Abstract
Background
On April 20, 2010, the Deepwater Horizon oil rig exploded, spilling over 4.9 million barrels of oil in the Gulf of Mexico over an 87-day period and developing into a long-term environmental disaster that affected people living in Gulf Coast states. Engagement of community members in recovery efforts is important for mitigating adverse effects of disasters and accelerating the rebuilding process for impacted communities; however, few studies have explored factors that determine participation in oil spill cleanups.
Methods
We analyzed data from the Gulf States Population Survey (GSPS) to study the determinants of participating in the Deepwater Horizon Oil Spill cleanup. The GSPS was a random-digit dialing survey conducted on 38,361 adults in counties and parishes in Alabama, Florida, Louisiana, and Mississippi impacted by the oil spill. Using survey estimation to account for the complex survey design, we estimated the probability of cleanup participation and used logistic regression to examine the association between sociodemographic factors and cleanup participation.
Results
Approximately 4.7% of residents in affected Gulf communities participated in the cleanup. Most participants were young, men, non-Hispanic white, and employed. Living in an affected coastal county was associated with higher odds of participation (unadjusted odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.28–2.24), as was having excellent or very good physical health (OR: 2.05; 95% CI: 1.11–3.81). Older persons were less likely to participate in the cleanup (OR for 65+ age group vs. 18–24 age group: 0.14; 95% CI: 0.05–0.36).
Conclusions
Understanding the demographics of cleanup participants may help inform civilian recruitment for future oil spill responses.
Keywords: Deepwater Horizon, Gulf States Population Survey, oil spill cleanup, community participation, Gulf Coast
1. Introduction
On April 20, 2010, the British Petroleum (BP)-operated Deepwater Horizon oil rig exploded in what became an environmental catastrophe, killing 11 rig workers and spilling over 4.9 million barrels of oil in the Gulf of Mexico over an 87-day period (Goldstein, Osofsky, & Lichtveld, 2011; National Commission on the BP Deepwater Horizon Oil Spill and Offshore Drilling, 2011). A disaster of such magnitude has detrimental effects on people living in both directly and indirectly affected areas, as this disaster impacted coastal communities as well as members of the response and cleanup efforts who were not exclusively local residents (Aguilera, Mendez, Pasaro, & Laffon, 2010; Laffon, Pasaro, & Valdiglesias, 2016). Research on the health effects of the oil spill identified rises in reports of depression (Buttke, Vagi, Bayleyegn, et al., 2012; Buttke, Vagi, Schnall, et al., 2012; Fan, Prescott, Zhao, Gotway, & Galea, 2015; Kwok, McGrath, et al., 2017; Lowe et al., 2016; Osofsky, Osofsky, & Hansel, 2011; Rung et al., 2016). Also, increases in anxiety were found among persons residing in places impacted by the oil spill (Buttke, Vagi, Bayleyegn, et al., 2012; Buttke, Vagi, Schnall, et al., 2012; Gould, Teich, Pemberton, Pierannunzi, & Larson, 2015; Lowe et al., 2016; Osofsky et al., 2011). Other studies examining the effects of the spill reported a greater occurrence of physical distress (Buttke, Vagi, Bayleyegn, et al., 2012; Buttke, Vagi, Schnall, et al., 2012; Fan et al., 2015; Gam et al., 2018; McGowan et al., 2017; Peres et al., 2016).
Engagement of community members in recovery efforts is important for mitigating some of the adverse environmental and health effects of disasters, like oil spills (Twigg & Mosel, 2017; Walker et al., 2013; Whittaker, McLennan, & Handmer, 2015). Much of the disaster-related research on civilian participation examines the role of communities in disaster preparedness as opposed to response and recovery efforts; however, including communities in both the planning process and implementation of recovery efforts is important for mitigating the effects of disasters (Khan, 2008; Walker, Pavia, Bostrom, Leschine, & Starbird, 2015). Research has shown that increasing community participation at the local level by recruiting civilians for response efforts improves the rebuilding process for that community (Rowlands, 2013; Walker et al., 2013; Walker et al., 2015). Studies have also found that participation in disaster response and recovery programs have beneficial impacts on mental and behavioral health of volunteers (Fukasawa, Suzuki, Obara, & Kim, 2015; Picou, 2009; Wyles, Pahl, Holland, & Thompson, 2017). Increasing civilian participation in disaster recovery activities, such as oil spill cleanups, can likely not only accelerate a community’s disaster response and recovery phase but have a beneficial effect on the well-being of community members involved in such efforts as well.
Various sociodemographic aspects determine whether and which civilians take part in disaster response and recovery tasks. There are barriers to civilian participation in disaster response and recovery activities, such as a lack of resources or social connectedness (Twigg & Mosel, 2017). Factors that enable such participation include proximity to the affected area, social and cultural capital, past experience with disasters, resources, and awareness of disaster risks (Fernandez, Barbera, & van Dorp, 2006; Smith, Hamerton, Hunt, & Sargisson, 2016; Twigg & Mosel, 2017). Demographic characteristics, such as gender and age, also influence civilian activeness in disaster recovery (Twigg & Mosel, 2017). Despite existing research, the knowledge base on which civilians participate in recovery activities is limited and varies by disaster event, requiring studies to investigate characteristics of civilian responders for specific disasters (Twigg & Mosel, 2017; Whittaker et al., 2015).
The cleanup efforts of the Deepwater Horizon oil spill involved controlled burning and releasing approximately two million gallons of dispersant chemicals to aid in the disintegration of the crude oil (Biello, 2010; National Commission on the BP Deepwater Horizon Oil Spill and Offshore Drilling, 2011; Repanich, 2010). Thousands of workers and volunteers were also employed to assist with cleanup tasks along the coastlines of affected Gulf States (Kwok, Engel, et al., 2017; National Commission on the BP Deepwater Horizon Oil Spill and Offshore Drilling, 2011). Persons opting to aid in the cleanup of the oil spill were not necessarily representative of all individuals in the Gulf communities that were impacted, and it is important to identify the subgroups of people who participated in the cleanup, especially to improve participant recruitment for future oil spills. Moreover, very few studies have explored factors that determine participation in oil spill cleanups, hence motivating this study. The objective of this study was to estimate the probability of participating in the oil spill cleanup and determine the factors associated with cleanup participation for the Deepwater Horizon oil spill.
