Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Cerda, M., D. Vlahov, M. Tracy, and Sandro Galea. 2008. "Alcohol use trajectories among adults in an urban area after a disaster: evidence from a population-based cohort study." Addiction, 103(8): 1296-1307.
Alcohol use increased in the New York City (NYC) metropolitan area in the first months after the 11 September 2001 terrorist attacks. Aims To investigate alcohol use trajectories in the NYC metropolitan area in the 3 years after 11 September and examine the relative contributions of acute exposure to the attacks and ongoing stressors to these trajectories. Design We used a population-based cohort of adults recruited through a random-digit-dial telephone survey in 2002; participants completed three follow-up interviews over 30 months. Setting The NYC metropolitan area. Participants A total of 2752 non-institutionalized adult residents of NYC. Measurements We used growth mixture models to assess trajectories in levels of total alcohol consumption and bingeing in the past 30 days, and predictors of these trajectories. Findings We identified five trajectories of alcohol consumption levels and three bingeing trajectories. Predictors of higher levels of use over time included ongoing stressors, traumatic events and lower income. Ongoing exposure to stressors and low income also play a central role in bingeing trajectories. Conclusions While point-in-time mass traumatic events may matter in the short term, their contribution subsides over time. Accumulated stressors and traumatic events, in contrast, lead to higher levels of consumption among respondents already vulnerable to high alcohol use. Interventions to mitigate post-disaster stressors may have substantial benefit in reducing alcohol abuse in the medium- to long term.