringpublic health disasters is also of import to future research(Katayama, 1992). Specifically, understanding the role ofethnic media in signaling public health threats will be animportant area of inquiry as disaster research increases inthis area (Beady & Bolin, 1985). Even as we pay attention tomedia and other forms of information delivery, inequalities incommunication that could potentially work to the disadvan-tage of the already vulnerable must be taken into account.

Limitations

One limitation of this study is that we have not measuredthe communication factors that affected the general public’sabilities to evacuate before the storm hit—that is, those peoplewho were not in the shelters for more than 1 week. However,one contribution of this study is that we focus on low-SEPBlack Americans—one group that may be hardest hit bydisasters and official response policies. Another limitationis that we did not test how communication outcomes andphysical barriers, such as not having a car or way to leave,were relatively associated with having left before the stormhit. To be sure, we hope to augment the literature, whichshows that physical barriers were the main reason victimsdid not leave, by elucidating how communication factorsmay have affected communities’ response to the disaster.

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