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225 12 Traumatic Stressors in Urban Settings Consequences and Implications Kenneth J. Ruggiero, Amy Van Wynsberghe, Tomika Stevens, and Dean G. Kilpatrick Introduction Violence, disasters, terrorism, and other potentially life-threatening events present serious challenges to health in urban settings. Such events, which affect most urban residents at some time in their lives, can produce extreme stress reactions and raise the risk of a wide range of mental and physical health problems.1–9 Also, these events are responsible for an enormous economic burden at the national, state, and local levels, stemming from consequences such as damage to the physical environment, lost productivity, medical costs of victims, and reduced quality of life.10–12 Throughout this chapter, we refer to these events collectively as traumatic stressors for two reasons: to reflect our focus on the mental- and physical-­ health-related impact of these events on victims and to acknowledge that different forms of violence, disasters, and other stressor events have serious economic effects as well as similar mental and physical health effects.1 Thus, we use the term traumatic stressors to refer to each of the following classes of stressor event: interpersonal violence (e.g., physical assault, rape, witnessed violence), natural disasters (e.g., hurricanes, floods, earthquakes), technological disasters (e.g., oil spills, fires), terrorist attacks (e.g., Oklahoma City bombing, September 11 attacks), and serious and injurious accidents (e.g., motor vehicle accidents). Note that the term potentially traumatic stressors is technically more accurate because such events do not always produce stress reactions. However, we omit the word potentially throughout the chapter in the interest of brevity and flow. This chapter draws from several areas of the traumatic stress literature to describe the prevalence of exposure to traumatic stressors, mental- and physicalhealth -related consequences, and how this research can be brought to bear on the study of urban health. First, we briefly summarize epidemiological research 226 Part IV: Health Outcomes and Determinants on the prevalence and correlates of traumatic stressors, with emphasis on studies conducted with nationally representative samples. Next, from our own data on prevalence of exposure to traumatic stressors between individuals who live in urban and rural settings, we offer comparisons that suggest that living in urban settings heightens risk of exposure. Third, we focus specifically on the prevalence of mental and physical health problems among adolescents and adults living in urban and rural settings. Fourth, we discuss the research-to-practice implications of findings from epidemiological and treatment-outcome research, refer to relevant mechanisms, health systems, and practices, and outline policy issues that deserve further consideration as well as research avenues that can guide the policy-making process. Prevalence and Correlates of Traumatic Stressors Prevalence of Traumatic Stressors Several studies with large probability samples have found that the prevalence of exposure to traumatic stressors ranges between 55% and 70% of U.S. adults.4, 13, 14 Prevalence estimates are similarly high among youth. With a nationally representative sample of adolescents, Kilpatrick and colleagues5 found that approximately 50% of American youth aged 12 to 17 years had experienced one or more of the four forms of traumatic stressor assessed in the study: sexual assault, physical assault , physical abusive punishment, witnessed violence. Also note­worthy is the number of individuals who are exposed to multiple types of traumatic stressor. Saunders15 found that among adolescents with a history of exposure to traumatic stressors, over 40% reported having been exposed to at least two different types of traumatic stressor and that those exposed to multiple types were at substantially higher risk for mental health problems than those exposed to a single type of stressor. Limited data are available on the prevalence of traumatic stressors in urban settings specifically and in comparison to rural settings. Breslau and colleagues16 estimated the prevalence to be 39.1% with an urban sample of 1,007 young adults, but methodology for this study differed substantially from studies cited above, thus precluding direct comparisons between studies. The only national sources that have regularly tracked prevalence of exposure to various types of traumatic stressor in rural and urban settings are the National Crime Victimization Survey and FBI Uniform Crime Reports. These sources reliably have estimated relatively higher rates of violent crime in urban populations—rates that are 70% to 170% higher per capita in urban versus rural settings.17, 18 However, as discussed elsewhere , the National Crime Victimization Survey and the Uniform Crime Reports are significantly limited in scope and methodology and offer limited guidance to policy...

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