Socioeconomic status and smoking exposure in Appalachia

描述（由申请人提供）：社会不平等是疾病发病率的重要预测因素，包括癌症。社会经济地位低的人患肺癌和其他烟草相关癌症的比率增加。虽然受教育程度和职业状况较低的人的吸烟率较高，但吸烟率并不能解释这种过高的风险。在前瞻性队列研究中，在调整吸烟数量和持续时间后，低社会经济地位与肺癌风险升高之间的关联仍然存在。研究人员的总体假设是，在社会经济地位较低的人群中，未被解释的风险增加是由于更多的吸烟暴露，而这不能用自我报告的吸烟习惯来解释。他们之前的实验室研究表明，每吸一支烟，接触烟草烟雾毒素和致癌物的生物程度存在很大差异。研究者建议在宾夕法尼亚州阿巴拉契亚医疗服务不足的地区开展一项基于社区的参与性研究，以确定SES与吸入主流烟雾剂量和烟草烟雾暴露生物标志物剂量之间的关系。具体目标是：确定SES是否与吸烟吞云吐雾行为有关，包括吞云吐雾量、持续时间、间隔时间和吸烟时长。具体目标2。确定SES是否与吸烟暴露的生物标志物有关，包括唾液可替宁和过期一氧化碳。除了使用诸如雾化剂量等环境措施外，还使用剂量的生物测量来解决SES假说。具体目标3。将烟雾暴露的环境和生物测量相关联。这一目标将确定主流烟雾暴露水平（如通过雾化剖面估计的那样）是否是香烟烟雾暴露生物学水平的决定因素，以及这种关系是否因SES而异。这将目标1和目标2结合在一起，以全面解决社会经济地位假说。具体目标通过心理量表和唾液压力生物标志物评估，确定心理压力对吸烟参数和唾液可替宁水平的影响。拟议的研究将在宾夕法尼亚州的阿巴拉契亚（PA）进行，这是一个美国国立卫生研究院指定的医疗服务不足但社会经济多样化的人群。研究人员预测，由地形和烟雾生物标志物决定，较低的社会经济地位与较高的吸烟摄入量有关，这一发现将有助于解释长期观察到的肺癌发病率差异模式。

DESCRIPTION (provided by applicant): Social inequalities are an important predictor of disease incidence, including cancer. Persons with low socioeconomic status (SES) have increased rates of lung and other tobacco-related cancers. Although smoking prevalence is higher in persons with lower levels of education and occupational status, smoking prevalence does not explain this excess risk. In prospective cohort studies, the associations between low SES and elevated lung cancer risk persist after adjustment for smoking amount and duration. The investigators' overall hypothesis is that the unaccounted increased risk in populations with lower SES is due to higher smoke exposure that cannot be accounted for by self-reported smoking habits. Their previous laboratory studies demonstrate that there is a wide degree of variation in biological exposure to tobacco smoke toxins and carcinogens per cigarette smoked. The investigators propose to conduct a community-based participatory study in the medically underserved area of Appalachian Pennsylvania to determine the relationship between SES and the dose of inhaled mainstream smoke and the dose of biological markers of tobacco smoke exposure. Specific aims are: Specific Aim 1. Determine whether SES is associated with smoking puffing behaviors including puff volume, duration, interval, and length of cigarette smoked. Specific Aim 2. Determine whether SES is associated with biomarkers of smoking exposure including salivary cotinine and expired carbon monoxide. This addresses the SES hypothesis using biological measures of dose in addition to environmental measures such as puffing dose. Specific Aim 3. Correlate environmental and biological measures of smoke exposure. This aim will determine whether levels of mainstream smoke exposure, as estimated by puffing profiles are determinants of the biological levels of cigarette smoke exposure, and whether this relationship differs by SES. This brings together aims 1 and 2 to comprehensively address the SES hypothesis. Specific Aim 4. Determine the effects of psychological stress, as assessed by psychological scales and salivary stress biomarkers, on smoking puffing parameters and salivary cotinine levels. The proposed research study will be conducted in Appalachia, Pennsylvania (PA), a NIH-designated medically underserved but socioeconomically diverse population. The investigators predict that lower SES is associated with higher smoke intake as determined by topography and smoke biomarkers, and that this finding will help to explain the long-observed patterns of lung cancer incidence disparities.