Research Publications

The following publication list serves as a bibliography of 9/11 health research and is updated regularly. The list contains publications related to 9/11 but may or may not have been funded under the WTC Health Program. Study findings are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC). Mention of any company or product does not constitute endorsement by NIOSH/CDC.

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Results:

Print Results

SARS-CoV2 re-infection incidence postacute sequelae COVID19 (PASC) essential workers New York retrospective cohort study

Babalola TK, Clouston SAP, Sekendiz Z, et al.

2025

BACKGROUND: After surviving Coronavirus Disease 2019 (COVID-19), some people develop symptoms known as post-acute sequelae of COVID-19 (PASC). PASC is an emerging phenomenon yet to be fully understood, and identifying risk factors has been challenging. This study investigated the association between the number of COVID-19 episodes and the incidence of PASC among essential workers. METHODS: We analyzed data from 2511 essential workers, mainly first responders, with confirmed polymerase chain reaction, antibody, or antigen-positive test results for SARS-CoV-2 infection from March 2020 to February 2024. Data were collected through in-person questionnaires and surveys sent via text and email, internal medical records, follow-up calls, and external medical records. Participants who reported continuation or the development of new symptoms three months after the initial SARS-CoV-2 infection, with symptoms lasting for at least two months, were categorized as having PASC, while those without any COVID-19 or whose symptoms resolved were classified as non-PASC. PASC was common in this cohort so we used a Poisson regression model to compute multivariable-adjusted Relative Risk (RR) for the association between risk of PASC and SARS-CoV-2 re-infection, severity, and vaccination status at first infection. FINDINGS: A total of 475 (prevalence = 18.9%, [95% confidence interval] = [17.4-20.5]) PASC patients were identified. The mean (standard deviation (SD)) age of participants who experienced PASC (54.8 (7.2) years) was similar to those who did not (54.2 (7.4) years). There were 403 (16.1% [14.6-17.5]) participants who experienced multiple instances of COVID-19. After adjusting for relevant demographic, lifestyle, and clinical variables, we found a significant association between the risk of experiencing PASC and multiple SARS-COV-2 infections (RR = 1.41 [1.14-1.74]), severe COVID-19 (RR = 3.17 [2.41-4.16]), and being unvaccinated at first infection (RR = 3.29 [2.46-4.41]). INTERPRETATION: Although the pathogenetic mechanism for PASC remains unclear, identifying risk factors such as lack of vaccination or re-infection can assist in better understanding and managing the condition. FUNDING: National Institute on Aging (NIH/NIA R01 AG049953) and Centers for Disease Control and Prevention (CDC/NIOSH U01 OH011864) and (CDC/NIOSH U01 OH012275).

Multiple myeloma and its precursor disease among firefighters exposed to the World Trade Center disaster

Landgren O, Zeig-Owens R, Giricz O, et al

2018

Importance: The World Trade Center (WTC) attacks on September 11, 2001, created an unprecedented environmental exposure to known and suspected carcinogens suggested to increase the risk of multiple myeloma. Multiple myeloma is consistently preceded by the precursor states of monoclonal gammopathy of undetermined significance (MGUS) and light-chain MGUS, detectable in peripheral blood. Objective: To characterize WTC-exposed firefighters with a diagnosis of multiple myeloma and to conduct a screening study for MGUS and light-chain MGUS. Design, Setting, and Participants: Case series of multiple myeloma in firefighters diagnosed between September 11, 2001, and July 1, 2017, together with a seroprevalence study of MGUS in serum samples collected from Fire Department of the City of New York (FDNY) firefighters between December 2013 and October 2015. Participants included all WTC-exposed FDNY white, male firefighters with a confirmed physician diagnosis of multiple myeloma (n = 16) and WTC-exposed FDNY white male firefighters older than 50 years with available serum samples (n = 781). Exposures: WTC exposure defined as rescue and/or recovery work at the WTC site between September 11, 2001, and July 25, 2002. Main Outcomes and Measures: Multiple myeloma case information, and age-adjusted and age-specific prevalence rates for overall MGUS (ie, MGUS and light-chain MGUS), MGUS, and light-chain MGUS. Results: Sixteen WTC-exposed white male firefighters received a diagnosis of multiple myeloma after September 11, 2001; median age at diagnosis was 57 years (interquartile range, 50-68 years). Serum/urine monoclonal protein isotype/free light-chain data were available for 14 cases; 7 (50%) had light-chain multiple myeloma. In a subset of 7 patients, myeloma cells were assessed for CD20 expression; 5 (71%) were CD20 positive. In the screening study, we assayed peripheral blood from 781 WTC-exposed firefighters. The age-standardized prevalence rate of MGUS and light-chain MGUS combined was 7.63 per 100 persons (95% CI, 5.45-9.81), 1.8-fold higher than rates from the Olmsted County, Minnesota, white male reference population (relative rate, 1.76; 95% CI, 1.34-2.29). The age-standardized prevalence rate of light-chain MGUS was more than 3-fold higher than in the same reference population (relative rate, 3.13; 95% CI, 1.99-4.93). Conclusions and Relevance: Environmental exposure to the WTC disaster site is associated with myeloma precursor disease (MGUS and light-chain MGUS) and may be a risk factor for the development of multiple myeloma at an earlier age, particularly the light-chain subtype.

Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: An observational cohort study

Zeig-Owens R, Webber MP, Hall CB, et al

2011

BACKGROUND: The attacks on the World Trade Center (WTC) on Sept 11, 2001 (9/11) created the potential for occupational exposure to known and suspected carcinogens. We examined cancer incidence and its potential association with exposure in the first 7 years after 9/11 in firefighters with health information before 9/11 and minimal loss to follow-up. METHODS: We assessed 9853 men who were employed as firefighters on Jan 1, 1996. On and after 9/11, person-time for 8927 firefighters was classified as WTC-exposed; all person-time before 9/11, and person-time after 9/11 for 926 non-WTC-exposed firefighters, was classified as non-WTC exposed. Cancer cases were confirmed by matches with state tumour registries or through appropriate documentation. We estimated the ratio of incidence rates in WTC-exposed firefighters to non-exposed firefighters, adjusted for age, race and ethnic origin, and secular trends, with the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) reference population. CIs were estimated with overdispersed Poisson models. Additional analyses included corrections for potential surveillance bias and modified cohort inclusion criteria. FINDINGS: Compared with the general male population in the USA with a similar demographic mix, the standardised incidence ratios (SIRs) of the cancer incidence in WTC-exposed firefighters was 1.10 (95% CI 0.98-1.25). When compared with non-exposed firefighters, the SIR of cancer incidence in WTC-exposed firefighters was 1.19 (95% CI 0.96-1.47) corrected for possible surveillance bias and 1.32 (1.07-1.62) without correction for surveillance bias. Secondary analyses showed similar effect sizes. INTERPRETATION: We reported a modest excess of cancer cases in the WTC-exposed cohort. We remain cautious in our interpretation of this finding because the time since 9/11 is short for cancer outcomes, and the reported excess of cancers is not limited to specific organ types. As in any observational study, we cannot rule out the possibility that effects in the exposed group might be due to unidentified confounders. Continued follow-up will be important and should include cancer screening and prevention strategies. FUNDING: National Institute for Occupational Safety and Health.

Psychological sequelae of the September 11 terrorist attacks in New York City

Galea S, Ahern J, Resnick H, et al

2002

Long-term cardiovascular disease risk among firefighters after the World Trade Center disaster

Cohen HW, Zeig-Owens R, Joe C, et al

2019

Published studies examining the association between World Trade Center (WTC) exposure on and after September 11, 2001, and longer-term findings of the study suggest a significant association between greater WTC exposure and long-term CVD risk. outcomes have reported mixed findings.To assess whether WTC exposure was associated with elevated CVD risk in Fire Department of the City of New York (FDNY) firefighters.In this cohort study, the association between WTC exposure and the risk of CVD was assessed between September 11, 2001, and December 31, 2017, in FDNY male firefighters. Multivariable Cox regression analyses were used to estimate CVD risk in association with 2 measures of WTC exposure: arrival time to the WTC site and duration of work at the WTC site. Data analyses were conducted from May 1, 2018, to March 8, 2019.The primary CVD outcome included myocardial infarction, stroke, unstable angina, coronary artery surgery or angioplasty, or CVD death. The secondary outcome (all CVD) included all primary outcome events or any of the following: transient ischemic attack; stable angina, defined as either use of angina medication or cardiac catheterization without intervention; cardiomyopathy; and other CVD (aortic aneurysm, peripheral arterial vascular intervention, and carotid artery surgery).There were 489 primary outcome events among 9796 male firefighters (mean [SD] age on September 11, 2001, was 40.3 [7.4] years and 7210 individuals [73.6%] were never smokers). Age-adjusted incident rates of CVD were higher for firefighters with greater WTC exposure. The multivariable adjusted hazard ratio (HR) for the primary CVD outcome was 1.44 (95% CI, 1.09-1.90) for the earliest arrival group compared with those who arrived later. Similarly, those who worked at the WTC site for 6 or more months vs those who worked less time at the site were more likely to have a CVD event (HR, 1.30; 95% CI, 1.05-1.60). Well-established CVD risk factors, including hypertension (HR, 1.41; 95% CI, 1.10-1.80), hypercholesterolemia (HR, 1.56; 95% CI, 1.28-1.91), diabetes (HR, 1.99; 95% CI, 1.33-2.98), and smoking (current: HR, 2.13; 95% CI, 1.68-2.70; former: HR, 1.55; 95% CI, 1.23-1.95), were significantly associated with CVD in the multivariable models. Analyses with the all-CVD outcome were similar.The findings of the study suggest a significant association between greater WTC exposure and long-term CVD risk. The findings appear to reinforce the importance of long-term monitoring of the health of survivors of disasters.

Estimation of future cancer burden among rescue and recovery workers exposed to the World Trade Center disaster

Singh A, Zeig-Owens R, Moir W, et al

2018

Importance: Elevated rates of cancer have been reported in individuals exposed to the World Trade Center (WTC) disaster, including Fire Department of the City of New York (FDNY) rescue and recovery workers. Objective: To the future burden of cancer in WTC-exposed FDNY rescue and recovery workers by estimating the 20-year cancer incidence. Design, Setting, and Participants: A total of 14474 WTC-exposed FDNY employees who were cancer-free on January 1, 2012; subgroup analyses were conducted of the cohort's white male population (n = 12374). In this closed-cohort study, we projected cancer incidence for the January 1, 2012, to December 31, 2031, period. Simulations were run using demographic-specific New York City (NYC) cancer and national mortality rates for each individual, summed for the whole cohort, and performed 1000 times to produce mean estimates. Additional analyses in the subgroup of white men compared case counts produced by using 2007-2011 FDNY WTC Health Program (FDNY-WTCHP) cancer rates vs NYC rates. Average and 20-year aggregate costs of first-year cancer care were estimated using claims data. Exposures: World Trade Center disaster exposure defined as rescue and recovery work at the WTC site at any time from September 11, 2001, to July 25, 2002. Main Outcomes and Measures: (1) Projected number of incident cancers in the full cohort, based on NYC cancer rates; (2) cancer incidence estimates in the subgroup projected using FDNY-WTCHP vs NYC rates; and (3) estimated first-year treatment costs of incident cancers. Results: On January 1, 2012, the cohort was 96.8% male, 87.1% white, and had a mean (SD) age of 50.2 (9.2) years. The projected number of incident cancer cases was 2960 (95% CI, 2883-3037). In our subgroup analyses using FDNY-WTCHP vs NYC cancer rates, the projected number of new cases in white men was elevated (2714 [95% CI, 2638-2786] vs 2596 [95% CI, 2524-2668]). Accordingly, we expect more prostate (1437 [95% CI, 1383-1495] vs 863 [95% CI, 816-910]), thyroid (73 [95% CI, 60-86] vs 57 [95% CI, 44-69]), and melanoma cases (201 [95% CI, 179-223] vs 131 [95% CI, 112-150), but fewer lung (237 [95% CI, 212-262] vs 373 [95% CI, 343-405]), colorectal (172 [95% CI, 152-191] vs 267 [95% CI, 241-292]), and kidney cancers (66 [95% CI, 54-80] vs 132 [95% CI, 114-152]) (P < .001 for all comparisons). The estimated 20-year cost of first-year treatment was $235835412 (95% CI, $187582227-$284088597). Conclusions and Relevance: We that the FDNY-WTCHP cohort will experience a greater cancer burden than would be expected from a demographically similar population. This underscores the importance of cancer prevention efforts and routine screening in WTC-exposed rescue and recovery workers.

Cognitive impairment among World Trade Center responders: Long-term implications of re-experiencing the 9/11 terrorist attacks

Clouston SA, Kotov R, Pietrzak RH, et al

2016

Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis

Haugen PT, McCrillis AM, Smid GE, et al

2017

Cancer incidence in World Trade Center rescue and recovery workers, 2001-2008

Solan S, Wallenstein S, Shapiro M, et al

2013

Health and environmental consequences of the World Trade Center disaster

Landrigan PJ, Lioy PJ, Thurston G, et al

2004

The attack on the World Trade Center (WTC) created an acute environmental disaster of enormous magnitude. This study characterizes the environmental exposures resulting from destruction of the WTC and assesses their effects on health. Methods include ambient air sampling; analyses of outdoor and indoor settled dust; high-altitude imaging and modeling of the atmospheric plume; inhalation studies of WTC dust in mice; and clinical examinations, community surveys, and prospective epidemiologic studies of exposed populations. WTC dust was found to consist predominantly (95%) of coarse particles and contained pulverized cement, glass fibers, asbestos, lead, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), and polychlorinated furans and dioxins. Airborne particulate levels were highest immediately after the attack and declined thereafter. Particulate levels decreased sharply with distance from the WTC. Dust pH was highly alkaline (pH 9.0-11.0). Mice exposed to WTC dust showed only moderate pulmonary inflammation but marked bronchial hyperreactivity. Evaluation of 10,116 firefighters showed exposure-related increases in cough and bronchial hyperreactivity. Evaluation of 183 cleanup workers showed new-onset cough (33%), wheeze (18%), and phlegm production (24%). Increased frequency of new-onset cough, wheeze, and shortness of breath were also observed in community residents. Follow-up of 182 pregnant women who were either inside or near the WTC on 11 September showed a 2-fold increase in small-for-gestational-age (SGA) infants. In summary, environmental exposures after the WTC disaster were associated with significant adverse effects on health. The high alkalinity of WTC dust produced bronchial hyperreactivity, persistent cough, and increased risk of asthma. Plausible causes of the observed increase in SGA infants include maternal exposures to PAH and particulates. Future risk of mesothelioma may be increased, particularly among workers and volunteers exposed occupationally to asbestos. Continuing follow-up of all exposed populations is required to document the long-term consequences of the disaster.

Cancer in general responders participating in World Trade Center Health Programs, 2003–2013

Shapiro MZ, Wallenstein SR, Dasaro CR, et al

2020

A systematic review of probable posttraumatic stress disorder in first responders following man-made mass violence

Wilson LC

2015

Serum perfluoroalkyl substances and cardiometabolic consequences in adolescents exposed to the World Trade Center disaster and a matched comparison group

Koshy TT, Attina TM, Ghassabian A, et al

2017

BACKGROUND: Large amounts of various chemical contaminants, including perfluoroalkyl substances (PFASs), were released at the time of the World Trade Center (WTC) disaster. Thousands of children who lived and/or attended school near the disaster site were exposed to these substances but few studies have examined the possible consequences related to these exposures. OBJECTIVES: To examine the relationship of PFASs serum levels with cardiometabolic profile in children and adolescents enrolled in the World Trade Center Health Registry (WTCHR) and a matched comparison group. METHODS: We evaluated WTCHR enrollees who resided in New York City and were born between September 11, 1993 and September 10, 2001, and a matched comparison group consisting of individuals who were ineligible for WTCHR participation upon distance of their home, school or work from the WTC and lack of participation in rescue and recovery activities. Matching was based on date of birth, sex, race, ethnicity, and income. We assessed exposure to PFASs, as measured by serum levels and association with cardiometabolic profile as measured by arterial wall stiffness, body mass index, insulin resistance, fasting total cholesterol, HDL, LDL and triglycerides. RESULTS: A total of 402 participants completed the study and serum samples were analyzed from 308 participants, 123 in the WTCHR group and 185 in the comparison group. In multivariable regression analysis, after adjusting for relevant confounders, we observed a significant, positive association of perfluorooctanoic acid (PFOA) with triglycerides (beta coefficient=0.14, 95% CI: 0.02, 0.27, 15.1% change), total cholesterol (beta coefficient=0.09, 95% CI: 0.04, 0.14, 9.2% change), and LDL cholesterol (beta coefficient=0.11, 95% CI: 0.03, 0.19, 11.5% change). Perfluorohexanesulfonic acid levels were associated with decreased insulin resistance (beta coefficient=-0.09, 95% CI: -0.18, -0.003, -8.6% change); PFOA and perfluorononanoic acid were associated with increased brachial artery distensibility. CONCLUSIONS: This research adds to our knowledge of the physical health impacts in a large group of children exposed to the WTC disaster. Abnormal lipid levels in young adults might be an early marker of atherosclerosis and cardiovascular diseases and our findings highlight the importance of conducting longitudinal studies in this population.

Metabolomics of World Trade Center-lung injury: A machine learning approach

Crowley G, Kwon S, Haider SH, et al

2018

Posttraumatic stress disorder symptoms following media exposure to tragic events: Impact of 9/11 on children at risk for anxiety disorders

Otto MW, Henin A, Hirshfeld-Becker DR, et al

2007

The anatomy of the exposures that occurred around the World Trade Center site: 9/11 and beyond

Lioy PJ and Georgopoulos P

2006

Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001

Alper HE, Yu S, Stellman SD, et al

2017

Incidence of dementia before age 65 years among World Trade Center attack responders

Clouston SAP, Mann FD, Meliker J, et al.

2024

IMPORTANCE: Reports suggest that the individuals who served in rescue operations following the terrorist attacks on the World Trade Center (WTC) have poorer brain health than expected. OBJECTIVE: To assess the incidence of dementia before age 65 years in a prospective study of WTC responders and to compare incidence among responders with severe exposures to debris vs responders not exposed to building debris or who wore personalized protective equipment (PPE). DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted from November 1, 2014, to January 1, 2023, in an academic medical monitoring program available to verified WTC responders residing on Long Island, New York. Responders 60 years of age or younger without dementia at the time of their first cognitive assessment were followed up every 18 months, on average, for up to 5 years. EXPOSURES: Exposure severity was based on responses to a detailed questionnaire of WTC exposures and exposure-related activities that included exposures to fine particulate dust and potentially neurotoxic debris, duration of work, and the use of PPE. Exposure level was divided into 5 categories ranging from low to severe. MAIN OUTCOMES AND MEASURES: Incidence of all-cause dementia before age 65 years was the primary outcome. Dementia was diagnosed following standard guidelines relying on repeated measures of cognition. RESULTS: Of 9891 responders, 5010 were eligible for inclusion in this study of cognitive function (median [IQR] age, 53 [48-57] years; 4573 [91.3%] male). There were 228 cases of dementia identified during 15 913.1 person-years of follow-up. Increasing WTC exposure severity was associated with incremental increases in the incidence rate of dementia per 1000 person-years (low, 2.95 [95% CI, 1.07-11.18]; mild, 12.16 [95% CI, 10.09-14.79]; moderate, 16.53 [95% CI, 13.30-20.81]; high, 30.09 [95% CI, 21.35-43.79]; and severe, 42.37 [95% CI, 24.86-78.24]). Adjusting for social, demographic, and relevant medical factors, each unit increase in exposure severity was associated with increased incidence of dementia (adjusted hazard ratio, 1.42 [95% CI, 1.18-1.71]; P < .001; mean risk difference, 9.74 [95% CI, 2.94-32.32] per 1000 person-years; P < .001). CONCLUSIONS AND RELEVANCE: In this cohort study of WTC responders who survived these unique exposures and participated in a longitudinal follow-up study of cognition from 2014 through 2022, when compared with responders with the lowest exposure levels or responders who used PPE, more severe exposure to dust or debris was significantly associated with a higher risk of dementia before 65 years of age. This study suggests that the reliable use of PPE might help prevent the onset of dementia before age 65 years among individuals exposed to an uncontrolled building collapse. Future research is warranted to determine cerebral biomarkers for individuals with exposure-associated dementia.

DTI connectometry analysis reveals white matter changes in cognitively impaired World Trade Center responders at midlife

Kritikos M, Huang C, Clouston SAP, et al.

2022

Persistent mental and physical health impact of exposure to the September 11, 2001 World Trade Center terrorist attacks

Jordan HT, Osahan S, Li J, et al

2019

BACKGROUND: Asthma, gastroesophageal reflux disease (GERD), posttraumatic stress disorder (PTSD) and depression have each been linked to exposure to the September 11, 2001 World Trade Center (WTC) terrorist attacks (9/11). We described the prevalence and patterns of these conditions and associated health-related quality of life (HRQOL) fifteen years after the attacks. METHODS: We studied 36,897 participants in the WTC Health Registry, a cohort of exposed rescue/recovery workers and community members, who completed baseline (2003-2004) and follow-up (2015-16) questionnaires. Lower respiratory symptoms (LRS; cough, dyspnea, or wheeze), gastroesophageal reflux symptoms (GERS) and self-reported clinician-diagnosed asthma and GERD history were obtained from surveys. PTSD was defined as a score > 44 on the PTSD checklist, and depression as a score > 10 on the Patient Health Questionnaire (PHQ). Poor HRQOL was defined as reporting limited usual daily activities for > 14 days during the month preceding the survey. RESULTS: In 2015-16, 47.8% of participants had >/=1 of the conditions studied. Among participants without pre-existing asthma, 15.4% reported asthma diagnosed after 9/11; of these, 76.5% had LRS at follow up. Among those without pre-9/11 GERD, 22.3% reported being diagnosed with GERD after 9/11; 72.2% had GERS at follow-up. The prevalence of PTSD was 14.2%, and of depression was 15.3%. HRQOL declined as the number of comorbidities increased, and was particularly low among participants with mental health conditions. Over one quarter of participants with PTSD or depression reported unmet need for mental health care in the preceding year. CONCLUSIONS: Nearly half of participants reported having developed at least one of the physical or mental health conditions studied by 2015-2016; comorbidity among conditions was common. Poor HRQOL and unmet need for health were frequently reported, particularly among those with post-9/11 PTSD or depression. Comprehensive physical and mental health care are essential for survivors of complex environmental disasters, and continued efforts to connect 9/11-exposed persons to needed resources are critical.

Alcohol use in New York after the terrorist attacks: A study of the effects of psychological trauma on drinking behavior

Boscarino JA, Adams RE, and Galea S

2006

Prostate cancer in World Trade Center responders demonstrates evidence of an inflammatory cascade

Gong Y, Wang L, Yu H, et al

2019

The impact of World Trade Center related medical conditions on the severity of covid-19 disease and its long-term sequelae

Lhuillier E, Yang Y, Morozova O, et al

2022

Mental healthcare needs in World Trade Center responders: Results from a large, population-based health monitoring cohort

Diab O, DePierro J, Cancelmo L, et al

2020

Health effects of World Trade Center (WTC) dust: An unprecedented disaster's inadequate risk management

Lippmann M, Cohen MD, and Chen LC

2015

Dynamic metabolic risk profiling of World Trade Center-lung disease: A longitudinal cohort study

Kwon S, Lee M, Crowley G, et al

2021

High burden of clonal hematopoiesis in first responders exposed to the World Trade Center disaster

Jasra S, Giricz O, Zeig-Owens R, et al

2022

A national survey of stress reactions after the September 11, 2001, terrorist attacks

Schuster MA, Stein BD, Jaycox LH, et al.

2001

Posttraumatic stress disorder post 9/11: A review of the evidence and implications for public health policy

Crupi R and Brondolo E

2017

Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: A review of the literature among highly exposed populations

Neria Y, DiGrande L, and Adams BG

2011

Reduced cortical thickness in World Trade Center responders with cognitive impairment

Clouston SA, Deri Y, Horton M, et al

2020

Post-9/11 cancer incidence in World Trade Center-exposed New York City firefighters as compared to a pooled cohort of firefighters from San Francisco, Chicago and Philadelphia (9/11/2001-2009)

Moir W, Zeig-Owens R, Daniels RD, et al

2016

Neuropathic symptoms in World Trade Center disaster survivors and responders

Wilkenfeld M, Fazzari M, Segelnick J, et al

2016

Myeloma precursor disease (MGUS) among rescue and recovery workers exposed to the World Trade Center disaster

Zeig-Owens R, Goldfarb DG, Luft BJ, et al.

2022

Cancer incidence in World Trade Center-exposed and non-exposed male firefighters, as compared with the us adult male population: 2001-2016

Webber MP, Singh A, Zeig-Owens R, et al

2021

Asthma control in adolescents 10 to 11 y after exposure to the World Trade Center disaster

Gargano LM, Thomas PA, and Stellman SD

2017

Evaluation of medical surveillance and incidence of post-September 11, 2001, thyroid cancer in World Trade Center-exposed firefighters and emergency medical service workers

Colbeth HL, Genere N, Hall CB, et al

2020

Importance: Elevated incidence rates of thyroid cancer among World Trade Center (WTC)-exposed individuals may be associated with the identification of asymptomatic cancers during medical surveillance. Objective: To examine the association between WTC exposure and thyroid cancer among Fire Department of the City of New York (hereafter, Fire Department) rescue/recovery workers as well as the association with medical surveillance. Design, Setting, and Participants: This closed-cohort study classified the method of detection (asymptomatic and symptomatic) of thyroid cancers in 14987 men monitored through the Fire Department-WTC Health Program diagnosed from September 12, 2001, to December 31, 2018. Age-, sex-, and histologic-specific Fire Department incidence rates were calculated and compared with demographically similar men in Olmsted County, Minnesota, from the Rochester Epidemiology using age-standardized rates, relative rates (RRs), and 95% CIs. The secondary analysis was restricted to papillary carcinomas. Exposures: World Trade Center exposure was defined as rescue/recovery work at the WTC site from September 11, 2001, to July 25, 2002. Main Outcomes and Measures: The outcomes evaluated comprised (1) number of incident thyroid cancers and their detection method categorizations in the Fire Department and Rochester Epidemiology cohorts; (2) Fire Department, Rochester Epidemiology Project, and Surveillance, Epidemiology, and End Results-21 age-standardized incidence rates of thyroid cancer; and (3) RRs comparing Fire Department and Rochester Epidemiology overall and by detection method categorization. Results: Seventy-two post-9/11 Fire Department cases of thyroid cancer were identified. Among the 65 cases (90.3%) with a categorized detection method, 53 cases (81.5%) were asymptomatic and 12 cases (18.5%) were symptomatic. Median (interquartile range) age at diagnosis was 50.2 (44.0-58.6) vs 46.6 (43.9-52.9) years for asymptomatic vs symptomatic cases. Associated primarily with asymptomatic cancers, the overall age-standardized incidence of Fire Department thyroid cancers (24.7; 95% CI, 17.4-52.3) was significantly higher than the Rochester Epidemiology (10.4; 95% CI, 8.5-12.7) and Surveillance, Epidemiology, and End Results-21 (9.1; 95% CI, 9.0-9.1) per 100000 person-years. Furthermore, the RR of thyroid cancer among symptomatic men in Fire Department cases was not significantly different from that of men in the Rochester Epidemiology (0.8; 95% CI, 0.4-1.5); however, the rate of asymptomatic cancers was more than 3-fold that of the Rochester Epidemiology rate (RR, 3.1; 95% CI, 2.1-4.7). Conclusions and Relevance: Excess asymptomatic thyroid cancer in Fire Department WTC-exposed rescue/recovery workers is apparently attributable to the identification of occult lesions during medical surveillance. Among WTC-exposed cohorts and the general population, these findings appear to have important implications for how thyroid cancer incidence rates are interpreted and how diagnoses should be managed.

Incidence of mild cognitive impairment in World Trade Center responders: Long-term consequences of re-experiencing the events on 9/11/2001

Clouston SA, Diminich ED, Kotov R, et al

2019

Psychopathology among New York City public school children 6 months after September 11

Hoven CW, Duarte CS, Lucas CP, et al

2005

CONTEXT: Children exposed to a traumatic event may be at higher risk for developing mental disorders. The prevalence of child psychopathology, however, has not been assessed in a population-based sample exposed to different levels of mass trauma or across a range of disorders. OBJECTIVE: To determine prevalence and correlates of probable mental disorders among New York City, NY, public school students 6 months following the September 11, 2001, World Trade Center attack. DESIGN: Survey. SETTING: New York City public schools. PARTICIPANTS: A citywide, random, representative sample of 8236 students in grades 4 through 12, including oversampling in closest proximity to the World Trade Center site (ground zero) and other high-risk areas. MAIN OUTCOME MEASURE: Children were screened for probable mental disorders with the Diagnostic Interview Schedule for Children Predictive Scales. RESULTS: One or more of 6 probable anxiety/depressive disorders were identified in 28.6% of all children. The most prevalent were probable agoraphobia (14.8%), probable separation anxiety (12.3%), and probable posttraumatic stress disorder (10.6%). Higher levels of exposure correspond to higher prevalence for all probable anxiety/depressive disorders. Girls and children in grades 4 and 5 were the most affected. In logistic regression analyses, child's exposure (adjusted odds ratio, 1.62), exposure of a child's family member (adjusted odds ratio, 1.80), and the child's prior trauma (adjusted odds ratio, 2.01) were related to increased likelihood of probable anxiety/depressive disorders. Results were adjusted for different types of exposure, sociodemographic characteristics, and child mental health service use. CONCLUSIONS: A high proportion of New York City public school children had a probable mental disorder 6 months after September 11, 2001. The data suggest that there is a relationship between level of exposure to trauma and likelihood of child anxiety/depressive disorders in the community. The results support the need to apply wide-area epidemiological approaches to mental health assessment after any large-scale disaster.

Blood eosinophils and World Trade Center exposure predict surgery in chronic rhinosinusitis. A 13.5-year longitudinal study

Kwon S, Putman B, Weakley J, et al

2016

RATIONALE: The World Trade Center (WTC) collapse generated caustic airborne particulates that caused chronic rhinosinusitis in exposed Fire Department of New York firefighters. Surgery was performed when symptoms remained uncontrolled despite medical management. OBJECTIVES: To identify predictors of surgical intervention for chronic rhinosinusitis in firefighters exposed to airborne irritants at the WTC collapse site. METHODS: We assessed in 8,227 firefighters with WTC exposure between September 11, 2001 (9/11), and September 25, 2001, including WTC-site arrival time, months of rescue and recovery work, and eosinophil concentration measured between 9/11 and March 10, 2003. We assessed the association of serum cytokines and immunoglobulins with eosinophil concentration and surgery for rhinosinusitis in 112 surgical cases and 376 control subjects with serum available from the first 6 months after exposure to the WTC collapse site. MEASUREMENTS AND MAIN RESULTS: Between 9/11 and March 10, 2015, the surgery rate was 0.47 cases per 100 person-years. In the first 18 months post-9/11, surgical patients had higher mean blood eosinophil levels than study cohort patients (219 +/- 155 vs. 191 +/- 134; P < 0.0001). Increased surgery risk was associated with increasing blood eosinophil counts (hazard ratio [HR], 1.12 per 100 cells/mul; 95% confidence interval [CI], 1.07-1.17; P < 0.001); arriving at the WTC site on 9/11 or September 12, 2001 (HR, 1.43; 95% CI, 1.04-1.99; P = 0.03); and working 6 months or longer at the WTC site (HR, 1.48; 95% CI, 1.14-1.93; P < 0.01). Median blood eosinophil levels for surgical patients were above levels for the cohort in all 18-month intervals March 11, 2000, through March 10, 2015, using 51,163 measurements representing 97,733 person-years of observation. Increasing age, increasing IL-17A, and low IgA in serum from 2001 to 2002 predicted blood eosinophil concentration in surgical patients but not in control subjects (R(2) = 0.26, P < 0.0001; vs. R(2) = 0.008, P = 0.56). CONCLUSIONS: Increasing blood eosinophil concentration predicts surgical intervention for chronic rhinosinusitis, particularly in those with intense acute and prolonged exposure to airborne irritants. WTC-exposed Fire Department of New York firefighters who underwent irritant-associated sinus surgery are immunologically different from the cohort. Surgical patients have a higher blood eosinophil levels that is associated with mediators of mucosal immunity.

PTSD and alcohol use after the World Trade Center attacks: A longitudinal study

Boscarino JA, Kirchner HL, Hoffman SN, et al

2011

Increased high risk sexual behavior after September 11 in men who have sex with men: An internet survey

Chiasson MA, Hirshfield S, Humberstone M, et al

2005

Prevalence and correlates of suicidal ideation in World Trade Center responders: Results from a population-based health monitoring cohort

Gibson R, Whealin JM, Dasaro CR, et al

2022

9/11 health update

Cone JE, Santiago-Colón A, and Lucchini R

2021

Assessing the protective metabolome using machine learning in World Trade Center particulate exposed firefighters at risk for lung injury

Crowley G, Kwon S, Ostrofsky DF, et al

2019

Post-9/11/2001 lung function trajectories by sex and race in World Trade Center-exposed New York City emergency medical service workers

Vossbrinck M, Zeig-Owens R, Hall CB, et al

2017

Post-traumatic stress disorder and cardiovascular diseases: A cohort study of men and women involved in cleaning the debris of the World Trade Center complex

Remch M, Laskaris Z, Flory J, et al

2018

COVID-19 cumulative incidence, asymptomatic infections, and fatality in long island, ny, january-august 2020: A cohort of World Trade Center responders

Morozova O, Clouston SA, Valentine J, et al

2021

Association between World Trade Center exposure and excess cancer risk

Li J, Cone JE, Kahn AR, et al

2012

CONTEXT: The terrorist attacks of September 11, 2001, resulted in the release of known and suspected carcinogens into the environment. There is public concern that exposures may have resulted in increased cancers. OBJECTIVE: To evaluate cancer incidence among persons enrolled in the World Trade Center Health Registry. DESIGN, SETTING, AND PARTICIPANTS: Observational study of 55,778 New York State residents enrolled in the World Trade Center Health Registry in 2003-2004, including rescue/recovery workers (n = 21,850) and those not involved in rescue/recovery (n = 33,928), who were followed up from enrollment through December 31, 2008. Within-cohort comparisons using Cox proportional hazards models assessed the relationship between intensity of World Trade Center exposure and selected cancers. MAIN OUTCOME MEASURES: Cases were identified through linkage with 11 state cancer registries. Standardized incidence ratios (SIRs) adjusted for age, race/ethnicity, and sex were computed with 2003-2008 New York State rates as the reference, focusing on cancers diagnosed in 2007-2008 as being most likely to be related to exposure during September 11 and its aftermath. The total and site-specific incidence rate differences (RDs) per 100,000 person-years between the study population and the New York State population in 2007-2008 also were calculated. RESULTS: There were 1187 incident cancers diagnosed, with an accumulated 253,269 person-years (439 cancers among rescue/recovery workers and 748 among those not involved in rescue/recovery). The SIR for all cancer sites combined in 2007-2008 was not significantly elevated (SIR, 1.14 [95% CI, 0.99 to 1.30]; RD, 67 [95% CI, -6 to 126] per 100,000 person-years among rescue/recovery workers vs SIR, 0.92 [95% CI, 0.83 to 1.03]; RD, -45 [95% CI, -106 to 15] per 100,000 person-years among those not involved in rescue/recovery). Among rescue/recovery workers, the SIRs had significantly increased by 2007-2008 for 3 cancer sites and were 1.43 (95% CI, 1.11 to 1.82) for prostate cancer (n = 67; RD, 61 [95% CI, 20 to 91] per 100,000 person-years), 2.02 (95% CI, 1.07 to 3.45) for thyroid cancer (n = 13; RD, 16 [95% CI, 2 to 23] per 100,000 person-years), and 2.85 (95% CI, 1.15 to 5.88) for multiple myeloma (n = 7; RD, 11 [95% CI, 2 to 14] per 100,000 person-years). No increased incidence was observed in 2007-2008 among those not involved in rescue/recovery. Using within-cohort comparisons, the intensity of World Trade Center exposure was not significantly associated with cancer of the lung, prostate, thyroid, non-Hodgkin lymphoma, or hematological cancer in either group. CONCLUSIONS: Among persons enrolled in the World Trade Center Health Registry, there was an excess risk for prostate cancer, thyroid cancer, and myeloma in 2007-2008 compared with that for New York State residents; however, these findings were based on a small number of events and multiple comparisons. No significant associations were observed with intensity of World Trade Center exposures. Longer follow-up for typically long-latency cancers and attention to specific cancer sites are needed.

Dose-response relationship between World Trade Center dust exposure and hepatic steatosis

Jirapatnakul A, Yip R, Branch AD, et al

2021

Reflux symptoms and disorders and pulmonary disease in former World Trade Center rescue and recovery workers and volunteers

de la Hoz RE, Christie J, Teamer JA, et al

2008

The effect of World Trade Center exposure on the latency of chronic rhinosinusitis diagnoses in New York City firefighters: 2001-2011

Weakley J, Hall CB, Liu X, et al

2016

Unique features of obstructive sleep apnea in World Trade Center responders with aerodigestive disorders

Sunderram J, Udasin I, Kelly-McNeil K, et al

2011

Epidemiology of respiratory health outcomes among World Trade Center disaster workers: Review of the literature 10 years after the September 11, 2001 terrorist attacks

Ekenga CC and Friedman-Jimenez G

2011

Fifteen-year surveillance of pathological findings associated with death or euthanasia in search-and-rescue dogs deployed to the September 11, 2001, terrorist attack sites

Otto CM, Hare E, Buchweitz JP, et al

2020

Validation of predictive metabolic syndrome biomarkers of World Trade Center lung injury: A 16-year longitudinal study

Kwon S, Crowley G, Caraher EJ, et al

2019

Excess hpv-related head and neck cancer in the World Trade Center Health Program general responder cohort

Graber JM, Harris G, Black K, et al

2019

Transgenerational effects of posttraumatic stress disorder in babies of mothers exposed to the World Trade Center attacks during pregnancy

Yehuda R, Engel SM, Brand SR, et al

2005

Health trends among 9/11 responders from 2011-2021: A review of World Trade Center Health Program statistics

Smith E, Holmes L, and Larkin B

2021

Introduction: In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches. Methods: The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded. Results: A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia. Discussion: Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later. Conclusion: Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.

Exploratory case study of suicide among a sample of 9/11 survivors

Seil K, Takemoto E, Farfel MR, et al

2022

Temporal association of prostate cancer incidence with World Trade Center rescue/recovery work

Goldfarb DG, Zeig-Owens R, Kristjansson D, et al

2021

Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York, residents after the September 11th terrorist attacks

Vlahov D, Galea S, Resnick H, et al

2002

World Trade Center-related physical and mental health burden among New York City fire department emergency medical service workers

Yip J, Zeig-Owens R, Webber MP, et al

2016

Studies of the vicarious traumatization of college students by the September 11th attacks: Effects of proximity, exposure, and connectedness

Blanchard EB, Kuhn E, Rowell DL, et al.

2004

Prenatal exposure to polybrominated diphenyl ethers and child attention problems at 3-7 years

Cowell WJ, Lederman SA, Sjodin A, et al

2015

World Trade Center Health Program: 20 years after 9/11

Calvert GM, Reissman D, and Howard J

2021

Reproductive outcomes following maternal exposure to the events of September 11, 2001, at the World Trade Center, in New York City

Maslow CB, Caramanica K, Li J, et al

2016

Case report: Lung disease in World Trade Center responders exposed to dust and smoke: Carbon nanotubes found in the lungs of World Trade Center patients and dust samples

Wu M, Gordon RE, Herbert R, et al

2010

Television images and psychological symptoms after the September 11 terrorist attacks

Ahern J, Galea S, Resnick H, et al

2002

Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001

Lioy PJ, Weisel CP, Millette JR, et al

2002

The explosion and collapse of the World Trade Center (WTC) was a catastrophic event that produced an aerosol plume impacting many workers, residents, and commuters during the first few days after 11 September 2001. Three bulk samples of the total settled dust and smoke were collected at weather-protected locations east of the WTC on 16 and 17 September 2001; these samples are representative of the generated material that settled immediately after the explosion and fire and the concurrent collapse of the two structures. We analyzed each sample, not differentiated by particle size, for inorganic and organic composition. In the inorganic analyses, we identified metals, radionuclides, ionic species, asbestos, and inorganic species. In the organic analyses, we identified polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls, polychlorinated dibenzodioxins, polychlorinated dibenzofurans, pesticides, phthalate esters, brominated diphenyl ethers, and other hydrocarbons. Each sample had a basic pH. Asbestos levels ranged from 0.8% to 3.0% of the mass, the PAHs were > 0.1% of the mass, and lead ranged from 101 to 625 microg/g. The content and distribution of material was indicative of a complex mixture of building debris and combustion products in the resulting plume. These three samples were composed primarily of construction materials, soot, paint (leaded and unleaded), and glass fibers (mineral wool and fiberglass). Levels of hydrocarbons indicated unburned or partially burned jet fuel, plastic, cellulose, and other materials that were ignited by the fire. In morphologic analyses we found that a majority of the mass was fibrous and composed of many types of fibers (e.g., mineral wool, fiberglass, asbestos, wood, paper, and cotton). The particles were separated into size classifications by gravimetric and aerodynamic methods. Material < 2.5 microm in aerodynamic diameter was 0.88-1.98% of the total mass. The largest mass concentrations were > 53 microm in diameter. The results obtained from these samples can be used to understand the contact and types of exposures to this unprecedented complex mixture experienced by the surviving residents, commuters, and rescue workers directly affected by the plume from 11 to 12 September and the evaluations of any acute or long-term health effects from resuspendable dust and smoke to the residents, commuters, and local workers, as well as from the materials released after 11 September until the fires were extinguished. Further, these results support the need to have the interior of residences, buildings, and their respective HVAC systems professionally cleaned to reduce long-term residential risks before rehabitation.

Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in lower Manhattan after the collapse of the WTC on September 11, 2001

Lioy PJ, Weisel CP, Millette JR, et al.

2002

9/11-related PTSD among highly exposed populations: A systematic review 15 years after the attack

Lowell A, Suarez-Jimenez B, Helpman L, et al

2018

Looking for resilience: Understanding the longitudinal trajectories of responses to stress

Norris FH, Tracy M, and Galea S

2009

Epidemiologic research on man-made disasters: Strategies and implications of cohort definition for World Trade Center worker and volunteer surveillance program

Savitz DA, Oxman RT, Metzger KB, et al

2008

Studies of long-term health consequences of disasters face unique methodologic challenges. The authors focused on studies of the health of cleanup and recovery workers, who are often poorly enumerated at the outset and difficult to follow over time. Comparison of the experience at the World Trade Center disaster with 4 past incidents of chemical and radiation releases at Seveso, Italy; Bhopal, India; Chernobyl, Ukraine; and Three Mile Island, USA, provided useful contrasts. Each event had methodologic advantages and disadvantages that depended on the nature of the disaster and the availability of records on area residents, and the emergency-response and cleanup protocol. The World Trade Center Worker Monitoring Program has well-defined eligibility criteria but lacks information on the universe of eligible workers to characterize response proportions or the potential for distortion of reported health effects. Nonparticipation may result from lack of interest, lack of awareness of the program, availability of another source of medical care, medical conditions precluding participation, inability to take time off from work, moving out of the area, death, or shift from initially ineligible to eligible status. Some of these considerations suggest selective participation by the sickest individuals, whereas others favor participation by the healthiest. The greatest concern with the validity of inferences regarding elevated health risks relative to external populations is the potential for selective enrollment among those who are affected. If there were a large pool of nonparticipating workers and those who suffered ill health were most motivated to enroll, the rates of disease among participants would be substantially higher than among all those eligible for the program. Future disaster follow-up studies would benefit substantially by having access to accurate estimates of the number of workers and information on the individuals who contributed to the cleanup and recovery effort.

The physical and mental health challenges experienced by 9/11 first responders and recovery workers: A review of the literature

Smith EC, Holmes L, and Burkle FM

2019

Asthma among staten island fresh kills landfill and barge workers following the September 11, 2001 World Trade Center terrorist attacks

Cone JE, Osahan S, Ekenga CC, et al

2016

Effect of asthma and PTSD on persistence and onset of gastroesophageal reflux symptoms among adults exposed to the September 11, 2001, terrorist attacks

Li J, Brackbill RM, Jordan HT, et al

2016

Growing up in the shadow of terrorism: Youth in america after 9/11

Eisenberg N and Silver RC

2011

Mortality among rescue and recovery workers and community members exposed to the September 11, 2001 World Trade Center terrorist attacks, 2003–2014

Jordan HT, Stein CR, Li J, et al

2018

BACKGROUND: Multiple chronic health conditions have been associated with exposure to the September 11, 2001 World Trade Center (WTC) terrorist attacks (9/11). We assessed whether excess deaths occurred during 2003-2014 among persons directly exposed to 9/11, and examined associations of 9/11-related exposures with mortality risk. MATERIALS AND METHODS: Deaths occurring in 2003-2014 among members of the World Trade Center Health Registry, a cohort of rescue/recovery workers and lower Manhattan community members who were exposed to 9/11, were identified via linkage to the National Death Index. Participants' overall levels of 9/11-related exposure were categorized as high, intermediate, or low. We calculated standardized mortality ratios (SMR) using New York City reference rates from 2003 to 2012. Proportional hazards were used to assess associations of 9/11-related exposures with mortality, accounting for age, sex, race/ethnicity and other potential confounders. RESULTS: We identified 877 deaths among 29,280 rescue/recovery workers (3.0%) and 1694 deaths among 39,643 community members (4.3%) during 308,340 and 416,448 person-years of observation, respectively. The SMR for all causes of death was 0.69 [95% confidence interval (CI) 0.65-0.74] for rescue/recovery workers and 0.86 (95% CI 0.82-0.90) for community members. SMRs for diseases of the cardiovascular and respiratory systems were significantly lower than expected in both groups. SMRs for several other causes of death were significantly elevated, including suicide among rescue recovery workers (SMR 1.82, 95% CI 1.35-2.39), and brain malignancies (SMR 2.25, 95% CI 1.48-3.28) and non-Hodgkin's lymphoma (SMR 1.79, 95% CI 1.24-2.50) among community members. Compared to low exposure, both intermediate [adjusted hazard ratio (AHR) 1.36, 95% CI 1.10-1.67] and high (AHR 1.41, 95% CI 1.06-1.88) levels of 9/11-related exposure were significantly associated with all-cause mortality among rescue/recovery workers (p-value for trend 0.01). For community members, intermediate (AHR 1.13, 95% CI 1.01-1.27), but not high (AHR 1.14, 95% CI 0.94-1.39) exposure was significantly associated with all-cause mortality (p-value for trend 0.03). AHRs for associations of overall 9/11-related exposure with heart disease- and cancer-related mortality were similar in magnitude to those for all-cause mortality, but with 95% CIs crossing the null value. CONCLUSIONS: Overall mortality was not elevated. Among specific causes of death that were significantly elevated, suicide among rescue/recovery workers is a plausible long-term consequence of 9/11 exposure, and is potentially preventable. Elevated mortality due to other causes, including non-Hodgkin's lymphoma and brain cancer, and small but statistically significant associations of 9/11-related exposures with all-cause mortality hazard warrant additional surveillance.

Toxicant-induced loss of tolerance for chemicals, foods, and drugs: Assessing patterns of exposure behind a global phenomenon

Masri S, Miller CS, Palmer RF, et al

2021

Background: Despite 15–36% of the U.S. population reporting Chemical Intolerances (CI) or sensitivity, the condition has been overlooked in medicine and public health. CI is characterized by multisystem symptoms and new-onset intolerances that develop in a subset of individuals following a major chemical exposure event or repeated low-level exposures. While Toxicant-Induced Loss of Tolerance (TILT) is a two-stage disease mechanism proposed to explain CI, less is known about the exposures that initiate the disease, than about the intolerances that have been documented. Methods: We reviewed eight major exposure events that preceded onset of chemical intolerance in groups of individuals sharing the same exposure. Our goal was to identify the chemicals and/or groups of chemicals that were most pervasive during each exposure event as well as identify the concentrations of key chemicals involved in each exposure event and the proportions of exposed individuals who ultimately developed TILT following exposure. Case studies we selected for review included (1) workers at U.S. Environmental Protection Agency (EPA) headquarters during renovations; (2) Gulf War veterans; (3) pesticide exposure among casino workers; (4) exposure to aircraft oil fumes; (5) the World Trade Center tragedy; (6) surgical implants; (7) moldy environments; and (8) tunnel workers exposed to solvents. Results: Mixed volatile and semi-volatile organic compounds (VOCs and SVOCs), followed by pesticides and combustion products were most prevalent across TILT initiation events. As a broader category, synthetic organic chemicals and their combustion products were the primary exposures associated with chemical intolerance. Such chemicals included pesticides, peroxides, nerve agents, anti-nerve agent drugs, lubricants and additives, xylene, benzene, and acetone. Conclusion: A select group of exposures were predominant in several major initiating events, suggesting their potential role in TILT initiation. Such insights are useful to public health scientists, physicians, and policymakers seeking to minimize harmful exposures and prevent future disease.

Blood leukocyte concentrations, FEV1 decline, and airflow limitation. A 15-year longitudinal study of World Trade Center-exposed firefighters

Zeig-Owens R, Singh A, Aldrich TK, et al

2018

RATIONALE: Rescue/recovery work at the World Trade Center disaster site (WTC) caused a proximate decline in lung function in Fire Department of the City of New York firefighters. A subset of this cohort experienced an accelerated rate of lung function decline over 15 years of post-September 11, 2001 (9/11) follow-up. OBJECTIVES: To determine if early postexposure blood leukocyte concentrations are biomarkers for subsequent FEV1 decline and incident airflow limitation. METHODS: Individual rates of forced expiratory volume in 1 second (FEV1) change were calculated for 9,434 firefighters using 88,709 spirometric measurements taken between September 11, 2001, and September 10, 2016. We categorized FEV1 change rates into three trajectories: accelerated FEV1 decline (FEV1 loss >64 ml/yr), expected FEV1 decline (FEV1 loss between 0 and 64 ml/yr), and improved FEV1 (positive rate of change >0 ml/yr). Occurrence of FEV1/FVC less than 0.70 after 9/11 defined incident airflow limitation. Using regression models, we assessed associations of post-9/11 blood eosinophil and neutrophil concentrations with subsequent FEV1 decline and airflow limitation, adjusted for age, race, smoking, height, WTC exposure level, weight change, and baseline lung function. RESULTS: Accelerated FEV1 decline occurred in 12.7% of participants (1,199 of 9,434), whereas post-9/11 FEV1 improvement occurred in 8.3% (780 of 9,434). Higher blood eosinophil and neutrophil concentrations were each associated with accelerated FEV1 decline after adjustment for covariates (odds ratio [OR], 1.10 per 100 eosinophils/mul; 95% confidence interval [CI], 1.05-1.15; and OR, 1.10 per 1,000 neutrophils/mul; 95% CI, 1.05-1.15, respectively). Multivariable-adjusted linear regression models showed that a higher blood neutrophil concentration was associated with a faster rate of FEV1 decline (1.14 ml/yr decline per 1,000 neutrophils/mul; 95% CI, 0.69-1.60 ml/yr; P < 0.001). Higher blood eosinophil concentrations were associated with a faster rate of FEV1 decline in ever-smokers (1.46 ml/yr decline per 100 eosinophils/mul; 95% CI, 0.65-2.26 ml/yr; P < 0.001) but not in never-smokers (P for interaction = 0.004). Higher eosinophil concentrations were also associated with incident airflow limitation (adjusted hazard ratio, 1.10 per 100 eosinophils/mul; 95% CI, 1.04-1.15). Compared with the expected FEV1 decline group, individuals experiencing accelerated FEV1 decline were more likely to have incident airflow limitation (adjusted OR, 4.12; 95% CI, 3.30-5.14). CONCLUSIONS: Higher post-9/11 blood neutrophil and eosinophil concentrations were associated with subsequent accelerated FEV1 decline in WTC-exposed firefighters. Both higher blood eosinophil concentrations and accelerated FEV1 decline were associated with incident airflow limitation in WTC-exposed firefighters.

Nested case-control study of selected systemic autoimmune diseases in World Trade Center rescue/recovery workers

Webber MP, Moir W, Zeig-Owens R, et al

2015

OBJECTIVE: To test the a priori hypothesis that acute and chronic work exposures to the World Trade Center (WTC) site on or after September 11, 2001 were associated with risk of new-onset systemic autoimmune diseases. METHODS: A nested case-control study was performed in WTC rescue/recovery workers who had received a rheumatologist-confirmed systemic autoimmune disease diagnosis between September 12, 2001 and September 11, 2013 (n = 59), each of whom was individually matched to 4 randomly selected controls (n = 236) on the basis of year of hire (+/-1 year), sex, race, and work assignment (firefighter or emergency medical service). Acute exposure was defined according to the earliest time of arrival (morning of 9/11 versus later) at the WTC site, and chronic exposure was defined as duration (number of months) of WTC site-related work. Rheumatologists were blinded with regard to each subject's exposure status. The conditional odds ratios (CORs) with 95% confidence intervals (95% CIs) for incident autoimmune disease were derived from exact conditional logistic regression models. RESULTS: Rheumatoid arthritis was the most common autoimmune diagnosis (37% of subjects), followed by spondyloarthritis (22%), inflammatory myositis (14%), systemic lupus erythematosus (12%), systemic sclerosis (5%), Sjogren's syndrome (5%), antiphospholipid syndrome (3%), and granulomatosis with polyangiitis (Wegener's) (2%). The COR for incident autoimmune disease increased by 13% (COR 1.13, 95% CI 1.02-1.26) for each additional month worked at the WTC site. These odds were independent of the association between high acute exposure (working during the morning of 9/11) and disease outcome, which conveyed an elevated, but not statistically significant, risk (COR 1.85, 95% CI 0.86-3.89). CONCLUSION: Prolonged work at the WTC site, independent of acute exposure, was an important predictor of post-9/11 systemic autoimmune diseases. The WTC Health Program should expand surveillance efforts for those with extended exposures, as early detection can facilitate early treatment, which has been shown to minimize organ damage and improve quality of life.

Cancer incidence in World Trade Center rescue and recovery workers: 14 years of follow-up

Li J, Yung J, Qiao B, et al

2022

Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study

Goldfarb DG, Zeig-Owens R, Kristjansson D, et al

2021

Biomarkers of patient intrinsic risk for upper and lower airway injury after exposure to the World Trade Center atrocity

Zeig-Owens R, Nolan A, Putman B, et al

2016

Reductions in circulating endocannabinoid levels in individuals with post-traumatic stress disorder following exposure to the World Trade Center attacks

Hill MN, Bierer LM, Makotkine I, et al

2013

Endocannabinoid (eCB) signaling has been identified as a modulator of adaptation to stress, and is integral to basal and stress-induced glucocorticoid regulation. Furthermore, interactions between eCBs and glucocorticoids have been shown to be necessary for the regulation of emotional memories, suggesting that eCB function may relate to the development of post-traumatic stress disorder (PTSD). To examine this, plasma eCBs were measured in a sample (n=46) drawn from a population-based cohort selected for physical proximity to the World Trade Center (WTC) at the time of the 9/11 attacks. Participants received a structured diagnostic interview and were grouped according to whether they met diagnostic criteria for PTSD (no PTSD, n=22; lifetime diagnosis of PTSD=24). eCB content (2-arachidonoylglycerol (2-AG) and anandamide (AEA)) and cortisol were measured from 8 a.m. plasma samples. Circulating 2-AG content was significantly reduced among individuals meeting diagnostic criteria for PTSD. The effect of reduced 2-AG content in PTSD remained significant after controlling for the stress of exposure to the WTC collapse, gender, depression and alcohol abuse. There were no significant group differences for AEA or cortisol levels; however, across the whole sample AEA levels positively correlated with circulating cortisol, and AEA levels exhibited a negative relationship with the degree of intrusive symptoms within the PTSD sample. This report shows that PTSD is associated with a reduction in circulating levels of the eCB 2-AG. Given the role of 2-AG in the regulation of the stress response, these data support the hypothesis that deficient eCB signaling may be a component of the glucocorticoid dysregulation associated with PTSD. The negative association between AEA levels and intrusive symptoms is consistent with animal data indicating that reductions in AEA promote retention of aversive emotional memories. Future work will aim to replicate these findings and extend their relevance to clinical pathophysiology, as well as to neuroendocrine and molecular markers of PTSD.

Exposure to World Trade Center dust exacerbates cognitive impairment and evokes a central and peripheral pro-inflammatory transcriptional profile in an animal model of Alzheimer's disease

Iban-Arias R, Trageser KJ, Yang EJ, et al.

2022

World Trade Center Health Program - United States, 2012-2020

Azofeifa A, Martin GR, Santiago-Colón A, et al

2021

PROBLEM/CONDITION: After the September 11, 2001, terrorist attacks on the United States, approximately 400,000 persons were exposed to toxic contaminants and other factors that increased their risk for certain physical and mental health conditions. Shortly thereafter, both federal and nonfederal funds were provided to support various postdisaster activities, including medical monitoring and treatment. In 2011, as authorized by the James Zadroga 9/11 Health and Compensation Act of 2010, the CDC World Trade Center (WTC) Health Program began providing medical screening, monitoring, and treatment of 9/11-related health conditions for WTC responders (i.e., persons who were involved in rescue, response, recovery, cleanup, and related support activities after the September 11, 2001, terrorist attacks) and affected WTC survivors (i.e., persons who were present in the dust or dust cloud on 9/11 or who worked, lived, or attended school, child care centers, or adult day care centers in the New York City disaster area). REPORTING PERIOD COVERED: 2012-2020. DESCRIPTION OF SYSTEM: The U.S. Department of Health and Human Services WTC Health Program is administered by the director of CDC's National Institute for Occupational Safety and Health. The WTC Health Program uses a multilayer administrative claims system to process members' authorized program health benefits. Administrative claims data are primarily generated by clinical providers in New York and New Jersey at the Clinical Centers of Excellence and outside those states by clinical providers in the Nationwide Provider Network. This report describes WTC Health Program trends for selected indicators during 2012-2020. RESULTS: In 2020, a total of 104,223 members were enrolled in the WTC Health Program, of which 73.4% (n = 76,543) were responders and 26.6% (n = 27,680) were survivors. WTC Health Program members are predominantly male (78.5%). The median age of members was 51 years (interquartile range [IQR]: 44-57) in 2012 and 59 years (IQR: 52-66) in 2020. During 2012-2020, enrollment and number of certifications of WTC-related health conditions increased among members, with the greatest changes observed among survivors. Overall, at enrollment, most WTC Health Program members lived in New York (71.7%), New Jersey (9.3%), and Florida (5.7%). In 2020, the total numbers of cancer and noncancer WTC-related certifications among members were 20,612 and 50,611, respectively. Skin cancer, male genital system cancers, and in situ neoplasms (e.g., skin and breast) are the most common WTC-related certified cancer conditions. The most commonly certified noncancer conditions are in the aerodigestive and mental health categories. The average number of WTC-related certified conditions per certified member is 2.7. In 2020, a total of 40,666 WTC Health Program members received annual monitoring and screening examinations (with an annual average per calendar year of 35,245). In 2020, the total number of WTC Health Program members who received treatment was 41,387 (with an annual average per calendar year of 32,458). INTERPRETATION: Since 2011, the WTC Health Program has provided health care for a limited number of 9/11-related health conditions both for responders and survivors of the terrorist attacks. Over the study period, program enrollment and WTC certification increased, particularly among survivors. As the members age, increased use of health services and costs within the WTC Health Program are expected; chronic diseases, comorbidities, and other health-related conditions unrelated to WTC exposures are more common in older populations, which might complicate the clinical management of WTC-related health conditions. PUBLIC HEALTH ACTION: Analysis of administrative claims data in the context of WTC research findings can better clarify the health care use patterns of WTC Health Program members. This information guides programmatic decision-making and might also help guide future disaster preparedness and response health care efforts. Strengthening the WTC Health Program health informatics infrastructure is warranted for timely programmatic and research decision-making.

FDNY and 9/11: Clinical services and health outcomes in World Trade Center-exposed firefighters and ems workers from 2001 to 2016

Yip J, Webber MP, Zeig-Owens R, et al

2016

Prenatal exposure to pbdes and neurodevelopment

Herbstman JB, Sjodin A, Kurzon M, et al

2010

Association between posttraumatic stress disorder and mortality among responders and civilians following the September 11, 2001, disaster

Giesinger I, Li J, Takemoto E, et al

2020

Importance: Posttraumatic stress disorder (PTSD) has been associated with increased mortality, primarily in studies of veterans. The World Trade Center Health Registry (Registry) provides a unique opportunity to study the association between PTSD and mortality among a population exposed to the World Trade Center attacks in New York, New York, on September 11, 2001 (9/11). Objectives: To assess whether 9/11-related probable PTSD (PTSD) is associated with increased mortality risk, as well as whether this association differs when including repeated measures of PTSD over time vs a single baseline assessment. Design, Setting, and Participants: A longitudinal cohort study of 63666 Registry enrollees (29270 responders and 34396 civilians) was conducted from September 5, 2003, to December 31, 2016, with PTSD assessments at baseline (wave 1: 2003-2004) and 3 follow-up time points (wave 2: 2006-2007, wave 3: 2011-2012, wave 4: 2015-2016). Data analyses were conducted from December 4, 2018, to May 20, 2019. Exposures: Posttraumatic stress disorder was defined using the 17-item PTSD Checklist-Specific (PCL-S) self-report measure (score >/=50) at each wave (waves 1-4). Baseline PTSD was defined using wave 1 PCL-S, and time-varying PTSD was defined using the PCL-S assessments from all 4 waves. Main Outcomes and Measures: Mortality outcomes were ascertained through National Death Index linkage from 2003 to 2016 and defined as all-cause, cardiovascular, and external-cause mortality. Results: Of 63666 enrollees (38883 men [61.1%]; mean [SD] age at 9/11, 40.4 [10.4] years), 6689 (10.8%) had PTSD at baseline (responders: 2702 [9.5%]; civilians: 3987 [12.0%]). Participants who were middle aged (2022 [12.5%]), female (3299 [13.8%]), non-Latino black (1295 [17.0%]), or Latino (1835 [22.2%]) were more likely to have PTSD. During follow-up, 2349 enrollees died (including 230 external-cause deaths and 487 cardiovascular deaths). Among all enrollees in time-varying analyses, PTSD was associated with all-cause, cardiovascular, and external-cause mortality, with adjusted hazard ratios (AHRs) of greater magnitude compared with analyses examining baseline PTSD. Among responders, time-varying PTSD was significantly associated with increased risk of all-cause (AHR, 1.91; 95% CI, 1.58-2.32), cardiovascular (AHR, 1.95; 95% CI, 1.25-3.04), and external-cause (AHR, 2.40; 95% CI, 1.47-3.91) mortality. Among civilians, time-varying PTSD was significantly associated with increased risk of all-cause (AHR, 1.54; 95% CI, 1.28-1.85), cardiovascular (AHR, 1.72; 95% CI, 1.15-2.58), and external-cause (AHR, 2.11; 95% CI, 1.06-4.19) mortality. Conclusions and Relevance: The risk of mortality differed in examination of baseline PTSD vs repeated measures of PTSD over time, suggesting that longitudinal data should be used where possible. Comparable findings between responders and civilians suggest that 9/11-related PTSD is associated with an increased mortality risk.

European position paper on rhinosinusitis and nasal polyps 2020

Fokkens WJ, Lund VJ, Hopkins C, et al

2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

W. J. Fokkens, V. J. Lund, C. Hopkins, P. W. Hellings, R. Kern, S. Reitsma, S. Toppila-Salmi, M. Bernal-Sprekelsen, J. Mullol, I. Alobid, W. Terezinha Anselmo-Lima, C. Bachert, F. Baroody, C. von Buchwald, A. Cervin, N. Cohen, J. Constantinidis, L. De Gabory, M. Desrosiers, Z. Diamant, R. G. Douglas, P. H. Gevaert, A. Hafner, R. J. Harvey, G. F. Joos, L. Kalogjera, A. Knill, J. H. Kocks, B. N. Landis, J. Limpens, S. Lebeer, O. Lourenco, C. Meco, P. M. Matricardi, L. O'Mahony, C. M. Philpott, D. Ryan, R. Schlosser, B. Senior, T. L. Smith, T. Teeling, P. V. Tomazic, D. Y. Wang, D. Wang, L. Zhang, A. M. Agius, C. Ahlstrom-Emanuelsson, R. Alabri, S. Albu, S. Alhabash, A. Aleksic, M. Aloulah, M. Al-Qudah, S. Alsaleh, M. A. Baban, T. Baudoin, T. Balvers, P. Battaglia, J. D. Bedoya, A. Beule, K. M. Bofares, I. Braverman, E. Brozek-Madry, B. Richard, C. Callejas, S. Carrie, L. Caulley, D. Chussi, E. de Corso, A. Coste, U. El Hadi, A. Elfarouk, P. H. Eloy, S. Farrokhi, G. Felisati, M. D. Ferrari, R. Fishchuk, W. Grayson, P. M. Goncalves, B. Grdinic, V. Grgic, A. W. Hamizan, J. V. Heinichen, S. Husain, T. I. Ping, J. Ivaska, F. Jakimovska, L. Jovancevic, E. Kakande, R. Kamel, S. Karpischenko, H. H. Kariyawasam, H. Kawauchi, A. Kjeldsen, L. Klimek, A. Krzeski, G. Kopacheva Barsova, S. W. Kim, D. Lal, J. J. Letort, A. Lopatin, A. Mahdjoubi, A. Mesbahi, J. Netkovski, D. Nyenbue Tshipukane, A. Obando-Valverde, M. Okano, M. Onerci, Y. K. Ong, R. Orlandi, N. Otori, K. Ouennoughy, M. Ozkan, A. Peric, J. Plzak, E. Prokopakis, N. Prepageran, A. Psaltis, B. Pugin, M. Raftopulos, P. Rombaux, H. Riechelmann, S. Sahtout, C. C. Sarafoleanu, K. Searyoh, C. S. Rhee, J. Shi, M. Shkoukani, A. K. Shukuryan, M. Sicak, D. Smyth, K. Snidvongs, T. Soklic Kosak, P. Stjarne, B. Sutikno, S. Steinsvag, P. Tantilipikorn, S. Thanaviratananich, T. Tran, J. Urbancic, A. Valiulius, C. Vasquez de Aparicio, D. Vicheva, P. M. Virkkula, G. Vicente, R. Voegels, M. M. Wagenmann, R. S. Wardani, A. Welge-Lussen, I. Witterick, E. Wright, D. Zabolotniy, B. Zsolt and C. P. Zwetsloot

Respiratory and other health effects reported in children exposed to the World Trade Center disaster of 11 September 2001

Thomas PA, Brackbill R, Thalji L, et al

2008

Serum perfluoroalkyl substances in children exposed to the World Trade Center disaster

Trasande L, Koshy TT, Gilbert J, et al

2017

Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001-2005

Berninger A, Webber MP, Cohen HW, et al

2010

Cough and bronchial responsiveness in firefighters at the World Trade Center site

Prezant DJ, Weiden M, Banauch GI, et al

2002

Lung function trajectories in WTC-exposed NYC firefighters over 13 years: The roles of smoking and smoking cessation

Aldrich TK, Vossbrinck M, Zeig-Owens R, et al

2016

Posttraumatic stress disorder and terrorism: 5 years after 9/11

Laugharne J, Janca A, and Widiger T

2007

Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack

Brackbill RM, Hadler JL, DiGrande L, et al

2009

CONTEXT: The World Trade Center Health Registry provides a unique opportunity to examine long-term health effects of a large-scale disaster. OBJECTIVE: To examine risk factors for new asthma diagnoses and event-related posttraumatic stress (PTS) symptoms among exposed adults 5 to 6 years following exposure to the September 11, 2001, World Trade Center (WTC) terrorist attack. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cohort study with wave 1 (W1) enrollment of 71,437 adults in 2003-2004, including rescue/recovery worker, lower Manhattan resident, lower Manhattan office worker, and passersby eligibility groups; 46,322 adults (68%) completed the wave 2 (W2) survey in 2006-2007. MAIN OUTCOME MEASURES: Self-reported diagnosed asthma following September 11; event-related current PTS symptoms indicative of probable posttraumatic stress disorder (PTSD), assessed using the PTSD Checklist (cutoff score > or = 44). RESULTS: Of W2 participants with no stated asthma history, 10.2% (95% confidence interval [CI], 9.9%-10.5%) reported new asthma diagnoses postevent. Intense dust cloud exposure on September 11 was a major contributor to new asthma diagnoses for all eligibility groups: for example, 19.1% vs 9.6% in those without exposure among rescue/recovery workers (adjusted odds ratio, 1.5 [95% CI, 1.4-1.7]). Asthma risk was highest among rescue/recovery workers on the WTC pile on September 11 (20.5% [95% CI, 19.0%-22.0%]). Persistent risks included working longer at the WTC site, not evacuating homes, and experiencing a heavy layer of dust in home or office. Of participants with no PTSD history, 23.8% (95% CI, 23.4%-24.2%) reported PTS symptoms at either W1 (14.3%) or W2 (19.1%). Nearly 10% (9.6% [95% CI, 9.3%-9.8%]) had PTS symptoms at both surveys, 4.7% (95% CI, 4.5%-4.9%) had PTS symptoms at W1 only, and 9.5% (95% CI, 9.3%-9.8%) had PTS symptoms at W2 only. At W2, passersby had the highest rate of PTS symptoms (23.2% [95% CI, 21.4%-25.0%]). Event-related loss of spouse or job was associated with PTS symptoms at W2. CONCLUSION: Acute and prolonged exposures were both associated with a large burden of asthma and PTS symptoms 5 to 6 years after the September 11 WTC attack.

Parental response and adolescent adjustment to the September 11, 2001 terrorist attacks

Gil-Rivas V, Silver RC, Holman EA, et al

2007

Pre-attack stress-load, appraisals, and coping in children's responses to the 9/11 terrorist attacks

Lengua LJ, Long AC, and Meltzoff AN

2006

The mental health and wellbeing of spouses, partners and children of emergency responders: A systematic review

Sharp M-L, Solomon N, Harrison V, et al.

2022

Emergency responders (ERs), often termed First Responders, such as police, fire and paramedic roles are exposed to occupational stressors including high workload, and exposure to trauma from critical incidents, both of which can affect their mental health and wellbeing. Little is known about the impact of the ER occupation on the mental health and wellbeing of their families. The aim of the current study was to investigate what mental health and wellbeing outcomes and experiences have been researched internationally in ER families, and to examine the prevalence and associated risk and protective factors of these outcomes. We conducted a systematic review in accordance with an a priori PROSPERO approved protocol (PROSPERO 2019 CRD42019134974). Forty-three studies were identified for inclusion. The majority of studies used a quantitative, cross-sectional design and were conducted in the United States; just over half assessed police/law enforcement families. Themes of topics investigated included: 1) Spousal/partner mental health and wellbeing; 2) Couple relationships; 3) Child mental health and wellbeing; 4) Family support and coping strategies; and 5) Positive outcomes. The review identified limited evidence regarding the prevalence of mental health and wellbeing outcomes. Family experiences and risk factors described were ER work-stress spillover negatively impacting spousal/partner wellbeing, couple relationships, and domestic violence. Traumatic exposure risk factors included concerns family had for the safety of their ER partner, the negative impact of an ER partners' mental health problem on the couples' communication and on family mental health outcomes. Protective factors included social support; however, a lack of organisational support for families was reported in some studies. Study limitations and future research needs are discussed. Progressing this area of research is important to improve knowledge of baseline needs of ER families to be able to target interventions, improve public health, and support ER's operational effectiveness.

Elevated prevalence of moderate-to-severe hepatic steatosis in World Trade Center general responder cohort in a program of ct lung screening

Chen X, Ma T, Yip R, et al

2020

Elevated c-reactive protein and posttraumatic stress pathology among survivors of the 9/11 World Trade Center attacks

Rosen RL, Levy-Carrick N, Reibman J, et al

2017

Molecular study of thyroid cancer in World Trade Center responders

van Gerwen MAG, Tuminello S, Riggins GJ, et al

2019

Implications of the World Trade Center attack for the public health and health care infrastructures

Klitzman S and Freudenberg N

2003

What might have been: Near miss experiences and adjustment to a terrorist attack

Poulin MJ and Silver RC

2020

Teamwork in health care: Maximizing collective intelligence via inclusive collaboration and open communication

Mayo AT and Woolley AW

2016

Frequent binge drinking five to six years after exposure to 9/11: Findings from the World Trade Center Health Registry

Welch AE, Caramanica K, Maslow CB, et al

2014

Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers

Perrin MA, DiGrande L, Wheeler K, et al

2007

Ten-year cancer incidence in rescue/recovery workers and civilians exposed to the September 11, 2001 terrorist attacks on the World Trade Center

Li J, Brackbill RM, Liao TS, et al

2016

Chemical analysis of World Trade Center fine particulate matter for use in toxicologic assessment

McGee JK, Chen LC, Cohen MD, et al

2003

Divorce following the September 11 terrorist attacks

Cohan CL, Cole SW, and Schoen R

2009

Social context and depression after a disaster: The role of income inequality

Ahern J and Galea S

2006

Lung function in rescue workers at the World Trade Center after 7 years

Aldrich TK, Gustave J, Hall CB, et al

2010

BACKGROUND: The terrorist attacks on the World Trade Center on September 11, 2001, exposed thousands of Fire Department of New York City (FDNY) rescue workers to dust, leading to substantial declines in lung function in the first year. We sought to determine the longer-term effects of exposure. METHODS: Using linear mixed models, we analyzed the forced expiratory volume in 1 second (FEV(1)) of both active and retired FDNY rescue workers on the basis of spirometry routinely performed at intervals of 12 to 18 months from March 12, 2000, to September 11, 2008. RESULTS: Of the 13,954 FDNY workers who were present at the World Trade Center between September 11, 2001, and September 24, 2001, a total of 12,781 (91.6%) participated in this study, contributing 61,746 quality-screened spirometric measurements. The median follow-up was 6.1 years for firefighters and 6.4 years for emergency-medical-services (EMS) workers. In the first year, the mean FEV(1) decreased significantly for all workers, more for firefighters who had never smoked (a reduction of 439 ml; 95% confidence interval [CI], 408 to 471) than for EMS workers who had never smoked (a reduction of 267 ml; 95% CI, 263 to 271) (P<0.001 for both comparisons). There was little or no recovery in FEV(1) during the subsequent 6 years, with a mean annualized reduction in FEV(1) of 25 ml per year for firefighters and 40 ml per year for EMS workers. The proportion of workers who had never smoked and who had an FEV(1) below the lower limit of the normal range increased during the first year, from 3% to 18% for firefighters and from 12% to 22% for EMS workers, stabilizing at about 13% for firefighters and 22% for EMS workers during the subsequent 6 years. CONCLUSIONS: Exposure to World Trade Center dust led to large declines in FEV(1) for FDNY rescue workers during the first year. Overall, these declines were persistent, without recovery over the next 6 years, leaving a substantial proportion of workers with abnormal lung function.

Psychological trauma associated with the World Trade Center attacks and its effect on pregnancy outcome

Engel SM, Berkowitz GS, Wolff MS, et al

2005

DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11)

Bromet EJ, Hobbs MJ, Clouston SA, et al

2016

Virtual reality exposure therapy for World Trade Center post-traumatic stress disorder: A case report

Difede J and Hoffman HG

2002

The distinctiveness of grief, depression, and posttraumatic stress: Lessons from children after 9/11

Geronazzo-Alman L, Fan B, Duarte CS, et al

2019

Compassion fatigue and psychological distress among social workers: A validation study

Adams RE, Boscarino JA, and Figley CR

2006

Alcohol and drug-related mortality among enrollees in the World Trade Center Health Registry (WTCHR), 2004 to 2012

Welch AE, Zweig KC, Liao T, et al

2018

Post-traumatic stress disorder, bronchodilator response, and incident asthma in World Trade Center rescue and recovery workers

de la Hoz RE, Jeon Y, Miller GE, et al

2016

Male fetal loss in the u.S. Following the terrorist attacks of September 11, 2001

Bruckner TA, Catalano R, and Ahern J

2010

Molecular linkage between post-traumatic stress disorder and cognitive impairment: A targeted proteomics study of World Trade Center responders

Kuan P-F, Clouston S, Yang X, et al

2020

Case-control study of paresthesia among World Trade Center-exposed community members

Marmor M, Thawani S, Cotrina ML, et al

2020

Clinical course of sarcoidosis in World Trade Center-exposed firefighters

Hena KM, Yip J, Jaber N, et al

2018

Factors related to the probable PTSD after the 9/11 World Trade Center attack among asian americans

Kung WW, Liu X, Huang D, et al

2018

Posttraumatic stress disorder in Manhattan, New York City, after the September 11th terrorist attacks

Galea S, Resnick H, Ahern J, et al

2002

Post-9/11 peripheral neuropathy symptoms among World Trade Center-exposed firefighters and emergency medical service workers

Colbeth HL, Zeig-Owens R, Webber MP, et al

2019

The burden of subthreshold posttraumatic stress disorder in World Trade Center responders in the second decade after 9/11

Chen C, Salim R, Rodriguez J, et al

2020

OBJECTIVE: To characterize the prevalence, risk and protective correlates, and clinical characteristics associated with probable subthreshold posttraumatic stress disorder (PTSD) in police and nontraditional (eg, construction workers) World Trade Center (WTC) responders a median of 12.2 years after September 11, 2001. METHODS: A total of 4,196 WTC responders, monitored via the WTC Health Program, completed a web-based survey between 2012 and 2014 assessing a range of variables, including demographics, WTC exposures, medical and psychiatric comorbidities, and mental health services use. The sample included 2,029 police responders and 2,167 nontraditional responders. Current (past-month) probable WTC-related PTSD level (none, subthreshold, or full PTSD) was assessed based on DSM-IV criteria using the PTSD Checklist-Specific Stressor version (PCL-S). RESULTS: The prevalence of current probable full and subthreshold WTC-related PTSD in police responders was 9.3% and 17.5%, respectively, and in nontraditional responders was 21.9% and 24.1%, respectively. Risk and protective correlates for subthreshold PTSD included post-9/11 medical comorbidities and traumatic events (odds ratios [ORs] = 1.1-1.2). Clinical characteristics included elevated rates of comorbid depression (OR = 3.2 and 3.9 for subthreshold PTSD and 17.2 and 30.3 for full PTSD for nontraditional and police responders, respectively). Among responders with subthreshold PTSD, police were more likely to have accessed mental health services and utilized a greater variety of treatments than nontraditional responders. CONCLUSIONS: Overall, 26.8% of police and 46.0% of nontraditional responders met criteria for probable WTC-related full or subthreshold PTSD an average of 12 years after 9/11. Probable subthreshold PTSD, which is not typically assessed in clinical settings, was more prevalent than probable full PTSD and was associated with significantly elevated rates of psychiatric comorbidities, functional impairment, and reduced quality of life. These findings underscore the importance of assessing, monitoring, and possibly treating subthreshold PTSD in WTC and other disaster responders.

How personal experience modulates the neural circuitry of memories of September 11

Sharot T, Martorella EA, Delgado MR, et al

2007

Mortality among survivors of the Sept 11, 2001, World Trade Center disaster: Results from the World Trade Center Health Registry cohort

Jordan HT, Brackbill RM, Cone JE, et al

2011

BACKGROUND: The Sept 11, 2001 (9/11) World Trade Center (WTC) disaster has been associated with several subacute and chronic health effects, but whether excess mortality after 9/11 has occurred is unknown. We tested whether excess mortality has occurred in people exposed to the WTC disaster. METHODS: In this observational cohort study, deaths occurring in 2003-09 in WTC Health Registry participants residing in New York City were identified through linkage to New York City vital records and the National Death Index. Eligible participants were rescue and recovery workers and volunteers; lower Manhattan area residents, workers, school staff and students; and commuters and passers-by on 9/11. Study participants were categorised as rescue and recovery workers (including volunteers), or non-rescue and non-recovery participants. Standardised mortality ratios (SMR) were calculated with New York City rates from 2000-09 as the reference. Within the cohort, proportional hazards were used to examine the relation between a three-tiered WTC-related exposure level (high, intermediate, or low) and total mortality. FINDINGS: We identified 156 deaths in 13,337 rescue and recovery workers and 634 deaths in 28,593 non-rescue and non-recovery participants. All-cause SMRs were significantly lower than that expected for rescue and recovery participants (SMR 0.45, 95% CI 0.38-0.53) and non-rescue and non-recovery participants (0.61, 0.56-0.66). No significantly increased SMRs for diseases of the respiratory system or heart, or for haematological malignancies were found. In non-rescue and non-recovery participants, both intermediate and high levels of WTC-related exposure were significantly associated with mortality when compared with low exposure (adjusted hazard ratio 1.22, 95% CI 1.01-1.48, for intermediate exposure and 1.56, 1.15-2.12, for high exposure). High levels of exposure in non-rescue and non-recovery individuals, when compared with low exposed non-rescue and non-recovery individuals, were associated with heart-disease-related mortality (adjusted hazard ratio 2.06, 1.10-3.86). In rescue and recovery participants, level of WTC-related exposure was not significantly associated with all-cause mortality (adjusted hazard ratio 1.25, 95% CI 0.56-2.78, for high exposure and 1.03, 0.52-2.06, for intermediate exposure when compared with low exposure). INTERPRETATION: This exploratory study of mortality in a well defined cohort of 9/11 survivors provides a baseline for continued surveillance. Additional follow-up is needed to establish whether these associations persist and whether a similar association over time will occur in rescue and recovery participants. FUNDING: US Centers for Disease Control and Prevention (National Institute for Occupational Safety and Health, Agency for Toxic Substances and Disease Registry, and National Center for Environmental Health); New York City Department of Health and Mental Hygiene.

Relation between cord blood mercury levels and early child development in a World Trade Center cohort

Lederman SA, Jones RL, Caldwell KL, et al

2008

Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack

Bonanno GA, Galea S, Bucciarelli A, et al

2006

Attack-related life disruption and child psychopathology in New York City public schoolchildren 6-months post-9/11

Comer JS, Fan B, Duarte CS, et al

2010

Persistence of multiple illnesses in World Trade Center rescue and recovery workers: A cohort study

Wisnivesky JP, Teitelbaum SL, Todd AC, et al

2011

BACKGROUND: More than 50,000 people participated in the rescue and recovery work that followed the Sept 11, 2001 (9/11) attacks on the World Trade Center (WTC). Multiple health problems in these workers were reported in the early years after the disaster. We report incidence and prevalence rates of physical and mental health disorders during the 9 years since the attacks, examine their associations with occupational exposures, and quantify physical and mental health comorbidities. METHODS: In this longitudinal study of a large cohort of WTC rescue and recovery workers, we gathered data from 27,449 participants in the WTC Screening, Monitoring, and Treatment Program. The study population included police officers, firefighters, construction workers, and municipal workers. We used the Kaplan-Meier procedure to estimate cumulative and annual incidence of physical disorders (asthma, sinusitis, and gastro-oesophageal reflux disease), mental health disorders (depression, post-traumatic stress disorder [PTSD], and panic disorder), and spirometric abnormalities. Incidence rates were assessed also by level of exposure (days worked at the WTC site and exposure to the dust cloud). FINDINGS: 9-year cumulative incidence of asthma was 27.6% (number at risk: 7027), sinusitis 42.3% (5870), and gastro-oesophageal reflux disease 39.3% (5650). In police officers, cumulative incidence of depression was 7.0% (number at risk: 3648), PTSD 9.3% (3761), and panic disorder 8.4% (3780). In other rescue and recovery workers, cumulative incidence of depression was 27.5% (number at risk: 4200), PTSD 31.9% (4342), and panic disorder 21.2% (4953). 9-year cumulative incidence for spirometric abnormalities was 41.8% (number at risk: 5769); three-quarters of these abnormalities were low forced vital capacity. Incidence of most disorders was highest in workers with greatest WTC exposure. Extensive comorbidity was reported within and between physical and mental health disorders. INTERPRETATION: 9 years after the 9/11 WTC attacks, rescue and recovery workers continue to have a substantial burden of physical and mental health problems. These findings emphasise the need for continued monitoring and treatment of the WTC rescue and recovery population. FUNDING: Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health.

Disasters and perinatal health:A systematic review

Harville E, Xiong X, and Buekens P

2010

BACKGROUND: The empirical literature on the effects of disaster on pregnancy and the postpartum period is limited. The objective of this review was to examine the existing evidence on the effect of disasters on perinatal health. METHODS: A systematic review was conducted by searching electronic databases (MEDLINE, EMBASE, Cinahl, PsycInfo), including literature on disasters and pregnancy outcomes (e.g., preterm birth, low birth weight, congenital anomalies), mental health, and child development. A total of 110 articles were identified, but many published reports were anecdotes or recommendations rather than systematic studies. The final review included 49 peer-reviewed studies that met inclusion criteria. RESULTS: Studies addressing the World Trade Center disaster of September 11 and other terrorist attacks, environmental/chemical disasters, and natural disasters such as hurricanes and earthquakes were identified. Disasters of various types may reduce fetal growth in some women, although there does not appear to be an effect on gestational age at birth. Severity of exposure is the major predictor of mental health issues among pregnant and postpartum women. After a disaster, mental health of the mother may more strongly influence on child development than any direct effect of disaster-related prenatal stress. CONCLUSIONS: There is evidence that disaster impacts maternal mental health and some perinatal health outcomes, particular among highly exposed women. Future research should focus on understudied outcomes such as spontaneous abortion. Relief workers and clinicians should concentrate on the most exposed women, particularly with respect to mental health. TARGET AUDIENCE: Obstetricians & Gynecologists. LEARNING OBJECTIVES: After completion of this educational activity, the obstetrician/gynecologist should be better able to compare and contrast the effects of different types of disasters (hurricanes, earthquakes, chemical spills) on pregnant and postpartum women in order to prepare for patient care in the aftermath of such disasters; differentiate the birth outcomes likely to be affected by disaster, in order to identify patients likely to be at high risk; and assess the extent to which pregnant and postpartum women are a uniquely vulnerable population after disaster, to assist in organizing care under such circumstances.

Systemic autoimmune disease among adults exposed to the September 11, 2001, terrorist attack

Miller-Archie SA, Izmirly PM, Berman JR, et al

2020

What we learned from 9/11: A terrorism grief and recovery process model

Jordan K

2005

Ambiguous loss research, theory, and practice: Reflections after 9/11

Boss P

2004

Exposure duration and cerebral amyloidosis in the olfactory cortex of World Trade Center responders: A positron emission tomography and magnetic resonance imaging study

Kritikos M, Zhou J-W, Huang C, et al.

2025

Twenty years after 9/11, responders are still healing

Abbasi J

2021

The World Trade Center Health Program: Twenty years of health effects research

Daniels RD, Kubale TL, Reissman DB, et al

2021

Short-term and medium-term health effects of 9/11

Perlman SE, Friedman S, Galea S, et al

2011

Self-enhancement among high-exposure survivors of the September 11th terrorist attack: Resilience or social maladjustment?

Bonanno GA, Rennicke C, and Dekel S

2005

Health status among emergency department patients approximately one year after consecutive disasters in New York City

Fernandez WG, Galea S, Miller J, et al

2005

Severe obstructive sleep apnea is associated with alterations in the nasal microbiome and increase in inflammation

Wu BG, Sulaiman I, Wang J, et al

2019

Effect of 11 September 2001 terrorist attacks in the USA on suicide in areas surrounding the crash sites

Claassen CA, Carmody T, Stewart SM, et al

2010

Sarcoidosis: An occupational disease?

Oliver LC and Zarnke AM

2021

Exposure, threat appraisal, and lost confidence as predictors of PTSD symptoms following September 11, 2001

Piotrkowski CS and Brannen SJ

2002

Genome-wide DNA methylation profiles and breast cancer among World Trade Center survivors

Tuminello S, Ashebir YA, Schroff C, et al.

2024

BACKGROUND: Increased incidence of cancer has been reported among World Trade Center (WTC)-exposed persons. Aberrant DNA methylation is a hallmark of cancer development. To date, only a few small studies have investigated the relationship between WTC exposure and DNA methylation. The main objective of this study was to assess the DNA methylation profiles of WTC-exposed community members who remained cancer free and those who developed breast cancer. METHODS: WTC-exposed women were selected from the WTC Environmental Health Center clinic, with peripheral blood collected during routine clinical monitoring visits. The reference group was selected from the NYU Women's Health Study, a prospective cohort study with blood samples collected before 9 November 2001. The Infinium MethylationEPIC array was used for global DNA methylation profiling, with adjustments for cell type composition and other confounders. Annotated probes were used for biological pathway and network analysis. RESULTS: A total of 64 WTC-exposed (32 cancer free and 32 with breast cancer) and 32 WTC-unexposed (16 cancer free and 16 with prediagnostic breast cancer) participants were included. Hypermethylated cytosine-phosphate-guanine probe sites (defined as β > 0.8) were more common among WTC-exposed versus unexposed participants (14.3% vs. 4.5%, respectively, among the top 5000 cytosine-phosphate-guanine sites). Cancer-related pathways (e.g., human papillomavirus infection, cGMP-PKG) were overrepresented in WTC-exposed groups (breast cancer patients and cancer-free subjects). Compared to the unexposed breast cancer patients, 47 epigenetically dysregulated genes were identified among WTC-exposed breast cancers. These genes formed a network, including Wnt/β-catenin signaling genes WNT4 and TCF7L2, and dysregulation of these genes contributes to cancer immune evasion. CONCLUSION: WTC exposure likely impacts DNA methylation and may predispose exposed individuals toward cancer development, possibly through an immune-mediated mechanism.

The impact of the September 11, 2001, attacks on the well-being of arab americans in New York City

Abu-Ras W and Abu-Bader SH

2008

Exogenous shocks to the human sex ratio: The case of September 11, 2001 in New York City

Catalano R, Bruckner T, Marks AR, et al

2006

World Trade Center Health Program: First decade of research

Santiago-Colón A, Daniels R, Reissman D, et al

2020

Increased incidence of thyroid cancer among World Trade Center first responders: A descriptive epidemiological assessment

Tuminello S, van Gerwen MAG, Genden E, et al

2019

Prostate cancer characteristics in the World Trade Center cohort, 2002-2013

Hashim D, Boffetta P, Galsky M, et al

2018

Trajectories of PTSD risk and resilience in World Trade Center responders: An 8-year prospective cohort study

Pietrzak RH, Feder A, Singh R, et al

2014

BACKGROUND: Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders. METHOD: A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks. RESULTS: Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories. CONCLUSIONS: Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.

Predictors of PTSD and delayed PTSD after disaster: The impact of exposure and psychosocial resources

Adams RE and Boscarino JA

2006

An assessment of healthcare access and utilization in the World Trade Center Health Program

Karasick AS, Udasin IG, Gusmano MK, et al

2021

Post-term birth as a response to environmental stress : The case of September 11, 2001

Margerison-Zilko CE, Goodman JM, Anderson E, et al

2015

World Trade Center disaster exposure-related probable posttraumatic stress disorder among responders and civilians: A meta-analysis

Liu B, Tarigan LH, Bromet EJ, et al

2014

Prevalence and psychological correlates of complicated grief among bereaved adults 2.5-3.5 years after September 11th attacks

Neria Y, Gross R, Litz B, et al

2007

The World Trade Center exposome and health effects in 9/11 rescue and recovery workers

Rechtman E, Rodriguez MA, Colicino E, et al.

2024

Neuroinflammation in World Trade Center responders at midlife: A pilot study using [(18)f]-feppa pet imaging

Deri Y, Clouston SAP, DeLorenzo C, et al

2021

The effect of World Trade Center exposure on the timing of diagnoses of obstructive airway disease, chronic rhinosinusitis, and gastroesophageal reflux disease

Liu X, Yip J, Zeig-Owens R, et al

2017

Police officers who responded to 9/11: Comorbidity of PTSD, depression, and anxiety 10-11 years later

Bowler RM, Kornblith ES, Li J, et al

2016

World Trade Center "sarcoid-like" granulomatous pulmonary disease in New York City fire department rescue workers

Izbicki G, Chavko R, Banauch GI, et al

2007

9/11 at 20: After war, what?

The Lancet

2021

Impact of 9/11-related chronic conditions and PTSD comorbidity on early retirement and job loss among World Trade Center disaster rescue and recovery workers

Yu S, Brackbill RM, Locke S, et al

2016

The response to September 11: A disaster case study

Crane MA, Levy-Carrick NC, Crowley L, et al

2014

Pulmonary function after exposure to the World Trade Center collapse in the New York City fire department

Banauch GI, Hall C, Weiden M, et al

2006

Posttraumatic stress in children with first responders in their families

Duarte CS, Hoven CW, Wu P, et al

2006

Initial whole-genome sequencing of plasma cell neoplasms in first responders and recovery workers exposed to the World Trade Center attack of September 11, 2001

Maura F, Diamond B, Maclachlan KH, et al

2021

Selected birth defects among males following the United States terrorist attacks of 11 September 2001

Singh P, Yang W, Shaw GM, et al

2017

Parenting and temperament prior to September 11, 2001, and parenting specific to 9/11 as predictors of children's posttraumatic stress symptoms following 9/11

Wilson AC, Lengua LJ, Meltzoff AN, et al

2010

Alcohol drinking problems among New York City residents after the September 11 terrorist attacks

Vlahov D, Galea S, Ahern J, et al

2006

Cancer risk among World Trade Center rescue and recovery workers: A review

Boffetta P, Hall CB, Todd AC, et al

2022

World Trade Center site exposure duration is associated with hippocampal and cerebral white matter neuroinflammation

Huang C, Kritikos M, Sosa MS, et al.

2022

Post-September 11, 2001, incidence of systemic autoimmune diseases in World Trade Center-exposed firefighters and emergency medical service workers

Webber MP, Moir W, Crowson CS, et al

2016

The World Trade Center disaster and the health of workers: Five-year assessment of a unique medical screening program

Herbert R, Moline J, Skloot G, et al

2006

Cognitive impairment and World Trade Centre-related exposures

Clouston SAP, Hall CB, Kritikos M, et al

2022

Combined prolonged exposure therapy and paroxetine for PTSD related to the World Trade Center attack: A randomized controlled trial

Schneier FR, Neria Y, Pavlicova M, et al

2012

Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on World Trade Center in New York City

Li J, Brackbill RM, Stellman SD, et al

2011

Combining three cohorts of World Trade Center rescue/recovery workers for assessing cancer incidence and mortality

Brackbill RM, Kahn AR, Li J, et al

2021

9/11 residential exposures: The impact of World Trade Center dust on respiratory outcomes of lower Manhattan residents

Antao VC, Pallos LL, Graham SL, et al

2019

Increased rates of asthma among World Trade Center disaster responders

Kim H, Herbert R, Landrigan P, et al

2012

World Trade Center cough syndrome and its treatment

Prezant DJ

2008

Risk assessment for asbestos-related cancer from the 9/11 attack on the World Trade Center

Nolan RP, Ross M, Nord GL, et al

2005

Risk factors for head and neck cancer in the World Trade Center Health Program general responder cohort: Results from a nested case-control study

Bover Manderski MT, Black K, Udasin IG, et al

2019

The forgotten responders: The ongoing impact of 9/11 on the ground zero recovery workers

Smith EC and Burkle FM

2018

Cohort profile: World Trade Center Health Program general responder cohort

Dasaro CR, Holden WL, Berman KD, et al

2017

Chronic physical health consequences of being injured during the terrorist attacks on World Trade Center on September 11, 2001

Brackbill RM, Cone JE, Farfel MR, et al

2014

The importance of being flexible: The ability to both enhance and suppress emotional expression predicts long-term adjustment

Bonanno GA, Papa A, Lalande K, et al

2004

Cardiovascular disease in the World Trade Center Health Program general responder cohort

Sloan NL, Shapiro MZ, Sabra A, et al

2021

Posttraumatic stress disorder and total amyloid burden and amyloid-β 42/40 ratios in plasma: Results from a pilot study of World Trade Center responders

Clouston SA, Deri Y, Diminich E, et al

2019

Mental health service use after the World Trade Center disaster: Utilization trends and comparative effectiveness

Boscarino JA, Adams RE, and Figley CR

2011

Substance use and misuse in the aftermath of terrorism. A bayesian meta-analysis

DiMaggio C, Galea S, and Li G

2009

The human capacity to thrive in the face of potential trauma

Bonanno GA and Mancini AD

2008

Pulmonary fibrosis among World Trade Center responders: Results from the WTC Health Registry cohort

Li J, Cone EJ, Brackbill MR, et al

2019

Distributed lag analyses of daily hospital admissions and source-apportioned fine particle air pollution

Lall R, Ito K, and Thurston GD

2011

Gene expression patterns associated with posttraumatic stress disorder following exposure to the World Trade Center attacks

Yehuda R, Cai G, Golier JA, et al

2009

When hindsight is not 20/20: Ecological momentary assessment of PTSD symptoms versus retrospective report

Schuler K, Ruggero CJ, Mahaffey B, et al

2021

Development of a physiological frailty index for the World Trade Center general responder cohort

Bello GA, Lucchini RG, Teitelbaum SL, et al

2018

The association between body mass index and gastroesophageal reflux disease in the World Trade Center Health Program general responder cohort

Icitovic N, Onyebeke LC, Wallenstein S, et al

2016

An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees

Farfel M, DiGrande L, Brackbill R, et al

2008

What predicts psychological resilience after disaster? The role of demographics, resources, and life stress

Bonanno GA, Galea S, Bucciarelli A, et al

2007

A workshop on cognitive aging and impairment in the 9/11-exposed population

Daniels RD, Clouston SAP, Hall CB, et al

2021

Exposure to mass disaster and probable panic disorder among children in New York City

Goodwin RD, Cheslack-Postava K, Musa GJ, et al

2021

Traumatic exposures, posttraumatic stress disorder, and cognitive functioning in World Trade Center responders

Clouston S, Pietrzak RH, Kotov R, et al

2017

The longitudinal course of PTSD among disaster workers deployed to the World Trade Center following the attacks of September 11th

Cukor J, Wyka K, Mello B, et al

2011

Postdisaster psychological intervention since 9/11

Watson PJ, Brymer MJ, and Bonanno GA

2011

The business of healing: Focus group discussions of readjustment to the post-9/11 work environment among employees of affected agencies

North CS, Pfefferbaum B, Hong BA, et al

2010

Air levels of carcinogenic polycyclic aromatic hydrocarbons after the World Trade Center disaster

Pleil JD, Vette AF, Johnson BA, et al

2004

Post-traumatic growth and quality of life among World Trade Center Health Registry enrollees 16 years after 9/11

Alper HE, Feliciano L, Millien L, et al.

2022

Media contact and posttraumatic stress in employees of New York City area businesses after the September 11 attacks

Pfefferbaum B, Palka J, and North CS

2022

Asthma among World Trade Center first responders: A qualitative synthesis and bias assessment

Kim H, Baidwan NK, Kriebel D, et al

2018

Mental health status of World Trade Center tower survivors compared to other survivors a decade after the September 11, 2001 terrorist attacks

Gargano LM, Nguyen A, DiGrande L, et al

2016

A focus group study of the impact of trauma exposure in the 9/11 terrorist attacks

North CS, Barney CJ, and Pollio DE

2015

World Trade Center disaster and sensitization to subsequent life stress: A longitudinal study of disaster responders

Zvolensky MJ, Farris SG, Kotov R, et al

2015

Posttraumatic stress disorder and new-onset diabetes among adult survivors of the World Trade Center disaster

Miller-Archie SA, Jordan HT, Ruff RR, et al

2014

Prevalence and predictors of posttraumatic stress symptoms in utility workers deployed to the World Trade Center following the attacks of September 11, 2001

Cukor J, Wyka K, Jayasinghe N, et al

2011

Long-term posttraumatic stress symptoms among 3,271 civilian survivors of the September 11, 2001, terrorist attacks on the World Trade Center

DiGrande L, Neria Y, Brackbill RM, et al

2011

Low birthweight in New York City and upstate New York following the events of September 11th

Eskenazi B, Marks AR, Catalano R, et al

2007

Risk and resilience in canine search and rescue handlers after 9/11

Alvarez J and Hunt M

2005

Calls for help after September 11: A community mental health hot line

Wunsch-Hitzig R, Plapinger J, Draper J, et al

2002

Lower respiratory symptoms associated with environmental and reconstruction exposures after hurricane sandy

Gargano LM, Locke S, Jordan HT, et al

2018

Predictive biomarkers of gastroesophageal reflux disease and barrett's esophagus in World Trade Center exposed firefighters: A 15 year longitudinal study

Haider SH, Kwon S, Lam R, et al

2018

Predictors of asthma/COPD overlap in FDNY firefighters with World Trade Center dust exposure: A longitudinal study

Singh A, Liu C, Putman B, et al

2018

Gene expression associated with PTSD in World Trade Center responders: An rna sequencing study

Kuan PF, Waszczuk MA, Kotov R, et al

2017

Mortality among World Trade Center rescue and recovery workers, 2002-2011

Stein CR, Wallenstein S, Shapiro M, et al

2016

The enduring mental health impact of the September 11th terrorist attacks: Challenges and lessons learned

Ozbay F, Auf der Heyde T, Reissman D, et al

2013

Multiple myeloma in World Trade Center responders: A case series

Moline JM, Herbert R, Crowley L, et al

2009

Resilience after 9/11: Multimodal neuroimaging evidence for stress-related change in the healthy adult brain

Ganzel BL, Kim P, Glover GH, et al

2008

The mental health consequences of disaster-related loss: Findings from primary care one year after the 9/11 terrorist attacks

Neria Y, Olfson M, Gameroff MJ, et al

2008

Enduring mental health morbidity and social function impairment in World Trade Center rescue, recovery, and cleanup workers: The psychological dimension of an environmental health disaster

Stellman JM, Smith RP, Katz CL, et al

2008

Biomonitoring of chemical exposure among New York City firefighters responding to the World Trade Center fire and collapse

Edelman P, Osterloh J, Pirkle J, et al

2003

PTSD symptoms, depressive symptoms, and subjective cognitive concerns in WTC-exposed and non-WTC-exposed firefighters

Mueller AK, Singh A, Webber MP, et al

2021

World Trade Center responders in their own words: Predicting PTSD symptom trajectories with ai-based language analyses of interviews

Son Y, Clouston SA, Kotov R, et al

2021

World Trade Center responders in their own words: Predicting PTSD symptom trajectories with AI-based language analyses of interviews

Son Y, Clouston SA, Kotov R, et al.

2021

Risk, coping and PTSD symptom trajectories in World Trade Center responders

Feder A, Mota N, Salim R, et al

2016

Longitudinal mental health impact among police responders to the 9/11 terrorist attack

Bowler RM, Harris M, Li J, et al

2012

The impact of pretrauma analogue gad and posttraumatic emotional reactivity following exposure to the September 11 terrorist attacks: A longitudinal study

Farach FJ, Mennin DS, Smith RL, et al

2008

Persistent organic pollutants in 9/11 World Trade Center rescue workers: Reduction following detoxification

Dahlgren J, Cecchini M, Takhar H, et al

2007

Current affairs and the public psyche: American anxiety in the post 9/11 world

Cohen P, Kasen S, Chen H, et al

2006

Understanding mental health needs and gathering feedback on transcutaneous auricular vagus nerve stimulation as a potential PTSD treatment among 9/11 responders living with PTSD symptoms 20 years later: A qualitative approach

Schwartz RM, Shaam P, Williams MS, et al

2022

Review of non-respiratory, non-cancer physical health conditions from exposure to the World Trade Center disaster

Gargano LM, Mantilla K, Fairclough M, et al

2018

Functional limitations among responders to the World Trade Center attacks 14 years after the disaster: Implications of chronic posttraumatic stress disorder

Clouston SA, Guralnik JM, Kotov R, et al

2017

Posttraumatic stress disorder after hurricane sandy among persons exposed to the 9/11 disaster

Caramanica K, Brackbill RM, Stellman SD, et al

2015

BACKGROUND: Traumatic exposure during a hurricane is associated with adverse mental health conditions post-event. The World Trade Center Health Registry provided a sampling pool for a rapid survey of persons directly affected by Hurricane Sandy in the New York City (NYC) metropolitan area in late October 2012. This study evaluated the relationship between Sandy experiences and Sandy-related posttraumatic stress disorder (PTSD) among individuals previously exposed to the September 11, 2001 (9/11) disaster. METHODS: A total of 4,558 surveys were completed from April 10-November 7, 2013. After exclusions for missing data, the final sample included 2,214 (53.5%) respondents from FEMA-defined inundation zones and 1,923 (46.5%) from non-inundation zones. Sandy exposures included witnessing terrible events, Sandy-related injury, fearing for own life or safety of others, evacuation, living in a home that was flooded or damaged, property loss, and financial loss. Sandy-related PTSD was defined as a score of >/=44 on a Sandy-specific PTSD Checklist. RESULTS: PTSD prevalence was higher in the inundation zones (11.3%) and lower in the non-inundation zones (4.4%). The highest prevalence of Sandy-related PTSD was among individuals in the inundation zone who sustained an injury (31.2%), reported a history of 9/11-related PTSD (28.8%), or had low social support prior to the event (28.6%). In the inundation zones, significantly elevated adjusted odds of Sandy-related PTSD were observed among persons with a prior history of 9/11-related PTSD, low social support, and those who experienced a greater number of Sandy traumatic events. CONCLUSIONS: Sandy-related stress symptoms indicative of PTSD affected a significant proportion of persons who lived in flooded areas of the NYC metropolitan area. Prior 9/11-related PTSD increased the likelihood of Sandy-related PTSD, while social support was protective. Public health preparation for events similar to Sandy should incorporate outreach and linkages to care for persons with prior disaster-related trauma.

The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort

Pietrzak RH, Schechter CB, Bromet EJ, et al

2012

9/11-related experiences and tasks of landfill and barge workers: Qualitative analysis from the World Trade Center Health Registry

Ekenga CC, Scheu KE, Cone JE, et al

2011

Lessons learned from the New York state mental health response to the September 11, 2001, attacks

Sederer LI, Lanzara CB, Essock SM, et al

2011

Sustained increased consumption of cigarettes, alcohol, and marijuana among Manhattan residents after September 11, 2001

Vlahov D, Galea S, Ahern J, et al

2004

Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks

Galea S, Vlahov D, Resnick H, et al

2003

Forget 9/11

Fitzgerald J

2021

The intergenerational impact of terror: Did the 9/11 tragedy impact the initial human capital of the next generation?

Brown R

2020

Sex differences in asthma and gastroesophageal reflux disease incidence among the World Trade Center Health Program general responder cohort

Jiang J, Icitovic N, Crane MA, et al

2016

Destruction of the World Trade Center towers. Lessons learned from an environmental health disaster

Reibman J, Levy-Carrick N, Miles T, et al

2016

Comorbidity of 9/11-related PTSD and depression in the World Trade Center Health Registry 10-11 years postdisaster

Caramanica K, Brackbill RM, Liao T, et al

2014

Sarcoidosis diagnosed after September 11, 2001, among adults exposed to the World Trade Center disaster

Jordan HT, Stellman SD, Prezant D, et al

2011

Long-term course of probable PTSD after the 9/11 attacks: A study in urban primary care

Neria Y, Olfson M, Gameroff MJ, et al

2010

Distal airway function in symptomatic subjects with normal spirometry following World Trade Center dust exposure

Oppenheimer BW, Goldring RM, Herberg ME, et al

2007

RATIONALE: Following collapse of the World Trade Center (WTC), individuals reported new-onset respiratory symptoms. Despite symptoms, spirometry often revealed normal airway function. However, bronchial wall thickening and air trapping were seen radiographically in some subjects. We hypothesized that symptomatic individuals following exposure to WTC dust may have functional abnormalities in distal airways not detectable with routine spirometry. METHODS: One hundred seventy-four subjects with respiratory symptoms and normal spirometry results were evaluated. Impedance oscillometry (IOS) was performed to determine resistance at 5 Hz, 5 to 20 Hz, and reactance area. Forty-three subjects were also tested for frequency dependence of compliance (FDC). Testing was repeated after bronchodilation. RESULTS: Predominant symptoms included cough (67%) and dyspnea (65%). Despite normal spirometry results, mean resistance at 5 Hz, 5 to 20 Hz, and reactance area were elevated (4.36 +/- 0.12 cm H(2)O/L/s, 0.86 +/- 0.05 cm H(2)O/L/s, and 6.12 +/- 0.50 cm H(2)O/L, respectively) [mean +/- SE]. Resistance and reactance normalized after bronchodilation. FDC was present in 37 of 43 individuals with improvement after bronchodilation. CONCLUSIONS: Symptomatic individuals with presumed WTC dust/fume exposure and normal spirometry results displayed airway dysfunction based on the following: (1) elevated airway resistance and frequency dependence of resistance determined by IOS; (2) heterogeneity of distal airway function demonstrated by elevated reactance area on oscillometry and FDC; and (3) reversibility of these functional abnormalities to or toward normal following administration of a bronchodilator. Since spirometry results were normal in all subjects, these abnormalities likely reflect dysfunction in airways more distal to those evaluated by spirometry. Examination of distal airway function when spirometry results are normal may be important in the evaluation of subjects exposed to occupational and environmental hazards.

Health consequences of the September 11 World Trade Center attacks: A review

Moline J, Herbert R, and Nguyen N

2006

The effects of the World Trade Center event on birth outcomes among term deliveries at three lower Manhattan hospitals

Lederman SA, Rauh V, Weiss L, et al

2004

Performance of risk factor-based guidelines and model-based chest ct lung cancer screening in World Trade Center-exposed fire department rescue/recovery workers

Cleven KL, Vaeth B, Zeig-Owens R, et al

2021

BACKGROUND: Lung cancer is a leading cause of cancer incidence and death in the United States. Risk factor-based guidelines and risk model-based strategies are used to identify patients who could benefit from low-dose chest CT (LDCT) screening. Few studies compare guidelines or models within the same cohort. We evaluate lung cancer screening performance of two risk factor-based guidelines (US Preventive Services Task Force 2014 recommendations [USPSTF-2014] and National Comprehensive Cancer Network Group 2 [NCCN-2]) and two risk model-based strategies, Prostate Lung Colorectal and Ovarian Cancer Screening (PLCOm2012) and the Bach model) in the same occupational cohort. RESEARCH QUESTION: Which risk factor-based guideline or model-based strategy is most accurate in detecting lung cancers in a highly exposed occupational cohort? STUDY DESIGN AND METHODS: Fire Department of City of New York (FDNY) rescue/recovery workers exposed to the September 11, 2001 attacks underwent LDCT lung cancer screening based on smoking history and age. The USPSTF-2014, NCCN-2, PLCOm2012 model, and Bach model were retrospectively applied to determine how many lung cancers were diagnosed using each approach. RESULTS: Among the study population (N = 3,953), 930 underwent a baseline scan that met at least one risk factor or model-based LDCT screening strategy; 73% received annual follow-up scans. Among the 3,953, 63 lung cancers were diagnosed, of which 50 were detected by at least one LDCT screening strategy. The NCCN-2 guideline was the most sensitive (79.4%; 50/63). When compared with NCCN-2, stricter age and smoking criteria reduced sensitivity of the other guidelines/models (USPSTF-2014 [44%], PLCOm2012 [51%], and Bach[46%]). The 13 missed lung cancers were mainly attributable to smoking less and quitting longer than guideline/model eligibility criteria. False-positive rates were similar across all four guidelines/models. INTERPRETATION: In this cohort, our findings support expanding eligibility for LDCT lung cancer screening by lowering smoking history from >/=30 to >/=20 pack-years and age from 55 years to 50 years old. Additional studies are needed to determine its generalizability to other occupational/environmental exposed cohorts.

Impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course: A systematic review

De Rubeis V, Lee J, Anwer MS, et al

2021

Background Disasters are events that disrupt the daily functioning of a community or society, and may increase long-term risk of adverse cardiometabolic outcomes, including cardiovascular disease, obesity and diabetes. The objective of this study was to conduct a systematic review to determine the impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course. Design A systematic search was conducted in May 2020 using two electronic databases, EMBASE and Medline. All studies were screened in duplicate at title and abstract, and full-text level. Studies were eligible for inclusion if they assessed the association between a population-level or community disaster and cardiometabolic outcomes ≥1 month following the disaster. There were no restrictions on age, year of publication, country or population. Data were extracted on study characteristics, exposure (eg, type of disaster, region, year), cardiometabolic outcomes and measures of effect. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tools. Results A total of 58 studies were included, with 24 studies reporting the effects of exposure to disaster during pregnancy/childhood and 34 studies reporting the effects of exposure during adulthood. Studies included exposure to natural (n=35; 60%) and human-made (n=23; 40%) disasters, with only three (5%) of these studies evaluating previous pandemics. Most studies reported increased cardiometabolic risk, including increased cardiovascular disease incidence or mortality, diabetes and obesity, but not all. Few studies evaluated the biological mechanisms or high-risk subgroups that may be at a greater risk of negative health outcomes following disasters. Conclusions The findings from this study suggest that the burden of disasters extend beyond the known direct harm, and attention is needed on the detrimental indirect long-term effects on cardiometabolic health. Given the current COVID-19 pandemic, these findings may inform public health prevention strategies to mitigate the impact of future cardiometabolic risk. PROSPERO registration number CRD42020186074.

Lessons learned from 9/11: Mental health perspectives on the COVID-19 pandemic

DePierro J, Lowe S, and Katz C

2020

World Trade Center-cardiorespiratory and vascular dysfunction: Assessing the phenotype and metabolome of a murine particulate matter exposure model

Veerappan A, Oskuei A, Crowley G, et al

2020

Vascular changes occur early in the development of obstructive airways disease. However, the vascular remodeling and dysfunction due to World Trade Center-Particulate Matter (WTC-PM) exposure are not well described and are therefore the focus of this investigation. C57Bl/6 female mice oropharyngeally aspirated 200 µg of WTC-PM(53) or phosphate-buffered saline (PBS) (controls). 24-hours (24-hrs) and 1-Month (1-M) after exposure, echocardiography, micro-positron emission tomography(µ-PET), collagen quantification, lung metabolomics, assessment of antioxidant potential and soluble-receptor for advanced glycation end products (sRAGE) in bronchoalveolar lavage(BAL) and plasma were performed. 24-hrs post-exposure, there was a significant reduction in (1) Pulmonary artery(PA) flow-velocity and pulmonary ejection time(PET) (2) Pulmonary acceleration time(PAT) and PAT/PET, while (3) Aortic ejection time(AET) and velocity time integral(VTI) were increased, and (4) Aortic acceleration time (AAT)/AET, cardiac output and stroke volume were decreased compared to controls. 1-M post-exposure, there was also significant reduction of right ventricular diameter as right ventricle free wall thickness was increased and an increase in tricuspid E, A peaks and an elevated E/A. The pulmonary and cardiac standard uptake value and volume 1-M post-exposure was significantly elevated after PM-exposure. Similarly, α-smooth muscle actin(α-SMA) expression, aortic collagen deposition was elevated 1-M after PM exposure. In assessment of the metabolome, prominent subpathways included advanced glycation end products (AGEs), phosphatidylcholines, sphingolipids, saturated/unsaturated fatty acids, eicosanoids, and phospholipids. BAL superoxide dismutase(SOD), plasma total-antioxidant capacity activity, and sRAGE (BAL and plasma) were elevated after 24-hrs. PM exposure and associated vascular disease are a global health burden. Our Vascular changes occur early in the development of obstructive airways disease. However, the vascular remodeling and dysfunction due to World Trade Center-Particulate Matter (WTC-PM) exposure are not well described and are therefore the focus of this investigation.

Head and neck cancers associated with exposure to the September 11, 2001 World Trade Center terrorist attacks

Leeman JE, McBride SM, Spielsinger D, et al

2018

Parenting with PTSD: A review of research on the influence of PTSD on parent-child functioning in military and veteran families

Creech SK and Misca G

2017

Trends in respiratory diagnoses and symptoms of firefighters exposed to the World Trade Center disaster: 2005-2010

Weakley J, Webber MP, Gustave J, et al

2011

Accelerated spirometric decline in New York City firefighters with alpha(1)-antitrypsin deficiency

Banauch GI, Brantly M, Izbicki G, et al

2010

Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade Center

Banauch GI, Alleyne D, Sanchez R, et al

2003

A deep learning approach for monitoring parietal-dominant Alzheimer's disease in World Trade Center responders at midlife

Chen APF, Clouston SAP, Kritikos M, et al

2021

Little is known about the characteristics and causes of early-onset cognitive impairment. Responders to the 2001 New York World Trade Center disaster represent an ageing population that was recently shown to have an excess prevalence of cognitive impairment. Neuroimaging and molecular data demonstrate that a subgroup of affected responders may have a unique form of parietal-dominant Alzheimer's Disease. Recent neuropsychological testing and artificial intelligence approaches have emerged as methods that can be used to identify and monitor subtypes of cognitive impairment. We utilized data from World Trade Center responders participating in a health monitoring program and applied a deep learning approach to evaluate neuropsychological and neuroimaging data to generate a cortical atrophy risk score. We examined risk factors associated with the prevalence and incidence of high risk for brain atrophy in responders who are now at midlife. Training was conducted in a randomly selected two-thirds sample (N = 99) enrolled using of the results of a structural neuroimaging study. Testing accuracy was estimated for each training cycle in the remaining third subsample. After training was completed, the scoring methodology that was generated was applied to longitudinal data from 1441 World Trade Center responders. The artificial neural network provided accurate classifications of these responders in both the testing (Area Under the Receiver Operating Curve, 0.91) and validation samples (Area Under the Receiver Operating Curve, 0.87). At baseline and follow-up, responders identified as having a high risk of atrophy (n = 378) showed poorer cognitive functioning, most notably in domains that included memory, throughput, and variability as compared to their counterparts at low risk for atrophy (n = 1063). Factors associated with atrophy risk included older age [adjusted hazard ratio, 1.045 (95% confidence interval = 1.027-1.065)], increased duration of exposure at the WTC site [adjusted hazard ratio, 2.815 (1.781-4.449)], and a higher prevalence of post-traumatic stress disorder [aHR, 2.072 (1.408-3.050)]. High atrophy risk was associated with an increased risk of all-cause mortality [adjusted risk ratio, 3.19 (1.13-9.00)]. In sum, the high atrophy risk group displayed higher levels of previously identified risk factors and characteristics of cognitive impairment, including advanced age, symptoms of post-traumatic stress disorder, and prolonged duration of exposure to particulate matter. Thus, this study suggests that a high risk of brain atrophy may be accurately monitored using cognitive data.

Pathway analysis for plasma beta-amyloid, tau and neurofilament light (atn) in World Trade Center responders at midlife

Kritikos M, Clouston SA, Diminich ED, et al

2020

Risk of stroke among survivors of the September 11, 2001 World Trade Center disaster

Yu S, Alper HE, Nguyen AM, et al

2018

Post-9/11 sarcoidosis in WTC-exposed firefighters and emergency medical service workers

Webber MP, Yip J, Zeig-Owens R, et al

2017

Cardiovascular disease hospitalizations in relation to exposure to the September 11, 2001 World Trade Center disaster and posttraumatic stress disorder

Jordan HT, Stellman SD, Morabia A, et al

2013

Proximity to the 9/11 terrorist attack and suicide ideation in police officers

Violanti JM, Castellano C, O'Rourke J, et al

2006

Effects of airborne World Trade Center dust on cytokine release by primary human lung cells in vitro

Payne JP, Kemp SJ, Dewar A, et al

2004

Discovery and replication of blood-based proteomic signature of PTSD in 9/11 responders

Waszczuk MA, Kuan PF, Yang X, et al.

2023

Impact of healthcare services on thyroid cancer incidence among World Trade Center-exposed rescue and recovery workers

Goldfarb DG, Colbeth HL, Skerker M, et al

2021

Cortical complexity in World Trade Center responders with chronic posttraumatic stress disorder

Kritikos M, Clouston SAP, Huang C, et al

2021

Artificial intelligence language predictors of two-year trauma-related outcomes

Oltmanns JR, Schwartz HA, Ruggero C, et al

2021

The intentional self-medication of 9/11-related PTSD symptoms with alcohol: 15 years after the disaster

Garrey SK, Welch AE, Jacobson MH, et al

2020

The impact of military deployment on children: Placing developmental risk in context

Alfano CA, Lau S, Balderas J, et al

2016

Adolescent behavior and PTSD 6–7 years after the World Trade Center terrorist attacks of September 11, 2001

Mann M, Li, Jiehui., Farfel, Mark R., Maslow, Carey B., Osahan, Sukhminder., Stellman, Steven D.

2014

Workplace response of companies exposed to the 9/11 World Trade Center attack: A focus-group study

North CS, Pfefferbaum B, Hong BA, et al

2013

Shared traumatic stress and the long-term impact of 9/11 on Manhattan clinicians

Tosone C, McTighe JP, Bauwens J, et al

2011

Alcohol use trajectories among adults in an urban area after a disaster: Evidence from a population-based cohort study

Cerda M, Vlahov D, Tracy M, et al

2008

Disaster mental health workers responding to ground zero: One year later

Daly ES, Gulliver SB, Zimering RT, et al

2008

Assessment of inhalation exposures and potential health risks to the general population that resulted from the collapse of the World Trade Center towers

Lorber M, Gibb H, Grant L, et al

2007

In the days following the collapse of the World Trade Center (WTC) towers on September 11, 2001 (9/11), the U.S. Environmental Protection Agency (EPA) initiated numerous air monitoring activities to better understand the ongoing impact of emissions from that disaster. Using these data, EPA conducted an inhalation exposure and human health risk assessment to the general population. This assessment does not address exposures and potential impacts that could have occurred to rescue workers, firefighters, and other site workers, nor does it address exposures that could have occurred in the indoor environment. Contaminants evaluated include particulate matter (PM), metals, polychlorinated biphenyls, dioxins, asbestos, volatile organic compounds, particle-bound polycyclic aromatic hydrocarbons, silica, and synthetic vitreous fibers (SVFs). This evaluation yielded three principal findings. (1) Persons exposed to extremely high levels of ambient PM and its components, SVFs, and other contaminants during the collapse of the WTC towers, and for several hours afterward, were likely to be at risk for acute and potentially chronic respiratory effects. (2) Available data suggest that contaminant concentrations within and near ground zero (GZ) remained significantly elevated above background levels for a few days after 9/11. Because only limited data on these critical few days were available, exposures and potential health impacts could not be evaluated with certainty for this time period. (3) Except for inhalation exposures that may have occurred on 9/11 and a few days afterward, the ambient air concentration data suggest that persons in the general population were unlikely to suffer short-term or long-term adverse health effects caused by inhalation exposures. While this analysis by EPA evaluated the potential for health impacts based on measured air concentrations, epidemiological studies conducted by organizations other than EPA have attempted to identify actual impacts. Such studies have identified respiratory effects in worker and general populations, and developmental effects in newborns whose mothers were near GZ on 9/11 or shortly thereafter. While researchers are not able to identify specific times and even exactly which contaminants are the cause of these effects, they have nonetheless concluded that exposure to WTC contaminants (and/or maternal stress, in the case of developmental effects) resulted in these effects, and have identified the time period including 9/11 itself and the days and few weeks afterward as a period of most concern based on high concentrations of key pollutants in the air and dust.

Cardiovascular mortality in New York City after September 11, 2001

Chi JS, Poole WK, Kandefer SC, et al

2003

Acute eosinophilic pneumonia in a New York City firefighter exposed to World Trade Center dust

Rom WN, Weiden M, Garcia R, et al

2002

Exposure to the World Trade Center particulate matter alters the gut-brain axis in early onset Alzheimer's disease mice

Iban-Arias R, Wang SH, Soares Dias Portela A, et al.

2024

World Trade Center rescue and recovery workers: Cancer increases are beginning to emerge

Heck JE and Hansen J

2022

Experiences and perceptions of family members of emergency first responders with post-traumatic stress disorder: A qualitative systematic review

May K, Van Hooff M, Doherty M, et al.

2022

OBJECTIVE: The objective of this review was to examine the perceptions and experiences of family members of emergency first responders (EFRs) with post-traumatic stress disorder (PTSD). INTRODUCTION: Research indicates that EFR rates of PTSD are approximately double civilian rates, however, very little is known about the resultant effects on their family members. This review identifies the qualitative literature and data examining the perceptions and experiences of families with a current or former EFR member with diagnosed or undiagnosed PTSD. INCLUSION CRITERIA: This review includes all relevant articles, books, reports, and doctoral theses in English, globally, with no time limits, examining the experiences of family members of current or former EFRs with diagnosed or undiagnosed PTSD. All possible familial configurations and family members were considered, including nuclear, separated, and blended families, of an EFR. There were no age restrictions on EFRs or their family members or limitations on recency of service. EFRs included police, ambulance/paramedics, firefighters, and rescue personnel. METHODS: The databases searched included MEDLINE (PubMed), PsycINFO (Ovid), Embase, CINAHL (EBSCOhost), and Scopus. Hand-searching of relevant journals was conducted across Australian Paramedic, Australasian Journal of Paramedicine, British Paramedic Journal, International Paramedic Practice, Irish Journal of Paramedicine, Journal of Paramedic Practice, Prehospital and Disaster Medicine, and Prehospital Emergency Care. Sources of unpublished studies and gray literature, such as dissertations, were searched via PTSDpubs (ProQuest) and OpenGrey (DANS ESASY Data Archive). The search was updated in October 2021. Titles, abstracts, and full texts were screened by 2 independent reviewers against the inclusion criteria, and any conflicting views were to be resolved by discussion or a third reviewer, which was not required. Results were critically appraised for methodological quality. Post-data extraction results were synthesized and evaluated for credibility and dependability in accordance with the a priori protocol. RESULTS: The search yielded 1264 records and 48 were deemed eligible for full-text review. Seven studies were critically appraised, and 5 studies were agreed upon for inclusion in the synthesis. From these 5 results, 53 findings were extracted with associated illustrations and synthesized into 9 categories. Following meta-aggregation, 4 broad synthesized findings were developed: i) Changed family member roles, spousal relationships difficulties and family functioning when living with an EFR PTSD; ii) Spouses of an EFR with PTSD, may experience vicarious trauma, secondary trauma, and/or overburden as a consequence of protecting the family unit; iii) Children of an EFR parent with PTSD may experience secondary trauma, vicarious trauma and/or separation anxiety; and iv) Spouse's help seeking and support needs for their EFR Partners with PTSD, their children and for themselves. The first 3 findings received a low ConQual score due to low dependability and moderate credibility. The final finding received a moderate ConQual score due to low dependability and high credibility. CONCLUSIONS: The findings of the 5 qualitative studies included in the review showed significant mental health and functional impacts for family members of EFR with PTSD. Most studies focused on spouses, with some limited data on children. Two of the 5 studies included focused on the 9/11 World Trade Center terrorist attacks in the United States of America. The findings also indicate the need for targeted psychological and social services for EFR family members. Recommendations derived from the synthesized findings of this review include the need for further qualitative research, not only to deepen the understanding of the impacts and needs of EFR with PTSD on family members, but also to inform the design and provision of support services. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020196605.

G-computation and agent-based modeling for social epidemiology: Can population interventions prevent posttraumatic stress disorder?

Mooney SJ, Shev AB, Keyes KM, et al

2022

Development and validation of a clinical frailty index for the World Trade Center general responder cohort

Bello GA, Ornstein KA, Lucchini RG, et al

2021

Translational impacts of World Trade Center Health Program research: A mixed methods study

Concannon TW, Faherty LJ, Madrigano J, et al

2021

New 9/11 casualties strain health-care programme

Jaffe S

2021

The association between perfluoroalkyl substances and lipids in cord blood

Spratlen MJ, Perera FP, Lederman SA, et al

2020

The association between prenatal exposure to perfluoroalkyl substances and childhood neurodevelopment

Spratlen MJ, Perera FP, Lederman SA, et al

2020

Polygenic prediction of PTSD trajectories in 9/11 responders

Waszczuk MA, Docherty AR, Shabalin AA, et al

2020

BACKGROUND: Genetics hold promise of predicting long-term post-traumatic stress disorder (PTSD) outcomes following trauma. The aim of the current study was to test whether six hypothesized polygenic risk scores (PRSs) developed to capture genetic vulnerability to psychiatric conditions prospectively predict PTSD onset, severity, and 18-year course after trauma exposure. METHODS: Participants were 1490 responders to the World Trade Center (WTC) disaster (mean age at 9/11 = 38.81 years, s.d. = 8.20; 93.5% male; 23.8% lifetime WTC-related PTSD diagnosis). Prospective longitudinal data on WTC-related PTSD symptoms were obtained from electronic medical records and modelled as PTSD trajectories using growth mixture model analysis. Independent regression models tested whether six hypothesized psychiatric PRSs (PTSD-PRS, Re-experiencing-PRS, Generalized Anxiety-PRS, Schizophrenia-PRS, Depression-PRS, and Neuroticism-PRS) are predictive of WTC-PTSD outcomes: lifetime diagnoses, average symptom severity, and 18-year symptom trajectory. All analyses were adjusted for population stratification, 9/11 exposure severity, and multiple testing. RESULTS: Depression-PRS predicted PTSD diagnostic status (OR 1.37, CI 1.17-1.61, adjusted p = 0.001). All PRSs, except PTSD-PRS, significantly predicted average PTSD symptoms (beta = 0.06-0.10, adjusted p < 0.05). Re-experiencing-PRS, Generalized Anxiety-PRS and Schizophrenia-PRS predicted the high severity PTSD trajectory class (ORs 1.21-1.28, adjusted p < 0.05). Finally, PRSs prediction was independent of 9/11 exposure severity and jointly accounted for 3.7 times more variance in PTSD symptoms than the exposure severity. CONCLUSIONS: Psychiatric PRSs prospectively predicted WTC-related PTSD lifetime diagnosis, average symptom severity, and 18-year trajectory in responders to 9/11 disaster. Jointly, PRSs were more predictive of subsequent PTSD than the exposure severity. In the future, PRSs may help identify at-risk responders who might benefit from targeted prevention approaches.

Understanding the connection between posttraumatic stress symptoms and respiratory problems: Contributions of anxiety sensitivity

Mahaffey BL, Gonzalez A, Farris SG, et al

2017

Bronchial reactivity and lung function after World Trade Center exposure

Aldrich TK, Weakley J, Dhar S, et al

2016

Factors associated with poor control of 9/11-related asthma 10-11 years after the 2001 World Trade Center terrorist attacks

Jordan HT, Stellman SD, Reibman J, et al

2015

Consequences of 9/11 and the war on terror on children's and young adult's mental health: A systematic review of the past 10 years

Rousseau C, Jamil U, Bhui K, et al

2015

Mental health of those directly exposed to the World Trade Center disaster: Unmet mental health care need, mental health treatment service use, and quality of life

Brackbill RM, Stellman SD, Perlman SE, et al

2013

Validation of the center for epidemiologic studies depression scale in screening for major depressive disorder among retired firefighters exposed to the World Trade Center disaster

Chiu S, Webber MP, Zeig-Owens R, et al

2010

Polychlorinated dibenzo-p-dioxins, dibenzofurans, biphenyls, and naphthalenes in plasma of workers deployed at the World Trade Center after the collapse

Horii Y, Jiang Q, Hanari N, et al

2010

Emerging exposures and respiratory health: World Trade Center dust

Rom WN, Reibman J, Rogers L, et al

2010

Obstructive airways disease with air trapping among firefighters exposed to World Trade Center dust

Weiden MD, Ferrier N, Nolan A, et al

2010

BACKGROUND: The World Trade Center (WTC) collapse produced a massive exposure to respirable particulates in New York City Fire Department (FDNY) rescue workers. This group had spirometry examinations pre-September 11, 2001, and post-September 11, 2001, demonstrating declines in lung function with parallel declines in FEV(1) and FVC. To date, the underlying pathophysiologic cause for this has been open to question. METHODS: Of 13,234 participants in the FDNY-WTC Monitoring Program, 1,720 (13%) were referred for pulmonary subspecialty evaluation at a single institution. Evaluation included 919 full pulmonary function tests, 1,219 methacholine challenge tests, and 982 high-resolution chest CT scans. RESULTS: At pulmonary evaluation (median 34 months post-September 11, 2001), median values were FEV(1) 93% predicted (interquartile range [IQR], 83%-101%), FVC 98% predicted (IQR, 89%-106%), and FEV(1)/FVC 0.78 (IQR, 0.72-0.82). The residual volume (RV) was 123% predicted (IQR, 106%-147%) with nearly all participants having normal total lung capacity, functional residual capacity, and diffusing capacity of carbon monoxide. Also, 1,051/1,720 (59%) had obstructive airways disease based on at least one of the following: FEV(1)/FVC, bronchodilator responsiveness, hyperreactivity, or elevated RV. After adjusting for age, gender, race, height and weight, and tobacco use, the decline in FEV(1) post-September 11, 2001, was significantly correlated with increased RV percent predicted (P < .0001), increased bronchodilator responsiveness (P < .0001), and increased hyperreactivity (P = .0056). CT scans demonstrated bronchial wall thickening that was significantly associated with the decline in FEV(1) post-September 11, 2001 (P = .024), increases in hyperreactivity (P < .0001), and increases in RV (P < .0001). Few had evidence for interstitial disease. CONCLUSIONS: Airways obstruction was the predominant physiologic finding underlying the reduction in lung function post-September 11, 2001, in FDNY WTC rescue workers presenting for pulmonary evaluation.

Biomonitoring of perfluorochemicals in plasma of New York state personnel responding to the World Trade Center disaster

Tao L, Kannan K, Aldous KM, et al

2008

The collapse of the World Trade Center (WTC) on September 11, 2001 resulted in the release of several airborne pollutants in and around the site. Perfluorochemicals including perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA), which are used in soil- and stain-resistant coatings on upholstery, carpets, leather, floor waxes, polishes, and in fire-fighting foams were potentially released during the collapse of the WTC. In this pilot study, we analyzed 458 plasma samples of New York State (NYS) employees and National Guard personnel assigned to work in the vicinity of the WTC between September 11 and December 23, 2001, to assess exposure to perfluorochemicals released in dust and smoke. The plasma samples collected from NYS WTC responders were grouped based on estimated levels of exposure to dust and smoke, as follows: more dust exposure (MDE), less dust exposure (LDE), more smoke exposure (MSE), and less smoke exposure (LSE). Furthermore, samples were grouped, based on self-reported symptoms at the time of sampling, as symptomatic and asymptomatic. Eight perfluorochemicals were measured in 458 plasma samples. PFOS, PFOA, perfluorohexanesulfonate (PFHxS), and perfluorononanoic acid (PFNA), were consistently detected in almost all samples. PFOA and PFHxS concentrations were approximately 2-fold higher in WTC responders than the concentrations reported for the U.S. general population. No significant difference was observed in the concentrations of perfluorochemicals between symptomatic and asymptomatic groups. Concentrations of PFHxS were significantly (p < or = 0.05) higher in the MDE group than in the LDE group. Concentrations of PFNA were significantly higher in the MSE group than in the LSE group. Significantly higher concentrations of PFOA and PFHxS were found in individuals exposed to smoke than in individuals exposed to dust. A significant negative correlation existed between plasma lipid content and concentrations of certain perfluorochemicals. Our initial findings suggest that WTC responders were exposed to perfluorochemicals, especially PFOA, PFNA, and PFHxS, through inhalation of dust and smoke released during and after the collapse of the WTC. The potential health implications of these results are unknown at this time. Expansion of testing to include all archived samples will be critical to help confirm these findings. In doing so, it may be possible to identify biological markers of WTC exposure and to improve our understanding of the health impacts of these compounds.

