Publications by authors named "Elena Savoia"

48 Publications

Enhancing COVID-19 Vaccines Acceptance: Results from a Survey on Vaccine Hesitancy in Northern Italy.

Vaccines (Basel) 2021 Apr 13;9(4). Epub 2021 Apr 13.

Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy.

In March 2021, the coronavirus disease 2019 (COVID-19) pandemic still poses a threat to the global population, and is a public health challenge that needs to be overcome. Now more than ever, action is needed to tackle vaccine hesitancy, especially in light of the availability of effective and safe vaccines. A cross-sectional online survey was carried out on a representative random sample of 1011 citizens from the Emilia-Romagna region, in Italy, in January 2021. The questionnaire collected information on socio-demographics, comorbidities, past vaccination refusal, COVID-19-related experiences, risk perception of infection, and likelihood to accept COVID-19 vaccination. Multiple logistic regression analyses and classification tree analyses were performed to identify significant predictors of vaccine hesitancy and to distinguish groups with different levels of hesitancy. Overall, 31.1% of the sample reported hesitancy. Past vaccination refusal was the key discriminating variable followed by perceived risk of infection. Other significant predictors of hesitancy were: ages between 35 and 54 years, female gender, low educational level, low income, and absence of comorbidities. The most common concerns about the COVID-19 vaccine involved safety (54%) and efficacy (27%). Studying the main determinants of vaccine hesitancy can help with targeting vaccination strategies, in order to gain widespread acceptance-a key path to ensure a rapid way out of the current pandemic emergency.
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http://dx.doi.org/10.3390/vaccines9040378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070202PMC
April 2021

Youth Exposure to Hate in the Online Space: An Exploratory Analysis.

Int J Environ Res Public Health 2020 11 17;17(22). Epub 2020 Nov 17.

Emergency Preparedness, Research, Evaluation, and Practice Program, Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.

Today's youth have extensive access to the internet and frequently engage in social networking activities using various social media platforms and devices. This is a phenomenon that hate groups are exploiting when disseminating their propaganda. This study seeks to better understand youth exposure to hateful material in the online space by exploring predictors of such exposure including demographic characteristics (age, gender, and race), academic performance, online behaviors, online disinhibition, risk perception, and parents/guardians' supervision of online activities. We implemented a cross-sectional study design, using a paper questionnaire, in two high schools in Massachusetts (USA), focusing on students 14 to 19 years old. Logistic regression models were used to study the association between independent variables (demographics, online behaviors, risk perception, parental supervision) and exposure to hate online. Results revealed an association between exposure to hate messages in the online space and time spent online, academic performance, communicating with a stranger on social media, and benign online disinhibition. In our sample, benign online disinhibition was also associated with students' risk of encountering someone online that tried to convince them of racist views. This study represents an important contribution to understanding youth's risk factors of exposure to hateful material online.
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http://dx.doi.org/10.3390/ijerph17228531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698507PMC
November 2020

Factors associated with access and use of PPE during COVID-19: A cross-sectional study of Italian physicians.

PLoS One 2020 12;15(10):e0239024. Epub 2020 Oct 12.

Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.

Objectives: During the course of the Novel Coronavirus (SARS-CoV-2) pandemic, Italy has reported one of the highest number of infections. Nearly ten percent of reported coronavirus infections in Italy occurred in healthcare workers. This study aimed to understand physicians' access to personal protective equipment (PPE) and to information about their use, risk perception and strategies adopted to prevent contracting the infection.

Methods: We undertook a cross-sectional, online self-reported survey implemented between March 31 and April 5 2020 of Italian physicians.

Results: Responses were received from 516 physicians, only 13% of which reported to have access to PPE every time they need them. Approximately half of the physicians reported that the information received about the use of PPE was either clear (47%) or complete (54%). Risk perception about contracting the infection was influenced by receiving adequate information on the use of PPE. Access to adequate information on the use of PPE was associated with better ability to perform donning and doffing procedures [OR = 2.2 95% C.I. 1.7-2.8] and reduced perception of risk [OR = 0.5, 95% C.I. 0.4-0.6].

Conclusions: Results from this rapid survey indicate that while ramping up supplies on PPE for healthcare workers is certainly of mandatory importance, adequate training and clear instructions are just as important.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239024PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549784PMC
October 2020

COVID-19 and the re-opening of schools: a policy maker's dilemma.

Ital J Pediatr 2020 Jun 9;46(1):79. Epub 2020 Jun 9.

Department of Pediatric Emergency Unit, S. Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, 40138, Bologna, Italy.

The epidemic of coronavirus disease 2019 (COVID-19) broke out in Wuhan, China, in December 2019 and rapidly spread across the world. In order to counter this epidemic, several countries put in place different restrictive measures, such as the school's closure and a total lockdown. However, as the knowledge on the disease progresses, clinical evidence showed that children mainly have asymptomatic or mild disease and it has been suggested that they are also less likely to spread the virus. Moreover, the lockdown and the school closure could have negative consequences on children, affecting their social life, their education and their mental health. As many countries have already entered or are planning a phase of gradual lifting of the containment measures of social distancing, it seems plausible that the re-opening of nursery schools and primary schools could be considered a policy to be implemented at an early stage of recovery efforts, putting in place measures to do it safely, such as the maintenance of social distance, the reorganisation of classes into smaller groups, the provision of adequate sanitization of spaces, furniture and toys, the prompt identification of cases in the school environment and their tracing. Therefore, policy makers have the task of balancing pros and cons of the school re-opening strategy, taking into account psychological, educational and social consequences for children and their families. Another issue to be considered is represented by socio-economic disparities and inequalities which could be amplified by school's closure.
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http://dx.doi.org/10.1186/s13052-020-00844-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280677PMC
June 2020

Development of a public health emergency preparedness competency model for European Union countries.

Euro Surveill 2018 Dec;23(49)

Public Health Capacity and Communication Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden.

In 2017, the European Centre for Disease Prevention and Control (ECDC) developed a competency model for individuals who work in public health emergency preparedness (PHEP) in European Union (EU) countries. The model serves as the basis for developing competency-based training programmes to support professionals in PHEP efforts at the country level. The competency model describes the knowledge and skills professionals need when working in national-level PHEP, such as preparedness committee members or their equivalents. In order to develop the model, existing competency statements were reviewed, as well as case studies and reports. Fifty-three professionals from the EU and other countries provided feedback to the model by participating in a three-stage consultation process. The model includes 102 competency, 100 knowledge and 158 skill statements. In addition to specifying the appropriate content for training programmes, the proposed common competency model can help to standardise terminology and approaches to PHEP training.
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http://dx.doi.org/10.2807/1560-7917.ES.2018.23.48.1700631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290531PMC
December 2018

Preparedness Emergency Response Research Centers (PERRCs): Addressing Public Health Preparedness Knowledge Gaps Using a Public Health Systems Perspective.

Am J Public Health 2018 11;108(S5):S363-S365

Elena Savoia, Dorothy Pordon Bernard, Nigel Harriman, Marcia Testa are with the Emergency Preparedness Research, Evaluation and Practice (EPREP) Program, Division of Policy Translation and Leadership Development, Harvard T. H. Chan School of Public Health, Boston, MA. Stefano Guicciardi is with the Department of Biomedical and Neuromotor Sciences, University of Bologna, Istituto di Igiene, Sanità Pubblica e Organizzazione dei Servizi Sanitari, Via San Giacomo, Bologna, Italy. Mary Leinhos is with the Office of Applied Research, Centers for Disease Control and Prevention (CDC), Atlanta, GA.

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http://dx.doi.org/10.2105/AJPH.2018.304812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236718PMC
November 2018

Integrating emergency risk communication (ERC) into the public health system response: Systematic review of literature to aid formulation of the 2017 WHO Guideline for ERC policy and practice.

PLoS One 2018 31;13(10):e0205555. Epub 2018 Oct 31.

Emergency Preparedness, Research, Evaluation & Practice (EPREP) program, Division of Policy Translation & Leadership Development, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America.

The World Health Organization (WHO) commissioned a systematic review of literature to facilitate evidence syntheses for the development of emergency risk communication (ERC) guidelines for its member states. The goal of this review was to integrate ERC best practices into governmental and non-governmental health systems for all emergencies of public health concern, by addressing three questions: (1) to identify best practices for the integration of ERC into national and international public health preparedness; (2) to identify mechanisms to establish effective intra-agency, inter-agency, and/or cross-jurisdictional information sharing; and (3) to identify methods to coordinate risk communication activities between responding agencies across organizations and levels of response. The review covered scientific and grey literature publications between January 2003 and February 2016, and searches were conducted in 17 English language electronic libraries besides Chinese, Portuguese and Spanish language databases. A mixed deductive-inductive process was used to synthesize findings across studies through identifying thematic areas. While 8,215 articles were initially retrieved, after a sequential screening process, the final evidence syntheses comprised of 21 articles for question (1) and 24 for questions (2) and (3) combined (due to overlap of themes). The confidence in findings was assessed by the Qualitative Evidence Syntheses (GRADE-CERQual) tool. PRISMA guidelines were followed to the extent possible given the limitations inherent to a review largely based on qualitative studies. The identified literature was very context-specific and referred to mechanisms, practices from the field, and recommendations that were derived from planning or response efforts implemented at the national or local levels in specific countries. Integration of ERC functions into public health emergency preparedness, planning and response activities was influenced by reforming components of the leadership structure when needed, modifying organizational factors, and nullifying restrictions (including amending laws/ regulations) that might have been an obstacle to the timely release of information. Exercises and trainings were recognized as effective strategies to identify the barriers and successes in this process of integration. Key elements to enhance information sharing and coordination across organizations included the creation of networks, task-forces and committees across disciplines, organizations and geographic areas. Engagement of local stakeholders was also important to guarantee the flow of information up and down the incident command system. On the whole, few empirical studies, especially from low- and middle-income countries, related to the WHO research questions, demonstrating the need for research in these areas. To facilitate an accurate identification of the gaps, the authors suggest integrating current findings with case studies across the WHO regions to better understand the specific evidence that is needed in practice across the multitude of ERC functions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205555PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209198PMC
April 2019

Social Media Learning Collaborative for Public Health Preparedness.

Am J Public Health 2018 11 27;108(S5):S375-S377. Epub 2018 Sep 27.

Marcia A. Testa, Elena Savoia, and Maxwell Su are with the Department of Biostatistics and the Emergency Preparedness Research, Evaluation, & Practice (EPREP) Program, Division of Policy Translation and Leadership Development, Harvard T. H. Chan School of Public Health, Boston, MA. Paul Biddinger is with the EPREP Program and the Department of Emergency Medicine, Division of Emergency Preparedness, Massachusetts General Hospital and Harvard Medical School, Boston.

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http://dx.doi.org/10.2105/AJPH.2018.304610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236724PMC
November 2018

Snow Storms and Vulnerable Populations: Local Public Health Activities in Response to the 2014-2015 Severe Winter Weather.

Disaster Med Public Health Prep 2019 06 7;13(3):647-649. Epub 2018 Sep 7.

