title: Effects of active, passive, and combined smoking on cervical cancer mortality: a nationwide proportional mortality study in Chinese urban women.
abstract: OBJECTIVE
  To determine whether smoking, in any form, is a risk factor in the development of cervical cancer (CC) among urban Chinese women.
  
  
  METHODS
  We ascertained retrospectively the smoking habits of 1,865 women (aged 35+) who had died from CC (cases) and 48,781 who had died from causes unrelated to smoking (controls) in 24 cities using data from a large national survey of smoking and mortality in 1989-1991. We assessed the risk of smoking on CC mortality with and without considering passive smoke exposure from a spouse using a proportional mortality study design.
  
  
  RESULTS
  Overall, there was a 51.0 % excess risk of death from CC among smokers. When the spouse's exposure was further considered, the RR (95 % CI) for exposed versus unexposed women was 1.28 (1.04-1.57) for passive smokers, 1.49 (1.02-2.20) for active smokers, and 1.69 (1.27-2.26) for women with both exposures (all p < 0.001). Significant dose-response associations were observed between smoking and CC for all categories of exposure. For example, individuals with both smoking exposure had the highest risk of CC mortality with moderate [RR = 1.67 (1.18-2.38)] and high [RR = 1.88 (1.04-3.41)] daily cigarette consumption, and they also had the highest risk with ≤15 years exposure [RR = 1.73 (1.19-2.52)] and >15 years exposure [RR = 1.95 (1.15-3.32)], compared with the active and passive groups (p for trend <0.001).
  
  
  CONCLUSIONS
  Younger trend of CC death and the rapid increase in smoking among young women may have a profound impact on future incidence of CC. Our findings emphasize the need for preventive efforts among both women and men in China.
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China, jingmeijiang@ibms.pumc.edu.cn.
authors.forename: Jingmei
authors.initials: J
authors.lastname: Jiang
authors.forename: Haiyu
authors.initials: H
authors.lastname: Pang
authors.forename: Boqi
authors.initials: B
authors.lastname: Liu
authors.forename: Philip C
authors.initials: PC
authors.lastname: Nasca
authors.forename: Biao
authors.initials: B
authors.lastname: Zhang
authors.forename: Yanping
authors.initials: Y
authors.lastname: Wu
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.forename: Margaret
authors.initials: M
authors.lastname: Gates
authors.forename: Tao
authors.initials: T
authors.lastname: Lu
authors.forename: Xiaonong
authors.initials: X
authors.lastname: Zou
authors.forename: Fang
authors.initials: F
authors.lastname: Xue
authors.forename: Lei
authors.initials: L
authors.lastname: Hou
authors.forename: Zixing
authors.initials: Z
authors.lastname: Wang
authors.forename: Yuyan
authors.initials: Y
authors.lastname: Wang
authors.forename: Yuanli
authors.initials: Y
authors.lastname: Chen
authors.forename: Junyao
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D002947:Cities / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012907:Smoking / Q000453:epidemiology*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000401:mortality*
chemical_list: D014028:Tobacco Smoke Pollution