Measuring and maximizing coverage in the World Trade Center Health Registry

Murphy J, Brackbill RM, Thalji L, et al

2007

The World Trade Center Health Registry (WTCHR) is a database for following people who were exposed to the disaster of 11 September 2001. Hundreds of thousands of people were exposed to the immense cloud of dust and debris, the indoor dust, the fumes from persistent fires, and the mental trauma of the terrorist attacks on the WTC on 9/11. The purpose of the WTCHR is to evaluate the potential short- and long-term physical and mental health effects of the disaster. The definitions of the exposed groups are broad and defined based on an understanding of which groups had the highest exposures to the WTC disaster and its aftermath. The four exposure groups include rescue and recovery workers, residents, students and school staff, and building occupants and passersby in Lower Manhattan. While one goal of the WTCHR was to maximize coverage overall and for each exposure group, another was to ensure equal representation within exposure groups. Because of the multiple sample types pursued, several approaches were required to determine eligibility. Estimates of the number of eligible persons in each of the exposed populations were based on the best available information including Census, entity-specific employment figures, and public and private school enrollment data, among other publicly available sources. To address issues of undercoverage and overcoverage a variety of methods were assessed or applied, including a capture-recapture analyses test of overlapping sample building list sources and automated deduplication of sample records. Estimates of the true eligible population indicate that over 400,000 unique individuals were eligible for the baseline health survey. Interviewer-administered surveys were completed with more than 71,000 persons, resulting in an overall enrollment rate of approximately 17 per cent. Coverage was highest among rescue and recovery workers, followed by residents, students and school staff, and building occupants. Both the accuracy of coverage estimates and the raw number and representativeness of enrollees were maximized by our approach to coverage. In designing a registry which relies on multiple pathways and sources of data to build the sample, it is important to develop a comprehensive approach that considers all sources of error and minimizes bias that may be introduced through the methodology.

Residual indoor contamination from World Trade Center rubble fires as indicated by polycyclic aromatic hydrocarbon profiles

Pleil JD, Funk WE, and Rappaport SM

2006

The catastrophic destruction of the World Trade Center (WTC) on Sept. 11, 2001 (9/11) created an immense dust cloud followed by fires that emitted smoke and soot into the air of New York City (NYC) well into December. Outdoor pollutant levels in lower Manhattan returned to urban background levels after about 200 days as the fires were put out and the debris cleanup was completed. However, particulate matter (PM) from the original collapse and fires also penetrated into commercial and residential buildings. This has created public concern because WTC dust is thought to cause adverse pulmonary symptoms including "WTC cough" and reduced lung capacity. Additionally, some recent studies have suggested a possible link between exposure to WTC contamination and other adverse health effects. Distinguishing between normal urban pollutant infiltration and residual WTC dust remaining in interior spaces is difficult; efforts are underway to develop such discriminator methods. Some progress has been made in identifying WTC dust by the content of fibers believed to be associated with the initial building collapse. There are also contaminants created by the fires that burned for 100 days in the debris piles of the building rubble. Using WTC ambient air samples, we have developed indicators for fire related PM based on the relative amounts of specific particle bound polycyclic aromatic hydrocarbons (PAHs) and the mass fraction of PAHs per mass of PM. These two parameters are combined, and we show a graphical method for discriminating between fire sources and urban particulate sources as applied to samples of settled dusts. We found that our PAHs based discriminator method can distinguish fire source contributions to WTC related particulate matter and dusts. Other major building fires or large open burn events could have similar PAHs characteristics. We found that random samples collected approximately 3.5 years after the WTC event from occupied indoor spaces (primarily residential) in the New York area are not statistically distinguishable from contemporary city background.

DNA damage from polycyclic aromatic hydrocarbons measured by benzo[a]pyrene-DNA adducts in mothers and newborns from northern Manhattan, the World Trade Center area, poland, and china

Perera F, Tang D, Whyatt R, et al

2005

Polycyclic aromatic hydrocarbons (PAH), of which benzo[a]pyrene is a representative member, are combustion-related environmental pollutants and include known carcinogens. Laboratory animal studies indicate that the dose of PAHs to the fetus is on the order of a 10th that to the mother and that there is heightened susceptibility to PAH-induced carcinogenesis during the fetal and infancy periods. Carcinogen-DNA adducts, a measure of procarcinogenic genetic damage, are considered a biomarker of increased cancer risk. Here we compare the levels of benzo[a]pyrene-DNA adducts as a proxy for PAH-DNA damage measured in maternal blood and newborn cord blood obtained at delivery in four different populations of mothers (total of 867) and newborns (total of 822), representing a 30-fold range of exposure to ambient PAHs. The populations include residents in Northern Manhattan, participants in a study of the effects of the World Trade Center disaster, residents in Krakow, Poland, and residents in Tongliang, China. Mean adduct concentrations in both maternal and cord blood and the proportion of samples with detectable adducts, increased across the populations [Northern Manhattan < World Trade Center (WTC) < Krakow < Tongliang], consistent with the trend in estimated ambient exposure to PAHs (P < 0.001). For mothers, the means in the respective populations were Northern Manhattan (0.21 adducts per 10(8) nucleotides), WTC (0.23 adducts per 10(8) nucleotides), Krakow (0.28 adducts per 10(8) nucleotides), Tongliang (0.31 adducts per 10(8) nucleotides); the corresponding means in the newborns were Northern Manhattan (0.23), WTC (0.24), Krakow (0.29), Tongliang (0.31). The percentage of mothers with detectable levels of adducts in the respective populations were Northern Manhattan (36.8%), WTC (57.5%), Krakow (72.9%), Tongliang (73.4%); the corresponding percentages among the newborns were Northern Manhattan (42.4%), WTC (60.6%), Krakow (71.1%), Tongliang (79.5%). Despite the estimated 10-fold lower PAH dose to the fetus based on laboratory animal experiments, the adduct levels in the newborns were similar to or higher than in the mothers. This study suggests that the fetus may be 10-fold more susceptible to DNA damage than the mother and that in utero exposure to polycyclic aromatic hydrocarbons may disproportionately increase carcinogenic risk. The data support preventive policies to limit PAH exposure to pregnant women and children.

Symptoms, respirator use, and pulmonary function changes among New York City firefighters responding to the World Trade Center disaster

Feldman DM, Baron SL, Bernard BP, et al

2004

CONTEXT: New York City firefighters responding to the World Trade Center (WTC) disaster on September 11, 2001, were exposed to numerous hazards. A medical screening program was conducted 3 weeks after the disaster on a sample of firefighters. OBJECTIVES: To determine whether arrival time at the WTC and other exposure variables (including respirator use) were associated with symptoms and changes in pulmonary function (after exposure - before exposure). DESIGN: A cross-sectional comparison of firefighters representing the following groups: (1) firefighters who arrived before/during the WTC collapse, (2) firefighters who arrived 1 to 2 days after the collapse, (3) firefighters who arrived 3 to 7 days after the collapse, and (4) unexposed firefighters. SETTING: Fire Department of New York City (FDNY) Bureau of Health Services on October 1 to 5, 2001. POPULATION: A stratified random sample of 362 of 398 recruited working firefighters (91%). Of these, 149 firefighters (41%) were present at the WTC collapse, 142 firefighters (39%) arrived after the collapse but within 48 h, 28 firefighters (8%) arrived 3 to 7 days after the collapse, and 43 firefighters (12%) were unexposed. MAIN OUTCOME MEASURES: New/worsening symptoms involving the eyes, skin, respiratory system, and nose and throat (NT), and changes in spirometry from before to after exposure. RESULTS: During the first 2 weeks at the WTC site, 19% of study firefighters reported not using a respirator; 50% reported using a respirator but only rarely. Prevalence ratios (PRs) for skin, eye, respiratory, and NT symptoms showed a dose-response pattern between exposure groups based on time of arrival at the WTC site, with PRs between 2.6 and 11.4 with 95% confidence intervals (CIs) excluding 1.0 for all but skin symptoms. For those spending > 7 days at the site, the PR for respiratory symptoms was 1.32 (95% CI, 1.13 to 1.55), compared with those who were exposed for < 7 days. Mean spirometry results before and after exposure were within normal limits. The change in spirometry findings (after exposure - before exposure) showed near-equal reductions for FVC and FEV(1). These reductions were greater than the annual reductions measured in a referent population of incumbent FDNY firefighters prior to September 11 (p or= 450 mL in FEV(1) in those arriving during the first 48 h compared to the referent (p

Hispanic ethnicity and post-traumatic stress disorder after a disaster: Evidence from a general population survey after September 11, 2001

Galea S, Vlahov D, Tracy M, et al

2004

Heart failure and late-onset Alzheimer's disease: A Mendelian randomization study

Arega Y and Shao Y

2022

Altered gene expression and PTSD symptom dimensions in World Trade Center responders

Marchese S, Cancelmo L, Diab O, et al

2022

Despite experiencing a significant trauma, only a subset of World Trade Center (WTC) rescue and recovery workers developed posttraumatic stress disorder (PTSD). Identification of biomarkers is critical to the development of targeted interventions for treating disaster responders and potentially preventing the development of PTSD in this population. Analysis of gene expression from these individuals can help in identifying biomarkers of PTSD. We established a well-phenotyped sample of 371 WTC responders, recruited from a longitudinal WTC responder cohort using stratified random sampling, by obtaining blood, self-reported and clinical interview data. Using bulk RNA-sequencing from whole blood, we examined the association between gene expression and WTC-related PTSD symptom severity on (i) highest lifetime Clinician-Administered PTSD Scale (CAPS) score, (ii) past-month CAPS score, and (iii) PTSD symptom dimensions using a 5-factor model of re-experiencing, avoidance, emotional numbing, dysphoric arousal and anxious arousal symptoms. We corrected for sex, age, genotype-derived principal components and surrogate variables. Finally, we performed a meta-analysis with existing PTSD studies (total N = 1016), using case/control status as the predictor and correcting for these variables. We identified 66 genes significantly associated with total highest lifetime CAPS score (FDR-corrected p < 0.05), and 31 genes associated with total past-month CAPS score. Our more granular analyses of PTSD symptom dimensions identified additional genes that did not reach statistical significance in our analyses with total CAPS scores. In particular, we identified 82 genes significantly associated with lifetime anxious arousal symptoms. Several genes significantly associated with multiple PTSD symptom dimensions and total lifetime CAPS score (SERPINA1, RPS6KA1, and STAT3) have been previously associated with PTSD. Geneset enrichment of these findings has identified pathways significant in metabolism, immune signaling, other psychiatric disorders, neurological signaling, and cellular structure. Our meta-analysis revealed 10 genes that reached genome-wide significance, all of which were downregulated in cases compared to controls (CIRBP, TMSB10, FCGRT, CLIC1, RPS6KB2, HNRNPUL1, ALDOA, NACA, ZNF429 and COPE). Additionally, cellular deconvolution highlighted an enrichment in CD4 T cells and eosinophils in responders with PTSD compared to controls. The distinction in significant genes between total lifetime CAPS score and the anxious arousal symptom dimension of PTSD highlights a potential biological difference in the mechanism underlying the heterogeneity of the PTSD phenotype. Future studies should be clear about methods used to analyze PTSD status, as phenotypes based on PTSD symptom dimensions may yield different gene sets than combined CAPS score analysis. Potential biomarkers implicated from our meta-analysis may help improve therapeutic target development for PTSD.

Moving forward from COVID-19: Organizational dimensions of effective hospital emergency management

Atkinson MK, Cagliuso NV, Hick JL, et al

2021

Twenty years after 9/11: The public health preparedness we need now

Fraser MR, Barishansky RM, and Blumenstock JS

2021

Characteristics of cancer patients in the World Trade Center Environmental Health Center

Durmus N, Shao Y, Arslan AA, et al

2020

Receptor for advanced glycation end-products and environmental exposure related obstructive airways disease: A systematic review

Haider SH, Oskuei A, Crowley G, et al

2019

Cord blood perfluoroalkyl substances in mothers exposed to the World Trade Center disaster during pregnancy

Spratlen MJ, Perera FP, Lederman SA, et al

2019

Chronic rhinosinusitis is an independent risk factor for osa in World Trade Center responders

Sunderram J, Weintraub M, Black K, et al

2019

Impact of health on early retirement and post-retirement income loss among survivors of the 11 September 2001 World Trade Center disaster

Yu S, Seil K, and Maqsood J

2019

Assessment of cumulative health risk in the World Trade Center general responder cohort

Bello GA, Teitelbaum SL, Lucchini RG, et al

2018

Risk factors for depression among civilians after the 9/11 World Trade Center terrorist attacks: A systematic review and meta-analysis

Chatterjee A, Banerjee S, Stein C, et al

2018

Prevalence and predictors of postdisaster major depression: Convergence of evidence from 11 disaster studies using consistent methods

North CS, Baron D, and Chen AF

2018

Unmet mental health care need 10-11 years after the 9/11 terrorist attacks: 2011-2012 results from the World Trade Center Health Registry

Ghuman SJ, Brackbill RM, Stellman SD, et al

2014

BACKGROUND: There is little current information about the unmet mental health care need (UMHCN) and reasons for it among those exposed to the World Trade Center (WTC) terrorist attacks. The purpose of this study was to assess the level of UMHCN among symptomatic individuals enrolled in the WTC Health Registry (WTCHR) in 2011-2012, and to analyze the relationship between UMHCN due to attitudinal, cost, and access factors and mental health symptom severity, mental health care utilization, health insurance availability, and social support. METHODS: The WTCHR is a prospective cohort study of individuals with reported exposure to the 2001 WTC attacks. This study used data from 9,803 adults who completed the 2003-2004 (Wave 1) and 2011-2012 (Wave 3) surveys and had posttraumatic stress disorder (PTSD) or depression in 2011-2012. We estimated logistic regression models relating perceived attitudinal, cost and access barriers to symptom severity, health care utilization, a lack of health insurance, and social support after adjusting for sociodemographic characteristics. RESULTS: Slightly more than one-third (34.2%) of study participants reported an UMHCN. Symptom severity was a strong predictor of UMHCN due to attitudinal and perceived cost and access reasons. Attitudinal UMHCN was common among those not using mental health services, particularly those with relatively severe mental health symptoms. Cost-related UMHCN was significantly associated with a lack of health insurance but not service usage. Access-related barriers were significantly more common among those who did not use any mental health services. A higher level of social support served as an important buffer against cost and access UMHCN. CONCLUSIONS: A significant proportion of individuals exposed to the WTC attacks with depression or PTSD 10 years later reported an UMHCN, and individuals with more severe and disabling conditions, those who lacked health insurance, and those with low levels of social support were particularly vulnerable.

Previous exposure to the World Trade Center terrorist attack and posttraumatic symptoms among older adults following hurricane sandy

Shrira A, Palgi Y, Hamama-Raz Y, et al

2014

Intrauterine stress and male cohort quality: The case of September 11, 2001

Bruckner TA and Nobles J

2013

Religiosity and mental health: Changes in religious beliefs, complicated grief, posttraumatic stress disorder, and major depression following the September 11, 2001 attacks

Seirmarco G, Neria Y, Insel B, et al

2012

The evolving spectrum of pulmonary disease in responders to the World Trade Center tragedy

Guidotti TL, Prezant D, de la Hoz RE, et al

2011

The impact of 9/11 on patients in New York City's substance abuse treatment programs

Dewart T, Frank B, and Schmeidler J

2006

Was there unmet mental health need after the September 11, 2001 terrorist attacks?

Stuber J, Galea S, Boscarino JA, et al

2006

Chrysotile as a cause of mesothelioma: An assessment based on epidemiology

Yarborough CM

2006

September 11, 2001, revisited: A review of the data

Feeney JM, Goldberg R, Blumenthal JA, et al

2005

HYPOTHESIS: The September 11, 2001, World Trade Center (WTC) attack was a disaster of epic proportion in New York City, NY. It was unprecedented in terms of the number of people who were killed in the bombings, as well as in terms of the volume of patients received at local (New York City) hospitals. The strain on local emergency medical services, hospitals, and the citywide trauma system is still felt today as the hospitals, physicians, and agencies involved struggle to train for similar events that may occur in the future, cope with the psychological and social aftermath, and even pay for the response to the bombing. The objective of this review of the data was to determine the major causes of morbidity (ie, hospital visits) during the hours immediately after the September 11, 2001, WTC attack, as well as to detail the costs involved in the medical response to a disaster of this scale and to identify some lessons learned with respect to the hospital's response to an event of this magnitude. DESIGN: Review of records and cost data submitted by Saint Vincent's Hospital, Manhattan, NY, to the state of New York and federal sources for financial relief from the September 11, 2001, WTC attack. SETTING: Saint Vincent's Hospital is an academic medical center of New York Medical College and a New York City-designated level I trauma center. PATIENTS: All medical records for the patients registered at Saint Vincent's Hospital on September 11, 2001, after 8:50 am were reviewed. RESULTS: The major cause of morbidity for the September 11, 2001, patients was smoke inhalation (30.0%); followed closely by chemical conjunctivitis and corneal abrasions (16%); lacerations, abrasions, and soft-tissue injuries (15.5%); isolated orthopedic complaints (12%); and psychiatric complaints (10%). Multiple-trauma patients were 3% of the patients seen. There were 5 fatalities at Saint Vincent's Hospital. CONCLUSIONS: The WTC disaster was a source of major morbidity and mortality to the people of New York City. The possibility that Saint Vincent's will again serve in that role is in the forefront of the minds of everyone involved in updating our contingency plan.

Graph theory-based analysis reveals neural anatomical network alterations in chronic post-traumatic stress disorder

Huang C, Hagan T, Kritikos M, et al.

2024

Systemic sclerosis in individuals with exposure to World Trade Center ground-zero rescue/recovery efforts: A case series

Own M, Bloostein A, Spiera R, et al.

2024

Assessment of Alzheimer's disease imaging biomarkers in World Trade Center responders with cognitive impairment at midlife

Kritikos M, Franceschi AM, Vaska P, et al.

2022

Metabolomics analysis of post-traumatic stress disorder symptoms in World Trade Center responders

Kuan PF, Yang X, Kotov R, et al

2022

Latent cause inference during extinction learning in trauma-exposed individuals with and without PTSD

Norbury A, Brinkman H, Kowalchyk M, et al.

2022

Posttraumatic stress disorder and the associated risk of autoimmune skin diseases: A nationwide population-based cohort study

Dai YX, Tai YH, Chang YT, et al

2021

Acute versus chronic exposures to inhaled particulate matter and neurocognitive dysfunction: Pathways to alzheimer’s disease or a related dementia

Kritikos M, Gandy S, Meliker JR, et al

2021

Assembling the career firefighter health study cohort: A methods overview

Zeig-Owens R, Singh A, Triplett S, et al

2021

Police stress, mental health, and resiliency during the covid-19 pandemic

Stogner J, Miller BL, and McLean K

2020

PTSD and comorbid depression: Social support and self-efficacy in World Trade Center tower survivors 14-15 years after 9/11

Adams SW, Bowler RM, Russell K, et al

2019

Respiratory health and lung function in children exposed to the World Trade Center disaster

Trye A, Berger KI, Naidu M, et al

2018

Posttraumatic stress disorder, gender, and risk factors: World Trade Center tower survivors 10 to 11 years after the September 11, 2001 attacks

Bowler RM, Adams SW, Gocheva VV, et al

2017

Differences in cortisol response to trauma activation in individuals with and without comorbid PTSD and depression

Dekel S, Ein-Dor T, Rosen JB, et al

2017

An epigenome-wide DNA methylation study of PTSD and depression in World Trade Center responders

Kuan PF, Waszczuk MA, Kotov R, et al

2017

Paresthesias among community members exposed to the World Trade Center disaster

Marmor M, Shao Y, Bhatt DH, et al

2017

Cancer in World Trade Center responders: Findings from multiple cohorts and options for future study

Boffetta P, Zeig-Owens R, Wallenstein S, et al

2016

The 9/11 dust cloud and pregnancy outcomes: A reconsideration

Currie J and Schwandt H

2016

Agreement between self-reported and confirmed cancer diagnoses in New York City firefighters and ems workers, 2001-2011

Zeig-Owens R, Kablanian A, Webber MP, et al

2016

Longitudinal study of the impact of psychological distress symptoms on new-onset upper gastrointestinal symptoms in World Trade Center responders

Litcher-Kelly L, Lam Y, Broihier JA, et al

2014

Elevated peripheral eosinophils are associated with new-onset and persistent wheeze and airflow obstruction in World Trade Center-exposed individuals

Kazeros A, Maa MT, Patrawalla P, et al

2013

Relationship between particulate matter exposure and atherogenic profile in "ground zero" workers as shown by dynamic contrast enhanced mr imaging

Mani V, Wong SK, Sawit ST, et al

2013

The respiratory pyramid: From symptoms to disease in World Trade Center exposed firefighters

Niles JK, Webber MP, Cohen HW, et al

2013

Associations of World Trade Center exposures with pulmonary and cardiometabolic outcomes among children seeking care for health concerns

Trasande L, Fiorino EK, Attina T, et al

2013

Respiratory disease in children exposed to World Trade Center dust

Fiorino EK, Trasande L, Berger KI, et al

2012

Rationale: The collapse of the World Trade Center (WTC) resulted in an unprecedented environmental exposure for the tens of thousands of children who lived or attended school in lower Manhattan. Studies in the responder and local resident/worker adult populations have demonstrated a clear association between dust exposure and obstructive lung disease. Biopsy studies in exposed adults have demonstrated bronchiolitis, emphysema, and alveolar destruction. The WTC Health Registry demonstrated an increased incidence of self-reported asthma and respiratory symptoms in children exposed to the dust cloud. Little is known, however, regarding the physiologic effects of exposure on the pediatric population. To date, full physiologic assessment in this population of exposed children has not been performed. Methods: 54 patients less than 18 years of age at the time of the WTC disaster were evaluated in the Pediatric Program in the WTC Environmental Health Center and consented to participate in this study. As part of their clinical evaluation, subjects and families completed a detailed questionnaire, including exposure history and lower respiratory symptoms. All subjects underwent spirometry. Univariate regression was performed to assess relationship of pulmonary function to dust cloud exposure. Results: At the time of evaluation, mean age was 11.9 years, ranging from 4.9-17.9 years. 53.7% were female. 33% were caught in the dust cloud. 25% reported heavy dust in the home. Lower respiratory symptoms with post-9/11 onset were reported as follows: cough in 48%, wheezing in 37%, and dyspnea with exercise in 46%. Regarding pulmonary function, results are presented in mean + standard deviation: forced expiratory volume in 1 second (FEV1) 98.08 + 12.76; forced vital capacity (FVC) 100.68 + 12.70; FEV1/FVC 85.36 + 5.89. For those children with dust cloud exposure, there was a mean 4.3% decrement in the FEV1/FVC ratio on univariate regression (p=0.38). Discussion: In this sample of WTC dust-exposed children, there was an increased report of respiratory symptoms following 9/11 in children who had previously been asymptomatic. Extending this finding, there was an association between lower FEV1/FVC and dust cloud exposure, suggesting a physiologic correlate to the increased lower respiratory symptoms. In light of what is known regarding the risks of exposure to air pollution and the development of obstructive lung disease in children, these data highlight the need for further study, especially to elucidate persistent effects on lung growth in the heavily and chronically exposed.

Lung pathologic findings in a local residential and working community exposed to World Trade Center dust, gas, and fumes

Caplan-Shaw CE, Yee H, Rogers L, et al

2011

Acute stress disorder, depression, and tobacco use in disaster workers following 9/11

Biggs QM, Fullerton CS, Reeves JJ, et al

2010

Atopy and upper and lower airway disease among former World Trade Center workers and volunteers

de la Hoz RE, Shohet MR, Wisnivesky JP, et al

2009

9/11 volunteerism: A pathway to personal healing and community engagement

Steffen SL and Fothergill A

2009

Vocal cord dysfunction in former World Trade Center (WTC) rescue and recovery workers and volunteers

de la Hoz RE, Shohet MR, Bienenfeld LA, et al

2008

A randomized controlled clinical treatment trial for World Trade Center attack-related PTSD in disaster workers

Difede J, Malta LS, Best S, et al

2007

Traumatic brain injuries after mass-casualty incidents: Lessons from the 11 September 2001 World Trade Center attacks

Rutland-Brown W, Langlois JA, Nicaj L, et al

2007

INTRODUCTION: The 11 September 2001 terrorist attacks on the World Trade Center (WTC) resulted in thousands of deaths and injuries. Research on previous bombings and explosions has shown that head injuries, including traumatic brain injuries (TBIs), are among the most common injuries. OBJECTIVE: The objective of this study was to identify diagnosed and undiagnosed (undetected) TBIs among persons hospitalized in New York City following the 11 September 2001 WTC attacks. METHODS: The medical records of persons admitted to 36 hospitals in New York City with injuries or illnesses related to the WTC attacks were abstracted for signs and symptoms of TBIs. Diagnosed TBIs were identified using the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Undiagnosed TBIs were identified by an adjudication team of TBI experts that reviewed the abstracted medical record information. Persons with an undiagnosed TBI were contacted and informed of the diagnosis of potential undetected injury. RESULTS: A total of 282 records were abstracted. Fourteen cases of diagnosed TBIs and 21 cases of undiagnosed TBIs were identified for a total of 35 TBI cases (12% of all of the abstracted records). The leading cause of TBI was being hit by falling debris (22 cases). One-third of the TBIs (13 cases) occurred among rescue workers. More than three years after the event, four out of six persons (66.67%) with an undiagnosed TBI who were contacted reported they currently were experiencing symptoms consistent with a TBI. CONCLUSIONS: Not all of the TBIs among hospitalized survivors of the WTC attacks were diagnosed at the time of acute injury care. Some persons with undiagnosed TBIs reported problems that may have resulted from these TBIs three years after the event. For hospitalized survivors of mass-casualty incidents, additional in-hospital, clinical surveys could help improve pre-discharge TBI diagnosis and provide the opportunity to link patients to appropriate outpatient services. The use and adequacy of head protection for rescue workers deserves re-evaluation.

The World Trade Center aftermath and its effects on health: Understanding and learning through human-exposure science

Lioy PJ, Pellizzari E, and Prezant D

2006

Early respiratory abnormalities in emergency services police officers at the World Trade Center site

Salzman SH, Moosavy FM, Miskoff JA, et al

2004

Plasma amyloid beta 40/42, phosphorylated tau 181, and neurofilament light are associated with cognitive impairment and neuropathological changes among World Trade Center responders: A prospective cohort study of exposures and cognitive aging at midlife

Kritikos M, Diminich ED, Meliker J, et al.

2023

INTRODUCTION: World Trade Center (WTC) responders are experiencing a high risk of mild cognitive impairment (MCI) and dementia, though the etiology remains inadequately characterized. This study investigated whether WTC exposures and chronic post-traumatic stress disorder (PTSD) were correlated with plasma biomarkers characteristic of Alzheimer's disease (AD) neuropathology. METHODS: Eligible participants included WTC-exposed individuals with a baseline cognitive assessment and available plasma sample. We examined levels of the amyloid beta (Abeta)40/42 ratio, phosphorylated tau 181 (p-tau181), and neurofilament light chain (NfL) and associations with a WTC exposures (duration on site >/=15 weeks, dust cloud), the PTSD Symptom Checklist for Diagnostic and Statistical Manual of Mental Disorders, 4th edition PTSD, and classification of amyloid/tau/neurodegeneration (AT[N]) profiles. Multinomial logistic regressions assessed whether biomarkers predicted increased risk of MCI or dementia. RESULTS: Of 1179 eligible responders, 93.0% were male, mean (standard deviation) age 56.6 years (7.8). Abeta40/42, p-tau181, and NfL intercorrelated and increased with age. In subgroup analyses of responders with available neuroimaging data (n = 75), Abeta40/42 and p-tau181 were further associated with decreased hippocampal volume (Spearman's rho = -0.3). Overall, 58.08% of responders with dementia had >/=1 elevated biomarker, and 3.45% had elevations across all biomarkers. In total, 248 (21.05%) had MCI and 70 (5.94%) had dementia. Increased risk of dementia was associated with plasma AT(N) profile T+ or A+N+. Exposure on site >/=15 weeks was independently associated with T+ (adjusted risk ratio [aRR] = 1.03 [1.01-1.05], P = 0.009), and T+N+ profile (aRR = 2.34 [1.12-4.87]). The presence of PTSD was independently associated with risk of A+ (aRR = 1.77 [1.11-2.82]). DISCUSSION: WTC exposures and chronic PTSD are associated with plasma biomarkers consistent with neurodegenerative disease.

Relationship between low serum IgE levels and malignancies in 9/11 World Trade Center responders

Ferastraoaru D, Zeig-Owens R, Goldfarb DG, et al

2022

Web and paper survey mode patterns and preferences, health & employment survey, World Trade Center Health Registry

Seil K, Yu MS, Brackbill R, et al

2021

Multiomics of WTC-particulate induced persistent airway hyperreactivity: Role of receptor for advanced glycation end products

Haider SH, Veerappan A, Crowley G, et al

2020

Dyspnea and inhaled corticosteroid and long-acting β-agonist therapy in an occupational cohort: A longitudinal study

Putman B, Lahousse L, Singh A, et al

2020

Risk factors for incident prostate cancer in a cohort of World Trade Center responders

Clouston SA, Kuan P, Kotov R, et al

2019

Association of obesity with quantitative chest ct measured airway wall thickness in WTC workers with lower airway disease

de la Hoz RE, Liu X, Celedón JC, et al

2019

Chest ct scan findings in World Trade Center workers

de la Hoz RE, Weber J, Xu D, et al

2019

Inhaled corticosteroid and long-acting beta agonist therapy and longitudinal respiratory symptoms

Putman B, Lahousse L, and Singh A

2019

Self-management behaviors in World Trade Center rescue and recovery workers with asthma

Rojano B, West E, Goodman E, et al

2019

BACKGROUND: Asthma is a major source of morbidity among World Trade Center (WTC) rescue and recovery workers. While physical and mental health comorbidities have been associated with poor asthma control, the potential role and determinants of adherence to self-management behaviors (SMB) among WTC rescue and recovery workers is unknown. OBJECTIVES: To identify modifiable determinants of adherence to asthma self-management behaviors in WTC rescue and recovery worker that could be potential targets for future interventions. METHODS: We enrolled a cohort of 381 WTC rescue and recovery workers with asthma. Sociodemographic data and asthma history were collected during in-person interviews. Based on the framework of the Model of Self-regulation, we measured beliefs about asthma and controller medications. Outcomes included medication adherence, inhaler technique, use of action plans, and trigger avoidance. RESULTS: Medication adherence, adequate inhaler technique, use of action plans, and trigger avoidance were reported by 44%, 78%, 83%, and 47% of participants, respectively. Adjusted analyses showed that WTC rescue and recovery workers who believe that they had asthma all the time (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.38-4.08), that WTC-related asthma is more severe (OR: 1.73; 95% CI: 1.02-2.93), that medications are important (OR: 12.76; 95% CI: 5.51-29.53), and that present health depends on medications (OR: 2.39; 95% CI: 1.39-4.13) were more likely to be adherent to their asthma medications. Illness beliefs were also associated with higher adherence to other SMB. CONCLUSIONS: Low adherence to SMB likely contributes to uncontrolled asthma in WTC rescue and recovery workers. Specific modifiable beliefs about asthma chronicity, the importance of controller medications, and the severity of WTC-related asthma are independent predictors of SMB in this population. Cognitive behavioral interventions targeting these beliefs may improve asthma self-management and outcomes in WTC rescue and recovery workers. Key message: This study identified modifiable beliefs associated with low adherence to self-management behaviors among World Trade Center rescue and recovery rescue and recovery workers with asthma which could be the target for future interventions. CAPSULE SUMMARY: Improving World Trade Center-related asthma outcomes will require multifactorial approaches such as supporting adherence to controller medications and other self-management behaviors. This study identified several modifiable beliefs that may be the target of future efforts to support self-management in this patient population.

Lessons in post-disaster self-care from 9/11 paramedics and emergency medical technicians

Smith E, Walker T, and Burkle FM

2019

The role of modifiable health-related behaviors in the association between PTSD and respiratory illness

Waszczuk MA, Ruggero C, Li K, et al

2019

Obstructive sleep apnea in community members exposed to World Trade Center dust and fumes

Ahuja S, Zhu Z, Shao Y, et al

2018

Post-9/11 drug- and alcohol- related hospitalizations among World Trade Center Health Registry enrollees, 2003-2010

Hirst A, Miller-Archie SA, Welch AE, et al

2018

Considerations for future disaster registries: Effectiveness of treatment referral outreach in addressing long-term unmet 9/11 disaster needs

Petrsoric L, Miller-Archie SA, Welch A, et al

2018

Maladaptive personality traits and 10-year course of psychiatric and medical symptoms and functional impairment following trauma

Waszczuk MA, Li K, Ruggero CJ, et al

2018

Background: Personality is a major predictor of many mental and physical disorders, but its contributions to illness course are understudied. Purpose: The current study aimed to explore whether personality is associated with a course of psychiatric and medical illness over 10 years following trauma. Methods: World Trade Center (WTC) responders (N = 532) completed the personality inventory for DSM-5, which measures both broad domains and narrow facets. Responders' mental and physical health was assessed in the decade following the WTC disaster during annual monitoring visits at a WTC Health Program clinic. Multilevel modeling was used in an exploratory manner to chart the course of health and functioning, and examine associations of maladaptive personality domains and facets with intercepts (initial illness) and slopes (course) of illness trajectories. Results: Three maladaptive personality domains-negative affectivity, detachment and psychoticism-were uniquely associated with initial posttraumatic stress disorder (PTSD); detachment and psychoticism were also associated with initial functional impairment. Five facets-emotional lability, anhedonia, callousness, distractibility and perceptual dysregulation-were uniquely associated with initial mental and physical health and functional impairment. Anxiousness and depressivity facets were associated with worse initial levels of psychiatric outcomes only. With regard to illness trajectory, callousness and perceptual dysregulation were associated with the increase in PTSD symptoms. Anxiousness was associated with greater persistence of respiratory symptoms. Conclusions: Several personality domains and facets were associated with initial levels and long-term course of illness and functional impairment in a traumatized population. Results inform the role of maladaptive personality in the development and maintenance of chronic mental-physical comorbidity. Personality might constitute a transdiagnostic prognostic and treatment target.

Proton pump inhibitors and the risk of severe cognitive impairment: The role of posttraumatic stress disorder

Clouston SAP, Shapira O, Kotov R, et al

2017

Risk factors for persistence of lower respiratory symptoms among community members exposed to the 2001 World Trade Center terrorist attacks

Jordan HT, Friedman SM, Reibman J, et al

2017

A comparative assessment of major international disasters: The need for exposure assessment, systematic emergency preparedness, and lifetime health care

Lucchini RG, Hashim D, Acquilla S, et al

2017

BACKGROUND: The disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC) and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members. METHODS: Comparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i) exposure assessment; ii) exposed populations; iii) health surveillance; iv) follow-up and research outputs; v) observed physical and mental health effects; vi) treatment and benefits; and vii) outreach activities. RESULTS: Exposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1) Know who was there; 2) Have public health input to the disaster response; 3) Collect health and needs data rapidly; 4) Take care of the affected; 5) Emergency preparedness; 6) Data driven, needs assessment, advocacy. CONCLUSIONS: Given the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of future threats.

Posttraumatic stress symptoms and body mass index among World Trade Center disaster-exposed smokers: A preliminary examination of the role of anxiety sensitivity

Farris SG, Paulus DJ, Gonzalez A, et al

2016

Quality of life of persons injured on 9/11: Qualitative analysis from the World Trade Center Health Registry

Gargano LM, Gershon RR, and Brackbill RM

2016

INTRODUCTION: A number of studies published by the World Trade Center Health Registry (Registry) document the prevalence of injuries sustained by victims of the World Trade Center Disaster (WTCD) on 9/11. Injury occurrence during or in the immediate aftermath of this event has been shown to be a risk factor for long-term adverse physical and mental health status. More recent reports of ongoing physical health and mental health problems and overall poor quality of life among survivors led us to undertake this qualitative study to explore the long-term impact of having both disaster-related injuries and peri-event traumatic exposure on quality of life in disaster survivors. Methods: Semi-structured, in-depth individual telephone interviews were conducted with 33 Registry enrollees who reported being injured on 9/11/01. Topics included: extent and circumstance of the injury(ies), description of medical treatment for injury, current health and functional status, and lifestyle changes resulting from the WTCD. The interviews were recorded, transcribed, and inductively open-coded for thematic analysis. RESULTS: Six themes emerged with respect to long term recovery and quality of life: concurrent experience of injury with exposure to peri-event traumatic exposure (e.g., witnessing death or destruction, perceived life threat, etc.); sub-optimal quality and timeliness of short- and long-term medical care for the injury reported and mental health care; poor ongoing health status, functional limitations, and disabilities; adverse impact on lifestyle; lack of social support; and adverse economic impact. Many study participants, especially those reporting more serious injuries, also reported self-imposed social isolation, an inability to participate in or take enjoyment from previously enjoyable leisure and social activities and greatly diminished overall quality of life. DISCUSSION: This study provided unique insight into the long-term impact of disasters on survivors. Long after physical injuries have healed, some injured disaster survivors report having serious health and mental health problems, economic problems due to loss of livelihood, limited sources of social support, and profound social isolation. Strategies for addressing the long-term health problems of disaster survivors are needed in order to support recovery.

Radiologic features of World Trade Center-related sarcoidosis in exposed NYC fire department rescue workers

Girvin F, Zeig-Owens R, Gupta D, et al

2016

PURPOSE: An increased incidence of sarcoidosis has been demonstrated in firefighters, supporting the concern that occupational/environmental exposure may pose an etiologic risk factor. This incidence increased further after September 11, 2001 following exposure to World Trade Center (WTC) dust and gases. We review computed tomography (CT) features in this population, comparing the range of findings and physiological correlates with those typically reported in unexposed individuals with pulmonary sarcoidosis. MATERIALS AND METHODS: With CT imaging we retrospectively identified 46 patients with WTC-related sarcoidosis, between March 18, 2002 and April 5, 2014. Scans were independently reviewed by 2 dedicated thoracic radiologists and assessed for disease patterns and correlation with pulmonary functions. RESULTS: The majority (37/46; 80%) had symmetric mediastinal and hilar lymphadenopathy. Similarly, most (38/46; 83%) had perilymphatic nodules. Foci of ill-defined ground glass attenuation were present in 6 (13%). Coalescent nodularity was present in 15 (33%). Only 3 (7%) had parenchymal reticulation. A mixed pattern of lung findings was present in 21 (46%). When all forms of parenchymal disease were scored by zonal distribution, 21 (46%) had parenchymal disease predominantly involving mid and upper lungs; 11/46 (24%) had a random distribution without zonal predominance; 6/46 (13%) demonstrated atypical lower zone predominance. Whereas 15/46 (33%) had obstructive airways disease on pulmonary function tests, there were no CT findings that were predictive of obstructive airways disease. CONCLUSIONS: The majority of cases of WTC-related sarcoidosis demonstrated typical radiographic appearances of sarcoidosis, with symmetric hilar and mediastinal lymphadenopathy and mid to upper lung perilymphatic nodules; these findings were consistent with other previously reported cases of sarcoid-like granulomatous disease in association with various alternate underlying etiologies. There was no correlation between disease patterns or extent on CT and pulmonary function testing, likely at least in part due to the overall mild extent of disease in this population.

Posttraumatic stress disorder and the risk of respiratory problems in World Trade Center responders: Longitudinal test of a pathway

Kotov R, Bromet EJ, Schechter C, et al

2015

Chitotriosidase is a biomarker for the resistance to World Trade Center lung injury in New York City firefighters

Cho SJ, Nolan A, Echevarria GC, et al

2013

Chronic and acute exposures to the World Trade Center disaster and lower respiratory symptoms: Area residents and workers

Maslow CB, Friedman SM, Pillai PS, et al

2012

Inflammatory biomarkers predict airflow obstruction after exposure to World Trade Center dust

Nolan A, Naveed B, Comfort AL, et al

2012

Respiratory protective equipment, mask use, and respiratory outcomes among World Trade Center rescue and recovery workers

Antao VC, Pallos LL, Shim YK, et al

2011

Case-control study of lung function in World Trade Center Health Registry area residents and workers

Friedman SM, Maslow CB, Reibman J, et al

2011

Work-related injuries and illnesses reported by World Trade Center response workers and volunteers

Perritt KR, Herbert R, Levin SM, et al

2011

INTRODUCTION: In 2002, the Mount Sinai Center for Occupational and Environmental Medicine, with support from the National Institute for Occupational Safety and Health (NIOSH), began coordinating the World Trade Center (WTC) Worker and Volunteer Medical Screening Program (MSP) to monitor the health of qualified WTC responders. Enrolled participants were offered a clinical examination; interviewed to collect medical, mental health, and exposure information; and requested to complete a self-administered medical questionnaire. The objective of this study was to better understand work-related injuries and illnesses sustained on-site by WTC responders. METHODS: A descriptive analysis of select data from the MSP self-administered medical questionnaire was conducted. Data collected July 2002 through April 2004 from MSP participants enrolled at the Mount Sinai clinic were reviewed using univariate statistical techniques. RESULTS: Records from 7,810 participants were analyzed, with most participants associated with either the construction industry (n = 2,623, 34%) or law enforcement (n = 2,036, 26%). Approximately a third of the participants (n = 2,486, 32%) reported at least one injury or illness requiring medical treatment that was sustained during WTC work/volunteer activities. Of the total 4,768 injuries/illnesses reported by these participants, respiratory complaints were most common (n = 1,350, 28%), followed by traumatic injuries excluding eye injuries (n = 961, 20%), eye injuries/ailments (n = 709, 15%), chest pain (n = 375, 8%), headaches (n = 359, 8%), skin conditions (n = 178, 4%), and digestive system conditions (n = 163, 3%). Participants reported that 36% of injuries/illnesses were treated off-site and 29% were treated on-site, with the remaining not specifying treatment location. Off-site treatment was prevalent for respiratory complaints, psychological stress, and chest pain. On-site treatment was predominate for eye injuries/ailments and traumatic injuries excluding eye injuries. CONCLUSION: Study results underscore the need for rapid deployment of personal protective equipment for disaster responders and medical care stations mobilized near disaster worksites. Additionally, the results, many of which are comparable to findings from previous WTC studies where data were collected in real-time, indicate that a screening program such as the MSP may be effective in retrospectively providing general information on disaster responder demographics and work-related injuries and illnesses.

Birth outcomes among offspring of women exposed to the September 11, 2001, terrorist attacks

Lipkind HS, Curry AE, Huynh M, et al

2010

Long-term respiratory symptoms in World Trade Center responders

Mauer MP, Cummings KR, and Hoen R

2010

Mental health of workers and volunteers responding to events of 9/11: Review of the literature

Bills CB, Levy NA, Sharma V, et al

2008

Occupational toxicant inhalation injury: The World Trade Center (WTC) experience

de la Hoz RE, Shohet MR, Chasan R, et al

2008

Birth outcomes among Arab Americans in Michigan before and after the terrorist attacks of September 11, 2001

El-Sayed A, Hadley C, and Galea S

2008

Standardization of spirometry in assessment of responders following man-made disasters: World Trade Center worker and volunteer medical screening program

Enright P, Skloot G, and Herbert R

2008

BACKGROUND: Spirometry is the most commonly used pulmonary function test to screen individuals for suspected lung disease. It is also used for screening workers with exposures to agents associated with pulmonary diseases. Although the American Thoracic Society (ATS) provides guidelines for spirometers and spirometry techniques, many factors are not standardized, so that results from individual pulmonary function laboratories vary substantially. These differences can create substantial difficulties in using data pooled from multiple sites to understand health consequences of disasters that involve exposures to pulmonary toxins. This article describes the approach used to minimize these differences for a consortium of institutions who are providing medical monitoring examinations to World Trade Center (WTC) responders. The protocol improved upon the minimal ATS guidelines. METHODS: Spirometric measurements were obtained before and after use of a bronchodilator. A fourth-generation spirometer was chosen that exceeded ATS spirometer accuracy standards. The accuracy was verified at the beginning of each day of testing. Technologists who performed the spirometry tests were centrally trained and certified and received regular reports on their performance. Reference values and normal ranges were obtained from the National Health and Nutrition Examination Survey (NHANES III) data set. A standardized interpretation flowchart was followed to reduce misclassification rates for airway obstruction and restriction. Patients with spirometric abnormalities were referred for more extensive diagnostic testing. RESULTS: More than 12,000 spirometry tests were performed during the first examination. The 20 spirometers used at the 6 participating institutions maintained accuracy within 3% for more than 4 years. Overall, more than 80% of the test sessions met ATS quality goals. Spirometry abnormality rates exceeded those obtained for adults who participated in the NHANES III survey. CONCLUSIONS: The program allowed standardization of the performance and interpretation of spirometry results across multiple institutions. This facilitated reliable and rapid diagnosis of lung disease in the large number of WTC responders screened. We recommend this approach for postdisaster pulmonary evaluations in other settings.

Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings

Brackbill RM, Thorpe LE, DiGrande L, et al

2006

PROBLEM/CONDITION: Survivors of collapsed or damaged buildings from the attack on the World Trade Center (WTC) were among those most exposed to injury hazards, air pollution, and traumatic events. REPORTING PERIOD: This report summarizes data from health outcomes collected during interviews conducted from September 5, 2003, to the close of the World Trade Center Health Registry (WTCHR) enrollment on November 20, 2004. DESCRIPTION OF SYSTEM: WTCHR will be used to monitor periodically the mental and physical health of 71,437 enrollees for 20 years. The analysis is limited to 8,418 adult survivors of collapsed buildings (n = 5,095) and buildings with major or moderate damage (n = 3,323), excluding those who were involved in rescue and recovery. RESULTS: A total of 62.4% of survivors of collapsed or damaged buildings were caught in the dust and debris cloud that resulted from the collapse of the WTC towers, and 63.8% experienced three or more potentially psychologically traumatizing events. Injuries were common (43.6%), but few survivors reported injuries that would have required extensive treatment. More than half (56.6%) of survivors reported experiencing new or worsening respiratory symptoms after the attacks, 23.9% had heartburn/reflux, and 21.0% had severe headaches. At the time of the interview, 10.7% of building survivors screened positive for serious psychological distress (SPD) using the K6 instrument. After multiple adjustments, data indicated that survivors caught in the dust and debris cloud were more likely to report any injuries (adjusted odds ratio [AOR] = 3.9; p< or =0.05); any respiratory symptom (AOR = 2.7; p< or =0.05); severe headaches (AOR = 2.0; p< or =0.05); skin rash/irritation (AOR = 1.7; p< or =0.05); hearing problems or loss (AOR = 1.7; p< or =0.05); heartburn (AOR = 1.7; p< or =0.05); diagnosed stroke (AOR = 5.6; p< or =0.05); self-reported depression, anxiety, or other emotional problem (AOR = 1.4; p< or =0.05); and current SPD (AOR = 2.2; p< or =0.05). Adjustment for SPD did not diminish the observed associations between dust cloud exposure and physical health outcomes. Building type and time of evacuation were associated with injuries on September 11, 2001 and reported symptoms; building type (collapsed versus damaged) also was associated with mental distress. INTERPRETATION: Two to three years after September 11, survivors of buildings that collapsed or that were damaged as a result of the WTC attack reported substantial physical and mental health problems. The long-term ramifications of these effects are unknown. Many survivors were caught directly in the dust and debris of collapsing towers, a dense cloud of particulate matter that might have produced or exacerbated these health effects. PUBLIC HEALTH ACTION RECOMMENDED: Long-term follow-up of building survivors and all other persons enrolled in WTCHR should be maintained, with particular attention to those persons exposed to the dust cloud. Some of these findings might lead to building designs that can minimize injury hazards.

The impact of 9/11 on New York City's substance abuse treatment programs: A study of program administrators

Frank B, Dewart T, Schmeidler J, et al

2006

Panic reactions to terrorist attacks and probable posttraumatic stress disorder in adolescents

Pfefferbaum B, Stuber J, Galea S, et al

2006

Disparities in mental health treatment following the World Trade Center disaster: Implications for mental health care and health services research

Boscarino JA, Adams RE, Stuber J, et al

2005

To assess disparities in mental health treatment in New York City (NYC) after the World Trade Center Disaster (WTCD) reported previously related to care access, we conducted analyses among a cross-sectional survey of adults who had posttraumatic stress disorder (PTSD) or major depression (N = 473) one year after the event. The dependent variables examined were use of mental health services, in general, and use of mental health services related to the WTCD. Similar dependent variables were developed for medication usage. Although a number of bivariate results were statistically significant for postdisaster mental health visits, in a multivariate logistic regression model, only WTCD exposure remained significant. For service utilization related to the WTCD, the multivariate results indicated that African Americans were less likely to have had these visits compared to Whites, while those with a regular doctor, who had greater exposure to WTCD events, and those who had a perievent panic attack were more likely to have had such visits. In terms of medication use, multivariate results suggested that African Americans were less likely to use postdisaster medications, whereas persons 45 + years old and those with a regular doctor, were more likely to use them. For WTCD-related medication use, multivariate models indicated that African Americans were less likely to use medications, relative to Whites, while those between 45 and 64 years old, those with a regular doctor, those exposed to more WTCD events, and those who had a perievent panic attack, were more likely to have taken medications related to the disaster. The primary reason respondents gave for not seeking treatment (55% of subsample) was that they did not believe that they had a problem (73%). Other reasons were that they wanted to solve the problem on their own (5%), had problems accessing services (6%), had financial problems (4%), or had a fear of treatment (4%). Despite the availability of free mental health services offered in a supportive and potentially less stigmatizing environment post disaster, there still appeared to be barriers to receiving postdisaster services among those presumably in need of care.

Participant reactions to survey research in the general population after terrorist attacks

Galea S, Nandi A, Stuber J, et al

2005

World Trade Center dyspnea: Bronchiolitis obliterans with functional improvement: A case report

Mann JM, Sha KK, Kline G, et al

2005

Injuries and illnesses treated at the World Trade Center, 14 September-20 november 2001

Perritt KR, Boal WL, and Helix Group I

2005

EMDR therapy following the 9/11 terrorist attacks: A community-based intervention project in New York City

Silver SM, Rogers S, Knipe J, et al

2005

Editors' conclusion: Child, youth, and parent responses to the terrorism of September 11, 2001: Implications for applied developmental science and practice

Aber JL and Gershoff ET

2004

Semivolatile organic compounds in window films from lower Manhattan after the September 11th World Trade Center attacks

Butt CM, Diamond ML, Truong J, et al

2004

Induced sputum assessment in New York City firefighters exposed to World Trade Center dust

Fireman EM, Lerman Y, Ganor E, et al

2004

Respiratory symptoms and physiologic assessment of ironworkers at the World Trade Center disaster site

Skloot G, Goldman M, Fischler D, et al

2004

STUDY OBJECTIVES: To characterize respiratory abnormalities in a convenience sample of ironworkers exposed at the World Trade Center (WTC) disaster site for varying lengths of time between September 11, 2001, and February 8, 2002. DESIGN: Cross-sectional study. SETTING: The Mount Sinai Medical Center, a large tertiary hospital. PARTICIPANTS: Ninety-six ironworkers engaged in rescue and recovery with exposure onset between September 11, 2001, and September 15, 2001, who responded to an invitation to undergo respiratory evaluation. MEASUREMENTS: Medical and exposure history, physical examination, spirometry, forced oscillation (FO), and chest radiographs. The relationships of prevalence of respiratory symptoms and presence of obstructive physiology to smoking, exposure on September 11, duration of exposure, and type of respiratory protection were examined using univariate and linear and logistic regression analyses. RESULTS: Seventy-four of 96 workers (77%) had one or more respiratory symptoms (similar in smokers [49 of 63 subjects, 78%] and nonsmokers [25 of 33 subjects, 76%]). Cough was the most common symptom (62 of 96 subjects, 65%), and was associated with exposure on September 11. Chest examination and radiograph findings were abnormal in 10 subjects (10%) and 19 subjects (20%), respectively. FO revealed dysfunction in 34 of 64 subjects tested (53%), while spirometry suggested obstruction in only 11 subjects (17%). Lack of a respirator with canister was a risk factor for large airway dysfunction, and cigarette smoking was a risk factor for small airway dysfunction. No other relationships reached statistical significance. CONCLUSIONS: Respiratory symptoms occurred in the majority of ironworkers at the WTC disaster site and were not attributable to smoking. Exposure on September 11 was associated with a greater prevalence of cough. Objective evidence of lung disease was less common. Spirometry underestimated the prevalence of lung function abnormalities in comparison to FO. Continuing evaluation of symptoms, chest radiographs, and airway dysfunction should determine whether long-term clinical sequelae will exist.

World Trade Center rescue worker injury and illness surveillance, New York, 2001

Berrios-Torres SI, Greenko JA, Phillips M, et al

2003

BACKGROUND: The September 11, 2001, terrorist attacks on the World Trade Center in New York City, New York, prompted an unprecedented rescue and recovery response. Operations were conducted around the clock, involved over 5000 workers per day, and extended into months following the attacks. The City of New York Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention implemented prospective surveillance to characterize rescue worker-related injury and illness and to help guide public health interventions. METHODS: From September 11 to October 11, 2001, personnel reviewed medical records at four Manhattan hospital emergency departments (EDs), and healthcare providers completed data collection forms at five temporary Disaster Medical Assistance Team (DMAT) facilities located at the site. Rescue workers included construction workers, police officers, firefighters, emergency medical service technicians, or Urban Search and Rescue workers. Data collected included demographic characteristics, injury type, illness, and disposition. RESULTS: Of 5222 rescue worker visits, 89% were to DMAT facilities and 12% to EDs. Musculoskeletal conditions were the leading cause of visits (19%), followed by respiratory (16%) and eye (13%) disorders. Incidence rates were estimated based on total injuries and/or illnesses reported times 200,000 (100 equivalent full-time workers in 1 year at 40 hours per week x 50 weeks per year), then divided by the total number of hours worked. Eye disorders (59.7) accounted for the highest estimated injury and illness rate, followed by headache (46.8). One death, 52 hospital admissions, and 55 transports were reported. Findings underscored the need to coordinate distribution and enforcement of personal protective equipment use, purchase of diagnostic equipment to diagnose corneal abrasions, and distribution of health advisories. CONCLUSIONS: This system provided objective, timely information that helped guide public health interventions in the immediate aftermath of the attacks and during the prolonged rescue and recovery operations. Lessons learned can be used to guide future surveillance efforts.

Health effects of World Trade Center site workers

Levin S, Herbert R, Skloot G, et al

2002

Health effects and occupational exposures among office workers near the World Trade Center disaster site

Trout D, Nimgade A, Mueller C, et al

2002

A vulnerable population in a time of crisis: Drug users and the attacks on the World Trade Center

Weiss L, Fabri A, McCoy K, et al

2002

Randomized controlled trial of two internet-based written therapies for World Trade Center workers and survivors with persistent PTSD symptoms

Feder A, Kowalchyk ML, Brinkman HR, et al.

2024

Inflammatory markers in World Trade Center workers with asthma: Associations with post-traumatic stress disorder

Wisnivesky JP, Agrawal N, Ankam J, et al.

2024

All-cause and cause-specific mortality in a cohort of WTC-exposed and non-WTC-exposed firefighters

Singh A, Zeig-Owens R, Cannon M, et al.

2023

OBJECTIVE: To compare mortality rates in World Trade Center (WTC)-exposed Fire Department of the City of New York (FDNY) firefighters with rates in similarly healthy, non-WTC-exposed/non-FDNY firefighters, and compare mortality in each firefighter cohort with the general population. METHODS: 10 786 male WTC-exposed FDNY firefighters and 8813 male non-WTC-exposed firefighters from other urban fire departments who were employed on 11 September 2001 were included in the analyses. Only WTC-exposed firefighters received health monitoring via the WTC Health Programme (WTCHP). Follow-up began 11 September 2001 and ended at the earlier of death date or 31 December 2016. Death data were obtained from the National Death Index and demographics from the fire departments. We estimated standardised mortality ratios (SMRs) in each firefighter cohort versus US males using demographic-specific US mortality rates. Poisson regression models estimated relative rates (RRs) of all-cause and cause-specific mortality in WTC-exposed versus non-WTC-exposed firefighters, controlling for age and race. RESULTS: Between 11 September 2001 and 31 December 2016, there were 261 deaths among WTC-exposed firefighters and 605 among non-WTC-exposed. Both cohorts had reduced all-cause mortality compared with US males (SMR (95% CI)=0.30 (0.26 to 0.34) and 0.60 (0.55 to 0.65) in WTC-exposed and non-WTC-exposed, respectively). WTC-exposed firefighters also had lower rates of all-cause mortality (RR=0.54, 95% CI=0.49 to 0.59) and cancer-specific, cardiovascular-specific and respiratory disease-specific mortality compared with non-WTC-exposed firefighters. CONCLUSION: Both firefighter cohorts had lower than expected all-cause mortality. Fifteen years post 11 September 2001, mortality was lower in WTC-exposed versus non-WTC-exposed firefighters. Lower mortality in the WTC-exposed suggests not just a healthy worker effect, but additional factors such as greater access to free health monitoring and treatment that they receive via the WTCHP.

Scientific value of the sub-cohort of children in the World Trade Center Health Registry

Brackbill RM, Butturini E, Cone JE, et al.

2022

Twenty-year reflection on the impact of World Trade Center exposure on pulmonary outcomes in fire department of the city of New York (FDNY) rescue and recovery workers

Cleven KL, Rosenzvit C, Nolan A, et al

2021

The association of post-traumatic stress disorder with longitudinal change in glomerular filtration rate in World Trade Center responders

Koraishy FM, Coca SG, Cohen BE, et al

2021

Post-traumatic stress disorder and the association with overweight, obesity, and weight change among individuals exposed to the World Trade Center disaster, 2003-2016

Takemoto E, Van Oss KR, Chamany S, et al

2021

Impact on rats from acute intratracheal inhalation exposures to WTC dusts

Cohen MD, Prophete C, Horton L, et al

2020

World Trade Center dust induces airway inflammation while promoting aortic endothelial dysfunction

Hernandez M, Harrington A, Ma Y, et al

2020

Reported worst life events and media exposure to terrorism in a nationally representative u.S. Sample

Thompson RR, Holman EA, and Silver RC

2020

Cancers related to 9/11 in responders & survivors

Vidaurri V

2020

Quantitative ct evidence of airway inflammation in WTC workers and volunteers with low fvc spirometric pattern

Weber J, Reeves AP, Doucette JT, et al

2020

Metabolic syndrome and air pollution: A narrative review of their cardiopulmonary effects

Clementi EA, Talusan A, Vaidyanathan S, et al

2019

Increased pulmonary artery diameter is associated with reduced FEV1 in former World Trade Center workers

de la Hoz RE, Jeon Y, Reeves AP, et al

2019

Posttraumatic stress disorder symptoms and sleep in the daily lives of World Trade Center responders

Dietch JR, Ruggero CJ, Schuler K, et al

2019

Associations between asthma trigger reports, mental health conditions, and asthma morbidity among World Trade Center rescue and recovery workers

Morales-Raveendran E, Goodman E, West E, et al

2019

Comparison of two home sleep testing devices with different strategies for diagnosis of osa

Gumb T, Twumasi A, Alimokhtari S, et al

2018

PURPOSE: Home sleep testing devices are being widely used in diagnosis/screening for obstructive sleep apnea (OSA). We examined differences in OSA metrics obtained from two devices with divergent home monitoring strategies, the Apnea Risk Evaluation System (ARES, multiple signals plus forehead reflectance oximetry) and the Nonin WristOx2 (single channel finger transmission pulse oximeter), compared to differences from night-night variability of OSA. METHODS: One hundred fifty-two male/26 female subjects (BMI = 30.3 +/- 5.6 kg/m(2), age = 52.5 +/- 8.9 years) were recruited without regard to OSA symptoms and simultaneously wore both ARES and Nonin WristOx2 for two nights (n = 351 nights). Automated analysis of the WristOx2 yielded oxygen desaturation index (ODIOx2, >/=4% O2 dips/h), and automated analysis with manual editing of ARES yielded AHI4ARES (apneas + hypopneas with >/=4% O2 dips/h) and RDIARES (apneas + hypopneas with >/=4% O2 dips/h or arousal surrogates). Baseline awake oxygen saturation, percent time < 90% O2 saturation (%time < 90%O2Sat), and O2 signal loss were compared between the two methods. RESULTS: Correlation between AHI4ARES and ODIOx2 was high (ICC = 0.9, 95% CI = 0.87-0.92, p < 0.001, bias +/- SD = 0.7 +/- 6.1 events/h). Agreement values for OSA diagnosis (77-85%) between devices were similar to those seen from night-to-night variability of OSA using a single device. Awake baseline O2 saturation was significantly higher in the ARES (96.2 +/- 1.6%) than WristOx2 (92.2 +/- 2.1%, p < 0.01). There was a significantly lower %time < 90%O2Sat reported by the ARES compared to WristOx2 (median (IQR) 0.5 (0.0, 2.6) vs. 2.1 (0.3, 9.7), p < 0.001), and the correlation was low (ICC = 0.2). CONCLUSIONS: OSA severity metrics predominantly dependent on change in oxygen saturation and metrics used in diagnosis of OSA (AHI4 and ODI) correlated well across devices tested. However, differences in cumulative oxygen desaturation measures (i.e., %time < 90%O2Sat) between the devices suggest that caution is needed when interpreting this metric particularly in populations likely to have significant hypoxia.

Adolescents exposed to the World Trade Center collapse have elevated serum dioxin and furan concentrations more than 12years later

Kahn LG, Han X, Koshy TT, et al

2018

BACKGROUND: The collapse of the World Trade Center (WTC) on September 11, 2001 released a dust cloud containing numerous environmental contaminants, including polychlorinated dibenzo-para-dioxins and polychlorinated dibenzofurans (PCDD/Fs). PCDD/Fs are toxic and are associated with numerous adverse health outcomes including cancer, diabetes, and impaired reproductive and immunologic function. Prior studies have found adults exposed to the WTC disaster to have elevated levels of PCDD/Fs. This is the first study to assess PCDD/F levels in WTC-exposed children. METHODS: This analysis includes 110 participants, a subset of the 2014-2016 WTC Adolescent Health Study, a group of both exposed youths who lived, attended school, or were present in lower Manhattan on 9/11 recruited from the WTC Health Registry (WTCHR) and unexposed youths frequency matched on age, sex, race, ethnicity, and income. Our sample was selected to maximize the contrast in their exposure to dust from the WTC collapse. Questionnaire data, including items about chronic home dust and acute dust cloud exposure, anthropometric measures, and biologic specimens were collected during a clinic visit. Serum PCDD/F concentrations were measured according to a standardized procedure at the New York State Department of Health Organic Analytical Laboratory. We used multivariable linear regression to assess differences in PCCD/Fs between WTCHR and non-WTCHR participants. We also compared mean and median PCDD/F and toxic equivalency (TEQ) concentrations in our cohort to 2003-4 National Health and Nutrition Examination Survey (NHANES) levels for youths age 12-19. RESULTS: Median PCDD/F levels were statistically significantly higher among WTCHR participants compared to non-WTCHR participants for 16 out of 17 congeners. Mean and median TEQ concentrations in WTCHR participants were >7 times those in non-WTCHR participants (72.5 vs. 10.1 and 25. 3 vs. 3.39pg/g lipid, respectively). Among WTCHR participants, median concentrations of several PCDD/Fs were higher than the NHANES 95th percentiles. After controlling for dust cloud exposure, home dust exposure was significantly associated with higher PCDD/F level. CONCLUSIONS: Adolescents in lower Manhattan on the day of the WTC attack and exposed to particulate contamination from the WTC collapse had significantly elevated PCDD/F levels >12years later compared to a matched comparison group, driven by chronic home dust exposure rather than acute dust cloud exposure. PCDD/F and TEQ levels substantially exceeded those in similar-aged NHANES participants. Future studies are warranted to explore associations of PCDD/Fs with health and developmental outcomes among individuals exposed to the WTC disaster as children.

Risk factors for post-9/11 chronic rhinosinusitis in Fire Department of the City of New York workers

Putman B, Zeig-Owens R, Singh A, et al

2018

Hurricane sandy exposure and the mental health of World Trade Center responders

Bromet EJ, Clouston S, Gonzalez A, et al

2017

Respiratory problems and anxiety sensitivity in smoking lapse among treatment seeking smokers

Zvolensky MJ, Rodriguez-Cano R, Paulus DJ, et al

2017

Risk factors for and consequences of persistent lower respiratory symptoms among World Trade Center health registrants 10 years after the disaster

Friedman SM, Farfel MR, Maslow C, et al.

2016

A PTSD symptoms trajectory mediates between exposure levels and emotional support in police responders to 9/11: A growth curve analysis

Schwarzer R, Cone JE, Li J, et al

2016

Trajectories of PTSD among lower Manhattan residents and area workers following the 2001 World Trade Center disaster, 2003-2012

Welch AE, Caramanica K, Maslow CB, et al

2016

The role of epidemiology in disaster response policy development

Thorpe LE, Assari S, Deppen S, et al

2015

Implications of the World Trade Center Health Program (WTChp) for the public health response to the great east japan earthquake

Crane MA, Cho HG, and Landrigan PJ

2014

Estimating the time interval between exposure to the World Trade Center disaster and incident diagnoses of obstructive airway disease

Glaser MS, Webber MP, Zeig-Owens R, et al

2014

Respiratory health of 985 children exposed to the World Trade Center disaster: Report on World Trade Center Health Registry wave 2 follow-up, 2007-2008

Stellman SD, Thomas PA, S SO, et al

2013

BACKGROUND: The World Trade Center (WTC) disaster of September 11, 2001, has been associated with early respiratory problems including asthma in workers, residents, and children. Studies on adults have documented persistence of longer term, 9/11-related respiratory symptoms. There are no comparable reports on children. METHODS: We surveyed 985 children aged 5-17 years who enrolled in the WTC Health Registry in 2003-04, and who were re-surveyed in 2007-08. Health data were provided by parents in both surveys and focused on respiratory symptoms suggestive of reactive airway impairment (wheezing or the combination of cough and shortness of breath) in the preceding 12 months. At follow-up, adolescents aged 11-17 years completed separate surveys that screened for post-traumatic stress symptoms and behavior problems (Strengths and Difficulties Questionnaire, SDQ). Associations between respiratory symptoms in the prior 12 months with 9/11 exposures and behavioral outcomes were evaluated with univariate and multivariate methods. RESULTS: Of the 985 children, 142 (14.4%) children reported respiratory symptoms in the prior 12 months; 105 (73.9%) children with respiratory symptoms had previously been diagnosed with asthma. Among children aged 5-10 years, respiratory symptoms were significantly elevated among African-Americans (adjusted odds ratio, (aOR) 3.8; 95% confidence interval (CI) 1.2-11.5) and those with household income below $75,000 (aOR 1.9; CI 1.0-3.7), and was more than twice as great in children with dust cloud exposure (aOR 2.2; CI 1.2-3.9). Among adolescents aged 11-17 years, respiratory symptoms were significantly associated with household income below $75,000 (aOR 2.4; CI 1.2-4.6), and with a borderline or abnormal SDQ score (aOR 2.7, 95% CI 1.4-5.2). Symptoms were reported more than twice as often by adolescents with vs. without dust cloud exposure (24.8% vs. 11.5%) but the adjusted odds ratio was not statistically significant (aOR 1.7; CI 0.9-3.2), CONCLUSIONS: Most Registry children exposed to the 9/11 disaster in New York City reported few respiratory problems. Respiratory symptoms were associated with 9/11 exposures in younger children and with behavioral difficulties in adolescents. Our findings support the need for continued surveillance of 9/11 affected children as they reach adolescence and young adulthood, and for awareness of both physical and behavioral difficulties by treating clinicians.

