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Measurement and evaluation of risk factors for cancers of the head and neck in a cohort of 9/11 World Trade Center responders

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Title
Measurement and evaluation of risk factors for cancers of the head and neck in a cohort of 9/11 World Trade Center responders
Name (type = personal)
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Bover Manderski
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Michelle T.
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1982-
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Michelle T. Bover Manderski
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author
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Graber
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Judith M
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Judith M Graber
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Advisory Committee
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chair
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Marian
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Marian Passannante
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Advisory Committee
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internal member
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Ohman Strickland
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Pamela
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Pamela Ohman Strickland
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Advisory Committee
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internal member
Name (type = personal)
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Giuliano
NamePart (type = given)
Anna R
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Anna R Giuliano
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Advisory Committee
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outside member
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Rutgers University
Role
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degree grantor
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School of Graduate Studies
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school
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Text
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theses
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2019
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2019-05
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2019
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English
Abstract (type = abstract)
Background: 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.
Subject (authority = local)
Topic
Head and neck cancer
Subject (authority = RUETD)
Topic
Public Health
Subject (authority = LCSH)
Topic
Head -- Cancer -- Diagnosis
Subject (authority = LCSH)
Topic
Neck -- Cancer -- Diagnosis
Subject (authority = LCSH)
Topic
September 11 Terrorist Attacks, 2001
Subject (authority = LCSH)
Topic
First responders -- Health risk assessment
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Rutgers University Electronic Theses and Dissertations
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ETD_9725
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1 online resource (ix, 120 pages)
Note (type = degree)
Ph.D.
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Includes bibliographical references
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School of Graduate Studies Electronic Theses and Dissertations
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rucore10001600001
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Identifier (type = doi)
doi:10.7282/t3-6k8q-2r17
Genre (authority = ExL-Esploro)
ETD doctoral
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The author owns the copyright to this work.
RightsHolder (type = personal)
Name
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Bover Manderski
GivenName
Michelle
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T.
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Copyright Holder
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Permission or license
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2019-04-08 23:03:01
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Michelle Bover Manderski
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Rutgers University. School of Graduate Studies
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Author Agreement License
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I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
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Embargo
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2019-05-31
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2020-05-30
Detail
Access to this PDF has been restricted at the author's request. It will be publicly available after May 30th, 2020.
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Copyright protected
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