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Learning from the World Trade Center Attacks
Several Mailman studies focus on critical public health questions

Confidence Drops in Government's Ability to Protect Citizens

One of the World Trade Center buildings in flames as the other collapses on Sept. 11, 2001.
Three years after the terrorist attacks of Sept.11, confidence in the federal government's ability to protect Americans has fallen to a crisis level – dropping to 53 percent from 62 percent in 2003 – according to a new study from the National Center for Disaster Preparedness (NCDP) at the Mailman School of Public Health and the Children's Health Fund (CHF).

NCDP and CHF commissioned a survey in July 2004 from the Marist Institute for Public Opinion as a follow-up to their 2003 study to identify trends and public attitudes related to Sept. 11 and the war on terrorism. The 2004 survey was completed before the most recent threat level elevation.

Irwin Redlener, M.D., director of NCDP and president of CHF, has proposed specific recommendations for improving overall preparedness and communication.

Key survey results about the lack of confidence include:

• Three-quarters (76 percent) of Americans remain concerned about the possibility of terror attacks in the United States, while the level of confidence in the government's ability to protect local areas has dropped to 53 percent from 62 percent in 2003.

• Only four in 10 (39 percent) of Americans are confident in the health care system's readiness to respond to a biological, chemical, or nuclear attack. This is down from 46 percent in 2003 and 53 percent in 2002.

• Despite lower confidence in the U.S. health system's readiness to respond effectively to a biological, chemical, or nuclear attack, nearly two-thirds (63 percent) of families nationally still do not have a basic emergency plan.

• Although 61 percent of Americans are confident in the level of airport security, only 43 percent of Americans are confident in the government's ability to protect other public transportation including trains and buses from a terror attack.

Key results about communication:

• Fifty-nine percent of Americans will not evacuate immediately if directed to do so by officials. The most prevalent reason for noncompliance (47 percent) is the desire to account for the whereabouts and safety of family or other dependents.

• Forty-eight percent of parents are unaware of emergency preparedness plans at their children's schools.

• Only 21 percent of Americans are familiar with their community's terrorism response plan.

"The challenge of preparedness in the age of international terrorism is virtually without parallel in our experience," says Dr. Redlener. "The recommendations that we have presented to Congress and others provide immediate steps that will motivate the public to take seriously the notion of personal preparedness and improve confidence in government."

Making High-Rise Evacuations Safer

Analysis of World Trade Center data on evacuees by The Mailman School has found that many people were unfamiliar with the building's safety features, including evacuation routes and that structural barriers such as heavy congestion, debris and lack of backup communications also impeded evacuation.

Because full-scale evacuations of high-rise buildings are rare, little is known about how readily and rapidly these types of buildings can be fully evacuated and what factors facilitate or impede the process. Mailman began the World Trade Center Evacuation Study to assess the factors that affected the evacuation of the WTC buildings 1 and 2 on Sept. 11, 2001.

The study's initial findings suggest that some of the key factors affecting evacuation centered on individuals, such as a perceived inability to walk down many floors; a lack of prior experience in evacuation of the WTC buildings, including lack of knowledge of stairwell exits; unfamiliarity in general with the building layout and uncertainty as to whether or not certain stairwells would lead to street level exits; poor physical condition and inappropriate footwear that delayed progression; and a feeling that senior administrators and/or direct supervisors would disapprove of individuals leaving their work area that led to delays in initiating evacuation.

Other factors such as inadequate workplace preparedness and problems related to the building environment, such as debris on stairways, partially collapsed interior walls, and heavy congestion on stairways also impeded evacuation.

Initial insights based on the first phase of the evacuation study suggest that preparedness planning at all levels can facilitate the rapid and safe evacuation of high-rise buildings. The study recommends that high-rise occupants should be personally responsible for becoming familiar with their building and its safety features; individuals should know whether they are able to descend multiple floors; and they should have appropriate footwear readily available.

Much more detailed information about the impact of these various factors on evacuation and how behaviors affected the length of time to evacuate is now being collected in Phase II of the study.

The preliminary results of the study may be found in the Morbidity and Mortality Weekly Report issued by the CDC.

The study is being funded by the Centers for Disease Control and Prevention.

Effects on Pregnant Women Found From 9/11 Exposure

A Mailman School study has found that babies born to women living within a 2-mile radius of the WTC site during the month following the event weighed significantly less at birth (on average about a third of a pound), compared with infants born to the other pregnant women studied, (after controlling for sociodemographic and biomedical risk factors). When length of pregnancy also was taken into account, there was still a significant reduction in birth weight (on average more than a quarter of a pound).

Regardless of the distance of their homes or workplaces from the WTC site, women in the study who were in the first trimester of pregnancy at the time of the WTC attack delivered infants with significantly shorter gestation (-3.6 days), compared with women at later stages of pregnancy on 9/11.

The observed adverse effects suggest an impact of pollutants and/or stress related to the attacks and may have implications for the health and development of the exposed children.

"This study indicates that fetal growth and length of gestation were significantly reduced as a result of exposure to pollutants or stress, or both, from the destruction of the World Trade Center," says Sally Ann Lederman, M.D., special lecturer in the Harriet and Robert Heilbrunn Department of Population and Family Health, and lead author of the report. "Shortened gestation means smaller, less mature babies. The first trimester appears to have been a sensitive time period for this effect. The decreases we saw in the length of gestation and the size of the newborns are in the range of the effects of exposure to tobacco smoke, although none of these women were smokers."

The research involved a sample of 300 nonsmoking women who were pregnant at the time of the attacks and delivered at term. They were enrolled in the study between December 2001 and June 2002, shortly before delivering at one of three downtown hospitals.

The researchers note that the effects observed in the study, although statistically significant, are relatively small and that the reported reductions in birth weight and in pregnancy duration represent group averages and do not apply to every individual in the study.

For more information or a copy of the study, contact Heather Ross at 212-576-2700, ext. 243.

This study was made possible by research grants from the September 11th Fund of the New York Community Trust and United Way of New York; the New York Times 9/11 Neediest Fund and the National Institute of Environmental Health Sciences.