The development of a household emergency plan is often regarded as one of the key elements in individual and family preparedness, which is an important part of public health emergency preparedness.^{Reference Levac, Toal-Sullivan and OSullivan1-4} Having such a plan could prove more valuable for rapid-onset disasters such as tornadoes when warnings are only issued minutes before they strike and little time is allowed for weighing different options.^{Reference Simmons and Sutter5,Reference Hoekstra, Klockow, Riley, Brotzge, Brooks and Erickson6} Of a national representative sample, 45% reported that they had emergency plans in 2016, while the percentage was 2% higher for respondents in areas prone to tornadoes.^{7,Reference Dutwin and Lavrakas8}

Despite the prominence of household emergency plans in individual and family preparedness, empirical evidence is sparse concerning what types of plans are more helpful in actual disaster settings. In addition, few studies have examined the importance of family involvement in the effectiveness of a household emergency plan, even though it is recognized that families play an important role in providing support, and mitigating the negative effects of stressful experiences of disasters while discussions among family members are encouraged for their importance to a successful planning process.^{Reference Chie, Okumura, Tai-Yuan and Wakai9}

Furthermore, this study directs attention to the unique vulnerabilities, needs, and challenges of older adults, guided by the social vulnerability perspective, which emphasizes that people with certain characteristics are vulnerable to disasters in the preparation, response, and recovery process. Older adults are over-represented in those who were injured and killed in disasters, especially tornadoes.^{Reference Legates and Biddle10,Reference Deng, Lv, Xue, Kang, Dong and Zhang11} Some studies have found higher levels of barriers faced by older adults in being prepared for disasters, which could be related to their declined health and disabilities.^{Reference Dostal12} But there are also studies showing that older adults could be more prepared than younger adults, which is contradictory to common beliefs.^{Reference Heller, Alexander, Gatz, Knight and Rose13,Reference Adams, Kaufman, Van Hattum and Moody14} For example, a national survey showed that older adults were more likely to be prepared and to have a household emergency plan.⁷ Our understanding of this subject is still very limited when considering the conflicting evidence and nuances in various contexts.

This study identified different patterns of household emergency plans based on their components and examined how effective they were when associated with those patterns and family discussions in the past two tornadoes in 2013. Built upon the Selection, Optimization, and Compensation theory (SOC) developed in gerontology, this study developed four hypotheses to investigate how the age factor was presented in the above-mentioned processes.^{Reference Baltes, Baltes, Baltes and Baltes15-Reference Weigl, Mueller, Hornung, Zacher and Angerer17}

Tornadoes, like other rapid-onset disasters, could present great threats to properties and people’s physical and mental health.^{Reference Simmons and Sutter5,Reference Bourque, Siegel, Kano, Wood, Rodríguez, Quarantelli and Dynes18} The Enhanced Fujita Scale, implemented by the National Weather Service (NWS) since 2007, categorizes tornadoes into 6 categories (EF0 to EF5) according to their wind speeds and the degree of damage.^{Reference McDonald, Mehta, Smith and Womble19} Tornadoes rated as EF-4 or EF-5 could cause astonishing damage and casualties. For example, in 2011, an EF-5 tornado in Joplin directly killed 159 people and an EF-4 tornado in Tuscaloosa resulted in 72 deaths.^20,21

The average lead time for warnings by the National Weather Service (NWS) is merely 13 minutes, which is not enough time for information seeking, and is responsible for some of the major casualties.^{Reference Simmons and Sutter5,Reference Hoekstra, Klockow, Riley, Brotzge, Brooks and Erickson6,Reference Bourque, Siegel, Kano, Wood, Rodríguez, Quarantelli and Dynes18} Therefore, being prepared in advance is essential to minimizing the risks of fear, anxiety, death, injuries, and other short and long-term health and mental health consequences.^{Reference Norris, Friedman and Watson22-Reference McNeill and Ronan24} For instance, research has shown that having a household emergency plan promotes protective and life-saving actions in tornadoes.^{21,Reference Cong, Liang and Luo25}

Governmental and non-governmental agencies provide a variety of guidelines for developing effective household emergency plans. For example, the Department of Homeland Security suggests that families should consider and plan alternative shelters, evacuation routes, and methods of communication.²⁶ The American Red Cross recommends that families record important contact info, designate an out of town contact, select a meeting place for a variety of instances/situations, and learn of disaster plans at work, school, and daycare to ensure family reunification.²⁷ The Federal Emergency Management Agency (FEMA) suggests that a Family Emergency Communication Plan should include important contact information, social media accounts, medical information, and emergency meeting places, etc.²³ Specifically for tornadoes, FEMA emphasizes the importance for the plan to include places to take shelter, either at home or in the community to provide sufficient protection.²⁸

It is noted that there is a great deal of variance in individuals’ planning process. Consistent with the social vulnerability perspective, studies have found that gender, socioeconomic status, race, age, media exposure, and experience are often related to different levels of disaster preparedness.^{Reference Ekenga and Ziyu2,Reference Norris, Smith and Kaniasty29,Reference McNeill, Dunlop, Heath, Skinner and Morrison30} For example, households with older adults, female-headed households with higher education and income levels, individuals that had experienced disasters previously, and those with more emergency-related media exposure tend to be better prepared.^{Reference McNeill, Dunlop, Heath, Skinner and Morrison30-Reference Paek, Hilyard, Freimuth, Barge and Mindlin33} Moreover, people living in areas with a history of tornadoes are likely to include a process in their plans for household members to get in touch with each other and to check on neighbors.³⁴

