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To Mark the 20th Anniversary of 9/11: Long-Term Health Effects
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To Mark the 20th Anniversary of 9/11: Long-Term Health Effects

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 30797

Special Issue Editors

Dr. Robert M. Brackbill

E-Mail Website
Guest Editor
Director of Research, World Trade Center Health Registry, Division of Epidemiology, Department of Health and Mental Hygiene, 125 Worth St, Floor 10, New York City, NY 10013, USA
Interests: 9/11; public health; environmental epidemiology; psychiatric epidemiology; long term health effects of disaster related trauma; disaster preparedness
Special Issues, Collections and Topics in MDPI journals
Dr. Howard E. Alper

E-Mail Website
Guest Editor
New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA
Interests: statistical methods to elucidate the health effects of the 9/11 attacks
Dr. Rachel Zeig-Owens

E-Mail Website
Guest Editor
1. The World Trade Center (WTC) Health Program, Fire Department of the City of New York/Montefiore Medical Center, Brooklyn, NY 11201, USA
2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
Interests: cancer epidemiology; occupational health; longitudinal studies

Special Issue Information

Dear Colleagues,

The International Journal of Environmental Research and Public Health is planning on publishing a Special Issue to mark the 20th Anniversary of the 9/11/2001 attacks on the World Trade Center. This is a follow-up of a 2019 Special Issue entitled “Long-Term Health Effects of the 9/11 Disaster”, which included 24 papers on this topic, and a 2020 Special Issue. We look forward to providing an additional opportunity for researchers to continue to document the long-term physical and mental health issues that plague people who were exposed to environmental pollutants and trauma related to the 9/11 disaster. The first aim of the second edition is to highlight research on non-rescue/recovery workers, which includes residents of downtown Manhattan, people who worked in the area on 9/11/2001, passersby, and people who were children on 9/11/2001, enrolled in schools, or school staff. The second aim includes a continued explication of the ongoing interactions between physical and mental health (especially PTSD), aging-related conditions, advances in the treatment of 9/11 conditions, the longitudinal course of previously reported conditions, and potential emerging conditions (e.g., heart disease, autoimmune diseases, cognitive impairment, cancer, and late sequelae). Quality of life, functioning, and unmet health care needs would also be in the purview of this Special Issue on the 9/11 disaster. The third aim includes the investigation of the occurrence and consequences of positive experiences related to the 9/11 disaster, such as post-traumatic growth.

Dr. Robert M. Brackbill
Dr. Howard E. Alper
Dr. Rachel Zeig-Owens
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • 9/11 disaster
  • physical and mental health
  • PTSD
  • pulmonary dysfunction
  • quality of life

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Published Papers (16 papers)

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17 pages, 1984 KiB  
Article
Characteristics of Cancers in Community Members Exposed to the World Trade Center Disaster at a Young Age
by Rebecca Lynn Florsheim, Qiao Zhang, Nedim Durmus, Yian Zhang, Sultan Pehlivan, Alan A. Arslan, Yongzhao Shao and Joan Reibman
Int. J. Environ. Res. Public Health 2022, 19(22), 15163; https://doi.org/10.3390/ijerph192215163 - 17 Nov 2022
Viewed by 1119
Abstract
The destruction of the World Trade Center (WTC) towers on 11 September 2001 (9/11) released tons of dust and smoke into the atmosphere, exposing hundreds of thousands of community members (survivors) and responders to carcinogens. The WTC Environmental Health Center (WTC EHC) is [...] Read more.
The destruction of the World Trade Center (WTC) towers on 11 September 2001 (9/11) released tons of dust and smoke into the atmosphere, exposing hundreds of thousands of community members (survivors) and responders to carcinogens. The WTC Environmental Health Center (WTC EHC) is a federally designated surveillance and treatment program for community members who were present in the New York City disaster area on 9/11 or during the months that followed. WTC EHC enrollment requires exposure to the WTC dust and fumes and a federally certifiable medical condition, which includes most solid and blood cancers. Several studies have described the prevalence and characteristics of cancers in responders and survivors exposed to the WTC dust and fumes as adults. Cancers in those exposed at a young age warrant specific investigation since environmental toxin exposure at a younger age may change cancer risk. We describe the characteristics of 269 cancer patients with 278 cancer diagnoses among WTC EHC enrollees who were young in age (aged 0 to 30) on 9/11. These include 215 patients with a solid tumor (79.9%) and 54 with a lymphoid and/or hematopoietic cancer (20.1%). Among them, 9 patients had a known second primary cancer. A total of 23 different types of cancer were identified, including cancer types rare for this age group. Many were diagnosed in individuals lacking traditional cancer-specific risk factors such as tobacco use. The current study is the first to report specifically on cancer characteristics of younger enrollees in the WTC EHC program. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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7 pages, 292 KiB  
Article
Long-Term Lower Respiratory Symptoms among World Trade Center Health Registry Enrollees Following Hurricane Sandy
by Sean H. Locke, Lisa M. Gargano, Howard E. Alper and Jennifer Brite
Int. J. Environ. Res. Public Health 2022, 19(21), 13738; https://doi.org/10.3390/ijerph192113738 - 22 Oct 2022
Viewed by 1111
Abstract
Several studies showed an association between lower respiratory tract symptoms (LRS) and exposure to the 9/11 terrorist attack. However, few studies have examined the long-term impact of natural disasters on those with prior respiratory distress. The present study aims to assess the impact [...] Read more.
Several studies showed an association between lower respiratory tract symptoms (LRS) and exposure to the 9/11 terrorist attack. However, few studies have examined the long-term impact of natural disasters on those with prior respiratory distress. The present study aims to assess the impact of Hurricane Sandy on persistent LRS among people exposed to the World Trade Center (WTC) terrorist attack. The analytic sample consisted of WTC Health Registry enrollees who completed survey waves 1, 3, and 4 and the Hurricane Sandy Survey and did not report LRS before the WTC terrorist attack. The log binomial was used to assess the association between the impact of Hurricane Sandy and persistent LRS. Of 3277 enrollees, 1111 (33.9%) reported persistent LRS post-Sandy. Participants of older age, males, lower household income, current smokers, and those with previous asthma were more likely to report persistent LRS. In separate adjusted models, multiple Sandy-related inhalation exposures (relative risk (RR): 1.2, 95% CI: 1.06–1.37), Sandy-related PTSD (RR: 1.27, 95% CI: 1.15–1.4), and Sandy LRS (RR: 1.64, 95% CI: 1.48–1.81) were associated with persistent LRS post-Sandy. Our findings suggest that respiratory protection is important for everyone performing reconstruction and clean-up work after a natural disaster, particularly among those with previous respiratory exposures. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
15 pages, 1498 KiB  
Article
Scientific Value of the Sub-Cohort of Children in the World Trade Center Health Registry
by Robert M. Brackbill, Emma Butturini, James E. Cone, Ayda Ahmadi, Robert D. Daniels, Mark R. Farfel and Travis Kubale
Int. J. Environ. Res. Public Health 2022, 19(19), 12461; https://doi.org/10.3390/ijerph191912461 - 30 Sep 2022
Viewed by 1447
Abstract
The World Trade Center Health Registry (WTCHR) was established in 2002 as a public health resource to monitor the health effects from the World Trade Center (WTC) disaster. We evaluated the representativeness of the WTC youth population (<18 years on 11 September 2001) [...] Read more.
The World Trade Center Health Registry (WTCHR) was established in 2002 as a public health resource to monitor the health effects from the World Trade Center (WTC) disaster. We evaluated the representativeness of the WTC youth population (<18 years on 11 September 2001) by comparing the distributions of age, gender, race/ethnic groups, and income to 2000 census data for the matched geographic area, including distance from disaster. There were 2379 WTCHR enrolled children living in Lower Manhattan south of Canal Street on 11 September 2001, along with 752 enrolled students who attended school in Lower Manhattan but were not area residents. The WTCHR sub-group of children who were residents was similar to the geographically corresponding census population on age and sex. Black and Hispanic children are moderately overrepresented at 0.9% and 2.4% in the WTCHR compared to 0.8% and 1.7% in census population, respectively, while lower-income households are slightly under-represented, 28.8% in the WTCHR and 30.8% for the corresponding census information. Asian children appear underrepresented at 3.0% participation compared to 6.3% in the census. While the demographics of WTCHR youth are somewhat skewed, the gaps are within expected patterns of under-representation observed in other longitudinal cohorts and can be effectively addressed analytically or through targeted study design. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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11 pages, 360 KiB  
Article
Post-Traumatic Growth and Quality of Life among World Trade Center Health Registry Enrollees 16 Years after 9/11
by Howard E. Alper, Leen Feliciano, Lucie Millien, Cristina Pollari and Sean Locke
Int. J. Environ. Res. Public Health 2022, 19(15), 9737; https://doi.org/10.3390/ijerph19159737 - 08 Aug 2022
Viewed by 1508
Abstract
A recent study of World Trade Center Health Registry enrollees found that about one-third experienced post-traumatic growth (PTG) in the wake of the 9/11 attacks and that PTG was associated with social support and social integration. However, the implications of PTG for the [...] Read more.