2. Methods
2.1. Data source
Data utilized for this study originated from the Gulf States Population Survey (GSPS) (Centers for Disease Control and Prevention). The GSPS was a random-digit dialing survey conducted by the Centers for Disease Control and Prevention (CDC) in partnership with state and local health departments and the Substance Abuse and Mental Health Services Administration (SAMHSA) from December 2010 to December 2011 (Centers for Disease Control and Prevention, 2013). The GSPS involved surveying persons who were 18 years of age or older and resided in counties and parishes impacted by the 2010 Deepwater Horizon oil spill in Alabama, Florida, Louisiana, and Mississippi (Centers for Disease Control and Prevention, 2013). It was implemented to assess the physical, behavioral, and mental health of the population in the Gulf region in order to evaluate the need for behavioral and mental health services and coordinate the provision of such services in areas affected by the oil spill (Centers for Disease Control and Prevention, 2013).
In total, 38,361 individuals completed interviews that were included in the GSPS. Initially, only persons living in one of 25 coastal counties and parishes within a 32-mile area that prohibited fishing due to the oil spill were included in the study sample (Centers for Disease Control and Prevention, 2013). In May 2011, the CDC began to recruit residents of counties and parishes in the affected Gulf States that were further from the oil spill into the study sample (Centers for Disease Control and Prevention, 2013). This was to enable comparison of results between the coastal and non-coastal counties and parishes. A total of 27,947 respondents lived in one of the 25 coastal counties and parishes, while the remaining 10,414 respondents resided in non-coastal areas of the Gulf States. Also, in May 2011, the CDC allowed cell phone respondents to be included in the study sample and began to administer a Spanish version of the survey (Centers for Disease Control and Prevention, 2013). Landline-based interviews were completed by 32,813 individuals, and 5,548 individuals used cell phones to complete the GSPS survey. Persons opting to participate in the survey in Spanish accounted for 122 of the completed interviews.
The GSPS was conducted using a complex survey design, incorporating cluster methodology and disproportionate stratified sampling. Due to this, the GSPS data were weighted using similar procedures as the Behavioral Risk Factor Surveillance system (Centers for Disease Control and Prevention, 2013). In a two-step process, GSPS data were weighted to adjusted U.S. census county-level estimates, using information on age, race, sex, geographic stratification, and phone ownership (Centers for Disease Control and Prevention, 2013). All data collected for the GSPS were de-identified, aggregated, and publicly accessible.
2.2. Study measures
Demographic measures
Self-reported demographic information included age, gender, race/ethnicity, marital status, county type of residence, and state of residence. Age was categorized into groups: 1824 years, 25–34 years, 35–44 years, 45–54 years, 55–64 years, and 65 years and older. Participants reported their gender as male or female. For this study, race/ethnicity was classified as non-Hispanic White, non-Hispanic Black, Hispanic, or other. Other included persons reporting to be non-Hispanic American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and other races or ethnicities. Current marital status reported by participants was categorized as married or not married. County type of residence was categorized as either residing in a coastal county or non-coastal county. Participants also reported their state of residence being either Alabama, Florida, Louisiana, or Mississippi.
Socioeconomic and health status measures
Self-reported information on socioeconomic and health status included employment status before the oil spill, household income, general health status, physical health status, and mental health status. Employment status was classified as employed, not employed, or other, which included being a homemaker, student, or retiree. Pre-oil spill employment was selected for inclusion rather than post-oil spill employment to ensure the temporality of this exposure variable and that cleanup participation did not influence a participant’s employment status (i.e. participating in the cleanup in order to earn an income). Estimated annual household income in 2010 was categorized into groups: Less than $25,000, $25,000-$49,999, $50,000-$74,999, and $75,000 or more. The variables for general health status, physical health status, and mental health status were categorized into the following groups based on health status reported at the time of interview: poor or fair; good; very good or excellent.
Outcome measures
Primarily, the outcome of interest was whether a survey respondent participated in the Deepwater Horizon oil spill cleanup activities. This variable was categorized as yes or no. Information on the position a respondent held during cleanup activities was collected and categorized as volunteer or paid. Information on the specific type of cleanup activity in which a respondent participated was also collected, which included helping with beach or marsh cleanup, bird or wildlife cleanup, boom deployment and recovery or off-shore skimming, decontamination or waste stream management, well-head cleanup or controlled burning, administrative, logistical, or medical support, and other cleanup activities. In any analysis investigating specific cleanup activities, activity participation was not analyzed mutually exclusively, allowing for full incorporation of the data on participants who performed multiple cleanup tasks.
2.3. Statistical analysis
In brief, summary statistics were generated using survey estimation methods, and logistic regression models were used to examine demographic, socioeconomic, and health factors associated with participating in the Deepwater Horizon oil spill cleanup. Using survey estimation, we estimated the probability of participating in the oil spill cleanup among the overall population of the four affected Gulf States and among demographic, socioeconomic, and health status subpopulations. Further, we estimated the probability of participating in specific cleanup activities among the overall population of cleanup participants and by whether a participant was a volunteer or was paid for cleanup services.
In addition, we used univariate logistic regression models to examine whether demographic, socioeconomic, and health factors were associated with oil spill cleanup participation. Univariate logistic regression methods were primarily emphasized for this study, as this research is exploratory in nature. As very few studies have been conducted to explore factors that are associated with participation in oil spill cleanups, there is not enough existing research to conduct a study more analytic in scope. Therefore, we elected to conduct this exploratory study to investigate whether certain factors are associated with cleanup participation of oil spills, and the findings from this study can be used to inform future analytic epidemiologic research in this area.
Using subpopulation estimation in the univariate logistic regression models, we also investigated whether these factors were associated with cleanup participation by specific Gulf State and residential county type (coastal versus non-coastal). Statistical significance for all logistic regression analyses was set to an alpha level of 0.05. Missing data were handled by multiple imputation using chained equations with 65 imputed datasets (Azur, Stuart, Frangakis, & Leaf, 2011). All analyses were performed using Stata SE 15.1 (StataCorp LP, College Station, Texas, USA).
