title: Effects of the 2002 sniper attacks on the homeless population in Washington, DC.
abstract: OBJECTIVE
  Despite the prevalence of homelessness, this population has rarely been included in disaster and terrorism planning. To better understand the mental health needs of the homeless during a terrorist event and to highlight the need to address methodological limitations in research in this area, we examined responses to the October 2002 Washington, DC, sniper attacks.
  
  
  METHODS
  We interviewed 151 homeless individuals 1 year after the Washington, DC, sniper attacks.
  
  
  RESULTS
  The majority (92.7%) was aware of the sniper events; 84.1% stayed informed through the media and 72.7% had someone to turn to for emotional support. Almost half (44%) reported identification with victims and 41% increased substance use during the attacks. More than half (61.7%) felt extremely frightened or terrified and 57.6% reported high perceived threat. Females, nonwhites, and participants with less than a high school education experienced greater threat. Women, nonwhites, and younger (<43 years old) participants were more likely to have decreased more activities and 32.7% increased confidence in local law enforcement; however, 32.7% became less confident.
  
  
  CONCLUSIONS
  During a terrorist attack the homeless population may be difficult to reach or reluctant to comply with public health programs. Addressing barriers to health care in vulnerable groups is critical to effective public health disaster response.
authors.affiliation: Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA. cfullert@erols.com
authors.forename: Carol S
authors.initials: CS
authors.lastname: Fullerton
authors.forename: Robert K
authors.initials: RK
authors.lastname: Gifford
authors.forename: Brian W
authors.initials: BW
authors.lastname: Flynn
authors.forename: Karen M
authors.initials: KM
authors.lastname: Peterson
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Ahearn
authors.forename: Linda Plitt
authors.initials: LP
authors.lastname: Donaldson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ursano
mesh_terms: D000328:Adult; D004219:District of Columbia; D005260:Female; D005389:Firearms; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D023481:Terrorism / Q000523:psychology*; D014505:Urban Population; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult