文章基本信息

标题：Exposure to Terrorism and Israeli Youths’ Cigarette, Alcohol, and Cannabis Use
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作者：Miriam Schiff ; Hillah Haim Zweig ; Rami Benbenishty 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：10
页码：1852-1858
DOI：10.2105/AJPH.2006.090514
语种：English
出版社：American Public Health Association
摘要：Objectives. We investigated the consequences of exposure to acts of terrorism among Israeli adolescents. We examined whether exposure to terrorism predicted adolescents’ use of cigarettes, alcohol (including binge drinking), and cannabis after we controlled for posttraumatic stress and depressive symptoms and background variables. Methods. Anonymous self-administered questionnaires were given to a random sample of 960 10th and 11th grade students (51.6% boys, 48.4% girls) in a large city in northern Israel. Results. Close physical exposure to acts of terrorism predicted higher levels of alcohol consumption (including binge drinking among drinkers) and cannabis use. These relationships remained even after we controlled for posttraumatic stress and depressive symptoms. Conclusions. In addition to posttraumatic stress symptoms, negative consequences of terrorism exposure among adolescents included substance abuse. The similarity between our findings among Israeli adolescents and previous findings among US adults suggests cross-cultural generalizability. Given the risks for later problems from early-onset substance abuse, the consequences of terrorism exposure among adolescents merit greater research and clinical attention. Israeli children and adolescents have been exposed to political violence, including wars and terrorist attacks, since Israel’s inception in 1948. 1 However, after September 2000 (the beginning of what is known as the Al Aksa Uprising), the frequency and severity of terrorist attacks increased substantially. From September 2000 until mid-February 2005, a total of 1042 Israelis were killed in terrorist attacks and an additional 7065 were injured, 2 including children and adolescents. 3 Exposure to terrorism can be physical or psychological. 4 ^, 5 Physical exposure can be considered as being physically close (present at the scene of a terror attack or seeing people injured in an attack—for example, in a hospital) or physically distant (being in the general area of an attack—for example, the neighborhood—but not actually witnessing the attack). Psychological exposure also can be considered close (when a family member is injured or killed) or distant (when one has acquaintances other than family members who are injured or killed). 6 ^, 7 There is also evidence that the cumulative effect of exposure to multiple traumatic events, 8 including terrorism, 9 is more harmful than distinct, single events. Reactions to exposure to terrorism can include posttraumatic stress symptoms (PTSS), depression, anxiety, and disturbance in behavior. 10 ^– 14 For example, New York City public schoolchildren (grades 4–12) had higher than expected rates of posttraumatic stress disorder (11%) and major depression (8%) 6 months after the September 11, 2001, terrorist attack in New York City. 15 Less attention has been given to the relationship between exposure to terrorism and substance use, 11 ^– 16 with most of the research focused on adult reactions to the September 11 attacks on New York and Washington, DC. 17 ^– 19 For example, immediately after the September 11 attack, New York adults had high rates of PTSS and increased their use of cigarettes, alcohol, or marijuana. 20 A 6-month follow-up showed that PTSS had declined substantially, although substance use persisted, suggesting differential relationships between exposure to terrorism and stress or substance use. 21 Many types of traumatic events (e.g., car crashes) are related to risk-taking traits that also predispose one to substance abuse. 22 ^, 23 Therefore, personality traits may confound studies of such traumas and subsequent substance abuse. By contrast, exposure to terrorism is by its nature a randomly occurring, fateful trauma. Thus, studies of terrorism exposure and substance abuse may provide important, unconfounded information about the relationship of trauma to substance abuse. Adolescence is the peak period for onset of substance use, 24 and use during adolescence increases the risk of later substance abuse and dependence, 25 ^, 26 other problems such as suicidal behavior, 27 and other risk behaviors. 28 ^– 30 Therefore, understanding the impact of terrorism exposure on adolescent substance abuse has implications potentially reaching beyond the adolescent years. In an earlier study of the relationship between adolescent exposure to terrorism and substance use, Schiff et al. examined PTSS, depressive symptoms, and alcohol use among 1150 junior high and high school students in an Israeli metropolitan area. 6 In this sample, physical proximity (being in the area of a terrorist attack) and psychological proximity (knowing someone who was killed or injured in an attack) predicted alcohol consumption after the authors controlled for posttraumatic stress and depressive symptoms. However, the study response rate was only 67.4%, and the measure of terrorism exposure included only 2 “yes” or “no” questions. We improved on these factors and examined cigarette use, binge drinking, and cannabis use as well as simple alcohol consumption. Moreover, we used a representative sample of 10th and 11th grade students residing in an area exposed to more suicide bombings than the area in the earlier report. 6 ^, 31 We sought to answer 2 questions: (1) Does exposure to terrorism predict adolescent PTSS and depressive symptoms, cigarette use, alcohol use, binge drinking, and marijuana use? (2) Does physical exposure to terrorism predict these mental health outcomes and substance use patterns differently than does psychological exposure?