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Burkhardt T, Sibul F, Pilz F, Scherer G, Pluym N, Scherer M. A comprehensive non-targeted approach for the analysis of biomarkers in exhaled breath across different nicotine product categories. J Chromatogr A 2024; 1736:465359. [PMID: 39303480 DOI: 10.1016/j.chroma.2024.465359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 09/04/2024] [Accepted: 09/06/2024] [Indexed: 09/22/2024]
Abstract
In the context of the evolving landscape of nicotine consumption, the assessment of biomarkers plays a crucial role in understanding the health impact of different product categories. Exhaled breath (EB) emerges as a promising, non-invasive matrix for biomarker analysis, complementary to conventional urine and plasma data. This study explores distinctive EB biomarker profiles among users of combustible cigarettes (CC), heated tobacco products (HTP), electronic cigarettes (EC), smokeless/oral tobacco (OT), and oral/dermal nicotine products (NRT). We have successfully developed and validated a non-targeted GC-TOF-MS method for the analysis of EB samples across the aforementioned product categories. A total of 66 compounds were identified, with significantly elevated levels in at least one study group. The study found that CC users had higher levels of established VOCs associated with smoking, which supports the proof-of-concept of the method. Breathomic analysis identified increased levels of p-cymene and α-pinene in EC users, while HTP users showed potential biomarker candidates like γ-butyrolactone. This study underscores the utility of EB biomarkers for a comprehensive evaluation of diverse nicotine products. The unique advantages offered by EB analysis position it as a valuable tool for understanding the relationship between exposure and health outcomes.
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Affiliation(s)
- Therese Burkhardt
- Analytisch-Biologisches Forschungslabor GmbH (ABF), Semmelweisstraße 5, Planegg, 82152, Germany
| | - Filip Sibul
- Analytisch-Biologisches Forschungslabor GmbH (ABF), Semmelweisstraße 5, Planegg, 82152, Germany
| | - Fabian Pilz
- Analytisch-Biologisches Forschungslabor GmbH (ABF), Semmelweisstraße 5, Planegg, 82152, Germany
| | - Gerhard Scherer
- Analytisch-Biologisches Forschungslabor GmbH (ABF), Semmelweisstraße 5, Planegg, 82152, Germany
| | - Nikola Pluym
- Analytisch-Biologisches Forschungslabor GmbH (ABF), Semmelweisstraße 5, Planegg, 82152, Germany
| | - Max Scherer
- Analytisch-Biologisches Forschungslabor GmbH (ABF), Semmelweisstraße 5, Planegg, 82152, Germany.
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Shaaban AN, Andersson F, Thiesmeier R, Orsini N, Peña S, Caspersen IH, Magnusson C, Karvonen S, Magnus PM, Hergens MP, Qazi B, Galanti MR. The association between tobacco use and COVID-19 diagnoses in three Nordic countries: a pooled analysis. Eur J Public Health 2024:ckae156. [PMID: 39419634 DOI: 10.1093/eurpub/ckae156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2024] Open
Abstract
Previous research has suggested an unexpected negative association between smoking and susceptibility to COVID-19. This study, drawing on population-based data from three Nordic countries-Sweden, Norway, and Finland-aims to investigate this association further, capitalizing on diversity introduced by different containment measures. The objective of this research was to examine the association between cigarette smoking and snus (smokeless tobacco) use and the risk of confirmed COVID-19 infection. A pooled analysis integrating original data from 547,685 participants across three countries. We used a multiple imputation approach based on conditional probabilities to impute the systematically missing covariates. The associations between tobacco use and COVID-19 infection were assessed, controlling for potential confounding factors. Current cigarette smokers had a lower risk of a confirmed COVID-19 case, whereas there was an increased risk among snus users. Our sensitivity analysis confirmed that the associations between tobacco use and COVID-19 infection risk are robust, remaining consistent regardless of whether covariate imputation was applied. Findings support a negative association between smoking and SARS-CoV-2 infection, but not the hypothesis that nicotine may be protective against the risk of contracting SARS-CoV-2 infection.
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Affiliation(s)
- Ahmed Nabil Shaaban
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Filip Andersson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine - Stockholm Region (CES), Stockholm, Sweden
| | - Robert Thiesmeier
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine - Stockholm Region (CES), Stockholm, Sweden
| | - Sebastian Peña
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine - Stockholm Region (CES), Stockholm, Sweden
| | - Sakari Karvonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Per Minor Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria Pia Hergens
- Unit for Communicable Disease Control, Stockholm Region, Stockholm, Sweden
- Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Basra Qazi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Maria Rosaria Galanti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine - Stockholm Region (CES), Stockholm, Sweden
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Moreau M, Simms L, Andersen ME, Trelles Sticken E, Wieczorek R, Pour SJ, Chapman F, Roewer K, Otte S, Fisher J, Stevenson M. Use of quantitative in vitro to in vivo extrapolation (QIVIVE) for the assessment of non-combustible next-generation product aerosols. FRONTIERS IN TOXICOLOGY 2024; 6:1373325. [PMID: 38665213 PMCID: PMC11043521 DOI: 10.3389/ftox.2024.1373325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
With the use of in vitro new approach methodologies (NAMs) for the assessment of non-combustible next-generation nicotine delivery products, new extrapolation methods will also be required to interpret and contextualize the physiological relevance of these results. Quantitative in vitro to in vivo extrapolation (QIVIVE) can translate in vitro concentrations into in-life exposures with physiologically-based pharmacokinetic (PBPK) modelling and provide estimates of the likelihood of harmful effects from expected exposures. A major challenge for evaluating inhalation toxicology is an accurate assessment of the delivered dose to the surface of the cells and the internalized dose. To estimate this, we ran the multiple-path particle dosimetry (MPPD) model to characterize particle deposition in the respiratory tract and developed a PBPK model for nicotine that was validated with human clinical trial data for cigarettes. Finally, we estimated a Human Equivalent Concentration (HEC) and predicted plasma concentrations based on the minimum effective concentration (MEC) derived after acute exposure of BEAS-2B cells to cigarette smoke (1R6F), or heated tobacco product (HTP) aerosol at the air liquid interface (ALI). The MPPD-PBPK model predicted the in vivo data from clinical studies within a factor of two, indicating good agreement as noted by WHO International Programme on Chemical Safety (2010) guidance. We then used QIVIVE to derive the exposure concentration (HEC) that matched the estimated in vitro deposition point of departure (POD) (MEC cigarette = 0.38 puffs or 11.6 µg nicotine, HTP = 22.9 puffs or 125.6 µg nicotine) and subsequently derived the equivalent human plasma concentrations. Results indicate that for the 1R6F cigarette, inhaling 1/6th of a stick would be required to induce the same effects observed in vitro, in vivo. Whereas, for HTP it would be necessary to consume 3 sticks simultaneously to induce in vivo the effects observed in vitro. This data further demonstrates the reduced physiological potency potential of HTP aerosol compared to cigarette smoke. The QIVIVE approach demonstrates great promise in assisting human health risk assessments, however, further optimization and standardization are required for the substantiation of a meaningful contribution to tobacco harm reduction by alternative nicotine delivery products.
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Affiliation(s)
| | - Liam Simms
- Imperial Brands PLC, Bristol, United Kingdom
| | | | | | - Roman Wieczorek
- Reemtsma Cigarettenfabriken GmbH, An Imperial Brands PLC Company, Hamburg, Germany
| | - Sarah Jean Pour
- Reemtsma Cigarettenfabriken GmbH, An Imperial Brands PLC Company, Hamburg, Germany
| | | | - Karin Roewer
- Reemtsma Cigarettenfabriken GmbH, An Imperial Brands PLC Company, Hamburg, Germany
| | - Sandra Otte
- Reemtsma Cigarettenfabriken GmbH, An Imperial Brands PLC Company, Hamburg, Germany
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Read D, Carter S, Hopley P, Chamari K, Taylor L. Snus use in football: the threat of a new addiction? Biol Sport 2024; 41:201-205. [PMID: 38188104 PMCID: PMC10765442 DOI: 10.5114/biolsport.2024.130050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 01/05/2024] Open
Abstract
The use of Snus, an oral nicotine pouch, is becoming increasingly common in English professional football. As a nicotine product, Snus raises important questions about health and performance for practitioners. The purpose of this short communication is to explain the current regulatory status of Snus, performance relatedeffects, and associated health outcomes. Further, based on player statements and evidence from the general public, we argue that Snus is used as a coping mechanism to deal with the stressors of professional football. Accordingly, the communication concludes with guidance for club-level multidisciplinary interventions to support player welfare, aimed at reducing Snus use as well as future research recommendations.
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Affiliation(s)
- Daniel Read
- Institute for Sport Business, Loughborough University London, London, United Kingdom
| | - Sarah Carter
- Faculty of Health, Exercise and Sports Science, Charles Darwin University, Darwin, NT 0810, Australia
| | | | - Karim Chamari
- Aspetar Sports Medicine and Orthopedic Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Lee Taylor
- School of Sport, Exercise and Health Sciences, Loughborough University. National Centre for Sport and Exercise Medicine (NCSEM), Loughborough, United Kingdom
- Sport and Exercise Discipline Group, Faculty of Health, University of Technology Sydney, Moore Park, NSW, Australia
- Human Performance Research Centre, University of Technology Sydney (UTS), Sydney, Australia
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Watle SV, Børud B, Laake I, Baranowska-Hustad M, Bryant-Bratlie D, Bekkevold T, Caugant DA, Tunheim G, Næss LM. Antibodies against Neisseria meningitidis serogroups A, C, W and Y in serum and saliva of Norwegian adolescents. Vaccine 2023; 41:6529-6537. [PMID: 37648606 DOI: 10.1016/j.vaccine.2023.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The incidence of invasive meningococcal disease (IMD) among Norwegian 16-19-year-olds was 1-7/100,000 in the decade before the COVID-19 pandemic, with serogroup Y (MenY) dominance. In contrast to many other European countries, meningococcal vaccines are not part of the national immunisation program (NIP) in Norway. This cross-sectional study aimed to measure the degree of natural immunity against Neisseria meningitidis among adolescents in Norway to evaluate the need for introducing tetravalent meningococcal conjugate vaccine (MCV4) in the NIP. MATERIALS AND METHODS Serum and saliva samples were collected from students in upper and lower secondary schools in Norway in 2018. Samples were analysed for meningococcal capsular polysaccharide (PS)-specific antibodies using a bead-based multiplex immunoassay. PS-specific antibody levels were linked to data on meningococcal carriage, vaccination status and risk factors for carriage (assessed with questionnaire) and analysed by linear regression of log transformed concentrations. A subset of samples from unvaccinated individuals was analysed for serum bactericidal antibodies (SBA). RESULTS A total of 1344 participants, median age 16 years (range 12-24), were included in the study. Overall, 60.9% of the participants were female and 1137 (84.6%) were not vaccinated with MCV4. PS-specific antibody concentrations in serum and saliva were low among unvaccinated individuals for all serogroups and only 6.7-20.0% of the subpopulation with high PS-specific antibodies assessed with SBA had protective levels. Unvaccinated MenY carriers had higher levels of MenY anti-PS IgG in serum and IgA in saliva than those not carrying MenY. Use of Swedish snus was associated with lower anti-PS IgG levels in serum and waterpipe use with lower anti-PS IgG levels in saliva. CONCLUSION Unvaccinated adolescents in Norway have a low degree of natural immunity against the serogroups of N. meningitidis predominating among cases of IMD in this age group. Therefore, introduction of MCV4 for adolescents in the NIP is recommended.
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Affiliation(s)
- Sara Viksmoen Watle
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway.
| | - Bente Børud
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Marta Baranowska-Hustad
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Diane Bryant-Bratlie
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Terese Bekkevold
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Dominique A Caugant
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway
| | - Gro Tunheim
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Lisbeth Meyer Næss
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
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Kim J, Kim J, Jin Y, Cho SW. In situbiosensing technologies for an organ-on-a-chip. Biofabrication 2023; 15:042002. [PMID: 37587753 DOI: 10.1088/1758-5090/aceaae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
Thein vitrosimulation of organs resolves the accuracy, ethical, and cost challenges accompanyingin vivoexperiments. Organoids and organs-on-chips have been developed to model thein vitro, real-time biological and physiological features of organs. Numerous studies have deployed these systems to assess thein vitro, real-time responses of an organ to external stimuli. Particularly, organs-on-chips can be most efficiently employed in pharmaceutical drug development to predict the responses of organs before approving such drugs. Furthermore, multi-organ-on-a-chip systems facilitate the close representations of thein vivoenvironment. In this review, we discuss the biosensing technology that facilitates thein situ, real-time measurements of organ responses as readouts on organ-on-a-chip systems, including multi-organ models. Notably, a human-on-a-chip system integrated with automated multi-sensing will be established by further advancing the development of chips, as well as their assessment techniques.
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Affiliation(s)
- Jinyoung Kim
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Junghoon Kim
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Yoonhee Jin
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seung-Woo Cho
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
- Institute for Basic Science (IBS), Center for Nanomedicine, Seoul 03722, Republic of Korea
- Graduate Program of Nano Biomedical Engineering (NanoBME), Advanced Science Institute, Yonsei University, Seoul 03722, Republic of Korea
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Caspersen IH, Trogstad L, Galanti MR, Karvonen S, Peña S, Shaaban AN, Håberg SE, Magnus P. Current tobacco use and SARS-CoV-2 infection in two Norwegian population-based cohorts. BMC Public Health 2023; 23:846. [PMID: 37165385 PMCID: PMC10170041 DOI: 10.1186/s12889-023-15822-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Clear evidence of an increased risk for SARS-CoV-2 infection among smokers has not been established. We aimed to investigate associations between cigarette smoking or use of snus (snuff) and other nicotine-containing products and a positive SARS-CoV-2 test, taking test behavior into account. METHODS Current tobacco use and testing behavior during the pandemic were recorded by adult participants from the Norwegian Mother, Father and Child Cohort Study and The Norwegian Influenza Pregnancy Cohort. SARS-CoV-2 infection status was obtained from The Norwegian Surveillance System for Communicable Diseases (MSIS) in May 2021 (n = 78,860) and antibody measurements (n = 5581). We used logistic regression models stratified by gender and adjusted for age, education, region, number of household members, and work situation. RESULTS Snus use was more common among men (26%) than women (9%) and more prevalent than cigarette smoking. We found no clear associations between cigarette smoking or snus and a COVID-19 diagnosis among men. Associations among women were conflicting, indicating that cigarette smoke was negatively associated with a diagnosis (OR 0.51, 95% CI 0.35, 0.75), while no association was found for snus use (OR 1.07, 95% CI 0.86, 1.34). Compared with non-users of tobacco, both cigarette smokers and snus users had increased odds of being tested for SARS-CoV-2. CONCLUSIONS Cigarette smoking, but not snus use, was negatively associated with SARS-CoV-2 infection in women. The lack of an association between snus use and SARS-CoV-2 infection in this population with prevalent snus use does not support the hypothesis of a protective effect of nicotine.
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Affiliation(s)
- Ida Henriette Caspersen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Postbox 222 Skøyen, N-0213, Oslo, Norway.
| | - Lill Trogstad
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Postbox 222 Skøyen, N-0213, Oslo, Norway
| | - Maria Rosaria Galanti
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Region, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - Sakari Karvonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Postbox 30, 00271, Helsinki, Finland
| | - Sebastián Peña
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Postbox 30, 00271, Helsinki, Finland
| | - Ahmed Nabil Shaaban
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Postbox 222 Skøyen, N-0213, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Postbox 222 Skøyen, N-0213, Oslo, Norway
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Nighbor T, Meredith S, Salazar E, Cartagena C, Koszowski B, Pickworth WB, Hull LC. A Comparison of Use Topography and Nicotine Pharmacokinetics Among Loose and Portioned Smokeless Tobacco Users. Nicotine Tob Res 2023; 25:624-630. [PMID: 35965261 DOI: 10.1093/ntr/ntac195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 06/27/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Moist snuff smokeless tobacco (ST) products are available in the United States in both "loose" and "portioned" (ie, pouched) formats, but no published study to date has clinically evaluated the associations between ST format, use behavior, and nicotine exposure. AIMS AND METHODS Participants used their usual brand of ST (loose ST [n = 30] or portioned ST [n = 20]) during an experimental visit wherein use behavior and plasma nicotine pharmacokinetic parameters were measured following single use (first hour of the session) and ad libitum use (remaining 7 h of the session). Participants' ST products were chemically characterized prior to use for pH and nicotine content. RESULTS The average amount per use (2.99 vs. 1.52 g; p = .005) and total amount used (11.45 vs. 5.4 g; p = .002) were significantly higher among the loose ST group. Maximum plasma nicotine concentration (Cmax; 33.4 vs. 19.1 ng/ml) and area under the nicotine concentration versus time curve (AUC) were significantly higher for the loose ST group for the first hour (1474.8 vs. 807.2 min* ng/ml; p = .003) and throughout the 8-hour session (15827.9 vs. 8155.3 min* ng/ml; p < .001). Significant associations were observed between free nicotine content and first use Cmax (rs = .488, loose ST group) and AUC0-1 h (rs = 0.448, loose ST group; rs = .441, portioned ST group). CONCLUSIONS The loose ST group used more product and had a greater average deposition time per use than the portioned ST group. Nicotine exposure was more strongly associated with free nicotine content than total nicotine content. IMPLICATIONS To our knowledge, the current investigation was the first study to date to clinically evaluate the associations between usual-brand smokeless format, use behavior, and nicotine exposure. We observed meaningful differences in use behavior and subsequent nicotine exposure between loose and portioned ST users. Further, we observed that nicotine exposure was more strongly associated with free nicotine content than total nicotine content.
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Affiliation(s)
| | | | | | | | | | | | - Lynn C Hull
- FDA Center for Tobacco Products, Calverton, MD, USA
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Titova OE, Baron JA, Fall T, Michaëlsson K, Larsson SC. Swedish Snuff (Snus), Cigarette Smoking, and Risk of Type 2 Diabetes. Am J Prev Med 2023:S0749-3797(23)00020-X. [PMID: 36754744 DOI: 10.1016/j.amepre.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Cigarette smoking is a known risk factor for Type 2 diabetes, but evidence regarding former smoking and moist snuff (snus) use and Type 2 diabetes risk is inconclusive. This study investigated the relationships of cigarette smoking and Swedish snus use with the risk of Type 2 diabetes in a cohort of middle-aged and elderly participants. METHODS Participants (N=36,742; age range=56-95 years) were followed for incident Type 2 diabetes and death between 2009 and 2017 through linkage to the Swedish National Patient, Prescribed Drug and Death Registers. Cox proportional hazards regression was used to obtain hazard ratios and 95% CIs adjusted for potential confounders, including physical activity, education, BMI, and alcohol intake. Analyses were conducted in 2021‒2022. RESULTS Former and current smoking was associated with an increased risk of Type 2 diabetes (hazard ratios [95% CI]=1.17 [1.07, 1.29] and 1.57 [1.36, 1.81], respectively). In those who stopped smoking, Type 2 diabetes risk remained elevated up to approximately 15 years after cessation. In participants who have never smoked, snus use was linked to a higher risk of Type 2 diabetes in the model adjusted for age and sex (hazard ratio [95% CI]=1.49 [1.04, 2.15]), but this was attenuated after multivariable adjustment (hazard ratio [95% Cl]=1.29 [0.89, 1.86]). CONCLUSIONS This study indicates that current and former smoking are associated with an increased risk of Type 2 diabetes in middle-aged and older individuals. There was less evidence of an association of snus use with the risk of Type 2 diabetes, suggesting that compounds other than nicotine may underlie the detrimental association of smoking with the risk of Type 2 diabetes.
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Affiliation(s)
- Olga E Titova
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - John A Baron
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Tove Fall
- Unit of Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karl Michaëlsson
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Susanna C Larsson
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Azzopardi D, Haswell LE, Frosina J, McEwan M, Gale N, Thissen J, Meichanetzidis F, Hardie G. Assessment of biomarkers of exposure and potential harm, and physiological and subjective health measures in exclusive users of nicotine pouches and current, former and never smokers. Biomarkers 2023; 28:118-129. [PMID: 36484137 DOI: 10.1080/1354750x.2022.2148747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Oral nicotine pouches (NPs) are smokeless, tobacco-free products that have a potential role in tobacco harm reduction strategies.Methods: In a cross-sectional study in Sweden/Denmark, several recognised biomarkers of potential harm (BoPHs) linked to smoking-related diseases/their initiating biological processes, and biomarkers of exposure (BoEs) to tobacco/tobacco smoke toxicants were compared among exclusive adult users of Velo NPs and current/former/never smokers. Over 24 h, participants used their usual product (Velo NP or cigarette) as normal, and BoEs/BoPHs were assessed via blood/24-h urine/exhaled breath/physiological assessments.Results: Among the primary endpoints, total NNAL (16.9 ± 29.47 vs 187.4 ± 228.93 pg/24 h), white blood cell count (5.59 ± 1.223 vs 6.90 ± 1.758 × 109/L), and COHb (4.36 ± 0.525 vs 8.03 ± 2.173% saturation) were significantly lower among Velo users than among smokers (91%, 19% and 46% lower, respectively, all P < 0.0001), while fractional exhaled NO, previously shown to be lower in smokers, was significantly higher (23.18 ± 17.909 vs 11.20 ± 6.980 ppb) among Velo users (107% higher, P < 0.0001). Furthermore, sICAM-1 tended to be lower (185.9 ± 42.88 vs 204.5 ± 64.85 ng/mL) among Velo users than smokers (9% lower). Several secondary endpoints, including six BoEs (3-HPMA (246.7 ± 91.07 vs 1165.7 ± 718.35 μg/24 h), 3-OH-B[a]P (82.4 ± 217.58 vs 258.3 ± 190.20 pg/24 h), HMPMA (135.1 ± 77.85 vs 368.8 ± 183.15 μg/24 h), MHBMA (0.22 ± 0.166 vs 3.39 ± 2.943 μg/24 h), S-PMA (0.10 ± 0.059 vs 3.53 ± 2.736 µg/24 h) and total NNN (7.5 ± 24.84 vs 9.7 ± 5.93 ng/24 h)), were significantly lower among Velo users (78.8%, 68.1%, 63.4%, 93.5%, 97.2% and 22.7% lower, respectively, P < 0.0001-0.0011), while total nicotine equivalents was significantly higher among Velo users (22.6 ± 12.69 vs 12.1 ± 7.92 mg/24 h, P < 0.0001), although Velo user levels are comparable to those previously reported among oral tobacco users, and Velo user and smoker mean levels were similar in Denmark.Conclusion: As compared with smokers, exclusive users of Velo NPs have significantly less exposure to tobacco toxicants and more favourable BoPHs associated with initiating biological processes of smoking-related diseases.International Standard Registered Clinical Trial number: ISRCTN16988167.
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Affiliation(s)
- David Azzopardi
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | - Linsey E Haswell
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | - Justin Frosina
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | - Michael McEwan
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | - Nathan Gale
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | - Jesse Thissen
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | | | - George Hardie
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
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11
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Galanti MR, Andersson F, Caspersen IH, Peña S, Karvonen S, Magnus P, Raffetti E, Orsini N, Magnusson C, Shaaban AN, Hergens MP, Skott P. Current tobacco use and COVID-19 diagnoses in a cohort of adult clients of public dental clinics in Sweden. Sci Rep 2023; 13:1204. [PMID: 36681700 PMCID: PMC9862224 DOI: 10.1038/s41598-023-28091-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/12/2023] [Indexed: 01/22/2023] Open
Abstract
Smoking has been linked with both increased and decreased risk of COVID-19, prompting the hypothesis of a protective role of nicotine in the pathogenesis of the disease. Studies of the association between use of smokeless tobacco and COVID-19 would help refining this hypothesis. We analysed data from 424,386 residents in the Stockholm Region, Sweden, with information on smoking and smokeless tobacco (snus) use prior to the pandemic obtained from dental records. Diagnoses of COVID-19 between February and October 2020 were obtained from health-care registers. We estimated the risk of receiving a diagnosis of COVID-19 for current smokers and for current snus users relative to non-users of tobacco, adjusting for potential confounders (aRR). The aRR of COVID -19 was elevated for current snus users (1.09 ;95%CI = 0.99-1.21 among men and 1.15; 95%CI = 1.00-1.33 among women). The risk for women consuming more than 1 can/day was twice as high as among non-users of tobacco. Current smoking was negatively associated with risk of COVID-19 (aRR = 0.68; 95% CI = 0.61-0.75); including hospital admission (aRR = 0.60; 95% CI = 0.47-0.76) and intensive care (aRR = 0.43; 95% CI = 0.21-0.89). The hypothesis of a protective effect of tobacco nicotine on COVID-19 was not supported by the findings. The negative association between smoking and COVID-19 remains unexplained.
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Affiliation(s)
- M R Galanti
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Centre for Epidemiology and Community Medicine, Stockholm Region, (CES), Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden.
| | - F Andersson
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Region, (CES), Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - I H Caspersen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Skøyen, Postbox 222, 0213, Oslo, Norway
| | - S Peña
- Finnish Institute for Health and Welfare, Postbox 30, 00271, Helsinki, Finland
| | - S Karvonen
- Finnish Institute for Health and Welfare, Postbox 30, 00271, Helsinki, Finland
| | - P Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Skøyen, Postbox 222, 0213, Oslo, Norway
| | - E Raffetti
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - N Orsini
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Region, (CES), Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - C Magnusson
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Region, (CES), Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - A N Shaaban
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - M P Hergens
- Unit for Communicable Disease Control, Postbox 6909, 102 39, Stockholm Region, Sweden
| | - P Skott
- Department of Orofacial Medicine, Folktandvården Stockholm, Postbox 6420, 113 82, Stockholm, Sweden
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12
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Mavragani A, Fewx M, Sprock J, Jiang H, Gao Y, Liu Y. A Novel Puff Recording Electronic Nicotine Delivery System for Assessing Naturalistic Puff Topography and Nicotine Consumption During Ad Libitum Use: Ancillary Study. JMIR Form Res 2023; 7:e42544. [PMID: 36542679 PMCID: PMC9887514 DOI: 10.2196/42544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/29/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Assessing the naturalistic puff topography and associated nicotine consumption during e-cigarette use is important as such information will not only unveil how these products are being consumed in real-world conditions, but also enable investigators and regulatory bodies to conduct quantitative, accurate, and realistic harmful exposure and nicotine abuse liability risk assessments based on actual e-cigarette use. Conventional approaches cannot accurately, conveniently, and noninvasively determine e-cigarette puff topography in a natural use environment. Thus, novel technology-enabled systems that do not primarily rely on self-report mechanisms or intrusive measurements to monitor e-cigarette product use behaviors are highly desired. OBJECTIVE This study aimed to explore and demonstrate the feasibility of a novel puff recording electronic nicotine delivery system (PR-ENDS) device for measuring naturalistic puff topography and estimating nicotine consumption during the ad libitum use of products among smokers and vapers. METHODS An ancillary data analysis based on a completed parent study was conducted. The parent study was a 1-way randomized controlled open-label puff topography and nicotine pharmacokinetic assessment carried out in 24 healthy adults (12 smokers and 12 vapers). Participants were assigned a randomized product use sequence of a PR-ENDS device within 5 site visits for both controlled and ad libitum product use sessions. Blood samples were obtained for plasma nicotine analysis, and questionnaires were administered at various time points. During the ad libitum use session, puff topography was measured using a Clinical Research Support System (CReSS) device as a benchmark, as well as the PR-ENDS device with a built-in puff recording feature. RESULTS There were no significant differences in representative puff topography parameters (number of puffs, total puff duration, and average puff duration) between the PR-ENDS and CReSS devices at the populational level across different device powers, e-liquid nicotine strengths, and flavors. The nicotine consumption estimated by the PR-ENDS device suggested that this device can be employed as a convenient monitoring tool for estimating nicotine use without measuring e-liquid weight loss between puffs. The linear relationship between nicotine consumption estimated by the PR-ENDS device and the pharmacokinetic parameter AUCad lib (plasma concentration-time curve for 1-hour ad libitum use) substantiated the potential of using this device as a pragmatic, noninvasive, and convenient means for estimating nicotine intake in the human body without blood collection. CONCLUSIONS The novel PR-ENDS device was feasible for assessing naturalistic puff topography and estimating nicotine consumption and intake in the human body during ad libitum use. Several key factors can influence users' puff topography, including device power levels, e-liquid nicotine strengths, and flavors. The study results pave the way for further research in the real-time measurement of naturalistic puff topography and puffing behaviors in the real world.
