Context The World Trade Center Health Registry provides a unique opportunity to examine long-term health effects of a large-scale disaster. Objective To examine risk factors for new asthma diagnoses and event-related posttraumatic stress (PTS) symptoms among exposed adults 5 to 6 years following exposure to the September 11, 2001, World Trade Center (WTC) terrorist attack. Design, Setting, and Participants Longitudinal cohort study with wave 1 (W1) enrollment of 71 437 adults in 2003-2004, including rescue/recovery worker, lower Manhattan resident, lower Manhattan office worker, and passersby eligibility groups; 46 322 adults (68%) completed the wave 2 (W2) survey in 2006-2007.Main Outcome Measures Self-reported diagnosed asthma following September 11; event-related current PTS symptoms indicative of probable posttraumatic stress disorder (PTSD), assessed using the PTSD Checklist (cutoff score Ն44). ResultsOf W2 participants with no stated asthma history, 10.2% (95% confidence interval [CI], 9.9%-10.5%) reported new asthma diagnoses postevent. Intense dust cloud exposure on September 11 was a major contributor to new asthma diagnoses for all eligibility groups: for example, 19.1% vs 9.6% in those without exposure among rescue/ recovery workers (adjusted odds ratio, 1.5 [95% CI, 1.4-1.7]). Asthma risk was highest among rescue/recovery workers on the WTC pile on September 11 (20.5% [95% CI, 19.0%-22.0%]). Persistent risks included working longer at the WTC site, not evacuating homes, and experiencing a heavy layer of dust in home or office. Of participants with no PTSD history, 23.8% (95% CI, 23.4%-24.2%) reported PTS symptoms at either W1 (14.3%) or W2 (19.1%). Nearly 10% (9.6% [95% CI, 9.3%-9.8%]) had PTS symptoms at both surveys, 4.7% (95% CI, 4.5%-4.9%) had PTS symptoms at W1 only, and 9.5% (95% CI, 9.3%-9.8%) had PTS symptoms at W2 only. At W2, passersby had the highest rate of PTS symptoms (23.2% [95% CI, 21.4%-25.0%]). Event-related loss of spouse or job was associated with PTS symptoms at W2. ConclusionAcute 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.

Fast fashion, inexpensive and widely available of-the-moment garments, has changed the way people buy and dispose of clothing. By selling large quantities of clothing at cheap prices, fast fashion has emerged as a dominant business model, causing garment consumption to skyrocket. While this transition is sometimes heralded as the “democratization” of fashion in which the latest styles are available to all classes of consumers, the human and environmental health risks associated with inexpensive clothing are hidden throughout the lifecycle of each garment. From the growth of water-intensive cotton, to the release of untreated dyes into local water sources, to worker’s low wages and poor working conditions; the environmental and social costs involved in textile manufacturing are widespread.In this paper, we posit that negative externalities at each step of the fast fashion supply chain have created a global environmental justice dilemma. While fast fashion offers consumers an opportunity to buy more clothes for less, those who work in or live near textile manufacturing facilities bear a disproportionate burden of environmental health hazards. Furthermore, increased consumption patterns have also created millions of tons of textile waste in landfills and unregulated settings. This is particularly applicable to low and middle-income countries (LMICs) as much of this waste ends up in second-hand clothing markets. These LMICs often lack the supports and resources necessary to develop and enforce environmental and occupational safeguards to protect human health. We discuss the role of industry, policymakers, consumers, and scientists in promoting sustainable production and ethical consumption in an equitable manner.

Respiratory illness1---9 and posttraumatic stress disorder (PTSD) 6,7,9---12 are 2 of the most commonly reported health outcomes related to the September 11, 2001 terrorist attacks on the New York City World Trade Center (WTC). Only recently, however, have studies addressed their co-occurrence among 9/11 disaster---exposed individuals. 13 Comorbidity is increasingly seen as the norm rather than the exception in primary care settings 14 and can significantly affect diagnosis, treatment, and prognosis of a given disease, 15 including respiratory illness. 16---20 Co-occurring physical illness may also affect the diagnosis, treatment, and prognosis of PTSD. Therefore, understanding the epidemiology of co-occurring respiratory illness and PTSD can have important implications for ongoing public health outreach and treatment efforts aimed at individuals exposed to the 9/11 disaster as well as individuals in the general population with respiratory or mental illness. The burden of co-occurring respiratory illness and PTSD among individuals directly exposed to the 9/11 disaster is likely to be high because of shared 9/11-related risk factors 6 and because of the close, reciprocal association between PTSD and physical health. Individuals with PTSD are at greater risk for long-term physical illness 20---30 partly because of lifestyle and health behaviors associated with PTSD and partly because of physiological dysregulation linked to PTSD. 30The latter might also underlie the well-documented association between PTSD and somatization. 31 Because symptoms can arise from interacting physical and psychological factors, a single, causative disease might not be found, 15 highlighting the importance of examining comorbid conditions and symptomatology in 9/11-exposed individuals.In this study we have described the prevalence, risk factors, and severity of illness associated with co-occurring lower respiratory symptoms (LRS) and probable PTSD 5 to 6 years after the 9/11 disaster among lower Manhattan residents, area workers, and passersby enrolled in the World Trade Center Health Registry. To better understand the burden of undiagnosed illness, we focused on symptoms. We hypothesized that severe dust cloud exposure and returning to homes or workplaces with dust or damage from the disaster would be associated with co-occurring LRS and PTSD. We also hypothesized that (1) independent of these risk factors LRS and PTSD would be risk factors for each other, (2) individuals with LRS who had comorbid PTSD would have worse respiratory illness and a higher prevalence of diagnosed asthma than would those with LRS alone, (3) those with PTSD who had cooccurring LRS would report more PTSD symptoms and have greater odds of comorbid mental health conditions than would those with PTSD alone, and (4) co-occurring LRS and PTSD would be associated with worse health-related quality of life (QOL) and more unmet health care needs after controlling for diagnosed respiratory and mental health conditions. METHODSThe Registry, a longitudinal cohort of per...

Background: Low-income and non-white children experience disparities in health, education, and access to nature. These health disparities are often associated and exacerbated by inequities in the U.S. educational system. Recent research suggests that nature contact may reduce these health and educational disparities for urban lowincome populations. Nature-based education (NBE) uses nature contact to inspire curiosity and improve health. This study examines the health and educational outcomes of a 15-week NBE intervention for urban low-income, black and Hispanic children 10-15 years of age. Methods: Children (n = 122) completed a pre-intervention and post-intervention survey that addressed seven science, technology, engineering, and math (STEM)-capacity items (leadership, teamwork, science relevance, sustainability relevance, STEM self-efficacy, science interest, and overall STEM capacity) and six widely used health-related quality-of-life (HRQoL) domains (physical health functioning, emotional health functioning, school functioning, social functioning, family functioning, and overall HRQoL). Focus groups with participating students and postintervention surveys of NBE mentors and teachers explored perceptions of the intervention impact. Results: There were statistically significant positive changes in STEM capacity and HRQoL for participating students. For example, children's overall STEM capacity and overall HRQoL scores improved by 44% and 46%, respectively (both p < 0.05). Qualitative data highlighted the intervention's educational and health benefits. Conclusions: These results support further research quantifying the effects of NBE on STEM capacity and HRQoL in urban, low-income, black and Hispanic children.

BackgroundThere is growing use of a job exposure matrix (JEM) to provide exposure estimates in studies of work-related musculoskeletal disorders; few studies have examined the validity of such estimates, nor did compare associations obtained with a JEM with those obtained using other exposures.ObjectiveThis study estimated upper extremity exposures using a JEM derived from a publicly available data set (Occupational Network, O*NET), and compared exposure-disease associations for incident carpal tunnel syndrome (CTS) with those obtained using observed physical exposure measures in a large prospective study.Methods2393 workers from several industries were followed for up to 2.8 years (5.5 person-years). Standard Occupational Classification (SOC) codes were assigned to the job at enrolment. SOC codes linked to physical exposures for forceful hand exertion and repetitive activities were extracted from O*NET. We used multivariable Cox proportional hazards regression models to describe exposure-disease associations for incident CTS for individually observed physical exposures and JEM exposures from O*NET.ResultsBoth exposure methods found associations between incident CTS and exposures of force and repetition, with evidence of dose–response. Observed associations were similar across the two methods, with somewhat wider CIs for HRs calculated using the JEM method.ConclusionExposures estimated using a JEM provided similar exposure-disease associations for CTS when compared with associations obtained using the ‘gold standard’ method of individual observation. While JEMs have a number of limitations, in some studies they can provide useful exposure estimates in the absence of individual-level observed exposures.