Racial differences in the relationship between tobacco, alcohol, and squamous cell carcinoma of the head and neck.
OBJECTIVE
Tobacco and alcohol use are well-known risk factors for squamous cell carcinoma of the head and neck (SCCHN), but there has been little examination of disparities in SCCHN and racial patterns of tobacco and alcohol use, especially for African-Americans. The Carolina Head and Neck Cancer Study, a population-based case-control study, was utilized to determine whether relationships between tobacco and alcohol use and SCCHN differed by race.


METHODS
Using a rapid case ascertainment system, cases were recruited from 46 contiguous counties in North Carolina from 2002 to 2006. Controls, selected from motor vehicle records, were frequency-matched to cases on age, sex, and race. This analysis was based on 989 white and 351 African-American cases and 1,114 white and 264 African-American controls. Analyses were performed using unconditional logistic regression, adjusting for age, sex, race, education, and fruit and vegetable consumption.


RESULTS
The association between SCCHN and ever tobacco use among African-Americans (odds ratio (OR), 9.68; 95 % confidence interval (CI), 4.70, 19.9) was much greater than that observed in whites (OR, 1.94; 95 % CI, 1.51, 2.50). Smaller differences were observed when examining ever alcohol use (African-Americans: OR, 3.71; CI, 1.65, 8.30, and Whites: OR, 1.31: CI 0.96, 1.78). African-Americans consistently had greater effect measure estimates when examining common levels of duration and intensity metrics of tobacco and alcohol use, both independently and jointly. No racial differences in the effects of environmental (passive) tobacco smoke were observed.


CONCLUSIONS
These findings suggest racial differences in SCCHN are not solely explained by differences in consumption patterns, and tobacco and alcohol may have greater impact in African-Americans.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
Jeanette A
JA
Stingone
William K
WK
Funkhouser
Mark C
MC
Weissler
Mary E
ME
Bell
Andrew F
AF
Olshan
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000208:ethnology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011379:Prognosis; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult