WTC Scientific Bibliography

Scientific research published in peer-reviewed journals comprises the bibliography below. Where possible, links to abstracts are provided. It will be updated on a weekly basis.

For research published prior to the current year, please scroll to the bottom of the page for a link to the WTC Science Summaries Overview maintained by the National Institute for Occupational Safety and Health.

All Health Effects Articles

2021 Articles

  • Robert M. Brackbill, Amy R. Kahn, Jiehui Li, et al. Combining Three Cohorts of World Trade Center Rescue/Recovery Workers for Assessing Cancer Incidence and Mortality
    Int J Environ Res Public Health. 2021 Feb; 18(4): 1386. Published online 2021 Feb 3. doi: 10.3390/ijerph18041386 PMCID: PMC7913216 PMID: 33546187

    This paper is the result of working with three responder cohorts, including the Fire Department of the City of New York (FDNY), the World Trade Center Health Registry (WTCHR), and the General Responder Cohort (GRC) to report the associations between WTC-exposures and rare cancers.
    Combining the three cohorts enabled researchers to collect data from a larger study group. Records from the FDNY, WTCHR, and GRC were combined resulting in 69,102 unique individuals. Overall, 7894 cancer tumors were matched to the study group, increasing the number of cancers by as much as 58% compared to previous studies. This combining of study group participants resulted in an effective resource for future research studies on rare cancers and mortality, with more representative of occupations and WTC- exposure.

2020 Articles

  • Meghan K. Hamwey, Lisa M. Gargano, Liza G. Friedman, Lydia F. Leon, Lysa J. Petrsoric, and Robert M. Brackbill, et al.
    Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature
    Int J Environ Res Public Health. 2020 Jun; 17(12): 4344. Published online 2020 Jun 17. doi: 10.3390/ijerph17124344 PMCID: PMC7344905 PMID: 32560511

    This paper is based on a review of studies published between 2002 and 2019 on post-tramatic stress disorder (PTSD) among adult civilian survivors of 9/11 who were directly exposed. The review considered a number of aspects of each published study. These included the study design, timeframe, reported prevalence and persistence of PTSD and conditions that co-occured with PTSD. several.
    This review paper further emphasizes that PTSD continues to be a critical area for understanding survivors’ emotional and physical development after 9/11 and makes recommendation for future research.

2019 Articles

  • Jacobson MH, Norman C, Sadler P, Petrsoric L, Brackbill RM.
    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. 2019 Feb 20;16(4). pii: E626. doi: 10.3390/ijerph16040626.

    This study helped identify experiences that led people to seek counseling 15 years after 9/11. Other objectives included determining the types of practitioners seen and the perceived helpfulness of therapy. Survey respondents were 35,629 enrollees in the World Trade Center Health Registry, who were potentially exposed to the attacks on 9/11. Nearly 40% reported receiving counseling at some time after 9/11. Key experiences of seeking counseling included exposure to the WTC attacks, traumatic experiences since 9/11, mental health symptoms, and having counseling before 9/11. Those with lower education and income were less likely to see mental health specialists, preferring to see general practitioners or religious advisors. Among those who said they had counseling in the last 12 months, 79% reported that the counseling was at least somewhat helpful. This study used data up to 15 years post-disaster to document mental health treatment utilization patterns, trends and disparities that has value for future preparedness plans and needs assessment.

  • Antao VC, Pallos LL, Graham SL, Brackbill RM, et al.
    9/11 Residential Exposures: The Impact of World Trade Center Dust on Respiratory Outcomes of Lower Manhattan Residents.
    International Journal of Environmental Research and Public Health. 2019 Mar 5;16(5). pii: E798. doi: 10.3390/ijerph16050798.

    The goal of this study was to describe patterns of home damage and cleaning practices among Lower Manhattan residents following the 9/11 disaster, and how this impacted respiratory outcomes. Among 6447 residents enrolled in the World Trade Center Health Registry, the presence of debris in their homes was associated with chronic cough and upper respiratory symptoms (URS). A heavy coating of dust was associated with increased shortness of breath, wheezing, and URS. Dusting or sweeping without water for cleaning was associated with the largest number of respiratory outcomes including shortness of breath, wheezing, URS, and asthma. This study demonstrates that lower Manhattan residents who suffered home damage following the 9/11 attacks are more likely to report respiratory diseases. The study also highlights the contribution of cleaning activities to increased vulnerability to symptoms and disease.

  • Seil K, Yu S, Alper H.
    A Cognitive Reserve and Social Support-Focused Latent Class Analysis to Predict Self-Reported Confusion or Memory Loss among Middle-Aged World Trade Center Health Registry Enrollees.
    International Journal of Environmental Research and Public Health 2019 Apr 18;16(8). pii: E1401. doi: 10.3390/ijerph16081401.

    Survivors of the 9/11 terrorist attacks in New York City have high rates of posttraumatic stress disorder (PTSD), which is a risk factor for cognitive decline. As the cohort ages, World Trade Center Health Registry (WTCHR) data will be used to illustrate the degree to which survivors may be experiencing confusion or memory loss – potential symptoms of cognitive decline. WTCHR staff examined self-reported confusion or memory loss among enrollees with the goal of determining whether higher levels of cognitive reserve (e.g., higher levels of social support, educational attainment) would be protective against these symptoms. Results showed that those with less cognitive reserve were more likely to report confusion or memory loss; these findings were similar regardless of whether or not an enrollee had probable PTSD.

  • Yung J, Osahan S, Friedman S, Li J, et al.
    Air Pollution/Irritants, Asthma Control and Health-Related Quality of Life Among 9/11-Exposed Individuals with Asthma.
    International Journal of Environmental Research and Public Health. 2019 May 30;16(11). pii: E1924. doi: 10.3390/ijerph16111924.

    Previous studies have shown that asthma control was suboptimal among World Trade Center (WTC) disaster-exposed individuals. Air pollution/irritants were reported as the most prevalent trigger among various populations as well as WTC responders with asthma. This study examined the relationship between self-report air pollutions/irritants trigger and asthma control among the WTC Health Registry’s enrollees. The study also investigated the impact of levels of asthma control on health-related quality of life (HRQoL). HRQoL has been recognized as a reflection of the effect of a disease on one’s health. We found that more than half of enrollees with asthma had either poorly-controlled or very poorly-controlled asthma. Reporting air pollution/irritants as trigger was associated with poorer asthma control. Poorer asthma control in turn worsened HRQoL. Our study has important implication that minimizing indoor/outdoor air pollution exposure may improve the well-being of Registry enrollees with asthma.

  • Morales-Raveendran E, Goodman E, West JE, Cone J, et al.
    Associations Between Asthma Trigger Reports, Mental Health Conditions, and Asthma Morbidity Among World Trade Center Rescue and Recovery Workers.
    Journal of Asthma 2019;56:833-840.

    The authors studied 372 WTC rescue and recovery workers (RRW) with asthma using the Asthma Trigger Inventory (ATI) that assessed triggers along five domains: psychological, allergens, physical activity, infection, and pollution. We administered the Structured Clinical Interview to diagnose post-traumatic stress disorder (PTSD), major depression and panic disorder. The Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (AQLQ) measured asthma control and quality of life, respectively. Models were fitted to examine the association of ATI total and subdomain scores with mental health conditions as well as the percent of ACQ and AQLQ variance explained by ATI subscales. The most common triggers were air pollution (75%) and general allergens (68%). PTSD was significantly associated with psychological triggers, physical activity and air pollution subscales while panic disorder was significantly associated with air pollution and general allergens. RRW with mental health conditions reported more asthma triggers and these triggers were associated with asthma morbidity. These data can help support interventions in RRW with asthma.

  • Adams SW, Allwood MA, Bowler RM.
    Post-traumatic Stress Trajectories in World Trade Center Tower Survivors: Hyperarousal and Emotional Numbing Predict Symptom Change.
    Journal of Traumatic Stress. 2019 32:67-77.

