Pilot Survey: For non-radiation Risk

FactorsFaith Davis, Ludmilla Krestinina, Oleg

Kalyov, Dale Preston, Alexander Akleyev, Timothy Johnson

(JCCRER Project 1.2b)

Background

Radiogenic cancer risk estimates limited by lack of control for confounding factors

Dosimetry available on individuals in the Techa River Cohort.

Cancer incidence and mortality data are accumulating in this cohort.

Attempts to obtain risk factor information on the Techa River cohort initially focused on members attending the URCRM and teams visiting larger villages

Risk Factor Information(5% randomized sample of the ChOS)

Risk factorsHaving

information, %

Unhealthy habits 40Occupation 57Social condition 90Anthropometry 43Education 52

Goals

Obtain highest yield risk factor information in a cost effective manner using state of the art survey methodology

Initial focus: smoking, alcohol and family hx of cancer Conduct a series of studies to address specific survey

research methodological issues in this cohort population

Use the results of these pilots to inform a survey protocol for the entire cohort population

Materials Initially Developed

Introductory letter Second letter Third letter Mail survey Telephone survey

Survey Development

Draft survey questions (Kalyov, Davis, Johnson) revised based on group discussion of project goals

Interviewers trained at URCRM Survey tested in URCRM patients, interviewers

debriefed and survey revised Survey tested in one village, using cognitive

interviews: interviewers debriefed and survey revised Questionnaires formatted for self-administered and

interviewer-assisted modes

Pilot: Sampling

300 cohort members with no RF information 100 cohort members with previous RF information If cohort member was deceased a proxy was chosen:

Family member residing with the member Family member residing in the same community Family member with most recent last contact date Family member next in age If only one relative we contacted that person

Initial Protocol

Mail Survey (n=300) Send initial letter with“return receipt” Send second letter within a month Send third letter within another month

Telephone calls on a similar schedule (n=100) Introductory letter (included questionnaire)

Will Presenting Multiple Survey Options increase response

rates?

Group No proxy or address (n)

Total Contacted (n)

Percent of Total Responded

Percent of Contacts Responded

Mail Only 34 66 20% 30%Telephone Only* 43 57 3% 5%

Mail and Telephone

35 65 29% 45%Groups Randomly Sampled with No Previous Risk Factor Information

*

Group No Proxy or

Address (n)

Total Contacte

d (n)

Percent of total

responded

Percent of

contacts responde

dTelephone* 43 57 3% 5%

Mail 12% 21%

Total 15% 26%

*Not strictly interpretable

Revised Protocol

Development of non-monetary incentive Send initial letter and incentive (wait 10 days)

Small flat magnet with URCRM information on it. Reminder post-cards (wait 14 days)Second letter (wait 14 days)Third letter “receipt requested”

Image of magnet

Will the use of incentives improve response rates?

Mail and telephon

e

No proxy or

address (n)

Total contacte

d (n)

Percent of total

Responded

Percent of

contacts responde

dNo

incentive(n=100)

35 65 29% 45%

With incentive 68 132 37% 56%

Will new Information enhance previous Information?

Mail and Telephone

No Proxy or

Address (n)

Total Contacted

(n)

Percent of Total

Responded

Percent of Contacts Responde

dNo Risk Factor Information

35 65 29% 45%

Some Risk Factor Information

9 91 25% 27%

Response rates by number of contacts

Revised Protocol

No Proxy or

Address (n)

Total Contacte

d (n)

Number Respond

ed (n)

Percent of Total Respond

ed

Percent of

Contacts Respond

ed1st letter 68 132 62 31% 47%2nd letter 76 12 6% 16%3rd letter 50 2 1% 4%Total 76 38% 58%

Response time for mail surveys

1 week (n)

2 weeks (n)

3 weeks (n)

>3 weeks (n)

Total (n)

1st letter 13 18 45 24 612nd letter 33 42 8 17 123rd letter 25 25 25 25 3

Will new information compare with old

information?

In sample of 100 members with previous risk factor information the old and new information was compared

New information was either the same as the previous information or was not in conflict with it.

Final Implementation Protocol

Restricted effort to mail surveys Limited information to smoking and alcohol Shortened protocol

Introductory Letter (wait 10 days) Postcard follow-up (wait 14 days) Second Letter (28 days)

Focus on 7000 alive and dead members with addresses and no previous information Selected alive cohort members for first contact

Current Survey Work:

Step 1 (n=2000 letters) 65% personal letter (to living cohort members with correct address) 35% letters to proxy (for lost and for deceased cohort members)

Step 2 (n=2000 letters) 100% letters to proxy:(n=1100 letters with 1 survey, n=389 with 2 or >

surveys)

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Current Results: (n=4000 letters)

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Response category

Personal surveys

Proxy surveys Total

Completed Surveys 460 (35.4%) 883 (32.7%) 1343 (33.6%)

Refusal 24 (1.8%) 98 (3.6%) 122 (3.1%)Deceased 65 (5.0%) 83 (3.1%) 148 (3.7%)Wrong address 109 (8.4%) 140 (5.2%) 249 (6.2%)

No response 643 (49.4%) 1495 (55.4%) 2138 (53.5%)

Total 1301 (100%) 2699 (100%) 4000 (100%)

Future Plans for survey work

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• Step 3: 6 months (October 2012 - March 2013) letters to proxy (2000 surveys)

• Step 4: 6 months (April 2013 - September 2013) letters to proxy (final 1000 surveys) If first proxy does not respond (deceased,

refused, wrong address) identify and mail to second

proxies (~1000)

Summary

Mail survey proved to be effective in this population: similar to surveys in US populations

Pilot study work allowed for protocol refinement which reduced costs of survey work and increased probability of cooperation

Analytic uses, including missing data, of new risk factor data will be challenging

Subset analysis of cohort members with risk factor data should be informative.

Acknowledgements

Appreciate the support of the US SRG for this work

Thank the cohort members and their families for their responses.