Epidemiologic Research and Disasters

INTRODUCTIONDisasters present a unique challenge for the epidemiologicresearch community. Disasters are almost always unexpect-ed and their aftermath is typically characterized by a strainon existing infrastructure and resources. These are not theconditions under which the epidemiologic research com-munity typically thrives. However, disasters by deﬁnitionaffect large numbers of people and a growing body ofevidence suggests that the consequences of disasters caninclude multiple health conditions (e.g., cardiovascular dis-ease, respiratory disease, mental health problems), can befar-reaching, and long-lasting (1–3). Although publichealth departments and federal organizations such as theCenters for Disease Control and Prevention (CDC) providethe ﬁrst-line of evaluation and intervention after suchevents, these agencies are typically overwhelmed by theimmediate needs after a mass disaster leaving much thatneeds to be done. The epidemiologic research communitythen has a unique role it can play after disasters, augmentingthe work of public health practitioners. To do so, epi-demiologists must identify the most acute areas where theycan be of assistance, build on existing resources, and designandimplement studies much more quickly thanis typical forepidemiologic work. In this commentary we present exam-ples from our own experience designing studies in theaftermath of the September 11, 2001 terrorist attacks inNew York City and offer suggestions about the role aca-demic epidemiologists can fruitfully play after disasters.THE SEPTEMBER 11, 2001 TERRORIST ATTACKSIn the aftermath of the September 11, 2001 terrorist attacks,government and disaster relief agencies started offeringservices to the persons who were most directly affected bythe disaster, including those surviving and evacuating theimmediate zone of destruction, ﬁrst responders, and thefamilies of the missing. However, for many weeks afterthe disaster, the magnitude of its effects remained unknownand best estimates were subject to continual revision. Froma public health point of view, it quickly became evident thatthere were three primary questions that warranted rapidassessment soon after the attacks: determining the impact ofthe attacks on those in and around Ground Zero, assessingthe potential impact of the smoke plume from the burningWorld Trade Center towers in the metropolitan area, anddocumenting the psychological consequences of the attacksin the general population.THE WORK OF THE NEW YORK ACADEMYOF MEDICINEIn the ﬁrst few days after the attack, in consultation with theCommissioner of the New York City Department of Health,we decided that the best use of our skills and resources wouldbe to assess the psychological impact of the disaster on thepopulation.OtherresearchteamsthroughouttheCitystartedto tackle issues related to the persons in and around GroundZero and to the environmental consequences of the plume.We generated research aims, focusing on assessing theprevalence and correlates of symptoms of post-traumaticstress disorder (PTSD), panic attacks, depression, substanceuse and abuse,andsomatic complaints in the general popula-tion with a particular focus on these symptoms in speciﬁcgroups, such as ethnic minorities and children. Optimisticthat telephone communications would be restored quickly,we decided to use random digit phone survey methodologybased on our previous experience with the technique and theability of telephone surveys to efﬁciently sample the generalpopulation.Wedevelopedacollaborationwithresearchersatthe Medical University of South Carolina who had prior ex-perience in post-disaster research. A protocol was submittedfor institutional review board approval and the decision wasmade to have two-tiered mental health backup available,includingpsychiatristsavailableonpagertoofferassistancetosurvey respondents assessed to require immediate attention.Trainingofinterviewersandapilottestreﬁnedthesurvey(4).Withnoclearfundinginplace,westakedourcorefundingongetting the project started and applied for an administrativesupplement from existing National Institutes of Health(NIH) grants. We obtained partial funding through an NIHsupplement to an existing grant and from a foundation daysbefore the ﬁrst survey started 5 weeks after the disaster.SUMMARY OF RESULTS DOCUMENTED INOUR WORK THUS FAROur ﬁrst assessment showed that we were able to recruita sample that mirrored the 2000 Census and that 7.5% of