title: Risk factors for cervical intraepithelial neoplasia in southwestern American Indian women.
abstract: The authors assessed risk factors for cervical intraepithelial neoplasia (CIN) among southwestern American Indian women using case-control methods. Cases were New Mexico American Indian women with biopsy-proven grade I (n = 190), grade II (n = 70), or grade III (n = 42) cervical lesions diagnosed between November 1994 and October 1997. Controls were American Indian women from the same Indian Health Service clinics with normal cervical epithelium (n = 326). All subjects underwent interviews and laboratory evaluations. Interviews focused on history of sexually transmitted diseases, sexual behavior, and cigarette smoking. Laboratory assays included polymerase chain reaction-based tests for cervical human papillomavirus infection, tests for gonorrhea and chlamydia, wet mounts, and serologic assays for antibodies to Treponema pallidum, herpes simplex virus, and hepatitis B and C viruses. In multiple logistic regression analysis, the strongest risk factors for CIN II/III among American Indian women were human papillomavirus type 16 infection (adjusted odds ratio (OR) = 7.6; 95% confidence interval (CI): 2.4, 23.2), any human papillomavirus infection (OR = 5.8; 95% CI: 3.3, 10.0), low income (OR = 3.3; 95% CI: 1.7, 6.2), and history of any sexually transmitted disease (OR = 2.0; 95% CI: 1.1, 3.5). Unlike previous research, this study found no strong associations between CIN and sexual activity or cigarette smoking.
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, USA. mschiff@u.washington.edu
authors.forename: M
authors.initials: M
authors.lastname: Schiff
authors.forename: T M
authors.initials: TM
authors.lastname: Becker
authors.forename: M
authors.initials: M
authors.lastname: Masuk
authors.forename: L
authors.initials: L
authors.lastname: van Asselt-King
authors.forename: C M
authors.initials: CM
authors.lastname: Wheeler
authors.forename: K K
authors.initials: KK
authors.lastname: Altobelli
authors.forename: C Q
authors.initials: CQ
authors.lastname: North
authors.forename: A J
authors.initials: AJ
authors.lastname: Nahmias
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007198:Indians, North American; D016015:Logistic Models; D017533:Marital Status; D008875:Middle Aged; D009516:New Mexico / Q000453:epidemiology; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000208:ethnology; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012720:Severity of Illness Index; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000208:ethnology; D012907:Smoking / Q000009:adverse effects; D014412:Tumor Virus Infections / Q000150:complications* / Q000208:ethnology; D002578:Uterine Cervical Dysplasia / Q000145:classification / Q000208:ethnology* / Q000209:etiology