2Department of Biostatistics,Emergency Preparedness,Research,Evaluation and Practice Program,Division of Policy Translation and Leadership Development,Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

ABSTRACTThe Northeastern United States experienced some of its coldest and snowiest conditions ever recorded during the winter of 2014-2015. The snowfall and extreme temperatures created significant challenges for local health departments attempting to continue critical services and respond to storm-related needs of the community. This report from the field aims to describe the impact of the severe weather on local health departments' operations, to examine the disruption to public health services, and to document public health support provided to vulnerable populations during the 2014-2015 winter season. Our findings show that the severe weather exposed major challenges in continuity of public health operations across health departments of various sizes and highlighted some key issues as well as effective strategies, such as collaborations with community-based organizations, to identify and address the needs of the most vulnerable during the winter storms. (Disaster Med Public Health Preparedness. 2019;13:647-649).
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http://dx.doi.org/10.1017/dmp.2018.81DOI Listing
June 2019

Organization or Community-Based Outbreak? Responding to Cases of Meningitis Under Epidemiologic Uncertainty.

Disaster Med Public Health Prep 2019 04 2;13(2):368-371. Epub 2018 May 2.

3Department of Biostatistics/Emergency Preparedness Evaluation Response Practice (EPREP) Program,Division of Policy Translation and Leadership Development,Harvard T.H. Chan School of Public Health,Cambridge,Massachusetts.

Six cases of serogroup C invasive meningococcal disease were identified in Treviso district, Veneto region, Italy between December 13 and 15, 2007. The afflicted patients were found to have attended the same Latin-dance clubs on the same nights, and chemoprophylaxis was provided to potentially exposed individuals. Despite these efforts, 2 cases caused by the same meningococcal strain subsequently occurred in the same area, without any apparent epidemiological correlation to the initial cases. This may have resulted from a failure to neutralize the meningococcal carrier/s. The root cause analysis method applied to public health emergency preparedness was used to analyze the response to this critical incident. The root cause analysis revealed a need to develop regional guidelines for the classification and management of a meningococcal outbreak and for developing risk-communication strategies that include the identification of appropriate channels of communication for differing segments of the population. (Disaster Med Public Health Preparedness. 2019;13:368-371).
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http://dx.doi.org/10.1017/dmp.2018.18DOI Listing
April 2019

Facilitated Look-Back Analysis of Public Health Emergencies to Enhance Preparedness: A Brief Report of a Chemical Spill in Charleston, West Virginia.

J Public Health Manag Pract 2018 Nov/Dec;24(6):E1-E5

Program on Population Impact, Recovery, and Resilience, College of Global Public Health, New York University, New York, New York (Ms Piltch-Loeb); Emergency Preparedness Research Evaluation Practice Program, Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Ms Savoia); Kanawha-Charleston Health Department, Charleston, West Virginia (Ms Wright); Department of Health & Human Services' Bureau for Public Health and West Virginia State Health, Charleston, West Virginia (Dr Gupta); Health Systems Administration and Population Health, Georgetown University, Washington, District of Columbia (Dr Stoto); and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Dr Stoto).

To demonstrate how public health emergency systems can use health systems tools to analyze and learn from critical incidents, we employed a facilitated look-back approach to review the public response to a chemical spill in Charleston, West Virginia. We reviewed official reports, news articles, and other documents; conducted in-person interviews with key public health and emergency response officials and local community stakeholders; and organized a facilitated look-back meeting to identify root causes of the problems that were encountered. The primary response challenges were (1) public distrust stemming from scientific uncertainty about potential harms of chemicals involved in the spill and how this uncertainty was communicated and (2) communication within the public health system, broadly defined. We found that to address inherent uncertainty, health officials should acknowledge uncertainty and tell the public what is known and unknown, and what they are doing to get more information.
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http://dx.doi.org/10.1097/PHH.0000000000000761DOI Listing
November 2019

Root-Cause Analysis for Enhancing Public Health Emergency Preparedness: A Brief Report of a Salmonella Outbreak in the Alamosa, Colorado, Water Supply.

J Public Health Manag Pract 2018 Nov/Dec;24(6):542-545

College of Global Public Health, New York University, New York City, New York (Ms Piltch-Loeb); Department of Health Systems Administration (Drs Kraemer and Stoto) and O'Neill Institute for National and Global Health Law (Dr Kraemer), Georgetown University, Washington, District of Columbia; RAND Corporation, Santa Monica, California (Dr Nelson); Pardee RAND Graduate School, Santa Monica, California (Dr Nelson); Division of Policy Translation and Leadership Development (Dr Savoia), Harvard T. H. Chan School of Public Health (Dr Stoto), Boston, Massachusetts; and San Luis Valley Region, Colorado Division of Homeland Security and Emergency Management, Centennial, Colorado (Mr Osborn).

To demonstrate how public health systems can use root-cause analysis (RCA) to improve learning from critical incidents, the research team utilized a facilitated look-back meeting to examine the public health systems' response to a Salmonella outbreak in the water supply in Alamosa, Colorado. We worked with public health, emergency management agencies, and other stakeholders to identify response challenges related to public health emergency preparedness capabilities, root causes, and lessons learned. The results demonstrate that RCA can help identify systems issues that, if addressed, can improve future responses. Furthermore, RCA can identify more basic issues that go beyond a specific incident or setting, such as the need for effective communication and coordination throughout the public health system, and the social capital needed to support it.
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http://dx.doi.org/10.1097/PHH.0000000000000763DOI Listing
November 2019

How Do the First Days Count? A Case Study of Qatar Experience in Emergency Risk Communication during the MERS-CoV Outbreak.