A recent study of World Trade Center Health Registry enrollees found that about one-third experienced post-traumatic growth (PTG) in the wake of the 9/11 attacks and that PTG was associated with social support and social integration. However, the implications of PTG for the enrollees’ overall quality of life are unknown. The present study investigated the prevalence of PTG and its association with the SF-12 physical and mental functioning quality of life scales in a sample of 4760 enrollees from the Registry’s Health and Quality of Life Study (HQoL) who completed the first four surveys, were older than 18 on 9/11, reported English as their primary spoken language, and provided consistent self-report of 9/11 physical injury at the Registry’s baseline and HQoL surveys. We employed multivariable linear regression to evaluate the association between PTG and the SF-12 physical and mental scales, controlling for sociodemographic and other variables. We found that 31% of the sample enrollees experienced PTG and that PTG exhibited a clinically and statistically significant association with the SF-12 mental scale but not the physical scale (physical: b = 0.15 (−0.45, 0.75), mental: b = 3.61 (2.85, 4.37)). Those who were physically injured during 9/11 showed larger improvements in mental functioning than those who were not. PTG has implications for the overall mental quality of life that should be further investigated. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
8 pages, 635 KiB  
Article
Risk Factors for COVID-19 in a Retired FDNY WTC-Exposed Cohort
by Krystal L. Cleven, Rachel Zeig-Owens, David G. Goldfarb, Theresa Schwartz and David J. Prezant
Int. J. Environ. Res. Public Health 2022, 19(15), 8891; https://doi.org/10.3390/ijerph19158891 - 22 Jul 2022
Viewed by 1022
Abstract
We evaluated the incidence and risk factors for COVID-19 in a prospectively followed cohort of Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed workers, thus reducing the potential for selection bias, a limitation in published studies of hospitalized [...] Read more.
We evaluated the incidence and risk factors for COVID-19 in a prospectively followed cohort of Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed workers, thus reducing the potential for selection bias, a limitation in published studies of hospitalized individuals. Participants were retired FDNY WTC-exposed rescue/recovery workers with ≥1 medical visit between 1 March 2020 and 1 August 2021. The cumulative incidence was calculated using self-reported COVID-19 diagnoses. Cox regression was performed to evaluate the association of WTC-exposure and COVID-19, adjusting for history of comorbidities, age, race, work assignment (emergency medical service providers vs. firefighter), and sex. The cumulative incidence of COVID-19 was 130 per 1000. The adjusted models showed the risk of infection was greater in those with highest WTC exposure versus less exposure (hazard ratio (HR) = 1.14 (95% CI 1.00–1.31)). Older age was associated with a lower risk of infection HR = 0.97 (95% CI 0.96–0.98). WTC-associated diseases (obstructive airways disease and interstitial lung disease) were not COVID-19 risk factors. This study is the first to show an association between WTC exposure and the risk of COVID-19. While participants are retired from FDNY work, the youngest individuals may still be in the workforce, explaining why younger age was a significant risk for COVID-19. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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16 pages, 621 KiB  
Article
Posttraumatic Stress Disorder Mediates the Association between Traumatic World Trade Center Dust Cloud Exposure and Ongoing Systemic Inflammation in Community Members
by Yian Zhang, Rebecca Rosen, Joan Reibman and Yongzhao Shao
Int. J. Environ. Res. Public Health 2022, 19(14), 8622; https://doi.org/10.3390/ijerph19148622 - 15 Jul 2022
Cited by 2 | Viewed by 1862
Abstract
Exposure to World Trade Center (WTC) dust/fumes and traumas on 11 September 2001 has been reported as a risk factor for post-traumatic stress disorder (PTSD) and other mental/physical health symptoms in WTC-affected populations. Increased systemic inflammation and oxidative stress from the exposure and [...] Read more.
