Impact of a college course on perceptions of terrorism preparedness activities.

Abstract: This study evaluates the effectiveness of a college course concerning terrorist attacks and preparedness activities. Information was presented on a variety of current efforts to prepare residents for terrorist activities. The participants' perceptions of the likelihood of terrorist attacks and the effectiveness of preparedness activities were assessed. Students responded that bioterrorism is the most likely type of attack to occur and metropolitan areas would be the most likely targets. Students expressed concerns about how they will receive information on vital services during an event. These findings provide insight on how to prepare students for possible future events.

**********

Courses on various aspects of terrorism are particularly important for college students who constitute a unique population. Many young people in college are away from home for the first time and are experiencing new and exciting changes in their lives. This seems to be particularly true of the current cohort of college students which reports higher levels of stress than previous groups (Goodman, 2001). The events of September 11, 2001 and the events that followed, including the war in Afghanistan and the anthrax bioterrorism, interrupted their lives and exposed this vulnerable population to a new reality. This generation has lived through violence from their peers and terrorism from their own countrymen. However, their parents have tried to insulate and protect them from these realities (Marston, 2003). September 11, 2001 was a different level of threat because it was terror perpetrated by groups outside the United States. This was perceived as the entire country being vulnerable to attack and led the college population to personalize the event and see themselves as potential victims (Schuster et al., 2001). Their parents could no longer protect them from the reality of these events.

After the attacks, The National Mental Health Association (National Mental Health Association, 2004) found that many college students, faced with the war on Iraq and the ongoing threat of terrorist attacks, feel additionally uncertain about a future for which they had just begun to plan. Some may be concerned about parents, relatives, and friends, or friends and family in the military or who are living overseas. Others may wonder how they may become directly involved with this crisis, while others may attempt to isolate themselves from thoughts of future attacks.

A study of stress symptoms among African-American college students after the September 11, 2001 terrorist attacks presented some of the same concerns (Murphy, Wismar, & Freeman, 2003). It was found that students experienced a variety of stress symptoms including academic problems and concerns about family and friends in the military. Most students in this study were highly distressed when viewing specific attack-related news reports and images.

The effect of the terrorist attacks on college students appears to correspond to that of the general population. Several studies have reported on the direct effects on residents near the epicenters of terrorist attacks (Galea et al., 2002; Melnick et al., 2002; North et al., 1999; Schlenger et al., 2002) and the indirect effects nationwide (Schuster et al., 2001; Silver, Holman, McIntosh, Poulin, & Gil-Rivas, 2002). These studies focused primarily on stress reactions broadly defined and the incidence of psychiatric symptoms in response to stress caused by the attacks. The overall feedback indicates that a large portion of the population experience some stress symptoms, that checking on the safety of family and friends was important, and that the fear of future attacks was present.

In an attempt to prepare students to better handle future attacks, many colleges and universities throughout the United States are offering courses on topics related to terrorist events (Argetsinger, 2004). The course content varies from developing a terrorist scenario (Argetsinger), to a course specifically for health care providers (Overview of the Bioterrorism Threat--One hour online course), to a microbiology based course (Montgomery, 2002), or a series of courses to cover multiple aspects of terrorism (UCLA Center for Public Health and Disasters).

The Community Health Department at this university determined in its strategic planning activities that students would benefit from a course introducing them to the realities of terrorism, preparedness plans, and how these plans would connect with public health management of disasters. An earlier study of community health students revealed their concerns that included: the immediate safety of family and friends, the perception of bioterrorism as a major threat, and an increased fear of terrorist attacks (S. Farner, personal communication, October 10, 2004).

A new course, "Terrorism, Disaster, and Health", was developed and offered to graduate and undergraduate students in the fall of 2003. This course addressed preparedness activities to respond to terrorist attacks as well as how these preparedness activities provide urban and rural communities resources to respond to natural disasters. The purpose of this report is to summarize students' perceptions of the likelihood of attacks, levels of preparedness in the event of a terrorist attack or natural disaster, and barriers to receiving communications regarding vital information. These data will provide additional information about how to engage and prepare students to cope with the situations created by a terrorist incident or natural disaster.

