Approximately 2 weeks after September 11th, adolescents from a national sample of households who were indirectly exposed to the terrorist attacks through the media completed a Web-based survey that assessed event-related acute stress symptoms. One year later, these adolescents (N = 142) and a randomly selected parent from their household completed a second survey. On average, adolescents reported mild to moderate acute stress symptoms shortly after the attacks and few trauma-related symptoms, low psychological distress and functional impairment, and moderate levels of positive affect 1 year later. After adjusting for acute stress symptoms reported after the attacks, greater parent-adolescent conflict was positively associated with adolescents’ trauma symptoms, distress, and functional impairment at 1 year. Higher levels of adolescent positive affect at 1 year were associated with greater parental positive affect, greater parental support, and higher levels of parenting self-efficacy. Parents may play an important role in adolescents ' responses to stressful national events.

This study investigated the role of parent-adolescent relationships in mediating the association between family-related negative life events and adolescent depressive symptoms and problem behaviors among 1,696 eleventh graders from the United States (n = 201), China (n = 502), Korea (n = 497), and Czech Republic (n = 496). Results indicated that perceived parental involvement and parent-adolescent conflict mediated the link between family-related life events and adolescent depressed mood. The path from family-related life events to adolescent problem behaviors was mediated by perceived parental involvement, parent-adolescent conflict, and perceived parental sanctions of adolescent misconduct. With the exception of minor cross-cultural differences in the magnitude of associations among variables, this study revealed considerable similarity in the association of family factors with adolescent internalizing and externalizing symptomatology. The findings contribute to the growing literature on culture-general developmental processes.

This study examined risk and protection for adolescent problem behavior and depressive symptomatology in an average-risk sample of 11th graders. Using a socioecological perspective, we aggregated risk factors for adolescent problem behavior and depressed mood by 3 social contexts: i.e., family and peer contexts, and a context comprising the most important nonparental adult ("VIP") in respondents' lives. Protective factors associated with these 3 contexts were also included in the analyses. We tested separate models (including outcome-specific risk and protective factors) for predicting problem behaviors and depressive symptoms; the models demonstrated divergent validity. Risk and protective factors accounted for 49% of the variance in problem behavior and 49% in depressive symptoms. Tests of interactions between risk-aggregates and protective factors yielded several significant cross-context buffering effects in the problem behavior model, but none in the depressive symptoms model. Parents' and VIP's perceived sanctions buffered adolescents against high risk for problem behavior emanating from the peer context. Additionally, perceived peers' sanctions buffered youths against risk emanating from each of the 3 contexts.

Context

The terrorist attacks of 9/11 (September 11, 2001) present an unusual opportunity to examine prospectively the physical health impact of extreme stress in a national sample.

Objective

To examine the degree to which acute stress reactions to the 9/11 terrorist attacks predict cardiovascular outcomes in a national probability sample over the subsequent 3 years.

Design, setting, and participants

A national probability sample of 2729 adults (78.1% participation rate), 95.0% of whom had completed a health survey before 9/11 (final health sample, 2592), completed a Web-based assessment of acute stress responses approximately 9 to 14 days after the terrorist attacks. Follow-up health surveys reassessed physician-diagnosed cardiovascular ailments 1 (n = 1923, 84.3% participation rate), 2 (n = 1576, 74.2% participation rate), and 3 (n = 1950, 78.9% participation rate) years following the attacks.

Main outcome measures

Reports of physician-diagnosed cardiovascular ailments over the 3 years following the attacks.

Results

Acute stress responses to the 9/11 attacks were associated with a 53% increased incidence of cardiovascular ailments over the 3 subsequent years, even after adjusting for pre-9/11 cardiovascular and mental health status, degree of exposure to the attacks, cardiovascular risk factors (ie, smoking, body mass index, and number of endocrine ailments), total number of physical health ailments, somatization, and demographics. Individuals reporting high levels of acute stress immediately following the attacks reported an increased incidence of physician-diagnosed hypertension (rate ratios, 2.15 at 1 year and 1.75 at 2 years) and heart problems (rate ratios, 2.98 at 1 year and 3.12 at 2 years) over 2 years. Among individuals reporting ongoing worry about terrorism post-9/11, high 9/11-related acute stress symptoms predicted increased risk of physician-diagnosed heart problems 2 to 3 years following the attacks (rate ratios, 4.67 at 2 years and 3.22 at 3 years).

Conclusion

Using health data collected before 9/11 as a baseline, acute stress response to the terrorist attacks predicted increased reports of physician-diagnosed cardiovascular ailments over 3 years following the attacks.

This study examined adolescents' adjustment following the attacks of September 11, 2001 (9/11). A Web-based survey was administered 2 weeks and 7 months postattacks to a national sample of adolescents (N = 104). A randomly selected parent also completed a survey at the 7-month assessment. Although exposure to the attacks was indirect, over half the participants felt threatened. Adolescents' posttraumatic stress symptoms were associated with their acute stress symptoms, parental distress, parental coping advice, parental availability to discuss the attacks, and reports that 9/11-related discussions were unhelpful. Adolescents' distress symptoms were associated with a history of mental health problems, acute stress symptoms, and parental unavailability to discuss the attacks.

