Terrorism Media Effects in Youth Exposed to Chronic Threat and Conflict in Israel.

PURPOSE OF REVIEW: This paper reviews the extant research on the effects of contact with terrorism media coverage on psychological outcomes in youth in the context of chronic threat and conflict in Israel. RECENT FINDINGS: The extant research is inconclusive with respect to the relationship between media contact and a variety of psychological outcomes in Israeli studies of youth exposed to ongoing threat and repeated terrorist attacks. Additional research is needed to examine potential differences in outcomes and the factors that influence youth coping and adaptation in an environment of chronic threat and extensive media coverage. Moreover, studies are needed to identify and evaluate potential parental, professional, and social strategies to enhance youth adjustment. Because political conflict in Israel is not likely to abate in the near future, the setting is ideal to conduct methodologically rigorous research including research using representative samples, prospective reporting, and longitudinal design.

Media Effects in Youth Exposed to Terrorist Incidents: a Historical Perspective.

PURPOSE OF REVIEW: This paper reviews the evidence on the relationship between contact with media coverage of terrorist incidents and psychological outcomes in children and adolescents while tracing the evolution in research methodology. RECENT FINDINGS: Studies of recent events in the USA have moved from correlational cross-sectional studies examining primarily television coverage and posttraumatic stress reactions to longitudinal studies that address multiple media forms and a range of psychological outcomes including depression and anxiety. Studies of events in the USA-the 1995 Oklahoma City bombing, the September 11 attacks, and the 2013 Boston Marathon bombing-and elsewhere have used increasingly sophisticated research methods to document a relationship between contact with various media forms and adverse psychological outcomes in children with different event exposures. Although adverse outcomes are associated with reports of greater contact with terrorism coverage in cross-sectional studies, there is insufficient evidence at this time to assume a causal relationship. Additional research is needed to investigate a host of issues such as newer media forms, high-risk populations, and contextual factors.

Involving children in disaster risk reduction: the importance of participation.

Background: Millions of children are affected by disasters every year. Children need not be passive victims, however, but instead may contribute to disaster risk reduction activities. Objective: This paper provides a theoretical foundation for children's involvement in disaster risk reduction activities. Method: The paper reviews and analyses the literature on children's participation, on their developmental capacity to participate, and on disaster risk reduction activities involving children. Results: Participation yields numerous potential benefits for children, including enhanced personal development and skills, self-efficacy, and interpersonal relationships, and for communities through improved social connections and networks and disaster preparedness. Conclusions: Children are resources to be cultivated and mobilized for disaster preparedness, response, recovery, and resilience. Attention is needed to identify approaches to appropriately enlist, engage, and involve children in disaster risk reduction activities; to promote these efforts; and to evaluate these approaches.

Planteamiento: Millones de niños se ven afectados por desastres cada año. Sin embargo, los niños no necesitan ser víctimas pasivas, sino que pueden contribuir a las actividades de reducción del riesgo de desastres. Objetivo: Este documento proporciona una base teórica para la participación de los niños en actividades de reducción del riesgo de desastres. Método: El documento revisa y analiza la literatura sobre la participación de los niños, acerca de su capacidad de desarrollo para participar y de las actividades de reducción del riesgo de desastres que involucran a los niños. Resultados: la participación ofrece numerosos beneficios potenciales tanto para los niños, que incluyen una mejoría de su desarrollo personal y habilidades, de su autoeficacia y de sus relaciones interpersonales, como para las comunidades a través de mejores conexiones y redes sociales, y una mejor preparación para los desastres. Conclusiones: Los niños son recursos que se pueden cultivar y movilizar para la preparación, la respuesta, la recuperación y la resiliencia ante desastres. Se necesita atención para identificar enfoques para reclutar, involucrar e implicar apropiadamente a los niños en actividades de reducción del riesgo de desastres; para promover estos esfuerzos; y para evaluar estos enfoques.

Reactions of Oklahoma City bombing survivors to media coverage of the September 11, 2001, attacks.

OBJECTIVE: This study explored the effects of media coverage of a terrorist incident in individuals remote from the location of a major attack who had directly experienced a prior terrorist incident. METHOD: Directly-exposed survivors of the 1995 Oklahoma City bombing, initially studied six months after the incident, and indirectly-affected Oklahoma City community residents were assessed two to seven months after the September 11, 2001, attacks. Survivors were assessed for a diagnosis of bombing-related posttraumatic stress disorder (PTSD) at index and follow up, and emotional reactions and September 11 media behavior were assessed in all participants. RESULTS: Among the three investigated forms of media (television, radio, and newspaper), only television viewing was associated with 9/11-related posttraumatic stress reactions. Exposure to the Oklahoma City bombing was associated with greater arousal in relation to the September 11 attacks, and among survivors, having developed bombing-related PTSD was associated with higher scores on all three September 11 posttraumatic stress response clusters (intrusion, avoidance, and arousal). Although time spent watching television coverage of the September 11 attacks and fear-related discontinuation of media contact were not associated with Oklahoma City bombing exposure, discontinuing September 11 media contact due to fear was associated with avoidance/numbing in the full sample and in the analysis restricted to the bombing survivors. CONCLUSION: Surviving a prior terrorist incident and developing PTSD in relation to that incident may predispose individuals to adverse reactions to media coverage of a future terrorist attack.

Assessing community resilience: A CART survey application in an impoverished urban community.

This article describes an application of the Communities Advancing Resilience Toolkit (CART) Assessment Survey which has been recognized as an important community tool to assist communities in their resilience-building efforts. Developed to assist communities in assessing their resilience to disasters and other adversities, the CART survey can be used to obtain baseline information about a community, to identify relative community strengths and challenges, and to re-examine a community after a disaster or post intervention. This article, which describes an application of the survey in a community of 5 poverty neighborhoods, illustrates the use of the instrument, explicates aspects of community resilience, and provides possible explanations for the results. The paper also demonstrates how a community agency that serves many of the functions of a broker organization can enhance community resilience. Survey results suggest various dimensions of community resilience (as represented by core CART community resilience items and CART domains) and potential predictors. Correlates included homeownership, engagement with local entities/activities, prior experience with a personal emergency or crisis while living in the neighborhood, and involvement with a community organization that focuses on building safe and caring communities through personal relationships. In addition to influencing residents' perceptions of their community, it is likely that the community organization, which served as a sponsor for this application, contributes directly to community resilience through programs and initiatives that enhance social capital and resource acquisition and mobilization.

Disaster media coverage and psychological outcomes: descriptive findings in the extant research.

This review of the literature on disaster media coverage describes the events, samples, and forms of media coverage (television, newspapers, radio, internet) studied and examines the association between media consumption and psychological outcomes. A total of 36 studies representing both man-made and natural events met criteria for review in this analysis. Most studies examined disaster television viewing in the context of terrorism and explored a range of outcomes including posttraumatic stress disorder (PTSD) caseness and posttraumatic stress (PTS), depression, anxiety, stress reactions, and substance use. There is good evidence establishing a relationship between disaster television viewing and various psychological outcomes, especially PTSD caseness and PTS, but studies are too few to draw definitive conclusions about the other forms of media coverage that have been examined. As media technology continues to advance, future research is needed to investigate these additional media forms especially newer forms such as social media.

Building community resilience to disasters through a community-based intervention: CART applications.

The Communities Advancing Resilience Toolkit (CART)* is a community-driven, publicly available, theory-based, and evidence-informed community intervention designed to build community resilience to disasters and other adversities. Based on principles of participatory action research, CART applications contribute to community resilience by encouraging and supporting community participation and cooperation, communication, self-awareness, and critical reflection. The primary value of CART lies in its ability to stimulate analysis, collaboration, skill building, resource sharing, and purposeful action. In addition to generating community assessment data, CART can be used as a vehicle for delivering other interventions and creating sustainable capacity within communities. Two models for CART implementation are described.

The Communities Advancing Resilience Toolkit (CART): development of a survey instrument to assess community resilience.

While building community resilience to disasters is becoming an important strategy in emergency management, this is a new field of research with few available instruments for assessing community resilience. This article describes the development of the Communities Advancing Resilience Toolkit (CART) survey instrument. CART is a community intervention designed to enhance community resilience to disasters, in part, by engaging communities in measuring it. The survey instrument, originally based on community capacity and related literature and on key informant input, was refined through a series of four field tests. Community organizations worked with researchers in a participatory action process that provided access to samples and helped to guide the research. Exploratory factor analysis performed after each field test led to the identification of four interrelated constructs (also called domains) which represent the foundation for CART Connection and Caring, Resources, Transformative Potential, and Disaster Management. This model was confirmed using confirmatory factor analysis on two community samples. The CART survey can provide data for organizations and communities interested in assessing a community's resilience to disasters. Baseline data, preferably collected pre disaster can be compared to data collected post disaster and/or post intervention.

The Communities Advancing Resilience Toolkit (CART): an intervention to build community resilience to disasters.

Community resilience has emerged as a construct to support and foster healthy individual, family, and community adaptation to mass casualty incidents. The Communities Advancing Resilience Toolkit (CART) is a publicly available theory-based and evidence-informed community intervention designed to enhance community resilience by bringing stakeholders together to address community issues in a process that includes assessment, feedback, planning, and action. Tools include a field-tested community resilience survey and other assessment and analytical instruments. The CART process encourages public engagement in problem solving and the development and use of local assets to address community needs. CART recognizes 4 interrelated domains that contribute to community resilience: connection and caring, resources, transformative potential, and disaster management. The primary value of CART is its contribution to community participation, communication, self-awareness, cooperation, and critical reflection and its ability to stimulate analysis, collaboration, skill building, resource sharing, and purposeful action.

