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与烟草有关的癌症的比率增加。虽然吸烟率在教育水平和职业地位较低的人中较高，但吸烟率并不能解释这种过度风险。在前瞻性队列研究中，在调整吸烟量和持续时间后，低SES与肺癌风险升高之间的相关性仍然存在。研究人员的总体假设是，SES较低的人群中不明原因的风险增加是由于更高的烟雾暴露，而自我报告的吸烟习惯无法解释。他们先前的实验室研究表明，每支香烟对烟草烟雾毒素和致癌物的生物暴露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：具体目标1。确定SES是否与吸烟抽吸行为相关，包括抽吸量、持续时间、间隔和吸烟长度。具体目标2。确定SES是否与吸烟暴露的生物标志物相关，包括唾液可替宁和呼出的一氧化碳。这解决了SES假设使用生物措施的剂量，除了环境措施，如膨化剂量。具体目标3。将烟雾暴露的环境和生物措施联系起来。这一目标将确定是否主流烟雾暴露水平，估计由吸烟配置文件的生物水平的香烟烟雾暴露的决定因素，以及这种关系是否不同的SES。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设。具体目标4。通过心理量表和唾液应激生物标志物评估，确定心理应激对吸烟抽吸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（PA）的阿巴拉契亚进行，这是一个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，较低的SES与较高的吸烟量有关，这是由地形和烟雾生物标志物确定的，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。 公共卫生相关性：癌症控制工作的一个主要目标是了解癌症发病率社会不平等的原因。社会经济地位较低的吸烟者比社会经济地位较高的吸烟者患肺癌和其他烟草相关疾病的几率更高。由于吸烟是一种可以改变的行为，因此，在低SES吸烟者中，更密集的吸烟和更大的烟草烟雾暴露可能有助于制定更有效和更有针对性的吸烟控制措施。

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. PUBLIC HEALTH RELEVANCE: A major objective of cancer control efforts is to understand the causes of social inequalities in cancer rates. Cigarette smokers of lower socioeconomic status (SES) have increased rates of lung cancer and other tobacco-related diseases than smokers of higher SES. Because smoking is a modifiable behavior, findings that demonstrate more intensive smoking and greater exposure to tobacco smoke among low SES smokers may be helpful in developing more effective and targeted smoking control efforts.