The New York Academy of Medicine
Responds to September 11 Attacks
Updated November 14, 2002

The New York Academy of Medicine has been in the business of health and healing for over 150 years, tackling the city's most pressing health needs. This work took on a new urgency after the September 11 terrorist attacks. In response to the disaster, the Academy swiftly initiated research projects to analyze the event's psychological, emotional and physical impacts on the New York City population. The Academy also provided expert assistance to federal and city health agencies. We are putting our existing strengths into practice: research, education, outreach to the community, and the capacity to convene multidisciplinary constituencies. We are also drawing upon our relationships with the medical community, the public health enterprise and government to make significant contributions.

On Sept. 9, national and regional leaders convened at a daylong conference at the Academy to examine the physical, mental and environmental health consequences of the worst terrorist acts in U.S. history. (Read the press release about this event). Experts in public health, science and medicine discussed research regarding the tragedy’s impact on people and the environment. They also brainstormed about future preparedness planning initiatives related to terrorism within our borders. The event was sponsored by the Academy and supported in part by a grant from the National Institute on Drug Abuse, a division of the National Institutes of Health. A conference at the Academy on Sept. 23-24 focused on the need for better public health surveillance systems that can detect outbreaks of potentially deadly diseases like anthrax and smallpox. The "Syndromic Surveillance" conference provided a forum for health agencies and academics to critically evaluate existing surveillance systems and help public health entities to define their needs. (Read the press release and posters/presentations from this event).

In October, The New York Academy of Medicine was awarded the 2002 Award for Special Achievement from the New York State Office of Mental Health (OMH). OMH Commissioner James L. Stone cited the Academy’s “extraordinary contributions to assessing and responding to the emotional needs of those affected by September 11." (View the Letter).

Outlined below are some of the initiatives the Academy set in motion following the attacks; many of these are continuing efforts to understand, quantify, and mitigate the impact of Sept. 11 on public health and safety. For further information about the Academy's studies and media coverage of our work, visit our Press Room.

Center for Urban Epidemiologic Studies
The Center for Urban Epidemiologic Studies (CUES) at The New York Academy of Medicine has completed many important studies surveying the psychological, physical and emotional impact of the Sept. 11 terrorist attack on New Yorkers of all ages. Summaries of the studies are below.

• A study published in the July 1, 2002, issue of the journal Psychiatric Services found that nearly one in four Manhattan children received counseling in the month following the Sept. 11 terrorist attacks. Children whose parents suffered from severe stress were most likely to have received counseling, according to the study, which marks the first peer-reviewed research about children's mental health following Sept. 11. Parents' level of distress -- not children's behavior -- was the biggest determinant of whether a child received care, the study found. Children whose parents suffered from post-traumatic stress disorder (PTSD) after Sept. 11 were more likely to receive counseling, as were children whose parent had a friend or relative killed. A child who saw a parent crying about the attacks was also more likely to be taken for mental health counseling.
  
  The lead author was Jennifer Stuber, Ph.D., a researcher in the Academy's Division of Health and Science Policy and in CUES. She said the findings raise questions about how accurately parents assess their children's need for mental health care. If parents base the decision on their own mental health rather than their children's, some youths may fail to receive needed intervention.
  
  Read the press release and media coverage of this study.
  
  
• A study of substance abuse trends in New York City following Sept. 11 uncovered significant increases in smoking, alcohol, and marijuana in the five to eight weeks after the terrorist attacks on the World Trade Center. Results appeared in the June 1, 2002, issue of the American Journal of Epidemiology. Academy researchers interviewed 988 Manhattan residents south of 110th Street in a random-digit dial phone survey, in the five to eight weeks after the attacks. Nearly 29 percent of those interviewed increased their intake of alcohol and smoked more marijuana and/or cigarettes after the Sept. 11. More Manhattan residents who were surveyed turned to alcohol than to any other substance: 24.6 percent of those surveyed reported drinking more than usual in the five to eight weeks after Sept. 11. Cigarette smoking increased by 9.7 percent above the norm in that time period, and marijuana by 3.2 percent.
  
