Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Office of Science, Center for Tobacco Products, Food and Drug Administration (FDA), Silver Spring, MD, USA.
Nicotine Tob Res. 2021 May 4;23(5):790-797. doi: 10.1093/ntr/ntaa252.
Concurrent use of tobacco cigarettes and e-cigarettes ("dual use") is common among tobacco users. Little is known about differences in demographics and toxicant exposure among subsets of dual users.
We analyzed data from adult dual users (current every/some day users of tobacco cigarettes and e-cigarettes, n = 792) included in the PATH Study Wave 1 (2013-2014) and provided urine samples. Samples were analyzed for biomarkers of exposure to nicotine and selected toxicants (tobacco-specific nitrosamine NNK [NNAL], lead, cadmium, naphthalene [2-naphthol], pyrene [1-hydroxypyrene], acrylonitrile [CYMA], acrolein [CEMA], and acrylamide [AAMA]). Subsets of dual users were compared on demographic, behavioral, and biomarker measures to exclusive cigarette smokers (n = 2411) and exclusive e-cigarette users (n = 247).
Most dual users were predominant cigarette smokers (70%), followed by daily dual users (13%), non-daily concurrent dual users (10%), and predominant vapers (7%). Dual users who smoked daily showed significantly higher biomarker concentrations compared with those who did not smoke daily. Patterns of e-cigarette use had little effect on toxicant exposure. Dual users with high toxicant exposure were generally older, female, and smoked more cigarettes per day. Dual users who had low levels of biomarkers of exposure were generally younger, male, and smoked non-daily.
In 2013-2014, most dual users smoked cigarettes daily and used e-cigarettes occasionally. Cigarette smoking appears to be the primary driver of toxicant exposure among dual users, with little-to-no effect of e-cigarette use on biomarker levels. Results reinforce the need for dual users to stop smoking tobacco cigarettes to reduce toxicant exposure.
With considerable dual use of tobacco cigarettes and e-cigarettes in the United States, it is important to understand differences in toxicant exposure among subsets of dual users, and how these differences align with user demographics. Findings suggest most dual users smoke daily and use e-cigarettes intermittently. Low exposure to toxicants was most common among younger users, males, and intermittent smokers; high exposure to toxicants was most common among older users, females, and heavier cigarette smokers. Results underscore the heterogeneity occurring within dual users, and the need to quit smoking cigarettes completely in order to reduce toxicant exposure.
在烟草使用者中，同时使用香烟和电子烟（“双重使用”）很常见。关于双重使用者亚组在人口统计学和毒物暴露方面的差异，知之甚少。
我们分析了来自成人双重使用者（当前每天/某些天使用香烟和电子烟的人，n=792）的数据，这些数据来自 PATH 研究波 1（2013-2014 年）并提供了尿液样本。样本分析了尼古丁和选定的毒物（烟草特异性亚硝胺 NNK[NNAL]、铅、镉、萘[2-萘酚]、芘[1-羟基芘]、丙烯腈[CYMA]、丙烯醛[CEMA]和丙烯酰胺[AAMA]）暴露的生物标志物。与独家香烟吸烟者（n=2411）和独家电子烟使用者（n=247）相比，在人口统计学、行为和生物标志物测量方面对双重使用者的亚组进行了比较。
大多数双重使用者主要是吸烟者（70%），其次是每日双重使用者（13%）、非每日同时双重使用者（10%）和主要电子烟使用者（7%）。与不每天吸烟的人相比，每天吸烟的双重使用者的生物标志物浓度明显更高。电子烟使用模式对毒物暴露几乎没有影响。具有高毒物暴露的双重使用者通常年龄较大、女性，并且每天吸烟更多。具有低暴露生物标志物的双重使用者通常年龄较小、男性，并且吸烟不规律。
在 2013-2014 年，大多数双重使用者每天吸烟且偶尔使用电子烟。吸烟似乎是双重使用者毒物暴露的主要驱动因素，电子烟的使用对生物标志物水平几乎没有影响。结果强化了双重使用者为减少毒物暴露而停止吸烟的必要性。
由于美国有相当数量的香烟和电子烟双重使用，了解双重使用者亚组之间毒物暴露的差异以及这些差异如何与使用者人口统计学相关联非常重要。研究结果表明，大多数双重使用者每天吸烟，间歇性使用电子烟。年轻用户、男性和间歇性吸烟者中，毒物暴露水平较低的情况最为常见；年龄较大的用户、女性和吸烟量较大的用户中，毒物暴露水平较高的情况最为常见。研究结果强调了双重使用者内部的异质性，以及为了减少毒物暴露而完全戒烟的必要性。
