{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:08:12Z","timestamp":1775038092403,"version":"3.50.1"},"reference-count":9,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":90,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Rural communities face unique challenges after a disaster as a result of overlapping vulnerabilities related to limited housing and transportation infrastructure, employment or income loss, and fewer emergency response and recovery resources. Hurricane Helene (Southeast Coast, USA; 2024) made landfall in Florida as a Category-4 hurricane, later impacting Western North Carolina with severe flooding, landslides, and hurricane-force winds. Communications and transportation were interrupted for months, leading to disinformation, recovery disruptions, and a loss of trust. To assess household impacts and recovery from Hurricane Helene in two rural Western North Carolina counties, a 29-question survey was adapted from a Community Assessment for Public Health Emergency Response (CASPER) conducted in Buncombe County, a nearby urban county. Thirty clusters were selected with probability proportionate to population across the two counties. Survey teams completed 183 interviews (completion rate = 87.1%). More than 35% of households evacuated because of Hurricane Helene, with nearly 18% evacuating in the week after due to on-going communication and utility outages. Less than 10% of households experienced new or worsening environmental health or chronic diseases. However, 40% reported anxiety, 30% reported trouble sleeping and depression, and 60% reported worrying about another disaster affecting their home. Nearly one year after the direct impact of the hurricane, much work remained as part of continued long-term recovery and resilience building. Because of their small populations and limited infrastructure, restoration of services necessary for response and recovery can be hindered in rural areas which often lack options such as public transportation, affordable short-term housing, and broadband or Wi-Fi.<\/jats:p>","DOI":"10.1017\/s1049023x26108863","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T07:53:20Z","timestamp":1775030000000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Community Assessment of Hurricane Helene Recovery in Rural Western North Carolina"],"prefix":"10.1017","volume":"41","author":[{"name":"Sustaining Essential and Rural Community Healthcare in Western North Carolina","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lilly","family":"Moreau","sequence":"additional","affiliation":[{"name":"University of Delaware"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt","family":"Simon","sequence":"additional","affiliation":[{"name":"Spatial Data Consulting"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9983-5304","authenticated-orcid":false,"given":"Sarah E.","family":"Scales","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3060-0894","authenticated-orcid":false,"given":"Jennifer A.","family":"Horney","sequence":"additional","affiliation":[{"name":"University of Delaware"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"S1049023X26108863_ref4","first-page":"399","article-title":"A modified cluster-sampling method for post-disaster rapid assessment of needs","volume":"74","author":"Malilay","year":"1996","journal-title":"Bulletin of the World Health Organization."},{"key":"S1049023X26108863_ref2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-10-295"},{"key":"S1049023X26108863_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(17)30138-9"},{"key":"S1049023X26108863_ref6","unstructured":"6. North Carolina Department of Public Safety. https:\/\/www.ncdps.gov\/Helene\/PRB. Accessed October 2025."},{"key":"S1049023X26108863_ref5","volume-title":"Hurricane Helene Recovery Revised Damage and Needs Assessment","year":"2024"},{"key":"S1049023X26108863_ref7","unstructured":"7. Colburn, Z. Road and bridge repairs continue one year after Hurricane Helene. https:\/\/www.wataugademocrat.com\/news\/local\/road-and-bridge-repairs-continue-one-year-after-hurricane-helene\/article_91b7708e-b7a7-4baa-b28c-10725d0ca324.html. Accessed October 2025."},{"key":"S1049023X26108863_ref1","unstructured":"1. Hagen, AB , Cangialosi, JP , Chenard, M , Alaka, L , Delgado, S. National Hurricane Center Tropical Cyclone Report Hurricane Helene. 2025 April 8. National Oceanic and Atmospheric Administration. https:\/\/www.nhc.noaa.gov\/data\/tcr\/AL092024_Helene.pdf. Accessed October 2025."},{"key":"S1049023X26108863_ref8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.107799"},{"key":"S1049023X26108863_ref3","volume-title":"Community Assessment for Public Health Emergency Response (CASPER) Toolkit: Third Edition","year":"2019"}],"container-title":["Prehospital and Disaster Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1049023X26108863","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T07:53:24Z","timestamp":1775030004000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1049023X26108863\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]}},"alternative-id":["S1049023X26108863"],"URL":"https:\/\/doi.org\/10.1017\/s1049023x26108863","relation":{},"ISSN":["1049-023X","1945-1938"],"issn-type":[{"value":"1049-023X","type":"print"},{"value":"1945-1938","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e3"}}