september 11 terrorist attacks


Summary: Terrorism on September 11, 2001 against targets in New York, the Pentagon in Virginia, and an aborted attack that ended in Pennsylvania.

Top Publications

  1. Johnson S, Langlieb A, Teret S, Gross R, Schwab M, Massa J, et al. Rethinking first response: effects of the clean up and recovery effort on workers at the world trade center disaster site. J Occup Environ Med. 2005;47:386-91 pubmed
    ..These workers' experiences were qualitatively similar to the experiences of the first responders. To protect workers in the future, the focus on preparing "first" responders should be reconsidered more broadly. ..
  2. Zeig Owens R, Webber M, Hall C, Schwartz T, Jaber N, Weakley J, et al. Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: an observational cohort study. Lancet. 2011;378:898-905 pubmed publisher
    ..Continued follow-up will be important and should include cancer screening and prevention strategies. National Institute for Occupational Safety and Health. ..
  3. Izbicki G, Chavko R, Banauch G, Weiden M, Berger K, Aldrich T, et al. World Trade Center "sarcoid-like" granulomatous pulmonary disease in New York City Fire Department rescue workers. Chest. 2007;131:1414-23 pubmed
    ..This new information about the early onset of WTC-SLGPD and its association with asthma/AHR has important public health consequences for disease prevention, early detection, and treatment following environmental/occupational exposures. ..
  4. Wu M, Gordon R, Herbert R, Padilla M, Moline J, Mendelson D, et al. Case report: Lung disease in World Trade Center responders exposed to dust and smoke: carbon nanotubes found in the lungs of World Trade Center patients and dust samples. Environ Health Perspect. 2010;118:499-504 pubmed publisher
    ..Between 60,000 and 70,000 responders were exposed. Many reported adverse health effects...
  5. Farfel M, DiGrande L, Brackbill R, Prann A, Cone J, Friedman S, et al. An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. J Urban Health. 2008;85:880-909 pubmed publisher
  6. Skloot G, Schechter C, Herbert R, Moline J, Levin S, Crowley L, et al. Longitudinal assessment of spirometry in the World Trade Center medical monitoring program. Chest. 2009;135:492-498 pubmed publisher
    ..Due to the presence of spirometric abnormalities > 5 years after the disaster in many exposed individuals, longer-term monitoring of WTC responders is essential. ..
  7. Reissman D, Howard J. Responder safety and health: preparing for future disasters. Mt Sinai J Med. 2008;75:135-41 pubmed publisher
    ..Worker safety and health preparedness and leadership are essential for protecting workers and promoting resiliency among personnel involved in disaster response, recovery, and cleanup. ..
  8. Bills C, Levy N, Sharma V, Charney D, Herbert R, Moline J, et al. Mental health of workers and volunteers responding to events of 9/11: review of the literature. Mt Sinai J Med. 2008;75:115-27 pubmed publisher
  9. Prezant D, Levin S, Kelly K, Aldrich T. Upper and lower respiratory diseases after occupational and environmental disasters. Mt Sinai J Med. 2008;75:89-100 pubmed publisher
    ..This review describes several respiratory consequences of occupational and environmental disasters and uses the World Trade Center disaster to illustrate in detail the consequences of chronic upper and lower respiratory inflammation. ..

More Information


  1. Prezant D. World Trade Center Cough Syndrome and its treatment. Lung. 2008;186 Suppl 1:S94-102 pubmed
    ..These treatment recommendations are described here. ..
  2. Brackbill R, Hadler J, DiGrande L, Ekenga C, Farfel M, Friedman S, et al. Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. JAMA. 2009;302:502-16 pubmed publisher
    ..4%-25.0%]). Event-related loss of spouse or job was associated with PTS symptoms at W2. Acute and prolonged exposures were both associated with a large burden of asthma and PTS symptoms 5 to 6 years after the September 11 WTC attack. ..
  3. Tao X, Massa J, Ashwell L, Davis K, Schwab M, Geyh A. The world trade center clean up and recovery worker cohort study: respiratory health amongst cleanup workers approximately 20 months after initial exposure at the disaster site. J Occup Environ Med. 2007;49:1063-72 pubmed
    ..40, 95% confidence interval: 2.33-4.94). These results suggest an impact on respiratory health related to work experience at the WTC and indicate further monitoring to address potential long-term effects. ..
  4. Mauer M, Cummings K, Hoen R. Long-term respiratory symptoms in World Trade Center responders. Occup Med (Lond). 2010;60:145-51 pubmed publisher
    ..Our findings suggest that even in a moderately exposed responder population, lower respiratory effects were a persistent problem 5 years post-9/11, indicating that some WTC responders require ongoing monitoring. ..
