World Trade Center Attacks Research Articles

Cross-sectional association between posttraumatic stress and cognition is moderated by pulmonary functioning in world trade center responders.

Posttraumatic stress disorder (PTSD) symptomatology and poorer pulmonary function are highly prevalent psychiatric and medical conditions. In the present study, we tested for the individual, additive, and modifying associations of PTSD symptomatology and pulmonary function with cognitive performance. In this cross-sectional study, a total of 1,401 World Trade Center (WTC) responders (mean age = 53, SD = 8 years, 92% males) participated in the study. Cogstate assessment measured cognitive performance. PTSD symptomatology was measured using the trauma-specific version of the posttraumatic stress disorder checklist (PCL-17) adapted for the WTC attacks. The 1-second forced expiratory volume and forced vital capacity (FEV1/FVC) ratio was used to measure pulmonary function. Linear regressions with cognitive performance as the outcome were conducted to assess individual, additive, and moderating associations of PTSD symptomatology and pulmonary function. Higher PTSD symptomatology and poorer pulmonary function were negatively associated with cognitive performance. A 10% increase on the FEV1/FVC ratio moderated the association between PTSD symptomatology and cognition, whereby its association with cognition was stronger when PTSD symptomatology was higher (est. = 0.01, 95%CI = 0.004, 0.01, p < 0.001). When stratified by responder type, these associations persisted in trained (est. = 0.01, 95%CI = 0.01, 0.02, p < 0.001), but not in non-trained (est. = 0.004, 95% C.I. = -0.01, 0.02, p = 0.39) responders. In the presence of higher PTSD, better pulmonary functioning is associated with better cognitive performance. Early intervention efforts to mitigate preventable cognitive decline in high-risk populations should be studied, especially since intervention in one modality may have an impact on others.

Teaching the art of compassionate inquiry: involving survivors from 9/11 in social work education

ABSTRACT This paper reports findings from pedagogic research evaluating the impact of the involvement of survivors from the World Trade Center attacks in New York City in 2001 in trauma-specific social work education. A pedagogic approach to mental health education is discussed which aims to prepare students to develop trauma-informed assessment and intervention skills concurrent with their encounters with trauma survivors in field practice placements. The small-scale research involved surveying students’ evaluations at a university in New York, following exposure to first-hand accounts of survivors’ experiences. Across the three areas—confidence in knowledge of trauma, impact on learning, and preparation for field practice—the evaluation findings indicate that the students’ knowledge, gained from the involvement of 9/11 survivors, improved over time. This paper presents the background to this project, preparations involved, and findings from research evaluations with the students. The findings suggest that the involvement of those with direct and lived trauma experience in classroom teaching, whilst challenging, can yield positive impacts for students. The 9/11 survivors poignantly shared with students that their lives were changed forever in the aftermath of these events. The findings have potential global educational impact and resonance.

Prevalence of Mild and Severe Cognitive Impairment in World Trade Center Exposed Fire Department of the City of New York (FDNY) and General Emergency Responders.

