Nicotine and Toxicant Exposure among U.S. Smokeless Tobacco Users: Results from 1999 to 2012 National Health and Nutrition Examination Survey Data

Rostron, Brian L.; Chang, Cindy M.; Bemmel, Dana M. van; Yang, Xia; Blount, Benjamin C.

doi:10.1158/1055-9965.epi-15-0376

Cited by 50 publications

(45 citation statements)

References 32 publications

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“…General linear models were conducted using PROC SURVEYREG adjusted for age, gender, race/ethnicity, and education. While body mass index (BMI) was included as a covariate in previous reports, (9, 10) we found that adjusting for BMI did not substantially change our findings. We therefore did not control for BMI for model parsimony.…”

Section: Methodscontrasting

confidence: 51%

“…These findings are supported by previous studies that reported higher levels of serum cotinine and urinary NNAL among dual cigarette and smokeless tobacco users compared to exclusive cigarette users. (10–12) This could be due to the route of administration for non-combustible products that provides longer absorption time, or due to higher levels of nicotine and tobacco-specific nitrosamines in non-combustible products included in the analysis. (13, 14) Our findings provide partial support to the argument that individuals with higher nicotine dependency may use tobacco products from multiple product categories to obtain nicotine from additional sources, perhaps especially when the environment does not allow the use of a specific product category (e.g., combustible users adding non-combustibles to circumvent smoke-free policies).…”

Section: Discussionmentioning

confidence: 99%

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Tobacco Product Use Patterns, and Nicotine and Tobacco-Specific Nitrosamine Exposure: NHANES 1999–2012

Choi

Sabado

El‐Toukhy

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Few studies have examined differences in product consumption patterns and nicotine and tobacco-specific nitrosamines (TSNAs) exposure between single versus dual and poly-tobacco users. We applied the Tobacco Product Use Patterns (T-PUPs) model to fill this gap in the literature. Methods Data from adults (aged >18 years) who used any tobacco products during the five days prior to participating in the 1999–2012 National Health and Nutrition Examination Survey (NHANES) were analyzed. Participants were classified into seven T-PUPs: (1) cigarettes only, (2) non-cigarette combustibles only, (3) non-combustibles only, (4) dual non-cigarette combustibles and non-combustibles, (5) dual cigarettes and non-combustibles, (6) dual cigarettes and non-cigarette combustibles, and (7) poly-tobacco use. Weighted regression models were used to compare product consumption, serum cotinine, and urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (i.e., NNAL) levels between single, dual, and poly-tobacco T-PUPs. Results Dual and poly-tobacco T-PUPs were associated with lower product consumption compared to single product T-PUPs only in some cases (e.g., dual cigarette and non-combustible users smoked cigarettes on 0.6 fewer days in the past five days compared to cigarette-only users; p<0.05). Dual and poly-tobacco T-PUPs had either non-distinguishable or higher levels of serum cotinine and urinary total NNAL than corresponding single product T-PUPs. Conclusion Product consumption, and nicotine and TSNAs exposure of dual and poly-tobacco product category users somewhat differ from those of single product category users as defined by the T-TUPs model. Impact Higher levels of cotinine and NNAL among dual- and poly-tobacco T-TUPs users compared to the single product T-TUPs users may indicate health concerns.

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Section: Methodscontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Tobacco Product Use Patterns, and Nicotine and Tobacco-Specific Nitrosamine Exposure: NHANES 1999–2012

Choi

Sabado

El‐Toukhy

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Similarly, cotinine, nicotine, some PAHs, lead, and halogenated aromatic hydrocarbons are higher in smokeless tobacco users than nonusers. However, biomarker levels were not significantly different for many other analytes, particularly for VOCs (96–98, 100). …”

Section: Resultsmentioning

confidence: 82%

“…However, in one study, the levels of some PAH urinary biomarkers in moist snuff (phenanthrene) and Camel Snus (naphthalene and pyrene) users were not significantly different from levels in cigarette smokers (99). In cross-sectional studies based on NHANES, blood lead levels among smokeless tobacco and cigarette smokers were comparable (97, 98). Several studies have found that smokeless tobacco users had comparable or higher levels of nicotine and NNAL or total TSNAs compared to cigarette smokers (96–98).…”