  5. Mendelson D, Roggeveen M, Levin S, Herbert R, de la Hoz R. Air trapping detected on end-expiratory high-resolution computed tomography in symptomatic World Trade Center rescue and recovery workers. J Occup Environ Med. 2007;49:840-5 pubmed
  6. Aldrich T, Gustave J, Hall C, Cohen H, Webber M, Zeig Owens R, et al. Lung function in rescue workers at the World Trade Center after 7 years. N Engl J Med. 2010;362:1263-72 pubmed publisher
    ..Overall, these declines were persistent, without recovery over the next 6 years, leaving a substantial proportion of workers with abnormal lung function. ..
  7. Berninger A, Webber M, Cohen H, Gustave J, Lee R, Niles J, et al. Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001-2005. Public Health Rep. 2010;125:556-66 pubmed
    ..Screening for elevated PTSD risk may be useful in identifying those who could benefit from interventions during long-term follow-up, as well as in the immediate aftermath of disasters. ..
  8. Lin S, Jones R, Reibman J, Bowers J, Fitzgerald E, Hwang S. Reported respiratory symptoms and adverse home conditions after 9/11 among residents living near the World Trade Center. J Asthma. 2007;44:325-32 pubmed
    ..While we cannot eliminate potential biases related to self-reported data, we took strategies to minimize their impact, and the observed effects are biologically plausible. ..
  9. Murphy J, Brackbill R, Thalji L, Dolan M, Pulliam P, Walker D. Measuring and maximizing coverage in the World Trade Center Health Registry. Stat Med. 2007;26:1688-701 pubmed
  10. Jordan H, Miller Archie S, Cone J, Morabia A, Stellman S. Heart disease among adults exposed to the September 11, 2001 World Trade Center disaster: results from the World Trade Center Health Registry. Prev Med. 2011;53:370-6 pubmed publisher
    ..62, 95% CI 1.34-1.96 in men). A dose-response relationship was observed between PCL score and HD risk. This exploratory study suggests that exposure to the WTC dust cloud, injury on 9/11 and 9/11-related PTSD may be risk factors for HD. ..
  11. Lioy P, Pellizzari E, Prezant D. The World Trade Center aftermath and its effects on health: understanding and learning through human-exposure science. Environ Sci Technol. 2006;40:6876-85 pubmed
  12. Nolan A, Naveed B, Comfort A, Ferrier N, Hall C, Kwon S, et al. Inflammatory biomarkers predict airflow obstruction after exposure to World Trade Center dust. Chest. 2012;142:412-418 pubmed publisher
    ..Biomarkers of inflammation may help identify pathways producing obstruction after irritant exposure. ..
  13. Li J, Cone J, Kahn A, Brackbill R, Farfel M, Greene C, et al. Association between World Trade Center exposure and excess cancer risk. JAMA. 2012;308:2479-88 pubmed publisher
    ..No significant associations were observed with intensity of World Trade Center exposures. Longer follow-up for typically long-latency cancers and attention to specific cancer sites are needed. ..
  14. Stellman J, Smith R, Katz C, Sharma V, Charney D, Herbert R, et al. Enduring mental health morbidity and social function impairment in world trade center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster. Environ Health Perspect. 2008;116:1248-53 pubmed publisher
    ..Psychological distress and psychopathology in WTC workers greatly exceed population norms. Surveillance and treatment programs continue to be needed. ..
  15. Thomas P, Brackbill R, Thalji L, DiGrande L, Campolucci S, Thorpe L, et al. Respiratory and other health effects reported in children exposed to the World Trade Center disaster of 11 September 2001. Environ Health Perspect. 2008;116:1383-90 pubmed publisher
    ..We will determine severity of asthma and persistence of other respiratory symptoms on follow-up surveys. ..
  16. Naveed B, Weiden M, Kwon S, Gracely E, Comfort A, Ferrier N, et al. Metabolic syndrome biomarkers predict lung function impairment: a nested case-control study. Am J Respir Crit Care Med. 2012;185:392-9 pubmed publisher
    ..Metabolic biomarkers are predictors of lung disease, and may be useful for assessing risk of impaired lung function in response to particulate inhalation. ..
  17. Perlman S, Friedman S, Galea S, Nair H, Erös Sarnyai M, Stellman S, et al. Short-term and medium-term health effects of 9/11. Lancet. 2011;378:925-34 pubmed publisher
    ..Investigators note associations between 9/11 exposures and additional disorders, such as depression and substance use; however, for some health problems association with exposures related to 9/11 is unclear. ..
