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Poliakova N, Shrier LA, Harris SK, Bélanger RE. Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products. Tob Use Insights 2024; 17:1179173X241259603. [PMID: 38846268 PMCID: PMC11155328 DOI: 10.1177/1179173x241259603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (>600 ng/mL, urine cotinine) participants than among unexposed (<50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.
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Affiliation(s)
- Natalia Poliakova
- Research Centre of CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Lydia A. Shrier
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sion Kim Harris
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard E. Bélanger
- Research Centre of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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Shiffman S, Oliveri DR, Goldenson NI, Liang Q, Black RA, Mishra S. Comparing Adult Smokers Who Switched to JUUL versus Continuing Smokers: Biomarkers of Exposure and of Potential Harm and Respiratory Symptoms. Nicotine Tob Res 2024; 26:494-502. [PMID: 37837438 DOI: 10.1093/ntr/ntad197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/31/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES Real-world evidence on exposure to harmful and potentially harmful constituents (HPHCs) and on biological effects in cigarette smokers who switch to electronic nicotine delivery systems (ENDS) can inform the health effects of switching. AIMS AND METHODS This cross-sectional, observational study assessed adults who had smoked ≥10 cigarettes/day for ≥10 years, comparing 124 continuing cigarette smokers (Smokers) to 140 former smokers who switched to JUUL-brand ENDS exclusively for ≥6 months (Switchers). Assessments included biomarkers of exposure (BOEs) to select HPHCs, biomarkers of potential harm (BOPHs) related to smoking-related diseases, psychometric assessments of dependence on cigarettes and ENDS, respectively, and respiratory symptoms. Planned analyses compared geometric means, adjusted for demographic covariates; further analyses adjusted for additional lifestyle and smoking history covariates. RESULTS Nicotine levels were significantly higher in Switchers (median time switched = 3 years), who were unusually heavy users of JUUL. All other BOEs, including NNAL and HPMA3 (primary endpoints), were significantly lower in Switchers than Smokers. Most BOPHs (sICAM-1 [primary], and eg, white blood cell count, MCP1, HbA1c) were significantly lower in Switchers than Smokers; HDL was significantly higher. Switchers reported significantly lower dependence on JUUL than Smokers did on cigarettes, and respiratory symptom scores were significantly lower among Switchers than Smokers. CONCLUSIONS Compared to continuing smokers, smokers who switched to JUUL had substantially lower exposures to multiple HPHCs, favorable differences in markers of inflammation, endothelial function, oxidative stress, and cardiovascular risk, and fewer respiratory symptoms. These findings suggest that switching from cigarettes to JUUL likely reduces smokers' health risks. IMPLICATIONS Short-term confinement studies and randomized clinical trials demonstrate that adult smokers who switch completely to ENDS experience substantial reductions in exposure to many smoking-related toxicants. This study extends those findings to longer periods of switching to JUUL-brand ENDS (almost 3 years on average) under naturalistic use conditions in real-world settings and also found that switching to JUUL resulted in favorable differences in BOPHs more proximally related to smoking-induced disease, as well as in respiratory symptoms. Smokers who switch to ENDS reduce their exposure to toxicants, likely reducing their disease risk.
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Affiliation(s)
| | | | | | - Qiwei Liang
- Population and Clinical Sciences, Juul Labs, Inc., Washington, DC, USA
| | - Ryan A Black
- Behavioral and Clinical Sciences, Juul Labs, Inc., Washington, DC, USA
| | - Snigdha Mishra
- Regulatory Sciences, Juul Labs, Inc., Washington, DC, USA
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Taylor E, Simonavičius E, McNeill A, Brose LS, East K, Marczylo T, Robson D. Exposure to Tobacco-Specific Nitrosamines Among People Who Vape, Smoke, or do Neither: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2024; 26:257-269. [PMID: 37619211 PMCID: PMC10882431 DOI: 10.1093/ntr/ntad156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Smoking exposes people to high levels of Tobacco-Specific Nitrosamines (TSNAs), which include potent carcinogens. We systematically reviewed TSNA exposure between people smoking, vaping, and doing neither. AIMS AND METHODS Databases were searched between August 2017-March 2022, using vaping-related terms. Peer-reviewed articles reporting TSNA metabolites (NNAL, NNN, NAB, and NAT) levels in bio-samples among adults exclusively vaping, exclusively smoking, or doing neither were included. Where possible, meta-analyses were conducted. RESULTS Of 12 781 identified studies, 22 were included. TSNA levels fell substantially when people who smoke switched to vaping in longitudinal studies and were lower among people who vaped compared to smoked in cross-sectional studies. Levels of TSNAs were similar when comparing people who switched from smoking to vaping, to those who switched to no use of nicotine products, in longitudinal studies. Levels were higher among people who vaped compared to people who neither vaped nor smoked in cross-sectional studies.When comparing people who vaped to smoked: pooled urinary NNAL was 79% lower across three randomized controlled trials and 96% lower across three cross-sectional studies; pooled NAB was 87% lower and NAT 94% lower in two cross-sectional studies. When comparing people who neither vaped nor smoked to people who vaped, pooled urinary NNAL was 80%, NAB 26%, and NAT 27% lower in two cross-sectional studies. Other longitudinal data, and NNN levels could not be pooled. CONCLUSIONS Exposure to all TSNAs was lower among people who vaped compared to people who smoked. Levels were higher among people who vaped compared to people who neither vaped nor smoked. IMPLICATIONS As well as TSNAs, there are many other toxicant exposures from smoking and vaping that can increase the risk of disease. However, it is likely that the reduced exposure to TSNAs from vaping relative to smoking reduces the risk to health of those who use vaping products to quit smoking. Future high-quality research, with robust definitions of exclusive vaping and smoking, and accounting for TSNAs half-lives, is needed to fully assess exposure to TSNAs among people who vape.
