Skip to main content
PMC home page
Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 1998 Dec;106(12):813–823. doi: 10.1289/ehp.106-1533247

Long-term concentrations of ambient air pollutants and incident lung cancer in California adults: results from the AHSMOG study.Adventist Health Study on Smog.

W L Beeson 1, D E Abbey 1, S F Knutsen 1
PMCID: PMC1533247  PMID: 9831542

Abstract

The purpose of this study was to evaluate the relationship of long-term concentrations of ambient air pollutants and risk of incident lung cancer in nonsmoking California adults. A cohort study of 6,338 nonsmoking, non-Hispanic, white Californian adults, ages 27-95, was followed from 1977 to 1992 for newly diagnosed cancers. Monthly ambient air pollution data were interpolated to zip code centroids according to home and work location histories, cumulated, and then averaged over time. The increased relative risk (RR) of incident lung cancer in males associated with an interquartile range (IQR) increase in 100 ppb ozone (O3) was 3.56 [95% confidence interval (CI), 1.35-9.42]. Incident lung cancer in males was also positively associated with IQR increases for mean concentrations of particulate matter <10 microm (PM10; RR = 5.21; CI, 1.94-13.99) and SO2 (RR = 2.66; CI, 1.62-4.39). For females, incident lung cancer was positively associated with IQR increases for SO2 (RR = 2.14; CI, 1.36-3.37) and IQR increases for PM10 exceedance frequencies of 50 microg/m3 (RR = 1.21; CI, 0.55-2.66) and 60 microg/m3 (RR = 1.25; CI, 0.57-2.71). Increased risks of incident lung cancer were associated with elevated long-term ambient concentrations of PM10 and SO2 in both genders and with O3 in males. The gender differences for the O3 and PM10 results appeared to be partially due to gender differences in exposure.

Full text

PDF
814

Images in this article

816Figure 1
on p.816
816Figure 2
on p.816
817Figure 3
on p.817
817Figure 4
on p.817
817Figure 5
on p.817

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abbey D. E., Colome S. D., Mills P. K., Burchette R., Beeson W. L., Tian Y. Chronic disease associated with long-term concentrations of nitrogen dioxide. J Expo Anal Environ Epidemiol. 1993 Apr-Jun;3(2):181–202. [PubMed] [Google Scholar]
  2. Abbey D. E., Hwang B. L., Burchette R. J., Vancuren T., Mills P. K. Estimated long-term ambient concentrations of PM10 and development of respiratory symptoms in a nonsmoking population. Arch Environ Health. 1995 Mar-Apr;50(2):139–152. doi: 10.1080/00039896.1995.9940891. [DOI] [PubMed] [Google Scholar]
  3. Abbey D. E., Moore J., Petersen F., Beeson L. Estimating cumulative ambient concentrations of air pollutants: description and precision of methods used for an epidemiological study. Arch Environ Health. 1991 Sep-Oct;46(5):281–287. doi: 10.1080/00039896.1991.9934388. [DOI] [PubMed] [Google Scholar]
  4. Balmes J. R. The role of ozone exposure in the epidemiology of asthma. Environ Health Perspect. 1993 Dec;101 (Suppl 4):219–224. doi: 10.1289/ehp.93101s4219. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bankson D. D., Kestin M., Rifai N. Role of free radicals in cancer and atherosclerosis. Clin Lab Med. 1993 Jun;13(2):463–480. [PubMed] [Google Scholar]
  6. Beeson W. L., Mills P. K., Phillips R. L., Andress M., Fraser G. E. Chronic disease among Seventh-day Adventists, a low-risk group. Rationale, methodology, and description of the population. Cancer. 1989 Aug 1;64(3):570–581. doi: 10.1002/1097-0142(19890801)64:3<570::aid-cncr2820640303>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  7. Borek C. Ozone carcinogenesis in vitro and its co-carcinogenesis with radiation. Discussion paper. Ann N Y Acad Sci. 1988;534:106–110. doi: 10.1111/j.1749-6632.1988.tb30100.x. [DOI] [PubMed] [Google Scholar]
  8. Borek C., Zaider M., Ong A., Mason H., Witz G. Ozone acts alone and synergistically with ionizing radiation to induce in vitro neoplastic transformation. Carcinogenesis. 1986 Sep;7(9):1611–1613. doi: 10.1093/carcin/7.9.1611. [DOI] [PubMed] [Google Scholar]
  9. Breslin K. The impact of ozone. Environ Health Perspect. 1995 Jul-Aug;103(7-8):660–664. doi: 10.1289/ehp.95103660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Breslow N. E. Elementary methods of cohort analysis. Int J Epidemiol. 1984 Mar;13(1):112–115. doi: 10.1093/ije/13.1.112. [DOI] [PubMed] [Google Scholar]
  11. Breslow N. E., Enstrom J. E. Geographic correlations between cancer mortality rates and alcohol-tobacco consumption in the United States. J Natl Cancer Inst. 1974 Sep;53(3):631–639. doi: 10.1093/jnci/53.3.631. [DOI] [PubMed] [Google Scholar]
  12. Bryant K. Impact of air pollution on women's health. Society for the Advancement of Women's Health Research. Otolaryngol Head Neck Surg. 1996 Feb;114(2):267–270. doi: 10.1016/S0194-59989670181-X. [DOI] [PubMed] [Google Scholar]
  13. Cohen A. J., Pope C. A., 3rd Lung cancer and air pollution. Environ Health Perspect. 1995 Nov;103 (Suppl 8):219–224. doi: 10.1289/ehp.95103s8219. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Detels R., Tashkin D. P., Sayre J. W., Rokaw S. N., Massey F. J., Jr, Coulson A. H., Wegman D. H. The UCLA population studies of CORD: X. A cohort study of changes in respiratory function associated with chronic exposure to SOx, NOx, and hydrocarbons. Am J Public Health. 1991 Mar;81(3):350–359. doi: 10.2105/ajph.81.3.350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Dockery D. W., Pope C. A., 3rd, Xu X., Spengler J. D., Ware J. H., Fay M. E., Ferris B. G., Jr, Speizer F. E. An association between air pollution and mortality in six U.S. cities. N Engl J Med. 1993 Dec 9;329(24):1753–1759. doi: 10.1056/NEJM199312093292401. [DOI] [PubMed] [Google Scholar]
  16. Dockery D. W., Schwartz J. Particulate air pollution and mortality: more than the Philadelphia story. Epidemiology. 1995 Nov;6(6):629–632. [PubMed] [Google Scholar]
  17. Drinkard C. R., Sellers T. A., Potter J. D., Zheng W., Bostick R. M., Nelson C. L., Folsom A. R. Association of body mass index and body fat distribution with risk of lung cancer in older women. Am J Epidemiol. 1995 Sep 15;142(6):600–607. doi: 10.1093/oxfordjournals.aje.a117681. [DOI] [PubMed] [Google Scholar]
  18. Euler G. L., Abbey D. E., Magie A. R., Hodgkin J. E. Chronic obstructive pulmonary disease symptom effects of long-term cumulative exposure to ambient levels of total suspended particulates and sulfur dioxide in California Seventh-Day Adventist residents. Arch Environ Health. 1987 Jul-Aug;42(4):213–222. [PubMed] [Google Scholar]
  19. Folinsbee L. J. Human health effects of air pollution. Environ Health Perspect. 1993 Apr;100:45–56. doi: 10.1289/ehp.9310045. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Godlee F. Air pollution: II--Road traffic and modern industry. BMJ. 1991 Dec 14;303(6816):1539–1543. doi: 10.1136/bmj.303.6816.1539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Gong H., Jr Health effects of air pollution. A review of clinical studies. Clin Chest Med. 1992 Jun;13(2):201–214. [PubMed] [Google Scholar]
  22. Greenland S. Modeling and variable selection in epidemiologic analysis. Am J Public Health. 1989 Mar;79(3):340–349. doi: 10.2105/ajph.79.3.340. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Greer J. R., Abbey D. E., Burchette R. J. Asthma related to occupational and ambient air pollutants in nonsmokers. J Occup Med. 1993 Sep;35(9):909–915. doi: 10.1097/00043764-199309000-00014. [DOI] [PubMed] [Google Scholar]
  24. Gross A. J. Presentation: The risk of lung cancer in nonsmokers in the United States and its reported association with environmental tobacco smoke. J Clin Epidemiol. 1995 May;48(5):587–598. doi: 10.1016/0895-4356(94)00166-n. [DOI] [PubMed] [Google Scholar]
  25. Hammond E. C., Garfinkel L. General air pollution and cancer in the United States. Prev Med. 1980 Mar;9(2):206–211. doi: 10.1016/0091-7435(80)90077-8. [DOI] [PubMed] [Google Scholar]
  26. Hassett C., Mustafa M. G., Coulson W. F., Elashoff R. M. Murine lung carcinogenesis following exposure to ambient ozone concentrations. J Natl Cancer Inst. 1985 Oct;75(4):771–777. [PubMed] [Google Scholar]
  27. Hayes S. R. Use of an indoor air quality model (IAQM) to estimate indoor ozone levels. J Air Waste Manage Assoc. 1991 Feb;41(2):161–170. doi: 10.1080/10473289.1991.10466833. [DOI] [PubMed] [Google Scholar]
  28. Health effects of outdoor air pollution. Committee of the Environmental and Occupational Health Assembly of the American Thoracic Society. Am J Respir Crit Care Med. 1996 Jan;153(1):3–50. doi: 10.1164/ajrccm.153.1.8542133. [DOI] [PubMed] [Google Scholar]
  29. Hinds M. W., Kolonel L. N., Lee J., Hirohata T. Associations between cancer incidence and alcohol/cigarette consumption among five ethnic groups in Hawaii. Br J Cancer. 1980 Jun;41(6):929–940. doi: 10.1038/bjc.1980.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Hodgkin J. E., Abbey D. E., Euler G. L., Magie A. R. COPD prevalence in nonsmokers in high and low photochemical air pollution areas. Chest. 1984 Dec;86(6):830–838. doi: 10.1378/chest.86.6.830. [DOI] [PubMed] [Google Scholar]
  31. Hosein H. R., Mitchell C. A., Bouhuys A. Evaluation of outdoor air quality in rural and urban communities. Arch Environ Health. 1977 Jan-Feb;32(1):4–13. doi: 10.1080/00039896.1977.10667245. [DOI] [PubMed] [Google Scholar]
  32. Humble C. G., Samet J. M., Pathak D. R. Marriage to a smoker and lung cancer risk. Am J Public Health. 1987 May;77(5):598–602. doi: 10.2105/ajph.77.5.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Ito T., Ikemi Y., Ohmori K., Kitamura H., Kanisawa M. Airway epithelial cell changes in rats exposed to 0.25 ppm ozone for 20 months. Exp Toxicol Pathol. 1994 Mar;46(1):1–6. doi: 10.1016/S0940-2993(11)80002-3. [DOI] [PubMed] [Google Scholar]
  34. Jakab G. J., Spannhake E. W., Canning B. J., Kleeberger S. R., Gilmour M. I. The effects of ozone on immune function. Environ Health Perspect. 1995 Mar;103 (Suppl 2):77–89. doi: 10.1289/ehp.95103s277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Knekt P., Järvinen R., Seppänen R., Rissanen A., Aromaa A., Heinonen O. P., Albanes D., Heinonen M., Pukkala E., Teppo L. Dietary antioxidants and the risk of lung cancer. Am J Epidemiol. 1991 Sep 1;134(5):471–479. doi: 10.1093/oxfordjournals.aje.a116118. [DOI] [PubMed] [Google Scholar]
  36. Kobayashi T., Todoroki T., Sato H. Enhancement of pulmonary metastasis of murine fibrosarcoma NR-FS by ozone exposure. J Toxicol Environ Health. 1987;20(1-2):135–145. doi: 10.1080/15287398709530967. [DOI] [PubMed] [Google Scholar]