Int J Environ Res Public Health 2017 12 19;14(12). Epub 2017 Dec 19.

Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.

This case study is the first to be developed in the Middle East region to document what happened during the response to the 2013 MERS outbreak in Qatar. It provides a description of key epidemiologic events and news released from a prime daily newspaper and main Emergency Risk Communication (ERC) actions that were undertaken by public health authorities. Using the Crisis and Emergency Risk Communication (CERC) theoretical framework, the study analyzes how the performed ERC strategies during the first days of the outbreak might have contributed to the outbreak management.

Methods: MERS-CoV related events were chronologically tracked, together with the relevant stories that were published in a major newspaper over the course of three distinct phases of the epidemic. The collected media stories were then assessed against the practiced emergency risk communication (ERC) activities during the same time frame.

Results: The Crisis & Emergency Risk Communication (CERC) framework was partially followed during the early days of the MERS-CoV epidemic, which were characterized by overwhelming uncertainty. The SCH's commitment to a proactive and open risk communication strategy since day one, contributed to creating the SCH's image as a credible source of information and allowed for the quick initiation of the overall response efforts. Yet, conflicting messages and over reassurance were among the observed pitfalls of the implemented ERC strategy.

Conclusion: The adoption of CERC principles can help restore and maintain the credibility of responding agencies. Further work is needed to develop more rigorous and comprehensive research strategies that address sharing of information by mainstream as well as social media for a more accurate assessment of the impact of the ERC strategy.
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http://dx.doi.org/10.3390/ijerph14121597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5751014PMC
December 2017

A Public Health Preparedness Logic Model: Assessing Preparedness for Cross-border Threats in the European Region.

Health Secur 2017 Sep/Oct;15(5):473-482

Improving preparedness in the European region requires a clear understanding of what European Union (EU) member states should be able to do, whether acting internally or in cooperation with each other or the EU and other multilateral organizations. We have developed a preparedness logic model that specifies the aims and objectives of public health preparedness, as well as the response capabilities and preparedness capacities needed to achieve them. The capabilities, which describe the ability to effectively use capacities to identify, characterize, and respond to emergencies, are organized into 5 categories. The first 3 categories-(1) assessment; (2) policy development, adaptation, and implementation; and (3) prevention and treatment services in the health sector-represent what the public health system must accomplish to respond effectively. The fourth and fifth categories represent a series of interrelated functions needed to ensure that the system fulfills its assessment, policy development, and prevention and treatment roles: (4) coordination and communication regards information sharing within the public health system, incident management, and leadership, and (5) emergency risk communication focuses on communication with the public. This model provides a framework for identifying what to measure in capacity inventories, exercises, critical incident analyses, and other approaches to assessing public health emergency preparedness, not how to measure them. Focusing on a common set of capacities and capabilities to measure allows for comparisons both over time and between member states, which can enhance learning and sharing results and help identify both strengths and areas for improvement of public health emergency preparedness in the EU.
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http://dx.doi.org/10.1089/hs.2016.0126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750449PMC
June 2018

Public Health System Research in Public Health Emergency Preparedness in the United States (2009-2015): Actionable Knowledge Base.

Am J Public Health 2017 09;107(S2):e1-e6

Elena Savoia, Leesa Lin, Dottie Bernard, Noah Klein, Lyndon P. James, and Stefano Guicciardi are with the Emergency Preparedness Research, Evaluation & Practice (EPREP) Program, Division of Policy Translation & Leadership Development, Harvard T. H. Chan School of Public Health, Boston, MA.

Background: In 2008, the Institute of Medicine released a letter report identifying 4 research priority areas for public health emergency preparedness in public health system research: (1) enhancing the usefulness of training, (2) improving timely emergency communications, (3) creating and maintaining sustainable response systems, and (4) generating effectiveness criteria and metrics.

Objectives: To (1) identify and characterize public health system research in public health emergency preparedness produced in the United States from 2009 to 2015, (2) synthesize research findings and assess the level of confidence in these findings, and (3) describe the evolution of knowledge production in public health emergency preparedness system research. Search Methods and Selection Criteria. We reviewed and included the titles and abstracts of 1584 articles derived from MEDLINE, EMBASE, and gray literature databases that focused on the organizational or financial aspects of public health emergency preparedness activities and were grounded on empirical studies.

Data Collection And Analysis: We included 156 articles. We appraised the quality of the studies according to the study design. We identified themes during article analysis and summarized overall findings by theme. We determined level of confidence in the findings with the GRADE-CERQual tool.

Main Results: Thirty-one studies provided evidence on how to enhance the usefulness of training. Results demonstrated the utility of drills and exercises to enhance decision-making capabilities and coordination across organizations, the benefit of cross-sector partnerships for successfully implementing training activities, and the value of integrating evaluation methods to support training improvement efforts. Thirty-six studies provided evidence on how to improve timely communications. Results supported the use of communication strategies that address differences in access to information, knowledge, attitudes, and practices across segments of the population as well as evidence on specific communication barriers experienced by public health and health care personnel. Forty-eight studies provided evidence on how to create and sustain preparedness systems. Results included how to build social capital across organizations and citizens and how to develop sustainable and useful planning efforts that maintain flexibility and rely on available medical data. Twenty-six studies provided evidence on the usefulness of measurement efforts, such as community and organizational needs assessments, and new methods to learn from the response to critical incidents.