3. Results
3.1. Descriptive characteristics of cleanup participation
Characteristics of the overall population of the four affected Gulf States, stratified by cleanup participation, are provided in Table 1. Approximately 4.7% (95% confidence interval [CI]: 3.7–5.6%) of residents in these states participated in the oil spill cleanup. Participants in cleanup efforts were mostly younger in age, as many were either aged 18–24 years (22.3%; 95% CI: 11.5–33.0%) or 25–34 years (26.8%; 95% CI: 17.7–35.9%). A majority of cleanup participants were men (56.2%; 95% CI: 45.8–66.7%) and of non-Hispanic white race (68.0%; 95% CI: 57.0–78.9%). Participants in the cleanup reported high employment rates prior to the occurrence of the oil spill (64.0%; 95% CI: 52.8–75.1%), and nearly one-third were students, retirees, or homemakers (27.5%; 95% CI: 16.3–38.6%). A majority of participants reported being from non-coastal areas (82.6%; 95% CI: 78.8–86.5%). Most of the participants were from the state of Florida (70.6%; 95% CI: 63.7–77.6%) followed by Louisiana (13.0%; 95% CI: 9.916.2%), Alabama (11.8%; 95% CI: 7.2–16.4%), and Mississippi (4.5%; 95% CI: 2.5–6.6%). Many reported very good or excellent overall health at the time of the survey (64.7%; 95%: 54.275.3%). See Table 1 for further descriptive information.
Table 1.
Demographic, socioeconomic, and health characteristics of participation in the Deepwater Horizon oil spill cleanup.
| Characteristic | Total | Participated | Did not participate | |||
|---|---|---|---|---|---|---|
| % | 95% CI | % | 95% CI | % | 95% CI | |
| Total Population | 4.7 | 3.7, 5.6 | 95.3 | 94.4, 96.3 | ||
| Age group | ||||||
| 18–24 | 11.4 | 9.9, 12.8 | 22.3 | 11.5, 33.0 | 10.8 | 9.4, 12.3 |
| 25–34 | 17.5 | 15.9, 19.1 | 26.8 | 17.7, 35.9 | 17.1 | 15.4, 18.7 |
| 35–44 | 16.4 | 14.8, 18.1 | 17.3 | 10.1,24.4 | 16.4 | 14.7, 18.1 |
| 45–54 | 17.8 | 16.2, 19.4 | 13.6 | 7.7, 19.5 | 18.0 | 16.3, 19.7 |
| 55–64 | 14.8 | 13.5, 16.2 | 13.6 | 6.8, 20.5 | 14.9 | 13.5, 16.3 |
| 65 + | 22.1 | 20.2, 23.9 | 6.5 | 1.7, 11.3 | 22.8 | 20.9, 24.7 |
| Gender | ||||||
| Male | 48.3 | 46.1,50.5 | 56.2 | 45.8, 66.7 | 47.9 | 45.7, 50.1 |
| Female | 51.7 | 49.5, 53.9 | 43.8 | 33.3, 54.2 | 52.1 | 49.9, 54.3 |
| Race/Ethnicity | ||||||
| White, Not Hispanic | 63.2 | 61.0, 65.5 | 68.0 | 57.0, 78.9 | 63.0 | 60.7, 65.3 |
| Black, Not Hispanic | 19.1 | 17.4, 20.7 | 16.6 | 6.8, 26.5 | 19.2 | 17.5, 20.9 |
| Hispanic | 11.4 | 9.5, 13.3 | 7.9 | 1.3, 14.5 | 11.6 | 9.6, 13.5 |
| Other | 6.3 | 4.9, 7.7 | 7.5 | 2.2, 12.9 | 6.3 | 4.8, 7.7 |
| Employment status | ||||||
| Employed | 54.6 | 52.5, 56.8 | 64.0 | 52.8, 75.1 | 54.2 | 51.9, 56.4 |
| Not employed | 12.9 | 11.5, 14.4 | 8.5 | 2.8, 14.3 | 13.2 | 11.7, 14.6 |
| Other | 32.4 | 30.4, 34.5 | 27.5 | 16.3, 38.6 | 32.7 | 30.6, 34.8 |
| Household income | ||||||
| Less than $25,000 | 33.0 | 30.8, 35.1 | 26.1 | 15.5, 36.6 | 33.3 | 31.1,35.5 |
| $25,000 – $49,999 | 24.7 | 22.8, 26.7 | 28.3 | 17.6, 39.0 | 24.5 | 22.6, 26.5 |
| $50,000 – $74,999 | 16.5 | 14.7, 18.3 | 17.9 | 8.2, 27.5 | 16.4 | 14.6, 18.2 |
| $75,000 or more | 25.8 | 23.8, 27.8 | 27.8 | 18.9, 36.6 | 25.7 | 23.7, 27.7 |
| Marital status | ||||||
| Married | 52.0 | 49.8, 54.1 | 42.8 | 32.4, 53.1 | 52.4 | 50.2, 54.6 |
| Not married | 48.0 | 45.9, 50.2 | 57.2 | 46.9, 67.6 | 47.6 | 45.4, 49.8 |
| County type | ||||||
| Coastal | 11.3 | 11.0, 11.6 | 17.4 | 13.5, 21.2 | 11.0 | 10.7, 11.4 |
| Non-coastal | 88.7 | 88.4, 89.0 | 82.6 | 78.8, 86.5 | 89.0 | 88.6, 89.3 |
| State of residence | ||||||
| Alabama | 15.2 | 14.5, 15.8 | 11.8 | 7.2, 16.4 | 15.3 | 14.7, 16.0 |
| Florida | 61.5 | 60.6, 62.5 | 70.6 | 63.7, 77.6 | 61.1 | 60.0, 62.1 |
| Louisiana | 14.1 | 13.8, 14.5 | 13.0 | 9.9, 16.2 | 14.2 | 13.8, 14.6 |
| Mississippi | 9.2 | 8.7, 9.6 | 4.5 | 2.5, 6.6 | 9.4 | 8.9, 9.9 |
| General health status | ||||||
| Poor or fair | 15.8 | 14.2, 17.4 | 13.0 | 5.8, 20.3 | 16.0 | 14.3, 17.6 |
| Good | 28.9 | 27.0, 30.9 | 22.2 | 12.7, 31.8 | 29.3 | 27.2, 31.3 |
| Excellent or very good | 55.2 | 53.1,57.4 | 64.7 | 54.2, 75.3 | 54.8 | 52.5, 57.0 |
| Physical health status | ||||||
| Poor or fair | 19.0 | 17.3, 20.7 | 11.4 | 5.4, 17.4 | 19.4 | 17.6, 21.1 |
| Good | 29.8 | 27.8, 31.8 | 27.6 | 17.7, 37.6 | 29.9 | 27.8, 32.0 |
| Excellent or very good | 51.2 | 49.0, 53.4 | 61.0 | 50.5, 71.4 | 50.7 | 48.5, 52.9 |
| Mental health status | ||||||
| Poor or fair | 10.9 | 9.4, 12.4 | 14.8 | 5.3, 24.3 | 10.7 | 9.2, 12.2 |
| Good | 21.7 | 19.9, 23.5 | 13.9 | 7.8, 19.9 | 22.1 | 20.3, 23.9 |
| Excellent or very good | 67.4 | 65.3, 69.5 | 71.4 | 61.3, 81.4 | 67.2 | 65.1,69.3 |
Data source: CDC, Gulf States Population Survey, 2010–2011.
CI: confidence interval
3.2. Characteristics of cleanup participation by task
Results describing cleanup participation by specific cleanup task are presented in Table 2. Most of the cleanup participants were volunteers (70.4%; 95% CI: 61.9–78.9%), and 29.6% (95% CI: 21.1–38.1%) were paid for their cleanup services. Most of the cleanup participants assisted with beach or marsh cleanup (71.3%; 95% CI: 61.9–80.7%), and nearly one-third participated in bird or wildlife cleanup activities (29.6%; 95% CI: 19.6–39.7%). Approximately one of four participants assisted with either decontamination or waste stream management tasks (24.9%; 95% CI: 14.8–35.0%) or administrative, logistical, or medical support (25.7%; 95% CI: 17.0–34.3%). Very few cleanup participants assisted with well-head cleanup or controlled burning (3.7%; 95% CI: 0.62–6.8%). There were differences by whether a cleanup participant volunteered or was paid for assisting with the oil spill cleanup. Of the volunteer cleanup participants, 72.8% (95% CI: 67.4–78.3%) participated in beach or marsh cleanup, and 52.0% (95% CI: 42.9–61.2%) of the paid participants participated in beach or marsh cleanup. Of the volunteer participants, 7.1% (95% CI: 4.2–10.0%) assisted with boom deployment and recovery or off-shore skimming compared to 36.7% (95% CI: 28.2–45.1%) of paid participants. Of the cleanup participants who volunteered, 12.2% (95% CI: 7.6–16.8%) aided with decontamination or waste stream management, while 39.5% (95% CI: 29.6–49.4%) of the paid cleanup participants helped with decontamination or waste stream management. See Table 2 for additional differences by participant type.
Table 2.
Activity characteristics of participation in the Deepwater Horizon oil spill cleanup.
| Any participation | Volunteer participation | Paid participation | ||||
|---|---|---|---|---|---|---|
| % | 95% Cl | % | 95% Cl | % | 95% Cl | |
| Total Population | 70.4 | 61.9, 78.9 | 29.6 | 21.1,38.1 | ||
| Activity | ||||||
| Beach or marsh cleanup | 71.3 | 61.9, 80.7 | 72.8 | 67.4, 78.3 | 52.0 | 42.9, 61.2 |
| Bird or wildlife cleanup | 29.6 | 19.6, 39.7 | 29.8 | 23.1,36.5 | 15.9 | 10.3, 21.6 |
| Boom deployment and recovery or off-shore skimming | 14.4 | 9.0, 19.8 | 7.1 | 4.2, 10.0 | 36.7 | 28.2, 45.1 |
| Decontamination or waste stream management | 24.9 | 14.8, 35.0 | 12.2 | 7.6, 16.8 | 39.5 | 29.6, 49.4 |
| Well-head cleanup or controlled burning | 3.7 | 0.62, 6.8 | 2.8 | 0.38, 5.3 | 6.6 | 2.0, 11.1 |
| Administrative, logistical, or medical support | 25.7 | 17.0, 34.3 | 21.0 | 15.4, 26.7 | 38.4 | 28.8, 48.0 |
| Other | 15.6 | 8.5, 22.7 | 16.0 | 11.5, 20.4 | 21.1 | 14.4, 27.9 |
Data source: CDC, Gulf States Population Survey, 2010–2011.
Note. Activity participation is not mutually exclusive, thus column percentages do not sum to 100%.
CI: confidence interval
3.3. Factors associated with cleanup participation
Table 3 presents the findings from the univariate logistic regression analyses. Results indicated that living in an affected coastal county on the Gulf was associated with higher odds of participating in the oil spill cleanup (unadjusted odds ratio [OR]: 1.69; 95% CI: 1.28–2.24), as was having excellent or very good physical health (OR: 2.05; 95% CI: 1.11–3.81). Older adults, or those aged 65 years and older, were less likely to participate in the cleanup (OR vs. 18–24 age group: 0.14; 95% CI: 0.05–0.36). This finding was similar to results for middle-aged participants between 45–54 years (OR vs. 18–24 age group: 0.37; 95% CI: 0.17–0.77).
Table 3.
Unadjusted estimates of factors associated with participation in the Deepwater Horizon oil spill cleanup.
| Factor | OR | 95% CI | P value |
|---|---|---|---|
| Age group | |||
| 18–24 | Ref | ||
| 25–34 | 0.76 | 0.37, 1.57 | 0.461 |
| 35–44 | 0.51 | 0.24, 1.08 | 0.080 |
| 45–54 | 0.37 | 0.17, 0.77 | 0.009* |
| 55–64 | 0.44 | 0.20, 1.00 | 0.050 |
| 65 + | 0.14 | 0.05, 0.36 | <0.001* |
| Gender | |||
| Female | Ref | ||
| Male | 1.40 | 0.90, 2.16 | 0.132 |
| Race/Ethnicity | |||
| White, Not Hispanic | Ref | ||
| Black, Not Hispanic | 0.80 | 0.39, 1.65 | 0.549 |
| Hispanic | 0.62 | 0.25, 1.53 | 0.304 |
| Other | 1.11 | 0.50, 2.50 | 0.795 |
| Employment status | |||
| Employed | Ref | ||
| Not employed | 0.55 | 0.26, 1.15 | 0.112 |
| Other | 0.71 | 0.40, 1.26 | 0.246 |
| Household income | |||
| Less than $25,000 | Ref | ||
| $25,000 – $49,999 | 1.47 | 0.75, 2.92 | 0.264 |
| $50,000 – $74,999 | 1.39 | 0.64, 3.03 | 0.406 |
| $75,000 or more | 1.38 | 0.77, 2.50 | 0.281 |
| Marital status | |||
| Married | Ref | ||
| Not married | 1.47 | 0.96, 2.28 | 0.079 |
| County type | |||
| Non-coastal | Ref | ||
| Coastal | 1.69 | 1.28, 2.24 | <0.001* |
| State of residence | |||
| Alabama | Ref | ||
| Florida | 1.51 | 0.92, 2.46 | 0.103 |
| Louisiana | 1.20 | 0.79, 1.82 | 0.402 |
| Mississippi | 0.63 | 0.35, 1.12 | 0.113 |
| General health status | |||
| Poor or fair | Ref | ||
| Good | 0.93 | 0.42, 2.06 | 0.861 |
| Excellent or very good | 1.45 | 0.75, 2.81 | 0.268 |
| Physical health status | |||
| Poor or fair | Ref | ||
| Good | 1.58 | 0.78, 3.20 | 0.206 |
| Excellent or very good | 2.05 | 1.11, 3.81 | 0.022* |
| Mental health status | |||
| Poor or fair | Ref | ||
| Good | 0.45 | 0.19, 1.09 | 0.076 |
| Excellent or very good | 0.77 | 0.35, 1.68 | 0.512 |
Data source: CDC, Gulf States Population Survey, 2010–2011.
P value < 0.05
OR: odds ratio
CI: confidence interval
Findings from additional logistic regression analyses stratified by Gulf State are provided in Table A1 in the Appendix. In Alabama, men had higher odds of cleanup participation (OR: 3.01; 95% CI: 1.50–6.05). Similar results were found in Louisiana (OR: 2.40; 95% CI: 1.74–3.32). Also, in both Alabama and Louisiana, black residents had lower odds of participating, and residents who were not employed or were a student, homemaker, or retiree were less likely to participate in the cleanup. For the state of Florida, persons not currently married were more likely to participate in the cleanup (OR: 1.95; 95% CI: 1.05–3.63). Having an annual income of $75,000 or more was associated with higher odds of oil spill cleanup participation in Mississippi (OR: 4.82; 95% CI: 1.87–12.44). Such findings were found in Alabama and Louisiana as well. See Table A1 for complete logistic regression results by state. Additional logistic regression results by county type of residence can be found in Table A2 in the Appendix.
Based upon previous research and results from the univariate regression analyses in this current study, a post-hoc secondary analysis was conducted using multivariable regression models to further examine the initial exploratory findings reported in Table 3 and Tables A1 and A2 in the Appendix. Prior studies on the Deepwater Horizon oil spill have found differences in cleanup participants and non-participants by age, sex, race and ethnicity, educational attainment, income, and residence (Kwok, Engel, et al., 2017). Thus, age group, gender, race/ethnicity, household income, county type of residence, and state of residence were included in the multivariable regression model. Employment status was included in the model as a proxy for educational attainment based on Kwok et al.’s work, and physical health status was also included based upon multiple statistically significant results from each of this study’s univariate regression analyses, as presented in Tables 3, A1, and A2. Table 4 presents the findings from the post-hoc analysis, confirming the negative associations between older age and cleanup participation among persons aged 45–54 years (adjusted odds ratio [AOR] vs. 18–24 age group: 0.36; 95% CI: 0.17–0.76) and persons aged 65 years and older (AOR vs. 18–24 age group: 0.13; 95% CI: 0.05–0.35). Similarly to the univariate analyses, living in an affected coastal county was associated with a greater likelihood of participating in the oil spill cleanup (AOR: 2.21; 95% CI: 1.77–2.76). In addition, being from the state of Florida was associated with higher odds of participation in the cleanup (AOR: 1.81; 95% CI: 1.07–3.08). See Table 4 for further results from the post-hoc multivariable analysis.
Table 4.
Adjusted estimates of factors associated with participation in the Deepwater Horizon oil spill cleanup.
| Factor | AOR | 95% CI | P value |
|---|---|---|---|
| Age group | |||
| 18–24 | Ref | ||
| 25–34 | 0.71 | 0.35, 1.46 | 0.355 |
| 35–44 | 0.50 | 0.24, 1.06 | 0.070 |
| 45–54 | 0.36 | 0.17, 0.76 | 0.007* |
| 55–64 | 0.45 | 0.19, 1.06 | 0.067 |
| 65 + | 0.13 | 0.05, 0.35 | <0.001* |
| Gender | |||
| Female | Ref | ||
| Male | 1.29 | 0.83, 2.01 | 0.253 |
| Race/Ethnicity | |||
| White, Not Hispanic | Ref | ||
| Black, Not Hispanic | 0.88 | 0.41, 1.88 | 0.741 |
| Hispanic | 0.55 | 0.22, 1.41 | 0.215 |
| Other | 1.08 | 0.47, 2.44 | 0.862 |
| Employment status | |||
| Employed | Ref | ||
| Not employed | 0.78 | 0.32, 1.93 | 0.598 |
| Other | 0.99 | 0.54, 1.81 | 0.971 |
| Household income | |||
| Less than $25,000 | Ref | ||
| $25,000 – $49,999 | 1.30 | 0.61, 2.77 | 0.498 |
| $50,000 – $74,999 | 1.11 | 0.45, 2.75 | 0.815 |
| $75,000 or more | 1.13 | 0.56, 2.29 | 0.729 |
| County type | |||
| Non-coastal | Ref | ||
| Coastal | 2.21 | 1.77, 2.76 | <0.001* |
| State of residence | |||
| Alabama | Ref | ||
| Florida | 1.81 | 1.07, 3.08 | 0.028* |
| Louisiana | 0.89 | 0.58, 1.34 | 0.566 |
| Mississippi | 0.60 | 0.33, 1.09 | 0.092 |
| Physical health status | |||
| Poor or fair | Ref | ||
| Good | 1.26 | 0.57, 2.77 | 0.565 |
| Excellent or very good | 1.50 | 0.71, 3.19 | 0.289 |
Data source: CDC, Gulf States Population Survey, 2010–2011.