  37. Koren H. S., Devlin R. B., Becker S., Perez R., McDonnell W. F. Time-dependent changes of markers associated with inflammation in the lungs of humans exposed to ambient levels of ozone. Toxicol Pathol. 1991;19(4 Pt 1):406–411. doi: 10.1177/0192623391019004-109. [DOI] [PubMed] [Google Scholar]
  38. Landry J. C., Cupelin F. The monitoring of ozone immissions in rural and urban areas. Int J Environ Anal Chem. 1981;9(3):169–187. doi: 10.1080/03067318108071513. [DOI] [PubMed] [Google Scholar]
  39. Last J. A., Warren D. L., Pecquet-Goad E., Witschi H. Modification by ozone of lung tumor development in mice. J Natl Cancer Inst. 1987 Jan;78(1):149–154. doi: 10.1093/jnci/78.1.149. [DOI] [PubMed] [Google Scholar]
  40. Li A. F., Richters A. Ambient level ozone effects on subpopulations of thymocytes and spleen T lymphocytes. Arch Environ Health. 1991 Jan-Feb;46(1):57–63. doi: 10.1080/00039896.1991.9937430. [DOI] [PubMed] [Google Scholar]
  41. Liau D. F., Hashim S. A., Pierson R. N., 3rd, Ryan S. F. Alcohol-induced lipid change in th lung. J Lipid Res. 1981 May;22(4):680–686. [PubMed] [Google Scholar]
  42. Linn W. S., Avol E. L., Shamoo D. A., Spier C. E., Valencia L. M., Venet T. G., Fischer D. A., Hackney J. D. A dose-response study of healthy, heavily exercising men exposed to ozone at concentrations near the ambient air quality standard. Toxicol Ind Health. 1986 Jul;2(1):99–112. doi: 10.1177/074823378600200105. [DOI] [PubMed] [Google Scholar]
  43. Lippmann M. Health effects of tropospheric ozone: review of recent research findings and their implications to ambient air quality standards. J Expo Anal Environ Epidemiol. 1993 Jan-Mar;3(1):103–129. [PubMed] [Google Scholar]
  44. McDonnell W. F., Stewart P. W., Andreoni S., Smith M. V. Proportion of moderately exercising individuals responding to low-level, multi-hour ozone exposure. Am J Respir Crit Care Med. 1995 Aug;152(2):589–596. doi: 10.1164/ajrccm.152.2.7633712. [DOI] [PubMed] [Google Scholar]
  45. Mehlman M. A., Borek C. Toxicity and biochemical mechanisms of ozone. Environ Res. 1987 Feb;42(1):36–53. doi: 10.1016/s0013-9351(87)80005-1. [DOI] [PubMed] [Google Scholar]
  46. Menzel D. B. Ozone: an overview of its toxicity in man and animals. J Toxicol Environ Health. 1984;13(2-3):183–204. [PubMed] [Google Scholar]
  47. Meyers D. G., Maloley P. A., Weeks D. Safety of antioxidant vitamins. Arch Intern Med. 1996 May 13;156(9):925–935. [PubMed] [Google Scholar]
  48. Mills P. K., Abbey D., Beeson W. L., Petersen F. Ambient air pollution and cancer in California Seventh-day Adventists. Arch Environ Health. 1991 Sep-Oct;46(5):271–280. doi: 10.1080/00039896.1991.9934387. [DOI] [PubMed] [Google Scholar]
  49. Mustafa M. G., Hassett C. M., Newell G. W., Schrauzer G. N. Pulmonary carcinogenic effects of ozone. Ann N Y Acad Sci. 1988;534:714–723. doi: 10.1111/j.1749-6632.1988.tb30161.x. [DOI] [PubMed] [Google Scholar]
  50. Nakamura T. Proportional hazards model with covariates subject to measurement error. Biometrics. 1992 Sep;48(3):829–838. [PubMed] [Google Scholar]
  51. Patrick D. L., Cheadle A., Thompson D. C., Diehr P., Koepsell T., Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994 Jul;84(7):1086–1093. doi: 10.2105/ajph.84.7.1086. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Peduzzi P., Concato J., Feinstein A. R., Holford T. R. Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates. J Clin Epidemiol. 1995 Dec;48(12):1503–1510. doi: 10.1016/0895-4356(95)00048-8. [DOI] [PubMed] [Google Scholar]
