Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-17 (of 17 Records) |
Query Trace: Chang CM [original query] |
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Volatile organic compounds and mortality from ischemic heart disease: A case-cohort study
Nalini M , Poustchi H , Bhandari D , Chang CM , Blount BC , Wang L , Feng J , Gross A , Khoshnia M , Pourshams A , Sotoudeh M , Gail MH , Graubard BI , Dawsey SM , Kamangar F , Boffetta P , Brennan P , Abnet CC , Malekzadeh R , Freedman ND , Etemadi A . American J Prev Cardiol 2024 19 Background: Volatile organic compounds (VOCs) are major components of air pollution and tobacco smoke, two known risk factors for cardiovascular diseases. VOCs are ubiquitous in the environment and originate from a wide range of sources, including the burning of biomass, fossil fuels, and consumer products. Direct evidence for associations between specific VOCs and ischemic heart disease (IHD) mortality in the general population is scarce. Methods: In a case-cohort study (stratified by age groups, sex, residence, and tobacco smoking), nested within the population-based Golestan cohort study (n = 50,045, 40–75 years, 58% women, enrollment: 2004–2008) in northeastern Iran, we measured urinary concentrations of 20 smoking-related VOC biomarkers using ultra high-performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry. We calculated hazard ratio (HR) and 95% confidence interval (CI) for their associations with IHD mortality during follow-up to 2018, using Cox regression models adjusted for age, ethnicity, education, marital status, body mass index, physical activity, wealth, and urinary cotinine. Results: There were 575 non-cases from random subcohort and 601 participants who died from IHD, mean (standard deviation) age, 58.2 (9.3) years, with a median of 8.4 years follow-up. Significant associations [3rd vs. 1st tertile, HR (95% CI), P for trend] were observed between biomarkers of acrylamide [1.68(1.05,2.69), 0.025], acrylonitrile [2.06(1.14,3.72), 0.058], acrolein [1.98(1.30,3.01), 0.003 and 2.44(1.43,4.18), 0.002], styrene/ethylbenzene [1.83(1.19,2.84), 0.007 and 1.44(1.01,2.07), 0.046], dimethylformamide/methylisocyanate [2.15(1.33,3.50), 0.001], and 1,3butadiene [2.35(1.52,3.63),<0.001] and IHD mortality. These associations were independent of tobacco smoking, and they were only present in the non-smoking subgroup. Conclusion: Our findings provide direct evidence for associations between exposure to several VOCs with widespread household and commercial use and IHD mortality many years after these exposures. These results highlight the importance of VOC exposure in the general population as a risk factor for cardiovascular diseases and underline the importance of bio-monitoring non-tobacco VOC exposure. © 2024 |
Assessing the relationship between biomarkers of exposure and biomarkers of potential harm: PATH Study Wave 1 (2013-2014)
Chang CM , Thakur S , Montes de Oca R , Rostron BL , Cheng YC , Wright MJ , van Bemmel DM , Wang L , Hatsukami DK . Cancer Epidemiol Biomarkers Prev 2024 BACKGROUND: The adequacy of biomarkers of potential harm (BOPH) for assessing tobacco products was explored based on their ability to distinguish tobacco use from non-use, change with cessation, and to show biological gradient. METHODS: The sample included individuals with biomarker data in Wave 1 of the Population Assessment of Tobacco Health (PATH) Study who never used tobacco, currently smoke cigarettes exclusively, used to smoke cigarettes exclusively (quit in past 12 months), currently use smokeless tobacco exclusively, and currently use e-cigarettes exclusively. We compared BOPH levels between groups and assessed the relationships between log-transformed biomarkers of exposure (BOE) [Total Nicotine Equivalents including seven nicotine metabolites (TNE-7), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanonol (NNAL), N-acetyl-S-(2-cyanoethyl)-L-cysteine (CYMA), 1-Hydroxypyrene (1-OHP), cadmium, and serum cotinine (SCOT)], and BOPH [high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), fibrinogen, soluble intercellular adhesion molecule-1 (sICAM-1) and 8-isoprostane]. RESULTS: Among people who smoke, both sICAM-1 and 8-isoprostane distinguished smoking from non-use and were associated with all six BOE. Among people who use smokeless tobacco, 8-isoprostane was associated with TNE-7 and NNAL whereas hs-CRP was associated with SCOT. Among people who use e-cigarettes, no associations between BOPH and BOE were observed. CONCLUSIONS: Both sICAM-1 and 8-isoprostane may be useful for assessing the use or changes in use of some tobacco products. Studies examining their predictive validity could further strengthen our understanding of these two biomarkers. IMPACT: We found that two BOPH, sICAM-1 and 8-isoprostane, may have utility in studies assessing the potential harm of tobacco use in absence of long-term epidemiological studies. |
Exposure to polycyclic aromatic hydrocarbons, volatile organic compounds, and tobacco-specific nitrosamines and incidence of esophageal cancer
Etemadi A , Poustchi H , Chang CM , Calafat AM , Blount BC , Bhandari D , Wang L , Roshandel G , Alexandridis A , Botelho JC , Xia B , Wang Y , Sosnoff CS , Feng J , Nalini M , Khoshnia M , Pourshams A , Sotoudeh M , Gail MH , Dawsey SM , Kamangar F , Boffetta P , Brennan P , Abnet CC , Malekzadeh R , Freedman ND . J Natl Cancer Inst 2023 BACKGROUND: Studying carcinogens in tobacco and non-tobacco sources may be key to understanding the pathogenesis and geographic distribution of esophageal cancer. METHODS: Golestan Cohort Study (GCS) has been conducted since 2004 in a region with high rates of esophageal squamous cell carcinoma (ESCC). For this nested study, the cases comprised of all incident cases by Jan 1, 2018; controls were matched to the case by age, sex, residence, time in cohort, and tobacco use. We measured urinary concentrations of 33 exposure biomarkers of nicotine, polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and tobacco-specific nitrosamines (TSNAs). We used conditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for associations between the 90th versus the 10th percentiles of the biomarker concentrations and incident ESCC. RESULTS: Among individuals who did not currently use tobacco (148 cases/163 controls), two acrolein metabolites, two acrylonitrile metabolites, one propylene oxide metabolite and one 1,3-butadiene metabolite were significantly associated with incident ESCC (adjusted ORs between 1.8 and 4.3). Among tobacco users (57 cases/63 controls), metabolites of two other VOCs (styrene and xylene) were associated with ESCC (ORs= 6.2 and 9.0). In tobacco users, two TSNAs (NNN and N'-Nitrosoanatabine) were also associated with ESCC. Suggestive associations were seen with some PAHs (especially 2-hydroxynaphthalene) in non-users of tobacco products and other TSNAs in tobacco users. CONCLUSION: These novel associations based on individual-level data and samples collected many years before cancer diagnosis, from a population without occupational exposure, have important public health implications. |
Influence of half-life and smoking/nonsmoking ratio on biomarker consistency between Waves 1 and 2 of the Population Assessment of Tobacco and Health Study
Ashley DL , Zhu W , Bhandari D , Wang L , Feng J , Wang Y , Meng L , Xia B , Jarrett JM , Chang CM , Kimmel HL , Blount BC . Cancer Epidemiol Biomarkers Prev 2023 33 (1) 80-87 BACKGROUND: Biomarkers of exposure are tools for understanding the impact of tobacco use on health outcomes if confounders like demographics, use behavior, biological half-life and other sources of exposure are accounted for in the analysis. METHODS: We performed multiple regression analysis of longitudinal measures of urinary biomarkers of alkaloids, tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons, volatile organic compounds (VOC), and metals to examine the sample-to-sample consistency in Waves 1 and 2 of the Population Assessment of Tobacco and Health Study including demographic characteristics and use behavior variables of persons who smoked exclusively. Regression coefficients, within- and between-person variance, and intra-class correlation coefficients were compared to biomarker smoking-nonsmoking population mean ratios and biological half-lives. RESULTS: Most biomarkers were similarly associated with sex, age, race/ethnicity, and product use behavior. The biomarkers with larger smoking-nonsmoking population mean ratios had greater regression coefficients related to recency of exposure. For VOC and alkaloid metabolites, longer biological half-life was associated with lower within-person variance. For each chemical class studied, there were biomarkers that demonstrated good intra-class correlation coefficients. CONCLUSIONS: For most of the biomarkers of exposure reported in the PATH Study, for people who smoke cigarettes exclusively, associations are similar between urinary biomarkers of exposure and demographic and use behavior covariates. Biomarkers of exposure within-subject consistency is likely associated with non-tobacco sources of exposure and biological half-life. IMPACT: Biomarkers measured in the PATH Study provide consistent sample-to-sample measures from which to investigate the association of adverse health outcomes with the characteristics of cigarettes and their use. |
Variability in urinary nicotine exposure biomarker levels between waves 1 (2013-2014) and 2 (2014-2015) in the Population Assessment of Tobacco and Health Study
