title: Exposure to the Lebanon War of 2006 and effects on alcohol use disorders: the moderating role of childhood maltreatment.
abstract: BACKGROUND
  Civilian populations now comprise the majority of casualties in modern warfare, but effects of war exposure on alcohol disorders in the general population are largely unexplored. Accumulating literature indicates that adverse experiences early in life sensitize individuals to increased alcohol problems after adult stressful experiences. However, child and adult stressful experiences can be correlated, limiting interpretation. We examine risk for alcohol disorders among Israelis after the 2006 Lebanon War, a fateful event outside the control of civilian individuals and uncorrelated with childhood experiences. Further, we test whether those with a history of maltreatment are at greater risk for an alcohol use disorder after war exposure compared to those without such a history.
  
  
  METHODS
  Adult household residents selected from the Israeli population register were assessed with a psychiatric structured interview; the analyzed sample included 1306 respondents. War measures included self-reported days in an exposed region.
  
  
  RESULTS
  Among those with a history of maltreatment, those in a war-exposed region for 30+ days had 5.3 times the odds of subsequent alcohol disorders compared to those exposed 0 days (95%C.I. 1.01-27.76), controlled for relevant confounders; the odds ratio for those without this history was 0.5 (95%C.I. 0.25-1.01); test for interaction: X(2)=5.28, df=1, P=0.02.
  
  
  CONCLUSIONS
  Experiencing a fateful stressor outside the control of study participants, civilian exposure to the 2006 Lebanon War, is associated with a heightened the risk of alcohol disorders among those with early adverse childhood experiences. Results suggest that early life experiences may sensitize individuals to adverse health responses later in life.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. Electronic address: kmk2104@columbia.edu.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Keyes
authors.affiliation: New York State Psychiatric Institute, New York, NY 10032, USA; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
authors.forename: Dvora
authors.initials: D
authors.lastname: Shmulewitz
authors.affiliation: New York State Psychiatric Institute, New York, NY 10032, USA; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
authors.forename: Eliana
authors.initials: E
authors.lastname: Greenstein
authors.affiliation: Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115-6092, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: McLaughlin
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Wall
authors.affiliation: New York State Psychiatric Institute, New York, NY 10032, USA; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
authors.forename: Efrat
authors.initials: E
authors.lastname: Aharonovich
authors.affiliation: Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Weizman
authors.affiliation: Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Amos
authors.initials: A
authors.lastname: Frisch
authors.affiliation: Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Baruch
authors.initials: B
authors.lastname: Spivak
authors.affiliation: Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
authors.forename: Bridget F
authors.initials: BF
authors.lastname: Grant
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, New York, NY 10032, USA; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hasin
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000523:psychology*; D002649:Child Abuse / Q000523:psychology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D014857:Warfare; D055815:Young Adult
keywords: Alcohol disorders; Childhood maltreatment; Interaction; Israel; Stress; War