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Background: Serious respiratory illnesses have been reported among rescue/recovery workers (RRW) following the World Trade Center (WTC) attacks., Methods: We studied RRW enrolled in the WTC Health Registry to assess the effects of different respiratory protection equipment (RPE) types on respiratory outcomes, such as recurrent respiratory symptoms and diseases possibly associated with 9/11 exposures. We performed descriptive and multivariate analyses adjusting for demographics and exposure variables., Results: A total of 9,296 RRW met inclusion criteria. The strongest predictors of using adequate RPE were being affiliated with construction, utilities or environmental remediation organizations and having received RPE training. Workers who used respirators were less likely to report adverse respiratory outcomes compared to those who reported no/lower levels of respiratory protection., Conclusions: Level of respiratory protection was associated with the odds of reporting respiratory symptoms and diseases. Training, selection, fit testing, and consistent use of RPE should be emphasized among emergency responders., (Copyright © 2011 Wiley Periodicals, Inc.)

The National Exposure Registry (NER) was created as a comprehensive group of data repositories that sought, over time, to relate specific environmental exposures to dioxin, trichloroethylene (TCE), benzene, and trichloroethane (TCA) to registrants' health conditions. Some parts of the NER were well conceived, whereas others were not. The most important design deficiency of the NER was its inability to adequately assess exposure. This was the key missing element and the Achilles heel of the NER program. At least three other important issues were never satisfactorily resolved in the design of the NER. They were unverified self-reporting, appropriate control groups, and the use of biomarkers. The many health effects that were observed to be in excess when compared with national norms might be explained by methodological differences in data analysis and reliance on self-reported nonverified data. Creating and maintaining a population-based chemical exposure registry is a more difficult challenge than creating and maintaining an outcome registry, such as a cancer registry.

Problem/condition: Survivors of collapsed or damaged buildings from the attack on the World Trade Center (WTC) were among those most exposed to injury hazards, air pollution, and traumatic events., Reporting Period: This report summarizes data from health outcomes collected during interviews conducted from September 5, 2003, to the close of the World Trade Center Health Registry (WTCHR) enrollment on November 20, 2004., Description of System: WTCHR will be used to monitor periodically the mental and physical health of 71,437 enrollees for 20 years. The analysis is limited to 8,418 adult survivors of collapsed buildings (n = 5,095) and buildings with major or moderate damage (n = 3,323), excluding those who were involved in rescue and recovery., Results: A total of 62.4% of survivors of collapsed or damaged buildings were caught in the dust and debris cloud that resulted from the collapse of the WTC towers, and 63.8% experienced three or more potentially psychologically traumatizing events. Injuries were common (43.6%), but few survivors reported injuries that would have required extensive treatment. More than half (56.6%) of survivors reported experiencing new or worsening respiratory symptoms after the attacks, 23.9% had heartburn/reflux, and 21.0% had severe headaches. At the time of the interview, 10.7% of building survivors screened positive for serious psychological distress (SPD) using the K6 instrument. After multiple adjustments, data indicated that survivors caught in the dust and debris cloud were more likely to report any injuries (adjusted odds ratio [AOR] = 3.9; p< or =0.05); any respiratory symptom (AOR = 2.7; p< or =0.05); severe headaches (AOR = 2.0; p< or =0.05); skin rash/irritation (AOR = 1.7; p< or =0.05); hearing problems or loss (AOR = 1.7; p< or =0.05); heartburn (AOR = 1.7; p< or =0.05); diagnosed stroke (AOR = 5.6; p< or =0.05); self-reported depression, anxiety, or other emotional problem (AOR = 1.4; p< or =0.05); and current SPD (AOR = 2.2; p< or =0.05). Adjustment for SPD did not diminish the observed associations between dust cloud exposure and physical health outcomes. Building type and time of evacuation were associated with injuries on September 11, 2001 and reported symptoms; building type (collapsed versus damaged) also was associated with mental distress., Interpretation: Two to three years after September 11, survivors of buildings that collapsed or that were damaged as a result of the WTC attack reported substantial physical and mental health problems. The long-term ramifications of these effects are unknown. Many survivors were caught directly in the dust and debris of collapsing towers, a dense cloud of particulate matter that might have produced or exacerbated these health effects. PUBLIC HEALTH ACTION RECOMMENDED: Long-term follow-up of building survivors and all other persons enrolled in WTCHR should be maintained, with particular attention to those persons exposed to the dust cloud. Some of these findings might lead to building designs that can minimize injury hazards.

The National Exposure Registry of the Agency for Toxic Substances and Disease Registry (ATSDR) uses standard methods to study human exposure in four chemical subregistries: trichloroethylene (TCE), dioxin, benzene, and trichloroethane. The TCE Subregistry includes a baseline cohort of 4006 white registrants with drinking water exposure in Michigan, Indiana, Illinois, Pennsylvania, and Arizona. Between 3 and 6 follow-ups per site were conducted from 1989 to 2000, after baseline. Standardized morbidity ratios, controlling for age and sex, compared prevalences of 16 general health conditions in the subregistry with aggregated national estimates from the 1989-1994 National Health Interview surveys. Excess cases of dermatologic, hematologic, or hepatic disorders and strokes persisted over the lifetime of the registry. Persistent excess urinary tract disorders are likely caused by a systematic bias. This review of first-generation methods may be used to strengthen future exposure registries.

This study examined attrition in the Trichloroethylene (TCE) Subregistry of the National Exposure Registry (NER). The analyses focused on 3915 persons exposed to the chemical TCE through the drinking water in their home. Baseline data were compared for subgroups of the TCE Subregistry members who were eligible to participate in the first TCE Subregistry follow-up. Study members were grouped according to their participation status in the first follow-up: remainers (n = 3494) and losses (n = 421), and three subgroups of losses: refusals, unable to locate, and unable to contact. The comparison of demographic variables of remainers and losses revealed that remainers had a higher percent of females, currently smoked less, were older, and fewer had no education and more had education beyond high school. These differences occurred for the losses subgroups unable to locate and unable to contact, however, not for refusals. The comparison of reporting rates of remainers and losses for 2.3 health outcomes revealed statistically significant decreases by losses for five health conditions but the pattern of statistically significant differences for the losses subgroups was not clear-cut. Altogether, the analyses indicated that the potential for bias due to attrition was minimal.