The emergency personnel who responded to the World Trade Center (WTC) attacks endured severe occupational exposures, yet the prevalence of cognitive impairment remains unknown among WTC-exposed-FDNY-responders. The present study screened for mild and severe cognitive impairment in WTC-exposed FDNY responders using objective tests, compared prevalence rates to a cohort of non-FDNY WTC-exposed responders, and descriptively to meta-analytic estimates of MCI from global, community, and clinical populations. A sample of WTC-exposed-FDNY responders (n = 343) was recruited to complete an extensive battery of cognitive, psychological, and physical tests. The prevalences of domain-specific impairments were estimated based on the results of norm-referenced tests, and the Montreal Cognitive Assessment (MoCA), Jak/Bondi criteria, Petersen criteria, and the National Institute on Aging and Alzheimer's Association (NIA-AA) criteria were used to diagnose MCI. NIA-AA criteria were also used to diagnose severe cognitive impairment. Generalized linear models were used to compare prevalence estimates of cognitive impairment to a large sample of WTC-exposed-non-FDNY responders from the General Responder Cohort (GRC; n = 7102) who completed the MoCA during a similar time frame. Among FDNY responders under 65 years, the unadjusted prevalence of MCI varied from 52.57% to 71.37% depending on the operational definition of MCI, apart from using a conservative cut-off applied to MoCA total scores (18 < MoCA < 23), which yielded a markedly lower crude prevalence (24.31%) compared to alternative criteria. The prevalence of MCI was higher among WTC-exposed-FDNY-responders, compared to WTC-exposed-non-FDNY-GRC-responders (adjusted RR = 1.53, 95% C.I. = [1.24, 1.88], p < .001) and meta-analytic estimates from different global, community, and clinical populations. Following NIA-AA diagnostic guidelines, 4.96% of WTC-exposed-FDNY-responders met the criteria for severe impairments (95% CI = [2.91% to 7.82%]), a prevalence that remained largely unchanged after excluding responders over the age of 65 years. There is a high prevalence of mild and severe cognitive impairment among WTC-responders highlighting the putative role of occupational/environmental and disaster-related exposures in the etiology of accelerated cognitive decline.

Beyond the flames: understanding the impact of loss without body recovery or identification in fire-related mass disaster contexts

Abstract The World Trade Center attack (2001), the Black Saturday (2009), the Malaysia Airlines Flight 17 (2014), the wildfires of June and October in Portugal (2017), the California wildfires (2018)—these are a few examples of mass disaster events, specifically related to fire and high temperatures, which resulted in multiple casualties and several people unidentified and/or missing. Besides the physical destruction, the lost lives are one of the main consequences of these contexts. Dealing with the loss of a family member may not be an easy process, however, it is easier to accept when there is a body to bury. Conversely, not knowing the whereabouts of a person who might have been involved in a disaster makes mourning and returning to daily life harder. The family of the missing/unidentified lives in doubt and in a state termed as ‘ambiguous loss’. Forensic anthropologists face several challenges and obstacles when detecting and analysing burnt skeletal remains, which are increased in mass disaster contexts. However, the suffering experienced by the families of the victims of these contexts is far superior. Therefore, it is of utmost importance to employ all efforts to achieve the identity of these victims to allow the families to mourn, as well as to reassure society that no death is insignificant. Thus, the importance of identifying the victims of scenarios involving fire/heat is addressed in this paper through a brief description of some mass disaster events, emphasizing the challenges faced in identifying burnt remains and the psychological consequences families endure resulting from it.

Incidence of Dementia Before Age 65 Years Among World Trade Center Attack Responders

Reports suggest that the individuals who served in rescue operations following the terrorist attacks on the World Trade Center (WTC) have poorer brain health than expected. To assess the incidence of dementia before age 65 years in a prospective study of WTC responders and to compare incidence among responders with severe exposures to debris vs responders not exposed to building debris or who wore personalized protective equipment (PPE). This prospective cohort study was conducted from November 1, 2014, to January 1, 2023, in an academic medical monitoring program available to verified WTC responders residing on Long Island, New York. Responders 60 years of age or younger without dementia at the time of their first cognitive assessment were followed up every 18 months, on average, for up to 5 years. Exposure severity was based on responses to a detailed questionnaire of WTC exposures and exposure-related activities that included exposures to fine particulate dust and potentially neurotoxic debris, duration of work, and the use of PPE. Exposure level was divided into 5 categories ranging from low to severe. Incidence of all-cause dementia before age 65 years was the primary outcome. Dementia was diagnosed following standard guidelines relying on repeated measures of cognition. Of 9891 responders, 5010 were eligible for inclusion in this study of cognitive function (median [IQR] age, 53 [48-57] years; 4573 [91.3%] male). There were 228 cases of dementia identified during 15 913.1 person-years of follow-up. Increasing WTC exposure severity was associated with incremental increases in the incidence rate of dementia per 1000 person-years (low, 2.95 [95% CI, 1.07-11.18]; mild, 12.16 [95% CI, 10.09-14.79]; moderate, 16.53 [95% CI, 13.30-20.81]; high, 30.09 [95% CI, 21.35-43.79]; and severe, 42.37 [95% CI, 24.86-78.24]). Adjusting for social, demographic, and relevant medical factors, each unit increase in exposure severity was associated with increased incidence of dementia (adjusted hazard ratio, 1.42 [95% CI, 1.18-1.71]; P < .001; mean risk difference, 9.74 [95% CI, 2.94-32.32] per 1000 person-years; P < .001). In this cohort study of WTC responders who survived these unique exposures and participated in a longitudinal follow-up study of cognition from 2014 through 2022, when compared with responders with the lowest exposure levels or responders who used PPE, more severe exposure to dust or debris was significantly associated with a higher risk of dementia before 65 years of age. This study suggests that the reliable use of PPE might help prevent the onset of dementia before age 65 years among individuals exposed to an uncontrolled building collapse. Future research is warranted to determine cerebral biomarkers for individuals with exposure-associated dementia.

Systemic Sclerosis in Individuals With Exposure to World Trade Center Ground Zero Rescue and Recovery Efforts: A Case Series.

The World Trade Center (WTC) attack in New York resulted in a dust plume containing silica, hydrocarbons, and asbestos. Autoimmune disorders have been reported among those with WTC site exposure. The characteristics of individuals developing systemic sclerosis (SSc) have not been previously described. The purpose of this study was to describe the features of patients with SSc with WTC exposure. Data were collected from 11 patients with SSc or SSc spectrum conditions who reported exposure to the WTC site. Seven patients completed an exposure assessment. Of the 11 patients, the majority (n = 8) were female. The median (range) for age at diagnosis was 46 (36-75) years, time between exposure and first non-Raynaud phenomenon SSc symptom was 8 (1-19) years, and time between exposure and diagnosis was 11 (2-18) years. Fifty-five percent had SSc onset > 5 years from WTC exposure. Five patients had limited cutaneous SSc, 3 patients had diffuse cutaneous SSc, 1 patient with SSc features met criteria for mixed connective tissue disease (CTD), and 2 patients had undifferentiated CTD with features of SSc. Four patients had overlapping features with other CTDs. Interstitial lung disease (ILD) was present in 10 patients. Five of 11 patients had a history of tobacco use. Seven of 7 patients who completed the questionnaire reported other hazardous exposures outside of WTC. Of these, only 2 patients reported personal protective equipment use. A high frequency of ILD and overlap features were observed among patients with SSc with WTC exposure. Future studies are needed to characterize this association.

Environmental Causes of Idiopathic Pulmonary Fibrosis.

Idiopathic pulmonary fibrosis (IPF), the most common and severe of the idiopathic interstitial pneumonias, is a chronic and relentlessly progressive disease, which occurs mostly in middle-aged and elderly males. Although IPF is by definition "idiopathic", multiple factors have been reported to increase disease risk, aging being the most prominent one. Several occupational and environmental exposures, including metal dust, wood dust and air pollution, as well as various lifestyle variables, including smoking and diet, have also been associated with an increased risk of IPF, probably through interaction with genetic factors. Many of the predisposing factors appear to act also as trigger for acute exacerbations of the disease, which herald a poor prognosis. The more recent literature on inhalation injuries has focused on the first responders in the World Trade Center attacks and military exposure. In this review, we present an overview of the environmental and occupational causes of IPF and its pathogenesis. While our list is not comprehensive, we have selected specific exposures to highlight based on their overall disease burden.

