{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T09:21:52Z","timestamp":1759483312486,"version":"3.37.3"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100022236","name":"Office of Research and Development, University of Botswana","doi-asserted-by":"publisher","award":["R1271"],"award-info":[{"award-number":["R1271"]}],"id":[{"id":"10.13039\/501100022236","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Cervical cancer, a malignancy caused by infection with oncogenic human papillomavirus, disproportionally affects women from low resource settings. Persistence of human papillomavirus infection may mediate an association between tobacco use and cervical cancer. In limited resource settings, women from indigenous communities are often marginalized and do not benefit from evidence-based interventions to prevent tobacco use or cervical cancer due to the limited reach of mainstream healthcare services to these communities. This study determined the association between smoking and high-risk human papillomavirus infection among women from indigenous communities in western Botswana.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cross-sectional study of women in indigenous communities was conducted between June and October 2022. Demographic, clinical and self-reported smoking data were collected. Cervical cytology and HPV DNA testing for high-risk human papillomavirus genotypes were performed. Multilevel multivariable logistic regression models were fit to evaluate the association between smoking and high-risk human papillomavirus infection while adjusting for potential confounders.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 171 participants with a median (interquartile range) age of 40 (31\u201350) years from three settlements and two villages were recruited for the study. Of these, 17% were current smokers, 32.8% were living with HIV and high-risk human papillomavirus DNA was detected in 32.8% of the cervical specimens. Women who were current smokers, were nearly twice as likely to have cervical high-risk human papillomavirus infection compared to non-smokers (Adjusted Odds Ratio (95% CI); 1.74(1.09, 2.79)) after controlling for confounders.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>These data underscore the need for effective tobacco control to help mitigate cervical cancer risk in this setting. These findings can help inform decisions about targeted cervical cancer prevention and tobacco cessation interventions for women from indigenous communities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0302153","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T18:06:00Z","timestamp":1717783560000},"page":"e0302153","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["The association between smoking and cervical human papillomavirus infection among women from indigenous communities in western Botswana"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8534-7198","authenticated-orcid":true,"given":"Billy M.","family":"Tsima","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keneilwe","family":"Motlhatlhedi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirthana","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Rantshabeng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8775-3966","authenticated-orcid":true,"given":"Andrew","family":"Ndlovu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tendani","family":"Gaolathe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynnette T.","family":"Kyokunda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"issue":"4","key":"pone.0302153.ref001","article-title":"Human Papillomavirus","volume":"4","author":"EM Burd","year":"2016","journal-title":"Microbiology Spectrum"},{"issue":"Suppl 5","key":"pone.0302153.ref002","doi-asserted-by":"crossref","first-page":"F55","DOI":"10.1016\/j.vaccine.2012.06.083","article-title":"The biology and life-cycle of human papillomaviruses","volume":"30","author":"J Doorbar","year":"2012","journal-title":"Vaccine"},{"issue":"5","key":"pone.0302153.ref003","first-page":"342","article-title":"Papillomaviruses and cancer: from basic studies to clinical application. Nature Reviews","volume":"2","author":"H. zur Hausen","year":"2002","journal-title":"Cancer"},{"issue":"2","key":"pone.0302153.ref004","doi-asserted-by":"crossref","first-page":"e191","DOI":"10.1016\/S2214-109X(19)30482-6","article-title":"Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis","volume":"8","author":"M Arbyn","year":"2020","journal-title":"The Lancet. Global Health"},{"issue":"Suppl 5","key":"pone.0302153.ref005","doi-asserted-by":"crossref","first-page":"F32","DOI":"10.1016\/j.vaccine.2012.07.092","article-title":"The burden of human papillomavirus infections and related diseases in sub-saharan Africa","volume":"31","author":"H De