Cigarette use, secondhand smoke exposure and age-related infertility among US women: A cross-sectional NHANES study.

Authors

Yuyan Li, Ying Zhou, Bingxue Wu, Yan Zhang, Yishi Jiang, Junqing Wu, Yan Che

Published in

Tobacco prevention & cessation. Volume 12. Epub Jul 09, 2026.

Abstract

While tobacco exposure is linked to infertility, age-specific risks across different exposure groups remain poorly characterized. This study aimed to examine the associations of active cigarette smoking and secondhand smoke (SHS) exposure with female infertility and to assess potential effect modification by age.
This is a cross-sectional secondary analysis of publicly available data from the National Health and Nutrition Examination Survey (NHANES, 2013-2020 cycles). The primary exposures were self-reported active cigarette smoking, SHS exposure (assessed via questionnaire and serum cotinine). The outcome was self-reported infertility. Survey-weighted restricted cubic spline (RCS) and logistic regression models were used to assess the respective associations.
This study comprised 4982 women aged 18-49 years. The overall prevalence of self-reported infertility was 12.0% (95% CI: 10.7-13.2), with the highest prevalence observed at approximately 40 years. The association between tobacco smoke exposure and infertility showed a significant negative interaction with age, observed for both self-reported smoking status and serum cotinine levels, and was most pronounced among women aged 18-40 years. In weighted multivariable logistic regression models fitted to the full sample, at age of 18 years, former smokers had significantly higher odds of infertility than never smokers (OR=2.78; 95% CI: 1.30-5.96). Also at this age, when using serum cotinine <0.05 ng/mL as the reference (unexposed), higher odds were observed both in the SHS-exposed group (0.05-10 ng/mL; OR=2.59; 95% CI: 1.25-5.38) and the active-smoking-exposed group (>10 ng/mL; OR=3.79; 95% CI: 1.86-7.69).
Among women aged 18-40 years, cigarette smoking and greater tobacco smoke exposure, indicated by serum cotinine, were associated with infertility. Public health efforts should prioritize smoking prevention, cessation, and reduced secondhand smoke exposure to support female reproductive health.

PMID:
42434477
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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