Cardiovascular biomarkers predict susceptibility to lung injury in World Trade Center dust-exposed firefighters

Weiden MD, Naveed B, Kwon S, et al

2013

Co-occurring lower respiratory symptoms and posttraumatic stress disorder 5 to 6 years after the World Trade Center terrorist attack

Nair HP, Ekenga CC, Cone JE, et al

2012

Metabolic syndrome biomarkers predict lung function impairment: A nested case-control study

Naveed B, Weiden MD, Kwon S, et al

2012

RATIONALE: Cross-sectional studies demonstrate an association between metabolic syndrome and impaired lung function. OBJECTIVES: To define if metabolic syndrome biomarkers are risk factors for loss of lung function after irritant exposure. METHODS: A nested case-control study of Fire Department of New York personnel with normal pre-September 11th FEV(1) and who presented for subspecialty pulmonary evaluation before March 10, 2008. We correlated metabolic syndrome biomarkers obtained within 6 months of World Trade Center dust exposure with subsequent FEV(1). FEV(1) at subspecialty pulmonary evaluation within 6.5 years defined disease status; cases had FEV(1) less than lower limit of normal, whereas control subjects had FEV(1) greater than or equal to lower limit of normal. MEASUREMENTS AND MAIN RESULTS: Clinical data and serum sampled at the first monitoring examination within 6 months of September 11, 2001, assessed body mass index, heart rate, serum glucose, triglycerides and high-density lipoprotein (HDL), leptin, pancreatic polypeptide, and amylin. Cases and control subjects had significant differences in HDL less than 40 mg/dl with triglycerides greater than or equal to 150 mg/dl, heart rate greater than or equal to 66 bpm, and leptin greater than or equal to 10,300 pg/ml. Each increased the odds of abnormal FEV(1) at pulmonary evaluation by more than twofold, whereas amylin greater than or equal to 116 pg/ml decreased the odds by 84%, in a multibiomarker model adjusting for age, race, body mass index, and World Trade Center arrival time. This model had a sensitivity of 41%, a specificity of 86%, and a receiver operating characteristic area under the curve of 0.77. CONCLUSIONS: Abnormal triglycerides and HDL and elevated heart rate and leptin are independent risk factors of greater susceptibility to lung function impairment after September 11, 2001, whereas elevated amylin is protective. Metabolic biomarkers are predictors of lung disease, and may be useful for assessing risk of impaired lung function in response to particulate inhalation.

Sarcoid like granulomatous pulmonary disease in World Trade Center disaster responders

Crowley LE, Herbert R, Moline JM, et al

2011

Prevalence and incidence of high risk for obstructive sleep apnea in World Trade Center-exposed rescue/recovery workers

Webber MP, Lee R, Soo J, et al

2011

The World Trade Center clean up and recovery worker cohort study: Respiratory health amongst cleanup workers approximately 20 months after initial exposure at the disaster site

Tao XG, Massa J, Ashwell L, et al

2007

A prospective cohort study of the effectiveness of employer-sponsored crisis interventions after a major disaster

Boscarino JA, Adams RE, and Figley CR

2005

Polychlorinated dioxins and furans from the World Trade Center attacks in exterior window films from lower Manhattan in New York City

Rayne S, Ikonomou MG, Butt CM, et al

2005

Behavioral impairments and increased risk of cortical atrophy risk scores among World Trade Center responders

Chen APF, Ismail Z, Mann FD, et al.

2023

Explainable automated evaluation of the clock drawing task for memory impairment screening

Handzlik D, Richmond LL, Skiena S, et al.

2023

Detecting genetic heterogeneities in response to trauma: The case of 9/11

Furuya S, Fletcher JM, Zhao Z, et al.

2022

Polygenic association of glomerular filtration rate decline in World Trade Center responders

Koraishy FM, Mann FD, Waszczuk MA, et al.

2022

Characteristics of women with lung adenocarcinoma in the World Trade Center Environmental Health Center

Shum E, Durmus N, Pehlivan S, et al

2022

Metabolic risk factors and the development of World Trade Center-lung disease

Holguin F

2021

Association between socioeconomic status and asthma-related emergency department visits among World Trade Center rescue and recovery workers and survivors

Brite J, Alper HE, Friedman S, et al

2020

Importance: Although the association between poor economic or social standing and health is well established, few studies have attempted to examine the mediational pathways that produce adverse outcomes in disadvantaged populations. Objective: To determine whether barriers to care mediate the association between socioeconomic status (SES) and asthma-related emergency department (ED) visits. Design, Setting, and Participants: This cohort study used data from the World Trade Center Health Registry, which comprises rescue and recovery workers and community members who worked, lived, studied or were otherwise present in downtown Manhattan, New York, during or immediately after the September 11, 2001, disaster. Data were matched to an administrative database of ED visits. Those who experienced an asthma-related ED visit and those who did not were compared in bivariate analysis. A mediation analysis was conducted to determine the role of barriers to care in the association between number of ED visits and SES. Exposures: Education, income, and race/ethnicity, which were collected at first survey in 2003 to 2004. Main Outcomes and Measures: Asthma-related ED visits that occurred after survey responses regarding barriers to care were collected (2006-2007) but before 2016, the latest date that data were available. Results: The analytic sample included 30452 enrollees (18585 [61%] male; median [interquartile range] age, 42.0 [35.0-50.0] years; 20180 [66%] white, 3834 [13%] African American, and 3961 [13%] Hispanic or Latino [any race]). Approximately half (49%) had less than a bachelor's degree, and 15% had an annual income less than $35000. Those of lower SES were more likely to experience an asthma-related ED visit. Although number of barriers to care mediated this association, they explained only a small percentage of the overall health disparity (ranging from 3.0% [95% CI, 2.3%-3.9%]) of the differences between African American and white individuals to 9.8% [95% CI, 7.7%-11.9%]) comparing those with less than a high school diploma to those with at least a bachelor's degree. However, the association varied by specific barrier to care. Lack of money, insurance, and transportation mediated up to 11.8% (95% CI, 8.1%-15.9%), 12.5% (95% CI, 8.5%-17.4%), and 4.3% (95% CI, 1.7%-8.4%), respectively, of the association between SES and number of ED visits. Lack of childcare, not knowing where to go for care, and inability to find a health care professional mediated a smaller or no percentage of the association. Conclusions and Relevance: The identification of vulnerable subpopulations is an important goal to reduce the burden of asthma-related hospital care. More research is needed to fully understand all of the pathways that lead disaster survivors of lower SES to disproportionately experience ED visits due to asthma.

Positive and negative affect in the daily life of World Trade Center responders with PTSD: An ecological momentary assessment study

Dornbach-Bender A, Ruggero CJ, Schuler K, et al

2020

World Trade Center exposure, post-traumatic stress disorder, and subjective cognitive concerns in a cohort of rescue/recovery workers

Singh A, Zeig-Owens R, Hall CB, et al

2020

Hearing loss among World Trade Center firefighters and emergency medical service workers

Flamme GA, Goldfarb DG, Zeig-Owens R, et al

2019

Comparing life satisfaction and functioning 15 years after September 11, 2001 among survivors with and without injuries: A mixed-method study

Gargano LM, Mok HK, Jacobson MH, et al

2019

Trauma and relationship strain: Oral histories with World Trade Center disaster responders

Hammock AC, Dreyer RE, Riaz M, et al

2019

Allergen sensitization and asthma outcomes among World Trade Center rescue and recovery workers

Rojano B, West E, Ferdermann E, et al

2019

Behavior problems in adolescence and subsequent mental health in early adulthood: Results from the World Trade Center Health Registry cohort

Gargano LM, Locke S, Li J, et al

2018

Comorbidity classes and associated impairment, demographics and 9/11-exposures in 8,236 children and adolescents

Geronazzo-Alman L, Guffanti G, Eisenberg R, et al

2018

The development of a biobank of cancer tissue samples from World Trade Center responders

Lieberman-Cribbin W, Tuminello S, Gillezeau C, et al

2018

BACKGROUND: World Trade Center (WTC) responders were exposed to mixture of dust, smoke, chemicals and carcinogens. Studies of cancer incidence in this population have reported elevated risks of cancer compared to the general population. There is a need to supplement current epidemiologic cancer follow-up with a cancer tissue bank in order to better elucidate a possible connection between each cancer and past WTC exposure. This work describes the implementation of a tissue bank system for the WTC newly diagnosed cancers, focused on advancing the understanding of the biology of these tumors. This will ultimately impact the modalities of treatment, and the probability of success and survival of these patients. METHODS: WTC Responders who participated (as employees or volunteers) in the rescue, recovery and cleanup efforts at the WTC sites have been enrolled at Mount Sinai in the World Trade Center Health Program. Responders with cancer identified and validated through linkages with New York, New Jersey, Pennsylvania, and Connecticut cancer registries were eligible to participate in this biobank. Potential participants were contacted through letters, phone calls, and emails to explain the research study, consent process, and to obtain the location where their cancer procedure was performed. Pathology departments were contacted to identify and request tissue samples. RESULTS: All the 866 solid cancer cases confirmed by the Data Center at Mount Sinai have been contacted and consent was requested for retrieval and storage of the tissue samples from their cancer. Hospitals and doctors' offices were then contacted to locate and identify the correct tissue block for each patient. The majority of these cases consist of archival paraffin blocks from surgical patients treated from 2002 to 2015. At the time of manuscript writing, this resulted in 280 cancer samples stored in the biobank. CONCLUSIONS: A biobank of cancer tissue from WTC responders has been compiled with 280 specimens in storage to date. This tissue bank represents an important resource for the scientific community allowing for high impact studies on environmental exposures and cancer etiology, cancer outcome, and gene-environment interaction in the unique population of WTC responders.

Parental posttraumatic stress and child behavioral problems in World Trade Center responders

Uchida M, Feng H, Feder A, et al

2018

Losing a family member in an act of terror: A review from the qualitative grey literature on the long-term affects of September 11, 2001 [survivors]

Bauwens J

2017

Receptor for advanced glycation endproducts and World Trade Center particulate induced lung function loss: A case-cohort study and murine model of acute particulate exposure

Caraher EJ, Kwon S, Haider SH, et al

2017

World Trade Center-particulate matter(WTC-PM) exposure and metabolic-risk are associated with WTC-Lung Injury(WTC-LI). The receptor for advanced glycation end-products (RAGE) is most highly expressed in the lung, mediates metabolic risk, and single-nucleotide polymorphisms at the AGER-locus predict forced expiratory volume(FEV). Our objectives were to test the hypotheses that RAGE is a biomarker of WTC-LI in the FDNY-cohort and that loss of RAGE in a murine model would protect against acute PM-induced lung disease. We know from previous work that early intense exposure at the time of the WTC collapse was most predictive of WTC-LI therefore we utilized a murine model of intense acute PM-exposure to determine if loss of RAGE is protective and to identify signaling/cytokine intermediates. This study builds on a continuing effort to identify serum biomarkers that predict the development of WTC-LI. A case-cohort design was used to analyze a focused cohort of male never-smokers with normal pre-9/11 lung function. Odds of developing WTC-LI increased by 1.2, 1.8 and 1.0 in firefighters with soluble RAGE (sRAGE)>=97pg/mL, CRP>=2.4mg/L, and MMP-9<=397ng/mL, respectively, assessed in a multivariate logistic regression model (ROCAUC of 0.72). Wild type(WT) and RAGE-deficient(Ager^-/-) mice were exposed to PM or PBS-control by oropharyngeal aspiration. Lung function, airway hyperreactivity, bronchoalveolar lavage, histology, transcription factors and plasma/BAL cytokines were quantified. WT-PM mice had decreased FEV and compliance, and increased airway resistance and methacholine reactivity after 24-hours. Decreased IFN-gamma and increased LPA were observed in WT-PM mice; similar findings have been reported for firefighters who eventually develop WTC-LI. In the murine model, lack of RAGE was protective from loss of lung function and airway hyperreactivity and was associated with modulation of MAP kinases. We conclude that in a multivariate adjusted model increased sRAGE is associated with WTC-LI. In our murine model, absence of RAGE mitigated acute deleterious effects of PM and may be a biologically plausible mediator of PM-related lung disease.

Post-traumatic stress disorder dimensions and asthma morbidity in World Trade Center rescue and recovery workers

Mindlis I, Morales-Raveendran E, Goodman E, et al

2017

Cardiometabolic profiles of adolescents and young adults exposed to the World Trade Center disaster

Trasande L, Koshy TT, Gilbert J, et al

2017

Intensity of binge drinking a decade after the September 11th terror attacks among exposed individuals

Welch AE, Caramanica Zweig K, McAteer JM, et al

2017

Improvement in severe lower respiratory symptoms and small airway function in World Trade Center dust exposed community members

Caplan-Shaw C, Kazeros A, Pradhan D, et al

2016

Fatigue severity in World Trade Center (9/11) responders: A preliminary study

Friedberg F, Adamowicz JL, Caikauskaite I, et al

2016

Quantitative bias analysis in an asthma study of rescue-recovery workers and volunteers from the 9/11 World Trade Center attacks

Jurek AM and Maldonado G

2016

The prevalence of metabolic syndrome among law enforcement officers who responded to the 9/11 World Trade Center attacks

Moline JM, McLaughlin MA, Sawit ST, et al

2016

Obesity and weight gain among former World Trade Center workers and volunteers

Napier CO, Mbadugha O, Bienenfeld LA, et al

2016

Neurologic evaluations of patients exposed to the World Trade Center disaster

Stecker MM, Yu H, Barlev R, et al

2016

Health conditions as mediators of the association between World Trade Center exposure and health-related quality of life in firefighters and ems workers

Yip J, Zeig-Owens R, Hall CB, et al

2016

Chronic probable PTSD in police responders in the World Trade Center Health Registry ten to eleven years after 9/11

Cone JE, Li J, Kornblith E, et al

2015

Anxiety sensitivity mediates the association between post-traumatic stress symptom severity and interoceptive threat-related smoking abstinence expectancies among World Trade Center disaster-exposed smokers

Farris SG, Paulus DJ, Gonzalez A, et al

2015

Exposure to the World Trade Center disaster and 9/11-related post-traumatic stress disorder and household disaster preparedness

Gargano LM, Caramanica K, Sisco S, et al

2015

Systemic inflammation associated with World Trade Center dust exposures and airway abnormalities in the local community

Kazeros A, Zhang E, Cheng X, et al

2015

Refractory sarcoid arthritis in World Trade Center-exposed New York City firefighters: A case series

Loupasakis K, Berman J, Jaber N, et al

2015

Posttraumatic stress symptoms and smoking among World Trade Center disaster responders: A longitudinal investigation

Zvolensky MJ, Farris SG, Kotov R, et al

2015

Post-disaster stressful life events and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among responders to the World Trade Center disaster

Zvolensky MJ, Kotov R, Schechter CB, et al

2015

BACKGROUND: The current study examined contributions of post-disaster stressful life events in relation to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning among rescue, recovery, and clean-up workers who responded to the September 11, 2001 World Trade Center (WTC) terrorist attacks. METHODS: Participants were 18,896 WTC responders, including 8466 police officers and 10,430 non-traditional responders (85.8% male; 86.4% Caucasian; M(age) = 39.5, SD = 8.8) participating in the WTC Health Program who completed an initial examination between July, 2002 and April, 2010 and who were reassessed, on average, 2.5 years later. RESULTS: Path analyses were conducted to evaluate contributions of life events to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning. These analyses were stratified by police and non-traditional responder groups and adjusted for age, sex, time from 9/11 to initial visit, WTC exposures (three WTC contextual exposures: co-worker, friend, or a relative died in the disaster; co-worker, friend, or a relative injured in the disaster; and responder was exposed to the dust cloud on 9/11), and interval from initial to first follow-up visit. In both groups, WTC-related posttraumatic stress, depressive symptoms, and overall functioning were stable over the follow-up period. WTC exposures were related to these three outcomes at the initial assessment. WTC-related posttraumatic stress, depressive symptoms, and overall functioning, at the initial assessment each predicted the occurrence of post-disaster stressful life events, as measured by Disaster Supplement of the Diagnostic Interview Schedule. Post-disaster stressful life events, in turn, were associated with subsequent mental health, indicating partial mediation of the stability of observed mental health. CONCLUSIONS: The present findings suggest a dynamic interplay between exposure, post-disaster stressful life events, and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among WTC disaster responders.

One airway: Biomarkers of protection from upper and lower airway injury after World Trade Center exposure

Cho SJ, Echevarria GC, Kwon S, et al

2014

The impact of military deployment and reintegration on children and parenting: A systematic review

Creech SK, Hadley W, and Borsari B

2014

“Check, change what you need to change and/or keep what you want”: An art therapy neurobiological-based trauma protocol

Hass-Cohen N, Clyde Findlay J, Carr R, et al

2014

The upper respiratory pyramid: Early factors and later treatment utilization in World Trade Center exposed firefighters

Niles JK, Webber MP, Liu X, et al

2014

Social integration buffers stress in New York police after the 9/11 terrorist attack

Schwarzer R, Bowler RM, and Cone JE

2014

Analysis of short-term effects of World Trade Center dust on rat sciatic nerve

Stecker M, Segelnick J, and Wilkenfeld M

2014

Lysophosphatidic acid and apolipoprotein a1 predict increased risk of developing World Trade Center-lung injury: A nested case-control study

Tsukiji J, Cho SJ, Echevarria GC, et al

2014

Agreement between upper respiratory diagnoses from self-report questionnaires and medical records in an occupational health setting

Weakley J, Webber MP, Ye F, et al

2014

Lessons from the World Trade Center disaster: Airway disease presenting as restrictive dysfunction

Berger KI, Reibman J, Oppenheimer BW, et al

2013

PTSD symptom dimensions and their relationship to functioning in World Trade Center responders

Ruggero CJ, Kotov R, Callahan JL, et al

2013

Public health consequences of terrorism on maternal-child health in New York City and madrid

Sherrieb K and Norris FH

2013

Self-reported skin rash or irritation symptoms among World Trade Center Health Registry participants

Huang MJ, Li J, Liff JM, et al

2012

Alcohol use in polish 9/11 responders: Implications for cross-cultural treatment

Katz CL, Jutras-Aswad D, Kiliman M, et al

2012

Longitudinal spirometry among patients in a treatment program for community members with World Trade Center-related illness

Liu M, Qian M, Cheng Q, et al

2012

Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers

Luft BJ, Schechter C, Kotov R, et al

2012

Newly recognized occupational and environmental causes of chronic terminal airways and parenchymal lung disease

Sauler M and Gulati M

2012

Newly recognized occupational and environmental causes of chronic terminal airways and parenchymal lung disease

Sauler M and Gulati M

2012

Pulmonary function predicting confirmed recovery from lower-respiratory symptoms in World Trade Center-exposed firefighters, 2001 to 2010

Soo J, Webber MP, Hall CB, et al

2012

A brief screening tool for assessing psychological trauma in clinical practice: Development and validation of the New York PTSD risk score

Boscarino JA, Kirchner HL, Hoffman SN, et al

2011

OBJECTIVE: The objective was to develop a brief posttraumatic stress disorder (PTSD) screening instrument that is useful in clinical practice, similar to the Framingham Risk Score used in cardiovascular medicine. METHODS: We used data collected in New York City after the World Trade Center disaster (WTCD) and other trauma data to develop a new PTSD prediction tool--the New York PTSD Risk Score. We used diagnostic test methods to examine different clinical domains, including PTSD symptoms, trauma exposures, sleep disturbances, suicidal thoughts, depression symptoms, demographic factors and other measures to assess different PTSD prediction models. RESULTS: Using receiver operating curve (ROC) and bootstrap methods, five prediction domains, including core PTSD symptoms, sleep disturbance, access to care status, depression symptoms and trauma history, and five demographic variables, including gender, age, education, race and ethnicity, were identified. For the best prediction model, the area under the ROC curve (AUC) was 0.880 for the Primary Care PTSD Screen alone (specificity=82.2%, sensitivity=93.7%). Adding care status, sleep disturbance, depression and trauma exposure increased the AUC to 0.943 (specificity=85.7%, sensitivity=93.1%), a significant ROC improvement (P<.0001). Adding demographic variables increased the AUC to 0.945, which was not significant (P=.250). To externally validate these models, we applied the WTCD results to 705 pain patients treated at a multispecialty group practice and to 225 trauma patients treated at a Level I Trauma Center. These results validated those from the original WTCD development and validation samples. CONCLUSION: The New York PTSD Risk Score is a multifactor prediction tool that includes the Primary Care PTSD Screen, depression symptoms, access to care, sleep disturbance, trauma history and demographic variables and appears to be effective in predicting PTSD among patients seen in healthcare settings. This prediction tool is simple to administer and appears to outperform other screening measures.

Occupational lower airway disease in relation to World Trade Center inhalation exposure

de la Hoz RE

2011

Comparison of health outcomes among affiliated and lay disaster volunteers enrolled in the World Trade Center Health Registry

Debchoudhury I, Welch AE, Fairclough MA, et al

2011

Heart disease among adults exposed to the September 11, 2001 World Trade Center disaster: Results from the World Trade Center Health Registry

Jordan HT, Miller-Archie SA, Cone JE, et al

2011

Pulmonary function in a cohort of New York City police department emergency responders since the 2001 World Trade Center disaster

Kleinman EJ, Cucco RA, Martinez C, et al

2011

Snoring and obstructive sleep apnea among former World Trade Center rescue workers and volunteers

de la Hoz RE, Aurora RN, Landsbergis P, et al

2010

No evidence of increased prevalence of premature coronary artery disease in New York City police officers as predicted by coronary artery calcium scoring

Wanahita N, See JL, Giedd KN, et al

2010

Young children's responses to September 11th: The New York City experience

Klein TP, Devoe ER, Miranda-Julian C, et al

2009

Characteristics of a residential and working community with diverse exposure to World Trade Center dust, gas, and fumes

Reibman J, Liu M, Cheng Q, et al

2009

Overview of findings from the World Trade Center disaster outcome study: Recommendations for future research after exposure to psychological trauma

Boscarino JA and Adams RE

2008

Health care and social issues of immigrant rescue and recovery workers at the World Trade Center site

de la Hoz RE, Hill S, Chasan R, et al

2008

Impact of September 11 World Trade Center disaster on children and pregnant women

Landrigan PJ, Forman J, Galvez M, et al

2008

BACKGROUND: Children are uniquely sensitive to toxic exposures in the environment. This sensitivity reflects children's disproportionately heavy exposures coupled with the biologic vulnerability that is a consequence of their passage through the complex transitions of early development. METHODS AND RESULTS: To assess effects on children's health associated with the attacks on the World Trade Center (WTC) of September 11, 2001, research teams at the Mount Sinai School of Medicine and other academic health centers in New York City launched a series of clinical and epidemiologic studies. Mount Sinai investigators undertook a prospective analysis of pregnancy outcomes in 182 women who were pregnant on September 11, 2001, and who had been either inside or within 0.5 miles of the WTC at the time of the attacks; they found a doubling in incidence of intrauterine growth retardation (IUGR) among infants born to exposed mothers as compared to infants born to unexposed women in northern Manhattan. A Columbia research team examined pregnancy outcomes in 329 women who lived, worked or gave birth in lower Manhattan in the 9 months after September 11; they found that these women gave birth to infants with significantly lower birth weight and shorter length than women living at greater distances from Ground Zero. NYU investigators documented increased numbers of new asthma cases and aggravations of preexisting asthma in children living in lower Manhattan. Mount Sinai mental health researchers documented a significant increase in mental health problems in children who directly witnessed the attacks and subsequent traumatic events; these problems were most severe in children with a past history of psychological trauma. The New York City Department of Health and Mental Hygiene established a WTC Registry that has enrolled over 70,000 persons of all ages in lower Manhattan and will follow the health of these populations to document on a continuing basis the health consequences of September 11.

Responder safety and health: Preparing for future disasters

Reissman DB and Howard J

2008

This article reviews lessons learned about managing the safety and health of workers who were involved in disaster response, recovery, and cleanup after the 2001 World Trade Center (WTC) disaster. The first two sections review ongoing responder health burdens and the tragic toll of this disaster from a worker safety and health perspective. The remaining sections address changes in federal infrastructure, response planning, and resources for protection of response and recovery personnel. Proper preparation includes pre-event and "just-in-time" disaster-worker training on likely hazards, organizational assets for hazard monitoring, and hands-on instruction in the use of assigned protective equipment. Good planning includes predeployment medical review to ensure "fitness for duty" and considers the following: (1) personal risk factors, (2) hazards likely to be associated with particular field locations, and (3) risks involved with assigned tasks (eg, workload and pace, work/rest cycles, available resources, and team/supervisory dynamics). Planning also should address worker health surveillance, medical monitoring, and availability of medical care (including mental health services). Disaster safety managers should anticipate likely hazards within planning scenarios and prepare asset inventories to facilitate making timely safety decisions. Disaster safety management begins immediately and provides ongoing real-time guidance to incident leadership at all levels of government. Robust standards must be met to reliably protect workers/responders. An integrated and measurable multiagency safety management function must be built into the incident command system before an incident occurs. This function delineates roles and responsibilities for rapid exposure assessments, ensuring cross-agency consistency in data interpretation, and timely, effective communication of information and control strategies. The ability to perform this safety management function should be tested and evaluated in exercise simulations and drills at multiple levels. Joint planning and exercising of the safety management plan and its function are effective ways to build interagency relationships and to be more systemic in managing logistics for safety equipment and converging personnel. Planning must include mechanisms to enable safety decisions to be implemented-such as effective and rapid scene control (site access), personnel tracking, and safety enforcement. Worker safety and health preparedness and leadership are essential for protecting workers and promoting resiliency among personnel involved in disaster response, recovery, and cleanup.

A 9/11 parent support group

MacColl GJ

2007

Air trapping detected on end-expiratory high-resolution computed tomography in symptomatic World Trade Center rescue and recovery workers

Mendelson DS, Roggeveen M, Levin SM, et al

2007

Posttraumatic stress disorder and other psychological sequelae among World Trade Center clean up and recovery workers

Gross R, Neria Y, Tao XG, et al

2006

Secondary traumatic stress among disaster mental health workers responding to the September 11 attacks

Creamer TL and Liddle BJ

2005

Rethinking first response: Effects of the clean up and recovery effort on workers at the World Trade Center disaster site

Johnson SB, Langlieb AM, Teret SP, et al

2005

Radical simplification: Disaster relief medicaid in New York City

Haslanger K

2003

Project liberty: A public health response to New Yorkers' mental health needs arising from the World Trade Center terrorist attacks

Felton CJ

2002

A protocol for ongoing systematic scoping reviews of World Trade Center health research

Concannon TW, Chari R, Lee J, et al.

2023

COPD in smoking and non-smoking community members exposed to the World Trade Center dust and fumes

Baba RY, Zhang Y, Shao Y, et al

2022

Temporal aspects of the association between exposure to the World Trade Center disaster and risk of skin melanoma

Boffetta P, Goldfarb DG, Zeig-Owens R, et al

2022

World Trade Center dust induces nasal and neurological tissue injury while propagating reduced olfaction capabilities and increased anxiety behaviors

Hernandez M, Vaughan J, Gordon T, et al

2022

Global DNA methylation of WTC prostate cancer tissues show signature differences compared to non-exposed cases

Yu H, Tuminello S, Alpert N, et al

2022

Polygenic regulation of PTSD severity and outcomes among World Trade Center responders

Huckins LM, Johnson JS, Cancelmo L, et al

2021

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition triggered by exposure to trauma. The study of PTSD is complicated by highly heterogeneous presentations and experiences of trauma between individuals. Capitalizing on the existence of the World Trade Center General Responder Cohort (WTC-GRC) of rescue, recovery and clean-up workers who responded during and in the aftermath of the World Trade Center (WTC) 9/11/2001 attacks, we studied genetic correlates of PTSD in a sample of 371 WTC responders, selected from the WTC-GRC utilizing stratified random sampling. This deeply phenotyped sample of WTC responders – ranging from no/low PTSD symptom levels to severe PTSD– provide a unique opportunity to study genetic risk factors for PTSD severity and chronicity following a single, shared, well-documented trauma, also incorporating measures of childhood and other lifetime traumas. We examined associations of polygenic risk scores (PRS) –derived from a range of genome-wide association studies (GWAS) of behavioral traits, psychiatric disorders, and brain volumetric phenotypes– with PTSD severity and chronicity among these 371 individuals. Our results demonstrate significant genetic regulation of lifetime PTSD severity, assessed with the lifetime version Clinician-Administered PTSD Scale (CAPS), and chronicity, assessed with the past-month CAPS. PRS derived from GWAS of attention deficit-hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and brain imaging phenotypes (amygdala and putamen volumes) were associated with several PTSD symptom dimensions. Interestingly, we found greater genetic contribution to PTSD among cases compared to our full sample. In addition, we tested for associations between exposures to traumatic stressors, including WTC-related exposures, childhood trauma, and other lifetime traumatic life events in our full sample. Together, polygenic risk and exposures to traumatic stress explained ~45% of variance in lifetime CAPS (R2=0.454), and ~48% of variance in past-month CAPS (R2=0.480) in the full sample. These participants represent a highly vulnerable population, with exposures to severe trauma during 9/11 and the following days and months. These novel identified associations between PTSD and PRS of behavioral traits and brain volume phenotypes, as well as replicated associations with PRS of other psychiatric disorders, may contribute to understanding the biological factors associated with risk for and chronicity of PTSD. In particular, the identification of neuroimaging phenotypes indicates that coupling of neuroimaging with genetic risk score calculations may predict PTSD outcomes.

Mapping the transcriptomics landscape of post-traumatic stress disorder symptom dimensions in World Trade Center responders

Kuan PF, Yang X, Ren X, et al

2021

Dietary phenotype and advanced glycation end-products predict WTC-obstructive airways disease: A longitudinal observational study

Lam R, Kwon S, Riggs J, et al

2021

Background: Diet is a modifier of metabolic syndrome which in turn is associated with World Trade Center obstructive airways disease (WTC‑OAD). We have designed this study to (1) assess the dietary phenotype (food types, physical activity, and dietary habits) of the Fire Department of New York (FDNY) WTC‑Health Program (WTC‑HP) cohort and (2) quantify the association of dietary quality and its advanced glycation end product (AGE) content with the development of WTC‑OAD. Methods: WTC‑OAD, defined as developing WTC‑Lung Injury (WTC‑LI; FEV1 < LLN) and/or airway hyperreactivity (AHR; positive methacholine and/or positive bronchodilator response). Rapid Eating and Activity Assessment for Participants‑Short Version (REAP‑S) deployed on 3/1/2018 in the WTC‑HP annual monitoring assessment. Clinical and REAP‑S data of consented subjects was extracted (7/17/2019). Diet quality [low‑(15–19), moderate‑(20–29), and high(30–39)] and AGE content per REAP‑S questionnaire were assessed for association with WTC‑OAD. Regression models adjusted for smoking, hyperglycemia, hypertension, age on 9/11, WTC‑exposure, BMI, and job description. Results: N = 9508 completed the annual questionnaire, while N = 4015 completed REAP‑S and had spirometry. WTCOAD developed in N = 921, while N = 3094 never developed WTC‑OAD. Low‑ and moderate‑dietary quality, eating more (processed meats, fried foods, sugary drinks), fewer (vegetables, whole‑grains),and having a diet abundant in AGEs were significantly associated with WTC‑OAD. Smoking was not a significant risk factor of WTC‑OAD. Conclusions: REAP‑S was successfully implemented in the FDNY WTC‑HP monitoring questionnaire and produced valuable dietary phenotyping. Our observational study has identified low dietary quality and AGE abundant dietary habits as risk factors for pulmonary disease in the context of WTC‑exposure. Dietary phenotyping, not only focuses our metabolomic/biomarker profiling but also further informs future dietary interventions that may positively impact particulate matter associated lung disease.

Telehealth for COVID-19 in World Trade Center responders: Meeting the needs of this unique population

Senay E, Byrne D, Mattson C, et al

2021

Mental health mediators of subjective cognitive concerns among World Trade Center responders

Stein CR, Cooney ML, Frank B, et al

2021

Stroke hospitalizations, posttraumatic stress disorder, and 9/11-related dust exposure: Results from the World Trade Center Health Registry

Yu S, Alper HE, Nguyen AM, et al

2021

Urgent engagement in 9/11 pregnant widows and their infants: Transmission of trauma

Beebe B, Hoven CW, Kaitz M, et al

2020

Retrospective assessment of risk factors for head and neck cancer among World Trade Center general responders

Bover Manderski MT, Black K, Udasin IG, et al

2020

Past experiences of getting bullied and assaulted and posttraumatic stress disorder (PTSD) after a severe traumatic event in adulthood: A study of World Trade Center (WTC) responders

Mukherjee S, Clouston S, Bromet E, et al

2020

Probable posttraumatic stress disorder and lower respiratory symptoms among rescue/recovery workers and community members after the 9/11 World Trade Center attacks-a longitudinal mediation analysis

Wyka K, Friedman SM, and Jordan HT

2020

OBJECTIVE: Posttraumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) often coexist among survivors of the September 11, 2001 (9/11) World Trade Center (WTC) attacks. Research in police and nontraditional responders suggests that PTSD mediates the relationship between 9/11 physical exposures and LRS, but not vice versa. We replicated these findings in WTC rescue/recovery workers (R/R workers), extended them to exposed community members, and explored the interplay between both physical and psychological 9/11 exposures, probable PTSD, and LRS over a 10-year follow-up. METHODS: Participants were 12,398 R/R workers and 12,745 community members assessed in three WTC Health Registry surveys (2003-2004, 2006-2007, and 2011-2012). LRS and 9/11 exposures were self-reported. Probable PTSD was defined as a PTSD Checklist score >/=44. RESULTS: Probable PTSD predicted LRS (R/R workers: beta = 0.88-0.98, p < .001; community members: beta = 0.67-0.86, p < .001) and LRS predicted PTSD (R/R workers: beta = 0.83-0.91, p < .001; community members: beta = 0.68-0.75, p < .001) at follow-ups, adjusting for prior symptoms and covariates. In both R/R workers and community members, probable PTSD mediated the relationship between 9/11 physical exposures (dust cloud, long duration of work) and LRS (indirect effects, p = .001-.006), and LRS mediated the physical exposure-PTSD relationship (indirect effects, p = .001-.006). In R/R workers, probable PTSD mediated the psychological exposure (losing friends or loved ones, witnessing horrific events)-LRS relationship (indirect effect, p < .001), but LRS did not mediate the psychological exposure-PTSD relationship (indirect effect, p = .332). In community members, high 9/11 psychological exposure predicted both probable PTSD and LRS at follow-ups; probable PTSD mediated the psychological exposure-LRS relationship (indirect effect, p < .001), and LRS mediated the psychological exposure-PTSD relationship (indirect effect, p = .001). CONCLUSIONS: Probable PTSD and LRS each mediated the other, with subtle differences between R/R workers and community members. A diagnosis of either should trigger assessment for the other; treatment should be carefully coordinated.

Exposure to multiple disasters: The long-term effect of hurricane sandy (October 29, 2012) on NYC survivors of the September 11, 2001 World Trade Center attack

Gargano LM, Li J, Millien L, et al

2019

Serum perfluoroalkyl substances and lung function in adolescents exposed to the World Trade Center disaster

Gaylord A, Berger KI, Naidu M, et al

2019

Clinical evaluation of sarcoidosis in community members with World Trade Center dust exposure

Hena KM, Murphy S, Zhang Y, et al

2019

Characterizing mental health treatment utilization among individuals exposed to the 2001 World Trade Center terrorist attacks 14-15 years post-disaster

Jacobson MH, Norman C, Sadler P, et al

2019

Enhanced exposure assessment and genome-wide DNA methylation in World Trade Center disaster responders

Kuan PF, Mi Z, Georgopoulos P, et al

2019

Cell type-specific gene expression patterns associated with posttraumatic stress disorder in World Trade Center responders

Kuan PF, Yang X, Clouston S, et al

2019

Mental health service use among asian americans five to six years after exposure to the World Trade Center attack

Kung WW, Goldmann E, Liu X, et al

2019

Metabolic syndrome biomarkers of World Trade Center airway hyperreactivity: A 16-year prospective cohort study

Kwon S, Crowley G, Mikhail M, et al

2019

The relationship between posttraumatic and depressive symptoms during virtual reality exposure therapy with a cognitive enhancer

Peskin M, Wyka K, Cukor J, et al

2019

Low serum iga and airway injury in World Trade Center-exposed firefighters: A 17-year longitudinal study

Putman B, Lahousse L, Zeig-Owens R, et al

2019

Increased airway wall thickness is associated with adverse longitudinal first-second forced expiratory volume trajectories of former World Trade Center workers

de la Hoz RE, Liu X, Doucette JT, et al

2018

Psychological outcomes in disaster responders: A systematic review and meta-analysis on the effect of social support

Guilaran J, de Terte I, Kaniasty K, et al

2018

Standardized morbidity ratios of four chronic health conditions among World Trade Center responders: Comparison to the national health interview survey

Kim H, Kriebel D, Liu B, et al

2018

Posttraumatic stress disorder in the short and medium term following the World Trade Center attack among asian americans

Kung WW, Liu X, Goldmann E, et al

2018

Pathway from PTSD to respiratory health: Longitudinal evidence from a psychosocial intervention

Waszczuk MA, Li X, Bromet EJ, et al

2017

Isolated small airway reactivity during bronchoprovocation as a mechanism for respiratory symptoms in WTC dust-exposed community members

Berger KI, Kalish S, Shao Y, et al

2016

Substance use in adolescents 10 years after the World Trade Center attacks in New York City

Gargano LM, Welch AE, and Stellman SD

2016

Homogeneity of severe posttraumatic stress disorder symptom profiles in children and adolescents across gender, age, and traumatic experiences related to 9/11

Guffanti G, Geronazzo-Alman L, Fan B, et al

2016

The role of theory-specific techniques and therapeutic alliance in promoting positive outcomes: Integrative psychotherapy for World Trade Center responders

Haugen PT, Werth AS, Foster AL, et al

2016

Latent typologies of posttraumatic stress disorder in World Trade Center responders

Horn SR, Pietrzak RH, Schechter C, et al

2016

Smoking to regulate negative affect: Disentangling the relationship between posttraumatic stress and emotional disorder symptoms, nicotine dependence, and cessation-related problems

Mahaffey BL, Gonzalez A, Farris SG, et al

2016

INTRODUCTION: Posttraumatic stress disorder (PTSD) is associated with various aspects of cigarette smoking, including higher levels of nicotine dependence and cessation difficulties. Affect-regulatory smoking motives are thought to, in part, underlie the association between emotional disorders such as PTSD and smoking maintenance, although few studies have empirically tested this possibility. METHODS: Data were analyzed from 135 treatment-seeking smokers who were directly exposed to the World Trade Center disaster on September 11, 2001. We modeled the direct effect of 9/11 PTSD symptom severity on nicotine dependence, perceived barriers to smoking cessation, and severity of problematic symptoms experienced during prior cessation attempts. We also examined the indirect effect of PTSD on these outcomes via negative affect reduction smoking motives. Parallel models were constructed for additional emotional disorder symptoms, including panic and depressive symptoms. RESULTS: PTSD symptom severity was associated with nicotine dependence and perceived barriers to cessation, but not problems during prior quit attempts indirectly via negative affect reduction smoking motives. Panic and depressive symptoms both had significant indirect effects, via negative affect reduction smoking motives, on all three criterion variables. CONCLUSIONS: Affect-regulatory smoking motives appear to underlie associations between the symptoms of emotional disorders such as PTSD, panic, and depression in terms of smoking dependence and certain cessation-related criterion variables. IMPLICATIONS: Overall, this investigation suggests negative affect reduction smoking motives help to explain the relationship of PTSD, depression, and panic symptoms to nicotine dependence, severity of problems experienced during prior quit attempts and perceived barriers to cessation. These results highlight the importance of assessing motivations for smoking in the context of cessation treatment, especially among those with emotional disorder symptoms. Future interventions might seek to utilize motivational interviewing and cognitive restructuring techniques to address coping-oriented motives for smoking, in addition to skills for managing negative affect, as a means of improving quit outcomes.

Biomarkers of World Trade Center particulate matter exposure: Physiology of distal airway and blood biomarkers that predict fev(1) decline

Weiden MD, Kwon S, Caraher E, et al

2016

Determinants of asthma morbidity in World Trade Center rescue and recovery workers

Xu KY, Goodman E, Goswami R, et al

2016

Asthma is one the most common chronic conditions affecting World Trade Center (WTC) rescue and recovery workers in the aftermath of the terrorist attacks on September 11, 2001. While exposure-response gradients between asthma risk and duration of work at the WTC site, exposure to the dust cloud, and work in the Ground Zero pit, compounded by inadequate protection have been described, there is limited knowledge about how exposure and other factors affect long-term asthma outcomes among WTC rescue and recovery workers. In this study, we used data from a cohort of WTC workers with a physician diagnosis of asthma to study factors associated with worse asthma control, acute asthma-related outpatient and inpatient resource utilization, and poor quality of life. We collected data on asthma history, levels of WTC exposures (categorized based on established criteria), and comorbidities from a prospective cohort of 218 WTC workers with physician-diagnosed asthma who were enrolled in the WTC Health Program (WTCHP). Structured clinical interviews assessed for post-traumatic stress disorder (PTSD) and major depression. A validated questionnaire was used to measure gastroesophageal reflux disease (GERD) symptoms.5 Outcomes included asthma control,6 self-report resource utilization, and quality of life. We performed multiple regression analyses to identify factors associated with increased morbidity. Our study revealed that WTC-related asthma is frequently poorly controlled and results in substantial impairment in quality of life. Furthermore, we found that lower income and physical and mental health comorbidities were independently associated with increased asthma morbidity in the WTC rescue and recovery worker populations. Our results highlight the medical needs of WTC workers with asthma and suggest potential targets for future interventions. Our findings are consistent with a study conducted among members of the WTC Health Registry, encompassing both local residents and rescue and recovery workers, which found participants to have low levels of asthma control. A potential reason for the high levels of asthma morbidity in WTC rescue and recovery workers is the high prevalence of comorbid GERD, estimated to affect almost 40% of WTC workers and identified as an important exacerbating factor in patients with poorly controlled asthma.4 In addition, our finding of a strong association between PTSD and worse asthma morbidity in adjusted analysis is consistent with some community-based studies that reported associations between mental health comorbidities and poor asthma control. In summary, we found high levels of asthma morbidity among WTC rescue and recovery workers over 15 years after exposure. Our finding that GERD symptom and PTSD are associated with worse asthma outcomes can help identify high-risk WTC workers and guide development of highly needed interventions.

Oscillometry complements spirometry in evaluation of subjects following toxic inhalation

Berger KI, Turetz M, Liu M, et al

2015

Trajectories of scores on a screening instrument for PTSD among World Trade Center rescue, recovery, and clean-up workers

Maslow CB, Caramanica K, Welch AE, et al

2015

Neural and genetic markers of vulnerability to post-traumatic stress symptoms among survivors of the World Trade Center attacks

Olsson A, Kross E, Nordberg SS, et al

2015

Ykl-40 is a protective biomarker for fatty liver in World Trade Center particulate matter-exposed firefighters

Cho SJ, Echevarria GC, Lee YI, et al

2014

Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders

Pietrzak RH, Feder A, Schechter CB, et al

2014

BACKGROUND: Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations. METHOD: Data were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11. RESULTS: CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time. CONCLUSIONS: Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.

Translating research into action: An evaluation of the World Trade Center Health Registry's treatment referral program

Welch AE, Debchoudhury I, Jordan HT, et al

2014

Health effects of the World Trade Center 9/11 disaster: An overview

Crane MA, Milek DJ, Globina Y, et al

2013

Changes in trauma memory and patterns of posttraumatic stress

Dekel S and Bonanno GA

2013

Integrative approach for the treatment of posttraumatic stress disorder in 9/11 first responders: Three core techniques

Haugen PT, Splaun AK, Evces MR, et al

2013

Mental and physical health consequences of the September 11, 2001 (9/11) attacks in primary care: A longitudinal study

Neria Y, Wickramaratne P, Olfson M, et al

2013

Agreement between obstructive airways disease diagnoses from self-report questionnaires and medical records

Weakley J, Webber MP, Ye F, et al

2013

Polysomnographic diagnoses among former World Trade Center rescue workers and volunteers

de la Hoz RE, Mallea JM, Kramer SJ, et al

2012

A qualitative examination of health and health care utilization after the September 11th terror attacks among World Trade Center Health Registry enrollees

Welch AE, Caramanica K, Debchoudhury I, et al

2012

BACKGROUND: Many individuals who have 9/11-related physical and mental health symptoms do not use or are unaware of 9/11-related health care services despite extensive education and outreach efforts by the World Trade Center (WTC) Health Registry (the Registry) and various other organizations. This study sought to evaluate Registry enrollees' perceptions of the relationship between physical and mental health outcomes and 9/11, as well as utilization of and barriers to 9/11-related health care services. METHODS: Six focus groups were conducted in January 2010 with diverse subgroups of enrollees, who were likely eligible for 9/11-related treatment services. The 48 participants were of differing race/ethnicities, ages, and boroughs of residence. Qualitative analysis of focus group transcripts was conducted using open coding and the identification of recurring themes. RESULTS: Participants described a variety of physical and mental symptoms and conditions, yet their knowledge and utilization of 9/11 health care services were low. Participants highlighted numerous barriers to accessing 9/11 services, including programmatic barriers (lack of program visibility and accessibility), personal barriers such as stigmatization and unfamiliarity with 9/11-related health problems and services, and a lack of referrals from their primary care providers. Moreover, many participants were reluctant to connect their symptoms to the events of 9/11 due to lack of knowledge, the amount of time that had elapsed since 9/11, and the attribution of current health symptoms to the aging process. CONCLUSIONS: Knowledge of the barriers to 9/11-related health care has led to improvements in the Registry's ability to refer eligible enrollees to appropriate treatment programs. These findings highlight areas for consideration in the implementation of the new federal WTC Health Program, now funded under the James Zadroga 9/11 Health and Compensation Act (PL 111-347), which includes provisions for outreach and education.

Odor identification ability and self-reported upper respiratory symptoms in workers at the post-9/11 World Trade Center site

Altman KW, Desai SC, Moline J, et al

2011

Evaluating risk factors and possible mediation effects in posttraumatic depression and posttraumatic stress disorder comorbidity

Chiu S, Niles JK, Webber MP, et al

2011

Comorbid trends in World Trade Center cough syndrome and probable posttraumatic stress disorder in firefighters

Niles JK, Webber MP, Gustave J, et al

2011

The impact of the World Trade Center attack on FDNY firefighter retirement, disabilities, and pension benefits

Niles JK, Webber MP, Gustave J, et al

2011

Effects of the September 11, 2001 disaster on pregnancy outcomes: A systematic review

Ohlsson A, Shah PS, and Knowledge Synthesis Group of Determinants of Preterm LBWb

2011

Respiratory symptoms were associated with lower spirometry results during the first examination of WTC responders

Udasin I, Schechter C, Crowley L, et al

2011

World Trade Center disaster: Assessment of responder occupations, work locations, and job tasks

Woskie SR, Kim H, Freund A, et al

2011

Longitudinal study of probable post-traumatic stress disorder in firefighters exposed to the World Trade Center disaster

Berninger A, Webber MP, Niles JK, et al

2010

Quality of life in relation to upper and lower respiratory conditions among retired 9/11-exposed firefighters with pulmonary disability

Berninger A, Webber MP, Weakley J, et al

2010

Gender differences in probable posttraumatic stress disorder among police responders to the 2001 World Trade Center terrorist attack

Bowler RM, Han H, Gocheva V, et al

2010

Implementation of CBT for youth affected by the World Trade Center disaster: Matching need to treatment intensity and reducing trauma symptoms

Consortium C

2010

The nature and course of subthreshold PTSD

Cukor J, Wyka K, Jayasinghe N, et al

2010

Chemosensory loss: Functional consequences of the World Trade Center disaster

Dalton PH, Opiekun RE, Gould M, et al

2010

Occupational asthma and lower airway disease among World Trade Center workers and volunteers

de la Hoz RE

2010

Occupational rhinosinusitis and upper airway disease: The World Trade Center experience

de la Hoz RE, Shohet MR, and Cohen JM

2010

Quality of spirometry performed by 13,599 participants in the World Trade Center worker and volunteer medical screening program

Enright PL, Skloot GS, Cox-Ganser JM, et al

2010

Disaster in context: The effects of 9/11 on youth distant from the attacks

Mijanovich T and Weitzman BC

2010

Stories behind the symptoms: A qualitative analysis of the narratives of 9/11 rescue and recovery workers

Bills CB, Dodson N, Stellman JM, et al

2009

Psychiatric symptoms in ground zero ironworkers in the aftermath of 9/11: Prevalence and predictors

Katz CL, Levin S, Herbert R, et al

2009

Correlates of functional impairment in treatment-seeking survivors of mass terrorism

Malta LS, Levitt JT, Martin A, et al

2009

The influence of a major disaster on suicide risk in the population

Mezuk B, Larkin GL, Prescott MR, et al

2009

Trial of prophylactic inhaled steroids to prevent or reduce pulmonary function decline, pulmonary symptoms, and airway hyperreactivity in firefighters at the World Trade Center site

Banauch GI, Izbicki G, Christodoulou V, et al

2008

Disaster-related mental health needs of women and children

Corrarino JE

2008

Prolonged exposure treatment for posttraumatic stress disorder following the 9/11 attack with a person who escaped from the twin towers

Kazi A, Freund B, and Ironson G

2008

Modeling exposure to air pollution from the WTC disaster based on reports of perceived air pollution

Lederman SA, Becker M, Sheets S, et al

2008

Mental health consequences of September 11: A five-year review of the behavioral sciences literature

Mardikian J

2008

WTC medical monitoring and treatment program: Comprehensive health care response in aftermath of disaster

Moline JM, Herbert R, Levin S, et al

2008

Upper and lower respiratory diseases after occupational and environmental disasters

Prezant DJ, Levin S, Kelly KJ, et al

2008

Use of mental health services among disaster survivors

Rodriguez JJ and Kohn R

2008

Dissociation versus posttraumatic stress: Cortisol and physiological correlates in adults highly exposed to the World Trade Center attack on 9/11

Simeon D, Yehuda R, Knutelska M, et al

2008

Potential for diffuse parenchymal lung disease after exposures at World Trade Center disaster site

Szeinuk J, Padilla M, and de la Hoz RE

2008

Stay connected: Psychological services for retired firefighters after 11 September 2001

Alvarez J, Rosen C, Davis K, et al

2007

Evolution of lower respiratory symptoms in New York police officers after 9/11: A prospective longitudinal study

Buyantseva LV, Tulchinsky M, Kapalka GM, et al

2007

The aftermath of 9/11: Effect of intensity and recency of trauma on outcome

Ganzel B, Casey BJ, Glover G, et al

2007

Reported respiratory symptoms and adverse home conditions after 9/11 among residents living near the World Trade Center

Lin S, Jones R, Reibman J, et al

2007

Salivary cortisol and psychopathology in children bereaved by the September 11, 2001 terror attacks

Pfeffer CR, Altemus M, Heo M, et al

2007

Asthma diagnosed after 11 September 2001 among rescue and recovery workers: Findings from the World Trade Center Health Registry

Wheeler K, McKelvey W, Thorpe L, et al

2007

Alcohol use, mental health status and psychological well-being 2 years after the World Trade Center attacks in New York City

Adams RE, Boscarino JA, and Galea S

2006

Social and psychological resources and health outcomes after the World Trade Center disaster

Adams RE, Boscarino JA, and Galea S

2006

Tobacco free with FDNY: The New York City fire department World Trade Center tobacco cessation study

Bars MP, Banauch GI, Appel D, et al

2006

CONTEXT: After the World Trade Center (WTC) collapse, 15% (1,767) of rescue workers from the Fire Department of the City of New York (FDNY) considered themselves to be current cigarette smokers. Post-WTC collapse, 98% reported acute respiratory symptoms, and 81% reported health concerns. Nonetheless, 29% of current smokers increased tobacco use, and 23% of ex-smokers resumed cigarette smoking. OBJECTIVE: To determine the effect of a comprehensive tobacco-cessation program using combination tobacco-dependency treatment medications adjusted to the individual's daily tobacco use. DESIGN: FDNY cigarette smokers enrolled in "Tobacco Free With FDNY," a no-cost quit-smoking program providing counseling, support, and medications. At the end of the 3-month treatment phase and at the 6-month and 12-month follow-up visits, abstinence rates were confirmed by expired carbon monoxide levels or by the verification of a household member. SETTING: FDNY Bureau of Health Services between August 1, 2002 and October 30, 2002. PARTICIPANTS: A total of 220 current cigarette smokers from the FDNY. RESULTS: At study enrollment, the mean (+/- SD) tobacco use was 20 +/- 7 cigarettes per day, and the mean tobacco dependency, as assessed by a modified Fagerstrom test score, was 6.7 +/- 2.5 (maximum score, 10). Based on tobacco use, 20% of enrollees used three types of nicotine medications, 64% used two types, 14% used one type, and 3% used no medications. Additionally, 14% of enrollees used bupropion sustained release. The confirmed continuous abstinence rates were 47%, 36%, and 37%, respectively, after 3 months of treatment and at the 6-month and 12-month follow-up. Abstinence rates did not correlate with the history of tobacco use but correlated inversely with tobacco dependency. Adverse events and maximal nicotine medication use were unrelated, and no one experienced a serious adverse event. CONCLUSION: Tobacco dependency treatment using combination nicotine medications is effective and safe. Future studies should consider the following: (1) both history of tobacco use and withdrawal symptoms to determine the number and dose of nicotine medications; and (2) continuing combination treatment for > 3 months.

Worker productivity and outpatient service use after the September 11th attacks: Results from the New York City terrorism outcome study

Boscarino JA, Adams RE, and Figley CR

2006

BACKGROUND: Research has shown that the terrorist attacks in New York City (NYC) on September 11, 2001 had an impact on the psychological status of area residents. Since a major goal of many terrorist attacks is to also adversely affect local socioeconomic activities, the long-term impact of exposure to terrorist attacks on productivity and outpatient service utilization among workers in NYC is assessed. METHODS: The impact of the World Trade Center disaster (WTCD) among 1,167 workers in NYC is examined using a prospective cohort design. The study included measures of WTCD exposures, stressful life events, other traumatic events, post-traumatic stress disorder (PTSD), and depression, assessed at 1 year and 2 years post-disaster. RESULTS: Bivariate analyses suggest that exposure to WTCD events is associated with high productivity loss at baseline, but not consistently at follow-up. Both PTSD and depression are associated with lower quality workdays at baseline and follow-up, but depression is more consistently associated with high work loss and medical service use. In multivariate analyses, WTCD exposure is associated with productivity loss at baseline, but less consistently at follow-up. At baseline, depression and history of traumatic events are associated with lower quality workdays and negative life events with greater workdays lost. Multivariate analyses at follow-up indicated that experiencing negative life events is associated with higher workdays lost and lower quality workdays and that PTSD is associated with lower quality workdays. Similar regression models suggested that increased outpatient service use is associated with depression and lifetime traumatic events at baseline and with negative life events at follow-up. CONCLUSION: This study suggests that while the WTCD had an impact on worker productivity within the first year after the attack, this did not generally persist, especially after controlling for baseline status. Having PTSD or experiencing stressful life events at follow-up, however, is associated with lower quality workdays, even after controlling for baseline status.

A propensity score analysis of brief worksite crisis interventions after the World Trade Center disaster: Implications for intervention and research

Boscarino JA, Adams RE, Foa EB, et al

2006

A peer-based assistance program for officers with the New York City police department: Report of the effects of sept. 11, 2001

Dowling FG, Moynihan G, Genet B, et al

2006

Predictors of responses to psychotherapy referral of WTC utility disaster workers

Jayasinghe N, Giosan C, Difede J, et al

2006

A mental health program for ground zero rescue and recovery workers: Cases and observations

Katz CL, Smith R, Silverton M, et al

2006

Findings of and treatment for high levels of mercury and lead toxicity in ground zero rescue and recovery workers and lower Manhattan residents

Kokayi K, Altman CH, Callely RW, et al

2006

Gender disparities in posttraumatic stress disorder after mass trauma

Stuber J, Resnick H, and Galea S

2006

BACKGROUND: Although several studies have shown that rates of posttraumatic stress disorder (PTSD) are higher in women than in men, less is known about whether women are more vulnerable to PTSD after a major community-wide traumatic event. OBJECTIVE: The aim of this study was to examine gender disparities in the prevalence of probable lifetime PTSD and probable PTSD after a mass traumatic event. METHODS: A representative sample of men and women living in the New York City metropolitan area was selected using random-digit dialing, and subjects were interviewed by telephone 6 to 9 months after the September 11, 2001 (9/11) terrorist attacks. We assessed probable lifetime PTSD and probable PTSD related to the 9/11 attacks using a brief screening instrument and potential correlates. RESULTS: A total of 2752 individuals (1479 women, 1273 men) were interviewed. The lifetime prevalence of probable PTSD was significantly higher for women than for men (17.2% vs 12.1%; P = 0.005). Experiences of sexual assault (P < 0.001), preexisting mental health problems (P = 0.04), race/ethnicity (P = 0.01), marital status (P < 0.001), and having had probable peri-event panic in the first few hours after the 9/11 attacks (P < 0.001) were all significantly related to women's greater susceptibility to probable lifetime PTSD. However, the prevalence of probable PTSD related to 9/11 was not significantly different between women and men (6.5% vs 5.4%), although women were significantly more likely to report re-experiencing (P < 0.001) and hyperarousal (P < 0.001) symptoms than were men. Women were more likely than men to experience probable peri-event panic during the 9/11 attacks (P < 0.001); this explained, in part, the greater subsequent likelihood of re-experiencing and hyperarousal symptoms among women compared with men. CONCLUSIONS: More factors explain the risk of PTSD among women and men after interpersonal trauma than after a disaster. Using peri-event panic symptomatology after a traumatic event to determine the risk of posttraumatic symptoms may suggest avenues for intervention that can decrease the burden of PTSD in women.

Pulmonary disease in rescue workers at the World Trade Center site

Banauch GI, Dhala A, and Prezant DJ

2005

Correlates of compassion fatigue and burnout in chaplains and other clergy who responded to the September 11th attacks in New York City

Flannelly KJ, Roberts SB, and Weaver AJ

2005

Posttraumatic stress disorder in the general population after mass terrorist incidents: Considerations about the nature of exposure

Galea S and Resnick H

2005

Upper respiratory symptoms and other health effects among residents living near the World Trade Center site after September 11, 2001

Lin S, Reibman J, Bowers JA, et al

2005

Probable cigarette dependence, PTSD, and depression after an urban disaster: Results from a population survey of New York City residents 4 months after September 11, 2001

Nandi A, Galea S, Ahern J, et al

2005

Relationships among polycyclic aromatic hydrocarbon-DNA adducts, proximity to the World Trade Center, and effects on fetal growth

Perera FP, Tang D, Rauh V, et al

2005

Polycyclic aromatic hydrocarbons (PAHs) are toxic pollutants released by the World Trade Center (WTC) fires and various urban combustion sources. Benzo[a]pyrene (BaP) is a representative member of the class of PAHs. PAH-DNA adducts, or BaP-DNA adducts as their proxy, provide a measure of chemical-specific genetic damage that has been associated with increased risk of adverse birth outcomes and cancer. To learn whether PAHs from the WTC disaster increased levels of genetic damage in pregnant women and their newborns, we analyzed BaP-DNA adducts in maternal (n = 170) and umbilical cord blood (n = 203) obtained at delivery from nonsmoking women who were pregnant on 11 September 2001 and were enrolled at delivery at three downtown Manhattan hospitals. The mean adduct levels in cord and maternal blood were highest among newborns and mothers who resided within 1 mi of the WTC site during the month after 11 September, intermediate among those who worked but did not live within this area, and lowest in those who neither worked nor lived within 1 mi (reference group). Among newborns of mothers living within 1 mi of the WTC site during this period, levels of cord blood adducts were inversely correlated with linear distance from the WTC site (p = 0.02). To learn whether PAHs from the WTC disaster may have affected birth outcomes, we analyzed the relationship between these outcomes and DNA adducts in umbilical cord blood, excluding preterm births to reduce variability. There were no independent fetal growth effects of either PAH-DNA adducts or environmental tobacco smoke (ETS), but adducts in combination with in utero exposure to ETS were associated with decreased fetal growth. Specifically, a doubling of adducts among ETS-exposed subjects corresponded to an estimated average 276-g (8%) reduction in birth weight (p = 0.03) and a 1.3-cm (3%) reduction in head circumference (p = 0.04). The findings suggest that exposure to elevated levels of PAHs, indicated by PAH-DNA adducts in cord blood, may have contributed to reduced fetal growth in women exposed to the WTC event.

The World Trade Center residents' respiratory health study: New-onset respiratory symptoms and pulmonary function

Reibman J, Lin S, Hwang SA, et al

2005

Dissociation and posttraumatic stress 1 year after the World Trade Center disaster: Follow-up of a longitudinal survey

Simeon D, Greenberg J, Nelson D, et al

2005

Physical and mental health symptoms among NYC transit workers seven and one-half months after the WTC attacks

Tapp LC, Baron S, Bernard B, et al

2005

Gender differences in posttraumatic stress disorder among primary care patients after the World Trade Center attack of September 11, 2001

Weissman MM, Neria Y, Das A, et al

2005

BACKGROUND: Debate surrounds the nature of gender differences in rates of posttraumatic stress disorder (PTSD). OBJECTIVE: The goal of this study was to quantify and explore the reasons for gender differences in rates of PTSD in low income, primary care patients after the World Trade Center (WTC) attack of September 11, 2001. METHODS: A survey was conducted at a large primary care practice in New York City 7 to 16 months after the WTC attack. The study involved a systematic sample of primary care patients aged 18 to 70 years. The main outcome measures were the Life Events Checklist, the Posttraumatic Stress Disorder Checklist-Civilian Version, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, all administered by a bilingual research staff. RESULTS: A total of 3807 patients were approached at the primary care clinic. Of the 1347 who met eligibility criteria, 1157 (85.9%) consented to participate. After the addition of the WTC/PTSD supplement to the study, the total number of patients was 992, of whom 982 (99.0%) completed the survey. Both sexes had high rates of direct exposure to the WTC attack and high rates of lifetime exposure to stressful life events. Overall, females had lower rates of exposure to the attack compared with males (P < 0.05). Hispanic females had the highest rate of PTSD in the full sample. Gender differences in rates of PTSD were largely accounted for by differences in marital status and education. The rate of current major depressive disorder (MDD) was higher in females than in males (P < 0.001), and the reverse was true for substance abuse (P < 0.001). Gender differences for MDD and substance abuse persisted even after adjustments for demographic differences between the sexes. CONCLUSIONS: The increased rate of PTSD in women attending a primary care clinic was mediated by their social and economic circumstances, such as living alone without a permanent relationship and with little education or income. The increased rate of MDD in women appeared to be less dependent on these circumstances. These findings have implications for the treatment of women with PTSD in primary care and for research on gender differences in rates of psychiatric disorders.

Mental health service use 1-year after the World Trade Center disaster: Implications for mental health care

Boscarino JA, Adams RE, and Figley CR

2004

The objective of this study was to assess prevalence and predictors of mental health service use in New York City (NYC) after the World Trade Center disaster (WTCD). One year after the attacks, we conducted a community survey by telephone of 2368 adults living in NYC on September 11, 2001. In the past year, 19.99% (95% confidence interval [CI]=18.2-21.77) of New Yorkers had mental health visits and 8.1% (95% CI=7.04-9.16) used psychotropic medications. In addition, 12.88% (95% CI=11.51-14.25) reported one or more visits were related to the WTCD. Compared to the year before, 8.57% (95% CI=7.36-9.79) had increased post-disaster visits and 5.28% (95% CI=4.32-6.25) had new post-disaster treatment episodes. Psychotropic medication use related to the WTCD was 4.51% (95% CI=3.75-5.26). Increased post-disaster medication use, compared to the year before, was 4.11% (95% CI=3.35-4.86) and new medication episodes occurred among 3.01% (95% CI=2.34-3.69). In multivariate logistic analyses, mental health visits were associated with younger age, peri-event panic attack, posttraumatic stress disorder (PTSD) and depression. In addition, WTCD-related visits had a positive "dose-response" association with WTCD event exposures (P<0.0001). WTCD-related visits also were positively associated with peri-event panic, anxiety, lower self-esteem, PTSD, and depression. All three medication measures were positively related to PTSD and depression, and negatively associated with African American status. WTCD-related medication use also was positively related to younger age, female gender, WTCD event exposures, negative life events, anxiety and lower self-esteem. Finally, while the percentage of New Yorkers seeking post-disaster treatment did not increase substantially, the volume of visits among patients apparently increased. We conclude that exposure to WTCD events was related to post-disaster PTSD and depression, as well as WTCD-related mental health service use. African Americans were consistently less likely to use post-disaster medications. Although the WTCD did have an impact on treatment-seeking among current patients, it did not substantially increase mental health treatment among the general population.

Adverse reactions associated with studying persons recently exposed to mass urban disaster

Boscarino JA, Figley CR, Adams RE, et al

2004

Posttraumatic stress disorder, depression, and perceived safety 13 months after September 11

Grieger TA, Fullerton CS, and Ursano RJ

2004

Mental health and primary care in a time of terrorism: Psychological impact of terrorist attacks

Miller AM and Heldring M

2004

Job loss, unemployment, work stress, job satisfaction, and the persistence of posttraumatic stress disorder one year after the September 11 attacks

Nandi A, Galea S, Tracy M, et al

2004

Persistent organic pollutants in dusts that settled indoors in lower Manhattan after September 11, 2001

Offenberg JH, Eisenreich SJ, Gigliotti CL, et al

2004

The explosion and collapse of the World Trade Center (WTC) was a catastrophic event that produced an aerosol impacting many residents, workers, and commuters after September 11, 2001. In all, 12 bulk samples of the settled dust were collected at indoor locations surrounding the epicenter of the disaster, including one sample from a residence that had been cleansed and was once again occupied. Additionally, one sample was collected from just outside a fifth story window on the sill. These samples were analyzed for many components, including inorganic and organic constituents as well as morphology of the various particles. The results of the analyses for persistent organic pollutants on dusts that settled at indoor locations are described herein, including polycyclic aromatic hydrocarbons, polychlorinated biphenyls, and select organo-chlorine pesticides. The Sigma(86)-PCB concentrations, comprising less than one part per million by mass of the bulk in the two samples analyzed, indicated that PCBs were of limited significance in the dust that settled at indoor locations across lower Manhattan. Likewise, organo-chlorine pesticides, Hexachlorobenzene, Heptachlor, 4,4'-DDE, 2,4'-DDT, 4,4'-DDT and Mirex were found at even lower concentrations in the bulk samples. Conversely, Sigma(37)-PAHs comprised up to 0.04% (<0.005-0.036%) by mass of the bulk indoor dust in the 11 WTC impacted bulk indoor samples. Analysis of one sample of indoor dusts collected from a vacuum cleaner of a rehabilitated home shows markedly lower PAH concentrations (<0.0005 mass%), as well as differing relative contributions for individual compounds. In addition to similar concentrations, comparison of PAH concentration patterns (i.e. chemical fingerprints) shows that dusts that settled indoors are chemically similar to previously measured WTC dusts found at outdoor locations and that these PAH analyses may be used in identifying dusts of WTC origin at indoor locations, along with ascertaining further needs for cleaning.

Comorbidity of fibromyalgia and posttraumatic stress disorder symptoms in a community sample of women

Raphael KG, Janal MN, and Nayak S

2004

A survey of New Yorkers after the sept. 11, 2001, terrorist attacks

DeLisi LE, Maurizio A, Yost M, et al

2003

2.0.co;2>Posttraumatic stress reactions in New York City children after the September 11, 2001, terrorist attacks

Fairbrother G, Stuber J, Galea S, et al

2003

Children's mental health after disasters: The impact of the World Trade Center attack

Hoven CW, Duarte CS, and Mandell DJ

2003

Persistent organic pollutants in the dusts that settled across lower Manhattan after September 11, 2001

Offenberg JH, Eisenreich SJ, Chen LC, et al

2003

Posttraumatic stress in women after the September 11 terrorist attacks in New York City

Pulcino T, Galea S, Ahern J, et al

2003

Polycyclic aromatic hydrocarbons and other semivolatile organic compounds collected in New York City in response to the events of 9/11

Swartz E, Stockburger L, and Vallero DA

2003

Impact of the September 11th attacks in New York City on drug users: A preliminary assessment

Deren S, Shedlin M, Hamilton T, et al

2002

An investigation of the psychological effects of the September 11, 2001, attacks on New York City: Developing and implementing research in the acute postdisaster period

Galea S, Vlahov D, Resnick H, et al

2002

Mental health needs in New York state following the September 11th attacks

Herman D, Felton C, and Susser E

2002

Safety and health of heavy equipment operators at ground zero

Lippy BE

2002

Assessing the health of immigrant workers near ground zero: Preliminary results of the World Trade Center day laborer medical monitoring project

Malievskaya E, Rosenberg N, and Markowitz S

2002

Use of psychotropics in two employee groups directly affected by the events of September 11

McCarter L and Goldman W

2002

Occupational exposures during the World Trade Center disaster response

Wallingford KM and Snyder EM

2001

Daily sleep-stress reactivity and functional impairment in World Trade Center responders

Messman BA, Slavish DC, Briggs M, et al.

2023

Role of small airway dysfunction in unexplained exertional dyspnoea

Sharpe AL, Reibman J, Oppenheimer BW, et al.

2023

The World Trade Center Health Program: An introduction to best practices

Calvert GM, Anderson K, Cochran J, et al.

2022

Reduced cerebellar cortical thickness in World Trade Center responders with cognitive impairment

Clouston SAP, Kritikos M, Huang C, et al

2022

Association of attention and memory biases for negative stimuli with post-traumatic stress disorder symptoms

Imbriano G, Waszczuk M, Rajaram S, et al

2022

Understanding the role of persistent organic pollutants and stress in the association between proximity to the World Trade Center disaster and birth outcomes

Spratlen MJ, Perera FP, Sjodin A, et al

2022

Respiratory impedance measured using impulse oscillometry in a healthy urban population

Berger KI, Wohlleber M, Goldring RM, et al

2021

This study derives normative prediction equations for respiratory impedance in a healthy asymptomatic urban population using an impulse oscillation system (IOS). In addition, this study uses body mass index (BMI) in the equations to describe the effect of obesity on respiratory impedance.Data from an urban population comprising 472 healthy asymptomatic subjects that resided or worked in lower Manhattan, New York City were retrospectively analysed. This population was the control group from a previously completed case–control study of the health effects of exposure to World Trade Center dust. Since all subjects underwent spirometry and oscillometry, these previously collected data allowed a unique opportunity to derive normative prediction equations for oscillometry in an urban, lifetime non-smoking, asymptomatic population without underlying respiratory disease.Normative prediction equations for men and women were successfully developed for a broad range of respiratory oscillometry variables with narrow confidence bands. Models that used BMI as an independent predictor of oscillometry variables (in addition to age and height) demonstrated equivalent or better fit when compared with models that used weight. With increasing BMI, resistance and reactance increased compatible with lung and airway compression from mass loading.This study represents the largest cohort of healthy urban subjects assessed with an IOS device. Normative prediction equations were derived that should facilitate application of IOS in the clinical setting. In addition, the data suggest that modelling of lung function may be best performed using height and BMI as independent variables rather than the traditional approach of using height and weight.Prediction equations for respiratory impedance were derived in an urban cohort incorporating the effects of mass loading from obesity. Urban exposures had minimal effect on impedance allowing application of the equations to a broad range of populations. https://bit.ly/3a3zZvd

Selective hippocampal subfield volume reductions in World Trade Center responders with cognitive impairment

Deri Y, Clouston SAP, DeLorenzo C, et al

2021

Assessing the effects of disasters and their aftermath on pregnancy and infant outcomes: A conceptual model

Harville EW, Beitsch L, Uejio CK, et al

2021

PTSD is associated with accelerated transcriptional aging in World Trade Center responders

Kuan PF, Ren X, Clouston S, et al

2021

Dynamic residential movement and depression among the World Trade Center Health Registry enrollees

Lim S, Liu SY, Brite J, et al

2021

World Trade Center exposure and posttraumatic growth: Assessing positive psychological change 15 years after 9/11

Pollari CD, Brite J, Brackbill RM, et al

2021

Comorbid post-traumatic stress disorder and major depression disorder associated with asthma morbidity among WTC workers

Wisnivesky J, Markowitz SB, James S, et al

2021

Mental health, long-term medication adherence, and the control of asthma symptoms among persons exposed to the WTC 9/11 disaster

Brite J, Friedman S, de la Hoz RE, et al

2020

An exploratory trial of cognitive-behavioral vs client-centered therapies for child-mother dyads bereaved from terrorism

Brown EJ, Goodman RF, Cohen JA, et al

2020

Post-traumatic stress disorder among survivors of the September 11, 2001 World Trade Center attacks: A review of the literature

Hamwey MK, Gargano LM, Friedman LG, et al

2020

Post-traumatic stress disorder and risk of prescription opioid use, over-use, and misuse among World Trade Center Health Registry enrollees, 2015-2016

Takemoto E, Brackbill R, Martins S, et al

2020

Shortened leukocyte telomere length is associated with reduced pulmonary function and greater subsequent decline in function in a sample of World Trade Center responders

Clouston SAP, Edelman NH, Abraham A, et al

2019

World Trade Center: A longitudinal case study for treating post traumatic stress disorder with emotional freedom technique and eye movement desensitization and reprocessing

Nicosia GJ, Minewiser L, and Freger A

2019

Comorbidity amplifies the effects of post-9/11 posttraumatic stress disorder trajectories on health-related quality of life

Li J, Zweig KC, Brackbill RM, et al

2018

Parent-reported child reactions to the September 11, 2001 World Trade Center attacks (New York USA) in relation to parent post-disaster psychopathology three years after the event

Pfefferbaum B, Simic Z, and North CS

2018

IntroductionParents are a primary support for children following disasters, even though they face numerous challenges in addressing the physical and social consequences of an event. Parents who are directly exposed to a disaster and those who develop psychiatric disorders post-event are likely to be especially challenged and may be limited in their ability to support their children. This Brief Report describes a pilot study of survivors of the September 11, 2001 World Trade Center (New York USA) attacks who reported their own psychosocial consequences and the reactions of their children three years post-event.HypothesesThe primary hypothesis of the study was that children's September 11th reactions would be associated with their parents' psychiatric status. Secondary hypotheses were that the children's disaster reactions would be associated with direct exposure to the disaster in children and/or their parents, parent-child separation due to the disaster, and disaster-related school absence. METHODS: Approximately three years after the 2001 World Trade Center attacks, 116 parents recruited from disaster-affected or disaster-related organizations were assessed using structured diagnostic interviews and queried about their children's (188 youths, aged three to 17 years at the time of the attacks) posttraumatic stress symptoms and behavioral changes. RESULTS: Almost one-half of the parents had a post-disaster psychiatric disorder, including major depression in 27% and disaster-related posttraumatic stress disorder (PTSD) in 11%. More than three-fourths of the children had at least one disaster-related posttraumatic stress symptom, and more than one-half experienced at least one post-disaster behavior change. A minority of the children were reported to have increased school behavior problems or a decline in their grades. Key correlates of children's disaster-related posttraumatic stress symptoms and post-disaster behavior changes were parent-child separation due to the disaster and parental post-disaster psychiatric disorders. CONCLUSION: Because parents provide primary caretaking and support for children post-disaster, addressing the needs of parents is critical to their ability to assist their children. Reducing parents' symptoms should increase their emotional availability and enhance their ability to address the needs of their children. Given the challenges in providing disaster interventions directly to children, especially when resources are limited, addressing parent psychopathology and distress (even in the absence of focusing on children's symptoms) may benefit children. PfefferbaumB, SimicZ, NorthCS. Parent-reported child reactions to the September 11, 2001, World Trade Center attacks (New York USA) in relation to parent post-disaster psychopathology three years after the event. Prehosp Disaster Med. 2018;33(5):558-564.

Resilience to post-traumatic stress among World Trade Center survivors: A mixed-methods study

Gargano LM, Hosakote S, Zhi Q, et al

2017

Trauma-focused smoking cessation for smokers exposed to the World Trade Center disaster: A randomized clinical trial

Gonzalez A, Friedberg F, Li X, et al

2017

Introduction: The main objective was to evaluate the efficacy of an 8-session, group-based comprehensive smoking cessation and trauma management (CSC-T) treatment among daily smokers (≥ 5 cigarettes/day) exposed to the World Trade Center (WTC) disaster with elevated WTC-related post-traumatic stress disorder (PTSD) symptoms. Methods: Participants (N = 90) were randomly assigned to CSC-T (N = 44; 63.6% white; 27.3% female; mean age = 51.32 ± 7.87) or comprehensive smoking cessation (CSC) alone (N = 46; 71.7% white; 28.3% female; mean age = 48.74 ± 10.66), which was comparable in length and time. Assessments included a diagnostic clinical interview and self-report measures of PTSD and respiratory symptoms, and smoking behavior, and biologically confirmed smoking abstinence. Evaluations occurred at a baseline visit, each treatment session, and at 1-, 2-, 4-, 12-, and 26-weeks post-treatment. Results: The two treatments did not differ in regard to PTSD symptom improvement. After quit day (week 6), the two groups had similar 7-day (~15%) and 6-month (~20%) abstinence rates as well as average number of cigarettes smoked, and PTSD and respiratory symptoms. Conclusions: It is possible that the Cognitive Behavioral Therapy skills specific to quitting smoking, group-based support, and degree of therapist contact, that were available in both treatments may have played a role in equalizing the abstinence rates between the two conditions. Although the current study found no evidence that the CSC-T was superior to the CSC alone treatment, the abstinence rates observed were high relative to previous trials of smokers with diagnosed PTSD. Further development of smoking cessation programs tailored to the needs of smokers with PTSD symptoms continues to be needed. Implications: This study suggests that a CSC program aids in smoking abstinence for smokers with PTSD symptoms and that incorporating trauma management skills, may not add additional benefits for abstinence and PTSD and respiratory symptom relief. Further work is needed to improve smoking cessation efforts for smokers with PTSD symptoms.

World Trade Center (WTC) dust exposure in mice is associated with inflammation, oxidative stress and epigenetic changes in the lung

Sunil VR, Vayas KN, Fang M, et al

2017

Performance of self-report to establish cancer diagnoses in disaster responders and survivors, World Trade Center Health Registry, New York, 2001–2007

Li J, Cone JE, Alt AK, et al

2016

Sudden gains and deteriorations in the treatment of posttraumatic stress disorder in World Trade Center responders

Haugen PT, Goldman RE, and Owen J

2015

Childhood maltreatment, 9/11 exposure, and latent dimensions of psychopathology: A test of stress sensitization

Meyers JL, Lowe SR, Eaton NR, et al

2015

Mmp-2 and TIMP-1 predict healing of WTC-lung injury in New York City firefighters

Nolan A, Kwon S, Cho SJ, et al

2014

Systematic review of the psychological consequences of terrorism among child victims

Pereda N

2013

Physician-diagnosed respiratory conditions and mental health symptoms 7-9 years following the World Trade Center disaster

Webber MP, Glaser MS, Weakley J, et al

2011

Risk-taking behaviors of gay and bisexual men in New York City post 9/11

Espinosa LS, Maddock CB, Osier HW, et al

2010

Impact of conjoined exposure to the World Trade Center attacks and to other traumatic events on the behavioral problems of preschool children

Chemtob CM, Nomura Y, and Abramovitz RA

2008

Treatment with children and adolescents traumatized by the September 11th attack

Latino R, Friedman B, and Bellucci V

2006

Exposures among pregnant women near the World Trade Center site on 11 September 2001

Wolff MS, Teitelbaum SL, Lioy PJ, et al

2005

We have characterized environmental exposures among 187 women who were pregnant, were at or near the World Trade Center (WTC) on or soon after 11 September 2001, and are enrolled in a prospective cohort study of health effects. Exposures were assessed by estimating time spent in five zones around the WTC and by developing an exposure index (EI) based on plume reconstruction modeling. The daily reconstructed dust levels were correlated with levels of particulate matter < or = 2.5 microm in aerodynamic diameter (PM2.5; r = 0.68) or PM10 (r = 0.73-0.93) reported from 26 September through 8 October 2001 at four of six sites near the WTC whose data we examined. Biomarkers were measured in a subset. Most (71%) of these women were located within eight blocks of the WTC at 0900 hr on 11 September, and 12 women were in one of the two WTC towers. Daily EIs were determined to be highest immediately after 11 September and became much lower but remained highly variable over the next 4 weeks. The weekly summary EI was associated strongly with women's perception of air quality from week 2 to week 4 after the collapse (p < 0.0001). The highest levels of polycyclic aromatic hydrocarbon-deoxyribonucleic acid (PAH-DNA) adducts were seen among women whose blood was collected sooner after 11 September, but levels showed no significant associations with EI or other potential WTC exposure sources. Lead and cobalt in urine were weakly correlated with sigmaEI, but not among samples collected closest to 11 September. Plasma OC levels were low. The median polychlorinated biphenyl level (sum of congeners 118, 138, 153, 180) was 84 ng/g lipid and had a nonsignificant positive association with sigmaEI (p > 0.05). 1,2,3,4,6,7,8-Heptachlorodibenzodioxin levels (median, 30 pg/g lipid) were similar to levels reported in WTC-exposed firefighters but were not associated with EI. This report indicates intense bystander exposure after the WTC collapse and provides information about nonoccupational exposures among a vulnerable population of pregnant women.

Chemical characterization of ambient particulate matter near the World Trade Center: Elemental carbon, organic carbon, and mass reconstruction

Olson DA, Norris GA, Landis MS, et al

2004

Post-traumatic stress in New York City children after the World Trade Center disaster

Fairbrother G, Stuber JP, Pfefferbaum B, et al

2003

Drug use frequency among street-recruited heroin and cocaine users in harlem and the bronx before and after September 11, 2001

Factor SH, Wu Y, Monserrate J, et al

2002

Study of traces of tritium at the World Trade Center

Semkow TM, Hafner S, Parekh PP, et al.

2002

A 15-year longitudinal study of search-and-rescue dogs identifies the musculoskeletal, integumentary, and gastrointestinal systems as commonly affected

Seeley AC, Isaksen KE, Lucas A, et al.

2024

Tracking diseases related to the terrorist attacks of September 11, 2001

Calvert GM

2023

The World Trade Center Health Program: Cancer screening and cancer care best practices

Calvert GM, Lilly G, and Cochran J

2023

Functional changes in neural mechanisms underlying post-traumatic stress disorder in World Trade Center responders

Invernizzi A, Rechtman E, Curtin P, et al.

2023

Trajectories of posttraumatic stress symptoms following the September 11, 2001, terrorist attacks: A comparison of two modeling approaches

Huber KA, Frazier PA, Alper HE, et al

2022

Obstructive sleep apnoea and left ventricular diastolic dysfunction among first responders to the 9/11 World Trade Center terrorist attack: A cross-sectional study

Iyengar-Kapuganti RL, Maceda CS, Croft LB, et al

2022

The bidirectional relationship between posttraumatic stress symptoms and social support in a 9/11-exposed cohort: A longitudinal cross-lagged analysis

Liu SY, Li J, Leon LF, et al

2022

Health effects following exposure to dust from the World Trade Center disaster: An update

Mears MJ, Aslaner DM, Barson CT, et al

2022

Physical functional impairment and the risk of incident mild cognitive impairment in an observational study of World Trade Center responders

Pellecchia A, Kritikos M, Guralnik J, et al.

2022

BACKGROUND AND OBJECTIVES: Posttraumatic stress disorder (PTSD) has been linked to increased risk of cognitive dysfunction and physical functional impairment (PFI). The objective of this prospective cohort study was to examine whether PFI was associated with increased risk of incident mild cognitive impairment (MCI) among World Trade Center (WTC) responders with PTSD. We hypothesized that responders with PTSD would have an elevated risk of incident MCI and that PFI would mediate this increase. METHODS: We examined responder participants in the WTC Aging Study whose baseline physical assessments were completed by May 2016-April 2017 and were followed up at least once before December 2019. Those without complete demographic, medical, or behavioral data were excluded. PFI was assessed using measures of upper body strength (maximal handgrip strength [HGS]) and lower extremity physical functioning (Short Physical Performance Battery). PTSD was rated using a diagnostic interview and symptom checklist; MCI and dementia were assessed using the Montreal Cognitive Assessment and diagnosed using the National Institute on Aging-Alzheimer's Association criteria. Group differences and longitudinal comparisons were examined. Cox proportional hazards models were evaluated from time to incident MCI and conversion to dementia. A mediation analysis examined whether PFI mediated associations between PTSD and MCI. RESULTS: Within the sample of 2,687 WTC responders, 324 (12.06%, 95% CI = [10.83-13.29]) had lower extremity PFI. Responders with lower extremity PFI were older, had lower education and higher body mass, and were at a higher risk of pulmonary embolisms and PTSD. Responders with lower extremity PFI demonstrated lower baseline cognition and had increased hazards of MCI (multivariable-adjusted hazards ratio [aHR] = 1.55 [95% CI 1.21-1.98]); those with MCI converted to dementia more rapidly than those without PFI (2.73 [1.38-5.39] p = 0.004). In addition, each standard deviation decrease in HGS was associated with increased hazards of developing MCI (aHR = 1.35 [95% CI 1.10-1.66]). A mediation model suggested PFI played an intermediary role in the relationship between PTSD and MCI. DISCUSSION: WTC responders with PFI demonstrated worse cognitive and behavioral outcomes, and PFI played an intermediary role in the relationship between PTSD and incident MCI, suggesting that PFI may be an early indicator of MCI in responders with PTSD. Regular monitoring of PFI should be considered among PTSD populations.

Cognitive function among World Trade Center-exposed community members with mental health symptoms

Rosen R, Shao Y, Zhang Q, et al

2022

Lung cancer incidence among World Trade Center rescue and recovery workers

Sigel K, de la Hoz RE, Markowitz SB, et al

2022

Exposure to the World Trade Center disaster and test performance among New York City public school students over time, 1998–2003

Takemoto E, Locke S, Goin DE, et al

2022

Race/ethnic differences in prevalence and correlates of posttraumatic stress disorder in World Trade Center responders: Results from a population-based, health monitoring cohort

Whealin JM, Ciro D, Dasaro CR, et al

2022

The relationship between post traumatic stress disorder and self-management behaviors in World Trade Center workers with asthma

Wisnivesky JP, Becker JH, Ankam J, et al

2022

World Trade Center Health Program, 2012-2020: Implications for clinicians and health care systems

Azofeifa A, Martin GR, and Howard J

2021

A cortical thinning signature to identify World Trade Center responders with possible dementia

Clouston SAP, Kritikos M, Deri Y, et al.

2021

Introduction World Trade Center (WTC) responders have a high risk of early-onset cognitive impairment (CI), but little is known about the etiology including the extent to which CI in WTC responders is accompanied by cortical atrophy as is common in progressive diseases causing age-related CI such as Alzheimer’s disease and related dementias. In the current study, we entrained an artificial neural network (ANN) to determine the accuracy of cortical thickness (CTX) on magnetic resonance imaging to identify World Trade Center responders at midlife (aged 44–65 years) with possible dementia. Methods A total of 119 WTC responders (57 with CI and 62 with intact cognition) underwent a structural MRI scanning protocol including T1-weighted MPRAGE as part of two imaging studies. The discovery study was divided into training and validation samples, while a second replication sample was used. An ANN was trained using regional CTX measured across 34 unilateral regions of interest (ROIs) using Freesurfer software and ‘Desikan-Killiany’ brain atlas. The discovery sample was used for model development, and the replication sample was used to evaluate predictive accuracy. Results In the WTC responder cohort, the ANN algorithm showed high discrimination performance for CI. The ANN model using regional CTX data from both hemispheres achieved an area under the receiver operating characteristic curve (AUC) of 0.96 95% C.I. = [0.91–1.00] (Accuracy = 96.0%, Precision = 97.8%, Recall = 95.8%, Sensitivity = 95.8%, Specificity = 98.0%, F1 = 96.8%) for the discovery sample and AUC = 0.90 [0.70–1.00] (Accuracy = 90.0%, Precision = 90.0%, Sensitivity = 90.0%, Specificity = 90.0%, F1 = 90.0%) in the replication sample. Conclusion Analysis of bilateral regional CTX data derived from T1-weighted MPRAGE images by ANN analysis demonstrated excellent accuracy in distinguishing WTC responders with early-onset CI.

PEDF, a pleiotropic WTC-LI biomarker: Machine learning biomarker identification and validation

Crowley G, Kim J, Kwon S, et al

2021

Biomarkers predict World Trade Center-Lung Injury (WTC-LI); however, there remains unaddressed multicollinearity in our serum cytokines, chemokines, and high-throughput platform datasets used to phenotype WTC-disease. To address this concern, we used automated, machine-learning, high-dimensional data pruning, and validated identified biomarkers. The parent cohort consisted of male, never-smoking firefighters with WTC-LI (FEV1, %Pred< lower limit of normal (LLN); n = 100) and controls (n = 127) and had their biomarkers assessed. Cases and controls (n = 15/group) underwent untargeted metabolomics, then feature selection performed on metabolites, cytokines, chemokines, and clinical data. Cytokines, chemokines, and clinical biomarkers were validated in the non-overlapping parent-cohort via binary logistic regression with 5-fold cross validation. Random forests of metabolites (n = 580), clinical biomarkers (n = 5), and previously assayed cytokines, chemokines (n = 106) identified that the top 5% of biomarkers important to class separation included pigment epithelium-derived factor (PEDF), macrophage derived chemokine (MDC), systolic blood pressure, macrophage inflammatory protein-4 (MIP-4), growth-regulated oncogene protein (GRO), monocyte chemoattractant protein-1 (MCP-1), apolipoprotein-AII (Apo-AII), cell membrane metabolites (sphingolipids, phospholipids), and branched-chain amino acids. Validated models via confounder-adjusted (age on 9/11, BMI, exposure, and pre-9/11 FEV1, %Pred) binary logistic regression had AUCROC [0.90(0.84-0.96)]. Decreased PEDF and MIP-4, and increased Apo-AII were associated with increased odds of WTC-LI. Increased GRO, MCP-1, and simultaneously decreased MDC were associated with decreased odds of WTC-LI. In conclusion, automated data pruning identified novel WTC-LI biomarkers; performance was validated in an independent cohort. One biomarker-PEDF, an antiangiogenic agent-is a novel, predictive biomarker of particulate-matter-related lung disease. Other biomarkers-GRO, MCP-1, MDC, MIP-4-reveal immune cell involvement in WTC-LI pathogenesis. Findings of our automated biomarker identification warrant further investigation into these potential pharmacotherapy targets.

Changes over 10 years in the retelling of the flashbulb memories of the attack of 11 September 2001

Dégeilh F, Lecouvey G, Hirst W, et al

2021

White matter connectivity in incident mild cognitive impairment: A diffusion spectrum imaging study of World Trade Center responders at midlife

Huang C, Kritikos M, Clouston SAP, et al

2021

Neighborhood characteristics and psychiatric disorders in the aftermath of mass trauma: A representative study of New York City public school 4th-12th graders after 9/11

Musa GJ, Geronazzo-Alman L, Fan B, et al

2021

Workplace and safety perceptions among New York City employees after the 9/11 attacks

North CS, Pedrazine A, and Pollio DE

2021

Posttraumatic stress disorder in daily life among World Trade Center responders: Temporal symptom cascades

Ruggero CJ, Schuler K, Waszczuk MA, et al

2021

The impact of 9/11 and the war on terror on arab and muslim children and families

Sirin SR, Choi E, and Tugberk C

2021

PAP Adherence and Nasal Resistance. A Randomized Controlled Trial of CPAPflex versus CPAP in World Trade Center Responders

Sunderram J, Ayappa I, Lu S-E, et al

2021

Post-9/11 excess risk of thyroid cancer: Surveillance or exposure?

van Gerwen M, Cerutti JM, Rapp J, et al

2021

Post-9/11 mental health comorbidity predicts self-reported confusion or memory loss in World Trade Center Health Registry enrollees

Alper HE, Tuly RA, Seil K, et al

2020

Mental health stigma and barriers to care in World Trade Center responders: Results from a large, population‐based health monitoring cohort

Depierro J, Lowe SM, Haugen PT, et al

2020

Chronic posttraumatic stress disorder and comorbid cognitive and physical impairments in World Trade Center responders

Diminich ED, Clouston SAP, Kranidis A, et al

2020

Housing stability and diabetes among people living in New York City public housing

Lim S, Liu SYS, Jacobson MH, et al

2020

Instilling hope and resiliency: A narrative photo-taking intervention during an intercultural exchange involving 9/11 survivors in post 3/11 japan

Lurie JM, Lever H, Goodson L, et al

2020

Factors predicting treatment of World Trade Center-related lung injury: A longitudinal cohort study

Putman B, Lahousse L, Goldfarb DG, et al

2020

Characterization of persistent uncontrolled asthma symptoms in community members exposed to World Trade Center dust and fumes

Reibman J, Caplan-Shaw C, Wu Y, et al

2020

The association between health conditions in World Trade Center responders and sleep-related quality of life and sleep complaints

Ayappa I, Chen Y, Bagchi N, et al

2019

Genomics of particulate matter exposure associated cardiopulmonary disease: A narrative review

Citron J, Willcocks E, Crowley G, et al

2019

Genetic variants associated with FDNY WTC-related sarcoidosis

Cleven KL, Ye K, Zeig-Owens R, et al

2019

Comorbid posttraumatic stress disorder and lower respiratory symptoms in disaster survivors: Qualitative results of a 17-year follow-up of World Trade Center disaster survivors

Gargano LM, Gershon RR, Ogunyemi A, et al

2019

A better understanding of the experiences of disaster survivors with post-traumatic stress disorder (PTSD) and serious comorbid medical conditions may lead to improvements in treatment, and help reduce the public health and healthcare burden of affected individuals. The purpose of this qualitative study was threefold; first, to explore the relationship between PTSD and lower respiratory symptoms (LRS); second, to identify factors influencing self-management and treatment of both disorders; and third, to determine the impact of these comorbidities on quality of life. The goal was to identify strategies to improve coordination of medical and mental health management in order to reduce the symptomatic burden of these two health conditions. In-depth, semi-structured qualitative interviews were conducted among 34 World Trade Center Health Registry (WTCHR) rescue/recovery workers and community members with both active LRS (self-reported history of cough, wheeze or shortness of breath) and report of PTSD diagnosis on their 2015–2016 survey. Thematic analysis identified 14 themes grouped into six main categories: relationship between LRS and PTSD, impact of symptoms on quality of life, medical management, symptom management strategies, current health status, and exposure history and symptoms. Participants spoke of a wide range of both symptom triggers and management strategies, including self-management and some maladaptive management behaviors such as smoking and alcohol consumption. Participants also spoke of feeling like there were gaps in their healthcare, particularly for mental health. In addition, many spoke to a lack of coordinated care between physical and mental health. The majority of participants did not feel that there was a link between their PTSD and LRS, and among them a large portion also reported a lack of control over their symptoms. Proactive and collaborative planning steps at multiple levels (healthcare, public health, disaster management) are needed to prevent adverse impacts of disasters. Because of the increasing trend in disasters (both natural and man-made), with potentially wide-ranging exposures, it is important to plan for the complex treatment of PTSD and other co-morbidities.

Examining associations between hurricane sandy exposure and posttraumatic stress disorder by community of residence

Schwartz RM, Rasul R, Gargano LM, et al

2019

The association between pollutant levels and asthma-related emergency department visits in the bronx after the World Trade Center attacks

Sharma KI, Abraham R, Mowrey W, et al

2019

Paramedic and emergency medical technician reflections on the ongoing impact of the 9/11 terrorist attacks

Smith EC and Burkle FM

2019

Sarcoid-like granulomatous disease: Pathologic case series in World Trade Center dust exposed rescue and recovery workers

Sunil VR, Radbel J, Hussain S, et al

2019

Air pollution/irritants, asthma control, and health-related quality of life among 9/11-exposed individuals with asthma

Yung J, Osahan S, Friedman SM, et al

2019

Head and neck cancer in World Trade Center responders: A case series

Graber JM, Chuang CT, Ward CL, et al

2018

Posttraumatic stress disorder, functional impairment, and subjective distress in World Trade Center disaster workers

Hunnicutt-Ferguson K, Wyka KE, Peskin M, et al

2018

Longitudinal determinants of depression among World Trade Center Health Registry enrollees, 14–15 years after the 9/11 attacks

Jacobson MH, Norman C, Nguyen A, et al

2018

Epigenetic meta-analysis across three civilian cohorts identifies NRG1 and HGS as blood-based biomarkers for post-traumatic stress disorder

Uddin M, Ratanatharathorn A, Armstrong D, et al

2018

Psychological distress in parents and school-functioning of adolescents: Results from the World Trade Center registry

Gargano LM, Dechen T, Cone JE, et al

2017

New onset of asthma and job status change among World Trade Center responders and workers

Kim H, Baron S, Baidwan NK, et al

2017

Respirable dust and silica exposure among World Trade Center cleanup workers

Pavilonis BT and Mirer FE

2017

Persistent post-9/11 hearing problems among World Trade Center Health Registry rescue and recovery workers, 2001 to 2007

Stein CR, Lee DJ, Flamme GA, et al

2017

Emergency preparedness safety climate and other factors associated with mental health outcomes among World Trade Center disaster evacuees

Sherman MF, Gershon RR, Riley HEM, et al

2016

The postdisaster prevalence of major depression relative to PTSD in survivors of the 9/11 attacks on the World Trade Center selected from affected workplaces

North CS, Pollio DE, Hong BA, et al

2015

Meaning reconstruction in the face of terror: An examination of recovery and posttraumatic growth among victims of the 9/11 World Trade Center attacks

Richardson KM

2015

Obstructive sleep apnea and World Trade Center exposure

Glaser MS, Shah N, Webber MP, et al

2014

Enlarged pulmonary artery is predicted by vascular injury biomarkers and is associated with WTC-lung injury in exposed fire fighters: A case-control study

Schenck EJ, Echevarria GC, Girvin FG, et al

2014

A novel system to generate WTC dust particles for inhalation exposures

Vaughan JM, Garrett BJ, Prophete C, et al

2014

Early elevation of serum MMP-3 and MMP-12 predicts protection from World Trade Center-lung injury in New York City firefighters: A nested case-control study

Kwon S, Weiden MD, Echevarria GC, et al

2013

Alcohol use disorders and drinking among survivors of the 9/11 attacks on the World Trade Center in New York City

North CS, Adinoff B, Pollio DE, et al

2013

Research methods in child disaster studies: A review of studies generated by the September 11, 2001, terrorist attacks; the 2004 indian ocean tsunami; and hurricane katrina

Pfefferbaum B, Weems CF, Scott BG, et al

2013

Potential carcinogenic effects of World Trade Center dust after intratracheal instillation to sprague-dawley rats: First observation

Soffritti M, Falcioni L, Bua L, et al

2013

Post-disaster reproductive health outcomes

Zotti ME, Williams AM, Robertson M, et al

2013

The distinctiveness of prolonged grief and posttraumatic stress disorder in adults bereaved by the attacks of September 11th

Barnes JB, Dickstein BD, Maguen S, et al

2012

World Trade Center Health Registry--a model for a nanomaterials exposure registry

Cone JE and Farfel M

2011

Young children in the aftermath of the World Trade Center attacks

DeVoe ER, Klein TP, Bannon W, Jr., et al

2011

Sarcoidosis in World Trade Center rescue workers presenting with rheumatologic manifestations

Bowers B, Hasni S, and Gruber BL

2010

Recent versus remote: Flashbulb memory for 9/11 and self-selected events from the reminiscence bump

Denver JY, Lane SM, and Cherry KE

2010

The psychological impact of terrorist attacks: Examining a dose-response relationship between exposure to 9/11 and axis i mental disorders

Henriksen CA, Bolton JM, and Sareen J

2010

Salivary cortisol and psychopathology in adults bereaved by the September 11, 2001 terror attacks

Pfeffer CR, Altemus M, Heo M, et al

2009

Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks

DiGrande L, Perrin MA, Thorpe LE, et al

2008

Organizational factors and office workers' health after the World Trade Center terrorist attacks: Long-term physical symptoms, psychological distress, and work productivity

Osinubi OY, Gandhi SK, Ohman-Strickland P, et al

2008

Post-September 11 mental health service help seeking among a group of highly exposed New York City parents

DeVoe ER, Bannon WM, Jr., Klein TP, et al

2007

Population psychiatric medication prescription rates following a terrorist attack

Dimaggio C, Galea S, and Madrid PA

2007

Health effects in New York state personnel who responded to the World Trade Center disaster

Mauer MP, Cummings KR, and Carlson GA

2007

Post-9/11 helpseeking by New York City parents on behalf of highly exposed young children

DeVoe ER, Bannon WM, Jr., and Klein TP

2006

Attachment and psychological adaptation in high exposure survivors of the September 11th attack on the World Trade Center

Fraley RC, Fazzari DA, Bonanno GA, et al

2006

Posttraumatic stress disorder in primary care one year after the 9/11 attacks

Neria Y, Gross R, Olfson M, et al

2006

Comparison of two widely used PTSD-screening instruments: Implications for public mental health planning

Ruggiero KJ, Rheingold AA, Resnick HS, et al

2006

Assessing truck driver exposure at the World Trade Center disaster site: Personal and area monitoring for particulate matter and volatile organic compounds during october 2001 and april 2002

Geyh AS, Chillrud S, Williams DL, et al

2005

Follow-up of pentagon employees two years after the terrorist attack of September 11, 2001

Grieger TA, Waldrep DA, Lovasz MM, et al

2005

A brief treatment with a posttraumatic stress disordered patient—a self psychological perspective

Rowe CE

2005

Voices of 9/11 first responders: Patterns of collective resilience

Freedman TG

2004

Elementary school children's responses 3 months after the September 11 terrorist attacks: A study in washington, dc

Phillips D, Prince S, and Schiebelhut L

2004

Sleep reactivity as a risk factor for psychopathology: A review of prospective studies, mechanisms, and biological correlates

Reffi AN, Jankowiak L, Iqal JN, et al.

2024

Managing cancer following the World Trade Center disaster

Zeig-Owens R and Prezant DJ

2024

Living review of World Trade Center health effects

Katruska A, Santiago-Colón A, and Iker K

2023

OBJECTIVES/GOALS: The goal of this project is to develop a strategy to collect and extract published evidence in real time and to house and model these data for efficient downstream application to Program activities such as targeted reviews, grant evaluation and partner engagement. METHODS/STUDY POPULATION: We created the World Trade Center Health Effects Library in 2016. Today, this living review is ongoing and is fueled by daily systematic searches of online publication databases. Each day we screen new references for health effects of 9/11. The publication must include measurements, reports, or discussion of 9/11 health effects. If a publication meets these criteria, it is categorized by outcome and funding category. Primary outcome category data, reference metadata, and funding data are then made immediately available for programmatic analysis. All reference data are entered into a data pipeline and modelled for targeted reviews. RESULTS/ ANTICIPATED RESULTS: The WTC Health Effects Library curates 1932 references and adds an average of 60 new references each year on a wide range of study populations, exposures, and conditions. The completeness of the library has been verified by comprehensive literature searches for 9/11 health outcomes conducted externally and by CDC Library staff. As a result, the curated library is a proven alternative to a lengthy literature search and allows the Program and stakeholders to explore the data and engage immediately in targeted reviews on curated topics. The data that are collected in the screening and categorization process are merged with publication metadata and funding data to inform a data pipeline that supports outputs such as interactive visuals, charts, reports, and curated bibliographies for structured review. DISCUSSION/SIGNIFICANCE: This living review allows the Program to rapidly conduct focused reviews, to evaluate grants, and to communicate accurate data to partners. By using the curated data, we have reduced the time required to perform mandated evidence reviews by weeks, have conducted two structured reviews, and defined gaps in research maturity and health equity.

The World Trade Center Health Program: Smoking cessation

Lilly G and Calvert GM

2023

World Trade Center Health Program best practices for the diagnosis and treatment of gastroesophageal reflux disease

Lin RA, Calvert GM, and Udasin IG

2023

Opioid prescriptions among the World Trade Center Health Program population

Liu R, Calvert GM, Anderson KR, et al.

2023

BACKGROUND: The World Trade Center Health Program (Program) provides limited health care to those directly affected by the 9/11 terrorist attacks. Because of physical/mental trauma arising from the 9/11 attacks, Program members might be at high risk of opioid use. To prevent prescription opioid overuse, in 2018 the Program implemented various measures to improve opioid prescribing and expand access to non-opioid pain management among Program members. However, the characteristics of opioid prescriptions dispensed among this population has never been described. METHODS: Administrative and claims data from 07/01/2011 to 09/30/2022 were used to describe opioid prescriptions dispensed during 2013-2021. RESULTS: From 2013-2021, 108,285 members were Program-enrolled for ≥ 10 months, 4,053 (3.7%) had 22,938 outpatient opioid prescriptions, of which, 62.1% were for cancer-related pain, 11.1% for hospice/end of life care, 4.8% for surgery pain, and 9.8% for acute/chronic pain. Among members with Program-paid diagnostic/treatment claims (n = 70,721), the proportion with opioid prescriptions for cancer/hospice/end of life care increased from 0.5% in 2013 to 1.6% in 2018 (p = 0.010), then decreased to 1.1% in 2021 (p = 0.070), and the proportion for non-cancer surgery/acute/chronic pain decreased from 0.6% in 2013 to 0.23% in 2021 (p = 0.0005). Among members prescribed opioids without cancer/hospice/sickle cell disease, the proportion who started with long-acting opioids or had opioid prescriptions from ≥ 4 prescribers were below 6.5% annually; the proportion receiving a high-dose (≥ 90 morphine milligram equivalents per day [MED]), or with concurrent opioids and benzodiazepines use, or who started opioids with MED ≥ 50 or with long duration (≥ 7 days' supply) were above 10% annually, but decreased since 2017. CONCLUSIONS: Prevalence of outpatient opioid prescriptions paid by the Program was very low and prescriptions were primarily dispensed for cancer/hospice/end of life care. Although Program efforts to improve opioid prescribing coincided with improvements in outcomes, ongoing surveillance is needed.

Perceived social support and longitudinal trajectories of depression and anxiety in World Trade Center responders

Pijnenburg LJ, Velikonja T, Pietrzak RH, et al.

2023

Scoping review of the health effects of youth due to the September 11, 2001 terrorist attacks

Santiago-Colón A, Katruska A, and Iker K

2023

OBJECTIVES/GOALS: Use the World Trade Center (WTC) Health Program Health Effects Library to identify the breadth and depth of research on the health effects of youth due to exposures from the events of September 11, 2001, to track the research trajectories by study population, and to identify gaps and define needs for future research. METHODS/STUDY POPULATION: We selected references from the WTC Health Effects Library. This curated library includes research publications that measure, report, or discuss health effects of 9/11 at the three disaster sites. Articles included had to evaluate people under 18 years old on 9/11/2001, including those in-utero. Of the 1,813 references considered, 195 were included in our study. Data from each reference was extracted using DistillerSR software and organized in four topics: overview, methods, conditions, and results. Each publication was abstracted independently by a team of two health scientists and conflicts were resolved by the four-person team. All data was then exported from DistillerSR into Microsoft Excel for analysis. RESULTS/ANTICIPATED RESULTS: The 195 articles included were published between 2002 through 2021, of which 29 were funded by the WTC Health Program. The study population represented ranged from in-utero to 18 years old. Research trajectories will be developed by assessing chronological research by outcome groups (physical, mental and behavioral, interventions, and biomarkers), study population categories, as well as exposure location and mechanism. Demographic data extracted will be used to assess whether there are disparities in the research conducted to date for this population and if so, in what areas. Research recommendations and clinical implication extracted from references will be used to assess whether more recent research has addressed research from the early post 9/11 years. DISCUSSION/ SIGNIFICANCE: WTC research strengthens our understanding of 9/11 health effects and provides a way to improve healthcare for the people afflicted from 9/11 exposures. The anticipated results from this scoping review can lead us to identify past research challenges and current knowledge gaps that the Program can address in future research grants.

Rostral anterior cingulate response to emotional conflict is modulated by trauma exposure burden in resilient World Trade Center responders

Seeley S

2023

Background: People vary widely in ability to successfully adapt after potentially-traumatic events. For example, a subset of 9/11 World Trade Center (WTC) responders have remained consistently psychologically well despite having endured considerable WTC-related exposures. Emotion regulation is one psychological factor that may support resilience: top-down cortical regulation of subcortical fear processing structures supports adaptive responding to environmental demands. Most neuroimaging studies have focused on effortful (explicit) emotion regulation. However, recent studies suggest that automatic (implicit) emotion regulation abnormalities constitute a core dysfunction in PTSD and could be key to resilience as well: Offringa and colleagues (2013) found greater rostral anterior cingulate (rACC) activation during implicit emotion regulation in trauma-exposed controls vs. symptomatic individuals. However, few neuroimaging studies investigated implicit emotion regulation in trauma-exposed adults across both dimensions of exposure severity and presence or absence of psychopathology. In the present study, we sought to examine rACC functioning (as a region subserving automatic emotion regulation) using an established picture-word emotional Stroop task. We hypothesized that (1) highly resilient WTC responders with high WTC-trauma exposure burden [Resilient-High group] would demonstrate the greatest degree of rACC BOLD activation in response to emotional conflict, while the lower-WTC-exposed responders [Resilient-Low group] would show lesser but still positive rACC activation, and (3) responders with PTSD would not exhibit significantly different rACC activation on incongruent (vs. congruent) trials. Methods: Rescue and recovery workers (N = 97) involved in WTC recovery efforts following the 9/11/01 attacks in New York City were enrolled in a neuroimaging study. All participants were administered the Structured Clinical Interview for DSM-5 and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). We categorized WTC trauma-exposed responders with no current or lifetime psychopathology (i.e., resilient) into two groups (Resilient-High and Resilient-Low) based on number of specific 9/11-related exposures (e.g., participated in search and rescue, exposed to human remains, experienced death of a colleague or loved one). The PTSD group met DSM-5 criteria for WTC-related PTSD, based on the CAPS-5. Groups were matched on age and sex, with approximately 82% males in each group. Participants attended a fMRI session during which they completed a task involving photos of fearful or happy faces, overlaid with a word (“AFRAID” or “HAPPY”) that was either congruent or incongruent with the face. They were instructed to indicate the emotion in the photo by pressing a button as quickly as possible, while ignoring the overlaid word. fMRI data preprocessing used fMRIPrep 21.0.2 to generate individual motion-, susceptibility distortion-, and slice timing-corrected echoes, which were subsequently denoised using TE-dependent independent components analysis (TEDANA 0.0.12) and smoothed with a 6-mm FWHM Gaussian kernel before single-subject and group-level analysis via SPM12. Ninety-six participants completed the FaceStroop task, of which 85 were included in the final FaceStroop task analyses (Resilient-High n=31, Resilient-Low n=26, PTSD n=28) after excluding data from 7 participants for excessive motion in the scanner and from 4 participants for task performance below conventional thresholds for this task (>25% missed trials and/or <75% 2 ACNP 2023 Annual Meeting accuracy). Results: There were no significant group differences in FaceStroop task performance (mean reaction time and accuracy), matching results from Offringa et. al (2013). Incongruent > Congruent fMRI single-subject contrast images were aggregated across the sample to assess for whole-brain effects of task and group. We found typical task-related activation in regions reflecting conflict processing (e.g., dorsal ACC, bilateral anterior insula) and cognitive control (inferior frontal gyrus, dorsolateral prefrontal and parietal cortices), among others (FWE-corrected p=.05, k=10). To test our a priori region of interest hypotheses, we created an 8-mm sphere around the rACC peak MNI coordinates reported by Offringa et al. (2013) [x=16, y=36, z=34] and extracted participants’ Incongruent > Congruent BOLD activation estimates within the mask. As predicted, there was an omnibus effect of group, F(2,82) = 3.20, p = .046, such that the Resilient-High group showed the greatest rACC response to emotional conflict, followed by the Resilient-Low group, with minimal to no rACC activation in the PTSD group. Linear contrast results supported our specific directional hypotheses: rACC in Resilient-High > PTSD (t(82) = 2.48, p = .015), Resilient-High > Resilient-Low (t(82) = 0.72, p = .48), and Resilient-Low > PTSD (t(82) = 1.67, p = .098). We obtained similar results using an anatomically-defined rACC mask. Conclusions: We replicated prior findings that rACC engagement during automatic regulation of emotional conflict is modulated by presence/absence of psychopathology, and further expanded these results by identifying differences in trauma exposure severity as another modulator in resilient individuals. These findings contribute to understanding the neural instantiation of psychological factors that enable some individuals to be highly resilient despite high trauma exposure burden.

The World Trade Center Health Program: Obstructive sleep apnea best practices

Udasin IG, Sunderram J, and Calvert G

2023

Occupational exposures and sarcoidosis: Current understanding and knowledge gaps

Lin NW and Maier LA

2022

The COVID-19 pandemic and the five essential elements in mass trauma intervention: Perspectives from World Trade Center Health Program mental health clinicians

Lowe SM, Haugen PT, Marrone K, et al

2022

Longitudinal impact of WTC dust inhalation on rat cardiac tissue transcriptomic profiles

Park SH, Lu Y, Shao Y, et al

2022

Autoimmune conditions in the World Trade Center general responder cohort: A nested case-control and standardized incidence ratio analysis

Sacks HS, Smirnoff M, Carson D, et al

2022

Where are they now: The narratives of children who lost a parent on 9/11

Sliwak RM, Lee M, and Collins MH

2022

Global DNA methylation profiles in peripheral blood of WTC-exposed community members with breast cancer

Tuminello S, Zhang Y, Yang L, et al

2022

Comparison of prevalence and exposure-disease associations using self-report and hospitalization data among enrollees of the World Trade Center Health Registry

Alper HE, Brite J, Cone JE, et al

2021

Breast cancer characteristics in the population of survivors participating in the World Trade Center Environmental Health Center Program 2002-2019

Arslan AA, Zhang Y, Durmus N, et al

2021

Remembering 9/11, moral injury, COVID-19 and measuring religion, spirituality and health

Carey LB, Cohen J, Koenig HG, et al

2021

Acculturation, coping, and PTSD in hispanic 9/11 rescue and recovery workers

Ciro D, Pietrzak RH, Lee RJ, et al

2021

Metabolomics at the intersection of murine WTC-pm exposure and high fat diet: A machine learning assessment

Crowley G, Caraher E, Veerappan A, et al

2021

TP112 PROTEOMICS/GENOMICS/METABOLOMICS IN LUNG DISEASE: Corresponding author's email: george.crowley@nyumc.org;RATIONALE We have previously reported that high fat diet-particulate matter (HFD-PM) co-exposure can induce airway hypereactivity (AHR) in a murine model similar to what is clinically seen in the WTC-exposed firefighter cohort. LPA, a potential pathway that links MetSyn and pulmonary disease, is increased in HFD-PM co-exposure. Echocardiography results indicate that PM exposure in obesity causes subsequent cardiopulmonary dysfunction.;To further our understanding of potential pathways involved in vascular and pulmonary remodeling, we assayed the metabolome of HFD and PM co-exposure. ;;METHODS Murine HFD PM Exposure Model. C57Bl/6 wild type (WT) mice (n=8/group), aged 6-8 weeks were fed HFD (60% of calories from lard; D12492i; Research Diets) or normal diet (ND) with 13% of calories from fat. After 12-weeks of HFD and ≥20% weight gain when compared to age matched ND controls, oropharyngeal aspiration of 200μg WTC-PM53 or an equal volume of PBS was administered.;Metabolomics. 24-hrs after exposure, 100-mg of lung was snap frozen and underwent metabolomics assessment (Metabolon); 3 mice/Group. Qualified/curated metabolites subjected to random forests(RF; randomForest package R3.4.3, R-Project). Refined metabolite profile (top 5% based on mean decrease accuracy) was developed and included in a second model to assess classification performance. Unsupervised, agglomerative, two-way hierarchical clustering (Spearman correlation, average linkage; MATLAB-R2018a) performed for data visualization on refined profile. ;;RESULTS The refined profile of metabolites (n=22) are shown, Figure 1A. Hierarchical clustering;of the refined profile revealed differential expression in 2 clusters, Figure 1B. Random forests of the refined profile had 0% estimated classification error. Cluster 1, elevated in PBS-exposed mice, contained metabolites related to dietary protein. Meanwhile, Cluster 2, elevated in PM-exposed mice, included fatty acid metabolites that play a role in inflammation, as well as metabolites of amino acids. ;;CONCLUSIONS Similar to our human population, we observe that fatty acids and acetylated lysine residues are differentially expressed. These metabolites may play a;role in WTC-PM-related pathology and implicate epigenetic modulation as a potential result of WTC-exposure and a mechanism of WTC-AHR. Furthermore, elevations in metabolites related to dietary protein have been linked to resistance to WTC-related lung disease, and are seen here to be decreased in response to PM-exposure. Future work will investigate cardiovascular and respiratory remodeling that occurs after PM exposure in the context of high fat diets.

The World Trade Center Health Program: Petitions for adding qualifying health conditions

Daniels RD, Carreon T, Bilics JA, et al

2021

Lung cancer characteristics in the World Trade Center Environmental Health Center

Durmus N, Pehlivan S, Zhang Y, et al

2021

Hospitalizations among World Trade Center Health Registry enrollees who were under 18 years of age on 9/11, 2001-2016

Gargano LM, Locke SH, Alper HE, et al

2021

A mixed-methods study after multiple disasters: September 11, 2001, World Trade Center terrorist attacks and hurricane sandy

Garrey SK, Ogunyemi AA, and Gargano LM

2021

Confirming mortality in a longitudinal exposure cohort: Optimizing national death index search result processing

Giesinger I, Li J, Takemoto E, et al

2021

Lung function decline before and after treatment of World Trade Center associated obstructive airways disease with inhaled corticosteroids and long-acting beta agonists

Goldfarb DG, Putman B, Lahousse L, et al

2021

BACKGROUND: Greater than average loss of one-second forced expiratory volume (FEV(1) ) is a risk factor for asthma, chronic obstructive pulmonary disease (COPD), and asthma/COPD overlap syndrome in World Trade Center (WTC)-exposed firefighters. Inhaled corticosteroids and long-acting beta agonists (ICS/LABA) are used to treat obstructive airways disease but their impact on FEV(1) -trajectory in this population is unknown. METHODS: The study population included WTC-exposed male firefighters who were treated with ICS/LABA for 2 years or longer (with initiation before 2015), had at least two FEV(1) measurements before ICS/LABA initiation and two FEV(1) measurements posttreatment between September 11, 2001 and September 10, 2019. Linear mixed-effects models were used to estimate FEV(1) -slope pre- and post-treatment. RESULTS: During follow-up, 1023 WTC-exposed firefighters were treated with ICS/LABA for 2 years or longer. When comparing intervals 6 years before and 6 years after treatment, participants had an 18.7 ml/year (95% confidence interval [CI]: 11.3-26.1) improvement in FEV(1) -slope after adjustment for baseline FEV(1) , race, height, WTC exposure, weight change, blood eosinophil concentration, and smoking status. After stratification by median date of ICS/LABA initiation (January 14, 2010), earlier ICS/LABA-initiators had a 32.5 ml/year (95% CI: 19.5-45.5) improvement in slope but later ICS/LABA-initiators had a nonsignificant FEV(1) -slope improvement (7.9 ml/year, 95% CI: -0.5 to 17.2). CONCLUSIONS: WTC-exposed firefighters treated with ICS/LABA had improved FEV(1) slope after initiation, particularly among those who started earlier. Treatment was, however, not associated with FEV(1) -slope improvement if started after the median initiation date (1/14/2010), likely because onset of disease began before treatment initiation. Research on alternative treatments is needed for patients with greater than average FEV(1) -decline who have not responded to ICS/LABA.

Asthma-COPD overlap in World Trade Center Health Registry enrollees, 2015–2016

Haghighi A, Cone JE, Li J, et al

2021

World Trade Center survivor with post solid-organ transplant plasma cell neoplasm

Khan NZ, Gur HD, and Hartley-Brown MA

2021

Trajectories of psychological distress among individuals exposed to the 9/11 World Trade Center disaster

Ko TM, Alper HE, Brackbill RH, et al

2021

Single‐cell transcriptomics analysis of mild cognitive impairment in World Trade Center disaster responders

Kuan PF, Clouston S, Yang X, et al

2021

Association of quantitative ct lung density measurements and lung function decline in World Trade Center workers

Liu X, Reeves AP, Antoniak K, et al

2021

World Trade Center disaster: Reflections after twenty years

Moline J

2021

401 clinical phenotypes of obstructive sleep apnea in World Trade Center responders

Parekh A, Castillo B, Kim DH, et al

2021

Introduction The heterogeneity of symptoms in obstructive sleep apnea (OSA) patients has been recently formalized into 3 distinct clusters: Sleepy, Disturbed Sleep, and Minimally Symptomatic. Our previous data showed that OSA is highly prevalent (>75%) in World Trade Center (WTC) responders, and positive airway pressure (PAP) treatment adherence is very poor (<20%). To better understand the heterogeneity of OSA in the WTC cohort, here we sought to examine the distribution of these distinct clinical phenotypes. Methods 643 subjects with no history of OSA or reported loud and frequent snoring before 9/11/2001 from the WTC health program clinical centers at Rutgers RWJMS, New Jersey, NYU School of Medicine, and Icahn School Medicine at Mount Sinai, New York underwent 2 nights of home sleep testing using the ARES unicorder (SleepMed, Inc., West Palm Beach, FL, USA). Epworth Sleepiness Scale (ESS), sleep onset insomnia, and sleep maintenance insomnia were assessed with questionnaires. OSA was defined as (AHI4%>=5 or RDI>=15/hr). The three clusters were defined as 1) Sleepy (ESS>10 and/or sleep onset/maintenance insomnia); 2) Disturbed Sleep (not sleepy (ESS<=10) and sleep onset/maintenance insomnia); and 3) Minimally Symptomatic (not sleepy (ESS<=10) and no sleep onset/maintenance insomnia). Distribution of clusters in the WTC cohort was compared to published data from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) and the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Results Among the subjects diagnosed with OSA (N 440; AHI4%=13(15); RDI =28(19); median(iqr); 81% men; age, 33–87 years; BMI, 27.4±3.7 kg/m2), the distribution of clinical phenotypes was 31.4% sleepy, 48.9% disturbed sleep, and 19.7% minimally symptomatic, and did not differ between OSA severity groups. In comparison to SAGIC and HCHS/SOL, the WTC cohort exhibited significantly increased prevalence of the disturbed sleep phenotype (WTC vs SAGIC: 48.9% vs. 19.8%, □2=54.9; p<0.001; WTC vs. HCHS/SOL: 48.9% vs. 38.1%, □2=26.1, p<0.001). Conclusion The predominant clinical phenotype of OSA in the WTC cohort is disturbed sleep (insomnia) and its prevalence is significantly greater than what has been observed in other large OSA cohorts. These findings may help explain the poor adherence to PAP treatment observed in the WTC cohort. Support (if any) NIOSH U01OH01415; AASM Foundation 233-BS-20.

Obstructive sleep apnea pathophysiology in World Trade Center (WTC) responders

Parekh A, Castillo B, Kim DH, et al

2021

TP062 TERRORISM AND INHALATIONAL DISASTERS: World Trade Center AND BEYOND / Thematic Poster Session;Obstructive Sleep Apnea Pathophysiology in World Trade Center (WTC) RespondersCorresponding author's email: ankit.parekh@mssm.edu;;Rationale: Obstructive sleep apnea (OSA) is highly prevalent in World Trade Center (WTC) responders and treatment adherence very poor, with our previous data suggesting a greater than 75% prevalence, and <20% adherence, respectively. It is being increasingly recognized that the mechanisms that lead to OSA are multifactorial and dependent on arousal threshold, respiratory control gain, upper airway muscle responsiveness and altered anatomy. While the presentation of OSA in the WTC cohort is similar to those in referred to a sleep clinic, whether the physiologic endotypes causing OSA are different in the WTC cohort is not well known.;;Methods: Using a previously published method by Sands et. al. that estimates OSA causing physiological endotypes of loop gain, arousal threshold and pharyngeal muscle responsiveness, we compared the endotypes between WTC responders (N = 14) and non-WTC responders (N = 12) that were referred to a sleep clinic (Mount Sinai Hospital, NY and Rutgers Health at RWJMS, New Brunswick, NJ). Vpassive (ventilatory equivalent of critical collapsing pressure) and muscle compensation (change in ventilation accompanying an increase in ventilatory drive) were calculated using diagnostic polysomnograms.;;Results: The two unmatched groups had similar characteristics (see Table 1). Sleep architecture was not significantly different across the two groups. Significantly higher loop gain was observed among the WTC responders as compared to the non-WTC responders while endotypes of arousal threshold (Mann-Whitney U Z value = -2.3, p=0.02), Vpassive and muscle compensation were not significantly different across the two groups (see Table 1).;;Conclusion: We observe that WTC responders appear to have significantly higher loop gain;as compared to non-WTC responders, with similar muscle responsiveness and arousal mechanisms. Corroboration of our observations with a larger sample size would lead to better understanding of the underlying mechanisms of OSA in WTC responders and possibly improve adherence to treatment of OSA in WTC responders by improved treatment targeting.

Effects of 9/11-related injury on retirement patterns among World Trade Center Health Registry enrollees

Seil K, Yu S, Brackbill R, et al

2021

The development of a WTC Environmental Health Center pan-cancer database

Shao Y, Durmus N, Zhang Y, et al

2021

Association between post-traumatic stress disorder and alcohol-related hospitalizations among World Trade Center Health Registry enrollees

Takemoto E, Giesinger I, Russell JS, et al

2021

Serum TH‐2 cytokines and FEV 1 decline in WTC‐exposed firefighters: A 19‐year longitudinal study

Weiden MD, Singh A, Goldfarb DG, et al

2021

Change in 9/11-related post-traumatic stress symptoms following cancer diagnosis

Yung J, Takemoto E, Cone J, et al

2021

Injury severity and psychological distress sustained in the aftermath of the attacks of 11 September 2001 predict somatic symptoms in World Trade Center Health Registry enrollees sixteen years later

Alper HE, Gargano LM, Cone JE, et al

2020

An introduction to probabilistic record linkage with a focus on linkage processing for WTC registries

Asher J, Resnick D, Brite J, et al

2020

World Trade Center (WTC) dust

Cohen MD, Chen L-C, and Lippmann M

2020

Mortality among Fire Department of the City of New York rescue and recovery workers exposed to the World Trade Center disaster, 2001–2017

Colbeth HL, Zeig-Owens R, Hall CB, et al

2020

Association of low fvc spirometric pattern with WTC occupational exposures

de la Hoz RE, Shapiro M, Nolan A, et al

2020

Population-based age adjustment tables for use in occupational hearing conservation programs

Flamme GA, Deiters KK, Stephenson MR, et al

2020

The impact of job loss on posttraumatic stress disorder among asian americans: 11-12 years after the World Trade Center attack

Huang D, Wang X, and Kung W

2020

Residential mobility and chronic disease among World Trade Center Health Registry enrollees, 2004-2016

Jacobson M, Crossa A, Liu SY, et al

2020

Food intake restriction for health outcome support and education (firehouse) protocol: A randomized clinical trial

Kwon S, Riggs J, Crowley G, et al

2020

Synergistic effect of WTC-particulate matter and lysophosphatidic acid exposure and the role of rage: In-vitro and translational assessment

Lam R, Haider SH, Crowley G, et al

2020

Change in binge drinking behavior after hurricane sandy among persons exposed to the 9/11 World Trade Center disaster

Locke S, Nguyen A-M, Friedman L, et al

2020

Adapting meaning-centered psychotherapy for World Trade Center responders

Masterson-Duva M, Haugen P, Werth A, et al

2020

PTSD and depressive symptoms as potential mediators of the association between World Trade Center exposure and subjective cognitive concerns in rescue/recovery workers

Singh A, Zeig-Owens R, Rabin L, et al

2020

Posttraumatic stress trajectories in World Trade Center tower survivors: Hyperarousal and emotional numbing predict symptom change

Adams SW, Allwood MA, and Bowler RM

2019

An assessment of long-term physical and emotional quality of life of persons injured on 9/11/2001

Brackbill RM, Alper HE, Frazier P, et al

2019

Persistent self-reported ear and hearing problems among World Trade Center-exposed firefighters and emergency medical service workers, 2001-2017—a longitudinal cohort analysis

Colbeth HL, Zeig-Owens R, Liu Y, et al

2019

Persistent hearing loss among World Trade Center Health Registry residents, passersby and area workers, 2006-2007

Cone JE, Stein CR, Lee DJ, et al

2019

Conducting a study to assess the long-term impacts of injury after 9/11: Participation, recall, and description

Jacobson MH, Brackbill RM, Frazier P, et al

2019

Background: The World Trade Center (WTC) attacks on September 11, 2001 (9/11) resulted in over 2700 fatalities and thousands injured. Injury on 9/11 has been identified as a risk factor for physical and mental health conditions, but the reasons for this are not well understood. In a population exposed to 9/11 and since followed, an in-depth study on the impacts of injury on 9/11 was conducted to identify factors that contribute to long-term functional issues. This report sought to examine factors influencing participation, participant recall of injury status over time, and determinants of injury severity. Methods: Enrollees from the World Trade Center Health Registry who completed all surveys between 2003 and 2016 and initially reported being injured (N= 2699) as well as a sample of non-injured (N= 2598) were considered to be eligible for the Health and Quality of Life 15 Years after 9/11 (HQoL) Study. Predictors of study non-participation and inconsistent recall of injury over time (i.e., discrepant reports) were identified through fitting log binomial models. Results: Participation rates were high overall (76.1%) and did not vary by initially reported injury status, although younger (vs. older), non-White (vs. White), and less educated (vs. more educated) enrollees were less likely to participate in the HQoL Study. Discrepant reporting of 9/11 injury status was much more common among enrollees who initially reported being injured on 9/11 (49.6%) compared with those who did not (7.3%). However, those who incurred more severe injuries on 9/11 were less likely to have discrepant reporting over time compared with those with more minor injuries (broken bone vs. sprain: risk ratio = 0.33, 95% Confidence Interval: 0.19, 0.57). Among those who consistently reported that they were injured on 9/11, most injuries occurred as a result of descending down stairs (31.5%) or by tripping and falling (19.9%); although being hit by a falling object was most often associated with high severity injuries (63.2%) compared with other modes of injury. Conclusions: These findings highlight the methodological issues involved in conducting a study on the long-term impact of injury more than a decade after the initial incident and may be relevant to future investigators. Factors affecting participation rates, such as demographic characteristics, and those related to discrepant reporting over time, such as injury severity, may affect both the internal and external validity of studies examining the long-term impact of injury.

Unmet mental health care needs among asian americans 10-11 years after exposure to the World Trade Center attack

Kung WW, Wang X, Liu X, et al

2019

Complementary biobank of rodent tissue samples to study the effect of World Trade Center exposure on cancer development

Lieberman-Cribbin W, Tuminello S, Gillezeau C, et al

2019

Abnormalities on chest computed tomography and lung function following an intense dust exposure: A 17-year longitudinal study

Liu C, Putman B, Singh A, et al

2019

Handgrip strength of World Trade Center (WTC) responders: The role of re-experiencing posttraumatic stress disorder (PTSD) symptoms

Mukherjee S, Clouston S, Kotov R, et al

2019

Bronchodilator response predicts longitudinal improvement in small airway function in World Trade Center dust exposed community members

Pradhan D, Xu N, Reibman J, et al

2019

Longitudinal change of PTSD symptoms in community members after the World Trade Center destruction

Rosen R, Zhu Z, Shao Y, et al

2019

A cognitive reserve and social support-focused latent class analysis to predict self-reported confusion or memory loss among middle-aged World Trade Center Health Registry enrollees

Seil K, Yu S, and Alper H

2019

The World Trade Center Health Registry includes 9/11 survivors who have been surveyed about their health conditions over time. The prevalence of posttraumatic stress disorder (PTSD) remains high among the cohort and is a risk factor for cognitive impairment or dementia. We thus sought to examine the degree to which confusion or memory loss (CML)-potential symptoms of cognitive decline-are occurring among enrollees aged 35-64 years. Cognitive reserve theory suggests that higher levels of education and engaging in cognitively challenging activities can create stronger neural connections, offering protection against cognitive decline. We hypothesized that enrollees with less cognitive reserve would be more likely to report CML. In this study, we: (1) estimated the incidence of CML in our study sample; (2) identified indicators of cognitive reserve (e.g., indicators of educational attainment, social support); and (3) determined whether CML is associated with cognitive reserve level, stratified by PSTD status. First, we described demographics of the study sample (n = 14,574) and probable PTSD status, also stratifying by CML. Next, we conducted a latent class analysis on two groups: those with probable PTSD and those without probable PTSD, creating classes with varying cognitive reserve levels. Finally, using adjusted log binomial models, we predicted risk of CML based on cognitive reserve level. The probable PTSD group (n = 1213) and not probable PTSD group (n = 13,252) each had four latent classes: low, medium-low, medium-high, and high cognitive reserve. In the probable PTSD model, compared to the high cognitive reserve class, those with medium-low cognitive reserve were 35% more likely to report CML (relative risk (RR) = 1.4, 95% confidence interval (CI): 1.1, 1.7). Among the not probable PTSD group, those with low and medium levels of cognitive reserve were significantly more likely to report CML (RR = 1.8 and 1.4, respectively). Overall, those with less cognitive reserve were more likely to report CML regardless of PTSD status.

Time to onset of paresthesia among community members exposed to the World Trade Center disaster

Thawani S, Wang B, Shao Y, et al

2019

Asthma-COPD overlap syndrome in World Trade Center Health Registry enrollees, 2015-2016

Haghighi AK

2018

Re-experiencing 9/11-related PTSD symptoms following exposure to hurricane sandy

Li J, Alper HE, Gargano LM, et al

2018

Media effects in youth exposed to terrorist incidents: A historical perspective

Pfefferbaum B, Tucker P, Pfefferbaum RL, et al

2018

Incidence and prevalence of antibody to hepatitis c virus in FDNY first responders before and after work at the World Trade Center disaster site

Webber MP, Liu Y, Cohen HW, et al

2018

Prevalence of and factors associated with mammography and prostate-specific antigen screening among World Trade Center Health Registry enrollees, 2015-2016

Yung J, Li J, Jordan HT, et al

2018

Airway disease in rescue/recovery workers: Recent findings from the World Trade Center collapse

Cleven KL, Webber MP, Zeig-Owens R, et al

2017

Parent physical and mental health comorbidity and adolescent behavior

Gargano LM, Locke S, and Brackbill RM

2017

Are rupture–repair episodes related to outcome in the treatment of trauma-exposed World Trade Center responders?

Haugen PT, Werth, A.S., Foster, A.L., Owen, J.

2017

Hospitalizations for asthma among adults exposed to the September 11, 2001 World Trade Center terrorist attack

Miller-Archie SA, Jordan HT, Alper H, et al

2017

Temporal variability of urinary cadmium in spot urine samples and first morning voids

Vacchi-Suzzi C, Porucznik CA, Cox KJ, et al

2017

Posttraumatic growth in trauma recollections of 9/11 survivors: A narrative approach

Dekel S, Hankin IT, Pratt JA, et al

2016

The duration of an exposure response gradient between incident obstructive airways disease and work at the World Trade Center site: 2001-2011

Hall CB, Liu X, Zeig-Owens R, et al

2016

Proteomic characterization of the World Trade Center dust-activated mdig and c-myc signaling circuit linked to multiple myeloma

Wu K, Li L, Thakur C, et al

2016

Acute high-level exposure to WTC particles alters expression of genes associated with oxidative stress and immune function in the lung

Cohen MD, Vaughan JM, Garrett B, et al

2015

First responders (FR) present at Ground Zero in the first 72 h after the World Trade Center (WTC) collapsed have progressively exhibited significant respiratory injuries. The few toxicology studies performed to date evaluated effects from just fine (< 2.5 microm) WTC dusts; none examined health effects/toxicities from atmospheres bearing larger particle sizes, despite the fact the majority (> 96%) of dusts were > 10 microm and most FR likely entrained dusts by mouth breathing. Using a system that generated/delivered supercoarse (10-53 microm) WTC dusts to F344 rats (in a manner that mimicked FR exposures), this study sought to examine potential toxicities in the lungs. In this exploratory study, rats were exposed for 2 h to 100 mg WTC dust/m(3) (while under isoflurane [ISO] anesthesia) or an air/ISO mixture; this dose conservatively modeled likely exposures by mouth-breathing FR facing approximately 750-1000 mg WTC dust/m(3). Lungs were harvested 2 h post-exposure and total RNA extracted for subsequent global gene expression analysis. Among the > 1000 genes affected by WTC dust (under ISO) or ISO alone, 166 were unique to the dust exposure. In many instances, genes maximally-induced by the WTC dust exposure (relative to in naive rats) were unchanged/inhibited by ISO only; similarly, several genes maximally inhibited in WTC dust rats were largely induced/unchanged in rats that received ISO only. These outcomes reflect likely contrasting effects of ISO and the WTC dust on lung gene expression. Overall, the data show that lungs of rats exposed to WTC dust (under ISO) - after accounting for any impact from ISO alone - displayed increased expression of genes related to lung inflammation, oxidative stress, and cell cycle control, while several involved in anti-oxidant function were inhibited. These changes suggested acute inflammogenic effects and oxidative stress in the lungs of WTC dust-exposed rats. This study, thus, concludes that a single very high exposure to WTC dusts could potentially have adversely affected the respiratory system - in terms of early inflammatory and oxidative stress processes. As these changes were not compared with other types of dusts, the uniqueness of these WTC-mediated effects remains to be confirmed. It also still remains to be determined if these effects might have any relevance to chronic lung pathologies that became evident among FR who encountered the highest dust levels on September 11, 2001 and the 2 days thereafter. Ongoing studies using longer-range post-exposure analyses (up to 1-year or more) will help to determine if effects seen here on genes were acute, reversible, or persistent, and associated with corresponding histopathologic/biochemical changes in situ.