  18. Bills C, Dodson N, Stellman J, Southwick S, Sharma V, Herbert R, et al. Stories behind the symptoms: a qualitative analysis of the narratives of 9/11 rescue and recovery workers. Psychiatr Q. 2009;80:173-89 pubmed publisher
    ..This work shows that large scale qualitative surveillance of trauma-exposed populations is both relevant and feasible. ..
  19. Webber M, Gustave J, Lee R, Niles J, Kelly K, Cohen H, et al. Trends in respiratory symptoms of firefighters exposed to the world trade center disaster: 2001-2005. Environ Health Perspect. 2009;117:975-80 pubmed publisher
    ..In most large disasters, exposures may be unavoidable during the rescue phase, but our data strongly suggest the need to minimize additional exposures during recovery and cleanup phases. ..
  20. Moline J, Herbert R, Crowley L, Troy K, Hodgman E, Shukla G, et al. Multiple myeloma in World Trade Center responders: a case series. J Occup Environ Med. 2009;51:896-902 pubmed publisher
    ..This finding underscores the importance of maintaining surveillance for cancer and other emerging diseases in this highly exposed population. ..
  21. Wisnivesky J, Teitelbaum S, Todd A, Boffetta P, Crane M, Crowley L, et al. Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study. Lancet. 2011;378:888-97 pubmed publisher
    ..These findings emphasise the need for continued monitoring and treatment of the WTC rescue and recovery population. Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health. ..
  22. Jordan H, Brackbill R, Cone J, Debchoudhury I, Farfel M, Greene C, et al. Mortality among survivors of the Sept 11, 2001, World Trade Center disaster: results from the World Trade Center Health Registry cohort. Lancet. 2011;378:879-87 pubmed publisher
  23. Lin S, Gomez M, Gensburg L, Liu W, Hwang S. Respiratory and cardiovascular hospitalizations after the World Trade Center disaster. Arch Environ Occup Health. 2010;65:12-20 pubmed publisher
    ..There was an immediate increase in respiratory admissions after the disaster and a delayed increase in cardiovascular and cerebrovascular admissions. ..
  24. Lin S, Jones R, Reibman J, Morse D, Hwang S. Lower respiratory symptoms among residents living near the World Trade Center, two and four years after 9/11. Int J Occup Environ Health. 2010;16:44-52 pubmed
    ..Psychological stress, dust/odors, and moisture were significantly associated with LRS at follow-up. These data demonstrate that LRS continue to burden residents living in the areas affected by the WTC disaster. ..
  25. Lederman S, Jones R, Caldwell K, Rauh V, Sheets S, Tang D, et al. Relation between cord blood mercury levels and early child development in a World Trade Center cohort. Environ Health Perspect. 2008;116:1085-91 pubmed publisher
    ..Higher cord blood mercury was associated with reductions in developmental scores at 36 and 48 months, after adjusting for the positive effects of fish/seafood consumption during pregnancy. ..
  26. Banauch G, Brantly M, Izbicki G, Hall C, Shanske A, Chavko R, et al. Accelerated spirometric decline in New York City firefighters with α₁-antitrypsin deficiency. Chest. 2010;138:1116-24 pubmed publisher
    ..Clinically meaningful decline acceleration occurred even with the mild serum AAT level reductions associated with PiS heterozygosity (without concomitant PiZ heterozygosity). ..
  27. McDonald S, Beckham J, Morey R, Calhoun P. The validity and diagnostic efficiency of the Davidson Trauma Scale in military veterans who have served since September 11th, 2001. J Anxiety Disord. 2009;23:247-55 pubmed publisher
    ..Thus, results illustrate that potency of the DTS as a diagnostic aid was highly dependent on the comparison group used for analyses. Results are discussed in terms of applications to clinical practice and research. ..
  28. Savitz D, Oxman R, Metzger K, Wallenstein S, Stein D, Moline J, et al. Epidemiologic research on man-made disasters: strategies and implications of cohort definition for World Trade Center worker and volunteer surveillance program. Mt Sinai J Med. 2008;75:77-87 pubmed publisher
    ..Future disaster follow-up studies would benefit substantially by having access to accurate estimates of the number of workers and information on the individuals who contributed to the cleanup and recovery effort. ..
  29. Smits L, Krabbendam L, de Bie R, Essed G, Van Os J. Lower birth weight of Dutch neonates who were in utero at the time of the 9/11 attacks. J Psychosom Res. 2006;61:715-7 pubmed
    ..These results provide evidence supporting the hypothesis that exposure of Dutch pregnant women to the 9/11 events via the media has had an adverse effect on the birth weight of their offspring. ..
