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Journalist Exposure at the World Trade Center
1. Physical Health Concerns
25%
Please feel free to answer honestly. Your answers are anonymous and confidential and your identity is not recorded at any point as part of this survey.
In this section we are trying to gauge the hazards journalists were exposed to at the World Trade Center and get an idea what physical health challenges exist as a result of our exposure. We are also going to establish a baseline with some of the questions. The responses are intended to identify what was or was not a problem before 9.11 and what is after 9.11.
1
. Which of the following were you exposed to during your time at the World Trade Center site? (Check all that apply):
Which of the following were you exposed to during your time at the World Trade Center site? (Check all that apply):
Smoke
Dust
Debris
Blood
Came in contact with blood or other biohazard
Came in contact with known or unknown chemicals
Other (please specify)
2
. Did you suffer any physical injury or illnesses during your exposure at the World Trade Center site? If not, please go to question 5.
Did you suffer any physical injury or illnesses during your exposure at the World Trade Center site? If not, please go to question 5.
Yes
No
3
. Which of the following physical injuries or illnesses did you suffer from as a result of your exposure at the World Trade Center. Please check all that apply.
Which of the following physical injuries or illnesses did you suffer from as a result of your exposure at the World Trade Center. Please check all that apply.
Allergies
Breathing problems
Broken bones
Bruises
Burns
Cancer
Cuts
Death
Heavy metals present in body or blood
Inhaled unknown substances
Leukemia
Lung damage
Lung disease
Tumors
Other injury or illnesses
4
. Were you hospitalized at any time for treatment of any of the injuries or illnesses you suffered during your exposure at the World Trade Center?
Were you hospitalized at any time for treatment of any of the injuries or illnesses you suffered during your exposure at the World Trade Center?
Yes
No
5
. Were you diagnosed with asthma or breathing problems BEFORE your exposure at the World Trade Center site?
Were you diagnosed with asthma or breathing problems BEFORE your exposure at the World Trade Center site?
Yes
No
6
. Were you diagnosed with asthma or breathing problems AFTER your exposure at the World Trade Center site?
Were you diagnosed with asthma or breathing problems AFTER your exposure at the World Trade Center site?
Yes
No
7
. If so, how long did your asthma or breathing problems persist?
0
1
2
3
4
5
6
7
8
9
10
11
12
months
*
If so, how long did your asthma or breathing problems persist? months 0
months 1
months 2
months 3
months 4
months 5
months 6
months 7
months 8
months 9
months 10
months 11
months 12
years
years 0
years 1
years 2
years 3
years 4
years 5
years 6
years 7
years 8
years 9
years 10
years 11
years 12
8
. Does your asthma or breathing problem still exist today? If the answer is no, please skip to question 10.
Does your asthma or breathing problem still exist today? If the answer is no, please skip to question 10.
Yes
No
9
. How would you rate your asthma or breathing problems today?
How would you rate your asthma or breathing problems today?
mild
moderate
severe
10
. Did you have a persistent cough BEFORE your exposure at the World Trade Center?
Did you have a persistent cough BEFORE your exposure at the World Trade Center?
Yes
No
11
. Did you develop a persistent cough AFTER your exposure at the World Trade Center?
Did you develop a persistent cough AFTER your exposure at the World Trade Center?
Yes
No
12
. If so, how long did the cough persist?
0
1
2
3
4
5
6
7
8
9
10
11
12
Months
*
If so, how long did the cough persist? Months 0
Months 1
Months 2
Months 3
Months 4
Months 5
Months 6
Months 7
Months 8
Months 9
Months 10
Months 11
Months 12
Years
Years 0
Years 1
Years 2
Years 3
Years 4
Years 5
Years 6
Years 7
Years 8
Years 9
Years 10
Years 11
Years 12
13
. Has this developed into a chronic cough that still exists today?
Has this developed into a chronic cough that still exists today?
Yes
No
14
. How would you rate your cough today?
How would you rate your cough today?
mild
moderate
severe
15
. Have you ever or do you currently smoke cigarettes regularly?
Have you ever or do you currently smoke cigarettes regularly?
Never smoked
Smoked in the past
Still smoke
16
. Did you suffer from heart burn, GERD or acid reflux BEFORE your exposure at the World Trade Center? If the answer is no, please skip to question 20.
Did you suffer from heart burn, GERD or acid reflux BEFORE your exposure at the World Trade Center? If the answer is no, please skip to question 20.
Yes
No
17
. Did you suffer from heart burn, GERD or acid reflux AFTER your exposure at the World Trade Center?
Did you suffer from heart burn, GERD or acid reflux AFTER your exposure at the World Trade Center?