P value < 0.05
AOR: adjusted odds ratio
CI: confidence interval
4. Discussion
Engaging local communities in the cleanup of oil spills can benefit the well-being of participating residents and expedite the post-oil spill recovery phase, such as through providing job training and additional income to civilians or building resilience in affected communities (Gulf Research Program, 2015; Walker et al., 2013; Walker et al., 2015). However, little research has been conducted to investigate the factors associated with whether a resident participates in the cleanup of an oil spill. In this large sample of persons residing in Gulf States affected by the Deepwater Horizon oil spill, we found associations between certain demographic, socioeconomic, and health-related factors and oil spill cleanup participation. While overall cleanup participation was low amongst the populations of the affected Gulf States, results indicated that persons who were younger, male, white, employed before the oil spill, and single were highly represented among cleanup participants. Having a very good or excellent health status was also a characteristic of participating in the cleanup, and nearly seven out of ten participants were volunteers. It was also evident that most cleanup participants assisted with less dangerous cleanup tasks, as well-head cleanup or controlled burning was the least participated task.
Findings from the logistic regression analyses indicated that living in areas closest to and directly impacted by the oil spill was associated with participating in the cleanup of the spill. This was confirmed when conducting the post-hoc multivariable regression analysis. This was also found when analyzing data from each of the four affected Gulf States, potentially signifying that those residing in affected communities may be most easily mobilized and motivated to improve their communities and assist with disaster recovery from an oil spill. Having very good or excellent physical health was positively associated with cleanup participation, and persons of older ages had lower odds of participating in the oil spill cleanup. This association between older age and cleanup participation was also validated in the multivariable analysis. In addition, factors associated with cleanup participation differed by county type of residence. As shown in Table A2 of the Appendix, having a high income and good, very good, or excellent health as well as being younger in age, male, employed, and not of black race were associated with greater odds of cleanup participation among individuals from coastal counties; however, of these factors, only younger age had such an association with cleanup among those with residence in non-coastal counties.
When stratifying by Gulf State in the logistic regression, we found that sociodemographic factors of cleanup participants varied by state. While being of young age and not currently married were associated with participating in cleanup efforts among Floridians, having a high income was associated with participation among Mississippians. Among Alabamians and Louisianians, being male and having employment, a high income, and optimal physical health were associated with participating in the oil spill cleanup. Also, among Louisianians, younger age and very good or excellent general health were associated with cleanup participation. Further, being of black race was associated with lower participation in the cleanup among Alabamians and Louisianians.
These are important findings because they signify that persons who may be members of vulnerable populations based on age, race and ethnicity, gender, or socioeconomic status are less likely to be involved in the oil spill cleanup, which is problematic in that these persons face unique risks and adverse health effects, and experiencing an oil spill may only exacerbate their present circumstances. Participation in post-disaster cleanups aids in community resilience, and it should be determined how to best engage these groups in cleanup activities to improve the resilience of whole communities (Gulf Research Program, 2015; Walker et al., 2013; Walker et al., 2015). Past research has found that community participation in disaster response mostly involves and engages those who are local elites, excluding vulnerable groups (Khan, 2008), which is consistent with our study findings as well.
Thus, populations who are already more likely to experience adverse effects of disasters are also disproportionately not participating in oil spill cleanups nor being exposed to the potentially mitigating effects that derive from increased social engagement. Such groups are also not being exposed to the potential income and job training to be gained from paid cleanup work, and these disparities may be addressed with more community-wide recruitment of civilians for future oil spill response efforts. In fact, there have been appeals in regards to this issue to view vulnerable groups in terms of their resilience, social capital, and capacity to contribute to disaster recovery efforts and less in terms of their vulnerability status (Khan, 2008). Moreover, future studies should explore why vulnerable populations had lower participation in oil spill recovery activities.
Limitations of this study should be considered. First, self-reported data can be biased if any GSPS respondents exhibited recall bias or answered some questions with dishonesty due to social desirability bias. Since some of the GSPS data were collected within a year of the oil spill, and all data were collected within two years of the spill, recall bias may be minimized. We also incorporated variables for health status at the time of survey as opposed to self-reported health status before the oil spill to minimize recall bias for this highly time-varying measure. Moreover, the CDC’s interview procedures were standardized; the surveys were not conducted in-person, and interviewers received sufficient training in administering the GSPS survey, thus minimizing the likelihood of social desirability bias and data collection inconsistencies.
Second, our study investigates civilian participation in initial cleanup activities only. The cleanup of the oil spill continued up until April 2014 and, likely, some time afterwards (Ramseur, 2015). Since the GSPS survey was conducted between December 2010 and December 2011 with a focus on initial cleanup efforts, the survey did not capture cleanup participants in later years. Recruitment efforts for an oil spill cleanup in later years may be very different from those for initial cleanup activities, and future research should investigate these potential differences. In addition, cleanup participants who originated from non-coastal areas may be systematically different from the initial survey population because they were not recruited until May 2011 as opposed to the December 2010 recruitment start for the initial population. Similarly, cell phone respondents and Spanish language respondents may also be systematically different from the initial GSPS population due to the recruitment lag. While it is difficult to determine whether the participation of the non-coastal, cell phone, and Spanish language respondents is biased based on the current data, future studies should intend to collect this missing information and further examine the potential impact of the recruitment lags.
Lastly, our study was based on a cross-sectional design, and our study objectives were exploratory in nature, inhibiting us from drawing causal conclusions between participating in the cleanup of the Deepwater Horizon oil spill and demographic, socioeconomic, and health-related factors. With this, it is important to note that since our analyses in this exploratory study were primarily univariate, future research may wish to conduct more robust multivariable logistic regression analyses and interaction tests to determine whether there are further nuances to participating in oil spill cleanups.
This research is distinct from previous work and provides additional insight into the determinants of civilian participation in oil spill cleanups due to the inclusion of a broader study population. In our study, we compared persons participating in the cleanup to those who did not among all persons residing in Alabama, Florida, Louisiana, and Mississippi. Prior studies have compared cleanup participants to those who did not participate among a cohort of workers trained for the oil spill cleanup (Kwok, Engel, et al., 2017), not among the whole populations living in the affected states, as in our study. While the population included in our study coincides with the work of Kwok and colleagues in regards to race and ethnicity, our study population is younger and wealthier as well as has lower proportions of male and married cleanup participants than Kwok et al.’s study population, contributing to differences in our findings compared to Kwok and colleagues’ results (Kwok, Engel, et al., 2017). Largely, since our study examined cleanup participation of persons residing in Alabama, Florida, Louisiana, and Mississippi, not solely persons trained to assist with the oil spill cleanup, our results further the work done by previous researchers and can be utilized to inform civilian participation in oil spill cleanups for a more extensive population.