Research Methods in Child Disaster Studies: A Review of Studies Generated by the September 11, 2001, Terrorist Attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina.

BACKGROUND: A comprehensive review of the design principles and methodological approaches that have been used to make inferences from the research on disasters in children is needed. OBJECTIVE: To identify the methodological approaches used to study children's reactions to three recent major disasters-the September 11, 2001, attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina. METHODS: This review was guided by a systematic literature search. RESULTS: A total of 165 unduplicated empirical reports were generated by the search and examined for this review. This included 83 references on September 11, 29 on the 2004 Tsunami, and 53 on Hurricane Katrina. CONCLUSIONS: A diversity of methods has been brought to bear in understanding children's reactions to disasters. While cross-sectional studies predominate, pre-event data for some investigations emerged from archival data and data from studies examining non-disaster topics. The nature and extent of the influence of risk and protective variables beyond disaster exposure are not fully understood due, in part, to limitations in the study designs used in the extant research. Advancing an understanding of the roles of exposure and various individual, family, and social factors depends upon the extent to which measures and assessment techniques are valid and reliable, as well as on data sources and data collection designs. Comprehensive assessments that extend beyond questionnaires and checklists to include interviews and cognitive and biological measures to elucidate the negative and positive effects of disasters on children also may improve the knowledge base.

The burden of disaster: Part I. Challenges and opportunities within a child's social ecology.

Child development and adaptation are best understood as biological and psychological individual processes occurring within the context of interconnecting groups, systems, and communities which, along with family, constitute the child's social ecology. This first of two articles describes the challenges and opportunities within a child's social ecology consisting of Micro-, Meso-, Exo-, and Macrosystems. The parent-child relationship, the most salient Microsystem influence in children's lives, plays an influential role in children's reactions to and recovery from disasters. Children, parents, and other adults participate in Mesosystem activities at schools and faith-based organizations. The Exosystem--including workplaces, social agencies, neighborhood, and mass media--directly affects important adults in children's lives. The Macrosystem affects disaster response and recovery indirectly through intangible cultural, social, economic, and political structures and processes. Children's responses to adversity occur in the context of these dynamically interconnected and interdependent nested environments, all of which endure the burden of disaster Increased understanding of the influences of and the relationships between key components contributes to recovery and rebuilding efforts, limiting disruption to the child and his or her social ecology A companion article (R. L. Pfefferbaum et al., in press) describes interventions across the child's social ecology.

Incident-related television viewing and psychiatric disorders in Oklahoma City bombing survivors.

The objective of this study was to examine terrorism media coverage and psychiatric outcomes in directly-exposed terrorism survivors. The study used (1) self-report questionnaires to retrospectively assess event-related media behaviors and reactions in a cross sectional design and (2) longitudinal structured diagnostic interviews to assess psychopathologic outcomes. The participants were 99 directly-exposed Oklahoma City bombing survivors who were initially studied six months after the 1995 incident. Though a fear reaction to bombing-related television coverage and fear-driven discontinuation of bombing-related media contact were associated with diagnostic outcomes, the number of hours viewing bombing-related television coverage in the first week after the event was not associated with the prevalence of bombing-related posttraumatic stress disorder or post-bombing major depressive disorder during the seven years post event. The results raise doubt about the effects of quantified incident-related television viewing on clinically-significant emotional outcomes in directly-exposed terrorism survivors.

The burden of disaster: part II. applying interventions across the child's social ecology.

This second of two articles describes the application of disaster mental health interventions within the context of the childs social ecology consisting of the Micro-, Meso-, Exo-, and Macrosystems. Microsystem interventions involving parents, siblings, and close friends include family preparedness planning andpractice, psychoeducation, role modeling, emotional support, and redirection. Mesosystem interventions provided by schools and faith-based organizations include safety and support, assessment, referral, and counseling. Exosystem interventions include those provided through community-based mental health programs, healthcare organizations, the workplace, the media, local volunteer disaster organizations, and other local organizations. Efforts to build community resilience to disasters are likely to have influence through the Exosystem. The Macrosystem - including the laws, history, cultural and subcultural characteristics, and economic and social conditions that underlie the other systems - affects the child indirectly through public policies and disaster programs and services that become available in the child's Exosystem in the aftermath of a disaster The social ecology paradigm, described more fully in a companion article (Noffsinger Pfefferbaum, Pfefferbaum, Sherrieb, & Norris,2012), emphasizes relationships among systems and can guide the development and delivery of services embedded in naturally-occurring structures in the child's environment.

