National study of behavioral and life changes since September 11

Urban Churches Show an Increase in Attendance, Donations, and Finances During the COVID-19 Pandemic in the USA: Evidence from the United Methodist Church

The COVID-19 pandemic has had a significant impact on religion and its practice. This paper aims to examine how the pandemic affects religious activities, donations, and finances over time and across regions within the United Methodist Church (UMC) in the USA. To address this question, we analyze survey data collected during the pandemic from 2963 churches in the USA by United Methodist Communications. Our analysis utilizes several quantitative techniques, including Z-tests, one-way analysis of variance (ANOVA), and multinomial logistic regressions. The results indicate a decrease in church attendance over time, with a more pronounced effect observed in non-urban areas (suburban, small town, and rural). Similarly, while church donations and finances mitigate over time across churches, churches in urban areas experience a quicker rebound compared to those in non-urban areas. Lastly, we find that church attendance and donations positively affect finances. These findings hold important implications for churches in various regions, offering insights to develop strategies for navigating the challenges posed by the COVID-19 pandemic.

Support for a right-wing populist party and subjective well-being: Experimental and survey evidence from Germany

With the rise of populism in many countries, including Germany, it is more important than ever to better understand the causes and consequences of populist support. Using two experiments within the context of a large panel survey, we study how support for the German right-wing populist party Alternative für Deutschland (AfD) is associated with subjective perceptions of personal and financial well-being. In both experiments, we rely on priming the identity of AfD supporters, once in a controlled manner and once in a natural setting. We document a causal relationship from AfD support to diminished well-being for new and marginal AfD supporters. Our findings challenge the prevailing assumption that causality moves unidirectionally, from life dissatisfaction to support for populist parties, and suggest that early interventions focusing on positive messages are particularly promising to win voters back into the mainstream.

Transmission Analysis of COVID-19 Outbreaks Associated with Places of Worship, Arkansas, May 2020-December 2020

The purpose of this study was to describe a statewide COVID-19 transmission involving places of worship (POWs) during the early phase of the pandemic. During the period of May 2020-December 2020, this analysis evaluated COVID-19 cases in Arkansas reported in REDCap for overall cases associated with POWs, cluster detection, and network analysis of one POW utilizing Microbetrace. A total of 9904 COVID-19 cases reported attending an in-person POW service during the early phase of the pandemic with 353 probable POW-associated clusters identified. Network analysis for 'POW A' showed at least 60 COVID-19 cases were traced to at least 4 different settings. The pandemic gave an opportunity to observe and stress the importance of public health and POWs working closely together with a shared goal of facilitating worship in a manner that optimizes congregational and community safety during a public health emergency.

Buffering the effects of bad news: Exposure to others' kindness alleviates the aversive effects of viewing others' acts of immorality

Negatively valenced news dominates the press, with stories of death and destruction gaining significant traction while also negatively impacting people's mental health and perceptions of humanity. Given that horrific acts happen and need to be reported, we examined if news stories featuring others' kindness could undo the aversive effects of news stories featuring others' immorality. In Studies 1a-d we tested whether media exposure to the acts of kindness that occurred in response to a terrorist attack could alleviate the aversive effects of media exposure to the terrorist attack. In Study 2, we examined whether, more generally, the aversive effects of news stories featuring immorality (e.g., homicide, paedophilia, bullying) could be alleviated through news stories featuring acts of kindness (e.g., volunteering, philanthropy, caring for the homeless). In Studies 1 and 2, we found that participants exposed to others' immorality and then others' kindness suffered from less aversive changes to their mood, experienced greater levels of elevation and were more inclined to believe in the goodness of others, than participants exposed only to others' immorality. Given this, we suggest there is merit in journalists shining a light on others' kindness if people's affective well-being and belief in the goodness of humanity is to remain intact.

Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

Worst Life Events and Media Exposure to Terrorism in a Nationally Representative U.S. Sample

Indirectly experienced negative life events are not considered Criterion A traumatic events per DSM-5 posttraumatic stress disorder diagnostic criteria, yet individuals indirectly exposed to trauma via the media may report these events as peak traumatic experiences. We studied which events people considered to be the "worst" in their lifetimes to gain a better understanding of the types of events individuals consider to be distressing. This longitudinal study included a nationally representative sample of U.S. residents living outside New York (N = 1,606) who were exposed to the September 11th, 2001 (9/11) terror attacks exclusively via the media. Bereavement was the most frequently cited "worst" life event (42.0%); violent events were cited by 11.4% of the sample. However, 22.0% of respondents reported 9/11 as their worst life event even though they did not directly experience the attacks. More lifetime exposure to violent events and bereavement, odds ratios (ORs) = 0.79 and 0.72, respectively, and a college education, OR = 0.61, were associated with decreased odds of naming 9/11 as one's worst life event. Watching 4 or more hours of 9/11-related television coverage in the week after the attacks, OR = 1.67, and identifying as African American, OR = 2.01, were associated with increased odds of naming 9/11 as one's worst life event 1 year after the attacks. Events experienced indirectly through the media may be considered the worst of people's lives, with important implications for assessing stressful life event history and understanding indirect exposure to negative life events.

