The role of epidemiology in disaster response policy development.

Purpose: Disasters expose the general population and responders to a range of potential contaminants and stressors which may harm physical and mental health. This article addresses the role of epidemiology in informing policies after a disaster to mitigate ongoing exposures, provide care and compensation, and improve preparedness for future disasters.

Methods: The World Trade Center disaster response is used as a case study.

Lessons learned from the september 11th disaster: a state health agency perspective.

The New York State Department of Health has conducted a number of studies over the past 10 years investigating health impacts related to the September 11, 2001 (9/11) disaster among New York City residents and New York State World Trade Center (WTC) responders. Efforts to evaluate the health effects of WTC exposures in these cohorts presented numerous challenges, including study design and associated concerns about bias, identifying the affected populations, gaining community support and participation, and determining the most appropriate clinical testing and follow-up approaches. The unique position of a state public health agency provided multiple points of support for these efforts.

FE NO concentrations in World Trade Center responders and controls, 6 years post-9/11.

The aim of this study was to evaluate whether underlying respiratory disease may be revealed by offline fractional exhaled nitric oxide (FE(NO)) testing among a cohort of New York State (NYS) World Trade Center (WTC) responders in comparison with a control group of similar but unexposed NYS employees, 6 years post-9/11. Participants (92 exposed, 141 unexposed) provided two breath samples that were collected in Mylar bags and sent to a central laboratory for FE(NO) testing. Participants also completed a brief questionnaire.

A nested case-control study of low birthweight among cosmetologists.

Objective: This study was designed to determine whether licensed female cosmetologists with a low birthweight child were more likely to perform specific occupational tasks during pregnancy than cosmetologists who had a normal weight child. We also investigated certain salon characteristics in relation to low birthweight status.

Methods: This nested case-control study followed-up a positive association of low birthweight children among cosmetologists found in a retrospective cohort study previously reported.

Polychlorinated dibenzo-p-dioxins, dibenzofurans, biphenyls, and naphthalenes in plasma of workers deployed at the World Trade Center after the collapse.

Blood plasma samples (n = 43) collected retrospectively from New York State employees and National Guard personnel who had been assigned to work in the vicinity of the World Trade Center (WTC) during the week after the collapse of the buildings were analyzed for polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), polychlorinated biphenyls (PCBs), and polychlorinated naphthalenes (PCNs). On the basis of algorithms developed to rank individual exposures to dust and debris and to smoke, we categorized the samples as: more smoke exposure (MSE), more dust exposure (MDE), less smoke exposure (LSE), and less dust exposure (LDE). Mean concentrations of PCDDs were 1070, 223, 3690, and 732 pg/g lipid wt, and mean concentrations of PCDFs were 910, 1520, 230, and 117 pg/g lipid wt, for the MSE, MDE, LSE, and LDE groups, respectively.

Long-term respiratory symptoms in World Trade Center responders.

Background: New York State (NYS) employees who responded to the World Trade Center (WTC) disaster on or after 11 September 2001 potentially experienced exposures that might have caused persistent respiratory effects. NYS responders represent a more moderately exposed population than typical first responders.

Aims: To assess whether NYS employees who were WTC responders were more likely than controls to report lower respiratory symptoms (LRS) or a diagnosis of asthma 5 years post-9/11.

Impulse oscillometry and respiratory symptoms in World Trade Center responders, 6 years post-9/11.

This study evaluated whether impulse oscillometry (IOS) testing revealed signs of respiratory disease in New York State (NYS) World Trade Center (WTC) responders in comparison with unexposed NYS employees. It also compared self-reported respiratory symptoms between the two groups, 6 years post-9/11. For this evaluation participants completed a self-administered questionnaire regarding respiratory symptoms.

Asthma and lower respiratory symptoms in New York State employees who responded to the World Trade Center disaster.

Purpose: To investigate whether New York State employees who responded to the World Trade Center disaster were more likely to report asthma or lower respiratory symptoms (LRS; cough, wheeze, chest tightness, shortness of breath) than non-exposed employees, 2 years post-September 11.

Methods: Participants (578 exposed, 702 non-exposed) completed mailed questionnaires in 2003. A unique exposure assessment method was used; exposure scores were divided at the mean (at/below, above).

The risk of congenital malformations and other neonatal and maternal health outcomes among licensed cosmetologists.

This study sought to determine if cosmetologists in New York State (NYS) have a higher risk of complications of labor/delivery or congenital malformations and poor neonatal health indicators among their offspring compared with Realtors and the general population. This retrospective cohort study matched licensing records for cosmetologists and realtors to birth records and the NYS Congenital Malformations Registry from 1997 to 2003. A random sample of NYS birth certificates, frequency matched to cosmetologists on year of child's birth, mother's ethnicity, and education, was also formed.

Biomonitoring of perfluorochemicals in plasma of New York State personnel responding to the World Trade Center disaster.

The collapse of the World Trade Center (WTC) on September 11, 2001 resulted in the release of several airborne pollutants in and around the site. Perfluorochemicals including perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA), which are used in soil- and stain-resistant coatings on upholstery, carpets, leather, floor waxes, polishes, and in fire-fighting foams were potentially released during the collapse of the WTC. In this pilot study, we analyzed 458 plasma samples of New York State (NYS) employees and National Guard personnel assigned to work in the vicinity of the WTC between September 11 and December 23, 2001, to assess exposure to perfluorochemicals released in dust and smoke.

The risk of having a low birth weight or preterm infant among cosmetologists in New York State.

Objectives: This study sought to determine if female licensed cosmetologists have a higher risk of low birth weight, small-for-gestational-age, and preterm delivery compared to two different comparison groups.

Methods: This retrospective cohort study matched 15,003 licensed cosmetologists and a comparison group of 4,246 licensed realtors to birth records in New York State from 1997 to 2003. A second comparison group from the general population of New York State (n = 12,171) was frequency matched to cosmetologists on child's year of birth, mother's ethnicity and mother's education.

Development of an exposure assessment method for epidemiological studies of New York State personnel who responded to the World Trade Center disaster.

Objectives: An exposure assessment method was developed for use in assigning an exposure score to New York State personnel who responded to the World Trade Center disaster site after the 11 September 2001 terrorist attacks.

Methods: The method consists of an algorithm with two instantiations. Each represents a major component of the overall exposures at the site: dust and smoke.

Health effects in New York State personnel who responded to the World Trade Center disaster.

Objective: To conduct an evaluation of health effects in New York State personnel who responded to the World Trade Center disaster.

Methods: Data from a medical monitoring program, including questionnaire data, physical examination results, and clinical and laboratory test results were evaluated for 1423 participants. Descriptive statistics were reviewed and data were analyzed using logistic regression.

An evaluation of a Lyme disease prevention program in a working population.

Purpose: Lyme disease vaccine was offered to New York State Department of Health employees considered at risk for Lyme disease because of their job duties. This evaluation was conducted to assess (1) attitudes that affected employees' decisions to accept or decline the vaccine, (2) preventive behaviors among employees who received the vaccine, and (3) effectiveness of the educational modalities offered in improving knowledge of Lyme disease and Lyme disease vaccine.

Methods: A total of 190 eligible employees were identified and were offered two educational modalities before deciding whether to receive the vaccine.