Title: 2848 - Nicotine and Carcinogen Exposure by Tobacco Product Type and Dual-Use


Benjamin Chaffee (Presenter)
University of California San Francisco

Neal Benowitz, University of California San Francisco


Objectives: Tobacco use remains a leading cause of oral cancer, but the tobacco landscape is evolving, with increasing use of non-cigarette tobacco products and dual-use of multiple product types. This study evaluated exposure to known carcinogens according to recent use of different tobacco product types, alone or in combination.

Methods: The Population Assessment of Tobacco and Health featured a national sample of 32,320 U.S. adults at baseline (2013-2014), of whom a subset provided urine specimens for analysis of tobacco-specific nitrosamines (TSNAs) N'-nitrosonornicotine (NNN, a known oral and esophageal carcinogen) and 4-(methynitrosamino)-1-(3)-pyridyle-1-butanol (NNAL, a metabolite of lung carcinogen NNK) and total nicotine equivalents (all measures standardized for urinary creatinine concentration). For this analysis, 6241 participants were categorized according to use of combustible (cigarettes, cigars, waterpipe, pipes, blunts [marijuana-containing cigars]), smokeless (moist snuff, chewing tobacco, snus), e-cigarette, and nicotine replacement products. For each product, recent use was defined as within the prior 3-days and non-use defined as none within 30-days.

Results: Analytic sample characteristics (unweighted) included: 48% female, 61% non-Hispanic white, and median age 35-years (range: 18-90). All tobacco use categories demonstrated elevated nicotine and TSNA concentrations relative to non-users. TSNA exposures were highest among smokeless tobacco users, whether used exclusively (median [Q1-Q3] NNN: 32-pg/mg-creatinine [15-64]; NNAL: 869-pg/mg [411-1632]) or together with other product types (NNN: 15-pg/mg [6-31]; NNAL: 350-pg/mg [199-709]). Exclusive e-cigarette users were exposed to lower NNN (4-pg/mg [2-9]) and NNAL (4-pg/mg [2-9]) levels than other product users, despite comparable nicotine exposure; however, most e-cigarette users (72%) concurrently used combustible tobacco, resulting in TSNA exposure similar to exclusive cigarette smokers (dual-users vs. cigarette-only: NNN: 10-pg/mg vs. 13-pg/mg; NNAL: 253-pg/mg vs. 286-pg/mg, respectively).

Conclusions: The vast majority of non-cigarette tobacco users are exposed to carcinogen levels comparable to or exceeding exposure among exclusive cigarette smokers: levels that are likely to place them at substantial risk.

This abstract is based on research that was funded entirely or partially by an outside source:
US National Cancer Institute and Food and Drug Administration Center for Tobacco Products (P50CA180890)

Disclosure Statement:
The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: Dr. Benowitz is a consultant/advisory board member for Pfizer and GlaxoSmithKline and has provided expert testimony for tobacco litigation. There are no other potential conflicts of interest to disclose.