Safety and Confidence in Local Law Enforcement and Government During Serial Shooting Events: Association With Daily Life Activities

OBJECTIVE

This study examined the relationship of perceived safety and confidence in local law enforcement and government to changes in daily life activities during the Washington, DC, sniper attacks.

METHODS

Participants were 1238 residents from the Washington, DC metropolitan area who were assessed using an Internet survey that included items related to safety at work, at home, and in general, confidence in law enforcement/government, and changes in routine daily life activities.

RESULTS

A majority of participants (52%, n = 640) reported changing their daily life activities, with approximately one-third identifying changes related to being in large places and getting gas. Perceived safety was associated with confidence in local law enforcement/government. After adjusting for demographics, lower feelings of safety and less confidence in law enforcement/government were related to a higher likelihood of altered daily activities. Confidence in local law enforcement/government modified the association of safety with changes in daily activities. Among participants with high safety, less confidence in local law enforcement/government was associated with greater changes in daily life activities.

CONCLUSIONS

Serial shooting events affect feelings of safety and disrupt routine life activities. Focus on enhancing experiences of safety and confidence in local law enforcement and government may decrease the life disruption associated with terrorist shootings.

Media Exposure to Terrorism and Perception of Immigrants as a Threat: The Role of Emotional Intelligence and Psychophysiological Self-Regulation

To better understand how media exposure to terrorism-related images can lead to perceiving immigrants as more threatening, in the present study we manipulated participants' exposure to media coverage of terrorist attacks and investigated how this may influence people's perception of Arab immigrants. Considering the important role of regulatory abilities when facing stressful events like terrorist attacks, we measured individual differences in both trait emotional intelligence and resting heart rate variability (HRV). Results showed that participants perceived Arab immigrants as more threatening in the media exposure condition than in the control condition. Importantly, there were moderating effects of both trait emotional intelligence and HRV. People with lower trait emotional intelligence or lower HRV at rest felt more threatened in the media exposure condition compared to the control condition, whereas this effect was not observed among participants with higher trait emotional intelligence or higher resting HRV. The present study highlights some of the complexities related to how media exposure to terrorism-related images influences people's reactions to, and evaluations of, an outgroup that is related to the perpetrators of the attacks.

Active Shooter and Terrorist Event-Related Posttraumatic Stress and Depression: Television Viewing and Perceived Safety

OBJECTIVE

This study examined the relationship of sniper-related television viewing (TV) and perceived safety to posttraumatic stress (PTS) and depressive symptoms during the Washington, DC sniper attacks.

METHODS

Participants were 1238 Washington, DC area residents assessed using an internet survey including the Impact of Event Scale-Revised, Patient Health Questionnaire-9, hours of TV, and perceived safety.

RESULTS

Almost 40% (n = 459) of participants watched at least 2 hours of sniper-related TV daily. TV viewing was associated with lower total perceived safety. After adjusting for demographics, more TV viewing and decreased perceived safety were related to increased PTS and depressive symptoms. TV viewing modified the effect of safety on PTS and depressive symptoms. Among participants with low and high perceived safety, hours of TV were positively associated with PTS; however, the effect was stronger among those with low perceived safety. The relationship of TV to increased depressive symptoms was identified only in participants who reported low perceived safety.

CONCLUSIONS

The influence of media exposure and perceived safety have implications for intervention by community leaders and mental health care providers. Recommendations include limiting media exposure during a terrorist event, particularly among those who perceive that their safety is at risk, and targeting safety in communication strategies. (Disaster Med Public Health Preparedness. 2019;13:570-576).

The two sides of Islamophobia and the perception of threat from Islamic terrorists

There is a heightened interest concerning the understanding of prejudice toward Muslims in Europe, steadily increasing since 2001. This study aimed at investigating whether the phenomenon of Islamophobia could have two different manifestations (i.e., Islamoprejudice and Secular Critique of Islam). In particular, we assessed whether two social attitudes, Right-Wing Authoritarianism (RWA, i.e., authoritarian aggression, and conservatism) and Social Dominance Orientation (SDO), could predict differently the two dimensions. Moreover, we wanted to investigate the different influence of the two dimensions in relation to the perceived threat from terrorism. A sample of 366 Italian adults participated in the study completing a self-report questionnaire. Data were analyzed by means of a structural equation model. Results showed that RWA and SDO were differently related to Islamoprejudice and Secular Critique of Islam, suggesting that certain forms of critique of Islam should not be associated with individual prejudice, because motivated only by secular, democratic, and universalistic convictions, denoting the traces of cultural biases. However, the nonprejudicial and apparently less problematic dimension of Islamophobia, that is, Secular Critique, does not preserve people from perceiving the threat from terrorism, in the same way as Islamoprejudice. Implications are discussed.

Aftermath of Terror: A Nationwide Longitudinal Study of Posttraumatic Stress and Worry Across the Decade Following the September 11, 2001 Terrorist Attacks

Research conducted in the early years after the September 11, 2001 (9/11) terrorist attacks in New York, Pennsylvania, and Washington, DC demonstrated adverse psychological outcomes among residents of the United States who were exposed to the attacks both directly and indirectly via the media. However, less is known about the impact of this collective trauma over time. Beginning at the end of December 2006, a longitudinal study of a nationally representative sample of U.S. residents (Cohort 2, N = 1,613) examined the long-term effects of 9/11, with annual assessments administered every year for 3 years. We assessed rates of 9/11-related posttraumatic stress (PTS) annually during the first 2 years of the study; during the second and third years of the study, we assessed fear and worry regarding future terrorism. Rates of PTS among participants were compared with those assessed annually in a nationally representative sample between 2002 and 2004 (Cohort 1); results indicated a relatively stable pattern of 9/11-related PTS symptoms for 6 years following the attacks. Five to six years after 9/11, we found an association between 9/11-related PTS and both direct, B = 8.45, 95% CI [4.32, 12.59] and media-based (live television), B = 1.78, 95% CI [0.90, 2.65] exposure to the attacks. Six to 7 years post-9/11, fear and worry regarding future terrorism were predicted by 9/11-related PTS symptoms that had been reported approximately 5 years after the attacks, B = 0.04, 95% CI [0.03, 0.05]. The psychological legacy of 9/11 was perceptible among many U.S. residents throughout the decade that followed.

Perception of Risk and Terrorism-Related Behavior Change: Dual Influences of Probabilistic Reasoning and Reality Testing

The present study assessed the degree to which probabilistic reasoning performance and thinking style influenced perception of risk and self-reported levels of terrorism-related behavior change. A sample of 263 respondents, recruited via convenience sampling, completed a series of measures comprising probabilistic reasoning tasks (perception of randomness, base rate, probability, and conjunction fallacy), the Reality Testing subscale of the Inventory of Personality Organization (IPO-RT), the Domain-Specific Risk-Taking Scale, and a terrorism-related behavior change scale. Structural equation modeling examined three progressive models. Firstly, the Independence Model assumed that probabilistic reasoning, perception of risk and reality testing independently predicted terrorism-related behavior change. Secondly, the Mediation Model supposed that probabilistic reasoning and reality testing correlated, and indirectly predicted terrorism-related behavior change through perception of risk. Lastly, the Dual-Influence Model proposed that probabilistic reasoning indirectly predicted terrorism-related behavior change via perception of risk, independent of reality testing. Results indicated that performance on probabilistic reasoning tasks most strongly predicted perception of risk, and preference for an intuitive thinking style (measured by the IPO-RT) best explained terrorism-related behavior change. The combination of perception of risk with probabilistic reasoning ability in the Dual-Influence Model enhanced the predictive power of the analytical-rational route, with conjunction fallacy having a significant indirect effect on terrorism-related behavior change via perception of risk. The Dual-Influence Model possessed superior fit and reported similar predictive relations between intuitive-experiential and analytical-rational routes and terrorism-related behavior change. The discussion critically examines these findings in relation to dual-processing frameworks. This includes considering the limitations of current operationalisations and recommendations for future research that align outcomes and subsequent work more closely to specific dual-process models.

Identification With Terrorist Attack Victims: Association With Television Viewing and Prior Life Threat

OBJECTIVE

A series of sniper attacks in the Washington, DC, area left 10 people dead and 3 wounded. We developed and tested a model that examined the unique and interdependent relationships of sniper-related television viewing, prior life-threatening events, and parental status to identification with attack victims.

