Tm. Becker et al., CONTRACEPTIVE AND REPRODUCTIVE RISKS FOR CERVICAL DYSPLASIA IN SOUTHWESTERN HISPANIC AND NON-HISPANIC WHITE WOMEN, International journal of epidemiology, 23(5), 1994, pp. 913-922
Background. Various contraceptive practices and reproductive factors h
ave been associated with cervical neoplasia in case-control studies wo
rldwide. Methods. To investigate contraceptive and reproductive risk f
actors associated with high-grade cervical dysplasia in southwestern H
ispanic and non-Hispanic white women, we carried out a clinic-based ca
se-control study among university-affiliate clinic attendees. Results.
Oral contraceptive use ever (odds ratio [OR] = 0.4, 95% confidence in
terval [CI]: 0.2-0.9) and past diaphragm use (OR = 0.3, 95% CI: 0.1-0.
8) were protective for dysplasia in analyses adjusted for age, ethnici
ty, sexual behaviour, and for cervical papillomavirus (HPV) infection.
After further adjustment for Pap smear screening interval. oral contr
aceptive use ever remained protective for dysplasia. Vaginal deliverie
s were strongly associated with dysplasia with > 2 vaginal deliveries
associated with a 3.9-fold increase in risk after adjustment for age,
ethnicity, sexual behaviour, and HPV infection. Using logistic regress
ion models to simultaneously control for effects of multiple factors a
s potentially related to cervical dysplasia, we found low educational
attainment, cervical HPV infection, cigarette smoking, history of any
sexually transmitted disease, and having one or more vaginal deliverie
s to be associated with dysplasia; oral contraceptive use and past dia
phragm use also remained protective for high-grade cervical dysplasia
in these regression analyses. Conclusions. The data suggest that use o
f oral contraceptives (ever) and past diaphragm use are protective for
high-grade cervical dysplasia among Hispanic and non-Hispanic white w
omen in New Mexico. The clinic-based perspective of this research (ver
sus population-based studies) may help explain some of these findings.