Yes
No
18
. Do you still have heartburn, GERD or acid reflux?
Do you still have heartburn, GERD or acid reflux?
Yes
No
19
. If so, how long did it persist?
0
1
2
3
4
5
6
7
8
9
10
11
12
Months
*
If so, how long did it persist? Months 0
Months 1
Months 2
Months 3
Months 4
Months 5
Months 6
Months 7
Months 8
Months 9
Months 10
Months 11
Months 12
Years
Years 0
Years 1
Years 2
Years 3
Years 4
Years 5
Years 6
Years 7
Years 8
Years 9
Years 10
Years 11
Years 12
20
. Are you currently taking prescription medication for illnesses as a result of your exposure at the World Trade Center?
yes
no
Acid reflex
*
Are you currently taking prescription medication for illnesses as a result of your exposure at the World Trade Center? Acid reflex yes
Acid reflex no
Asthma
Asthma yes
Asthma no
Breathing problems
Breathing problems yes
Breathing problems no
Cough
Cough yes
Cough no
GERD
GERD yes
GERD no
Heartburn
Heartburn yes
Heartburn no
Other WTC exposure related illnesses
Other WTC exposure related illnesses yes
Other WTC exposure related illnesses no
Sinus problems
Sinus problems yes
Sinus problems no
Sleep problems
Sleep problems yes
Sleep problems no
What other WTC exposure related illness are you taking medication for?
21
. Which of the following sleep problems did you have prior to your exposure at the World Trade Center, after your exposure at the World Trade Center or currently have?
Never had
Had prior to exposure at WTC
Have after exposure at WTC
Currently have
Trouble falling asleep
*
Which of the following sleep problems did you have prior to your exposure at the World Trade Center, after your exposure at the World Trade Center or currently have? Trouble falling asleep Never had
Trouble falling asleep Had prior to exposure at WTC
Trouble falling asleep Have after exposure at WTC
Trouble falling asleep Currently have
Trouble staying asleep
Trouble staying asleep Never had
Trouble staying asleep Had prior to exposure at WTC
Trouble staying asleep Have after exposure at WTC
Trouble staying asleep Currently have
Wake at night suddenly gulping for air
Wake at night suddenly gulping for air Never had
Wake at night suddenly gulping for air Had prior to exposure at WTC
Wake at night suddenly gulping for air Have after exposure at WTC
Wake at night suddenly gulping for air Currently have
Nightmares
Nightmares Never had
Nightmares Had prior to exposure at WTC
Nightmares Have after exposure at WTC
Nightmares Currently have
Night sweats
Night sweats Never had
Night sweats Had prior to exposure at WTC
Night sweats Have after exposure at WTC
Night sweats Currently have
Snoring
Snoring Never had
Snoring Had prior to exposure at WTC
Snoring Have after exposure at WTC
Snoring Currently have
Sleep apnea
Sleep apnea Never had
Sleep apnea Had prior to exposure at WTC
Sleep apnea Have after exposure at WTC
Sleep apnea Currently have
Unusual feeling of fatigue
Unusual feeling of fatigue Never had
Unusual feeling of fatigue Had prior to exposure at WTC
Unusual feeling of fatigue Have after exposure at WTC
Unusual feeling of fatigue Currently have
Other sleep problems
Other sleep problems Never had
Other sleep problems Had prior to exposure at WTC
Other sleep problems Have after exposure at WTC
Other sleep problems Currently have
Specify other sleep problems
22
. Have health problems AFTER your exposure at the World Trade Center affected your career?
Have health problems AFTER your exposure at the World Trade Center affected your career?
Yes
No
How
23
. Have health problems AFTER your exposure at the World Trade Center affected your personal life?
Have health problems AFTER your exposure at the World Trade Center affected your personal life?
Yes
No
How?
24
. Have you had any illnesses or health issues that doctors cannot explain?
Have you had any illnesses or health issues that doctors cannot explain?
Yes
No
Please describe the unexplainable health issues that you faced
25
. Would you like to add anything to describe your current health challenges that you believe are related to your exposure at the World Trade Center
Would you like to add anything to describe your current health challenges that you believe are related to your exposure at the World Trade Center
26
. Do you believe you HAVE become sick from your exposure at ground zero?
Do you believe you HAVE become sick from your exposure at ground zero?
Yes
No
I'm not sure
27
. Are you concerned that you MIGHT become sick from your exposure at ground zero?
Are you concerned that you MIGHT become sick from your exposure at ground zero?
Yes
No
I'm not sure
28
. Do you feel you are getting adequate medical care for injuries related to your exposure at the World Trade Center?
Do you feel you are getting adequate medical care for injuries related to your exposure at the World Trade Center?
Yes
No
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