# Presentation: 763717

## Claudia Thompson Ph.D.
Program Administrator
NIEHS

- July 12, 2005

- St Johns University, NYC New York

- Claudia Thompson Ph.D.
- Program Administrator
- NIEHS

***WTC Health Effects Research Activities***

## 
Health Studies		  66
Exposure Assessment	  20
Animal Studies                     4
Other				135

**Health Studies****	****	****  66**
**Exposure Assessment****	****  20**
**Animal Studies                     4**
**Other****	****	****	****	****135**

**World Trade Center Related Articles**

- Source:  PubMed

## Health Effects Research

- Mental Health			19
- Respiratory Effects		  9
- Cardiac Effects			  5
- Pregnancy Outcome	  	  5
- Other					  4

- Mental Health			  2
- Respiratory Effects		13
- Cardiac Effects		  0
- Other 				  9

**General Population – 42 Publications**

**Workers – 24 Publications**

**Notes:**
Thank you Larry
I am going to briefly run through the two programs
While we both support research, we have each carved out different pieces of the pie
Important : we work together, coordinate with the goal of improving research translation and providing you and other stakeholders with resources you can use.

First in the research continuum from the most basic to the most applied  - SBRP falls on the Basic side and ORD on the applied – next slide

## Timeline of NIEHS WTC-Related Activities

- 9/11/2001

- WTC Collapse

- Initial WTC studies

- Sept. 2001

- Congress Appropriation of $4.5M for Research

- Feb. 2002

- Awards

- April 2002

- Congress Appropriation of $4.0M for Research

- April 2003

- July 2003

- Awards

**Notes:**
Briefly to touch on a few details
EPA’s Office of Research and Development employs approximately 2,000 scientists, managers and support staff – but they support all of EPA, not just Superfund
ORD’s total budget is about $700 million, including about $100 million for the STAR grant program (the extramural component).
ORD is organized into three national laboratories, three national centers and two offices located in 14 facilities around the country.  These labs, centers and offices provide information and technical support to EPA programs offices, regions, state, local and tribal governments and other agencies performing environmental research, assessment and risk management.  EPA scientists collaborate with private sector partners to address important environmental issues.  For more information, visit www.epa.gov/ord. Randy will tell you more about how to use these as resources/tools
Research, development and science at EPA are the basis for decision-making.  Quality science informs sound policy.

## Congressional Appropriations

- In 2002 and 2003, the VA HUD and Independent Agencies sub-committee of Congress provides NIEHS with funds to support WTC research activities in the following areas:

**exposure assessment**
**clinical and epidemiology studies**
**community outreach**

**Congressional Appropriations**

## Awardee Institutions

- Columbia University
- Johns Hopkins University
- Mount Sinai School of Medicine
- New York University
- University of Medicine and Dentistry of New Jersey
- University of North Carolina, Chapel Hill

## Exposure Assessment Activities

**An exposure assessment of indoor air quality (2002, 2003 UMDNJ).**
**Analysis of collected air and dust samples (Columbia 2002)**
**Analysis of collected indoor and outdoor settled dust samples and air samples for elemental and chemical composition (2002, 2003 NYU)**
**Analysis of PAH levels in filter samples gathered by EPA at ground zero during the weeks following the WTC collapse 2002, 2003 UNC)**

-  **Sample Analysis**

## Exposure Assessment Activities

**Exposure assessment employing NASA’s Airborne Visible Infrared Imaging Spectrometer (AVRIS) for remote sensing imagery for quantitative assessment of WTC plume emissions (2002, 2003 Columbia)**
**The development of a GIS/RDBS micro-environment model (2002,2003 UMDNJ) **
**Spatiotemporal mapping (2002, 2003 UNC)**

**Exposure Assessment Activities**

-  **Exposure Models**

## Human Health Effects Research

**WTC resident respiratory impact study to examine prevalence for respiratory symptoms, especially new onset of asthma-like symptoms  (2002, 2003 NYU)**
**An epidemiological study of pregnant women and children to assess pregnancy outcomes and relationships to fetal/child development (2002, 2003 MSSM & Columbia)**
- A reproductive outcome study (2002, 2003 UMDNJ)
- A qualitative risk assessment to assess perceived community concerns and documentation of actual risks (2002 UMDNJ)
- Integrate exposure data with  residents post-traumatic stress, depression and panic (2002, 2003 UMDNJ)
- A pilot study to initiate validation of a newly developed personal passive air particulate monitoring device (2002, 2003 UNC)

-  **General Population**

## Objectives

- All Respondents
*n = 2,812*

- Control
*n = 292*

- Exposed
*n = 2,520*

- Previous respiratory diagnosis
*n = 417*
- 16.6%

- Previously normal
*n = 2,103*
- 83.4%

- Previous respiratory diagnosis
- N=41
- 14.9%

- Previously normal
*n = 251*
- 86.0%

*EHP vol 113 Number 4 April 2005*

## Results

*EHP vol 113 Number 4 April 2005*

## Results

*EHP vol 113 Number 4 April 2005*

## New onset respiratory symptoms
Exposed – 55%		 Control – 20.1%

**Exposed – 55%****	****	**** Control – 20.1%**

**Summary of Results**

*Persistent new onset respiratory symptoms*
- 	**Exposed – 26.4%****	****	****Control – 7.5 %**

*No differences in screening spirometry*

*Possible increased hyper responsiveness in exposed individuals with persistent symptoms*

## Two-fold increased risk of having a small for gestational age birth (birth wt below the 10th percentile for gestational age)a

Lower cortisol levels in mothers (p=.03) and babies of mothers (p = 0.008) who developed PTSD in response to 9/11.  Most apparent in babies born to mothers with PTSD in third trimesterb.