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Affiliation(s)
- Eve Taylor
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- NIHR HPRU Environmental Exposures and Health, London, UK
| | - Erikas Simonavičius
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- NIHR HPRU Environmental Exposures and Health, London, UK
- SPECTRUM Consortium, London, UK
- NIHR ARC SouthLondon, Oxford, UK
| | - Leonie S Brose
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- SPECTRUM Consortium, London, UK
| | - Katherine East
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
| | - Tim Marczylo
- NIHR HPRU Environmental Exposures and Health, London, UK
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency (UKHSA)
| | - Debbie Robson
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- NIHR HPRU Environmental Exposures and Health, London, UK
- SPECTRUM Consortium, London, UK
- NIHR ARC SouthLondon, Oxford, UK
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Dai HD, Nollen N, Rennard S, Guenzel N, Pham H, Khan AS. Racial and ethnic disparities in biomarkers of exposure and potential harm among U.S. adult exclusive e-cigarette users: 2013-2019. Drug Alcohol Depend 2023; 252:110984. [PMID: 37804563 PMCID: PMC10615775 DOI: 10.1016/j.drugalcdep.2023.110984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE Provide evidence on racial and ethnic differences in biomarkers of exposure from rising e-cigarette use among U.S. adults. METHODS Data were drawn from Waves 1-5 of the Population Assessment of Tobacco and Health study (September 2013-November 2019). Differences in biomarkers of exposure and potential harm (BOE/BoPH) across non-Hispanic (NH)-Whites, NH Blacks, Hispanic/Latinos, and NH others were examined using generalized estimation equations. RESULTS Among exclusive e-cigarette users, mean concentrations of BOEs/BoPHs were not significantly different across NH Blacks (n=97), NH others (n=122), and NH Whites (n=1062), after adjustment by wave, age, sex, education, exposure to the secondhand smoke, and the number of recent puffs. Compared to NH Whites, Hispanics (n=151) had lower concentrations of nicotine equivalents (0.5[0.2-1.7] vs. 15.5 [12.5-19.1] nmol/mg creatinine, p<.0001), cotinine (33.4[9.7-114.7] vs. 1008.3 [808.3-1257.9] ng/mg creatinine, p<.0001), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) (2.6[1.5-4.4] vs. 5.7 [4.9-6.6] pg/mg creatinine, p=.004), but similar concentrations of BOEs for heavy metals, polycyclic aromatic hydrocarbons, volatile organic compounds, and oxidative stress. Differences between Hispanics and NH Whites are expected, given different e-cigarette use profiles. Specifically, Hispanics were less likely to be daily vapers (49.4[35.1-63.8]% vs 81.3[77.7-84.5]%, p<.0001) and nicotine e-cigarette users (72.7 [64.0-79.9]% vs. 89.2 [86.4-91.5]%, p=.0002] and reported a lower number of recent puffs (mean[standard error]=16.7[3.6] vs. 28.6[2.0], p=.02] than their NH-White counterparts. Hispanic vapers were also less likely than NH Whites to have previously smoked cigarettes (49.7 [37.2-62.3]% vs. 88.5 [84.7-91.5]%, p<.0001]). CONCLUSIONS Hispanic vapers exhibited lower exposure to nicotine metabolites and carcinogens than their non-Hispanic White counterparts. The harm reduction potential from e-cigarette use are likely to be realized across diverse racial and ethnic groups.
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Affiliation(s)
- Hongying Daisy Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States.
| | - Nikki Nollen
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Stephen Rennard
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Nicolas Guenzel
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, United States
| | - Hanh Pham
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States; College of Osteopathic Medicine, Kansas City University, Kansas City, MO, United States
| | - Ali S Khan
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
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Wadkin R, Allen C, Fearon IM. E-cigarette puffing topography: The importance of assessing user behaviour to inform emissions testing. Drug Test Anal 2023; 15:1222-1232. [PMID: 36574584 DOI: 10.1002/dta.3322] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 12/29/2022]
Abstract
Analysis of the chemical composition of e-cigarette emissions is an important step in determining whether e-cigarettes offer both individual and population-level harm reduction potential. Commonly, e-cigarette emissions for chemical analysis are collected when using e-cigarettes according to standardised puffing regimens, such as those recommended by the International Organization for Standardization (ISO) or the Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA). While the use of such standard puffing regimens affords a degree of uniformity between studies and are also recommended by regulatory authorities who require the submission of e-cigarette emissions data to make decisions regarding allowing a product to be commercially marketed, the standardised regimens do not necessarily reflect human puffing behaviour. This can lead to under- or over-estimating real-world emissions from e-cigarettes and inaccuracy in determining their harm reduction potential. In this review, we describe how human puffing behaviour (topography) information can be collected both in the clinical laboratory and in the real world using a variety of different methodologies. We further discuss how this information can be used to dictate e-cigarette puffing regimens for collecting emissions for chemical analyses and how this may lead to better predictions both of human yields of e-cigarette emissions constituents and of risk assessments to predict e-cigarette tobacco harm reduction potential.
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Affiliation(s)
- Rhys Wadkin
- Scientific Affairs, Broughton Life Sciences, Earby, UK
| | - Chris Allen
- Scientific Affairs, Broughton Life Sciences, Earby, UK
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6
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Fearon IM. Human abuse liability assessment of e-cigarettes: Why, what and how? Drug Test Anal 2023; 15:1211-1221. [PMID: 35302289 DOI: 10.1002/dta.3251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/12/2022]
Abstract
Cigarette smoking is the world's leading cause of preventable death and disease. Alternative nicotine products such as e-cigarettes have tobacco harm reduction potential, by providing smokers with an alternative form of nicotine delivery but with either the reduced presence or absence of the numerous harmful chemicals found in combustible cigarette smoke. One aspect of importance in determining the potential of e-cigarettes to provide a viable alternative to combustible cigarettes for smokers is their ability to cause dependence, also known as their abuse liability. E-cigarettes with little or no abuse liability would be unlikely to be used as a substitute for cigarettes, whereas at least some degree of abuse liability is acknowledged as supportive both to aiding cigarette substitution or complete cessation and to preventing relapse. Given this link between abuse liability and substitution efficacy, human studies assessing the abuse liability of e-cigarettes are important to determine their true harm reduction potential. In this review, the concept of tobacco product abuse liability is discussed, along with the primary elements-pharmacokinetics and pharmacodynamics (subjective effects)-that need to be assessed to determine abuse liability. The review also presents a number of human abuse liability study design considerations and discusses what existing studies in the literature tell us about the abuse liability and harm reduction potential of e-cigarettes.
