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Lahars pose a significant risk to communities, particularly those living near snow-capped volcanoes. Flows of mud and debris, typically but not necessarily triggered by volcanic activity, can have huge impacts, such as those seen at Nevado Del Ruiz, Colombia, in 1985 which led to the loss of over 23,000 lives and destroyed an entire town. We surveyed communities around Mount Rainier, Washington, United States, where over 150,000 people are at risk from lahar impacts. We explored how factors including demographics, social effects such as perceptions of community preparedness, evacuation drills, and cognitive factors such as risk perception and self-efficacy relate to preparedness when living within or nearby a volcanic hazard zone. Key findings include: women have stronger intentions to prepare but see themselves as less prepared than men; those who neither live nor work in a lahar hazard zone were more likely to have an emergency kit and to see themselves as more prepared; those who will need help to evacuate see the risk as lower but feel less prepared; those who think their community and officials are more prepared feel more prepared themselves; and benefits of evacuation drills and testing evacuation routes including stronger intentions to evacuate using an encouraged method and higher self-efficacy. We make a number of recommendations based on these findings including the critical practice of regular evacuation drills and the importance of ongoing messaging that focuses on appropriate ways to evacuate as well as the careful recommendation for residents to identify alternative unofficial evacuation routes.

Throughout the United States, state governments are allocating millions of dollars to support Voluntary Pre-Kindergarten (VPK) programs. Recent research has indicated that students that participate in VPK demonstrate higher academic achievement scores across a number of subject areas. Moreover, VPK participants are more likely to enter primary school on grade level, which in turn leads to a reduction in grade retention. Studies have indicated that although all students that participate in VPK programs benefit from such programs, minority students and students that come from low-socioeconomic backgrounds benefit at an even higher level. The intent of this study was to determine to what extent, if any, a VPK program within a large, suburban school district impacted the academic achievement and kindergarten preparedness of participants in comparison to students that did not participate in the VPK program offered by the district. To measure the impact, student scores on the 2006-2007 Florida Kindergarten Readiness Screener (FLKRS) were compared through the use of an independent samples t-test. The same students had their 3rd grade Florida Comprehensive Assessment Test (FCAT) Reading and Mathematics scored compared as well. Two groups were compared against one another. The control group was a group of students that did not participate in the VPK offered by the school district. The treatment group was the group of students that participated in the district offered VPK. The results of each of the independent sample t-tests conducted determined that there was not a statistically significant different in either student preparedness or student academic achievement between the VPK participant group and the non-participant group.

I. BACKGROUND: Following a review of donor funding priorities and concepts of health system strengthening (HSS) and resilience, this dissertation documents health system resilience factors existing in the Liberian health system in late 2014/early 2015 as the Ebola epidemic flared. The effectiveness of the WHO health system building blocks framework in addressing resilience was assessed, and specific factors that can promote health system resilience for Liberia going forward were identified. II. METHODS: Methods applied as part of this intrinsic case study include document and literature review, analysis of health facility and population-level statistics, and key informant and group interviews at the county and national levels. The methodology allowed for an in-depth assessment of how HSS (using the WHO health system building blocks) and resilience factors (using the WHO-defined key aspects of emergency preparedness) exist (or could exist) within the Liberian institutional and cultural context, and for tentative conclusions to be drawn about the importance of system factors to building specific health system capacities and overall health system resilience. III. FINDINGS: While dealing with myriad other public health priorities, public health preparedness went largely unaddressed in pre-Ebola Liberia where effectively none of the 16 key components or their 51 essential attributes listed in the WHO table of emergency preparedness were in place. The lack of integration of public health preparedness into HSS interventions left the country vulnerable to public health emergencies. There are two limitations to the government’s Ebola recovery and investment plan: (1) lack of a holistic approach to addressing emergency preparedness; and (2) not integrating emergency preparedness needs and corresponding activities into the existing national HSS framework. IV. CONCLUSION: By integrating emergency preparedness and response initiatives into HSS activities, health systems in Liberia and elsewhere can be strengthened to be more resilient, and thus better able to anticipate and adapt to challenges, and ultimately improve the system to be able to anticipate new future challenges. However, strengthening health systems so that they are resilient takes resources, including sector-wide, HSS resources that can be used to build functioning, integrated systems and skilled, networked individuals and groups across sectors.

Indiana University-Purdue University Indianapolis (IUPUI) / Background and Purpose - State Health Officials (SHOs), as the leaders of state governmental public health agencies, play a critical role in their respective states. Their decisions guide the overall actions of their organizations in executing programs, policies and activities that ultimately affect the health of the state’s population. This study will add to the research and serve as a potential guide to future SHO training, specific to decision making, in a public health emergency Methods – Twenty-one individuals, who are either currently working as SHOs or who were former SHOs, were interviewed to understand their perspectives on issues that may impact their response to a public health emergency: decision-making, interaction with the public and the media and the role of politics in public health, and other areas of consequence. Results – While the study was focused more broadly, all of the respondents specifically mentioned the COVID19 pandemic as the most complicated public health emergency they have responded to as a SHO. All respondents also mentioned that they did not have a specific decision-making tool to utilize during this emergency and primarily relied on a consensus-driven decision-making process. Additionally, issues such as the challenges of managing the media and the politicization of public health during this pandemic, were mentioned by many of the respondents. Conclusion - These findings pointed to the need for a step-by-step decision-making tool to be utilized by SHOs in a public health emergency. This has the potential to lead to a more methodical approach to SHOs decision-making during a public health emergency, including a focus on various operational aspects such as understanding the role of the media in a public health emergency, managing elected officials in a public health emergency, and lessons learned from past public health emergencies.

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The purpose of this study was to examine crisis preparedness at Christian-affiliated institutions of higher education. Second, this study examined Christian-affiliated institutions of higher education presidents’ perspective of their institution’s ability to prepare for crises based upon the four critical indicators of organizational crisis preparedness as described by Zdziarski (2001): a) the types of crisis institutions prepare for, b) the phase of crisis prepared for, c) the systems in place to respond to crisis, and d) the stakeholders involved and considered in preparations. Implications from this study provided recommendations for crisis preparedness that are specific to Christian-affiliated colleges and universities. A total of (n=77) presidents of Christian-affiliated institutions of higher education completed the Campus Crisis Management Questionnaire. Overall, results indicated that presidents of Christian-affiliated colleges and universities perceived their institutions to be well-prepared to respond to campus crises. This study adds to the crisis preparedness literature in higher education on how smaller private, specialized institutions with limited resources prepares for crisis.