Xue Zheng, Orr-Souza Eva, Nargis Nigar, Patel Minal, Nighbor Tyler
Tobacco Control Research Group, Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA.
Nicotine Tob Res. 2025 Aug 22;27(9):1591-1599. doi: 10.1093/ntr/ntaf053.
Dual use of combustible cigarettes and e-cigarettes is the most common multiple tobacco-use behavior in the United States, but its long-term health impact remains unclear. Biomarkers of exposure (BOE) can help identify potential health risks of dual use.
We analyzed data from 2,679 adult participants from Wave 5 of the Population Assessment on Tobacco and Health Study, a U.S. nationally representative study, including individuals reporting current exclusive cigarette use (n = 1,913), exclusive e-cigarette use (n = 316), and dual use (n = 450). Eight subgroups were created based on self-reported high/low (above/below mean) cigarettes per day (CPD) and days of e-cigarette use in past the 30 days (ECIG). Adjusted geometric mean concentrations were compared for total nicotine equivalents, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), three volatile organic compounds (VOCs), and heavy metals (lead and cadmium).
Individuals reporting dual use did not differ from those reporting exclusive cigarette use on CPD (13.1 vs. 11.8, respectively). Dual-use groups with high CPD had higher levels of NNAL and VOCs compared to those with low CPD (eg, NNAL for high CPD/high ECIG: 257.07 ng/mg creatinine vs. low CPD/high ECIG: 64.57 ng/mg creatinine, p < .001; high CPD/low ECIG: 312.02 ng/mg creatinine vs. low CPD/low ECIG: 144.11 ng/mg creatinine, p < .001). Cigarette use (dual or exclusive use) was generally associated with higher BOE than exclusive e-cigarette use, though metal exposure did not differ between groups.
Dual use and exclusive cigarette use are associated with higher toxicant exposure compared to exclusive e-cigarette use.
In this population-based cross-sectional study, individuals reporting dual use appear to have nicotine and toxicant exposure at least at the same level as those using cigarettes alone and higher than exclusive e-cigarette use (except for metals). Given the adverse health consequences of dual use, including potential cancer risk, our findings highlight the need for clinicians and public health practitioners to increase awareness of the potential risks associated with dual use.
在美国,同时使用可燃香烟和电子烟是最常见的多种烟草使用行为,但其对健康的长期影响仍不明确。接触生物标志物(BOE)有助于识别同时使用的潜在健康风险。
我们分析了来自美国全国代表性研究“烟草与健康人口评估”第5波的2679名成年参与者的数据,包括报告当前仅使用香烟的个体(n = 1913)、仅使用电子烟的个体(n = 316)以及同时使用两种烟草的个体(n = 450)。根据自我报告的每日高/低(高于/低于平均值)香烟消费量(CPD)和过去30天内电子烟使用天数(ECIG)创建了八个亚组。比较了总尼古丁当量、4-(甲基亚硝胺基)-1-(3-吡啶基)-1-丁醇(NNAL)、三种挥发性有机化合物(VOCs)和重金属(铅和镉)的调整几何平均浓度。
报告同时使用两种烟草的个体在CPD方面与报告仅使用香烟的个体没有差异(分别为13.1和11.8)。与低CPD的同时使用组相比,高CPD的同时使用组的NNAL和VOCs水平更高(例如,高CPD/高ECIG组的NNAL:257.07 ng/mg肌酐,而低CPD/高ECIG组为64.57 ng/mg肌酐,p <.001;高CPD/低ECIG组为312.02 ng/mg肌酐,而低CPD/低ECIG组为144.11 ng/mg肌酐,p <.001)。与仅使用电子烟相比,使用香烟(同时使用或仅使用)通常与更高的BOE相关,尽管各组之间的金属暴露没有差异。
与仅使用电子烟相比,同时使用和仅使用香烟与更高的毒物暴露相关。
在这项基于人群的横断面研究中,报告同时使用两种烟草的个体似乎至少与仅使用香烟的个体有相同水平的尼古丁和毒物暴露,且高于仅使用电子烟的个体(金属除外)。鉴于同时使用两种烟草的不良健康后果,包括潜在的癌症风险,我们的研究结果强调临床医生和公共卫生从业者需要提高对与同时使用相关的潜在风险的认识。