Friday, August 14, 2009

Terrorism-Related Fear and Avoidance Behavior in a Multiethnic Urban Population

One public health definition of terrorism proposes that the effects of terrorism ‘‘real or threatened’’ may include ‘‘adverse health effects in those immediately affected and their community, ranging from a loss of well-being or security to injury, illness, or death.’’1 The events of September 11, 2001, influenced wellbeing and security beyond the regions directly attacked.2–4 Many people throughout the United States felt they were at risk from terrorism. Risk perceptions, along with antiterrorism programs, laws, and policies (e.g., airport security regulations, visa restrictions, and warrantless surveillance) affected Americans’ lifestyles and behaviors. In the months following the attacks, 40% to 50% of US adults still feared for their safety4,5 and 11% reported changed behaviors such as avoiding public gatherings.6,7 Risk perception theories and research posit that individuals assess risks based on a balance of many factors, including the probability of a hazard or risk personally affecting them, the severity of the personal consequences from risk exposure, feelings of personal control, the perceived inequality of risk distribution across society, and trust in institutions managing risks.8,9 For instance, a national survey conducted 2 months after the attacks of September 11 found that the distance between one’s home and the World Trade Center was inversely correlated with perceptions of terrorism risk among non-Hispanic Whites.9 By contrast, Latinos’ and African Americans’ judgments of future terror risks were not affected by how far they lived from New York City. These results are consistent with findings of lower risk perceptions among politically conservative White males, who feel greater control over their environment and greater trust in the institutions protecting them.10 As noted by Fischhoff, The estimation of personal risk and vulnerability to terrorism may act as a key motivator to behavioral adaptations, including avoidance of usual activities or increased adoption of protective behaviors.11–14 Those who believe they are particularly vulnerable to a riskmay be motivated to perform risk reduction.

Studies document that vulnerable populations, such as the chronically ill, the physically disabled, non-White racial/ ethnic minorities, and immigrants, bear a disproportionate burden of harm from natural disasters15–18 and that there are racial/ethnic differences in perceived risks of natural disasters.15 Similarly, research finds specifically that African Americans and Latinos perceive they are at greater risk from terrorism than do non- Latino Whites.9,19 A survey conducted less than a year after September 11, 2001, reported that African Americans were most likely to limit their outside activities and change their mode of transportation in response to fears of terrorism.5 Also, a national survey found that persons with disabilities were more anxious about their personal risk from terrorism than were persons without disabilities, even when equally prepared. 20 Another study reported that persons who increased their disaster preparations in response to the possibility of terrorist attacks included African Americans, Latinos, persons with disabilities or household dependents, and non– US-born populations.21 As with health and disasters generally, these populations may experience disparities in the effects of terrorism and terrorism policies including their risk perceptions and avoidant behavior. An Israeli survey found that large social groups, including women, had adapted their daily behaviors to minimize the impact of terrorism risks



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