title: An Ecological Analysis of Tobacco Use and Oral Cavity and Pharynx Cancers in U.S. Males.
abstract: BACKGROUND
  As the 8th most frequently diagnosed cancers among U.S. males, cancers of the oral cavity and pharynx are a significant component of the cancer burden among U.S. males. Avoidance of tobacco products is critical for the prevention of oral cavity and pharynx cancers. The objective of this brief report was to describe state-specific incidence rates of oral cavity and pharynx cancers and to examine the correlation between state-specific prevalences of tobacco use and oral cavity and pharynx cancer incidence rates among U.S. adult males.
  
  
  METHODS
  Secondary surveillance data were used to conduct this ecological analysis. Incidence rates of oral cavity and pharynx cancers during 2009 through 2011 among males were obtained from the Centers for Disease Control and Prevention (CDC) WONDER system. Prevalences of cigarette smoking and smokeless tobacco use during 1995 and 1996 among males were obtained from the CDC STATE System. Relations were examined by calculating Pearson correlation coefficients and by performing linear regression analysis. Statistical significance was considered at alpha < 0.05.
  
  
  RESULTS
  Current cigarette smoking prevalence was significantly correlated (r = 0.57; r2 = 0.33; p-value = < .0001) with the incidence rate of oral cavity and pharynx cancer; while there was a non-statistically significant correlation (r = 0.22; r2 = 0.05; p-value = 0.1147) between smokeless tobacco use and oral cavity and pharynx cancer. A 1% increase in the prevalence of current cigarette smoking was estimated to increase the incidence rate of oral cavity and pharynx cancer by 0.52 per 100,000 males. Although non-statistically significant, a 1% increase in the prevalence of smokeless tobacco use was estimated to increase the incidence rate of oral cavity and pharynx cancer by 0.18 per 100,000 males.
  
  
  CONCLUSIONS
  Among U.S. males, a statistically significant positive correlation was observed between cigarette smoking and oral cancer, but not between smokeless tobacco use and oral cancer. Moreover, current cigarette smoking was estimated to predict one-third of the total variability in oral cancer. These findings contribute to the body of literature and provide further evidence that cigarette smoking is an important behavioral risk factor for oral cavity and pharynx cancer among U.S. males.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Damphousse
authors.forename: Dana S
authors.initials: DS
authors.lastname: Mowls
authors.forename: Laura A
authors.initials: LA
authors.lastname: Beebe
mesh_terms: D006801:Humans; D008297:Male; D009062:Mouth Neoplasms / Q000453:epidemiology* / Q000209:etiology; D010610:Pharyngeal Neoplasms / Q000453:epidemiology* / Q000209:etiology; D064424:Tobacco Use / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology