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

BACKGROUND: Effects of the World Trade Center (WTC) disaster on children's respiratory health have not been definitively established. OBJECTIVE: This report describes respiratory health findings among children who were < 18 years of age on 11 September 2001 (9/11) and examine associations between disaster-related exposures and respiratory health. METHODS: Children recruited for the WTC Health Registry (WTCHR) included child residents and students (kindergarten through 12th grade) in Manhattan south of Canal Street, children who were south of Chambers Street on 9/11, and adolescent disaster-related workers or volunteers. We collected data via computer-assisted telephone interviews in 2003-2004, with interview by adult proxy for children still < 18 years of age at that time. We compared age-specific asthma prevalence with National Health Interview Survey estimates. RESULTS: Among 3,184 children enrolled, 28% were < 5 years of age on 9/11; 34%, 5-11 years; and 39%, 12-17 years. Forty-five percent had a report of dust cloud exposure on 9/11. Half (53%) reported at least one new or worsened respiratory symptom, and 5.7% reported new asthma diagnoses. Before 9/11, age-specific asthma prevalence in enrolled children was similar to national estimates, but prevalence at interview was elevated among enrollees < 5 years of age. Dust cloud exposure was associated with new asthma diagnosis (adjusted odds ratio = 2.3; 95% confidence interval, 1.5-3.5). CONCLUSIONS: Asthma prevalence after 9/11 among WTCHR enrollees < 5 years of age was higher than national estimates, and new asthma diagnosis was associated with dust cloud exposure in all age groups. We will determine severity of asthma and persistence of other respiratory symptoms on follow-up surveys.

Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks.

Manhattan residents living near the World Trade Center may have been particularly vulnerable to posttraumatic stress disorder (PTSD) after the September 11, 2001 (9/11) terrorist attacks. In 2003-2004, the authors administered the PTSD Checklist to 11,037 adults who lived south of Canal Street in New York City on 9/11. The prevalence of probable PTSD was 12.6% and associated with older age, female gender, Hispanic ethnicity, low education and income, and divorce. Injury, witnessing horror, and dust cloud exposure on 9/11 increased risk for chronic PTSD. Postdisaster risk factors included evacuation and rescue and recovery work. The results indicate that PTSD is a continued health problem in the local community. The relationship between socioeconomic status and PTSD suggests services must target marginalized populations. Followup is necessary on the course and long-term consequences of PTSD.

Measuring and maximizing coverage in the World Trade Center Health Registry.

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.

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

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.

Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11.

CONTEXT: The terrorist attacks of September 11, 2001, represent an unprecedented exposure to trauma in the United States. OBJECTIVES: To 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. DESIGN: Web-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 PARTICIPANTS: Sample of 2273 adults, including oversamples of the New York, NY, and Washington, DC, metropolitan areas. MAIN OUTCOME MEASURES: Self-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. RESULTS: The 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. CONCLUSIONS: One 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.