Living in the shadow of terrorism: Psychological distress and alcohol use among religious and non-religious adolescents in Jerusalem

Prevalence of increased alcohol use and alcohol use disorders in adult victims of terrorist attacks: a systematic and meta-analytic review

Background: Previous studies have reviewed the evidence on the increase in alcohol consumption after a terrorist attack. However, an increase does not necessarily imply the presence of an alcohol use disorder.Objectives: To conduct a systematic and meta-analytic review of the literature on the prevalence of increased alcohol consumption and alcohol use disorders in adult exposed to terrorism.Methods: A search of PsycINFO, MEDLINE and PTSDpubs identified 29 studies published up to March 2023 in which 38 adult samples totaling 282,753 persons exposed to terrorism were assessed. Using inverse variance heterogeneity models, pooled prevalence rates of increased alcohol use and alcohol use disorders were calculated.Results: 6% (95% CI [2.9, 9.5]) of the adults exposed to a terrorist attack increased their alcohol consumption. The prevalence of increased alcohol use varied depending on the degree of exposure (p = .006, R2 = .18) and the procedure for measuring increases (p = .043, R2 = .37). The prevalence of alcohol use disorders in adults exposed to a terrorist attack was 5.5% (95% CI [3.7, 7.5]), a rate that was not higher than that obtained in the general population and varied depending on the type of alcohol disorder (p = .015, R2 = .30).Conclusions: A relevant number of adults exposed to terrorist attacks will subsequently increase their alcohol consumption, but this increase is not associated with an increase in the prevalence of alcohol use disorders. Effects of terrorism on people's health are potentially widespread, but concerns of excessive alcohol use after terrorist attacks may be unwarranted.

Exposure to Terrorism, Post-Traumatic Stress Disorder and University Teachers' Performance: Underpinning the Role of Social Support

This study aims to investigate the impact of exposure to terrorism on post-traumatic stress disorder and employee performance, and to determine whether social support acts as a boundary condition that can attenuate the adverse effects of PTSD on employee performance. The study used a cross-sectional sample of 178 university teachers who had experienced a terrorist attack. Data was collected using closed-ended questionnaires and analyzed using PROCESS Macro). The results found a negative and significant relationship between exposure to terrorism, post-traumatic disorder, and employees' performance. Moreover, it was also found that social support helps attenuate the negative impact of PTSD on performance levels. This study adds to the existing body of knowledge by exploring the relationship between terrorism exposure, PTSD, employee performance, and the potential mitigating effects of social support.

Media Exposure to Armed Conflict: Dispositional Optimism and Self-Mastery Moderate Distress and Post-Traumatic Symptoms among Adolescents

BACKGROUND

Rapid technological developments enable the immediate transmission of armed conflict events through a variety of media channels, inducing mass anxiety, fear, and helplessness. Youth are particularly vulnerable and face new challenges as a result of this exposure. The effects of media exposure to such events on psychological distress and post-traumatic symptoms were examined.

METHODS

A total of 161 participants aged 13-18 years completed a questionnaire battery that included measures of media exposure to armed conflict events, previous direct exposure to armed conflict events, psychological distress, post-traumatic symptoms, dispositional optimism, and self-mastery. A structural equation model (SEM) approach was employed for data analysis.

RESULTS

The extent of media exposure to armed conflict was directly associated with psychological distress and post-traumatic symptoms. Dispositional optimism moderated the association between media exposure and psychological distress, while self-mastery moderated the association between media exposure and post-traumatic symptoms. The effects of the Internet factor of media exposure, which included social media, were particularly disturbing as neither of the resilience factors moderated negative outcomes.

CONCLUSIONS

The findings suggest that clinical interventions to enhance dispositional optimism and self-mastery as well as other potential resilience factors can protect adolescents from the severe effects of media exposure to violent armed conflict events. Developmental and public health implications related to vulnerabilities and resilience during adolescence are discussed.

Childhood exposure to war and adult onset of cardiometabolic disorders among older Europeans

Childhood exposure to contexts of war is a common occurrence among current and recent cohorts of children in various parts of the world. It was also common among older cohorts across Europe. Utilizing the Survey of Health, Ageing, and Retirement in Europe (SHARE) the present study links early life course residential histories with detailed information on the timing and location of hostilities during WWII to address three questions: 1) is childhood exposure to war associated with earlier onset of cardiometabolic disease (cardiovascular disease, hypertension, high cholesterol, and diabetes)? 2) did this additional risk vary depending on the timing of first exposure? 3) did this additional risk manifest via different life course pathways depending on exposure timing? Results demonstrate that exposure to war is associated with increased lifetime risk of cardiovascular disease, diabetes, high cholesterol, and hypertension and that this association is strongly concentrated among cohorts exposed in utero or during early childhood (e.g., before age 8). The results also suggest that the impact of war exposure on cardiometabolic disorders are likely to be direct, operating through latent biological processes rather than through childhood hardship, stunting of adult socioeconomic attainment, or elevated risk-taking behaviors.

COVID-19 vs. terrorism: Contribution of the COR theory to the process of coping with invisible threats

Two years have passed since the outbreak of the COVID-19 pandemic. The entire world is still struggling with the virus and its mutations, and governments have been imposing various restrictions, including social distancing and quarantine. This paper leans on the Conservation of Resources (COR) theoretical model in comparing the impact of COVID-19 with that of an ongoing threat of terror attacks, allowing us to understand the similarities and differences between them. Such exploration could result in an understanding that may guide devising psycho-social interventions to minimize the negative psychological consequences of a continuous life-threatening situation. By applying the extensive available literature on the aftermath of terrorist attacks to the little-known long-run consequences of the COVID-19 pandemic, this paper comes up with several guidelines such as increasing online social support and enhancing adaptive coping with stress, that are applicable on the individual, community, and societal levels.

Religiosity: Protective or Risk Factor for Posttraumatic Distress Among Adolescents Who Were Exposed to Different Types of Acts of Political Violence

This study examined the potential moderating effects of religiosity on the associations between exposure to acts of political violence and posttraumatic stress symptoms (PTS) among Jewish adolescents in Israel. In addition, it examined whether self-reported physical and interpersonal exposure to acts of political violence predicts PTS symptoms beyond the objective exposure effects (i.e., the proximity of participants' place of residence to high-, moderate-, or low-intensity political violence). A representative sample of 2,992 Jewish high school students (Grades 10 and 11) was taken. We used self-reporting to measure the level of religiosity and the Impact of Events Scale-Revised (IES-R) to measure PTS symptoms. Results show that self-reported exposure to acts of political violence adds a significant additional amount of variance to the prediction of PTS symptoms after objective exposure is already included in the regression equation. Religiosity was found as a risk factor for PTS symptoms such that the greater the religiosity of the adolescents, the higher their PTS symptoms. Therefore, prevention interventions should target the vulnerable group of religious Jewish adolescents.

Political Efficacy as a Buffer of the Heightened Risk of Posttraumatic Stress in Disadvantaged Communities

External collective political efficacy (PE) is an individual's perception of the extent to which the government is responsive to the needs of his or her group or community or to its collective actions. Does PE play a role in the association between exposure to political violence and posttraumatic stress? The current study aimed to examine whether such PE may help explain why exposure to political violence results in posttraumatic stress for some people but not others. Based on the conservation of resource theory, research has found that residents of some types of communities are less likely to suffer from posttraumatic stress when exposed to political violence, due to the economic and psychological resources these communities provide. Political efficacy, as an individual-level factor that relates to the community, may help predict who will suffer more or less posttraumatic stress from exposure to political violence within a given community. Based on a panel study conducted immediately before and after the 2008-2009 Gaza conflict (N = 650) and hierarchical linear modeling analyses, we found that type of community indeed moderated the association between exposure to political violence and posttraumatic stress, Δ-2 log likelihood = 30.4, p < .001. In addition, we found that PE mitigated the psychological distress resulting from exposure to political conflict in disadvantaged communities, Δ-2 log likelihood = 22.8, p < .001. This study not only further untangled the association between exposure and distress during times of war but also identified the role that governments can play in preventing conflict-induced distress beyond offering physical protection.

Mothering under political violence: Post-traumatic symptoms, observed maternal parenting practices and child externalising behaviour

Using the family stress model as our conceptual framework, we explored whether observed maternal parenting practices (positive and coercive) account for the associations between mothers' post-traumatic stress symptoms and children's externalising behaviours. Mothers' self-reported post-traumatic stress symptoms, observed maternal practices, and reports of children's externalising behaviour were collected from 123 Israeli mothers and their children, who were exposed to ongoing rocket attacks in southern Israel. A structural equation model revealed that mothers' post-traumatic stress symptoms were linked with greater maternal coercive parenting practices, which in turn were associated with more externalising behaviours in children. The study highlights the crucial role of maternal distress and mothers' parenting skills in the development of externalising behaviours in children exposed to chronic political violence. These results suggest that prevention interventions designed to promote parenting skills for mothers exposed to political violence may be beneficial for children's healthy development.

Narrating hope and resistance: A critical analysis of sources of agency among Palestinian children living under military violence

BACKGROUND

In light of critical and socioconstructionist theories, the aim of our research was to analyze source of agency, psychological adjustment to trauma as protective factors against political violence in children living in three different refugee camps in Palestine, as well as exploring the risks to which these children are exposed.

METHODS

Thematic content analysis was applied to children's written and drawn productions in order to extract the main categories and themes.

RESULTS

Four main domains of agency emerged from the analysis: personal growth, political well-being, social relationships, and geographical context. For each domain, specific dimensions are discussed.

CONCLUSIONS

The results of this preliminary exploration of children's agency suggest that the children's living environment plays a key role in shaping their suffering and reactions to war and ongoing violence. Furthermore, the social nature of the children affected by war-related suffering forces practitioners and policymakers to question the effectiveness of intervention programs that are predominantly focused on symptoms.

Engagement in community activities and trust in local leaders as concomitants of psychological distress among Israeli civilians exposed to prolonged rocket attacks

BACKGROUND AND OBJECTIVES

Present study, conducted in the aftermath of the 2014 Israel-Gaza conflict, investigated psychological toll of exposure to rockets attacks in a sample of residents of central and southern Israel. Analyses focused on the distress-protective functions of collectively grounded resources: engagement in community activities and trust in local leadership.

DESIGN

This cross-sectional study was conducted between 2 and 3 months after the hostilities.

METHOD

Participants (N = 764) were recruited by an online survey company that distributed a questionnaire assessing, in addition to focal predictors, sociodemographic factors and prior exposure to trauma. The outcome variables were post-traumatic stress disorder (PTSD) and nonspecific distress symptoms.

RESULTS

Conservative regression analyses revealed that greater exposure to rocket attacks was predictive of higher levels of posttraumatic stress symptoms. Higher engagement in community activities exhibited a partial trauma-buffering function. However, higher levels of trust in local leaders appeared to exacerbate, rather than diminish, negative impact of rocket exposure on PTSD. Symptoms of psychological distress were not influenced neither by trauma exposure nor by stressor interactions with resources. Trust in local leadership exerted a beneficial main effect on distress.

CONCLUSIONS

Collectively based resources are important for coping in times of community-wide stressors, yet their role is complex.

Psychological Aspects of the Israeli-Palestinian Conflict: A Systematic Review

Despite ongoing local and international peace efforts, the Jews, Arabs, and other residents of Israel and the Palestinian territories (i.e., the West Bank and Gaza) have endured decades of political, social, and physical upheaval, with periodic eruptions of violence. It has been theorized that the psychological impact of the Israeli-Palestinian conflict extends beyond the bounds of psychiatric disorders such as posttraumatic stress disorder (PTSD). Exposure to the ongoing conflict may lead to changes in the way Israelis and Palestinians think, feel, and act; while these changes may not meet the thresholds of PTSD or depression, they nonetheless could have a strong public health impact. It is unclear whether existing studies have found associations between exposure to the conflict and nonclinical psychological outcomes. We conducted a systematic review to synthesize the empirical research on the Israeli-Palestinian conflict and its psychological consequences. As a whole, the body of literature we reviewed suggests that exposure to regional political conflict and violence may have detrimental effects on psychological well-being and that these effects likely extend beyond the psychiatric disorders and symptoms most commonly studied. We found evidence that exposure to the conflict informs not only the way Israelis and Palestinians think, feel, and act but also their attitudes toward different religious and ethnic groups and their degree of support for peace or war. We also found that Palestinians may be at particularly high risk of experiencing psychological distress as a result of the conflict, though more research is needed to determine the extent to which this is due to socioeconomic stress. Our review suggests the need for more studies on the nonclinical psychological aspects of the Israeli-Palestinian conflict as well as for longitudinal studies on the impact of the conflict on both Israelis and Palestinians.

