Tobacco Use and Prevalence of Human Papillomavirus in Self-Collected Cervicovaginal Swabs Between 2009 and 2014

OBJECTIVE:To evaluate relationships between an objective biomarker of current tobacco exposure and high-risk genital human papillomavirus (HPV) prevalence among adult women in the United States. METHODS:We performed a retrospective analysis of adult women (aged 18–59 years) using three consecutive 2-year cycles (2009–2014) from the cross-sectional National Health and Nutrition Examination Surveys. Women who provided self-collected cervicovaginal swabs and serum were included. Human papillomavirus genotyping was conducted on cervicovaginal samples with a Linear Array HPV assay. Cotinine, a major metabolite of nicotine, was assayed from serum to provide a biomarker of recent tobacco exposure. Participants were stratified into three levels of tobacco exposure (nonsmokers, secondhand smoke exposure, and smokers) based on serum cotinine concentration levels using previously published ethnic-specific cut points. Weighted percentages are provided to account for unequal selection probabilities among participants and adjustments for nonresponse. RESULTS:Among the 5,158 women analyzed, 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. Prevalence of HPV infection differed between nicotine exposure groups (P