title: Lifetime cigarette smoke and second-hand smoke and cervical intraepithelial neoplasm--a community-based case-control study.
abstract: BACKGROUND
  Both active cigarette smoking and human papillomavirus (HPV) infection are known risk factors for cervical intraepithelial neoplasm (CIN). The association between second-hand smoke (SHS) and CIN has not been conclusively determined. We conducted a community-based case-control study to estimate the relationship between SHS and CIN.
  
  
  METHODS
  Potential study subjects were selected through Pap smear screening in Kaohsiung County, Taiwan. A total of 171 subjects with either their first case of inflammation (benign epithelial lesion) or > or = CIN1 by biopsy confirmation were assigned to a case group; 513 normal subjects with negative findings by Pap smears or biopsies were assigned to a control group.
  
  
  RESULTS
  Non-smoking women exposed to more than 20 pack-years of cigarette smoke had a significantly greater risk of developing > or = CIN2 than unexposed non-smokers (adjusted OR=7.2, 95% CI=2.5-20.6). Among the women without HPV infections, the greater the severity of disease found in the groups (normal, inflammation, CIN1, to > or = CIN2), the more likely it was for the women to be exposed to SHS, a significant increasing trend (p=0.037).
  
  
  CONCLUSIONS
  In addition to HPV infection and active cigarette smoking, exposure to SHS is a major risk factor for CIN among Taiwanese women.
authors.affiliation: School of Nursing, College of Nursing, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Hsiu-Ting
authors.initials: HT
authors.lastname: Tsai
authors.forename: Ying-Mei
authors.initials: YM
authors.lastname: Tsai
authors.forename: Sheau-Fang
authors.initials: SF
authors.lastname: Yang
authors.forename: Kuen-Yuh
authors.initials: KY
authors.lastname: Wu
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chuang
authors.forename: Trong-Neng
authors.initials: TN
authors.lastname: Wu
authors.forename: Chi-Kung
authors.initials: CK
authors.lastname: Ho
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
authors.forename: Ying-Se
authors.initials: YS
authors.lastname: Kuo
authors.forename: Ming-Tsang
authors.initials: MT
authors.lastname: Wu
mesh_terms: D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology
chemical_list: D014028:Tobacco Smoke Pollution