Pauline A. Thomas

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.

Respiratory and other health effects reported in children exposed to the World Trade Center disaster of 11 September 2001.

Background Effects of the World Trade Center (WTC) disaster on children’s respiratory health have not been definitively established. Objective This report describes respiratory health findings among children who were < 18 years of age on 11 September 2001 (9/11) and examine associations between disaster-related exposures and respiratory health. Methods Children recruited for the WTC Health Registry (WTCHR) included child residents and students (kindergarten through 12th grade) in Manhattan south of Canal Street, children who were south of Chambers Street on 9/11, and adolescent disaster-related workers or volunteers. We collected data via computer-assisted telephone interviews in 2003–2004, with interview by adult proxy for children still < 18 years of age at that time. We compared age-specific asthma prevalence with National Health Interview Survey estimates. Results Among 3,184 children enrolled, 28% were < 5 years of age on 9/11; 34%, 5–11 years; and 39%, 12–17 years. Forty-five percent had a report of dust cloud exposure on 9/11. Half (53%) reported at least one new or worsened respiratory symptom, and 5.7% reported new asthma diagnoses. Before 9/11, age-specific asthma prevalence in enrolled children was similar to national estimates, but prevalence at interview was elevated among enrollees < 5 years of age. Dust cloud exposure was associated with new asthma diagnosis (adjusted odds ratio = 2.3; 95% confidence interval, 1.5–3.5). Conclusions Asthma prevalence after 9/11 among WTCHR enrollees < 5 years of age was higher than national estimates, and new asthma diagnosis was associated with dust cloud exposure in all age groups. We will determine severity of asthma and persistence of other respiratory symptoms on follow-up surveys.

Respiratory Health of 985 Children Exposed to the World Trade Center Disaster: Report on World Trade Center Health Registry Wave 2 Follow-up, 2007-2008

Background. The World Trade Center (WTC) disaster of September 11, 2001, has been associated with early respiratory problems including asthma in workers, residents, and children. Studies on adults have documented persistence of longer term, 9/11-related respiratory symptoms. There are no comparable reports on children. Methods. We surveyed 985 children aged 5–17 years who enrolled in the WTC Health Registry in 2003–04, and who were re-surveyed in 2007–08. Health data were provided by parents in both surveys and focused on respiratory symptoms suggestive of reactive airway impairment (wheezing or the combination of cough and shortness of breath) in the preceding 12 months. At follow-up, adolescents aged 11–17 years completed separate surveys that screened for post-traumatic stress symptoms and behavior problems (Strengths and Difficulties Questionnaire, SDQ). Associations between respiratory symptoms in the prior 12 months with 9/11 exposures and behavioral outcomes were evaluated with univariate and multivariate methods. Results. Of the 985 children, 142 (14.4%) children reported respiratory symptoms in the prior 12 months; 105 (73.9%) children with respiratory symptoms had previously been diagnosed with asthma. Among children aged 5–10 years, respiratory symptoms were significantly elevated among African-Americans (adjusted odds ratio, (aOR) 3.8; 95% confidence interval (CI) 1.2–11.5) and those with household income below

Higher cost, but poorer outcomes: the US health disadvantage and implications for pediatrics

75,000 (aOR 1.9; CI 1.0–3.7), and was more than twice as great in children with dust cloud exposure (aOR 2.2; CI 1.2–3.9). Among adolescents aged 11–17 years, respiratory symptoms were significantly associated with household income below

Interprofessional Integrative Medicine Training for Preventive Medicine Residents.

75,000 (aOR 2.4; CI 1.2–4.6), and with a borderline or abnormal SDQ score (aOR 2.7, 95% CI 1.4–5.2). Symptoms were reported more than twice as often by adolescents with vs. without dust cloud exposure (24.8% vs. 11.5%) but the adjusted odds ratio was not statistically significant (aOR 1.7; CI 0.9–3.2), Conclusions. Most Registry children exposed to the 9/11 disaster in New York City reported few respiratory problems. Respiratory symptoms were associated with 9/11 exposures in younger children and with behavioral difficulties in adolescents. Our findings support the need for continued surveillance of 9/11 affected children as they reach adolescence and young adulthood, and for awareness of both physical and behavioral difficulties by treating clinicians.

Pediatricians and Public Health: Optimizing the Health and Well-Being of the Nation’s Children

Despite spending more than 2.5 times as much on health care as in peer nations,1 there is a consistent and pervasive pattern of higher mortality and inferior health in the United States.2 This commentary, based on a symposium at the 2014 Pediatric Academic Societies meeting in Vancouver, highlights factors that may be responsible for these differences, comments on implications for policy, practice, and research, and proposes a call to action. A report by the National Research Council and the Institute of Medicine (IOM), Shorter Lives, Poorer Health (hereafter called the IOM report), describes major health disadvantages between the United States and 16 comparable, high-income “peer” countries.2 All of these nations have sufficient national wealth to support a variety of health and social services policies and programs to address the health needs of their populations. Yet the IOM report, along with other reports, revealed significantly poorer outcomes for the US population, beginning at birth, and affecting all age groups.2–4 The substantially higher US rates of infant mortality, low birth weight, and preterm birth weight have been well known. What is perhaps less well known is that this disadvantage continues throughout childhood and adolescence. Indeed, the probability of children dying before age 5 (8 per 1000) is highest in the United States and US adolescents have higher all-cause mortality, including mortality from injuries and violence.2 Compared with peer countries, the prevalence of obesity among US adolescents is more than twice other national means, and the US prevalence of diabetes is in the top third. What is behind this paradox of spending more and achieving less? Although the reasons undoubtedly include our fragmented health care system and large uninsured population, the pervasive nature of low US rankings suggests something more profound: a fundamental difference between policies … Address correspondence to Gerry Fairbrother, PhD, AcademyHealth, 1150 17th St NW, Suite 600, Washington, DC 20036. E-mail: gerry.fairbrother{at}academyhealth.org

The Epidemiology of Infant Mortality in the Greater Newark, New Jersey Area: A New Look at an Old Problem.