Weak State as a Security Threat: Study Case of El Salvador (2014-2019)

Weak State as a Security Threat: Study Case of El Salvador (2014-2019)

Glial suppression and post-traumatic stress disorder: A cross-sectional study of 1,520 world trade center responders

BackgroundChronically re-experiencing the memory of a traumatic event might cause a glial response. This study examined whether glial activation would be associated with PTSD in a study of responders present after the 9/11 World Trade Center attacks without comorbid cerebrovascular disease. MethodsPlasma was retrieved from 1,520 WTC responders and stored for a cross-sectional sample of responders of varying levels of exposure and PTSD. Plasma levels (pg/ml) of glial fibrillary acidic protein (GFAP) were assayed. Because stroke and other cerebrovascular diseases cause distributional shifts in GFAP levels, multivariable-adjusted finite mixture models analyzed GFAP distributions in responders with and without possible cerebrovascular disease. ResultsResponders were aged 56.3 years and primarily male; 11.07% (n = 154) had chronic PTSD. Older age was associated with increased GFAP, whereas higher body mass was associated with decreased GFAP. Multivariable-adjusted finite mixture models revealed that severe re-experiencing trauma from 9/11 was associated with lower GFAP (B = −0.558, p = 0.003). ConclusionThis study presents evidence of reduced plasma GFAP levels among WTC responders with PTSD. Results suggest re-experiencing traumatic events might cause glial suppression.

Challenges Facing Kenya-United States America Partnership Counterterrorism in Kenya

This reflection is an attempt to understand interstate partnership in bid to thwart global terrorism as a challenge in the post-cold war era. Terrorism attacks seem to have attracted global attention in the aftermath of 9/11 twin tower of the world trade center attack in the New York city. Global war on terror is a multi-dimensional, multi-faceted war led by USA with the main objective of protecting its interests globally. The horn of Africa is considered one of the safe haven for training and executing these attacks globally due to inherent prevailing circumstances in this region. Kenya has been a terrorist targetdue to its perceived closeness with the USA. The study adopted a mixed approach to reach its logical conclusion. It was found that; unemployment, USA coordination from Nairobi, internal politics, prolonged and severe inter-state conflicts in the region, geography and proximity to the gulf are the main challenges facing these partners in counterterrorism. The study concludes that for counterterrorism to succeed there is need to address the challenges and forge a close partnership among all stakeholders for a safer region.

World Trade Center Site Exposure Duration Is Associated with Hippocampal and Cerebral White Matter Neuroinflammation

Responders to the World Trade Center (WTC) attacks on 9/11/2001 inhaled toxic dust and experienced severe trauma for a prolonged period. Studies report that WTC site exposure duration is associated with peripheral inflammation and risk for developing early-onset dementia (EOD). Free Water Fraction (FWF) can serve as a biomarker for neuroinflammation by measuring in vivo movement of free water across neurons. The present case-controlled study aimed to examine associations between WTC site exposure duration as well as EOD status with increased hippocampal and cerebral neuroinflammation. Ninety-nine WTC responders (mean age of 56) were recruited between 2017 and 2019 (N = 48 with EOD and 51 cognitively unimpaired). Participants were matched on age, sex, occupation, race, education, and post-traumatic stress disorder (PTSD) status. Participants underwent neuroimaging using diffusion tensor imaging protocols for FWF extraction. Region of interest (ROI) analysis and correlational tractography explored topographical distributions of FWF associations. Apolipoprotein-e4 allele (APOEε4) status was available for most responders (N = 91). Hippocampal FWF was significantly associated with WTC site exposure duration (r = 0.30, p = 0.003), as was cerebral white matter FWF (r = 0.20, p = 0.044). ROI analysis and correlational tractography identified regions within the limbic, frontal, and temporal lobes. Hippocampal FWF and its association with WTC exposure duration were highest when the APOEε4 allele was present (r = 0.48, p = 0.039). Our findings demonstrate that prolonged WTC site exposure is associated with increased hippocampal and cerebral white matter neuroinflammation in WTC responders, possibly exacerbated by possession of the APOEε4 allele.

World Trade Center Exposome: A novel, data-driven approach to modeling risk and protective factors for adverse mental and physical health outcomes among WTC Responders

Background and Aim: Responders involved in rescue and recovery efforts following the 9/11 World Trade Center (WTC) attacks were exposed to hazardous working conditions and toxic agents. Previous studies associating WTC exposure with adverse health outcomes focus on a small number of risk factors selected a priori. We proposed a data-driven, exposomic approach to investigate the mixture of risk and protective factors experienced by WTC responders (i.e., a ’WTC exposome’) and its relation to responder health. Methods: We included 34,096 responders from the WTC Health Program (WTC-HP) with a physical and mental health evaluation and exposure assessment at first (post 9/11/01) visit. We used generalized weighted quantile sum (gWQS) regression to examine positive (i.e., risk) and negative (i.e., protective) associations between the &amp;#x22;WTC Exposome” index containing 84 factors (i.e., dust and traumatic exposures, baseline health information, social support) and five WTC-related health outcomes as dichotomous (ever/never): post-traumatic stress disorder (PTSD), gastroesophageal reflux disease (GERD), respiratory problems, diabetes, and headaches. All models were adjusted for age, race, ethnicity, and gender. Results: The WTC exposome was associated with all five health outcomes (PTSD βrisk = 6.4, βprotective = 0.1; GERD βrisk = 4.4, βprotective= 0.5; respiratory problems βrisk = 3.9, βprotective = 0.6; diabetes βrisk = 1.6, βprotective = 0.7; headaches βrisk = 5.6, βprotective = 0.3; p&amp;#x3c;0.0001 for all models). The WTC exposomic profile (i.e., the mix of risk and protective factors) differed by health outcome. For example, working in an enclosed area contaminated with dust contributed most to PTSD risk while full-time employment post 9/11 appeared protective against PTSD. Conclusion: Understanding WTC-related risk and protective factors enable us to better identify responders vulnerable to adverse outcomes and identify factors that may protect against the development or progression of disease. This approach has potential for future disaster response studies.

Treatment procedures for ideology-based terrorist offenders in Indonesia

Studies on terrorism have increased dramatically since the 9/11 World Trade Center attacks. However, the ways in which terrorist offenders’ rehabilitation should be constructed needs to be examined systematically, regardless of whether the approach used to look at terrorism is clinical or non-clinical. This research was carried out to identify treatment procedures for terrorist offenders based on first-hand experience of terrorism rehabilitators by applying qualitative design. The study involved interviews with terrorist rehabilitators in Indonesia who had been involved in treatment for ideology-based terrorist offenders in Indonesia in a variety of counseling and deradicalization programs. The findings show that the participants mention the presence of modifiable and unmodifiable domains of terrorist offenders. They believe that the domain of terrorism Motivation is likely modifiable, whereas Ideology is more challenging or takes longer to modify, while Capability is unlikely to be modified. The findings also demonstrate that there are nineteen steps for treating modifiable domains and seventeen steps for addressing unmodifiable domains of offenders. The results of this study may provide insights on treatment for offenders with different specifications related to motives, doctrines, attitudes, roles in ideological groups, militancy, and capabilities.

Investigating the impact of terrorist attacks on the mental health of emergency responders: systematic review.

Terrorist attacks have strong psychological effects on rescue workers, and there is a demand for effective and targeted interventions. The present systematic review aims to examine the mental health outcomes of exposed emergency service personnel over time, and to identify risk and resilience factors. A literature search was carried out on PubMed and PubPsych until 27 August 2021. Only studies with a real reported incident were included. The evaluation of the study quality was based on the Quality Assessment Tool for Quantitative Studies, and the synthesis used the 'Guidance on the Conduct of Narrative Synthesis in Systematic Reviews'. Thirty-three articles including 159 621 individuals were identified, relating to five different incidents with a post-event time frame ranging from 2 weeks to 13 years. The post-traumatic stress disorder prevalence rates were between 1.3 and 16.5%, major depression rates were between 1.3 and 25.8%, and rates for specific anxiety disorders were between 0.7 and 14%. The highest prevalence rates were found after the World Trade Center attacks. Reported risk factors were gender, no emergency service training, peritraumatic dissociation, spatial proximity to the event and social isolation. The inconsistency of the prevalence rates may be attributable to the different severities of the incidents. Identified risk factors could be used to optimise training for emergency personnel before and after catastrophic events. Voluntary repetitive screening of rescue workers for mental health symptoms is recommended.

