Researchers Describe Impact of Sept. 11 on City Residents at Academy Conference

Some of the 440 people who attended the Academy???s conference regarding Sept. 11 research

NEW YORK CITY, Sept. 12 ??? New Yorkers are gradually healing from the terrorist attacks that traumatized the city one year ago, but some Manhattan and outer borough residents remain gripped by a troubling mix of mental stress, substance abuse and respiratory problems, distinguished researchers said this week during a daylong conference at The New York Academy of Medicine.

???We awakened to the fact that we???re not invulnerable to international terrorism,??? Dr. Jeremiah A. Barondess, president of the Academy, told a 440-person audience in his opening remarks. ???In the clinical and public health communities, we???ve responded with a spate of research efforts.???

City, state and national health leaders and scientists presented their research findings on Sept. 9 in Hosack Hall at one of the most significant conferences the Academy ever convened. Few were left unscathed by the terrorist acts that took more than 3,000 lives in New York, at the Pentagon and in Pennsylvania, said Dr. Thomas Frieden, commissioner of the New York City Department of Health and Mental Hygiene. Children, adults, firefighters, drug users, people who watched the Twin Towers crumble in person, those who saw it unfold on television: most New Yorkers suffered some degree of emotional or physical impact.

???Virtually everybody was affected by the World Trade Center attacks and indeed, most everybody felt some level of stress,??? said Frieden, who was among 28 speakers at the event, all who???ve been immersed in disaster-related health research and recovery efforts. ???The bottom line is, do people feel safe, and are they able to function after the attack???? As the city marks the one-year anniversary of the attacks, it is improving preparedness for dealing with bioterrorism by installing a new ???Syndromic Surveillance??? system in citywide emergency rooms to detect clusters of symptoms that warn of suspicious outbreaks or foul play. (The Academy is co-hosting a Sept. 23-24 conference about this new system).

Nobel Laureate Joshua Lederberg speaking at the conference.

Mental health on the rebound
New Yorkers??? mental health has collectively improved since last Sept. 11 but has still not returned to normal, explained David Vlahov, Ph.D., director of the Academy???s Center for Urban Epidemiologic Studies. Academy surveys conducted in the first half of 2002 show that New Yorkers were sleeping better, were less jumpy, and felt less fearful of a shortened future by the time June arrived. Insomnia dropped to 15 percent by June, down from 25 percent in February. Far fewer people were suffering from post-traumatic stress disorder (PTSD). Still, the news on mental health was not all good, especially in the outer boroughs, researchers reported. Staten Islanders and residents of the Bronx suffered from more extensive PTSD symptoms than did Manhattanites (22 percent, 21.7 percent and 16 percent, respectively). ???The data suggests that New York City is recovering, but outreach to all boroughs remains an important need,??? Vlahov said.

Patients with PTSD symptoms must not be treated using a one-size-fits-all approach, cautioned Dr. Carol North, Professor of Psychiatry at the Washington University School of Medicine in St. Louis. Patients with symptoms like nightmares, jumpiness, and intrusive thoughts can benefit by talking about their Sept. 11 experiences in counseling, North said. But such discussions may worsen the pain for people struggling with avoidance or numbing symptoms, said North, a 15-year specialist in mental health effects of disasters. ???There are different treatments for different populations,??? she said.

New York residents who???ve called the state???s crisis counseling hotline have overwhelmingly reported feelings of ???sadness and tearfulness,??? said Chip Felton, Associate Commissioner with the state Office of Mental Health. Forty-six percent of callers to Project Liberty have reported these symptoms, Felton said. While a significant number of New Yorkers have recovered from the mental trauma, Felton said ???there still is a core group of individuals who are heavily impacted by this event whose functioning is impaired.???

