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On Tuesday morning, September 11, 2001, the U.S. came under attack when four commercial airliners were hijacked and used to strike targets on the ground. Nearly 3,000 people tragically lost their lives. Because of the actions of the 40 passengers and crew aboard one of the planes, Flight 93, the attack on the U.S. Capitol was thwarted.

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Flight 93 National Memorial (U.S. National Park Service)

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On Tuesday morning, September 11, 2001, the U.S. came under attack when four commercial airliners were hijacked and used to strike targets on the ground. Nearly 3,000 people tragically lost their lives. Because of the actions of the 40 passengers and crew aboard one of the planes, Flight 93, the attack on the U.S.

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Note for screen reader users: once expanded, the first four items of the navigation menu have some associated content which may provide additional information of interest. These sections can be located by jumping to the level 3 heading which follows each sub-menu.

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Twenty-one years after the Sept. 11 terrorist attacks of 2001, Americans across the political spectrum share many of the same feelings when it comes to their memories and sentiments related to the attacks.

However, younger adults demonstrate less connection to the event - and the feelings of unity that many Americans felt following the attacks - than their older counterparts, according to a new poll by nonprofit More In Common and research firm YouGov.

The poll also found nuance in American attitudes related to patriotism, safety and Islamophobia following the 9/11 attacks. Fifty-seven percent of U.S. adults - including 72% of Democrats and 50% of all other Americans - said they associate the post-9/11 period with the mistreatment of Muslim Americans.

But 73% of adults - including large majorities of Democrats and Republicans - remember the era for American unity. An identical 63% of both Democrats and Republicans associate the era with American politicians working together.

However, those numbers fall off precipitously for younger Americans. While more than half of seniors said "united" was one of the best descriptors of the United States after the 9/11 attacks, only 22% of millennials and 21% of Gen Z adults chose that word.
The Man Who Told the President 'America Is Under Attack' on 9/11 Tells His Story
When asked if 9/11 changed their lives, 56% of respondents - including 60% of Democrats and 63% of Republicans - answered yes.

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Fifty-nine percent of millennials, who were between the ages of 5 and 20 in 2001, answered yes - a rate higher than Gen Z (37%), Gen X (54%) and the Silent Generation (56%). Only Baby Boomers (61%) were more likely to say the event changed their lives.

"Never Forget"

When asked what Americans are supposed to "never forget" about 9/11, clear majorities of Republicans and Democrats mentioned the victims and their families and the sacrifices of first responders.

However, the rates of response were much lower for millennials and Gen Z adults, who were less likely to choose victims or first responders - and much more likely to answer "I don't know."

"9/11 remains one of the most significant events many Americans have experienced," said Dan Vallone, director for More in Common USA. "But it is receding into history for younger Americans.

"We need to involve younger Americans more in the process of creating memories and lessons from 9/11. If we want to try and build stronger shared memories of the attacks and what we should learn from them, it will not be enough to tell younger Americans about that period, from the vantage point of older Americans," he said.

This year's anniversary of the attacks comes just a few weeks after one of the 9/11 museums in Lower Manhattan closed its doors for good. The National September 11 Memorial & Museum remains open a few blocks away, underground at Ground Zero.

New Yorkers Remember 'Strength' and 'Resiliency'

Approximately 1-in-2 New Yorkers say that "Never Forget" also means Americans should remember the resilience of New York City and its residents (compared to only 34% of Americans in general feeling this way).

New York City residents were also more likely than average to say the post-9/11 era was defined by unity, strength and resiliency. But New Yorkers were also more likely to say the era was defined by mistreatment of Americans of Middle Eastern/South Asian descent; and less likely than average to say the era was defined by "anger" or "patriotism."

However, 54% of New Yorkers say the country is safer today from foreign terrorism than it was before the attacks - 10 full points higher than the national average of 45%.

Muslim Americans Proud to Be American, But More Likely to Experience Prejudice

In addition to a majority of Americans remembering Islamophobia in the period following 9/11, Muslim Americans were almost as likely to say mistreatment of Muslim Americans (71%) defined the era than any other characteristic, including heightened security (75%), fear of terrorism (72%) and American unity (63%).

Sixty-eight percent of Muslim Americans also responded they were "proud to be an American," in line with the responses from Hispanic Americans and Americans of the millennial generation.

Asian Americans (62%) and Gen Z adults (56%) were less likely to say they were proud to be American, while white Americans (80%), Baby Boomers (86%), the Silent Generation (93%) and Republicans (95%) were more likely to say they were proud. The national average was 76%.

"It is hard for many Americans to remember the way Americans came together after 9/11 if they do not feel a sense of belonging today," Vallone said. "We should do more to address the underlying lack of belonging that many Americans, especially younger Americans of all races, Black Americans and Asian Americans feel [by putting] more resources and effort towards work that builds connections within and across communities."

The More in Common/YouGov survey polled 1,000 U.S. adults between Aug. 12 and Aug. 24, with an additional 200 New York City residents and 200 Muslim Americans. The margin of error is +/- 3.1 for the U.S. average and +/- 8.5 for the Muslim American data and +/- 7.0 for the New York City resident data.
Noah Pransky is LX News' National Political Editor, covering Washington and state politics, with a special focus on young voters. His political and investigative work has been honored with national Murrow, Polk, duPont, and Cronkite awards, and you can contact him confidentially at noah.pransky@nbcuni.com, or on Facebook, Instagram or Twitter.

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Poll: Americans' Views on 9/11 Depend More on Age Than Political Party

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"9/11 remains one of the most significant events many Americans have experienced," said Dan Vallone, director for More in Common USA. "But it is receding into history for younger Americans."

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Thousands of first responders and workers who have suffered from health issues in the aftermath of the Sept. 11, 2001, terrorist attacks are still fighting for health benefits and face a critical funding shortfall in a program designed to benefit them.

"The 20 years after 9/11 decimated the responder community. The next 20 years is going to eradicate the 9/11 responders,"John Feal, founder of the FealGood Foundation, an advocacy group for 9/11 responders and survivors, told Fox News Digital.

Feal, a retired construction worker who lost part of his foot while working at Ground Zero in the aftermath of the attacks, founded the FealGood Foundation to benefit responders who have suffered from numerous health issues related to the fallout of the attacks.

The organization organized numerous protests on Capitol Hill and pressured lawmakers to act, scoring a victory with the World Trade Center Health Program that Congress approved in 2015.
ICONIC 9/11 PHOTOS AND THE PHOTOGRAPHERS WHO SHOT THEM: HERE ARE THEIR STORIES
The bill pays the medical costs of first responders, many of whom have suffered from respiratory diseases, digestive disorders and cancers as a result of their exposure to toxins at the site of the Twin Towers. Others suffered life-altering injuries that require constant care and rehabilitation.

Feal is again pushing for lawmakers to take action, this time on a funding shortfall in the program, which he said will be $3 billion short sometime before 2025.

While the bill authorizes funding through 2090, Feal said it did not account for the cost of health care inflation, a problem he said will leave many responders unable to pay their medical bills.

"In 2015, there were 76,000 people in the World Trade Center Health Care Program. Now there's close to 118,000 people in the program," Feal said. "Nobody took into consideration medical inflation."

The additional $3 billion in funding would ensure people keep the doctors, nurses and administrators who have been working with them on the job while also making sure responders continue to receive the medications and treatments they need.

But the program hasn't been a catch-all solution for all 9/11 first responders, some of whom have been excluded from receiving its benefits, something Feal hopes Congress will address in addition to the $3 billion in extra funding.

"You've been seeing stories about people from the Pentagon that were excluded," Feal said. "The bill will provide about 800 to 1,200 civilians and military from the Pentagon to either go back into the program or get into the program."
FORMER FLIGHT ATTENDANT TO HONOR 9/11 VICTIMS BY PUSHING BEVERAGE CART FROM BOSTON TO GROUND ZERO
Feal said he has been in Washington working toward a solution to the issue, noting he has gotten assurances from Senate Majority Leader Chuck Schumer that the funding will be included in this year's omnibus legislation.

While the additional funding would be another victory for 9/11 first responders, Feal said there are still issues for which his organization will have to continue fighting.

"There's no bill ever written in Congress that's perfect," Feal said. "Like any government-run agency like workman's comp or Social Security at the state and federal levels, people fall through the cracks ... that don't meet the criteria."

Some of the people who fall through the cracks do so because of what Feal called "arbitrary" eligibility criteria written in by Congress, pointing to a rule that responders had to have been south of Canal Street during exposure to be considered for the program.
FOX CORP. ANNOUNCES $1M DONATION TO TUNNEL TO TOWERS IN SUPPORT OF FIRST RESPONDERS, MILITARY HEROES
"It's not like the toxic clouds said 'Oh, we have to stop at Canal Street,'" Feal said.

He also pointed to a rule that all cancers had to be diagnosed after September 2005 for a person to be eligible for the program.

"Most cancers, you have to have gotten them after September of 2005," Feal said. "That's just an arbitrary date they chose. These are things that have prevented people from getting into the program."

Some of the most vulnerable responders are those who did not work for police and fire departments, and who have adequate insurance, even in retirement. But construction and trade workers who have gotten injured or sick often lost their jobs and health benefits and depend on funding to get the treatment they need.

"A lot of them don't qualify because of some sort of criteria that has hindered them from getting into the program," Feal said. "So every day we advocate for them."

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Many 9/11 first responders still fighting for health benefits 21 years later

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Thousands of first responders and workers who have suffered from health issues in the aftermath of the Sept. 11, 2001, terrorist attacks are still fighting for health benefits and face a critical funding shortfall in a program designed to benefit them. "The 20 years after 9/11 decimated the responder community.

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World Trade Center

On September 11, 2001, at 8:45 a.m. on a clear Tuesday morning, an American Airlines Boeing 767 loaded with 20,000 gallons of jet fuel crashed into the north tower of the World Trade Center in New York City.

The impact left a gaping, burning hole near the 80th floor of the 110-story skyscraper, instantly killing hundreds of people and trapping hundreds more in higher floors.

As the evacuation of the tower and its twin got underway, television cameras broadcasted live images of what initially appeared to be a freak accident. Then, 18 minutes after the first plane hit, a second Boeing 767-United Airlines Flight 175-appeared out of the sky, turned sharply toward the World Trade Center and sliced into the south tower near the 60th floor.

The collision caused a massive explosion that showered burning debris over surrounding buildings and onto the streets below. It immediately became clear that America was under attack.

Osama bin Laden

The hijackers were Islamic terrorists from Saudi Arabia and several other Arab nations. Reportedly financed by the al Qaeda terrorist organization of Saudi fugitive Osama bin Laden, they were allegedly acting in retaliation for America's support of Israel, its involvement in the Persian Gulf War and its continued military presence in the Middle East.

Some of the terrorists had lived in the United States for more than a year and had taken flying lessons at American commercial flight schools. Others had slipped into the country in the months before September 11 and acted as the "muscle" in the operation.

Where Did the 9/11 Planes Take Off From?

The 19 terrorists smuggled box-cutters and knives through security at three East Coast airports-Logan International Airport in Boston, Dulles International Airport in Washington, D.C. and Newark International Airport in New Jersey-and boarded four early-morning flights bound for California, chosen because the planes were loaded with fuel for the long transcontinental journey. Soon after takeoff, the terrorists commandeered the four planes and took the controls, transforming ordinary passenger jets into guided missiles.

Pentagon Attack

As millions watched the events unfolding in New York, American Airlines Flight 77 circled over downtown Washington, D.C., before crashing into the west side of the Pentagon military headquarters at 9:45 a.m.

Jet fuel from the Boeing 757 caused a devastating inferno that led to the structural collapse of a portion of the giant concrete building, which is the headquarters of the U.S. Department of Defense.

All told, 125 military personnel and civilians were killed in the Pentagon, along with all 64 people aboard the airliner.

Twin Towers Collapse

Less than 15 minutes after the terrorists struck the nerve center of the U.S. military, the horror in New York took a catastrophic turn when the south tower of the World Trade Center collapsed in a massive cloud of dust and smoke.

The structural steel of the skyscraper, built to withstand winds in excess of 200 miles per hour and a large conventional fire, could not withstand the tremendous heat generated by the burning jet fuel.

At 10:30 a.m., the north building of the twin towers collapsed. Only 18 people in the World Trade Center towers at the time of the collapse survived. Most were with a group of FDNY firefighters in the North Tower's Stairwell B, which remained intact. One woman survived after the stairs she was rushing down disintegrated around her. Almost 10,000 others were treated for injuries, many severe.

Flight 93

Meanwhile, a fourth California-bound plane- United Flight 93-was hijacked about 40 minutes after leaving Newark Liberty International Airport in New Jersey. Because the plane had been delayed in taking off, passengers on board learned of events in New York and Washington via cell phone and Airfone calls to the ground.

Knowing that the aircraft was not returning to an airport as the hijackers claimed, a group of passengers and flight attendants planned an insurrection.

One of the passengers, Thomas Burnett, Jr., told his wife over the phone that "I know we're all going to die. There's three of us who are going to do something about it. I love you, honey." Another passenger-Todd Beamer-was heard saying "Are you guys ready? Let's roll" over an open line.

Sandy Bradshaw, a flight attendant, called her husband and explained that she had slipped into a galley and was filling pitchers with boiling water. Her last words to him were "Everyone's running to first class. I've got to go. Bye."

The passengers fought the four hijackers and are suspected to have attacked the cockpit with a fire extinguisher. The plane then flipped over and sped toward the ground at upwards of 500 miles per hour, crashing in a rural field near Shanksville in western Pennsylvania at 10:10 a.m.

All 44 people aboard were killed. Its intended target is not known, but theories include the White House, the U.S. Capitol, the Camp David presidential retreat in Maryland or one of several nuclear power plants along the eastern seaboard.

How Many People Died in the 9/11 Attacks?

A total of 2,996 people were killed in the 9/11 attacks, including the 19 terrorist hijackers aboard the four airplanes. Citizens of 78 countries died in New York, Washington, D.C., and Pennsylvania.

At the World Trade Center, 2,763 died after the two planes slammed into the twin towers. That figure includes 343 firefighters and paramedics, 23 New York City police officers and 37 Port Authority police officers who were struggling to complete an evacuation of the buildings and save the office workers trapped on higher floors.

At the Pentagon, 189 people were killed, including 64 on American Airlines Flight 77, the airliner that struck the building. On Flight 93, 44 people died when the plane crash-landed in Pennsylvania.

America Responds to the Attacks

At 7 p.m., President George W. Bush, who was in Florida at the time of the attacks and had spent the day being shuttled around the country because of security concerns, returned to the White House.

At 9 p.m., he delivered a televised address from the Oval Office, declaring, "Terrorist attacks can shake the foundations of our biggest buildings, but they cannot touch the foundation of America. These acts shatter steel, but they cannot dent the steel of American resolve."

In a reference to the eventual U.S. military response he declared, "We will make no distinction between the terrorists who committed these acts and those who harbor them."

Operation Enduring Freedom, the American-led international effort to oust the Taliban regime in Afghanistan and destroy Osama bin Laden's terrorist network based there, began on October 7. Within two months, U.S. forces had effectively removed the Taliban from operational power, but the war continued, as U.S. and coalition forces attempted to defeat a Taliban insurgency campaign based in neighboring Pakistan.

Osama bin Laden, the mastermind behind the September 11th attacks, remained at large until May 2, 2011, when he was finally tracked down and killed by U.S. forces at a hideout in Abbottabad, Pakistan. In June 2011, then-President Barack Obama announced the beginning of large-scale troop withdrawals from Afghanistan; it took until August 2021 for all U.S. forces to withdraw.

Department of Homeland Security Is Created

In the wake of security fears raised by 9/11 and the mailing of letters containing anthrax that killed two and infected 17, The Homeland Security Act of 2002 created the Department of Homeland Security. It was signed into law by President George W. Bush on November 25, 2002. Today, the Department of Homeland Security is a cabinet responsible for preventing terror attacks, border security, immigrations and customs and disaster relief and prevention.

The act was followed two days later by the formation of the National Commission on Terrorist Attacks Upon the United States. The bipartisan " 9/11 Commission," as it came to be known, was charged with investigating the events that lead up to September 11th. The 9/11 Commission Report was released on July 22, 2004. It named Khalid Sheikh Mohammed, the accused mastermind behind 9/11, "the principal architect of the 9/11 attacks."

Mohammed led propaganda operations for al Qaeda from 1999-2001. He was captured on March 1, 2003 by the Central Intelligence Agency and Pakistan's Inter-Services Intelligence and interrogated before being imprisoned in Guantanamo Bay detention camp with four other accused terrorists charged with 9/11-related war crimes. The use of torture, including waterboarding, during Khalid Sheikh Mohammed's interrogation has received international attention. In August 2019, a U.S. military court judge in Guantánamo Bay, Cuba set a trial date for Mohammed and the other four men charged with plotting the 9/11 terrorist attacks to begin in 2021; it was later postponed because of the COVID-19 pandemic.

Economic Impact of 9/11

The 9/11 attacks had an immediate negative effect on the U.S. economy. Many Wall Street institutions, including the New York Stock Exchange, were evacuated during the attacks. On the first day of trading after the attacks, the market fell 7.1 percent, or 684 points. New York City's economy alone lost 143,000 jobs a month and $2.8 billion wages in the first three months. The heaviest losses were in finance and air transportation, which accounted for 60 percent of lost jobs. The estimated cost of the World Trade Center damage is $60 billion. The cost to clean the debris at Ground Zero was $750 million.

Victim Compensation Fund

Thousands of first responders and people working and living in lower Manhattan near Ground Zero were exposed to toxic fumes and particles emanating from the towers as they burned and fell. By 2018, 10,000 people were diagnosed with 9/11-related cancer.

From 2001 to 2004, over $7 billion dollars in compensation was given to families of the 9/11 victims and the 2,680 people injured in the attacks. Funding was renewed on January 2, 2011, when President Barack Obama signed The James Zadroga 9/11 Health and Compensation Act into law. Named for James Zadroga, a New York City Police officer who died of respiratory disease he contracted after rescuing people from the rubble at Ground Zero, the law continued health monitoring and compensation for 9/11 first responders and survivors.

In 2015, funding for the treatment of 9/11-related illness was renewed for five more years at a total of $7.4 billion. The Victim Compensation Fund was set to stop accepting claims in December 2020.

On July 29, 2019, then-President Trump signed a law authorizing support for the September 11 Victim Compensation Fund through 2092. Previously, administrators had cut benefits by up to 70 percent as the $7.4 billion fund depleted. Vocal lobbyists for the fund included Jon Stewart, 9/11 first responder John Feal and retired New York Police Department detective and 9/11 responder Luis Alvarez, who died of cancer 18 days after testifying before Congress.

Anniversary and Memorial

On December 18, 2001, Congress approved naming September 11 "Patriot Day" to commemorate the anniversary of the 9/11 attacks. In 2009, Congress named September 11 a National Day of Service and Remembrance.

The first memorials to September 11 came in the immediate wake of the attacks, with candlelight vigils and flower tributes at U.S. embassies around the world. In Great Britain, Queen Elizabeth sang the American national anthem during the changing of the guard at Buckingham Palace. Rio de Janeiro put up billboards showing the city's Christ the Redeemer statue embracing the New York City skyline.

For the first anniversary of the attacks in New York City in 2002, two bright columns of light were shot up into the sky from where the Twin Towers once stood. The "Tribute in Light" then became an annual installation run by the Municipal Art Society of New York. On clear nights, the beams are visible from over 60 miles away.

A World Trade Center Site Memorial Competition was held to select an appropriate permanent memorial to the victims of 9/11. The winning design by Michael Arad, "Reflecting Absence," now sits outside the museum in an eight-acre park. It consists of two reflecting pools with waterfalls rushing down where the Twin Towers once rose into the sky.

The names of all 2,983 victims are engraved on the 152 bronze panels surrounding the pools, arranged by where individuals were on the day of the attacks, so coworkers and people on the same flight are memorialized together. The site was opened to the public on September 11, 2011, to commemorate the 10-year anniversary of 9/11. The National September 11 Memorial & Museum followed, opening on the original World Trade Center site in May 2014. The Freedom Tower, also on the original World Trade Center site, opened in November 2014.

Sources

"Study Confirms 9/11 Impact on New York City Economy." The New York Times
"September 11: nearly 10,000 people affected by 'cesspool of cancer.'" The Guardian.
"Congress passes 9/11 Victim Compensation Fund extension championed by Jon Stewart." CNN.com
The Encyclopedia of 9/11. New York Magazine.
FAQ About 9/11. 9/11 Memorial.
September 11th Terror Attacks Fast Facts. CNN.
9/11 Death Statistics. StatisticBrain.com.

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September 11 Attacks: Facts, Background & Impact

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On September 11, 2001, 19 militants associated with the Islamic extremist group al Qaeda hijacked four airplanes and carried out suicide attacks against targets in the United States. Two of the planes were flown into the twin towers of the World Trade Center in New York City, a third plane hit the Pentagon just outside Washington, D.C., and the fourth plane crashed in a field in Pennsylvania.

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Homepage | National September 11 Memorial & Museum

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Ensuring that students in classrooms across the U.S. learn not only the history of 9/11 but also its context remains central to our mission. Now more than ever, we encourage you to explore our age-appropriate lesson plans and programs, developed to help educators impart what transpired before, during, and after the attacks.

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Mental health resources are available for veterans unsettled by Afghanistan news

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Mental health resources are available for veterans unsettled by Afghanistan news

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Advocates are reminding veterans that help is available if headlines about the disastrous end of the U.S mission in Afghanistan and the looming Sept. 11 anniversary are triggering anxiety and mental health issues.

"Veterans should be on the lookout for red flags if news of Afghanistan starts changing behavior," Dr. Sonya Norman, director of the Department of Veterans Affairs' PTSD Consultation Program, said in a statement late last week. "These include isolating, using alcohol and drugs or any increase in unhealthy behaviors compared to normal."

Even before the collapse of the Afghan government over the weekend, VA officials had been preparing for increased requests for mental health care and trauma assistance amid the ongoing U.S. military withdrawal from the country.

Health officials said they have already seen an uptick in the number of veterans seeking help, and expected even more demand "as [veterans] come to terms with their service and as the Afghanistan withdrawal comes to completion."

About 1.9 million post-9/11 veterans are currently enrolled in health care with the department. A 2014 study by department officials found that nearly 16 percent of all veterans who deployed to Iraq or Afghanistan screened positive for post-traumatic stress.

Both VA and Defense Department officials in recent years have worked to eliminate the stigmas surrounding mental health care, noting that PTSD and related issues can be handled if individuals acknowledge they are facing personal difficulties.

The department has been running a series on mental health issues on its official blog, including a feature on lessons learned from the aftermath of the Vietnam War for veterans struggling with unresolved medical issues.

The Veteran Crisis Line is also available around-the-clock at 1-800-273-8255 (veterans should select option 1 for a VA staffer.) Veterans, troops or their family members can also text 838255 or visit VeteransCrisisLine.net for assistance.

Numerous lawmakers and congressional committees shared the crisis line number on social media on Monday, thanking veterans for their service and letting them know help is available.

Veterans service organizations are also stepping up their outreach efforts in light of the unsettling news overseas.

In a statement Monday, officials from Wounded Warrior Project noted that "developments in Afghanistan may bring back difficult memories for warriors and their families." The group urged anyone needing assistance to contact their counselors at 888-997-2586 or through the organization's web site.

Officials from Iraq and Afghanistan Veterans of America said veterans who served in the recent wars should remember that their service "was important and mattered." The organization's Quick Reaction Force for help is available online and at 855-917-274.

In a statement, VA Secretary Denis McDonough said that all Americans should remember the debt owed to veterans for their service.

"They made our world infinitely safer," he said. "Their service did not come without sacrifice as some carry physical and emotional wounds. We must ensure they get the world-class care they've earned and deserve."

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

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Mental health resources are available for veterans unsettled by Afghanistan news

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Advocates are reminding veterans that help is available if headlines about the disastrous end of the U.S mission in Afghanistan and the looming Sept. 11 anniversary are triggering anxiety and mental health issues.

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Mental Health Statistics of First Responders

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Mental Health Statistics of First Responders

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1. Bentley MA, Crawford JM, Wilkins JR, et al. An assessment of depression, anxiety, and stress among nationally certified EMS professionals. Prehosp Emerg Care. 2013;17(3):330-338.

2. Abbott C, Barber E, Burke B, et al. What's killing our medics? Reviving Responders. 2015. Accessed August 20, 2021. http://www.revivingresponders.com/originalpaper/

3. Bowler RM, Kornblith ES, Li J, et al. Police officers who responded to 9/11: comorbidity of PTSD, depression, and anxiety 10-11 years later. Am J Ind Med. 2016;59(6):425-436.

4. Kennedy-Hansen H. How employers can help first responders stay mentally and emotionally strong. Kaiser Permanente. November 18, 2020. Accessed August 20, 2021. https://business.kaiserpermanente.org/insights/mental-health-workplace/first-responder-support

5. Office Suicide Statistics. Blue HELP. Accessed August 20, 2021. https://bluehelp.org/the-numbers/

6. Fahy R, Petrillo JT, Molis J. On-duty firefighter fatalities in the United States in 2019. NFPA Journal. July 1, 2020. Accessed August 20, 2021. https://www.nfpa.org/News-and-Research/Publications-and-media/NFPA-Journal/2020/July-August-2020/Features/Firefighter-Fatalities

7. Lulla A, Tian L, Moy HP, et al. The EMS suicide threat. EMS World. February 2020. Accessed August 20, 2021. https://www.hmpgloballearningnetwork.com/site/EMSWorld/1223779/ce-article-ems-suicide-threat

8. Stanley IH, Hom MA, Joiner TE. A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics. Clin Psychol Rev. 2016;44:25-44.

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In the Wake of 9/11: Mental Health Statistics of First Responders

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1. Bentley MA, Crawford JM, Wilkins JR, et al. An assessment of depression, anxiety, and stress among nationally certified EMS professionals. Prehosp Emerg Care. 2013;17(3):330-338. 2. Abbott C, Barber E, Burke B, et al. What's killing our medics? Reviving Responders. 2015. Accessed August 20, 2021. http://www.revivingresponders.com/originalpaper/ 3.

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9/11 Facts to Commemorate the 20th Anniversary of the Flight 93, Pentagon and World Trade Center Attacks 

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9/11 Facts to Commemorate the 20th Anniversary of the Flight 93, Pentagon and World Trade Center Attacks 

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Parade: Entertainment, Recipes, Health, Life, Holidays

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For many, the 9/11 attacks and the trauma associated with them still feels fresh. This year will mark the 20th anniversary of the Sept. 11 terror attacks, and while America has pushed forward, the country and world were never the same in their aftermath: We entered two wars, with the War on Terror in Afghanistan only just winding down; the Department of Homeland Security and National Security Agency were created-and, obviously closest to home, many lost loved ones, as well as a sense of security that most Americans took for granted.

For all America lost on Sept. 11, 2001, we also, in the smallest sliver of silver linings, gained other things: The sense of unity and patriotism that followed the World Trade Center and Pentagon attacks, as well as the United Flight 93 crash, were unlike anything the United States had seen since World War II.

Take a look back at the basic facts of the Pentagon, Flight 93 and World Trade Center attacks, but be warned: Some of the content may be triggering.

9/11 Facts

What year was 9/11?

The September 11 attacks took place in 2001.

What day was 9/11?

The 9/11 terror attacks took place on Tuesday, Sept. 11, 2001.

When was 9/11?

The 9/11 attacks were on Tuesday, Sept. 11, 2001.
Related: Looking Back on The World Trade Center Attacks-Here Are Newspaper Front Pages Covering 9/11
How many years ago was 9/11?

The 20th anniversary of 9/11 is on Sept. 11, 2021.

How many people died on 9/11?

A total of 2,977 were killed on 9/11 and more than 6,000 were injured. The total dead include the hijackers; the plane passengers, pilots and crew; 2,606 people in the World Trade Center and nearby areas and 125 people at the Pentagon.

The 9/11 attacks killed 2,751 victims initially. In 2007, the total death toll was increased to account for those who succumbed to illnesses caused by exposure to the dust, debris and toxins ( including asbestos, lead and mercury) from the terror attacks, and tragically, that number continues to rise. As of 2019, the new World Trade Center deaths totaled 2,753 and the overall deaths from all afflicted areas is 2,996.

How many planes were involved in 9/11?

Four planes were involved in the 9/11 terror attacks.
Related: The Most Powerful Quotes Remembering 9/11 on the Upcoming 20th Anniversary
What time did 9/11 happen?

The 9/11 attacks occurred in the morning hours of Sept. 11, 2001. Departing from Boston's Logan International Airport, American Airlines Flight 11 was flown into the World Trade Center's North Tower at 8:46 a.m. ET. United Airlines Flight 175, also departing from Logan, hit the South Tower 17 minutes later at 9:03 a.m. ET.

American Airlines Flight 77 departed from Dulles International Airport in Virginia when it was hijacked over Ohio and crashed into the Pentagon at 9:37 a.m. ET. The fourth plane, United Airlines Flight 93, departed from Newark International Airport (now called Newark Liberty). It was hijacked at approximately 9:28 a.m. ET and crashed into a field over Shanksville, Pa., at approximately 10:03 a.m. ET.

How many total hijackers took part in the 9/11 attacks?

A total of 19 hijackers participated in the 9/11 attacks.

Where did the 4th plane crash on 9/11?

The fourth plane crashed into a field in Shanksville, Pa., on 9/11, killing all the passengers and crew on board.
Related: Children's Book Series 9/11 Courage and Tributes Aims to Help Teach Kids About Sept. 11, 2001-Read an Excerpt Here
How many buildings collapsed on 9/11?

In addition to the Twin Towers, the Marriott Hotel at 3 World Trade Center and the building at 7 World Trade Center also collapsed as a result of the 9/11 attacks. Other nearby buildings sustained extreme damage as well, including the Deutsche Bank at 130 Liberty Street in New York City. It was demolished about six years after the attacks.

Who alerted President George W. Bush that America was under attack on 9/11?

President George W. Bush was reading The Pet Goat with students at Emma E. Booker Elementary School in Sarasota, Fla., during the 9/11 attacks. He was initially informed of the first crash into the World Trade Center's North Tower, but was told it was likely a small propeller aircraft. Minutes later, his Chief of Staff, Andrew Card, told him that a second plane crashed into the South Tower and that it was a coordinated attack on the country.

How many firefighters died on 9/11?

A total of 340 firefighters died from the 9/11 terror attacks. Tragically, there may be more due to ongoing health issues that first responders and those in the surrounding areas of the attacks, especially the World Trade Center, faced as a result of the dust, debris and toxins in the air.

How many first responders died on 9/11?

A total of 412 first responders died on 9/11, comprised of 340 firefighters and 72 police officers. The total number of casualties of the aftermath of the attack will likely, tragically, rise: Over 1,100 9/11 first responders have been diagnosed with cancer directly linked to the dust and air quality after the terror attacks.
Related: How One Family Found New Purpose After Losing a Son on 9/11
How many people died at the Pentagon on 9/11?

A total of 125 people died at the Pentagon on 9/11.

How many children died on 9/11?

Eight children died in the 9/11 attacks. You can learn about their all-too-short lives here.

How many people survived 9/11?

No one on any of the four planes survived the 9/11 attacks.

Only 15 people escaped from the North Tower of the World Trade Center attack before the building collapsed. The South Tower had 18 survivors, all from the floors beneath the impact zone of the plane. Following the buildings' collapse, only 23 people, including first responders, made it out of the debris.

At the Pentagon, an average of 23,000 individuals are in the building at any given time -meaning it had a statistically much higher rate of survival than the WTC did upon impact.

Where is the 9/11 Memorial?

The 9/11 Memorial and Museum is located at the former site of the World Trade Center in New York City.

How much blood was donated after 9/11?

In the days following 9/11, Americans donated 1.5 million pints of blood nationwide, with 36,000 of those in the immediate New York City area.

How much money was raised for 9/11 charities?

Various charities raised over $1.2 billion for 9/11 relief.
Next, see Jon Stewart's amazing, moving tribute to 9/11 first responders.

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9/11 Facts to Commemorate the 20th Anniversary of the Flight 93, Pentagon and World Trade Center Attacks

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For many, the 9/11 attacks and the trauma associated with them still feels fresh. This year will mark the 20th anniversary of the Sept. 11 terror attacks, and while America has pushed forward, the country and world were never the same in their aftermath: We entered two wars, with the War on Terror in Afghanistan only [...]

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A key deadline for a 9/11 relief program approaches. How survivors can apply for relief

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A key deadline for a 9/11 relief program approaches. How survivors can apply for relief

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The 20th anniversary of the 9/11 tragedy is less than two months away.

There will be many commemorations, many reflections on how downtown New York and the country has changed since then. But for the people who lived and worked downtown during that time and are still with us, this is also time to take stock of their own health.

The federal government has created two programs to assist the 300,000 people who lived and worked downtown, the World Trade Center Health Program and the September 11th Victim Compensation Fund. One of those programs is up against a deadline that is expiring this week.

We talk with Chris Sorrentino, a market maker who worked on the NYSE floor for 24 years before and after 9/11, and Michael Barasch, an attorney who has been involved in 9/11 health issues.

Sorrentino is a cancer survivor and discusses how the Health Program helped pay for his medical expenses.

Barash discusses the Victim Compensation Fund, which was set up to compensate people who have illnesses linked to 9/11 and have experienced pain, suffering and lost income. Jon Stewart was instrumental in obtaining a permanent extension of this fund. However, there is a deadline approaching for a key part of the program.

The law requires that all claims be submitted within two years of the WTC Health Program certifying an illness, and within two years of someone's death. The VCF Special Master has extended the deadline for family members to register claims on behalf of loved ones who died of 9/11 illnesses more than two years ago, but the deadline expires on July 29, 2021.

Barash explains how both these programs work and how those worked downtown can apply for them.

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A key deadline for a 9/11 relief program approaches. How survivors can apply for relief

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The 20th anniversary of the 9/11 tragedy is less than two months away. There will be many commemorations, many reflections on how downtown New York and the country has changed since then. But for the people who lived and worked downtown during that time and are still with us, this is also time to take stock of their own health.

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On September 11, 2001, members of the Islamic extremist group Al Qaeda coordinated four attacks using hijacked commercial airliners in the United States.

Two iconic towers fell. The Pentagon sustained major damage. Nearly 3,000 victims lost their lives. Countless more suffered immediate injuries and long-term health issues that are still being felt to this day.

The 9/11 attacks changed America, and the world, forever.

Here's what it looked like on the ground, from the streets of New York to the Pentagon to a field outside of a Pennsylvania town, from the point of view of people who were there.

The first attack

The first tower was struck at 8:46 a.m. on September 11, 2001.

Five attackers, armed with box cutters, crashed American Airlines Flight 11 into the north face of the north tower of the World Trade Center complex in lower Manhattan.

Minutes later, the south tower was hit by a second hijacked plane, United Airlines Flight 175.

A fourth attack

The final hijacked plane, United Flight 93, took off from Newark International Airport.

Investigators believe the intended target was likely either the White House or the U.S. Capitol. But passengers, who learned of the other hijackings in cellphone calls to loved ones, attempted to rush the cockpit and retake control from the terrorists.

In this photo, emergency workers look at the crater created when that plane crashed in a field near Shanksville, Pennsylvania.

Bravery

Firefighters battle the flames at ground zero.

On the day of the attacks, 343 New York City firefighters died in the twin towers. At least 200 more have since died from illnesses related to their work at the site.

Also killed that day were 37 officers from the Port Authority Police Department and 23 members of the NYPD.

View at the Pentagon

Meanwhile, rescue operations were also underway at the Pentagon, where 184 people died.

The building itself would be fully repaired within the year.

Sickening smoke

An unidentified New York City firefighter walks away from ground zero after the collapse of the twin towers on September 11, 2001.

In the years following the attack, comedian and former "Daily Show" host Jon Stewart became a prominent advocate for better health care for the first responders. In 2019, Congress permanently extended the victims' compensation program.

Rescue efforts

Rescue workers sift through the wreckage of the World Trade Center on September 13, 2001.

Thousands of people showed up in the days following the attacks, eager to help with the rescue effort.

Several people, including first responders, were rescued from the rubble within a day of the attacks. But after that, no more survivors were found.

9/11 Memorial & Museum

A view of the 9/11 Memorial & Museum in New York City. Names of those who died are etched into the fountain.

First published on August 23, 2021 / 12:18 PM

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Photos of 9/11 and its aftermath to mark the 20-year anniversary

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On September 11, 2001, members of the Islamic extremist group Al Qaeda coordinated four attacks using hijacked commercial airliners in the United States. Two iconic towers fell. The Pentagon sustained major damage. Nearly 3,000 victims lost their lives. Countless more suffered immediate injuries and long-term health issues that are still being felt to this day.

