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Concept: United 93

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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.

Concepts: Psychological trauma, PTSD, September 11 attacks, World Trade Center, United 93, 7 World Trade Center, World Trade Center site, National September 11 Memorial & Museum

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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.

Concepts: 2001, September 11 attacks, September 11, World Trade Center, Lower Manhattan, United 93, 7 World Trade Center, World Trade Center site

18

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.

Concepts: September 11 attacks, World Trade Center, United 93

11

The objective of this research is to determine whether responders and survivors of the World Trade Center (WTC) disaster experience symptoms of neuropathy at a rate higher than those not exposed.

Concepts: September 11 attacks, World Trade Center, United 93

10

BackgroundLittle is known about asthma control in adolescents who were exposed to the World Trade Center (WTC) attacks of 9/11/2001 and diagnosed with asthma after 9/11. This report examines asthma and asthma control 10-11 years after 9/11 among exposed adolescents.MethodsThe WTC Health Registry adolescent Wave 3 survey (2011-2012) collected data on asthma diagnosed by a physician after 9/11/2001, extent of asthma control based on modified National Asthma Education and Prevention Program criteria, probable mental health conditions, and behavior problems. Parents reported healthcare needs and 9/11-exposures. Logistic regression was used to evaluate associations between asthma and level of asthma control and 9/11-exposure, mental health and behavioral problems, and unmet healthcare needs.ResultsPoorly/very poorly controlled asthma was significantly associated with a household income of ≤$75,000 (AOR: 3.0; 95% CI: 1.1-8.8), having unmet healthcare needs (AOR: 6.2; 95% CI: 1.4-27.1), and screening positive for at least one mental health condition (AOR: 5.0; 95% CI: 1.4-17.7), but not with behavioral problems. The impact of having at least one mental health condition on the level of asthma control was substantially greater in females than in males.ConclusionsComprehensive care of post-9/11 asthma in adolescents should include management of mental health-related comorbidities.

Concepts: September 11 attacks, World Trade Center, Lower Manhattan, United 93, Al-Qaeda, 7 World Trade Center, World Trade Center site, National September 11 Memorial & Museum

7

Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11-13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being.

Concepts: September 11 attacks, September 11, World Trade Center, Lower Manhattan, United 93, Al-Qaeda, 7 World Trade Center, World Trade Center site

4

Little is known about the direction of causality among asthma, posttraumatic stress disorder (PTSD), and onset of gastroesophageal reflux symptoms (GERS) after exposure to the 9/11/2001 World Trade Center (WTC) disaster.

Concepts: Gastroesophageal reflux disease, Cognitive behavioral therapy, 2001, September 11 attacks, World Trade Center, Lower Manhattan, United 93, 7 World Trade Center

3

After the World Trade Center (WTC) attacks on September 11, 2001, the Fire Department of the City of New York (FDNY) instituted a WTC medical monitoring and treatment program and established a data center to document health outcomes in the WTC-exposed workforce of ∼16,000 firefighters and EMS workers.

Concepts: New York City, 2001, September 11 attacks, World Trade Center, Lower Manhattan, United 93, New York City Fire Department, American Airlines Flight 11

2

Exposure to the terrorist attack on the World Trade Center (WTC) on 9/11/2001 resulted in continuing stress experience manifested as Posttraumatic Stress Disorder (PTSD) Symptoms in a minority of the police responders. The WTC Health Registry has followed up a large number of individuals, including police officers, at three waves of data collection from 2003 to 2011. This analysis examines the relationship between initial exposure levels, long-term PTSD symptoms, and subsequent emotional support among police responders.

Concepts: September 11 attacks, World Trade Center, Lower Manhattan, United 93, Al-Qaeda, 7 World Trade Center, World Trade Center site, National September 11 Memorial & Museum

1

We studied the course of lower respiratory symptoms (LRS; cough, wheeze or dyspnoea) among community members exposed to the 9/11/2001 World Trade Center (WTC) attacks during a period of 12-13 years following the attacks, and evaluated risk factors for LRS persistence, including peripheral airway dysfunction and post-traumatic stress disorder (PTSD).

Concepts: September 11 attacks, World Trade Center, Lower Manhattan, United 93, Al-Qaeda, 7 World Trade Center, World Trade Center site, National September 11 Memorial & Museum