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7
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Haswell LE, Gale N, Brown E, Azzopardi D, McEwan M, Thissen J, Meichanetzidis F, Hardie G. Biomarkers of exposure and potential harm in exclusive users of electronic cigarettes and current, former, and never smokers. Intern Emerg Med 2023; 18:1359-1371. [PMID: 37249753 PMCID: PMC10412681 DOI: 10.1007/s11739-023-03294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023]
Abstract
Electronic cigarette (EC) aerosol emissions generally contain fewer and lower concentrations of harmful and potentially harmful constituents, compared with cigarette smoke. Further studies are needed to establish whether decreased emissions translate to reduced health risks for EC users. In a cross-sectional study, biomarkers of exposure (BoE) to certain tobacco smoke toxicants and biomarkers of potential harm (BoPH), associated with biological processes linked to the potential development of smoking-related diseases and oxidative stress, were assessed in solus Vuse ECs users and current, former, and never smokers. In total, 213 participants were enrolled, and smoking status was confirmed by urinary cotinine, exhaled carbon monoxide, and N-(2-cyanoethyl)valine levels (EC users and former smokers only). During confinement participants used their usual product (EC or cigarette) as normal and BoE and BoPHs were assessed via blood, 24-h urine, and physiological assessment. Significantly lower levels of all urinary BoE; MHBMA, HMPMA, 3-HPMA, NNN, 3-OH-B[a]P, S-PMA, NNAL (all p < 0.0001), and TNeq (p = 0.0074) were observed in EC users when compared with smokers. Moreover, significantly lower levels were observed in EC users for 3 of the 7 BoPH measured, carboxyhaemoglobin (p < 0.0001), soluble intercellular adhesion molecule-1 (p = 0.0028), and 11-dehydrothromboxane B2 (p = 0.0012), when compared with smokers. As compared with smokers, solus Vuse EC users have significantly lower exposure to tobacco toxicants for the BoE, and 3 BoPH measured. These results add to the weight of evidence supporting EC as part of a tobacco harm reduction strategy.
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Affiliation(s)
- Linsey E Haswell
- BAT (Investments) Limited, Regents Park Road, Millbrook, Southampton, SO15 8TL, UK.
| | - Nathan Gale
- BAT (Investments) Limited, Regents Park Road, Millbrook, Southampton, SO15 8TL, UK
| | - Elaine Brown
- BAT (Investments) Limited, Regents Park Road, Millbrook, Southampton, SO15 8TL, UK
| | - David Azzopardi
- BAT (Investments) Limited, Regents Park Road, Millbrook, Southampton, SO15 8TL, UK
| | - Michael McEwan
- BAT (Investments) Limited, Regents Park Road, Millbrook, Southampton, SO15 8TL, UK
| | - Jesse Thissen
- BAT (Investments) Limited, Regents Park Road, Millbrook, Southampton, SO15 8TL, UK
| | | | - George Hardie
- BAT (Investments) Limited, Regents Park Road, Millbrook, Southampton, SO15 8TL, UK
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8
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Kanobe MN, Nelson PR, Brown BG, Chen P, Makena P, Caraway JW, Prasad GL, Round EK. Changes in Biomarkers of Exposure and Potential Harm in Smokers Switched to Vuse Vibe or Vuse Ciro Electronic Nicotine Delivery Systems. TOXICS 2023; 11:564. [PMID: 37505530 PMCID: PMC10384956 DOI: 10.3390/toxics11070564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/05/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023]
Abstract
Electronic nicotine delivery systems (ENDS) have the potential to provide nicotine to tobacco consumers while reducing exposure to combustion-related toxicants. Here, we report changes in biomarkers of exposure (BoE) and biomarkers of potential harm (BoPH) in smokers who completely switched to Vuse Vibe and Vuse Ciro ENDS products, or to smoking abstinence in a randomized, controlled clinical study. Thirteen BoE (12 urinary and one blood) that indicate exposure to harmful and potentially harmful toxicants (HPHCs) were evaluated at baseline on day 5. Urinary BoPH linked to oxidative stress, platelet activation, and inflammation were also assessed at baseline, and on day 5 and day 7. Nicotine exposure was lower in Vuse Vibe and Vuse Ciro groups compared to baseline values. Urinary non-nicotine BoE decreased significantly (52.3-96.7%) in the Vuse ENDS groups, and the reductions were similar in magnitude to those observed in the abstinence group. Blood carboxyhemoglobin decreased 52.8-55.0% in all study groups. Decreases (10-50%) in BoPH were observed in all study groups. Thus, smokers who switch exclusively to Vuse Vibe or Vuse Ciro products or completely abstain from smoking are exposed to substantially lower levels of HPHCs, and experience improvements in BoPH of oxidative stress and inflammation pathways.
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Affiliation(s)
- Milly N Kanobe
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Paul R Nelson
- Former Employees of RAI Services Company, 105 Bowes Road, Winston Salem, NC 27106, USA
| | - Buddy G Brown
- Former Employees of RAI Services Company, 5714 Wonderous Lane, Durham, NC 27712, USA
| | - Peter Chen
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Patrudu Makena
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - John W Caraway
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Gaddamanugu L Prasad
- Former Employees of RAI Services Company, 490 Friendship Place Ct, Lewisville, NC 27023, USA
- Prasad Scientific Consulting LLC, 490 Friendship Place Ct, Lewisville, NC 27023, USA
| | - Elaine K Round
- BAT (Investments) Limited, Globe House, 1 Water Street, London WC2R 3LA, UK
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Holt NM, Shiffman S, Black RA, Goldenson NI, Sembower MA, Oldham MJ. Comparison of biomarkers of exposure among US adult smokers, users of electronic nicotine delivery systems, dual users and nonusers, 2018-2019. Sci Rep 2023; 13:7297. [PMID: 37147399 PMCID: PMC10163269 DOI: 10.1038/s41598-023-34427-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/29/2023] [Indexed: 05/07/2023] Open
Abstract
The harm caused by cigarette smoking is overwhelmingly due to byproducts of tobacco combustion. Electronic Nicotine Delivery Systems (ENDS) provide nicotine to users without combustion, and may support tobacco harm reduction among cigarette smokers who would not otherwise quit in the near term. Analyses of Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study compared biomarkers of exposure (BOE) levels for nicotine, 3 metals, 2 tobacco-specific nitrosamines and 14 smoking-related volatile organic compounds in 151 exclusive ENDS users, 1341 exclusive cigarette smokers, 115 dual users (cigarettes and ENDS), and 1846 past 30-day nonusers of tobacco, adjusting for demographics. Nicotine exposure in ENDS users and dual users did not significantly differ from smokers. Among ENDS users, 16 of 18 other BOEs were significantly lower than smokers'; 9 BOEs were not significantly different from nonusers. Among dual users smoking < 10 cigarettes/day, 15 of 18 non-nicotine BOEs were significantly lower than smokers', whereas in dual users smoking ≥ 10 cigarettes per day none of the BOEs significantly differed from smokers'. In this representative sample of US adults, exclusive use of ENDS (vs. cigarette smoking) was associated with much lower exposures to many harmful chemicals associated with smoking-related disease. BOE levels in dual users were directly related to their cigarette consumption. These BOE data provide further evidence that ENDS expose users to substantially lower levels of toxicants than combustible cigarettes, confirming their potential for harm reduction.
