Tarney CM, et al. - In this large cross-sectional, population-based study, the relationships between an objective biomarker of current tobacco exposure and high-risk genital human papillomavirus (HPV) prevalence were evaluated among adult women in the United States. Researchers identified increased odds of infection with high-risk genital HPV in association with cigarette smoking and exposure to secondhand smoke. This association was noted to be independent of lifetime number of sexual partners.

Methods

• Using three consecutive 2-year cycles (2009–2014) from the cross-sectional National Health and Nutrition Examination Surveys, a retrospective analysis of adult women (aged 18–59 years) was performed.
• Inclusion of women who provided self-collected cervicovaginal swabs and serum was done.
• Using a Linear Array HPV assay, researchers conducted human papillomavirus genotyping on cervicovaginal samples.
• To provide a biomarker of recent tobacco exposure, they assayed cotinine (a major metabolite of nicotine) from serum.
• Based on serum cotinine concentration levels, they stratified participants into three levels of tobacco exposure (nonsmokers, secondhand smoke exposure, and smokers) using previously published ethnic-specific cut points.
• They provided weighted percentages to account for unequal selection probabilities among participants and adjustments for nonresponse.

Results

• Researchers analyzed 5,158 women.
• Of these, 2,778 were classified as nonsmokers (57.1%, 95% CI 54.5–59.6%), 1,109 classified as having secondhand smoke exposure (18.4%, 95% CI 16.5–20.3%), and 1,271 classified as smokers (24.6%, 95% CI 22.8–26.5%) using serum cotinine concentration levels.
• Nicotine exposure groups differed regarding prevalence of HPV infection (P<.001): 441 smokers (32.1%, 95% CI 29.6–34.7%), 322 women with secondhand smoke exposure (26.1%, 95% CI 22.7–29.7%), and 451 nonsmokers (15.1%, 95% CI 13.3–17.1%) had a high-risk genital HPV infection.
• Compared with nonsmokers, risks for infection with a high-risk HPV genotype for smokers (adjusted odds ratio [OR] 1.7, 95% CI 1.4–22) and secondhand smokers (adjusted OR 1.4, 95% CI 1.1–1.8) are similarly increased (P<.001) controlling for demographics and number of lifetime sexual partners.