Conclusions: In the United States, the field of public health emergency preparedness system research has been supported by the US Centers for Disease Control and Prevention since the release of the 2008 Institute of Medicine letter report. The first definition of public health emergency preparedness appeared in 2007, and before 2008 there was a lack of research and empirical evidence across all 4 research areas identified by the Institute of Medicine. This field can be considered relatively new compared with other research areas in public health; for example, tobacco control research can rely on more than 70 years of knowledge production. However, this review demonstrates that, during the past 7 years, public health emergency preparedness system research has evolved from generic inquiry to the analysis of specific interventions with more empirical studies. Public Health Implications: The results of this review provide an evidence base for public health practitioners responsible for enhancing key components of preparedness and response such as communication, training, and planning efforts.
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http://dx.doi.org/10.2105/AJPH.2017.304051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594402PMC
September 2017

A Conceptual Framework for the Evaluation of Emergency Risk Communications.

Am J Public Health 2017 09;107(S2):S208-S214

Elena Savoia is with the Department of Biostatistics and Emergency Preparedness, Research, Evaluation, and Practice Program, Division of Policy Translation and Leadership Development, Harvard T. H. Chan School of Public Health, Boston, MA. Leesa Lin is with the Emergency Preparedness, Research, Evaluation, and Practice Program, Division of Policy Translation and Leadership Development, Harvard T. H. Chan School of Public Health. Gaya Gamhewage is with Interventions and Guidance, Expert Networks and Interventions Unit, World Health Organization Health Emergencies Programme, Geneva, Switzerland.

Objectives: To articulate a conceptual framework in support of evaluation activities in emergency risk communications (ERC).

Methods: The framework proposed is based on a systematic review of the scientific literature (2001-2016) combined with data derived from a series of semistructured interviews with experts and practitioners in ERC, and it is designed to support local, national, and international public health organizations in implementing evaluation studies in ERC.

Results: We identified a list of ERC outcomes from the full-text review of 152 articles and categorized these into 3 groups, depending upon the level at which the outcome was measured: (1) information environment, (2) population, and (3) public health system. We analyzed interviewees' data from 18 interviews to identify practices and processes related to the effectiveness of ERC and included these as key structural components and processes in the developed evaluation framework.

Conclusions: Researchers and public health practitioners interested in the evaluation of ERC can use the conceptual framework described in this article to guide the development of evaluation studies and methods for assessing communication outcomes related to public health emergencies.
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http://dx.doi.org/10.2105/AJPH.2017.304040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594401PMC
September 2017

Sources of Information During the 2014 West Virginia Water Crisis: A Cross-Sectional Survey.

Disaster Med Public Health Prep 2017 04 9;11(2):196-206. Epub 2016 Sep 9.

3Dana-Farber Cancer Institute (DFCI),McGraw-Patterson Center for Population Sciences/Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences,Boston,Massachusetts.

Objective: On January 9, 2014, a faulty storage tank leaked 10,000 gallons of an industrial coal-processing liquid into the Elk River in West Virginia, contaminating the drinking water of 9 counties collectively known as the Kanawha Valley. In the context of this event, we explored the relationship between social determinants and (1) the timeliness with which residents learned about the crisis, (2) the source of information, (3) opinions on the source of information, (4) information-seeking behaviors, and (5) knowledge acquired.

Methods: Between February 7 and 26, 2014, we conducted a survey of 690 adult residents of West Virginia. Descriptive statistics and multivariable statistical models were performed.

Results: Information about water contamination spread quickly, with 88% of respondents from the affected counties hearing about the incident on the same day it occurred. Most people received the information from local television news (73%); social media users had 120% increased odds of knowing about the recommended behaviors. People who had a favorable opinion of the source of information demonstrated better knowledge of recommended behaviors.

Conclusions: The use of local television news during a crisis is important for timely dissemination of information. Information exposure across segments of the population differed on the basis of the population's background characteristics. (Disaster Med Public Health Preparedness. 2017;11:196-206).
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http://dx.doi.org/10.1017/dmp.2016.98DOI Listing
April 2017

Engaging the Diaspora in Response to the 2014 Fogo Volcano Eruption in Cape Verde.

Disaster Med Public Health Prep 2016 Apr 19;10(2):185-6. Epub 2016 Jan 19.

Division of Policy Translation and Leadership Development,Harvard T.H. Chan School of Public Health,Boston,Massachusetts.

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http://dx.doi.org/10.1017/dmp.2015.168DOI Listing
April 2016

Development of an Online Toolkit for Measuring Performance in Health Emergency Response Exercises.

Prehosp Disaster Med 2015 Oct 15;30(5):503-8. Epub 2015 Sep 15.

1Division of Policy Translation and Leadership Development,Harvard T.H. Chan School of Public Health,Boston,MassachusettsUSA.

Introduction: Exercises that simulate emergency scenarios are accepted widely as an essential component of a robust Emergency Preparedness program. Unfortunately, the variability in the quality of the exercises conducted, and the lack of standardized processes to measure performance, has limited the value of exercises in measuring preparedness.

Methods: In order to help health organizations improve the quality and standardization of the performance data they collect during simulated emergencies, a model online exercise evaluation toolkit was developed using performance measures tested in over 60 Emergency Preparedness exercises. The exercise evaluation toolkit contains three major components: (1) a database of measures that can be used to assess performance during an emergency response exercise; (2) a standardized data collection tool (form); and (3) a program that populates the data collection tool with the measures that have been selected by the user from the database. The evaluation toolkit was pilot tested from January through September 2014 in collaboration with 14 partnering organizations representing 10 public health agencies and four health care agencies from eight states across the US. Exercise planners from the partnering organizations were asked to use the toolkit for their exercise evaluation process and were interviewed to provide feedback on the use of the toolkit, the generated evaluation tool, and the usefulness of the data being gathered for the development of the exercise after-action report.

