Tobacco-Specific Nitrosamine Exposures in Smokers and Nonsmokers Exposed to Cigarette or Waterpipe Tobacco Smoke

Radwan, Ghada Nasr; Hecht, Stephen S.; Carmella, Steven G.; Loffredo, Christopher A.

doi:10.1093/ntr/nts099

Cited by 54 publications

(40 citation statements)

References 47 publications

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“…Levels of NNAL in cigarette smokers in our study were similar to those reported by Jacob et al 12. A recent study comparing NNAL of waterpipe smokers, cigarette smokers, and their non-smoking wives (passively exposed by definition), also detected higher levels of NNAL in cigarette and waterpipe smokers when compared with their wives 19. However, the selection of the non-smoking group (spouses), and the daily smoking frequency of waterpipe smokers (approximately 12 waterpipes/day) in that study limits its generalisability in terms of differentiating exposure gradients between waterpipe smokers and non-smokers 19.…”

Section: Discussionsupporting

confidence: 91%

“…A recent study comparing NNAL of waterpipe smokers, cigarette smokers, and their non-smoking wives (passively exposed by definition), also detected higher levels of NNAL in cigarette and waterpipe smokers when compared with their wives 19. However, the selection of the non-smoking group (spouses), and the daily smoking frequency of waterpipe smokers (approximately 12 waterpipes/day) in that study limits its generalisability in terms of differentiating exposure gradients between waterpipe smokers and non-smokers 19. In our study, we recruited the three groups independent of each other; although our recruitment strategy did not guarantee that the enrolled participants were representative of waterpipe, cigarette and non-smokers in the general population.…”

Section: Discussionmentioning

confidence: 88%

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A comparative study of systemic carcinogen exposure in waterpipe smokers, cigarette smokers and non-smokers

et al. 2013

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Background In the past decade, waterpipe smoking—also known as hookah, shisha, narghileh—has increased among youth. The scarcity of rigorous studies linking waterpipe smoking to smoking-related diseases has hindered policy and regulatory efforts to confront the waterpipe epidemic. This study compares systemic carcinogen exposure between independent groups of exclusive waterpipe smokers, cigarette smokers and nonsmokers. Methods This study was conducted at the Syrian Center for Tobacco Studies (SCTS) in Aleppo, Syria, between 2010 and 2011. First morning urinary samples were collected from three groups of subjects; exclusive daily waterpipe smokers (n=24), exclusive daily cigarette smokers (n=23), and non-smokers (n=28). These samples were analysed for carcinogenic tobacco-specific nitrosamines 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) using liquid chromatography—tandem mass spectrometry (LC-MS/MS). Results Our results show that waterpipe smokers are exposed to about 5–10 times greater NNAL than nonsmokers. Mean (95% CI) free and total NNAL was 0.7 (0.3 to 1. 4) and 3.9 (1.6 to 9.5) pg/mL urine for nonsmokers, 8.4 (4.8 to 14.8) and 33.0 (21.6 to 50.6) pg/mL urine for waterpipe smokers, and 10.7 (5.0 to 22.6) and 46.8 (27.6 to 79.3) pg/mL urine for cigarette smokers (p<0.001 for all comparisons). Daily waterpipe smokers were less exposed to NNAL than daily cigarette smokers, although the difference did not reach statistical significance for all measurements. Conclusions These results provide the clearest indication to date about systemic exposure to harmful carcinogens associated with long-term waterpipe smoking. Such evidence can support policy and regulatory efforts designed to confront the emerging global waterpipe epidemic, as well as drive interventions aimed at increasing the public awareness about the cancer risk associated with waterpipe smoking.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 88%

A comparative study of systemic carcinogen exposure in waterpipe smokers, cigarette smokers and non-smokers

et al. 2013

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“…In comparison, smoking of a full tobacco bowl in a clinical research setting resulted in an average urine NNAL boost of 5 pg/mg creatinine, a ~3-fold greater increase than was observed in the current study (13). NNAL exposure has been shown to be lower when smoking water pipes compared to cigarettes (14), similar to the findings of a cross-sectional study in which lower NNAL was measured in water pipe smokers compared to cigarette smokers in Egypt (34). NNAL, a metabolite of the potent lung carcinogen NNK, is used to characterize systemic exposure to TSNAs.…”