Ashley DL , Zhu W , Wang L , Sosnoff C , Feng J , Del Valle-Pinero AY , Cheng YC , Chang CM , van Bemmel D , Borek N , Kimmel HL , Silveira ML , Blount BC . Nicotine Tob Res 2022 25 (4) 616-623 INTRODUCTION: To date, no studies have evaluated the consistency of biomarker levels in people who smoke over a long-time period in real-world conditions with a large number of subjects and included use behavior and measures of nicotine metabolism. We evaluated the variability of biomarkers of nicotine exposure over approximately a 1-year period in people who exclusively smoke cigarettes, including intensity and recency of use and brand switching to assess impact on understanding associations with product characteristics. AIMS AND METHODS: Multivariate regression analysis of longitudinal repeated measures of urinary biomarkers of nicotine exposure from 916 adults in the Population Assessment of Tobacco and Health (PATH) Study with demographic characteristics and use behavior variables. Intraclass correlation coefficients (ICCs) were calculated to examine individual variation of nicotine biomarkers and the uncertainty of repeat measures at two time points (Waves 1 and 2). RESULTS: Age, race, and urinary creatinine were significant covariates of urinary cotinine. When including use behavior, recency, and intensity of use were highly significant and variance decreased to a higher extent between than within subjects. The ICC for urinary cotinine decreased from 0.7530 with no use behavior variables in the model to 0.5763 when included. Similar results were found for total nicotine equivalents. CONCLUSIONS: Urinary nicotine biomarkers in the PATH Study showed good consistency between Waves 1 and 2. Use behavior measures such as time since last smoked a cigarette and number of cigarettes smoked in the past 30 days are important to include when assessing factors that may influence biomarker concentrations. IMPLICATIONS: The results of this study show that the consistency of the nicotine biomarkers cotinine and total nicotine equivalents in spot urine samples from Waves 1 to 2 of the PATH Study is high enough that these data are useful to evaluate the association of cigarette characteristics with biomarkers of exposure under real-world use conditions. |
Changes in Biomarkers of Tobacco Exposure among Cigarette Smokers Transitioning to ENDS Use: The Population Assessment of Tobacco and Health Study, 20132015
Anic GM , Rostron BL , Hammad HT , vanBemmel DM , Valle-Pinero AYD , Christensen CH , Erives G , Faulcon LM , Blount BC , Wang Y , Wang L , Bhandari D , Calafat AM , Kimmel HL , Everard CD , Compton WM , Edwards KC , Goniewicz ML , Wei B , Hyland A , Hatsukami DK , Hecht SS , Niaura RS , Borek N , Ambrose BK , Chang CM . Int J Environ Res Public Health 2022 19 (3) Limited data are available for how biomarkers of tobacco exposure (BOE) change when cigarette smokers transition to using electronic nicotine delivery systems (ENDS). Using biomarker data from Waves 1 (20132014) and 2 (20142015) of the PATH Study, we examined how mean BOE concentrations, including metabolites of nicotine, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOCM) and metals, changed when 2475 adult smokers transitioned to using ENDS or quit tobacco products. Exclusive smokers who transitioned to dual use had a significant decrease in NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), but not nicotine metabolites, most PAHs, metals, or VOCMs. Exclusive smokers who became dual users had significant reductions in total nicotine equivalents, NNAL, and 2CyEMA (acrylonitrile metabolite), but only in those who reduced cigarettes per day (CPD) by >=50%. Smokers who transitioned to exclusive ENDS use had significant reductions in most TSNAs, PAHs, and VOCMs; however, nicotine metabolites did not decrease in dual users who became exclusive ENDS users. Smokers who quit tobacco use had significant decreases in nicotine metabolites, all TSNAs, most PAHs, and most VOCMs. Cigarette smokers who became dual users did not experience significant reductions in most BOEs. Reductions were impacted by changes in CPD. However, transitioning from smoking to no tobacco or exclusive ENDS use was associated with reduced exposure to most BOEs measured. Future analyses could incorporate additional waves of PATH data and examine changes in biomarker exposure by ENDS device type and CPD. 2022 by the authors. Licensee MDPI, Basel, Switzerland. |
Biomarkers of Inflammation and Oxidative Stress Among Adult Former Smoker, Current E-Cigarette Users Results from Wave 1 PATH Study
Christensen CH , Chang JT , Rostron BL , Hammad HT , van Bemmel DM , Del Valle-Pinero AY , Wang B , Mishina EV , Faulcon LM , DePina A , Brown-Baker L , Kimmel HL , Lambert E , Blount BC , Vesper HW , Wang L , Goniewicz ML , Hyland A , Travers MJ , Hatsukami DK , Niaura R , Cummings KM , Taylor KA , Edwards KC , Borek N , Ambrose BK , Chang CM . Cancer Epidemiol Biomarkers Prev 2021 30 (10) 1947-1955 BACKGROUND: Former smokers who currently use e-cigarettes have lower concentrations of biomarkers of tobacco toxicant exposure than current smokers. It is unclear whether tobacco toxicant exposure reductions may lead to health risk reductions. METHODS: We compared inflammatory biomarkers (high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), fibrinogen, soluble intercellular adhesion molecule-1 (sICAM-1)) and an oxidative stress marker (F2-isoprostane) among 3,712 adult participants in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study by tobacco user groups: dual users of cigarettes and e-cigarettes; former smokers who currently use e-cigarettes-only; current cigarette-only smokers; former smokers who do not currently use any tobacco; and never tobacco users. We calculated geometric means (GMs) and estimated adjusted geometric mean ratios (GMRs). RESULTS: Dual users experienced greater concentration of F2-isoprostane than current cigarette-only smokers (GMR 1.09 [95%CI 1.03, 1.15]). Biomarkers were similar between former smokers who currently use e-cigarettes and both former smokers who do not use any tobacco and never tobacco users, but among these groups most biomarkers were lower than those of current cigarette-only smokers. The concentration of F2-isoprostane decreased by time since smoking cessation among both exclusive e-cigarette users (p-trend=0.03) and former smokers who do not currently use any tobacco (p-trend=0.0001). CONCLUSIONS: Dual users have greater concentration of F2-isoprostane than smokers. Exclusive e-cigarette users have biomarker concentrations that are similar to those of former smokers who do not currently use tobacco, and lower than those of exclusive cigarette smokers. IMPACT: This study contributes to an understanding of the health effects of e-cigarettes. |
Associations between Biomarkers of Exposure and Lung Cancer Risk among Exclusive Cigarette Smokers in the Golestan Cohort Study.
Rostron BL , Wang J , Etemadi A , Thakur S , Chang JT , Bhandari D , Botelho JC , De Jesús VR , Feng J , Gail MH , Inoue-Choi M , Malekzadeh R , Pourshams A , Poustchi H , Roshandel G , Shiels MS , Wang Q , Wang Y , Xia B , Boffetta P , Brennan P , Abnet CC , Calafat AM , Wang L , Blount BC , Freedman ND , Chang CM . Int J Environ Res Public Health 2021 18 (14) Biomarkers of tobacco exposure are known to be associated with disease risk but previous studies are limited in number and restricted to certain regions. We conducted a nested case–control study examining baseline levels and subsequent lung cancer incidence among current male exclusive cigarette smokers in the Golestan Cohort Study in Iran. We calculated geometric mean biomarker concentrations for 28 matched cases and 52 controls for the correlation of biomarker levels among controls and for adjusted odds’ ratios (ORs) for lung cancer incidence by biomarker concentration, accounting for demographic characteristics, smoking quantity and duration, and opium use. Lung cancer cases had higher average levels of most biomarkers including total nicotine equivalents (TNE-2), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and 3-hydroxyfluorene (3-FLU). Many biomarkers correlated highly with one another including TNE-2 with NNAL and N-Acetyl-S-(2-cyanoethyl)-L-cysteine (2CYEMA), and N-Acetyl-S-(4-hydroxy-2-buten-1-yl)-L-cysteine (t4HBEMA) with N-Acetyl-S-(3-hydroxypropyl-1-methyl)-L-cysteine (3HMPMA) and N-Acetyl-S-(4-hydroxy-2-methyl-2-buten-1-yl)-L-cysteine (4HMBEMA). Lung cancer risk increased with concentration for several biomarkers, including TNE-2 (OR = 2.22, 95% CI = 1.03, 4.78) and NNN (OR = 2.44, 95% CI = 1.13, 5.27), and estimates were significant after further adjustment for demographic and smoking characteristics for 2CYEMA (OR = 2.17, 95% CI = 1.03, 4.55), N-Acetyl-S-(2-carbamoylethyl)-L-cysteine (2CAEMA) (OR = 2.14, 95% CI = 1.01, 4.55), and N-Acetyl-S-(2-hydroxypropyl)-L-cysteine (2HPMA) (OR = 2.85, 95% CI = 1.04, 7.81). Estimates were not significant with adjustment for opium use. Concentrations of many biomarkers were higher at the baseline for participants who subsequently developed lung cancer than among the matched controls. Odds of lung cancer were higher for several biomarkers including with adjustment for smoking exposure for some but not with adjustment for opium use. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. |
Biomarkers of Potential Harm among Adult Cigarette and Smokeless Tobacco Users in the PATH Study Wave 1 (2013-2014): A Cross-Sectional Analysis
