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Healthcare Access, Utilization, and Health Promotion Publications

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2025

  • Disparities in Utilization of the World Trade Center Health Program Among World Trade Center Rescue and Recovery Workers and Volunteers
    • After the 9/11 attacks, hundreds of thousands of people were exposed to harmful dust and extreme stress, including many responders and volunteers. Health programs were created to monitor and treat 9/11-related illnesses. This study found that volunteers are less likely than other responders to use these health services, even though they face serious health risks. The findings show a need for better outreach to volunteers to ensure fair access to care and long-term health support.
    • Ayers, C. D., Kehm, R. D., Cone, J. E., & Li, J. (2025). Disparities in Utilization of the World Trade Center Health Program Among World Trade Center Rescue and Recovery Workers and Volunteers. International Journal of Environmental Research and Public Health, 22(4), 643. https://doi.org/10.3390/ijerph22040643

2022

  • Self-Efficacy and Mental Health Help-Seeking Behavior of World Trade Center Health Registry Enrollees, 2015–2016
    • This paper reports on WTC survivors with Post Traumatic Stress Disorder and the relationship between self-efficacy and those seeking mental health help. Studies show that those with high-self efficacy are less likely to have PTSD then those with low self-efficacy. Those with lower self-efficacy were more likely to seek mental health treatment.
    • Garrey, S. K., Takemoto, E., Petrsoric, L., & Gargano, L. M. (2022). Self-Efficacy and Mental Health Help-Seeking Behavior of World Trade Center Health Registry Enrollees, 2015–2016. International Journal of Environmental Research and Public Health, 19(12), 7113. https://doi.org/10.3390/ijerph19127113

2020

  • Association Between Socioeconomic Status and Asthma-Related Emergency Department Visits Among World Trade Center Rescue and Recovery Workers and Survivors
    • The association between low socioeconomic standing (SES) and diminished health is one of the most well-described in social epidemiology. However, many of the mechanisms that lead disad-vantaged populations to be more susceptible to many health conditions like asthma compared to more affluent populations are not fully understood. This study examined whether barriers to care, such as lack of money or transportation and not knowing where to go for care, helped explain why enrollees who had lower income, were racial minorities, or who had lower education were more likely to be hospitalized for asthma. Those of lower SES were more likely to experience an asthma-related emergency department (ED) visit. Although the number of barriers to care influ-enced this association, they explained only a small percentage of the overall health disparity of the differences between African American and white individuals and between those with less than a high school diploma to those with at least a bachelor’s degree. However, the association varied by specific barrier to care. Lack of money, insurance, and transportation accounted for up to 11.8%), 12.5% and 4.3% respectively, of the association between SES and number of ED vis-its. Barriers such as lack of childcare, not knowing where to go for care, and inability to find a health care professional contributed to a smaller or no percentage of the association. Health eq-uity, a situation where everyone has a fair and just opportunity to be as healthy as possible, irre-spective of SES, is an important goal for public health authorities. In order to bring it about, we need to better understand the circumstances that are related to poorer health outcomes in vul-nerable populations.
    • Brite, J., Alper, H. E., Friedman, S., Takemoto, E., & Cone, J. (2020). Association Between Socioeconomic Status and Asthma-Related Emergency Department Visits Among World Trade Center Rescue and Recovery Workers and Survivors. JAMA Network Open, 3(3), e201600. https://doi.org/10.1001/jamanetworkopen.2020.1600

2019

  • Characterizing mental health treatment utilization among individuals exposed to the 2001 World Trade Center terrorist attacks 14-15 years post-disaster
    • Thousands in NYC who experienced 9/11 had significant stress reactions and disorders. These people needed immediate counseling. The WTC Health Registry used info from 35,629 enrollees of the Health Registry. The study examined predictors of counseling after 9/11. It also examined the types of practitioners seen, and the perceived helpfulness of therapy up to 15 years post-disaster.
    • Jacobson, M. H., Norman, C., Sadler, P., Petrsoric, L. J., & Brackbill, R. M. (2019). Characterizing Mental Health Treatment Utilization among Individuals Exposed to the 2001 World Trade Center Terrorist Attacks 14–15 Years Post-Disaster. International Journal of Environmental Research and Public Health, 16(4), 626. https://doi.org/10.3390/ijerph16040626