Vuyst","year":"2013","journal-title":"Vaccine"},{"issue":"7","key":"pone.0302153.ref006","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.3390\/vaccines11071246","article-title":"Implementation Strategies Used to Increase Human Papillomavirus Vaccination Uptake by Adolescent Girls in Sub-Saharan Africa: A Scoping Review","volume":"11","author":"MK Lubeya","year":"2023","journal-title":"Vaccines"},{"issue":"Suppl 5","key":"pone.0302153.ref007","doi-asserted-by":"crossref","first-page":"F12","DOI":"10.1016\/j.vaccine.2012.07.055","article-title":"Global burden of human papillomavirus and related diseases","volume":"30","author":"D Forman","year":"2012","journal-title":"Vaccine"},{"issue":"10","key":"pone.0302153.ref008","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1086\/383479","article-title":"Relationship between smoking and human papillomavirus infections in HIV-infected and -uninfected women","volume":"189","author":"H Minkoff","year":"2004","journal-title":"The Journal of Infectious Diseases"},{"issue":"1","key":"pone.0302153.ref009","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.pec.2019.07.026","article-title":"Are health care providers making the most of patient encounters to promote HPV vaccination among cigarette smokers?","volume":"103","author":"LT Wigfall","year":"2020","journal-title":"Patient Education and Counseling"},{"issue":"11","key":"pone.0302153.ref010","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1158\/1055-9965.EPI-06-0399","article-title":"Synergy between cigarette smoking and human papillomavirus type 16 in cervical cancer in situ development","volume":"15","author":"AS Gunnell","year":"2006","journal-title":"Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology"},{"issue":"2\u20133","key":"pone.0302153.ref011","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/0165-1161(94)90057-4","article-title":"DNA adducts in cervical tissue of smokers and non-smokers","volume":"313","author":"DH Phillips","year":"1994","journal-title":"Mutation Research"},{"issue":"11","key":"pone.0302153.ref012","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.annepidem.2017.10.004","article-title":"Smoking and subsequent human papillomavirus infection: a mediation analysis","volume":"27","author":"RC Eldridge","year":"2017","journal-title":"Annals of Epidemiology"},{"issue":"4","key":"pone.0302153.ref013","doi-asserted-by":"crossref","first-page":"2741733","DOI":"10.17061\/phrp2741733","article-title":"The Aboriginal and Torres Strait Islander smoking epidemic: what stage are we at, and what does it mean?","volume":"27","author":"R Lovett","year":"2017","journal-title":"Public Health Research & Practice"},{"issue":"5","key":"pone.0302153.ref014","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1136\/tobaccocontrol-2018-054508","article-title":"Commercial tobacco and indigenous peoples: a stock take on Framework Convention on Tobacco Control progress","volume":"28","author":"R Maddox","year":"2019","journal-title":"Tobacco Control"},{"issue":"5","key":"pone.0302153.ref015","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1093\/ntr\/ntw288","article-title":"Smoking in Pregnancy Among Indigenous Women in High-Income Countries: A Narrative Review","volume":"19","author":"GS Gould","year":"2017","journal-title":"Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco"},{"issue":"3","key":"pone.0302153.ref016","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1097\/IGC.0000000000000375","article-title":"Factors associated with cancer-specific and overall survival among Indigenous and non-Indigenous gynecologic cancer patients in Queensland, Australia: a matched cohort study","volume":"25","author":"A Diaz","year":"2015","journal-title":"International Journal of Gynecological Cancer: Official Journal of the International Gynecological Cancer Society"},{"key":"pone.0302153.ref017","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/1741-7015-9-104","article-title":"Human papillomavirus prevalence among indigenous and non-indigenous Australian women prior to a national HPV vaccination program.","volume":"9","author":"SM Garland","year":"2011","journal-title":"BMC medicine"},{"key":"pone.0302153.ref018","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s12889-015-2645-x","article-title":"Effective strategies to reduce commercial tobacco use in Indigenous communities globally: A systematic review","volume":"16","author":"A Minichiello","year":"2016","journal-title":"BMC public health"},{"issue":"1","key":"pone.0302153.ref019","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/s12939-019-1059-2","article-title":"Barriers and facilitators to the implementation of brief interventions targeting smoking, nutrition, and physical activity for indigenous populations: a narrative review","volume":"18","author":"M Fazelipour","year":"2019","journal-title":"International Journal for Equity in Health"},{"issue":"10","key":"pone.0302153.ref020","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1002\/ijc.27485","article-title":"Human papillomavirus types in 115,789 HPV-positive women: a meta-analysis from cervical infection to cancer","volume":"131","author":"P Guan","year":"2012","journal-title":"International Journal of Cancer"},{"issue":"5","key":"pone.0302153.ref021","first-page":"779","article-title":"From Papanicolaou to Bethesda: the rationale for a new cervical cytologic classification","volume":"77","author":"RJ Kurman","year":"1991","journal-title":"Obstetrics and Gynecology"},{"issue":"6","key":"pone.0302153.ref022","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1136\/jech.2004.023473","article-title":"A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon","volume":"59","author":"J Merlo","year":"2005","journal-title":"Journal of Epidemiology and Community Health"},{"issue":"12","key":"pone.0302153.ref023","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1136\/jech.2004.028035","article-title":"A brief conceptual tutorial on multilevel analysis in social epidemiology: interpreting neighbourhood differences and the effect of neighbourhood characteristics on individual health","volume":"59","author":"J Merlo","year":"2005","journal-title":"Journal of Epidemiology and Community Health"},{"key":"pone.0302153.ref024","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ssmph.2018.05.006","article-title":"General and specific contextual effects in multilevel regression analyses and their paradoxical relationship: A conceptual tutorial","volume":"5","author":"J Merlo","year":"2018","journal-title":"SSM\u2014population health"},{"issue":"6","key":"pone.0302153.ref025","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1177\/0146621617695521","article-title":"Comparison of Relative Fit Indices for Diagnostic Model Selection","volume":"41","author":"S Sen","year":"2017","journal-title":"Applied Psychological Measurement"},{"issue":"3","key":"pone.0302153.ref026","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.ygyno.2012.08.033","article-title":"Prevalence and risk factors for cervical HPV infection and abnormalities in young adult women at enrolment in the multinational PATRICIA trial","volume":"127","author":"E Roset Bahmanyar","year":"2012","journal-title":"Gynecologic Oncology"},{"issue":"3","key":"pone.0302153.ref027","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1002\/ijc.24752","article-title":"Predictors of human papillomavirus persistence among women with equivocal or mildly abnormal cytology","volume":"126","author":"D Maucort-Boulch","year":"2010","journal-title":"International Journal of Cancer"},{"issue":"2","key":"pone.0302153.ref028","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.ejca.2009.09.015","article-title":"Cigarette smoking is an independent risk factor for cervical intraepithelial neoplasia in young women: a longitudinal study","volume":"46","author":"S Collins","year":"2010","journal-title":"European Journal of Cancer (Oxford, England: 1990)"},{"issue":"6","key":"pone.0302153.ref029","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/CEJ.0000000000000822","article-title":"Duration of human papillomavirus persistence and its relationship with recurrent cervical dysplasia","volume":"32","author":"G Bogani","year":"2023","journal-title":"European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP)"},{"key":"pone.0302153.ref030","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ygyno.2023.04.030","article-title":"Ten-year outcomes following laparoscopic and open abdominal radical hysterectomy for \u201clow-risk\u201d early-stage cervical cancer: A propensity-score based analysis","volume":"174","author":"V Di Donato","year":"2023","journal-title":"Gynecologic Oncology"},{"issue":"7","key":"pone.0302153.ref031","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1038\/sj.bjc.6604972","article-title":"Persistence of HPV infection and risk of high-grade cervical intraepithelial neoplasia in a cohort of Colombian women","volume":"100","author":"N Mu\u00f1oz","year":"2009","journal-title":"British Journal of Cancer"},{"issue":"3","key":"pone.0302153.ref032","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1093\/ije\/dyn033","article-title":"Smoking and human papillomavirus infection: pooled analysis of the International Agency for Research on Cancer HPV Prevalence Surveys","volume":"37","author":"S Vaccarella","year":"2008","journal-title":"International Journal of Epidemiology"},{"key":"pone.0302153.ref033","first-page":"176","article-title":"Human papillomavirus prevalence and risk factors among HIV-negative and HIV-positive women residing in rural Eastern Cape, South Africa","volume":"95","author":"O Taku","year":"2020","journal-title":"International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases"},{"issue":"4","key":"pone.0302153.ref034","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1155\/2007\/136906","article-title":"HPV infections in adolescents","volume":"23","author":"A-B Moscicki","year":"2007","journal-title":"Disease Markers"},{"issue":"4","key":"pone.0302153.ref035","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.ogc.2008.09.004","article-title":"Management of adolescents who have abnormal cytology and histology","volume":"35","author":"A-B Moscicki","year":"2008","journal-title":"Obstetrics and Gynecology Clinics of North America"},{"issue":"2","key":"pone.0302153.ref036","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1783\/147118909787931979","article-title":"Early age of sexual debut: a risky experience","volume":"35","author":"M. Stanley","year":"2009","journal-title":"The Journal of Family Planning and Reproductive Health Care"},{"issue":"1","key":"pone.0302153.ref037","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12879-022-07130-x","article-title":"HPV prevalence among young adult women living with and without HIV in Botswana for future HPV vaccine impact monitoring","volume":"22","author":"N McClung","year":"2022","journal-title":"BMC infectious diseases"},{"issue":"1","key":"pone.0302153.ref038","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12889-022-14879-y","article-title":"Prevalence and correlates of tobacco use in Botswana: evidence from the 2014 Botswana STEPwise survey","volume":"23","author":"M Keetile","year":"2023","journal-title":"BMC public health"},{"issue":"5","key":"pone.0302153.ref039","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1159\/000328554","article-title":"ASCUS-LSIL Triage Study. Design, methods and characteristics of trial participants","volume":"44","author":"M Schiffman","year":"2000","journal-title":"Acta Cytologica"},{"issue":"1","key":"pone.0302153.ref040","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1136\/tobaccocontrol-2016-053266","article-title":"Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries","volume":"27","author":"CT Sreeramareddy","year":"2018","journal-title":"Tobacco Control"},{"issue":"7","key":"pone.0302153.ref041","doi-asserted-by":"crossref","first-page":"e0132401","DOI":"10.1371\/journal.pone.0132401","article-title":"A Systematic Review of Tobacco Smoking Prevalence and Description of Tobacco Control Strategies in Sub-Saharan African Countries; 2007 to 2014","volume":"10","author":"R Brathwaite","year":"2015","journal-title":"PloS One"},{"issue":"9972","key":"pone.0302153.ref042","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/S0140-6736(15)60312-9","article-title":"Exposing and addressing tobacco industry conduct in low-income and middle-income countries","volume":"385","author":"AB Gilmore","year":"2015","journal-title":"Lancet (London, England)"},{"key":"pone.0302153.ref043","volume-title":"WHO global report on trends in prevalence of tobacco smoking 2000\u20132025","author":"World Health Organization","year":"2018","edition":"2"},{"issue":"6","key":"pone.0302153.ref044","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1002\/ijc.21493","article-title":"Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies","volume":"118","author":"International Collaboration of Epidemiological Studies of Cervical Cancer","year":"2006","journal-title":"International Journal of Cancer"},{"issue":"1","key":"pone.0302153.ref045","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1080\/1354750X.2020.1853810","article-title":"Comparing cotinine and NNAL verification of self-reported smoking status among lung cancer screening eligible population from the 2007\u20132014 National Health and Nutrition Examination Survey (NHANES)","volume":"26","author":"W Li","year":"2021","journal-title":"Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals"},{"key":"pone.0302153.ref046","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.lungcan.2020.04.019","article-title":"Serum cotinine verification of self-reported smoking status among adults eligible for lung cancer screening in the 1999\u20132018 National Health and Nutrition Examination Survey","volume":"144","author":"B Liu","year":"2020","journal-title":"Lung Cancer (Amsterdam, Netherlands)"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302153","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T18:06:41Z","timestamp":1717783601000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302153"}},"subtitle":[],"editor":[{"given":"Violante","family":"Di Donato","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,6,7]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0302153","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2024,6,7]]}}}