Introduction: Cervical cancer (CC) is among the most prevalent and preventable cancers worldwide. There have been significant efforts to prevent CC through screening and human papillomavirus (HPV) vaccination. Despite these efforts, CC remains a significant problem. Active smoking is a well-established cofactor for the development of CC. What is less well understood is the role of secondhand smoke exposure in the pathogenesis of CC. The primary purpose of this study was to examine the relationship between smoke exposure (active and secondhand) and CC. A secondary purpose was to compare methods of collecting smoke exposure data and trends of exposure among United States (US) women.
Methods: The National Health and Nutrition Examination Survey (NHANES) 2007-2016 were used for this study. NHANES is a cross-sectional, nationally representative sample of the non-institutionalized US population. A total sample of 13,396 women ≥20 years old were used for the analysis. Cervical cancer history and smoke exposure, both biochemical and self-report measures, were used in analysis. Analysis included descriptive statistics, correlational studies and logistic regression.
Results: The primary purpose found a strong upward correlation between CC prevalence and number of household smokers (Rao Scott X2 =128.77, 3 DF, p<.0001). Active smokers were more than twice as likely to have CC (Rao Scott X2 =111.51, 2 DF, p<.0001). Controlling for race/ethnicity, age, education and annual household income, there was a > four times increased odds of CC among active smokers (OR=4.21, CI: 2.45-7.25, p<.0001). Controlling for the same covariates, the odds of CC increased significantly with each household smoker (1 smoker household: OR=2.99, 95% CI: 1.76-5.11, 2 smoker household: OR=4.65, 95% CI: 2.40-9.01, 3 or more smoker household: OR 7.88, 95% CI: 3.92-15.85; all p<.0001). Number of household smokers was the best self-report tool available for examination of NHANES data based on a specific upward trend in mean cotinine levels. Women most at risk for smoke exposure were non-Hispanic black and white women and women with annual household incomes <$20,000. Black women were the most likely to be secondhand smoke exposed.
Discussion: CC odds was significantly increased with each number of household smokers. Women who are active smokers or exposed to household smoke should be educated about the risks and the relationship to CC. Specific populations identified at high risk for smoke exposure should be targeted for health education, clinical intervention and public policy implementation regarding reduction of CC through reducing smoke exposure.
|Advisor:||Barone, Claudia, Rhods, Sarah|
|Commitee:||Selig, James, Wright, Patricia, Rojo, Martha|
|School:||University of Arkansas for Medical Sciences|
|School Location:||United States -- Arkansas|
|Source:||DAI 81/11(E), Dissertation Abstracts International|
|Keywords:||Cervical cancer, Passive smoking, Secondhand smoke, Smoking|
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