METHODS

Participants were 1238 residents of the DC area (aged 18-90 years, mean=41.7 years; 51% female; 68% white) who completed an online survey that assessed identification with sniper attack victims, amount of television viewing, and prior life-threatening events. Identification was measured by using a previously developed scale that assessed to what extent participants identified victims as similar to themselves, a friend, or a family member.

RESULTS

The relationship of television viewing to identification was examined by using multivariate linear regression analyses. In univariate analyses, female gender, having children, higher levels of television viewing, and past life-threatening events were independently related to greater identification. After adjustment for demographics and life-threatening events, sniper-related television viewing continued to be associated with identification (B=0.61, P≤0.001, ∆R2=0.07). Examination of the interactions of television viewing by parental status and television viewing by life-threatening event revealed significant relationships.

CONCLUSIONS

Attention to events preceding and during a terrorist event could help in the recognition of those at particular risk for increased identification with attack victims. These findings also have implications for recommendations for media exposure during an event. (Disaster Med Public Health Preparedness. 2018; 12: 337-344).

Exposure to the World Trade Center Disaster and 9/11-Related Post-Traumatic Stress Disorder and Household Disaster Preparedness

Objective

In a population with prior exposure to the World Trade Center disaster, this study sought to determine the subsequent level of preparedness for a new disaster and how preparedness varied with population characteristics that are both disaster-related and non-disaster-related.

Methods

The sample included 4496 World Trade Center Health Registry enrollees who completed the Wave 3 (2011-2012) and Hurricane Sandy (2013) surveys. Participants were considered prepared if they reported possessing at least 7 of 8 standard preparedness items. Logistic regression was used to determine associations between preparedness and demographic and medical factors, 9/11-related post-traumatic stress disorder (PTSD) assessed at Wave 3, 9/11 exposure, and social support.

Results

Over one-third (37.5%) of participants were prepared with 18.8% possessing all 8 items. The item most often missing was an evacuation plan (69.8%). Higher levels of social support were associated with being prepared. High levels of 9/11 exposure were associated with being prepared in both the PTSD and non-PTSD subgroups.

Conclusions

Our findings indicate that prior 9/11 exposure favorably impacted Hurricane Sandy preparedness. Future preparedness messaging should target people with low social support networks. Communications should include information on evacuation zones and where to find information about how to evacuate. (Disaster Med Public Health Preparedness. 2015;9:625–633)

Distress of Routine Activities and Perceived Safety Associated with Post-Traumatic Stress, Depression, and Alcohol Use: 2002 Washington, DC, Sniper Attacks

OBJECTIVE

For over 3 weeks in October 2002, a series of sniper attacks in the Washington, DC, area left 10 people dead and 3 wounded. This study examined the relationship of distress associated with routine activities and perceived safety to psychological and behavioral responses.

METHODS

Participants were 1238 residents of the Washington, DC, metropolitan area (aged 18 to 90 years, mean=41.7 years) who completed an Internet survey including the Impact of Event Scale-Revised, Patient Health Questionnaire-9, and items pertaining to distress related to routine activities, perceived safety, and alcohol use. Data were collected at one time point approximately 3 weeks after the first sniper shooting and before apprehension of the suspects. Relationships of distress and perceived safety to post-traumatic stress, depressive symptoms, and increased alcohol use were examined by using linear and logistic regression analyses.

RESULTS

Approximately 8% of the participants met the symptom criteria for probable post-traumatic stress disorder, 22% reported mild to severe depression, and 4% reported increased alcohol use during the attacks. Distress related to routine activities and perceived safety were associated with increased post-traumatic stress and depressive symptoms and alcohol use.

CONCLUSION

Distress and perceived safety are associated with specific routine activities and both contribute to psychological and behavioral responses during a terrorist attack. These findings have implications for targeted information dissemination and risk communication by community leaders.

Psychological Distress Among Nurses Caring for Victims of War in Sri Lanka

Objective

To determine prevalence and factors associated with psychological distress among nurses caring for war victims in Sri Lanka.

Methods

Descriptive, cross-sectional study design was used to collect data from 241 nurses from 2 hospitals with stratified random sampling according to workstation. Self-administered 30-item General Health Questionnaire was used to detect psychological distress.

Results

The prevalence of psychological distress was 21%. Female sex was found to be the most significant predictor of psychological distress among nurses. Factors, such as being married, having children, or both, were found to be protective. High exposure to war victims, measured by the frequency with which a nurse tended to those patients, also resulted in less psychological distress.