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9/11 first responders begin to feel attack's long-term health effects

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9/11 first responders begin to feel attack's long-term health effects

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Rob Serra was just 21 and had not even started in his new job as a New York City firefighter when terrorists brought down the World Trade Center's twin towers on Sept. 11, 2001.

"I just got out of the academy on Sept. 10," Serra told NBC News last week. He spotted the burning skyscrapers from the Verrazano-Narrows Bridge, called his firefighter brother for guidance and hopped on a bus to get as close as possible.

"I had no idea what I was doing. I had never been to a fire before," Serra said.

He joined the crowds of first responders pawing through the chunks of building material, breathing in the pulverized dust loaded with cement, asbestos, lead, glass fibers, dioxins and other chemicals.

"Everyone had a half inch of white paste on their face," Serra recalls.

Now, 17 years later, he and thousands of others are still paying for the time they spent in Lower Manhattan.

"I do remember thinking that this is probably going to kill me," Serra said.

"You figure two buildings full of glass, asbestos, steel. You could taste it," he added. "I hope I have a lot of years left, but common sense and reason tells me I don't."

His sinuses are full of scar tissue from the removal of growths called polyps and he says he has some evidence of neurological damage, including trouble walking. Serra fears that he will develop cancer.

"We all think it's coming at some point," he said. "It's just a matter of when, not really if."

Three hundred forty-three firefighters and paramedics were among the 2,753 people who died in the fires and in the collapse of the two buildings on Sept. 11, 2001. More than 150 have died since, according to Dr. David Prezant, chief medical officer of the New York Fire Department.

Several programs are trying to keep track of the health problems plaguing people directly affected by the 9/11 attack in New York and its aftermath. There's a federally funded program for people with documented illnesses, including dozens of different cancers, asthma and other respiratory problems, post-traumatic stress disorder, and long-term problems caused by injuries.

The World Trade Center Health Program, established by the 2010 James Zadroga 9/11 Health and Compensation Act - named for a New York City police officer whose death was linked to his work at ground zero - helps people with illnesses that have documented links to the disaster.

Dr. Michael Crane, who directs the program at the Icahn School of Medicine at Mount Sinai Hospital in New York, says 72,000 people are enrolled, including firefighters and police officers but also utility workers, medical examiners and others. Of them, he says, 8,000 already have cancer.

He expects many more cases.

"Some of the toxic exposures ... the effects of those are now due," he said.

Asbestos-related cancers, notably lung cancer, can take 20 years for symptoms to show. "It's time for them to start appearing," Crane told NBC News.

"I am concerned about rising cancer rates."

Many of the cancers are treatable, including the most common skin cancers related to the chemical exposures. For that reason, not too many cancer deaths can be directly blamed on 9/11.

But other cancers will be deadly. Earlier this year, a team at Memorial Sloan Kettering Cancer Center in New York reported that 9/11 firefighters had an elevated risk of multiple myeloma, among other cancers.

The researchers said all of those exposed to the toxic dust at ground zero need continued careful surveillance.

Because of the health issues, many of those who helped with cleanup and recovery can no longer work.

Elizabeth Wilson, a former city bus driver who was assigned to work with other transit workers at ground zero after the attack, is one of them. Now 59, she retired two years ago. She has nodules, a potentially precancerous type of growth, in her lungs; asthma; acid reflux; and other conditions that have been certified as having been caused by the 9/11 dust.

Like so many people living and working at ground zero, Wilson never wore a face mask. "It was like a cloud," Wilson said. "You couldn't see your hand in front of you, it was so bad."

Only about half of those assigned to work in the area wore protective gear, and even fewer of the people living and working nearby did.

"We were supposed to have been fitted for respirators at the time," Wilson told NBC News. But Christine Todd Whitman, then the Environmental Protection Agency administrator, erroneously assured people that the air was safe to breathe. "I never got a mask after that," Wilson said.

Whitman has since said she regrets having said that.

Wilson said her clothes were covered in so much dust during the first days and weeks that she would stuff them into yard waste bags and throw them out rather than trying to wash them.

Many more people were similarly exposed, and don't even know that they are at risk or that help is available, said Dr. Gaetane Michaud, a lung health specialist at New York University.

"I feel heartbroken to know that if at the lowest number, we're saying there are about 400,000 people that should be benefiting from the World Trade resources, and about 80,000 are actually benefiting from them," Michaud said in a statement.

"It's not just lung cancers. It's lung cancers, breast cancers, esophageal cancers and thyroid cancers, to name a few. These people should be screened and be taken care of."

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9/11 first responders join death toll from attack

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Rob Serra was just 21 and had not even started in his new job as a New York City firefighter when terrorists brought down the World Trade Center's twin towers on Sept. 11, 2001. "I just got out of the academy on Sept. 10," Serra told NBC News last week.

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As 9/11 health problems mount, an uncertain future for students in lower Manhattan 

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As 9/11 health problems mount, an uncertain future for students in lower Manhattan 

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Lila Nordstrom was a senior at storied Stuyvesant High School in lower Manhattan when "we saw a huge fireball engulf the first tower" of the World Trade Center back in 2001.

Brook Peters was just starting his second day of kindergarten two blocks away.

They're two of the thousands of children who were at school in lower Manhattan on the day of the Sept. 11 terror attacks, many of whom are now grappling with the fact that they may face life-long, potentially fatal diseases as a result of their proximity to ground zero, much like the first responders.

Both Peters, now 22, and Nordstrom, now 35, are already facing what doctors say are 9/11-related health issues: Nordstrom has been diagnosed with gastroesophageal reflux disease, asthma and a respiratory condition called rhinosinusitis and both she and Peters have been diagnosed with post-traumatic stress disorder. Nordstrom's case has been certified by the World Trade Center Health Program (WTCHP).

Peters' mom, Michelle, picked him up from P.S. 150 shortly after the first tower was struck, but they went to ground zero to try to help.

"The walkie-talkies were down... people had to physically run messages to one another," Peters said of the work his mom -- who coordinated fundraisers and other events with the FDNY for years -- was doing at the scene. She put him in a firetruck and he felt safe "because I'd always been in firetrucks. I'd taken my first steps in a firehouse."

"After the second tower was hit, [the firefighters who were gearing up] started to tell me messages to give their loved ones," he said. "It was a lot of different people and a lot of different names and a lot of different messages and of course, being four, it was hard to account for all of them."

One of the lasting consequences of that day was the guilt he says he felt at not being able to remember which message was intended for whom.

"The guilt I dealt with in therapy [was] 'who was who and what was what?'" said Peters, who later created a documentary about his experience and that of others who were at school that day.

"The [message] that was always the most resounding personally to me was one that was to me: 'Grow up be a good man. Take care of your mother but be a good man,'" he told ABC News.

Peters says he evacuated the scene with his mom when the towers started to collapse, running north through the dust cloud.

Returning to Stuyvesant H.S.

Nordstrom's architecture class didn't immediately evacuate as soon as the first tower was hit. Knowing her history of having childhood asthma, however, Nordstrom "went to the nurse's office because it was on the other side of the building." When the school evacuated, she started running.

"I literally turned around and watched as the fire on the second tower disappeared and just started to run because everyone was running," she said, but noted that "I was asthmatic, so I didn't get very far."

She ended up staying with a friend in Queens for the night after the attack, but stressed that "the story of Stuyvesant [High School] is really about the return."

The students returned to their school, a public high school regularly ranked among the best in the country, just weeks later on Oct. 9, 2001.

"The city had promised parents that all of these safety precautions had been taken," said Nordstrom, who also testified to this effect before the House Judiciary Committee in June.

"The vents in our school building were not cleaned out," she said to ABC News. "The barge where they were taking all the debris from the site was moored right next to our building so they were carting debris past our building all day. The fires down at ground zero which were coating the area with smoke would burn for another three months."

The school was scrubbed, four environmental tests were conducted and while asbestos was detected in initial tests, it was not subsequently, according to a 2001 report in the New York Times. Still, parents remained concerned about the haze of dust around the school from debris being moved nearby, despite sprinkler trucks wetting the street near the school.

Education Week reported at the time that the school system worked with the Environmental Protection Agency and city health and environmental officials to conduct the tests. On top of that, former EPA Administrator Christine Todd Whitman said at the time that the air in lower Manhattan was safe to breathe, a comment she apologized for, although she said they did the best they could at the time with the information they had.

The school was shut down in the summer of 2002 for a comprehensive cleaning after elevated lead levels were found in the ventilation system.

Miranda Barbot, the deputy press secretary for the New York City Department of Education, shared a statement with ABC News about the testing that was done before the students returned to lower Manhattan.

"The safety of our students and staff is our top priority, and we tested the air quality of many schools below Canal Street and in Brooklyn, and relocated six schools in the area for varying lengths of time," Barbot said in the statement. "All air quality tests were done by EPA-certified contractors, and in some cases, the air circulation for a building was redone in order to keep our schools safe. We continued daily cleaning and air quality monitoring in buildings for months afterwards."

ABC News could not reach a representative at Stuyvesant High School after repeated calls for comment.

'We're never going to know'

Michael Barasch, an attorney based in lower Manhattan, said that much like some of the students, he and his colleagues "all came back to work [and] we were smelling this awful smell and they stayed because they said it was okay."

"They wanted to reopen Wall Street and they wanted to send a message to our enemies that 'New Yorkers are resilient and you can't stop us,' but boy are we paying the price for that mistake today," Barasch said.

Barasch said he represents 15,000 clients relating to 9/11. Only 65 of them are young adults who were children in the area at the time of the attack.

"They're not making that connection, that they're entitled to free healthcare -- let alone compensation --and that's now free healthcare for the next 70 years. It's compensation if they ever get cancer for the next 70 years," Barasch said of the young adults who were children in the area at the time.

It is unclear how many students who were in lower Manhattan that day have developed a 9/11-related illness or which sicknesses they developed. According to data from the World Trade Center Health Program, which is administered by the Centers for Disease Control and Prevention, the vast majority of the more than 95,000 enrolled in the program are responders (nearly 80%) as opposed to survivors. Of the survivors, 791 are under 35.

Of the program's 269 certified cases for people under 35, 194 have aerodigestive conditions, 126 have mental health issues and 28 have cancer, all 1% or less of the total, the data shows. The WTCHP provides screening and healthcare to survivors and responders.

In the years since 9/11, there have been reported cases of cancer among former Stuyvesant students.

There were more than a dozen schools south of Canal Street in Manhattan, which is considered the exposure zone for the Victim Compensation Fund -- which provides compensation to responders or survivors who are sick or families of those who have died -- while the exposure zone for the World Trade Center Health Program extends to everything south of Houston Street in Manhattan several blocks north of Canal Street and parts of Brooklyn, Barasch said.

"Every year that goes by it's going to be more and more difficult for the children who were here to remember who their classmates were who their teacher was. It's going to be more and more difficult for a janitor to have a coworker sign an affidavit saying that they were there," Barasch said.

For Nordstrom, the prospect that her health could be impacted didn't really hit her until NYPD Det. James Zadroga died in 2006. Zadroga was the first NYPD officer whose death was tied to exposure of the toxins at Ground Zero, and the 9/11 Victim Compensation Fund is named after him.

"I was graduating that spring from college and I kind of had this epiphany: 'Oh, we're going to get sick. We were there in the same conditions as these guys,'" Nordstrom told ABC News.

Dr. Jacqueline Moline is the director of the Northwell Health Queens World Trade Center Health Program and said that part of the problem in the immediate aftermath was that regulators were testing for certain compounds and not others.

"Because there was such a focus on asbestos and rightfully so... they weren't paying as much attention to the other toxic Polycyclic Aromatic Hydrocarbons [PAHs] and products of combustion and other things that were in the dust that could lead to health problems down the road and I think that was one of the flaws," Moline told ABC News.

"Ultimately I think, we're never going to know because we don't really know what was in the air," she said. "There weren't even measurements of the PAHs in the air until 10 days after."

Part of the problem now, she said, is that "there's not good data" on the impacts of the air quality on children whose lungs were still developing. Moline said that diseases that are tied to the air that the children breathed 18 years ago can "absolutely" develop decades after the fact.

In her written testimony to Congress in June during the effort to reauthorize the Victim Compensation Fund, Moline warned that various respiratory diseases in addition to cancers like "leukemia, lymphoma, and multiple myeloma" were found in responders, survivors and school children, and "it is expected that more of these cancers will continue to occur in the future."

"Nearly 20,000 children attended school below Houston Street on September 11, 2001, and were exposed to the toxic mixture. We do not know what World Trade Center diseases these now-young adults will develop," Moline said in her testimony.

According to the CDC's website dedicated to the WTC Health Program, there are more than 100 types of cancers and unspecified cancers that have been tied to 9/11 exposure. But the site also discusses linking childhood childhood cancers to 9/11.

For Nordstrom, that hit close to home.

"I know five people who have or have had lymphoma just among my classmates," she said.

She founded a group called Stuy Health, advocating for students to get access to World Trade Center health benefits and compensation. And Peters may be one such student who signs up.

Peters, who graduated from Emory University in May and has since returned to New York, said he has not been tested through the WTCHP. He thinks he has been "lackadaisical and not wanting to know," in spite of earlier PTSD diagnoses.

"A lot of youth and a lot of people even younger than me can still see the extent of the illnesses in the coming years," he said. "We still have our full lives to see the full extent of what might happen."
This story was featured in the Wednesday, Sept. 11, 2019, episode of ABC News' daily news podcast, "Start Here."

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As 9/11 health problems mount, an uncertain future for students in lower Manhattan

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Lila Nordstrom was a senior at storied Stuyvesant High School in lower Manhattan when "we saw a huge fireball engulf the first tower" of the World Trade Center back in 2001. Brook Peters was just starting his second day of kindergarten two blocks away.

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Last survivor to be pulled from the rubble

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Last survivor to be pulled from the rubble

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Speakers Bureau | Keynote Speakers | Qualified Speakers | Qualified presenters for your meetings and events.

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Sept. 11, 2001 started out just like any other day for Port Authority of New York & New Jersey employee Genelle Guzman-McMillan. She arrived at work on the 64th floor of the north tower of the World Trade Center, signed in and made her way down to the 44th-floor café to grab a bagel.

"I was looking forward to that day," she recalled. "I had plans coming up for the next three or four months and was looking forward to finalizing those plans.".

She was sitting at her desk talking to a coworker when the building shook.

Out the window she saw debris and a ball of fire falling from the sky above.

"I just thought something had blown up, up above. I heard noise, but the shake was what was scary. It was like an earthquake or something," she said. "I had no clue what was going on."

A supervisor told her a plane had hit the building, her mind picturing just a small aircraft clipping the side. But reports of a terrorist attack scrolled across TVs around her.

They were told to stay put. Then, they felt the shake from the second tower. "That's when we decided we needed to leave, so we took the staircase and kept walking down," she said.

Guzman-McMillan never made it to the bottom of the staircase as the building shook and began to collapse when she reached the 13th floor.

"I really thought we were almost there. There were firefighters coming up as we were going down. They told us we were doing good, to keep going," she said. "It happened so fast: The walls burst open and the rubble came falling down."

She would be pinned under the rubble for the next 27 hours. "My head was wedged between a concrete pillar and I couldn't move it."

Eventually, she could hear voices calling for help, radios going in and out, as she drifted in and out of consciousness.

"I just started to pray and hoped for a miracle," she said.

Exhausted and in pain, she kept her hand extended waiting on help.

"Someone grabbed me and called me by my name and told me to keep holding his hand. He said his name was Paul and he told me to hold on because help was on the way. Then someone started calling my name and Paul told me to keep talking. I could hear the machinery cutting away the steel above me. It was then I could feel someone grab me by my shoulder and start to pull me out," she said.

No one other than Guzman-McMillan ever got the chance to speak to Paul, and rescue workers told her they didn't see anyone with her when they arrived.

As they pulled her from the rubble, she wasn't able to completely open her eyes, but kept asking the rescuers if she was there yet.

"I was just smiling because I knew I was alive and was going to go home," she said.

A few years ago she made a trek with some coworkers to the memorial fountain commemorating the victims because she wanted to see her friend Rosa's name. It's the closest she's gone to the site of the attacks since it happened.

Every year as the anniversary of the attacks occurs, she has the same flashbacks, remembering the 14 coworkers and friends she lost that day.

"I see all those moments, the back and forth of should we stay or should we go. I see my friend Rosa's face and we were talking," she said.

She is still in disbelief when she sees footage of the attacks, asking herself, "Did I really go through that?"

She'll find herself looking at news broadcasts with the volume down until they reach the letter G when naming the victims, because at that moment she turns up the volume to hear them call her friend Rosa Gonzalez name and see her face across the screen.

"It's been 15 years now, but as it gets closer to the date, it seems like it was just yesterday," she said. "I try and put it out of my mind and behind me and move on."

She moved on by defying medical science, having two children and by trying to be a positive role model to them.

Doctors told her she would need her leg amputated, and her leg healed enough to avoid that. They also told her she'd need heart medicine due to the amount of times she fainted during her 27-hour ordeal, and yet she hasn't taken any heart pills.

"I had to learn to walk again, and I have a permanent limp from it. I have the scars on my leg to this day, but people wouldn't know it because I won't wear faults. I am usually walking in 4-inch heels. "The doctors told me I wouldn't be able to do things, but I am doing it!"

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Genelle Guzman-McMillan | Speakers Bureau | Keynote Speakers | Qualified Speakers

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CBA SPEAKERS BUREAU was founded with the single focus: making a resounding impression on organizations by providing keynote speakers, motivational speakers, celebrity speakers, sports stars, and corporate entertainers to clients all over the world for their meetings, conferences and events.

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NEW YORK (Reuters) - As the ruins of New York's World Trade Center smoldered following the September 11 attacks of 2001, skeptics doubted it could ever rise again.

Now, as the 19th anniversary of 9/11 approaches, the grand vision set forth after its destruction has largely been realized. But the rebuilt World Trade Center complex is under threat anew - this time, from a microscopic virus.

"People are much more worried about someone coughing on them than someone blowing up a building," said Vishal Garg, chief executive of mortgage refinance startup Better.com, headquartered at 3 World Trade Center on the site known as Ground Zero.

After the Twin Towers and surrounding buildings were destroyed by al Qaeda hijackers, killing 2,753 of the nearly 3,000 people who died that day, the economy of lower Manhattan was devastated.

But a plan was born, and a lengthy metamorphosis turned the disaster zone into a giant pit, then a walled-off construction site, and finally, some $25 billion later, a tourist attraction and business center with three skyscrapers, a transportation hub, a museum and a memorial.

The coronavirus pandemic has stalled its completion, with a performing arts center under construction and a fourth and final skyscraper planned. Six months after New York City began shutting down due to COVID-19, the World Trade Center and the once-bustling Financial District are now eerily devoid of crowds.