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Affiliation(s)
| | - Melody Fewx
- Scientific Horizons Consulting, Irvine, CA, United States
| | - John Sprock
- Scientific Horizons Consulting, Irvine, CA, United States
| | - Huanhuan Jiang
- Scientific Horizons Consulting, Irvine, CA, United States
| | - Yong Gao
- Scientific Horizons Consulting, Irvine, CA, United States
| | - Yatao Liu
- Scientific Horizons Consulting, Irvine, CA, United States
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13
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Moen K, Stjernbrandt A. A prospective study on local cold injuries in northern Sweden. Int J Circumpolar Health 2022; 81:2149381. [PMID: 36403140 PMCID: PMC9683046 DOI: 10.1080/22423982.2022.2149381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The study aimed to determine the prevalence and incidence proportion of local cold injuries in northern Sweden, and identify associated factors. It was based on prospective data from surveys in 2015 and 2021 sent to a population-based sample in northern Sweden. Multiple binary logistic regression was performed. The study included 5,017 subjects (response rate 44.4%). The prevalence of cold injuries in the hands was 11.4%, feet 12.6%, and face 19.9%, while the incidence proportion was 1.0%, 1.0%, and 0.9%, respectively. Male gender was associated with incident cold injuries in the hands (OR 1.69; 95% CI 1.31-1.28), feet (OR 1.34; 95% CI 1.04-1.73), and face (OR 1.53; 95% CI 1.15-2.03); mental stress with cold injuries in the hands (OR 1.55; 95% CI 1.16-2.05) and feet (OR 1.39; 95% CI 1.04-1.88); previous stroke with cold injuries in the hands (OR 2.64; 95% CI 1.09-6.40) and face (OR 3.09; 95% CI 1.26-7.56); and Raynaud's phenomenon with cold injuries in the hands (OR 2.48; 95% CI 1.80-3.41) and feet (OR 2.07; 95% CI 1.50-2.87). We conclude that male gender, mental stress, previous stroke, and Raynaud's phenomenon increased the probability of contracting local cold injuries.
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Affiliation(s)
- Karolina Moen
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87Umeå, Sweden
| | - Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87Umeå, Sweden,CONTACT Albin Stjernbrandt Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87Umeå, Sweden
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14
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Liu J, Rensch J, Wang J, Jin X, Vansickel A, Edmiston J, Sarkar M. Nicotine pharmacokinetics and subjective responses after using nicotine pouches with different nicotine levels compared to combustible cigarettes and moist smokeless tobacco in adult tobacco users. Psychopharmacology (Berl) 2022; 239:2863-2873. [PMID: 35869988 PMCID: PMC9385814 DOI: 10.1007/s00213-022-06172-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/01/2022] [Indexed: 12/03/2022]
Abstract
RATIONALE Oral tobacco-derived nicotine products include on!® nicotine pouches (NPs) which are tobacco-leaf free and available in multiple flavors and nicotine levels. Switching completely to NPs from cigarettes and moist smokeless tobacco (MST) has the potential to reduce harm for adult tobacco consumers. However, the dependence potential of NPs is not established. Therefore, we characterized the abuse potential of NPs with different nicotine levels compared to cigarettes and MST. OBJECTIVES To evaluate nicotine pharmacokinetics (PK) and subjective effects of NPs (ranging from 1.5 to 8 mg nicotine) compared to own brand cigarettes (OBCs) and MST (OBMST). METHODS We used a randomized, in-clinic, partial single-blind, 7-way crossover design to assess nicotine PK and subjective effects in dual users of cigarettes and MST. RESULTS The mean nicotine Cmax for NPs increased with nicotine level, ranging from 3.5 ng/mL (1.5 mg NP) to 15.4 ng/mL (8 mg NP), compared with 12.2 ng/mL for OBCs and 9.8 ng/mL for OBMST. Nicotine tmax was much longer for all NPs and OBMST (32.5-34.4 min) compared to OBCs (8.5 min). Reductions in urges to smoke after use of the 2 mg, 3.5 mg, and 8 mg NPs were not statistically different (p > 0.05) relative to OBC. Also, NPs resulted in lower ratings of positive subjective effects relative to OBCs and OBMST. CONCLUSIONS Overall, based on the study results and literature reported nicotine PK values for cigarettes and MST, the abuse potential of NPs is not likely to be higher than OBCs and OBMST. NPs may be potentially acceptable switching products for users of cigarettes and MST products.
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Affiliation(s)
- Jianmin Liu
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Jesse Rensch
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Jingzhu Wang
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Xiaohong Jin
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Andrea Vansickel
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Jeffery Edmiston
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Mohamadi Sarkar
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA.
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15
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Sharma V, Kumar D, Kumar S, Singh H, Sharma N, Gupta S. Impact of tobacco smoking on oral cancer genetics-A next-generation sequencing perspective. IMETA 2022; 1:e44. [PMID: 38868711 PMCID: PMC10989814 DOI: 10.1002/imt2.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/22/2022] [Accepted: 07/16/2022] [Indexed: 06/14/2024]
Abstract
This study identified a total of 28 genetic loci (comprising 31 genes), which were found to be altered in oral cancer patients having a habit of tobacco smoking. Three loci, that is, 17p13.1 (TP53), 9p21.3 (CDKN2A), and 9q34.3 (NOTCH1) were found to be modified and common in three records whereas one locus, that is, 3q26.32 (PIK3CA) was found to be modified and common in two records. This study suggests that oral cancer patients should be categorized into different subgroups based on (i) genetic signatures, and (ii) smoking status, then the treatment strategies for each group should be precisely defined.
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Affiliation(s)
- Vishwas Sharma
- Division of CytopathologyICMR—National Institute of Cancer Prevention and ResearchNoidaUttar PradeshIndia
| | - Dinesh Kumar
- WHO FCTC Global Knowledge Hub on Smokeless TobaccoICMR‐ National Institute of Cancer Prevention and ResearchNoidaUttar PradeshIndia
| | - Shravan Kumar
- WHO FCTC Global Knowledge Hub on Smokeless TobaccoICMR‐ National Institute of Cancer Prevention and ResearchNoidaUttar PradeshIndia
| | - Harpreet Singh
- Indian Council of Medical ResearchInformatics, Systems & Research Management (ISRM)New DelhiIndia
| | - Naveen Sharma
- Biomedical Informatics DivisionIndian Council of Medical ResearchNew DelhiIndia
| | - Sanjay Gupta
- Division of CytopathologyICMR—National Institute of Cancer Prevention and ResearchNoidaUttar PradeshIndia
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16
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Hardie G, Gale N, McEwan M, Oscar SM, Ziviani L, Proctor CJ, Murphy J. An abuse liability assessment of the glo tobacco heating product in comparison to combustible cigarettes and nicotine replacement therapy. Sci Rep 2022; 12:14701. [PMID: 36038580 PMCID: PMC9424205 DOI: 10.1038/s41598-022-19167-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/25/2022] [Indexed: 11/26/2022] Open
Abstract
Tobacco heating products (THPs) have reduced emissions of toxicants compared with cigarette smoke, and as they expose user to lower levels than smoking, have for a role to play in tobacco harm reduction. One key concern of Public Health is that new tobacco and nicotine products should not be more addictive than cigarettes. To assess their abuse liability, we determined nicotine pharmacokinetics and subjective effects of two THPs compared with conventional cigarettes and a nicotine replacement therapy (Nicotine inhaler). In a randomised, controlled, open-label, crossover study healthy adult smokers used a different study product in a 5 min ad libitum use session in each of four study periods. Product liking, overall intent to use again, urge for product and urge to smoke questionnaires were utilised to assess subjective effects. Nicotine uptake was greater for the cigarette (Cmax = 22.7 ng/mL) than for either THP (8.6 and 10.5 ng/mL) and the NRT (2.3 ng/mL). Median Tmax was significantly longer for the NRT (15.03 min) than for the tobacco products (4.05–6.03 min). Product liking and overall intent to use again was highest for the cigarette, and higher for the THPs than the NRT. Urge to smoke was reduced more by the cigarette than by the other three products. Urge to use the THPs was greater than the NRT. These findings suggest that the abuse liability of the THPs lies between that of subjects usual brand cigarettes and the NRT.
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Affiliation(s)
- George Hardie
- British American Tobacco (Investments) Limited, Research and Development, Regents Park Road, Southampton, SO15 8TL, UK.
| | - Nathan Gale
- British American Tobacco (Investments) Limited, Research and Development, Regents Park Road, Southampton, SO15 8TL, UK
| | - Michael McEwan
- British American Tobacco (Investments) Limited, Research and Development, Regents Park Road, Southampton, SO15 8TL, UK
| | - Stefano Milleri Oscar
- Centro Ricerche Cliniche di Verona, Policlinico G. B. Rossi, P.Le L. A. Scuro 10, 37134, Verona, Italy
| | - Luigi Ziviani
- Centro Ricerche Cliniche di Verona, Policlinico G. B. Rossi, P.Le L. A. Scuro 10, 37134, Verona, Italy
| | | | - James Murphy
- R. J. Reynolds Tobacco Company, 401 N Main Street, Winston Salem, NC, 27101, USA
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17
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Vedøy TF, Lund KE. Nicotine Content in Swedish-Type Snus Sold in Norway From 2005 to 2020. Nicotine Tob Res 2022; 24:1130-1133. [PMID: 35022786 PMCID: PMC9199937 DOI: 10.1093/ntr/ntac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Use of snus (moist smokeless tobacco) is widespread in Scandinavia and increasingly popular in the U.S. Snus products vary in terms of product design, portion size, and nicotine content. The aim of this study was to examine variations in the nicotine content in snus sold on the Norwegian market from 2005 to 2020. METHODS We calculated the nicotine content in dry snus in milligram per gram (mg/g) and milligram per serving (mg/s), weighted by the products' market share from data on nicotine content, water content, and portion size (both for portion and loose snus) for the ten most sold snus products from each of the three largest manufacturers in 2005, 2010, 2015, and 2020. RESULTS In all snus products combined, the nicotine content per gram snus (mg/g) increased from 16.3 to 24.1, while nicotine per serving (mg/s) was stable around 13.0. In portion snus, the nicotine content increased for both mg/g and mg/s, most notably from 2005 to 2010. In loose snus, mg/g decreased marginally, while mg/s was stable throughout the period. CONCLUSIONS In a period with increasing snus use, the nicotine content in snus increased per gram snus, but not per serving. The stability in nicotine per serving is likely due to a decreasing market share of loose snus which accounted for 54% of the snus products in 2005 and 5% in 2020, and which traditionally has a high content of nicotine per serving. IMPLICATIONS Use of snus is popular in Scandinavia, most notably in Sweden and Norway, but also increasingly common in Finland, especially among young adults. There are no prior market-based studies of variations in the nicotine content in Swedish snus over time. We found that the average amount of nicotine per gram snus sold on the Norwegian market increased in the period 2005 to 2020, most notably from 2005 to 2010, while the amount of nicotine per serving was stable in the same period, primarily due to a decreasing share of loose snus.
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Affiliation(s)
- Tord Finne Vedøy
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, PO Box 222-Skøyen, 0213 Oslo, Norway
| | - Karl Erik Lund
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, PO Box 222-Skøyen, 0213 Oslo, Norway
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18
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A randomised study to assess the nicotine pharmacokinetics of an oral nicotine pouch and two nicotine replacement therapy products. Sci Rep 2022; 12:6949. [PMID: 35484309 PMCID: PMC9050656 DOI: 10.1038/s41598-022-10544-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/04/2022] [Indexed: 12/23/2022] Open
Abstract
Nicotine replacement therapies (NRTs) are intended for short-term use to help cigarette smokers to quit. Some smokers find NRTs ineffective or seek a more satisfactory source of nicotine. Tobacco-free oral nicotine pouch (NP) products have emerged as a potential reduced risk product compared with cigarettes and other tobacco products. In a randomised crossover clinical study, thirty-four healthy adult smokers were enrolled and their nicotine Cmax and AUC0-T determined for three 4 mg nicotine products (NP, gum, lozenge) under fasting conditions. The NP, lozenge and gum mean Cmax values were 8.5, 8.3 and 4.4 ng/mL, AUC0-T values were 30.6, 31.5 and 14.3 ng*h/mL, respectively. The NP showed similar nicotine bioavailability to the lozenge (p = 0.6526 (Cmax), p = 1.0000 (AUC0-T)), and superior bioavailability to the gum (p < 0.0001 for Cmax and AUC0-T). Compared with the lozenge, the NP demonstrated greater product satisfaction with a higher number of positive responses to subjective satisfaction questions. All products were judged to be well-tolerated; the incidence of minor adverse events was lower for the NP (18.2%) than the lozenge (33.3%) or gum (18.8%). In summary, NPs may provide smokers with a more satisfying alternative nicotine source as compared to the reference NRTs. Study Registry/Registered Trial No: ISRCTN/ISRCTN65708311.