METHOD

The survey was presented to undergraduate and graduate students enrolled in a new seminar at a large public Midwest university. There were 78 students in the class consisting of 25 males and 53 females. All students were 18 years of age or older. Graduate students comprised 40 percent of the class with 50 percent juniors and seniors, respectively; the remainder was freshman and sophomores. This project had received prior approval by the University Institutional Review Board. Each student signed an informed consent that was collected separately from the surveys.

The course consisted of seven sessions presented every two weeks by professionals in different areas of bioterrorism preparedness for the campus, state, and national arenas. The same survey was used for the pre- and posttest. The pretest was administered in the second-class session of the course; the posttest was given in the last class session. Students were given sufficient time to complete the survey at the beginning of the respective session. A five-point Likert scale was used to measure the responses.

The survey was designed to determine the students' perceptions of terrorism preparedness and how they would respond to these events should they occur at the campus, state, and federal levels. The faculty conducting the course determined the domains for the survey. The first domain in the questionnaire examined the type of terrorist attack the students felt was most likely in the United States and on the campus. The second domain assessed if students felt different locations, such as urban and rural areas, were prepared in the event of a terrorist attack. The third area assessed the students' perceptions of the likelihood of certain locations being attacked. It also assessed the impact of an attack on family and friends. In the fourth domain, the students were asked about their concern of the availability of information detailing the status of events and services required. In the last domain, the students responded to questions concerning how they might react if travel restrictions or quarantines were imposed on campus.

Local and state professionals with responsibilities in some aspect of terrorism preparedness, disaster management, or public health facilitated the lecture discussions. Representatives from the Federal Bureau of Investigation, the Emergency Medical Service, and the American Red Cross presented information about the investigation and management of disasters. Professionals from the Illinois Department of Public Health, campus student health, and a local health care facility summarized the preparedness activities of their agencies. In addition, a veterinarian discussed the possible threat and planning efforts related to agriterrorism.

Frequencies of responses were determined using SPSS (SPSS, 1996). Mann-Whitney U tests were performed to test for differences in direction of response and significance of observed changes. All data were reported as mean [+ or -] SD. Any missing data were coded as such and eliminated from analysis.

RESULTS

The students indicated bioterrorism or chemical attacks were the most likely in the United States and on campus. The students' concerns for the likelihood of this type of attack on campus increased from the pre- to post survey. Concern was also expressed for attacks from suicide bombers, car bombs, and sniper attacks. The data are displayed in Figure 1.

[FIGURE 1 OMITTED]

The students were asked about their concern regarding the level of preparedness for certain locations in response to a terrorist attack. There was a significant change from the pre- to post-survey on three locations, the university, the state and rural areas. The students reported on the post survey that all three locations were more prepared than they had on the pre-survey. However, the post-survey showed the students perceived the level of preparedness was still lacking in the rural areas. The results of the level of concern about preparedness in various areas are given in Table 1.

The students responded that of the locations provided in Table 1, the city of Chicago was the most likely target of a terrorist attack. The response of "very likely" was given by 50 percent of the students on the pretest and 44 percent on the post survey. Nuclear power plants were also identified as "very likely" targets with 42 percent of students on both the pre- and post survey indicating this response. However, the university was not seen as a potential target with zero and 1.9 percent respectively considering it as a "very likely" target. Only one-third of the students indicated there would be "moderate" to "great impact" in their personal lives or the lives of their families and friends.

The students displayed great concern about obtaining information on the status of events and services available following a terrorist attack on both the pre- and post surveys. Over 70 percent were "moderately" to "very much concerned" about obtaining information on the status of the country, water and food supplies, and medical services on both the pre- and posttests for the United States and the campus.

The students' responses to questions on both surveys concerning their reaction to a terrorist event on campus and the imposition of movement restrictions revealed that a majority, over 60 percent, would remain on campus and would follow instructions. The one change from pre- to post surveys was fewer students, 30.6 percent to 19.6 percent respectively, stated that they would attempt to leave the area after a terrorist event. Less than 5 percent of students reported they would attempt to escape or avoid quarantine should one be imposed.

DISCUSSION

It has been noted that communication with people to provide them with vital facts can help allay their fears (Gray & Ropeike, 2002). The campus community's obligation to prepare and educate students would include providing information to address their fears regarding a terrorist attack (Eskew, 2002). To provide this information to a generation heretofore unaccustomed to acknowledging external threats poises a creative challenge. However, higher education is uniquely positioned to both inform and prepare young Americans for responding to a complex, and at times, dangerous world.

The goal of this course was to provide students with a safe environment to discuss the potential for terrorist events and preparedness activities at the local, state and national level. This information should better prepare students to handle the effects of an event should it occur.

This study found that students' awareness to the potential of terrorist attacks increased following the course presentations. An increased number of students recognized bioterrorism as the most likely type of attack to occur on the campus from the beginning to the end of the course. This reflects not only the original research which indicated that students were concerned about bioterrorism following September 11, 2001, but also the United States Government's attention to this issue having passed a public law entitled "Public Health Security and Bioterrorism Preparedness and Response Act of 2002" (United States, 2002). Also the Department of Health and Human Services recognizes bioterrorism threats as potentially life-threatening on a large scale (Department of Health and Human Services, 2001).

Many of the presenters for the course focused on the ongoing activities to increase the preparedness for a terrorist event including surveillance, law enforcement, protection of agriculture, and other topics for the campus, state, and national levels. The students' responses displayed a significant increase in the knowledge of the processes in place to prepare the state and rural areas for terrorist attacks. This acquired information may serve to decrease the students' anxiety toward future events.

The students revealed that they were concerned about receiving information regarding the status of the country and how they would access services including food, water and medical care. This information may not be readily available in a concise format that students can access; yet the provision of this information may reduce anxiety levels. To expand the students' involvement in this area, future course offerings could include an active learning community based component where students would work with agencies in developing plans for communication networks to better provide vital information at the time of an event.

The students indicated that they were willing to abide by rules set down by the university in the event of an incident and they would follow quarantine regulations if necessary. Because the students have not experienced an actual quarantine or restrictions of movement their response to these limitations may differ from these self-reported actions. Providing more detailed scenarios in future course offerings may better assess the students' true reactions to events. It might also provide the students with a realistic idea of how restrictions and quarantine would involve them personally. This could also lead to discussions of the limits imposed during natural disasters.

From the study it appears that college courses on various aspects of terrorism can be an effective method to help students cope with and respond appropriately to future events. To fulfill their commitment to students, university administrators should make the development of these courses a priority.

LIMITATIONS

The majority of the participants in this course were graduate students. Graduate students are, on average, a little older than undergraduate students, have more education, and many have held professional positions or been working before returning to school. It is possible that different results could have been obtained by presenting this course strictly to undergraduate students. Also the student body at the university has a large proportion of students from the Chicago, Illinois metropolitan area. Students from the metropolitan area, as a result of their limited exposure to rural counties, may have a distorted view of the needs of the citizens from these less populated areas.

REFERENCES

Argetsinger, A. (2004). Terror for college credit. Retrieved June 13, 2004, from www.washingtonpost.com/ wp-dyn/articles/A2252602004Mar24.html.

Department of Health and Human Services. (2001). HHS initiative prepares for possible bioterrorism threat. Retrieved December 6, 2004, from http://www.os.dhhs.ogv/news/press/2001pres/01fsbioterrorism.html

Eskew, P. (2002). Key strategic foci for student affairs for 1997-2002. Retrieved September 29, 2003, from http://www.vcsa.uiuc.edu/mission.html

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

Goodman, R. (2001). Transition to college: separation and change for parents and students. Retrieved September 25, 2003, from http://www.aboutourkids.org/articles/transition.html

Gray, G., & Ropeike, D. (2002). Dealing with the dangers of fear: The role of risk communication. Health Affairs, 21(6), 106-116.

Marston, C. (2003). Millennials: At a glance. Retrieved October 6, 2003, from http://www.marstoncomm.com/Four_Generations.html

Melnick, T. A., Baker, C. T., Adams, M. L., O'Dowd, K., Mokdad, A. H., Brown, D. W., et al. (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(35), 784-786.

Montgomery, D. (2002). Courses in bioterrorism, Islam among most popular on U.S. campuses. Retrieved November 17, 2004, from http://www.uwire.com/content/topnews090602001.html

Murphy, R., Wismar, K., & Freeman, K. (2003). Stress symptoms among African-American college students after the September 11, 2001 terrorist attacks. The Journal of Nervous and Mental Disease, 191(2), 108-114.

National Mental Health Association. (2004). Tips for college students on coping with the war and terrorism. Retrieved June 13, 2004, from www.nmha.org/reassurance/collegeWarCoping.cfm

North, C. S., Nixon, S. J., Shariet, S., Mallonce, S., McMillen, J. C., Spitznagel, E. L., et al. (1999). Psychiatric disorders among survivors of the Oklahoma City bombing. Journal of the American Medical Association, 282(8), 755-762.

Overview of the bioterrorism threat--One hour online course. Retrieved November 17, 2004, from http;//www.chse.louisville.edu/bioterrorismcourse4B.html

Schlenger, W. E., Caddell, J. M., Ebert, L., Jordan, B. K., Rourke, K. M., Wilson, D., et al. (2002). Psychological reactions to terrorist attacks. Journal of the American Medical Association, 288(5), 581-588.

Schuster, M. A., Stein, B. D., Jaycox, L. H., Collins, R. L., Marshall, G. N., Elliott, M. N., et al. (2001). A national survey of stress reactions after the September 11, 2001, terrorist attacks. New England Journal of Medicine, 345(20), 1507-1512.

Silver, R. C., Holman, E. A., McIntosh, D. N., Poulin, M., & Gil-Rivas, V. (2002). Nationwide longitudinal study of psychological responses to September 11. Journal of the American Medical Association, 288(10), 1235-1244.

SPSS (Artist). (1996). Statistical Package for the Social Sciences.

UCLA Center for public health and disasters. Retrieved November 17, 2004, from http://www.cphd.ucla.edu/course.html

United States. (2002). Public Health Security and Bioterrorism Preparedness and Response Act of 2002. Retrieved December 6, 2004, from http://www.fda.gov/oc/bioterrorism/PL107-188.htm.

RESPONSIBILITES AND COMPETENCIES IN HEALTH EDUCATION

Responsibility III--Implementing Health Education Programs

Competency A: Exhibit competency in carrying out planned educational programs Sub-competency:

1. Employ a wide range of educational methods and techniques

2. Apply individual or group process methods as appropriate to given learning situations

3. Utilize instructional equipment and other instructional media effectively

4. Develop, demonstrate, and model implementation strategies

Competency B: Infer enabling objectives as needed to implement instructional programs in specified settings

Sub-competency:

1. Pretest learners to ascertain present abilities and knowledge relative to proposed program objectives

Susan M. Farner, PhD, is affiliated with the Department of Community Health at the University of Illinois at Urbana-Champaign. Stephen J. Notaro, PhD, is affiliated with the Department of Community Health at the University of Illinois at Urbana-Champaign. Please address all correspondence to: Susan M. Farner, PhD, Department of Community Health at the University of Illinois at Urbana-Champaign, 127 Huff Hall, 1206 S. Fourth Street, Champaign, IL, 61821; PHONE: [phone]; FAX: [phone]; EMAIL: [e-mail].

Table 1. Pre- and Posttest Concern of Preparedness

                              Mean      [+ or -] SD       p

University          Pre       3.28          0.97        .004 *
                    Post      3.80          0.73
State               Pre       3.26          0.83        .000 *
                    Post      4.38          0.70
Chicago             Pre       3.45          0.94        .166
                    Post      3.68          0.79
Rural Area          Pre       1.92          0.82        .015 *
                    Post      2.40          1.05
United States       Pre       3.44          0.92        .498
                    Post      3.38          0.78
Dept of Defense     Pre       3.98          0.83        .727
                    Post      3.90          0.89

* p value <.05, 2 tailed test