Children and adolescents facing a continuous security threat: Aggressive behavior and post-traumatic stress symptoms

There is extensive research evidence indicating that children and youth are the most vulnerable population for developing psychological symptoms relating to war and terror. Although studies have documented a wide range of detrimental emotional and behavioral effects of such exposure, much less is known about the effects of exposure to a continuous security threat for children and adolescents. Against this background, the current article examined the implications of continuous exposure to missile attacks among 1096 children and adolescents enrolled in public schools near the Israeli border with Gaza. Participants filled out quantitative questionnaires, which relate to the pathological consequences of continuous exposure to security threats, and to the role of the school and the community as a protective environment against disruptive behavior resulting from such exposure. The findings revealed that PTSS responses were mainly related to the security threat, whereas interpersonal aggression resulted from other types of traumatic events. Significant differences were found between aggression and posttraumatic symptoms, by age and gender. PTSS was found to be lower for older participants and higher for girls, whereas aggression was higher for boys and higher for older participants. Furthermore, the sense of belonging to the place of residence was negatively associated with PTSS as well as with aggressive behavior: the higher the participants' sense of belonging, the lower their levels of PTSS and aggressive responses. In contrast, the sense of belonging to the school was negatively associated only with aggressive behavior: the higher the participants' sense of belonging to the school, the lower their aggressive responses. The findings are discussed in the light of trauma theories and in light of the results of previous research. The study contributed to knowledge about the differential consequences of exposure to a security threat, and highlighted the importance of differential interventions with children who show post-traumatic symptoms versus those who show aggressive behavior. Accordingly, the security situation should not overshadow social issues that need to be addressed, such as family violence and aggression among school children.

Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review

In this meta-analytic and narrative review, we examine several overarching issues related to the study of coping, emotion regulation, and internalizing and externalizing symptoms of psychopathology in childhood and adolescence, including the conceptualization and measurement of these constructs. We report a quantitative meta-analysis of 212 studies (N = 80,850 participants) that measured the associations between coping and emotion regulation with symptoms of internalizing and externalizing psychopathology. Within the meta-analysis we address the association of broad domains of coping and emotion regulation (e.g., total coping, emotion regulation), intermediate factors of coping and emotion regulation (e.g., primary control coping, secondary control coping), and specific coping and emotion regulation strategies (e.g., emotional expression, cognitive reappraisal) with internalizing and externalizing symptoms. For cross-sectional studies, which made up the majority of studies included, we examine 3 potential moderators: age, measure quality, and single versus multiple informants. Finally, we separately consider findings from longitudinal studies as these provide stronger tests of the effects. After accounting for publication bias, findings indicate that the broad domain of emotion regulation and adaptive coping and the factors of primary control coping and secondary control coping are related to lower levels of symptoms of psychopathology. Further, the domain of maladaptive coping, the factor of disengagement coping, and the strategies of emotional suppression, avoidance, and denial are related to higher levels of symptoms of psychopathology. Finally, we offer a critique of the current state of the field and outline an agenda for future research. (PsycINFO Database Record

Religiosity as a Moderator of Self-Efficacy and Social Support in Predicting Traumatic Stress Among Combat Soldiers

Based on a sample of 54 Israeli soldiers (51 % non-religious, 49 % religious) surveyed upon their return from combat, this study investigates the moderating role of religiosity as a factor that may strengthen cognitive processing tied to the belief in oneself to persevere (i.e., self-efficacy) after trauma and/or as a factor tied to enhanced external social support that religious individuals in particular may benefit from by their involvement in a religious community. Findings revealed (1) social support was tied to greater resilience within the general sample; (2) religious soldiers were less susceptible to traumatic stress than non-religious soldiers; and (3) religiosity moderated the relationship between self-efficacy and traumatic stress but not the relationship between social support and traumatic stress. Implications of findings are discussed.

