Tobacco-Specific Nitrosamines (NNAL, NNN, NAT, and NAB) Exposures in the US Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013–2014)

Abstract

Introduction The tobacco-specific nitrosamines (TSNAs) are an important group of carcinogens found in tobacco and tobacco smoke. To describe and characterize the levels of TSNAs in the Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013–2014), we present four biomarkers of TSNA exposure: N′-nitrosonornicotine, N′-nitrosoanabasine, N′-nitrosoanatabine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) which is the primary urinary metabolite of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone. Methods We measured total TSNAs in 11 522 adults who provided urine using automated solid-phase extraction coupled to isotope dilution liquid chromatography–tandem mass spectrometry. After exclusions in this current analysis, we selected 11 004 NNAL results, 10 753 N′-nitrosonornicotine results, 10 919 N′-nitrosoanatabine results, and 10 996 N′-nitrosoanabasine results for data analysis. Geometric means and correlations were calculated using SAS and SUDAAN. Results TSNA concentrations were associated with choice of tobacco product and frequency of use. Among established, every day, exclusive tobacco product users, the geometric mean urinary NNAL concentration was highest for smokeless tobacco users (993.3; 95% confidence interval [CI: 839.2, 1147.3] ng/g creatinine), followed by all types of combustible tobacco product users (285.4; 95% CI: [267.9, 303.0] ng/g creatinine), poly tobacco users (278.6; 95% CI: [254.9, 302.2] ng/g creatinine), and e-cigarette product users (6.3; 95% CI: [4.7, 7.9] ng/g creatinine). TSNA concentrations were higher in every day users than in intermittent users for all the tobacco product groups. Among single product users, exposure to TSNAs differed by sex, age, race/ethnicity, and education. Urinary TSNAs and nicotine metabolite biomarkers were also highly correlated. Conclusions We have provided PATH Study estimates of TSNA exposure among US adult users of a variety of tobacco products. These data can inform future tobacco product and human exposure evaluations and related regulatory activities.

Improving on estimates of the potential relative harm to health from using modern ENDS (vaping) compared to tobacco smoking

“…Many of the identified biomarker studies excluded from the analysis had collected data before our cut-off period of prior to January 2017 (e.g., [37][38][39][40][41][42][43][44][45][46][47] ). Furthermore, some more recent studies did not involve appropriate comparison groups i.e., did not compare exclusive ENDS users with exclusive tobacco smokers (e.g., [48][49][50][51][52] ).…”

1,2-Propylene Glycol: A Biomarker of Exposure Specific to e-Cigarette Consumption

“…The two most common BoE that can be evaluated for all nicotine containing products are nicotine itself, as the most abundant alkaloid found in the tobacco leaf [2,3] as well as cotinine, its major metabolite possessing a longer half-life. Other relevant urinary biomarkers in tobacco smoke exposure assessment originate from tobacco-specific nitrosamines (TSNAs) (e.g., NNN, NNAL), polycyclic aromatic hydrocarbons (PAHs) (e.g., 1-hydroxypyrene, 3-hydroxybenzo[a]pyrene), aromatic amines (e.g., ortho-toluidine, 1-/2-naphthylamine, 3-/4-aminobiphenyl), and mercapturic acids of volatile organic compounds (VOCs) (e.g., 3-HPMA, CEMA) [2,[4][5][6][7][8][9]. In the past decade, the tobacco landscape has changed, and a variety of new tobacco and nicotine-delivery products have been developed that pose a potentially reduced risk for the consumer as compared to smoking cigarettes.…”

Associations between Biomarkers of Exposure and Lung Cancer Risk among Exclusive Cigarette Smokers in the Golestan Cohort Study

“…A total of 31 confirmed cases and 58 controls were identified from this group. Three study participants with extremes in hydration (i.e., urinary creatinine levels outside the range of 10–370 mg/dL) were excluded from the analysis [ 21 ], as were six participants who were no longer matched to an eligible case or control, resulting in the inclusion of 28 cases and 52 controls in the analysis. Figure S1 in the Supplementary Material graphically presents the selection of participants.…”