Measurement and evaluation of risk factors for cancers of the head and neck in a cohort of 9/11 World Trade Center responders
Citation & Export
Hide
Simple citation
Bover Manderski, Michelle T..
Measurement and evaluation of risk factors for cancers of the head and neck in a cohort of 9/11 World Trade Center responders. Retrieved from
https://doi.org/doi:10.7282/t3-6k8q-2r17Export
Description
TitleMeasurement and evaluation of risk factors for cancers of the head and neck in a cohort of 9/11 World Trade Center responders
Date Created2019
Other Date2019-05 (degree)
Extent1 online resource (ix, 120 pages)
DescriptionBackground: Responders to the World Trade Center (WTC) on 9/11 and throughout the subsequent rescue, recovery, and cleanup efforts were potentially exposed to a host of known and suspected human carcinogens. Emerging research suggests that head and neck cancers (HNCs) may be among the health consequences of involvement in the World Trade Center (WTC) response efforts that followed September 11, 2001.
Objective and Specific Aims: This dissertation sought to identify risk factors for HNC among WTC Health Program general responders. Three specific aims supported this goal: (1) develop and assess the reliability of a questionnaire designed to retrospectively reconstruct risk behaviors before, during, and after the WTC exposure period; (2) evaluate WTC-related and behavioral risk factors for HNC among WTC responders using a nested case-control approach; and (3) compare the distribution of risk factors for HNC subtypes among WTC responders using a case-case approach.
Methods: A questionnaire was developed to retrospectively assess risk behaviors for HNC, including tobacco use, alcohol consumption, and sexual activity and administered to 64 cases (responders with HNC) and 136 controls identified via risk-set sampling and matched on age, sex, and race/ethnicity. For study 1, Cohen’s kappa and intraclass correlation coefficient were used to assess agreement of the questionnaire’s measures of tobacco and alcohol use with data previously collected during WTCHP monitoring visits using. For study 2, WTC exposures and behavioral risk factors were compared between cases and controls using conditional logistic regression models. For study 3, risk factor profiles were compared among cases with oropharyngeal, oral cavity, laryngeal, and other HNCs using bivariate statistics (ANOVA, Chi-Square, Fisher’s Exact) and unconditional logistic regression.
Results: Study 1 found high agreement between most measures common to both data sources but noted some differences in agreement by disease status and survey mode. The nested case-control analysis (Study 2) found estimated HNC risk associated with having a protective services occupation, lifetime and post-WTC cigarette smoking, and post-WTC number of sex partners. Increased risk was also associated with arriving on 9/11 as opposed to later, but only among responders without protective services occupations. The case-case analysis (Study 3) revealed differential risk factor profiles by cancer site that did not fully align with what is seen in the general population.
Conclusion: The findings from this dissertation contribute to development of a unique HNC risk factor profile and inform potential HNC risk mitigation strategies for WTC responders. These recommendations may assist WTCHP clinicians with identifying high-risk responders and thus improve HNC detection and treatment outcomes in this population.
NotePh.D.
NoteIncludes bibliographical references
Genretheses, ETD doctoral
LanguageEnglish
CollectionSchool of Graduate Studies Electronic Theses and Dissertations
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.
Statistical Profile