Departments of Pediatrics,
Family, Population, and Preventive Medicine.
Pediatrics. 2019 May;143(5). doi: 10.1542/peds.2018-3531.
Surveys have been instrumental in describing adolescent use of tobacco, electronic cigarettes (e-cigarettes), and marijuana. However, objective biomarker data are lacking. We compared adolescent self-reported use to urinary biomarkers.
From April 2017 to April 2018, adolescents 12 to 21 years old completed an anonymous questionnaire regarding tobacco, e-cigarette, and marijuana use and provided a urine sample. Urine was analyzed for biomarkers cotinine, total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, and tetrahydrocannabinolic acid (THCA).
Of 517 participants, 2.9% reported using tobacco, 14.3% e-cigarettes, and 11.4% marijuana in the past week. Only 2% reporting no smoking had total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels above cutoff (14.5 pg/mL); 2% of non-e-cigarette users had cotinine above cutoff (10 ng/mL); 2% of those denying marijuana use had THCA above cutoff (10 ng/mL). Daily e-cigarette users showed significantly higher median cotinine than nondaily users (315.4 [interquartile range (IQR) 1375.9] vs 1.69 ng/mL [IQR 28.2]; < .003). Overall, 40% who reported using nicotine-free products had cotinine >10 ng/mL. Pod users' median cotinine was significantly higher than in nonpod users (259.03 [IQR 1267.69] vs 1.61 ng/mL [IQR 16.3]; < .003). Median THCA among daily marijuana users was higher than in nondaily users (560.1 [IQR 1248.3] vs 7.2 ng/mL [IQR 254.9]; = .04). Sixty-one percent of those with cotinine >10 ng/mL vs 39% of those with cotinine<10 ng/mL had THCA >10 ng/mL ( < .001).
Adolescents' self-report correlated with measured urinary biomarkers, but subjects were unaware of their nicotine exposure. More frequent e-cigarette and pod use correlated with elevated biomarkers. Co-use of tobacco, e-cigarettes, and marijuana was corroborated by higher THCA in those with higher cotinine.
调查在描述青少年使用烟草、电子烟（e-cigarettes）和大麻方面发挥了重要作用。然而，缺乏客观的生物标志物数据。我们将青少年的自我报告使用情况与尿液生物标志物进行了比较。
从 2017 年 4 月到 2018 年 4 月，12 至 21 岁的青少年完成了一份关于烟草、电子烟和大麻使用情况的匿名问卷，并提供了一份尿液样本。尿液样本用于分析可替宁、总 4-（甲基亚硝氨基）-1-（3-吡啶基）-1-丁醇和四氢大麻酚酸（THCA）的生物标志物。
在 517 名参与者中，2.9%的人报告在过去一周内使用过烟草，14.3%的人使用过电子烟，11.4%的人使用过大麻。只有 2%的不吸烟人群的总 4-（甲基亚硝氨基）-1-（3-吡啶基）-1-丁醇水平高于临界值（14.5pg/mL）；2%的非电子烟使用者的可替宁水平高于临界值（10ng/mL）；2%否认使用大麻的人群的 THCA 水平高于临界值（10ng/mL）。每天使用电子烟的人群的可替宁中位数明显高于非每天使用电子烟的人群（315.4[四分位距（IQR）1375.9]比 1.69ng/mL[IQR 28.2]；<0.003）。总体而言，40%报告使用无尼古丁产品的人群的可替宁水平>10ng/mL。Pod 用户的可替宁中位数明显高于非 Pod 用户（259.03[IQR 1267.69]比 1.61ng/mL[IQR 16.3]；<0.003）。每天使用大麻的人群的 THCA 中位数高于非每天使用大麻的人群（560.1[IQR 1248.3]比 7.2ng/mL[IQR 254.9]；=0.04）。61%的可替宁水平>10ng/mL 人群的 THCA 水平高于 39%的可替宁水平<10ng/mL 人群（<0.001）。
青少年的自我报告与测量的尿液生物标志物相关，但他们不知道自己的尼古丁暴露情况。电子烟和 Pod 使用更频繁与生物标志物升高相关。在可替宁水平较高的人群中，THCA 水平较高表明存在同时使用烟草、电子烟和大麻的情况。