Exposure to World Trade Center (WTC) dust/fumes and traumas on 11 September 2001 has been reported as a risk factor for post-traumatic stress disorder (PTSD) and other mental/physical health symptoms in WTC-affected populations. Increased systemic inflammation and oxidative stress from the exposure and subsequent illnesses have been proposed as contributors to the underlying biological processes. Many blood-based biomarkers of systemic inflammation, including C-reactive protein (CRP), are useful for non-invasive diagnostic and monitoring of disease process, and also potential targets for therapeutic interventions. Twenty years after 9/11, however, the relationships between WTC exposure, chronic PTSD, and systemic inflammation are only beginning to be systematically investigated in the WTC-affected civilian population despite the fact that symptoms of PTSD and systemic inflammation are still common and persistent. This paper aims to address this knowledge gap, using enrollees of the WTC Environmental Health Center (EHC), a federally designated treatment and surveillance program for community members (WTC Survivors) exposed to the 9/11 terrorist attack. We conducted a mediation analysis to investigate the association between acute WTC dust cloud traumatic exposure (WDCTE) on 9/11, chronic PTSD symptoms, and levels of systemic inflammation. The data indicate that the chronic PTSD symptoms and some specific symptom clusters of PTSD significantly mediate the WDCTE on systemic inflammation, as reflected by the CRP levels. As both chronic PTSD and systemic inflammation are long-term risk factors for neurodegeneration and cognitive decline, further research on the implications of this finding is warranted. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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18 pages, 2392 KiB  
Article
Molecular Clustering Analysis of Blood Biomarkers in World Trade Center Exposed Community Members with Persistent Lower Respiratory Symptoms
by Gabriele Grunig, Nedim Durmus, Yian Zhang, Yuting Lu, Sultan Pehlivan, Yuyan Wang, Kathleen Doo, Maria L. Cotrina-Vidal, Roberta Goldring, Kenneth I. Berger, Mengling Liu, Yongzhao Shao and Joan Reibman
Int. J. Environ. Res. Public Health 2022, 19(13), 8102; https://doi.org/10.3390/ijerph19138102 - 01 Jul 2022
Cited by 3 | Viewed by 1852
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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10 pages, 460 KiB  
Article
Characteristics of Women with Lung Adenocarcinoma in the World Trade Center Environmental Health Center
by Elaine Shum, Nedim Durmus, Sultan Pehlivan, Yuting Lu, Yian Zhang, Alan A. Arslan, Yongzhao Shao and Joan Reibman
Int. J. Environ. Res. Public Health 2022, 19(13), 7618; https://doi.org/10.3390/ijerph19137618 - 22 Jun 2022
Cited by 2 | Viewed by 1924
Abstract
The destruction of the World Trade Center towers on 11 September 2001 exposed local residents, workers, and individuals in the area (Survivors) to dust and fumes that included known and suspected carcinogens. Given the potential for inhalation of toxic substances and the long [...] Read more.
The destruction of the World Trade Center towers on 11 September 2001 exposed local residents, workers, and individuals in the area (Survivors) to dust and fumes that included known and suspected carcinogens. Given the potential for inhalation of toxic substances and the long latency after exposure, the incidence of lung cancer is expected to increase in WTC-exposed individuals. We describe the characteristics of women WTC Survivors with lung adenocarcinoma who were enrolled in the WTC Environmental Health Center (WTC EHC) between May 2002 and July 2021. A total of 173 women in WTC EHC had a diagnosis of any type of lung cancer, representing 10% of all cancers in women. Most of the lung cancers (87%) were non-small cell carcinomas, with adenocarcinoma (77%) being the most common subtype. Nearly half (46%) of these patients were exposed to dust clouds on 11 September 2001. Race and ethnicity varied by smoking status, as follows: 44% of Asian women compared with 29% of non-Hispanic White women were never-smokers (p < 0.001). There was no significant difference between the pathologic characteristics of adenocarcinomas between never and ever smokers. We also summarize EGFR, ALK, KRAS, ROS-1 and BRAF mutation status stratified by smoking, race and ethnicity. The identification of a relatively high proportion of women never-smokers with lung cancer warrants further investigation into the role of WTC dust exposure. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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13 pages, 319 KiB  
Article
Self-Efficacy and Mental Health Help-Seeking Behavior of World Trade Center Health Registry Enrollees, 2015–2016
by Sascha K. Garrey, Erin Takemoto, Lysa Petrsoric and Lisa M. Gargano
Int. J. Environ. Res. Public Health 2022, 19(12), 7113; https://doi.org/10.3390/ijerph19127113 - 10 Jun 2022
Cited by 1 | Viewed by 1684
Abstract
The September 11th World Trade Center (WTC) disaster resulted in an elevated prevalence of Post-Traumatic Stress Disorder (PTSD) among those directly exposed, yet lower than expected rates of mental health treatment seeking and high levels of reported perceived unmet mental healthcare need were [...] Read more.
