title: The role of epidemiology in disaster response policy development.
abstract: OBJECTIVE
  Disasters expose the general population and responders to a range of potential contaminants and stressors which may harm physical and mental health. This article addresses the role of epidemiology in informing policies after a disaster to mitigate ongoing exposures, provide care and compensation, and improve preparedness for future disasters.
  
  
  METHODS
  The World Trade Center disaster response is used as a case study. We examine how epidemiologic evidence was used to shape postdisaster policy and identify important gaps in early research.
  
  
  RESULTS
  In the wake of World Trade Center attacks, epidemiologic research played a key role in identifying and characterizing affected populations, assessing environmental exposures, quantifying physical and mental health impacts, and producing evidence to ascribe causation. However, most studies suffered from methodological challenges, including delays, selection biases, poor exposure measurement, and nonstandardized outcomes. Gaps included measuring unmet health needs and financing coverage, as well as coordination across longitudinal cohorts of studies for rare conditions with long latency, such as cancer.
  
  
  CONCLUSIONS
  Epidemiologists can increase their impact on evidence-based policymaking by ensuring core mechanisms are in place before a disaster to mount monitoring of responders and other affected populations, improve early exposure assessment efforts, identify critical gaps in scientific knowledge, and coordinate communication of scientific findings to policymakers and the public.
authors.affiliation: Epidemiology and Biostatistics Program, City University of New York School of Public Health, NY. Electronic address: lthor@hunter.cuny.edu.
authors.forename: Lorna E
authors.initials: LE
authors.lastname: Thorpe
authors.affiliation: Health Behavior and Health Education Program, University of Michigan School of Public Health, Ann Arbor.
authors.forename: Shervin
authors.initials: S
authors.lastname: Assari
authors.affiliation: Department of Epidemiology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Stephen
authors.initials: S
authors.lastname: Deppen
authors.affiliation: School of Public Service, Wagner School of Public Service, New York University, NY.
authors.forename: Sherry
authors.initials: S
authors.lastname: Glied
authors.affiliation: Department of Health and Human Services, Washington, DC.
authors.forename: Nicole
authors.initials: N
authors.lastname: Lurie
authors.affiliation: Department of Epidemiology and Biostatistics, Albany School of Public Health, State University of New York, Albany.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Mauer
authors.affiliation: Department of Psychology, School of Public Health, University of California, Los Angeles, Los Angeles.
authors.forename: Vickie M
authors.initials: VM
authors.lastname: Mays
authors.affiliation: Department of Epidemiology, School of Public Health, Louisiana State University, New Orleans.
authors.forename: Edward
authors.initials: E
authors.lastname: Trapido
mesh_terms: D004189:Disaster Planning / Q000331:legislation & jurisprudence*; D004190:Disasters / Q000517:prevention & control*; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009519:New York City; D011050:Policy Making; D011640:Public Policy / Q000331:legislation & jurisprudence*; D018635:Rescue Work / Q000458:organization & administration; D012106:Research; D012107:Research Design; D012380:Role; D047851:September 11 Terrorist Attacks
keywords: Case study; Disaster epidemiology; Policy; World Trade Center