Relationship between persistent posttraumatic stress disorder and human remains exposure for staten island barge and landfill recovery and clean-up workers after 9/11

Fairclough MA, Miller-Archie, S.A., Cone, J.E., Dechen, T., Ekenga, C.C., Osahan, S., Perlman, S.E., Gargano, L.M., Imasuen, J., Farfel, M.R.

2015

Sleep disturbance, disability, and posttraumatic stress disorder in utility workers

Giosan C, Malta LS, Wyka K, et al

2015

A brief retrospective method for identifying longitudinal trajectories of adjustment following acute stress

Mancini AD, Bonanno GA, and Sinan B

2015

The surviving sisters club: Examining social support and posttraumatic growth among FDNY 9/11 widows

Richardson KM

2015

Cigarette smoking and 9/11-related posttraumatic stress disorder among World Trade Center Health Registry enrollees, 2003-12

Welch AE, Jasek JP, Caramanica K, et al

2015

Evaluation of non-response bias in a cohort study of World Trade Center terrorist attack survivors

Yu S, Brackbill RM, Stellman SD, et al

2015

BACKGROUND: Few longitudinal studies of disaster cohorts have assessed both non-response bias in prevalence estimates of health outcomes and in the estimates of associations between health outcomes and disaster exposures. We examined the factors associated with non-response and the possible non-response bias in prevalence estimates and association estimates in a longitudinal study of World Trade Center (WTC) terrorist attack survivors. METHODS: In 2003-04, 71,434 enrollees completed the WTC Health Registry wave 1 health survey. This study is limited to 67,670 adults who were eligible for both wave 2 and wave 3 surveys in 2006-07 and 2011-12. We first compared the characteristics between wave 3 participants (wave 3 drop-ins and three-wave participants) and non-participants (wave 3 drop-outs and wave 1 only participants). We then examined potential non-response bias in prevalence estimates and in exposure-outcome association estimates by comparing one-time non-participants (wave 3 drop-ins and drop-outs) at the two follow-up surveys with three-wave participants. RESULTS: Compared to wave 3 participants, non-participants were younger, more likely to be male, non-White, non-self enrolled, non-rescue or recovery worker, have lower household income, and less than post-graduate education. Enrollees' wave 1 health status had little association with their wave 3 participation. None of the disaster exposure measures measured at wave 1 was associated with wave 3 non-participation. Wave 3 drop-outs and drop-ins (those who participated in only one of the two follow-up surveys) reported somewhat poorer health outcomes than the three-wave participants. For example, compared to three-wave participants, wave 3 drop-outs had a 1.4 times higher odds of reporting poor or fair health at wave 2 (95% CI 1.3-1.4). However, the associations between disaster exposures and health outcomes were not different significantly among wave 3 drop-outs/drop-ins as compared to three-wave participants. CONCLUSION: Our results show that, despite a downward bias in prevalence estimates of health outcomes, attrition from the WTC Health Registry follow-up studies does not lead to serious bias in associations between 9/11 disaster exposures and key health outcomes. These findings provide insight into the impact of non-response on associations between disaster exposures and health outcomes reported in longitudinal studies.

Characteristics of student assistance and prevention counseling programs in response to environmental impacts

Corrigan MJ, Videka L, Loneck B, et al

2014

Use of mental health services by children and adolescents six months after the World Trade Center attack

Graeff-Martins AS, Hoven CW, Wu P, et al

2014

Cortisol and PTSD symptoms among male and female high-exposure 9/11 survivors

Dekel S, Ein-Dor T, Gordon KM, et al

2013

Comorbid persistent lower respiratory symptoms and posttraumatic stress disorder 5-6 years post-9/11 in responders enrolled in the World Trade Center Health Registry

Friedman SM, Farfel MR, Maslow CB, et al

2013

Patient-clinician agreement on treatment type and helpfulness: Results from a WTC rescue and recovery worker cohort

Leikauf J, Schechter CB, Marrone K, et al

2013

A review and retrospective analysis of mental health services provided after the September 11 attacks

Pandya A

2013

Study of ph and cellular response in pulmonary fibroblasts after exposure to market street World Trade Center particulate matter

Hernandez M, Choi S, and DiLorenzo AM

2012

Statistical evaluation of data from multi-laboratory testing of a measurement method intended to indicate the presence of dust resulting from the collapse of the World Trade Center

Kahn HD, Rosati JA, and Bray AP

2012

Firefighters’ psychological and physical outcomes after exposure to traumatic stress: The moderating roles of hope and personality

Riolli L and Savicki V

2012

Relationship between posttraumatic stress disorder and asthma among New York area residents exposed to the World Trade Center disaster

Shiratori Y and Samuelson KW

2012

Effects of job control and situational severity on the timing of help-seeking

Vashdi DR, Bamberger PA, and Bacharach S

2012

Comparison of WTC dust size on macrophage inflammatory cytokine release in vivo and in vitro

Weiden MD, Naveed B, Kwon S, et al

2012

A structural equation model of perievent panic and posttraumatic stress disorder after a community disaster

Adams RE and Boscarino JA

2011

Description of the project: A longitudinal primary prevention project for mothers pregnant and widowed in the World Trade Center tragedy of September 11, 2001, and their young children

Beebe B and Jaffe J

2011

The enduring influence of drinking motives on alcohol consumption after fateful trauma

Beseler CL, Aharonovich E, and Hasin DS

2011

Adolescent exposure to the World Trade Center attacks, PTSD symptomatology, and suicidal ideation

Chemtob CM, Madan A, Berger P, et al

2011

Performance characteristics of the PTSD checklist in retired firefighters exposed to the World Trade Center disaster

Chiu S, Webber MP, Zeig-Owens R, et al

2011

World Trade Center tragedy: Concomitant healing in traumatic grief through art therapy with children

DiSunno R, Linton K, and Bowes E

2011

Media use by children and adolescents from New York City 6 months after the WTC attack

Duarte CS, Wu P, Cheung A, et al

2011

Integrating mental health services into humanitarian relief responses to social emergencies, disasters, and conflicts: A case study

Henley R, Marshall R, and Vetter S

2011

Fe no concentrations in World Trade Center responders and controls, 6 years post-9/11

Mauer MP, Hoen R, and Jourd'heuil D

2011

Unusual ciliary abnormalities in three 9/11 response workers

McMahon JT, Aslam R, and Schell SE

2011

Support group II: Maternal representation of the lost father

Reiswig R

2011

Trends in probable PTSD in firefighters exposed to the World Trade Center disaster, 2001-2010

Soo J, Webber MP, Gustave J, et al

2011

Children's play in the wake of loss and trauma

Sossin KM and Cohen P

2011

Interactive effect of cigarette smoke extract and World Trade Center dust particles on airway cell cytotoxicity

Xu A, Prophete C, Chen LC, et al

2011

Rescue workers and residents exposed to the environment surrounding the collapse of the World Trade Center (WTC) on September 11, 2001, have suffered a disproportionate incidence of chronic lung disease attributed to the inhalation of airborne dust. To date, the pathophysiology of this lung disease is poorly understood. The aim of this study was to examine whether airborne dust contaminants recovered from the surrounding area 24-48 h after the collapse of the WTC demonstrate direct cytotoxicity to two airway cell types that were most directly exposed to inhaled dust, airway epithelial and smooth muscle cells. It was also of interest to determine whether the presence of these dusts could modulate the effects of cigarette smoke on these cell types in that some of the individuals who responded to the collapse site were also smokers. Human cultured airway epithelial (BEAS-2B) cells were exposed to 10% cigarette smoke extract (CSE), WTC dust particles (10-53 mum; 0.01-0.5 mug/mul), or a combination of the two for 2-24 h. Cell viability was measured by determining mitochondrial integrity (MTT assays) and apoptosis (poly-ADP-ribose polymerase [PARP] immunoblotting). Conditioned cell culture media recovered from the CSE- and/or WTC dust-exposed BEAS-2B cells were then applied to cultured human airway smooth muscle cells that were subsequently assayed for mitochondrial integrity and their ability to synthesize cyclic AMP (a regulator of airway smooth muscle constriction). BEAS-2B cells underwent necrotic cell death following exposure to WTC dust or CSE for 2-24 h without evidence of apoptosis. Smooth muscle cells demonstrated cellular toxicity and enhanced cyclic AMP synthesis following exposure to conditioned media from WTC- or CSE-exposed epithelial cells. These acute toxicity assays of WTC dust and CSE offer insights into lung cell toxicity that may contribute to the pathophysiology of chronic lung disease in workers and residents exposed to WTC dust. These studies clearly showed that WTC dust (at least the supercoarse particle fraction) or CSE alone exerted direct adverse effects on airway epithelial and smooth muscle cells, and altered the signaling properties of airway smooth muscle cells. In addition the combination of CSE and WTC exerted an interactive effect on cell toxicity. It remains to be determined whether these initial cell death events might account, in part, for the chronic lung effects associated with WTC dust exposure among First Responders and others.

Professional posttraumatic growth after a shared traumatic experience: Manhattan clinicians' perspectives on post-9/11 practice

Bauwens J and Tosone C

2010

Impact of maternal posttraumatic stress disorder and depression following exposure to the September 11 attacks on preschool children's behavior

Chemtob CM, Nomura Y, Rajendran K, et al

2010

Spatial proximity and the risk of psychopathology after a terrorist attack

DiMaggio C, Galea S, and Emch M

2010

Exposure to 9/11 among youth and their mothers in New York City: Enduring associations with mental health and sociopolitical attitudes

Gershoff ET, Aber JL, Ware A, et al

2010

Disaster mental health training programmes in New York City following September 11, 2001

Gill KB and Gershon RR

2010

Event-exposure stress, coping, and psychological distress among New York students at six months after 9/11

Heyman JC, Brennan M, and Colarossi L

2010

Respiratory and cardiovascular hospitalizations after the World Trade Center disaster

Lin S, Gomez MI, Gensburg L, et al

2010

Lower respiratory symptoms among residents living near the World Trade Center, two and four years after 9/11

Lin S, Jones R, Reibman J, et al

2010

Impulse oscillometry and respiratory symptoms in World Trade Center responders, 6 years post-9/11

Mauer MP and Cummings KR

2010

Asthma and lower respiratory symptoms in New York state employees who responded to the World Trade Center disaster

Mauer MP, Herdt-Losavio ML, and Carlson GA

2010

Psychosocial capacity building in New York: Building resiliency with construction workers assigned to ground zero after 9/11

Miller J, Grabelsky J, and Wagner KC

2010

Factor structure of the youth coping in traumatic times (YCITT) scale

Paasivirta ME, Duarte CS, Wu P, et al

2010

Services provided by volunteer psychiatrists after 9/11 at the New York City family assistance center: September 12-november 20, 2001

Pandya A, Katz CL, Smith R, et al

2010

OBJECTIVE: To characterize the experience of volunteer disaster psychiatrists who provided pro bono psychiatric services to 9/11 survivors in New York City, from September 12, 2001 to November 20, 2001. METHOD: Disaster Psychiatry Outreach (DPO) is a non-profit organization founded in 1998 to provide volunteer psychiatric care to people affected by disasters and to promote education and research in support of this mission. Data for this study were collected from one-page clinical encounter forms completed by 268 DPO psychiatrists for 2 months after 9/11 concerning 848 patients served by the DPO 9/11 response program at the New York City Family Assistance Center. RESULTS: In this endeavor, 268 psychiatrist volunteers evaluated 848 individuals and provided appropriate interventions. The most commonly recorded clinical impressions indicated stress-related and adjustment disorders, but other conditions such as bereavement, major depression, and substance abuse/dependence were also observed. Free samples were available for one sedative and one anxiolytic agent; not surprisingly, these were the most commonly prescribed medications. Nearly half of those evaluated received psychotropic medications. CONCLUSIONS: In the acute aftermath of the attacks of September 11, 2001, volunteer psychiatrists were able to provide services in a disaster response setting, in which they were co-located with other disaster responders. These services included psychiatric assessment, provision of medication, psychological first aid, and referrals for ongoing care. Although systematic diagnoses could not be confirmed, the fact that most patients were perceived to have a psychiatric diagnosis and a substantial proportion received psychotropic medication suggests potential specific roles for psychiatrists that are unique and different from roles of other mental health professionals in the early post-disaster setting. In addition to further characterizing post-disaster mental health needs and patterns of service provision, future research should focus on the short- and long-term effects of psychiatric interventions, such as providing acute psychotropic medication services and assessing the effectiveness of traditional acute post-disaster interventions including crisis counseling and psychological first aid.

Roles of mapk pathway activation during cytokine induction in beas-2b cells exposed to fine World Trade Center (WTC) dust

Wang S, Prophete C, Soukup JM, et al

2010

The World Trade Center (WTC) collapse on September 11, 2001 released copious amounts of particulate matter (PM) into the atmosphere of New York City. Follow-up studies on persons exposed to the dusts have revealed a severely increased rate for asthma and other respiratory illnesses. There have only been a few studies that have sought to discern the possible mechanisms underlying these untoward pathologies. In one study, an increased cytokine release was detected in cells exposed to WTC fine dusts (PM(2).(5) fraction or WTC(2).(5)). However, the mechanism(s) for these increases has yet to be fully defined. Because activation of the mitogen-activated protein kinase (MAPK) signaling pathways is known to cause cytokine induction, the current study was undertaken to analyze the possible involvement of these pathways in any increased cytokine formation by lung epithelial cells (as BEAS-2B cells) exposed to WTC(2).(5). Our results showed that exposure to WTC(2).(5) for 5 hr increased interleukin-6 (IL-6) mRNA expression in BEAS-2B cells, as well as its protein levels in the culture media, in a dose-dependent manner. Besides IL-6, cytokine multiplex analyses revealed that formation of IL-8 and -10 was also elevated by the exposure. Both extracellular signal-regulated kinase (ERK) and p38, but not c-Jun N-terminal protein kinase, signaling pathways were found to be activated in cells exposed to WTC(2).(5). Inactivation of ERK signaling pathways by PD98059 effectively blocked IL-6, -8, and -10 induction by WTC(2).(5); the p38 kinase inhibitor SB203580 significantly decreased induction of IL-8 and -10. Together, our data demonstrated activation of MAPK signaling pathway(s) likely played an important role in the WTC(2).(5)-induced formation of several inflammatory (and, subsequently, anti-inflammatory) cytokines. The results are important in that they help to define one mechanism via which the WTC dusts may have acted to cause the documented increases in asthma and other inflammation-associated respiratory dysfunctions in the individuals exposed to the dusts released from the WTC collapse.

Gender as a moderator of the relationship between child exposure to the World Trade centre disaster and behavioural outcomes

Bannon W, DeVoe ER, Klein TP, et al

2009

Method development for analysis of urban dust using scanning electron microscopy with energy dispersive x-ray spectrometry to detect the possible presence of World Trade Center dust constituents

Bern AML, Heather A.: Meeker, Gregory P.: Rosati, Jacky A.

2009

PTSD onset and course following the World Trade Center disaster: Findings and implications for future research

Boscarino JA and Adams RE

2009

OBJECTIVE: We sought to identify common risk factors associated with posttraumatic stress disorder (PTSD) onset and course, including delayed, persistent, and remitted PTSD following a major traumatic exposure. METHOD: Based on a prospective study of New York City adults following the World Trade Center disaster (WTCD), we conducted baseline interviews with 2,368 persons one year after this event and then at follow-up 1 year later to evaluate changes in current PTSD status based on DSM-IV criteria. RESULTS: Baseline analysis suggested that current PTSD, defined as present if this occurred in the past 12 months, was associated with females, younger adults, those with lower self-esteem, lower social support, higher WTCD exposure, more lifetime traumatic events, and those with a history of pre-WTCD depression. At follow-up, current PTSD was associated with Latinos, non-native born persons, those with lower self-esteem, more negative life events, more lifetime traumatic events, and those with mixed handedness. Classifying respondents at follow-up into resilient (no PTSD time 1 or 2), remitted (PTSD time 1, not 2), delayed (no PTSD time 1, but PTSD time 2), and persistent (PTSD both time 1 and 2) PTSD, revealed the following: compared to resilient cases, remitted ones were more likely to be female, have more negative life events, have greater lifetime traumatic events, and have pre-WTCD depression. Delayed cases were more likely to be Latino, be non-native born, have lower self-esteem, have more negative life events, have greater lifetime traumas, and have mixed handedness. Persistent cases had a similar profile as delayed, but were the only cases associated with greater WTCD exposures. They were also likely to have had a pre-WTCD depression diagnosis. Examination of WTCD-related PTSD at follow-up, more specifically, revealed a similar risk profile, except that handedness was no longer significant and WTCD exposure was now significant for both remitted and persistent cases. CONCLUSION: PTSD onset and course is complex and appears to be related to trauma exposure, individual predispositions, and external factors not directly related to the original traumatic event. This diagnostic classification may benefit from additional conceptualization and research as this relates to changes in PTSD status over time.

Otolaryngologic symptoms in persons exposed to World Trade Center dust and particle pollutants: A case for caution in declaring a diagnosis of WTC syndrome

Chandran SK, Hawkshaw MJ, and Sataloff RT

2009

Substance use and functional impairment among adolescents directly exposed to the 2001 World Trade Center attacks

Chemtob CM, Nomura Y, Josephson L, et al

2009

A computerized, self-administered questionnaire to evaluate posttraumatic stress among firefighters after the World Trade Center collapse

Corrigan M, McWilliams R, Kelly KJ, et al

2009

Bayesian hierarchical spatial modeling of substance abuse patterns following a mass trauma: The role of time and place

DiMaggio C, Galea S, and Vlahov D

2009

Does acute maternal stress in pregnancy affect infant health outcomes? Examination of a large cohort of infants born after the terrorist attacks of September 11, 2001

Endara SM, Ryan MA, Sevick CJ, et al

2009

Disability and posttraumatic stress disorder in disaster relief workers responding to September 11, 2001 World Trade Center disaster

Evans S, Patt I, Giosan C, et al

2009

Screening for generalized anxiety disorder symptoms in the wake of terrorist attacks: A study in primary care

Ghafoori B, Neria Y, Gameroff MJ, et al

2009

Relationships between memory inconsistency for traumatic events following 9/11 and PTSD in disaster restoration workers

Giosan C, Malta L, Jayasinghe N, et al

2009

Psychological risk assessment following the terrorist attacks in New York in 2001

Greenberg N, Dow C, and Bland D

2009

Parental exposure to mass violence and child mental health: The first responder and WTC evacuee study

Hoven CW, Duarte CS, Wu P, et al

2009

Lack of association between estimated World Trade Center plume intensity and respiratory symptoms among New York City residents outside of lower Manhattan

Laumbach RJ, Harris G, Kipen HM, et al

2009

Patterns and predictors of trajectories of depression after an urban disaster

Nandi A, Tracy M, Beard JR, et al

2009

Effect of maternal psychopathology on behavioral problems in preschool children exposed to terrorism: Use of generalized estimating equations to integrate multiple informant reports

Nomura Y and Chemtob CM

2009

No evidence of suicide increase following terrorist attacks in the United States: An interrupted time-series analysis of September 11 and oklahoma city

Pridemore WA, Trahan A, and Chamlin MB

2009

The 2001 World Trade Center disaster: Summary and evaluation of experiences

Pryor JP

2009

Longitudinal assessment of spirometry in the World Trade Center medical monitoring program

Skloot GS, Schechter CB, Herbert R, et al

2009

Post 9/11: High asthma rates among children in chinatown, New York

Szema AM, Savary KW, Ying BL, et al

2009

Trends in respiratory symptoms of firefighters exposed to the World Trade Center disaster: 2001-2005

Webber MP, Gustave J, Lee R, et al

2009

Cortisol metabolic predictors of response to psychotherapy for symptoms of PTSD in survivors of the World Trade Center attacks on September 11, 2001

Yehuda R, Bierer LM, Sarapas C, et al

2009

BACKGROUND: A proportion of subjects with symptoms of posttraumatic stress disorder (PTSD) are unresponsive to specialized psychotherapy, but a biological basis for this has not been described. To observe whether differences in cortisol or its metabolites predict or correlate with response to therapy for PTSD symptoms, cortisol and its metabolites were measured from urine samples at pre-treatment, at the conclusion of psychotherapy, and at 3-month follow-up. METHODS: 28 survivors of the World Trade Center attacks on September 11, 2001 seeking psychological treatment for PTSD symptoms received four sessions of either exposure therapy or supportive counseling, followed by up to 10 sessions of prolonged exposure in a specialized PTSD treatment program at a private hospital serving the New York City metropolitan area. 24-h mean integrated cortisol excretion was assessed by radioimmunoassay (RIA); urinary free cortisol and metabolites cortisone, 5alpha-tetrahydrocortisol (5alpha-THF), 5beta-tetrahydrocortisol, and tetrahydrocortisone were assessed by gas chromatography-mass spectrometry (GC-MS); and indices of enzyme activity for 5alpha- and 5beta-reductase and for the 11beta-hydroxysteroid dehydrogenases were derived from the metabolite and glucocorticoid measures. RESULTS: 5alpha-Reductase activity was significantly lower at pre-treatment among non-responders, whereas there were no significant pre-treatment differences between responders and non-responders in any other hormone or metabolite level. In repeated measures analyses across the three time points, 5alpha-reductase activity, as well as 5alpha-THF and total glucocorticoids, significantly differed between responders and non-responders. For urinary cortisol measured by RIA, there was a significant groupxtime interaction indicating that, although not different at pre-treatment, urinary cortisol levels declined over time in the non-responder group, such that by follow-up, lowered cortisol significantly distinguished non-responders from responders. Indices of 5alpha-reductase activity, including 5alpha-THF and total glucocorticoids, were significantly negatively correlated with avoidance symptom severity at pre-treatment. At follow-up, indices of 5alpha-reductase activity were significantly negatively correlated with severity of all three PTSD symptom clusters and with total PTSD severity scores. CONCLUSION: Lower 5alpha-reductase activity is associated with avoidance severity and predicts non-responsiveness to psychological treatment for PTSD symptomatology. Relatively diminished 5alpha-reductase activity may mark a state of primary vulnerability, perhaps via attenuated peripheral catabolism of cortisol resulting in the suppression of hypothalamic-pituitary-adrenal axis responsiveness. Lower cortisol levels appear later in the progression to chronic, treatment-resistant PTSD.

The imam's role in mental health promotion: A study at 22 mosques in New York City's muslim community

Abu-Ras W, Gheith A, and Cournos F

2008

Anxiety-related visits to new jersey emergency departments after September 11, 2001

Adinaro DJ, Allegra JR, Cochrane DG, et al

2008

Media exposure predicts children's reactions to crime and terrorism

Becker-Blease KA, Finkelhor D, and Turner H

2008

A rare case of peritoneal sarcoidosis in a 36-year-old construction worker

Chubineh S and Katona K

2008

Victims' groups following the 9/11 terrorist attacks

Couch SR, Wade B, and Kindler JD

2008

Ayurvedic herbal supplements as an antidote to 9/11 toxicity

Dahl JJ and Falk K

2008

Pathology and toxicology findings for search-and-rescue dogs deployed to the September 11, 2001, terrorist attack sites: Initial five-year surveillance

Fitzgerald SD, Rumbeiha WK, Emmett Braselton W, et al

2008

Service and science in times of crisis: Developing, planning, and implementing a clinical research program for children traumatically bereaved after 9/11

Goodman RF and Brown EJ

2008

Outreach and peer-delivered mental health services in New York City following September 11, 2001

Hardiman ER and Jaffee EM

2008

Anger and posttraumatic stress disorder in disaster relief workers exposed to the September 11, 2001 World Trade Center disaster: One-year follow-up study

Jayasinghe N, Giosan C, Evans S, et al

2008

In their own words: The 9/11 disaster child care providers

Kinsel JD and Thomasgard M

2008

Subjective effect of September 11, 2001 among pregnant women: Is cumulative history of interpersonal violence important?

Lewis MW, Cavanagh PK, Ahn G, et al

2008

9/11 environmental health--disaster and response

Newman DM

2008

The relationship between PTSD arousal symptoms and depression among mothers exposed to the World Trade Center attacks

Rubacka JM, Schmeidler J, Nomura Y, et al

2008

9/11 and New York City firefighters' post hoc unit support and control climates: A context theory of the consequences of involvement in traumatic work-related events

Bacharach SB and Bamberger PA

2007

Children who lost a parent as a result of the terrorist attacks of September 11, 2001: Registry construction and population description

Chemtob CM, Conroy DL, Hochauser CJ, et al

2007

Implementing CBT for traumatized children and adolescents after September 11: Lessons learned from the child and adolescent trauma treatments and services (cats) project

Consortium C

2007

The first 24 hours of the World Trade Center attacks of 2001--the centers for disease control and prevention emergency phase response

Cruz MA, Burger R, and Keim M

2007

Emergency department visits for behavioral and mental health care after a terrorist attack

DiMaggio C, Galea S, and Richardson LD

2007

Psychological and health problems in a geographically proximate population time-sampled continuously for three months after the September 11th, 2001 terrorist incidents

Ford JD, Adams ML, and Dailey WF

2007

The effects of indirect exposure to September 11th–related trauma on cardiovascular reactivity

Friedberg JP, Adonis MN, and Suchday S

2007

Effective risk communication in children's environmental health: Lessons learned from 9/11

Galvez MP, Peters R, Graber N, et al

2007

Children and megadisasters: Lessons learned in the new millennium

Garrett AL, Grant R, Madrid P, et al

2007

Many specific lessons were learned from recent megadisasters in the United States at the expense of children who suffered from a government and a citizenry that was desperately unprepared to respond to and recover from the disaster's short- and long-term effects. During the 9/11 attacks, the nation learned a new sense of vulnerability as the specter of terrorism was delivered repeatedly to our collective consciousness. As this article has emphasized, children experienced significant and widespread psychological effects from this event, and many did not receive adequate treatment. Hurricane Katrina exploited the weaknesses of an already strained child mental health system and vividly demonstrated the liability of poor preparedness and inadequate communication by both families and governments. The impact of Katrina continues to affect many thousands of children over a year later, as the systems that were intended to care for them have largely moved on. Indeed, there was no mention of Hurricane Katrina, the Gulf Coast, or the storm's survivors in the 2007 State of the Union address by the President. After 9/11 and the unprecedented federal spending that occurred to increase our nation's readiness, it is discouraging that the response to Hurricane Katrina fell so short of what had the potential to be the greatest disaster response and recovery story in the history of our nation. It is unlikely that further uncontained expenditures will solve the problems that were exposed in the Gulf Coast. There is not a solution that money can buy. One need only look a few hundred miles south to the Cuban disaster response system to appreciate where some of our shortfalls lie. Cuba has succeeded where the United States has not in part because its citizens are participants in their own preparedness. They engage their children and their families in preparedness planning and they rely upon other members of their community to strengthen their ability to survive as individuals. The American mentality of "dial 911 in an emergency and wait for help" works only as long as there are enough resources to match the need. In a disaster, this approach has proven to be inadequate over and over again. In America, we are well positioned to be leaders in responding to the needs of children affected by disaster. The resources of our government and the resourcefulness of our people should offer much promise for the future. By analyzing our past shortfalls and taking practical steps to mitigate the existing barriers to preparedness, our children, we hope, will fare much better the next time a megadisaster strikes. Box 7 includes suggestions for national priorities for child disaster care.

Alcohol consumption and posttraumatic stress after exposure to terrorism: Effects of proximity, loss, and psychiatric history

Hasin DS, Keyes KM, Hatzenbuehler ML, et al

2007

Bereavement and coping of south asian families post 9/11

Inman AG, Yeh CJ, Madan-Bahel A, et al

2007

The flexible application of a manualized treatment for PTSD symptoms and functional impairment related to the 9/11 World Trade Center attack

Levitt JT, Malta LS, Martin A, et al

2007

Psychological distress among american red cross disaster workers responding to the terrorist attacks of September 11, 2001

Long ME, Meyer DL, and Jacobs GA

2007

School of social work disaster response following the World Trade Center disaster: Msw student and field instructor perspectives

Matthieu M, Lewis SJ, Ivanoff A, et al

2007

Student perspectives on the impact of the World Trade Center disaster: A longitudinal qualitative study

Matthieu MM, Conroy K, Lewis S, et al

2007

Confirmatory factor analysis of the PTSD checklist and the clinician-administered PTSD scale in disaster workers exposed to the World Trade Center ground zero

Palmieri PA, Weathers FW, Difede J, et al

2007

Relationship between polycyclic aromatic hydrocarbon-DNA adducts, environmental tobacco smoke, and child development in the World Trade Center cohort

Perera FP, Tang D, Rauh V, et al

2007

Focus groups with children after the World Trade Center attacks

Pfefferbaum B, North CS, Pollio DE, et al

2007

Relative congener scaling of polychlorinated dibenzo-p-dioxins and dibenzofurans to estimate building fire contributions in air, surface wipes, and dust samples

Pleil JD and Lorber MN

2007

The United States Environmental Protection Agency collected ambient air samples in lower Manhattan for about 9 months following the September 11, 2001 World Trade Center (WTC) attacks. Measurements were made of a host of airborne contaminants including volatile organic compounds, polycyclic aromatic hydrocarbons, asbestos, lead, and other contaminants of concern. The present study focuses on the broad class of polychlorinated dibenzo-p-dioxins (CDDs) and dibenzofurans (CDFs) with specific emphasis on the 17 CDD/CDF congeners that exhibit mammalian toxicity. This work is a statistical study comparing the internal patterns of CDD/CDFs using data from an unambiguous fire event (WTC) and other data sets to help identify their sources. A subset of 29 samples all taken between September 16 and October 31, 2001 were treated as a basis set known to be heavily impacted by the WTC building fire source. A second basis set was created using data from Los Angeles and Oakland, CA as published by the California Air Resources Board (CARB) and treated as the archetypical background pattern for CDD/CDFs. The CARB data had a congener profile appearing similar to background air samples from different locations in America and around the world and in different matrices, such as background soils. Such disparate data would normally be interpreted with a qualitative pattern recognition based on congener bar graphs or other forms of factor or cluster analysis that group similar samples together graphically. The procedure developed here employs aspects of those statistical methods to develop a single continuous output variable per sample. Specifically, a form of variance structure-based cluster analysis is used to group congeners within samples to reduce collinearity in the basis sets, new variables are created based on these groups, and multivariate regression is applied to the reduced variable set to determine a predictive equation. This equation predicts a value for an output variable, OPT: the predicted value of OPT is near zero (0.00) for a background congener profile and near one (1.00) forthe profile characterized by the WTC air profile. Although this empirical method is calibrated with relatively small sets of airborne samples, it is shown to be generalizable to other WTC, fire source, and background air samples as well as other sample matrices including soils, window films and other dust wipes, and bulk dusts. However, given the limited data set examined, the method does not allow further discrimination between the WTC data and the other fire sources. This type of analysis is demonstrated to be useful for complex trace-level data sets with limited data and some below-detection entries.

Clinical correlates of 24-h cortisol and norepinephrine excretion among subjects seeking treatment following the World Trade Center attacks on 9/11

Bierer LM, Tischler L, Labinsky E, et al

2006

UNLABELLED: Whereas trauma-associated arousal has been linked fairly consistently with elevations in both glucocorticoids and catecholamines, neuroendocrine correlates of hyperarousal in the context of posttraumatic stress disorder (PTSD) have been more variable. Further, neuroendocrine predictors of the development of PTSD following trauma have been related to prior exposure, and data from several laboratories suggests that hyperarousal may develop in a neuroendocrine milieu of relatively diminished basal glucocorticoid secretion. METHODS: In this article we examined 24-h cortisol and norepinephrine excretion in 42 treatment-seeking survivors of the 9/11 World Trade Center (WTC) attacks, 32 of whom met criteria for PTSD, and 15 of whom met criteria for major depression, at the time of evaluation; 14 of the 15 subjects meeting criteria for major depression also suffered from PTSD. RESULTS: PTSD subjects' 24-h cortisol excretion (46.3 +/- 20.0 microL/dL) was lower than that of the non-PTSD cohort (72.2 +/- 22.4 microL/dL; t = 3.18, df = 37, P = 0.003), and 24-h urinary cortisol was negatively correlated with the experience of the WTC attacks as a Criterion-A event (r = -0.427, P = 0.007), and with self-rated avoidance (r = -0.466, P = 0.003) and total score (r = -0.398, P = 0.012) on the PTSD Symptom Scale (PSS). In contrast, 24-h norepinephrine excretion was not associated with the development of PTSD or with PTSD-related symptoms, but was negatively correlated with days since 9/11 at the time of evaluation (r = -0.393, P = 0.015). DISCUSSION: The latter finding suggests a relationship of norepinephrine to a dimension of stress-related arousal not captured by the symptom-rating scales chosen for this study to reflect symptoms related to PTSD and other neuropsychiatric disorders, but instead, of one to that of the sudden multidimensional life disruption suffered by the WTC survivors that applied for treatment. These data also confirm, in a naturalistic sample, the previously observed negative association of urinary cortisol excretion with development of PTSD in the aftermath of severe trauma exposure.

Fear of terrorism and preparedness in New York City 2 years after the attacks: Implications for disaster planning and research

Boscarino JA, Adams RE, Figley CR, et al

2006

OBJECTIVES: To help improve disaster planning and research, we studied psychosocial predictors of terrorism fear and preparedness among New York City residents after the World Trade Center disaster (WTCD). METHOD: We conducted a random cross-sectional survey of 1,681 adults interviewed 2 years after the WTCD. Participants were living in New York City at the time of the attack and exposed to ongoing terrorist threats. RESULTS: We found 44.9 percent (95% confidence interval [CI] = 41.9-47.9) of residents were concerned about future attacks and 16.9 percent (95% CI = 14.7-19.3) reported a fear level of "10" on a 10-point analog scale. Furthermore, 14.8 percent (95% CI = 12.8-17.0) reported they had made some plans for a future attack, a significant increase from the previous year. In addition, although 42.6 percent (95% CI = 39.6-45.7) indicated that they would likely wait for evacuation instructions following a chemical, biological, or nuclear attack, 34.4 percent (95% CI = 31.5-37.3) reported they would evacuate immediately against official advice. Predictors of high terrorism fear in a multivariate model included Hispanic ethnicity (odds ratio [OR] = 2.0, P = .006), lower education (OR = 4.4, P < .001, and OR = 3.7, P < .001, respectively, for nonhigh school and high school graduates, compared with college graduates), being exposed to stressful life events (OR = 1.6, P = .048), having current posttraumatic stress disorder (3.1, P < .001), having a fear of death (OR = 2.5, P = .002), and reporting a likelihood of fleeing an attack against advice (OR = 1.5, P = .034). The best predictors of preparedness in a multivariate model was being between 30 to 64 years old (30-44 years old, OR = 2.6, P = .001; 45-64 years old, OR = 1.8, P = .03, respectively, compared with 18-29 years old), having higher exposure to the WTCD (moderate exposure, OR = 1.7, P = .05; high exposure, OR = 2.4, P = .002; very high exposure, OR = 4.1, P < .001), respectively, compared with no little WTCD exposure), and having greater exposure to other lifetime traumatic events (high traumatic event exposure, OR = 2.1, P = .005, compared with no exposure). CONCLUSION: Our study suggests that among those exposed to ongoing terrorism threats, terrorism fear and preparedness were related to socioeconomic factors, mental health status, terrorism exposure levels, and exposure to stressful life events.

The effect of maternal PTSD following in utero trauma exposure on behavior and temperament in the 9-month-old infant

Brand SR, Engel SM, Canfield RL, et al

2006

The mental health impact of 9/11 on inner-city high school students 20 miles north of ground zero

Calderoni ME, Alderman EM, Silver EJ, et al

2006

PURPOSE: To determine the rate of post-traumatic stress disorder (PTSD) after 9/11 in a sample of New York City high school students and associations among personal exposure, loss of psychosocial resources, prior mental health treatment, and PTSD. METHODS: A total of 1214 students (grades 9 through 12) attending a large community high school in Bronx County, 20 miles north of "Ground Zero," completed a 45-item questionnaire during gym class on one day eight months after 9/11. Students were primarily Hispanic (62%) and African American (29%) and lived in the surrounding neighborhood. The questionnaire included the PCL-T, a 17-item PTSD checklist supplied by the Office of Behavioral and Social Science Research of the National Institutes of Health (NIH). The PCL-T was scored following the DSM-IV criteria for PTSD requiring endorsement of at least one repeating symptom, two hyperarousal symptoms, and three avoidance symptoms. Bivariate analysis comparing PTSD with personal exposure, loss of psychosocial resources, and mental health variables was done and multiple logistic regression was used to identify significant associations. RESULTS: There were 7.4 % of students with the PTSD symptom cluster. Bivariate analysis showed a trend for females to have higher rates of PTSD (males [6%] vs. females [9%], p = .06] with no overall ethnic differences. Five of the six personal exposure variables, and both of the loss of psychosocial resources and mental health variables were significantly associated with PTSD symptom cluster. Multiple logistic regression analysis found one personal exposure variable (having financial difficulties after 9/11, odds ratio [OR] = 5.27; 95% confidence interval [CI] 2.9-9.7); both the loss of psychosocial resources variables (currently feeling less safe, OR = 3.58; 95% CI 1.9-6.8) and currently feeling less protected by the government, (OR = 4.04; 95% CI 2.1-7.7); and one mental health variable (use of psychotropic medication before 9/11, OR = 3.95; 95% CI 1.2-13.0) were significantly associated with PTSD symptom cluster. CONCLUSIONS: We found a rate of PTSD in Bronx students after 9/11 that was much higher than other large studies of PTSD in adolescents done before 9/11. Adolescents living in inner cities with high poverty and violence rates may be at high risk for PTSD after a terrorist attack. Students who still felt vulnerable and less safe eight months later and those with prior mental health treatment were four times more likely to have PTSD than those without such characteristics, highlighting the influence of personality and mental health on development of PTSD after a traumatic event.

Comparative analysis of three crisis intervention models applied to law enforcement first responders during 9/11 and hurricane katrina

Castellano C and Plionis E

2006

Mixed lateral preference and peritraumatic reactions to the World Trade Center attacks

Chemtob CM, Wang Y, Dugan KL, et al

2006

Service utilization and event reaction patterns among children who received project liberty counseling services

Covell NH, Allen G, Essock SM, et al

2006

Use of project liberty counseling services over time by individuals in various risk categories

Covell NH, Donahue SA, Allen G, et al

2006

Characteristics of project liberty clients that predicted referrals to intensive mental health services

Covell NH, Essock SM, Felton CJ, et al

2006

PTSD, depression, prescription drug use, and health care utilization of chinese workers affected by the WTC attacks

de Bocanegra HT, Moskalenko S, and Kramer EJ

2006

The application of virtual reality to the treatment of PTSD following the WTC attack

Difede J, Cukor J, Patt I, et al

2006

Demographic characteristics of individuals who received project liberty crisis counseling services

Donahue SA, Covell NH, Foster MJ, et al

2006

Outcomes of enhanced counseling services provided to adults through project liberty

Donahue SA, Jackson CT, Shear KM, et al

2006

Mental health service use among american red cross disaster workers responding to the September 11, 2001 u.S. Terrorist attacks

Elhai JD, Jacobs GA, Kashdan TB, et al

2006

Use of clients' self-reports to monitor project liberty clinicians' fidelity to a cognitive-behavioral intervention

Essock SM, Covell NH, Shear KM, et al

2006

Anger and its association to distress and social/occupational functioning in symptomatic disaster relief workers responding to the September 11, 2001, World Trade Center disaster

Evans S, Giosan C, Patt I, et al

2006

Cardiac sequelae in brooklyn after the September 11 terrorist attacks

Feng J, Lenihan DJ, Johnson MM, et al

2006

Perceived safety in disaster workers following 9/11

Fullerton CS, Ursano RJ, Reeves J, et al

2006

The aftermath of disaster: Children in crisis

Gaffney DA

2006

Coping motives and trait negative affect: Testing mediation and moderation models of alcohol problems among american red cross disaster workers who responded to the September 11,2001 terrorist attacks

Gaher RM, Simons JS, Jacobs GA, et al

2006

Community mental health response to crisis

Gard BA and Ruzek JI

2006

Physical characteristics and health effects of aerosols from collapsed buildings

Gavett SH

2006

Did project liberty displace community-based medicaid services in New York?

Gomes C, McGuire TG, Foster MJ, et al

2006

Trends in healthcare use in the New York City region following the terrorist attacks of 2001

Green DC, Buehler JW, Silk BJ, et al

2006

The impact of resource loss and traumatic growth on probable PTSD and depression following terrorist attacks

Hobfoll SE, Tracy M, and Galea S

2006

Training needs of pediatricians facing the environmental health and bioterrorism consequences of September 11th

Hu YY, Adams RE, Boscarino JA, et al

2006

Clients' satisfaction with project liberty counseling services

Jackson CT, Allen G, Essock SM, et al

2006

Clusters of event reactions among recipients of project liberty mental health counseling

Jackson CT, Allen G, Essock SM, et al

2006

The road back: Predictors of regaining preattack functioning among project liberty clients

Jackson CT, Covell NH, Shear KM, et al

2006

Are male disaster workers with vietnam military service at greater risk for PTSD than peers without combat history?

Jayasinghe N, Jedel S, Leck P, et al

2006

Predictors of peritraumatic reactions and PTSD following the September 11th terrorist attacks

Lawyer SR, Resnick HS, Galea S, et al

2006

Alexithymia and PTSD symptoms in urban police officers: Cross-sectional and prospective findings

McCaslin SE, Metzler TJ, Best SR, et al

2006

Health responses of New York City firefighter spouses and their families post-September 11, 2001 terrorist attacks

Menendez AM, Molloy J, and Magaldi MC

2006

A psychometric analysis of project liberty's adult enhanced services referral tool

Norris FH, Donahue SA, Felton CJ, et al

2006

Adolescents discuss their reactions to the September 11 attacks

Pfefferbaum B, North CS, Pollio DE, et al

2006

Internet-based intervention for mental health and substance use problems in disaster-affected populations: A pilot feasibility study

Ruggiero KJ, Resnick HS, Acierno R, et al

2006

Screening for complicated grief among project liberty service recipients 18 months after September 11, 2001

Shear KM, Jackson CT, Essock SM, et al

2006

Multiscale plume transport from the collapse of the World Trade Center on September 11, 2001

Stenchikov G, Lahoti N, Diner DJ, et al

2006

Exposure to the World Trade Center attack and the use of cigarettes and alcohol among New York City public high-school students

Wu P, Duarte CS, Mandell DJ, et al

2006

Asian american families' collectivistic coping strategies in response to 9/11

Yeh CJ, Inman AC, Kim AB, et al

2006

Burn-injured patients in a disaster: September 11th revisited

Yurt RW, Bessey PQ, Alden NE, et al

2006

Posttraumatic stress disorder in disaster relief workers following direct and indirect trauma exposure to ground zero

Zimering R, Gulliver SB, Knight J, et al

2006

Stress and well-being in the aftermath of the World Trade Center attack: The continuing effects of a communitywide disaster

Adams RE and Boscarino JA

2005

Differences in mental health outcomes among whites, African Americans, and hispanics following a community disaster

Adams RE and Boscarino JA

2005

A war that had come right to them: Group work with traumatized adolescents following September 11

Aronson S

2005

Bronchial hyperreactivity and other inhalation lung injuries in rescue/recovery workers after the World Trade Center collapse

Banauch GI, Dhala A, Alleyne D, et al

2005

Asbestos exposures to truck drivers during World Trade Center cleanup operations

Breysse PN, Williams DL, Herbstman JB, et al

2005

This article presents results of asbestos air sampling conducted to assess the exposure to truck drivers working at the World Trade Center site. Sampling consisted of a combination of area and personal monitoring of 49 truck drivers and included optical and electron microscopic analyses. Three sampling periods were conducted: October 1-7, 2001, October 17-26, 2001, and April 13-23, 2002. Area sample locations were selected to estimate airborne concentrations around the perimeter of the site, on top of the pile, and in the pit. Air samples were collected using a 50-mm conductive cowl and a 25-mm mixed cellulose ester filter at flow rates ranging from 0.5-2 L/min. Samples were analyzed using a combination of phase contrast microscopy (PCM) NIOSH method 7400, transmission electron microscopy (TEM) NIOSH method 7402, and the direct method specified under the Asbestos Hazardous Emergency Response Act. Sample times and flow rates were adjusted to prevent overloading while maximizing sample volume. Personal sampling results suggest that asbestos fiber exposures to truck drivers at the site were low. Exposures based on TEM results generally ranged from less than detectable to 0.1 structures per cubic centimeter (s/cm(3)). TEM-based results further indicate that the majority of asbestos fibers were chrysotile and less than 5 microm in length. PCM-based estimates were generally higher than the TEM results. This is likely due to the counting of nonasbestos fibers. This conclusion is supported by the NIOSH 7402 TEM results, which did not detect asbestos fibers longer than 5 micro m. Area sample results were generally less than the personal results (except for the sample collected on top of the rubble pile) and decreased over the course of the cleanup. Our results show low airborne asbestos concentrations and a predominance of short fibers. Given these low concentrations, evidence of short fibers, and the short duration of the exposure (less than 10 months to complete the cleanup), it is likely that truck drivers working at the site are not at an increased risk for asbestos-related disease.

Childhood traumatic grief: An exploration of the construct in children bereaved on September 11

Brown EJ and Goodman RF

2005

Longitudinal stress responses to the 9/11 terrorist attacks in a New York metropolitan college sample

Callahan KL, Hilsenroth MJ, Yonai T, et al

2005

Social workers' experiences of the World Trade Center disaster: Stressors and their relationship to symptom types

Colarossi L, Heyman J, and Phillips M

2005

Coping responses of asian, black, and latino/latina New York City residents following the September 11, 2001 terrorist attacks against the United States

Constantine MG, Alleyne VL, Caldwell LD, et al

2005

September 11th related stress and trauma in New Yorkers

Friedberg JP, Adonis MN, Von Bergen HA, et al

2005

Respiratory effects of inhalation exposure among workers during the clean-up effort at the World Trade Center disaster site

Herbstman JB, Frank R, Schwab M, et al

2005

The pentagon attack of September 11, 2001: A burn center's experience

Jordan MH, Hollowed KA, Turner DG, et al

2005

How does negative life change following disaster response impact distress among red cross responders?

McCaslin SE, Jacobs GA, Meyer DL, et al

2005

The experiences of project liberty crisis counselors in the bronx

Moynihan PJ, Levine JM, and Rodriguez O

2005

The role of the bereavement group in the face of 9/11: A self-psychology perspective

Phillips SB

2005

In the aftermath of September 11: Group interventions with traumatized children revisited

Scheidlinger S and Kahn GB

2005

Associations between alcohol use and PTSD symptoms among american red cross disaster relief workers responding to the 9/11/2001 attacks

Simons JS, Gaher RM, Jacobs GA, et al

2005

Behavior problems in New York City's children after the September 11, 2001, terrorist attacks

Stuber J, Galea S, Pfefferbaum B, et al

2005

PTSD and depression among displaced chinese workers after the World Trade Center attack: A follow-up study

Thiel de Bocanegra H, Moskalenko S, and Chan P

2005

Through their own eyes: A media-based group approach to adolescent trauma

Tosone C, Gelman CR, and McVeigh L

2005

Using staff focus groups to refine a feedback process for people who used project liberty

Ulaszek WR, Dunakin LK, Donahue SA, et al

2005

Asthma in medicaid managed care enrollees residing in New York City: Results from a post-World Trade Center disaster survey

Wagner VL, Radigan MS, Roohan PJ, et al

2005

Groups for children traumatically bereaved by the attacks of September 11, 2001

Webb NB

2005

Television watching and mental health in the general population of New York City after September 11

Ahern J, Galea S, Resnick H, et al

2004

Mental health service and medication use in New York City after the September 11, 2001, terrorist attack

Boscarino JA, Galea S, Adams RE, et al

2004

Facing fears and sadness: Cognitive-behavioral therapy for childhood traumatic grief

Brown EJ, Pearlman MY, and Goodman RF

2004

Conducting analysis after September 11: Implications for psychoanalytic technique

Cabaniss DL, Forand N, and Roose SP

2004

Airborne fine and ultrafine particles near the World Trade Center disaster site

Cohen BS, Heikkinen MSA, and Hazi Y

2004

Documentation of the airborne fine and ultrafine particles produced by the terrorist attack on the World Trade Center (WTC), particularly while fires were burning, was essential for evaluating the risk of adverse health effects in people who live and work in this area. We collected airborne particles for 3 months at a site about 400 m east of the former WTC. Ultrafine particles were collected by deposition onto small detector chips for morphometric analysis by atomic force microscopy. Some chips were coated with an iron nanofilm for detection of strong acids. A condensation nucleus counter and two impactors measured particle number concentrations and size distributions. Collected particles exhibited a variety of globular forms, and most appeared to be agglomerates. No ultrafine acid particles were detected. Particle number concentrations ranged from below 1 x 10(4) cm(-3) to about 5 x 10(4) cm(-3). Occasional peaks reached values over 7 x 10(4) cm(-3). The average total mass concentration was about 17 mug/m(3) in mid-October, about half that value in November, and as low as 5 mug/m(3) in mid-December. Particle size distributions were mostly bimodal. The mass concentration of very fine particles (0.1 mum to 0.29 mum) ranged from 4.3 mug/m(3) to 0.7 mug/m(3), and the ultrafine (d < 0.1 μm) ranged from 1.46 μg/m(3) to nondetectable after 5 November 2001. Some backup filters from the October sampling sessions were analyzed for organic and elemental carbon (OC/EC) and polyaromatic hydrocarbons (PAH). About 70% of the total carbon was organic. The PAIR levels ranged from 10 to 1500 ng m(-3). Overall, our data for particle mass and number concentrations did not differ substantially from data we had collected in Manhattan the previous year. The dominant organic compounds found in these samples are those most common in urban environments. These data do not suggest, but cannot rule out, an unusual risk of adverse health effects from the number, or mass, of the fine ambient particles.

Hospitalized psychiatric patients view the World Trade Center disaster

DeLisi LE, Cohen TH, and Maurizio AM

2004

The effects of the September 11 World Trade Center attack on a man with a preexisting mental illness

Ellick JD and Paradis CM

2004

Unmet need for counseling services by children in New York City after the September 11th attacks on the World Trade Center: Implications for pediatricians

Fairbrother G, Stuber J, Galea S, et al

2004

Letting the story unfold: A case study of client-centered therapy for childhood traumatic grief

Goodman RF, Morgan AV, Juriga S, et al

2004

Exposure to trauma and separation anxiety in children after the WTC attack

Hoven CW, Duarte CS, Wu P, et al

2004

Mental health impact of 9/11 pentagon attack: Validation of a rapid assessment tool

Jordan NN, Hoge CW, Tobler SK, et al

2004

Reactions and needs of tristate-area pediatricians after the events of September 11th: Implications for children's mental health services

Laraque D, Boscarino JA, Battista A, et al

2004

OBJECTIVE: The terrorist attacks of September 11, 2001, caused mass destruction in Lower Manhattan, the Pentagon, and rural Pennsylvania and resulted in the death of >3000 people. Children were prominent among those affected. Given the wide impact of the attacks, we hypothesized that primary care professionals would see the broad population of affected children but would feel ill-prepared to respond to children's mental health needs. METHODS: One year after the September 11th disaster, a hyperlink to a web-based 42-item survey was sent to all New York, Connecticut, and New Jersey American Academy of Pediatrics members with e-mail addresses (N = 4330), and a paper version of the survey was sent via postal mail to a random sample of those without e-mail (N = 1320). The survey requested demographic data, personal and practice experience of 9/11, perceived knowledge and skills regarding mental health, and perceived barriers to accessing mental health services for their patients. Both groups were contacted a total of 3 times at 2-week intervals, resulting in 1396 completed surveys from providers who were actively seeing patients. RESULTS: Twenty-nine percent of respondents stated that they were seeing affected patients, and 32.6% reported seeing children who were exposed to at least 1 9/11 event. Sixty-four percent of the respondents identified behavioral problems in directly affected children: 41.6% identified acute stress disorder, and 26.3% identified posttraumatic stress disorder (PTSD). However, a majority of these professionals indicated that they either lacked or were uncertain (50.8% PTSD, 51.7% acute stress disorder) of their skills to identify children with mental health problems and that they were "not" or only "somewhat" knowledgeable (76.8% PTSD) in these areas. The majority agreed that child health professionals should be trained to screen for these 2 disorders. Generalists as compared with specialists were more likely to report seeing patients who were affected by 9/11. Gender, race/ethnicity, and geographic location were associated with reported effects of 9/11 on respondents' practice and perceived skills and knowledge related to the psychological effects of community disasters. CONCLUSIONS: Pediatric practitioners in the tristate area reported that children/families sought care for an array of mental health-related concerns. Generalists in the areas affected and those who identified gaps in knowledge or skills in responding to the psychological effects of community disasters should be targeted for additional education.

Adolescents’ reactions to the World Trade Center destruction: A study of political trauma in metropolitan New York

Malin AM and Fowers BJ

2004

Teachers in the aftermath of terrorism: A case study of one New York City school

Pfefferbaum RL, Fairbrother G, Brandt EN, Jr., et al

2004

Estimating capacity requirements for mental health services after a disaster has occurred: A call for new data

Siegel CE, Laska E, and Meisner M

2004

Assessing loss reactions among older adults: Strategies to evaluate the impact of September 11, 2001

Sofka CJ

2004

Clinical deterioration in pediatric asthmatic patients after September 11, 2001

Szema AM, Khedkar M, Maloney PF, et al

2004

Characterization of background concentrations in upper Manhattan, New York apartments for select contaminants identified in World Trade Center dust

Tang KM, Nace CG, Jr., Lynes CL, et al

2004

The use of murals in preadolescent inpatient groups: An art therapy approach to cumulative trauma

Testa N and McCarthy JB

2004

Mental health impact of the World Trade Center attacks on displaced chinese workers

Thiel de Bocanegra H and Brickman E

2004

Consumption of cigarettes, alcohol, and marijuana among New York City residents six months after the September 11 terrorist attacks

Vlahov D, Galea S, Ahern J, et al

2004

Psychological effects of attack on the World Trade Center: Analysis before and after

Wilson WC and Rosenthal BS

2004

Comparisons of the dust/smoke particulate that settled inside the surrounding buildings and outside on the streets of southern New York City after the collapse of the World Trade Center, September 11, 2001

Yiin LM, Millette JR, Vette A, et al

2004

The World Trade Center disaster and intrauterine growth restriction

Berkowitz GS

2003

Psychiatric medication use among Manhattan residents following the World Trade Center disaster

Boscarino JA, Galea S, Ahern J, et al

2003

Healing loss, ambiguity, and trauma: A community-based intervention with families of union workers missing after the 9/11 attack in New York City

Boss P, Beaulieu L, Wieling E, et al

2003

The September 11th attacks and depressive symptomatology among older adults with vision loss in New York City

Brennan M, Horowitz A, and Reinhardt JP

2003

The emotional distress in a community after the terrorist attack on the World Trade Center

Chen H, Chung H, Chen T, et al

2003

The impact of the 9/11 attacks on the elderly in NYC chinatown: Implications for culturally relevant services

Chung I

2003

Relationship of self-reported asthma severity and urgent health care utilization to psychological sequelae of the September 11, 2001 terrorist attacks on the World Trade Center among New York City area residents

Fagan J, Galea S, Ahern J, et al

2003

New horizons for or nurses--lessons learned from the World Trade Center attack

Forgione T, Owens PJ, Lopes JP, et al

2003

Supporting the federal emergency management agency rescuers: A variation of critical incident stress management

Garcia E and Horton DA

2003

World Trade Center fine particulate matter causes respiratory tract hyperresponsiveness in mice

Gavett SH, Haykal-Coates N, Highfill JW, et al

2003

Pollutants originating from the destruction of the World Trade Center (WTC) in New York City on 11 September 2001 have been reported to cause adverse respiratory responses in rescue workers and nearby residents. We examined whether WTC-derived fine particulate matter [particulate matter with a mass median aerodynamic diameter < 2.5 microm (PM2.5)] has detrimental respiratory effects in mice to contribute to the risk assessment of WTC-derived pollutants. Samples of WTC PM2.5 were derived from settled dust collected at several locations around Ground Zero on 12 and 13 September 2001. Aspirated samples of WTC PM2.5 induced mild to moderate degrees of pulmonary inflammation 1 day after exposure but only at a relatively high dose (100 microg). This response was not as great as that caused by 100 microg PM2.5 derived from residual oil fly ash (ROFA) or Washington, DC, ambient air PM [National Institute of Standards and Technology, Standard Reference Material (SRM) 1649a]. However, this same dose of WTC PM2.5 caused airway hyperresponsiveness to methacholine aerosol comparable to that from SRM 1649a and to a greater degree than that from ROFA. Mice exposed to lower doses by aspiration or inhalation exposure did not develop significant inflammation or hyperresponsiveness. These results show that exposure to high levels of WTC PM2.5 can promote mechanisms of airflow obstruction in mice. Airborne concentrations of WTC PM2.5 that would cause comparable doses in people are high (approximately 425 microg/m3 for 8 hr) but conceivable in the aftermath of the collapse of the towers when rescue and salvage efforts were in effect. We conclude that a high-level exposure to WTC PM2.5 could cause pulmonary inflammation and airway hyperresponsiveness in people. The effects of chronic exposures to lower levels of WTC PM2.5, the persistence of any respiratory effects, and the effects of coarser WTC PM are unknown and were not examined in these studies. Degree of exposure and respiratory protection, individual differences in sensitivity to WTC PM2.5, and species differences in responses must be considered in assessing the risks of exposure to WTC PM2.5.

Posttraumatic stress disorder, alcohol use, and perceived safety after the terrorist attack on the pentagon

Grieger TA, Fullerton CS, and Ursano RJ

2003

Adherence to HIV medications in a cohort of men who have sex with men: Impact of September 11th

Halkitis PN, Kutnick AH, Rosof E, et al

2003

Two shadows of the twin towers: Missing safe spaces and foreclosed opportunities

Krauss BJ, Franchi D, O'Day J, et al

2003

Destruction of the World Trade Center and pcbs, pbdes, pcdd/fs, pbdd/fs, and chlorinated biphenylenes in water, sediment, and sewage sludge

Litten S, McChesney DJ, Hamilton MC, et al

2003

September 11th survivors and the refugee model

Myer RA, Moore H, and Hughes TL

2003

World Trade Center trauma interventions: A clinical model for affected workers

Pawlukewicz J

2003

Granulomatous pneumonitis following exposure to the World Trade Center collapse

Safirstein BH, Klukowicz A, Miller R, et al

2003

Continuing psychological aftermath of 9/11: A poppa experience and critical incident stress debriefing revisited

Scurfield RM, Viola J, Platoni K, et al

2003

Volume of va patients with posttraumatic stress disorder in the New York metropolitan area after September 11

Weissman EM, Kushner M, Marcus SM, et al

2003

Rapid assessment of injuries among survivors of the terrorist attack on the World Trade Center--New York City, September 2001

Centers for Disease Control and Prevention

2002

Walter Reed Army Medical Center's mental health response to the pentagon attack

Cozza SJ, Huleatt WJ, and James LC

2002

Integration of a small clinic into the pentagon response: The bolling air force base perspective

Furman KA

2002

In the face of tragedy: Placing children's reactions to trauma in a new context

Gurwitch RH, Kees M, and Becker SM

2002

Lifestyle changes in New Yorkers after September 11, 2001 (data from the post-disaster heart attack prevention program)

Ho JE, Paultre F, and Mosca L

2002

Development of a brief questionnaire to measure mental health outcomes among pentagon employees following the September 11, 2001 attack

Hoge CW, Engel CC, Orman DT, et al

2002

The medical student experience with disasters and disaster response

Katz CL, Gluck N, Maurizio A, et al

2002

Handling human remains following the terrorist attack on the pentagon: Experiences of 10 uniformed health care workers

Keller RT and Bobo WV

2002

Post-traumatic stress disorder and terrorism

Lee A, Isaac M, and Janca A

2002

Use of respiratory protection among responders at the World Trade Center site--New York City, September 2001

Prezant D, Kelly K, Jackson B, et al

2002

A community-based survey of fibromyalgia-like pain complaints following the World Trade Center terrorist attacks

Raphael KG, Natelson BH, Janal MN, et al

2002

Determinants of counseling for children in Manhattan after the September 11 attacks

Stuber J, Fairbrother G, Galea S, et al

2002

Risk communication in the aftermath of the World Trade Center disaster

Thurston GD and Chen LC

2002

Meeting the patients where they are: Consultation-liaison response to trauma victims of the pentagon attack

Wain HJ, Grammer GG, Stasinos JJ, et al

2002

Application of army combat stress control doctrine in work with pentagon survivors

Waits W and Waldrep D

2002

The U.S. Army Center for Health Promotion and Preventive Medicine response to the Pentagon attack: A multipronged prevention-based approach

Wells JD, Egerton WE, Cummings LA, et al

2002

Mediterranean diet intervention among World Trade Center responders with post-traumatic stress disorder: Feasibility and outcomes of a pilot randomized controlled trial

Arcan C, Hou W, Hoffman K, et al.

2024

OBJECTIVE: Responders of the World Trade Center (WTC) disaster suffer from co-morbidities. A Mediterranean Diet (MedDiet) nutrition intervention with physical activity was implemented among WTC responders with overweight/obesity and post-traumatic stress disorder (PTSD). METHODS: WTC Health Program members (N = 62), 45-65 years, males 87%, body mass index (BMI) 27-45 kg/m(2) randomized to MedDiet (n = 31) or usual nutrition counseling (n = 31). The 10-week intervention included online nutrition education, text messages, and group experiential cooking; both groups had three in-person individual nutrition counseling. Anthropometrics, serum biomarkers, psychosocial factors, MedDiet score, and PTSD symptoms were assessed at baseline, post-intervention, and 3-months (follow-up). The primary outcome was intervention feasibility and secondary outcomes were within- and between-group changes of all measures at post-intervention and follow-up. Nonparametric Wilcoxon rank sum tests for between-group comparisons and Wilcoxon signed rank tests for pre-post within-group comparisons. RESULTS: A total of 58(94%) and 46(74%) participants completed the post-intervention and follow-up measurements, respectively. Both groups experienced significant improvements in anthropometrics, MedDiet score, oxidized low-density lipoprotein, and PTSD symptoms. Baseline median (range) were weight 100.42 (73.66-135.17) kg, BMI 33.20 (27.50-41.75) kg/m(2), and Waist circumference (WC) 109.22 (90.17-150.62) cm. Median % weight loss at post-intervention was MedDiet: -3% (-11%-7%), p = 0.0002; Control: -1% (-13%-4%), p = 0.008 and at follow-up MedDiet: -2% (-14%-12%), p = 0.07; Control: -2% (-20%-3%), p = 0.006. The overall BMI was reduced by -0.68 kg/m(2) (-4.61-2.09) kg/m(2) p < 0.0001 at post-intervention and by -0.60 kg/m(2) (-6.91-3.39) kg/m(2), p < 0.0009 at follow-up. Overall, median WC was reduced (p < 0.0001); post-intervention -3.81 cm (-33.00-3.30)cm and follow-up -4.45(-38.10-4.57)cm. There were group differences in HbA1c (p = 0.019) and serum ω6/ω3 (p = 0.029) at post-intervention. CONCLUSION: Online intervention with personal counseling was feasible in this population. Improvements in anthropometrics, MedDiet score, selected serum biomarkers and PTSD symptoms were found in both groups; group differences in HbA1c and serum ω6/ω3. A larger study with a delayed control is needed to better assess intervention effects.

Self-reported cardiovascular disease in career firefighters with and without World Trade Center exposure

Mueller AK, Cohen H, Singh A, et al.

2024

World Trade Center Health Program best practices for diagnosing and treating chronic rhinosinusitis

de la Hoz RE and Shohet MR

2023

World Trade Center-related asthma: Clinical care essentials

Harrison D and Reibman J

2023

Genetic liability, exposure severity, and post-traumatic stress disorder predict cognitive impairment in World Trade Center responders

Mann FD, Clouston SAP, Cuevas A, et al.

2023

World Trade Center exposure, DNA methylation changes, and cancer: A review of current evidence

Tuminello S, Nguyen E, Durmus N, et al.

2023

Novel approach to studying effects of inhalational exposure on lung function in civilians exposed to the World Trade Center disaster

Wang Y, Berger KI, Zhang Y, et al.

2023

The relationship between 9/11 exposure, systemic autoimmune disease, and post-traumatic stress disorder: A mediational analysis

Brite J, Miller-Archie SA, and Cone J

2022

Characteristics of cancers in community members exposed to the World Trade Center disaster at a young age

Florsheim RL, Zhang Q, Durmus N, et al.

2022

A 15-year follow-up study of mortality in a pooled cohort of World Trade Center rescue and recovery workers

Li J, Hall CB, Yung J, et al.

2022

Introduction Hazardous exposures from the World Trade Center (WTC) terrorist attacks have been linked to increased adverse health conditions, often associated with increased mortality. We assessed mortality in a pooled cohort of WTC rescue/recovery workers over 15 years of follow-up. Materials and methods We analyzed mortality through 2016 in a pooled and deduplicated cohort of WTC rescue/recovery workers from three WTC-exposed cohorts (N = 60,631): the Fire Department of the City of New York (FDNY); the WTC Health Registry (WTCHR); and the General Responder Cohort (GRC). Standardized mortality ratios (SMRs) were estimated to assess mortality vs. the US and NY state populations. Multivariable Cox proportional hazards models were used to examine associations of WTC exposures (date of first arrival, working on the WTC debris pile) with mortality risk. Results There were 1912 deaths over 697,943.33 person-years of follow-up. The SMR for all-cause mortality was significantly lower-than-expected, both when using US (SMR 0.43, 95% confidence interval [CI] 0.42–0.45) and NYS (SMR 0.51, 95% CI 0.49–0.53) as reference populations. SMRs were not elevated for any of the 28 major causes of death. Arriving to the WTC site on 9/11-9/17/2001 vs. 9/18/2001-6/30/2002 was associated with 30–50% higher risk of all-cause, heart disease and smoking-related mortality in non-FDNY/non-GRC members. Conversely, arriving on 9/11/2001 vs. 9/18/2001-6/30/2002 was associated with 40% lower all-cause and smoking-related mortality risk in FDNY members. Working on vs. off the WTC pile was associated with an increased risk of all-cause mortality in non-FDNY/non-GRC members (adjusted hazard ratio [aHR] 1.25, 95% CI 1.04–1.50), and cancer-specific mortality in GRC members (aHR 1.39, 95% CI 1.05–1.84), but lower mortality risks were found in FDNY members. Conclusions We did not observe excess mortality among WTC rescue/recovery workers compared with general populations. However, significantly increased mortality risks among some sub-groups with high WTC exposure warrants further investigation.

Memory and its entanglements: A psychoanalytic meditation on terror and aftermath

Mahon E

2022

The role of personality in the mental and physical health of World Trade Center responders: Self- versus informant-reports

Oltmanns JR, Ruggero C, Miao J, et al.

2022

World Trade Center dust exposure promotes cancer in PTEN-deficient mouse prostates

Wang L, Xu Y, Zhang L, et al.

2022

A study of suicidal thoughts and behaviour in a sample of adults affected by the 9/11 attacks on New York City's World Trade Center

Xue J, Raitt J, Roaten K, et al

2022

Genome-wide DNA methylation profiles in community members exposed to the World Trade Center disaster

Arslan AA, Tuminello S, Yang L, et al

2020

Psychological impact of spontaneous memorials: A narrative review

Collins H, Allsopp K, Arvanitis K, et al

2020

Editorial: Grief in children: Phenomenology and beyond

Melhem NM and Brent D

2019

Nypd cancer incidence rates 1995-2014 encompassing the entire World Trade Center cohort

Kleinman EJ, Christos PJ, Gerber LM, et al

2015

Follicular cell dendritic sarcoma of cervical nodes in a patient with significant WTC exposure

Shemen L, Kaplan B, and Sussman L

2015

Lessons learned from the September 11th disaster: A state health agency perspective

Lin S, Mauer MP, Jones R, et al

2012

Genetic markers for PTSD risk and resilience among survivors of the World Trade Center attacks

Sarapas C, Cai G, Bierer LM, et al

2011

Using exterior building surface films to assess human exposure and health risks from pcdd/fs in New York City, USA, after the World Trade Center attacks

Rayne S

2005

Fear of terrorism in New York after the September 11 terrorist attacks: Implications for emergency mental health and preparedness

Boscarino JA, Figley CR, and Adams RE

2003

Childbirth education and doula care during times of stress, trauma, and grieving

Pascali-Bonaro D

2003

World Trade Center cough

Chen LC and Thurston G

2002

Importance of reference group selection in the evaluation of cancer incidence

Mueller AK, Vaeth B, Todd AC, et al.

2025

The long-term physical–psychiatric comorbidities related to childhood exposure to 9/11 trauma

Amsel L, Cycowicz YM, Rodriguez-Moreno DV, et al.

2024

Normal lung function and mortality in World Trade Center responders and National Health and Nutrition Examination Survey III participants

Cannon MF, Goldfarb DG, Zeig-Owens RA, et al.

2024

Cluster analysis of World Trade Center related lower airway diseases

de la Hoz RE, Jeon Y, Doucette JT, et al.

2024

Families of cancer victims wait for benefits decades after the World Trade Center attack

Gruber K

2024

MRI signature brain age underlying post-traumatic stress disorder in World Trade Center responders

Invernizzi A, La Rosa F, Sather A, et al.

2024

Comparison of extent and progression respiratory cardiovascular disease in World Trade Center responders to lung screening participants

Jirapatnakul A, Yip R, Branch AD, et al.

2024

Responders to the World Trade Center (WTC) site in the aftermath of the 9/11 attacks were exposed to toxic dust, which has been linked to increased risk of respiratory and cardiovascular disease. The respiratory and cardiovascular effects of WTC dust exposure have been studied using pulmonary function tests and the number of cardiovascular events, but computed tomography (CT) scans provide an opportunity to see the early structural changes in the lungs and cardiovascular system before clinical symptoms appear. CT scans are used in the screening and evaluation of respiratory diseases such as lung cancer, interstitial lung disease, and chronic obstructive pulmonary disease, and to visualize coronary arteries and quantify the amount of coronary artery calcifications; in fact, it is possible to detect multiple diseases from a single chest CT scan. While manual evaluation by a radiologist is often the gold standard, automated image analysis tools can quickly and accurately quantify these diseases. We identified non-contrast chest CT scans from members of the World Trade Center General Responders Cohort (WTC GRC) with slice thickness of 2.5 mm or less. We used the open-source Chest Imaging Platform software to compute measures of emphysema and interstitial lung disease and research software from Cornell University to compute measures of pulmonary hypertension and coronary artery calcification. We identified a sex, age (within 5 years), smoking status, one or more CT scans, and follow-up time -matched cohort of participants enrolled in the lung screening program at Mount Sinai. We compared disease measures from the WTC GRC group to the lung screening group to assess whether there was a difference in the extent and progression of disease. There were 4909 chest CT images of members of the WTC GRC that met our image quality criteria. There were 3855 members of the GRC for which we could obtain both chest CT images and clinical data. Of these, there were 2284 members for which we could obtain pulmonary disease measurements on at least one scan, 1246 members for which we could calculate cardiac measurements. The matched controls from the lung screening cohort consisted of 557 participants with 1122 chest CT images that met our image quality criteria and for which we obtained all four disease measures. We compared members of the WTC GRC with matched participants from the lung screening program. One of the key findings is that after a median time of 11-13 years after 9/11, the WTC GRC group exhibited higher burdens of coronary artery calcification, emphysema, and interstitial lung disease compared with a matched control group of lung screening participants. This supports the continued surveillance of WTC responders. Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis study was funded by an NIH/CDC grant R21OH012244.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:The Institutional Review Board (IRB) of the Icahn School of Medicine gave ethical approval for this work.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesData produced in this present study are not available, though the underlying clinical and image data are available upon request to the World Trade Center General Responders Data Center.

Epigenome-wide association studies identify novel DNA methylation sites associated with PTSD: A meta-analysis of 23 military and civilian cohorts

Katrinli S, Wani AH, Maihofer AX, et al.

2024

BACKGROUND: The occurrence of post-traumatic stress disorder (PTSD) following a traumatic event is associated with biological differences that can represent the susceptibility to PTSD, the impact of trauma, or the sequelae of PTSD itself. These effects include differences in DNA methylation (DNAm), an important form of epigenetic gene regulation, at multiple CpG loci across the genome. Moreover, these effects can be shared or specific to both central and peripheral tissues. Here, we aim to identify blood DNAm differences associated with PTSD and characterize the underlying biological mechanisms by examining the extent to which they mirror associations across multiple brain regions. METHODS: As the Psychiatric Genomics Consortium (PGC) PTSD Epigenetics Workgroup, we conducted the largest cross-sectional meta-analysis of epigenome-wide association studies (EWASs) of PTSD to date, involving 5077 participants (2156 PTSD cases and 2921 trauma-exposed controls) from 23 civilian and military studies. PTSD diagnosis assessments were harmonized following the standardized guidelines established by the PGC-PTSD Workgroup. DNAm was assayed from blood using Illumina HumanMethylation450 or MethylationEPIC (850 K) BeadChips. Within each cohort, DNA methylation was regressed on PTSD, sex (if applicable), age, blood cell proportions, and ancestry. An inverse variance-weighted meta-analysis was performed. We conducted replication analyses in tissue from multiple brain regions, neuronal nuclei, and a cellular model of prolonged stress. RESULTS: We identified 11 CpG sites associated with PTSD in the overall meta-analysis (1.44e - 09 < p < 5.30e - 08), as well as 14 associated in analyses of specific strata (military vs civilian cohort, sex, and ancestry), including CpGs in AHRR and CDC42BPB. Many of these loci exhibit blood-brain correlation in methylation levels and cross-tissue associations with PTSD in multiple brain regions. Out of 9 CpGs annotated to a gene expressed in blood, methylation levels at 5 CpGs showed significant correlations with the expression levels of their respective annotated genes. CONCLUSIONS: This study identifies 11 PTSD-associated CpGs and leverages data from postmortem brain samples, GWAS, and genome-wide expression data to interpret the biology underlying these associations and prioritize genes whose regulation differs in those with PTSD.

S. Katrinli, A. H. Wani, A. X. Maihofer, A. Ratanatharathorn, N. P. Daskalakis, J. Montalvo-Ortiz, D. L. Núñez-Ríos, A. S. Zannas, X. Zhao, A. E. Aiello, A. E. Ashley-Koch, D. Avetyan, D. G. Baker, J. C. Beckham, M. P. Boks, L. A. Brick, E. Bromet, F. A. Champagne, C.-Y. Chen, S. Dalvie, M. F. Dennis, S. Fatumo, C. Fortier, S. Galea, M. E. Garrett, E. Geuze, G. Grant, M. A. Hauser, J. P. Hayes, S. M. J. Hemmings, B. R. Huber, A. Jajoo, S. Jansen, R. C. Kessler, N. A. Kimbrel, A. P. King, J. E. Kleinman, N. Koen, K. C. Koenen, P.-F. Kuan, I. Liberzon, S. D. Linnstaedt, A. Lori, B. J. Luft, J. J. Luykx, C. E. Marx, S. A. McLean, D. Mehta, W. Milberg, M. W. Miller, M. S. Mufford, C. Musanabaganwa, J. Mutabaruka, L. Mutesa, C. B. Nemeroff, N. R. Nugent, H. K. Orcutt, X.-J. Qin, S. A. M. Rauch, K. J. Ressler, V. B. Risbrough, E. Rutembesa, B. P. F. Rutten, S. Seedat, D. J. Stein, M. B. Stein, S. Toikumo, R. J. Ursano, A. Uwineza, M. H. Verfaellie, E. Vermetten, C. H. Vinkers, E. B. Ware, D. E. Wildman, E. J. Wolf, R. M. Young, Y. Zhao, L. L. Van Den Heuvel, R. S. Alisch, A. B. Amstadter, D. Armstrong, A. Basu, N. L. Bjorklund, B. H. Chaiyachati, J. B. M. Ensink, L. L. Fleming, J. Gelernter, R. J. Herringa, S. Jain, D. L. Juvinao-Quintero, E. Ketema, J. J. Martínez-Magaña, B. Misganaw, S. T. Nagamatsu, D. M. Nispeling, J. Pfeiffer, C. Schmahl, G. Shinozaki, C. Snijders, J. A. Sumner, P. C. Swart, A. Tyrka, M. Van Zuiden, J. S. Womersley, N. A. Youssef, Y. Zheng, Y. Zhu, L. Zillich, D. Arasappan, S. Berretta, R. A. Bharadwaj, L. Collado-Torres, C. Chatzinakos, C. P. Dipietro, D. M. Duong, A. Deep-Soboslay, N. Eagles, L. Huuki, T. Hyde, A. Iatrou, G. Pertea, D. Ross, N. T. Seyfried, J. H. Shin, V. E. Alvarez, D. Benedek, A. Che, D. A. Cruz, D. A. Davis, M. J. Girgenti, E. Hoffman, P. E. Holtzheimer, A. Kaye, J. H. Krystal, A. T. Labadorf, T. M. Keane, A. McKee, B. Marx, C. Noller, M. Pierce, W. K. Scott, P. Schnurr, K. Disano, T. Stein, D. E. Williamson, K. A. Young, M. Uddin, C. M. Nievergelt, A. K. Smith and M. W. Logue

Effects of daily posttraumatic stress disorder symptoms on heart rate variability

Slavish DC, Ruggero CJ, Schuler K, et al.

2024

World Trade Center Health Program best practices for the diagnosis and treatment of fibrosing interstitial lung diseases

de la Hoz RE and Johannson KA

2023

Association of World Trade Center (WTC) occupational exposure intensity with chronic obstructive pulmonary disease (COPD) and asthma COPD overlap (ACO)

de la Hoz RE, Shapiro M, Nolan A, et al.

2023

Association of rheumatoid arthritis with opioid pain medication overuse among persons exposed to the 9/11 World Trade Center disaster

Dhanya AS, Yung J, Cone JE, et al.

2023

Prevalence of and risk factors for hepatitis c virus infection in World Trade Center responders

Factor SH, Desai V, Crane MA, et al.

2023

Association of lung function decline with all-cause and cancer-cause mortality after World Trade Center dust exposure

Goldfarb DG, Hall CB, Choi J, et al.

2023

RATIONALE: In numerous cohorts, lung function decline is associated with all-cause and cardiovascular-cause mortality but the association between forced expiratory volume in one second (FEV1) decline and cancer-cause mortality, particularly after occupational/environmental exposure(s), is unclear. Exposure to dust/smoke from the World Trade Center (WTC) disaster caused inflammation and lung injury in Fire Department of the City of New York (FDNY) rescue/recovery workers. In addition, prior research found that over 10% of the cohort experienced greater than twice the age-related decline in FEV1 (≥64 mL/year). OBJECTIVE: To evaluate the association of longitudinal lung function with all-cause and cancer-cause mortality after exposure to the WTC disaster. METHODS: We conducted a prospective cohort study using longitudinal pre-bronchodilator FEV1 data for 12,264 WTC-exposed FDNY firefighters and emergency medical service (EMS) providers. All-cause and cancer-cause mortality were ascertained using National Death Index data from 9/12/2001-12/31/2021. Joint longitudinal survival models evaluated the association of baseline FEV1 and change in FEV1 from baseline with all-cause and cancer-cause mortality adjusted for age, race/ethnicity, height, smoking, work assignment (firefighter vs. EMS providers) and WTC exposure. RESULTS: By 12/31/2021, 607/12,264 (4.9%) of the cohort had died (crude rate=259.5/100,000 person-years) and 190/12,264 (1.5%) had died from cancer (crude rate=81.2/100,000 person-years). Baseline FEV1 was ≥80% predicted in 10,970/12,264 (89.4%); final FEV1 was ≥80% in 9,996 (81.5%). Lower FEV1 at baseline was associated with greater risk for all-cause mortality (hazard ratio [HR] per liter=2.32; 95% CI=1.98-2.72) and cancer-cause mortality (HR per liter=1.99; 95% CI=1.49-2.66). Longitudinally, each 100 mL/year decline in FEV1 was associated with an 11% increase in all-cause mortality (HR=1.11; 95% CI=1.06-1.15) and a 7% increase in cancer-cause mortality (HR=1.07; 95% CI=1.00-1.15). Compared with FEV1 decline <64 mL/year, those with FEV1 decline ≥64 mL/year had higher all-cause (HR=2.91; 95% CI=2.37-3.56) and cancer-cause mortality (HR=2.68; 95% CI=1.90-3.79). CONCLUSIONS: Baseline FEV1 and longitudinal FEV1 decline are associated with increased risk of all-cause and cancer-cause mortality in a previously healthy occupational cohort, the majority of whom had normal lung function, after intense exposure to dust/smoke. Further investigation is needed to define pathways by which lung function impacts mortality after an irritant exposure.

Cancer incidence in World Trade Center rescue and recovery workers by race and ethnicity

Khalifeh M, Goldfarb DG, Zeig-Owens R, et al.

2023

Perceived social support moderates the relation between forward-focused coping and PTSD symptoms in World Trade Center trauma survivors

Kowalchyk M, Chernoff E, Brinkman HR, et al.

2023

Trace and major element concentrations in cadaveric lung tissues from World Trade Center Health Registry decedents and community controls

Marmor M, Burcham JL, Chen L-C, et al.

2023

Studies of the health impacts of the 11 September 2001 terrorist attacks on New York City’s(NYC’s) World Trade Center (WTC) towers have been hindered by imprecise estimates of exposure.We sought to identify potential biomarkers of WTC exposure by measuring trace and major metal concentrations in lung tissues from WTC-exposed individuals and less exposed community controls. We also investigated associations of lung tissue metal concentrations with self-reported exposureand respiratory symptoms. The primary analyses contrasted post-mortem lung tissue concentrationsobtained from autopsies in 2007–2011 of 76 WTC Health Registry (WTCHR) enrollees with those of55 community controls. Community controls were frequency-matched to WTCHR decedents by ageat death, calendar quarter of death, gender, race, ethnicity and education and resided at death in NYC zip codes less impacted by WTC dust and fumes. We found WTCHR decedents to have significantlyhigher iron (Fe) lung tissue concentrations than community controls. Secondary analyses among WTCHR decedents adjusted for sex and age showed the log (molybdenum (Mo)) concentration to be significantly associated with non-rescue/recovery exposure. Post hoc analyses suggested thatindividuals whose death certificates listed usual occupation or industry as the Sanitation or PoliceDepartments had elevated lung tissue Fe concentrations. Among WTCHR decedents, exposureto the WTC dust cloud was significantly associated with elevated lung tissue concentrations of titanium (Ti), chromium (Cr) and cadmium (Cd) in non-parametric univariable analyses but not inmultivariable analyses adjusted for age and smoking status. Logistic regression adjusted for age andsmoking status among WTCHR decedents showed one or more respiratory symptoms to be positivelyassociated with log (arsenic (As)), log(manganese (Mn)) and log(cobalt (Co)) concentrations, whilenew-onset wheezing and sinus problems were negatively associated with log(Fe) concentration.Fe concentrations among individuals with wheezing, nonetheless, exceeded those in communitycontrols. In conclusion, these data suggest that further research may be warranted to explore the utility as biomarkers of WTC exposure of Fe in particular and, to a lesser extent, Mo, Ti, Cr and Cd indigestions of lung tissue

Occupational etiology of oropharyngeal cancer: A literature review

Nikkila R, Tolonen S, Salo T, et al.

2023

Functional neuroimaging of resilience to trauma: Convergent evidence and challenges for future research

Norbury A, Seeley SH, Perez-Rodriguez MM, et al.

2023

Tobacco and illicit drug use and drug use disorders among employees of businesses affected by the 9/11 attacks on the World Trade Center in New York City post-9/11 tobacco use and drug use/disorders

North CS and Pfefferbaum B

2023

Objective: To study the New York City area population after the September 11, 2001, 9/11 attacks, focusing on tobacco and drug use and drug use disorders. An abundance of research has identified the important mental health sequelae stemming from exposure to disasters, especially vulnerability to the development of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). There also is a body of literature on the association of disaster exposure with alcohol use/misuse, but far less research on tobacco and other drug use/disorders. Methods: A terrorism-affected sample (N = 379) was assessed nearly 3 years after the attacks using structured diagnostic interviews, providing predisaster and postdisaster prevalence and incidence of tobacco and drug use, changes in tobacco and drug use, and predisaster and postdisaster prevalence and incidence of drug use disorders in relation to the 9/11 attacks. DSM-IV criteria were fully assessed using structured diagnostic interviews for psychiatric disorders including PTSD, MDD, panic disorder, generalized anxiety disorder, and alcohol and drug use disorders. Results: Tobacco use did not increase significantly, and no predictors of increased tobacco use could be found for any subgroups, including disaster trauma exposures. Drug use (largely cannabis) increased initially but decreased by 3 years after the attacks. Drug use disorders, which were associated with other psychiatric disorders, were rare and primarily began prior to 9/11. Conclusions: The overall lack of increase of tobacco use or predictors of increased use found after the disaster and the low rates of new drug use disorders suggest that universal screening for increased tobacco use and new drug use disorders by clinicians may have very low yield. Regardless, postdisaster settings provide suitable circumstances for general discussions about self-care including concern for increased tobacco use, avoiding drug use, and guidance on healthier means of managing stress than through substances. Additionally, because existing tobacco and drug use are endemic in populations, the postdisaster setting can serve as a reminder for clinicians to assess these problems generally and provide appropriate referrals when needed. Postdisaster circumstances offer opportunities to disseminate and promote public health messages and address issues of substance use and misuse.

TERT and BRAF V600E mutations in thyroid cancer of World Trade Center responders

van Gerwen M, Cerutti JM, Mendes TB, et al.

2023

Polygenic risk scores for asthma and allergic disease associate with COVID-19 severity in 9/11 responders

Waszczuk MA, Morozova O, Lhuillier E, et al.

2023

The vocal dialogue in 9/11 pregnant widows and their infants: Specificities of co-regulation

Beebe B, Crown CL, Jasnow M, et al.

2022

Thyroid cancer diagnostics related to occupational and environmental risk factors: An integrated risk assessment approach

Berinde GM, Socaciu AI, Socaciu MA, et al

2022

Risk factors for COVID-19 in a retired FDNY WTC-exposed cohort

Cleven KL, Zeig-Owens R, Goldfarb DG, et al.

2022

World Trade Center Health Program best practices for diagnosing and treating chronic obstructive pulmonary disease

Cone JE and de la Hoz RE

2022

Change in asthma is associated with change in PTSD in World Trade Center health registrants, 2011 to 2016

Friedman SM, Alper H, de la Hoz RE, et al

2022

Molecular clustering analysis of blood biomarkers in World Trade Center exposed community members with persistent lower respiratory symptoms

Grunig G, Durmus N, Zhang Y, et al

2022

The destruction of the World Trade Center (WTC) on September 11, 2001 (9/11) released large amounts of toxic dusts and fumes into the air that exposed many community members who lived and/or worked in the local area. Many community members, defined as WTC survivors by the federal government, developed lower respiratory symptoms (LRS). We previously reported the persistence of these symptoms in patients with normal spirometry despite treatment with inhaled corticosteroids and/or long-acting bronchodilators. This report expands upon our study of this group with the goal to identify molecular markers associated with exposure and heterogeneity in WTC survivors with LRS using a selected plasma biomarker approach. Samples from WTC survivors with LRS (n = 73, WTCS) and samples from healthy control participants of the NYU Bellevue Asthma Registry (NYUBAR, n = 55) were compared. WTCS provided information regarding WTC dust exposure intensity. Hierarchical clustering of the linear biomarker data identified two clusters within WTCS and two clusters within NYUBAR controls. Comparison of the WTCS clusters showed that one cluster had significantly increased levels of circulating matrix metalloproteinases (MMP1, 2, 3, 8, 12, 13), soluble inflammatory receptors (receptor for advanced glycation end-products-RAGE, Interleukin-1 receptor antagonist (IL-1RA), suppression of tumorigenicity (ST)2, triggering receptor expressed on myeloid cells (TREM)1, IL-6Ra, tumor necrosis factor (TNF)RI, TNFRII), and chemokines (IL-8, CC chemokine ligand- CCL17). Furthermore, this WTCS cluster was associated with WTC exposure variables, ash at work, and the participant category workers; but not with the exposure variable WTC dust cloud at 9/11. A comparison of WTC exposure categorial variables identified that chemokines (CCL17, CCL11), circulating receptors (RAGE, TREM1), MMPs (MMP3, MMP12), and vascular markers (Angiogenin, vascular cell adhesion molecule-VCAM1) significantly increased in the more exposed groups. Circulating biomarkers of remodeling and inflammation identified clusters within WTCS and were associated with WTC exposure.

Employee job satisfaction and performance in association with workplace responses to the 9/11 attacks on New York City's World Trade Center

Miu AS, Davis A, Raitt J, et al

2022

Posttraumatic stress disorder and functional impairment among World Trade Center Health Registry enrollees 14-15 years after the September 11, 2001, terrorist attacks

Trivedi NU, Gargano LM, Brackbill RM, et al.

2022

Covid-19-specific mortality among World Trade Center Health Registry enrollees who resided in New York City

Yung J, Li J, Kehm RD, et al.

2022

Close observation of mother-infant interactive process in the wake of traumatic loss: The September 11, 2001 primary prevention project

Beebe B, Sossin KM, Cohen P, et al

2021

Applications of peer support in disasters: Connecting in times of disaster

Castellano C

2021

Disasters invariably result in a surge in demand for mental health services, and this surge quickly exceeds available mental health resources. The pursuit of alternative sources of psychological support for communities adversely affected by disasters has therefore been necessitated. This paper describes the application of an awarding-winner, empirically validated, model for psychological support and its applicability for enhancing community disaster mental health resources that are consistent with United Nations' recommendations for a "whole society" approach to disaster mental health. The model utilises the concept of peer-based psychological support. Peer psychological support is defined as the utilisation of individuals specially trained in the provision of acute psychological crisis interventions and psychological first aid, but who do not possess professional-level training or licensure in one of the mental health disciplines. These peer-based crisis intervention services may be delivered telephonically, via the internet, or face-to-face. This model, referred to as Reciprocal Peer Support (RPS), is the peer support activity provided at Rutgers University Behavioural HealthCare (UBHC) National Center for Peer Support in a variety of peer programs. More than 20 years of peer support interventions have been reviewed and assessed to clarify the lessons learned for the application of RPS as a prime exemplar for the utilization of peer support during and after a disaster. The Cop 2 Cop, NJ Vet 2 Vet, and several other UBHC peer support programs, which conform to best practices criteria, have been created, sustained, and expanded based on the RSP principles discussed in this article. RPS and derivative applications for human-made disasters such as the terrorist events of 9/11/2001 as well as natural disasters such as Hurricane Katrina or the COVID- 19 pandemic represent platforms for the implementation of peer psychological support and the establishment of a peer-based continuum of psychological connection.

The health of firefighters deployed to the Fort Mcmurray fire: Lessons learnt

Cherry N, Beach J, and Galarneau JM

2021

Introduction: Firefighters were working in exceptionally difficult conditions during the Fort McMurray/Horse River fire in May 2016. Methods: From mid-May, we recruited firefighters from 13 fire services as they returned from the fire. In October 2016 we extended recruitment to all Alberta-based firefighters deployed to the fire. In December 2017–May 2018 we sent a first online follow-up: this concentrated on mental health supports. The second follow-up, in October 2018–January 2019, included screening scales for respiratory ill-health and PTSD. All three contacts included visual analogue scales for chest symptoms and the Hospital Anxiety and Depression Scale. We estimated exposure to PM2.5, and calculated an exposure mitigation index from reports of respiratory protective equipment (RPE). Results: We recruited 1,234 firefighters and examined the relation of respiratory symptoms to estimated particulate exposure. The relation was strong immediately post fire but weakened over time. We found less chest tightness and cough in those whose RPE in the first week mitigated exposure by at least 10%. We examined the relation between particulate exposure and mental ill-health from screening questionnaires and found those with high exposure (reflecting the ferocity of the fire) had poorer mental health scores. Firefighters reporting their “worst moment during the fire” was life threatening were more anxious at second follow-up. Overall both anxiety and depression scores increased at successive contacts, more so in those with mental ill-health recorded in physician billing records before the fire. Discussion: The results from this study overall suggest on-going fire-related health effects in a substantial minority of firefighters, similar to those reported in the longitudinal follow-up of firefighters after the collapse of the World Trade Centre. Self-reports of both respiratory symptoms and mental ill-health were strongly related, soon after the fire, to estimated particulate exposures. Anxiety increased over time since the fire in those who felt their life or safety had been threatened, underlining the need for ongoing support. Our conclusions about the benefits of rapid research relate particularly to the collection of biomarkers of exposure as quickly and widely as possible, and the establishment of a nominal list of participants before they are too widely dispersed.

What causes prostate cancer-learning from a tragedy

Chiao JW

2021

Incidence of head and neck cancers before and after 9/11 in New York City and New York state

Machado R, Tham T, Zhu D, et al

2021

INTRODUCTION: The incidence of cancers in New York State (NYS) before and after 9/11 including lung, colorectal, and renal cancers has been previously described. To date, the incidence of head and neck cancers (HNCs) before and after 9/11 has not been described. METHODS: Cancers involving the oral cavity and oropharynx; the nose, nasal cavity, nasopharynx, and middle ear; larynx; and thyroid were identified using the New York State Cancer Registry (NYSCR). Age-adjusted incidence and rates per 100,000 residents from 1987 to 2015 were analyzed using joinpoint regression. Trends in incidence using annual percent changes are presented. RESULTS: The overall rate of HNC increased slightly by 0.7% (p < 0.001) from 1987 to 2003 in NYS. From 2003 to 2008, the rate increased by 5.73% (p < 0.001), and from 2008 to 2015, the rate increased by 1.68% (p < 0.001). The rate of thyroid cancer increased by 6.79% (p < 0.001) from 1987 to 2003, by 9.99% (p < 0.001) from 2003 to 2009, and by 2.41% (p = 0.001) from 2009 to 2015. The rate of thyroid cancer was higher in women at all time points. In a subset analysis of HNCs excluding thyroid cancer, the rate decreased by 2.02% (p < 0.001) from 1991 to 2001, followed by a nonsignificant increase of 0.1% (p = 0.515) from 2001 to 2015. The rate of oropharyngeal (OP) cancer significantly increased from 1999 to 2015 (2.65%; p < 0.001). The rate of oral cavity cancer significantly decreased from 1987 to 2003 (1.97%; p < 0.001), with no significant change after 2003. The rate of laryngeal cancer decreased significantly by 2.43% (p < 0.001) from 1987 to 2015, as did the rate of nasal cavity/nasopharyngeal cancer (0.33%; p = 0.03). CONCLUSIONS: In NYS, OP cancer and thyroid cancer rates increased significantly during the study period. The rate of thyroid cancer was higher in women. The rate of combined HNC increased significantly after 9/11 compared to before 9/11; however, in a subset analysis of all HNC patients excluding thyroid cancer, the rate decreased significantly prior to 9/11 and then nonsignificantly increased afterward. This suggests that the increase in thyroid cancer accounts for the increase in combined HNC in NYS. The impact of 9/11 on rates of HNC requires further research.

The symptom structure of postdisaster major depression: Convergence of evidence from 11 disaster studies using consistent methods

North CS and Baron D

2021

Associations between news media coverage of the 11 September attacks and depression in employees of New York City area businesses

Pfefferbaum B, Palka JM, and North CS

2021

The September 11, 2001, terrorist attacks from a dermatology perspective: A remembrance

Zaidi AJ, Mahmoud A, Hassan S, et al

2021

Allergy and lung injury among rescue workers exposed to the World Trade Center disaster assessed 17 years after exposure to ground zero

Caruana DL, Huang PH, Li JC, et al

2020

Human remains identification, grief, and posttraumatic stress in bereaved family members 14 years after the September 11, 2001, terrorist attacks

Cozza SJ, Fisher JE, Hefner KR, et al

2020

Understanding and improving patient access to the never forget the heroes: James zadroga, ray pfeifer, and luis alvarez permanent authorization of the September 11th victim compensation fund act

McGibbon MF and Maccaro CM

2020

Impact of acute exposure to WTC dust on ciliated and goblet cells in lungs of rats

Cohen MD, Vaughan JM, Garrett B, et al

2015

Clinical studies and the World Trade Center (WTC) Health Registry have revealed increases in the incidence of chronic (non-cancer) lung disorders among first responders (FR) who were at Ground Zero during the initial 72 h after the collapse. Our previous analyses of rats exposed to building-derived WTC dusts using exposure scenarios/levels that mimicked FR mouth-breathing showed that a single WTC dust exposure led to changes in expression of genes whose products could be involved in the lung ailments, but few other significant pathologies. We concluded that rather than acting as direct inducers of many of the FR health effects, it was more likely inhaled WTC dusts instead may have impacted on toxicities induced by other rescue-related co-pollutants present in Ground Zero air. To allow for such effects to occur, we hypothesized that the alkaline WTC dusts induced damage to the normal ability of the lungs to clear inhaled particles. To validate this, rats were exposed on two consecutive days (2 h/d, by intratracheal inhalation) to WTC dust (collected 12-13 September 2001) and examined over a 1-yr period thereafter for changes in the presence of ciliated cells in the airways and hyperplastic goblet cells in the lungs. WTC dust levels in the lungs were assessed in parallel to verify that any changes in levels of these cells corresponded with decreases in host ability to clear the particles themselves. Image analyses of the rat lungs revealed a significant decrease in ciliated cells and increase in hyperplastic goblet cells due to the single series of WTC dust exposures. The study also showed there was only a nominal non-significant decrease (6-11%) in WTC dust burden over a 1-yr period after the final exposure. These results provide support for our current hypothesis that exposure to WTC dusts caused changes in airway morphology/cell composition; such changes could, in turn, have led to potential alterations in the clearance/toxicities of other pollutants inhaled at Ground Zero in the critical initial 72-h period.

A Deese-Roediger-Mcdermott study of trauma memory among employees of New York City companies affected by the September 11, 2001, attacks

Triantafyllou D, North CS, Zartman A, et al

2015

Differences in mental health outcomes by acculturation status following a major urban disaster

Adams RE and Boscarino JA

2013

Does a one-day educational training session influence primary care pediatricians' mental health practice procedures in response to a community disaster? Results from the reaching children initiative (rci)

Adams RE, Laraque D, Chemtob CM, et al

2013

Stress-related changes in toddlers and their mothers following the attack of September 11

Conway A, McDonough SC, MacKenzie MJ, et al

2013

Mental health approaches to child victims of acts of terrorism

Saraiya A, Garakani A, and Billick SB

2013

The psychological adjustment of a sample of New York City preschool children 8–10 months after September 11, 2001

Saigh PA, Yasik AE, Mitchell P, et al

2011

Transforming trauma and empowering children and adolescents in the aftermath of disaster through group work

Malekoff A

2008

Parents, children, and trauma: Parent role perceptions and behaviors related to the 9/11 tragedy

Mowder BA, Guttman M, Rubinson F, et al

2006

Terrorism and cardiovascular responses to acute stress in children

Gump BB, Reihman J, Stewart P, et al

2005

The emotional and behavioral impact of terrorism on children: Results from a national survey

Stein BD, Jaycox LH, Elliott MN, et al

2004

The public costs of mental health response: Lessons from the New York City post-9/11 needs assessment

Jack K and Glied S

2002

Telemedicine trends and lessons learned during the COVID-19 pandemic—World Trade Center Health Program, 2020–2021

Azofeifa A, Liu R, Dupont H, and Reissman DB

2024

The association between socioeconomic status and race/ethnicity with home evacuation of lower Manhattan residents following the 9/11/2001 World Trade Center disaster

Cone JE, Millien L, Pollari C, et al.

2024

Characteristics of survivors enrolled in the World Trade Center Health Program

Liu R, Santiago-Colón A, Butturini E, et al.

2024

Left nucleus accumbens response to anticipatory reward differentiates highly resilient World Trade Center responders

Seeley S, Schreiber Z, Block A, et al.

2024

A pilot study to identify factors associated with frailty within the World Trade Center general responder cohort

Thompson HM, Thanik E, Sabra A, et al.

2024

Quantitative CT marker of distal airway inflammation is correlated with marker of proximal airway dysfunction in WTC workers with low FVC

Weber J, San José Estépar R, Reeves A, et al.

2024

Environmental causes of idiopathic pulmonary fibrosis

Gandhi S, Tonelli R, Murray M, et al.

2023

Terrorism & health

Garfin DR, Attick E, and Holman EA

2023

Longitudinal associations between PTSD and sleep disturbances among World Trade Center responders

Slavish DC, Ruggero CJ, Briggs M, et al.

2023

Victim identification and body completeness based on last known location at the World Trade Center

Adams B, Warnke-Sommer J, Odien J, et al.

2022

Cognitive impact of exposure to airborne particles captured by brain imaging

Azmoun S, Diaz J, Tang CY, et al

2022

Terrorism & health

Garfin DR, Attick E, and Holman EA

2022

Occupational interstitial lung disease

Gulati M and Maier LA

2022

Longitudinal trajectories of PTSD symptoms predict levels of posttraumatic growth in World Trade Center responders

Kautz MM, Collins A, Schechter CB, et al.

2022

First responders and mental health

Ryan M, Hasan F, Molina L, et al

2022

Environmental health in Ukraine: Lessons from 9/11

Speiser E and Nazarenko Y

2022

Investigating the impact of terrorist attacks on the mental health of emergency responders: Systematic review

Wesemann U, Applewhite B, and Himmerich H

2022

Associations of embeddedness and posttraumatic stress disorder among 9/11 survivors

Hamwey MK, Pollari CD, Osahan S, et al.

2021

Affective heritage and the politics of memory after 9/11

Micieli-Voutsinas J

2021

Outcomes and correlates of major depression in 11 disaster studies using consistent methods

North CS and Baron D

2021

The mental health of children and adolescents exposed to 9/11: Lessons learned and still to be learned

Greene T, Gross R, Amsel L, et al

2018

A longitudinal study of traumatic play activity using the children’s developmental play instrument (cdpi)

Chazan S, Kuchirko Y, Beebe B, et al.

2016

Terrorism & health

Garfin DR and Holman EA

2016

Neurodevelopment of children assessed after prenatal exposure to polybrominated diethyl ethers from collapse of World Trade Center

Poon S and Koren G

2013

The World Trade Center health surveillance program: Results of the first 10 years and implications for prevention

Lucchini RG, Crane MA, Crowley L, et al

2012

BACKGROUND: The terrorist attacks on the World Trade Center (WTC) of September 11, 2001 resulted in the deaths of 2,823 persons. They also generated a long-lasting burden of multiple physical and mental health illnesses among the cohort of 50,000 rescue workers who responded to the attacks and in the 400,000 residents and workers in nearby areas of New York City. A comprehensive health surveillance program was developed from the first months after the accidents and was further developed in the subsequent ears. Individual exposure and health data were stored in ad hoc databases and produced epidemiological outcomes on the various exposure-related illnesses. METHODS: About 10 years of longitudinal assessment of this large cohort of WTC rescue and recovery workers, yielded data from participants in the WTC Screening, Monitoring, and Treatment Program. Police officers, firefighters, construction workers, and municipal workers were included in the cohort. Cumulative and annual incidence were estimated for various physical disorders including asthma, sinusitis, and gastroesophageal reflux disease, mental health disorders including depression, post-traumatic stress disorder [PTSD], and panic disorder. Respiratory functionality was also assessed. Exposure was characterized with qualitative parameter including working on the pile and being engulfed in the dust cloud, and quantitative parameters including the time of arrival on site and the exposure duration. RESULTS: Upper and lower respiratory conditions such as rhinosinusitis and asthma have been found in a significant number of people in WTC-exposed populations. A lack of appropriate respiratory protection may have contributed to these effects. Other commonly observed physical health conditions include gastro-esophageal reflux disease, obstructive sleep apnea and musculo-skeletal injuries. Many WTC-exposed individuals also suffer from mental health conditions, primarily post-traumatic stress disorder, depression, panic disorder, and substantial stress reaction. Recent studies suggest that WTC exposure may increase the risk of cancer and of mortality from cardiac disease. CONCLUSION: Ten years of systematic health surveillance after the 9/11 WTC attacks, show long lasting burden of physical and mental health problems. Continued monitoring and treatment of this population is needed for early diagnoses of initial clinical conditions that can be treated more effectively. The experience of September 11 offers also indications on how to approach the acute and delayed health effects of civilian catastrophes. Critical lessons are derived about the importance of having trained responders--medical and non-medical--in place in advance of disasters, and about the need to proceed with adequate exposure assessment in a timely manner.

Trauma exposure and posttraumatic stress disorder among employees of New York City companies affected by the September 11, 2001 attacks on the World Trade Center

North CS, Pollio DE, Smith RP, et al

2011

OBJECTIVE: Several studies have provided prevalence estimates of posttraumatic stress disorder (PTSD) related to the September 11, 2001 (9/11) attacks in broadly affected populations, although without sufficiently addressing qualifying exposures required for assessing PTSD and estimating its prevalence. A premise that people throughout the New York City area were exposed to the attacks on the World Trade Center (WTC) towers and are thus at risk for developing PTSD has important implications for both prevalence estimates and service provision. This premise has not, however, been tested with respect to DSM-IV-TR criteria for PTSD. This study examined associations between geographic distance from the 9/11 attacks on the WTC and reported 9/11 trauma exposures, and the role of specific trauma exposures in the development of PTSD. METHODS: Approximately 3 years after the attacks, 379 surviving employees (102 with direct exposures, including 65 in the towers, and 277 with varied exposures) recruited from 8 affected organizations were interviewed using the Diagnostic Interview Schedule/Disaster Supplement and reassessed at 6 years. The estimated closest geographic distance from the WTC towers during the attacks and specific disaster exposures were compared with the development of 9/11-related PTSD as defined by the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. RESULTS: The direct exposure zone was largely concentrated within a radius of 0.1 mi and completely contained within 0.75 mi of the towers. PTSD symptom criteria at any time after the disaster were met by 35% of people directly exposed to danger, 20% of those exposed only through witnessed experiences, and 35% of those exposed only through a close associate's direct exposure. Outside these exposure groups, few possible sources of exposure were evident among the few who were symptomatic, most of whom had preexisting psychiatric illness. CONCLUSIONS: Exposures deserve careful consideration among widely affected populations after large terrorist attacks when conducting clinical assessments, estimating the magnitude of population PTSD burdens, and projecting needs for specific mental health interventions.

Latina workers at WTC ground zero: A socio-cultural approach to long-term impact of trauma

Weed RMB

2011

Issues: In the days and months following the terrorist attacks on September 11, 2001, between 18,800 and 35,000 people worked or volunteered in recovery efforts which officially ended in July 2002. A majority of cleanup workers were first generation immigrants to the USA. Latina workers constituted a significant number of those who cleaned office buildings, as they took advantage of the opportunity to help and gain income. The long-term exposure to debris, asbestos, and witnessing human terror contributed to their disproportionately suffering from health hazard and post-traumatic stress disorder. Almost 10 years after the events of 2001, medical reports indicate that asthma and other chronic lung conditions remain a significant burden for rescue and recovery workers responding to the attacks on the World Trade Center (The New England Journal of Medicine, 2010). Latina workers suffer long-term effects of occupational hazard such as lung complications, coughs, asthma, and lower airway disease. Psycho-social stressors related to fear of deportation and to PTSD are prevalent in Latinas who worked in ground zero. Often in caretaker role, they worked harder when spouses were ill. Single parent Latina households had children who witnessed their mother asking for help and being denied, missed school due to loss of home, and developed their own trauma and instability. These factors contribute to social isolation, depressive symptoms, and risk of intimate partner violence. Description: A socio-culturally integrative approach evolved working with Latinas in Queens, New York. Services are in Spanish, integrating culturally congruent values to process healing and restoration of hope and human dignity. The approach addresses the trauma of migratory experience and validates their story which many Latina workers believe were "forgotten" or "invisible." In a safe setting, clients learn to release body tension through relaxation. Lessons learned: Cultural integration in clinical practice enhances the client's ability to understand impact of trauma on herself and family. Latina clients bring in neighbors and friends to counseling session to bear witness to client experience, give meaning to their lives, and decrease isolation. Overseas dialogs are established to share with families the work limitations, thereby reduce the pressure, secrecy, and shame of the inability to send money to host countries. Recommendations: Further research is needed to address this vulnerable population and service advocacy in terms of health care and compensation.

New York City social workers after 9/11: Their attachment, resiliency, and compassion fatigue

Tosone C, Bettmann JE, Minami T, et al

2010

Toward assessing traumatic events and stress symptoms in preschool children from low-income families

Graham-Bermann SA, Howell K, Habarth J, et al

2008

Cumulative trauma and posttraumatic stress disorder among children exposed to the 9/11 World Trade Center attack

Mullett-Hume E, Anshel D, Guevara V, et al

2008

Social work field instructors in New York City after 9/11/01: Impact and needs resulting from the World Trade Center disaster

Matthieu MM, Ivanoff A, Lewis S, et al

2007

Reach out and have some fun

King C

2006

Lower birth weight of dutch neonates who were in utero at the time of the 9/11 attacks

Smits L, Krabbendam L, de Bie R, et al

2006

The 9/11 experience: Who's listening to the children?

Koplewicz HS, Cloitre M, Reyes K, et al

2004

Tracking levels of psychiatric distress associated with the terrorist events of September 11, 2001: A review of the literature

Lovejoy DW, Diefenbach GJ, Licht DJ, et al

2003

Children's response to terrorism: A critical review of the literature

Pfefferbaum B, Pfefferbaum RL, Gurwitch RH, et al

2003

Utilization of mental health services following the September 11th terrorist attacks in Manhattan, New York City

Boscarino JA, Galea S, Ahern J, et al

2002

Adolescent grief: "It never really hit me...Until it actually happened"

Christ GH, Siegel K, and Christ AE

2002

Prevalence of mild and severe cognitive impairment in World Trade Center exposed Fire Department of the City of New York (FDNY) and general emergency responders

Mann FD, Mueller AK, Zeig-Owens R, et al.

2025

BACKGROUND: The emergency personnel who responded to the World Trade Center (WTC) attacks endured severe occupational exposures, yet the prevalence of cognitive impairment remains unknown among WTC-exposed-FDNY-responders. The present study screened for mild and severe cognitive impairment in WTC-exposed FDNY responders using objective tests, compared prevalence rates to a cohort of non-FDNY WTC-exposed responders, and descriptively to meta-analytic estimates of MCI from global, community, and clinical populations. METHODS: A sample of WTC-exposed-FDNY responders (n = 343) was recruited to complete an extensive battery of cognitive, psychological, and physical tests. The prevalences of domain-specific impairments were estimated based on the results of norm-referenced tests, and the Montreal Cognitive Assessment (MoCA), Jak/Bondi criteria, Petersen criteria, and the National Institute on Aging and Alzheimer's Association (NIA-AA) criteria were used to diagnose MCI. NIA-AA criteria were also used to diagnose severe cognitive impairment. Generalized linear models were used to compare prevalence estimates of cognitive impairment to a large sample of WTC-exposed-non-FDNY responders from the General Responder Cohort (GRC; n = 7102) who completed the MoCA during a similar time frame. RESULT: Among FDNY responders under 65 years, the unadjusted prevalence of MCI varied from 52.57% to 71.37% depending on the operational definition of MCI, apart from using a conservative cut-off applied to MoCA total scores (18 < MoCA < 23), which yielded a markedly lower crude prevalence (24.31%) compared to alternative criteria. The prevalence of MCI was higher among WTC-exposed-FDNY-responders, compared to WTC-exposed-non-FDNY-GRC-responders (adjusted RR = 1.53, 95% C.I . = [1.24, 1.88], p < .001) and meta-analytic estimates from different global, community, and clinical populations. Following NIA-AA diagnostic guidelines, 4.96% of WTC-exposed-FDNY-responders met the criteria for severe impairments (95% CI = [2.91% to 7.82%]), a prevalence that remained largely unchanged after excluding responders over the age of 65 years. DISCUSSION: There is a high prevalence of mild and severe cognitive impairment among WTC-responders highlighting the putative role of occupational/environmental and disaster-related exposures in the etiology of accelerated cognitive decline.

Mortality in a cohort of WTC-exposed law-enforcement officers compared to non-WTC law-enforcement officers

Singh A, Khalifeh M, Violanti J, et al.

2025

Self-reported chronic rhinosinusitis diagnoses and symptoms in World Trade Center-exposed and non-World Trade Center-exposed United States firefighters

Singh A, Zeig-Owens R, Webber MP, et al.

2025

BACKGROUND: Greater World Trade Center (WTC) exposure levels have been associated with chronic rhinosinusitis (CRS) diagnoses and symptoms. We aimed to determine whether self-reported CRS is elevated in WTC-exposed Fire Department of the City of New York (FDNY) firefighters when compared with non-WTC-exposed/non-FDNY firefighters and with the general population. METHODS: The study included male WTC-exposed (N = 7840) and non-WTC-exposed (N = 2771) firefighters who were employed on 9/11/2001 and later completed a health survey. Self-reported CRS diagnoses and symptoms were evaluated. Multivariable logistic regression analyses estimated the odds of self-reported ever CRS diagnosis and current symptoms in WTC-exposed vs. non-WTC-exposed firefighters. Additional analyses compared self-reported current CRS diagnoses in firefighters vs. American males. Models were adjusted for demographics, smoking, and BMI. RESULTS: Fifty-one percent of WTC-exposed firefighters reported ever having a CRS diagnosis vs. 20 % of non-WTC-exposed firefighters (adjusted-OR = 3.84, 95 %CI = 3.44-4.28). WTC-exposure was also associated with specific rhinosinusitis symptoms, including nasal/sinus congestion (adjusted-OR = 1.17, 95 %CI = 1.06-1.29), nose irritation (adjusted-OR = 1.48, 95 %CI = 1.24-1.76), and sinus pain/pressure (adjusted-OR = 1.42, 95 %CI = 1.26-1.60). Both WTC-exposed (adjusted-OR = 3.84, 95 %CI = 3.46-4.27) and non-WTC-exposed firefighters (adjusted-OR = 1.97, 95 %CI = 1.71-2.27) were more likely to report a current CRS diagnosis than similar adult males. CONCLUSIONS: WTC-exposure was associated with self-reported CRS diagnoses and symptoms in firefighters. Higher CRS diagnosis prevalence in the WTC-exposed cohort could be a result of exposure to irritants present at the WTC site, and may also be explained, in part, by the enhanced surveillance and healthcare WTC-exposed firefighters receive via the WTC Health Program. Elevated levels of CRS in firefighters overall could be due to routine, non-WTC-related firefighting exposures.

Long-term oral health effects traumatic events amongWorldTradeCenterHealthRegistry enrollees, 2003–2020

Akinkugbe AA, Midya V, Crane MA, et al.

2024

Nasal resistance inflammation: Mechanisms for obstructive sleep apnea from chronic rhinosinusitis

Ayappa I, Laumbach R, Black K, et al.

2024

Rare diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) finding in a 9/11 World Trade Center survivor: A case report

Bellegarde SB, Gibson V, Andaz S, et al.

2024

Chronic acute pain adverse economic outcomes a 9/11-exposed cohort

Brite J, Maqsood J, Yu S, et al.

2024

Cross-sectional association between posttraumatic stress and cognition is moderated by pulmonary functioning in World Trade Center responders

Choi J, Hall CB, Clouston SAP, et al.

2024

Interstitial lung disease and progressive pulmonary fibrosis: A World Trade Center cohort 20-year longitudinal study

Cleven KL, Zeig-Owens R, Mueller AK, et al.

2024

Incidence dementia before age 65 years followingWorldTradeCenter exposure prospective study cognition general responders

Clouston SAP and Team WTCAR

2024

A comparison of two user-friendly methods to identify and support correction of misspelled medications

Dasaro CR, Sabra A, Jeon Y, et al.

2024

Accentuated susceptibility lung lymphocytosis fromWorldTradeCenter(WTC)dust mice targeted deletion vasoactive intestinal peptide(VIP) gene

Favazza NJ, Israel J, McClain S, et al.

2024

RATIONALE: Models of World Trade Center (WTC) dust lung injury have not yet replicated lung fibrosis. Our team has generated lung fibrosis in mice using similar dust samples collected from burn pits in Iraq and Afghanistan. We hypothesized that WTC dust collected and chemically characterized shortly after 9/11/2001 by the late Paul Lioy, PhD, who died of pulmonary fibrosis, may also induce lung fibrosis. Dr. Lioy’s team at Rutgers analyzed WTC samples and confirmed that the dust contains JP-8 jet fuel, polycyclic aromatic hydrocarbons (PAH) and oxidized/burned metals. Dust collected from burn pits in Iraq and Afghanistan contain these toxic substances as well. Currently, there are no FDAapproved treatments which reverse idiopathic pulmonary fibrosis. Therefore, models of lung fibrosis, including WTC dust lung injury, have broader scientific applicability and may be used to test novel therapeutic agents. METHODS: C57BL/6 wild type (WT) and Vasoactive Intestinal Peptide gene knockout mice backcrossed to the C57BL/6 strain (VIP-KO) underwent intratracheal instillation of 5 μL of WTC dust suspension (500mg/1mL). After isoflurane anesthesia, we employed the shutter-gulp technique. One month later, mice underwent CO2 euthanasia, and lungs were inflation fixed in formalin for Hematoxylin and Eosin staining. Lung injury was analyzed and scored by a pathologist blinded to the identities of the samples. Lymphocytic accumulation was assessed in 5 lobes at low and high power in a minimum of 4 fields per lobe and graded from 0-4, with the most severe being 4+ (Figure 1). RESULTS: 3/6 VIP-KO mice had 3+ lymphocytic accumulation around airways and blood vessels, and 1/6 had evidence of mucus accumulation in the airways, while none of the WT mice had significant lymphocytic accumulation or mucous plugging. 3/5 WT mice had normal histology in at least 2 lobes, but among the VIP-KO mice exposed to WTC dust, only 1/6 mice had normal histology. CONCLUSIONS: In this pilot study, there is a trend towards increased accumulation of airway lymphocytes in VIP-KO mice after intratracheal instillation of WTC dust at a low dose and brief dwell time. Next steps for our protocol will include administration of WTC dust at higher doses for a longer dwell time to duplicate our other models which have produced lung fibrosis.

PTSD and lower respiratory symptoms: A systematic review of longitudinal associations in early 9/11 World Trade Center responders

Finch AJ and Dickerman AL

2024

September 11, 2001: Special web sites

Fitzpatrick RB

2024

Association of firefighting exposures with lung function using a novel job exposure matrix (JEM)

Goldfarb DG, Prezant DJ, Zeig-Owens R, et al.

2024

Biomarkers of airway disease, Barrett’s, and underdiagnosed reflux noninvasively (BAD-BURN): A case-control observational study protocol

Javed U, Podury S, Kwon S, et al.

2024

BACKGROUND: Particulate matter exposure (PM) is a cause of aerodigestive disease globally. The destruction of the World Trade Center (WTC) exposed fifirst responders and inhabitants of New York City to WTC-PM and caused obstructive airways disease (OAD), gastroesophageal Refux disease (GERD) and Barrett's Esophagus (BE). GERD not only diminishes health-related quality of life but also gives rise to complications that extend beyond the scope of BE. GERD can incite or exacerbate allergies, sinusitis, bronchitis, and asthma. Disease features of the aerodigestive axis can overlap, often necessitating more invasive diagnostic testing and treatment modalities. This presents a need to develop novel non-invasive biomarkers of GERD, BE, airway hyperreactivity (AHR), treatment efficacy, and severity of symptoms. METHODS: Our observational case-cohort study will leverage the longitudinally phenotyped Fire Department of New York (FDNY)-WTC exposed cohort to identify Biomarkers of Airway Disease, Barrett's and Underdiagnosed Refux Noninvasively (BAD-BURN). Our study population consists of n = 4,192 individuals from which we have randomly selected a sub-cohort control group (n = 837). We will then recruit subgroups of i. AHR only ii. GERD only iii. BE iv. GERD/BE and AHR overlap or v. No GERD or AHR, from the sub-cohort control group. We will then phenotype and examine non-invasive biomarkers of these subgroups to identify under-diagnosis and/or treatment efficacy. The findings may further contribute to the development of future biologically plausible therapies, ultimately enhance patient care and quality of life. DISCUSSION: Although many studies have suggested interdependence between airway and digestive diseases, the causative factors and specific mechanisms remain unclear. The detection of the disease is further complicated by the invasiveness of conventional GERD diagnosis procedures and the limited availability of disease-specific biomarkers. The management of Refux is important, as it directly increases risk of cancer and negatively impacts quality of life. Therefore, it is vital to develop novel noninvasive disease markers that can effectively phenotype, facilitate early diagnosis of premalignant disease and identify potential therapeutic targets to improve patient care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05216133; January 18, 2022.

Racial and ethnic disparities in mortality among World Trade Center Health Registry enrollees with post–9/11 cancer

Kehm RD, Li J, and Cone JE

2024

The association of air pollution exposure with glucose and lipid levels: The role of an extreme air pollution event alongside two decades of moderate exposure

Knobel P, Just AC, Colicino E, et al.

2024

Exposure severity and cognitive dysfunction are mediated by low‐grade cerebral amyloidosis: A PET/MRI study of World Trade Center responders

Kritikos M, Zhou JW, Huang C, et al.

2024

Emergency medical services use in New York City amidst record-breaking fine particulate matter levels from the Canadian wildfires, June 2023

Lancet EA, Asaeda G, Zeig-Owens R, and Prezant DJ

2024

Partial-linear single-index Cox regression models with multiple time-dependent covariates

Lee M, Troxel AB, Kwon S, et al.

2024

Background: In cohort studies with time-to-event outcomes, covariates of interest often have values that change over time. The classical Cox regression model can handle time-dependent covariates but assumes linear effects on the log hazard function, which can be limiting in practice. Furthermore, when multiple correlated covariates are studied, it is of great interest to model their joint effects by allowing a flexible functional form and to delineate their relative contributions to survival risk. Methods: Motivated by the World Trade Center (WTC)-exposed Fire Department of New York cohort study, we proposed a partial-linear single-index Cox (PLSI-Cox) model to investigate the effects of repeatedly measured metabolic syndrome indicators on the risk of developing WTC lung injury associated with particulate matter exposure. The PLSI-Cox model reduces the dimensionality of covariates while providing interpretable estimates of their effects. The model’s flexible link function accommodates nonlinear effects on the log hazard function. We developed an iterative estimation algorithm using spline techniques to model the nonparametric single-index component for potential nonlinear effects, followed by maximum partial likelihood estimation of the parameters. Results: Extensive simulations showed that the proposed PLSI-Cox model outperformed the classical time-dependent Cox regression model when the true relationship was nonlinear. When the relationship was linear, both the PLSI-Cox model and classical time-dependent Cox regression model performed similarly. In the data application, we found a possible nonlinear joint effect of metabolic syndrome indicators on survival risk. Among the different indicators, BMI had the largest positive effect on the risk of developing lung injury, followed by triglycerides. Conclusion: The PLSI-Cox models allow for the evaluation of nonlinear effects of covariates and offer insights into their relative importance and direction. These methods provide a powerful set of tools for analyzing data with multiple time-dependent covariates and survival outcomes, potentially offering valuable insights for both current and future studies. © The Author(s) 2024.

Benefits, harms, and cost-effectiveness of risk model-based and risk factor-based low-dose computed tomography screening strategies for lung cancer: A systematic review

Liu Y, Geng Q, Lin X, et al.

2024

BACKGROUND: It has been proposed that risk model-based strategies could serve as viable alternatives to traditional risk factor-based approaches in lung cancer screening; however, there has been no systematic discussion. In this review, we provide an overview of the benefits, harms, and cost-effectiveness of these two strategies in lung cancer screening application, as well as discussing possible future research directions. METHODS: Following the PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Web of Science, Cochrane libraries, and EMBASE from January 1994 to April 2024. Studies comparing risk model-based and risk factor-based low-dose computed tomography(LDCT) screening strategies for lung cancer were included, with data extracted on study characteristics, screening criteria, and outcomes such as sensitivity, specificity, lung cancer deaths averted, false positive, biopsies, overdiagnosis, radiation-related cancer, and cost-effectiveness measures, et al. RESULTS: A total of 16 fulfilled articles were included, comprising 6 model simulation studies, 9 retrospective cohort studies, and 1 interim analysis of a prospective cohort study. Risk model-based strategies generally demonstrated higher sensitivity, comparable specificity and lower radiation-related harms compared to risk factor-based strategies. However, there were variations in life years gained, quality-adjusted life years gained, lung cancer deaths averted and overdiagnosis cases, highlighting the need for optimal risk threshold determination. Risk model-based strategies showed a potential for greater cost-effectiveness, particularly when tailored to individual risk profiles. Furthermore, subgroup analyses revealed a higher net benefit in women, emphasizing the importance of sex-specific eligibility criteria. CONCLUSION: Risk model-based LDCT screening strategies present a more sensitive and potentially more efficient approach for lung cancer detection. Future research should explore optimal risk thresholds for broader applicability, with attention to sex-specific criteria and individual risk factor dynamics.

P3.01F.02 retrospective characterization of patients with primary lung cancer related to World Trade Center disaster exposure

Lo Cascio JN, Mourikis N, Okpara CJ, et al.

2024

Background: World Trade Center (WTC) Environmental Health Center (EHC) is a treatment program for community members with exposure to the WTC dust and fumes. Most patients have respiratory symptoms with a variety of lung function abnormalities. The characteristics of community members with spirometry consistent with COPD in the WTC EHC, including those without a history of tobacco use are incompletely described and provide clues to mechanisms of severe airflow obstruction. Methods: The WTC EHC baseline assessment includes documentation of respiratory symptoms and functional capacity, lung function measures including pre and post bronchodilator (BD) spirometry, small airway measures using forced oscillation- impulse oscillometry (IOS) (R5, R5-10, AX), and biomarker measures of absolute blood eosinophil and neutrophil counts. WTC-related COPD was defined by absence of pre-9/11 symptoms and post BD spirometry according to the 2019 GOLD criteria. Patients with ≥ 5 and < 5 pack year smoking history were classified as smoker-COPD and nonsmoker-COPD, respectively. BD response was defined by ΔFEV1 of 200 cc/12% or Δ R5 of 1.4 cmH2O/(L/s). Results: Among WTC EHC patients, 3,430 patients fit inclusion/exclusion criteria for evaluation and 467 patients (13.6%) fit criteria for COPD. Residence in WTC affected area (p=0.03), but not exposure to the dust clouds on 9/11, was significantly associated with COPD. COPD patients had more respiratory symptoms, reduced spirometry measures and more abnormal IOS measures compared to non-COPD. Among patients with COPD, 248 (53.1%) had nonsmoker- COPD. Smoker-COPD were more likely to be WTC affected area residents than nonsmoker- COPD (p=0.007). More nonsmoker-COPD had a spirometry BD response compared to smoker- COPD (24 vs. 14%, p = 0.008) or IOS BD response (36 vs. 21%, p = 0.002). Non-smoker-COPD had a greater improvement in the post BD large airway (FEV1) and small airway measures (R5- 20, Ax) compared to smoker-COPD. Blood eosinophils were slightly higher in the nonsmoker- COPD compared to non-COPD (135(176) vs. 118(130) cells/microL, median (IQR), p=0.001). In contrast, blood neutrophils were higher in smoker-COPD compared to nonsmoker-COPD (4.7(2.6) vs. 3.8(1.7) cells/microL, median x 103(IQR), p<0.001). Conclusions: Symptom and spirometry criteria for COPD were present in non-smokers as well as smokers in WTC community members. A significant BD response and post BD increase in large and small airway function was more likely in nonsmoker-COPD compared to smoker-COPD. Blood eosinophils were slightly increased in nonsmoker-COPD whereas smoker-COPD had increased blood neutrophils. These findings suggest potential for differing mechanisms of airway injury and have potential therapeutic implications.

Environmental toxins are important risk factors for liver fibrosis: Focus on African Americans in general U.S. population and members of Mount Sinai World Trade Center general responders

Ma N

2024

Liver disease presentation and outcome vary by race and ethnicity. Liver fibrosis is the most important prognostic factor for liver disease progression and liver-related mortality. This research project identified liver fibrosis risk factors in non-Hispanic Blacks (NHB) and members of other racial and ethnic groups in the United States. Study participants were either members of the Mount Sinai World Trade Center (WTC) General Responder cohort or participants in the National Health and Nutrition Examination Survey (NHANES).In the WTC General Responder Cohort, NHB individuals had a higher prevalence of advanced liver fibrosis (LF) than Non-Hispanic Whites (NHW). Self-reported pre-9/11 occupational exposure to cadmium was a risk factor for significant-LF, whereas body mass index inversely correlated with significant-LF. These results prompted an investigation of liver fibrosis risk factors in NHANES datasets, which provide nationally representative data. Among participants in NHANES, 1999-2018, the estimated number of people with advanced-LF increased 3-fold over time. Notably, NHB and Mexican American (MA) populations had a higher prevalence of advanced-LF than NHW. NHB had a distinctive set of risk factors compared to NHW that included poverty and lead (Pb) exposure, but did not include obesity or diabetes, whereas diabetes was a strong fibrosis risk factor in NHW and most other racial/ethnic groups.To obtain a more granular understanding of the relationship between environmental toxins and liver-related end points, we used weighted quantile sum (WQS) modeling to identify the most hepatotoxic compounds in NHANES datasets. This revealed that Pb was associated with advanced-LF in NHB individuals only, suggesting that NHB may have a heightened susceptibility to Pb toxicity and that pollution may contribute to liver-related healthcare disparities.The noteworthy disconnection between diabetes and liver fibrosis in NHB prompted an investigation of other cardiometabolic risk factors, liver steatosis (fatty liver), and fibrosis, using data from NHANES 2017-March 2020 with measurements of vibration controlled transient elastography and NHANES III (1988-1994) with abdominal ultrasound data. The diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) requires one or more cardiometabolic risk factors. In NHB, MASLD/fibrosis risk factors did not include diabetes or hypertension in either NHANES dataset. In NHANES III, elevated blood Pb levels increased MASLD/fibrosis risk in NHB.In summary, this analysis revealed that NHB have a distinctive set of LF risk factors, which include exposure to Pb, highlighting the need to reduce toxic exposures, especially in African American neighborhoods.

Assessing the public health implications of aviation terrorism: A retrospective analysis of global trends and response strategies

Mani Z and Goniewicz K

2024

Cognitive impairment in firefighters and emergency medical services workers after severe WTC exposures

Mann FD

2024

BACKGROUND: Members of the Fire Department of New York (FDNY) who responded to the World Trade Center (WTC) attacks that occurred on 9/11/2001 were exposed to severe trauma. The present study screened for cognitive impairment in a prospective cohort study of FDNY fire fighters and emergency personnel who reside in the greater NYC metropolitan area. METHOD: A large sample (n = 338) of FDNY personnel who were exposed to the WTC attacks were recruited to complete a large battery of neuropsychiatric and psychological tests. The Montreal Cognitive Assessment (MoCA) was used to screen for mild cognitive impairment (MCI) and probable dementia. Neuropsychiatric, psychological, and physical deficits were further characterized by the Short Physical Performance Battery (SPPB), Hopkins Verbal Learning Task (HVLT-R), Boston Naming Task (BNT), Wide Range Achievement Test (WRAT-4), Trail-Making Task (TMT), Symbol Digit Modalities Test (SDMT), Controlled Oral Word Association (COWA), Patient Health Questionnaire (PHQ-9), and the Cognitive Function Instrument (CFI). Diagnoses of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) were made using the Structural Clinical Interview for DSM-5. RESULT: Compared to the general population, prevalence of MCI (22.92%, CI.95 = [18.42%, 27.63%]) and probable dementia (4.14%, CI.95 = [2.28%, 6.85%]) were precipitously high. Compared to unimpaired firefighters, those with MCI and probable dementia exhibited statistically significant deficits (p-values < .05) on the HVLT-R, BNT, WRAT-4, TMT, SDMT, and COWA, while differences on the SPPB, PHQ-9, and CFI were not statistically significant (p-values > .05). Prevalence of current PTSD (18.05%, CI.95 = [14.10, 22.57] and MDD (6.51%, CI.95 = [4.12%, 9.69%] were high and moderate, respectively, but not significantly associated with MCI or probable dementia (p-values > .05). CONCLUSION: There is a high prevalence of MCI and probable dementia among member of the FDNY who responded to the WTC attacks. The present study further highlights the role of extreme physical exposes in the pathogenesis of cognitive impairment and dementia. This group is a high priority for public health efforts and clinicians need to anticipate MCI and dementia in treatment planning.

Evaluating evidence for interventions directed at healing collective trauma: A systematic review

Morrison NMV and Morrison BW

2024

Longitudinal links between PTSD and physical activity in 9/11 World Trade Center first responders

Shteynberg YA

2024

Do proton pump inhibitors cause myocardial infarction and stroke? Time-variable analyses can resolve the debate

Sloan NL, Sabra A, Sacks HS, et al.

2024

Lack of association of impaired upper airway sensation with the presence or absence of obstructive sleep apnoea or chronic rhinosinusitis in World Trade Center responders

Sunderram J, Legard A, De Resende A, et al.

2024

Cancer development in subjects exposed to environmental exposures: Do germline mutations play a role?

Susheian K, Sahu S, Verma D, et al.

2024

Colorectal cancer screening: Results from the World Trade Center Health Registry cohort

Thompson HM, Yung J, Li J, and Cone J

2024

DNA methylation as a molecular mechanism for carcinogenesis in World Trade Center dust exposure: Insights from a structured literature review

Tuminello S, Durmus N, Snuderl M, et al.

2024

Association between World Trade Center disaster exposures and body mass index in community members enrolled at the World Trade Center Environmental Health Center

Wang Y, Alptekin R, Goldring RM, et al.

2024

Mesothelioma cases in the World Trade Center survivors

Yilmaz ME, Rashidfarokhi M, Pollard K, et al.

2024

Parallel processes of posttraumatic stress and metabolic dysfunction: Long-term costs of trauma on psychological and physical health for 9/11 survivors

Adams SW

2023

Diagnostic scrutiny and patterns of elevated cancer risk: Uncovering overdiagnosis through standardized incidence ratios

Chen Y, Gutierrez V, Morris L, et al.

2023

Transcriptomic analysis of World Trade Center particulate matter-induced pulmonary inflammation and drug treatments

Chen YT, Li J, Chang JN, et al.

2023

Over 400,000 people are estimated to have been exposed to World Trade Center particulate matter (WTC(PM)) since the attack on the Twin Towers in Lower Manhattan on September 11, 2001. Epidemiological studies have found that exposure to dust may cause respiratory ailments and cardiovascular diseases. However, limited studies have performed a systematic analysis of transcriptomic data to elucidate the biological responses to WTC(PM) exposure and the therapeutic options. Here, we developed an in vivo mouse exposure model of WTC(PM) and administered two drugs (i.e., rosoxacin and dexamethasone) to generate transcriptomic data from lung samples. WTC(PM) exposure increased the inflammation index, and this index was significantly reduced by both drugs. We analyzed the transcriptomics derived omics data using a hierarchical systems biology model (HiSBiM) with four levels, including system, subsystem, pathway, and gene analyses. Based on the selected differentially expressed genes (DEGs) from each group, WTC(PM) and the two drugs commonly affected the inflammatory responses, consistent with the inflammation index. Among these DEGs, the expression of 31 genes was affected by WTC(PM) exposure and consistently reversed by the two drugs, and these genes included Psme2, Cldn18, and Prkcd, which are involved in immune- and endocrine-related subsystems and pathways such as thyroid hormone synthesis, antigen processing and presentation, and leukocyte transendothelial migration. Furthermore, the two drugs reduced the inflammatory effects of WTC(PM) through distinct pathways, e.g., vascular-associated signaling by rosoxacin, whereas mTOR-dependent inflammatory signaling was found to be regulated by dexamethasone. To the best of our knowledge, this study constitutes the first investigation of transcriptomics data of WTC(PM) and an exploration of potential therapies. We believe that these findings provide strategies for the development of promising optional interventions and therapies for airborne particle exposure.

