The purpose of this nested case-control study is to investigate the
synergistic relationship between human papillomaviruses (HPV) and diet,
cigarette smoking and race, in the development of cervical intraepithelial
neoplasia (CIN) among low-income and rural South Carolinians. South
Carolina health department family planning clinic clients will be the
cohort within which this study is nested. From March 1991 to March 1992
cervical samples were collected from each woman receiving a Pap smear at
one of eleven clinics in the Charleston area (N = 8,000). Incident cases
will be women developing CIN (either CIN I, II, or III) over this FIRST
Award time period who also had a normal Pap smear between March 1991-1992
(and had a cervical sample collected for HPV typing). Controls will be
women with normal cervical cytology in 1991-1992 who did not develop CIN
in the subsequent follow-up years. The HPV DNA type of these cases and
controls will be determined in the stored sample using polymerase chain
Cases and controls will be interviewed over the telephone to determine
their active and passive cigarette smoke exposure, age, education, parity,
contraceptive use, sexual and reproductive history, and history of
sexually transmitted diseases. Dietary intake will be determined using a
self-administered short version of the NCI Health Habits and Diet History
questionnaire. The analysis will compare cases with controls regarding (a)
HPV infection status, (b) cigarette smoke exposure (active and passive),
and (c) dietary nutrient levels. We will investigate the consistency of
findings across racial groups (blacks and whites) by CIN level.
Interaction between HPV 16/18/33 and dietary nutrient levels, smoking
exposures, race and contraceptive use, on CIN risk will also be evaluated.
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