Changes in Substance Abuse Patterns Following the Terrorist Attacks of September

描述（由申请人提供）：关于恐怖事件等灾害对健康影响的流行病学数据对于帮助指导救援和恢复工作至关重要。没有对2001年9月11日恐怖主义袭击对药物滥用的发生率、流行率、模式和趋势的影响进行大规模、全面和以人口为基础的分析。门诊和急诊科医疗补助数据的拟议分析提供了一个宝贵的机会，以帮助描述和分析如何流行病学的测量和方法，利用大型，行政收集的健康数据集，可以利用在物理，社会和经济环境的巨大变化的背景下，评估药物滥用的恐怖主义，人为和自然灾害。统计分析将包括解决相关数据、空间关系问题的方法，以及纳入地理和建筑环境措施，以帮助改进非实验数据来源的因果推断，以评估恐怖袭击的影响。该假设是，在纽约市世界贸易中心塔楼遭受袭击和随后倒塌的个人中，存在可测量的短期和长期行为健康影响，这些影响是由于创伤应激，通过接近事件进行空间调解，并与受影响社区的整体社会，经济和公共健康不利有关。具体目标是：（1）审查、记录和综合关于恐怖主义等群体事件对药物滥用的影响的文献;（2）对9月11日恐怖主义袭击之前、期间和之后纽约市社区药物滥用模式进行时间序列分析，2001年，以确定是否在社会和经济环境的破坏与改变药物使用行为和（3）确定是否有证据的空间之间的关联的影响后攻击期和药物滥用。该项目以首席调查员对2001年9月11日恐怖袭击对纽约社区的健康影响进行的初步研究为基础。它将利用元分析、泊松和逻辑回归、中断和动态时间序列分析以及贝叶斯方法来进行分层空间建模。结果将导致建议应急管理从业人员和决策者在准备和动员他们的社区灾害或恐怖事件，以及行为健康研究人员和从业人员在确定风险，脆弱性，保护性和弹性因素时，规划全社区的健康干预措施后，恐怖袭击和自然灾害。

DESCRIPTION (provided by applicant): Epidemiologic data on the health effects of disasters such as terrorist incidents is essential to help guide relief and recovery efforts. No large-scale, comprehensive, population- based analysis of the effects of the September 11, 2001 terrorist attacks on the incidence, prevalence, patterns and trends of substance abuse has been conducted. This proposed analysis of outpatient and emergency department Medicaid data offers a valuable opportunity to help describe and analyze how epidemiologic measurement and methodology utilizing large, administratively collected health data sets can be utilized in the context of dramatic changes in the physical, social and economic environment to assess drug abuse following terrorism, man-made and natural disasters. The statistical analyses will include methodology to address issues of correlated data, spatial relationships, and the inclusion of geographic and built environment measures to help improve causal inference from non-experimental sources of data to assess the effects of the terrorist attacks. The hypothesis is that there were measurable short-term and long-term behavioral health effects among individuals exposed to the attacks on and subsequent collapse of the World Trade Center towers in New York City, that these effects were due to traumatic stress, were spatially mediated via proximity to the events, and were associated with adverse overall social, economic and public health of the affected communities. The specific aims are to (1) Review, document and synthesize the literature on the effect of mass events such as terrorism on substance abuse (2) Conduct time series analyses of patterns of drug abuse in New York City communities for the periods preceding, during and following the terrorist attacks of September 11, 2001 to determine if disruptions in social and economic environments are linked to changes drug use behavior and (3) Determine if there is evidence of a spatial association between the effects of the post-attack period and drug abuse. The project builds on initial research conducted by the principal investigator into the health effects of the terrorist attacks of September 11, 2001 on the communities of New York. It will utilize methods of meta-analysis, Poisson and logistic regression, interrupted and dynamic time series analyses and Bayesian approaches to hierarchical spatial modeling. Results will lead to recommendations for emergency management practitioners and policy makers in preparing and mobilizing their communities for disasters or terrorist events, as well as for behavioral health researchers and practitioners in identifying risk, vulnerability, protective and resiliency factors when planning community-wide health interventions following terrorist attacks and natural disasters.