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10
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Makena P, Scott E, Chen P, Liu HP, Jones BA, Prasad GL. Biomarkers of Exposure and Potential Harm in Two Weeks of Smoking Abstinence: Changes in Biomarkers of Platelet Function, Oxidative Stress, and Inflammation. Int J Mol Sci 2023; 24:ijms24076286. [PMID: 37047257 PMCID: PMC10093936 DOI: 10.3390/ijms24076286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
: Chronic cigarette smoking is a major risk factor for many serious diseases. While complete cessation of smoking is the best option to reduce harm from smoking, adverse impacts of smoking on health could persist for several years after cessation. Therefore, Biomarkers of Potential Harm (BoPH) are useful in interim evaluations of the beneficial effects of smoking cessation or switching to potentially lower-risk tobacco products. A 14-day smoking abstinence study was conducted under clinical confinement conditions and enrolled 70 subjects into younger (24–34 years, n = 33) and older (35–60 years, n = 37) age cohorts. Biomarkers of Exposure (BoE), which indicate exposure to nicotine and other toxicants, were measured at baseline, 7 and 14 days. Several BoPH including previously identified eicosanoids (leukotriene 4 (LTE4) and 2,3-dinor thromboxane 2 (2,3-d-TXB2) and others were evaluated. Significant declines in BoE, LTE4, 2,3-d-TXB2, neutrophils, WBC and select RBC, and arterial blood gas parameters were observed in both age cohorts at Days 7 and 14 compared to baseline, while other BoPH (e.g., FeNO) showed age-related effects. Rapid and reproducible reductions in LTE4, 2,3-d-TXB2 WBC, and neutrophil counts were consistently detected following smoking abstinence, indicating the value of these markers as useful BoPH.
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Affiliation(s)
- Patrudu Makena
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Eric Scott
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Peter Chen
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Hsiao-Pin Liu
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Bobbette A Jones
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
| | - Gaddamanugu L Prasad
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC 27101, USA
- Prasad Scientific Consulting LLC, Lewisville, NC 27023, USA
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11
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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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12
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Wasfi RA, Bang F, de Groh M, Champagne A, Han A, Lang JJ, McFaull SR, Melvin A, Pipe AL, Saxena S, Thompson W, Warner E, Prince SA. Chronic health effects associated with electronic cigarette use: A systematic review. Front Public Health 2022; 10:959622. [PMID: 36276349 PMCID: PMC9584749 DOI: 10.3389/fpubh.2022.959622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/29/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Over the last decade, e-cigarette use has been on the rise but with growing health concerns. The objective of this systematic review was to update findings for chronic health outcomes associated with e-cigarette use from the 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report. Methods Three bibliographic databases were searched to identify studies comparing the chronic health effects of e-cigarette users (ECU) to non-smokers (NS), smokers, and/or dual users indexed between 31 August 2017 and 29 January 2021. Two independent reviewers screened abstracts and full texts. Data were extracted by one reviewer and verified by a second one. Outcomes were synthesized in a narrative manner using counts and based on statistical significance and direction of the association stratified by study design and exposure type. Risk of bias and certainty of evidence was assessed. The protocol was prospectively registered on Open Science Framework https://osf.io/u9btp. Results A total of 180 articles were eligible. This review focused on 93 studies for the 11 most frequently reported outcomes and from which 59 reported on daily e-cigarette use. The certainty of evidence for all outcomes was very low because of study design (84% cross-sectional) and exposure type (27% reported on exclusive ECU, i.e., never smoked traditional cigarettes). Overall, the summary of results for nearly all outcomes, including inflammation, immune response, periodontal and peri-implant clinical parameters, lung function, respiratory symptoms, and cardiovascular disease, suggested either non-significant or mixed results when daily ECU was compared to NS. This was also observed when comparing exclusive ECU to NS. The only notable exception was related to oral health where most (11/14) studies reported significantly higher inflammation among daily ECU vs. NS. Compared to the smokers, the exclusive-ECUs had no statistically significant differences in inflammation orperiodontal clinical parameters but had mixed findings for peri-implant clinical parameters. Conclusions This review provides an update to the 2018 NASEM report on chronic health effects of e-cigarette use. While the number of studies has grown, the certainty of evidence remains very low largely because of cross-sectional designs and lack of reporting on exclusive e-cigarette exposure. There remains a need for higher quality intervention and prospective studies to assess causality, with a focus on exclusive e-cigarette use.
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Affiliation(s)
- Rania A. Wasfi
- Applied Research Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada,*Correspondence: Rania A. Wasfi
| | - Felix Bang
- Surveillance and Epidemiology Division, Centre for Immunization and Respiratory Infectious Diseases, Infectious Diseases Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Margaret de Groh
- Applied Research Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Andre Champagne
- Behaviours, Environments and Lifespan Division, Centre for Surveillance and Applied Research, Health Promotions and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Arum Han
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Justin J. Lang
- Applied Research Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Steven R. McFaull
- Behaviours, Environments and Lifespan Division, Centre for Surveillance and Applied Research, Health Promotions and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Alexandria Melvin
- Centre for Indigenous Statistics and Partnerships, Statistics Canada, Ottawa, ON, Canada
| | - Andrew Lawrence Pipe
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada,Division of Cardiac Prevention & Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shika Saxena
- Behaviours, Environments and Lifespan Division, Centre for Surveillance and Applied Research, Health Promotions and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Wendy Thompson
- Behaviours, Environments and Lifespan Division, Centre for Surveillance and Applied Research, Health Promotions and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Emily Warner
- Vaccine Safety, Vaccine Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Stephanie A. Prince
- Applied Research Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada,Stephanie A. Prince
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13
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How Electronic Cigarette Affects the Vascular System. J Smok Cessat 2022; 2022:3216580. [PMID: 36262466 PMCID: PMC9553677 DOI: 10.1155/2022/3216580] [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: 07/07/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
The popularity of the electronic cigarette has soared in the last decades. However, the health effect of smoking electronic cigarettes on the vascular system is unclear. This systematic review examines the electronic cigarettes’ effect on the vascular system from recent evidence. A systematic search was conducted in MEDLINE (PubMed) database from January 2016 to August 2021 for studies assessing the vascular effect of chronic use of electronic cigarettes on human and animal. The Cochrane Risk of Bias 2, NIH Quality Assessment for Cross-Sectional Study, and SYRCLE’s Risk of Bias were used to assess the risk of bias in interventional, observational, and animal study, respectively. A narrative synthesis of evidence is provided to describe results. From 101 retrieved studies related to electronic cigarettes effect on the vascular system, a total of 16 studies are included in this review. The overall results indicated that electronic cigarette use is associated with adverse events in the vascular, including the incident of elevated oxidative stress, endothelial dysfunction, inflammation, arterial stiffness, and the development of atherosclerotic lesion. Further studies should broaden perspectives and reveal more about the mechanism of how electronic cigarettes impact on vascular system.
