Risk for cervical intraepithelial neoplasia grade 3 or worse in relation to smoking among women with persistent human papillomavirus infection.

BACKGROUND: Smoking has been associated with cervical cancer. We examined whether smoking increases the risk for high-grade cervical lesions in women with high-risk human papillomavirus (HPV) infection. METHODS: In a population-based cohort study, 8,656 women underwent a structured interview, and subsequently cervical cells were obtained for HPV DNA testing. Women with high-risk HPV infection and no prevalent cervical disease at baseline (n = 1,353) were followed through the Pathology Data Bank for cervical lesions for up to 13 years. Separate analyses of women with persistent high-risk HPV infection (n = 312) were also conducted. HRs for a diagnosis of cervical intraepithelial neoplasia grade 3 or worse/high-grade squamous intraepithelial lesions or worse (CIN3+) and the corresponding 95% confidence intervals (CI) were calculated in the two groups. RESULTS: Among high-risk HPV-positive women, an increased risk for CIN3+ was associated with long-term smoking (≥10 years) and heavy smoking (≥20 cigarettes/d). In the subgroup of women with persistent HPV infection, heavy smoking was also associated with a statistically significantly higher risk for CIN3+ than never smoking (HR, 1.85; 95% CI, 1.05-3.22, adjusted for length of schooling, parity, and HPV type at baseline). The average number of cervical cytology screening tests per year during follow-up did not explain the differences in risk in relation to smoking (P = 0.4). CONCLUSIONS: Smoking is associated with an increased risk for subsequent high-grade cervical lesions in women with persistent high-risk HPV infection. IMPACT: Our study adds to the understanding of the role of smoking in the natural history of HPV and cervical carcinogenesis.

Young age at first intercourse and risk-taking behaviours--a study of nearly 65 000 women in four Nordic countries.

BACKGROUND: Risk-taking behaviours such as early initiation of smoking, alcohol drinking and sexual activity often cluster within individuals and could be characteristics of adolescents who in general are risk takers. In the present study, using a large population-based sample of 64 659 women aged 18-45 years in four Nordic countries, we investigate whether young age at first sexual intercourse is associated with subsequent risk-taking behaviours. METHODS: We examined the association between young age at first sexual intercourse (age ≤14 years) and subsequent risk-taking behaviours by using multivariate logistic regression by which odds ratios (ORs) and the corresponding 95% confidence intervals (95% CIs) were estimated. RESULTS: The OR of reporting more than 10 lifetime sexual partners was almost four times higher among women who reported a young age at first intercourse (OR = 3.79; 95% CI: 3.60-4.00) in comparison with women >14 years at first intercourse. Furthermore, women who were young at first intercourse were more likely to report two or more recent partners (OR = 1.67; 95% CI: 1.54-1.82) and to have a history of STIs (OR = 2.03; 95% CI: 1.93-2.13). In addition, young age at first intercourse was associated with current smoking (OR = 2.31; 95% CI: 2.20-2.43) and binge drinking (OR = 1.36; 95% CI: 1.28-1.44). All ORs were adjusted for age, years of education and country of residence. CONCLUSION: Young age at first intercourse is associated with subsequent risk-taking behaviours. Our study emphasizes the importance of targeting prevention efforts towards the complexity of risk-taking behaviours.

Women's sexual behavior. Population-based study among 65,000 women from four Nordic countries before introduction of human papillomavirus vaccination.

OBJECTIVE: Sexual behavior is of public health interest because of the association with reproductive health and sexually transmitted infections such as human papillomavirus, which is the causal factor of cervical cancer. The aim of the study was to describe patterns in women's sexual behavior in four Nordic countries. DESIGN: Population-based cross-sectional study. SETTING: Denmark, Iceland, Norway, and Sweden (November 2004-June 2005). POPULATION: A random sample of 18-45-year-old women from the female population in the four participating Nordic countries. The participation rate ranged from 81.3% in Denmark to 54.5% in Iceland. In total, 65 623 women were included. METHODS: Each participant completed a structured questionnaire containing questions about sociodemographic factors, lifestyle factors and sexual behavior. MAIN OUTCOME MEASURES: Age-specific and country-specific descriptive measures of sexual behavior, notably age at first intercourse and lifetime number of partners. In addition, risk factors for having had multiple (>10) sexual partners were examined. RESULTS: Overall, median age at first intercourse was 16, and 30.2% (95% CI: 29.9-30.6) of the participating women reported having had ≥10 partners. There was great variation with birth cohort but limited variation between countries. The main correlates of multiple sexual partners were increasing age at enrollment, a higher alcohol intake and young age at first intercourse. CONCLUSIONS: These measurements of sexual behavior before the introduction of national human papillomavirus vaccination programs will form the basis for a comparison with a similar survey performed after vaccination has been introduced.

[''Liva"--population survey of female sexual habits]. / "Liva"--en befolkningsundersøgelse af kvinders seksualvaner.

INTRODUCTION: Sexual and contraceptive habits, e.g. early age at first intercourse, multiple sexual partners and non-use of condoms, are well-established risk factors for sexually transmitted infections and unwanted pregnancy. The aim was to examine if and how educational level and degree of urbanization are related to age at first intercourse, lifetime number of sexual partners and condom use. MATERIAL AND METHODS: We used data from a large population-based questionnaire survey conducted during 2004-2005, including a random sample of 20,478 women (18-45 years) (participation rate: 81.4%). We used multiple logistic regression analysis to estimate odds ratios (OR) of early sexual debut (≤ 15 years old), having had > 5 lifetime sexual partners and never-use of condoms associated with educational level and degree of urbanization. The OR of having had an early sexual debut was almost twofold higher among women with a lower educational level (OR = 1.93; 95% CI: 1.73-2.15) than among women with higher educational level, and the OR of having had > 5 lifetime sexual partners was highest among women in the capital centre (OR = 2.36; 95% CI: 2.16-2.57) compared with women in the small provincial town areas. Furthermore, the OR of never-use of condoms was 2.53 (95% CI: 2.15-2.97) for women with a lower educational level compared with those with a higher educational level (mutually adjusted for age, degree of urbanization and educational level). CONCLUSION: Low educational level is associated with young age at first sexual intercourse and never-use of condoms, and living in an area of high urbanization is associated with a higher lifetime number of sexual partners. This information may be of importance for prevention in relation to women's reproductive health.

Social inequality and incidence of and survival from cancer of the female genital organs in a population-based study in Denmark, 1994-2003.

We investigated the effects of socioeconomic, demographic and health-related indicators on the incidence of and survival from cancers of the cervix, endometrium and ovary diagnosed in 1994-2003 with follow-up through 2006 in Denmark using information from nationwide registers. The analyses were based on the data on 3007 patients with cervical cancer, 3826 with endometrial cancer and 3855 with ovarian cancer in a cohort of 3.22 million persons born between 1925 and 1973 and aged >or=30 years. The incidence of cervical cancer increased with decreasing socioeconomic position; the incidences of endometrial and ovarian cancer were mostly associated with higher disposable income. Relative survival from cervical cancer was the highest among women of high socioeconomic position; increased excess mortality rates from endometrial and ovarian cancer were associated with low educational level, mainly during the first year after diagnosis. Socioeconomic position seemed to affect both the incidence of and the survival from cancers of the female genital organs.