In closing, to our knowledge, few studies have specifically explored the factors that are associated with civilian participation in an oil spill cleanup, adding to the novelty of this work. Our study found that those who are young, white, male, and single were most likely to participate in the Deepwater Horizon oil spill cleanup. This research provides further evidence for recognizing that persons who are of high socioeconomic status and of great health have a higher probability of participating in oil spill cleanups. Our results may also be useful for identifying and targeting populations that are not greatly represented among the cleanup participants in efforts to include persons from vulnerable, hard-to-reach groups and diversify oil spill response efforts. In closing, understanding the demographics of cleanup participants may help inform how best to recruit community members for future oil spill responses.
Highlights.
An estimated 4.7% of residents in impacted areas participated in the cleanup of the Deepwater Horizon oil spill
Most cleanup participants were young, male, white, single, and employed before the oil spill, highlighting the need to target members of underrepresented groups for cleanups
Approximately seven out of ten participants were volunteers, with most persons assisting with less dangerous cleanup tasks
Having optimal physical health and living in an affected coastal county were associated with cleanup participation, while older persons were less likely to participate
Acknowledgements
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: JDS was supported in part by the Laney Graduate School at Emory University and the National Institute of General Medical Sciences (R25 GM99644–3S1). JAK was supported in part by the Laney Graduate School at Emory University. MOG was supported in part by funding from the National Institute of Environmental Health Sciences (P30 ES019776). The authors wish to thank the study participants of the Gulf States Population Survey (GSPS). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
APPENDIX A
Table A1.
Factors associated with participation in the Deepwater Horizon oil spill cleanup by state of residence.
| Factor | Alabama | Florida | Louisiana | Mississippi | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OR | 95% CI | P value | OR | 95% CI | P value | OR | 95% CI | P value | OR | 95% CI | P value | |
| Age group | ||||||||||||
| 18–24 | Ref | Ref | Ref | Ref | ||||||||
| 25–34 | 0.57 | 0.20, 1.64 | 0.293 | 0.71 | 0.28, 1.83 | 0.477 | 0.85 | 0.52, 1.38 | 0.517 | 2.70 | 0.65, 11.24 | 0.172 |
| 35–44 | 1.53 | 0.50, 4.66 | 0.456 | 0.34 | 0.12, 0.98 | 0.045* | 0.66 | 0.41, 1.08 | 0.096 | 2.69 | 0.62, 11.79 | 0.188 |
| 45–54 | 0.86 | 0.28, 2.67 | 0.798 | 0.27 | 0.10, 0.75 | 0.012* | 0.50 | 0.29, 0.86 | 0.012* | 1.34 | 0.38, 4.80 | 0.650 |
| 55–64 | 0.66 | 0.13, 3.42 | 0.623 | 0.41 | 0.15, 1.16 | 0.093 | 0.31 | 0.18, 0.53 | <0.001* | 0.97 | 0.27, 3.52 | 0.967 |
| 65 + | 0.36 | 0.08, 1.63 | 0.186 | 0.11 | 0.03, 0.37 | <0.001* | 0.12 | 0.06, 0.23 | <0.001* | 0.39 | 0.10, 1.60 | 0.191 |
| Gender | ||||||||||||
| Female | Ref | Ref | Ref | Ref | ||||||||
| Male | 3.01 | 1.50, 6.05 | 0.002* | 1.11 | 0.61,2.01 | 0.730 | 2.40 | 1.74, 3.32 | <0.001* | 1.67 | 0.73, 3.85 | 0.228 |
| Race/Ethnicity | ||||||||||||
| White, Not Hispanic | Ref | Ref | Ref | Ref | ||||||||
| Black, Not Hispanic | 0.22 | 0.07, 0.67 | 0.008* | 1.27 | 0.47, 3.38 | 0.636 | 0.58 | 0.38, 0.89 | 0.013* | 0.52 | 0.16, 1.65 | 0.266 |
| Hispanic | 2.88 | 0.50, 16.69 | 0.237 | 0.49 | 0.17, 1.42 | 0.191 | 1.28 | 0.65, 2.54 | 0.476 | 0.26 | 0.06, 1.14 | 0.075 |
| Other | 3.53 | 1.14, 10.90 | 0.028* | 0.83 | 0.27, 2.58 | 0.747 | 1.59 | 0.92, 2.75 | 0.094 | 1.23 | 0.39, 3.88 | 0.724 |
| Employment status | ||||||||||||
| Employed | Ref | Ref | Ref | Ref | ||||||||
| Not employed | 0.24 | 0.08, 0.74 | 0.013* | 0.66 | 0.24, 1.82 | 0.422 | 0.33 | 0.18, 0.59 | <0.001* | 1.10 | 0.30, 3.96 | 0.889 |
| Other | 0.36 | 0.15, 0.85 | 0.021* | 0.87 | 0.42, 1.79 | 0.698 | 0.44 | 0.29, 0.65 | <0.001* | 0.46 | 0.20, 1.08 | 0.076 |
| Household income | ||||||||||||
| Less than $25,000 | Ref | Ref | Ref | Ref | ||||||||
| $25,000 – $49,999 | 1.05 | 0.35, 3.12 | 0.931 | 1.39 | 0.58, 3.34 | 0.463 | 1.75 | 1.08, 2.86 | 0.024* | 2.81 | 1.04, 7.60 | 0.042* |
| $50,000 – $74,999 | 1.30 | 0.36, 4.62 | 0.689 | 1.31 | 0.49, 3.49 | 0.593 | 1.11 | 0.65, 1.89 | 0.700 | 2.85 | 0.69, 11.71 | 0.146 |
| $75,000 or more | 4.38 | 1.68, 11.46 | 0.003* | 0.84 | 0.36, 1.98 | 0.688 | 2.28 | 1.48, 3.50 | <0.001* | 4.82 | 1.87, 12.44 | 0.001* |
| Marital status | ||||||||||||
| Married | Ref | Ref | Ref | Ref | ||||||||
| Not married | 0.57 | 0.28, 1.18 | 0.133 | 1.95 | 1.05, 3.63 | 0.034* | 1.01 | 0.75, 1.38 | 0.928 | 0.79 | 0.33, 1.87 | 0.587 |
| County type | ||||||||||||
| Non-coastal | Ref | Ref | Ref | Ref | ||||||||
| Coastal | 3.71 | 2.01,6.84 | <0.001* | 1.49 | 1.03, 2.16 | 0.036* | 1.86 | 1.35, 2.58 | <0.001* | 7.63 | 3.33, 17.45 | <0.001* |
| General health status | ||||||||||||
| Poor or fair | Ref | Ref | Ref | Ref | ||||||||
| Good | 1.44 | 0.47, 4.44 | 0.524 | 0.85 | 0.30, 2.39 | 0.752 | 1.08 | 0.67, 1.74 | 0.760 | 0.78 | 0.18, 3.40 | 0.744 |
| Excellent or very good | 2.59 | 0.90, 7.44 | 0.078 | 1.19 | 0.51,2.81 | 0.687 | 2.27 | 1.49, 3.46 | <0.001* | 1.68 | 0.39, 7.31 | 0.489 |
| Physical health status | ||||||||||||
| Poor or fair | Ref | Ref | Ref | Ref | ||||||||
| Good | 1.19 | 0.45, 3.16 | 0.730 | 1.83 | 0.68, 4.93 | 0.233 | 1.58 | 0.99, 2.53 | 0.055 | 0.34 | 0.10, 1.14 | 0.080 |
| Excellent or very good | 2.99 | 1.14, 7.88 | 0.026* | 2.06 | 0.83, 5.08 | 0.118 | 2.39 | 1.60, 3.57 | <0.001* | 0.73 | 0.22, 2.35 | 0.592 |
| Mental health status | ||||||||||||
| Poor or fair | Ref | Ref | Ref | Ref | ||||||||
| Good | 0.78 | 0.25, 2.46 | 0.670 | 0.33 | 0.11, 1.04 | 0.058 | 1.27 | 0.70, 2.32 | 0.427 | 0.98 | 0.11,8.61 | 0.982 |
| Excellent or very good | 1.36 | 0.48, 3.86 | 0.563 | 0.60 | 0.23, 1.61 | 0.315 | 1.59 | 0.97, 2.60 | 0.065 | 1.45 | 0.23, 8.90 | 0.690 |
Data source: CDC, Gulf States Population Survey, 2010–2011.