    This study looked into post-traumatic stress symptom (PTSS) patterns in 2,355 World Trade Center (WTC) tower survivors surveyed by the WTC Health Registry. This survey occurred an average of 2.5, 5.5, and 10.5 years after the September 11, 2001 terrorist attacks. Researchers looked at different variables, including sociodemographic characteristics, WTC-related exposure, and other traumas or stressors. Four PTSS patterns were identified: low symptom (74.9%), recovering (8.0%), worsening (6.7%), and chronic (10.4%). The majority of WTC survivors (85.3%) maintained stable symptom patterns over time. Although WTC-related exposure was associated with initial PTSS severity, exposure was not associated with chronicity or change of PTSS over time. Male gender and a higher number of post-WTC disaster life-stressors were associated with worsening symptom severity over time. Individuals with more severe hyperarousal symptoms at Wave 1, particularly of anxious arousal were more likely to have PTSS that worsened over time, adjusted odds ratio (aOR) = 1.55. Interventions that target hyperarousal and emotional numbing symptoms may help prevent a worsening of symptoms and facilitate recovery following future mass traumas, such as terrorist attacks.

  • Jordan HT, Osahan S, Li J, et al.
    Persistent mental and physical health impact of exposure to the September 11, 2001 World Trade Center terrorist attacks.
    Environ Health. 2019 Feb;18(1):12. doi: 10.1186/s12940-019-0449-7.

    The WTC Health Registry studied 36,897 participants who completed the 2015-2016 survey questionnaires. The survey asked about lower respiratory symptoms (LRS - cough, dyspnea, or wheeze), gastroesophageal reflux symptoms (GERS) and self-reported clinician-diagnosed asthma and Gastroesophageal Reflux Disease history. About half of participants had one or more 9/11-related condition (comorbidity). Among participants without pre-existing asthma, 15.4% reported asthma diagnosed after 9/11. The prevalence of PTSD was 14.2%, and of depression was 15.3%. Health related quality of life (HRQOL) declined as the number of 9/11-related comorbidities increased. Over one quarter of participants with PTSD or depression reported unmet need for mental health care in the preceding year. Comorbidity among conditions was common. Poor HRQOL and unmet need for health were frequently reported, particularly among those with post-9/11 PTSD or depression. Comprehensive physical and mental health care are essential for survivors of complex environmental disasters, and continued efforts to connect 9/11-exposed persons to needed resources are critical.

2018 Articles

  • Gargano LM, Hosakote S, Zhi Q, et al.
    Resilience to Post-Traumatic Stress among World Trade Center Survivors: A Mixed-Methods Study.
    Journal of Emergency Management 275 Vol. 15, No. 5, September/October 2017

    The goal of this study was to identify characteristics linked with symptoms of PTSD among 9/11 survivors who evacuated one of the WTC Towers. Analysis identified factors (protective for PTSD) and risk factors for PTSD. Factors, included leadership, action based on “gut” feelings and social support. Plus going on “automatic survival” mode, and previous emergency training. Risk factors for PTSD included lack of emergency response training, lack of sense of urgency and poor physical condition. Plus a lack of communication skills and lack of direction. Several modifiable factors that may confer resilience were identified. Emergency response training in preventing disaster related mental illness should be explored.

  • Li J, Zweig KC, Brackbill, RM, et al.
    Comorbidity Amplifies the Effects of Post-9/11 Posttraumatic Stress Disorder Trajectories on Health-Related Quality of Life.
    Quality of Life Research 2018 Mar; 27 (3):651-660. doi: 10.1007/s11136-017-1764-5. Epub 2017 Dec 20.

    The effect of multiple comorbidities and PTSD chronicity on HRQOL has not been well studied among those directly exposed to 9/11. We examined the different effects of (PTSD) on (HRQOL) among 30,002 adult World Trade Center Health Registry enrollees reporting no pre-9/11 PTSD. Age-adjusted prevalence of comorbid conditions was 95.8% and 61.4% among the chronic and no PTSD groups. Associations between 9/11-related PTSD and poor HRQOL were great and became greater when comorbidity was included. Adjusted prevalence ratios were elevated for fair/poor health status (APR=7.3, 95% CI=6.5-8.2), ≥14 unhealthy days (4.7; 95% CI=4.4-5.1), and ≥14 activity limitation days (9.6; 95% CI=8.1-11.4) in the chronic PTSD group with physical and mental health comorbidity compared to those without PTSD and comorbidity; similar associations were observed for delayed PTSD. The link between PTSD and HRQOL is driven by the high prevalence of many co-morbidities among individuals with PTSD.