Section: Nicotine Intakesupporting

confidence: 74%

Nicotine and Carcinogen Exposure after Water Pipe Smoking in Hookah Bars

Helen

Benowitz

Dains

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Water pipe tobacco smoking is spreading globally and is increasingly becoming popular in the United States, particularly among young people. While many perceive water pipe smoking to be relatively safe, clinical experimental studies indicate significant exposures to tobacco smoke carcinogens following water pipe use. We investigated biomarkers of nicotine intake and carcinogen exposure from water pipe smoking in the naturalistic setting of hookah bars. Methods Fifty-five experienced water pipe users were studied before and after smoking water pipe in their customary way in a hookah bar. Urine samples were analyzed for nicotine, cotinine, the tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanol (NNAL), and mercapturic acid metabolites of volatile organic compounds (VOCs). Results We found an average 73-fold increase in nicotine, 4-fold increase in cotinine, 2-fold increase in NNAL, and 14-91% increase in VOC mercapturic acid metabolites immediately following water pipe smoking. We saw moderate to high correlations between changes in tobacco-specific biomarkers (nicotine, cotinine, and NNAL) and several mercapturic acid metabolites of VOC. Conclusion Water pipe smoking in a hookah bar is associated with significant nicotine intake and carcinogen exposure. Impact Given the significant intake of nicotine and carcinogens, chronic water pipe use could place users at increased risk of cancer and other chronic diseases.

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“…12 Studies demonstrated elevated urinary NNAL levels following smoking hookah tobacco; however, levels were lower compared to smoking cigarettes. 13,21–24 …”

Section: Introductionmentioning

confidence: 99%

Urinary NNAL in hookah smokers and non-smokers after attending a hookah social event in a hookah lounge or a private home

Kassem

Liles

Jackson

et al. 2017

Regulatory Toxicology and Pharmacology

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Tobacco smoking and exposure to tobacco secondhand smoke (SHS) can cause lung cancer. We determined uptake of NNK (4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone), a tobacco specific potent pulmonary carcinogen, in hookah smokers and non-smokers exposed to hookah tobacco SHS. We analyzed data from a community-based convenience sample of 201 of adult (aged ≥18 years) exclusive hookah smokers (n=99) and non-smokers (n=102) residing in San Diego County, California. Participants spent an average of three consecutive hours indoors, in hookah lounges or private homes, where hookah tobacco was smoked exclusively. Total NNAL [the sum of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronides], the major metabolites of NNK, were quantified in spot urine samples provided the morning of and the morning after attending a hookah event. Among hookah smokers urinary NNAL increased significantly (p<0.001) following a hookah social event; the geometric mean doubled, from 1.97 to 4.16 pg/mg. Among non-smokers the increase was not significant (p=0.059). Post hookah event urinary NNAL levels were highest in daily hookah smokers, and significantly higher than in non-daily smokers or non-smokers (GM: 14.96 pg/mg vs. 3.13 pg/mg and 0.67 pg/mg, respectively). For both hookah smokers and non-smokers, pre-to-post event change in urinary NNAL was not significantly different between hookah lounges and homes. We suggest posting health warning signs inside hookah lounges, and encouraging voluntary bans of smoking hookah tobacco in private homes.

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Tobacco-Specific Nitrosamine Exposures in Smokers and Nonsmokers Exposed to Cigarette or Waterpipe Tobacco Smoke

Cited by 54 publications

References 47 publications

A comparative study of systemic carcinogen exposure in waterpipe smokers, cigarette smokers and non-smokers

A comparative study of systemic carcinogen exposure in waterpipe smokers, cigarette smokers and non-smokers

Nicotine and Carcinogen Exposure after Water Pipe Smoking in Hookah Bars

Urinary NNAL in hookah smokers and non-smokers after attending a hookah social event in a hookah lounge or a private home

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