Sexual identity differences in biomarkers of tobacco exposure among women in a national sample |
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| Affiliation: | 1. Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA;2. Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA;3. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA;4. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA;5. Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA;6. Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA;7. Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA;8. Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA;1. Institute for Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany;2. Danish Cancer Society, Strandboulevarden 49, 2100, København, Denmark;1. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda;2. Harvard Medical School, Boston, MA, United States;3. Moi University, Eldoret, Kenya;4. Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;5. University of California, San Francisco, CA, United States;6. Masaka Regional Referral Hospital, Masaka, Uganda;7. Mbarara Regional Referral Hospital, Mbarara, Uganda;8. Indiana University, Indianapolis, IN, United States;1. Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA;2. Division of Metabolism, Endocrinology, and Diabetes and Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA;1. Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Paediatric Oncology and Haematology, Germany;2. Charité-Universistätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Germany;3. Charité-Univesristätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology (iBiKE), Germany;4. St. Anna Kinderspital Vienna, Austria;5. University Hospital Hradec Králové, Czech Republic;6. University Hospital Ostrava, Czech Republic;7. University Hospital Brno, Czech Republic;8. Medical University Bialystok, Poland;9. University Hospital Motol, Prague, Czech Republic;10. Medical University Graz, Austria;11. University of Lucerne, Department of Health Sciences and Medicine, Switzerland;12. Medical University Wroclaw, Poland;13. Kepler Universitätsklinikum GmbH, Linz, Austria;14. Eastern Switzerland University of Applied Sciences, Department of Health Sciences, Institute of Applied Nursing Science, St. Gallen, Switzerland;15. Berlin Institute of Health (BIH), Berlin, Germany;1. Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA;2. Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA;3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA;4. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA;5. Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA;1. Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom;2. Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholin’s Allé 2, 8000, Aarhus C, Denmark |
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| Abstract: | BackgroundSexual minority women are consistently at increased risk for tobacco use compared to heterosexual women. Neither biomarkers of nicotine exposure nor biomarkers of tobacco toxicant exposure have been examined by sexual identity.MethodsThis study used interview and biomarker data from women in the biomarker core sample of Wave 1 of the Population Assessment of Tobacco and Health (PATH) study (2013–2014; n = 4930). We examined associations of sexual identity with nicotine exposure (measured with urinary cotinine and TNE-2) and with tobacco-specific nitrosamines (measured with urinary NNAL). Multivariable regression modeling was used to examine these associations among the full biomarker core sample, among past 30-day tobacco users, and among exclusive established cigarette users before and after controlling for tobacco use quantity and intensity.ResultsIn the full biomarker sample of women, prior to adjusting for tobacco use quantity and intensity, bisexual women had significantly higher cotinine, TNE-2, and NNAL levels compared to heterosexual women. Among exclusive established cigarette users, gay/lesbian women had significantly higher NNAL compared to heterosexual women prior to adjusting for tobacco quantity and intensity. No differences by sexual identity were found after adjusting for tobacco use quantity and intensity.ConclusionsThis is the first study to demonstrate differences in biological markers of tobacco exposure by sexual identity among women in the U.S. This has important public health implications as greater exposure to both nicotine and to tobacco-specific nitrosamines are strongly linked to cancer risk. |
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| Keywords: | Biomarkers of exposure Tobacco use Sexual identity Health disparities Women’s health |
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