The September 11th World Trade Center (WTC) disaster resulted in an elevated prevalence of Post-Traumatic Stress Disorder (PTSD) among those directly exposed, yet lower than expected rates of mental health treatment seeking and high levels of reported perceived unmet mental healthcare need were observed in this population in the years following. Self-efficacy, an individual’s self-perception of their ability to succeed in specific situations or accomplish a task or goal, may in part explain this discrepancy; however, little is known about its interplay with the help-seeking behaviors of disaster-exposed populations. We used WTC Health Registry data (n = 11,851) to describe the relationship between self-efficacy and three outcomes related to help-seeking behavior: (1) seeking mental health treatment, (2) perceived unmet mental health care needs, and (3) satisfaction with mental health treatment. Multinomial logistic regression models were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CI). We found a dose-response relationship between self-efficacy score and mental health help-seeking: for every one unit increase in self-efficacy score, we observed a 6% increase in the odds of having treatment 4 to 12 months ago (OR = 1.06, CI: 1.03–1.09), a 7% increase in the odds of having had treatment 1 to 2 years ago (OR = 1.07, CI: 1.04, 1.09), and a 10% increase in the odds of having sought treatment 2 or more years ago (OR = 1.10, CI: 1.08, 1.12) compared to those who had sought treatment more recently. An understanding of individual self-efficacy may help improve post-disaster mental health treatment in order to provide more tailored and helpful care. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
15 pages, 339 KiB  
Article
The Impact of World Trade Center Related Medical Conditions on the Severity of COVID-19 Disease and Its Long-Term Sequelae
by Elizabeth Lhuillier, Yuan Yang, Olga Morozova, Sean A. P. Clouston, Xiaohua Yang, Monika A. Waszczuk, Melissa A. Carr and Benjamin J. Luft
Int. J. Environ. Res. Public Health 2022, 19(12), 6963; https://doi.org/10.3390/ijerph19126963 - 07 Jun 2022
Cited by 4 | Viewed by 3410
Abstract
The individuals who served our country in the aftermath of the attacks on the World Trade Center (WTC) following the attacks of 11 September 2001 have, since then, been diagnosed with a number of conditions as a result of their exposures. In the [...] Read more.
The individuals who served our country in the aftermath of the attacks on the World Trade Center (WTC) following the attacks of 11 September 2001 have, since then, been diagnosed with a number of conditions as a result of their exposures. In the present study, we sought to determine whether these conditions were risk factors for increased COVID-19 disease severity within a cohort of N = 1280 WTC responders with complete information on health outcomes prior to and following COVID-19 infection. We collected data on responders diagnosed with COVID-19, or had evidence of receiving positive SARS-CoV-2 polymerase chain reaction or antigen testing, or were asymptomatic but had IgG positive antibody testing. The presence of post-acute COVID-19 sequelae was measured using self-reported symptom severity scales. Analyses revealed that COVID-19 severity was associated with age, Black race, obstructive airway disease (OAD), as well as with worse self-reported depressive symptoms. Similarly, post-acute COVID-19 sequelae was associated with initial analysis for COVID-19 severity, upper respiratory disease (URD), gastroesophageal reflux disease (GERD), OAD, heart disease, and higher depressive symptoms. We conclude that increased COVID-19 illness severity and the presence of post-acute COVID-19 sequelae may be more common in WTC responders with chronic diseases than in those responders without chronic disease processes resulting from exposures at the WTC disaster. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
15 pages, 1186 KiB  
Article
Global DNA Methylation Profiles in Peripheral Blood of WTC-Exposed Community Members with Breast Cancer
by Stephanie Tuminello, Yian Zhang, Lei Yang, Nedim Durmus, Matija Snuderl, Adriana Heguy, Anne Zeleniuch-Jacquotte, Yu Chen, Yongzhao Shao, Joan Reibman and Alan A. Arslan
Int. J. Environ. Res. Public Health 2022, 19(9), 5104; https://doi.org/10.3390/ijerph19095104 - 22 Apr 2022
Cited by 4 | Viewed by 2089
Abstract
Breast cancer represents the most common cancer diagnosis among World Trade Center (WTC)-exposed community members, residents, and cleanup workers enrolled in the WTC Environmental Health Center (WTC EHC). The primary aims of this study were (1) to compare blood DNA methylation profiles of [...] Read more.
