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Carroll DM, Cigan S, Ikuemonisan J, Hammonds T, Stepanov I, St. Helen G, Benowitz N, Hatsukami DK. Relationships Between Race, Gender, and Spot Urine Levels of Biomarkers of Tobacco Exposure Vary Based on How Creatinine Is Handled in Analyses. Nicotine Tob Res 2020; 22:2109-2113. [PMID: 32598452 PMCID: PMC7593361 DOI: 10.1093/ntr/ntaa117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/23/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION We illustrate the differential impact of common analysis approaches to handling urinary creatinine, a measure for urine dilution, on relationships between race, gender, and biomarkers of exposure measured in spot urine. METHODS In smokers, spot urine levels of total nicotine equivalents (TNE, sum of total nicotine, total cotinine, and total 3'-hydroxycotinine) and total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) overall and per cigarette were examined. Relationships between race (African Americans [AA] n = 373, Whites n = 758) or gender (males n = 629, females n = 502) and TNE or NNAL were examined using the following approaches to handling creatinine: (1) unadjusted/unstandardized; (2) standardization; (3) adjustment as a covariate. Significance was considered at p < .05. RESULTS Creatinine was higher in AA versus Whites (1.19 vs. 0.96 mg/mL; p < .0001) and in males versus females (1.21 vs. 0.84 mg/mL; p < .0001). Independent of how creatinine was handled, TNE was lower among AA than Whites (TNE ratios AA vs. Whites: 0.67-0.84; p's < .05). Unadjusted TNE per cigarette was higher among AA versus Whites (ratio 1.12; p = .0411); however, the relationship flipped with standardization (ratio 0.90; p = .0360) and adjustment (ratio 0.95; p = .3165). Regarding gender, unadjusted TNE was higher among males versus females (ratio 1.13; p = .0063), but the relationship flipped with standardization (ratio 0.79; p < .0001) or adjustment (ratio 0.89; p = .0018). Unadjusted TNE per cigarette did not differ across gender (ratio 0.98; p = .6591), but lower levels were found in males versus females with standardization (ratio 0.68; p < .0001) and adjustment (ratio 0.74; p < .0001). NNAL displayed similar patterns. CONCLUSIONS Relationships between race, gender, and spot urine levels of biomarkers of exposure can vary greatly based on how creatinine is handled in analyses. IMPLICATIONS Lack of appropriate methods can lead to discrepancies across reports on variability of urinary biomarkers by race and gender. We recommend that for any analyses of biomarkers of exposure measure in spot urine samples across race, gender, or other population subgroups that differ in urinary creatinine levels, sensitivity analyses comparing the different methods for handling urinary creatinine should be conducted. If methods result in discrepant findings, this should be clearly noted and discussed.
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Affiliation(s)
- Dana M Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Shannon Cigan
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | - Taylor Hammonds
- Graduate Program in Regulatory Sciences and Interdisciplinary Biomedical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Irina Stepanov
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Gideon St. Helen
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA
| | - Neal Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN
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Meier E, Vandrey R, Rubin N, Pacek LR, Jensen JA, Donny EC, Hecht SS, Carmella SG, Murphy SE, Luo X, Stepanov I, Ikuemonisan J, Severson H, Al’absi M, Hatsukami DK. Cigarette Smokers Versus Cousers of Cannabis and Cigarettes: Exposure to Toxicants. Nicotine Tob Res 2020; 22:1383-1389. [PMID: 31616939 PMCID: PMC7366295 DOI: 10.1093/ntr/ntz199] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/11/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Cannabis and tobacco couse is common and could expose users to higher levels of toxicants. No studies have examined biomarkers of toxicant exposure in cousers of cannabis and cigarettes, compared with cigarette smokers (CS). AIMS AND METHODS Adult daily CS were recruited from 10 US sites for a study of reduced nicotine cigarettes. In this analysis of baseline data, participants were categorized as either cousers of cannabis and tobacco (cousers; N = 167; urine positive for 11-nor-9-carboxy-Δ 9-tetrahydrocannnabinol and self-reported cannabis use ≥1×/week), or CS (N = 911; negative urine and no self-reported cannabis use). Participants who did not meet either definition (N = 172) were excluded. Self-reported tobacco and cannabis use and tobacco and/or combustion-related biomarkers of exposure were compared between groups. RESULTS Compared to CS, cousers were younger (couser Mage = 38.96, SD = 13.01; CS Mage = 47.22, SD = 12.72; p < .001) and more likely to be male (cousers = 67.7%, CS = 51.9%, p < .001). There were no group differences in self-reported cigarettes/day, total nicotine equivalents, or breath carbon monoxide, but cousers had greater use of non-cigarette tobacco products. Compared to CS, cousers had higher concentrations of 3-hydroxypropylmercapturic acid, 2-cyanoethylmercapturic acid, S-phenylmercapturic acid, 3-hydroxy-1-methylpropylmercapturic acid (ps < .05), and phenanthrene tetraol (p < .001). No biomarkers were affected by number of cannabis use days/week or days since last cannabis use during baseline (ps > .05). CONCLUSIONS Cousers had higher concentrations of biomarkers of exposure than CS, but similar number of cigarettes per day and nicotine exposure. Additional studies are needed to determine whether cannabis and/or alternative tobacco products are driving the increased toxicant exposure. IMPLICATIONS Cousers of cannabis and tobacco appear to be exposed to greater levels of harmful chemicals (ie, volatile organic compounds and polycyclic aromatic hydrocarbons), but similar levels of nicotine as CS. It is unclear if the higher levels of toxicant exposure in cousers are due to cannabis use or the increased use of alternative tobacco products compared with CS. It is important for studies examining biomarkers of exposure among CS to account for cannabis use as it may have a significant impact on outcomes. Additionally, further research is needed examining exposure to harmful chemicals among cannabis users.
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Affiliation(s)
- Ellen Meier
- Department of Psychology, University of Wisconsin—Stevens Point, Stevens Point, WI
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nathan Rubin
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Lauren R Pacek
- Department of Psychiatry, Duke University School of Medicine, Durham, NC
| | - Joni A Jensen
- University of Minnesota, Tobacco Research Programs, Minneapolis, MN
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen S Hecht
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | | | - Sharon E Murphy
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Xianghua Luo
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55414
| | - Irina Stepanov
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
- University of Minnesota, Tobacco Research Programs, Minneapolis, MN
| | | | | | - Mustafa Al’absi
- Department of Family Medicine and BioBehavioral Health, University of Minnesota Medical School, Duluth, MN
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Jain V, Alcheva A, Huang D, Caruso R, Jain A, Lay M, O'Connor R, Stepanov I. Comprehensive Chemical Characterization of Natural American Spirit Cigarettes. TOB REGUL SCI 2019; 5:381-399. [PMID: 33907702 PMCID: PMC8075288 DOI: 10.18001/trs.5.4.8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Marketing of the Natural American Spirit (NAS) cigarettes implies reduced risk of toxic exposures. We aimed to provide a comprehensive chemical characterization of these cigarettes. METHODS We analyzed 13 varieties of NAS for a range of tobacco- and combustion-derived constituents. Cigarettes were smoked by 2 standard regimens and analyzed using our routine analytical procedures. We also analyzed tobacco filler and physical cigarette characteristics. RESULTS Under intense smoking conditions, nicotine in smoke of NAS cigarettes averaged 3.3(±0.7) mg/cigarette, compared to 2.4(±0.4) in other brands. The levels of carcinogenic nitrosamines NNN and NNK varied extensively across NAS varieties, their sum ranging from 71 to 443 ng/cigarette. Levels of volatile toxicants were generally similar to, or higher than those found in other commercial US cigarettes. CONCLUSIONS High nicotine content suggests that NAS cigarettes may be more addictive than many other brands. Similarly low TSNA levels were measured in some NAS varieties, independent of whether or not they were labeled as organic. Levels of other toxicants were similar to other brands. Consumer education and additional regulatory measures are needed to address the misperceptions that NAS cigarettes are safer than other commercial cigarette brands.
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Affiliation(s)
- Vipin Jain
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Aleksandra Alcheva
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Darlene Huang
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Rosalie Caruso
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Anshu Jain
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Mula Lay
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Richard O'Connor
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Irina Stepanov
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
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