  53. Pollack E. S., Nomura A. M., Heilbrun L. K., Stemmermann G. N., Green S. B. Prospective study of alcohol consumption and cancer. N Engl J Med. 1984 Mar 8;310(10):617–621. doi: 10.1056/NEJM198403083101003. [DOI] [PubMed] [Google Scholar]
  54. Pope C. A., 3rd, Bates D. V., Raizenne M. E. Health effects of particulate air pollution: time for reassessment? Environ Health Perspect. 1995 May;103(5):472–480. doi: 10.1289/ehp.95103472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Pope C. A., 3rd, Thun M. J., Namboodiri M. M., Dockery D. W., Evans J. S., Speizer F. E., Heath C. W., Jr Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am J Respir Crit Care Med. 1995 Mar;151(3 Pt 1):669–674. doi: 10.1164/ajrccm/151.3_Pt_1.669. [DOI] [PubMed] [Google Scholar]
  56. Potter J. D., McMichael A. J., Hartshorne J. M. Alcohol and beer consumption in relation to cancers of bowel and lung: an extended correlation analysis. J Chronic Dis. 1982;35(11):833–842. doi: 10.1016/0021-9681(82)90048-0. [DOI] [PubMed] [Google Scholar]
  57. Prentice R. L. On the ability of blood pressure effects to explain the relation between oral contraceptives and cardiovascular disease. Am J Epidemiol. 1988 Feb;127(2):213–219. doi: 10.1093/oxfordjournals.aje.a114797. [DOI] [PubMed] [Google Scholar]
  58. Pryor W. A. Free radical biology: xenobiotics, cancer, and aging. Ann N Y Acad Sci. 1982;393:1–22. doi: 10.1111/j.1749-6632.1982.tb31228.x. [DOI] [PubMed] [Google Scholar]
  59. Reynolds T. EPA finds passive smoking causes lung cancer. J Natl Cancer Inst. 1993 Feb 3;85(3):179–180. doi: 10.1093/jnci/85.3.179. [DOI] [PubMed] [Google Scholar]
  60. Schwartz A. G., Yang P., Swanson G. M. Familial risk of lung cancer among nonsmokers and their relatives. Am J Epidemiol. 1996 Sep 15;144(6):554–562. doi: 10.1093/oxfordjournals.aje.a008965. [DOI] [PubMed] [Google Scholar]
  61. Schwartz J. Lung function and chronic exposure to air pollution: a cross-sectional analysis of NHANES II. Environ Res. 1989 Dec;50(2):309–321. doi: 10.1016/s0013-9351(89)80012-x. [DOI] [PubMed] [Google Scholar]
  62. Seitz H. K., Garro A. J., Lieber C. S. Enhanced pulmonary and intestinal activation of procarcinogens and mutagens after chronic ethanol consumption in the rat. Eur J Clin Invest. 1981 Feb;11(1):33–38. doi: 10.1111/j.1365-2362.1981.tb01762.x. [DOI] [PubMed] [Google Scholar]
  63. Shapiro S., Castellana J. V., Sprafka J. M. Alcohol-containing mouthwashes and oropharyngeal cancer: a spurious association due to underascertainment of confounders? Am J Epidemiol. 1996 Dec 15;144(12):1091–1095. doi: 10.1093/oxfordjournals.aje.a008886. [DOI] [PubMed] [Google Scholar]
  64. Sills R. C., Hong H. L., Greenwell A., Herbert R. A., Boorman G. A., Devereux T. R. Increased frequency of K-ras mutations in lung neoplasms from female B6C3F1 mice exposed to ozone for 24 or 30 months. Carcinogenesis. 1995 Jul;16(7):1623–1628. doi: 10.1093/carcin/16.7.1623. [DOI] [PubMed] [Google Scholar]
  65. Spektor D. M., Lippmann M., Thurston G. D., Lioy P. J., Stecko J., O'Connor G., Garshick E., Speizer F. E., Hayes C. Effects of ambient ozone on respiratory function in healthy adults exercising outdoors. Am Rev Respir Dis. 1988 Oct;138(4):821–828. doi: 10.1164/ajrccm/138.4.821. [DOI] [PubMed] [Google Scholar]