Conclusions

The prevalence of psychological distress is higheramong nurses in this study compared with that among the general population. Brief screening instruments, such as the General Health Questionnaire, can be used to identify individuals at risk for psychological distress. Results suggest that the presence of a social support network helped to psychologically buffer these nurses. Findings also imply the importance of promoting positive attitudes and beneficial stress (eustress) to complement a well-developed focus on distress prevention. (Disaster Med Public Health Preparedness. 2013;7:278-286)

Perceived coping & concern predict terrorism preparedness in Australia

BACKGROUND

In the aftermath of major terrorist incidents research shows population shifts towards protective behaviours, including specific preparedness and avoidance responses. Less is known about individual preparedness in populations with high assumed threat but limited direct exposure, such as Australia. In this study we aimed to determine whether individuals with high perceived coping and higher concern would show greater preparedness to respond to terrorism threats.

METHODS

Adults in New South Wales (NSW) completed terrorism perception and response questions as part of computer assisted telephone interviews (CATI) in 2010 (N=2038). Responses were weighted against the NSW population. Multiple logistic regression analyses were conducted to evaluate the relationship between personal coping/concern factors and terrorism-related preparedness and avoidance behaviours, and to control for potential confounders such as socio-demographic and threat perception factors.

RESULTS

Increased vigilance for suspicious behaviours was the most commonly reported behavioural response to perceived terrorism threat. Multivariate analyses showed that the factor combination of high perceived coping and higher concern was the most consistent predictor of terrorism preparedness behaviours and evacuation intentions, including increased vigilance (Adjusted Odd Ratios (AOR)=2.07, p=0.001) learning evacuation plans (AOR=1.61, p=0.05), establishing emergency contact plans (AOR=2.73, p<0.001), willingness to evacuate homes (AOR=2.20, p=0.039), and willingness to evacuate workplaces or public facilities (AOR=6.19, p=0.015) during potential future incidents.

CONCLUSION

The findings of this study suggest that terrorism preparedness behaviours are strongly associated with perceived high coping but that this relationship is also mediated by personal concerns relating to this threat. Cognitive variables such as coping self-efficacy are increasingly targeted as part of natural hazard preparedness and are a viable intervention target for terrorism preparedness initiatives. Raising individual coping perceptions may promote greater general and incident-specific preparedness and could form an integral element of community resilience strategies regarding this threat.

The dynamics of evolving beliefs, concerns emotions, and behavioral avoidance following 9/11: a longitudinal analysis of representative archival samples

September 11 created a natural experiment that enables us to track the psychological effects of a large-scale terror event over time. The archival data came from 8,070 participants of 10 ABC and CBS News polls collected from September 2001 until September 2006. Six questions investigated emotional, behavioral, and cognitive responses to the events of September 11 over a five-year period. We found that heightened responses after September 11 dissipated and reached a plateau at various points in time over a five-year period. We also found that emotional, cognitive, and behavioral reactions were moderated by age, sex, political affiliation, and proximity to the attack. Both emotional and behavioral responses returned to a normal state after one year, whereas cognitively-based perceptions of risk were still diminishing as late as September 2006. These results provide insight into how individuals will perceive and respond to future similar attacks.

Alert but less alarmed: a pooled analysis of terrorism threat perception in Australia

Background

Previous Australian research has highlighted disparities in community perceptions of the threat posed by terrorism. A study with a large sample size is needed to examine reported concerns and anticipated responses of community sub-groups and to determine their consistency with existing Australian and international findings.

Methods

Representative samples of New South Wales (NSW) adults completed terrorism perception questions as part of computer assisted telephone interviews (CATI) in 2007 (N = 2081) and 2010 (N = 2038). Responses were weighted against the NSW population. Data sets from the two surveys were pooled and multivariate multilevel analyses conducted to identify health and socio-demographic factors associated with higher perceived risk of terrorism and evacuation response intentions, and to examine changes over time.

Results

In comparison with 2007, Australians in 2010 were significantly more likely to believe that a terrorist attack would occur in Australia (Adjusted Odd Ratios (AOR) = 1.24, 95%CI:1.06-1.45) but felt less concerned that they would be directly affected by such an incident (AOR = 0.65, 95%CI:0.55-0.75). Higher perceived risk of terrorism and related changes in living were associated with middle age, female gender, lower education and higher reported psychological distress. Australians of migrant background reported significantly lower likelihood of terrorism (AOR = 0.52, 95%CI:0.39-0.70) but significantly higher concern that they would be personally affected by such an incident (AOR = 1.57, 95%CI:1.21-2.04) and having made changes in the way they live due to this threat (AOR = 2.47, 95%CI:1.88-3.25). Willingness to evacuate homes and public places in response to potential incidents increased significantly between 2007 and 2010 (AOR = 1.53, 95%CI:1.33-1.76).

