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This is the first known study of the psychosocial impact of terrorism among pregnant women. Ninety-nine women attending prenatal care in New York City were interviewed after September 11, 2001 and classified by drinking patterns. Current drinkers with a history of alcohol dependence perceived less social support following the disaster compared to other women. History of illegal drug use prior to maternal awareness of pregnancy was related to a weaker maternal-fetal bond. Greater exposure to trauma predicted stronger subjective effects and more depressive symptoms. These data support findings in non-pregnant samples that exposure of terrorist attacks predicts the subjective experience.


Ahern, J., Galea, S., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., & Vlahov, D. (2002). Television images and psychological symptoms after the September 11 terrorist attacks. Psychiatry, 65(4), 289-300.

Alexander, G.R., & Kogan, M.D. (1998). Ethnic differences in birth outcomes: The search for answers continues. Birth, 25, 787-793.

American Psychiatric Association (APA). (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. D.O.: Washington, D.C. p. 181.

Babor, T.F., Steinberg, K., Anton, R., & del Boca, F. (2000). Talk is cheap: Measuring drinking outcomes in clinical trials. Journal of Studies on Alcohol, 61, 55-63.

Benitzhak, Y. & Verny, T.R. (2004). The nature of stress due to terrorism on pregnant women and their offspring. Journal of Prenatal and Perinatal Psychology and Health, 19(1), 65-74.

Canino, G.J., Bravo, M., Ramirez, R., Febo, V.E., Rubio-Stipec, M., Fernandez, R.L., & Hasin, D. (1999). Spanish Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability and concordance with clinical diagnoses in a Hispanic population. Journal of Studies on Alcohol, 60, 790-799.

Center for Disease Control and Prevention (CDC). (2002). Psychological and emotional effects of the September 11 attacks on the World Trade Center-Connecticut, New Jersey, and New York, 2001. Morbidity and Mortality Weekly Report, 51, 784-786.

Daeppen, J.B., Yersin, B., Landry, U., Pecoud, A., & Decrey, H. (2000). Reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) imbedded within a general health-risk screening questionnaire: Results of a survey in 332 primary care patients. Alcohol: Clinical & Experimental Research, 24(5), 659-665.

DeLisi, L.E., Maurizio, A., Yost, M., Papparozzi, C.F., Fulchino, C., Katz, C.L., Altesman, J., Biel, M., Lee, J., & Stevens, P. (2003). A survey of New Yorkers after the Sept. 11, 2001, terrorist attacks. American Journal of Psychiatry, 160, 780-783.

Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., & Vlahov, D. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346(13), 982-987.

Grant, B.F., Dawson, D.A., Stinson, F.S., Chou, P.S., Kay, W., & Pickering, R. (2003). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): Reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence, 71, 7-16.

Grant, B.F., Hartford, T.C., Dawson, D.A., Chou, P.S., & Pickering, R. (1995). The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample. Drug & Alcohol Dependence, 39, 37-44.

Grant, B.F., & Hasin, D.S. (1992). Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS). Bethesda, M.D.: National Institute on Alcohol Abuse and Alcoholism.

Harrison, L. (1997). The validity of self-reported drug use in survey research: An overview and critique of research methods. In: L. Harrison & A. Hughes (Eds.). The validity of self-reported drug use: Improving the accuracy of survey estimates. National Institute on Drug Abuse (NIDA) Research Monograph, 167, D.C.: DHHS, NIH, NIDA; pp. 17-36.

Hasin, D., Carpenter, K.M., McCloud, S., Smith, M., & Grant, B.F. (1997). The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability of alcohol and drug modules in a clinical sample. Drug and Alcohol Dependence, 44, 133-141.

Hobfoll, S.E., Ritter, C., Lavin, J., Hulsizer, M.R., & Cameron, R.P. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psychology, 63(3), 445-453.

Howard, J., & Beckwith, L. (1996). Issues in subject recruitment and retention with pregnant and parenting substance-abusing women. National Institute on Drug Abuse Research Monograph 166. D.C.: DHHS, NIH, NIDA. pp. 68-85.

Kramer, M.S., Seguin, L., Lydon, J., & Goulet, L. (2000). Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly? Paediatric & Perinatal Epidemiology, 14, 194-210.

Leifer, M. (1977). Psychological changes accompanying pregnancy and motherhood. General Psychiatry Monograph, 95, 55-96.

Lundy, B.L., Jones, N.A., Field, T., Nearing, G., Davalos, M., Pietro, P.A., Schanberg, S., & Kühn, C. (1999). Prenatal depression effects on neonates. Infant Behavior and Development, 22(1), 119-129.

Marcus, S.M., Flynn, H.A., & Barry, K.L. (2003). Depressive symptoms among pregnant women screened in obstetrics settings. Journal of Women's Health, 12(4), 373-380.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (1997). Alcohol and Health. Ninth Special Report to the U.S. Congress from the secretary of Health and Human Services. D.C.: DHHS, PHS, NIH. NIAAA.

North, C.S., Nixon, S.J., Shariat, S., Mallonee, S., McMillan, J.C., Spitznagel, E.L., & Smith, E.M. (1999). Psychiatric disorders among survivors of the Oklahoma City bombing. Journal of the American Medical Association, 282(S), 755-762.

Ockene, J.K., Ma, Y., Zapka, J.G., Pbert, L.A., Goins, KV., & Stoddard, A.M. (2002). Spontaneous cessation of smoking and alcohol use among low-income pregnant women. American Journal of Preventive Medicine, 23(3), 150-159.

