title: Comparison of health outcomes among affiliated and lay disaster volunteers enrolled in the World Trade Center Health Registry.
abstract: BACKGROUND
  Volunteers (non-professional rescue/recovery workers) are universally present at man-made and natural disasters and share experiences and exposures with victims. Little is known of their disaster-related health outcomes.
  
  
  METHODS
  We studied 4974 adult volunteers who completed the World Trade Center Health Registry 2006-07 survey to examine associations between volunteer type (affiliated vs. lay) and probable posttraumatic stress disorder (PTSD); new or worsening respiratory symptoms; post-9/11 first diagnosis of anxiety disorder, depression, and/or PTSD; and asthma or reactive airway dysfunction syndrome (RADS). Affiliated volunteers reported membership in a recognized organization. Lay volunteers reported no organizational affiliation and occupations unrelated to rescue/recovery work. Adjusted odds ratios (OR(adj)) were calculated using multinomial regression.
  
  
  RESULTS
  Lay volunteers were more likely than affiliated volunteers to have been present in lower Manhattan, experience the dust cloud, horrific events and injury on 9/11 and subsequently to report unmet healthcare needs. They had greater odds of early post-9/11 mental health diagnosis (OR(adj) 1.6; 95% CI: 1.4-2.0) and asthma/RADS (1.8; 1.2-2.7), chronic PTSD (2.2; 1.7-2.8), late-onset PTSD (1.9; 1.5-2.5), and new or worsening lower respiratory symptoms (2.0; 1.8-2.4).
  
  
  CONCLUSIONS
  Lay volunteers' poorer health outcomes reflect earlier, more intense exposure to and lack of protection from physical and psychological hazards. There is a need to limit volunteers' exposures during and after disasters, as well as to provide timely screening and health care post-disaster.
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 2 Gotham Center, 42-09 28th Street, 7th Floor, Queens, NY 11101, USA. idebchou@health.nyc.gov
authors.forename: Indira
authors.initials: I
authors.lastname: Debchoudhury
authors.forename: Alice E
authors.initials: AE
authors.lastname: Welch
authors.forename: Monique A
authors.initials: MA
authors.lastname: Fairclough
authors.forename: James E
authors.initials: JE
authors.lastname: Cone
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill
authors.forename: Steven D
authors.initials: SD
authors.lastname: Stellman
authors.forename: Mark R
authors.initials: MR
authors.lastname: Farfel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006306:Health Surveys; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009519:New York City; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D012042:Registries; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D047851:September 11 Terrorist Attacks; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D014838:Volunteers / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult