Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Tongzhang Zheng

Second Advisor

Robert Dubrow


Recent epidemiologic studies suggest that cigarette smoking may increase the risk of hepatocellular carcinoma (HCC), yet inconsistent dose-response relationships still exist with this association. We examined whether cigarette smoking was associated with HCC risk and explored their dose-response relationship in a case-control study including 590 incident HCC cases and 784 hospital controls in Xiamen, China. Comparisons of HCC cases with hospital controls were conducted for each of the four measures of exposure levels of cigarette smoking - age started smoking, years smoked, cigarettes per day, pack-years in lifetime. After adjustment for demographic factors (sex, age, education, and income level) and alcohol drinking history (lifetime spirit-equivalents intake), no significantly elevated HCC risk was found associated with cigarette smoking in terms of any of these four measures of exposure levels, nor did we demonstrate the dose-response relationship, either in men or in population (women and men together). Comparisons were also conducted for second-hand smoking using "hours of exposure per week" as the measure of exposure levels, but we did not find significant association after adjustment either. Further studies are needed to explore the association between cigarette smoking and HCC risk in this population.


This is an Open Access Thesis.

Open Access

This Article is Open Access