Integrative medicine training was incorporated into the Rutgers New Jersey Medical School Preventive Medicine residency at the Rutgers Biomedical and Health Sciences Newark Campus as a collaboration between the Rutgers New Jersey Medical School and the School of Health Related Professions. Beginning in 2012, an interdisciplinary faculty team organized an Integrative Medicine program in a Preventive Medicine residency that leveraged existing resources across Rutgers Biomedical and Health Sciences. The overarching aim of the programs was to introduce residents and faculty to the scope and practice of integrative medicine in the surrounding Newark community and explore evidence-based research on integrative medicine. The faculty team tapped into an interprofessional network of healthcare providers to organize rotations for the preventive medicine residents that reflected the unique nature of integrative medicine in the greater Newark area. Residents provided direct care as part of interdisciplinary teams at clinical affiliates and shadowed health professionals from diverse disciplines as they filled different roles in providing patient care. The residents also participated in research projects. A combination of formal and informal programs on integrative medicine topics was offered to residents and faculty. The Integrative Medicine program, which ran from 2013 through 2014, was successful in exposing residents and faculty to the unique nature of integrative medicine across professions in the community served by Rutgers Biomedical and Health Sciences.

Access to Care in the Wake of Hurricane Sandy, New Jersey, 2012.

Ensuring optimal health for children requires a population-based approach and collaboration between pediatrics and public health. The prevention of major threats to children’s health (such as behavioral health issues) and the control and management of chronic diseases, obesity, injury, communicable diseases, and other problems cannot be managed solely in the pediatric office. The integration of clinical practice with public health actions is necessary for multiple levels of disease prevention that involve the child, family, and community. Although pediatricians and public health professionals interact frequently to the benefit of children and their families, increased integration of the 2 disciplines is critical to improving child health at the individual and population levels. Effective collaboration is necessary to ensure that population health activities include children and that the child health priorities of the American Academy of Pediatrics (AAP), such as poverty and child health, early brain and child development, obesity, and mental health, can engage federal, state, and local public health initiatives. In this policy statement, we build on the 2013 AAP Policy Statement on community pediatrics by identifying specific opportunities for collaboration between pediatricians and public health professionals that are likely to improve the health of children in communities. In the statement, we provide recommendations for pediatricians, public health professionals, and the AAP and its chapters.

Communicating With Parents About Immunization Safety: Messages for Pediatricians in the IOM Report “The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies”

REVIEW This research had institutional review board approval from the University of Medicine and Dentistry of New Jersey and the State of New Jersey Department of Health and Senior Services. IRB #0120110286 BACKGROUND: The death rate during the first year of life, or infant mortality rate (IMR), is a key indicator of a nations health. Many factors affect IMR in the United States, including race and ethnicity. The 2020 U.S. Healthy People IMR target goal has been revised to 6.0 deaths per 1,000 births. In 2006, the IMR in New Jersey was 5.5 deaths per 1,000 births, ranging from 4.4 for Caucasians, to 11.5 for African Americans. OBJECTIVE This study is designed to determine whether IMRs vary by zip code in the greater Newark region and identify maternal/infant characteristics associated with elevated IMRs. METHODS A descriptive study was conducted using New Jersey Department of Health (NJDOH) birth certificate data and U.S. Census data by zip code in the greater Newark area. IMRs were analyzed by zip code and by characteristics of mothers and infants. RESULTS IMRs vary by zip code of residence. The lowest and highest IMRs were in zip codes 07105 and 07102, respectively, both located within the city of Newark. Maternal characteristics associated with high IMR, in multivariable analysis, include: lack of prenatal care, single marital status, and non-Hispanic black race. Demographic characteristics associated with high IMRs were: low mean household income and a large percentage of the population living below poverty level. CONCLUSIONS Race/ethnicity, marital status, and zip code of residence show significant impact upon infant mortality. Poverty and race/ethnicity are associated with increased IMRs and track to ZIP code.

World Trade Center Disaster and Asthma Type: Thomas et al. Respond

OBJECTIVE Evacuation and damage following a widespread natural disaster may affect short-term access to medical care. We estimated medical care needs in New Jersey following Hurricane Sandy in 2012. METHODS Hurricane Sandy-related questions regarding medical needs included in the Behavioral Risk Factor Surveillance System survey were administered to survey respondents living in New Jersey when Sandy occurred. RESULTS Recently arrived foreign-born residents were more likely than US-born residents to need medical care following Sandy. Others with greater medical needs included the uninsured and evacuees. Persons who evacuated or lived in areas that experienced the greatest hurricane impact were less likely to be able to fill a prescription. Only 15% of New Jerseyans were aware of the Emergency Pharmaceutical Assistance Program (EPAP), a federal program which allows prescription refills for the uninsured following a disaster. Recently arrived foreign-born residents and the uninsured were less frequently aware of EPAP: 8.7% and 10.9%. CONCLUSIONS Populations with impaired access to care in normal times-such as the recently arrived foreign-born and the uninsured-were also at risk of compromised access in the hurricanes aftermath. Measures to address prescription refills during a disaster need better promotion among at-risk populations. (Disaster Med Public Health Preparedness. 2016;10:485-491).