# Risk and resilience factors for adverse mental and physical health outcomes related to WTC exposure

> **NIH ALLCDC U01** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2020 · $395,587

## Abstract

Abstract
The men and women involved in the rescue and recovery efforts following the events of September 11, 2001
were exposed to extraordinarily hazardous working conditions and toxic agents. The National Institute of
Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention (CDC)
implemented the World Trade Center Health Program (WTCHP), which provides health surveillance to monitor
and treat WTC-related health consequences among rescue/recovery workers involved in the emergency
response and cleanup. Upon enrollment into the program, all responders completed a battery of self- and
interviewer-administered questionnaires and scales. Continued follow-up monitors changes in health status and
indicates significant long term medical and psychological effects among first responders, including post-traumatic
stress disorder (PTSD), gastroesophageal reflux disease (GERD), respiratory outcomes (i.e., asthma) and all
cancers. Recent evidence suggest emerging health outcomes including diabetes, headaches, and hearing
loss/problems. Despite strong links between WTC exposure and disease outcomes, factors associated with the
heterogeneity of disease development and trajectory remain largely unexplained. While several studies of WTC-
associated diseases have examined risk and protective factors associated with disease development and
trajectory, these studies are limited to a small number of WTC-associated exposure variables (i.e.,
presence/absence in the dust/debris cloud, working more than 90 days at the site, time at arrived to Ground
Zero, etc.) selected a priori based on the disease. Potential protective factors previously examined include
education, family and work support. The richness and breadth of the information on potential risk and protective
factors in the WTC surveillance dataset is largely untapped. In this proposal, we refer to this mixture of WTC-
related risk and protective factors as the “WTC exposome” and adopt a data-driven approach to examine
associations with WTC related health outcomes. We focus on posttraumatic stress disorder, gastroesophageal
reflux, respiratory outcomes and all cancers. This proposal addresses a critical gap in our understanding of risk
and protective factors for WTC-related diseases by leveraging generalized weighted quantile sum (gWQS)
regression, a statistical approach designed to examine associations between a mixture of correlated factors and
a health outcome. Using gWQS, we will create a weighted index representing the totality of characteristics
described in the WTC-surveillance dataset and examine a) how the overall index (or “mixture”) is associated with
the incidence of WTC-related disease and b) determine which of the baseline factors are most strongly
associated with the outcome and the direction of those associations (i.e., increase the risk for disease vs.
protect against the risk for disease). Application of this approach could be expanded to understand risk and
resil...

## Key facts

- **NIH application ID:** 10064740
- **Project number:** 1U01OH012075-01
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Megan K Horton
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2020
- **Award amount:** $395,587
- **Award type:** 1
- **Project period:** 2020-07-01 → 2021-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10064740

## Citation

> US National Institutes of Health, RePORTER application 10064740, Risk and resilience factors for adverse mental and physical health outcomes related to WTC exposure (1U01OH012075-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10064740. Licensed CC0.

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