In the meantime, discussions among family members during the planning process could help to address individuals’ needs, reach consensus, and implicitly or explicitly execute drills.⁴ The American Red Cross encourages families to evaluate the needs of each family member and make plans by discussing potential disasters relevant to their geographical area, identifying responsibilities among them, and practicing plans.³⁵

Despite those recommendations, actual emergency plans developed by individuals could be very different from each other. Few empirical studies have evaluated the quality of those emergency plans developed and examined how helpful they are. Based on prior knowledge and recommendations of different agencies in including critical components such as shelter places, important contact information, and re-unification places, we formulated the following hypotheses:

As some subgroups in the population are shown to be more vulnerable and experience disproportional hardships in coping with disasters, we chose to take a deeper look at older adults in these settings.^{Reference Enarson36-Reference Tobin-Gurley, Peek and Loomis40} Older adults are more likely to be physically impaired and face more limitations, which prevent them from securing transportation and communication services before, during, or after disasters.^{Reference Adams, Kaufman, Van Hattum and Moody14,Reference Ngo41-Reference Sanders, Bowie and Bowie44} However, the Selection, Optimization, and Compensation theory (SOC) developed in gerontology, directs attention to processes that enable them to maintain regular functions.^{Reference Baltes, Baltes, Baltes and Baltes15-Reference Weigl, Mueller, Hornung, Zacher and Angerer17} The selection process of the theory refers to reducing the number of options that are more than allowable by available internal and external resources. Optimization refers to the process of maximizing gains and practicing goal-related skills, acquiring goal-related resources, and modeling others for the realization of goals. Compensation is to activate latent resources and acquire new resources to mitigate losses. Based on this theory, better preparation efforts, such as developing an effective household emergency plan, help older adults to concentrate on a few well-thought-out and viable options (selection) and compensate for their generally declined resources (compensation). The practice or mental visualization of those plans further helps them achieve higher performance when a real disaster occurs (optimization). Thus, we hypothesize that:

RESULTS

Table 1 showed that older and younger adults did not differ significantly in education, gender, and reporting on the effectiveness of household emergency plans. Older adults were more likely to be white (χ² (1) = 4.54, P < 0.05) but less likely to be married (χ² (1) = 11.12, P < 0.05) and to have discussed the plan with family members (χ² (1) = 7.94, P < 0.05). Older adults were also less likely to have quality household emergency plans (χ² (1) = 3.94, P < 0.05), the meaning of which was explained below in Table 2.

TABLE 1 Descriptives

* significant difference (p < .05) between age groups by χ² tests.

TABLE 2 Latent Class and Typology Developed

^a For example, this could be necessary when the home does not have a shelter, and a neighbor’s shelter or community shelter is identified.

Table 2 showed the result of a two-latent-class model. It did not differ significantly from the saturated model (χ² (50) = 65.546, P > 0.05) and thus displayed a good fit. In comparison, the three-latent-class model did not converge. Consequently, a two-latent-class model was adopted for the remainder of this study. As seen in Table 2, 27% of plans were classified into the first class whereas 73% were classified into the other. Based on the marginal means of each observable variable in each identified class, we named the first class as limited plans and the other as quality plans. Limited plans, on average, were very unlikely to include a plan telling people what to do when they are in different situations (6%), telephone numbers that they may need (8%), and a re-unification place that members in the household are aware of (11%). What was infrequently included were when to take action (31%) and having an identified place outside the home to take shelter (23%). However, 68% of those plans did have an identified place in the home to take shelter. In contrast, quality plans excelled in almost every dimension, particularly concerning an identified place in the home to take shelter (94%), telephone numbers that people may need (94%), and when to take action (88%). Quality plans outperformed limited plans in other dimensions, but with smaller margins: having an identified place outside the home to take shelter (45%); a plan telling people what to do when they are in different situations (65%); and a re-unification place that members in the household are aware of (66%).

As shown in Model 1 of Table 3, significant predictors for younger adults included place (Adjusted Odds Ratio, OR = 0.30, P < 0.05) and education; those who had some college education (OR = 5.16, P < 0.05) and graduate or professional degrees (OR = 4.98, P < 0.05) were significantly more likely than those with high school or lower certificates to report the plan as very helpful. For older adults, both discussing with family members (OR = 3.35, P < 0.05) and having a quality plan (OR = 2.37, P < 0.05) increased the helpfulness. To test whether the differences between older adults and younger adults in the impact of family discussions and plan types were statistically significant, the interaction between age groups and plan types was included in Model 4 and the interaction between age groups and family discussions was included in Model 5. Model 4 indicated that the difference between older and younger adults in terms of having a better plan was statistically significant (OR = 3.92, P < 0.05), while Model 5 showed that the difference in family discussions was not (OR = 0.82, P > 0.05).

TABLE 3 Odds Ratio (OR)^a of Predicting a Plan Provided a Lot of Help versus No help or Some help (n = 223)

^a Odds Ratios here are adjusted odds ratios, controlling for other variables in the model.

†, P < 0.1; *, P < 0.05; **, P < 0.01.