The survey cooperation rate (defined according to the American Association for Public Opinion Research Cooperation Rate 3 criteria) was 58 %.17 The majority of interviews were conducted on a landline (81 % landlines vs. 19 % cell phones) and 7 % of interviews were conducted in Spanish.
Demographic characteristics corresponded to characteristics in 2010 Census data for adult New Yorkers, although fewer Asians were sampled in our survey (9 vs. 13 % in the 2010 census, p = <0.001).18 The high heat-health risk group—those who reported either having poor or fair general health status or were aged ≥65—comprised 24 % of respondents. Altogether, 8 % of adults had high heat-health risk and high heat-exposure “most vulnerable” risk (Table 1), which translates to approximately 545,000 (438,000–676,000) New Yorkers.
Respondents in this most vulnerable group had significantly lower household incomes compared to those with lower vulnerability, with 82 % reporting a household income <$30,000 (p = <0.001). A higher percentage of people in the most vulnerable group lived in the Bronx (26 vs. 15 % of the total sample, p = 0.035). Those who had incomes <$30,000 or were aged ≥65 were more likely to not own or use AC during very hot weather (Table 2).
In 2011, 11 % did not have AC, and about 15 % of adults who owned AC used it “less than half the time” or “never” during very hot weather. The most frequently cited barriers to AC ownership among those at high risk of heat illness were cost (54 %), the perception that AC was not needed (28 %), and a dislike of AC (16 %). A dislike of AC was a frequently cited reason (29 %) among those who do not use AC during very hot weather; another 18 % volunteered that they prefer to use a fan instead (Table 3).
Among the most vulnerable group (high heat-health risk and high heat-exposure risk), 49 % reported staying home during very hot weather even if they could not stay cool there (Table 3). A follow-up question asked those who stayed home to specify the most important reason and 72 % responded that they preferred to stay home. In addition, 11 % of those who stay home reported feeling unsafe leaving home and 7 % cited health concerns.
Among the entire sample, 79 % recalled that they heard or saw a heat warning during summer 2011. Those in the most vulnerable category were somewhat less likely to recall that they heard or seen a heat warning than those who are less vulnerable (70 vs. 80 % (p = 0.06); Table 4). Among the most vulnerable who heard a warning, about the same proportion stayed home (50 %) as those who left home (49 %). Most respondents (75 %) received their heat information from TV; while about 82 % of those in the vulnerable group received information about dangerous heat from TV and 13 % from radio. During very hot weather, 54 % of all respondents reported checking on a family member, friend, or neighbor.
Approximately two thirds of senior participants rated their health as good or very good. Potential caregivers reported numerous types of relationships with seniors, including friend, grandparent, and parent. Interactions with seniors included social visits, running errands, and meal preparation. Several themes emerged during the groups, which are summarized below.
Heat-Health Awareness and Risk Perception
Gaps in risk perception were evident among both caregivers and seniors. Although most seniors knew heat could be dangerous to health and understood age is a risk factor for heat illness, they did not believe that heat was a major risk to their own health (i.e., it was dangerous to other seniors): “I am not personally afraid of heat.” Some seniors were aware that chronic health conditions like heart disease and obesity can increase heat vulnerability while others were surprised that some medications can impair thermoregulation. While both groups accurately described extreme heat conditions as including high temperatures and humidity, caregivers associated heat-related illness with outdoor physical activities and had not considered poorly cooled indoor environments as health risks for vulnerable people.
Behaviors During Hot Weather
Although most seniors (79 %) reported having AC, the majority reported using AC either never or less than half the time during hot weather. Some noted that they typically do not use AC but will use it when they are uncomfortable. Reasons for not using AC included not liking the feel, the cost of electricity, and energy conservation. Several seniors noted that they preferred using a fan over AC. Some believed AC could exacerbate health problems like arthritis and asthma. Seniors also reported that individuals may not actually feel hot during extreme heat, while others said they were “used” to the heat or that it was not as hot in NYC as in tropical locations: “I think it’s only three months of summer here in New York, so three or four days it’s really hot. Nothing happens.”
Even those who were not regularly using AC often took some protective steps during hot weather such as drinking water, wearing light clothing, and going to a cooler place. Many fan users reported incorrectly using fans in rooms with closed windows during hot weather. Some thought that advice to use fans with open windows was not correct.
The majority of seniors were aware of cooling centers. Some had visited cooling centers and reported receiving heat-health information and having positive experiences. Others reported that they, or other seniors in their lives, did not visit cooling centers because of a preference to stay at home, a lack of interest in socializing, or not wanting to be around “old people.” Many participants in all groups reported that they check on vulnerable contacts or knew of outreach from service organizations to homebound or vulnerable people during heat events.
Responses to Heat-Health Messages in News Media
Participants did not identify AC use as an important preventive measure after viewing local news clips about extreme heat. Participants also noticed a discrepancy between TV voiceovers and images, which tended to depict children and younger adults in outdoor environments, rather than seniors and potentially dangerous indoor locations. Local TV health/medical correspondents and meteorologists, doctors, and the health department were considered trustworthy sources of heat-health information.