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19
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Pluym N, Scherer G, Edmiston JS, Jin XC, Sarkar M, Scherer M. Assessment of the Exposure to NNN in the Plasma of Smokeless Tobacco Users. Chem Res Toxicol 2022; 35:663-669. [PMID: 35298127 PMCID: PMC9019808 DOI: 10.1021/acs.chemrestox.1c00431] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 01/10/2023]
Abstract
N-Nitrosonornicotine (NNN) is a human carcinogen present in cigarette smoke and smokeless tobacco. Urinary NNN is usually measured in order to assess the exposure to this toxicant for tobacco users. NNN excretion in urine can be highly biased due to the formation of NNN by nitrosation of nornicotine under acidic conditions, both endogenously and exogenously. Hence, urinary NNN levels may not necessarily correctly reflect the product-specific exposure. Measurement of plasma NNN may be less prone to endogenous formation due to the stable pH (7.4) of blood. We developed an LC-MS/MS method for the quantification of NNN using 1 mL of human plasma. Validation according to FDA guidelines proved that the method is selective and highly sensitive with an LLOQ of 0.3 pg/mL. Accuracy and precision averaged to 98.7 and 7.5% (CV), respectively. The assay was applied to plasma samples collected from 10 experienced moist smokeless tobacco users during and after a single use of 2 g of the product for 40 min under controlled use conditions. Blood was drawn at 15 time points over a 6 h time course. The maximum NNN concentration (Cmax) ranged from 3.5 to 10 pg/mL (mean: 7.1 pg/mL) at a tmax of 32 min. Plasma NNN and nicotine were found to have similar time courses. In conclusion, the determination of NNN in plasma may be fit-for-purpose to evaluate the product-use-specific exposure to this carcinogen.
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Affiliation(s)
- Nikola Pluym
- ABF,
Analytisch-Biologisches Forschungslabor GmbH, Semmelweisstraße 5, 82152 Planegg, Germany
| | - Gerhard Scherer
- ABF,
Analytisch-Biologisches Forschungslabor GmbH, Semmelweisstraße 5, 82152 Planegg, Germany
| | - Jeffery S. Edmiston
- Altria
Client Services LLC. Center for Research and Technology, 601 East Jackson Street, Richmond, Virginia 23219, United States
| | - Xiaohong C. Jin
- Altria
Client Services LLC. Center for Research and Technology, 601 East Jackson Street, Richmond, Virginia 23219, United States
| | - Mohamadi Sarkar
- Altria
Client Services LLC. Center for Research and Technology, 601 East Jackson Street, Richmond, Virginia 23219, United States
| | - Max Scherer
- ABF,
Analytisch-Biologisches Forschungslabor GmbH, Semmelweisstraße 5, 82152 Planegg, Germany
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20
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Sæther SMM, Askeland KG, Pallesen S, Erevik EK. Smoking and snus use among Norwegian students: Demographic, personality and substance use characteristics. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 38:141-160. [PMID: 35310004 PMCID: PMC8899072 DOI: 10.1177/1455072520980219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Background and aim: Smoking rates are decreasing in Norway while the use of snus has increased.
We aimed to investigate the co-occurrence of, and the socio-demographics,
personality and substance use characteristics associated with, student
smoking and snus use. Methods: Survey data were collected among students in higher education in Bergen,
Norway in 2015 (N = 11,236, response rate 39.4%).
Multinomial regression analyses comparing snus users and smokers to
non-users and non-smokers, respectively, on demographic, personality and
substance use variables were conducted. Regression analyses comparing
current dual users to current smokers and current snus users and comparing
daily smokers to daily snus users, on demographic, personality and substance
use variables were also conducted. Results: In total 67.9% of ever snus users identified themselves as non-smokers (past
and current). Several demographic, personality and substance use
characteristics associated with smoking and snus use were identified (all =
p < .05), some of which were common for both (e.g.,
use of cannabis) and some which were exclusively associated with either
smoking (e.g., neuroticism) or snus use (e.g., extroversion). Conclusion: The current study contributes with several novel findings regarding traits
associated with smoking and snus use. Though limited by a cross-sectional
design, the current findings may suggest that the group of students using
snus consists of a combination of previous smokers, students who would have
smoked if snus was not available and a new segment who may not have used
nicotine if snus was not available.
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Affiliation(s)
| | - Kristin Gärtner Askeland
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Ståle Pallesen
- University of Bergen, Bergen, Norway; and Optentia, the Vaal Triangle Campus of the North-West University, Vanderbijlpark, South-Africa
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21
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Scherer G, Mütze J, Pluym N, Scherer M. Assessment of nicotine delivery and uptake in users of various tobacco/nicotine products. Curr Res Toxicol 2022; 3:100067. [PMID: 35330709 PMCID: PMC8938277 DOI: 10.1016/j.crtox.2022.100067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 12/23/2022] Open
Abstract
Today various tobacco and nicotine products are available, many of them can be regarded as potentially risk-reduced products when compared to the most frequently used product, combustible cigarettes (CCs). A commonality of these products is that they deliver nicotine, although in quite different amounts and uptake routes, the most common of which are inhalation through the lung and absorption through the oral mucosa. Product-specific nicotine delivery as well as the subject-related use patterns are important factors which determine the pharmacokinetics and achieved internal dose levels of the alkaloid. The latter two parameters are highly relevant for the long-term product loyalty and, consequently, for the implicated health risks, since the risk-reduced products will replace CCs in the long-term only when users will experience a similar level of satisfaction. We measured nicotine and its major metabolites in plasma, saliva and urine samples collected in a controlled clinical study with habitual users (10 per group) of CCs, electronic cigarettes (ECs), heated tobacco products (HTP), oral tobacco (OT), and nicotine replacement therapy (NRT). Non-users (NU) of any tobacco/nicotine products served as (negative) control group. Moderate to strong correlations were observed between the daily consumption and the urinary nicotine equivalents (comprising nicotine and its 10 major metabolites, Nic + 10) or plasma and saliva cotinine concentrations. The average daily nicotine dose as measured by the urinary excretion of Nic + 10 (reflecting approximately 95 % of the absorbed nicotine) amounted to 17 and 22 mg/24 h for smokers (CC) and OT users, respectively, while it was in the range of 6-12 mg/24 h for users of ECs, HTP and NRT products, with high inter-individual variations in each user group. The individual daily nicotine intake, which was calculated by applying product-specific models, showed none to good agreement with the corresponding internal nicotine dose measured by Nic + 10 excretion. Possible reasons for the observed deviations between calculated and objectively measured nicotine doses are discussed.
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Key Words
- 3-OH-Cot, trans-3′-hydroxycotinine
- 3-OH-Cot-gluc, trans-3′-hydroxycotinine-N,O-glucuronide
- B, blood
- CC, combustible cigarettes
- CI, 95%-confidence interval
- CNO, cotinine-N-1-oxide
- Combustible cigarettes
- Cot, cotinine
- Cot-gluc, cotinine-N-glucuronide
- EC, electronic cigarettes
- Electronic cigarettes
- HTP, heated tobacco product
- Heated tobacco products
- Hypybut, 4-OH-4-(3-pyridyl)-butanoic acid
- IQR, inter-quartile range (25th–75th percentile)
- LC-MS/MS, liquid chromatography with tandem mass spectrometry
- NCot, norcotinine
- NNO, nicotine-N-1′-oxide
- NNic, nornicotine
- NRT, nicotine replacement therapy
- NU, non-user of any tobacco/nicotine product
- Nequ, nicotine equivalents
- Nic+10, nicotine and its 10 major metabolites Cot, 3-OH-Cot, Nic-gluc, Cot-gluc, 3-OH-Cot-gluc, NNic, NCot, NNO, CNO, Hypybut
- Nic, nicotine
- Nic-gluc, nicotine-N’-glucuronide
- Nicotine
- Nicotine gum
- OT, oral tobacco
- P, plasma
- S, saliva
- SD, standard deviation of the mean
- SEM, standard error of the mean
- Snus
- U, urine
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Affiliation(s)
- Gerhard Scherer
- ABF Analytisch-Biologisches Forschungslabor GmbH, Semmelweisstr. 5, 82152 Planegg, Germany
| | - Janina Mütze
- ABF Analytisch-Biologisches Forschungslabor GmbH, Semmelweisstr. 5, 82152 Planegg, Germany
| | - Nikola Pluym
- ABF Analytisch-Biologisches Forschungslabor GmbH, Semmelweisstr. 5, 82152 Planegg, Germany
| | - Max Scherer
- ABF Analytisch-Biologisches Forschungslabor GmbH, Semmelweisstr. 5, 82152 Planegg, Germany
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Vansickel A, Baxter S, Sherwood N, Kong M, Campbell L. Human Abuse Liability Assessment of Tobacco and Nicotine Products: Approaches for Meeting Current Regulatory Recommendations. Nicotine Tob Res 2022; 24:295-305. [PMID: 34498698 DOI: 10.1093/ntr/ntab183] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/07/2021] [Indexed: 11/14/2022]
Abstract
Many regulatory bodies now recommend that tobacco product manufacturers provide information regarding new tobacco products' abuse liability to inform regulatory authorization of currently marketed tobacco products or new product applications (including premarket tobacco product applications in the United States). In addition, the US Food and Drug Administration (FDA) recommends including this information as part of modified risk tobacco product applications. Regulators, including FDA, and many public health officials and researchers consider abuse liability assessment a model which predicts the likelihood that the use of the tobacco product would result in addiction and be used repeatedly or even sporadically resulting in undesirable effects. Abuse liability of a new, potentially reduced harm product can also inform its ability to substitute completely for more harmful tobacco products. While many methods exist, no standard tobacco product abuse liability assessment has been established. The purpose of this review is to provide background information and practical recommendations for human abuse liability testing methods to meet tobacco regulatory needs. A combination of nicotine test product pharmacokinetic, subjective effect and/or behavioral response, and physiological response data relative to comparator products with known abuse liability satisfies some regulatory requirements. Implications: This review provides a practical inspection of the current, international regulatory recommendations for abuse liability assessment of tobacco and regulatory review of such information within the United States and also recommends study designs and methods for abuse liability testing of tobacco products based on scientific and regulatory knowledge. Given that tobacco product abuse liability testing is of increasing interest to regulatory bodies globally, especially with the emergence of novel tobacco products, this timely work provides background and functional recommendations for tobacco product abuse liability testing.
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Affiliation(s)
- Andrea Vansickel
- Regulatory Affairs, Altria Client Services LLC, Richmond, VA, USA
| | - Sarah Baxter
- Clinical Studies, RAI Services Company, Winston-Salem, NC, USA
| | | | - Michael Kong
- Altasciences Clinical Research, Montreal, Canada
| | - Leanne Campbell
- Clinical Studies, RAI Services Company, Winston-Salem, NC, USA
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A comprehensive physiologically based pharmacokinetic (PBPK) model for nicotine in humans from using nicotine-containing products with different routes of exposure. Sci Rep 2022; 12:1091. [PMID: 35058535 PMCID: PMC8776883 DOI: 10.1038/s41598-022-05108-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/06/2022] [Indexed: 12/17/2022] Open
Abstract
Physiologically based pharmacokinetic (PBPK) modeling can be a useful tool for characterizing nicotine pharmacokinetics (PK) from use of tobacco products. We expand a previously published PBPK model to simulate a nicotine PK profile, following single or multiple use of various tobacco products [cigarettes, smokeless tobacco, and electronic nicotine delivery systems, or a nicotine inhaler (NICOTROL)] The uptake route in the model was designed to allow for three uptake compartments: buccal cavity (BC), upper respiratory tract (URT) (conducting and transitional airways) and lower respiratory tract (alveolar region). Within each region, the model includes product-specific descriptions of the flux of nicotine into plasma, as well as the flux of nicotine from the BC and URT to the gastrointestinal tract. These descriptions are based on regional deposition and diffusion models of nicotine into plasma, which depends on the product type. Regional deposition flux combined with regional differences in physiological parameters (e.g., blood perfusion ratio and tissue thickness) play a key role in the product-specific PK profile of nicotine. The current model describes the slower flux of nicotine into plasma across the BC and URT, as well as the rapid flux known to occur in the alveolar region. Overall, the addition of the BC and respiratory tract compartments to the nicotine model provided simulation results that are comparable to the nicotine time-course plasma concentrations reported from clinical studies for the four product categories simulated.
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A Randomised Study to Investigate the Nicotine Pharmacokinetics of Oral Nicotine Pouches and a Combustible Cigarette. Eur J Drug Metab Pharmacokinet 2021; 47:211-221. [PMID: 34923602 PMCID: PMC8917032 DOI: 10.1007/s13318-021-00742-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 12/02/2022]
Abstract
Background and Objectives Nicotine pouches (NPs) are a relatively new type of oral smokeless tobacco-free nicotine product. Currently, few data are available on the nicotine pharmacokinetics or subjective effects of NP use. The objective of this study was to determine and compare the pharmacokinetics of nicotine absorption into the blood from different NP variants and a combustible cigarette. Methods In a randomised, controlled, crossover clinical study, nicotine pharmacokinetics and subjective effects were compared among commercially available NPs (five different brands; 6–10 mg nicotine/pouch) and a combustible cigarette. During an 8-day confinement period, 35 healthy adult participants who were current dual users of snus and combustible cigarettes used one study product each day for a defined period following overnight nicotine abstinence. Results Nicotine maximum plasma concentration (Cmax) and area under the plasma concentration-time curve between 0 and 6 h (AUC0–6h) were significantly greater for the Lyft 10 mg NP than for the cigarette (both p < 0.0001), while the other NPs had Cmax and AUC0–6h values that were either greater than or similar to those of the cigarette. Plasma nicotine concentration was not associated with the nicotine contents of the NPs. Time to reach maximum plasma concentration (Tmax) was higher for all NPs (60–65 min) than for the cigarette (7 min). Regarding subjective effects, liking and intent to use product again scores were higher for the cigarette than for any NP and were lowest for the NP with the lowest nicotine content. Conclusions This study provides important insight into nicotine pharmacokinetics and subjective effects during NP use, and demonstrates that NPs can provide nicotine in amounts sufficient to replicate cigarette smokers' nicotine uptake following a switch from conventional cigarettes to these potentially less harmful NP products. Further studies are required to ascertain how physical characteristics of NPs other than nicotine content may affect nicotine delivery, pharmacokinetics and subjective responses. ISRCTN Clinical Trial Registry ISRCTN17828518.
