Strengthening Public Health and Disaster Resilience in American Samoa: The use of the Precede-Proceed Model

Emma Apatu, Dan Aga, Echo Osland, Chris E. Gregg


American Samoa is part of the Samoan Islands located in the South Pacific Ocean about halfway between Hawaii and New Zealand. In 2009, a magnitude 8.1 earthquake occurred between nearby Tonga and American Samoa, creating a regionally destructive tsunami that destroyed coastal infrastructure, killing  approximately 169 people. In coordination with the local Territorial Emergency Management Coordinating Office and the Office of Samoan Affairs, we conducted an interview study of 300 adult residents of American Samoa in 2012 to better understand the associations between individual determinants (i.e. health and household characteristics) and household response to the 2009 earthquake and subsequent tsunami. Not unlike many areas in the United States, American Samoa has experienced a sustained rise in obesity. Our study confirmed preliminary reports that the people of American Samoa displayed a remarkable adaptive response to the earthquake and tsunami events by evacuating to safe areas between the time they first experience ground motion from the earthquake and the time the tsunami arrived on shore, which was as little as 15 minutes after the earthquake. Despite this overwhelming adaptive response, it was also determined that some individuals were unable to respond appropriately to the earthquake and impending tsunami due to obesity related health conditions, which  limited their mobility. This paper applied a modified version of the Precede-Proceed Model to quantitative and qualitative data collected from the interviews in search of innovative ways to improve disaster preparedness and response capabilities for hazards requiring quick response.  The aim is to ultimately reduce morbidity and mortality from obesity and obesity related conditions.


tsunami preparedness; precede- proceed model; obesity prevention; American Samoa

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