  Those who smoked more cigarettes and marijuana were dramatically more likely to experience post-traumatic stress disorder than those who did not, according to David Vlahov, Ph.D., lead author. Vlahov is director of the Academy's Center for Urban Epidemiologic Studies and an adjunct professor at the Johns Hopkins University Bloomberg School of Public Health in Baltimore and at Columbia University.
  
  Read the press release and full text of this study.
  
  
• CUES researchers published the first examination of the city's psychological health in the first five to eight weeks after the attacks. The full study was published in the March 28, 2002, issue of The New England Journal of Medicine, and results were publicized internationally. More than 13 percent of Manhattan residents suffered from PTSD and/or depression after the Sept. 11 terrorist attacks, the study found. Psychological trauma was even more widespread among residents south of Canal Street, a short walk from the World Trade Center site, according to lead author Dr. Sandro Galea, an epidemiologist in CUES. An overwhelming one-fifth of those residents suffered from PTSD directly related to the tragedy, the study shows. CUES is currently compiling data from a survey examining the psychological health of New Yorkers, six months after the World Trade Center tragedy. The telephone survey was conducted using the random-digit dialing method.
  
  Read the press release and full text of this study. Read media coverage of this study.
  A PowerPoint presentation of that research, carried out from Oct. 16 to Nov. 15, 2001, is available. This presentation in part or in whole may be used after contacting sgalea@nyam.org. Please include appropriate attribution of The New York Academy of Medicine.
  
  
• CUES is conducting research on the respiratory health of preschoolers south of 14th Street. The "Preschool Respiratory Health Surveys" designed by CUES, will heighten understanding of whether children ages 3 to 5 who live in lower Manhattan suffer from uncontrolled asthma and other breathing problems at rates comparable to children in other parts of the city. The results can be used to appropriately target programs and services to control this health problem, according to lead investigator Sebastian Bonner, Ph.D., an asthma expert in CUES.
  
  Surveys were distributed to parents at preschools and day care centers in Battery Park City, the West Village, Alphabet City and the Lower East Side, and Chinatown. Surveys distributed in Chinatown were translated into Chinese to maximize participation from parents of the predominantly Chinese-American students. Results from Chinatown will be particularly important, because the disaster's human impact has largely gone unchronicled in this district of lower Manhattan. The effort is funded by the New York City Department of Health, using allocations from the U.S. Centers for Disease Control and Prevention that were earmarked for post-Sept. 11 research and interventions.
  
  Read the press release and media coverage of this study, and view photos of CUES staff at a Chinatown day care center.
  
  
• In a related effort, CUES is testing a behavioral intervention to improve asthma care for pre-school children enrolled in Head Start centers in East and Central Harlem. Dr. Bonner is developing the role of "Asthma Coaches," who will train Head Start staff and parents of asthmatic children to work with physicians at preventively managing asthma. Care is often delayed until acute symptoms appear. Head Start child development programs serve more than 800,000 low-income pre-school children, many living in inner-city communities disproportionately impacted by pediatric asthma.
  

Journal of Urban Health

• The March 2002 issue of the Journal of Urban Health, published by The New York Academy of Medicine, featured editorial and commentaries on Sept. 11-related issues. Coverage included: the reaction and response to the Sept. 11 attacks in New York City; the public health sector’s preparedness for disaster, with perspectives from Washington, D.C., and Canada; whether cities can prepare for terrorism, with commentary from England; and, the challenges that bioterrorism poses to the relationship between public health and the media. Read more about the Journal of Urban Health.

Center for Urban Bioethics

• The Center for Urban Bioethics consulted with the Commissioner of Health of the City of New York concerning research on the survivors and family members of victims. The Center conducted a comprehensive review of the literature on disaster- and trauma-stricken populations, formulating a framework for the ethical analysis of research involving victims of extreme trauma. This was presented to the Department of Health and Human Services, National Human Research Protections Advisory Committee. In addition, the Center's Urban Health Initiative held a student forum addressing aspects of health and mental health issues affecting immigrants and refugees.

Special Populations

• Research indicates that stress and disruptions in everyday routines following a disaster may affect a patient's ability to adhere to a medication schedule. The Office of Special Populations adjusted its ongoing HIV/AIDS research project into adherence trends, to include assessments of the impact of Sept. 11 on clients' adherence to antiviral medication schedules, and a cost-effectiveness analysis of different interventions.
  
  
• In fall 2001, the Office of Special Populations collaborated with CUES to begin investigating the impact of Sept. 11 on the emotional states, economic situations, daily living routines, and drug using behavior among active substance users. Preliminary findings revealed that this population was strongly and adversely affected.

Health and Science Policy

• After the Sept.11 disaster, the Division of Health and Science Policy initiated a project to assess the prevalence and correlates of post-traumatic stress disorder symptoms among children 18 years and younger. This will help to determine factors that are associated with the presence and severity of such symptoms in children after a single-event trauma, such as the terrorist attack in New York.
  
  
• The first study published as a result of this research appeared in the July 1, 2002, issue of the journal Psychiatric Services, as described above. The study, whose authors included Jennifer Stuber and Gerry Fairbrother of the Division of Health and Science Policy, found that nearly one in four Manhattan children received counseling in the month following the Sept. 11 terrorist attacks. Children whose parents suffered from severe stress were most likely to have received counseling, according to the study, which marks the first peer-reviewed research about children's mental health following Sept. 11.
  
  Read the press release and media coverage of this study.
  
  
• After the terrorist attacks, New York leaders waived the standard application and recertification requirements of Medicaid, under the Disaster Relief Medicaid Program. The result was that more than 300,000 New Yorkers signed up for Medicaid in just over three months. The New York Forum for Child Health disseminated information to East Harlem health and social service providers about the temporary, simplified registration process.
  
  
• The Academy and the Child Health Forum, collaborating with the local chapter of the American Academy of Pediatrics, held a conference in December about the symptoms of children's stress and trauma and the potential for pathologic bereavement for those who have lost loved ones. The conference was organized to educate pediatricians, nurse practitioners and others responsible for the health of children, and it provided these professionals with the skills needed to identify children who will require referral to the most intensive mental health services.

School Health

The Office of School Health Programs has developed "Moving from Crisis to Hope and Well-Being: A Response to the Events of September 11, 2001." The five-year program is being implemented in the New York City public school system to rebuild the emotional and psychological well-being of school communities, and to develop essential mental and emotional health skills. The program is designed to help teachers, school administrators, school staff, students, parents and families to strengthen their ability to cope with stress and change of all kinds. It will help families learn to be empowered and resilient in the face of adversity and move forward after a crisis. The program will also assist school communities in building tolerance for and appreciation of the diverse cultures, ethnicities and religions that are omnipresent in this city. While this initiative will address the aftermath of the Sept. 11 trauma, it also introduces a long-term structural change to the city's health education curriculum, emphasizing important skills that have not previously been included.

Training workshops began in June to assist teachers of kindergarten through 12th grade in integrating emotional and mental health skills into their regular health curriculum. On June 6, 2002, the Office of School Health conducted a full-day training session in comprehensive health education with a special focus on mental and emotional health issues for 130 teachers in elementary and middle schools. Teachers learned strategies for helping students develop the resiliency needed in the long term to cope with stress, manage feelings, and to deal with change and crisis. Teachers will continue to learn how to integrate these and other themes, including how to express concern for others, communicate effectively, and set positive future goals. Training workshops will also be conducted to help parents and families understand how to increase the protective factors at home to build student and family resiliency and encourage positive ways to move forward after crisis.