Substance use and related disorders among persons exposed to the 9/11 terrorist attacks: Essentials for screening and intervention

Dowling FG and Lowe SM

2023

Post-traumatic stress disorder and risk of first-time and repeated opioid-related hospitalizations among World Trade Center Health Registry enrollees

Garrey SK, Locke S, Pollari C, et al.

2023

Emotion language use in narratives of the 9/11 attacks predicts long-term memory

Kredlow MA, Oyarzún JP, Fan H, et al.

2023

World Trade Center psychological exposures and trauma-related disorders: PTSD and adjustment disorders

Lowe SM, Haugen PT, Rosen R, et al.

2023

Best practices for managing depression and suicide risk in World Trade Center responders and survivors

Lowe SM, Haugen PT, Rosen R, et al.

2023

Comparing self‐reported obstructive airway disease in firefighters with and without World Trade Center exposure

Mueller AK, Singh A, Webber MP, et al.

2023

Glial suppression and post-traumatic stress disorder: A cross-sectional study of 1,520 World Trade Center responders

Natale G, Kritikos M, Kuan P-F, et al.

2023

Characteristics and experiences of professionals providing 9/11 mental health services

North CS, Mahesar S, Meltzer KJ, et al.

2023

Prevalence of increased alcohol use and alcohol use disorders in adult victims of terrorist attacks: A systematic and meta-analytic review

Sanz J, Hernández-Martínez T, Castillo-Burgos P, et al.

2023

Association of PTSD history with confusion or memory loss among World Trade Center Health Registry enrollees

Seil K, Alper H, Yu S, et al.

2023

World Trade Center workers with asthma and post-traumatic stress disorder perceive airflow limitation more accurately

Wisnivesky JP, Agrawal N, Ankam J, et al.

2023

When the analytic field becomes a minefield: Analyzing in the post-9/11 era

Abbasi A

2022

Mutagenicity of the organic fraction of World Trade Center dust

DeMarini DM, Warren SH, and Brooks LR

2022

Mutagenicity of the organic fraction of World Trade Center dust

DeMarini DM, Warren SH, and Brooks LR

2022

Self-efficacy and mental health help-seeking behavior of World Trade Center Health Registry enrollees, 2015-2016

Garrey SK, Takemoto E, Petrsoric L, et al

2022

The association between body mass index and anxious arousal, depressive, and insomnia symptoms among World Trade Center responders

Kauffman BY, Kotov R, Garey L, et al.

2022

Mortality after the 9/11 terrorist attacks among World Trade Center Health Registry enrollees with cancer

Kehm RD, Li J, Takemoto E, et al.

2022

Background: While several studies have reported the association between 9/11 exposure and cancer risk, cancer survival has not been well studied in the World Trade Center (WTC) exposed population. We examined associations of 9/11-related exposures with mortality in WTC Health Registry enrollees diagnosed with cancer before and after 9/11/2001. Patients and Methods: This is a longitudinal cohort study of 5061 enrollees with a first-ever primary invasive cancer diagnosis between 1995 and 2015 and followed through 2016. Based on the timing of first cancer diagnosis, pre-9/11 (n = 634) and post-9/11 (n = 4427) cancer groups were examined separately. 9/11-related exposures included witnessing traumatic events, injury on 9/11, and 9/11-related post-traumatic stress disorder (PTSD). Associations of exposures with all-cause mortality were examined using Cox proportional hazards regression. In the post- 9/11 group, cancer-specific mortality was evaluated by enrollee group (WTC rescue/recovery workers vs. non-workers) using Fine and Gray's proportional sub- distribution hazard models, adjusting for baseline covariates, tumor characteris- tics, and treatment. Results: In the pre-9/11 group, 9/11-related exposures were not associated with all-cause mortality. In the post-9/11 group, increased risk of all-cause mortality was associated with PTSD (adjusted HR = 1.35; 95% CI = 1.11–1.65), but not with injury or witnessing traumatic events. Cancer-specific mortality was not statistically significantly associated with 9/11-related exposures. In rescue/re- covery workers, increased non-cancer mortality risk was associated with PTSD (aHR = 2.13, 95% CI = 1.13–4.00) and witnessing ≥3 traumatic events (aHR = 2.00, 95% CI = 1.13–3.55). Conclusions: We did not observe associations between 9/11-related exposures and cancer-specific mortality. Similar to findings in the non-cancer WTC exposed population, PTSD was associated with increased risk of all-cause mortality in cancer patients.

Long-term lower respiratory symptoms among World Trade Center Health Registry enrollees following Hurricane Sandy

Locke SH, Gargano LM, Alper HE, et al.

2022

Terrorism’s impact on mental health outcomes among directly and indirectly exposed victims and the development of psychopathology

Mazurkiewicz DW, Strzelecka J, and Piechocka DI

2022

After the events of 9/11, many police-responders developed post-traumatic stress disorder (PTSD) and were potentially vulnerable to developing depression and/or anxiety; in addition, nearly half of police with probable PTSD had comorbid depression and anxiety. Having in mind that victims who experience the effects of terrorism are exposed to high levels of psychological damage, we thus aimed to determine how sequelae of a terrorist act directly and indirectly affect victims. Quantitative synthesis findings were concluded on the basis of 200 records that met the inclusion criteria out of a total of 650. We grouped the patients according to their level of exposure to the WTC terrorist attack on 11 September 2001. The Level I group included individuals who had experienced the traumatic event and/or those who had observed the attack. The Level II group consisted of rescuers and/or persons who cleaned up debris in the area after the attack. The Level III group comprised the victims’ families. Our research enabled us to create a profile for those who were most vulnerable to mental disorders after the WTC terrorist attack. Patients who had survived the terrorist attack and/or those who had observed the incident exhibited fewer traumatic symptoms and a lower percentage of suicidal thoughts in comparison to individuals who had worked as rescuers or cleaning staff in the area after the attack. The number of symptoms rose along with increased contact time with the stressor. The dominant symptom was the triad of intrusion, avoidance, and hyperarousal. The findings may confirm the positive effect of protracted court cases in legal proceedings for compensation on the maintenance and development of psychopathology. Our research may contribute to a better understanding of the consequences of terrorism outcomes on the human psyche and be used in the development of standards for dealing with victims of terrorism’s impact. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

COPD in firefighters: A specific event-related condition rather than a common occupational respiratory disorder

Rajnoveanu AG, Rajnoveanu RM, Motoc NS, et al

2022

Personality and psychiatric disorders among employees of New York City workplaces affected by the 9/11 attacks on the World Trade Center

Reynolds ME, Raitt JM, Üstyol A, et al

2022

OBJECTIVE: Personality is associated with psychopathology after disasters, but its association with the portion of postdisaster psychopathology that is incident remains unclear. It is also unclear whether any particular attributes of personality are associated with resistance to the persistence or recurrence of preexisting psychopathology after disasters. This exploratory study of employees of workplaces affected by the September 11, 2001, attacks on the World Trade Center in New York City examined the specific relationships of personality variables (specifically, novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence) to incident postdisaster psychiatric disorders and resistance to the persistence/recurrence of preexisting psychiatric disorders after the disaster. METHODS: Approximately 3 years after the 9/11 attacks, 379 employees were recruited from 8 selected affected workplaces (3 in the World Trade Center towers, 5 at varied distances in the geographic area). Lifetime predisaster and postdisaster psychiatric disorders were assessed retrospectively with the Diagnostic Interview Schedule for DSM-IV, disaster experience details were collected with the Disaster Supplement, and personality was assessed with the Temperament and Character Inventory. RESULTS: Underdeveloped executive functioning (low self-directedness and/or low cooperativeness) was associated with incident postdisaster psychopathology, and components of resilience (low harm avoidance, high self-directedness, and high persistence) were associated with postdisaster resistance to persistence/recurrence of preexisting psychiatric illness. CONCLUSIONS: Personality is related to both incident and persistent/recurrent portions of postdisaster psychopathology, not clearly distinguished in previous research. Personality variables related to executive functioning and resilience may aid in assessing risk and developing treatments to prevent disaster-related psychopathology.

The effects of radon on 9/11 emergency response teams

Rivera D, Torres K, and Santos S

2022

Anxiety sensitivity and pain experience: A prospective investigation among World Trade Center responders

Rogers AH, Zvolensky MJ, Vujanovic AA, et al

2022

Risk of post-traumatic stress disorder following major disasters and critical incidents in police officers — a systematic review

Sørensen LN, Olesen KH, Midtgaard CD, et al.

2022

9/11 World Trade Center 10 anniversary: Exploring Catholic/religious affiliated response efforts and disaster mental/behavioral health responder resilience

Strock-Lynskey DM

2022

This exploratory, qualitative research dissertation, retrospective cohort group case study and comparative analysis presents findings on organizationally based 9/11 World Trade Center Disaster (WTCD), Disaster Mental/Behavioral Health (DMBH) Response/Responder efforts, and aspects that contributed to and/or posed challenges for responder resilience. Data gathered during the one-year period preceding and year following the 9/11 WTCD 10th (2011) anniversary yielded in-depth accounts on the experiences of 20 Catholic and/or Catholic agency affiliated Disaster/DMBH responders that, collectively, cut across several disaster phases and time frames for involvement ranging from a few days/weeks to approximately 10 years. Data collection instruments included a participant background questionnaire and nonrandomized, individual key informant interviews, and focus group sessions consisting of the following cohort groups/study participants: • Three Diocese of Brooklyn/Queens Clergy/Parish Leaders, one of whom was also serving as a Fire Department of New York (FDNY) Chaplain and two who were also serving as New York Police Department (NYPD) Chaplains; one Assistant Superintendent of the Diocese of Brooklyn Schools extensively involved in 9/11 Response efforts for their Catholic local schools; and one Diocese of Manhattan Franciscan Priest/Administrative Vicar (also an EMT and clinical social worker) who served for FDNY on 9/11 as a volunteer clergy responder and, post 9/11, as a DMBH response leader/responder. Three Catholic Charities of Brooklyn (CCBQ) 9/11 WTCD Corporate Leadership Disaster Response Team (including the Director of the overall response) and six Disaster/DMBH Response Team members who were involved in 9/11 and/or Post-9/11 Disaster/DMBH Response efforts. One Catholic Charities of Diocese of Albany (CCA) Administrator responsible for the 9/11 WTCD CCA/CCBQ Volunteer initiative, and five Women Religious professionals from congregationalist communities who served as Post-9/11 CCBQ Disaster/DMBH volunteers (including two CCA school administrators who had also worked on their own CCA 9/11 Disaster/DMBH response efforts). Prior research findings on 9/11 WTC DMBH responders that incorporated a theoretical/research-based framework are scant. Three theories – Resilience, Identity, and Complex dynamical systems – were selected as the theoretical foundation for this study. Through use of the Constructivist Grounded theory (CGT) method and methodological processes, these theories were applied to findings culled from an extensive literature review of interdisciplinary, cross-cultural research studies and scholarly works pertaining to 9/11 WTC and other Disaster/DMBH response and responder efforts. Four themes deemed of relevance to dissertation study research questions were incorporated into a preliminary applied theoretical framework. CGT methodological processes were utilized to construct a case study of dissertation study findings on 9/11 and Post-911 WTC Disaster/DMBH response/responder efforts (split into two separate chapters). Through the process of developing the integrative summary/conclusion for this dissertation, a within/across cohort group, comparative analysis was undertaken that drew from literature review findings on preliminary themes and other research that provided a retrospective basis for comparison. Three new areas of findings became evident that also warranted being elevated to theme status. A follow-up literature search yielded a small body of new sources that could provide contextually relevant, theoretical /research-based constructs in which to “ground” these themes. Two new theories (Conservation of resources and Ambiguous loss) and two ancillary theoretical models (Phases of disaster and Servant leadership) were integrated into findings for these three new themes. When integrated into the original applied theoretical framework, a preliminary model on DMBH responder resilience comprised of the following six themes emerged that became the foundation for the integrative summary analysis: 1) DMBH 1st/Frontline Responder Identity Paradigm; 2) Post-9/11 DMBH 1st/Frontline Response/Responder Efficacy Capacity Building; 3) Aspects That Posed Adverse/Severe Challenges to DMBH Responder Resilience During Response Efforts; 4) DMBH Responder Other-Based Professional Care Supports/Alliances, Services/Structures, Networks, and Interventions; 5) Resilience-Affirming Assets/Actions and Trauma-Resistive Coping Mechanisms as Domains for Self-Care and Resilience; and 6) 9/11 WTCD Legacy Residual Effects (e.g., response and post-response severe/prolonged trauma reactions, cumulative stress/overload, compassion fatigue, PTSD symptomatology) and Resilience Indicators (e.g., response processes associated with growth such as meaning making, reframing of assumptive world views associated with compassionate caregiving/chaplaincy care, religious/spiritual/faith-based beliefs, and forgiveness). A final conclusionary segment incorporates examples from within/across cohort groups, of what can be conceptualized as Disaster/DMBH Response-related Resilience Labor. Education, practice, policy, and research implications as well as future directions that may be taken by Social Work, Psychology, Mental health, Public Health, Disaster Mental/Behavioral Health responders, Disaster/DMBH Response agencies, Thanatologists, Disaster Chaplains, Clergy, and Women Religious and Grief/Loss practitioners as well as other disciplines/professions, are offered for consideration.

Postdisaster mental health assistance provision and utilization among employees of companies affected by the 9/11 attacks on New York City

White MB, Raitt JM, Pfefferbaum B, et al

2022

Posttraumatic stress disorder mediates the association between traumatic World Trade Center dust cloud exposure and ongoing systemic inflammation in community members

Zhang Y, Rosen R, Reibman J, et al.

2022

Managing the human dimension of disasters: Caring for the bereaved, survivors and first responders

Brataas K

2021

September 11-twenty years on: A reflection and review

Cohen J

2021

New York City police officers’ experiences of 9/11

Fiore CA

2021

World Trade Center health impacts on FDNY rescue workers: 20 years: 2001 to 2021

Fire Department of New York

2021

Impact of World Trade Center-related health research: An application of the NIEHS translational framework

Madrigano J, Concannon TW, Mann S, et al

2021

The impact on medical students of the 9/11 attacks on New York’s World Trade Center

Nabors C, Frishman WH, Dhand A, et al

2021

Phenomenon: Little is known about how participation in disaster relief impacts medical students. During the terror attacks of September 11, 2001, New York Medical College School of Medicine students witnessed the attacks and then became members of emergency treatment teams at St. Vincent?s Hospital, the trauma center nearest to the World Trade Center. To date, only two reports describe how 9/11 influenced the lives of medical students. This study was designed to characterize the short- and long-term effects on NYMC students and to compare those effects between students assigned to St Vincent?s Hospital and classmates assigned to rotations at facilities more remote from the attack site. We hypothesized that participation in direct relief efforts by students assigned to the St. Vincent?s site might have long-lasting effects on their lives and these effects might vary when compared to classmates assigned elsewhere. Approach: This was a retrospective, survey-based, unmatched cohort study. Participants included all school of medicine graduates who were St. Vincent?s rotators on 9/11 (N?=?22) and classmates (N?=?24) assigned to other sites who could be contacted and agreed to participate. Our primary measure was whether the 9/11 experience affected the participant?s life, defined as an affirmative response to the item which asked whether the 9/11 experience affected the participant?s ?life thereafter, career choice, attitudes toward life or attitudes toward practice.? Secondary measures included self-reported effects on career, life, attitudes, health, resilience, personal growth, personality features, and the temporal relationship between the attack and stress symptoms. Findings: Completed surveys were received from 16/22 (73%) St. Vincent?s and 18/24 (75%) non-Saint Vincent?s participants: 62% male, 82% had children, 74% identified as Caucasian/white and 76% employed full-time. Overall, slightly more than half (58%) of respondents reported an effect of 9/11 on their life, with a greater but non-significant proportion of St. Vincent?s rotators reporting life impact (67% versus 50% for St. Vincent?s versus other locations, respectively). High post-9/11 stress levels, current marriage, and ability to make and keep family and social relationships were associated with an effect on life which approached statistical significance. Participants reported positive or no post 9/11 effects on empathy and altruism (50%), resilience (47%), attitudes toward medical practice and career (32%), and charitable giving (24%), while positive, negative, or no effects were reported for attitude toward life, family and social relations, physical health, and conscientiousness. Mental health was the only domain in which all participants reported unchanged or negative effects. Two St. Vincent?s rotators but no students assigned elsewhere believed they experienced 9/11-related post-traumatic stress disorder. Insights: Just over half of New York Medical College School of Medicine students rotating at St. Vincent?s Hospital on 9/11 or elsewhere reported significant life-effects as a result of direct/indirect experiences related to the attack. Perceived stress may have been a more important driver of this life-change than other factors such as geographic proximity to the disaster site and/or direct participation in relief efforts. Further study of medical school interventions focused on stress reduction among students who participate in disaster relief is warranted.

Changes in perceptions and attitudes toward self and others in survivors of the September 11, 2001, terrorist attacks

Shaw Y, Pollio DE, and North CS

2021

Airway hyperresponsiveness and distal airways narrowing in 9/11 rescue workers seventeen years after the World Trade Center disaster

Caruana D, Huang PH, Li J, et al

2020

Photography and September 11th: Spectacle, memory, trauma

Good J

2020

The red purse and human remains: Personal and professional experiences of 9/11 mental health workers

Meltzer K, Mahesar S, Pollio D, et al

2020

Cancer among WTC responders—a collaboration of three principal study centers and the New York State Cancer Registry

Schymura MJ, Kahn A, and Qiao B

2020

Satisfaction with justice and desire for revenge in survivors of the September 11, 2001, attacks on New York City’s World Trade Center

Zettl RE, Page LE, Bhatti S, et al

2020

Sarcoidosis-like granulomatous lymphadenopathy mistaken for neoplastic disease on positron emission tomography

Ammar A, Esber Z, Bali SD, et al

2019

A quality improvement assessment of the delivery of mental health services among WTC responders treated in the community

Bellehsen M, Moline J, Rasul R, et al

2019

Children's knowledge about parental exposure to trauma

Duarte CS, Eisenberg R, Musa GJ, et al

2019

Psychosocial correlates of post-traumatic stress disorder symptoms and well-being among hispanic World Trade Center rescue and recovery workers

Ciro D

2018

Thousands of first responders are estimated to have endured extremely distressing experiences during their recovery efforts at the 9/11 World Trade Center (WTC) site. While the effects of 9/11 continue to be studied, few studies have examined how rescue and recovery workers have been coping since 9/11 and how their coping is associated with their psychological well-being. Moreover, we do not know how distinct coping patterns may be associated with post-traumatic growth, experiences of positive emotion, or quality of life among WTC responders. This study compared coping differences among Hispanic, Non-Hispanic White, and Non-; Hispanic Black first responders. In addition, it examined the relationship between their coping, Post- Traumatic Stress Disorder (PTSD) symptoms, and psychological well-being. I also examined these associations in Hispanic responders by language preference and US nativity as proxies of acculturation.; ; Data from a cohort of 4,148 WTC responders who attended monitoring visits at the Mount Sinai WTC Health Program (WTC-HP) and who participated in a web-based survey administered by the Mount Sinai WTC Mental Health Program research team were used for secondary data analyses. More specifically, I utilized multiple regression analyses to compare differences in coping among Hispanics, Non-Hispanic Whites, and Non-Hispanic Blacks, while controlling for WTC-related trauma exposure, demographics, and clinical and psychosocial characteristics. Data were also used to examine the relationship between the responders’ coping, PTSD symptoms, and psychological well-being. Further, I used the data to examine differences in coping and well-being (e.g., post-traumatic growth, positive affect, and quality of life) in Hispanic responders by language preference and US nativity. Last, I tested a moderation effect to examine the relationship between active coping, PTSD symptom levels, and wellbeing among Hispanic responders by their level of acculturation using language preference and US nativity as proxies.; ; Key findings suggested broad similarities in coping between Hispanic and Non-Hispanic Black first responders, significant differences in coping among Hispanics, and the prevalence of post-traumatic growth in Hispanic responders. Further, the results revealed a moderating effect of US nativity on the Hispanic responders’ experiences of positive affect and quality of life. This study’s results are consistent with other study findings that show Hispanic ethnicity is associated with higher PTSD symptom levels in 9/11 first responders. However, the study findings also show that positive religious coping and active coping are strongly associated with post-traumatic growth in Hispanic first responders. Further, positive religious coping and perceived social support are strongly associated with Hispanic responders experiencing positive affect and reporting a higher quality of life. ; ; Finally, the study findings demonstrate that US nativity among Hispanic responders moderates the relationship between active coping and positive affect and between active coping and quality of life, suggesting that Hispanic responders who are born abroad and use active coping report higher rates of positive affect and quality of life than those who are US born. Clinical and policy implications of these findings are of importance in designing programs for this population.

Development of the inventory of 9/11 agents

Howard J

2018

Working towards wellness: Lessons from 9/11 paramedics and emergency medical technicians for australian ambulance services

Smith EC and Burkle Jr FM

2018

Associations of major and trace elements in lung tissues with World Trade Center exposures and subsequent respiratory symptoms

Lin IH

2017

Objective: To investigate associations of major and trace elements in lung tissues with self-reported World Trade Center (WTC) exposures, and with respiratory symptoms developed after September 11th, 2001 in order to evaluate whether elements characteristic of WTC exposure have been retained and might be constituents of biomarkers of WTC exposures. Methods:. Study Subjects. Study subjects (n=130) were decedents autopsied by the Office of Chief Medical Examiner (OCME) of the City of New York during 2007--2011. Among 71,437 members of World Trade Center Health Registry (WTCHR), we obtained 75 peripheral lung and 61central lung tissue samples from 75 decedent enrollees. We also obtained 55 peripheral lung and 43 central lung tissue samples from 55 decedent NYC reference individuals. Materials Assessed. Tissue samples were dried, weighed, homogenized, and acid-digested. Inductively-coupled magnetic sector plasma mass spectrometry (ICP-MS) was performed to measure levels (ppm;microg/g) of 34 major and trace elements known to be enriched in WTC dust. We excluded 7 elements from the final analyses due to poor recovery percentages or concentrations under the limits of detection. WTC exposure histories (rescue/recovery exposure and non-rescue/recovery exposure) were assessed at Wave 1 of WTCHR enrollment (2003--2004). Respiratory symptoms (wheezing, shortness of breath, persistent cough and throat irritation) were assessed at Wave 1 and Wave 2 (2006--2008). Statistical Methods. We used the Mann-Whitney-Wilcoxon test to evaluate differences in elemental concentrations between the WTCHR enrollees and NYC reference individuals after creating a merged estimate of both rescue/recovery and non-rescue/recovery exposures. The chi-square test or Fisher's exact test was used to compare the frequencies of categorical variables, including demographic characteristics, disease and symptom status between autopsied WTCHR enrollees and all other enrollees in the original WTCHR cohort; elemental concentrations in lung tissues dichotomized at ≥ median vs. < median among WTCHR enrollees and NYC reference individuals; and among WTCHR enrollees who reported post-9/11 respiratory symptoms (wheezing, shortness of breath, persistent cough and throat irritations) and those who did not. We used multivariable logistic regression analysis to assess the associations of elemental concentrations in lung tissues with WTCHR membership compared to memberships in the NYC reference group after controlling for age, gender, race/ethnicity, and year of death. We also used unconditional logistic regression analysis to evaluate the associations of major and trace elements in lung tissues with both self-reported WTC exposure histories and post-9/11 respiratory symptoms, after adjusting for race/ethnicity, smoking status and year of death. Results: With the exception of smoking status, place of residence on September 11th, 2001, and race/ethnicity, all other demographic variables, post-9/11 diseases and symptoms were similar between the autopsied WTCHR enrollees in the present study and all other enrollees in the original WTCHR cohort. The distribution of gender, race/ethnicity, education, marital status, borough of residence, lung diseases, chronic diseases, substances abuse and metal concentrations in lung tissues also were similar in the WTCHR enrollee group and the NYC reference group. After adjusting for age, gender, race/ethnicity, year of death, the majority of elemental concentrations in lung tissue did not differ between the WTCHR enrollee groups. However, significant differences were found for Ag and U. Aluminum in central lung was associated with rescue/recovery exposure among all WTCHR enrollees [adjusted OR=4.78 (95% C.I.= 1.01--29.27)] after adjustment for age on September 11th, 2001, gender, race/ethnicity, smoking and year of death.

The prevalence, characteristics, and correlates of anger among survivors of the 9/11 World Trade Center attacks

Tran DV and North CS

2017

Emergency mental health services for children after the terrorist attacks of September 11, 2001

Bruckner TA, Kim Y, Lubens P, et al

2016

Volunteerism and well-being in the context of the World Trade Center terrorist attacks

Adams RE and Boscarino JA

2015

Minimum latency & types or categories of cancer: World Trade Center Health Program

Howard JM

2015

World Trade Center Health Program; amendments to list of WTC-related health conditions; cancer; revision. Interim final rule

Centers for Disease Control and Prevention

2014

Crisis-induced depression, physical activity and dietary intake among young adults: Evidence from the 9/11 terrorist attacks

Wang Y and Yang M

2013

Predicting future PTSD using a modified New York risk score: Implications for patient screening and management

Boscarino JA, Kirchner HL, Hoffman SN, et al

2012

Frequent allergy symptoms among children living near the World Trade Center associated with elevated peripheral airways resistance

Chen Y, Pan K, Yan Y, et al

2012

Emergency and crisis management: Critical incident stress management for first responders and business organisations

Guenthner DH

2012

Summary of evidence for establishing dates on which cleanup of the Pentagon and Shanksville, Pennsylvania sites of the terrorist-related aircraft crashes of September 11, 2001 concluded

McCleery RE

2012

The impact of maternal reflective functioning on children's reaction to 9/11: A comparison of two cases

Odahl C

2012

Engagement in trauma-specific CBT for youth post-9/11

Rodriguez J, Hoagwood KE, Gopalan G, et al

2012

Perievent panic attack and depression after the World Trade Center disaster: A structural equation model analysis

Adams RE and Boscarino JA

2011

The team approach to the treatment of a traumatized mother and child: Christina and bobby

Bergman A and Remez A

2011

Early years of support group i: Three therapists' views

Bergman A, Moskowitz S, and Friedman DD

2011

The team approach to the treatment of a traumatized mother and child: Lydia and ryan

Bergman A, Sossin KM, Tortora S, et al

2011

The evolution of the project: Helping the mothers, infants and young children of September 11, 2001

Cohen P

2011

Video feedback and the impact of multiple therapists

Cohen P

2011

First periodic review of scientific and medical evidence related to cancer for the World Trade Center Health Program

Connick KD, Enright PL, Middendorf PJ, et al.

2011

The review is based on three information sources. First, a systematic search was conducted for peer-reviewed findings on exposure and cancer resulting from the September 11, 2001, terrorist attacks that have been published in the scientific and medical literature between September 11, 2001, and July 1, 2011. Second, findings and recommendations related to cancer were solicited from the WTC Clinical Centers of Excellence and Data Centers, the WTC Health Registry at the New York City Department of Health and Mental Hygiene, and the New York State Department of Health. Third, information from the public about cancer was solicited through a Request for Information published in the Federal Register on March 8, 2011, and March 29, 2011. Overall, this inaugural review of cancer presents findings from the peer-reviewed scientific and medical literature about exposures and cancer resulting from the September 11, 2001, terrorist attacks. In addition, the review provides the status of planned and ongoing research efforts to address questions about cancer related to the exposures resulting from the terrorist attacks. Specifically, Chapter I describes how the bibliographic search of scientific and medical findings was conducted. Chapter II summarizes the information contained in scientific and medical publications about September 11, 2001, exposures. Chapter III cites the very few peer-reviewed study reports that contain any quantitative data about cancer as a health outcome resulting from September 11, 2001, exposures. In Chapter IV, a primer on cancer epidemiology is presented. In Chapter V, input from the public and from the WTC Clinical Centers of Excellence, the WTC Health Registry, and the New York State Department of Health about cancer is presented. Chapter VI discusses the challenge of determining whether an observed association between one or more of the September 11, 2001, exposure variables and the health outcome of cancer is causal. Finally, the review includes updates from researchers about current studies of cancer. It is expected that the second periodic review of cancer will be conducted in early to mid-2012 to capture any emerging findings about exposures and cancer in responders and survivors affected by the September 11, 2001, terrorist attacks.

Working toward resilience: A retrospective report of actions taken in support of a New York school crisis team following 9/11

Johnson K and Luna JM

2011

In Manhattan, children still battle 9/11-related illnesses

Jothianandan S

2011

The day the Twin Towers crumbled, more than 25,000 kids inhaled toxic substances. Ten years later, many of them are suffering from health problems that still haven't gone away. The evening of September 11, 2001, after the towers fell and a torrent of toxic dust inundated the arteries of downtown New York City, Mariama James returned to her Lower Manhattan home, to a white apartment. "Every inch was covered in dust," she says of her Southbridge towers unit, located just blocks from where the World Trade Center stood that morning. "It was a beautiful day and my windows were wide open," she recalls. James was 8 1/2 months pregnant at the time. "My children were completely covered in dust, they couldn't escape it," she says of her son and daughter, then 9 and 6 years old. "I swept, I vacuumed, but you couldn't get rid of it, it was everywhere. It's like if you took pounds and pounds of chalk and chopped it up and rolled around in it for four days. ... You know that feeling when you hit two erasers together and breathe it in? This was like sticking the entire eraser down your throat." Two years after the attacks her eldest daughter Armani, now 15, started experiencing chronic sinuses infections, ear infections, throat infections, and a persistent cough. Soon after that all three of her children, including her newborn daughter, had a host of health conditions including asthma, chronic bronchitis, and acid reflux. They were seeing a pediatric pulmonologist once a month without fail and were missing school more than any child probably should. At one point, each child was on at least seven different medications. "I initially came to the conclusion that my kids were sick from 9/11 on my own, but my pediatrician just didn't buy it at all," says James, adding that both of her older children were more of less healthy prior to the attacks. "I still love my pediatrician, but I only go to him for regular annual visits." All of James' children are now being treated in the pediatric program at the World Trade Center Environmental Health Center, which operates out of Bellevue Hospital in New York City. A study based on the Dept of Health and Mental Hygeine's WTC Health Registry cites that 25,000 children were either living or attending school in Lower Manhattan the day of the attacks, and projects that tens of thousands more "were in the path of the plume of building debris and smoke, close enough to inhale particulates and toxic substances."

Attention orientation in parents exposed to the 9/11 terrorist attacks and their children

Lindstrom KM, Mandell DJ, Musa GJ, et al

2011

Primary maternal preoccupation disrupted by trauma and loss: Early years of the project

Moskowitz S

2011

From 9/11 to 2011: A brief overview from a child and adolescent psychiatry perspective

Pfeffer CR

2011

Return to work after 9/11

Precin P

2011

Creating space for mourning a lost father and husband after September 11: A therapist's reflections

Reiswig R

2011

Support group ii: An evolving approach: Reflections on group process in the early years

Sossin KM

2011

Defining a moment in history: Parent communication with adolescents about September 11, 2001

Stoppa TM, Wray-Lake L, Syvertsen AK, et al

2011

Social work contribution to a comprehensive model of mourning: The experience of bereaved families of fire-fighters killed on 9/11/01

Christ G

2010

Medical surveillance of search dogs deployed to the World Trade Center and pentagon: 2001-2006

Otto CM, Downend AB, Moore GE, et al

2010

Subgroups of New York City children at high risk of PTSD after the September 11 attacks: A signal detection analysis

Rosen CS and Cohen M

2010

The parent-rated social skills of a sample of New York City preschool children 8-10 months after September 11, 2001

Yasik AE, Saigh PA, Mitchell P, et al

2010

Peritraumatic panic attacks and health outcomes two years after psychological trauma: Implications for intervention and research

Boscarino JA and Adams RE

2009

Cord blood mercury and early child development: Effects of the World Trade Center

Dorea JG

2009

Clinical guidelines for children and adolescents exposed to the World Trade Center disaster

New York Dept. of Health and Mental Hygiene

2009

Lessons learned for pediatric disaster preparedness from September 11, 2001: New York City trauma centers

Stamell EF, Foltin GL, and Nadler EP

2009

Swyer-James-Macleod syndrome presenting in a World Trade Center ground zero first responder

Varghese RS and Fleming R

2009

INTRODUCTION: The September 11, 2001 terrorist attack in New York City (NYC) that caused the collapse of the World Trade Center (WTC) resulted in the release of large amounts of smoke, debris, and particulate matter into the air. Many people involved in the initial rescue and recovery effort were exposed to these respirable materials. There has been an increasing number of pulmonary diseases reported in association with this exposure. We report a case of Swyer-James-Macleod Syndrome (SJMS) in a WTC first responder. CASE PRESENTATION: A 38-year-old male nonsmoker presented with 2 years of dyspnea on minimal exertion, cough, and wheezing. He was a first responder at WTC, "Ground Zero," during which time he was exposed to particulate matter in the air. Prior to this, he was able to run miles and perform various exercises for his police department training. In 2002, he underwent treatment for "pneumonia". In 2007, during WTC screening at Mt. Sinai, NYC, he reported a negative chest radiograph. Review of systems revealed occasional right-sided chest pressure on exertion. He noted symptomatic relief with albuterol meter-dose-inhaler. Physical examination showed reduced air-entry over the right chest without wheezing or rhonchi. Oxygen saturation on room air decreased to 92% while walking. Pulmonary function testing showed mild restrictive lung disease with minimal response to bronchodilator therapy. Computed tomography (CT) of chest demonstrated a hyperlucent right upper lobe with oligemic lung field consistent with SJMS (Figure 1). DISCUSSIONS: To our knowledge, this is the first case reported of SJMS occuring after exposure to WTC respirable particulate matter. Exposure to materials in the air caused by the collapse of the WTC has been reported to result in bronchial responsiveness, cough, sarcoid-like granulomatous disease as well as bronchiolitis obliterans[2]. SJMS is a rare disorder characterized radiographically by a unilateral hyperlucent lung. It is believed to be a postinfectious manifestation of childhood bronchiolitis obliterans caused by injury of the immature lung. Acute viral respiratory infection during the first 8 years of life is thought to be the main causative factor, however about 40% of cases have documented no history of episodes of childhood respiratory infection[1]. The diagnosis is usually made based on clinical and radiographic findings rather than by pathology. When pathologic specimens have been examined, they have shown bronchiolitis obliterans with various degrees of chronic inflammation, fibrosis, and dilatation of airways and air spaces distal to the obstructed bronchioles. Air trapping results from air entering the spaces via collateral air drift but being unable to exit due to bronchiolar obstruction[2]. Chest CT Scan is valuable because it eliminates other diagnoses that may mimic unilateral hyperlucency, such as central bronchial obstruction, cysts, and vascular disease[1]. The prognosis and severity of SJMS is variable and depends on the development of bronchiectasis and frequency of recurrent pneumonia[1]. CONCLUSION: Although pulmonary disease has been reported following WTC exposure, this is the first reported case of SJMS. Our previously healthy male presented with dyspnea on exertion, persistent cough, wheezing, and chest pressure following exposure to WTC debris. We believe the inhalation of toxic material during the intense short-term exposure to WTC led to bronchiolitis obliterans and subsequently to SJMS. Absence of respiratory symptoms with normal functioning capacity prior to 9/11/2001 emphasizes that the WTC exposure was the cause of his disease. This suggests that when presented with a case of SJMS, a history of toxic inhalation should be elicited along with that of recurrent respiratory infections.

Development of an exposure assessment method for epidemiological studies of New York state personnel who responded to the World Trade Center disaster

Herdt-Losavio ML, Mauer MP, and Carlson GA

2008

OBJECTIVES: An exposure assessment method was developed for use in assigning an exposure score to New York State personnel who responded to the World Trade Center disaster site after the 11 September 2001 terrorist attacks. METHODS: The method consists of an algorithm with two instantiations. Each represents a major component of the overall exposures at the site: dust and smoke. The algorithm uses US Environmental Protection Agency air monitoring data collected between 23 September 2001 and 28 February 2002, as well as information on duration, location and time period of work assignment and type and frequency of personal protective respiratory equipment (PPE) use, collected by a self-administered mailed questionnaire. These data were used to calculate an overall exposure score for each participant. For each time period/location combination, individuals provided average number of hours and number of days worked. This was multiplied by a weighting factor derived from the median of the air monitoring data for the time period/location. Calcium was chosen as a surrogate for the dust exposure, so the weighting factors for the dust instantiation were calculated from calcium air monitoring data. Total hepta-chlorinated dibenzo-p-dioxin was chosen as a surrogate for the smoke exposure and was similarly used in the smoke instantiation. RESULTS: More individuals in the highest exposure score category performed tasks such as search/rescue and hand digging than those in the lowest exposure category. Also, those in the highest exposure category had a higher mean number of hours at the site than other exposure groups. CONCLUSIONS: The exposure assessment method presented accounts for PPE use, amount of time at the site, proximity to the site and ambient air monitoring results taken in the immediate vicinity. The algorithm can be used to rank individuals in the same study with very different patterns of exposure, such as high-level, short-term exposures and low-level, long-term exposures. The concepts could be modified for use in other epidemiological studies where long-term chronic exposure is a concern.

Constructing peace: Helping youth cope in the aftermath of 9/11

Hernandez-Cordero LJ and Fullilove MT

2008

P-flash: Development of an empirically-based post-9/11 disaster mental health training program

North CS, Hong BA, and Pfefferbaum B

2008

Health effects following 9/11: Implications for occupational health nurses

Pak VM, O'Hara M, and McCauley LA

2008

Multi-laboratory testing of a screening method for World Trade Center (WTC) collapse dust

Rosati JA, Bern AM, Willis RD, et al

2008

Asthma among WTC children: Registry yields first child health report

Washam C

2008

New York City young adults' psychological reactions to 9/11: Findings from the reach for health longitudinal study

Agronick G, Stueve A, Vargo S, et al

2007

Contributions to understanding therapeutic change: Now we have a playground

Harrison AM and Tronick EZ

2007

Implementing an evidence-based trauma treatment in a state system after September 11: The cats project

Hoagwood KE, Vogel JM, Levitt JM, et al

2007

World Trade Center disaster: Short- and medium-term health outcome

Moscato G and Yacoub MR

2007

Geography of asbestos contamination near the World Trade Center site

Thayer WC, Griffith DA, and Diamond GL

2007

The traumatic impact of the September 11, 2001, terrorist attacks and the potential protection of optimism

Ai AL, Evans-Campbell T, Santangelo LK, and Cascio T

2006

Matching interventions to children's mental health needs: Feasibility and acceptability of a pilot school-based trauma intervention program

Brown EJ, McQuaid J, Farina L, et al

2006

Counseling firefighters post 9/11

Cordero J and Zimbelmann C

2006

Bio-psycho-social assessment of 9/11-bereaved children

Demaria T, Barrett M, Kerasiotis B, et al

2006

Incidence of male childhood sexual abuse and psychological sequelae in disaster workers exposed to a terrorist attack

Leck P, Difede J, Patt I, et al

2006

Risk factors for depression after a disaster

Person C, Tracy M, and Galea S

2006

Intergenerational transmission of trauma: What we have learned from our work with mother and infants affected by the trauma of 9/11

Pierce M and Bergman A

2006

College students with previous exposure to crime report more PTSD after 9-11-2001

Saylor C, DeRoma V, and Swickert R

2006

Factor structure of posttraumatic stress among western New York undergraduates following the September 11th terrorist attack on the World Trade Center

Baschnagel JS, O'Connor RM, Colder CR, et al

2005

Posttraumatic stress and depressive symptoms in a college population one year after the September 11 attacks: The effect of proximity

Blanchard EB, Rowell D, Kuhn E, et al

2005

Rebuilding security: Group therapy with children affected by September 11

Haen C

2005

Marking the anniversary: Adolescents and the September 11 healing process

Holmes L

2005

Media effects on post-traumatic stress disorder and the World Trade Center tragedy

Jarolmen J and Sisco H

2005

Predictors of treatment utilization in World Trade Center attack disaster workers: Role of race/ethnicity and symptom severity

Jayasinghe N, Spielman L, Cancellare D, et al

2005

Final report: Mapping the spatial extent of ground dust and debris from the collapse of the World Trade Center buildings

Jennings, DB

2005

This report presents the results of an analysis into the geographical extent of the ground dust/debris field produced by the collapse of the buildings at the World Trade Center (WTC) on September 11, 2001. The study focused on an area within an approximate eight mile radius from the World Trade Center. The study period ranged from September 11, 2001 through September 13, 2001. This temporal limit is due to an approximate two inch precipitation event on the morning of September 14, 2001. Various remote sensing imaging sources (aerial photographic and satellite image data) and analytical techniques (qualitative interpretive analysis and quantitative image processing analysis) were utilized in this study. Results include: High-spatial-resolution aerial photographs from September 11, 2001 and September 13, 2001 show distinct primary and secondary deposition along roadways, parking lots and other ground areas in lower Manhattan that extend as far north as Canal Street on the September 13 photographs. In the small area of Brooklyn covered by the September 13 photographs, possible dust is observed on pier areas adjacent the East River and directly south-southeast of the WTC area. An excavated area and multiple mounds of material are also observed on the piers in the general vicinity of the possible dust. The area of coverage for the high-spatial-resolution aerial photographs was generally limited to the lower Manhattan area during the study period. This limitation prevented a determination of ground dust/debris boundaries over the wider study area On one-meter IKONOS-1 satellite imagery from September 12, 2001 ground dust/debris was observed in lower Manhattan. However, the extreme oblique perspective provided by the image precluded a boundary determination for the lower Manhattan area. For those areas outside of lower Manhattan, ground dust/debris could not be ascertained. Multi-temporal Landsat 7 ETM+ multispectral images (September 12, 2001 and August 27, 2001) and EO-1 Hyperion satellite hyperspectral data were used to assess ground dust/debris over a wide geographic area. A qualitative assessment of spatial patterns of high reflectance change, derived from Landsat 7 temporal image ratio data, provided three distinct spatial patterns. One generally coincided with the ground boundaries derived from September 11, 2001 aerial photographs in lower Manhattan, south of Chambers Street. A second was related to the WTC plume and a third was related to the eastern edges of shorelines (land/water interface). Lower reflectance change, although prevalent throughout the study area, showed no coherent spatial pattern for ground dust/debris. The spatial patterns derived from spectral signature mapping of EO-1 Hyperion data also showed a spatial coincidence with the ground dust/debris boundaries derived from September 11, 2001 aerial photographs in lower Manhattan, south of Chambers Street. An additional pattern was noted along the west side of Manhattan proceeding from the WTC area in the south towards Central Park to the north. The maps produced from the Landsat and Hyperion data do not assure the presence or absence of ground dust/debris for any given pixel, but rather illustrate spatial relationships from which ground dust/debris, per pixel, may be qualitatively assessed. The spatial resolution provided by these sensors (30 meters) was not sufficient for interpretive mapping of ground dust/debris boundaries, such as those delineated using the high resolution aerial photographs.

The treatment of children impacted by the World Trade Center attack

Kaplan SJ, Pelcovitz D, and Fornari V

2005

Pre-attack symptomatology and temperament as predictors of children's responses to the September 11 terrorist attacks

Lengua LJ, Long AC, Smith KI, et al

2005

BACKGROUND: The aims of this study were to assess the psychological response of children following the September 11, 2001 terrorist attacks in New York and Washington, DC and to examine prospective predictors of children's post-attack responses. METHOD: Children's responses were assessed in a community sample of children in Seattle, Washington, participating in an ongoing study. Symptomatology and temperament assessed prior to the attacks were examined as prospective predictors of post-attack post-traumatic stress (PTS), anxiety, depression and externalizing problems. RESULTS: Children demonstrated PTS symptoms and worries at levels comparable to those in children directly experiencing disasters, with 77% of children reporting being worried, 68% being upset by reminders, and 39% having upsetting thoughts. The most common PTS symptom cluster was re-experiencing, and 8% of children met criteria consistent with PTSD. African-American children reported more avoidant PTS symptoms and being more upset by the attacks than European-American children. Girls reported being more upset than boys. Prior internalizing, externalizing, social competence and self-esteem were related to post-attack PTS; and child inhibitory control, assessed prior to the 9/11 attacks, demonstrated a trend towards an association with post-attack PTS symptoms controlling for prior levels of symptomatology. PTS predicted child-report anxiety and conduct problem symptoms at follow-up, approximately 6 months after 9/11. CONCLUSIONS: Children experiencing a major disaster at a distance or indirectly through media exposure demonstrated worries and PTS symptoms suggesting that communities need to attend to children's mental health needs in response to national or regional disasters. Pre-disaster symptomatology or low self-regulation may render children more vulnerable in response to a disaster, and immediate post-disaster responses predict subsequent symptomatology. These variables might be used in the identification of children in need of intervention.

Maternal drinking patterns and drug use increase impact of terrorism among pregnant women attending prenatal care

Lewis MW, Lanzara BL, Stein JL, et al

2005

Analysis of background residential dust for World Trade Center signature components using scanning electron microscopy and x-ray microanalysis

Lowers HA, Meeker GP, and Brownfield IK

2005

Psychological impact of terrorism on children and families in the United States

Pfefferbaum BJ, Devoe ER, Stuber J, et al

2005

Preterm delivery in boston before and after September 11th, 2001

Rich-Edwards JW, Kleinman KP, Strong EF, et al

2005

Addressing political and racial terror in the therapeutic relationship

Tummala-Narra P

2005

Community-based interventions in New York City after 9/11

Waizer J, Dorin A, Stoller E, et al

2005

The pentagon and 9/11

Wang D, Sava J, Sample G, et al

2005

Estimating the effects of September 11th and other forms of violence on the mental health and social development of New York City's youth: A matter of context

Aber JLG, Elizabeth T: Ware, Angelica: Kotler, Jennifer A

2004

Effect of the September 11, 2001 terrorist attacks on death anxiety in university students

Campbell D and Felts WM

2004

Creative use of focus groups: Providing healing and support to NYC chinatown residents after the 9/11 attacks

Chung I

2004

Modeling air pollution from the collapse of the World Trade Center and assessing the potential impacts on human exposures

Huber A, Georgopoulos P, Gilliam R, et al

2004

Disaster at a distance: Impact of 9.11.01 televised news coverage on mothers' and children's health

Kennedy C, Charlesworth A, and Chen JL

2004

Physical health status of World Trade Center rescue and recovery workers and volunteers - New York City, july 2002-august 2004

Levin S, Herbert R, Moline JM, et al

2004

Assessment of inhalation exposures and potential health risks that resulted from the collapse of the World Trade Center

Lorber M, Gibb H, Grant L, et al.

2004

Clinic record review of pediatric asthmatic patients after September 11, 2001, does not support authors' conclusions

Matte TD and Mostashari F

2004

Wind tunnel simulation of flow and pollutant dispersal around the World Trade Center site

Perry SG, Heist DK, Thompson RS, et al

2004

Psychological impact of the September 11, 2001 terrorist attacks

Schlenger WE

2004

Gender related correlates of posttraumatic stress symptoms in a World Trade Center tragedy sample

Sciancalepore R and Motta RW

2004

Coping with disasters: Estimation of additional capacity of the mental health sector to meet extended service demands

Siegel C, Wanderling J, and Laska E

2004

BACKGROUND: The September 11th disaster in New York City resulted in an increase in mental health service delivery as a vast network of providers responded to the urgent needs of those impacted by the tragedy. Estimates of current capacity, potential additional capacity to deliver services and of potential shortfall within the mental health sector are needed pieces of information for planning the responses to future disasters. AIMS OF THE STUDY: Using New York State data, to determine the distribution of clinical service delivery rates among programs and to examine an explanatory model of observed variation; to estimate potential additional capacity in the mental health sector; and to estimate shortfall based on this capacity and data from studies on the need and use of services post September 11th METHODS: Empirical distributions of weekly clinical service delivery rates in programs likely to be used by persons with post disaster mental health problems were obtained from available data. Three regression models were fit to explain rate variation in terms of unmodifiable program characteristics likely to impact the rates. We argue that rates could not be easily increased if any of the models had good explanatory power, and could be increased if it did not. All models had poor fit. We then assumed that the median and 75th percentile of the clinical service delivery rates were candidates for the minimum production capability of a clinician. The service rates of those clinicians whose rates fell below these quartiles were increased to the quartile value to yield estimates of potential additional capacity. These were used along with data on clinical need to estimate shortfall. RESULTS: There is substantial variation in clinical service delivery rates within impact regions and among programs serving different age populations. The estimate of the percent increase in services overall based on the median is 12% and based on the 75th percentile is 27%. Using an estimate of need of.03 suggested by available data, and a range of services (1-10) that might be required in a six month period, shortfall estimates based on the median ranged between 22-92% and for the 75th percentile from no shortfall to 86%. A less conservative estimate of need of.05 produces median shortfall ranging between 59-96% and for the 75th percentile between 10-91%. LIMITATIONS: While the program descriptor variables used in the explanatory model of rates were those most likely to impact rates, explanatory power of the model might have increased if other characteristics that are not modifiable had been included. In this case, the assumption that service production can be increased is called into question. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: In the first six months post September 11th, in New York State (NYS) 250,000 persons received crisis counseling through Project Liberty. In 1999, NYS served approximately that same number in mental health clinic programs during the entire year. The estimates of this study suggest that additional funding and personnel are needed to provide mental health services in the event of a major disaster. IMPLICATIONS FOR HEALTH POLICIES: A disaster plan is needed to coordinate the use of current and additional personnel including mental health resources from other sources and sectors.

Mental health status of World Trade Center rescue and recovery workers and volunteers - New York City, july 2002-august 2004

Smith R, Katz CL, Holmes A, et al

2004

At a glance review of conflict of interest allegations pertaining to the peer review of EPA's draft report, exposure and human health evaluation of airborne pollution from the World Trade Center disaster

U.S. Environmental Protection Agency Office of Inspector General

2004

Environmental research in response to 9/11 and homeland security

Vette A, Gavett S, Perry S, et al.

2004

Air pollution measurements in the vicinity of the World Trade Center

Vette A, Seila R, Swartz E, et al

2004

Cognitive complexity in response to traumatic experiences

Woike B and Matic D

2004

EPA’s response to the World Trade Center collapse: Challenges, successes, and areas for improvement

Beusse R, Gilmore D, Hatfield J, et al.

2003

World Trade Center background study report : Interim final (indoor dust sampling)

Callahan, Kathleen C.

2003

The objective of this Background Study was to determine and/or estimate indoor basehne levels or background concentrations for the presence of specific contaminants related to bmldmg matenals and combustion byproducts that may be released when building materials are burned during a fire. The background concentrations denved from this Study will be used to supplement the healthbased benchmarks established in the "World Trade Center Indoor Air Assessment· Selectmg Contaminants of Potential Concern and Setting Health-Based Benchmarks" document and were identified as a potential source of alternate cleanup values if the health-based benchmarks were not able to be achieved The selected Contammants of Potential Concern (COPC) mcludes asbestos, lead, dioxms, polycyclic aromatic hydrocarbons (PAHs), fibrous glass and minerals including crystallme sihca (i.e., a-quartz, cnstobalite, tndymite), calcite, gypsum, and portlandite. The number ofbuildmgs, residences and common spaces samples were determined by what could practJcally be achieved to avoid impeding the proJect. The geographical area for the Background Study (78th Street and North) was selected based on prehmmary modelmg of meteorological data on September 11, 2001 and shortly thereafter. The modeling was perfonned by EPA's Office of Research and Development The distance ofbmldmgs sampled in the Study with respect to the WTC site ranges from 8 to 19 kilometers (5 to 12 miles). Sarnplmg was conducted m fourteen residential bmldmgs not impacted by the airborne dust plume which emanated from the WTC site. When possible, samples were collected from two residential umts and from one common area, such as the lobby, hallway, stairwell, or bmldmg laundry facility, in each bmlding. In total EPA sampled twenty-five residential umts and nine common areas withm the fourteen buildings. Results of the Background Study are discussed in general terms and are not specific to the umts sampled. The analytical data for each sample collected were evaluated for mdividual apartments and cumulatively in data sets (e.g., asbestos wipe sample data for residential dwellings, common spaces and a combined data set for residential and common spaces) to denve a background concentrat10n that is representative for Manhattan. The evaluation for individual apartments compared the reported results for each sample to the health-based criteria developed in the "World Trade Center Indoor Air Assessment: Selecting Contarnmants of Potential Concern and Setting Health-Based Benchmarks" report. The analytical data was presented in tabular format for each apartment with text that explains the reported results. Any detected concentration that exceeded the health-based benchmarks were discussed in detail in writing and orally when requested by owner. Cumulatively, the data were statistically evaluated in this report to provide a mean, standard deviation, minimum and maximum. For each analyte and sample media, a concentration representative of background for Manhattan has been calculated (see table below) These background concentrations will be used to supplement the health-based benchmarks estabhshed in the "World Trade Center Indoor Au Assessment: Selecting Contaminants of Potential Concern and Settmg Health-Based Benchmarks" report and may be used as an alternative cleanup value if the health-based benchmark cannot be achieved.

Large group crisis intervention for law enforcement in response to the September 11 World Trade Center mass disaster

Castellano C

2003

Two New York City hospitals' surgical response to the September 11, 2001, terrorist attack in New York City

Cushman JG, Pachter HL, and Beaton HL

2003

BACKGROUND: We describe the surgical response of two affiliated hospitals during the day of, and week following, the September 11th, 2001 terrorist attack at the World Trade Center in New York City. The city of New York has 18 state designated regional trauma centers that receive major trauma victims. The southern half of Manhattan is served by a burn center, two regional trauma centers, and a community hospital that is an affiliate of one of the regional trauma centers. This report accounts for the surgical response by a regional trauma center (Hospital A, located 2.5 miles from the World Trade Center) and its affiliate hospital (Hospital B, located 5 city blocks from the World Trade Center) on September 11th when two commercial jets crashed into the Twin Towers at the World Trade Center mall., METHODS: Hospital A maintained a concurrent log of patients received during the first 5 hours, the first day, and the first week after the disaster which was kept by the Surgical Triage Officer. The trauma registry completed and verified this data by September 18th. Hospital B collected its data by hand counting and verification by chart review. Both hospitals, A and B, had established disaster plans that were implemented., RESULTS: Nine hundred eleven patients were received by two affiliated hospitals from the World Trade Center attack. Seven hundred seventy six patients (85%) were walking wounded, sustaining mild inhalation and eye irritant injuries. One hundred thirty five (15%) were admitted with 18 (13%) of these undergoing surgery. Twenty two of the 23 transfers were from the community hospital to specialized orthopedic or burn centers. Of the 109 patients admitted to Hospital A, 30 were to the surgical service. The mean ISS score of these patients was 12. There were 4 deaths (within minutes of arrival at the hospital) and 6 delayed deaths (day 1-14). Excluding walking wounded and DOAs, the critical mortality rate was 37.5% overall., CONCLUSION: The September 11th, 2001, terrorist attack in New York City, involving two commercial airliners crashing into the World Trade Center, led to 911 patients received at two affiliated hospitals in lower Manhattan. One hospital is a regional trauma center and one was an affiliate community hospital. Eighty five percent of the patients received were walking wounded. Of the rest, 13% underwent surgical procedures with an overall critical mortality rate of 37.5%.

Information on fema’s post 9/11 public assistance to the New York City area

Hecker J

2003

Potential exposures to airborne and settled surface dust in residential areas of lower Manhattan following the collapse of the World Trade Center--New York City, november 4-December 11, 2001 (mmwr)

MMWR

2003

Interim final WTC residential confirmation cleaning study. Volume 1

Nebelsick J and Smith T

2003

Environmental data trend report World Trade Center disaster final update - trends for data collected 9/11/01 to 4/24/02 from lower Manhattan

Quality Assurance Technical Support Program Shaw Environmental, Inc. Prepared for the USEPA

2003

Identification and characterization of World Trade Center disaster fine particulate matter air pollution at a site in lower Manhattan following September 11.: Isee-432

Thurston G, Maciejczyk P, Lall R, et al.

2003

In the weeks following the World Trade Center (WTC) Disaster in New York City (NYC), it was presumed by many that particulate matter (PM) air pollution in Lower Manhattan was dominated by pollution from Ground Zero. But NYC is a city with numerous pollution sources. So we sought to determine the nature and mass contribution of fine particulate matter (PM2.5) measured at a community-oriented site in Lower Manhattan that was associated with the WTC dust and combustion plume. We analyzed PM2.5 samples collected once or twice daily by our monitor at the NYU Downtown Hospital, located some 5 blocks east of Ground Zero, from Sept 14 through December, 2001. Each sample was analyzed for trace elements via X-ray Fluorescence and for elemental carbon (EC) via reflectance. Positive Matrix Factorization (PMF) source apportionment analysis was applied to determine the PM components contributing to the ambient PM2.5 measured in September-December, 2001. The PMF identified 5 PM2.5 source components: 1) the WTC fire's plume (S, Cl, K, Cu, Zn, Pb, EC); 2) the WTC Collapse-related Dust (Mn, Cr, EC); 3) WTC Demolition-related Dust (S, Si, Ca, Ti, Fe); 4) oil combustion particles (S, V, EC); and, 5) soil (Al, Fe). Time-series plots of the source factor impacts indicate that the WTC fire plume impact were maximum during September, diminishing greatly during October. In mid-October, the demolition operations dust increased as the rescue operations ended and the clean-up began, and then decreased greatly during November. Oil combustion was a large contributor to PM2.5 throughout the entire study period, regardless of WTC emissions. PM2.5 concentrations at this site averaged 35 ug/m3 during late September, and some 23 ug/m3 during the month of October, while during November and December levels returned to more usual NYC levels (18 and 14 ug/m3, respectively). Analyses of the source contributions indicated that the WTC-related sources (Factors 1–3) contributed some 54% of the PM2.5 pollution at this site in Lower Manhattan during September 14–30th, 29% in October, 16% in November, and only 5% in December. While the WTC pollution added greatly to the PM2.5 levels in lower Manhattan in September, it had a diminishing impact on this pollutant in the following months, and non-WTC sources of PM2.5 (such as fuel oil burning) were also major contributors to pollution in Lower Manhattan throughout the entire period. While the WTC pollution added significantly to the PM2.5 impacts in Lower Manhattan in the weeks following 9/11, any analysis of fine PM outdoor exposures seeking to assess the impacts of the WTC Disaster must also consider non-WTC PM2.5 sources. Research Supported by: The NYU-NIEHS Environmental Health Center (ES00260) and the NYU-EPA Particulate Matter Health Research Center (R827351). n

After action report on the response to the September 11 terrorist attack on the pentagon

Titan Systems Corp. (document was prepared for Arlington County Virginia)

2003

Although the terrorist attack occurred in Arlington County, VA, the target was a U.S. military facility under the direct control of the Secretary of Defense. The response to the attack involved a large number of agencies, organizations, and individuals from all levels of government and the private sector, and it lasted for an extended period of time. This AAR consists primarily of descriptions of the response, rescue, and recovery activities as perceived and recounted by the responders at all levels and by representatives of all participating organizations. The AAR project team conducted 92 separate debriefing sessions and interviewed approximately 475 participants. The AAR is organized into four annexes and four supporting appendices. An annex on fire department operations encompasses all aspects of fire, rescue, and emergency medical services activities performed by Arlington County, as well as supporting jurisdictions, agencies, and organizations that operated under mutual-aid or similar provisions. The annex that focuses on hospitals and clinics describes the response of medical treatment centers throughout the Washington Metropolitan Area, including hospitals, urgent care centers, and military health clinics. The annex on law enforcement describes the activities of those law enforcement agencies that shared primary jurisdictional responsibilities for the attack, i.e., the Arlington County Police Department, the Defense Protective Service, and the Federal Bureau of Investigation, as well as many other law enforcement organizations that provided response support. The annex on the emergency management and the emergency operations center presents the activities of the Arlington County Government in support of the first responders and citizens of the county. The standard format of each annex consists of observations of what occurred, findings regarding what was learned from the perspectives of responders, and recommendations and lessons learned that can lead to improvements in responding to disasters. 23 figures and appended 24-hour timeline, data reference directory, and Pentagon penetration damage diagrams

Shared trauma

Tosone C, Lee M, Bialkin L, et al

2003

Factors influencing experienced distress and attitude toward trauma by emergency medicine practitioners

Warren T, Lee S, and Saunders S

2003

Exposure and human health evaluation of airborne pollution from the World Trade Center disaster

Alapas GW

2002

Penetrating axillary trauma in a survivor of the World Trade Center disaster

Albert P, Del Prado D, Karidas S, et al

2002

Bystander trauma in the World Trade Center disaster

Albert P, Handel J, Yeghiayan P, et al

2002

The children's war: Their reactions to devastating events

Atwood JD and Donnelly JW

2002

Injuries and illnesses among New York City fire department rescue workers after responding to the World Trade Center attacks

Banauch G, Mclaughlin M, Hirschorn R, et al

2002

Impact of September 11 attacks on workers in the vicinity of the World Trade Center--New York City

Centers for Disease Control and Prevention

2002

Deaths in World Trade Center terrorist attacks--New York City, 2001

Centers for Disease Control and Prevention

2002

Syndromic surveillance for bioterrorism following the attacks on the World Trade Center--New York City, 2001

Centers for Disease Control and Prevention

2002

Community needs assessment of lower Manhattan residents following the World Trade Center attacks--Manhattan, New York City, 2001

Centers for Disease Control and Prevention

2002

Psychological and emotional effects of the September 11 attacks on the World Trade Center--connecticut, new jersey, and New York, 2001

Centers for Disease Control and Prevention

2002

Self-reported increase in asthma severity after the September 11 attacks on the World Trade Center--manhattaan, New York, 2001

Centers for Disease Control and Prevention

2002

From the centers for disease control and prevention. Occupational exposures to air contaminants at the World Trade Center disaster site--New York, September-october 2001

Centers for Disease Control and Prevention

2002

The occupational safety and health administration's response to the World Trade Center attack

Clark P

2002

Nursing at ground zero: Experiences during and after September 11 World Trade Center attack

Dickerson SS, Jezewski MA, Nelson-Tuttle C, et al

2002

Toxicological effects of fine particulate matter derived from the destruction of the World Trade Center

Gavett SH

2002

Best practices: Terrorism and mental health: Private-sector responses and issues for policy makers

Goldman W

2002

In the shadows of terror: A community neighboring the World Trade Center disaster uses art therapy to process trauma

Gonzalez-Dolginko B

2002

Treating survivors of the World Trade Center terrorist attacks of September 11, 2001

Grossman R and Yehuda R

2002

Psychoeducational debriefings after the September 11 disaster

Herman R, Kaplan M, and LeMelle S

2002

Effects of the World Trade Center attack on NYC public school students: Initial report to the New York City Board of Education

Hoven CW, Duarte CS, Lucas CP, et al

2002

Providing crisis counseling to New Yorkers after the terrorist attack on the World Trade Center

Jordan K

2002

World Trade Center disaster effect on blood pressure

Lipsky SI, Pickering TG, and Gerin W

2002

If we had known then what we know now: A review of local and national surveys following September 11, 2001

Marshall RD

2002

Affirming flames: Debriefing survivors of the World Trade Center attack

Miller J

2002

Final technical report of the public health investigation to assess potential exposures to airborne and settled surface dust in residential areas of lower Manhattan

NYC Health Department, USPHS, ATSDR

2002

From November 4 through December 11, 2001, environmental samples were collected in and around 30 residential buildings in lower Manhattan. In addition, four buildings above 59th Street were sampled and used as a comparison area for this investigation. The New York City Department of Health and Mental Hygiene (NYC DOHMH) and the U.S. Agency for Toxic Substances and Disease Registry (ATSDR) conducted this limited investigation with support and collaboration from the U.S. Public Health Service Commissioned Corps Readiness Force and the World Trade Center Environmental Assessment Working Group. The purpose of the sampling was to assess the composition of both outdoor and indoor settled surface and airborne dust within residential areas around the World Trade Center. This information was used to help determine whether additional public health actions are needed to address any remaining World Trade Center-related dust inside residential areas. The information collected could also be used to compare the findings from the locations that were known or were likely to have received dust directly from the collapse of the World Trade Center towers, to findings from areas that were unlikely to have received dust directly from the disaster (comparison areas).; Attention was given to those materials reasonably expected to be in the original dust cloud and in dust generated by ongoing activities at the World Trade Center. The focus was on building materials that have been shown to have irritant properties (e.g., synthetic vitreous fibers [SVF] and gypsum) and be associated with long-term health concerns (i.e., crystalline silica and asbestos). The samples collected during this investigation were analyzed for the following materials: asbestos, SVF, mineral components of concrete (crystalline silica, calcite, and portlandite), and mineral components of building wallboard (gypsum, mica, and halite). Efforts were made to get as much information as possible with the sampling that could be conducted, given accessibility and equipment limitations.; Results from this investigation do not necessarily reflect conditions that would be found in other buildings, at other times just following the collapse, or after the sampling period. The measurements reflect conditions present at the time of the sampling (November 4– December 12, 2001) in the buildings and areas sampled. The limited number of results obtained from the comparison areas above 59th Street was an attempt to determine the New York City–specific background levels of asbestos, SVF, mi neral components of concrete (quartz, calcite, and portlandite), and mineral components of building wallboard (gypsum, mica, and halite).

Psychological reactions to terrorist attacksfindings from the national study of americans' reactions to September 11

Schlenger WE, Caddell JM, Ebert L, et al

2002

ContextThe terrorist attacks of September 11, 2001, represent an unprecedented exposure to trauma in the United States.ObjectivesTo assess psychological symptom levels in the United States following the events of September 11 and to examine the association between postattack symptoms and a variety of indices of exposure to the events.DesignWeb-based epidemiological survey of a nationally representative cross-sectional sample using the Posttraumatic Stress Disorder (PTSD) Checklist and the Brief Symptom Inventory, administered 1 to 2 months following the attacks.Setting and ParticipantsSample of 2273 adults, including oversamples of the New York, NY, and Washington, DC, metropolitan areas.Main Outcome MeasuresSelf-reports of the symptoms of PTSD and of clinically significant nonspecific psychological distress; adult reports of symptoms of distress among children living in their households.ResultsThe prevalence of probable PTSD was significantly higher in the New York City metropolitan area (11.2%) than in Washington, DC (2.7%), other major metropolitan areas (3.6%), and the rest of the country (4.0%). A broader measure of clinically significant psychological distress suggests that overall distress levels across the country, however, were within expected ranges for a general community sample. In multivariate models, sex, age, direct exposure to the attacks, and the amount of time spent viewing TV coverage of the attacks on September 11 and the few days afterward were associated with PTSD symptom levels; sex, the number of hours of television coverage viewed, and an index of the content of that coverage were associated with the broader distress measure. More than 60% of adults in New York City households with children reported that 1 or more children were upset by the attacks.ConclusionsOne to 2 months following the events of September 11, probable PTSD was associated with direct exposure to the terrorist attacks among adults, and the prevalence in the New York City metropolitan area was substantially higher than elsewhere in the country. However, overall distress levels in the country were within normal ranges. Further research should document the course of symptoms and recovery among adults following exposure to the events of September 11 and further specify the types and severity of distress in children.

Elevated tritium levels at the World Trade Center

Semkow TM, Hafner RS, Parekh PP, et al.

2002

Firefighter safety and health issues at the World Trade Center site

Spadafora R

2002

Children of victims of September 11th: A perspective on the emotional and developmental challenges they face and how to help meet them

Swick SD, Jellinek MS, Dechant E, et al

2002

Returning to the Pentagon: The use of mass desensitization following the September 11, 2001 attack

Waldrep D and Waits W

2002

Toward an analysis of the September 11, 2001 terrorist event from the holistic, developmental, systems-oriented perspective

Wapner S and Wapner JG

2002

Summary report: Characterization of particulate found in apartments after destruction of the World Trade Center

Chatfield EJ and Kominsky JR

2001

Environmental studies of the World Trade Center area after the September 11, 2001 attack.

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