Section: Resultsmentioning

confidence: 99%

Biomarkers of Tobacco Exposure: Summary of an FDA-Sponsored Public Workshop

Chang

Edwards

Arab

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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105

102

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Since 2009, the United States (U.S.) Food and Drug Administration (FDA) Center for Tobacco Products (CTP) has had the authority to regulate the manufacturing, distribution, and marketing of tobacco products in order to reduce the death and disease caused by tobacco use. Biomarkers of exposure pertain to actual human exposure to chemicals arising from tobacco use and could play an important role across a number of FDA regulatory activities, including assessing new and modified risk tobacco products and identifying and evaluating potential product standards. On August 3–4, 2015, FDA/CTP hosted a public workshop focused on biomarkers of exposure with participants from government, industry, academia, and other organizations. The workshop was divided into four sessions focused on: 1) approaches to evaluating and selecting biomarkers; 2) biomarkers of exposure and relationship to disease risk; 3) currently-used biomarkers of exposure and biomarkers in development; and 4) biomarkers of exposure and the assessment of smokeless tobacco and electronic nicotine delivery systems (ENDS). This paper synthesizes the main findings from the workshop and highlights research areas that could further strengthen the science around biomarkers of exposure and help determine their application in tobacco product regulation.

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“…While toxicant exposure levels were lower in dual Cig-OTP users, their levels are elevated and substantially higher than non-tobacco users. For example average urine NNAL ranged from 0.98–1.01 pg/mg creatinine in large, nationally representative cohorts of non-tobacco users (Chen et al, 2014; Rostron et al, 2015) compared to levels of 251 pg/mg creatinine for NNAL in the current study. Levels of exposure of this magnitude place dual Cig-OTP users at substantial risk from the health effects of smoking (Timofeeva et al, 2011; Yuan et al, 2014; Yuan et al, 2011; Yuan et al, 2009), and it is not clear to what extent, if any, the difference in exposure levels translates to differences in health outcomes.…”

Section: Discussionmentioning

confidence: 53%

Tobacco toxicant exposure in cigarette smokers who use or do not use other tobacco products

Nollen

Mayo

Clark

et al. 2017

Drug and Alcohol Dependence

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Background Non-cigarette other tobacco products (OTP; e.g., cigarillos, little cigars) are typically used in combination with cigarettes, but limited data exists on the tobacco toxicant exposure profiles of dual cigarette-OTP (Cig-OTP) users. This study examined biomarkers of nicotine and carcinogen exposure in cigarette smokers who used or did not use OTP. Methods 111 Cig-OTP and 111 cigarette only (Cig Only) users who smoked equivalent cigarettes per day were matched on age (< 40, >= 40), race (African American, White), and gender. Participants reported past 7-day daily use of cigarettes and OTP and provided urine for nicotine, cotinine, total nicotine equivalents (TNE) and total NNAL concentrations. Results Cig-OTP users reported greater past 7-day tobacco use (15.9 versus 13.0 products/day, p < 0.01) but had significantly lower creatinine-normalized nicotine (606 versus 1,301 ng/mg), cotinine (1,063 versus 2,125 ng/mg), TNE (28 versus 57 nmol/mg) and NNAL (251 versus 343 pg/mg) than Cig Only users (p < 0.001). Conclusions Cig-OTP users had lower levels of nicotine and metabolites of a lung carcinogen relative to Cig-Only users, but concentrations of toxicants among Cig-OTP users were still at levels that place smokers at great risk from the detrimental health effects of smoking. Impact Our study finds that nicotine and carcinogen exposure in Cig-OTP users are lower compared to cigarette only users, but still likely to be associated with substantial harm. A better understanding of why toxicant levels may be lower in Cig-OTP is an important area for future study.

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Nicotine and Toxicant Exposure among U.S. Smokeless Tobacco Users: Results from 1999 to 2012 National Health and Nutrition Examination Survey Data

Cited by 50 publications

References 32 publications

Tobacco Product Use Patterns, and Nicotine and Tobacco-Specific Nitrosamine Exposure: NHANES 1999–2012

Tobacco Product Use Patterns, and Nicotine and Tobacco-Specific Nitrosamine Exposure: NHANES 1999–2012

Biomarkers of Tobacco Exposure: Summary of an FDA-Sponsored Public Workshop

Tobacco toxicant exposure in cigarette smokers who use or do not use other tobacco products

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