Pascoe, J.M., Kokotailo, P.K., & Broekhuizen, F.F. (1995). Correlates of multigravida women's binge drinking during pregnancy. Archives of Pediatric and Adolescent Medicine, 149, 1325-1329.

Peirce, R.S., Frone, M.R., Russell, M., Cooper, M.L., & Mudar, P. (2000). A longitudinal model of social contact, social support, depression, and alcohol use. Health Psychology, 19(1), 28-38.

Perrine, M.W.B., Schroder, K.E.E., Forester, R., McGonagle-Moulton, P., & Huessy, F. (2004). The impact of the September 11, 2001, terrorist attacks on alcohol consumption and distress: Reactions to a national trauma 300 miles from Ground Zero. Journal of Studies of Alcohol, 65, 5-15.

Pfefferbaum, B. & Doughty, D.E. (2001). Increased alcohol use in a treatment sample of Oklahoma City bombing victims. Psychiatry, 64(4), 296-303.

Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Journal of Applied Psychological Measurement, 1, 385-401.

Reading, A.E., Campbell, S., Cox, D.N., & Sledmere, C.M. (1982). Health beliefs and health care behaviour in pregnancy. Psychological Medicine, 12, 379-383.

Simeon, D., Greenberg, J., Knutelska, M., Schmeidler, J., & Hollander, E. (2003). Peritraumatic reactions associated with the World Trade Center disaster. American Journal of Psychiatry, 160, 1702-1705.

Smith D.W., Christiansen, E.H., Vincent, R., & Kann, N.E. (1992). Population effects of the bombing of Oklahoma City. Journal of Oklahoma State Medical Association, 92(4), 193-198.

Streissguth, A.P., Grant, T.M., Barr, H.M., Brown, Z.A., Martin, J.C., Mayock, D.E., Ramey, S.L., & Moore, L. (1991). Cocaine and the use of alcohol and other drugs during pregnancy. American Journal of Obstetrics & Gynecology, 164(5), 1239-1243.

Tourangeau, R., Jobe, J.B., Pratt, W.F., & Rasinski, K. (1997). Design and results of the Women's Health Study. In: L. Harrison & A. Hughes (Eds.). The validity of self-reported drug use: Improving the accuracy of survey estimates. National Institute on Drug Abuse Research Monograph, 167, D.C.: DHHS, NIH, NIDA. pp. 344-365.

Vlahov, D., Galea, S., Resnick, H., Ahern, J., Boscarino, J.A., Bucuvalas, M., Gold, J., & Kilpatrick, D. (2002). Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York residents after the September 11th terrorists' attacks. American Journal of Epidemiology, 155(11), 988-996.

Wasserman, G.A., Rauh, V.A., Brunelli, S.A., Garcia-Castro, M., & Necos, B. (1990). Psychosocial attributes and life experiences of disadvantaged minority mothers: Age and ethnic variations. Child Development, 61, 566-580.

Weaver, R.H. & Cranley, M.S. (1983). An exploration of paternal-fetal attachment behavior. Nursing Research, 32(2), 68-72.

Wilsnack, S.C. & Wilsnack, R.W. (1995). Drinking and problem drinking in U.S. women. In: M. Galanter (Ed.) Recent Developments in Alcoholism, Vol. 12 Women and Alcoholism. Ch.2. N.Y.: Plenum Press, pp. 29-60.

Zimet, G.D., Dahlem, N.W., Zimet, S.G., & Parley, G.K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30-41.

Zywiak, W.H., Stout, R.L., Trefry, W.B., LaGrutta, J.E., Lawson, C.C., Khan, N., Swift, R.M., & Schneider, R.J. (2003). Alcohol relapses associated with September 11, 2001: a case report. Substance Abuse, 24(2), 123-128.

Marilyn W. Lewis, Ph.D., Barbara L. Lanzara, M.D., Janet L. Stein, M.D., and Deborah S. Hasin, Ph.D.

Marilyn Lewis, Ph.D. is an Assistant Professor at The Ohio State University, College of Social Work. Please address correspondence about this article to Dr. Lewis at lewis.998@osu.edu, 1947 College Rd., Stillman Hall Rm325-N, Columbus, OH 43210. Dr. Lanzara is Associate Director of the Department of Obstetrics and Gynecology at Harlem Hospital Medical Center, affiliated with Columbia University College of Physicians and Surgeons and the New York City Health and Hospitals Corporation, 506 Lenox Ave., New York, NY, 10037, bl2@columbia.edu. Dr. Stein is Director of the Medical Residency Program in the Department of Obstetrics & Gynecology at Beth Israel Medical Center, affiliated with Albert Einstein College of Medicine University Hospital, First Ave. at 16th St., New York, NY 10003, jstein@chpnet.org. Dr. Hasin is Professor of Epidemiology at the Mailman School of Public Health at Columbia University, 1051 Riverside Dr., Box 123, New York, NY, dsh2@columbia.edu.

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in conjunction with the Office of Research on Women's Health of the National Institutes of Health (F31AA05560-02, MWL) and the Jewish Foundation for Education of Women (MWL). Parts of this manuscript were prepared while the first author (MWL) was supported by NIAAA (T32AA07290-22) as a Postdoctoral Fellow at the Alcohol Research Center at the University of Connecticut, School of Medicine. Portions of these data were presented at the Research Society on Alcoholism annual meeting at Ft. Lauderdale, FL, June 2003.