Substance use remains higher
Some New York residents have been turning to drugs to cope with the lingering pain and anguish, researchers reported at the conference. While little or no change was detected in the use of hard-core drugs like heroin, cocaine and crack after Sept. 11, alcohol use as well as cigarette- and marijuana-smoking did increase, and those increases persisted at least through June, said Dr. Sandro Galea, a medical epidemiologist in the Academy???s Center for Urban Epidemiologic Studies. Six to nine months after Sept. 11, an estimated 1.5 million New York City residents (25 percent of adults) were still drinking and smoking more than they had prior to the attacks, Academy research shows. Cigarette use was still about 8.3 percent higher than normal, alcohol use remained 19 percent higher, and marijuana use was elevated by 5.1 percent.

???Use of substances remain as high, almost, six to nine months after the event??? as they did 1-2 months after the event, said Galea, calling the findings ???surprising,??? especially since PTSD and depression had begun to subside by that time. Research exploring the relationship between stress and substance use will be a funding priority for the National Institute on Drug Abuse in the coming fiscal year, Associate Director Timothy Condon, Ph.D., told the crowd.

Left to right, Dr. James Hughes of the CDC, former New York City Health Commissioner Dr. Neal Cohen, and Dr. Marci Layton, Assistant Commissioner at the city Health Department.

Children feel the stress; newborns appear unscathed
As was widely anticipated, some of society???s most vulnerable members ??? children -- were also severely impacted. Thousands of children were plagued by fears and anxieties after living through the unprecedented horror of Sept. 11. Christina Hoven, Ph.D., a professor at the Columbia Mailman School of Public Health, surveyed 8,266 fourth- through 12-graders in the New York City public schools to determine the prevalence of mental disorders relating from Sept. 11. What she found was striking: 15 percent of kids reported a fear of public places, 12 percent of the children reported separation anxiety, 11 percent reported PTSD symptoms, and nine percent said they had experienced panic.

Black and Hispanic children, children whose parents were involved in the Sept. 11 rescue efforts and children whose parents had PTSD were most likely to exhibit behavioral problems after the terrorist attacks and to be sent to counseling, according to Jennifer Stuber, Ph.D., a research associate in the Academy???s Division of Health and Science Policy. Stuber was lead author of a January-February survey of 2,001 New York City adults. Children from single-parent homes were more likely to receive counseling, the survey showed.

Youths who attended school in the Twin Towers??? shadows were not the only ones likely to feel psychological pain resulting from Sept. 11. Research presented by Dr. Betty Pfefferbaum showed that children suffer mental distress even if they are not physically near to the disaster site. Pfefferbaum, chair of the Department of Psychiatry and Behavioral Science at the University of Oklahoma, studied Oklahoma City middle school students seven weeks after the bombing of a federal office building that killed 168 people. Two years later, she surveyed sixth graders residing 100 miles from the 1995 bombing site. ???Television exposure was as important as physical exposure or interpersonal exposure (knowing someone in the blast) in predicting post-traumatic stress,??? Pfefferbaum said.

Perhaps the day???s most encouraging news was shared by Trudy Berkowitz, Ph.D., a professor at the Mount Sinai School of Medicine. Her preliminary data shows that the World Trade Center collapse did not negatively impact the health of babies carried by pregnant downtown residents last September. The study so far involved 173 women, most from lower Manhattan. Researchers examined the babies, and looked at mothers??? blood, urine and breast milk samples.

Respiratory problems linger A concern that continues to frighten many New Yorkers is the long-term impact of the World Trade Center collapse on respiratory health. Just how damaging was the thick cloud of smoke and pulverized debris that blanketed streets, offices, apartments and people downtown? Several ongoing studies aim to provide a comprehensive answer, researchers explained. The World Trade Center Respiratory Health Study, a collaborative effort of New York University and the state Health Department, will assess new and worsened asthma cases that occurred after Sept. 11 among downtown residents. Health of those living within a mile of the World Trade Center site will be compared to that of residents living more than five miles away, in Upper Manhattan and Queens. The city Health Department and the Centers for Disease Control and Prevention this fall will begin enrolling 200,000 New Yorkers in a 20-year study to determine Sept. 11???s long-term impact on their health. ???We cannot rule out with absolute certainty, any long-term health effects,??? said Jessica Leighton, Ph.D., Assistant Commissioner at the city Health Department. The department detected a vast amount of fiberglass in the dust sampled from 59 apartments in 30 buildings south of Canal Street last November and December.

Outdoor air samples that were collected between Sept. 14 and Dec. 31 by a New York University School of Medicine team also showed high levels of fiberglass particles, as well as gypsum board particles. Professor Lung Chi Chen and colleagues set up air sampling stations at several points downtown and compared them to samples collected at Sterling Forest State Park, about 40 miles north of the city. ???We wanted to see what the particles were made of,??? Chen said. Most of the World Trade Center dust particles were too large to penetrate past the throat into the lungs, he said, but are probably to blame for what???s known as the ???World Trade Center Cough.??? Chronic breathing problems have sidelined 363 firefighters and emergency medical workers with respiratory disabilities, according to new CDC reports. ???These particles are very irritating,??? Chen said.

In the most emotional presentation of the day, Dr. Kerry Kelly, Chief Medical Officer for the New York City Fire Department, recalled that every one of the department???s 11,000+ firefighters was called to duty on Sept. 11. The department suffered a devastating loss of 341 firefighters and two paramedics from more than 60 firehouses, she said somberly, as pictures of firemen flashed on the screen behind her. ???Over 70 of our members lost a brother, a father or a son,??? Kelly said. Fires at the disaster site burned well into December and firefighters breathed the smoke clouds every day. The deleterious health impact was staggering: 1,768 firemen suffered respiratory stress after Sept. 11, five times as many as before the terrorist attacks. Coughing, wheezing and eye irritation were common complaints, with more than 90 percent of the FDNY workforce developing a cough after the towers collapsed.

Breathing is not the only impairment firefighters are grappling with. A full 250 department employees remain out on leave for PTSD, Kelly said, and 90 others are out with orthopedic injuries. Smoking has increased so much that the department is beginning a smoking cessation program. There is also grave concern about the disaster???s long-term effect on firefighters??? emotional health. ???We???ll be sending surveys to firehouses shortly to see how they???re doing as a group and as individuals,??? Kelly said.

Bracing for bioterrorism Now that the first year anniversary of the attacks has passed, city, state and federal agencies are working to increase the nation???s preparedness. In New York City, the public will need to be widely educated about the city???s mass prophylaxis plan, explained Dr. Marci Layton, Assistant Commissioner in the city Health Department???s Communicable Disease Program. The department must clearly and proactively communicate with the media about the risk of an outbreak, and must create telephone hotlines to provide updated information to the public and physicians.

Dr. James Hughes, the director of the CDC???s National Center for Infectious Diseases, said the CDC has placed a new focus on combating bioterrorism in the wake of the anthrax deaths and illnesses that first appeared last fall. Improved partnerships between clinicians and public health agencies, better surveillance, more prompt investigation and adequate lab capacity will all be critical to fight the bioterrorism threat, Hughes said. Echoing Layton???s concerns, he said communication with the public must also be enhanced. The CDC was widely viewed as failing to adequately inform people about the threats posed by anthrax and about protective measures. ???Communication was obviously the aspect of this that worked least well,??? Hughes said.

Microbiologist Joshua Lederberg, who received the Nobel prize in 1958 for proving that bacteria can reproduce sexually, summed up the day by explaining that the nation???s health professionals will be important soldiers in the nation???s new war. But he said Americans face a moral struggle as we proceed in the battle.

???We have no choice but to fight back,??? Lederberg said in closing remarks at the conference. ???I am perplexed how we can do that and preserve oursoul as a liberal, democratic society. Our own actions in self-defense will put many innocents at risk.There is one step we can take ... and that is to undertake global health as part of our compaign to exalt global civility.???

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Posted on September 13, 2002

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