  30. Enright P, Skloot G, Herbert R. Standardization of spirometry in assessment of responders following man-made disasters: World Trade Center worker and volunteer medical screening program. Mt Sinai J Med. 2008;75:109-14 pubmed publisher
    ..This facilitated reliable and rapid diagnosis of lung disease in the large number of WTC responders screened. We recommend this approach for postdisaster pulmonary evaluations in other settings. ..
  31. Wheeler K, McKelvey W, Thorpe L, Perrin M, Cone J, Kass D, et al. Asthma diagnosed after 11 September 2001 among rescue and recovery workers: findings from the World Trade Center Health Registry. Environ Health Perspect. 2007;115:1584-90 pubmed
    ..The findings underscore the need for adequate and timely distribution of appropriate protective equipment and the enforcement of its use when other methods of controlling respiratory exposures are not feasible. ..
  32. Oppenheimer B, Goldring R, Herberg M, Hofer I, Reyfman P, Liautaud S, et al. Distal airway function in symptomatic subjects with normal spirometry following World Trade Center dust exposure. Chest. 2007;132:1275-82 pubmed
    ..Examination of distal airway function when spirometry results are normal may be important in the evaluation of subjects exposed to occupational and environmental hazards. ..
  33. Buyantseva L, Tulchinsky M, Kapalka G, Chinchilli V, Qian Z, Gillio R, et al. Evolution of lower respiratory symptoms in New York police officers after 9/11: a prospective longitudinal study. J Occup Environ Med. 2007;49:310-7 pubmed
    ..We studied the evolution of lower respiratory symptoms at 1 month (initial) and 19 months (follow-up) after the collapse of the World Trade Center on September 11, 2001 (9/11)...
  34. Perrin M, DiGrande L, Wheeler K, Thorpe L, Farfel M, Brackbill R. Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry. 2007;164:1385-94 pubmed
    ..Disaster preparedness training and shift rotations to enable shorter duration of service at the site may reduce PTSD among workers and volunteers in future disasters. ..
  35. Samet J, Geyh A, Utell M. The legacy of World Trade Center dust. N Engl J Med. 2007;356:2233-6 pubmed
  36. Marshall R, Bryant R, Amsel L, Suh E, Cook J, Neria Y. The psychology of ongoing threat: relative risk appraisal, the September 11 attacks, and terrorism-related fears. Am Psychol. 2007;62:304-16 pubmed
    ..The authors present ways in which these concepts and related techniques can be helpful in treating persons with September 11- or terrorism-related distress or psychopathology. ..
  37. de la Hoz R, Shohet M, Chasan R, Bienenfeld L, Afilaka A, Levin S, et al. Occupational toxicant inhalation injury: the World Trade Center (WTC) experience. Int Arch Occup Environ Health. 2008;81:479-85 pubmed
    ..Cigarette smoking and early arrival at the WTC site appear to be risk factors for lower airway disease diagnosis. ..
  38. Li J, Brackbill R, Stellman S, Farfel M, Miller Archie S, Friedman S, et al. Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on World Trade Center in New York City. Am J Gastroenterol. 2011;106:1933-41 pubmed publisher
    ..7; 1.2-2.3); and area workers exposed to the intense dust cloud (aRR=1.5; 1.2-1.8). Disaster-related environmental exposures may contribute to the development of GERS. GERS may be accentuated in the presence of asthma or PTSD. ..
  39. Weiden M, Naveed B, Kwon S, Segal L, Cho S, Tsukiji J, et al. Comparison of WTC dust size on macrophage inflammatory cytokine release in vivo and in vitro. PLoS ONE. 2012;7:e40016 pubmed publisher
    ..Subject-specific response to WTC-PM may underlie individual susceptibility to lung injury after irritant dust exposure. ..
  40. Green D, Buehler J, Silk B, Thompson N, Schild L, Klein M, et al. Trends in healthcare use in the New York City region following the Terrorist Attacks of 2001. Biosecur Bioterror. 2006;4:263-75 pubmed
    ..A transient decline in visits across all settings occurred immediately after September 11, followed by a sustained increase in demand for health care for conditions that may be associated with stress or other disaster consequences. ..
  41. Herbert R, Moline J, Skloot G, Metzger K, Baron S, Luft B, et al. The World Trade Center disaster and the health of workers: five-year assessment of a unique medical screening program. Environ Health Perspect. 2006;114:1853-8 pubmed
    ..5 years after the attacks. Longterm medical monitoring is required to track persistence of these abnormalities and identify late effects, including possible malignancies. Lessons learned should guide future responses to civil disasters. ..
