Lack of ecological association between state-level cervical and colorectal cancer incidence and nitrosamine exposure from condomuse for a cross-sectional study of the United States Open Access

Abstract

Background: N-nitrosamines are a class of carcinogenic compounds that are commonly found in a wide variety of sources, including tobacco products, cured or fermented foods, and rubber goods, such as latex gloves. Nitrosamines are also found in condoms and no previous research has explored whether condom use is associated with cancer incidence.

Methods: Using state-level data from 2012, potential ecological association between colorectal and cervical cancer incidence and condom use was studied with multiple linear regression models, controlling for potential confounders.

Results: No ecological association between reported condom use and cervical or colorectal cancer was found in either bivariate or multivariable analyses, controlling for variables including race/ethnicity, smoking, obesity, physical activity and fruit/vegetable consumption.

Conclusions: This study finds no evidence indicating an association between nitrosamine exposure from condoms and incidence of cervical and colorectal cancer. Condoms provide substantial and measurable public health benefits, and providers and healthcare organizations should continue to recommend and promote them without hesitation.

Table of Contents

INTRODUCTION........................................................................1

Nitrosamines in food and water.................................................5

Occupational exposure to nitrosamines....................................9

Nitrosamines in rubber products..............................................13

Colorectal cancer......................................................................18

Cervical Cancer.........................................................................19

METHODS.................................................................................21

Data Sources..............................................................................21

Spatial Analysis.........................................................................23

Bivariate association with cancer incidence..............................24

Multivariable association with cancer incidence......................25

RESULTS....................................................................................27

Colorectal Cancer Incidence.....................................................27

Cervical Cancer Incidence.........................................................28

DISCUSSION..............................................................................29

Conclusions................................................................................29

Limitations.................................................................................30

Future directions........................................................................32

APPENDIX..................................................................................34

Figure 1.......................................................................................34

Figure 2.......................................................................................35

Figure 3.......................................................................................36

Figure 4.......................................................................................37

Figure 5......................................................................................38

Figure 6......................................................................................39

Figure 7......................................................................................40

Figure 8......................................................................................41

Table 1........................................................................................42

Table 2.......................................................................................43

Table 3.......................................................................................44

Table 4.......................................................................................45

Table 5.......................................................................................46

Works Cited................................................................................47

Non-printed sources cited.........................................................53

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	cervical cancer United States cancer incidence ecological study colorectal cancer nitrosamine condom
Committee Chair / Thesis Advisor	Guest, Jodie L., Emory University Siegler, Aaron J, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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