"It's pretty melancholy. A bit gloomy," said James Busse, a retail stock broker taking a cigarette break nearby.

Ground Zero became both a solemn memorial and a leisure destination. Choked-up visitors to the 9/11 museum or memorial could step onto an esplanade of children eating ice cream or out-of-town visitors admiring the glass-sheathed towers.

One World Trade Center, America's tallest building at 1,776 feet (541 meters), was built with a bomb-resistant base, as the old World Trade Center had been attacked in a truck bombing in 1993.

The vision laid out in Daniel Libeskind's 2003 master plan drove a renaissance that has diversified the local economy, previously reliant on finance.

The public and private sectors have invested some $25 billion in reconstruction, according to the Port Authority of New York and New Jersey, which owns the land.

"Everybody coming to New York wants to come to Ground Zero," Libeskind said in an interview. "It is the center of New York. It is the great public space."

At its heart are two reflecting pools designed by Michael Arad, marking the footprints of where the Twin Towers once stood, with a pair of four-sided waterfalls draining into an abyss. The names of the victims are etched into its bronze borders.

Pre-pandemic, hundreds of visitors would gather there. But on a recent afternoon a family from Wichita, Kansas, were the only people at the south tower pool.

TWIN TOWER NOSTALGIA

Nostalgia over the Twin Towers grew after they were destroyed along with so many innocent lives, but they were unloved in their time.

Completed in the 1970s, the World Trade Center replaced a neighborhood known as Radio Row with an oversized block containing the Twin Towers and little else. The site was frequently called a "windswept plaza."

"The problem with the World Trade Center is that it never really was that good," said Carl Weisbrod, a former city planning official who worked on the redevelopment of the new site. "What's emerged is a central business district that is now a model for the 21st Century as opposed to a sort of a historical artifact of the 20th Century."

Planning the new site stirred public emotions associated with the attack on the United States, the loss of life and fears of working in tall buildings again.

Critics say the end result still lacks affordable housing and lament the absence of a direct rail link to major regional airports. Architectural critics have called One World Trade Center lackluster.

But there is agreement that, considering all the interests and complexities, it works.

"They did a really wonderful job of knitting it back in the city, but still honoring that sacred site," said Leslie Koch, president of the complex's Performing Arts Center.

THE MOVERS ARE HERE

In New York's vertigo-inducing real estate market, prices rarely drop except after events like 9/11 or a recession, and prices are falling again now.

Downtown Manhattan rents are down 1.4% through July, the largest annualized fall since 2010, said Nancy Wu, an economist with the real estate database StreetEasy.

As of 2019, the neighborhood's rental market was the city's fastest-growing. But the inventory of available apartments rose 80 percent this July from a year earlier, Wu said.

Guy Khan,  director of banking at a financial services company, said the downturn was apparent around his home near City Hall, with chain stores and mom-and-pops closing and neighbors fleeing for the suburbs.

"You see moving trucks every day," he said.

Developer Larry Silverstein acquired a 99-year lease on the Twin Towers from the Port Authority for $3.2 billion just six weeks before 9/11. He has spent the past 19 years rebuilding.

In 2015, Silverstein forecast the entire site would be rebuilt by 2020, but that changed after the planned anchor tenant for 2 World Trade Center pulled out.

"Life is so unpredictable," he said.

Silverstein and Libeskind, the master planner, see the pandemic as a temporary pause in downtown Manhattan's ascendance, noting how predictions of decline after 9/11 proved wrong.

"People said New York will never come back. And it's the same thing during the pandemic," Libeskind said. "But I don't believe it. New York is too resilient," .

(This story corrects address of Better.com)

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construction & engineering (trbc level 4)

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Rebuilt after 9/11, World Trade Center threatened anew by coronavirus

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NEW YORK (Reuters) - As the ruins of New York's World Trade Center smoldered following the September 11 attacks of 2001, skeptics doubted it could ever rise again. Now, as the 19th anniversary of 9/11 approaches, the grand vision set forth after its destruction has largely been realized.

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9/11 Responders Encouraged to Register for Health Benefits

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9/11 Responders Encouraged to Register for Health Benefits

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9/11 Responders Encouraged to Register for Health Benefits

﻿ Update: In July 2019, the U.S. House and Senate passed and President Donald Trump signed into law a bill to fully finance and reauthorize the September 11th Victim Compensation Fund through 2092.

The death this month of yet another FBI employee who responded to the September 11, 2001 terrorist attacks and a looming deadline for 9/11 responders to sign up for some health-related benefits is leading to renewed efforts inside the Bureau to make sure everyone who worked the expansive crime scenes in New York, Virginia, and Pennsylvania is plugged into the health resources available to them.

William "Homer" Lewis, an engineer and electronics technician at the FBI Academy, died April 3 after battling an illness attributed to his work at the Pentagon in the days and weeks after terrorists crashed an aircraft into the side of the building. Lewis, who joined the FBI in 1990, brings to at least 16 the number of FBI agents and professionals who have died from illnesses they incurred through work at or near the recovery and screening sites in lower Manhattan, the Pentagon, and Shanksville, Pennsylvania.

"Our folks responded without concerns for themselves," FBI Deputy Director David Bowdich said during a recent event at FBI Headquarters-and broadcast to all 56 field offices-aimed at spreading awareness about the need for 9/11 responders to register for available health care resources before it's too late.

"If you hear nothing else I have to say, please register today," Bowdich said. "We've lost too many good people, and I feel we are going to lose more."

The federal government has several programs for affected 9/11 responders, including the World Trade Center Health Program (WTCHP) and the September 11th Victim Compensation Fund (VCF). The WTCHP, which authorizes coverage through 2090, provides ongoing screening, monitoring, and treatment for certified conditions, and the VCF provides compensation to individuals-or their families if deceased-for certain injuries or conditions or deaths related to the 9/11 attacks.

To learn about the World Trade Center Health Program, visit the WTCHP website or call (toll-free) 1-888-982-4748. For additional information about the September 11th Victim Compensation Fund and how to file a claim, visit the VCF website or call (toll-free) 1-855-885-1555. The FBI's Human Resources Division can assist FBI employees with other resources, including filing with the health program and compensation fund. Email

Some estimates put the number of FBI responders to 9/11 crime scenes in New York, Virginia, and Pennsylvania at 4,000 employees, with only a fraction having registered with the World Trade Center Health Program or with the September 11th Victim Compensation Fund.

The renewed urgency within the Bureau's ranks is due in part by a looming statutory deadline to submit claims for the Victim Compensation Fund-December 18, 2020. The urgency was compounded earlier this year when the special master in charge of the $7.3 billion compensation fund announced that future payouts would be significantly reduced (by up to 70 percent) because of dwindling funds. More than $5.1 billion has already been awarded to more than 21,000 claimants as of March 31, 2019, with thousands more claims still pending review.

"I am painfully aware of the inequity of the situation," VCF Special Master Rupa Bhattacharyya wrote in a February 15, 2019 message posted on the VCF website. "I also deeply regret that I could not honor my intention to spare any claim submitted prior to this announcement from any reductions made due to a determination of funding insufficiency. But the stark reality of the data leaves me no choice."

With at least three deaths last year of FBI special agents whose illnesses were directly related to their work at 9/11 sites and more than 40 FBI employees currently being treated for 9/11-related illnesses, a concerted effort is underway to get all 9/11 responders-working and retired-to register for the programs even if they are not showing any signs of illness.

"We're trying to make sure people are at least registering for a potential claim, whether they are sick or not," said Jean O'Connor, a 9/11 responder and special agent in the Washington Field Office who is part of a cadre of FBI staffers leading the awareness campaign. They are encouraging all 9/11 responders-at the FBI and elsewhere, to include task force officers, police officers, and firefighters-to get registered so that if there is a need down the road they have already established their eligibility. "The Victim Compensation Fund only kicks in when you make a claim, but the registration is just saying, 'I was a first responder,' " and gets the VCF to acknowledge that you were."

Current and former FBI special agents describe their roles during the FBI's response to the 9/11 attacks and encourage other 9/11 responders to register for the health benefit and compensation programs available to them.
Transcript/Download

Jack Hess, an FBI agent for 21 years before retiring in 2009, worked briefly at the Pentagon recovery site before moving off-site to a command center. Earlier this year, his doctors removed a cancerous tumor that doctors attributed to his work in 2001. Hess thought so much time had passed and that he was in the clear, so he hadn't registered for benefits, even as his former colleagues suggested he should.

"Frankly, my perspective was, 'It was 17 years ago, I'm fine, I was there for one day, I'm fine,' " said Hess, whose prognosis is good. "In reality, those were bad assumptions. Seventeen years is right within the gestation period for the type of tumor that I had. And after extensive research, they've determined that four hours' exposure to the carcinogens in the air that day was plenty to get sick."

On September 7, 2018, FBI Director Christopher Wray and the VCF special master hosted a forum in New York for nearly 200 law enforcement officers about the programs available for 9/11 responders. In the six months prior, Wray had attended three memorial services for agents who died from illnesses related to their work at 9/11 sites.

"We are only now beginning to understand and witness the long-term effects of that work and the full extent of the sacrifices all of our first responders made," Wray said at the time.

Some estimates put the number of FBI responders to 9/11 sites at 4,000 employees, with only a fraction having registered with the WTCHP or the VCF. The FBI group leading the awareness campaign, in coordination with the Bureau's Human Resources Division, said reasons vary for colleagues' reluctance to sign up for the programs-from feeling healthy and therefore unaffected to fearing that by registering they would shrink the pool of funds available to someone else who may need them more.

"This is not a matter of taking resources from another person," said Special Agent John Nagashima, who spent weeks at the Pentagon site collecting and sifting for potential evidence. He's healthy, but registered after seeing several of his colleagues fall ill or die. "It's just trying to detect these things early enough so you can get appropriate treatment."

Director Wray said as much last fall, encouraging all those who worked so selflessly in the wake of 9/11 to take this opportunity to look after themselves.

"There are resources that may be available to you," Wray said. "You fought to make sure that what happened that day would never ever happen again. So let us help you now."

Inside the FBI: First Responders and 9/11-Related Illnesses

FBI Wall of Honor: 9/11-Related Deaths

In addition to one agent who died during the terrorist attacks, many other FBI employees have died thus far from illnesses they incurred through work at or near 9/11 crash sites. Several have been added to the FBI's Wall of Honor, with more names to be added in the months and years to come.

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Help for 9/11 Responders | Federal Bureau of Investigation

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9/11 Responders Encouraged to Register for Health Benefits ﻿ Update: In July 2019, the U.S. House and Senate passed and President Donald Trump signed into law a bill to fully finance and reauthorize the September 11th Victim Compensation Fund through 2092.

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Where were you when you heard about the terrorist attacks that took place on September 11, 2001?

Though everyone has a different story to tell, we were all traumatized as we watched the events of that day unfold on television. But, it was the people directly affected, including rescue workers, survivors, and eyewitnesses, who continue to experience post- traumatic symptoms even today. As you might expect, research has consistently shown that individuals exposed to the attacks showed rates of PTSD and depression far greater than lifetime rates found in the general population. For example, a research study looking at police officers who responded to 9/11 showed that 12.9 percent reported PTSD symptoms over a decade after the attacks. Of those who had PTSD symptoms, 72.4 percent also reported problems with depression and anxiety.

Researchers have also identified specific risk factors that made survivors especially vulnerable to trauma and depression afterward. In first responders particularly, having arrived early at the scene (following the first airplane impact) increased the risk of PTSD while history of alcohol abuse was linked to developing depression. Other factors included:

Being a woman

Having experienced stressful situations before or after the attacks

Traumatic symptoms experienced during the attacks themselves

Having a history of mental health issues

Loss of psychosocial resources

Less social support

These last two factors highlighted how important emotional support can be for survivors of trauma. Along with providing an emotional sounding board for survivors to share their experiences, this kind of support can also boost resilience. According to the enabling hypothesis, social support helps survivors by building up their sense of self-efficacy, i.e., belief in their ability to overcome obstacles and face challenges. Still, though social support and self-efficacy seem to play an important role in protecting against PTSD and depression, actual research into the long-term consequences of the 9/11 trauma has been relatively scarce up to now.

But a new research study published in the the journal Psychological Trauma provides the most up-to-date conclusions about the long-term psychological impact of 9/11. Conducted by Shane W. Adams of John Jay College of Criminal Justice and a team of researchers, the study used data taken from the World Trade Center Health Registry (WTCHR) to examine the prevalence of PTSD and depression among 9/11 survivors and the factors that influenced their recovery.

Already the largest registry of its kind in U.S. history, the WTCHR collects information on anyone who lived, worked or went to school in the area of the WTC disaster, or were involved in rescue and recovery efforts to determine long-term health trends. While participation in the registry is strictly voluntary, thousands of survivors have chosen to participate to provide better information about long-term health consequences. By surveying participants in a series of waves beginning in 2003-2004 and extending up to the latest wave completed in 2015, researchers have already completed numerous studies looking at different health issues including depression, mortality, hearing loss, and hospitalizations for asthma, among others.

For their own research, Adams and his colleagues collected data on 1,304 participants who were adults at the time of 9/11 and who were physically present in WTC Towers 1 or 2 between the first plane's impact and subsequent WTC collapse. None of the participants had been diagnosed with PTSD prior to 9/11 and they all completed PTSD checklists during each of the four waves of the WTCHR survey project. They also completed survey questionnaires measuring perceived self-efficacy, the kind of social support network they had in place, depression, and PTSD symptoms. Participants were also questioned about their level of exposure to the traumatic events of that day. This included dust cloud exposure; horrific events witnessed; encountering problems during building evacuation (eg., fire, poor lighting, smoke, extreme crowding, panicky crowds, water in the stairs/lobby, etc.); and physical injuries occurring on 9/11.

Overall, 13 percent of the participants were still experiencing PTSD symptoms 14 years after 9/11 with 68 percent also reporting depression. Not surprisingly, all participants with PTSD had significantly greater exposure to the events of 9/11 than participants who weren't reporting mental health symptom or who had depression alone. Also, those participants reporting both PTSD and depression scored much lower in perceived self-efficacy than other participants. They were also significantly more likely to abuse alcohol, report a lower quality of life, as well as being less physically active compared with other participants.

When looking at those factors that predicted whether a survivor would develop PTSD, Adams and his fellow researchers found that, while trauma might predict PTSD symptoms, survivors typically only developed depression due to other factors including, later stress issues, more importantly, lack of social support. As for how well self-efficacy helped protect survivors from developing PTSD, that appeared to depend on how much exposure they had to the traumatic events of that day.

But what does this mean in terms of helping 9/11 victims recover from PTSD and depression? Along with demonstrating the need to look at other issues such as depression when assessing victims of trauma, this study also reflects previous research in showing that treatment aimed at depression or PTSD alone may not be very effective for people reporting combined symptoms. In dealing with tower survivors who experienced multiple traumatic events on 9/11, it is often as important to focus on improving self-efficacy as it is to help improve their social support networks. This research also shows that there is no one-size-fits-all therapy for survivors and that the kind of therapy given should be based on the full range of symptoms they are showing.

There is much more research that needs to be done, especially because many survivors have not come forward to ask for help. As a result, most studies to date may actually underestimate the true extent of PTSD and depression symptoms among tower survivors. Despite this limitation, we can see from this latest study that 9/11 continues to haunt many of the people directly affected. Understanding their symptoms and their treatment needs not only provides better treatment options, but also helps us be more prepared for future disasters.

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Where were you when you heard about the terrorist attacks that took place on September 11, 2001? Though everyone has a different story to tell, we were all traumatized as we watched the events of that day unfold on television.

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The battle over extending the September 11th Victim Compensation Fund, explained

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The battle over extending the September 11th Victim Compensation Fund, explained

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First responders who fell ill after working at the World Trade Center or the Pentagon in the aftermath of the 9/11 attacks might seem like a universally sympathetic group.

But paying into the fund that helps them has a long, bitter history in Congress. That struggle finally came to an end Monday when President Donald Trump signed a bill that permanently reauthorized the September 11th Victim Compensation Fund, which pays out claims for deaths and illnesses related to the attack.

"Our nation owes each of you a profound debt that no words or deeds will ever repay," Trump said during the bill signing ceremony. "But we can and we will keep our nation's promise to you."

Under the bill, $10.2 billion will be authorized for the fund for the next 10 years, then additional billions until 2090, essentially covering the surviving 9/11 responders for the rest of their lives. This is a major win for first responders, who have been pushing for permanent funding for over a decade.

That battle had been newly highlighted: Jon Stewart went viral on June 11 for blasting Congress for their "callous indifference" toward the men and women who handled the aftermath of 9/11. During a hearing on extending of the September 11th Victim Compensation Fund, the former Daily Show host angrily addressed the empty committee seats in front of him.

"I can't help but think what an incredible metaphor this room is for the entire process that getting health care and benefits for 9/11 first responders has come to," Stewart said. "Behind me, a filled room of 9/11 first responders, and in front of me, a nearly empty Congress."

A day after, the House Judiciary Committee unanimously voted to pass the Never Forget the Heroes Act, which would extend the fund through 2090. The entire House of Representatives passed the bill 402-12 on July 12, putting the pressure on Senate Republicans. Despite some protest from Sens. Rand Paul (R-KY) and Mike Lee (R-UT) due to budget concerns, the Senate overwhelmingly approved the bill 97-2 last week.

With the bill now signed into law, the financial pressures on the fund will be alleviated, and first responders and their families won't have to worry about slashed benefits or whether they'd be compensated for the harm they suffered while serving the country.

Many 9/11 first responders suffer from cancer and respiratory diseases

The original September 11th Victim Compensation Fund operated from 2001 to 2004 to compensate those who suffered physical harm or the families of those who were killed due to the terrorist attacks in 2001.

But as first responders continued to fall sick and die years after the attacks, the fund was reactivated in 2011 as part of the James Zadroga 9/11 Health and Compensation Act of 2010. First responders with an illness that stemmed from their work during the aftermath of the 9/11 attacks could receive compensation. The act was named after NYPD officer James Zadroga, who developed a respiratory disease after weeks of contact with the toxic chemicals around the attack site and died in 2006.

Zadroga's illness isn't an isolated case, according to the World Trade Center Health Program, a health care program funded through the Zadroga Act. Tens of thousands of first responders worked at ground zero, and more than 70,000 have enrolled in the program. More than 32,000 of them have developed diseases of the respiratory or digestive tracts, and 705 have died of those diseases. Cancer has also affected almost 9,000 first responders, and 600 have died.

At this rate, experts predict that the number of deaths from 9/11 diseases will outnumber the almost 3,000 people who died on September 11, 2001.

But getting compensation for those victims, who could die decades later, took years - and is now under threat due to funding issues. Rep. Carolyn Maloney (D-NY) introduced the Remember 9/11 Health Act in 2005, but it never came to a vote. When the bill was reintroduced, Senate Republicans balked at the idea of a permanent compensation fund with an initial price tag of $7.4 billion. The bill passed with $4.2 billion set aside for survivors and the requirement that it be reauthorized in 2015.

That renewal was also a political fight, but ultimately, the bill was extended for five years. So far, $5 billion of the $7.3 billion fund has been paid out to 21,000 claimants, and there are 190,000 additional claims to address, according to NPR. In an effort to make ends meet, significant reductions in awards ⁠- 70 percent less for claims made after February 2, 2019 ⁠- were announced in February.

First responders and their advocates are pushing for an extension that would guarantee funding through 2090. The bill has 323 co-sponsors in the House and 46 in the Senate.

Senate Minority Leader Chuck Schumer has said publicly that Congress has to pass the extension as soon as possible. When McConnell was asked about the efforts to extend the fund a day after the House Judiciary Committee passed the bill, he said he was unaware of the matter but that he would deal with the matter "compassionately."

That wasn't enough for Jon Stewart.

Jon Stewart has been one of the 9/11 fund's fiercest advocates

The 9/11 attacks have always been personal to Jon Stewart, who has been a New Yorker for most of his life. The comedian tearfully talked about his house's view of the World Trade Center during the first Daily Show episode after the attacks.

He has been a fierce advocate for first responders ever since, and he's been able to use his platform to turn around public policy. In December 2010, when it seemed like the Zadroga Act wasn't going to pass after being struck down by Republicans earlier that month, Stewart devoted an entire episode of The Daily Show to it. He shamed Republicans as " the party that turned 9/11 into a catchphrase " and brought 9/11 first responders to speak on the show. Less than a week later, Congress passed the Zadroga Act, and Stewart's 9/11 episode is credited as the tipping point for the issue.

Stewart never stopped fighting for first responders, and once again became a key figure during the reauthorization of the fund in 2015. The battle for funding had gotten particularly bitter when McConnell struck down a deal to include funding for an extension in a spending package. Democratic aides at the time reportedly accused McConnell of using the extension as political leverage to negotiate lifting a four-decade ban on oil exports - an account that McConnell denies.

First responders crashed McConnell's office in protest, and Stewart relentlessly criticized the lawmaker on The Daily Show.

"What message does it send to our first responders if once we're done as a nation with them helping us that we forget about them? That's unacceptable," Stewart said on the show, according to Mashable.

Eventually, the fund was extended for five years as part of a last-minute, year-end spending deal in 2015.

The two clashed again last month, as Stewart once again pushed McConnell to reauthorize the fund in a timely manner. In response, McConnell called Stewart " all bent-out-of-shape " and denied ever having failed to support the fund. McConnell was true to his word, and the Senate voted on the bill by August, as promised.

.@McConnellPress walks past Jon Stewart at the Ohio Clock Corridor in the Capitol. The Senate will be voting later today on HR 1327: Never Forget the Heroes: Permanent Authorization of the September 11th Victim Compensation Fund Act. pic.twitter.com/bZ0FaOhTSl
- Bill Clark (@billclarkphotos) July 23, 2019

"We can never repay all the 9/11 community has done for our country, but we can stop penalizing them," Stewart said after the Senate passed the bill. "I'm hopeful that today begins the process of being able to heal without the burden of having to advocate."

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The battle over extending the September 11th Victim Compensation Fund, explained

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First responders who fell ill after working at the World Trade Center or the Pentagon in the aftermath of the 9/11 attacks might seem like a universally sympathetic group. But paying into the fund that helps them has a long, bitter history in Congress.

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Feature American Psychologist examines Americans' reactions over time to terrorist attacks September 2011, Vol 42, No. 8 Print version: page 79 3 min read Hamilton, A. (2011, September). 9/11 10 years later. Monitor on Psychology, 42(8).

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Just watching television footage of the terrorist attacks of September 11, 2001, was enough to cause clinically diagnosable stress responses in some people who did not even live near the attacks-let alone the millions of people who did.

Like many other major disasters, 9/11 brought with it a host of psychological repercussions, one of the most severe of which has been post-traumatic stress disorder. PTSD is characterized by trouble sleeping, difficulty controlling anger, losing interest in activities, flashbacks, emotional numbness and/or other symptoms. If not treated, it can be debilitating.

But these reactions are not uncommon after a major disaster-and teasing apart post-9/11 disorders has been tricky for psychologists and researchers. "We tend to use the terminology of PTSD very loosely. A lot of people will have traumatic reactions but not necessarily PTSD," says Priscilla Dass-Brailsford of Georgetown University Medical Center's psychiatry department.

Researchers have been poring over the piecemeal collection of studies conducted over the past decade on the conditions of people after the attacks-how they felt and how well various treatments, and the passage of time, have helped them overcome mental afflictions. And from the literature, we are learning that old styles of early intervention, such as debriefing sessions, are not as effective as once thought-and that more often than not, people are incredibly resilient and can recover on their own and should be given the opportunity to do so.

"Research on 9/11-related PTSD has challenged the ways in which mental health researchers assess exposure to trauma," Yuval Neria, of Columbia University's psychiatry and epidemiology departments, and his colleagues wrote in a new paper published in the September issue of American Psychologist. Those in the mental health field have also borrowed research from other traumatic events to better understand the psychological wounds inflicted by the terrorist attacks. "Despite the fact that the exposure is different, the symptoms and problems are more similar than some people think," Neria says of PTSD sufferers from natural disasters or combat.
The exception, not the rule
During the week after the September 11 attacks, Dass-Brailsford was on one of the first trains to New York City, where she conducted debriefing sessions with a large financial company that had had offices in the World Trade Center. Many of the workers she spoke with in those sessions "were really traumatized," especially those who had been the last persons that friends or colleagues had spoken to before they perished.

But not everyone who was at the scene of any of the attacks on the morning of September 11 wound up suffering from PTSD or an other severe stress response. In fact, the majority did not. After traumatic events, such as 9/11 or Hurricane Katrina, "people expect the survivors or the victims to have PTSD, but that's not necessarily the case," says Dass-Brailsford, who also worked as a psychiatric first responder in the week after Katrina. Even if people experience occasional anxiety or stress having "perfectly normal reactions," she explains.

"We cannot assume that everyone will have trauma reactions, Dass-Brailsford says. "We shouldn't be projecting that." Patricia Watson, of the National Center for Child Traumatic Stress at the University of California, Los Angeles, explains that labeling someone as needing help just based on their exposure also implies "that they don't have the resources to recover on their own, effectively undermining their own abilities and their chances of viewing themselves as a stronger person via having to solve their own problem."

Another reaction frequently projected on survivors of the attacks is the notion of survivor guilt. Although it is no longer recognized as a formal condition-now living, diagnostically, as a part of PTSD-it is especially common among those "who used to fight together or endure adversity together, such as firefighters, police officers or soldiers," Neria says. And for victims of 9/11, it is much more likely to play a role in overall PTSD if the affected individual survived and a close friend or colleague did not.
An uneven recovery
In general, the prevalence of PTSD tends to decline steadily in the months and years after a traumatic event, especially if people can get back to relatively normal routines. Research conducted in New York showed that the rates of PTSD among the general population eased from about 5 percent a year after the attacks to 3.8 percent two years later, according to work published in 2006 in The Journal of Nervous and Mental Disease.

Even many of the first responders and long-term cleanup workers seem to have largely recovered psychologically. But one group of workers has curiously not followed this trend: retired firefighters. In some studies, they seemed to have an increased prevalence of PTSD as time went on.

Some 22 percent of retired firefighters who responded on 9/11 were still suffering from PTSD some four and six years after the event, according to research published earlier this year in Public Health Reports.

Dass-Brailsford suggests that in addition to having to cope with the trauma of the event, having gone on disability or into early retirement "means that you're not working, you're not occupying your time, and you have more time to sit and think about what happened to you, so your reactions become stronger." Additionally, leaving behind a highly active and service-oriented job might result in a feeling that "you're not able to do anything meaningful," she says, which could add to depression and stress levels.

First responders of any type also rely on having delayed emotional reactions to best perform their stressful jobs. "They develop a capacity to contain their reactions so they can deal with it later" and get through the task at hand-whether it is rescuing people from a fire or pulling the injured from a car accident, Dass-Brailsford says.

And in the general population as well, "in the immediate aftermath of a traumatic event, a lot of people are numb," Dass-Brailsford explains. "For some people that state of shock and numbness can last a long time, sometimes for a number of years." After Katrina, for example, widespread mental health problems, such as debilitating depression and suicides, became more widespread several months after the event.

Research has also found that basic differences in socioeconomic status can make big differences in how likely someone is to have sustained PTSD. One study found that 9/11 survivors who earned less than $25,000 a year had a 49 percent chance of having PTSD, whereas those who made more than $100,000 per annum had only a 6 percent risk.

And not everyone who suffered from PTSD or other symptoms the event had any direct contact with the attacks-or even lived in the affected areas. One survey, published in 2002 in JAMA The Journal of the American Medical Association, found that in the month or two afterward, some 4.3 percent of the general population had signs of PTSD. The more graphic television coverage of the attacks a person had watched in the intervening time, the more likely they were to report the major symptoms.
A new kind of psychological first aid
At the time of the September 11 attacks, the accepted protocol for handling large-scale traumatic events was to perform so-called critical incident stress debriefing, like that Dass-Brailsford led in New York, to discuss events and assess how people are reacting psychologically.

In the past decade, however, research has shown that sort of intervention, no matter how well intentioned, is probably not the most helpful response to get victims feeling better more quickly. As Watson notes, these sessions might well "be too brief to allow for adequate emotional processing, may increase arousal and anxiety levels or may inadvertently decrease the likelihood that individuals will pursue more intense interventions.

Since the late 1990s, the trauma-response field has been moving toward what is known as psychological "first aid." This triage approach "is designed to reduce distress, foster short- and long-term adaptive functioning, and link survivors with additional services," Watson and her co-authors explained in a new paper, also published in the September issue of American Psychologist. Psychological first aid's focus is on practical needs so that, the theory goes, other immediate stressors, such as finding a safe place or a way to reach relatives, do not exacerbate trauma from the event itself.

In the days after the 2010 earthquake in Haiti, for example, many public health officials worried that rather than infectious diseases, mental health was going to be a more pressing issue for the country. Sandro Galea, chair of the Department of Epidemiology of Columbia's Mailman School of Public Health, noted at the time that, "psychological first aid is giving people what they need to rebuild their lives. It will mean restoring people to their jobs, restoring people to their schools, restoring families."

Current guidelines, published in 2008, suggest a five-pronged approach to promote mental and emotional well-being after a disaster or during ongoing violence: "promoting a sense of safety, promoting calming, promoting a sense of self-efficacy and community efficacy, promoting connectedness and instilling hope," Watson and her colleagues summarized in their recent paper.
Treating terrorism's psychological wounds
The study of psychological reactions to terrorism is ongoing. But in the past decade researchers have made small steps in understanding how it is similar to other traumatic events, such as experiencing natural disasters, and how it differs. "Terrorism and human-caused disasters can have strong impacts on communities because of their uncertain and long-lasting nature, resulting in long-term stress and disruption," Watson notes.

To treat victims of terrorism, mental health practitioners have been turning to cognitive behavioral therapy, which has gained favor in recent years to treat many common mental ailments, including depression and PTSD. In this sort of therapy, patients work through traumatic events in a safe, supportive setting. This allows them to "reprocess the experience to support the natural extinction of the fear, extinction of the painful memories," Neria says. Taking lessons from the extensive work done with veterans and other survivors with PTSD, researchers have found that "the content of the treatment could be different" when treating terrorist attack survivors "but the strategies and interventions are pretty similar," Neria says.

But cognitive behavioral therapy might not be a cure-all. People experience trauma reactions differently, Watson notes, so the field should not limit itself to cognitive-behavioral approaches entirely. "Interventions should seek to address the multitude of possible effects of disasters," she says.

As Neria points out, as well, "the mental health toll of disasters and terrorism is not limited to post-traumatic stress disorder." They can also trigger major depressive disorder, generalized anxiety disorder, complicated grief (recognized in the mental health world as being unusually strong and long-lasting), substance abuse and a host of other symptoms that might come and go over time.

But diagnosing these conditions and getting the right help to the right people has become much more efficient in the past decade. Researchers have learned to work through schools, workplaces and other institutions to more efficiently screen larger populations of people and address their specific needs.
The hazards of an anniversary
A decade is more than enough time for most witnesses to 9/11 to have recovered from any initial stress response. But that does not mean that the anniversary this year will be smooth sailing-at least emotionally.

A major anniversary of any difficult event-the death of a loved one or a damaging natural disaster-can be a tricky time. And the already extensive rehashing of 9/11 means that, "for many people, they begin to re-experience the reactions they would have had at that time," Dass-Brailsford says. Whether they were at the site of the attacks or not, people might have nightmares, trouble sleeping, difficulty concentrating or a general sense of irritation. These symptoms can be especially difficult because they "can creep up on you, and you will start feeling odd, and you won't know why," she notes.

But there is one event that might help those especially affected by the events of 9/11 to further ease their anxiety. "The new wrinkle this year will be that bin Laden was captured and killed," Dass-Brailsford says. "In doing trauma work, usually when the perpetrator is brought to justice it can be very healing for survivors," she explains. As when a burglar who has been on the loose is finally captured, locals fell safer

But in this instance, "that safety is very relative because we know that the organization that he belonged to didn't depend just on him," Dass-Brailsford says. Nevertheless, now that he has been dispatched, "for some people, now they can start working on healing and recovering.

Fortunately, large-scale traumatic events such as terrorist attacks are relatively rare, but that means that their effects on mental health are tricky to study systematically. And as Neria and his co-authors noted in their paper, "In the immediate aftermath of disasters, it may be both inappropriate and unethical for researchers to assess some of [the] key variables related to exposure [and] short-term outcomes."

In the meantime researchers are pressing on to better understand how major disasters play out in minds across the world. Disasters can leave a vastly different mental health footprint depending on where they happen, Watson notes. "Disasters occurring in developing countries, whether human-caused or natural, cause more numerous and severe mental consequences than do disasters in developed countries," she says.

And despite the new cautions against assuming people exposed to trauma are unable to rebound on their own, Watson says that she and peers in the field are hoping "to get the message across that people may need a little assistance to feel better or function better, without needing formal diagnosis or treatment," to help overcome the stigma that remains attached to seeking psychological help.

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The Changing Mental Health Aftermath of 9/11--Psychological "First Aid" Gains Favor over Debriefings

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Just watching television footage of the terrorist attacks of September 11, 2001, was enough to cause clinically diagnosable stress responses in some people who did not even live near the attacks-let alone the millions of people who did.

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September 11 Attack Timeline. On September 11, 2001, nineteen al Qaeda terrorists hijacked four commercial U.S. jetliners, deliberately crashing two of the planes into the North and South Towers of the World Trade Center and a third plane into the Pentagon.

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Physical Health

A month after 9/11, nearly 50% of people living near the WTC site who participated in a survey about their health needs and concerns said they had nose, throat or eye irritation.

Respiratory hospital admissions increased significantly among lower Manhattan residents the first week after 9/11 compared with a similar demographic in Queens. Cardiovascular and cerebrovascular disease admissions also increased two to three weeks after 9/11, especially among women and those over 65 years of age.

Two literature reviews focusing on birth outcomes among WTC-exposed pregnant women suggest that environmental exposure or attack-related stress reduced fetal growth in some women, a finding similar to that in studies of birth outcomes after other terrorist attacks, environmental/chemical disasters and natural disasters. Disaster literature not specific to 9/11 indicates that child development may be more influenced by maternal mental health than by direct effects of disaster-related pre-natal stress. A newer study not included in these reviews compared two groups of women who were pregnant between September 11 and December 1, 2001: 500 women who were enrolled in the WTC Health Registry, and 50,000 women who lived at least 5 miles from the WTC site. Although researchers found similar birth weight and gestational age at delivery in the groups, Registry enrollees with probable PTSD were more likely than women without PTSD to deliver premature or underweight babies.

A study compared the estimated smoke plume path 5 days after 9/11 with health survey findings of about 3,000 New Yorkers 6 months after 9/11. Of respondents outside lower Manhattan, the study showed no connection between the estimated smoke plume intensity and new or worsening respiratory symptoms among those with asthma. However, the smoke plume was different from the WTC dust cloud.

Among a small group of lower Manhattan residents, lower respiratory symptoms, such as a cough and wheezing, decreased almost 8% four years after 9/11. Yet the prevalence remained elevated compared with those not exposed to 9/11. Residents who also worked in lower Manhattan on 9/11 were at highest risk for persistent symptoms.

Eight percent (8%) of residents enrolled in the WTC Health Registry reported newly diagnosed asthma 5 to 6 years after 9/11. Intense dust cloud exposure on 9/11, experiencing a heavy coating of dust in the home and not evacuating homes were major contributors to new asthma diagnoses.

A study of nearly 2,000 people exposed to WTC dust who sought care at the WTC Environmental Health Center 5 to 7 years after 9/11 showed high rates of respiratory symptoms, including persistent shortness of breath, cough and sinus or nasal problems. While pulmonary function was normal for the total group, about one-third (31%) had below-normal pulmonary function similar to the level found in WTC rescue, recovery and clean up workers.

The WTC Health Registry, in collaboration with the WTC Environmental Health Center, found abnormal lung function in Lower Manhattan residents and area workers who reported persistent respiratory symptoms 7 to 8 years after exposure to the WTC disaster. In a case control study using spirometry and oscillometry, a test to measure how well the lungs' small airways are working, researchers found that 180 enrollees with persistent respiratory symptoms (cases) were more likely to have abnormal lung function than nearly 500 enrollees who had not reported any new respiratory symptoms since 9/11 (controls). Oscillometric abnormalities were found even among cases with normal spirometry.

WTC Health Registry researchers identified 790 deaths from 2003 through 2009 among 41,930 adults who resided in New York City at the time of their enrollment in the Registry. The all-cause death rate among Registry enrollees was 43% lower than among NYC residents as a whole. Researchers detected exposure-related differences in mortality rates among those in the Registry: lower Manhattan residents, area workers and passersby with intermediate or high levels of exposure, including those with 2 or more injuries on 9/11, had elevated all-cause and heart disease mortality risks in comparison to those with intermediate or lower levels of exposure. The study did not detect exposure-related mortality differences among rescue and recovery workers even when internal comparisons were conducted.

Researchers found an association between chronic WTC exposures and lower respiratory symptoms in a case control study of nearly 800 Lower Manhattan residents and area workers in the WTC Health Registry up to 6 years after 9/11. Residents reporting lower respiratory symptoms were 2 to 3 times more likely than residents who never had symptoms to recall that the surfaces in their homes were covered in dust following the WTC collapse; residents who recalled a thicker layer of dust were at greater risk, suggesting a dose/response relationship.

Among residents, office workers and passers-by enrolled in the WTC Health Registry who reported either lower respiratory symptoms or probable posttraumatic stress disorder, more than 25% said they had both conditions 5-6 years after 9/11. Also, enrollees who had both conditions were much more likely to report 14 days of activity lost in the 30 days before being surveyed compared to enrollees with only 1 condition.

In a longitudinal study of nearly 1,000 office workers, residents and clean-up workers who sought care for respiratory illness at the World Trade Center Environmental Health Center between 2005 and 2011, and who were symptom-free prior to 9/11, researchers found improvements in lung function overall among treated patients who were not heavy smokers. However, lung function among office workers, who had the highest likelihood of dust cloud exposure, improved the least.

A WTC Health Registry analysis of verified cancer diagnoses among 33,928 adult enrollees NOT involved in rescue and recovery work, including Lower Manhattan residents, found no increase in cancer rates compared to non-exposed New York State residents during the period studied (2003-2008).

Mental Health

Those directly affected by 9/11 were more likely to report post-traumatic stress disorder (PTSD) symptoms 6 months after 9/11. However, a substantial number not directly affected also met the criteria for probable PTSD.

In a study that examined the prevalence of resilience among New Yorkers during the 6 months after 9/11, 65% of participants showed resilience (ability to recover). This suggests that more New Yorkers demonstrated resilience during the 6 months after 9/11 than previously believed. Even among those with the highest levels of exposure and highest probable PTSD, the proportion that were resilient never dropped below 33%.

A study of low-income patients seven to 16 months after 9/11 found that:

Those suffering a 9/11-related loss were twice as likely to be diagnosed with a mental health condition, such as depression, anxiety or PTSD.

This group was also more likely to suffer functional impairment and work loss.

Patients with loved ones in danger on 9/11 or who knew someone involved in the rescue and recovery effort were twice as likely to suffer from an anxiety disorder.

A small study of New Yorkers 18 to 21 years of age with and without generalized anxiety disorder compared their mental health before and after 9/11. Among those with generalized anxiety disorder, findings showed high rates of functional impairment but no increase in post-traumatic stress symptoms.

A study of 2,300 New Yorkers interviewed 1, 2 and 3 years after 9/11 showed that:

People who received early, brief interventions at their worksites reported better mental health than those who received more extensive interventions, such as psychotherapy of 30 minutes or longer. Although the study adjusted for 9/11 exposure, it did not adjust for illness severity. Support from friends, neighbors and spiritual communities was also beneficial.

Problem drinking and alcohol use were connected with psychological trauma up to 4 years after 9/11, as well as other mental health problems.

Analyses of NYC death records that compared suicide rates before and after 9/11 found that suicide rates did not increase four years after the terrorist attacks.

Among a sample of 455, mostly female patients who were screened for mental health conditions when they sought primary care at a general medicine clinic in New York City, the PTSD rate decreased significantly from 9.6% 1 year after 9/11 to 4.1% 3 years later. Patients who reported pre-9/11 depression, the only significant predictor of PTSD trajectory, were 10 times more likely to have PTSD 4 years after the WTC attacks than those who didn't.

A study of national mortality data showed that suicide rates among New Yorkers declined significantly six months after 9/11.

Lower-income New Yorkers exposed to ongoing stress and trauma were more likely to suffer from persistent depression.

While low-income adolescents and mothers exposed to the WTC disaster were more likely to suffer from depression and PTSD 15 months after 9/11, respectively, there were few long-term associations between 9/11 exposure and mental health among this group.

More than 21% of residents enrolled in the WTC Health Registry reported new PTSD symptoms 5 to 6 years after 9/11. Probable PTSD among residents increased from more than 13% 2-3 years after the attacks to more than 16% 5-6 years later. Risk factors included:

Intense dust cloud exposure

Witnessing horror

Returning to a home with a heavy layer of dust

Job loss

Lack of social support

To search for 2003/2004 baseline survey data, visit the Health Department's interactive data tool.

A small, cross-sectional study assessed more than 300 low-income, trauma-exposed patients in a large urban primary care clinic, including some who had been exposed to the WTC disaster, for mental health disorders and functioning at 2 time points after 9/11. Although patients with a past PTSD diagnosis functioned better than patients with a current PTSD diagnosis, they continued to experience more difficulties with their social and family lives than patients who had never been diagnosed with PTSD.

References

1. Kramer R, Hayes MA, Nolan V, et al. Community needs assessment of lower Manhattan residents following the World Trade Center Attacks - Manhattan, New York City, 2001. Morbidity and Mortality Weekly Report. 2002. 51;10-13.

2. Ohlsson A, Shah PS; the Knowledge Synthesis Group of Determinants of Preterm/LBW births. Effects of the September 11, 2001 Disaster on Pregnancy Outcomes: A Systematic Review. Acta Obstetricia et Gynecologica Scandinavica. 2011;90(1):6-18.

3. Laumbach RJ, Harris G, Kipen HM, et al. Lack of Association Between Estimated WTC Plume Intensity and Respiratory Symptoms among New York City Residents Outside of Lower Manhattan. American Journal of Epidemiology 2009; [Epub ahead of print].

4. Brackbill RM, Hadler JL, Ekenga CC, et al. Asthma and Posttraumatic Stress Symptoms 5 to 6 Years Following Exposure to the WTC Terrorist Attack. Journal of the American Medical Association 2009; 302(5):502-516.

5. Reibman J, Liu M, Cheng Q, et al. Characteristics of a Residential and Working Community with Diverse Exposure to WTC Dust, Gas and Fumes. Journal of Occupational and Environmental Medicine 2009; 51(5):534-541.

6. Galea S, Vlahov D, Resnick H, et al. Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. American Journal of Epidemiology. 2003. 58;514-524.

7. Bonanno GA, Galea S, Bucciarelli A, et al. Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attacks. Psychological Science 2006. 17;181-186.

8. Farach FJ, Mennin DS, Smith RL, & Mandelbaum M. The Impact of Pretrauma Analogue GAD and Posttraumatic Emotional Reactivity Following Exposure to the September 11 Terrorist Attacks: A Longitudinal Study. Behavior Therapy 2008; 39: 262-276.

9. Boscarino JA & Adams RE. Overview of Findings from the WTC Disaster Outcome Study: Recommendations for Future Research after Exposure to Psychological Trauma. International Journal of Emergency Mental Health 2008; 10(4): 275-290.

10. Cerda M, Vlahov D, Tracy M & Galea S. Alcohol Use Trajectories among Adults in an Urban Area after a Disaster: Evidence from a Population-based Cohort Study. Addiction 2008; 103: 1296-1307.11.

11. Brackbill RM, Hadler JL, Ekenga CC, et al. Asthma and Posttraumatic Stress Symptoms 5 to 6 Years Following Exposure to the WTC Terrorist Attack. Journal of the American Medical Association 2009; 302(5): 502-516.

12. Lin S, Gomez MI, Gensburg L, et al. Respiratory and Cardiovascular Hospitalizations after the World Trade Center Disaster. Archives of Environmental & Occupational Health 2010; 65(1):12-20.

13. Lin S, Jones R, Reibman J, Morse D, Hwang SA. Lower Respiratory Symptoms Among Residents Living Near the World Trade Center, Two and Four Years After 9/11. International Journal of Occupational and Environmental Health. 2010 16(1):44-52.

14. Neria Y, Olfson M, Gameroff MJ et al. The Mental Health Consequences of Disaster-related Loss: Findings from Primary Care One Year after the 9/11 Terrorist Attacks. Psychiatry. 2008 71(4):339-348.

15. Ghafoori B, Neria Y, Gameroff MJ et al. Screening for Generalized Anxiety Disorder Symptoms in the Wake of Terrorist Attacks: A Study in Primary Care. Journal of Traumatic Stress. 2009 22(3): 218-226.

16. Mezuk B, Larkin GL, Prescott MR, et al. The Influence of a Major Disaster on Suicide Risk in the Population. Journal of Traumatic Stress. 2009 22(6):481-488.

17. Pridemore WA, Trahan A & Chamlin MB. No Evidence of Suicide Increase Following Terrorist Attacks in the United States: An Interrupted Time-series Analysis of September 11 and Oklahoma City. Suicide & Life Threatening Behavior. 2009 39(6):659-670.

18. Claassen CA, Carmody T, Stewart SM et al. Effect of 11 September 2001 Terrorist Attacks in the USA on Suicide in Areas Surrounding the Crash Sites. British Journal of Psychiatry. 2010 196(5):359-364.

19. Nandi A, Tracy M, Beard JR et al. Patterns and Predictors of Trajectories of Depression after an Urban Disaster. Annals of Epidemiology. 2009 19(11):761-770.

20. Gershoff ET, Aber JL, Ware A et al. Exposure to 9/11 Among Youth and Their Mothers in New York City: Enduring Associations With Mental Health and Sociopolitical Attitudes. Child Development. 2010 81;4:1142-1160.

21. Harville E, Xiong X, Buekens P. Disasters and Perinatal Health: A Systematic Review. Obstetrical & Gynecological Survey. 2010;65(11):713-28.

22. Lipkind HS, Curry, AE, Huynh M et al. Birth Outcomes Among Offspring of Women Exposed to the September 11, 2001, Terrorist Attacks. Obstetrics & Gynecology. 2010;116(4):917-925.

23. Friedman SM, Maslow CB, Reibman J et al. Case-control Study of Lung Function in World Trade Center Health Registry Area Residents and Workers. American Journal of Respiratory Critical Care Medicine. 2011 June 3.

24. Jordan HT, Brackbill RM, Cone JE 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;378:898-905.

25. Neria Y, Ofson M, Gameroff MJ et al. Long-term Course of Probable PTSD After the 9/11 Attacks: A Study in Urban Primary Care. Journal of Traumatic Stress. 2010;23(4): 474-482.

26. Westphal M, Olfson M, Gameroff MJ et al. Functional Impairment in Adults with Past Posttraumatic Stress Disorder: Findings from Primary Care. Depression and Anxiety. 2011;28(8):686-695.

27. Maslow CB, Friedman SM, Pillai PS et al. Chronic and Acute Exposures to the World Trade Center Disaster and Lower Respiratory Symptoms: Area Residents and Workers. American Journal of Public Health. 2012 Apr 19. [Epub ahead of print]

28. Nair HP, Ekenga CC, Cone JE et al. Co-occurring Lower Respiratory Symptoms and Posttraumatic Stress Disorder 5 to 6 Years After the World Trade Center Terrorist Attack. American Journal of Public Health. 2012 Aug 16. [Epub ahead of print]

29. Liu M, Qian M, Cheng Q et al. Longitudinal Spirometry Among Patients in a Treatment Program for Community Members With World Trade Center-Related Illness. Journal of Occupational & Environmental Medicine. 2012 Sep 19. [Epub ahead of print]

30. Li J, Cone JE, Kahn AR et al. Association between World Trade Center Exposure and Excess Cancer Risk. Journal of the American Medical Association. 2012 Dec 19;308(23):2479-88.

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A month after 9/11, nearly 50% of people living near the WTC site who participated in a survey about their health needs and concerns said they had nose, throat or eye irritation. Respiratory hospital admissions increased significantly among lower Manhattan residents the first week after 9/11 compared with a similar demographic in Queens.

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Statistics fro the 9/11 and the aftermath

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Statistics fro the 9/11 and the aftermath

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Year the World Trade Centre was built: 1970

Number of companies housed in the WTC: 430

Number working in World Trade Centre on average working day prior to 11 September: 50,000

Average number of daily visitors: 140,000

Number killed in attack on New York, in the Twin Towers and in aircraft that crashed into them: 2,823

Distance, in miles, from which the burning towers were visible: 20

Maximum heat of fires, in degrees fahrenheit, at World Trade Center site: 2,300

Number of days underground fires at World Trade Centre continued to burn: 69

Number of days that workers dug up debris at Ground Zero, searching for body parts: 230

Number of body parts collected: 19,500

Number of bodies discovered intact: 291

Number of victims identified by New York medical examiner: 1,102

Number of death certificates issued without a body at request of victims' families: 1,616

Number of people still classified as missing from the World Trade Centre that day: 105

Number of people who died when American Airlines flight 11 from Boston, Massachusetts, to Los Angeles, California, crashed into the north tower of the World Trade Center: 92

Number of people who died when United Airlines flight 175

from Boston, Massachusetts, to Los Angeles, California, crashed into the south tower of the World Trade Center: 65

Number of people who died when United Airlines flight 93,

from Newark, New Jersey, to San Francisco, California, crashed in rural southwest Pennsylvania: 45

Number of people who died when American Airlines flight 77,

from Washington to Los Angeles, crashed into the Pentagon: 64

Number of peole killed in the Pentagon: 125

Number of survivors rescued from Ground Zero: 0
Al-Qaeda
Number of children born to Yemen-born construction magnate Muhammad Awad Bin Laden: 52

Number child Osama was: 17

Estimated fortune of Osama Bin Laden, inherited from father: $300m

Number of wives Bin Laden has: 3

Year Al-Qaeda was founded by Osama Bin Laden and Mohammed Atef: 1988

Date Bin Laden expelled from Saudi Arabia, due to anti-government activities there, and moved to Sudan: 1991

Year the Taliban seized control of Kabul implementing fundamentalist Islamic law and offering refuge to Osama bin Laden: 1996

Date expelled from Sudan due to US pressure, prompting return to Afghanistan: 1996

Number of Al-Qaeda members thought to have hijacked the four planes: 19

Number of the 19 who were Saudi: 15

Number of the 19 who are known to have made a will: 1

Number of years 'American Taliban' Johnny Walker Lindh (left) has been sentenced to for fighting with the Taliban against the Northern Alliance: 20

Percentage of New York Post readers who would like to see him executed: 42

Amount of money 500 relatives of 9/11 victims are suing the Bin Laden family company and Saudi princes for in an effort to bankrupt terrorism: $1,000,000,000,000 (trillion)
Emotional fallout
Number of orphans created by the 9/11 attacks: 1,300

Number of babies born to women whose husbands were lost on 11 September: 17

Number of days after 9/11 that Pat Flounders, widowed in the attacks, shot herself, the first related suicide: 91

Percentage of those living within a one mile radius from the Twin Towers suffering from Post Traumatic Stress Disorder: 20

Increase in PTSD among Manhattanites post-9/11: 200 per cent

Estimated minimum number of New Yorkers suffering from PTSD as a result of 9/11: 422,000

Estimated number of the city's public school students suffering from PTSD as a result of 9/11: 10,000

Percentage of Manhattanites who increased their alcohol consumption following 9/11: 25

Percentage of Manhattanites who increased their cigarette consumption following 9/11: 10

Percentage of Manhattanites who increased their marijuana consumption following 9/11: 3.2

Percentage sales increase at Toys in Babeland, a sex store in the Lower East of New York, in late September/October 2001: 30

Percentage increase in number of births reported in New York hospitals nine months on from 9/11: 20

Reported increase in church and synagogue attendance following 9/11: 20
Media and culture
Percentage of this year's 14 Pulitzer prizes won by the New York Times: 50

Previous record number of Pulitzer wins by a single organisation: 3

Number of copies of Toby Keith's (above) album 'Unleashed' sold in the first week of its release in October 2001, one song contained the line 'We'll put a boot in your ass/It's the American Way': 338,000

Number of songs, including 'Ruby Tuesday' and 'Imagine', banned post- 9/11 for being 'lyrically questionable': 150

Number of countries in which the star-studded telethon, 'America's Tribute to Heroes', was shown on 21 September (including Afghanistan): 200

Amount raised by the telethon: $150m

Cost of making the terrorist movie Collateral Damage starring Arnold Schwarzenegger: $85m

Number of months the release of Collateral Damage was delayed on account of Warner Bros.' 'sensitivity' to the attacks: 5

Number of mentions of 9/11 at the four-hour 25-minute Oscars ceremony 24 March, 2002: 26

Number of English language books published on the subject of 11 September: 672

Mayor Giuliani's approval rating post 11 September: 91 per cent
Charity
Amount of Federal Aid New York received within two months: $9.5bn

Amount collected by the September 11th Fund: $501m

Percentage of fund used for cash assistance and services such as grief counseling for families of victims and survivors: 89

Quantity, in pounds, of food and supplies supplied by 11 September Fund at Ground Zero: 4.3m

Number of hot meals served to rescue workers by 11 September Fund: 343,000

Number of displaced workers receiving job referrals: 5,000

Amount of compensation sought by the families of civilian casualties of US bombing in Afghanistan from the US government: $10,000

Amount of compensation sought for reckless misconduct and negligence from American Airlines by husband of 11 September victim: $50 million
Britain
Number of British victims: 67

Number of articles written over the last year in the UK press mentioning 11 September: 27,920

Number of specific mentions of Britain in threats from Al Qaeda: 1

Days after 9/11 that the 'Anti-Terrorism, Crime and Security Act 2001' was passed: 63

Votes for and against the Bill in the House of Commons: 458-5

Number of defeats in the House of Lords before a compromise was reached: 8

Number of Muslims in the UK: 1.8m

Proportion of those deemed to be practising Muslims: 42%

Number of 'terror suspects' imprisoned without trial after the 'Anti-Terrorism' act was passed: 11

Airline security

Number of days after 9/11 that Bush signed the Aviation Security Act requiring all checked-in bags to be screened for bombs and explosives by January 2002: 39

Percentage of bags checked in screened for bombs and explosives prior to the bill in the US: 10%

Number of bags carried each day by airline passengers in the United States: 3,000,000

Size (in inches) of toy soldier's mini replica Armalite rifle, intended as a present for her grandson, confiscated from British tourist Judy Powell's bag by airport security at LA International Airport: 5

Percentage of fake weapons undetected at America's leading Airports: 24

Cost of Frequent Flyers Bra manufactured by a Tokyo-based lingerie company in response to a number of security alerts relating to bra underwires: £20
The financial cost
Value of US economy: $11 trillion

Estimated cost of attacks to US based solely on property losses and insurance costs: $21billion

Estimated total losses to the world insurance market from the World Trade Centre: £25bn-£50bn

Amount of office space lost, in square feet: 13.5m

Estimated number of jobs lost in lower Manhattan area following 9/11: 100,000

Number of jobs it has been estimated will be lost in the US as result of the attacks by the end of 2002: 1.8m

Number of jobs lost in US travel industry in last 5 months of 2001: 237,000

Amount it has been estimated that US commercial insurance premiums will rise by to cover the potential cost of future terrorism between 2002 and 2004: 50%

Amount allocated by Congress for emergency assistance to airline industry in September 2001: $15bn

Military

Days after 9/11 that the US military began bombing Afghanistan: 26

Number of US bombs dropped on Afghanistan in the following six months: 22,000

Proportion of US bombs dropped in Afghanistan that may have missed the target: 25 per cent

Proportion that didn't explode, leaving landmines: 10 per cent

Estimated Afghan civilian death toll from US bombing campaign so far (they're still bombing): 3,125-3,620

Size of UK military budget 2001-2002: £23.4bn

Increase in 2002 budget defence spending that President Bush signed for on 10 January 2002: $30bn

Number of major Bush political appointees with significant financial ties to the arms industry: 32

Number of major Bush political appointees with significant financial ties to the energy industry: 21

Wage of a US Special Forces Green Beret with five to seven years' experience: $25,000

Number of UK marines sent to Afghanistan to 'clear up' the remnants of the Al-Qaeda and Taliban forces in Operation Snipe in March: 1,700

Number of sightings of the enemy and shots fired in anger in the three month tour of duty: 0

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Year the World Trade Centre was built: 1970 Number of companies housed in the WTC: 430 Number working in World Trade Centre on average working day prior to 11 September: 50,000 Average number of daily visitors: 140,000 Number killed in attack on New York, in the Twin Towers and in

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First Responders: Behavioral Health Concerns, Emergency Response, and Trauma

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First Responders: Behavioral Health Concerns, Emergency Response, and Trauma

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Rebuilding work continues, 18 years after 9/11

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Rebuilding work continues, 18 years after 9/11

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Rebuilding work continues, 18 years after 9/11

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NEW YORK (AP) — Over 18 years, the rubble left by the destruction of the World Trade Center has given way to a gleaming new complex of office towers, a museum, a transit hub and a memorial that...