Marketing Islamophobia: A Post-Colonial Analysis of the John Updike’s Terrorist (2006)

Many people's opinions of Muslims and Islam have evolved since the World Trade Center attacks on September 11, 2001. Muslims and Islam have been blamed for helping to breed terrorists. This prediction has thus been included in the literature. The same thing is done by John Updike in his book Terrorist. He has played Jews and Muslims. The disparity between the two identities fuels Western viewers' and Americans' fears about Islam. Updike masterfully alienates his Muslim protagonist from his community by utilising language, narrative style, concepts, and symbols. To analyse the Islamophobic and Orientalist elements in Updike's Terrorist, this study analyses and contrasts the two. American Jews and Muslims from Egypt are two very different populations.

Lasting Cruelties

Lasting Cruelties Lyle Jeremy Rubin (bio) Reign of Terror: How the 9/11 Era Destabilized America and Produced Trump by Spencer Ackerman Viking, 2021, 448 pp. On the heels of the U.S. invasion in 2003, Iraqis plundered and burned government offices, banks, businesses, and hospitals. Donald Rumsfeld, the defense secretary at the time, responded: While no one condones looting, on the other hand, one can understand the pent-up feelings that may result from decades of repression and people who have had members of their family killed by that regime, for them to be taking their feelings out on that regime. And I don't think there's anyone in any of those pictures … [who wouldn't] accept it as part of the price of getting from a repressed regime to freedom. In Reign of Terror: How the 9/11 Era Destabilized America and Produced Trump, Spencer Ackerman repurposes Rumsfeld's words in his chapter on the aftermath of George Floyd's murder. That juxtaposition between post-invasion Iraq and the Black Lives Matter uprising encapsulates the thesis of Ackerman's sweeping history of America's early-twenty-first-century wars. Ackerman details not just how the reactionary mindset and methods of the War on Terror have been brought home, but [End Page 130] also how U.S.-led militarism diverts liberationist energies abroad while containing or distorting them at national borders. Ackerman begins his striking prologue with the story of what was at that point "the worst terrorist attack in American history": the 1995 Oklahoma City bombing, which claimed 168 lives, with hundreds of others maimed or dismembered. Its perpetrator, Timothy McVeigh, was a veteran of the first Gulf War, a white supremacist, and an associate of a robust far-right network with the Christian Identity movement at its center. His two accomplices, Terry Nichols and Michael Fortier, were Army pals. Yet journalists and officials were reluctant to explore the significance of these facts and instead tended to treat McVeigh as a curious loner. The days after the bombing, before McVeigh was identified as the suspect, politicians from both parties, along with FBI agents, blamed the mass murder on Muslims. (They had in mind the culprits behind the first World Trade Center attack in 1993.) One pundit claimed—;without any grounding—;that Oklahoma City was "probably considered one of the largest centers of Islamic radical activity outside the Middle East." Another called for the mass surveillance or assassination of threatening foreigners. Law enforcement recorded an uptick in instances of Islamophobic harassment nationwide. And a year later, in a prelude to the 2001 Patriot Act, Congress passed the 1996 Antiterrorism and Effective Death Penalty Act, authorizing the FBI and federal prosecutors to spy on and prosecute any Muslim suspected of association with "international terrorists." Ackerman goes on to chronicle the boomerang effects of militarized weaponry, tactics, and culture. In this project, Reign of Terror joins the scholarship of historians like Kathleen Belew and Karen J. Greenberg, along with many other academics and reporters cited by Ackerman. But Ackerman insists on an even more discomfiting verdict: the U.S. security Click for larger view View full resolution Donald Rumsfeld in Kandahar, Afghanistan, in 2005 (Jim Young-Pool/Getty Images) [End Page 131] policies that have contributed to the hollowing out of American democracy and encouraged the rise of Donald Trump and the far right are part of a longer story of domination that can be traced back to the nation's founding as a settler-colonial project and slaveholding behemoth. The title of the book itself, an explicit reference to the French Revolution, is an implicit jibe at how perseverations over the crimes of lowlier challengers can obscure the more lasting cruelties of the Global North. Ackerman's career as a journalist spans nearly the entire War on Terror. He has embedded in Afghanistan and toured Guantanamo Bay's notorious detention camp, interviewed generals like David Petraeus and Stanley McChrystal, and played a central role in monumental scoops like the Snowden leaks. The breadth of his knowledge and experience are evident throughout Reign of Terror, which focuses primarily on political dynamics within the United States. Ackerman moves chronologically from the...