- Lower cortisol levels in mothers (p=.03) and babies of mothers (p = 0.008) who developed PTSD in response to 9/11.  Most apparent in babies born to mothers with PTSD in third trimesterb.

**Pregnancy Studies - Results**

*A** *Berkowitz et al – JAMA August 6, 2003 – Vol 290, No. 5
*B** *Yehuda et al – J Clin Endocrin & Metab May 3, 2005

## Pregnancy Studies - Results

| Outcome | Coefficient
Model 1 | Coefficient
Model 2 | Predictor |
| --- | --- | --- | --- |
|  |  |  |  |
| Birth weight
(n = 295) | -149 grams
p = .012 | -122 grams
p= .024 | resided within 2 miles |
| Birth length
(n = 287) | -0.819 cm
p = .026 | -0.737 cm
p = 0.039 | resided within 2 miles |
| Head circumference
(n = 286) | -0.477 cm
p = 0.010 | -0.300 cm
p = 0.096 | 1st trimester on Sept 11 |

- Lederman et al – EHP Dec 2004 - Vol 112, No. 17

## Biomarkers of Exposure among pregnant women near the  WTC

- Detectable PAH-DNA adducts are observed in maternal blood and cord blood samples.
- PAH-DNA adducts were seen among women whose blood was collected sooner after 9/11.
- There appears to be no significant relationship between adduct levels and exposure index (EI)
- Weekly summary of EI was associated with strongly with perception of air quality (PAQ)
- No significant associations between metal biomarkers (Pb, Cd, Co, Sb, U) or organochlorines and EI or timing of blood draw.

- Wolff et al – EHP, June 2005 – Volume 113, No. 6

**Notes:**
In addition to getting to know you, we hope to accomplish two objectives today – 
	(1) Introduce the types of research results and services that are coming out of the NIEHS and EPA research programs, 	
	(2) Encourage feedback on and interest in the application of these research efforts

We have a display and many handouts!

## Biomarkers of Exposure among pregnant women near the  WTC

- Mean PAH-DNA concentrations  in maternal and cord blood and the proportion of samples with detectable adducts, increased across populations with increasing estimated ambient exposure to PAH (Northern Manhattan < WTC < Krakow < Tongliang)* *
- PAH-DNA adducts in newborns were similar to or higher than found in mothers, although fetus has an estimated 10-fold lower PAH dose

- Perera et al – Cancer Epidemiol Biomarkers Prev, March 2005 – Volume 14, No. 3

**Notes:**

“Two way” communication:
	to encourage communication of new research results and their strengths and weaknesses. 
Slide serves to demonstrate that there are two programs – who work to coordinate with each other - - 
	and as we will discuss in more detail, both are available to you.
There are obstacles in Research Translation and we want to overcome obstacles 
We have relationship with Regions – but are supportive to states and tribe, too

We have split our message into two parts
1st a brief overview of the two programs – how they complement each other
2nd discuss the tools we have available for you to use

## World Trade Center Related Activities

- A clinical and epidemiology study of ironworkers at the WTC to investigate respiratory abnormalities and Post-Traumatic Stress (2002, 2003 MSSM)
- A WTC-NYC firefighters clinical study to assess cardio-pulmonary effects (2002, 2003 NYU)
- Registry of WTC site clean up workers (2002, 2003 JHSPH)
**Respiratory symptoms and psychological health assessment of WTC workers (2002, 2003 JHSPH)**
- Personal exposure assessment of WTC workers (2002, 2003 JHSPH)

-  **Worker Populations**

## World Trade Center Clean Up and Recovery Worker Health SurveyPI: Alison Geyh  Johns Hopkins Bloomberg School of Public Health

**Study population:**
- WTC workers identified by 3 NY local labor unions and the NYC Department of Sanitation
- non-WTC workers identified by 2 NY local labor unions
**Survey:**
- mailed questionnaire
- 4546 WTC workers
- 2103 non-WTC workers
- sent March – June 2003
**Response:**
- 1131 WTC workers
-  224 non-WTC workers
- received June 2003-June 2004

**Questionnaire included:**
**Exposure**
- first/last day on site
- number of days on site
- respirator use
- airborne contaminants/human remains
**Respiratory health**
- current cough, wheeze, phlegm
- historical cough, wheeze, phlegm
- smoking
**Mental health**
- post traumatic stress disorder
- depression
- anxiety
- quality of life
**Historical health**