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Almost as soon as the World Trade Center's Twin Towers fell on September 11, 2001, thousands of firefighters, police officers, construction workers, search-and-rescue dogs and volunteers headed to Ground Zero to look for survivors. Because they didn't know how many people were trapped alive in the wreckage, firefighters and other rescue workers had to search carefully through the unstable piles of rubble for air pockets, called "voids," where they might find people who had been unable to escape from the collapsing buildings. To be safe, they didn't use any heavy equipment at first. Some dug with their bare hands, while others formed bucket brigades to move small amounts of debris as efficiently as possible.

First Responders and Volunteers at Ground Zero

U.S. Customs/Getty Images

Unfortunately, there were not many survivors to find: Two firemen were pulled from their truck in a cavity beneath some wreckage, and a few people were pinned at the edges of the pile. By September 12, workers had rescued all of the people who were trapped at the site. After that, the Ground Zero workers had a new and more heartbreaking mission: to sift carefully through the debris in search of human remains. The fallen buildings were unstable, and engineers worried that the weight of trucks and cranes would cause the wreckage to shift and collapse again, so the workers had to keep using the bucket brigades. Meanwhile, huge fires continued to burn at the center of the pile. Jagged, sharp pieces of iron and steel were everywhere. The work was so dangerous that many firefighters and police officers wrote their names and phone numbers on their forearms in case they fell into the hole or were crushed.

Did you know? Fires continued to burn in lower Manhattan for 99 days after the attack.

Eventually, the pile stabilized enough that construction crews could start using excavators and other heavy equipment. Ironworkers hung from tall cranes and cut the buildings down, one reporter said, "like trees." Structural engineers worked to reinforce the giant concrete "bathtub" that formed the two-by-four-block foundation of the buildings and protected it from flooding by the Hudson River. Crews built roads across the site to make it easier to haul away the debris. (By May 2002, when the cleanup officially ended, workers had moved more than 108,000 truckloads-1.8 million tons-of rubble to a Staten Island landfill.) But the site was still dangerous. Underground fires continued to burn for months. Every time a crane moved a large chunk of debris, the sudden rush of oxygen intensified the flames. Downtown Manhattan reeked of smoke and burning rubber, plastic and steel.

READ MORE: How 9/11 Became the Deadliest Day in History for U.S. Firefighters

Ground Zero: Environmental and Health Concerns

In fact, the site was awash in harmful fumes and toxic dust. Especially in the days immediately after the towers fell, when investigators estimated that only 20 percent of the workers at the site had masks that would protect their lungs, the air was filled with diesel exhaust, pulverized cement, glass fibers, asbestos, silica, benzene from the jet fuel and lead. On September 11 alone more than 300 workers sought treatment for eye and respiratory problems caused by the pollutants in the air. Soon the official workers at Ground Zero received masks and other protective gear, but volunteers and other workers-like the day laborers and undocumented workers who were hired to clean the dust from nearby office buildings-simply covered their faces with bandannas and hoped for the best.

In 2002, the Centers for Disease Control's National Center for Environmental Health sponsored a comprehensive study of the health of the rescue and recovery workers at Ground Zero and 9/11-related illnesses. They found that many of the first responders had developed severe respiratory problems and had persistent symptoms of post-traumatic stress. Other studies agreed: Enormous numbers of workers had sore throats, trouble breathing and "WTC cough." Science Daily reported that " New York City firemen and emergency personnel exposed to dust from the collapse of the World Trade Center buildings experienced a decrease in lung function capability equal to 12 years of age-related decline during the year following the 9/11 disaster." Many were gravely ill with kidney problems, silicosis, lung cancer, leukemia and heart disease. Doctors and public health officials traced these illnesses to the polluted air at Ground Zero.

In 2006, then-governor of New York George Pataki signed legislation aimed at expanding benefits for those whose deaths were linked to their cleanup work at the World Trade Center site. Initial efforts to pass a measure that would provide health monitoring and financial aid to Ground Zero workers on the federal level stalled. Finally, in January 2011, the James Zadroga 9/11 Health and Compensation Act, named after an NYPD officer whose death has been attributed to his work at Ground Zero, was signed into law.

The cleanup and recovery efforts at Ground Zero lasted for more than a year, with crews working around the clock. Construction workers found human remains in several places near the site of the Twin Towers in 2006, while the Environmental Protection Agency spent several years working to clean toxic dust out of downtown apartments. Still, dust and debris from the September 11th attacks will likely continue to affect downtown Manhattan for years; still, the impressive scale and speed of the cleanup work was a testament to the dedication of the workers and volunteers at the site.

Rebuilding efforts at the World Trade Center site continue. The centerpiece, a 1,776-foot tall skyscraper, opened in 2013, and the National September 11 Memorial and Museum opened in phases between 2011 and 2013.

9/11 Memorial

A competition was held to design a permanent memorial for the victims of 9/11. The winning design, Michael Arad's "Reflecting Absence," opened to the public on September 11, 2011, the 10 anniversary of the attacks. The eight-acre park features two reflecting pools with waterfalls in the footprint of the Twin Towers encircled by bronze panels featuring the names of all 2,983 people who died on 9/11. The National September 11 Memorial and Museum opened in May 2014.

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Almost as soon as the World Trade Center's Twin Towers fell on September 11, 2001, thousands of firefighters, police officers, construction workers, search-and-rescue dogs and volunteers headed to Ground Zero to look for survivors.

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Physical Health

A month after 9/11, nearly 50% of people living near the WTC site who participated in a survey about their health needs and concerns said they had nose, throat or eye irritation.

Respiratory hospital admissions increased significantly among lower Manhattan residents the first week after 9/11 compared with a similar demographic in Queens. Cardiovascular and cerebrovascular disease admissions also increased two to three weeks after 9/11, especially among women and those over 65 years of age.

Two literature reviews focusing on birth outcomes among WTC-exposed pregnant women suggest that environmental exposure or attack-related stress reduced fetal growth in some women, a finding similar to that in studies of birth outcomes after other terrorist attacks, environmental/chemical disasters and natural disasters. Disaster literature not specific to 9/11 indicates that child development may be more influenced by maternal mental health than by direct effects of disaster-related pre-natal stress. A newer study not included in these reviews compared two groups of women who were pregnant between September 11 and December 1, 2001: 500 women who were enrolled in the WTC Health Registry, and 50,000 women who lived at least 5 miles from the WTC site. Although researchers found similar birth weight and gestational age at delivery in the groups, Registry enrollees with probable PTSD were more likely than women without PTSD to deliver premature or underweight babies.

A study compared the estimated smoke plume path 5 days after 9/11 with health survey findings of about 3,000 New Yorkers 6 months after 9/11. Of respondents outside lower Manhattan, the study showed no connection between the estimated smoke plume intensity and new or worsening respiratory symptoms among those with asthma. However, the smoke plume was different from the WTC dust cloud.

Among a small group of lower Manhattan residents, lower respiratory symptoms, such as a cough and wheezing, decreased almost 8% four years after 9/11. Yet the prevalence remained elevated compared with those not exposed to 9/11. Residents who also worked in lower Manhattan on 9/11 were at highest risk for persistent symptoms.

Eight percent (8%) of residents enrolled in the WTC Health Registry reported newly diagnosed asthma 5 to 6 years after 9/11. Intense dust cloud exposure on 9/11, experiencing a heavy coating of dust in the home and not evacuating homes were major contributors to new asthma diagnoses.

A study of nearly 2,000 people exposed to WTC dust who sought care at the WTC Environmental Health Center 5 to 7 years after 9/11 showed high rates of respiratory symptoms, including persistent shortness of breath, cough and sinus or nasal problems. While pulmonary function was normal for the total group, about one-third (31%) had below-normal pulmonary function similar to the level found in WTC rescue, recovery and clean up workers.

The WTC Health Registry, in collaboration with the WTC Environmental Health Center, found abnormal lung function in Lower Manhattan residents and area workers who reported persistent respiratory symptoms 7 to 8 years after exposure to the WTC disaster. In a case control study using spirometry and oscillometry, a test to measure how well the lungs' small airways are working, researchers found that 180 enrollees with persistent respiratory symptoms (cases) were more likely to have abnormal lung function than nearly 500 enrollees who had not reported any new respiratory symptoms since 9/11 (controls). Oscillometric abnormalities were found even among cases with normal spirometry.

WTC Health Registry researchers identified 790 deaths from 2003 through 2009 among 41,930 adults who resided in New York City at the time of their enrollment in the Registry. The all-cause death rate among Registry enrollees was 43% lower than among NYC residents as a whole. Researchers detected exposure-related differences in mortality rates among those in the Registry: lower Manhattan residents, area workers and passersby with intermediate or high levels of exposure, including those with 2 or more injuries on 9/11, had elevated all-cause and heart disease mortality risks in comparison to those with intermediate or lower levels of exposure. The study did not detect exposure-related mortality differences among rescue and recovery workers even when internal comparisons were conducted.

Researchers found an association between chronic WTC exposures and lower respiratory symptoms in a case control study of nearly 800 Lower Manhattan residents and area workers in the WTC Health Registry up to 6 years after 9/11. Residents reporting lower respiratory symptoms were 2 to 3 times more likely than residents who never had symptoms to recall that the surfaces in their homes were covered in dust following the WTC collapse; residents who recalled a thicker layer of dust were at greater risk, suggesting a dose/response relationship.

Among residents, office workers and passers-by enrolled in the WTC Health Registry who reported either lower respiratory symptoms or probable posttraumatic stress disorder, more than 25% said they had both conditions 5-6 years after 9/11. Also, enrollees who had both conditions were much more likely to report 14 days of activity lost in the 30 days before being surveyed compared to enrollees with only 1 condition.

In a longitudinal study of nearly 1,000 office workers, residents and clean-up workers who sought care for respiratory illness at the World Trade Center Environmental Health Center between 2005 and 2011, and who were symptom-free prior to 9/11, researchers found improvements in lung function overall among treated patients who were not heavy smokers. However, lung function among office workers, who had the highest likelihood of dust cloud exposure, improved the least.

A WTC Health Registry analysis of verified cancer diagnoses among 33,928 adult enrollees NOT involved in rescue and recovery work, including Lower Manhattan residents, found no increase in cancer rates compared to non-exposed New York State residents during the period studied (2003-2008).

Mental Health

Those directly affected by 9/11 were more likely to report post-traumatic stress disorder (PTSD) symptoms 6 months after 9/11. However, a substantial number not directly affected also met the criteria for probable PTSD.

In a study that examined the prevalence of resilience among New Yorkers during the 6 months after 9/11, 65% of participants showed resilience (ability to recover). This suggests that more New Yorkers demonstrated resilience during the 6 months after 9/11 than previously believed. Even among those with the highest levels of exposure and highest probable PTSD, the proportion that were resilient never dropped below 33%.

A study of low-income patients seven to 16 months after 9/11 found that:

Those suffering a 9/11-related loss were twice as likely to be diagnosed with a mental health condition, such as depression, anxiety or PTSD.

This group was also more likely to suffer functional impairment and work loss.

Patients with loved ones in danger on 9/11 or who knew someone involved in the rescue and recovery effort were twice as likely to suffer from an anxiety disorder.

A small study of New Yorkers 18 to 21 years of age with and without generalized anxiety disorder compared their mental health before and after 9/11. Among those with generalized anxiety disorder, findings showed high rates of functional impairment but no increase in post-traumatic stress symptoms.

A study of 2,300 New Yorkers interviewed 1, 2 and 3 years after 9/11 showed that:

People who received early, brief interventions at their worksites reported better mental health than those who received more extensive interventions, such as psychotherapy of 30 minutes or longer. Although the study adjusted for 9/11 exposure, it did not adjust for illness severity. Support from friends, neighbors and spiritual communities was also beneficial.

Problem drinking and alcohol use were connected with psychological trauma up to 4 years after 9/11, as well as other mental health problems.

Analyses of NYC death records that compared suicide rates before and after 9/11 found that suicide rates did not increase four years after the terrorist attacks.

Among a sample of 455, mostly female patients who were screened for mental health conditions when they sought primary care at a general medicine clinic in New York City, the PTSD rate decreased significantly from 9.6% 1 year after 9/11 to 4.1% 3 years later. Patients who reported pre-9/11 depression, the only significant predictor of PTSD trajectory, were 10 times more likely to have PTSD 4 years after the WTC attacks than those who didn't.

A study of national mortality data showed that suicide rates among New Yorkers declined significantly six months after 9/11.

Lower-income New Yorkers exposed to ongoing stress and trauma were more likely to suffer from persistent depression.

While low-income adolescents and mothers exposed to the WTC disaster were more likely to suffer from depression and PTSD 15 months after 9/11, respectively, there were few long-term associations between 9/11 exposure and mental health among this group.

More than 21% of residents enrolled in the WTC Health Registry reported new PTSD symptoms 5 to 6 years after 9/11. Probable PTSD among residents increased from more than 13% 2-3 years after the attacks to more than 16% 5-6 years later. Risk factors included:

Intense dust cloud exposure

Witnessing horror

Returning to a home with a heavy layer of dust

Job loss

Lack of social support

To search for 2003/2004 baseline survey data, visit the Health Department's interactive data tool.

A small, cross-sectional study assessed more than 300 low-income, trauma-exposed patients in a large urban primary care clinic, including some who had been exposed to the WTC disaster, for mental health disorders and functioning at 2 time points after 9/11. Although patients with a past PTSD diagnosis functioned better than patients with a current PTSD diagnosis, they continued to experience more difficulties with their social and family lives than patients who had never been diagnosed with PTSD.

References

1. Kramer R, Hayes MA, Nolan V, et al. Community needs assessment of lower Manhattan residents following the World Trade Center Attacks - Manhattan, New York City, 2001. Morbidity and Mortality Weekly Report. 2002. 51;10-13.

2. Ohlsson A, Shah PS; the Knowledge Synthesis Group of Determinants of Preterm/LBW births. Effects of the September 11, 2001 Disaster on Pregnancy Outcomes: A Systematic Review. Acta Obstetricia et Gynecologica Scandinavica. 2011;90(1):6-18.

3. Laumbach RJ, Harris G, Kipen HM, et al. Lack of Association Between Estimated WTC Plume Intensity and Respiratory Symptoms among New York City Residents Outside of Lower Manhattan. American Journal of Epidemiology 2009; [Epub ahead of print].

4. Brackbill RM, Hadler JL, Ekenga CC, et al. Asthma and Posttraumatic Stress Symptoms 5 to 6 Years Following Exposure to the WTC Terrorist Attack. Journal of the American Medical Association 2009; 302(5):502-516.

5. Reibman J, Liu M, Cheng Q, et al. Characteristics of a Residential and Working Community with Diverse Exposure to WTC Dust, Gas and Fumes. Journal of Occupational and Environmental Medicine 2009; 51(5):534-541.

6. Galea S, Vlahov D, Resnick H, et al. Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. American Journal of Epidemiology. 2003. 58;514-524.

7. Bonanno GA, Galea S, Bucciarelli A, et al. Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attacks. Psychological Science 2006. 17;181-186.

8. Farach FJ, Mennin DS, Smith RL, & Mandelbaum M. The Impact of Pretrauma Analogue GAD and Posttraumatic Emotional Reactivity Following Exposure to the September 11 Terrorist Attacks: A Longitudinal Study. Behavior Therapy 2008; 39: 262-276.

9. Boscarino JA & Adams RE. Overview of Findings from the WTC Disaster Outcome Study: Recommendations for Future Research after Exposure to Psychological Trauma. International Journal of Emergency Mental Health 2008; 10(4): 275-290.

10. Cerda M, Vlahov D, Tracy M & Galea S. Alcohol Use Trajectories among Adults in an Urban Area after a Disaster: Evidence from a Population-based Cohort Study. Addiction 2008; 103: 1296-1307.11.

11. Brackbill RM, Hadler JL, Ekenga CC, et al. Asthma and Posttraumatic Stress Symptoms 5 to 6 Years Following Exposure to the WTC Terrorist Attack. Journal of the American Medical Association 2009; 302(5): 502-516.

12. Lin S, Gomez MI, Gensburg L, et al. Respiratory and Cardiovascular Hospitalizations after the World Trade Center Disaster. Archives of Environmental & Occupational Health 2010; 65(1):12-20.

13. Lin S, Jones R, Reibman J, Morse D, Hwang SA. Lower Respiratory Symptoms Among Residents Living Near the World Trade Center, Two and Four Years After 9/11. International Journal of Occupational and Environmental Health. 2010 16(1):44-52.

