Open Access Research article

Smoking and drinking in relation to oral potentially malignant disorders in Puerto Rico: a case-control study

Lin Li1*, Walter J Psoter1, Carmen J Buxó2, Augusto Elias2, Lumarie Cuadrado2 and Douglas E Morse1

Author Affiliations

1 Department of Epidemiology & Health Promotion, New York University College of Dentistry, 250 Park Avenue South, Room 633, MC: 9479, New York, NY, 10003-1402, USA

2 Office of the Assistant Dean of Research, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, 00936-5067 Puerto Rico

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BMC Cancer 2011, 11:324  doi:10.1186/1471-2407-11-324

Published: 29 July 2011



Oral cancer incidence is high on the Island of Puerto Rico (PR), particularly among males. As part of a larger study conducted in PR, we evaluated smoking and drinking as risk factors for oral potentially malignant disorders (OPMDs).


Persons diagnosed with either an OPMD (n = 86) [oral epithelial dysplasia (OED), oral hyperkeratosis/epithelial hyperplasia without OED] or a benign oral tissue condition (n = 155) were identified through PR pathology laboratories. Subjects were interviewed using a standardized, structured questionnaire that obtained information, including detailed histories of smoking and drinking. Odds ratios (ORs) for smoking and drinking in relation to having an OPMD, relative to persons with a benign oral tissue condition, were obtained using logistic regression and adjusted for age, gender, education, fruit/vegetable intake and smoking or drinking.


For persons with an OPMD and relative to individuals with a benign oral tissue condition, the adjusted OR for current smoking was 4.32 (95% CI: 1.99-9.38), while for former smokers, the ORadj was 1.47 (95% CI: 0.67-3.21), each ORadj relative to never smokers. With regard to drinking, no adjusted ORs approached statistical significance, and few point estimates exceeded 1.0, whether consumption was defined in terms of ever, current, level (drinks/week), or beverage type.


In this study, conducted in Puerto Rico, current smoking was a substantial risk factor for OPMDs while former smokers had a considerably reduced risk compared to current smokers. There was little evidence suggesting that alcohol consumption was positively associated with OPMD risk.