  66. Thomassen D. G., Harkema J. R., Stephens N. D., Griffith W. C. Preneoplastic transformation of rat tracheal epithelial cells by ozone. Toxicol Appl Pharmacol. 1991 Jun 1;109(1):137–148. doi: 10.1016/0041-008x(91)90197-m. [DOI] [PubMed] [Google Scholar]
  67. Van Loveren H., Krajnc E. I., Rombout P. J., Blommaert F. A., Vos J. G. Effects of ozone, hexachlorobenzene, and bis(tri-n-butyltin)oxide on natural killer activity in the rat lung. Toxicol Appl Pharmacol. 1990 Jan;102(1):21–33. doi: 10.1016/0041-008x(90)90080-e. [DOI] [PubMed] [Google Scholar]
  68. Van Loveren H., Rombout P. J., Wagenaar S. S., Walvoort H. C., Vos J. G. Effects of ozone on the defense to a respiratory Listeria monocytogenes infection in the rat. Suppression of macrophage function and cellular immunity and aggravation of histopathology in lung and liver during infection. Toxicol Appl Pharmacol. 1988 Jul;94(3):374–393. doi: 10.1016/0041-008x(88)90279-7. [DOI] [PubMed] [Google Scholar]
  69. Vena J. E. Air pollution as a risk factor in lung cancer. Am J Epidemiol. 1982 Jul;116(1):42–56. doi: 10.1093/oxfordjournals.aje.a113401. [DOI] [PubMed] [Google Scholar]
  70. Vesterinen E., Pukkala E., Timonen T., Aromaa A. Cancer incidence among 78,000 asthmatic patients. Int J Epidemiol. 1993 Dec;22(6):976–982. doi: 10.1093/ije/22.6.976. [DOI] [PubMed] [Google Scholar]
  71. Victorin K. Review of the genotoxicity of ozone. Mutat Res. 1992 Sep;277(3):221–238. doi: 10.1016/0165-1110(92)90045-b. [DOI] [PubMed] [Google Scholar]
  72. Witschi H. Effects of oxygen and ozone on mouse lung tumorigenesis. Exp Lung Res. 1991 Mar-Apr;17(2):473–483. doi: 10.3109/01902149109064433. [DOI] [PubMed] [Google Scholar]
  73. Witschi H. Ozone, nitrogen dioxide and lung cancer: a review of some recent issues and problems. Toxicology. 1988 Jan;48(1):1–20. doi: 10.1016/0300-483x(88)90054-6. [DOI] [PubMed] [Google Scholar]
  74. Wu A. H., Fontham E. T., Reynolds P., Greenberg R. S., Buffler P., Liff J., Boyd P., Correa P. Family history of cancer and risk of lung cancer among lifetime nonsmoking women in the United States. Am J Epidemiol. 1996 Mar 15;143(6):535–542. doi: 10.1093/oxfordjournals.aje.a008783. [DOI] [PubMed] [Google Scholar]
  75. Wu A. H., Fontham E. T., Reynolds P., Greenberg R. S., Buffler P., Liff J., Boyd P., Henderson B. E., Correa P. Previous lung disease and risk of lung cancer among lifetime nonsmoking women in the United States. Am J Epidemiol. 1995 Jun 1;141(11):1023–1032. doi: 10.1093/oxfordjournals.aje.a117366. [DOI] [PubMed] [Google Scholar]
  76. Yagi K., Komura S. Inhibitory effect of female hormones on lipid peroxidation. Biochem Int. 1986 Dec;13(6):1051–1055. [PubMed] [Google Scholar]
  77. Zelikoff J. T., Kraemer G. L., Vogel M. C., Schlesinger R. B. Immunomodulating effects of ozone on macrophage functions important for tumor surveillance and host defense. J Toxicol Environ Health. 1991 Dec;34(4):449–467. doi: 10.1080/15287399109531582. [DOI] [PubMed] [Google Scholar]
  78. Ziegler R. G. Alcohol-nutrient interactions in cancer etiology. Cancer. 1986 Oct 15;58(8 Suppl):1942–1948. doi: 10.1002/1097-0142(19861015)58:8+<1942::aid-cncr2820581423>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  79. van de Mheen P. J., Gunning-Schepers L. J. Reported prevalences of former smokers in survey data: the importance of differential mortality and misclassification. Am J Epidemiol. 1994 Jul 1;140(1):52–57. doi: 10.1093/oxfordjournals.aje.a117158. [DOI] [PubMed] [Google Scholar]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Sciences

RESOURCES