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25
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Wilhelm J, Mishina E, Viray L, Paredes A, Pickworth WB. The pH of Smokeless Tobacco Determines Nicotine Buccal Absorption: Results of a Randomized Crossover Trial. Clin Pharmacol Ther 2021; 111:1066-1074. [PMID: 34826137 DOI: 10.1002/cpt.2493] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/14/2021] [Indexed: 11/08/2022]
Abstract
Nicotine absorption rate influences tobacco products' addictiveness. For smokeless tobacco, nicotine buccal absorption is associated with its free-base form; the pH of smokeless tobacco defines the proportion of free-base (i.e., unprotonated) vs. protonated nicotine. This was the first study to compare nicotine pharmacokinetics (PK) and pharmacodynamics (PD) after the use of commercial smokeless tobacco products that were experimentally manipulated to differ only in pH and percent free-base nicotine. Moist snuff users (N = 40) completed four crossover visits and used a single 2 g portion of Copenhagen Original Long Cut amended to 4 pH levels: 5.0, 7.7, 8.2, and 8.6 (free-base nicotine 0.1, 32, 60, and 79%) for 30 minutes. Nicotine PK and PD were assessed for 4 hours post-use. Nicotine PK substantially depends on its free-base proportion, with more than 4-fold increases in mean plasma nicotine maximum concentration and area under the curve over 240 minutes (3.9 to 16.7 ng/mL; 385 to 1810 ng min/mL, respectively, both P < 0.001) from pH 5.0 to 8.6. The autonomic cardiovascular effects of smokeless tobacco use reflected percent free-base nicotine, with small (albeit significant) systematic increases in heart rate and blood pressure associated with free-base nicotine. Smokeless tobacco product pH and percent free-base nicotine play a major role in the rate and extent of nicotine absorption, determining product PD effects and abuse potential. Research and regulation of smokeless tobacco products should consider both total nicotine content and product pH. Further research may address the impact of modifying pH on the addictiveness of smokeless tobacco and associated use behaviors.
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Affiliation(s)
- Jess Wilhelm
- Battelle Public Health Research Center, Baltimore, Maryland, USA
| | - Elena Mishina
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Lauren Viray
- Battelle Public Health Research Center, Baltimore, Maryland, USA
| | - Antonio Paredes
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
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Danielsson M, Tanner T, Patinen P, Birkhed D, Anttonen V, Lammi A, Siitonen S, Ollgren J, Pylkkänen L, Vasankari T. Prevalence, duration of exposure and predicting factors for snus use among young Finnish men: a cross-sectional study. BMJ Open 2021; 11:e050502. [PMID: 34521671 PMCID: PMC8442068 DOI: 10.1136/bmjopen-2021-050502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The health hazards of tobacco products depend on the level of exposure, but little is known about the characteristics of snus use. The aim of this study was to investigate the duration of daily exposure to snus among occasional and daily users and its associated predictive factors among young Finnish men. DESIGN Cross-sectional questionnaire study. SETTING Three out of 16 Finnish Defence Forces units. PARTICIPANTS 1280 young Finnish male conscripts starting their military service in 2016 chosen by simple random sampling. PRIMARY AND SECONDARY MEASURES The prevalence, duration of use and the amount of daily usage of snus and cigarettes were investigated. The attitudes towards perceived harmfulness of snus and the predictive factors affecting the total time of snus consumption were examined. RESULTS Almost a fifth (19.5%) of the conscripts reported daily snus use, and a further 16% reported occasional use. Daily snus use was associated with an earlier starting age, longer duration of use and higher daily exposure time compared with occasional use. On average, daily snus users consumed 10 portions and occasional users three portions per day (p<0.001). The daily total exposure time for daily users was 372 min (95% CI 344 to 401) and for occasional users 139 min (95% CI 106 to 171). Respondents with an upper secondary education had significantly less daily total exposure than those with basic comprehensive education (p=0.036). Perceptions of snus as a harmful substance resulted in a significantly lower duration of exposure. CONCLUSION Snus use was very common among young Finnish men. High snus exposure duration was associated with an earlier starting age, a longer history of use and a careless attitude to its health hazards. A higher education level was a protective factor for total exposure time. Studies of the long-term health effects and dependency profile of snus use are needed.
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Affiliation(s)
- Maria Danielsson
- Center for Military Medicine, Finnish Defence Forces, Helsinki, Uusimaa, Finland
- Doctoral Programme in Population Health, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Tarja Tanner
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
- Medical Research Center, University Hospital and University of Oulu, Oulu, Finland
| | - Pertti Patinen
- Center for Military Medicine, Finnish Defence Forces, Helsinki, Uusimaa, Finland
| | - Dowen Birkhed
- Former: Department of Cariology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vuokko Anttonen
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
- Medical Research Center, University Hospital and University of Oulu, Oulu, Finland
| | - Anelma Lammi
- Finnish Lung Health Association, Helsinki, Uusimaa, Finland
| | - Simo Siitonen
- The Defence Command, Finnish Defence Forces, Helsinki, Uusimaa, Finland
| | - Jukka Ollgren
- Department of Infectious Disease Surveillance and Control, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | - Liisa Pylkkänen
- Finnish Medicines Agency Fimea, Helsinki, Uusimaa, Finland
- Division of Medicine, Department of Oncology, University of Turku, Turku, Varsinais-Suomi, Finland
| | - Tuula Vasankari
- Finnish Lung Health Association, Helsinki, Uusimaa, Finland
- Division of Medicine, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Varsinais-Suomi, Finland
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27
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Briggs FB. Nicotinic acetylcholine receptors α7 and α9 modifies tobacco smoke risk for multiple sclerosis. Mult Scler 2021; 27:1166-1174. [PMID: 32924781 DOI: 10.1177/1352458520958361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Tobacco smoke exposure is an established risk factor for multiple sclerosis (MS), yet how it confers risk is not known. Evidence from observational studies suggests nicotine may be a protective component. Animal studies further support this hypothesis, demonstrating nicotine's protective effect in MS is mediated by the presence and absence of α7 and α9 nicotinic acetylcholine receptors (nAChRs), respectively. OBJECTIVE To determine if variation in the genes encoding α7 and α9 nAChRs (cholinergic receptor nicotinic alpha 7 (CHRNA7) and alpha 9 (CHRNA9)) will modify MS risk conferred by tobacco smoking. METHODS A multi-stage gene-environment (G×E) framework was utilized, including a case-control analysis (286 cases, 176 controls) with haplotype- and gene-based analyses, followed by an extension case-only (1053 cases) analysis for overlapping variants. RESULTS The results suggest that CHRNA7 and CHRNA9 modifies MS risk conferred by tobacco smoke, where risk among smokers was increased in carriers of the minor CHRNA9 haplotype and in non-carriers the minor CHRNA7 haplotype. The findings are consistent with the pharmacology of these receptors and animal studies of MS. CONCLUSION This study implicates novel processes in MS initiation and demonstrate the need for further G×E studies to advancing our understanding of the missing heritability of MS.
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Affiliation(s)
- Farren Bs Briggs
- Neuroimmunological Disorders Gene-Environment Epidemiology Lab, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Azzopardi D, Liu C, Murphy J. Chemical characterization of tobacco-free "modern" oral nicotine pouches and their position on the toxicant and risk continuums. Drug Chem Toxicol 2021; 45:2246-2254. [PMID: 34034614 DOI: 10.1080/01480545.2021.1925691] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
As compared with cigarette smoking, use of Swedish snus is associated with significantly fewer health risks. Nicotine pouches (NPs), a new form of oral nicotine product, are smokeless and tobacco-free, comprising a nicotine-containing cellulose matrix inside a fiber pouch. NPs are similar in appearance/use to snus, but without tobacco, have the potential to further reduce tobacco-related harm. This study aimed to evaluate toxicant levels of NPs to estimate their position on the tobacco/nicotine product continuums of toxicant delivery and risk. NPs, snus and nicotine replacement therapy products (NRTs) were analyzed for 24-26 compounds applicable to oral tobacco, and their levels were compared. Twenty of these compounds were further used to compare the toxicant profile of NPs, as well as estimated daily toxicant exposure from NP use, with that of tobacco/nicotine products spanning the risk continuum. Of the compounds measured, 22 (NPs), 22 (lozenge NRT), 20 (gum NRT), and 11 (snus) were not quantifiable. Compared with snus, NPs had lower levels of 10 HPHCs and comparable/undetectable levels of a further 13. Across the product categories, NPs and NRTs had the lowest toxicant profiles and estimations of relative toxicant exposure. Based on the present chemical analysis and estimated exposure, use of NPs appears likely to expose users to lower levels of toxic compounds than Swedish snus, which is recognized to offer reduced levels of harm than associated with tobacco smoking. We conclude that NPs should be placed close to NRTs on the tobacco/nicotine product toxicant delivery continuum, although further studies will be needed to confirm this.
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Affiliation(s)
- David Azzopardi
- Research and Development, British American Tobacco (Investments) Limited, Southampton, UK
| | - Chuan Liu
- Research and Development, British American Tobacco (Investments) Limited, Southampton, UK
| | - James Murphy
- Research and Development, British American Tobacco (Investments) Limited, Southampton, UK
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Giri S, Barhoi D, Nath Barbhuiya S, Giri A, Das S, Das A, Devi SH, Talukdar D, Upadhaya P, Langthasa P, Pandey N, Singh S. Consumption pattern and genotoxic potential of various smokeless tobacco products in Assam, India: A public health concern. Mutat Res 2021; 866:503349. [PMID: 33985693 DOI: 10.1016/j.mrgentox.2021.503349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/02/2021] [Accepted: 03/12/2021] [Indexed: 01/23/2023]
Abstract
Smokeless tobacco (SLT) consumption is presumed to be one of the major causes of high incidence of oral cancer in India. The present study aimed to document various types of SLT products consumed and their potential impact on the genome instability on the population from Assam state in Northeast India. A cross-sectional study (n = 5000) showed that 60.56 % of the study population consumed at least one of the three forms (sadagura, zarda and khaini) of SLT of which 52.0 % were only sadagura users. Genotoxicity assessment using buccal cytome assay in 240 age and sex matched volunteers revealed that except for zarda, other forms of SLT induced significantly higher incidence micronuclei in the buccal epithelial cells compared to the control individuals. Similar effects were also observed in other cytome parameters related to cell proliferation, cytokinesis defects and cell death. Significantly higher incidence of micronucleus was observed among sadagura and khaini users in lymphocyte cytokinesis-blocked micronucleus assay. The addition of lime in sadagura increased the pH and anion levels which possibly result in higher absorption and may lead to the development of cellular anomalies.
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Affiliation(s)
- Sarbani Giri
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Dharmeswar Barhoi
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Sweety Nath Barbhuiya
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Anirudha Giri
- Laboratory of Environmental and Human Toxicology, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Samrat Das
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Aparajita Das
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Salam Himika Devi
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Doli Talukdar
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Puja Upadhaya
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Pimily Langthasa
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Neelam Pandey
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
| | - Supriya Singh
- Molecular and Cell Biology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India.
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The influence of snuff and smoking on bone accretion in late adolescence. The Tromsø study, Fit Futures. Arch Osteoporos 2021; 16:143. [PMID: 34570277 PMCID: PMC8476466 DOI: 10.1007/s11657-021-01003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/13/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Areal bone mineral density (aBMD) predicts future fracture risk. This study explores associations between use of tobacco and bone accretion in Norwegian adolescents. Our results indicate that use of snuff is negatively associated with accretion of aBMD in adolescence and may be a signal of increased future fracture risk. PURPOSE Bone mineral accrual in childhood and adolescence is a long-term primary preventive strategy of osteoporosis. Areal bone mineral density (aBMD) is a surrogate measure of bone strength and a predictor of fracture risk. The aim of this population-based 2-year follow-up cohort study was to explore associations between use of snuff and smoking and changes (∆) in aBMD in Norwegian girls and boys aged 15-17 years at baseline. METHODS The first wave of the Tromsø study, Fit Futures was conducted from 2010 to 2011. Femoral neck (FN), total hip (TH), and total body (TB) bone mineral content (BMC) and aBMD were measured by dual-energy X-ray absorptiometry. Information on use of snuff, smoking habits, and other lifestyle related variables were collected through self-administered questionnaires. Two years later, during 2012-2013, the measurements were repeated in the second wave. The present study included 349 girls and 281 boys and compared "non-users" (n = 243 girls, 184 boys) with "users" (n = 105 girls, 96 boys) of snuff and "non-smokers" (n = 327 girls, 249 boys) with "smokers" (n = 21 girls, 31 boys) using linear regression adjusted for age, baseline height and weight, change in height and weight, pubertal maturation, physical activity, ethnicity, alcohol consumption, diagnosis known to affect bone, and medication known to affect bone. The influence of "double use" on bone accretion was also explored. RESULTS In girls, no associations between use of snuff and ∆aBMD were found. In boys, use of snuff was associated with reduced bone accretion in all ∆aBMD models. Sensitivity analysis with exclusion of "sometimes" users of snuff strengthened associations at femoral sites in girls and attenuated all associations in boys. In girls, no associations between smoking and ∆aBMD were found. In boys, only the association with TB ∆aBMD was significant in the fully adjusted models. In girls, "double users" analyses showed similar association to smoking. In boys, nearly all models showed statistically significant associations with a difference of ~ 1-2% in ∆aBMD between "non-users" and "double users" during 2 years of follow-up. CONCLUSIONS Our results indicate that tobacco use in late adolescence could be detrimental to bone accretion and may be a signal of increased fracture risk in adult life.
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Spahn JE, Stavchansky SA, Cui Z. Critical research gaps in electronic cigarette devices and nicotine aerosols. Int J Pharm 2020; 593:120144. [PMID: 33285247 DOI: 10.1016/j.ijpharm.2020.120144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
Electronic cigarettes (e-cigs) are devices that aerosolize nicotine-containing liquids for delivery as an inhaled vapor. E-cigs are currently marketed as smoking cessation devices, though the emergence and rapid adoption of these devices in recent years has sparked a great deal of concern over their safety. Given the plethora of devices and nicotine solutions available on the market and the lack of regulation and quality control, it is imperative that these devices and nicotine formulations are studied to assess critical operating parameters, the pharmacokinetic profiles of the inhaled nicotine, and the toxicity profiles of the e-cig aerosols. This review aims to deliver an overview of current research regarding electronic cigarette devices, nicotine-containing liquid formulations, pharmacokinetics of nicotine, and toxicology studies in order to highlight areas lacking in research or requiring greater standardization and regulation.
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Affiliation(s)
- Jamie E Spahn
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, Austin, TX, USA.
| | - Salomon A Stavchansky
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, Austin, TX, USA.
| | - Zhengrong Cui
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, Austin, TX, USA.
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Li AP, Ho MD, Alam N, Mitchell W, Wong S, Yan Z, Kenny JR, E. C. A. Hop C. Inter-individual and inter-regional variations in enteric drug metabolizing enzyme activities: Results with cryopreserved human intestinal mucosal epithelia (CHIM) from the small intestines of 14 donors. Pharmacol Res Perspect 2020; 8:e00645. [PMID: 32851819 PMCID: PMC7449955 DOI: 10.1002/prp2.645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
We have previously reported successful isolation and cryopreservation of human intestinal mucosa (CHIM) with retention of viability and drug metabolizing enzyme activities. Here we report the results of the quantification of drug metabolizing enzyme activities in CHIM from different regions of the small intestines from 14 individual donors. CHIM were isolated from the duodenum, jejunum, and ileum of 10 individuals, and from 10 consecutive 12-inch segments starting from the pyloric sphincter of human small intestines from four additional individuals. P450 and non-P450 drug metabolizing enzyme activities (CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A, UGT, SULT, FMO, MAO, AO, NAT1, and NAT2) were quantified via incubation with pathway-selective substrates. Quantifiable activities were observed for all pathways except for CYP2A6. Comparison of the duodenum, jejunum, and ileum in 10 donors shows jejunum had higher activities for CYP2C9, CYP3A, UGT, SULT, MAO, and NAT1. Further definition of regional variations with CHIM from ten 12-inch segments of the proximal small intestine shows that the segments immediately after the first 12-inch segment (duodenum) had the highest activity for most of the drug metabolizing enzymes but with substantial differences among the four donors. Our overall results demonstrate that there are substantial individual differences in drug metabolizing enzymes and that jejunum, especially the regions immediately after the duodenum, had the highest drug metabolizing enzyme activities.
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Affiliation(s)
| | | | - Novera Alam
- In Vitro ADMET Laboratories, Inc.ColumbiaMDUSA
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E B, N E, S B, S S, D S, M T, S M, A B, D B, D T, M G. An approach for the extract generation and toxicological assessment of tobacco-free 'modern' oral nicotine pouches. Food Chem Toxicol 2020; 145:111713. [PMID: 32998027 DOI: 10.1016/j.fct.2020.111713] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 01/06/2023]
Abstract
Tobacco-free 'modern' oral nicotine pouches (MOPs), are similar in appearance and use to Swedish-style snus, but without tobacco. There are few identified methods to create test samples for toxicologically assessment of MOPs in vitro. In this study we present a simple method for the extraction of pouch material in cell culture media, providing consistent nicotine concentration and easy in vitro assessment. A series of contemporary in vitro screening assays (viability, cell health markers, oxidative stress and genotoxicity) using human oral fibroblasts (HGF) and human lung epithelial cells (H292) were employed. Extracts were generated from LYFT and compared to snus (CRP1.1) and cigarette (1R6F) reference products. MOP and CRP1.1 extracts were generated by incubating one pouch in 20 ml of cell culture media, while 1R6F AqE was prepared by smoking 1 cigarette into 20 ml of cell culture media. 1R6F demonstrated toxicological responses in most assays; CRP1.1 had minimal to moderate effects while MOP demonstrated little or no response in all assays. This study demonstrated the generation of MOPs extracts and their toxicological evaluation using in vitro screening approaches. Future product usage, pharmacokinetics and clinical studies will further substantiate the reduced risk potential of MOPs.
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Affiliation(s)
- Bishop E
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK
| | - East N
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK
| | - Bozhilova S
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK
| | - Santopietro S
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK
| | - Smart D
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK
| | - Taylor M
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK
| | - Meredith S
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK
| | - Baxter A
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK
| | - Breheny D
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK
| | - Thorne D
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK.
| | - Gaca M
- British American Tobacco, R&D, Southampton, Hampshire, SO15 8TL, UK
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Strong DR, Leas E, Noble M, White M, Frissell KC, Glasser A, Katz L, Taylor K, Compton WM, Conway KP, Lambert E, Kimmel HL, Silveira ML, Green V, Hull LC, Cummings KM, Hyland A, Niaura R. Predictive validity of the adult tobacco dependence index: Findings from waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) study. Drug Alcohol Depend 2020; 214:108134. [PMID: 32629146 PMCID: PMC7446939 DOI: 10.1016/j.drugalcdep.2020.108134] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Building on published work1 establishing concurrent validity of a self-report tobacco dependence (TD) index among users of different tobacco products in Wave 1 (W1) of the Population Assessment of Tobacco and Health (PATH) Study, the current study examines prospective relationships with tobacco use behaviors to establish predictive validity of the TD index. Hypotheses suggested high levels of W1 TD would be associated with persistent tobacco use at Wave 2 (W2). PARTICIPANTS A U.S. nationally representative sample of 32,320 adult W1 and W2 interviews focused on 11,615 W1 adults who were current established tobacco users and completed the W2 interview. FINDINGS Higher TD scores and greater changes in TD scores were associated with greater quantity and frequency of tobacco use at the W2 interview for Cigarette Only (n = 7068), Smokeless (smokeless or snus pouches) Only (n = 772), Cigarette plus E-Cigarette (n = 592), and Multiple Products (n = 1866) users, although not significantly so for E-Cigarette Only (n = 367), Cigar Only (traditional, cigarillo, or filtered) (n = 584), or Hookah Only (n = 366) users. Higher TD was associated with decreased odds of successful quitting for Cigarette and Multiple Product users. Higher TD was associated with increased odds of a quit attempt for those in the Hookah and Multiple Products user groups and was not associated with quit attempts or deceased odds of quit success among exclusive E-Cigarette, Cigar, Smokeless and Cigarette plus E-Cigarette users. CONCLUSION Support for the predictive validity of the PATH Study measures of adult TD will enable regulatory investigations of TD across several tobacco products.
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Affiliation(s)
- David R Strong
- Cancer Prevention & Control Program, Moores Cancer Center University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States.
| | - Eric Leas
- Cancer Prevention & Control Program, Moores Cancer Center University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States
| | - Madison Noble
- Cancer Prevention & Control Program, Moores Cancer Center University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States
| | - Martha White
- Cancer Prevention & Control Program, Moores Cancer Center University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States
| | | | - Allison Glasser
- College of Global Public Health, New York University, United States
| | - Lauren Katz
- College of Global Public Health, New York University, United States
| | | | - Wilson M Compton
- National Institute on Drug Abuse (NIDA/NIH), Bethesda, MD, United States(1)
| | - Kevin P Conway
- National Institute on Drug Abuse (NIDA/NIH), Bethesda, MD, United States(1)
| | - Elizabeth Lambert
- National Institute on Drug Abuse (NIDA/NIH), Bethesda, MD, United States(1)
| | - Heather L Kimmel
- National Institute on Drug Abuse (NIDA/NIH), Bethesda, MD, United States(1)
| | - Marushka L Silveira
- National Institute on Drug Abuse (NIDA/NIH), Bethesda, MD, United States(1); Kelly Government Solutions, Rockville, MD, United States
| | - Victoria Green
- National Institute on Drug Abuse (NIDA/NIH), Bethesda, MD, United States(1); Kelly Government Solutions, Rockville, MD, United States
| | - Lynn C Hull
- Center for Tobacco Products, FDA, Silver Spring, MD, United States
| | | | - Andrew Hyland
- Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Ray Niaura
- College of Global Public Health, New York University, United States
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35
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Herland A, Maoz BM, Das D, Somayaji MR, Prantil-Baun R, Novak R, Cronce M, Huffstater T, Jeanty SSF, Ingram M, Chalkiadaki A, Benson Chou D, Marquez S, Delahanty A, Jalili-Firoozinezhad S, Milton Y, Sontheimer-Phelps A, Swenor B, Levy O, Parker KK, Przekwas A, Ingber DE. Quantitative prediction of human pharmacokinetic responses to drugs via fluidically coupled vascularized organ chips. Nat Biomed Eng 2020; 4:421-436. [PMID: 31988459 PMCID: PMC8011576 DOI: 10.1038/s41551-019-0498-9] [Citation(s) in RCA: 246] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/25/2019] [Indexed: 01/15/2023]
Abstract
Analyses of drug pharmacokinetics (PKs) and pharmacodynamics (PDs) performed in animals are often not predictive of drug PKs and PDs in humans, and in vitro PK and PD modelling does not provide quantitative PK parameters. Here, we show that physiological PK modelling of first-pass drug absorption, metabolism and excretion in humans-using computationally scaled data from multiple fluidically linked two-channel organ chips-predicts PK parameters for orally administered nicotine (using gut, liver and kidney chips) and for intravenously injected cisplatin (using coupled bone marrow, liver and kidney chips). The chips are linked through sequential robotic liquid transfers of a common blood substitute by their endothelium-lined channels (as reported by Novak et al. in an associated Article) and share an arteriovenous fluid-mixing reservoir. We also show that predictions of cisplatin PDs match previously reported patient data. The quantitative in-vitro-to-in-vivo translation of PK and PD parameters and the prediction of drug absorption, distribution, metabolism, excretion and toxicity through fluidically coupled organ chips may improve the design of drug-administration regimens for phase-I clinical trials.
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Affiliation(s)
- Anna Herland
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Division of Micro and Nanosystems, KTH Royal Institute of Technology, Stockholm, Sweden
- AIMES, Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Ben M Maoz
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Debarun Das
- CFD Research Corporation, Huntsville, AL, USA
| | | | - Rachelle Prantil-Baun
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Richard Novak
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Michael Cronce
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Tessa Huffstater
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Sauveur S F Jeanty
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Miles Ingram
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Angeliki Chalkiadaki
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - David Benson Chou
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Susan Marquez
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Aaron Delahanty
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Sasan Jalili-Firoozinezhad
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Department of Bioengineering and Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Portugal Graduate Program, Universidade de Lisboa, Lisbon, Portugal
| | - Yuka Milton
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Alexandra Sontheimer-Phelps
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Ben Swenor
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Oren Levy
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Kevin K Parker
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | | | - Donald E Ingber
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.
- Division of Micro and Nanosystems, KTH Royal Institute of Technology, Stockholm, Sweden.
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
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36
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Watle SV, Caugant DA, Tunheim G, Bekkevold T, Laake I, Brynildsrud OB, Næss LM. Meningococcal carriage in Norwegian teenagers: strain characterisation and assessment of risk factors. Epidemiol Infect 2020; 148:e80. [PMID: 32228726 PMCID: PMC7189347 DOI: 10.1017/s0950268820000734] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/19/2020] [Indexed: 11/24/2022] Open
Abstract
Teenagers have a higher risk of invasive meningococcal disease (IMD) than the general population. This cross-sectional study aimed to characterise strains of Neisseria meningitidis circulating among Norwegian teenagers and to assess risk factors for meningococcal carriage. Oropharyngeal swabs were collected from secondary-school students in southeastern Norway in 2018-2019. Meningococcal isolates were characterised using whole genome sequencing. Risk factors for meningococcal carriage were assessed from questionnaire data. Samples were obtained from 2296 12-24-year-olds (majority 13-19-year-olds). N. meningitidis was identified in 167 (7.3%) individuals. The highest carriage rate was found among 18-year-olds (16.4%). Most carriage isolates were capsule null (40.1%) or genogroup Y (33.5%). Clonal complexes cc23 (35.9%) and cc198 (32.3%) dominated and 38.9% of carriage strains were similar to invasive strains currently causing IMD in Norway. Use of Swedish snus (smokeless tobacco) (OR 1.56, 95% CI 1.07-2.27), kissing >two persons/month (OR 2.76, 95% CI 1.49-5.10) and partying >10 times/3months (OR 3.50, 95% CI 1.45-8.48) were associated with carriage, while age, cigarette smoking, sharing of drinking bottles and meningococcal vaccination were not. The high meningococcal carriage rate among 18-year-olds is probably due to risk-related behaviour. Use of Swedish snus is possibly a new risk factor for meningococcal carriage. Almost 40% of circulating carriage strains have invasive potential.
