Mark R. Farfel

Asthma Diagnosed after 11 September 2001 among Rescue and Recovery Workers: Findings from the World Trade Center Health Registry

Background Studies have consistently documented declines in respiratory health after 11 September 2001 (9/11) among surviving first responders and other World Trade Center (WTC) rescue, recovery, and clean-up workers. Objectives The goal of this study was to describe the risk of newly diagnosed asthma among WTC site workers and volunteers and to characterize its association with WTC site exposures. Methods We analyzed 2003–2004 interview data from the World Trade Center Health Registry for workers who did not have asthma before 9/11 (n = 25,748), estimating the risk of newly diagnosed asthma and its associations with WTC work history, including mask or respirator use. Results Newly diagnosed asthma was reported by 926 workers (3.6%). Earlier arrival and longer duration of work were significant risk factors, with independent dose responses (p < 0.001), as were exposure to the dust cloud and pile work. Among workers who arrived on 11 September, longer delays in the initial use of masks or respirators were associated with increased risk of asthma; adjusted odds ratios ranged from 1.63 [95% confidence interval (CI), 1.03–2.56) for 1 day of delay to 3.44 (95% CI, 1.43–8.25) for 16–40 weeks delay. Conclusions The rate of self-reported newly diagnosed asthma was high in the study population and significantly associated with increased exposure to the WTC disaster site. Although we could not distinguish appropriate respiratory protection from inappropriate, we observed a moderate protective effect of mask or respirator use. The findings underscore the need for adequate and timely distribution of appropriate protective equipment and the enforcement of its use when other methods of controlling respiratory exposures are not feasible.

Co-occurring Lower Respiratory Symptoms and Posttraumatic Stress Disorder 5 to 6 Years After the World Trade Center Terrorist Attack

OBJECTIVES We have described the epidemiology of co-occurring lower respiratory symptoms (LRS) and probable posttraumatic stress disorder (PTSD) 5 to 6 years after exposure to the 9/11 disaster. METHODS We analyzed residents, office workers, and passersby (n = 16,363) in the World Trade Center Health Registry. Using multivariable logistic regression, we examined patterns of reported respiratory symptoms, treatment sought for symptoms, diagnosed respiratory conditions, mental health comorbidities, quality of life, and unmet health care needs in relation to comorbidity. RESULTS Among individuals with either LRS or PTSD, 24.6% had both conditions. The odds of comorbidity was significantly higher among those with more severe 9/11 exposures. Independent of 9/11 exposures, participants with LRS had 4 times the odds of those without it of meeting criteria for PTSD, and those with PTSD had 4 times the odds of those without it of meeting criteria for LRS. Participants with comorbidity had worse quality of life and more unmet mental health care needs than did all other outcome groups. CONCLUSIONS Respiratory and mental illness are closely linked in individuals exposed to 9/11 and should be considered jointly in public health outreach and treatment programs.

An evaluation of experimental practices for abatement of residential lead-based paint: Report on a pilot project

In this pilot study, we prospectively evaluated experimental practices for abating lead-based paint in six dwellings. These experimental abatements were based upon a new approach to abatement which reflects current understanding of low-level lead toxicity in children and the role of lead-contaminated dust as an important contributor to childrens total body burden. Our previous study of traditional abatement practices in Baltimore showed them to be inadequate for reducing lead in both house dust and childrens blood. Our experimental abatements resulted in significant reductions in house dust-lead levels (PbD) which persisted during 6-9 months of followup. Geometric mean PbD at floors, window sills, and window wells were respectively 5.6, 49.6, and 316.7 mg/m2 at preabatement, and respectively 0.6, 4.4, and 10.8 mg/m2 at 6-9 months. Experimental abatements involved (1) treatment of lead-painted surfaces above and below 4 ft from the floor, including interior and exterior components of windows; (2) sealing or covering of wooden floors; (3) procedures for containment of dust during abatement; and (4) a final cleanup using a high-efficiency particle air (HEPA) vacuum. We recommend that more research be done to further evaluate and compare the long-term efficacy of these and other abatement methodologies.

Lead in residential soil and dust in a mining and smelting district in northern Armenia: a pilot study.

