Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes

Maciej Ł Goniewicz ,Dana Van Bemmel,Danielle M Smith,Kathryn C Edwards,Elizabeth Lambert,Raymond Niaura ,Mark J Travers ,Karen Konkel,Gladys Erives,Cassandra A Stanton,Carol H Christensen ,Benjamin C Blount,Charles E Lawrence ,Dorothy K Hatsukami ,Nicolette Borek,Heather L Kimmel,Jun Feng,Lanqing Wang,Kathleen L Caldwell,Bridget K Ambrose ,Stephen S Hecht,Andrew Hyland

doi:10.1001/jamanetworkopen.2018.5937

Abstract

Use of electronic cigarettes (e-cigarettes) is increasing. Measures of exposure to known tobacco-related toxicants among e-cigarette users will inform potential health risks to individual product users. To estimate concentrations of tobacco-related toxicants among e-cigarette users and compare these biomarker concentrations with those observed in combustible cigarette users, dual users, and never tobacco users. A population-based, longitudinal cohort study was conducted in the United States in 2013-2014. Cross-sectional analysis was performed between November 4, 2016, and October 5, 2017, of biomarkers of exposure to tobacco-related toxicants collected by the Population Assessment of Tobacco and Health Study. Participants included adults who provided a urine sample and data on tobacco use (N = 5105). The primary exposure was tobacco use, including current exclusive e-cigarette users (n = 247), current exclusive cigarette smokers (n = 2411), and users of both products (dual users) (n = 792) compared with never tobacco users (n = 1655). Geometric mean concentrations of 50 individual biomarkers from 5 major classes of tobacco product constituents were measured: nicotine, tobacco-specific nitrosamines (TSNAs), metals, polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs). Of the 5105 participants, most were aged 35 to 54 years (weighted percentage, 38%; 95% CI, 35%-40%), women (60%; 95% CI, 59%-62%), and non-Hispanic white (61%; 95% CI, 58%-64%). Compared with exclusive e-cigarette users, never users had 19% to 81% significantly lower concentrations of biomarkers of exposure to nicotine, TSNAs, some metals (eg, cadmium and lead), and some VOCs (including acrylonitrile). Exclusive e-cigarette users showed 10% to 98% significantly lower concentrations of biomarkers of exposure, including TSNAs, PAHs, most VOCs, and nicotine, compared with exclusive cigarette smokers; concentrations were comparable for metals and 3 VOCs. Exclusive cigarette users showed 10% to 36% lower concentrations of several biomarkers than dual users. Frequency of cigarette use among dual users was positively correlated with nicotine and toxicant exposure. Exclusive use of e-cigarettes appears to result in measurable exposure to known tobacco-related toxicants, generally at lower levels than cigarette smoking. Toxicant exposure is greatest among dual users, and frequency of combustible cigarette use is positively correlated with tobacco toxicant concentration. These findings provide evidence that using combusted tobacco cigarettes alone or in combination with e-cigarettes is associated with higher concentrations of potentially harmful tobacco constituents in comparison with using e-cigarettes alone.

Highlights

Most cigarette smokers continue to smoke owing to the addictive nature of nicotine.1 Cigarettes are harmful nicotine delivery products, exposing smokers to more than 6000 chemicals, many of which are toxic to human health.1 Reducing smoking-related health risks requires complete cessation
Of the 5105 participants, most were aged 35 to 54 years, women (60%; 95% CI, 59%-62%), and non-Hispanic white (61%; 95% CI, 58%-64%)
Exclusive e-cigarette users showed 10% to 98% significantly lower concentrations of biomarkers of exposure, including tobacco-specific nitrosamines (TSNAs), polycyclic aromatic hydrocarbons (PAHs), most volatile organic compounds (VOCs), and nicotine, compared with exclusive cigarette smokers; concentrations were comparable for metals and 3 VOCs

Summary

Introduction

Most cigarette smokers continue to smoke owing to the addictive nature of nicotine. Cigarettes are harmful nicotine delivery products, exposing smokers to more than 6000 chemicals, many of which are toxic to human health. Reducing smoking-related health risks requires complete cessation. Most cigarette smokers continue to smoke owing to the addictive nature of nicotine.. Cigarettes are harmful nicotine delivery products, exposing smokers to more than 6000 chemicals, many of which are toxic to human health.. Reducing smoking-related health risks requires complete cessation. Among continuing smokers who cannot or will not quit, questions remain about the potential harm of alternative tobacco products, such as electronic cigarettes (e-cigarettes).. 6.7% of US adults have used e-cigarettes within the past 30 days, which translates to roughly 16.1 million Americans.. Most adult e-cigarette users are current or former cigarette smokers (84%), and nearly 23% of current multiple tobacco product users report concurrent use of combusted tobacco cigarettes and e-cigarettes (dual users). Among continuing smokers who cannot or will not quit, questions remain about the potential harm of alternative tobacco products, such as electronic cigarettes (e-cigarettes). Approximately 6.7% of US adults have used e-cigarettes within the past 30 days, which translates to roughly 16.1 million Americans. Most adult e-cigarette users are current or former cigarette smokers (84%), and nearly 23% of current multiple tobacco product users report concurrent use of combusted tobacco cigarettes and e-cigarettes (dual users).

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