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Affiliation(s)
- S. V. Watle
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1078 Blindern, 0316 Oslo, Norway
| | - D. A. Caugant
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1078 Blindern, 0316 Oslo, Norway
| | - G. Tunheim
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - T. Bekkevold
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - I. Laake
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - O. B. Brynildsrud
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - L. M. Næss
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
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Tam E, Bruseghini P, Capelli C, Baraldo M, Chiamulera C, Zandonai T. Effects of nicotine on microvascular responsiveness after nicotine satiety versus overnight nicotine abstinence. Vasc Med 2020; 25:223-225. [PMID: 32202231 DOI: 10.1177/1358863x20906029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Enrico Tam
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Bruseghini
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Carlo Capelli
- Department of Physical Performances, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Cristiano Chiamulera
- Neuropsychopharmacology Lab, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Thomas Zandonai
- Department of Experimental Psychology, Mind, Brain and Behaviour Research Centre, Faculty of Psychology, University of Granada, Granada, Spain.,Alicante Institute for Health and Biomedical Research, ISABIAL-FISABIO Foundation, Neuropharmacology on Pain, Miguel Hernández University, Elche, Alicante, Spain
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38
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McGrath-Morrow SA, Gorzkowski J, Groner JA, Rule AM, Wilson K, Tanski SE, Collaco JM, Klein JD. The Effects of Nicotine on Development. Pediatrics 2020; 145:peds.2019-1346. [PMID: 32047098 PMCID: PMC7049940 DOI: 10.1542/peds.2019-1346] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/08/2023] Open
Abstract
Recently, there has been a significant increase in the use of noncombustible nicotine-containing products, including electronic cigarettes (e-cigarettes). Of increasing popularity are e-cigarettes that can deliver high doses of nicotine over short periods of time. These devices have led to a rise in nicotine addiction in adolescent users who were nonsmokers. Use of noncombustible nicotine products by pregnant mothers is also increasing and can expose the developing fetus to nicotine, a known teratogen. In addition, young children are frequently exposed to secondhand and thirdhand nicotine aerosols generated by e-cigarettes, with little understanding of the effects these exposures can have on health. With the advent of these new nicotine-delivery systems, many concerns have arisen regarding the short- and long-term health effects of nicotine on childhood health during all stages of development. Although health studies on nicotine exposure alone are limited, educating policy makers and health care providers on the potential health effects of noncombustible nicotine is needed because public acceptance of these products has become so widespread. Most studies evaluating the effects of nicotine on health have been undertaken in the context of smoke exposure. Nevertheless, in vitro and in vivo preclinical studies strongly indicate that nicotine exposure alone can adversely affect the nervous, respiratory, immune, and cardiovascular systems, particularly when exposure occurs during critical developmental periods. In this review, we have included both preclinical and clinical studies to identify age-related health effects of nicotine exposure alone, examining the mechanisms underlying these effects.
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Affiliation(s)
- Sharon A. McGrath-Morrow
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine and
| | - Julie Gorzkowski
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
| | - Judith A. Groner
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Ana M. Rule
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Karen Wilson
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Department of Pediatrics, Icahn School of Medicine at Mount Sinai and Kravis Children’s Hospital, New York, New York
| | - Susanne E. Tanski
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; and
| | - Joseph M. Collaco
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine and
| | - Jonathan D. Klein
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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39
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Camacho OM, Hedge A, Lowe F, Newland N, Gale N, McEwan M, Proctor C. Statistical analysis plan for "A randomised, controlled study to evaluate the effects of switching from cigarette smoking to using a tobacco heating product on health effect indicators in healthy subjects". Contemp Clin Trials Commun 2020; 17:100535. [PMID: 32072070 PMCID: PMC7013164 DOI: 10.1016/j.conctc.2020.100535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/10/2020] [Accepted: 01/26/2020] [Indexed: 02/06/2023] Open
Abstract
Tobacco harm reduction strategies aim to substitute smoking with potentially reduced risk products (PRRPs) such as e-cigarettes and tobacco-heating products (THPs). The health benefits of switching from smoking to PRRPs is unknown. A randomised controlled trial is being conducted to increase understanding of the health effects of switching from smoking to a THP in a 12-month long ambulatory study (ISRCTN81075760). Here we describe the study endpoints and the statistical analysis plan. Endpoints are divided into biomarkers of exposure (BoE) to tobacco smoke constituents and health effect indicators related to risk of lung cancer, cardiovascular and obstructive lung disease. These have been selected on the basis of extensive literature evidence. Three primary endpoints, augmentation index (risk factor for cardiovascular disease), total NNAL (linked to lung cancer) and 8-Epi-PGF2α type III (indicator of oxidative stress linked to various diseases), and multiple secondary endpoints will be analysed at 90, 180, and 360 days. Changes from baseline will be compared between study arms by specific contrasts in mixed models. Study wise multiple comparisons adjustments will be performed to account for multiplicity of timepoints and comparisons within timepoints. Generalisability of outcomes will be tested by a sensitivity analysis adjusting for age and gender. Importantly, an ancillary analysis will be performed to assess product compliance during the study based on plasma levels of CEVal, a surrogate marker for acrylonitrile exposure. The rationale underlying the selection of BoEs and health effect indicators, coupled with the statistical analysis plan will be central to understanding the potential health effects of replacing smoking with THP use for one year.
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Affiliation(s)
- Oscar M. Camacho
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Andrew Hedge
- Covance Clinical Research Unit Ltd, Springfield House, Hyde Street, Leeds, Yorkshire, LS2 9LH, UK
| | - Frazer Lowe
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Nik Newland
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Nathan Gale
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Mike McEwan
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Christopher Proctor
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
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40
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Mobarrez F, Antoniewicz L, Hedman L, Bosson JA, Lundbäck M. Electronic cigarettes containing nicotine increase endothelial and platelet derived extracellular vesicles in healthy volunteers. Atherosclerosis 2020; 301:93-100. [PMID: 32122618 DOI: 10.1016/j.atherosclerosis.2020.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/04/2020] [Accepted: 02/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS E-cigarette use is increasingly common. Whether e-cigarettes are harmful to human health is an intensely debated subject. In order to investigate whether e-cigarettes with and without nicotine cause different vascular responses, we obtained blood samples from healthy young volunteers who performed brief active e-cigarette inhalations. Extracellular vesicles (EVs) of endothelial and platelet origin were measured to determine vascular changes. METHODS Using a randomized, double-blind, crossover design, 17 healthy occasional smokers inhaled 30 puffs of e-cigarette vapor during 30 min. Blood samples were collected at baseline, as well as at 0, 2, 4 and 6 h post-exposure. EVs from platelets and endothelial cells were measured by flow cytometry. RESULTS Platelet and endothelial derived EVs were significantly increased with peak levels seen at 4 h following exposure to active inhalation of e-cigarette vapor with nicotine. Moreover, platelet derived EVs, expressing platelet activation marker P-selectin and the inflammation marker, CD40 ligand, were also significantly increased following inhalation of e-cigarette vapor with nicotine. In addition, platelet derived EVs expressing CD40 ligand was increased after inhalation of e-cigarette vapor without nicotine. CONCLUSION As few as 30 puffs of nicotine-containing e-cigarette vapor caused an increase in levels of circulating EVs of endothelial and platelet origin, which may signify underlying vascular changes. Although e-cigarette vapor without nicotine caused an increase in platelet EVs expressing CD40 ligand, nicotine, as a component in the vapor, seems to have a more compelling effect on extracellular vesicle formation and protein composition.
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Affiliation(s)
- Fariborz Mobarrez
- Department of Medical Sciences, Uppsala University, 75185, Uppsala, Sweden
| | - Lukasz Antoniewicz
- Karolinska Institutet, Department of Clinical Sciences, Division of Internal Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Linnea Hedman
- Umeå University, Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå, Sweden
| | - Jenny A Bosson
- Umeå University, Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå, Sweden
| | - Magnus Lundbäck
- Karolinska Institutet, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd University Hospital, Stockholm, Sweden.
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41
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Shah SS, Shah M, Habib SH, Shah FA, Malik MO. Correlation of plasma kisspeptin with total testosterone levels in smokeless tobacco and smoking tobacco users in a healthy cohort: A cross-sectional study. Andrologia 2019; 51:e13409. [PMID: 31502328 DOI: 10.1111/and.13409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022] Open
Abstract
Human infertility is a worldwide health issue and is the inability to conceive following twelve months of unprotected sexual intercourse. Consistent studies reiterated tobacco abuse to be an important risk factor which adversely effects male fertility. This study aims to determine the correlation of kisspeptin and total testosterone levels in smokeless tobacco, smoking tobacco users and healthy controls. A total of 180 subjects were selected using random sampling technique. Non-fasting blood samples (5 ml) were drawn, and ELISA technique was used for the evaluation of plasma levels of kisspeptin and total testosterone. Total testosterone was found to be significantly high in smokers and smokeless tobacco users, while the level of kisspeptin was found to be significantly high in smokeless tobacco users only as compared to control group. Furthermore, the level of cholesterol was found to be significantly low, whereas HDL and triglycerides were found to be significantly high in smokeless tobacco users relative to control subjects. Findings of this study suggest that tobacco use has impact on HPG axis by affecting kisspeptin level. The increase in kisspeptin level can affect hypothalamic function leading to pituitary and gonadal dysfunction along with impairment of reproduction. The finding that smokeless tobacco significantly raises kisspeptin strengthens the idea that smokeless tobacco use has more potent effects centrally compared to smoking.
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Affiliation(s)
- Syed Salman Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Syed Hamid Habib
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Fawad Ali Shah
- Department of Pharmacology, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Muhammad Omar Malik
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
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Newland N, Lowe FJ, Camacho OM, McEwan M, Gale N, Ebajemito J, Hardie G, Murphy J, Proctor C. Evaluating the effects of switching from cigarette smoking to using a heated tobacco product on health effect indicators in healthy subjects: study protocol for a randomized controlled trial. Intern Emerg Med 2019; 14:885-898. [PMID: 31049783 PMCID: PMC6722146 DOI: 10.1007/s11739-019-02090-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022]
Abstract
Tobacco heating products (THPs) are a potentially safer alternative to combustible cigarette smoking. Through continued use, THPs may reduce smoking-related disease risk, whilst maintaining the sensorial experience and nicotine delivery sought by smokers. While literature evidence of the biological effects of THP aerosol exposure is increasing, there remains a knowledge gap with respect to substantiation of THP reduced risk potential in longer term real-life use. This randomized, multi-centre, controlled clinical study will test the hypotheses that following a switch from combustible cigarettes to a THP for 1 year, participants will experience a sustained reduction in exposure to tobacco-related toxicants that will lead to favourable changes in health effect indicators associated with smoking-related disease development. Changes in such indicators will be contextualized against smoking cessation and never-smoker cohorts. Up to 280 participants who do not intend to quit smoking will be randomized to continued combustible smoking (arm A, up to n = 80) or a commercially available THP (arm B n = 200). Furthermore, up to 190 participants with a high intent to quit smoking will undergo smoking cessation (arm D), and 40 never smokers will serve as a control group (arm E). Recruitment numbers were determined to be sufficient to achieve n = 50 in arms A, B and D, at study end. Enrolment started in March 2018 and the trial is scheduled to be completed in March 2020. Data from this study will be a valuable addition to the growing body of evidence in the field of understanding the individual and public health impact of THPs.Clinical Trial Registration: https://www.isrctn.com/ISRCTN81075760.
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Affiliation(s)
- Nik Newland
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - Frazer John Lowe
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK.
| | - Oscar Martin Camacho
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - Mike McEwan
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - Nathan Gale
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - James Ebajemito
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - George Hardie
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - James Murphy
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
| | - Christopher Proctor
- Group Research and Development, British American Tobacco (Investments) Ltd., Regents Park Road, Southampton, SO15 8TL, UK
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43
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Nordenstam F, Lundell B, Edstedt Bonamy A, Raaschou P, Wickström R. Snus users had high levels of nicotine, cotinine and 3-hydroxycotinine in their breastmilk, and the clearance was slower than in smoking mothers. Acta Paediatr 2019; 108:1250-1255. [PMID: 30276861 DOI: 10.1111/apa.14602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/08/2018] [Accepted: 09/27/2018] [Indexed: 11/29/2022]
Abstract
AIM Using snus, an oral moist tobacco, has increased among pregnant women in Sweden, the only European Union country where sales are legal. This study evaluated whether snus generated similar concentrations of nicotine and its metabolites in breastmilk to cigarette smoking. METHODS We analysed 49 breastmilk samples from 33 nursing mother - 13 snus users, six cigarette smokers and 14 controls - for concentrations of nicotine, cotinine and 3-hydroxycotinine. The mothers were recruited at antenatal clinics in Sweden from 2007 to 2012. RESULTS The median nicotine concentration in breastmilk of the snus users was 38.7 ng/mL (0-137) versus 24.0 ng/mL (0-56) in smokers, with median cotinine levels of 327.6 ng/mL (37-958) versus 164.4 ng/mL and median 3-hydroxycotinine levels of 202.7 ng/mL (28-452) versus 112.4 (0-231), respectively. Nicotine was still detected in the breastmilk of eight of the 13 snus users after abstaining from tobacco for a median duration of 11 hours (0.6-12.5), while the breastmilk of the smokers was nicotine-free after four hours' abstinence. CONCLUSION Snus users had high levels of nicotine and metabolites in their breastmilk and nicotine was found even after 12.5 hours of abstinence.
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Affiliation(s)
- Felicia Nordenstam
- Pediatric Cardiology Unit Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
| | - Bo Lundell
- Pediatric Cardiology Unit Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
| | - Anna‐Karin Edstedt Bonamy
- Neonatal Research Unit Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
- Clinical Epidemiology Unit Department of Medicine Karolinska Institute Stockholm Sweden
| | - Pauline Raaschou
- Clinical Epidemiology Unit Department of Medicine Karolinska Institute Stockholm Sweden
| | - Ronny Wickström
- Neuropediatric Unit Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
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44
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Carlsson S, Kuja-Halkola R, Magnusson C, Lagerros YT, Andersson T. Tobacco and type 2 diabetes: is the association explained by genetic factors? Int J Epidemiol 2019; 48:926-933. [PMID: 30726916 DOI: 10.1093/ije/dyz002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking and use of Swedish smokeless tobacco (snus) are associated with increased risk of type 2 diabetes (T2D). Our aim was to estimate the unique and shared genetic components of these traits and to what extent the association is explained by shared genetic factors. METHODS We used twins of the Swedish Twin Registry who responded to a questionnaire between 1998 and 2006 (n = 40 247) and were followed until 2015 in the National Prescription and Patient Registries. We estimated hazard ratios (HRs) and odds ratios (ORs) for the association between smoking/snus use and T2D (n = 2130) and used structural equation models to estimate genetic and environmental variance components and genetic correlations. RESULTS Current smokers [HR 1.69, 95% confidence interval (CI), 1.49-1.92] and snus users (HR 1.19, 95% CI 1.01-1.41) had an increased risk of T2D. In within-pair analyses of monozygotic twins, corresponding ORs were 1.36, 95% CI 0.75-2.46 (smoking) and 1.54, 95% CI 0.80-2.99 (snus). Heritability was 43% (95% CI 36-51) for ever smoking, 58% (95% CI 44- 70) for ever snus use and 66% (95% CI 59-72) for T2D. The genetic correlation with T2D was 18% (95% CI 1-35) for smoking and -6% (95% CI -24 to 4) for snus use, indicating that only a small fraction of the genetic influence is shared. CONCLUSIONS We could confirm that consumers of snus and cigarettes are at increased risk of T2D. Both snus use and smoking have strong genetic components, which appears to be attributable primarily to genes that are distinct from those promoting T2D.
