World Trade Center Adolescent Health Study
Condition: Asthma; Hypertension; Cardiovascular Risk Factor; Insulin Resistance; Stress Disorders, Post-Traumatic; Exposure to Toxic Dust
MeSH terms: Insulin Resistance; Stress Disorders, Post-Traumatic
Study type: Observational

Summary: 
      The proposed study builds upon preliminary studies in self-selected populations to identify
      opportunities for early identification of World Trade Center-related health consequences in
      adolescents. If adverse health consequences are identified, proactive cardiometabolic and
      pulmonary screening of exposed children may be indicated, with targeted interventions
      intended to prevent development of chronic obstructive pulmonary disease, and adverse
      cardiometabolic outcomes in adulthood.
    

Detailed description: 
      The study will assess the potential for longer-latency cardiometabolic and pulmonary effects
      of early life exposure to the World Trade Center (WTC) disaster, and to identify
      opportunities for early identification of WTC-related health consequences. Preliminary data
      from the only investigators who regularly provide clinical care to children who
      lived/attended school near the WTC site identified decrements in spirometry associated with
      dust cloud exposure, and a remarkably high frequency of cardiometabolic risk factors.
      Findings from this clinically, self-selected population cannot be extrapolated to the entire
      population of children who were exposed to the disaster but nonetheless suggest that further
      study is warranted of the possible metabolic and cardiovascular consequences of WTC
      exposures. If associated with WTC exposures in a larger, more representative sample, two new
      and innovative techniques, oscillometry and pulse wave velocity assessment, hold great
      promise for earlier detection of WTC-related pulmonary and cardiometabolic disease, for whom
      dietary, environmental and medication interventions may prevent disease progression in later
      life.

      The study will recruit 225 adolescents who respond to the WTC Health Registry (WTCHR), the
      most representative pediatric population and best-characterized from an environmental
      exposure standpoint. Connecting the study to the WTCHR also presents efficiency of federal
      resource utilization, providing more objective clinical data to support self-reported
      findings of increased persistent respiratory symptoms captured by the WTCHR, thereby
      improving reliability of the registry data. We will compare pulmonary and cardiometabolic
      outcomes to carefully matched (age, race/ethnicity, gender, and socioeconomic status) and
      unexposed control (not resident/attending school south of Houston Street on September 11,
      2001) populations from NYU School of Medicine affiliated primary care (private and public
      clinics).
    

Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        The study population for the present proposal will be drawn from the pediatric component of
        the WTCHR, a cohort of 71,436 adults and children who were first interviewed in 2003-04. To
        further investigate the associations of WTC exposures with health outcomes, we will compare
        health parameters in the cohort of WTCHR registrants with 225 subjects in a control cohort
        drawn from pediatric and adolescent clinics in Manhattan and Brooklyn.
      
Biospecimen description: 
      A research assistant well trained in pediatric phlebotomy will collect 25 mL of blood at the
      first visit, as one aliquot of 3 ml blood in a lavender top vacutainer for CBC, one aliquot
      of 5 ml blood in a goldtop vacutainer for whole blood, and one 3 ml of blood in a PAX Gene
      (PreAnalitycX - Hombrechtikon, Switzerland) tube for RNA isolation. One 4 ml cryovial of
      whole blood will be reserved for future DNA analysis and heavy metal analysis, and another 10
      ml vacutainer will be reserved for persistent organic pollutants, while the blood in the PAX
      Gene will be stored for RNA isolation.
    
Keywords: World Trade Center exposure; cardiovascular risk; insulin resistance; post-traumatic stress; pulmonary disease