The program will help school staff, students and families better deal with short-term responses to a crisis, and then, to move toward long-term hope and well-being. Short-term skills for which education will be offered include: dealing with the current crisis; coping and healing; dealing with feelings of vulnerability; addressing immediate emotional responses, including grief and loss; dealing with a lost sense of security, feelings of isolation, and a loss of meaning; and, calming surges in racism and intolerance.

Educators will also focus on long-term student achievement goals, including: promoting healthy emotional responses, now and in the future; helping students to heal, grow and flourish; building resiliency for the future; building long-term mental and emotional health skills, including coping with stress, managing strong feelings, dealing with fear, anger and frustration, expressing caring and concern for others, negotiating differences, and communicating effectively; enhancing a sense of control over one's health and life; building caring school communities by cultivating sustained connections between people and a deep sense of belonging; affirming the core values of family, compassion, faith and optimism; and, building tolerance of and appreciation for others.

Teachers, administrators, parents, and students from high- risk districts as well as citywide helped to shape the initiative by participating in discussion groups. Community school district administrators have participated in a workshop to identify schools that will take part. On May 21, 2002, Community School District Health Coordinators were introduced to the project and began the process of school selection.

A paper on "Moving from Crisis to Hope and Well-Being: A Response to the Events of September 11th, 2001" has been selected for presentation at the 76th Annual School Health Conference of the American School Health Association. The conference will be held in Charlotte, N.C., in October.

• The Division of Public Health's expertise in collaboration and community governance became even more relevant following Sept. 11. Two weeks after the attacks, the Division sponsored a conference that showed how human services and health could be improved through communication and cooperation among neighborhood residents, service providers, and city agencies in response to the crisis and others that might arise-and in a manner that would not divert attention away from other important health and human service needs in low-income neighborhoods.
  
  
• The Division also began exploring how city/community partnerships could help the New York City government, local foundations, and intermediary organizations identify and address health and social service issues related to the attacks. At the national level, it participated in a community health preparedness meeting with Tom Ridge, Director of the White House Office of Homeland Security. It also helped launch a "Community 9/11 Initiative" to enhance the effectiveness and feasibility of health preparedness by engaging community residents and practicing clinicians in the development and implementation of emergency plans.

President's Office

• The New York City Department of Health distributed to all area physicians information gathered by the Academy two years ago about symptoms patients would present after exposure to agents of both biological and chemical terrorism.
  
  
• In response to the greatly heightened public concern about anthrax, we were a broadcast site for two emergency briefings for physicians-"Anthrax What Every Clinician Should Know"-produced by the Centers for Disease Control (CDC).

SVP; Finance and Administration

• On November 17, 2001, the Academy held a conference for community service organization employees and volunteers to help them understand mental health disorders emerging from the disaster and to provide them with information about sources of treatment for their clients and themselves.

Doctors Against Handgun Injury (DAHI)

• Doctors Against Handgun Injury served as a primary source of information for a major New York Times article documenting and assessing the potentially negative public health impact of the surge in gun sales that followed the attacks.

Information Management

• Academy librarians in the Division of Information Management played a pivotal role in supporting the development of research proposals by conducting comprehensive literature searches. In response to the enormous increase in demand for information following September 11, the Division co-sponsored a conference for information professionals on resources relating to biochemical terrorism and disasters. It also oversaw creation of new pages for the health website NOAH (New York Online Access to Health) to address traumatic events, grieving and bereavement, and anthrax. This Spanish/English website, located at www.noah-health.org, also includes links to the CDC, the EPA, and the American Lung Association. NOAH averages 250,000 page views a week and is used primarily by the general public.

Office of Education/Conference Center

• Soon after Sept.11, the Academy's Office of Education and Conference Center partnered with leading health agencies and organizations, conducting educational programs that addressed recognizing and treating anthrax exposure, bioterrorism, post-traumatic stress disorder in children, and other public health topics related to the attacks and their consequences.

For further information you may contact:

Kathryn Cervino,
Public Information Officer
at (212) 822-7285

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