Dissertations and Theses

Date of Degree

9-1-2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.)

Department

Environmental, Occupational, and Geospatial Health Sciences

Advisor(s)

Glen Johnson

Committee Members

Deborah Balk

Rachael Piltch-Loeb

Subject Categories

Demography, Population, and Ecology | Environmental Public Health | Public Health

Keywords

environmental health, disasters, extreme weather, residential mold, social isolation and loneliness

Abstract

BACKGROUND: Extreme weather events such as storms can impact health through a myriad of ways, both directly and indirectly, such as via mold, damage to and displacement from one’s home, and disrupted social networks. The study of the indirect impacts of extreme weather events is a developing field with many studies focused on single events and community-level exposures. More work is needed to understand longer-term impacts of exposures and individual-level factors that contribute to how extreme events and disasters shape health. To better prepare for and mitigate health impacts, it is necessary to study mechanisms. Demographic and socioeconomic factors such as age, race/ethnicity, and income are associated with differential vulnerability and exposure to weather-related hazards and may play a role in health outcomes. Geospatial characteristics shape the likelihood of exposure to hazards and may interact with other determinants such as social, demographic, and built environment factors to impact health. New integrations of existing datasets can provide opportunities to study individual-level, longer-term impacts of exposures to weather-related hazards. This dissertation harnessed two different data collections – addressing different spatial and temporal scales, as well as exposures and health outcomes – to assess the indirect impacts of extreme events on health, organized around the study of three aims.

METHODS: Aim 1 assessed indoor mold exposure following extreme weather by characterizing spatial and temporal patterns of residential mold complaints in New York City (NYC) through the 311 call-in system (2010 – 2025). In addition, the analysis assessed complaints following major storms as well as associations with neighborhood demographic composition, built environment characteristics, and environmental factors such as precipitation.

The Health and Retirement Study (HRS), a nationally-representative longitudinal cohort study of adults over age 50 (1992 – 2022), presented an opportunity to study how older adults are impacted by and respond to disasters by examining self-reported and location-derived exposure to disasters. Aim 2 leveraged the HRS to assess how social isolation and loneliness are associated with other known risk factors for vulnerability to disaster impacts. Additionally, Aim 2 characterized rates and trajectories of loneliness and social isolation in disaster-exposed populations. Aim 3 also used the HRS to examine whether disaster exposure is associated with mortality and other health outcomes.

RESULTS: Aim 1 found strong and significant spatial clustering of complaint rates overall and after major storms, as well as associations of weekly complaints with precipitation. Flooded areas saw significant increases in complaints following flooding compared to non-flooded areas based on a difference-in-difference analysis. Aim 2 found that, controlling for other demographic and socioeconomic characteristics, those with characteristics that influence disaster vulnerability (living with limitations of activities of daily living, in poverty, in a mobile home) were more likely to be isolated or lonely. While rates do not seem to be influenced much by disaster exposure, disaster-exposed respondents show nuanced individual trajectories, indicating heterogeneity in experiences. Aim 3 found that self-reported disaster exposure and county-level disaster exposure were both significant predictors of increased mortality and respondents who self-reported disaster exposure had significantly more limitations in activities of daily living and worse self-reported health.

DISCUSSION: Disparities exist in mold complaints, which increase after major storms and are associated with precipitation. Because exposure to residential dampness and mold is negatively associated with health, and because mold is poorly studied, an understanding of residential mold prevalence and incidence is critical to informing prevention and remediation efforts, protecting health especially after extreme weather. With higher rates of mortality and other adverse health outcomes among disaster-exposed respondents, plus evidence of heterogeneity in experiences regarding social isolation and loneliness following disasters, mechanisms should be investigated further to inform future interventions. Future work should explore alternative ways of measuring exposure to disasters and their impacts, including mold and constructs such as social isolation and loneliness.

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