Chang JT , Vivar JC , Tam J , Hammad HT , Christensen CH , van Bemmel DM , Das B , Danilenko U , Chang CM . Cancer Epidemiol Biomarkers Prev 2021 30 (7) 1320-1327 BACKGROUND: While smokeless tobacco (ST) is causes oral cancer and is associated with cardiovascular diseases, less is known about how its effects differ from other tobacco use. Biomarkers of potential harm (BOPH) can measure short-term health effects such as inflammation and oxidative stress. METHOD: We compared BOPH concentrations (interleukin-6 [IL-6], high-sensitivity C-reactive protein, fibrinogen, soluble intercellular adhesion molecule-1 (sICAM-1), and F2-isoprostane) across 3,460 adults in Wave 1 of the Population Assessment of Tobacco and Health Study (2013-2014) by tobacco use groups: primary ST users (current exclusive ST use among never smokers), secondary ST users (current exclusive ST use among former smokers), exclusive cigarette smokers, dual users of ST and cigarettes, former smokers, and never tobacco users. We estimated geometric mean ratios (GMRs) using never tobacco users, cigarette smokers, and former smokers as referents, adjusting for demographic and health conditions, creatinine (for F2-isoprostane), and pack-years in smoker referent models. RESULTS: BOPH levels among primary ST users were similar to both never tobacco users and former smokers. Most BOPH levels were lower among ST users compared to current smokers. Compared to never tobacco users, dual users had significantly higher sICAM-1, IL-6 and F2-isoprostane. However, compared to smokers, dual users had similar biomarker levels. Former smokers and secondary ST users had similar levels of all five biomarkers. CONCLUSIONS: ST users have lower levels of inflammatory and oxidative stress biomarkers than smokers. IMPACT: ST use alone and in combination with smoking may result in different levels of inflammatory and oxidative stress levels. |
Nicotine exposure by device type among adult electronic nicotine delivery system users in the Population Assessment of Tobacco and Health Study, 2015-2016
Rostron BL , Coleman B , Cheng YC , Kimmel HL , Oniyide O , Wang L , Chang CM . Cancer Epidemiol Biomarkers Prev 2020 29 (10) 1968-1972 BACKGROUND: Previous studies have examined the characteristics of open and closed system electronic nicotine delivery system (ENDS) users, but population-level information on nicotine exposure among these users has not been available. METHODS: We analyzed nicotine biomarker and survey data from Wave 3 of the Population Assessment of Tobacco and Health (PATH) Study collected from October 2015 to October 2016. We identified 277 exclusive ENDS users and 468 dual cigarette and ENDS users and analyzed concentrations of nicotine and its metabolites obtained from urine samples by device type and other characteristics such as frequency of use and e-liquid flavor. RESULTS: Among exclusive ENDS users, open system users had higher levels of total nicotine exposure (TNE-2) than closed system users (8.8 µmol/g creatinine (95% CI=5.3, 14.8 µmol/g) vs. 2.0 µmol/g (95% CI=0.7, 5.4 µmol/g). However, TNE-2 concentrations were similar when open and closed system users were stratified as daily (26.4 µmol/g (95% CI=20.1, 34.7 µmol/g) vs. 27.1 µmol/g (95% CI=16.4, 44.9 µmol/g)) and non-daily (0.5 µmol/g (95% CI=0.1, 1.9 µmol/g) vs. 0.2 µmol/g (95% CI=0.0, 0.7 µmol/g)) ENDS users. Dual users generally had higher nicotine exposure than exclusive users. CONCLUSIONS: Nicotine exposure was observed to be higher among exclusive open system ENDS users compared to closed system users, but levels were similar when users were stratified by frequency of use. IMPACT: These results suggest that exclusive ENDS users with similar use patterns receive comparable levels of nicotine, regardless of whether they use open or closed system devices. |
Tobacco-specific nitrosamines (NNAL, NNN, NAT, and NAB) exposures in the US Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014)
Xia B , Blount BC , Guillot T , Brosius C , Li Y , Van Bemmel DM , Kimmel HL , Chang CM , Borek N , Edwards KC , Lawrence C , Hyland A , Goniewicz ML , Pine BN , Xia Y , Bernert JT , De Castro BR , Lee J , Brown JL , Arnstein S , Choi D , Wade EL , Hatsukami D , Ervies G , Cobos A , Nicodemus K , Freeman D , Hecht SS , Conway K , Wang L . Nicotine Tob Res 2020 23 (3) 573-583 INTRODUCTION: The tobacco-specific nitrosamines (TSNAs) are an important group of carcinogens found in tobacco and tobacco smoke. To describe and characterize the levels of TSNAs in the Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014), we present four biomarkers of TSNA exposure: N'-nitrosonornicotine, N'-nitrosoanabasine, N'-nitrosoanatabine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) which is the primary urinary metabolite of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone. METHODS: We measured total TSNAs in 11 522 adults who provided urine using automated solid-phase extraction coupled to isotope dilution liquid chromatography-tandem mass spectrometry. After exclusions in this current analysis, we selected 11 004 NNAL results, 10 753 N'-nitrosonornicotine results, 10 919 N'-nitrosoanatabine results, and 10 996 N'-nitrosoanabasine results for data analysis. Geometric means and correlations were calculated using SAS and SUDAAN. RESULTS: TSNA concentrations were associated with choice of tobacco product and frequency of use. Among established, every day, exclusive tobacco product users, the geometric mean urinary NNAL concentration was highest for smokeless tobacco users (993.3; 95% confidence interval [CI: 839.2, 1147.3] ng/g creatinine), followed by all types of combustible tobacco product users (285.4; 95% CI: [267.9, 303.0] ng/g creatinine), poly tobacco users (278.6; 95% CI: [254.9, 302.2] ng/g creatinine), and e-cigarette product users (6.3; 95% CI: [4.7, 7.9] ng/g creatinine). TSNA concentrations were higher in every day users than in intermittent users for all the tobacco product groups. Among single product users, exposure to TSNAs differed by sex, age, race/ethnicity, and education. Urinary TSNAs and nicotine metabolite biomarkers were also highly correlated. CONCLUSIONS: We have provided PATH Study estimates of TSNA exposure among US adult users of a variety of tobacco products. These data can inform future tobacco product and human exposure evaluations and related regulatory activities. |
Evaluation of tobacco smoke and diet as sources of exposure to two heterocyclic aromatic amines for the U.S. population: NHANES 2013-2014
Zhang L , Wang L , Li Y , Xia Y , Chang CM , Xia B , Sosnoff CS , Pine BN , deCastro BR , Blount BC . Cancer Epidemiol Biomarkers Prev 2019 29 (1) 103-111 BACKGROUND: Heterocyclic aromatic amines (HAAs) are a group of hazardous substances produced during combustion of tobacco or high-temperature cooking of meats. 2-Amino-9H-pyrido[2,3-b]indole (AalphaC) is a major carcinogenic HAAs in tobacco smoke. METHODS: Urinary AalphaC, used as a marker of AalphaC exposure, was analyzed on spot urine samples from adult participants of the 2013-2014 cycle of the National Health and Nutrition Examination Survey (NHANES; N=1,792). AalphaC was measured using isotope-dilution liquid chromatography-tandem mass spectrometry. Exclusive combusted tobacco smokers were differentiated from non-users of tobacco products through both self-report and serum cotinine data. RESULTS: Among exclusive smokers, sample-weighted median urinary AalphaC was 40 times higher than non-users. Sample-weighted regression models showed that urinary AalphaC increased significantly with serum cotinine among both exclusive tobacco users and non-users with second-hand smoke exposure. Among non-users, eating beef cooked at high temperature was associated with a significant increase in urinary AalphaC, while consuming vegetables was associated with decreased AalphaC. In addition, smoking one-half pack of cigarettes per day was associated with a significant increase of 23.6 pg AalphaC/mL calculated at geometric mean of AalphaC, controlling for potential confounders. In comparison, increase in AalphaC attributable to consuming the 99th percentile of beef cooked at high temperature was 0.99 pg AalphaC/mL. CONCLUSIONS: Both exclusive smokers and non-users of tobacco in the general U.S. population are exposed to AalphaC from tobacco smoke, with additional, lesser contributions from certain dietary components. IMPACT: AalphaC is an important biomarker that is associated with tobacco smoke exposure. |
Biomarkers of exposure among U.S. Adult cigar smokers: Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014)
Chang CM , Rostron BL , Chang JT , Corey CG , Kimmel HL , Sosnoff CS , Goniewicz ML , Edwards KC , Hatsukami DK , Wang Y , Del Valle-Pinero AY , Yang M , Travers MJ , Arnstein S , Taylor K , Conway K , Ambrose BK , Borek N , Hyland A , Wang L , Blount BC , van Bemmel DM . Cancer Epidemiol Biomarkers Prev 2019 28 (5) 943-953 BACKGROUND: Given the diverse cigar market and limited data on biomarker patterns by cigar type, we compared biomarkers of nicotine and tobacco toxicants among cigar smokers and other groups. METHODS: Using Wave 1 urinary biomarker data from 5,604 adults in the Population Assessment of Tobacco and Health (PATH) Study, we compared geometric mean concentrations among cigar-only smokers (all cigars and separately for traditional, cigarillo, and filtered cigars), cigarette-only smokers, dual cigar/cigarette smokers, and never users of tobacco. We calculated geometric mean ratios (GMR) comparing groups with never users adjusting for sex, age, race/ethnicity, education and creatinine. RESULTS: Some day cigar-only smokers had lower biomarker concentrations than every day cigar-only smokers but higher than never users. Every day cigar-only smokers (n=61) had lower TNE-2 (cotinine+trans-3'-hydroxycotinine) compared to every day cigarette-only (n=2217;p<0.0001) and dual cigar/cigarette smokers (n=601;p<0.0001). Several biomarkers, including NNAL (NNK metabolite) and CYMA (metabolite of acrylonitrile), were comparable in these groups. In exploratory analyses, every day filtered cigar-only (n=7) smokers had higher biomarker concentrations compared to every day traditional cigar-only smokers (n=12) and cigarillo-only smokers (n=24). Every day smokers of each cigar type were similar to exclusive cigarette smokers. For some biomarkers, particularly for every day filtered cigar-only smokers, concentrations were higher. CONCLUSIONS: For some biomarkers, every day cigar-only smokers were comparable to every day cigarette-only smokers. Exploratory analyses suggest that biomarkers vary by cigar type with every day filtered cigar-only smokers having the highest concentrations. IMPACT: High exposure to harmful constituents among cigar smokers is a continuing health issue. |
Urinary biomarkers of carcinogenic exposure among cigarette, waterpipe and smokeless tobacco users and never users of tobacco in the Golestan Cohort Study
Etemadi A , Poustchi H , Chang CM , Blount BC , Calafat AM , Wang L , De Jesus VR , Pourshams A , Shakeri R , Shiels MS , Inoue-Choi M , Ambrose BK , Christensen CH , Wang B , Murphy G , Ye X , Bhandari D , Feng J , Xia B , Sosnoff CS , Kamangar F , Brennan P , Boffetta P , Dawsey SM , Abnet CC , Malekzadeh R , Freedman ND . Cancer Epidemiol Biomarkers Prev 2019 28 (2) 337-347 BACKGROUND: How carcinogen exposure varies across users of different, particularly non-cigarette, tobacco products remains poorly understood. METHODS: We randomly selected 165 participants of Golestan Cohort Study from northeastern Iran: 60 never users of any tobacco, 35 exclusive cigarette, 40 exclusive (78% daily) waterpipe, and 30 exclusive smokeless tobacco (nass) users. We measured concentrations of 39 biomarkers of exposure in 4 chemical classes in baseline urine samples: tobacco alkaloids, tobacco-specific nitrosamines (TSNAs), polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs). We also quantified the same biomarkers in a second urine sample, obtained five years later, among continuing cigarette smokers and never tobacco users. RESULTS: Nass users had the highest concentrations of tobacco alkaloids. All tobacco users had elevated TSNA concentrations which correlated with nicotine dose. In both cigarette and waterpipe smokers, PAH and VOC biomarkers were higher than never tobacco users and nass users, and highly correlated with nicotine dose. PAH biomarkers of phenanthrene and pyrene, and two VOC metabolites (phenylmercapturic acid and phenylglyoxylic acid) were higher in waterpipe smokers than all other groups. PAH biomarkers among Golestan never tobacco users were comparable to those in U.S. cigarette smokers. All biomarkers had moderate to good correlations over five years, particularly in continuing cigarette smokers. CONCLUSION: We observed two patterns of exposure biomarkers that differentiated the use of the combustible products (cigarettes and waterpipe) from the smokeless product. Environmental exposure from non-tobacco sources appeared to contribute to the presence of high levels of PAH metabolites in the Golestan Cohort. |
Nicotine and toxicant exposure among U.S. smokeless tobacco users: Results from 1999 to 2012 National Health and Nutrition Examination Survey Data
Rostron BL , Chang CM , van Bemmel DM , Xia Y , Blount BC . Cancer Epidemiol Biomarkers Prev 2015 24 (12) 1829-37 BACKGROUND: It has been suggested that smokeless tobacco users have high nicotine and toxicant exposure, but studies with nationally representative data have been limited. METHODS: We analyzed biomarkers of tobacco exposure for 23,684 adult participants from the National Health and Nutrition Examination Survey from 1999 to 2012. The biomarkers analyzed were serum cotinine, urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), blood lead, blood cadmium, blood mercury, urinary arsenic, and urinary N-acetyl-S-(2-cyanoethyl)-L-cysteine. We calculated geometric mean concentrations for each biomarker by tobacco use category and geometric mean ratios adjusting for demographic factors. RESULTS: Exclusive smokeless tobacco users had higher geometric mean concentrations of serum cotinine [178.9 ng/mL, 95% confidence interval (CI), 145.5-220.0] and NNAL (583.0 pg/mg creatinine, 95% CI, 445.2-763.5) than exclusive cigarette smokers (130.6 ng/mL, 95% CI, 122.3-139.6 and 217.6 pg/mg creatinine, 95% CI, 193.0-245.2, respectively). Smokeless tobacco users also had higher concentrations of blood lead compared with nontobacco users (adjusted geometric mean ratio = 1.30, 95% CI, 1.21-1.38). Based on limited sample sizes, NNAL concentrations for smokeless tobacco users appear to have declined from 2007 to 2008 (geometric mean = 1013.7 pg/mg creatinine, 95% CI, 738.9-1390.8) to 2011 to 2012 (geometric mean = 325.7 pg/mg creatinine, 95% CI, 159.6-664.9). CONCLUSIONS: Exclusive smokeless tobacco users have higher observed levels of exposure to nicotine and carcinogenic tobacco-specific nitrosamines, as measured by cotinine and NNAL biomarker concentrations, than exclusive cigarette smokers. These patterns in NNAL levels for smokeless tobacco users may be changing over time. IMPACT: High exposure to harmful constituents among smokeless tobacco users is a continuing health issue. |
Estimation of cigarette smoking-attributable morbidity in the United States
Rostron BL , Chang CM , Pechacek TF . JAMA Intern Med 2014 174 (12) 1922-8 IMPORTANCE: Cigarette smoking has been found to harm nearly every bodily organ and is a leading cause of preventable disease, but current estimates of smoking-attributable morbidity by condition for the United States are generally unavailable. OBJECTIVE: To estimate the burden of major medical conditions attributable to cigarette smoking in the United States. DESIGN, SETTING, AND PARTICIPANTS: The disease burden of smoking was estimated using population-attributable risk calculations, taking into account the uncertainty of estimates. Population estimates came from 2009 US Census Bureau data and smoking prevalence, disease prevalence, and disease relative risk estimates came from National Health Interview Survey data for surveyed adults from 2006 through 2012. National Health and Nutrition Examination Survey spirometry data obtained from medical examination of surveyed adults from 2007 through 2010 was used to adjust for underreporting of chronic obstructive pulmonary disease. Exposures: Smoking status was assessed from self-reported National Health Interview Survey data. MAIN OUTCOMES AND MEASURES: The number of adults 35 years and older who had had a major smoking-attributable disease by sex and condition and the total number of these conditions were estimated for the United States in 2009. RESULTS: Using National Health Interview Survey data, we estimated that 6.9 million (95% CI, 6.5-7.4 million) US adults had had a combined 10.9 million (95% CI, 10.3-11.5 million) self-reported smoking-attributable medical conditions. Using chronic obstructive pulmonary disease prevalence estimates obtained from National Health and Nutrition Examination Survey self-reported and spirometry data, we estimated that US adults had had a combined 14.0 million (95% CI, 12.9-15.1 million) smoking-attributable conditions in 2009. CONCLUSIONS AND RELEVANCE: We estimate that US adults have had approximately 14 million major medical conditions that were attributable to smoking. This figure is generally conservative owing to the existence of other diseases and medical events that were not included in these estimates. Cigarette smoking remains a leading cause of preventable disease in the United States, underscoring the need for continuing and vigorous smoking-prevention efforts. |
Exposure to tobacco coupons among U.S. middle and high school students
Tessman GK , Caraballo RS , Corey CG , Xu X , Chang CM . Am J Prev Med 2014 47 S61-8 BACKGROUND: Tobacco marketing contributes to increased tobacco use susceptibility and sustained use. There are limited data on youth exposure to tobacco coupons, a type of pro-tobacco promotion. PURPOSE: To explore channels through which youth report exposure to coupons and characteristics associated with this exposure. This may help inform efforts aimed at decreasing youth exposure to advertising and promotion. METHODS: Data from the 2012 National Youth Tobacco Survey were analyzed in 2013 to estimate the self-reported prevalence of U.S. middle and high school student exposure to coupons through various channels. Associations among exposure to coupons and demographics, tobacco use, living with a tobacco user, and receptivity to tobacco marketing were examined using multivariate logistic regression models. RESULTS: Approximately 13% of students reported exposure to tobacco coupons in the past 30 days through mail, digital communications, or tobacco packages. Prevalence was greatest among current tobacco users (34.0%) and those receptive to tobacco marketing (23.4%) compared to non-tobacco users (9.3%) and those not receptive to tobacco marketing (8.2%), respectively. Coupon exposure varied by sex, grade, and race/ethnicity. In adjusted models, current tobacco use (AOR=3.4, 95% CI=3.0, 3.9); living with a tobacco user (AOR=2.1, 95% CI=1.9, 2.4); and receptivity to tobacco marketing (AOR=2.3, 95% CI=2.0, 2.7) were independently associated with coupon exposure. CONCLUSIONS: Findings from this study indicate that despite restrictions on marketing to youth, youth are still being exposed to tobacco promotions such as coupons. Efforts to limit youth exposure may be valuable in reducing curiosity, susceptibility, and initiation. |
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