P value < 0.05
OR: odds ratio
CI: confidence interval
Table A2.
Factors associated with participation in the Deepwater Horizon oil spill cleanup by residential county type.
| Factor | Coastal county | Non-coastal county | ||||
|---|---|---|---|---|---|---|
| OR | 95% CI | P value | OR | 95% CI | P value | |
| Age group | ||||||
| 18–24 | Ref | Ref | ||||
| 25–34 | 0.68 | 0.47, 0.98 | 0.040* | 0.77 | 0.33, 1.82 | 0.550 |
| 35–44 | 0.57 | 0.39, 0.82 | 0.003* | 0.50 | 0.20, 1.22 | 0.129 |
| 45–54 | 0.43 | 0.30, 0.62 | <0.001* | 0.35 | 0.14, 0.86 | 0.022* |
| 55–64 | 0.33 | 0.22, 0.49 | <0.001* | 0.46 | 0.18, 1.20 | 0.114 |
| 65 + | 0.14 | 0.09, 0.23 | <0.001* | 0.14 | 0.04, 0.42 | 0.001* |
| Gender | ||||||
| Female | Ref | Ref | ||||
| Male | 2.01 | 1.62, 2.48 | <0.001* | 1.30 | 0.77, 2.19 | 0.318 |
| Race/Ethnicity | ||||||
| White, Not Hispanic | Ref | Ref | ||||
| Black, Not Hispanic | 0.70 | 0.51,0.96 | 0.026* | 0.82 | 0.34, 1.97 | 0.654 |
| Hispanic | 1.13 | 0.68, 1.87 | 0.632 | 0.63 | 0.23, 1.70 | 0.359 |
| Other | 1.38 | 0.94, 2.04 | 0.099 | 1.10 | 0.42, 2.86 | 0.850 |
| Employment status | ||||||
| Employed | Ref | Ref | ||||
| Not employed | 0.64 | 0.43, 0.97 | 0.034* | 0.53 | 0.21, 1.33 | 0.179 |
| Other | 0.56 | 0.43, 0.73 | <0.001* | 0.75 | 0.39, 1.46 | 0.400 |
| Household income | ||||||
| Less than $25,000 | Ref | Ref | ||||
| $25,000 – $49,999 | 1.22 | 0.89, 1.67 | 0.220 | 1.52 | 0.68, 3.43 | 0.311 |
| $50,000 – $74,999 | 1.04 | 0.73, 1.48 | 0.821 | 1.46 | 0.59, 3.64 | 0.414 |
| $75,000 or more | 1.53 | 1.14, 2.06 | 0.005* | 1.32 | 0.64, 2.73 | 0.450 |
| Marital status | ||||||
| Married | Ref | Ref | ||||
| Not married | 1.09 | 0.88, 1.35 | 0.415 | 1.57 | 0.93, 2.66 | 0.091 |
| State of residence | ||||||
| Alabama | Ref | Ref | ||||
| Florida | 0.78 | 0.57, 1.07 | 0.125 | 1.95 | 1.02, 3.72 | 0.043* |
| Louisiana | 0.58 | 0.43, 0.78 | <0.001* | 1.15 | 0.61,2.17 | 0.655 |
| Mississippi | 0.97 | 0.67, 1.41 | 0.876 | 0.47 | 0.18, 1.24 | 0.126 |
| General health status | ||||||
| Poor or fair | Ref | Ref | ||||
| Good | 1.56 | 1.10, 2.22 | 0.013* | 0.85 | 0.33, 2.16 | 0.729 |
| Excellent or very good | 2.15 | 1.57, 2.94 | <0.001* | 1.36 | 0.64, 2.89 | 0.426 |
| Physical health status | ||||||
| Poor or fair | Ref | Ref | ||||
| Good | 1.61 | 1.17, 2.21 | 0.004* | 1.59 | 0.68, 3.70 | 0.282 |
| Excellent or very good | 2.27 | 1.72, 2.99 | <0.001* | 2.02 | 0.96, 4.26 | 0.063 |
| Mental health status | ||||||
| Poor or fair | Ref | Ref | ||||
| Good | 1.68 | 1.11,2.56 | 0.015* | 0.36 | 0.13, 0.98 | 0.046* |
| Excellent or very good | 1.77 | 1.24, 2.52 | 0.002* | 0.69 | 0.29, 1.62 | 0.393 |
Data source: CDC, Gulf States Population Survey, 2010–2011.
P value < 0.05
OR: odds ratio
CI: confidence interval
Footnotes
Declaration of Conflicting Interests
The authors have no conflicts of interest to declare.
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