This pilot study of sources of lead exposure in residential settings was conducted in a mining and smelting district in northern Armenia. Samples of exterior soil and dust and interior house dust were collected in and around apartment buildings in Alaverdi where the countrys largest polymetallic smelter is located, and in nearby mining towns of Aghtala and Shamlugh. The NITON XL-723 Multi-Element XRF analyzer was used for lead testing. Lead levels in samples from Alaverdi were higher than those in Shamlugh and Aghtala. In all three towns, the highest lead levels were found in loose exterior dust samples, and lead concentrations in yard soil were higher than those in garden soil. Many soil samples (34%) and the majority of loose dust samples (77%) in Alaverdi exceeded the US Environmental Protection Agency standard of 400 mg/kg for bare soil in childrens play areas. In addition, 36% of floor dust samples from apartments in Alaverdi exceeded the US Environmental Protection Agency standard of 40 microg/ft(2) for lead loading in residential floor dust. The Armenian Ministry of Health and other interested agencies are being informed about the findings of the study so that they can consider and develop educational and preventive programs including blood lead screening among sensitive populations.

Chronic Physical Health Consequences of Being Injured During the Terrorist Attacks on World Trade Center on September 11, 2001

Few studies have focused on injuries from the World Trade Center disaster on September 11, 2001. Severe injury has health consequences, including an increased mortality risk 10 years after injury and the risk of mental health problems, such as posttraumatic stress disorder (PTSD). The World Trade Center Health Registry identified 14,087 persons with none of a selected group of preexisting chronic conditions before 2002 who were present during and soon after the World Trade Center attacks, 1,980 of whom reported sustaining 1 or more types of injury (e.g., a broken bone or burn). Survey data obtained during 2003-2004 and 2006-2007 were used to assess the odds of reporting a diagnosis of chronic conditions (heart disease, respiratory disease, diabetes, cancer) up to 5-6 years after the attacks. Number of injury types and probable PTSD were significantly associated with having any chronic conditions diagnosed in 2002-2007. Persons with multiple injuries and PTSD had a 3-fold higher risk of heart disease than did those with no injury and no PTSD, and persons with multiple injuries and with no PTSD had a 2-fold higher risk of respiratory diseases. The present study shows that injured persons with or without comorbid PTSD have a higher risk of developing chronic diseases. Clinicians should be aware of the heightened risk of chronic heart and respiratory conditions among injured persons.

Posttraumatic Stress Disorder after Hurricane Sandy among Persons Exposed to the 9/11 Disaster.

BACKGROUND Traumatic exposure during a hurricane is associated with adverse mental health conditions post-event. The World Trade Center Health Registry provided a sampling pool for a rapid survey of persons directly affected by Hurricane Sandy in the New York City (NYC) metropolitan area in late October 2012. This study evaluated the relationship between Sandy experiences and Sandy-related posttraumatic stress disorder (PTSD) among individuals previously exposed to the September 11, 2001 (9/11) disaster. METHODS A total of 4,558 surveys were completed from April 10-November 7, 2013. After exclusions for missing data, the final sample included 2,214 (53.5%) respondents from FEMA-defined inundation zones and 1,923 (46.5%) from non-inundation zones. Sandy exposures included witnessing terrible events, Sandy-related injury, fearing for own life or safety of others, evacuation, living in a home that was flooded or damaged, property loss, and financial loss. Sandy-related PTSD was defined as a score of ≥44 on a Sandy-specific PTSD Checklist. RESULTS PTSD prevalence was higher in the inundation zones (11.3%) and lower in the non-inundation zones (4.4%). The highest prevalence of Sandy-related PTSD was among individuals in the inundation zone who sustained an injury (31.2%), reported a history of 9/11-related PTSD (28.8%), or had low social support prior to the event (28.6%). In the inundation zones, significantly elevated adjusted odds of Sandy-related PTSD were observed among persons with a prior history of 9/11-related PTSD, low social support, and those who experienced a greater number of Sandy traumatic events. CONCLUSIONS Sandy-related stress symptoms indicative of PTSD affected a significant proportion of persons who lived in flooded areas of the NYC metropolitan area. Prior 9/11-related PTSD increased the likelihood of Sandy-related PTSD, while social support was protective. Public health preparation for events similar to Sandy should incorporate outreach and linkages to care for persons with prior disaster-related trauma.