Conclusion

While an increased proportion of Australians believe that the national threat of terrorism remains high, concern about being personally affected has moderated and may reflect habituation to this threat. Key sub-groups remain disproportionately concerned, notably those with lower education and migrant groups. The dissonance observed in findings relating to Australians of migrant background appears to reflect wider socio-cultural concerns associated with this issue. Disparities in community concerns regarding terrorism-related threat require active policy consideration and specific initiatives to reduce the vulnerabilities of known risk groups, particularly in the aftermath of future incidents.

Predictors of the impact of the September 11th terrorist attacks on victims of intimate partner violence

This study examined the role of several hypothesized predictors of the impact of a potentially traumatic event, the terrorist attacks of September 11, 2001 (9/11), on a sample of women experiencing intimate partner violence (IPV) and related posttraumatic stress symptoms (PTSS). We found that IPV-related PTSS mediated the relationship between IPV and 9/11-related PTSS, confirming the hypothesis that severity of symptoms related to prior trauma plays a role in the development and severity of PTSS related to subsequent potentially traumatic events. Media exposure and threat appraisal were significantly positively associated with 9/11-related PTSS, whereas social support was significantly negatively associated with 9/11-related PTSS, with none of these variables serving as moderators of the relationship between IPV-related and 9/11-related PTSS. Our results suggest that trauma-related psychiatric history is an important factor in the development of PTSS subsequent to an additional potentially traumatic event, even after adjusting for relevant variables occurring at the time of that event.

Integrating mental health services into humanitarian relief responses to social emergencies, disasters, and conflicts: a case study

Utilizing lessons learned from development and implementation of "Project Liberty" in New York City, created in response to the attacks of September 11, 2001, this paper explores the importance of integrating structured mental health services with community-based social service programs offered in large-scale humanitarian relief responses. Relevant international research studies illustrating similar integrated programs are also reviewed. The primary approach is community-based and resilience-enhancement focused, offering structure, stability, support, and community cohesion, with an added integrated screening component to identify persons with severe treatable mental health conditions. Because there is thus far little evidence that resilience-enhancing programs are effective for severe mental health conditions, a secondary program initiated in parallel would be staffed with more specialized providers offering services for those referred from the primary program. The key implication supports the establishment of more effective links between programs and professionals from different disciplines, who then can more effectively implement integrated program responses to large-scale disasters.

[Risk perception and psychological reactions in public crisis situations using the example of terror attacks]

The reactions to the 9/11 terror attacks were immense in the western population. In the current review, the impact of terror attacks is presented with surveys, clinical interviews, and scientific polls, which were identified in a comprehensive literature search. Results show that the fear of further terror attacks is comparatively overestimated in the population and is associated with numerous psychological consequences and reactions. The overestimation of the probability of further terror attacks is related among other reasons to its unique features and its strong representation in the media. Several independent studies proved that the number of stress symptoms and psychiatric diagnoses is associated with a high risk perception in relation to terror attacks. This was not only the case for victims of terror attacks, but also for people indirectly exposed to the terror attacks. In addition, there is evidence that the number of the stress symptoms correlate with the duration of TV consumption of new findings about terror attempts. Methodologically, there is a critical lack of more in-depth analyses to explain the development of risk perceptions and its influence on mental and physical health. Because of the international importance and cross-cultural differences, an international standardization of research is desirable.

Factors predicting individual emergency preparedness: a multi-state analysis of 2006 BRFSS data

Disasters pose a very real threat to every individual in the United States. One way to mitigate the threat of disasters is through personal preparedness, yet numerous studies indicate that individual Americans are not prepared for a disaster. This study attempted to identify the factors most likely to predict individual disaster preparedness. We used 2006 Behavioral Risk Factor Surveillance System (BRFSS) data from the 5 states that included the optional general preparedness module. Respondents were defined as being "prepared" if they were deficient in no more than 1 of the 6 actionable preparedness measures included on the BRFSS. Analyses were conducted comparing preparedness rates based on medical and demographic factors. Using logistic regression, a predictive model was constructed to identify which factors most strongly predicted an individual's likelihood of being prepared. Although 78% of respondents reported feeling prepared for a disaster, just 45% of respondents were actually prepared by objective measures. Factors predicting an increased likelihood of preparedness included feeling "well prepared" (OR 9.417), having a disability or health condition requiring special equipment (OR 1.298), being 55 to 64 years old (OR 1.794), and having an annual income above $50,000 (OR 1.286). Among racial and ethnic minorities, an inability to afford medical care in the previous year (OR .581) was an important factor in predicting a decreased likelihood of being prepared. This study revealed a pervasive lack of disaster preparedness overall and a substantial gap between perceived and objective preparedness. Income and age were important predictors of disaster preparedness.

Finding social benefits after a collective trauma: perceiving societal changes and well-being following 9/11

Individuals frequently perceive positive changes in themselves following adversity; after a collective trauma, they may perceive such benefits in others or in their society as well. We examined perceived benefits of the September 11, 2001 (9/11) terrorist attacks in a 3-year study of a national sample of adults (N = 1382). Many individuals (57.8%) perceived social benefits of 9/11, including increased prosocial behavior, religiousness, or political engagement. Individuals who found increased national religiosity as a benefit 2 months post-9/11 reported greater positive affect and life satisfaction and lower distress and posttraumatic stress up to 3 years post-9/11. Pre-9/11 religiousness and Republican political affiliation predicted perceiving religion-related social benefits post-9/11. Perceptions of social change are important but understudied responses to stressful events.

Terrorism in Australia: factors associated with perceived threat and incident-critical behaviours

Background

To help improve incident preparedness this study assessed socio-demographic and socio-economic predictors of perceived risk of terrorism within Australia and willingness to comply with public safety directives during such incidents.

Methods

The terrorism perception question module was incorporated into the New South Wales Population Health Survey and was completed by a representative sample of 2,081 respondents in early 2007. Responses were weighted against the New South Wales population.

Results

Multivariate analyses indicated that those with no formal educational qualifications were significantly more likely (OR = 2.10, 95%CI:1.32–3.35, p < 0.001) to think that a terrorist attack is very or extremely likely to occur in Australia and also more likely (OR = 3.62, 95%CI:2.25–5.83, p < 0.001) to be very or extremely concerned that they or a family member would be directly affected, compared to those with a university-level qualification. Speaking a language other than English at home predicted high concern (very/extremely) that self or family would be directly affected (OR = 3.02, 95%CI:2.02–4.53, p < 0.001) and was the strongest predictor of having made associated changes in living (OR = 3.27, 95%CI:2.17–4.93, p < 0.001). Being female predicted willingness to evacuate from public facilities. Speaking a language other than English at home predicted low willingness to evacuate.

Conclusion

Low education level is a risk factor for high terrorism risk perception and concerns regarding potential impacts. The pattern of concern and response among those of migrant background may reflect secondary social impacts associated with heightened community threat, rather than the direct threat of terrorism itself. These findings highlight the need for terrorism risk communication and related strategies to address the specific concerns of these sub-groups as a critical underpinning of population-level preparedness.

Are Londoners prepared for an emergency? A longitudinal study following the London bombings

The UK government sees increasing individual preparedness as a priority, but the level of preparedness of people in the UK for a large-scale emergency is not known. The London bombings of July 7, 2005, affected many Londoners and may have altered their sense of vulnerability to a future terrorist attack. We used a longitudinal study design to assess individual preparedness within the same sample of Londoners at 2 points in time: immediately after the bombings (T(1)) and 7 to 8 months later (T(2)). A demographically representative sample of 1,010 Londoners participated in a phone interview at T(1). Subsequently, at T(2), 574 of the same people participated in a follow-up phone interview. At T(1) 51% of Londoners had made 4 or more relevant emergency plans; 48% had gathered 4 or more relevant supplies in case of emergency. There was evidence of increased preparedness at T(2), by which time 90% had made 4 or more emergency plans. Ethnicity, low social status, and having felt a sense of threat during the bombings predicted increased preparedness between T(1) and T(2). Women in general, and women of low social status in particular, perceived themselves to be unprepared in the event of a future terrorist attack. In summary, Londoners show moderate levels of emergency preparedness, which increased following the London bombings. Although we cannot know whether this association is causal, the prospective nature of the study increases the likelihood that it is. However, preparedness is still patchy, and there are important demographic associations with levels of preparedness and perception of vulnerability. These findings have implications for future development of individual and community emergency preparedness policy.

Terrorism-related fear and avoidance behavior in a multiethnic urban population

OBJECTIVES

We sought to determine whether groups traditionally most vulnerable to disasters would be more likely than would be others to perceive population-level risk as high (as measured by the estimated color-coded alert level) would worry more about terrorism, and would avoid activities because of terrorism concerns.