Breast cancer represents the most common cancer diagnosis among World Trade Center (WTC)-exposed community members, residents, and cleanup workers enrolled in the WTC Environmental Health Center (WTC EHC). The primary aims of this study were (1) to compare blood DNA methylation profiles of WTC-exposed community members with breast cancer and WTC-unexposed pre-diagnostic breast cancer blood samples, and (2) to compare the DNA methylation differences among the WTC EHC breast cancer cases and WTC-exposed cancer-free controls. Gene pathway enrichment analyses were further conducted. There were significant differences in DNA methylation between WTC-exposed breast cancer cases and unexposed prediagnostic breast cancer cases. The top differentially methylated genes were Intraflagellar Transport 74 (IFT74), WD repeat-containing protein 90 (WDR90), and Oncomodulin (OCM), which are commonly upregulated in tumors. Probes associated with established tumor suppressor genes (ATM, BRCA1, PALB2, and TP53) were hypermethylated among WTC-exposed breast cancer cases compared to the unexposed group. When comparing WTC EHC breast cancer cases vs. cancer-free controls, there appeared to be global hypomethylation among WTC-exposed breast cancer cases compared to exposed controls. Functional pathway analysis revealed enrichment of several gene pathways in WTC-exposed breast cancer cases including endocytosis, proteoglycans in cancer, regulation of actin cytoskeleton, axon guidance, focal adhesion, calcium signaling, cGMP-PKG signaling, mTOR, Hippo, and oxytocin signaling. The results suggest potential epigenetic links between WTC exposure and breast cancer in local community members enrolled in the WTC EHC program. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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13 pages, 638 KiB  
Article
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
by Rebecca M. Schwartz, Pooja Shaam, Myia S. Williams, Molly McCann-Pineo, Laura Ryniker, Shubham Debnath and Theodoros P. Zanos
Int. J. Environ. Res. Public Health 2022, 19(8), 4847; https://doi.org/10.3390/ijerph19084847 - 16 Apr 2022
Cited by 1 | Viewed by 2225
Abstract
Posttraumatic stress disorder (PTSD) remains one of the most prevalent diagnoses of World Trade Center (WTC) 9/11 responders. Transcutaneous auricular vagus nerve stimulation (taVNS) is a potential treatment for PTSD, as it can downregulate activity in the brain, which is known to be [...] Read more.