Nonfatal injuries 1 week after Hurricane Sandy - New York City metropolitan area, October 2012

On October 29, 2012, Hurricane Sandy (Sandy) made landfall in densely populated areas of New York, New Jersey, and Connecticut. Flooding affected 51 square miles (132 square kilometers) of New York City (NYC) and resulted in 43 deaths, many caused by drowning in the home, along with numerous storm-related injuries. Thousands of those affected were survivors of the World Trade Center (WTC) disaster of September 11, 2001 (9/11) who had previously enrolled in the WTC Health Registry (Registry) cohort study. To assess Sandy-related injuries and associated risk factors among those who lived in Hurricane Sandy-flooded areas and elsewhere, the NYC Department of Health and Mental Hygiene surveyed 8,870 WTC survivors, who had provided physical and mental health updates 8 to 16 months before Sandy. Approximately 10% of the respondents in flooded areas reported injuries in the first week after Sandy; nearly 75% of those had more than one injury. Injuries occurred during evacuation and clean-up/repair of damaged or destroyed homes. Hurricane preparation and precautionary messages emphasizing potential for injury hazards during both evacuation and clean-up or repair of damaged residences might help mitigate the occurrence and severity of injury after a hurricane.

Comparison of Two Cyclone-Based Collection Devices for the Evaluation of Lead-Containing Residential Dusts

Abstract Although lead-containing house dust is an important source of childhood lead exposure, methods for collection of house dust have not been standardized. Wipe and vacuum-based dust collection methods have been employed in past studies of lead exposure and for clearance purposes following remediation. Little is known about performance characteristics and potential biases of these sample collection methods, especially with respect to the influence of particle size on sampling and retention characteristics. This study compared performances of two portable cyclone devices via replicate samplings of three different and well-characterized dusts which covered the range of particle sizes expected in house dust (0.9–2000 μm). Significant differences in performance that were a function of particle size and dust loading were measured. The cyclone device with significantly higher dust recoveries also demonstrated a pattern of more consistent recoveries across particle sizes and dust loadings and higher precisi...

Community experiences and perceptions related to demolition and gut rehabilitation of houses for urban redevelopment

Reports about current residential demolition practices received from residents and plans for large-scale urban redevelopment in East Baltimore provided impetus for this study to assess community concerns and develop approaches to addressing them. This article describes the following themes regarding residents’ experiences with demolition and gut rehabilition of older housing performed as part of urban redevelopment: (1) lack of notification and awareness about protective measures; (2) concerns about environmental and safety hazards; (3) psychosocial impact from displacement, disruption in daily life, and inattention to community concerns; and (4) recommendations to improve redevelopment practices, including ideas to control neighborhood exposure to environmental hazards potentially exacerbated by residential demolition and gut rehabilitation. the findings from focus groups substantiated and deepened our understanding of earlier anecdotal reports of residents’ concerns and emphasized the need for including community perceptions and ideas in addressing environmental and psychosocial issues related to urban redevelopment.

Pilot study of sources of lead exposure in Moscow, Russia

This preliminary investigation of sources of lead exposure in Moscow, Russia, by Russian and US collaborators measured lead in paint, interior dust, and drinking water in seven day-care centres, and in petrol, soil and canned food. Some paint samples exceeded US regulatory standards for lead in paint on surfaces (0.5%). Dust lead loadings were < 1.7 μg cm−2 and below the guidance levels of the US EPA. Drinking water lead concentrations were at or below the US drinking water standard of 15 μg L−1. Lead concentrations in petrol from Moscow vehicles and petrol stations were consistent with a regulation banning the sale of leaded petrol within the Moscow City limits. Except for baby food, lead levels were higher in the Russian canned foods (range 6 to 1240 μg kg−1, dry weight) compared to corresponding US canned foods, with ratios of Russian to US levels of up to 120:1 for evaporated milk. Lead concentrations in soil generally ranged from 500 to 2000 μg g−1, levels that would trigger hazard reduction measures according to US EPA guidance. These findings, together with the use of lead in petrol outside Moscow, indicate multiple sources of lead exposure in Russia. Priorities for future research are discussed including the establishment of interlaboratory quality control programmes.