  42. DiGrande L, Neria Y, Brackbill R, Pulliam P, Galea S. Long-term posttraumatic stress symptoms among 3,271 civilian survivors of the September 11, 2001, terrorist attacks on the World Trade Center. Am J Epidemiol. 2011;173:271-81 pubmed publisher
    ..09, 95% confidence interval: 1.84, 2.36). Identification of these risk factors may be useful when screening survivors of large-scale terrorist events for long-term psychological sequelae. ..
  43. Eskenazi B, Marks A, Catalano R, Bruckner T, Toniolo P. Low birthweight in New York City and upstate New York following the events of September 11th. Hum Reprod. 2007;22:3013-20 pubmed
    ..Stress may contribute to observed associations. ..
  44. Weiden M, Ferrier N, Nolan A, Rom W, Comfort A, Gustave J, et al. Obstructive airways disease with air trapping among firefighters exposed to World Trade Center dust. Chest. 2010;137:566-74 pubmed publisher
    ..Few had evidence for interstitial disease. Airways obstruction was the predominant physiologic finding underlying the reduction in lung function post-September 11, 2001, in FDNY WTC rescue workers presenting for pulmonary evaluation. ..
  45. Endara S, Ryan M, Sevick C, Conlin A, Macera C, Smith T. Does acute maternal stress in pregnancy affect infant health outcomes? Examination of a large cohort of infants born after the terrorist attacks of September 11, 2001. BMC Public Health. 2009;9:252 pubmed publisher
    ..The findings from this large population-based study suggest that women who were pregnant during the terrorist attacks of September 11, 2001 had no increased risk of adverse infant health outcomes. ..
  46. Moline J, Herbert R, Levin S, Stein D, Luft B, UDASIN I, et al. WTC medical monitoring and treatment program: comprehensive health care response in aftermath of disaster. Mt Sinai J Med. 2008;75:67-75 pubmed publisher
  47. Su J, Tran A, Wirtz J, Langteau R, Rothman A. Driving under the influence (of stress): evidence of a regional increase in impaired driving and traffic fatalities after the september 11 terrorist attacks. Psychol Sci. 2009;20:59-65 pubmed publisher
    Did the September 11 terrorist attacks elicit a subsequent increase in traffic fatalities? Gigerenzer (2004) argued that decreases in flying and increases in driving in the 3 months after the attacks led to 353 "surplus" traffic ..
  48. DiGrande L, Perrin M, Thorpe L, Thalji L, Murphy J, Wu D, et al. Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks. J Trauma Stress. 2008;21:264-73 pubmed publisher
    ..The relationship between socioeconomic status and PTSD suggests services must target marginalized populations. Followup is necessary on the course and long-term consequences of PTSD. ..
  49. Lengua L, Long A, Smith K, Meltzoff A. Pre-attack symptomatology and temperament as predictors of children's responses to the September 11 terrorist attacks. J Child Psychol Psychiatry. 2005;46:631-45 pubmed
    ..These variables might be used in the identification of children in need of intervention. ..
  50. Herbstman J, Frank R, Schwab M, Williams D, Samet J, Breysse P, et al. Respiratory effects of inhalation exposure among workers during the clean-up effort at the World Trade Center disaster site. Environ Res. 2005;99:85-92 pubmed
    ..The prevalence rates of upper airway symptoms (nasal congestion, sore throat, hoarse throat) exceeded those of lower respiratory symptoms, however, it was not determined whether symptoms pre-dated arrival at the WTC site. ..
  51. Brackbill R, Thorpe L, DiGrande L, Perrin M, Sapp J, Wu D, et al. Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings. MMWR Surveill Summ. 2006;55:1-18 pubmed
    ..Some of these findings might lead to building designs that can minimize injury hazards. ..
  52. Moline J, Herbert R, Nguyen N. Health consequences of the September 11 World Trade Center attacks: a review. Cancer Invest. 2006;24:294-301 pubmed
    ..This article reviews WTC-related health effects, the spectrum of exposures and how they were documented, and discusses future preventive efforts. ..
  53. Wagner V, Radigan M, Roohan P, Anarella J, Gesten F. Asthma in Medicaid managed care enrollees residing in New York City: results from a post-World Trade Center disaster survey. J Urban Health. 2005;82:76-89 pubmed
    ..Results from this study provide guidance to health care organizations in the development of plans to ensure the health of people with asthma during disaster situations. ..