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

• Published in: Cancer epidemiology, biomarkers & prevention biomarkers & prevention, 2017-10, Vol.26 (10), p.1525-1530
• Main Authors: Choi, Kelvin, Sabado, Melanie, El-Toukhy, Sherine, Vogtmann, Emily, Freedman, Neal D, Hatsukami, Dorothy
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Bioindicators; Butanol; Cancer; Cigarette smoking; Cigarettes; Cotinine; Exposure; Female; History, 20th Century; History, 21st Century; Humans; Male; Middle Aged; Nicotine; Nicotine - adverse effects; Nitrosamine; Nitrosamines; Nitrosamines - adverse effects; Regression analysis; Tobacco; Tobacco Use - adverse effects; Young Adult
• ISSN: 1055-9965; 1538-7755
• DOI: 10.1158/1055-9965.EPI-17-0338

Few studies have examined differences in product consumption patterns and nicotine and tobacco-specific nitrosamines (TSNA) 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. Data from adults (age ≥18 years) who used any tobacco products during the 5 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) noncigarette combustibles only, (3) noncombustibles only, (4) dual noncigarette combustibles and noncombustibles, (5) dual cigarettes and noncombustibles, (6) dual cigarettes and noncigarette 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. Dual- and poly-tobacco T-PUPs were associated with lower product consumption compared with single-product T-PUPs only in some cases (e.g., dual cigarette and noncombustible users smoked cigarettes on 0.6 fewer days in the past 5 days compared with cigarette-only users; < 0.05). Dual- and poly-tobacco T-PUPs had either nondistinguishable or higher levels of serum cotinine and urinary total NNAL than corresponding single-product T-PUPs. 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. Higher levels of cotinine and NNAL among dual- and poly-tobacco T-TUPs users compared with the single-product T-TUPs users may indicate health concerns. .