  • Gargano LM, Mantilla K, Fairclough M, et al.
    Review of Non-Respiratory, Non-Cancer Physical Health Conditions from Exposure to the World Trade Center Disaster.
    Int J Environ Res Public Health. 2018 Feb 3;15 (2). pii: E253. doi: 10.3390/ijerph15020253

    The September 11th attacks on the World Trade Centers caused human and environmental problems. The poisons released by 9/11 and its relation to lung problems and cancer have been well researched. This review uses published papers to shed light on new 9/11 related health problems. Most of the research on the physical health effects of 9/11 focused on rescue/recover workers. There is new information that shows heart disease, stomach problems, trouble sleeping and other conditions are linked to the 9/11. Research following the new health conditions will help explain the link between exposure to the 9/11 and new physical health effects. This type of research can guide treatment efforts and inform future disaster response activities.

  • Yung J, Li J, Jordan HT, et al. Prevalence of and Factors Associated with Mammography and Prostate-Specific Antigen Screening among World Trade Center Health Registry Enrollees, 2015–2016.

    After the 9/11 WTC attacks, the people exposed to the disaster reported an increase in certain cancers. And there is a need to understand why. This study compared the increased amount of breast examines and prostate exams among the enrollees compared to the general population. It was determined there was a connection between WTC-exposure with enrollees’ screening uptake. Proximity to the WTC at the time of attacks was associated with increased PSA testing in the age 60-74 group. Rescue and recovery workers went for more PSA testing than other types of workers. This study includes important information to be used for future post-9/11 cancer studies of people exposed to 9/11.

  • Jacobson MH, Norman C, Nguyen A, Brackbill R. Longitudinal Determinants of Depression Among World Trade Center Health Registry Enrollees, 14-15 Years After the 9/11 Attacks.
    Journal of Affective Disorders. 2018.

    This was a study of the longitudinal predictors of depression among a cohort exposed to 9/11 attacks. We found that depression more common among those with history of PTSD (56.2%) vs. without (5.6%). Low income, unemployment, and low social support increased the risk of depression among those with and without a history of PTSD. In general, the risk factors for depression were similar for those with and without a history of PTSD.

  • Jordan HT, Stein CR, Li J, Cone JE, et al.
    Mortality Among Rescue and Recovery Workers and Community Members Exposed to the September 11, 2001 World Trade Center Terrorist Attacks, 2003-2014.
    Environmental Research, 2018.

    Have more deaths occurred among persons directly exposed to the 9/11 disaster than expected, based on comparison to the general New York City population? The WTC Health Registry identified the number and causes of death among Registry enrollees between the years of 2003-2014 via linkage to the National Death Index. We compared this number to the expected number of deaths based on mortality rates in the general NYC population. Overall, mortality among WTC Health Registry enrollees was not elevated. In fact, fewer deaths occurred than would be expected, based on comparison to the general NYC population. Registry enrollees had fewer cardiovascular and respiratory deaths than expected based on NYC reference rates. However, there were more deaths due to suicide among rescue-recovery workers than expected; these deaths mostly occurred among workers who did not perform rescue and recovery work in their usual, pre-9/11 work. There were also more deaths than expected due to non-Hodgkin’s lymphoma among community members. Even though the number of deaths overall was not elevated among Registry enrollees, there appears to have been an increased risk of death associated with higher levels of 9/11-related exposures. The Registry will continue to follow the numbers and causes of death among enrollees.

2017 Articles

2016 Articles

2015 Articles

2014 Articles

2013 Articles

2012 Articles

2011 Articles

2010 Articles