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Respiratory health of 985 children exposed to the World Trade Center disaster: report on world trade center health registry wave 2 follow-up, 2007-2008.

Stellman-SD; Thomas-PA; Osahan-SS; Brackbill-RM; Farfel-MR
J Asthma 2013 May; 50(4):354-363
BACKGROUND: The World Trade Center (WTC) disaster of September 11, 2001, has been associated with early respiratory problems including asthma in workers, residents, and children. Studies on adults have documented persistence of longer term, 9/11-related respiratory symptoms. There are no comparable reports on children. METHODS: We surveyed 985 children aged 5-17 years who enrolled in the WTC Health Registry in 2003-04, and who were re-surveyed in 2007-08. Health data were provided by parents in both surveys and focused on respiratory symptoms suggestive of reactive airway impairment (wheezing or the combination of cough and shortness of breath) in the preceding 12 months. At follow-up, adolescents aged 11-17 years completed separate surveys that screened for post-traumatic stress symptoms and behavior problems (Strengths and Difficulties Questionnaire, SDQ). Associations between respiratory symptoms in the prior 12 months with 9/11 exposures and behavioral outcomes were evaluated with univariate and multivariate methods. RESULTS: Of the 985 children, 142 (14.4%) children reported respiratory symptoms in the prior 12 months; 105 (73.9%) children with respiratory symptoms had previously been diagnosed with asthma. Among children aged 5-10 years, respiratory symptoms were significantly elevated among African-Americans (adjusted odds ratio, (aOR) 3.8; 95% confidence interval (CI) 1.2-11.5) and those with household income below $75,000 (aOR 1.9; CI 1.0-3.7), and was more than twice as great in children with dust cloud exposure (aOR 2.2; CI 1.2-3.9). Among adolescents aged 11-17 years, respiratory symptoms were significantly associated with household income below $75,000 (aOR 2.4; CI 1.2-4.6), and with a borderline or abnormal SDQ score (aOR 2.7, 95% CI 1.4-5.2). Symptoms were reported more than twice as often by adolescents with vs. without dust cloud exposure (24.8% vs. 11.5%) but the adjusted odds ratio was not statistically significant (aOR 1.7; CI 0.9-3.2). CONCLUSIONS: Most Registry children exposed to the 9/11 disaster in New York City reported few respiratory problems. Respiratory symptoms were associated with 9/11 exposures in younger children and with behavioral difficulties in adolescents. Our findings support the need for continued surveillance of 9/11 affected children as they reach adolescence and young adulthood, and for awareness of both physical and behavioral difficulties by treating clinicians.
Emergency-response; Respiratory-system-disorders; Pulmonary-system-disorders; Lung-disorders; Bronchial-asthma; Airway-obstruction; Children; Adolescents; Health-programs; Surveillance-programs; Medical-monitoring; Health-surveys; Racial-factors; Dust-exposure; Behavior; Sociological-factors; Air-contamination; Environmental-pollution; Author Keywords: air pollution; asthma; behavior; children; disaster; respiratory symptoms; World Trade Center
Steven D. Stellman, Ph.D., M.P.H., New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, Long Island City, NY 11101, USA
Publication Date
Document Type
Journal Article
Email Address
Funding Type
Cooperative Agreement
Fiscal Year
NTIS Accession No.
NTIS Price
Identifying No.
Cooperative-Agreement-Number-U50-OH-009739; M082013
Issue of Publication
Source Name
Journal of Asthma
Performing Organization
New York City Health/Mental Hygiene