Posttraumatic stress disorder (PTSD) remains one of the most prevalent diagnoses of World Trade Center (WTC) 9/11 responders. Transcutaneous auricular vagus nerve stimulation (taVNS) is a potential treatment for PTSD, as it can downregulate activity in the brain, which is known to be related to stress responses and hyperarousal. To understand barriers and facilitators to engagement in mental health care and the feasibility and acceptability of using the taVNS device as a treatment for PTSD symptoms, a focus group was conducted among patients from the Queens WTC Health Program who had elevated symptoms of PTSD. The focus group discussion was recorded, transcribed, and analyzed. Three themes and subthemes emerged: (1) the continued prevalence of mental health difficulties and systematic challenges to accessing care; (2) positive reception toward the taVNS device as a potential treatment option, including a discussion of how to increase usability; and (3) feedback on increasing the feasibility and acceptance of the research methodology associated with testing the device in a pilot clinical trial. The findings highlight the need for additional treatment options to reduce PTSD symptoms in this population and provide key formative phase input for the pilot clinical trial of taVNS. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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13 pages, 1418 KiB  
Article
Cognitive Function among World Trade Center-Exposed Community Members with Mental Health Symptoms
by Rebecca Rosen, Yongzhao Shao, Qiao Zhang, Jia Bao, Yian Zhang, Arjun Masurkar, Thomas Wisniewski, Nina Urban and Joan Reibman
Int. J. Environ. Res. Public Health 2022, 19(6), 3440; https://doi.org/10.3390/ijerph19063440 - 15 Mar 2022
Cited by 4 | Viewed by 2302
Abstract
The World Trade Center Environmental Health Center (WTC EHC), is a federally designated clinical center of excellence for surveillance and treatment of WTC disaster exposed community members (WTC Survivors). Cognitive impairment (CI) has been extensively described in WTC responders and a concern for [...] Read more.
The World Trade Center Environmental Health Center (WTC EHC), is a federally designated clinical center of excellence for surveillance and treatment of WTC disaster exposed community members (WTC Survivors). Cognitive impairment (CI) has been extensively described in WTC responders and a concern for progressive impairment in all WTC disaster exposed groups has been raised. Cognitive status, however, has not been systematically characterized in the WTC Survivor population. We describe cognitive status in a subgroup of the Survivor population referred for mental health evaluation (N = 480) in the WTC EHC as measured by scores on the Montreal Cognitive Assessment (MoCA) instrument, and examine their association with WTC exposures and individual-level covariates including PTSD and depression screening inventory scores. In regression analyses, probable cognitive impairment (MoCA score < 26) was found in 59% of the study subjects and was significantly associated with age, race/ethnicity, education, income, depression and PTSD scores. Being caught in the dust cloud on 11 September 2011 was significantly associated with cognitive impairment even after controlling for the above. These data suggest an association with cognitive dysfunction in WTC Survivors with exposure to the toxic dust/fumes and psychological stress from the 9/11 terrorist attack and warrant further systematic study. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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10 pages, 819 KiB  
Article
The Bidirectional Relationship between Posttraumatic Stress Symptoms and Social Support in a 9/11-Exposed Cohort: A Longitudinal Cross-Lagged Analysis
by Sze Yan Liu, Jiehui Li, Lydia F. Leon, Ralf Schwarzer and James E. Cone
Int. J. Environ. Res. Public Health 2022, 19(5), 2604; https://doi.org/10.3390/ijerph19052604 - 24 Feb 2022
Cited by 3 | Viewed by 1820
Abstract
Research on the longitudinal relationship between posttraumatic stress disorder (PTSD) and social support among survivors of large-scale trauma is limited. This study assessed bidirectional relationships between PTSD and perceived social support in a large sample of the 9/11-exposed cohort over a 14-year follow-up. [...] Read more.
Research on the longitudinal relationship between posttraumatic stress disorder (PTSD) and social support among survivors of large-scale trauma is limited. This study assessed bidirectional relationships between PTSD and perceived social support in a large sample of the 9/11-exposed cohort over a 14-year follow-up. We used data from 23,165 World Trade Center Health Registry (WTCHR) enrollees who were exposed to the 9/11 attacks and participated in the first four WTCHR surveys (Wave 1 (2003–2004) to Wave 4 (2015–2016)). PTSD symptoms were measured using the 17-item PTSD Checklist. Perceived social support was measured using the five-item version of the Modified Social Support Survey. We used a cross-lagged panel analysis and found an inverse relationship between PTSD symptoms and social support. PTSD at Wave 2 (W2) predicted less social support at Wave 3 (W3) (β = −0.10, p < 0.01), and PTSD at W3 predicted less social support at W4 (β = −0.05, p < 0.01). Conversely, social support at W3 buffered PTSD symptoms at W4 (β = −0.03, p < 0.05). Sub-analyses by types of perceived social support suggest greater effects of PTSD on emotional support than tangible support and in community members than rescue/recovery workers. Our findings suggest a bidirectional effect between PTSD symptoms and social support in a longitudinal study of 9/11-exposed populations. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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11 pages, 333 KiB  
Article
Hospitalizations among World Trade Center Health Registry Enrollees Who Were under 18 Years of Age on 9/11, 2001–2016
by Lisa M. Gargano, Sean H. Locke, Howard E. Alper and Jennifer Brite
Int. J. Environ. Res. Public Health 2021, 18(14), 7527; https://doi.org/10.3390/ijerph18147527 - 15 Jul 2021
Cited by 1 | Viewed by 1938
Abstract
Much of the literature on hospitalizations post-September 11, 2001 (9/11) focuses on adults but little is known about post-9/11 hospitalizations among children. Data for World Trade Center Health Registry enrollees who were under 18-years old on 9/11 were linked to New York State [...] Read more.
