Abstract
Transitions between e-cigarettes and cigarettes are common among tobacco users, but empirical evidence on the health outcomes of switching tobacco products is scarce. To examine changes in urinary biomarkers between baseline and 1-year follow-up among adult tobacco users switching between e-cigarettes and cigarettes. This cohort study used data from wave 1 (baseline, September 2013 to December 2014) and wave 2 (1-year follow-up, October 2014 to October 2015) of the Population Assessment of Tobacco and Health Study. A subset of the probability sample of US adults who voluntarily provided biospecimens at 2 waves was analyzed. Participants were divided into 3 mutually exclusive groups at baseline: exclusive cigarette smokers, exclusive e-cigarette users, and dual users. Data analysis was performed in 2021. Harmful and potentially harmful constituents included nicotine metabolites, tobacco-specific nitrosamines (TSNAs; including 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol [NNAL]), metals, polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs). Within-participant changes in 55 urinary biomarkers of exposure (BOEs) to harmful and potentially harmful constituents were examined using multivariable regression models. Among 3211 participants (55.6% women, 68.3% White, 13.2% Black, and 11.8% Hispanic) at baseline, 21.9% of exclusive cigarette users, 42.8% of exclusive e-cigarette users, and 62.1% of dual users changed product use at follow-up (all percentages are weighted). There was a significant reduction in urine concentrations of TSNAs, PAHs, and VOCs when users transitioned from exclusive cigarette to exclusive e-cigarette use, with a 92% decrease in NNAL, from a mean of 168.4 pg/mg creatinine (95% CI, 102.3-277.1 pg/mg creatinine) to 12.9 pg/mg creatinine (95% CI, 6.4-25.7 pg/mg creatinine; P < .001). A similar panel of BOEs decreased when dual users transitioned to exclusive e-cigarette use; NNAL levels decreased by 96%, from a mean of 143.4 pg/mg creatinine (95% CI, 86.7-237.0 pg/mg creatinine) to 6.3 pg/mg creatinine (95% CI, 3.5-11.4 pg/mg creatinine; P < .001). Nicotine metabolites, TSNAs, PAHs, and VOCs significantly increased when baseline exclusive e-cigarette users transitioned to exclusive cigarette use or dual use. Switching from exclusive cigarette use to dual use was not associated with significant decreases in BOEs. This national cohort study provides evidence on the potential harm reduction associated with transitioning from exclusive cigarette use or dual use to exclusive e-cigarette use. e-Cigarettes tend to supplement cigarettes through dual use instead of cessation at the population level. Continuous monitoring of BOE at the population level and assessment of BOE change by product transition are warranted, as well as defined adverse health outcomes.
Highlights
The use of e-cigarettes has been increasing in the US.[1,2] The electronic vaping device simulates tobacco smoking by aerosolizing liquid solutions, usually containing nicotine, for users to inhale.[3] e-Cigarette companies have heavily promoted their products to cigarette smokers through extensive marketing campaigns and the development of multiple generations of products, including those with sleek designs, high nicotine concentration, and numerous flavors.[4,5] Current smokers reported a higher e-cigarette use prevalence (14.4%) compared with former smokers (7.6%) and never smokers (1.4%).[6]Transitions in tobacco use are common among e-cigarette users.[7]
There was a significant reduction in urine concentrations of tobacco-specific nitrosamine (TSNA), polycyclic aromatic hydrocarbon (PAH), and volatile organic compound (VOC) when users transitioned from exclusive cigarette to exclusive e-cigarette use, with a 92% decrease in NNAL, from a mean of 168.4 pg/mg creatinine to 12.9 pg/mg creatinine
A similar panel of biomarkers of exposure (BOEs) decreased when dual users transitioned to exclusive e-cigarette use; NNAL levels decreased by 96%, from a mean of 143.4 pg/mg creatinine to 6.3 pg/mg creatinine
Summary
The use of e-cigarettes (ie, vaping) has been increasing in the US.[1,2] The electronic vaping device simulates tobacco smoking by aerosolizing liquid solutions, usually containing nicotine, for users to inhale.[3] e-Cigarette companies have heavily promoted their products to cigarette smokers through extensive marketing campaigns and the development of multiple generations of products, including those with sleek designs, high nicotine concentration, and numerous flavors.[4,5] Current smokers reported a higher e-cigarette use prevalence (14.4%) compared with former smokers (7.6%) and never smokers (1.4%).[6]Transitions in tobacco use are common among e-cigarette users.[7]. The use of e-cigarettes (ie, vaping) has been increasing in the US.[1,2]. Current smokers reported a higher e-cigarette use prevalence (14.4%) compared with former smokers (7.6%) and never smokers (1.4%).[6]. Young adults (aged 18-24 years) are more likely to transition among tobacco products than older adults (aged Ն55 years).[8]. Tobacco use history and frequency (experimental vs established use) could be associated with the likelihood of product transition.[8]. Some transition patterns may provide net public health benefits by substantially reducing exposure to toxic combustion compounds. Switching completely from combustible cigarettes to e-cigarettes may provide meaningful health benefits for current smokers, especially those who could not quit as the result of severe nicotine dependence, withdrawal symptoms, or mental illness.[9]
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