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We examined exposure to the World Trade Center attack and changes in cigarette smoking and drinking among 2731 New York City public high-school students evaluated 6 months after the attack. Increased drinking was associated with direct exposure to the World Trade Center attack (P<.05). Increased smoking was not directly associated with exposure to the World Trade Center attack but was marginally significantly associated with posttraumatic stress disorder (P=.06). Our findings suggest that targeted substance-use interventions for youths may be warranted after large-scale disasters.