Individuals frequently perceive positive changes in themselves following adversity; after a collective trauma, they may perceive such benefits in others or in their society as well. We examined perceived benefits of the September 11, 2001 (9/11) terrorist attacks in a 3-year study of a national sample of adults (N = 1382). Many individuals (57.8%) perceived social benefits of 9/11, including increased prosocial behavior, religiousness, or political engagement. Individuals who found increased national religiosity as a benefit 2 months post-9/11 reported greater positive affect and life satisfaction and lower distress and posttraumatic stress up to 3 years post-9/11. Pre-9/11 religiousness and Republican political affiliation predicted perceiving religion-related social benefits post-9/11. Perceptions of social change are important but understudied responses to stressful events.

This study examined the contribution of individual and family variables to depressive symptoms among youths in a family-centered culture. Participants were 262 Mexican adolescents (mean age = 15.9 years). At the individual level, gender (being female) and higher levels of perceived stressfulness of life events and ruminative coping style were correlated with higher frequency of depressive symptoms. At the family level, higher levels of perceived parental warmth and acceptance and parental monitoring were correlated with lower levels of depressed mood, whereas higher levels of parent-adolescent conflict were associated with greater frequency of depressive symptoms. Regression analyses confirmed our prediction that both individual factors (gender, ruminative coping) and family factors (parental warmth and parental monitoring) would make unique contributions to depressive symptoms. The model comprised of individual and family variables accounted for 50% of the variance in depressed mood. Moreover, parental warmth and acceptance attenuated the impact of ruminative coping style on adolescents' depressive symptomatology. Findings are discussed in relation to previous research on adolescents in another family-centered culture (China), and directions for future research are proposed.

Context

The September 11, 2001, attacks against the United States provide a unique opportunity to examine longitudinally the process of adjustment to a traumatic event on a national scale.

Objective

To examine the degree to which demographic factors, mental and physical health history, lifetime exposure to stressful events, September 11-related experiences, and coping strategies used shortly after the attacks predict psychological outcomes over time.

Design, setting, and participants

A national probability sample of 3496 adults received a Web-based survey; 2729 individuals (78% participation rate) completed it between 9 and 23 days (75% within 9 to 14 days) after the terrorist attacks. A random sample of 1069 panelists residing outside New York, NY, were drawn from the wave 1 sample (n = 2729) and received a second survey; 933 (87% participation rate) completed it approximately 2 months following the attacks. A third survey (n = 787) was completed approximately 6 months after the attacks.

Main outcome measures

September 11-related symptoms of acute stress, posttraumatic stress, and global distress.

Results

Seventeen percent of the US population outside of New York City reported symptoms of September 11-related posttraumatic stress 2 months after the attacks; 5.8% did so at 6 months. High levels of posttraumatic stress symptoms were associated with female sex (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.17-2.31), marital separation (OR, 2.55; 95% CI, 1.06-6.14), pre-September 11 physician-diagnosed depression or anxiety disorder (OR, 1.84; 95% CI, 1.33-2.56) or physical illness (OR, 0.93; 95% CI, 0.88-0.99), severity of exposure to the attacks (OR, 1.31; 95% CI, 1.11-1.55), and early disengagement from coping efforts (eg, giving up: OR, 1.68; 95% CI, 1.27-2.20; denial: OR, 1.33; 95% CI, 1.07-1.64; and self-distraction: OR, 1.31; 95% CI, 1.07-1.59). In addition to demographic and pre-September 11 health variables, global distress was associated with severity of loss due to the attacks (beta =.07; P =.008) and early coping strategies (eg, increased with denial: beta =.08; P =.005; and giving up: beta =.05; P =.04; and decreased with active coping: beta = -.08; P =.002).

Conclusions

The psychological effects of a major national trauma are not limited to those who experience it directly, and the degree of response is not predicted simply by objective measures of exposure to or loss from the trauma. Instead, use of specific coping strategies shortly after an event is associated with symptoms over time. In particular, disengaging from coping efforts can signal the likelihood of psychological difficulties up to 6 months after a trauma.

Millions of people witnessed early, repeated television coverage of the September 11 (9/11), 2001, terrorist attacks and were subsequently exposed to graphic media images of the Iraq War. In the present study, we examined psychological- and physical-health impacts of exposure to these collective traumas. A U.S. national sample (N = 2,189) completed Web-based surveys 1 to 3 weeks after 9/11; a subsample (n = 1,322) also completed surveys at the initiation of the Iraq War. These surveys measured media exposure and acute stress responses. Posttraumatic stress symptoms related to 9/11 and physician-diagnosed health ailments were assessed annually for 3 years. Early 9/11- and Iraq War-related television exposure and frequency of exposure to war images predicted increased posttraumatic stress symptoms 2 to 3 years after 9/11. Exposure to 4 or more hr daily of early 9/11-related television and cumulative acute stress predicted increased incidence of health ailments 2 to 3 years later. These findings suggest that exposure to graphic media images may result in physical and psychological effects previously assumed to require direct trauma exposure.

Health disparities persist despite ongoing efforts. Given the United States' rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the ConNECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT's five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice.