Abstract
Objective: To assess the reliability of a questionnaire designed to reconstruct risk factors for head and neck cancer relative to the 9/11 World Trade Center (WTC) response and over the lifetime.Methods: As part of a nested case-control study, 200 WTC Health Program (WTCHP) General Responder Cohort (GRC) members completed a newly-developed study questionnaire via telephone (with a trained interviewer) or online (self-administered). We assessed agreement between measures of tobacco and alcohol use in our questionnaire results and data collected previously during WTCHP-GRC monitoring visits using Cohens Kappa (κ) and intraclass correlation coefficient (ICC) for categorical and continuous measures, respectively. We compared agreement by disease status, survey mode, and year of WTCHP enrollment.Results: We observed high agreement between measures of lifetime, pre-WTC, and post-WTC smoking prevalence (all κ > 0.85) and smoking duration (all ICC > 0.84). There was moderate agreement between measures of smoking frequency (ICC: 0.61–0.73). Agreement between measures of smoking frequency, but not duration, differed by disease status, and agreement between smoking measures was higher for participants who completed our survey by phone than by web. Among cases, there were no differences based on enrollment in the WTCHP before or after diagnosis.Conclusion: Agreement between measures was generally high, although potential reporting bias and a mode effect that should be considered when interpreting analyses of self-reported data in this population; however differential misclassification appears to be minimal. Our questionnaire may be useful for future studies examining similar behavioral risk factors among disaster-exposed populations.
Highlights
People involved in the World Trade Center (WTC) rescue, recovery, and cleanup efforts following the collapse of the WTC towers on September 11, 2001 (9/11) faced potential exposure to multiple known and suspected human carcinogens [1,2,3]
Risk Epidemiology Study, WTC-CARES) [16], we developed a risk factor assessment questionnaire designed to reconstruct lifetime exposure to tobacco, alcohol, and marijuana use, as well as tooth loss and sexual history
We developed questions based on previously validated instruments, to the extent possible it is important to assess validity and reliability of study questionnaires in each population
Summary
People involved in the World Trade Center (WTC) rescue, recovery, and cleanup efforts following the collapse of the WTC towers on September 11, 2001 (9/11) faced potential exposure to multiple known and suspected human carcinogens [1,2,3]. WTC-related exposures may place responders at increased risk for adverse health outcomes, including cancer. A 40% excess incidence [standardized incidence ratio (SIR): 1.40, 95% confidence interval (CI): 1.01, 1.89] of head and neck cancers diagnosed between 2009 and 2012 has been reported among members of the WTC Health Program (WTCHP) General Responder Cohort [6]. Other population-level behavioral risk factors, including tobacco use, alcohol consumption, and increased sexual activity [an established indicator of human papillomavirus (HPV) infection risk [7,8,9]] [10,11,12,13,14], may play a role in the etiology of head and neck cancer in this population. Given that risk behaviors may change over time or after traumatic events (such as participation in the WTC response), reconstruction of these risk factors before, during, and after the WTC exposure period, is critical to understanding any associations between WTC exposures and head and neck cancer
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