Results: Ninety-three percent (93%) of exercise planners reported that they found the online database of performance measures appropriate for the creation of exercise evaluation forms, and they stated that they would use it again for future exercises. Seventy-two percent (72%) liked the exercise evaluation form that was generated from the toolkit, and 93% reported that the data collected by the use of the evaluation form were useful in gauging their organization's performance during the exercise. Seventy-nine percent (79%) of exercise planners preferred the evaluation form generated by the toolkit to other forms of evaluations.

Conclusion: Results of this project show that users found the newly developed toolkit to be user friendly and more relevant to measurement of specific public health and health care capabilities than other tools currently available. The developed toolkit may contribute to the further advancement of developing a valid approach to exercise performance measurement.
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http://dx.doi.org/10.1017/S1049023X15005117DOI Listing
October 2015

The Use of Social Media by State Health Departments in the US: Analyzing Health Communication Through Facebook.

J Community Health 2016 Feb;41(1):174-9

Department of Biostatistics and Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.

The use of social media as a powerful health communication tool is an area of current research interest. Our objective was to describe use of Facebook by State Health Departments (SHDs) in US, and their relationship with CDC's Behavioral Risk Factor Surveillance System (BRFSS) data. Facebook pages of 34 SHDs were studied over a 200 day period, coding 2597 posts into 19 broad health communication categories. Mean number of Facebook posts per SHD was 76.4 (range 34-133); most frequent topic areas included healthy living (12%), communicable diseases (9%), vaccines and immunization (7%), emergency preparedness and response (7%), infant and child health (5%), smoking and tobacco use (5%), and miscellaneous (32%). Through web-based interactive graphics (Google motion charts), we contrasted Facebook posts with CDC's BRFSS data on adult nutrition and physical activity, vaccination, smoking, adolescent health and road traffic accidents. Our research finds an apparent disconnect between content provided on Facebook by SHDs and the health conditions that affect their populations. Acknowledging the severe limitations in funding and human resources faced by the SHDs, our research attempts to present the factual situation in embracing a vastly popular social media platform for health communication. We believe there is a need for research exploring methods to balance the demands and resources.
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http://dx.doi.org/10.1007/s10900-015-0083-4DOI Listing
February 2016

Public response to the 2014 chemical spill in West Virginia: knowledge, opinions and behaviours.

BMC Public Health 2015 Aug 19;15:790. Epub 2015 Aug 19.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, 02115, MA, USA.

Background: On January 9(th) 2014, a faulty storage tank leaked 10,000 gal of an industrial coal processing liquid into the Elk River in West Virginia (WV), contaminating the drinking water of the nine counties collectively known as the Kanawha Valley. The aim of this study was to 1) explore how and when people obtained information about the water contamination and 2) understand how individual and social factors such as socio-demographic characteristics, timing of information, trust in government, and risk perception influenced compliance with recommended behaviours and the public's views on the need for environmental regulations.

Methods: Between February 7-26, 2014, a survey was conducted of adult residents of West Virginia including geographic areas affected and non-affected by the chemical spill. The total population-based sample size was 690 and the survey was administered online. Descriptive statistics and multivariate statistical models were created to determine what factors influenced compliance and public opinions.

Results: Findings from this study show that, during the 2014 West Virginia water crisis, information about water contamination spread quickly, as 73 % of survey respondents across the state and 89 % within the affected counties reported they heard about the incident the same day it occurred. Most people received the information promptly, understood what happened, and understood what to do to prevent exposure to the contaminant. The majority of respondents living in affected counties (70 %) followed the recommended behaviours. Among participants who voiced an opinion on the role of government in environmental regulations, the majority of respondents (54 %) reported there is "too little regulation."

Conclusion: Data from this study show that a higher perception of risk and timely receipt of information are associated with compliance with recommended behaviours, underlying the importance of releasing information to the public as quickly as possible during a crisis. This study also highlights the importance of coordinating risk communication activities beyond the area of the incident to assure public understanding of what measures are recommended, which are not and where.
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http://dx.doi.org/10.1186/s12889-015-2134-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539923PMC
August 2015

A peer assessment approach for learning from public health emergencies.

Public Health Rep 2014 ;129 Suppl 4:28-34

Georgetown University, Department of Health Systems Administration, Washington, DC.

As an alternative to standard quality improvement approaches and to commonly used after action report/improvement plans, we developed and tested a peer assessment approach for learning from singular public health emergencies. In this approach, health departments engage peers to analyze critical incidents, with the goal of aiding organizational learning within and across public health emergency preparedness systems. We systematically reviewed the literature in this area, formed a practitioner advisory panel to help translate these methods into a protocol, applied it retrospectively to case studies, and later field-tested the protocol in two locations. These field tests and the views of the health professionals who participated in them suggest that this peer-assessment approach is feasible and leads to a more in-depth analysis than standard methods. Engaging people involved in operating emergency health systems capitalizes on their professional expertise and provides an opportunity to identify transferable best practices.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187304PMC
http://dx.doi.org/10.1177/00333549141296S405DOI Listing
December 2014

A conceptual framework to measure systems' performance during emergency preparedness exercises.

Int J Environ Res Public Health 2014 Sep 17;11(9):9712-22. Epub 2014 Sep 17.

Division of Policy Translation and Leadership Development, Harvard School of Public Health, Boston, MA 02115, USA.

Large-scale public health emergencies require a sophisticated, coordinated response involving multiple entities to protect health and minimize suffering. However, the rarity of such emergencies presents a barrier to gathering observational data about the effectiveness of the public health response before such events occur. For this reason, public health practitioners increasingly have relied on simulated emergencies, known as "exercises" as proxies to test their emergency capabilities. However, the formal evaluation of performance in these exercises, historically has been inconsistent, and there is little research to describe how data acquired from simulated emergencies actually support conclusions about the quality of the public health emergency response system. Over the past six years, we have designed and evaluated more than seventy public health emergency exercises, collaborating with public health agencies, hospitals and others to test a wide variety of systems and their capabilities. Using the data and experience that we gathered, we have developed a conceptual framework that describes the essential elements necessary to consider when applying performance measurement science to public health emergency exercises. We suggest that this framework may assist practitioners and researchers who wish to better measure performance in exercises and to improve public health emergency preparedness.
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http://dx.doi.org/10.3390/ijerph110909712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199045PMC
September 2014

The public health system response to the 2008 Sichuan province earthquake: a literature review and interviews.

Disasters 2014 Oct;38(4):753-73

Project Manager in the Division of Policy Translation and Leadership Development, Harvard School of Public Health, Boston, United States, and was a student in the Department of Global Health and Population, Harvard School of Public Health at the time of the experiential learning activity.

This paper describes and analyses the public health system response to the deadly earthquake in Sichuan province, China, in May 2008. Drawing on an experiential learning project consisting of a literature review and field research, including a series of interviews with medical and public health professionals, policy-makers and first responders, a conceptual framework was developed to describe the response. This approach emphasises the pre-existing preparedness level of the medical and public health systems, as well as social, economic and geo-political factors that had an impact on mitigation efforts. This framework was used to conduct post-disaster analyses addressing major response issues and examining methods employed during the public health response to the disaster. This framework could be used to describe and analyse the emergency response to other disasters.
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http://dx.doi.org/10.1111/disa.12079DOI Listing
October 2014

Measurement, geospatial, and mechanistic models of public health hazard vulnerability and jurisdictional risk.

J Public Health Manag Pract 2014 Sep-Oct;20 Suppl 5:S61-8

Department of Biostatistics and Preparedness and Emergency Response Learning Center, Division of Policy Translation and Leadership Development, Harvard School of Public Health, Boston, Massachusetts (Drs Testa and Savoia); and Office of Public Health Preparedness and Response, Department of Public Health, State of Connecticut, Hartford (Ms Pettigrew).

Context: County and state health departments are increasingly conducting hazard vulnerability and jurisdictional risk (HVJR) assessments for public health emergency preparedness and mitigation planning and evaluation to improve the public health disaster response; however, integration and adoption of these assessments into practice are still relatively rare. While the quantitative methods associated with complex analytic and measurement methods, causal inference, and decision theory are common in public health research, they have not been widely used in public health preparedness and mitigation planning.

Objective: To address this gap, the Harvard School of Public Health PERLC's goal was to develop measurement, geospatial, and mechanistic models to aid public health practitioners in understanding the complexity of HVJR assessment and to determine the feasibility of using these methods for dynamic and predictive HVJR analyses.

Methods: We used systematic reviews, causal inference theory, structural equation modeling (SEM), and multivariate statistical methods to develop the conceptual and mechanistic HVJR models. Geospatial mapping was used to inform the hypothetical mechanistic model by visually examining the variability and patterns associated with county-level demographic, social, economic, hazards, and resource data. A simulation algorithm was developed for testing the feasibility of using SEM estimation.

Results: The conceptual model identified the predictive latent variables used in public health HVJR tools (hazard, vulnerability, and resilience), the outcomes (human, physical, and economic losses), and the corresponding measurement subcomponents. This model was translated into a hypothetical mechanistic model to explore and evaluate causal and measurement pathways. To test the feasibility of SEM estimation, the mechanistic model path diagram was translated into linear equations and solved simultaneously using simulated data representing 192 counties.

Conclusions: Measurement, geospatial, and mechanistic models can be used to confirm and validate existing and proposed HVJR models and potentially increase the predictive validity of these models for optimizing and improving public health preparedness planning.
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http://dx.doi.org/10.1097/PHH.0000000000000079DOI Listing
July 2016

What have we learned about communication inequalities during the H1N1 pandemic: a systematic review of the literature.

BMC Public Health 2014 May 21;14:484. Epub 2014 May 21.

Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Landmark Center, 3rd Floor East, Boston MA 02115, USA.

Background: During public health emergencies, public officials are busy in developing communication strategies to protect the population from existing or potential threats. However, a population's social and individual determinants (i.e. education, income, race/ethnicity) may lead to inequalities in individual or group-specific exposure to public health communication messages, and in the capacity to access, process, and act upon the information received by specific sub-groups- a concept defined as communication inequalities.The aims of this literature review are to: 1) characterize the scientific literature that examined issues related to communication to the public during the H1N1 pandemic, and 2) summarize the knowledge gained in our understanding of social determinants and their association with communication inequalities in the preparedness and response to an influenza pandemic.

Methods: Articles were searched in eight major communication, social sciences, and health and medical databases of scientific literature and reviewed by two independent reviewers by following the PRISMA guidelines. The selected articles were classified and analyzed in accordance with the Structural Influence Model of Public Health Emergency Preparedness Communications.

Results: A total of 118 empirical studies were included for final review. Among them, 78% were population-based studies and 22% were articles that employed information environment analyses techniques. Consistent results were reported on the association between social determinants of communication inequalities and emergency preparedness outcomes. Trust in public officials and source of information, worry and levels of knowledge about the disease, and routine media exposure as well as information-seeking behaviors, were related to greater likelihood of adoption of recommended infection prevention practices. When addressed in communication interventions, these factors can increase the effectiveness of the response to pandemics.