Review of Coping in Children Exposed to Mass Trauma: Measurement Tools, Coping Styles, and Clinical Implications

Evidence-based practice requires the use of data grounded in theory with clear conceptualization and reliable and valid measurement. Unfortunately, developing a knowledge base regarding children's coping in the context of disasters, terrorism, and war has been hampered by a lack of theoretical consensus and a virtual absence of rigorous test construction, implementation, and evaluation. This report presents a comprehensive review of measurement tools assessing child and adolescent coping in the aftermath of mass trauma, with a particular emphasis on coping dimensions identified through factor analytic procedures. Coping measurement and issues related to the assessment of coping are reviewed. Concepts important in instrument development and psychometric features of coping measures used in disasters, terrorism, and war are presented. The relationships between coping dimensions and both youth characteristics and clinical outcomes also are presented. A discussion of the reviewed findings highlights the difficulty clinicians may experience when trying to integrate the inconsistencies in coping dimensions across studies. Incorporating the need for multiple informants and the difference between general and context-specific coping measures suggests the importance of a multilevel, theoretical conceptualization of coping and thus, the use of more advanced statistical measures. Attention also is given to issues deemed important for further exploration in child disaster coping research.

Explaining the frequency of alcohol consumption in a conflict zone: Jews and Palestinians in Israel

Experiencing stress and exposure to terrorism may have an adverse effect on health risk behaviors. Few studies have examined alcohol use among adults living in Israel under chronic, stressful terrorism-related conditions. In this study, we examined the relationships of demographics, past stressful events, and terrorism exposure to the frequency of alcohol use and the mediating roles of depressive and post-traumatic stress disorder (PTSD) symptoms. We used three waves of data from a 2007-2008 nationally representative sample of Jewish and Palestinian adults in Israel. We assessed past stressful events, in addition to direct and indirect exposures to terrorism. Results indicated that past stressful events and exposure to terrorism were not directly associated with alcohol use, but were indirectly associated and mediated by depressive and PTSD symptomology. Mental health symptoms were differentially associated with alcohol use. More frequent drinking was mediated by higher levels of depression, including for women and Palestinians; however, PTSD symptom severity was related to less frequent drinking. Mental health may play a prominent role in the frequency of alcohol use among adults exposed to terrorism in Israel. Alcohol use, as a coping mechanism, may differ by demographic characteristics (gender and ethnicity) and psychological symptomology for adults living in a conflict zone in Israel.

Post-traumatic stress and world assumptions: the effects of religious coping

Religiosity has been shown to moderate the negative effects of traumatic event experiences. The current study was designed to examine the relationship between post-traumatic stress (PTS) following traumatic event exposure; world assumptions defined as basic cognitive schemas regarding the world; and self and religious coping conceptualized as drawing on religious beliefs and practices for understanding and dealing with life stressors. This study examined 777 Israeli undergraduate students who completed several questionnaires which sampled individual world assumptions and religious coping in addition to measuring PTS, as manifested by the PTSD check list. Results indicate that positive religious coping was significantly associated with more positive world assumptions, while negative religious coping was significantly associated with more negative world assumptions. Additionally, negative world assumptions were significantly associated with more avoidance symptoms, while reporting higher rates of traumatic event exposure was significantly associated with more hyper-arousal. These findings suggest that religious-related cognitive schemas directly affect world assumptions by creating protective shields that may prevent the negative effects of confronting an extreme negative experience.

Socio-ecological correlates of mental health among ethnic minorities in areas of political conflict: a study of Druze adolescents in Israel

Children and youths living in areas of political conflict are at increased risk of mental health problems, but little is known about psychosocial adjustment among ethnic minorities living in war-afflicted settings. This cross-sectional study used an ecological approach to investigate the unique contributions of child, family/social, and minority related factors as well as traumatic exposure and perceived discrimination to the mental health of 167 Druze adolescents in Northern Israel. Outcome measures included participants' self-reported posttraumatic stress disorder symptoms, psychological distress, and emotional and behavioral problems. Adolescents reported high indirect exposure, moderate discrimination, strong ethnic identity and high religious involvement. Regression analyses showed that female gender, number of traumatic events, and perceived discrimination were associated with more severe mental health outcomes. In addition, low social support and high religious involvement predicted increased PTSD symptom severity, while stronger ethnic identity was associated with less emotional and behavioral problems. Findings are discussed in terms of the cultural characteristics of the Druze community and highlight the need to consider additional stressors, such as discrimination, when working with ethnic minority youth in conflict zones.

The dislocations of terror: Assessments of risk during the Second Intifada

The goal of terrorism is to create havoc and disrupt the normal functioning of society. To understand the impact of terrorism on a country it is useful to consider two types of country experiences with these shocks to the social order-the instance of a very small number of attacks against high profile targets and the case of chronic terror with a great number of attacks, generally against targets that are part of routine daily activities. The present study explores the Israeli experience with chronic terror. Using expenditure information from coffee shops and restaurants we examine how individuals assess their vulnerability to an attack and adjust their behavior. Specifically, we explore whether distance from the site of an attack, and similarity of a contemplated undertaking to the target of a recent attack, influence decision making in a context of chronic terror. We find strong support for a situational similarity effect but only weak evidence for a proximity effect. We examine the implications of these findings for the organization of economic activity.

High school students' posttraumatic symptoms, substance abuse and involvement in violence in the aftermath of war

This study examined one-year after effects of exposure to war events on adolescents' Posttraumatic Stress Symptoms (PTS) and risk behaviors (substance use and involvement in school violence). In addition, it addressed two potential vulnerability factors: at the micro level, it examined whether childhood trauma raised the vulnerability of Israeli adolescents to PTS and risk behaviors when exposed to war events. At the macro level, we explored whether ethnicity, i.e., being an Israeli Arab, is a vulnerability factor to PTS and risk behaviors. We used a representative sample of 7th to 11th grade students from the north of Israel that included 4151 students: 1800 Jewish (54.4% boys) and 2351 Arab (41.5% boys). We assessed exposure to war events and childhood traumatic events, PTS and PTSD, substance use (alcohol, cannabis, Ecstasy) and involvement in school violence. The findings revealed extensive exposure to war events among both Jewish and Arab students. A year after the war, its effects on adolescents were still manifested in PTS, and involvement in school violence and substance use. Exposure to child physical abuse was associated with higher levels of PTS symptoms, substance use and involvement in violence. Exposure to other traumatic events was also associated with greater PTS symptoms and involvement in violence but not with greater substance use. Arab students were a more vulnerable population. They reported higher PTS symptoms, more cannabis use and greater involvement in school violence than Jewish students. However, exposure to war events had similar effects on both Arab and Jewish students. We conclude that war effects include a broad range of psychological distress and risk behaviors that last long after the war ends, especially among youth who have experienced childhood trauma and high exposure to war-related stressors.

A systematic review on the mental health of children and adolescents in areas of armed conflict in the Middle East

For many decades, the Middle East has been troubled with numerous long-standing armed conflicts and wars. Children and adolescents were not spared the trauma and its consequences. Exposure to traumatic events can result in mental, behavioural and emotional problems in children and adolescents. To date, this is the first paper that aims to systematically review the literature on the mental health of children and adolescents living in areas of armed conflict in the Middle East, specifically Israel, Palestine, Lebanon and Iraq. It explores factors that mediate between exposure to armed conflict and mental, behavioural and emotional problems and places them in a cultural context. Pubmed was searched and papers were identified using specific inclusion criteria. Seventy-one eligible studies were included. The main findings are that children and adolescents living in these conflict zones are exposed to high levels of traumatic experiences. Number of conflict-related traumatic experiences correlates positively with prevalence of mental, behavioural and emotional problems. Prevalence of post-traumatic stress disorder in children and adolescents is estimated to be 5-8% in Israel, 23-70% in Palestine and 10-30% in Iraq (insufficient data for Lebanon). The main determining factors identified were level and type of exposure, age, gender, socio-economic adversity, social support and religiosity. These findings bring to light the pressing need to provide children and adolescents living in conflict areas with help. They are useful in designing new interventions to strengthen child and adolescent resilience in areas of conflict worldwide. Specific recommendations are included.

Affective and behavioral changes following exposure to traumatic events: the moderating effect of religiosity on avoidance behavior among students studying under a high level of terror event exposure

The goals of this study were to examine the development of affective and behavioral changes following exposure to traumatic events among Israeli students studying under a high level of terror event exposure and to assess the effects of religiosity on those changes development. A questionnaire was administered to 770 students in the Ariel University Center in Judea and Samaria. Higher levels of terror exposure were associated with higher levels of avoidance behavior, subjective feelings of insecurity, and emotional distress. Higher religiosity moderated avoidance behavior, even when controlling for the level of objective exposure to terror events exposure, but had no influence on subjective sense of insecurity, or the level of emotional distress. These findings suggest that religiosity moderates behavioral changes development after traumatic event exposure mainly by reducing avoidance behavior.

