- [work by david Opp]
Exposure to Terrorism and Israeli Youth's Psychological
Distress and Alcohol Use: An Exploratory Study

[taken from the original paper] / credits below
Consequences of Israeli youth exposure to terrorism
Context: Youth as well as adults in Israel have been exposed to a great
number of terrorist attacks since 2000. Relatively little is known about the
psychological impact of terrorism on youth, and no studies of youth have
addressed alcohol.
Objectives: To examine the associations between physical and psychological
proximity to terrorist attacks and PTSD and depressive symptoms, and alcohol
use among Israeli youth.
Methods: 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. Data were
analyzed with linear regression.
Results: High levels of exposure to terrorism were reported. Physical and
psychological proximity to terrorist attacks were associated with more PTSD
symptoms, and alcohol consumption. Physical proximity was also associated with
symptoms of depression.
Conclusion: Physical and psychological proximity to terrorist attacks is associated
with an increased alcohol use among adolescents. The implications of terrorassociated
early drinking for later alcohol problems should be explored.
Consequences of Israeli youth exposure to terrorism
Israeli children have been exposed to political violence including wars and terrorist
attacks since Israel's inception in 1948 1. However, since 2000, the frequency and
severity of attacks substantially increased. From September 2000 until mid July
2004, 879 terrorist attacks occurred within the "green line" (original Israeli borders
since 1948) areas, killing 972 persons, and injuring an additional 6,499. Among
these injured or killed, a significant number were children and adolescents 2. The
number of attacks amongst a relatively small population (about 6.6 million 3) has
exposed a high proportion of Israeli citizens to this real and ongoing threat.
It is widely assumed that exposure to disasters in general and war and terrorism in
particular takes a heavy toll on children and adolescents’ mental health41,58.
However, the small number of empirical studies, especially on ongoing exposure to
political violence, and their varied methodology leave open many questions about
psychological distress symptoms and risk behavior following terror attacks for
youth 4 5 6.
Studies conducted in the U.S. following the 1993 World Trade Center bombing 7,
the 1995 Oklahoma City bombing 8 9, and the September 11 2001 attack 10 11
reveal that children and adolescents are at high risk for psychological harm
following terrorist acts. This includes high levels of posttraumatic stress symptoms,
depression and anxiety disorders 12. In addition, being in the area of a terrorist
attack and knowing someone who was hurt in the attack are associated with higher
level of stress and trauma related symptoms (see 12 for a review). One of the
largest studies conducted in the U.S. on children and adolescents exposed to
terrorism, was the study of a representative sample of students in New York public
schools4 following the September 11 terror attack. The findings revealed that
children in New York City had higher than expected rates of posttraumatic stress
disorder, major depression, and various anxiety disorders. In addition, personal
exposure to the event (e.g., fled the disaster site), or knowing someone who was
personally exposed (e.g., family member killed or injured) were identified as risk
factors associated with psychological distress.
Previous studies conducted in Israel before the Al Akza uprising 6, 13, 14 used small
sample size and measured only psychological distress. The only extensive study
on the psychological impact of current terrorism in Israel is focused on adults 15. In
this study, level of exposure to terrorist attacks and the prevalence of posttraumatic
stress disorder were studied in a representative sample of 512 adult
Israeli residents. Findings revealed that 22.1% reported a friend or family member
was wounded or killed in an attack and 15.3% reported that they knew someone
who survived an attack uninjured. In addition, more than 67% reported at least one
trauma- or stress-related symptom for at least one month, with a mean of four
symptoms reported per person. The relationship of overall alcohol or drug use to
terror exposure was not analyzed.

Miriam Schiff (Ph.D.), Rami Benbenishty (Ph.D.)
Hebrew University of Jerusalem, School of Social Work and Social Welfare,
Research Group: Mental Health and Well Being in Childhood and Adolescence
Mary McKay (Ph.D.), Mount Sinai School of Medicine
Ellen DeVoe (Ph.D.), Columbia University School of Social Work,
Xinhua, Liu (Ph.D.), Deborah Hasin (Ph.D.)- Columbia University School of
Public Health and College of Physicians and Surgeons
In press: American Journal on Addictions
Submitted: October, 2004
Revised: January, 2005
Key Words: Terrorism, Youth, Alcohol Use, PTSD, Depression, Adverse Life
Events, Israel
Please address correspondence to:
Miriam Schiff, Ph.D.
The Hebrew University of Jerusalem
Paul Baerwald School of Social Work and Social Welfare
Mt Scopus, Jerusalem 91905
Fax: (972 2) 582-3587
E-mail: msschiff@mscc.huji.ac.il