Exploring community resilience in workforce communities of first responders serving Katrina survivors.

Community resilience activities were assessed in workplace teams that became first responders for Hurricane Katrina survivors. Community resilience was assessed by a survey, focus groups, and key informant interviews. On the survey, 90 first responders ranked their team's disaster response performance as high on community resilience activities. The same participants, interviewed in 11 focus groups and 3 key informant interviews, discussed how their teams engaged in community resilience activities to strengthen their ability to deliver services. Specifically, their resilient behaviors were characterized by: shared organizational identity, purpose, and values; mutual support and trust; role flexibility; active problem solving; self-reflection; shared leadership; and skill building. The implications for research, policy, practice, and education of professionals are discussed.

Change in smoking and drinking after september 11, 2001, in a national sample of ever smokers and ever drinkers.

Telephone survey methodology was used to examine smoking and drinking after the September 11 terrorist attacks in a representative national sample. Most ever smokers and ever drinkers reported no change in substance use after the attacks. Smokers and drinkers who increased substance use were significantly more likely than those who did not to endorse a number of emotional reactions and functional difficulties. The pattern of associations of decreased use with emotional reactions and functional difficulties differed between smokers and drinkers. In general, decreased smoking was associated with denial of emotional reactions and functional difficulties whereas decreased drinking was associated with endorsement of these reactions and difficulties. The results have implications for research, clinical practice, and public health.

Community resilience as a metaphor, theory, set of capacities, and strategy for disaster readiness.

Communities have the potential to function effectively and adapt successfully in the aftermath of disasters. Drawing upon literatures in several disciplines, we present a theory of resilience that encompasses contemporary understandings of stress, adaptation, wellness, and resource dynamics. Community resilience is a process linking a network of adaptive capacities (resources with dynamic attributes) to adaptation after a disturbance or adversity. Community adaptation is manifest in population wellness, defined as high and non-disparate levels of mental and behavioral health, functioning, and quality of life. Community resilience emerges from four primary sets of adaptive capacities--Economic Development, Social Capital, Information and Communication, and Community Competence--that together provide a strategy for disaster readiness. To build collective resilience, communities must reduce risk and resource inequities, engage local people in mitigation, create organizational linkages, boost and protect social supports, and plan for not having a plan, which requires flexibility, decision-making skills, and trusted sources of information that function in the face of unknowns.

Media coverage and children's reactions to disaster with implications for primary care and public health.

To address the potential for media coverage of traumatic events to generate fear reactions in children, we examined exposure and reactions to media coverage of the 1995 Oklahoma City bombing in children attending a middle school 100 miles from the disaster site two and three years after the event. Many of the children studied recalled feeling "afraid," "sad," or "mad" in relation to initial media coverage. Overall exposure and reactions to bomb-related media coverage declined over the three years. However, these reactions persisted for some children and, when they did, the reactions were related to exposure to coverage right after the bombing. Approximately one-fourth of the children recalled that the bombing made them feel "a lot" less safe in their home, school, and/or neighborhood. These perceptions persisted for approximately 10% of the children. Our Findings suggest the importance of primary care and public health interventions to determine and monitor children's reactions.

Trauma, grief and depression in Nairobi children after the 1998 bombing of the American Embassy.

Despite the increasingly dangerous world where trauma and loss are common, relatively few studies have explored traumatic grief in children. The 1998 American Embassy bombing in Nairobi, Kenya, provided an unfortunate opportunity to examine this topic. This report describes findings in 156 children who knew someone killed in the incident, assessed 8 to 14 months after the explosion. Bomb-related posttraumatic stress was associated with physical exposure, acute response, posttraumatic stress related to other negative life events, type of bomb-related loss, and subsequent loss. Grief was associated with bomb-related posttraumatic stress, posttraumatic stress related to other negative life events, and type of bomb-related loss. The study supports the developing literature on traumatic grief and the need for studies exploring the potentially unique aspects of this construct.

Teachers in the aftermath of terrorism: a case study of one New York City school.

Teachers are frequently expected to support children psychologically in the aftermath of mass casualty events, yet they generally have not been trained to do so. This study of a small private school in New York City reports the reactions, needs, and interests in preparedness training among teachers in response to the September 11, 2001, terrorist attacks. By and large, teachers coped by talking to others and/or a health professional, but felt ill-equipped to intervene with students and expressed substantial need for assistance.

Teachers' psychological reactions 7 weeks after the 1995 Oklahoma City bombing.

This study assessed teachers' reactions to the Oklahoma City bombing. Peritraumatic reactions, the interaction of media exposure with stress from media coverage, feelings toward the perpetrators, and worry about safety predicted posttraumatic stress. Twenty percent reported difficulty handling demands; 5% sought counseling. Outreach efforts should assess and assist teachers.