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Tobacco Use and Prevalence of Human Papillomavirus in Self-Collected Cervicovaginal Swabs Between 2009 and 2014

Tarney, Christopher M., MD; Beltran, Thomas A., MA; Klaric, John, PhD; Han, Jasmine J., MD

doi: 10.1097/AOG.0000000000002681
Contents: Cancer Prophylaxis/Sterilization: Original Research

OBJECTIVE: To evaluate relationships between an objective biomarker of current tobacco exposure and high-risk genital human papillomavirus (HPV) prevalence among adult women in the United States.

METHODS: We performed a retrospective analysis of adult women (aged 18–59 years) using three consecutive 2-year cycles (2009–2014) from the cross-sectional National Health and Nutrition Examination Surveys. Women who provided self-collected cervicovaginal swabs and serum were included. Human papillomavirus genotyping was conducted on cervicovaginal samples with a Linear Array HPV assay. Cotinine, a major metabolite of nicotine, was assayed from serum to provide a biomarker of recent tobacco exposure. Participants were stratified into three levels of tobacco exposure (nonsmokers, secondhand smoke exposure, and smokers) based on serum cotinine concentration levels using previously published ethnic-specific cut points. Weighted percentages are provided to account for unequal selection probabilities among participants and adjustments for nonresponse.

RESULTS: Among the 5,158 women analyzed, 2,778 were classified as nonsmokers (57.1%, 95% CI 54.5–59.6%), 1,109 classified as having secondhand smoke exposure (18.4%, 95% CI 16.5–20.3%), and 1,271 classified as smokers (24.6%, 95% CI 22.8–26.5%) using serum cotinine concentration levels. Prevalence of HPV infection differed between nicotine exposure groups (P<.001): 441 smokers (32.1%, 95% CI 29.6–34.7%), 322 women with secondhand smoke exposure (26.1%, 95% CI 22.7–29.7%), and 451 nonsmokers (15.1%, 95% CI 13.3–17.1%) had a high-risk genital HPV infection. Controlling for demographics and number of lifetime sexual partners, the risks compared with nonsmokers for infection with a high-risk HPV genotype for smokers (adjusted odds ratio [OR] 1.7, 95% CI 1.4–22) and secondhand smokers (adjusted OR 1.4, 95% CI 1.1–1.8) are similarly increased (P<.001).

CONCLUSION: In this large cross-sectional, population-based study, we show a relationship between an objective biomarker of current tobacco use and genital HPV infection. Cigarette smoking and exposure to secondhand smoke are associated with increased odds of infection with high-risk genital HPV independent of lifetime number of sexual partners.

Cigarette smoking and secondhand smoke exposure are associated with increased odds of cervicovaginal high-risk human papillomavirus infection.

Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina; and the Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Madigan Army, Medical Center, Fort Lewis, Washington.

Corresponding author: Christopher M. Tarney, MD, Walter Reed National Military Medical Center, Gynecologic Cancer Center of Excellence, 8901 Rockville Pike, Bethesda, MD 20889; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the American College of Obstetricians and Gynecologists' Annual Clinical and Scientific Meeting, May 6–9, 2017, San Diego, California.

The authors thank the Centers for Disease Control and Prevention for their role in organizing the National Health and Nutrition Examination Survey.

The views expressed herein are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or U.S. Government.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received January 12, 2018. Received in revised form February 16, 2018. Accepted March 15, 2018.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.