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Wilson N, Summers JA, Ouakrim DA, Hoek J, Edwards R, Blakely T. Correction: Improving on estimates of the potential relative harm to health from using modern ENDS (vaping) compared to tobacco smoking. BMC Public Health 2022; 22:1788. [PMID: 36131253 PMCID: PMC9491000 DOI: 10.1186/s12889-022-13983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Nick Wilson
- University of Otago, Wellington, New Zealand.
| | | | - Driss Ait Ouakrim
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Janet Hoek
- University of Otago, Wellington, New Zealand
| | | | - Tony Blakely
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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15
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Edmiston JS, Webb KM, Wang J, Oliveri D, Liang Q, Sarkar M. Biomarkers of Exposure and Biomarkers of Potential Harm in Adult Smokers Who Switch to e-Vapor Products Relative to Cigarette Smoking in a 24-week, Randomized, Clinical Trial. Nicotine Tob Res 2022; 24:1047-1054. [PMID: 35134961 PMCID: PMC9199942 DOI: 10.1093/ntr/ntac029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/14/2021] [Accepted: 01/02/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Long-term health effects of e-vapor products (EVPs) are not well-established. We compared biomarkers of exposure (BoE) to select harmful and potentially harmful constituents and biomarkers of potential harm (BoPH) in adult smokers who switched to EVPs versus continued smoking for 24 weeks. METHODS Adult smokers (n = 450, >10 cigarettes per day for ≥10 years) were randomly assigned to continue smoking (control) or switch to one of two cartridge-based EVPs (test 1: classic; test 2: menthol, 4% nicotine). BoE and BoPH were measured at baseline and 12 weeks. The results presented here are from a subset of 150 control and EVP subjects (switchers with exhaled carbon monoxide <8 ppm and <10% baseline cigarettes per day) followed for 24 total weeks. RESULTS Total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and carboxyhemoglobin were significantly reduced (p < .0001) in tests 1 and 2 at 24 weeks. Urinary nicotine equivalents were not statistically significantly different between the control and EVP groups. At week 24, statistically significant reductions (p < .05) were observed for white blood cell counts, 11-dehydrothromboxane β2, and sICAM in both test groups, and there were several significant changes in measures of pulmonary function. High-density lipoprotein cholesterol and 8-epi-prostaglandin-F2α were directionally favorable in both EVP groups versus control. CONCLUSIONS We demonstrate that significant reductions of selected harmful and potentially harmful constituents in EVP aerosol results in significant reductions in BoEs and favorable changes in BoPHs after switching to EVPs for 24 weeks. These changes approached those reported for smoking cessation, suggesting that switching to exclusive use of the EVPs may be less harmful than continuing smoking. IMPLICATIONS Cigarette smoking causes serious diseases. Switching from cigarettes to a noncombustible product is a potential harm reduction pathway for adult smokers unable or unwilling to quit. Long-term health effects of e-vapor products (EVPs) compared with continued smoking have not been extensively studied. We present biomarker of exposure evidence on select harmful and potentially harmful constituents and biomarkers of potential harm related to inflammation and oxidative stress in adult smokers switching to two EVPs. This study demonstrates significant reductions in biomarkers of exposure (except for nicotine) accompanied with favorable changes in various biomarkers of potential harm, including pulmonary function. The totality of evidence suggests that exclusive EVP use may present lower health risks compared with smoking cigarettes.
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Affiliation(s)
- Jeffery S Edmiston
- Altria Client Services LLC, Center for Research and Technology, Richmond, VA, USA
| | - Katy M Webb
- Altria Client Services LLC, Center for Research and Technology, Richmond, VA, USA
| | - Jingzhu Wang
- Altria Client Services LLC, Center for Research and Technology, Richmond, VA, USA
| | - Douglas Oliveri
- Employees of Altria Client Services LLC at the time of the study
| | - Qiwei Liang
- Employees of Altria Client Services LLC at the time of the study
| | - Mohamadi Sarkar
- Altria Client Services LLC, Center for Research and Technology, Richmond, VA, USA
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16
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Wilson N, Summers JA, Ait Ouakrim D, Hoek J, Edwards R, Blakely T. Improving on estimates of the potential relative harm to health from using modern ENDS (vaping) compared to tobacco smoking. BMC Public Health 2021; 21:2038. [PMID: 34749706 PMCID: PMC8577029 DOI: 10.1186/s12889-021-12103-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although the harm to health from electronic nicotine delivery systems (ENDS) compared to smoked tobacco remains highly uncertain, society and governments still need to know the likely range of the relative harm to inform regulatory policies for ENDS and smoking. METHODS We identified biomarkers with specificity of association with different disease groupings e.g., volatile organic compound (VOCs) for chronic obstructive pulmonary disease; and tobacco-specific N´-nitrosamines (TSNAs) and polycyclic aromatic hydrocarbons (PAHs) for all cancers. We conducted a review of recent studies (post January 2017) that compared these biomarkers between people exclusively using ENDS and those exclusively smoking tobacco. The percentage differences in these biomarkers, weighted by study size and adjusted for acrolein from other sources, were used as a proxy for the assumed percentage difference in disease harm between ENDS and smoking. These relative differences were applied to previously modelled estimates of smoking-related health loss (in health-adjusted life-years; HALYs). RESULTS The respective relative biomarker levels (ENDS vs smoking) were: 28% for respiratory diseases (five results, three studies); 42% for cancers (five results, four studies); and 35% for cardiovascular (seven results, four studies). When integrated with the HALY impacts by disease, the overall harm to health from ENDS was estimated to be 33% that of smoking. CONCLUSIONS This analysis, suggests that the use of modern ENDS devices (vaping) could be a third as harmful to health as smoking in a high-income country setting. But this estimate is based on a limited number of biomarker studies and is best be considered a likely upper level of ENDS risk given potential biases in our method (i.e., the biomarkers used being correlated with more unaccounted for toxicants in smoking compared to with using ENDS).
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Affiliation(s)
- Nick Wilson
- University of Otago, Wellington, New Zealand.
| | | | - Driss Ait Ouakrim
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Janet Hoek
- University of Otago, Wellington, New Zealand
| | | | - Tony Blakely
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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17
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Hiler M, Weidner AS, Hull LC, Kurti AN, Mishina EV. Systemic biomarkers of exposure associated with ENDS use: a scoping review. Tob Control 2021:tobaccocontrol-2021-056896. [PMID: 34732539 DOI: 10.1136/tobaccocontrol-2021-056896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/13/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This scoping review provides an overview of the existing literature on biomarkers of exposure from electronic nicotine delivery systems (ENDS) use and identifies gaps in existing knowledge. DATA SOURCES We searched two international databases (PubMed and Web of Science) to identify relevant studies published from August 2013 to February 2021. DATA SELECTION Studies were included if they assessed and compared biomarkers of exposure between exclusive ENDS users, non-users, exclusive cigarette smokers, dual users of ENDS and cigarettes or cigarette smokers who switch to ENDS. DATA EXTRACTION AND SYNTHESIS Of the 5074 studies identified, 188 studies met criteria and were selected for full-text screening. Of these, 27 studies were selected for inclusion and data extraction. CONCLUSIONS Consistent, although limited, evidence shows that exclusive ENDS users have elevated levels of biomarkers of certain volatile organic compounds (VOCs; eg, acrylamide and acrylonitrile), metals (eg, cadmium and selenium) and propylene glycol compared with non-users; however, evidence for biomarkers of other toxicants (eg, acrolein, benzene and chromium) is mixed. Biomarkers of most VOCs are lower in ENDS users compared with cigarette smokers, and cigarette smokers who switch to ENDS consistently show reductions in VOC biomarkers. Evidence comparing metal exposures from exclusive ENDS use, cigarette smoking and dual use is mixed and depends on the metal. ENDS and e-liquid characteristics as well as use patterns may be associated with elevated exposure to VOCs and metals. Additional rigorous, controlled studies can assess biomarker exposures from ENDS use and inform the overall risk-benefit of ENDS use for different user populations.
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Affiliation(s)
- Marzena Hiler
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Anna-Sophie Weidner
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Lynn C Hull
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Allison N Kurti
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Elena V Mishina
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
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18
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Cohen G, Goldenson NI, Bailey PC, Chan S, Shiffman S. Changes in Biomarkers of Cigarette Smoke Exposure After 6 Days of Switching Exclusively or Partially to Use of the JUUL System with Two Nicotine Concentrations: A Randomized Controlled Confinement Study in Adult Smokers. Nicotine Tob Res 2021; 23:2153-2161. [PMID: 34161586 PMCID: PMC8570669 DOI: 10.1093/ntr/ntab134] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
Introduction Evidence suggests that cigarette smokers who switch to electronic nicotine delivery systems (ENDS) reduce their exposure to harmful toxicants and carcinogens. It is unclear if dual-use is associated with decreases in exposure to toxicants. Methods This parallel-group confinement study assessed changes in biomarkers of exposure (BOEs) over six days among healthy adult smokers who were randomized into 1 of 11 study groups: eight JUUL-brand System (JUUL) groups (4 JUUL flavors [Virginia Tobacco, Menthol, Mint, Mango] × 2 nicotine concentrations [5.0% or 3.0% by weight]); Dual-Use group used preferred JUUL flavor (5.0% nicotine) and ≤50% usual brand (UB) cigarettes/day; UB Cigarette group and one group abstained from all tobacco/nicotine product use (Abstinence group). Urine and blood analysis assessed changes in primary BOE endpoints (NNAL, 3-HPMA, MHBMA, S-PMA COHb) and secondary BOE endpoints (NNN, HMPMA, CEMA, 1-OHP, O-toluidine, 2-NA, 4-ABP) among 279 adult smokers. Results In JUUL groups, median percent reductions in primary BOEs (Day 6–Baseline) were 90%–≥100% of Abstinence; there were no significant differences between JUUL groups and Abstinence. All reductions in JUUL groups were substantially and statistically significantly greater than reductions in the UB Cigarette group (ps < 0.025). Median reductions in primary BOEs in the Dual-Use group were 43%–55% of Abstinence. Similar results were observed for secondary BOEs. Conclusion This study suggests that the use of JUUL as a complete or partial substitute (i.e., dual-use with ≥50% reduction in cigarette consumption) for combustible cigarettes can substantially reduce exposure to multiple toxins associated with cigarette smoking. Implications This study adds to the growing body of evidence supporting the utility of ENDS products as potentially reduced-harm alternatives to cigarettes for adult smokers. Adult smokers who switched completely from cigarette smoking to use of the JUUL System (“JUUL”) in two nicotine concentrations (5.0% and 3.0%) and four flavors significantly reduced their exposure to multiple classes of cigarette-related toxicants. Additionally, smokers who used JUUL and continued smoking but reduced their daily cigarette consumption by ≥50% (dual users) also significantly reduced their toxicant exposure compared to cigarette smoking.
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Affiliation(s)
- Gal Cohen
- Juul Labs, Inc., Washington, DC, USA
- Corresponding Author: Gal Cohen, PhD, Juul Labs, Inc., 1000 F Street NW, Suite 800, Washington, D.C, 20004, USA. E-mail:
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Rudasingwa G, Kim Y, Lee C, Lee J, Kim S, Kim S. Comparison of Nicotine Dependence and Biomarker Levels among Traditional Cigarette, Heat-Not-Burn Cigarette, and Liquid E-Cigarette Users: Results from the Think Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4777. [PMID: 33947137 PMCID: PMC8124521 DOI: 10.3390/ijerph18094777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 11/21/2022]
Abstract
This study aimed to compare Korean smokers' smoking-related biomarker levels by tobacco product type, including heat-not-burn cigarettes (HNBC), liquid e-cigarettes (EC), and traditional cigarettes (TC). Nicotine dependence levels were evaluated in Korean adult study participants including TC-, EC-, HNBC-only users and nonsmokers (n = 1586) from March 2019 to July 2019 in Seoul and Cheonan/Asan South Korea using the Fagerström Test Score. Additionally, urine samples (n = 832) were collected for the measurement of urinary nicotine, cotinine, OH-cotinine, NNAL(4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), CYMA(N-acetyl-S-(2-cyanoehtyl)-L-cysteine), or CEMA (2-cyanoethylmercapturic acid) using LC-MS/MS. The median(interquartile range) nicotine dependence level was not different among the three types of smokers, being 3.0 (2.0-5.0) for TC- (n = 726), 3.0 (1.0-4.0) for EC- (n = 316), and 3.0 (2.0-4.0) for HNBC- (n = 377) only users. HNBC-only users presented similar biomarker levels compared to TC-only users, except for NNAL (HNBC: 14.5 (4.0-58.8) pg/mL, TC: 32.0 (4.0-69.6) pg/mL; p = 0.0106) and CEMA (HNBC: 60.4 (10.0-232.0) ng/mL, TC: 166.1 (25.3-532.1) ng/mL; p = 0.0007). TC and HNBC users showed increased urinary cotinine levels as early as the time after the first smoke of the day. EC users' biomarker levels were possibly lower than TC or HNBC users' but higher than those of non-smokers.
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Affiliation(s)
- Guillaume Rudasingwa
- Integrated Research Center of Risk Assessment, Soonchunhyang University, Soonchunhyang-Ro 22, Asan 31538, Korea;
| | - Yeonjin Kim
- Department of ICT Environmental Health System, Graduate School, Soonchunhyang University, Soonchunhyang-Ro 22, Asan 31538, Korea;
| | - Cheolmin Lee
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, Korea;
| | - Jeomkyu Lee
- Division of Respiratory and Allergy Disease Research, Department of Chronic Disease Convergence Research, National Institute of Health (NIH), Korea Disease Control and Prevention Agency (KDCA), Osong 28159, Korea; (J.L.); (S.K.)
| | - Seunghyun Kim
- Division of Respiratory and Allergy Disease Research, Department of Chronic Disease Convergence Research, National Institute of Health (NIH), Korea Disease Control and Prevention Agency (KDCA), Osong 28159, Korea; (J.L.); (S.K.)
| | - Sungroul Kim
- Integrated Research Center of Risk Assessment, Soonchunhyang University, Soonchunhyang-Ro 22, Asan 31538, Korea;
- Department of ICT Environmental Health System, Graduate School, Soonchunhyang University, Soonchunhyang-Ro 22, Asan 31538, Korea;
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Sakaguchi C, Nagata Y, Kikuchi A, Takeshige Y, Minami N. Differences in Levels of Biomarkers of Potential Harm Among Users of a Heat-Not-Burn Tobacco Product, Cigarette Smokers, and Never-Smokers in Japan: A Post-Marketing Observational Study. Nicotine Tob Res 2021; 23:1143-1152. [PMID: 33502518 PMCID: PMC8274485 DOI: 10.1093/ntr/ntab014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/19/2021] [Indexed: 12/14/2022]
Abstract
Introduction Cigarette smoking is associated with the risk of certain diseases, but
non-combustible products may lower these risks. The potential long-term
health effects of the next-generation non-combustible products
(heat-not-burn tobacco products (HNBP) or electronic vapor products) have
not been thoroughly studied. The present study aimed to investigate the
impact of biomarkers of potential harm (BoPH) of one of HNBP (a novel vapor
product: NTV (novel tobacco vapor)), under the conditions of actual use. Aims and Methods This study was an observational, cross-sectional, three-group, multi-center
study. Exclusive NTV users (NTV, n = 259), conventional
cigarette smokers (CC, n = 100) and never-smokers (NS,
n = 100) were enrolled. Biomarkers of tobacco smoke
exposure (cotinine and total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol
(NNAL)) and BoPH including parameters of physical pulmonary functions
relevant to smoking-related diseases were examined, and subjects answered a
questionnaire on cough-related symptoms (J-LCQ) and health-related quality
of life (SF-36v2®). Results Levels of cotinine, total NNAL and BoPH (high-density lipoprotein
(HDL)-cholesterol, triglyceride, sICAM-1, WBC count, 11-DHTXB2, 2,3-d-TXB2,
8-epi-PGF2α, forced expiratory volume in 1 second (FEV1), % predicted
value of FEV1 (%FEV1) and maximum midexpiratory flow (FEF25-75))
were significantly different in the NTV group as compared to levels in CC
group (p < .05). Significantly higher levels of
cotinine, total NNAL, and 2,3-d-TXB2, and lower levels of FEV1 and %FEV1,
were observed among NTV users compared to the NS group. Conclusion In a post-marketing study under actual use conditions, BoPH associated with
smoking-related disease examined in exclusive NTV users were found to be
favorably different from those of CC smokers, a finding attributable to a
reduction in exposure to harmful substances of tobacco smoke. Implications Cigarette smoking is associated with an increased risk of pulmonary diseases
like COPD, cardiovascular diseases, and certain cancers. There is a growing
body of evidence that HNBP reduces the exposure associated with smoking and
that there is a favorable change in BoPH. However, long-term effects
regarding the relative health risks to HNBP users compared to CC smokers
have not been examined. This study provides post-marketing data under actual
use conditions of the effects on biomarkers of potential harm in NTV, one of
HNBP, exclusive users compared to CC smokers and never-smokers. The evidence
suggests that exclusive NTV users have favorable levels of BoPH compared to
CC smokers, and that is result from a sustained reduction in exposure to
harmful substances of tobacco smoke.