**Notes:**

Re the SBRP 
Again you can consider all of the SBRP investigators to be a resource to you. Also as Beth mentioned there is point of contact in each program  responsible for interfacing with stakeholders (Research Translation Core Leader)

## Risk of respiratory symptoms associated with ever/never exposure at WTC

- Assessing the impact of ever being at the WTC on current (at the time the questionnaire was completed) lower respiratory symptoms (LRS).  Compared with those who were never at the disaster site, WTC workers were at greater risk for all LRS. These results suggest that having ever worked at the WTC is associated with an increased risk of cough, shortness of breath, phlegm, and being wheezy. These associations were statistically significant for all symptoms except phlegm

| Symptoms | OR | 95% CI |  |
| --- | --- | --- | --- |
| Cough | 1.78 | 1.29 | 2.46 |
| Shortness of breath | 1.72 | 1.25 | 2.37 |
| Phlegm | 1.23 | 0.96 | 1.57 |
| Wheeze | 1.67 | 1.23 | 2.28 |

**Notes:**

Re the SBRP 
Again you can consider all of the SBRP investigators to be a resource to you. Also as Beth mentioned there is point of contact in each program  responsible for interfacing with stakeholders (Research Translation Core Leader). We have a hand out listing the programs and the principal investigators.

## Selected Current Mental Health Problems by Work on WTC Site

| Characteristic | Worked on Site | Did Not Work on Site |
| --- | --- | --- |
|  | N (%) | N (%) |
| PTSD (DSM-IV criteria)** | 149 (13.5) | 12 (5.7) |
| PTSD (PCL score ≥50)** | 118 (10.4) | 8 (3.6) |
| PTSD (strict definition)** | 112 (10.2) | 7 (3.3) |
| Major depression**** | 178 (16.1) | 9 (4.4) |
| Generalized anxiety disorder*  | 54 (5.9) | 4 (2.0) |
| Panic attack(s)**** | 264 (24.1) | 21 (10.1) |
| Panic disorder** | 78 (7.2) | 3 (1.5) |

****P*****<.05   *******P*****<.005**
**********P*****<.0005 *********P*****≤.0001**

- There was significant prevalence of posttraumatic stress disorder (PTSD) and depression in the cohort. As compared with those who were never at the disaster site, WTC workers demonstrated significantly higher prevalence rates for all mental health symptoms for which we queried.

**Notes:**

Re the SBRP 
Again you can consider all of the SBRP investigators to be a resource to you. Also as Beth mentioned there is point of contact in each program  responsible for interfacing with stakeholders (Research Translation Core Leader). We have a hand out listing the programs and the principal investigators.

## Respiratory Symptoms in Worker Populations

| Clinical Syndrome | Clinical Syndrome | Study cohort |
| --- | --- | --- |
| RUDS | Nasal congestion/drip, sore throat, sinusitis | FDNY firefighters; iron workers; ESU police; technical, law enforcement and construction workers |
| Lower respiratory tract - WTC cough | Productive cough, wheeze, SOB, chest tightness | FDNY firefighters |
| RADS | Cough, wheeze, dyspnea | FDNY firefighters |
| LRT symptoms | Cough, wheeze, dyspnea, chest tightness
 | FDNY firefighters; iron workers; ESU police; technical, law enforcement and construction workers |
| LRT PFT abnormalities |  | FDNY firefighters; ESU police officers; iron workers |
| Gastrointestinal tract | Persistent upper GI complaints incl. heartburn | FDNY firefighters; rescue and clean-up workers |
| Eosinophilic pneumonitis |  | FDNY firefighter |
| Granlomatous pneumonitis |  | Power engineer |

- Banauch et al – Curr Opin Pulm Med, March 2005 – Volume 11, No. 2

**Notes:**
Clearly an over simplified diagram to depict that
An underlying difference between the two programs

ORD’s research is problem driven – finding solutions for immediate needs, where as the SBRP is charged with supporting the science to meet long term needs.
The division between the two programs is not absolute, we have flexibility

## Unanswered Questions

- Will pulmonary disease persist in workers and the general population exposed to WTC dust?
- Will exposure to airborne dioxins and furans in lower Manhattan in days and weeks after 9/11 increase risk of cancer, diabetes, or other chronic disease?
- Will there be long-term adverse effects on growth or development to children born of mothers exposed to WTC contaminants?

**Notes:**

SBRP has implemented several tools to make the research findings more accessible
Research Briefs are an electronic distributions of research findings – disseminated monthly
They are a quick read with follow up references.

Risk E Learning is a web based seminar series. SBRP brings in different investigators both  SBRP and others to discuss hot topics
The next series will begin late this summer and will be about DNAPls

Of course, all investigators are encouraged to publish and the Program produces about 500 pubs per year.

Although the SBRP is not a site specific program, it does conduct some site specific work – I think you can gloss over this point...

Scientific Expertise – There is a wide array of scientific expertise within the SBRP that you can consider a resource. (you can kind of sweep over this and go into more detail next slide)

Web pages – self explanatory... 
By the way I have added a slide at the end with Web addresses