title: Differences in Active and Passive Smoking Exposures and Lung Cancer Incidence Between Veterans and Non-Veterans in the Women's Health Initiative.
abstract: BACKGROUND
  Women Veterans may have higher rates of both active and passive tobacco exposure than their civilian counterparts, thereby increasing their risk for lung cancer.
  
  
  OBJECTIVE
  To compare differences in active and passive smoking exposure and lung cancer incidence among women Veterans and non-Veterans using prospective data from the Women's Health Initiative (WHI).
  
  
  METHODS
  We used data from the WHI, which collected longitudinal demographic, clinical, and laboratory data on 161,808 postmenopausal women. We employed linear and multinomial regression and generalized linear models to compare active and passive smoking exposure between Veterans and non-Veterans and Cox proportional hazards models to estimate differences in lung cancer incidence rates.
  
  
  RESULTS
  After adjustment, Veterans had 2.54 additional pack years of smoking compared with non-Veterans (95% confidence interval [CI] 1.68, 3.40). Veterans also had a 1% increase in risk of any passive smoking exposure (95% CI 1.00, 1.02) and a 9% increase in risk of any workplace exposure (95% CI 1.07, 1.11) compared with non-Veterans. After adjustment for age and smoking exposures, Veterans did not have a higher risk of lung cancer compared with non-Veterans (relative risk = 1.06 95% CI 0.86, 1.30).
  
  
  CONCLUSIONS
  Women Veterans had higher rates of tobacco use and exposure to passive smoking, which were associated with a higher risk for lung cancer compared with non-Veterans. Clinicians who care for Veterans need to be aware that older women Veterans have more exposures to risk factors for lung cancer.
authors.affiliation: VA Connecticut, Newington. Division of General Internal Medicine, University of Connecticut, Farmington. lori.bastian@va.gov.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
authors.affiliation: Health Services Research and Development (HSR&D), VA Puget Sound Health Care System, Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Gray
authors.affiliation: VA Connecticut, Newington.
authors.forename: Eric
authors.initials: E
authors.lastname: DeRycke
authors.affiliation: VA Connecticut, Newington. Department of Medicine, University of Connecticut, Newington.
authors.forename: Shireen
authors.initials: S
authors.lastname: Mirza
authors.affiliation: Durham VA Medical Center, North Carolina. Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Gierisch
authors.affiliation: VA Office of Patient Care, Women's Health Services, Washington, District of Columbia. VA Connecticut Health Care System, West Haven, Connecticut. Department of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Sally G
authors.initials: SG
authors.lastname: Haskell
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University South Carolina, Charleston. VA Medical Center, Charleston, South Carolina.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Magruder
authors.affiliation: Department of Medicine, Oncology, Stanford University, California.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Wakelee
authors.affiliation: Department of Medicine, Stanford University, California.
authors.forename: Ange
authors.initials: A
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Gloria Y F
authors.initials: GY
authors.lastname: Ho
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology*; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology*; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D055752:Small Cell Lung Carcinoma / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology*; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Lung cancer; Smoking; Tobacco; Women Veterans