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Affiliation(s)
| | - Yasufumi Nagata
- Scientific and Regulatory Affairs, Japan Tobacco Inc., Tokyo, Japan
| | - Akira Kikuchi
- Scientific and Regulatory Affairs, Japan Tobacco Inc., Tokyo, Japan
| | - Yuki Takeshige
- Scientific and Regulatory Affairs, Japan Tobacco Inc., Tokyo, Japan
| | - Naoki Minami
- Scientific and Regulatory Affairs, Japan Tobacco Inc., Tokyo, Japan
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21
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Akiyama Y, Sherwood N. Systematic review of biomarker findings from clinical studies of electronic cigarettes and heated tobacco products. Toxicol Rep 2021; 8:282-294. [PMID: 33552927 PMCID: PMC7850959 DOI: 10.1016/j.toxrep.2021.01.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Worldwide adoption of electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) has increased exponentially over the past decade. These products have been proposed as non-combustible alternatives to traditional tobacco products such as cigarettes and may thus reduce the negative health consequences associated with tobacco smoke. However, the overall health impact and safety of using these products remains unclear. This review seeks to provide an updated summary of available evidence on changes to levels of tobacco-related biomarkers to aid the overall assessment of the consequences of using e-cigarettes and HTPs. METHODS A systematic review was conducted through major databases (Medline/PubMed, Scopus, EMBASE) searching for articles directly comparing biomarker levels in humans using e-cigarettes or HTPs and those using combustible cigarettes. We included peer reviewed articles with comparative or longitudinal design and extracted key information for our purpose (type of population, demographics, biomarkers measurements, and health effects). An initial qualitative analysis was performed followed by a summary of findings. RESULTS A total of 44 studies were included from initial citations. The vast majority of the literature reported reductions in levels of biomarkers of tobacco smoke exposure (BOE), especially nicotine, MHBMA, 3-HPMA, S-PMA, 1-OHP and NNAL, when using e-cigarettes and HTPs compared to combustible cigarettes. There was a slight tendency toward a larger reduction in these biomarkers levels with the use of e-cigarettes, although direct comparisons between e-cigarettes and HTPs were lacking. There was also a trend toward positive changes in levels of biomarkers of biological effect (BOBE) with the use of e-cigarettes and HTPs. CONCLUSIONS A comparison of levels of biomarkers of tobacco-related exposure collected in clinical studies revealed that the use of e-cigarettes and HTPs could lead to a significant reduction in exposure to harmful substances compared to combusted cigarettes. In tandem, the health status of e-cigarettes and HTP users, indexed by levels of biomarkers of biological effect showed potential for improvement compared to smoking. However, larger and longer-term population-based studies are needed to further clarify these findings.
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Key Words
- BAT, British American Tobacco
- BOBE, biomarkers of biological effect
- BOE, biomarkers of tobacco smoke exposure
- Biomarkers of biological effect (BOBE)
- Biomarkers of tobacco smoke exposure (BOE)
- CHTP, Carbon-Heated Tobacco Product
- Clinical study
- E-cigarettes, electronic cigarettes
- EHCSS, Electrically Heated Cigarette Smoking System
- EVPs, electronic vapor products
- Electronic cigarette
- FV, Fontem Ventures
- HC, heated cigarette
- HTPs, heated tobacco products
- Heated tobacco products
- JT, Japan Tobacco
- NOS scale, The Newcastle-Ottawa Scale
- NSPS, nicotine-salt pod system
- NTV, Novel Tobacco vapor products
- PMI, Philip Morris International
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RAI, Reynolds American Inc
- RCT, randomized controlled trial
- RJR, R.J. Reynolds Tobacco Company
- RJRVC, R.J. Reynolds Vapor Company
- RTP, reduced-toxicant-prototype cigarette
- THP, tobacco heating product
- THS, Tobacco Heating System
- UCS, Uncontrolled smoking conditions
- WHO, World Health Organization
- mTHS, Menthol Tobacco Heating System
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Affiliation(s)
- Yukio Akiyama
- Department of Environmental Management, University of Occupational and Environmental Health, Kitakyushu, Japan
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22
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Habibagahi A, Alderman N, Kubwabo C. A review of the analysis of biomarkers of exposure to tobacco and vaping products. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2020; 12:4276-4302. [PMID: 32853303 DOI: 10.1039/d0ay01467b] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Quantification of exposure to different chemicals from both combustible cigarettes and vaping products is important in providing information on the potential health risks of these products. To assess the exposure to tobacco products, biomarkers of exposure (BOEs) are measured in a variety of biological matrices. In this review paper, current knowledge on analytical methods applied to the analysis of biomarkers of exposure to tobacco products is discussed. Numerous sample preparation techniques are available for the extraction and sample clean up for the analysis of BOEs to tobacco and nicotine delivery products. Many tobacco products-related exposure biomarkers have been analyzed using different instrumental techniques, the most common techniques being gas and liquid chromatography coupled with mass spectrometry (GC-MS, GC-MS/MS and LC-MS/MS). To assess exposure to emerging tobacco products and study exposure in dual tobacco users, the list of biomarkers analyzed in urine samples has been expanded. Therefore, the current state of the literature can be used in preparing a preferred list of biomarkers based on the aim of each study. The information summarized in this review is expected to be a handy tool for researchers involved in studying exposures to tobacco products, as well as in risk assessment of biomarkers of exposure to vaping products.
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Affiliation(s)
- Arezoo Habibagahi
- Exposure and Biomonitoring Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON K1A 0K9, Canada.
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23
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Abstract
PURPOSE OF REVIEW Tobacco smoking is the most significant modifiable risk factor in the development of cardiovascular disease (CVD). Exposure to mainstream cigarette smoke (MCS) is associated with CVD through the development of endothelial dysfunction, a condition characterized by an imbalance of vasoactive factors in the vasculature. This dysfunction is thought to be induced in part by aldehydes generated at high levels in MCS. RECENT FINDINGS Electronic cigarettes (e-cigs) may also pose CVD risk. Although the health effects of e-cigs are still largely unknown, the presence of aldehydes in e-cig aerosol suggests that e-cigs may induce adverse cardiovascular outcomes similar to those seen with MCS exposure. Herein, we review studies of traditional and emerging tobacco product use, shared harmful and potentially harmful constituents, and measures of biomarkers of harm (endothelial dysfunction) to examine a potential and distinct role of aldehydes in cardiovascular harm associated with cigarette and e-cig use.
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Affiliation(s)
- Jordan Lynch
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, 40292, USA.
- Diabetes & Obesity Center, University of Louisville, Louisville, KY, 40292, USA.
- University of Louisville American Heart Association - Tobacco Regulation and Addiction Center, Louisville, KY, 40202, USA.
| | - Lexiao Jin
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, 40292, USA
- Diabetes & Obesity Center, University of Louisville, Louisville, KY, 40292, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Andre Richardson
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, 40292, USA
- Diabetes & Obesity Center, University of Louisville, Louisville, KY, 40292, USA
- University of Louisville American Heart Association - Tobacco Regulation and Addiction Center, Louisville, KY, 40202, USA
| | - Daniel J Conklin
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, 40292, USA
- Diabetes & Obesity Center, University of Louisville, Louisville, KY, 40292, USA
- University of Louisville American Heart Association - Tobacco Regulation and Addiction Center, Louisville, KY, 40202, USA
- Superfund Research Center, University of Louisville, Louisville, KY, 40202, USA
- Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY, 40292, USA
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