METHODS

We conducted a random digit dial survey of the Los Angeles County population October 2004 through January 2005 in 6 languages. We asked respondents what color alert level the country was under, how often they worry about terrorist attacks, and how often they avoid activities because of terrorism. Multivariate regression modeled correlates of worry and avoidance, including mental illness, disability, demographic factors, and estimated color-coded alert level.

RESULTS

Persons who are mentally ill, those who are disabled, African Americans, Latinos, Chinese Americans, Korean Americans, and non-US citizens were more likely to perceive population-level risk as high, as measured by the estimated color-coded alert level. These groups also reported more worry and avoidance behaviors because of concerns about terrorism.

CONCLUSIONS

Vulnerable populations experience a disproportionate burden of the psychosocial impact of terrorism threats and our national response. Further studies should investigate the specific behaviors affected and further elucidate disparities in the disaster burden associated with terrorism and terrorism policies.

The psychology of ongoing threat: relative risk appraisal, the September 11 attacks, and terrorism-related fears

There are now replicated findings that posttraumatic stress disorder (PTSD) symptoms related to the September 11, 2001, attacks occurred in large numbers of persons who did not fit the traditional definition of exposure to a traumatic event. These data are not explained by traditional epidemiologic "bull's eye" disaster models, which assume the psychological effects are narrowly, geographically circumscribed, or by existing models of PTSD onset. In this article, the authors develop a researchable model to explain these and other terrorism-related phenomena by synthesizing research and concepts from the cognitive science, risk appraisal, traumatic stress, and anxiety disorders literatures. They propose the new term relative risk appraisal to capture the psychological function that is the missing link between the event and subjective response in these and other terrorism-related studies to date. Relative risk appraisal highlights the core notion from cognitive science that human perception is an active, multidimensional process, such that for unpredictable societal threats, proximity to the event is only one of several factors that influence behavioral responses. Addressing distortions in relative risk appraisal effectively could reduce individual and societal vulnerability to a wide range of adverse economic and ethnopolitical consequences to terrorist attacks. The authors present ways in which these concepts and related techniques can be helpful in treating persons with September 11- or terrorism-related distress or psychopathology.

Predicting Travel Attitudes Among University Faculty After 9/11

The authors interviewed a random sample of 306 university faculty as part of an annual university poll. Items focused on air travel concerns following 9/11, positive aspects of travel, and future travel intentions. Demographic factors were not significant predictors for men or women faculty. Faculty expressed positive attitudes toward travel, for example agreeing that travel allows them to demonstrate competency. Concerns about missing connections and delays elicited a larger percent of negative reactions than concerns about hijackings or security. Gender differences were not observed on individual items, but in regression analyses a composite of self-reported travel risk factors was more predictive of future travel plans for women than for men, although women expected to travel as much in the future as men. The results are consistent with positive psychology and speak to applied aspects of travel and tourism.

Differences in individual-level terrorism preparedness in Los Angeles County

BACKGROUND

Increasing individual preparedness for disasters, including large-scale terrorist attacks, is a significant concern of public health planners. As with natural disasters, individuals can help protect their health and safety by preparing for the emergency situation that may follow a terrorist event. Our study describes variations in preparedness among the population of Los Angeles County after the September 11, 2001 and subsequent anthrax attacks.

METHODS

In 2004, the data were analyzed from the Los Angeles County Health Survey, a random-digit-dialed telephone survey of the non-institutionalized population in Los Angeles County fielded October 2002 through February 2003.

RESULTS

Overall, 28.0% of respondents had emergency supplies, and 17.1% developed an emergency plan in the past year in response to the possibility of terrorism. Factors associated with having emergency supplies included African American (adjusted odds ratio [AOR] 1.8, 95% confidence interval [CI]=1.1-3.1) and Latino (AOR=1.5, 95% CI=1.0-2.4) race/ethnicity; having a household dependent aged<or=18 years (AOR=1.4, 95% CI=1.0-2.0); being born outside the United States (AOR=1.9, 95% CI=1.3-2.9); some college or trade school education (AOR=1.9, 95% CI=1.3-2.9); and higher perceived likelihood of a bioterrorist attack (AOR=2.2, 95% CI=1.6-3.0). Factors associated with having an emergency plan included African American (AOR=2.6, 95% CI=1.5-4.6) race/ethnicity; having a household dependent aged<or=18 years (AOR=2.4, 95% CI=1.6-3.5); and physical disability (AOR=1.7, 95% CI=1.1-2.7).

CONCLUSIONS

Some groups were more likely to adopt some, but not all, recommended preparedness activities. Identifying subpopulation differences in preparedness is important since different public health messages, programs, and distribution channels are required for different subgroups.