Exploratory Case Study of Suicide among a Sample of 9/11 Survivors

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.

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Hurricane Sandy Evacuation Among World Trade Center Health Registry Enrollees in New York City

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2016.57 ◽

2016 ◽

Vol 10 (3) ◽

pp. 411-419 ◽

Cited By ~ 2

Author(s):

Shakara Brown ◽

Lisa M. Gargano ◽

Hilary Parton ◽

Kimberly Caramanica ◽

Mark R. Farfel ◽

...

Keyword(s):

New York ◽

Physical Health ◽

World Trade ◽

World Trade Center ◽

Hurricane Sandy ◽

Adverse Outcomes ◽

Community Cohesion ◽

Poor Physical Health ◽

Trade Center ◽

Health Registry

AbstractObjectiveTimely evacuation is vital for reducing adverse outcomes during disasters. This study examined factors associated with evacuation and evacuation timing during Hurricane Sandy among World Trade Center Health Registry (Registry) enrollees.MethodsThe study sample included 1162 adults who resided in New York City’s evacuation zone A during Hurricane Sandy who completed the Registry’s Hurricane Sandy substudy in 2013. Factors assessed included zone awareness, prior evacuation experience, community cohesion, emergency preparedness, and poor physical health. Prevalence estimates and multiple logistic regression models of evacuation at any time and evacuation before Hurricane Sandy were created.ResultsAmong respondents who evacuated for Hurricane Sandy (51%), 24% had evacuated before the storm. In adjusted analyses, those more likely to evacuate knew they resided in an evacuation zone, had evacuated during Hurricane Irene, or reported pre-Sandy community cohesion. Evacuation was less likely among those who reported being prepared for an emergency. For evacuation timing, evacuation before Hurricane Sandy was less likely among those with pets and those who reported 14 or more poor physical health days.ConclusionsHigher evacuation rates were observed for respondents seemingly more informed and who lived in neighborhoods with greater social capital. Improved disaster messaging that amplifies these factors may increase adherence with evacuation warnings. (Disaster Med Public Health Preparedness. 2016;10:411–419)

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Oscillometry complements spirometry in evaluation of subjects following toxic inhalation

ERJ Open Research ◽

10.1183/23120541.00043-2015 ◽

2015 ◽

Vol 1 (2) ◽

pp. 00043-2015 ◽

Cited By ~ 12

Author(s):

Kenneth I. Berger ◽

Meredith Turetz ◽

Mengling Liu ◽

Yongzhao Shao ◽

Angeliki Kazeros ◽

...

Keyword(s):

New York ◽

Respiratory Symptoms ◽

World Trade Center ◽

Community Members ◽

Normal Limits ◽

Department Of Health ◽

Trade Center ◽

Asymptomatic Subjects ◽

Health Registry ◽

Airway Abnormalities

The World Trade Center (WTC) destruction released dust and fumes into the environment. Although many community members developed respiratory symptoms, screening spirometry was usually normal. We hypothesised that forced oscillation testing would identify functional abnormalities undetected by spirometry and that symptom severity would relate to magnitude of abnormalities measured by oscillometry.A symptomatic cohort (n=848) from the Bellevue Hospital WTC Environmental Health Center was evaluated and compared to an asymptomatic cohort (n=475) from the New York City Department of Health WTC Health Registry. Spirometry and oscillometry were performed. Oscillometry measurements included resistance (R5) and frequency dependence of resistance (R5−20).Spirometry was normal for the majority of subjects (73.2% symptomatic versus 87.6% asymptomatic, p<0.0001). In subjects with normal spirometry, R5 and R5−20 were higher in symptomatic versus asymptomatic subjects (median (interquartile range) R5 0.436 (0.206) versus 0.314 (0.129) kPa·L−1·s−1, p<0.001; R5−20 0.075 (0.085) versus 0.004 (0.042) kPa·L−1·s−1, p<0.0001). In symptomatic subjects, R5 and R5−20 increased with increasing severity and frequency of wheeze (p<0.05).Measurement of R5–20 correlated with the presence and severity of symptoms even when spirometry was within normal limits. These findings are in accord with small airway abnormalities as a potential explanation of the respiratory symptoms.

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Hospitalizations among World Trade Center Health Registry Enrollees Who Were under 18 Years of Age on 9/11, 2001–2016

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147527 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7527

Author(s):

Lisa M. Gargano ◽

Sean H. Locke ◽

Howard E. Alper ◽

Jennifer Brite

Keyword(s):

Mental Health ◽

New York ◽

Physical Health ◽

World Trade ◽

World Trade Center ◽

Dust Cloud ◽

Health Condition ◽

Ptsd Symptoms ◽

Trade Center ◽

Health Registry

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.

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E-mail and Misinformation: A South African Case Study

10.28945/2741 ◽

2004 ◽

Author(s):

Laurette Pretorius ◽

Andries Barnard

Keyword(s):

New York ◽

South African ◽

Social Issues ◽

World Trade Center ◽

Time Line ◽

South Africans ◽

Legal Nature ◽

Trade Center ◽

E Mail

In this paper certain ethical and social issues, insights and lessons learnt surrounding the spread of misinformation resulting from a hoax e-mail sent in South Africa on September 11 2001, linking South Africans to the World Trade Center disaster in New York are considered. A case study, based on the South African newspaper press coverage that this incident received, is discussed. The factual contents are provided in the form a time line, followed by the grouping of stakeholders and a list of stakeholder comments of an ethical, a social or legal nature. Subsequently, various ethical perspectives are explored, different approaches to ethical analysis are employed and an ethical conclusion regarding this incident is reached. This is followed by a brief investigation of the perceived divergence of the ethical and legal perspectives. We conclude this paper by expressing the hope that this case study, and the analysis thereof, would assist South African computing instructors in sensitizing their students to computer ethics issues related to misinformation, the use of e-mail and the Internet.

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Performance of Self-Report to Establish Cancer Diagnoses in Disaster Responders and Survivors, World Trade Center Health Registry, New York, 2001–2007

Public Health Reports ◽

10.1177/003335491613100308 ◽

2016 ◽

Vol 131 (3) ◽

pp. 420-429 ◽

Cited By ~ 4

Author(s):

Jiehui Li ◽

James E. Cone ◽

Abigail K. Alt ◽

David R. Wu ◽

Jonathan M. Liff ◽

...

Keyword(s):

New York ◽

World Trade ◽

World Trade Center ◽

Self Report ◽

Trade Center ◽

Health Registry

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Comparison of prevalence and exposure-disease associations using self-report and hospitalization data among enrollees of the world trade center health registry

BMC Medical Research Methodology ◽

10.1186/s12874-021-01358-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Howard E. Alper ◽

Jennifer Brite ◽

James E. Cone ◽

Robert M. Brackbill

Keyword(s):

New York ◽

Chronic Diseases ◽

Administrative Data ◽

World Trade Center ◽

New York State ◽

Disease Prevalence ◽

Self Report ◽

Disease Associations ◽

Trade Center ◽

Health Registry

Abstract Background Although many studies have investigated agreement between survey and hospitalization data for disease prevalence, it is unknown whether exposure-chronic disease associations vary based on data collection method. We investigated agreement between self-report and administrative data for the following: 1) disease prevalence, and 2) the accuracy of self-reported hospitalization in the last 12 months, and 3) the association of seven chronic diseases (rheumatoid arthritis, hypertension, heart attack, stroke, asthma, diabetes, hyperlipidemia) with four measures of 9/11 exposure. Methods Enrollees of the World Trade Center Health Registry who resided in New York State were included (N = 18,206). Hospitalization data for chronic diseases were obtained from the New York State Planning and Research Cooperative System (SPARCS). Prevalence for each disease and concordance measures (kappa, sensitivity, specificity, positive agreement, and negative agreement) were calculated. In addition, the associations of the seven chronic diseases with the four measures of exposure were evaluated using logistic regression. Results Self-report disease prevalence ranged from moderately high (40.5% for hyperlipidemia) to low (3.8% for heart attack). Self-report prevalence was at least twice that obtained from administrative data for all seven chronic diseases. Kappa ranged from 0.35 (stroke) to 0.04 (rheumatoid arthritis). Self-reported hospitalizations within the last 12 months showed little overlap with actual hospitalization data. Agreement for exposure-disease associations was good over the twenty-eight exposure-disease pairs studied. Conclusions Agreement was good for exposure-disease associations, modest for disease prevalence, and poor for self-reported hospitalizations. Neither self-report nor administrative data can be treated as the “gold standard.” Which source to use depends on the availability and context of data, and the disease under study.

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