Inflection Points [President’s Message

Sometimes history is a Morse function. Inflection points arrive, unanticipated, and in the blink of an eye, the present reality and our expectations for the future are redefined. The assassinations of John F. Kennedy and Martin Luther King Jr. in the 1960s, Tiananmen Square and the fall of the Berlin Wall in 1989, the World Trade Center attacks in 2001—all occupied mere seconds, minutes, or, at most, a few days; each changed the trajectory of history.

Temporal Aspects of the Association between Exposure to the World Trade Center Disaster and Risk of Cutaneous Melanoma

Rescue/recovery workers who responded to the World Trade Center (WTC) attacks were exposed to known/suspected carcinogens. Studies have identified a trend toward an elevated risk of cutaneous melanoma in this population; however, few found significant increases. Furthermore, temporal aspects of the association have not been investigated. A total of 44,540 non-Hispanic White workers from the WTC Combined Rescue/Recovery Cohort were studied between March 12, 2002 and December 31, 2015. Cancer data were obtained through linkages with 13 state registries. Poisson regression was used to estimate hazard ratios and 95% confidence intervals using the New York State population as the reference; change points in hazard ratios were estimated using profile likelihood. We observed 247 incident cases of melanoma. No increase in incidence was detected during 2002–2004. From 2005 to 2015, the hazard ratio was 1.34 (95% confidence interval = 1.18–1.52). A dose‒response relationship was observed by arrival time at the WTC site. Risk was elevated just over 3 years after the attacks. Whereas WTC-related exposures to UVR or other agents might have contributed to this result, exposures other than those at the WTC site, enhanced medical surveillance, and lack of a control group with a similar proportion of rescue/recovery workers cannot be discounted. Our results support continued study of this population for melanoma.

Temporal association of prostate cancer incidence with World Trade Center rescue/recovery work

BackgroundThe World Trade Center (WTC) attacks on 11 September 2001 created a hazardous environment with known and suspected carcinogens. Previous studies have identified an increased risk of prostate cancer in...

Dose-response relationship between World Trade Center dust exposure and hepatic steatosis.

The World Trade Center (WTC) attack exposed thousands of workers to toxic chemicals that have been linked to liver diseases and cancers. This study examined the relationship between the intensity of WTC dust exposure and the risk of hepatic steatosis in the WTC General Responders Cohort (GRC). All low-dose computed tomography (CT) scans of the chest performed on the WTC GRC between September 11, 2001 and December 31, 2018, collected as part of the World Trade Center Health Program, were reviewed. WTC dust exposure was categorized into five groups based on WTC arrival time. CT liver density was estimated using an automated algorithm, statistics-based liver density estimation from imaging. The relationship between the intensity of WTC dust exposure and the risk of hepatic steatosis was examined using univariate and multivariable regression analyses. Of the 1788 WTC responders, 258 (14.4%) had liver attenuation less than 40 Hounsfield units (HU < 40) on their earliest CT. Median time after September 11, 2001 and the earliest available CT was 11.3 years (interquartile range: 8.0-14.9 years). Prevalence of liver attenuationless than 40 HU was 17.0% for arrivals on September 11, 2001, 16.0% for arrivals on (September12, 2001 or September13, 2001), 10.9% for arrivals on September 14-30, 2001, and 9.0% for arrivals on January 10, 2001 or later (p = 0.0015). A statistically significant trend of increasing liver steatosis was observed with earlier arrival times (p < 0.0001). WTC arrival time remained a significant independent factor for decreased liver attenuation after controlling for other covariates. Early arrival at the WTC site was significantly associated with increasing hepatic steatosis.