Conclusions: Consistently across studies, a number of potential predictors of behavioral compliance to preventive recommendations during a pandemic were identified. Our findings show the need to include such evidence found in the development of future communication campaigns to ensure the highest rates of compliance with recommended protection measures and reduce communication inequalities during future emergencies.
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http://dx.doi.org/10.1186/1471-2458-14-484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048599PMC
May 2014

Communications in public health emergency preparedness: a systematic review of the literature.

Biosecur Bioterror 2013 Sep;11(3):170-84

During a public health crisis, public health agencies engage in a variety of public communication efforts to inform the population, encourage the adoption of preventive behaviors, and limit the impact of adverse events. Given the importance of communication to the public in public health emergency preparedness, it is critical to examine the extent to which this field of study has received attention from the scientific community. We conducted a systematic literature review to describe current research in the area of communication to the public in public health emergency preparedness, focusing on the association between sociodemographic and behavioral factors and communication as well as preparedness outcomes. Articles were searched in PubMed and Embase and reviewed by 2 independent reviewers. A total of 131 articles were included for final review. Fifty-three percent of the articles were empirical, of which 74% were population-based studies, and 26% used information environment analysis techniques. None had an experimental study design. Population-based studies were rarely supported by theoretical models and mostly relied on a cross-sectional study design. Consistent results were reported on the association between population socioeconomic factors and public health emergency preparedness communication and preparedness outcomes. Our findings show the need for empirical research to determine what type of communication messages can be effective in achieving preparedness outcomes across various population groups. They suggest that a real-time analysis of the information environment is valuable in knowing what is being communicated to the public and could be used for course correction of public health messages during a crisis.
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http://dx.doi.org/10.1089/bsp.2013.0038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778998PMC
September 2013

A consensus process on the use of exercises and after action reports to assess and improve public health emergency preparedness and response.

Prehosp Disaster Med 2013 Jun 28;28(3):305-8. Epub 2013 Mar 28.

Division of Policy Translation and Leadership Development, Harvard School of Public Health, Boston, MA, USA.

Introduction: The objective of disaster preparedness is to ensure that appropriate systems, procedures, and resources are in place to provide prompt, effective assistance to disaster victims, thus facilitating relief measures and rehabilitation of services. Disaster preparedness efforts include the identification of possible health scenarios based on the probability of hazards and vulnerability of the population as a basis for creating a disaster plan. Exercises that simulate emergency response, involving the health and other sectors, have been suggested as useful tools to test the plans on a regular basis and measure preparedness efforts; the absence of actual testing is likely to negate even the best of abstract plans. Problem Exercises and after action reports (AARs) are used to document preparedness activities. However, to date, limited analysis has been performed on what makes an exercise an effective tool to assess public health emergency preparedness (PHEP), and how AARs can be developed and used to support PHEP improvement efforts. The scope of this project was to achieve consensus on: (1) what makes an exercise an effective tool to assess PHEP; and (2) what makes an AAR an effective tool to guide PHEP improvement efforts.

Methods: Sixty-one PHEP experts were convened by the use of Nominal Group Techniques to achieve consensus on a series of characteristics that exercises should have when designed to assess PHEP and on the recommendations for developing high-quality AARs.

Results: The panelists achieved consensus on a list of recommendations to improve the use of exercises and AARs in PHEP improvement efforts. Such recommendations ranged from the characteristics of the exercise audience to the evaluation methodology being used and the characteristics of the produced AAR such as its structure and content.

Conclusions: The characteristics of the exercise audience, scenario and scope are among the most important attributes to the effectiveness of an exercise conducted for PHEP evaluation purposes. The evaluation instruments used to gather observations need an appropriate matching between exercise objectives and the response capabilities tested during the exercise, to build the base for the production of a good AAR. Improvements in the design and creation of exercises and AARs could facilitate better reporting and measurement of preparedness outcomes.
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http://dx.doi.org/10.1017/S1049023X13000289DOI Listing
June 2013

Administration of emergency preparedness Department of Health And Human Service funds: the experience of state and local health departments.

J Public Health Manag Pract 2013 Mar-Apr;19(2):192-5

Preparedness and Emergency Response Learning Center, Harvard School of Public Health, Boston, Massachusetts 02115, USA.

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http://dx.doi.org/10.1097/PHH.0b013e3182868c25DOI Listing
December 2013

Use of after action reports (AARs) to promote organizational and systems learning in emergency preparedness.

Int J Environ Res Public Health 2012 08 16;9(8):2949-63. Epub 2012 Aug 16.

Department of Biostatistics and Division of Policy Translation and Leadership Development, Harvard School of Public Health, 401 Park Drive, Landmark Center, Boston, MA 02215, USA.

Many public health and healthcare organizations use formal knowledge management practices to identify and disseminate the experiences gained over time. The "lessons-learned" approach is one such example of knowledge management practice applied to the wider concept of organizational learning. In the field of emergency preparedness, the lessons-learned approach stands on the assumption that learning from experience improves practice and minimizes avoidable deaths and negative economic and social consequences of disasters. In this project, we performed a structured review of AARs to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness (PHEP) exercises. We chose as a source of data the "Lessons Learned Information Sharing (LLIS.gov)" system, a joined program of the U.S. Department of Homeland Security DHS and FEMA that serves as the national, online repository of lessons learned, best practices, and innovative ideas. We identified recurring challenges reported by various states and local public health agencies in the response to different types of incidents. We also strove to identify the limitations of systematic learning that can be achieved due to existing weaknesses in the way AARs are developed.
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http://dx.doi.org/10.3390/ijerph9082949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447598PMC
August 2012