Global surveillance of oral tobacco products: total nicotine, unionised nicotine and tobacco-specificN-nitrosamines

Abstract

ObjectiveOral tobacco products contain nicotine and carcinogenic tobacco-specificN-nitrosamines (TSNAs) that can be absorbed through the oral mucosa. The aim of this study was to determine typical pH ranges and concentrations of total nicotine, unionised nicotine (the most readily absorbed form) and five TSNAs in selected oral tobacco products distributed globally.MethodsA total of 53 oral tobacco products from 5 World Health Organisation (WHO) regions were analysed for total nicotine and TSNAs, including 4-(methyl-nitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), using gas chromatography or liquid chromatography with mass spectrometric detection. Unionised nicotine concentrations were calculated using product pH and total nicotine concentrations. Fourier transform infrared spectroscopy was used to help categorise or characterise some products.ResultsTotal nicotine content varied from 0.16 to 34.1 mg/g product, whereas, the calculated unionised nicotine ranged from 0.05 to 31.0 mg/g product; a 620-fold range of variation. Products ranged from pH 5.2 to 10.1, which translates to 0.2% to 99.1% of nicotine being in the unionised form. Some products have very high pH and correspondingly high unionised nicotine (eg, gul powder, chimó, toombak) and/or high TSNA (eg, toombak, zarda, khaini) concentrations. The concentrations of TSNAs spanned five orders of magnitude with concentrations of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) ranging from 4.5 to 516 000 ng/g product.ConclusionsThese data have important implications for risk assessment because they show that very different exposure risks may be posed through the use of these chemically diverse oral tobacco products. Because of the wide chemical variation, oral tobacco products should not be categorised together when considering the public health implications of their use.

A study on prevalence of tobacco consumption in tribal district of Madhya Pradesh

“…Smokeless tobacco can lead to nicotine addiction, is associated with diseases of the mouth causes cancer of mouth, oesophagus, and pancreas, may increase the risk for death from heart disease and stroke and can increase risk for early delivery and still birth when used during pregnancy. 6,7 The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing around 6 million people year, more than 5 million of those deaths are the result of direct tobacco use while more than 6,00,000 are the result of non-smokers being exposed to second-hand smoke. 4 As per report of the tobacco control in India (2004), more than 8-9 lakh people die due to tobacco consumption every year in India, and the proportion of all deaths that can be attributed to tobacco use is expected to rise from 1.4%in 1990 to 13.3% in 2020.…”

Secondhand smoke exposure within semi-open air cafes and tobacco specific 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) concentrations among nonsmoking employees

“…One of the most extensively investigated TSNAs in tobacco products is NNK (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone), a potent carcinogen that is metabolized in the liver to form NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanonol) [2,3]. NNAL concentrations within subjects have been associated with a higher risk for developing lung cancer among smokers, indicating its use as a biomarker of lung cancer risk among smokers [4,5].…”

Urine 4-(methylnitrosamino)-1-(3) pyridyl-1-butanol and cotinine in Alaska native postpartum women and neonates comparing smokers and smokeless tobacco users

“…Commercial ST has on average much higher ratios of NNK to nicotine than has cigarette tobacco [21]. In addition, there is variability in the ratio as well as the pH across smokeless products, and the bioavailability of nicotine depends on the pH of the particular ST product [21,22]. Iqmik is homemade from tobacco and ash and has a very high pH, resulting in very high nicotine bioavailability [8,21].…”