The role of religious orientations in youth's posttraumatic symptoms after exposure to terror

This study examined the effect of religiosity on youth's posttraumatic symptoms resulting from exposure to terror. Participants consisted of 1,973 Israeli high school students. Objective and subjective exposure (fear) to terror were positively associated with posttraumatic symptoms. Intrinsic religiosity was negatively associated with posttraumatic symptoms and found to decrease the effects of objective exposure. Personal extrinsic orientation and social extrinsic orientation were positively associated with posttraumatic symptoms, having no mediating effect. Theoretical implications regarding religiosity as a coping mechanism in light of exposure to terror are discussed.

Six rapid assessments of alcohol and other substance use in populations displaced by conflict

BACKGROUND

Substance use among populations displaced by conflict is a neglected area of public health. Alcohol, khat, benzodiazepine, opiate, and other substance use have been documented among a range of displaced populations, with wide-reaching health and social impacts. Changing agendas in humanitarian response-including increased prominence of mental health and chronic illness-have so far failed to be translated into meaningful interventions for substance use.

METHODS

Studies were conducted from 2006 to 2008 in six different settings of protracted displacement, three in Africa (Kenya, Liberia, northern Uganda) and three in Asia (Iran, Pakistan, and Thailand). We used intervention-oriented qualitative Rapid Assessment and Response methods, adapted from two decades of experience among non-displaced populations. The main sources of data were individual and group interviews conducted with a culturally representative (non-probabilistic) sample of community members and service providers.

RESULTS

Widespread use of alcohol, particularly artisanally-produced alcohol, in Kenya, Liberia, Uganda, and Thailand, and opiates in Iran and Pakistan was believed by participants to be linked to a range of health, social and protection problems, including illness, injury (intentional and unintentional), gender-based violence, risky behaviour for HIV and other sexually transmitted infection and blood-borne virus transmission, as well as detrimental effects to household economy. Displacement experiences, including dispossession, livelihood restriction, hopelessness and uncertain future may make communities particularly vulnerable to substance use and its impact, and changing social norms and networks (including the surrounding population) may result in changed - and potentially more harmful-patterns of use. Limited access to services, including health services, and exclusion from relevant host population programmes, may exacerbate the harmful consequences.

CONCLUSIONS

The six studies show the feasibility and value of conducting rapid assessments in displaced populations. One outcome of these studies is the development of a UNHCR/WHO field guide on rapid assessment of alcohol and other substance use among conflict-affected populations. More work is required on gathering population-based epidemiological data, and much more experience is required on delivering effective interventions. Presentation of these findings should contribute to increased awareness, improved response, and more vigorous debate around this important but neglected area.

Measurement of religiosity/spirituality in adolescent health outcomes research: trends and recommendations

The relationship between religious/spiritual (R/S) factors and adolescent health outcomes has been studied for decades; however, the R/S measurement tools used may not be developmentally relevant for adolescents. A systematic literature review was conducted to review and evaluate trends in measuring R/S in adolescent health outcomes research. In this review a total of 100 articles met criteria for inclusion. Relatively few (n = 15) included adolescent-specific R/S measures or items accounting for developmentally relevant issues such as parental religiosity or age-appropriate language. Future R/S and health research with adolescents would be strengthened by incorporating developmentally relevant R/S measurement tools, psychometrics, and multidimensional measures.

Adolescents' mental health outcomes according to different types of exposure to ongoing terror attacks

This study investigates the impact of several types of exposure to terror attacks on adolescents' psychological outcomes in the context of ongoing terror. A total of 913 adolescents (51% girls) aged 12 to 18 years (12-13.6 = 33%; 13.7-15.6 = 38%; 15.7-18 = 28%) took part in the study. Detailed data were collected concerning objective, subjective and "mixed" types of exposure to terror, as well as demographics, post-traumatic stress symptoms (PTSS), emotional and behavioral problems and overall psychological and psychiatric difficulties. Subjective exposure was found to be the most important contributor to adolescents' post-traumatic stress and other mental health problems in this context. Gender also had important effects. The effects of objective and mixed types of exposure, as well as age, were less prominent. We did find, however, that the more adolescents consulted media, the less they experienced behavioral and emotional problems. Given that subjective experiences appear to be the best factor in explaining mental health outcomes when adolescents are confronted with persistent terror, the cognitive and emotional dynamics along with the coping behavior linked to such experiences merit further investigation.