Much of the literature on hospitalizations post-September 11, 2001 (9/11) focuses on adults but little is known about post-9/11 hospitalizations among children. Data for World Trade Center Health Registry enrollees who were under 18-years old on 9/11 were linked to New York State hospitalization data to identify hospitalizations from enrollment (2003–2004) to December 31, 2016. Logistic regression was used to analyze factors associated with hospitalization. Of the 3151 enrollees under age 18 on 9/11, 243 (7.7%) had at least one 9/11-related physical health hospitalization and 279 (8.9%) had at least one 9/11-related mental health hospitalization. Individuals of non-White race, those living in New York City Housing Authority housing, those exposed to the dust cloud on 9/11, and those with probable 9/11-related PTSD symptoms were more likely to be hospitalized for a 9/11-related physical health condition. Older age and having probable 9/11-related PTSD symptoms at baseline were associated with being hospitalized for a 9/11-related mental health condition. Dust cloud exposure on 9/11 and PTSD symptoms were associated with hospitalizations among those exposed to 9/11 as children. Racial minorities and children living in public housing were at greater risk of hospitalization. Continued monitoring of this population and understanding the interplay of socioeconomic factors and disaster exposure will be important to understanding the long-term effects of 9/11. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)

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Jump to: Research

7 pages, 412 KiB  
Case Report
Exploratory Case Study of Suicide among a Sample of 9/11 Survivors
by Kacie Seil, Erin Takemoto, Mark R. Farfel, Mary Huynh and Jiehui Li
Int. J. Environ. Res. Public Health 2022, 19(1), 57; https://doi.org/10.3390/ijerph19010057 - 22 Dec 2021
Cited by 1 | Viewed by 1943
Abstract
Background: Previous research has found higher than expected suicide mortality among rescue/recovery workers (RRWs) enrolled in the World Trade Center Health Registry (WTCHR). Whether any enrollee suicides are related to the decedents’ experiences on 9/11 is unknown. We abstracted medical examiner file data [...] Read more.
Background: Previous research has found higher than expected suicide mortality among rescue/recovery workers (RRWs) enrolled in the World Trade Center Health Registry (WTCHR). Whether any enrollee suicides are related to the decedents’ experiences on 9/11 is unknown. We abstracted medical examiner file data to learn more about 9/11-related circumstances of suicides among WTCHR enrollees. Methods: We identified 35 enrollee suicide cases that occurred in New York City using linked vital records data. We reviewed medical examiner files on each case, abstracting demographic and circumstantial data. We also reviewed survey data collected from each case at WTCHR enrollment (2003–2004) and available subsequent surveys to calculate descriptive statistics. Results: Cases were mostly non-Hispanic White (66%), male (83%), and middle-aged (median 58 years). Nineteen decedents (54%) were RRWs, and 32% of them worked at the WTC site for >90 days compared to 18% of the RRW group overall. In the medical examiner files of two cases, accounts from family mentioned 9/11-related circumstances, unprompted. All deaths occurred during 2004–2018, ranging from one to four cases per year. Leading mechanisms were hanging/suffocation (26%), firearm (23%), and jump from height (23%). Sixty percent of the cases had depression mentioned in the files, but none mentioned posttraumatic stress disorder. Conclusions: RRWs may be at particular risk for suicide, as those who worked at the WTC site for long periods appeared to be more likely to die by suicide than other RRWs. Mental health screening and treatment must continue to be prioritized for the 9/11-exposed population. More in-depth investigations of suicides can elucidate the ongoing impacts of 9/11. Full article
(This article belongs to the Special Issue To Mark the 20th Anniversary of 9/11: Long-Term Health Effects)
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