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Affiliation(s)
- Sofia Carlsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet and Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Tomas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Waeiss RA, Knight CP, Hauser SR, Pratt LA, McBride WJ, Rodd ZA. Therapeutic challenges for concurrent ethanol and nicotine consumption: naltrexone and varenicline fail to alter simultaneous ethanol and nicotine intake by female alcohol-preferring (P) rats. Psychopharmacology (Berl) 2019; 236:1887-1900. [PMID: 30758525 PMCID: PMC6606358 DOI: 10.1007/s00213-019-5174-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/16/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES Simultaneous alcohol and nicotine consumption occurs in the majority of individuals with alcohol use disorder (AUD) and nicotine dependence. Varenicline (Var) is used to assist in the cessation of nicotine use, while naltrexone (Nal) is the standard treatment for AUD. Despite evidence that ethanol (EtOH) and nicotine (NIC) co-use produces unique neuroadaptations, preclinical research has focused on the effects of pharmacotherapeutics on a single reinforcer. The current experiments examined the effects of Var and Nal on EtOH, NIC, or EtOH+NIC intake. METHODS Animals were randomly assigned to one of four drinking conditions of 24-h access to a three-bottle choice paradigm, one of which always contained water. Drinking conditions were water only, 0.07 and 0.14 mg/mL NIC (NIC only), 15% and 30% EtOH (EtOH only), or 15% and 30% EtOH with 0.14 mg/mL NIC (EtOH+NIC). The effects of Var (0, 1, or 2 mg/kg) or Nal (0, 1, or 10 mg/kg) injections on maintenance and relapse consumption were determined during four consecutive days. RESULTS Var reduced maintenance and relapse NIC intake but had no effect on EtOH or EtOH+NIC drinking. Conversely, Nal reduced EtOH maintenance and relapse drinking, but had no effect on NIC or EtOH+NIC drinking. DISCUSSION The results indicate the standard pharmacological treatments for nicotine dependence and AUD were effective at reducing consumption of the targeted reinforcer but neither reduced EtOH+NIC co-use/abuse. These findings suggest that co-abuse may promote unique neuroadaptations that require models of polysubstance abuse to develop pharmacotherapeutics to treat AUD and nicotine dependence.
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Affiliation(s)
- Robert A Waeiss
- Program in Medical Neuroscience, Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Christopher P Knight
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Building, 320 W. 15th Street, Suite 300B, Indianapolis, IN, 46202-2266, USA
| | - Sheketha R Hauser
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Building, 320 W. 15th Street, Suite 300B, Indianapolis, IN, 46202-2266, USA
| | - Lauren A Pratt
- Program in Medical Neuroscience, Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - William J McBride
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Building, 320 W. 15th Street, Suite 300B, Indianapolis, IN, 46202-2266, USA
| | - Zachary A Rodd
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Building, 320 W. 15th Street, Suite 300B, Indianapolis, IN, 46202-2266, USA.
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46
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Araneda D, Korhonen T, Laatikainen T, Haukkala A, Rose RJ, Kaprio J. Association of snus experimentation in late adolescence with daily cigarette smoking in early adulthood: A longitudinal study among Finnish men. Scand J Public Health 2019; 48:638-645. [PMID: 30973058 DOI: 10.1177/1403494819828868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Swedish smokeless tobacco (snus) is a lower-risk tobacco product than cigarette smoking for individuals. However, the public health impact of snus use is less well studied. Critically, it is uncertain whether use of snus leads to the onset of smoking. This study aimed to investigate prospectively the association between snus experimentation in late adolescence and daily cigarette smoking in early adulthood among Finnish young men. Methods: Data were obtained from 1090 young men within the population-based FinnTwin12 cohort. At baseline (mean age 17 years), we assessed lifetime use of cigarettes and snus, plus other potential predictors of cigarette smoking. At follow-up (mean age 24 years), participants were categorized according to their current smoking status. The final analyses were conducted among 375 young men who were never smokers at baseline with adequate data on follow-up smoking status and other potential predictors of cigarette smoking. Results: Age-adjusted logistic regressions showed an increased risk of becoming a daily smoker at follow-up among those participants who had at least tried snus but had never smoked cigarettes at baseline (odds ratio (OR) 6.48, 95% confidence interval (CI) 2.02-20.7), compared with those who had never used snus. When additionally adjusted for monthly alcohol intoxication, maternal smoking, and peer drug use, the association between snus experimentation and later daily cigarette smoking was attenuated, but remained significant (OR 3.94, 95% CI 1.22-12.7). Conclusions: Our data support the proposition that snus experimentation during late adolescence is longitudinally associated with daily cigarette smoking in early adulthood. Although a causal association cannot be inferred with certainty, snus experimentation might constitute an indicator of the propensity to proceed to regular snus use and initiation of use of other tobacco or nicotine products.
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Affiliation(s)
- David Araneda
- Department of Public Health, University of Helsinki, Finland
| | - Tellervo Korhonen
- Department of Public Health, University of Helsinki, Finland.,Institute of Molecular Medicine FIMM, University of Helsinki, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,National Institute for Health and Welfare, Finland.,Joint municipal authority for North Karelia social and health services (Siun sote), Joensuu, Finland
| | - Ari Haukkala
- Faculty of Social Science, University of Helsinki, Finland
| | - Richard J Rose
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, Finland.,Institute of Molecular Medicine FIMM, University of Helsinki, Finland
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47
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Kreyberg I, Bains KES, Carlsen KH, Granum B, Gudmundsdóttir HK, Haugen G, Hedlin G, Hilde K, Jonassen CM, Nordhagen LS, Nordlund B, Sjøborg KD, Skjerven HO, Staff AC, Söderhäll C, Vettukatil RM, Lødrup Carlsen KC. Stopping when knowing: use of snus and nicotine during pregnancy in Scandinavia. ERJ Open Res 2019; 5:00197-2018. [PMID: 30972353 PMCID: PMC6452060 DOI: 10.1183/23120541.00197-2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/26/2018] [Indexed: 12/02/2022] Open
Abstract
The risk of adverse health effects in offspring due to maternal tobacco smoking during pregnancy is well documented [1], including epigenetic changes persisting in the offspring after prenatal exposure [2]. The effects of fetal exposure to nicotine from non-combustible tobacco products, such as snus or nicotine-replacement therapies (NRTs), are less clear. Use of snus leads to systemic absorption of nicotine into the maternal circulatory system, with subsequent exposure of the foetus through the placenta [3]. In young women, the use of snus increases in parallel with decreasing smoking rates but the use in pregnancy is unclear. Our aims were to determine the prevalence of snus use, smoking and other nicotine-containing product use during pregnancy, and to identify predictors for snus use in pregnancy. Prevalence was determined for 2528 women in Norway and Sweden based on the Preventing Atopic Dermatitis and ALLergies (PreventADALL) study, a population-based, mother–child birth cohort. Electronic questionnaires were completed in pregnancy week 18 and/or week 34, and potential predictors of snus use were analysed using logistic regression models. Ever use of any snus, tobacco or nicotine-containing products was reported by 35.7% of women, with similar rates of snus use (22.5%) and smoking (22.6%). Overall, 11.3% of women reported any use of nicotine-containing products in pregnancy up to 34 weeks, most often snus alone (6.5%). Most women (87.2%) stopped using snus by week 6 of pregnancy. Snus use in pregnancy was inversely associated with age and positively associated with urban living and personal or maternal history of smoking. While 11.3% of women used snus or other nicotine-containing products at some time, most stopped when recognising their pregnancy. Younger, urban living, previously smoking women were more likely to use snus in pregnancy. Of the 11.3% of women using any nicotine products in pregnancy (most often snus (6.5%)), the majority stop within pregnancy week 6. Snus use is associated with urban living, previous smoking, in utero smoking exposure of the index woman and lower age.http://ow.ly/Gyg230nmxIo
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Affiliation(s)
- Ina Kreyberg
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Karen E S Bains
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Kai-H Carlsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Berit Granum
- Dept of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Oslo, Norway
| | - Hrefna K Gudmundsdóttir
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Guttorm Haugen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Dept of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Katarina Hilde
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Christine M Jonassen
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.,Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Live S Nordhagen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,VID Specialized University, Oslo, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Dept of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Katrine D Sjøborg
- Dept of Obstetrics and Gynaecology, Østfold Hospital Trust, Kalnes, Norway
| | - Håvard O Skjerven
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne C Staff
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Cilla Söderhäll
- Dept of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Riyas M Vettukatil
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Karin C Lødrup Carlsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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48
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Nicotine: Sporting Friend or Foe? A Review of Athlete Use, Performance Consequences and Other Considerations. Sports Med 2018; 47:2497-2506. [PMID: 28791650 PMCID: PMC5684328 DOI: 10.1007/s40279-017-0764-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nicotine use amongst athletes is high and increasing, especially in team sports. This narrative review examines the rationale behind its use and evidence of its effect on physical performance, and considers important factors that should determine future research efforts. To date, ten studies have assessed muscular strength and power, sub- or maximal endurance and high-intensity exercise when nicotine (medication) or smokeless tobacco was used as an intervention. Two studies observed an ergogenic effect, one an ergolytic with the remaining seven reporting no change. These studies have notable limitations and confounding factors that include participant tolerance to nicotine, interindividual responses, the nicotine delivery system used and failure to adhere to rigorous experimental/scientific design. Further research is encouraged to address these limitations and determine the extent to which anti-doping and governing bodies should consider promoting, coordinating and monitoring any effort against nicotine and nicotine-containing substances in sports.
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49
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Nicotine pharmacokinetics of electronic cigarettes: A review of the literature. Regul Toxicol Pharmacol 2018; 100:25-34. [PMID: 30201538 DOI: 10.1016/j.yrtph.2018.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 02/05/2023]
Abstract
E-cigarettes are battery-powered electronic devices from which users can inhale nicotine following its aerosolisation from a liquid solution. Some regulators and public health bodies consider e-cigarettes as potentially playing a major role in tobacco harm reduction. Their ability to provide nicotine to smokers in both amount and in a manner and form generally similar to cigarette smoking have been proposed as key components to help smokers reduce or cease the use of combustible cigarettes. Nicotine pharmacokinetic studies of e-cigarettes have been performed for a number of years and are beginning to show how nicotine delivery is evolving as the products themselves evolve. In this review, we provide a critical overview of the literature to describe what is known about nicotine delivery from e-cigarettes. We will discuss how the progression of e-cigarette design, development, and user familiarity has allowed increases in nicotine availability to the user, in the context of how much and how rapidly nicotine is delivered during acute-use periods. This review will also provide insight into current research gaps and highlight the potential utility of modelling and the standardisation of methodologies used to assess nicotine delivery to facilitate identification of products that are best suited to displace cigarette smoking among adult smokers.
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50
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Antoniewicz L, Novo M, Bosson J, Lundbäck M. Brief exposure to Swedish snus causes divergent vascular responses in healthy male and female volunteers. PLoS One 2018; 13:e0195493. [PMID: 29668699 PMCID: PMC5905986 DOI: 10.1371/journal.pone.0195493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/23/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction The use of Swedish oral moist snuff, known as snus, has for a long time been limited to the Scandinavian countries. With declining cigarette sales in the western world, tobacco companies have looked to the development of alternative tobacco products. In 2006 snus products were launched in the US. Even though several studies have demonstrated negative health effects, snus is often depicted as harmless. The aim of the present study was to investigate acute vascular effects of snus as measured by arterial stiffness as well as blood pressure and heart rate. Methods Two separate randomized double-blind crossover studies with the same study design were pooled for analysis. Twenty-nine healthy snus-users (17 females, 12 males) were included. Snus (Göteborgs Rapé) and tobacco free snus (Onico) were administered in a randomized order at two separate visits. Arterial stiffness, blood pressure and heart rate were measured at baseline as well as every five minutes for 40 minutes during exposure. Following snus removal, measurements continued for 30 minutes post exposure. Arterial stiffness was measured using pulse wave velocity (Vicorder) and pulse wave analysis (Sphygmocor). Results Compared to placebo, snus significantly increased systolic and diastolic blood pressure as well as heart rate, however, only in females (p = 0.004, p = 0.006 and p<0.001 respectively). No changes were seen in arterial stiffness measurements in either gender. Conclusion We observed an increase in blood pressure and heart rate only in females, but not in males due to snus usage as compared to placebo. This novel finding was surprising and needs to be further investigated considering most of the earlier studies have mainly focused on male snus users and the increasing usage of snus among females.
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Affiliation(s)
- Lukasz Antoniewicz
- Karolinska Institutet, Department of Clinical Sciences, Division of Internal Medicine, Danderyd Hospital, Stockholm, Sweden
- Umeå University, Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå, Sweden
- * E-mail:
| | - Mirza Novo
- Umeå University, Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå, Sweden
| | - Jenny Bosson
- Umeå University, Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå, Sweden
| | - Magnus Lundbäck
- Karolinska Institutet, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden
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