Socioeconomic status and smoking exposure in Appalachia

描述(申请人提供)：社会不平等是包括癌症在内的疾病发病率的重要预测因素。社会经济地位低的人患肺癌和其他与烟草有关的癌症的几率更高。尽管受教育程度和职业地位较低的人吸烟率较高，但吸烟率并不能解释这种额外的风险。在前瞻性队列研究中，在调整吸烟量和持续时间后，低SES和高肺癌风险之间的关联仍然存在。研究人员的总体假设是，在SES较低的人群中，不明原因的风险增加是由于更高的吸烟暴露，而这不能用自我报告的吸烟习惯来解释。他们以前的实验室研究表明，每吸一支香烟，在生物接触烟草烟雾、毒素和致癌物质方面存在很大程度的差异。研究人员建议在宾夕法尼亚州阿巴拉契亚医疗服务不足的地区进行一项基于社区的参与性研究，以确定SES与吸入主流烟雾的剂量和烟草烟雾暴露的生物标志物剂量之间的关系。具体目标是：具体目标1。确定SES是否与吸烟行为有关，包括吸烟量、持续时间、间隔时间和吸烟时间。具体目标2.确定SES是否与吸烟暴露的生物标志物相关，包括唾液可替宁和过期一氧化碳。这解决了SES假说，除了使用膨化剂量等环境测量之外，还使用了生物剂量测量。具体目标3.将烟雾暴露的环境和生物措施联系起来。这一目标将决定主流烟雾暴露水平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SES假说。具体目标4.通过心理量表和唾液压力生物标记物评估心理压力对吸烟膨胀参数和唾液可替宁水平的影响。这项拟议的研究将在宾夕法尼亚州阿巴拉契亚(PA)进行，这是NIH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确定的较低的SES与较高的烟雾摄入量有关，这一发现将有助于解释长期以来观察到的肺癌发病率差异的模式。

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.