2018

  • Considerations for Future Disaster Registries: Effectiveness of Treatment Referral Outreach in Addressing Long-Term Unmet 9/11 Disaster Needs
    • A study examined a program that helped people exposed to 9/11 connect with specialized health care. The program targeted nearly 23,000 people who reported health problems linked to the attacks. By 2015, staff had reached about 8,800 people, and 5,554 requested an application for health care. About 2,425 reported submitting an application. The findings show that a dedicated outreach team can help large numbers of disaster survivors and responders access needed health services.
    • Petrsoric, L., Miller-Archie, S. A., Welch, A., Cone, J., & Farfel, M. (2018). Considerations for future disaster registries: Effectiveness of treatment referral outreach in addressing long-term unmet 9/11 disaster needs. Disaster Prevention and Management: An International Journal, 27(3), 321–333. https://doi.org/10.1108/DPM-01-2018-0026

2015

  • A Qualitative Analysis of New York City Based Primary Care and Specialty Providers' Knowledge of 9/11-Related Health Conditions and Health Care Services
    • The study found that many doctors understood common 9/11-related health problems but were less familiar with conditions still being researched. Although most doctors viewed 9/11 exposure as an important part of a patient’s medical history, they often did not ask about it or refer patients to 9/11 health programs. Doctors said they wanted more information about these programs and related health conditions. Providing clear educational materials and program details could help doctors make more referrals.
    • Welch AE, Caramanica K, Yip J, Petrsoric LJ and Cone JE. A Qualitative Analysis of New York City Based Primary Care and Specialty Providers’ Knowledge of 9/11-Related Health Conditions and Health Care Services. Austin J Emergency & Crit Care Med. 2015; 2(5): 1029. https://stacks.cdc.gov/view/cdc/211087.

2014

  • Translating research into action: An evaluation of the World Trade Center Health Registry’s Treatment Referral Program
    • A program was created to help people exposed to 9/11 get care for physical and mental health problems. From 2009 to 2011, staff contacted 7,518 people who reported health concerns linked to the attacks. Of those, 1,232 took part in the program, and 32% scheduled a first appointment. About 79% of those who scheduled an appointment kept it. The findings show that continued outreach and support can help people access care after a disaster.
    • Welch, A. E., Debchoudhury, I., Jordan, H. T., Petrsoric, L. J., Farfel, M. R., & Cone, J. E. (2014). Translating research into action: An evaluation of the World Trade Center Health Registry’s Treatment Referral Program. Disaster Health, 2(2), 97–105. https://doi.org/10.4161/dish.28219
  • Unmet mental health care need 10-11 years after the 9/11 terrorist attacks: results from 2011-2012 World Trade Center Health Registry
    • A study investigating the mental health care needs of 30,000 Registry enrollees 10 to 11 years after 9/11 found: over 15 % reported having PTSD, nearly 15% percent experienced depression, and 10% percent had both conditions. Enrollees who reported having both PTSD and depression were more likely to have increased 9/11 exposure, be unemployed, have lower social support and quality of life and have more unmet mental health care needs. It is common for traumatized populations to suffer from both PTSD and depression; the combination is often associated with functional impairment, greater symptom severity and disability.
    • Ghuman, S. J., Brackbill, R. M., Stellman, S. D., Farfel, M. R., & Cone, J. E. (2014). Unmet mental health care need 10–11 years after the 9/11 terrorist attacks: 2011–2012 results from the World Trade Center Health Registry. BMC Public Health, 14(1), 491. https://doi.org/10.1186/1471-2458-14-491

2013

  • Mental health of those directly exposed to the World Trade Center disaster: Unmet mental health care need, mental health treatment service use, and quality of life
    • High levels of unmet mental health needs and poor mental health days were reported by adult enrollees with probable PTSD symptoms five to six years after 9/11, especially among those who also reported being diagnosed with a mental health condition. However, those with a mental health condition are a vulnerable group. They were much less likely to use mental health services despite having perceived a need for mental health care.
    • Brackbill, R. M., Stellman, S. D., Perlman, S. E., Walker, D. J., & Farfel, M. R. (2013). Mental health of those directly exposed to the World Trade Center disaster: Unmet mental health care need, mental health treatment service use, and quality of life. Social Science & Medicine, 81, 110–114. https://doi.org/10.1016/j.socscimed.2012.12.016

2012

  • A qualitative examination of health and health care utilization after the September 11th terror attacks among World Trade Center Health Registry enrollees
    • In focus groups with both responders and survivors, participants reported barriers that prevented them from accessing 9/11 services: lack of visibility and accessibility of 9/11 health programs; fear of stigma related to receiving mental health care; unfamiliarity with 9/11-related health conditions; and few referrals from primary care providers.
    • Welch, A. E., Caramanica, K., Debchoudhury, I., Pulizzi, A., Farfel, M. R., Stellman, S. D., & Cone, J. E. (2012). A qualitative examination of health and health care utilization after the September 11th terror attacks among World Trade Center Health Registry enrollees. BMC Public Health, 12(1), 721. https://doi.org/10.1186/1471-2458-12-721