14. Neria Y, Olfson M, Gameroff MJ et al. The Mental Health Consequences of Disaster-related Loss: Findings from Primary Care One Year after the 9/11 Terrorist Attacks. Psychiatry. 2008 71(4):339-348.

15. Ghafoori B, Neria Y, Gameroff MJ et al. Screening for Generalized Anxiety Disorder Symptoms in the Wake of Terrorist Attacks: A Study in Primary Care. Journal of Traumatic Stress. 2009 22(3): 218-226.

16. Mezuk B, Larkin GL, Prescott MR, et al. The Influence of a Major Disaster on Suicide Risk in the Population. Journal of Traumatic Stress. 2009 22(6):481-488.

17. Pridemore WA, Trahan A & Chamlin MB. No Evidence of Suicide Increase Following Terrorist Attacks in the United States: An Interrupted Time-series Analysis of September 11 and Oklahoma City. Suicide & Life Threatening Behavior. 2009 39(6):659-670.

18. Claassen CA, Carmody T, Stewart SM et al. Effect of 11 September 2001 Terrorist Attacks in the USA on Suicide in Areas Surrounding the Crash Sites. British Journal of Psychiatry. 2010 196(5):359-364.

19. Nandi A, Tracy M, Beard JR et al. Patterns and Predictors of Trajectories of Depression after an Urban Disaster. Annals of Epidemiology. 2009 19(11):761-770.

20. Gershoff ET, Aber JL, Ware A et al. Exposure to 9/11 Among Youth and Their Mothers in New York City: Enduring Associations With Mental Health and Sociopolitical Attitudes. Child Development. 2010 81;4:1142-1160.

21. Harville E, Xiong X, Buekens P. Disasters and Perinatal Health: A Systematic Review. Obstetrical & Gynecological Survey. 2010;65(11):713-28.

22. Lipkind HS, Curry, AE, Huynh M et al. Birth Outcomes Among Offspring of Women Exposed to the September 11, 2001, Terrorist Attacks. Obstetrics & Gynecology. 2010;116(4):917-925.

23. Friedman SM, Maslow CB, Reibman J et al. Case-control Study of Lung Function in World Trade Center Health Registry Area Residents and Workers. American Journal of Respiratory Critical Care Medicine. 2011 June 3.

24. Jordan HT, Brackbill RM, Cone JE 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;378:898-905.

25. Neria Y, Ofson M, Gameroff MJ et al. Long-term Course of Probable PTSD After the 9/11 Attacks: A Study in Urban Primary Care. Journal of Traumatic Stress. 2010;23(4): 474-482.

26. Westphal M, Olfson M, Gameroff MJ et al. Functional Impairment in Adults with Past Posttraumatic Stress Disorder: Findings from Primary Care. Depression and Anxiety. 2011;28(8):686-695.

27. Maslow CB, Friedman SM, Pillai PS et al. Chronic and Acute Exposures to the World Trade Center Disaster and Lower Respiratory Symptoms: Area Residents and Workers. American Journal of Public Health. 2012 Apr 19. [Epub ahead of print]

28. Nair HP, Ekenga CC, Cone JE et al. Co-occurring Lower Respiratory Symptoms and Posttraumatic Stress Disorder 5 to 6 Years After the World Trade Center Terrorist Attack. American Journal of Public Health. 2012 Aug 16. [Epub ahead of print]

29. Liu M, Qian M, Cheng Q et al. Longitudinal Spirometry Among Patients in a Treatment Program for Community Members With World Trade Center-Related Illness. Journal of Occupational & Environmental Medicine. 2012 Sep 19. [Epub ahead of print]

30. Li J, Cone JE, Kahn AR et al. Association between World Trade Center Exposure and Excess Cancer Risk. Journal of the American Medical Association. 2012 Dec 19;308(23):2479-88.

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A month after 9/11, nearly 50% of people living near the WTC site who participated in a survey about their health needs and concerns said they had nose, throat or eye irritation. Respiratory hospital admissions increased significantly among lower Manhattan residents the first week after 9/11 compared with a similar demographic in Queens.

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For nearly a year after the terrorist attacks of September 11, 2001, workers continued to remove debris and recover bodies from the ruins of the Twin Towers at

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Sept. 11 Responders May Be at Heightened Risk of Developing Leukemia

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Sept. 11 Responders May Be at Heightened Risk of Developing Leukemia

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9/11 Responders May Be at Increased Risk of Leukemia

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9/11 first responders are at a higher-than-average risk of cancer. A new study says they have higher rates of leukemia, plus other cancers.

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Well, it's interesting. We've been obsessed understandably with all that's changed. A great deal has changed. We should begin by acknowledging that the greatest change obviously is for those who lost a loved one 10 years ago today or in the subsequent wars in Iraq and Afghanistan. Life will never be the same for them.

To the rest of us, there's a certain amount of trauma. I think geography is a factor. I think if you live in New York, it's much more real than if you're in Terre Haute. Much of what has changed, like the proverbial iceberg, is beneath the surface. Government, we're all thinking about this, the age of cutting back on government, the fact is government has been transformed, expanded by, I saw one estimate $600 billion has been spent over the last ten years on domestic security. New agencies have been created. Old agendas have been torn up.

On the other hand, think of what hasn't changed. We had a brief moment of unity, of coming together, of common purpose, of collective outrage and a collective response. And that seems very much to be in the rear-view mirror.

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Historians Discuss What's Changed, What Hasn't After 9/11

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Well, it's interesting. We've been obsessed understandably with all that's changed. A great deal has changed. We should begin by acknowledging that the greatest change obviously is for those who lost a loved one 10 years ago today or in the subsequent wars in Iraq and Afghanistan.

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9/11 Anniversary: How Lower Manhattan Has Healed Since Sept. 11 Attacks

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9/11 Anniversary: How Lower Manhattan Has Healed Since Sept. 11 Attacks

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Lower Manhattan, the neighborhood that was home to the Twin Towers and which endured the brunt of the Sept. 11, 2001, terrorist attacks, has spent the last decade and a half in a state of healing and recovery. Today that process appears to be paying off.

It hasn't been easy. According to data provided by the Alliance for Downtown New York, 90 percent of Lower Manhattan stores saw revenues decline for a full year after the attacks - and 47 percent of the neighborhood's retailers, services and restaurants reported layoffs.

It was also hit hard by the 2008 financial crisis. At the time of the 2001 attacks, it boasted almost 237,000 private-sector jobs. In 2009 it could account for less than 200,000. Anyone could have been forgiven for wondering if the area could recover from two disasters in a single decade.

By the end of 2015, the picture had changed considerably. More than 232,000 people were employed in Lower Manhattan, and the number continues to grow. It's nothing less than a rebirth, which is a by-product of the grit and resilience of neighborhood residents and small-business owners who were determined to stick it out.

One such business owner and neighborhood denizen is Todd A. Spodek, managing partner at Spodek Law Group P.C. The firm was founded in 1976 by his father and has always operated out of Lower Manhattan, even when business took a big hit in the wake of 9/11.

"After 9/11, new business stopped for a considerable amount of time," Spodek told CNBC.com. "The entire city was in shock, and certainly people were not running downtown to relive this nightmare every day."

The firm's business didn't dry up completely - its ongoing caseload kept its doors open in the immediate aftermath of the attacks. But Spodek conceded that it was two or three years before the firm experienced any significant uptick in new business. Today, however, he believes that both his firm and the neighborhood it calls home have returned to full strength. Spodek Law Firm currently houses six lawyers, four support staff and pulls in $3 million in annual revenue.

"At this point the neighborhood is booming," he said. "We have since moved directly next to the World Trade Center, and it's a fantastic neighborhood. There's a tremendous amount of new restaurants, bars and businesses. ... I think that the neighborhood has bounced back completely."

Another small-business owner who stayed in Lower Manhattan after 9/11 is Mary White, founder and CEO of BnBFinder.com, an online guide to bed & breakfasts and inns. She started it as a home business in 1998, and she was working and living directly across the street from the World Trade Center on Sept. 11, 2001.

Complete Coverage: Remembering 9/11

Her building was forced to close for two months to recover from the damage, and she considered shutting down. However, the programmers who hosted her site out of Dallas wouldn't hear of it, and offered to run the business for free until she could come back. She rented a temporary apartment to work from with her single employee, and she kept going. She had to, anyway, because work never let up.

"What stands out to me is the number of inquiries we got from brides and others scrambling to make plans for weddings, honeymoons, family reunions and other trips that they could drive to, because of the general fear of flying," she told CNBC.com. "That holiday season we sold what was then a record number of gift certificates, because a number of articles were written about giving time, something not material, being with loved ones, and our gift certificates made this possible."

BnBFinder.com survived 9/11 and grew right along with the internet, with the gift certificate business in particular seeing great success. In November 2008 it relocated to Broad Street, in the Financial District, where it remains to this day. The company has 2,000 clients and pulls in $800,000 in annual revenue.

Lower Manhattan's recovery is likely to see a further boost, courtesy of the Westfield World Trade Center, a shopping mall within the World Trade Center complex that opened in August. Occupying 365,000 square feet, it serves as home to approximately 60 businesses, including an Apple store and Kate Spade, with Crabtree & Evelyn and Victoria's Secret still to come. It's all part of the long rebirth that the neighborhood has undergone in the last 15 years.

"Downtown has evolved from what was primarily a working district for people in the financial industries to a 24/7 neighborhood that has nearly 60,000 residents and hosts over 14 million visitors a year," said Jessica Lappin, president of the Alliance for Downtown New York. "We anticipate that the growth will continue and will complement and enhance what's already here and hope that it helps increase business traffic for everyone."

Business aside, the rebirth of Lower Manhattan would never have happened without people like Spodek and White, who never lost faith in it. White has since moved out of her old apartment, but her new one is on Fulton Street, with the Freedom Tower in plain view. From the sound of it, she seems to be a Lower Manhattan lifer.

"I am committed to downtown and love living and working here," she said. "I'm just glad we're no longer calling it Ground Zero."
Read More From CNBC: Millennials Will Be Renting for a Lot Longer

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Rising from the ashes: How lower Manhattan has healed since 9/11

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Lower Manhattan, the neighborhood that was home to the Twin Towers and which endured the brunt of the Sept. 11, 2001, terrorist attacks, has spent the last decade and a half in a state of healing and recovery. Today that process appears to be paying off. It hasn't been easy.

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Passengers at Los Angeles International Airport pass through security in 2010. File photo by David McNew/Getty Images When Denver International Airport opened in 1995, the city was particularly proud of the main terminal building. They spent a lot of money to make it unique. There’s a soaring fiberg…

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Feature American Psychologist examines Americans' reactions over time to terrorist attacks September 2011, Vol 42, No. 8 Print version: page 79 3 min read Hamilton, A. (2011, September). 9/11 10 years later. Monitor on Psychology, 42(8).

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How New York City Rebuilt Anew After Its Darkest Day

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How New York City Rebuilt Anew After Its Darkest Day

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When a man-made disaster of unfathomable scope strikes your city and its central symbol of prosperity has been leveled to ruin - and it's your job to jolt it into resurgence - where do you begin?

Only hours had passed after the planes struck New York City's twin towers on Sept. 11, 2001, when then-Mayor Rudy Giuliani made a promise to rebuild: "We're not only going to rebuild, we're going to come out of this stronger than we were before."

Four months later, New York's new mayor, Michael Bloomberg, stood on the flag-clad steps of City Hall and echoed that promise: "We will rebuild, renew and remain the capital of the free world. ... In the next four years I will devote myself to building a better New York."

Days later, Bloomberg's deputy mayor for economic development and rebuilding, Dan Doctoroff, assembled the heads of the city's many agencies in one room. He made a big request: Each team was to produce a strategic plan and a timeline for the next year. Regular updates would be presented at what would become monthly meetings.

People were dumbfounded, Doctoroff says. Part of it was the how: "No one had ever done PowerPoint before," he says. But also the what: "There was never that kind of level of City Hall-driven coordination on such a large scale." It's been decades since New York City had a citywide comprehensive planning vision.

What ensued was an exceptional flurry of urban strategizing, a city planning renaissance that produced some of New York's now-famous locations, some purely aspirational visions and a downtown better than before. All of this was fueled by deadlines imposed by a bid to host the Olympics, the money suddenly devoted to rebuilding and the nation's unified will to witness a rebirth.

It was the atmosphere of, "We've got to think big; we've got to do big things again," says Karen Phillips, who had spent years in real estate and community development before joining the city planning commission in 2002.
"Moral imperative to rebuild"
The plan didn't exactly begin at ground zero.

As far back as 1996, Doctoroff - then a private equity investor - had pitched an idea for how to recharge New York: host the Olympics. And in 2002, he brought the Olympic bid to City Hall.

Doctoroff's proposal envisioned new sports venues dotted throughout the entire city, an Olympic Village in Queens and the development of ferry transportation.

The idea was to site venues in communities that people had long talked about revitalizing "but had never been able to muster the political will or economic resources," Doctoroff says. And then use the Olympic process deadlines "to create a catalyst to getting things done."

Bloomberg's city planning chief, Amanda Burden, came in with a passion of her own, for turning industrial and underused areas into public spaces. And one particular love - the High Line.

"It was just the most beautiful thing I ever saw," she says. Burden and a few other devotees had been fighting to preserve what at the time was a disused and dilapidated railroad and turn it into an elevated park. It was slated for demolition after complaints from businesses below. "I kept thinking," Burden says, "if I didn't think about it every day, it would come down."

In fact, many of the ideas that materialized or were proposed after Sept. 11 had been simmering for a while. What changed was the impetus.

"We had almost a moral imperative to rebuild," Doctoroff says, "which enabled us ... to do things that people had talked about for a long time."
Beyond ground zero
By accounts of several city development veterans, Bloomberg's became the first extensive citywide vision since the late-1960s efforts of Mayor John Lindsay.

Eventually - after the Olympic bid was rejected - its many elements shaped a wide-ranging five-borough plan. But the bid became a kickstarter. That first year, Doctoroff says, the city began moving on half a dozen projects at once, in Manhattan, Brooklyn and Queens.

The centerpiece was Hudson Yards, a massive redevelopment of what was known as the "far West Side." Originally intended to house an Olympic stadium - a plan that was later voted down - the area is now a rising skyscraper cluster of apartments, offices and shops.

As a byproduct of Hudson Yards, the city also pushed to extend the subway 7 line to the area - a train that seemed at the time to go to "never-never land," as Phillips put it - the first new subway station in decades. The authorities also began to expand the ferry service and comb the city with rezonings and updated housing plans.

As Burden describes it, one of the plan's goals was to diffuse the spotlight from Manhattan to the other four boroughs: Brooklyn, Queens, the Bronx and Staten Island.

"This is a city - an archipelago, right?" she says. "The natural segue was: What connects all of our boroughs? Our waterfront."

And so, the city's attention also spread to New York's waterfronts, particularly those along both sides of the East River, in Brooklyn and Manhattan. Many riverfronts were long dotted with abandoned industrial sites.

"The goal of our waterfront plan ... was to have the water be part of New Yorkers' everyday lives," Burden says. "And it kind of is now, but that was the furthest thing from people's minds."
Aspirational Lower Manhattan
Yet one thing remained outside Bloomberg's plans: ground zero itself, where after the incredibly speedy cleanup, plans were underway for the construction of the memorial and new World Trade Center buildings.

There, in fact, the city was locked out of big decision-making, says Lynne Sagalyn, the author of Power at Ground Zero: Politics, Money, and the Remaking of Lower Manhattan.

The 16 acres of the World Trade Center site actually belong to the Port Authority, which is run by the states of New York and New Jersey. And then-New York Gov. George Pataki had a heavy influence on the city-state corporation formed to coordinate the rebuilding of the area, Sagalyn says.

What the city did have control over was some of the surrounding streets, she says. That gave the administration the opening to both leave its mark and take advantage of the financial windfall for the rebuilding of Lower Manhattan. The focus went to streets, parks and public spaces.

Very quickly, by December 2002, Bloomberg's office produced a "Vision for Lower Manhattan" - the financial district "envisioned as an urban hamlet," as The New York Times described it.

The area's problems were well-known. The World Trade Center had been cut off from the city; major streets didn't connect end-to-end. Banks and businesses had started relocating north to Midtown; it wasn't a prime place to live. "In the city that never sleeps," the mayor's proposal observed, "much of Lower Manhattan goes to bed promptly at 6 o'clock."

The city's plan to re-insert some of the downtown streets back into the grid - where the World Trade Center superblock had previously cut them off - was "the one true point of consensus" in the entire rebuilding of Lower Manhattan, says Sagalyn, a professor at Columbia Business School.

Burden says a lot of attention also went to knitting the sidewalks, the ramps and the landscaping together with the memorial and the World Trade Center. The waterfronts got a major makeover, too.

The mayor's plan also had envisioned an expanded transportation hub for the downtown area, including a direct train to John F. Kennedy airport (an element that proved too expensive to complete).

Doctoroff invited architects to re-imagine Lower Manhattan's public spaces, purely for inspiration. They dreamed up tree-lined roadways, a waterfront colonnade - even a sea-level ice skating rink and a downtown beach.

Doctoroff would call Lower Manhattan "an aspirational place," Burden says.

"The pile was still smoldering," she says. "It was important for people to think that there was a future for Lower Manhattan, and it was bright."
"Command our future"
How much of this work would have happened, had the Sept. 11 attacks not shattered New York City?

Doctoroff has a stark view: "Virtually none of it," he says - because Bloomberg wouldn't have been elected.

Bloomberg ran as a Republican, with Giuliani's endorsement, in a city that was 5-to-1 Democratic, clinching the victory just two months after the disaster - by only about 30,000 votes.

Doctoroff says he had "spent a lot of time talking" with Bloomberg's Democratic opponent, Mark Green, who was "dramatically less enthusiastic" about the city planning agenda.

Phillips says the eyes of the world being on New York City helped smooth the way for many proposals that would have otherwise been contentious.

"This started as New York's darkest day," Burden says. "There was a real doubt about whether the city would ever recover."

But she lists the many Bloomberg plans: the vision for Lower Manhattan, revitalization of all five boroughs, "reclaiming" of the waterfronts, creation of "inspirational" public spaces and pursuit of the Olympic bid.

"All of these had the same trajectory," Burden says, "that we're a global city, we're moving forward, we're a growing city, we're an optimistic city, we want to command our future."

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How New York City Rebuilt Anew After Its Darkest Day

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When a man-made disaster of unfathomable scope strikes your city and its central symbol of prosperity has been leveled to ruin - and it's your job to jolt it into resurgence - where do you begin? Only hours had passed after the planes struck New York City's twin towers on Sept.