Changes in Substance Abuse Patterns Following the Terrorist Attacks of September

描述(由申请人提供)：关于恐怖主义事件等灾害对健康影响的流行病学数据对于帮助指导救济和恢复工作至关重要。没有对2001年9月11日恐怖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的、全面的、以人口为基础的分析。这项拟议的门急诊医疗补助数据分析提供了一个宝贵的机会，以帮助描述和分析如何在物理、社会和经济环境发生巨大变化的情况下，利用大量管理收集的健康数据集进行流行病学测量和方法，以评估恐怖主义、人为和自然灾害之后的药物滥用情况。统计分析将包括处理相关数据、空间关系问题的方法，以及纳入地理和建筑环境措施，以帮助改进非试验性数据来源的因果推断，以评估恐怖袭击的影响。假设是，在纽约市世贸中心双子塔遭受袭击并随后倒塌的个人中，存在可测量的短期和长期行为健康影响，这些影响是由创伤应激造成的，通过接近事件在空间上中介，并与受影响社区的整体社会、经济和公共健康不利相关。其具体目的是(1)审查、记录和综合关于恐怖主义等群众性事件对药物滥用的影响的文献(2)对2001年9月11日恐怖袭击之前、期间和之后纽约市社区的药物滥用模式进行时间序列分析，以确定社会和经济环境的破坏是否与药物使用行为的变化有关，以及(3)确定是否有证据表明袭击后时期的影响与药物滥用之间存在空间联系。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。它将利用荟萃分析、泊松和Logistic回归、间断和动态时间序列分析以及贝叶斯方法进行分层空间建模。这些成果将为应急管理从业者和政策制定者在准备和动员社区应对灾害或恐怖事件方面提出建议，并为行为健康研究人员和从业者在规划恐怖袭击和自然灾害后的社区卫生干预措施时确定风险、脆弱性、保护性和复原力因素提出建议。

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.