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bioterrorism, community disasters, mental health, preparedness, public health, risk communication, terrorism



  1. Boscarino, Joseph A. PhD, MPH
  2. Adams, Richard E. PhD
  3. Figley, Charles R. PhD
  4. Galea, Sandro MD, Dr PH
  5. Foa, Edna B. PhD


Objectives: To help improve disaster planning and research, we studied psychosocial predictors of terrorism fear and preparedness among New York City residents after the World Trade Center disaster (WTCD).


Method: We conducted a random cross-sectional survey of 1,681 adults interviewed 2 years after the WTCD. Participants were living in New York City at the time of the attack and exposed to ongoing terrorist threats.


Results: We found 44.9 percent (95% confidence interval [CI] = 41.9-47.9) of residents were concerned about future attacks and 16.9 percent (95% CI = 14.7-19.3) reported a fear level of "10" on a 10-point analog scale. Furthermore, 14.8 percent (95% CI = 12.8-17.0) reported they had made some plans for a future attack, a significant increase from the previous year. In addition, although 42.6 percent (95% CI = 39.6-45.7) indicated that they would likely wait for evacuation instructions following a chemical, biological, or nuclear attack, 34.4 percent (95% CI = 31.5-37.3) reported they would evacuate immediately against official advice. Predictors of high terrorism fear in a multivariate model included Hispanic ethnicity (odds ratio [OR] = 2.0, P = .006), lower education (OR = 4.4, P < .001, and OR = 3.7, P < .001, respectively, for nonhigh school and high school graduates, compared with college graduates), being exposed to stressful life events (OR = 1.6, P = .048), having current posttraumatic stress disorder (3.1, P < .001), having a fear of death (OR = 2.5, P = .002), and reporting a likelihood of fleeing an attack against advice (OR = 1.5, P = .034). The best predictors of preparedness in a multivariate model was being between 30 to 64 years old (30-44 years old, OR = 2.6, P = .001; 45-64 yeas old, OR = 1.8, P = .03, respectively, compared with 18-29 years old), having higher exposure to the WTCD (moderate exposure, OR = 1.7, P = .05; high exposure, OR = 2.4, P = .002; very high exposure, OR = 4.1, P < .001), respectively, compared with no little WTCD exposure), and having greater exposure to other lifetime traumatic events (high traumatic event exposure, OR = 2.1, P = .005, compared with no exposure).


Conclusion: Our study suggests that among those exposed to ongoing terrorism threats, terrorism fear and preparedness were related to socioeconomic factors, mental health status, terrorism exposure levels, and exposure to stressful life events.