Source Paper
Mark Farfel, Laura DiGrande, Robert Brackbill, Angela Prann, James Cone et al.
Journal of Urban Health • 2008
To date, health effects of exposure to the September 11, 2001 disaster in New York City have been studied in specific groups, but no studies have estimated its impact across the different exposed populations. This report provides an overview of the World Trade Center Health Registry (WTCHR) enrollees, their exposures, and their respiratory and mental health outcomes 2-3 years post-9/11. Results are extrapolated to the estimated universe of people eligible to enroll in the WTCHR to determine magnitude of impact. Building occupants, persons on the street or in transit in lower Manhattan on 9/11, local residents, rescue and recovery workers/volunteers, and area school children and staff were interviewed and enrolled in the WTCHR between September 2003 and November 2004. A total of 71,437 people enrolled in the WTCHR, for 17.4% coverage of the estimated eligible exposed population (nearly 410,000); 30% were recruited from lists, and 70% were self-identified. Many reported being in the dust cloud from the collapsing WTC Towers (51%), witnessing traumatic events (70%), or sustaining an injury (13%). After 9/11, 67% of adult enrollees reported new or worsening respiratory symptoms, 3% reported newly diagnosed asthma, 16% screened positive for probable posttraumatic stress disorder (PTSD), and 8% for serious psychological distress (SPD). Newly diagnosed asthma was most common among rescue and recovery workers who worked on the debris pile (4.1%). PTSD was higher among those who reported Hispanic ethnicity (30%), household income < $25,000 (31%), or being injured (35%). Using previously published estimates of the total number of exposed people per WTCHR eligibility criteria, we estimate between 3,800 and 12,600 adults experienced newly diagnosed asthma and 34,600-70,200 adults experienced PTSD following the attacks, suggesting extensive adverse health impacts beyond the immediate deaths and injuries from the acute event.
Objective: Proxy-based assessment of possible posttraumatic stress symptoms in child enrollees using an eight-question scale derived from Hoven et al.
Gather these items before starting the experiment. Check off items as you prepare.
SAS Institute
Chow and Rodgers
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Registrants were recruited for enrollment through outreach to eligible individuals and groups, as well as local and regional media. Lists of names and contact information were provided voluntarily by entities such as employers and governmental agencies. Individuals were also contacted through a widespread advertising campaign encouraging enrollment via toll-free number or website preregistration.
Note: A total of 232 lists representing 135,450 potential registrants were provided from rescue/recovery workers, building occupants, students/school staff, and residents
“Registrants were recruited for enrollment through outreach to eligible individuals and groups, as well as local and regional media”
Informed consent was obtained from all participants prior to interview administration
“The interview included: (a) informed consent”
Determination of eligibility based on proximity by time and place to WTC attack, acute exposure to dust and debris cloud, and chronic exposure to smoke and fumes
“Development of eligibility criteria took into account proximity by time and place to the WTC attack, acute exposure to the dust and debris cloud”
Collection of demographic information from participants
“The interview included: (c) demographics”
Collection of contact information for follow-up including information on up to three people who would be likely to know future whereabouts of respondent
“contact information for follow-up (including information on up to three people who would be likely to know the future whereabouts of the respondent)”
Administration of general exposure questions regarding dust and debris cloud exposure
“general exposure questions (e.g., to the dust and debris cloud)”
Administration of specific exposure assessment sections tailored to each of the four eligibility groups
“specific exposure assessment sections for each of the four eligibility groups”
Assessment of injuries sustained on 9/11
“9/11 injuries”
Assessment of physical health symptoms and conditions before and after 9/11, including respiratory symptoms, nonrespiratory symptoms, and physician-diagnosed conditions
“physical health symptoms and conditions before and after 9/11”
For children under 18 years of age at time of interview, parents and guardians completed proxy interviews using an eight-question scale derived from Hoven et al. to assess possible posttraumatic stress symptoms
Note: A total of 2,635 proxy interviews were completed for children. Interviewers took actions (e.g., suggested breaks, stopped interview, provided referrals) if respondent's answers or behavior indicated emotional distress
“Proxy interviews with parents and guardians of child enrollees included an eight-question scale derived from Hoven et al. to assess possible posttraumatic stress symptoms”
Baseline interviews were conducted using either computer-assisted telephone interviewing (CATI) or computer-assisted in-person personal interviewing (CAPI)
Note: 95% of interviews (67,527) were completed via CATI; 5% (3,910) via CAPI. Questionnaire administered in four languages: English (95.2%), Spanish (1.9%), Cantonese (1.5%), and Mandarin (1.0%)
“67,527 (95%) were completed using computer-assisted telephone interviewing (CATI) and the remaining 3,910 were completed using computer-assisted in-person personal interviewing (CAPI)”
For enrollees who reported being caught in the dust cloud, geographic location information was collected and geocoded using street address, closest cross street intersection, closest landmark, or closest subway stop
Note: Geocoding occurred only if enrollee answered yes to being caught in dust cloud. Street addresses (n=15,167), cross street intersections (n=11,329), landmarks (n=10,732), and subway stops (n=1,119) were used as locator variables
“Enrollees were asked about their geographic location when they first encountered the dust cloud. Locator variables included street address, closest cross street intersection, closest landmark, and the closest subway stop”
Descriptive statistics and bivariate associations between health symptoms/conditions and demographic characteristics were computed. Chi-square and Cochran-Armitage tests were used to determine statistical significance. Proportional-to-size Venn diagram was created to depict overlap in eligibility criteria
Note: All enrollees were included in data analysis. Analyses of respiratory and mental health outcomes were restricted to adult enrollees (>18 years) at time of interview
“SAS ® (version 9.1) was used to compute descriptive statistics and bivariate associations between health symptoms or conditions and demographic characteristics”
Children exposed to World Trade Center attack on September 11, 2001; parents and guardians served as proxies for assessment