Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users

A Cross-sectional Study

Bibliographic Data

ID23364848
AuthorsLion Shahab (0000-0003-4033-442X, From University College London and King's College, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.), Maciej Ł Goniewicz (0000-0001-6748-3068, From University College London and King's College, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.), Benjamin C Blount (0000-0003-4788-8169, From University College London and King's College, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.), Jamie Brown (0000-0002-2797-5428, From University College London and King's College, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.), Allan Mcneill (0000-0002-6223-4000, Roswell Park Comprehensive Cancer Center), Ann Mcneill (From University College London and King's College, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.), K Udeni Alwis (From University College London and King's College, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.), June Feng (From University College London and King's College, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.), Lanqing Wang (0000-0001-6620-7096, From University College London and King's College, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.), Robert West (0000-0001-7305-3654, From University College London and King's College, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.)
Year2017
Volume166
Issue6
Pages390-400
Publication date2017-03-21
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueAnnals of Internal Medicine (JOURNAL)
Journal identifiersISSN: 0003-4819 • E-ISSN: 1539-3704
PublisherAmerican College of Physicians (PUBLISHER • US)
DOI10.7326/m16-1107
PMID28166548
OpenAlexW2586197770
LanguageEN
Citations received61
References cited62

BACKGROUND: Given the rapid increase in the popularity of e-cigarettes and the paucity of associated longitudinal health-related data, the need to assess the potential risks of long-term use is essential. OBJECTIVE: To compare exposure to nicotine, tobacco-related carcinogens, and toxins among smokers of combustible cigarettes only, former smokers with long-term e-cigarette use only, former smokers with long-term nicotine replacement therapy (NRT) use only, long-term dual users of both combustible cigarettes and e-cigarettes, and long-term users of both combustible cigarettes and NRT. DESIGN: Cross-sectional study. SETTING: United Kingdom. PARTICIPANTS: The following 5 groups were purposively recruited: combustible cigarette-only users, former smokers with long-term (≥6 months) e-cigarette-only or NRT-only use, and long-term dual combustible cigarette-e-cigarette or combustible cigarette-NRT users (n = 36 to 37 per group; total n = 181). MEASUREMENTS: Sociodemographic and smoking characteristics were assessed. Participants provided urine and saliva samples and were analyzed for biomarkers of nicotine, tobacco-specific N-nitrosamines (TSNAs), and volatile organic compounds (VOCs). RESULTS: After confounders were controlled for, no clear between-group differences in salivary or urinary biomarkers of nicotine intake were found. The e-cigarette-only and NRT-only users had significantly lower metabolite levels for TSNAs (including the carcinogenic metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol [NNAL]) and VOCs (including metabolites of the toxins acrolein; acrylamide; acrylonitrile; 1,3-butadiene; and ethylene oxide) than combustible cigarette-only, dual combustible cigarette-e-cigarette, or dual combustible cigarette-NRT users. The e-cigarette-only users had significantly lower NNAL levels than all other groups. Combustible cigarette-only, dual combustible cigarette-NRT, and dual combustible cigarette-e-cigarette users had largely similar levels of TSNA and VOC metabolites. LIMITATION: Cross-sectional design with self-selected sample. CONCLUSION: Former smokers with long-term e-cigarette-only or NRT-only use may obtain roughly similar levels of nicotine compared with smokers of combustible cigarettes only, but results varied. Long-term NRT-only and e-cigarette-only use, but not dual use of NRTs or e-cigarettes with combustible cigarettes, is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes. PRIMARY FUNDING SOURCE: Cancer Research UK.

Carcinogen · Cotinine · Environmental health · Metabolite · Nicotine · Nicotine replacement therapy · Carcinogens and Genotoxicity Assessment · Chemistry · Indoor Air Quality and Microbial Exposure · Internal Medicine · Medicine · Smoking Behavior and Cessation · Toxicology

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