Substance use and misuse in the aftermath of terrorism. A Bayesian meta-analysis

AIM

To conduct a comprehensive analysis of the conflicting evidence on substance use and misuse following mass traumas such as terrorist incidents.

METHODS

We reviewed and synthesized evidence from 31 population-based studies using Bayesian meta-analysis and meta-regression.

RESULTS

The majority of the studied were conducted in the aftermath of the terrorist attacks of 11 September 2001. Controlling for exposure, type of incident and time since the event occurred, 7.3% [95% credible interval (CrI) 1.1-32.5%] of a population can be expected to report increased alcohol consumption in the first 2 years following a terrorist event. There is, however, a 20% probability that the prevalence will be as high as 14%. The unadjusted prevalence of increased cigarette smoking following a terrorist event is 6.8% (95% Cr I 2.6-16.5%). Unadjusted reports of mixed drug use (including narcotics and prescription medications) was 16.3% (95% Cr I 1.3-72.5%).

CONCLUSIONS

These results underscore the potentially pervasive behavioral health effects of mass terrorism, and suggest that public health interventions may usefully consider substance use as an area of focus after such events.

Terrorism, post-traumatic stress, coping strategies, and spiritual outcomes

This mail survey measured post-traumatic stress symptoms, spiritual and non-spiritual coping strategies, and positive spiritual outcomes following the tragedies of 9/11/01 in a national, random sample of 1,056 Presbyterians. Respondents reported mild to moderate degrees of re-experiencing and hyper-arousal symptoms of post-traumatic stress, unrelated to location or knowing someone involved. People experiencing high stress used greater frequency and variety of both spiritual and non-spiritual types of coping strategies. Positive spiritual outcomes were remarkably related to positive spiritual coping strategies, in contrast to no association with negative coping. This study illustrates the significant degree of post-traumatic stress experienced with vicarious exposure and a wide spectrum of coping strategies used following the major terrorist attacks.

Threat to life and risk-taking behaviors: a review of empirical findings and explanatory models

This article reviews the literature focusing on the relationship between perceived threat to life and risk-taking behaviors. The review of empirical data, garnered from field studies and controlled experiments, suggests that personal threat to life results in elevated risk-taking behavior. To account for these findings, this review proposes a number of theoretical explanations. These frameworks are grounded in divergent conceptual models: coping with stress, emotion regulation, replenishing of lost resources through self-enhancement, modifications of key parameters of cognitive processing of risky outcomes, and neurocognitive mechanisms. The review concludes with a number of methodological considerations, as well as directions for future work in this promising area of research.

A Systematic Review of Recent Literature on Religiosity and Substance Use

This paper contains a systematic review of articles about the relationship between religiosity/spirituality and alcohol and drug use that were published between 1997 and 2006. Summaries of methodological characteristics (e.g., study design, sample size and composition, specific dimensions of religiosity, and substances investigated) and general findings of 105 studies provide an overview of the field. The association between religiosity/spirituality and reduced risk of substance use is well established, but a well defined body of knowledge on this relationship has been slow to emerge. The development of more sophisticated instrumentation to measure religiosity and spirituality, the investigation of samples that include users of major drugs of abuse, and the integration of the study of religion and drug use into the broader literature on religion and health can help the field build upon the considerable work that has been published.

Exposure to terrorism and Israeli youths' psychological distress and alcohol use: an exploratory study

This study examined the associations between physical and psychological proximity to terrorist attacks and post-traumatic symptoms (PTS), depressive symptoms, and alcohol use among Israeli youth. Self-administered questionnaires were completed under anonymous conditions by 1,150 high and junior high school students (51.3% boys and 48.7% girls) in a town in the Tel Aviv metropolitan area. Standardized, validated scales were used to measure psychological symptoms and alcohol use. High levels of exposure to terrorism were reported. Physical and psychological proximity to terrorist attacks were associated with more PTS symptoms and alcohol consumption. Physical proximity was also associated with symptoms of depression. The implications of terror-associated early drinking for later alcohol problems should be explored.