Cotinine and Tobacco-Specific Carcinogen Exposure Among Nondaily Smokers in a Multiethnic Sample

Khariwala, Samir S.; Scheuermann, Taneisha S.; Berg, Carla J.; Hayes, Rashelle B.; Nollen, Nicole L.; Thomas, Janet L.; Guo, Hongbo; Ahluwalia, Jasjit S.; Benowitz, Neal L.

doi:10.1093/ntr/ntt194

Cited by 20 publications

(13 citation statements)

References 22 publications

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“…Finally, the possibility of reporting bias of tobacco product use cannot be ruled out, although the bias would likely be non-differential and equally influence the responses for both the Cig-Only and Cig-OTP groups. Given that the strength of the associations found between cigarette consumption and biomarkers are consistent with those found in the literature (Benowitz et al, 2011b; Khariwala et al, 2014), it is unlikely that misreporting alone explains the lack of association between OTPs and biomarkers in the current study.…”

Section: Discussionsupporting

confidence: 88%

Tobacco toxicant exposure in cigarette smokers who use or do not use other tobacco products

Nollen

Mayo

Clark

et al. 2017

Drug and Alcohol Dependence

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Background Non-cigarette other tobacco products (OTP; e.g., cigarillos, little cigars) are typically used in combination with cigarettes, but limited data exists on the tobacco toxicant exposure profiles of dual cigarette-OTP (Cig-OTP) users. This study examined biomarkers of nicotine and carcinogen exposure in cigarette smokers who used or did not use OTP. Methods 111 Cig-OTP and 111 cigarette only (Cig Only) users who smoked equivalent cigarettes per day were matched on age (< 40, >= 40), race (African American, White), and gender. Participants reported past 7-day daily use of cigarettes and OTP and provided urine for nicotine, cotinine, total nicotine equivalents (TNE) and total NNAL concentrations. Results Cig-OTP users reported greater past 7-day tobacco use (15.9 versus 13.0 products/day, p < 0.01) but had significantly lower creatinine-normalized nicotine (606 versus 1,301 ng/mg), cotinine (1,063 versus 2,125 ng/mg), TNE (28 versus 57 nmol/mg) and NNAL (251 versus 343 pg/mg) than Cig Only users (p < 0.001). Conclusions Cig-OTP users had lower levels of nicotine and metabolites of a lung carcinogen relative to Cig-Only users, but concentrations of toxicants among Cig-OTP users were still at levels that place smokers at great risk from the detrimental health effects of smoking. Impact Our study finds that nicotine and carcinogen exposure in Cig-OTP users are lower compared to cigarette only users, but still likely to be associated with substantial harm. A better understanding of why toxicant levels may be lower in Cig-OTP is an important area for future study.

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Section: Discussionsupporting

confidence: 88%

Tobacco toxicant exposure in cigarette smokers who use or do not use other tobacco products

Nollen

Mayo

Clark

et al. 2017

Drug and Alcohol Dependence

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“…This may not be true for African American NDS. African American non-daily smokers take in more cotinine per cigarette and have nicotine blood levels in the range of White daily smokers [16, 17], suggesting that African American NDS may be in need of nicotine replacement to succeed in quitting. NDS in this study noted more primary versus secondary dependence motives.…”

Section: Discussionmentioning

confidence: 99%

“…African Americans, in particular, have higher cardiovascular and cancer-disease risk at lower levels of smoking, including non-daily smoking [14, 15]. Concentrations of NNAL, a metabolite of the potent lung carcinogen NNK, and cotinine, the primary metabolite of nicotine, are three to six times higher in African American NDS compared to White and Hispanic/Latino NDS [16, 17]. This difference persists after adjustment for racial/ethnic variations in smoking level and nicotine metabolism, suggesting that African American NDS incur substantial risk from their intermittent pattern of smoking.…”

Section: Introductionmentioning

confidence: 99%

A randomized clinical trial of counseling and nicotine replacement therapy for treatment of African American non-daily smokers: Design, accrual, and baseline characteristics

Nollen

Cox

Mayo

et al. 2018

Contemporary Clinical Trials

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BACKGROUND: Non-daily smokers (NDS) who smoke on some but not all days are a growing subset of United States (US) tobacco users. Racial/ethnic minorities are more likely to be NDS. African American NDS have strikingly high levels of nicotine and carcinogen exposure, making treatment of this high risk group a priority. METHODS: The current study is one of three ongoing federally-funded clinical trials of NDS and, to our knowledge the only RCT focused on racial/ethnic minority NDS. The design has been guided by input from Patient and Stakeholder Advisory Panels who helped develop the research questions, design the intervention, and select the outcomes. The objective is to compare the effectiveness of smoking cessation counseling alone (C) or smoking cessation counseling plus participant’s choice of nicotine replacement therapy (NRT; C+NRT) for African American NDS. Two-hundred seventy-eight African American NDS will be randomized in a 2:1 fashion to C+NRT or C. All participants receive five sessions of smoking cessation counseling; those randomized to C+NRT receive their choice of nicotine gum, patch, and/or lozenge. Treatment in both groups lasts for 12 weeks. We hypothesize that C+NRT will be more effective than C on the primary outcome of biochemically-confirmed abstinence from smoking at week 12. Secondary aims will compare C+NRT and C on patient- and provider-desired outcomes including abstinence from smoking at week 26, change in biochemically-verified nicotine and carcinogen exposure, days abstinent, and treatment process measures (e.g., NRT use and side effects). Predictors of abstinence will also be explored. DISCUSSION: Findings will illuminate effective treatment options for African American NDS and contribute to development of evidence-based guidelines for treating the 8.9 million US adult NDS for whom no guidelines currently exist.

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“…[15][16][17] Numerous studies have documented higher rates of nondaily (ie, smoking on only some days) or light smoking (ie, 10 or fewer cigarettes per day [CPD]) among Latinos compared with non-Latino Whites. 15,[18][19][20][21][22] Nondaily smoking is under-studied and undertreated, 22,23 despite its association with significant health risks, [24][25][26][27] making it an important target for study. Additionally, a nuanced analysis demonstrates that significant proportions of Latino smokliefs, and behaviors of one's heritage culture with those of a new culture.…”

Section: Smoking and Acculturation Among Latinos -Pulvers Et Almentioning

confidence: 99%

“…37 A logical next step is to examine the association between acculturation and smoking level (ie, daily or nondaily smoking) among Latino men and women. Nondaily smoking is increasingly common among both native and US Latinos 19,38 and is associated with significant health risks, [24][25][26][27] yet is under-studied and under-treated. 22,23 A granular, within smoker analysis among a growing segment of the Latino population that is most at-risk (ie, highly acculturated) stands to make the greatest public health impact.…”

Section: Smoking and Acculturation Among Latinos -Pulvers Et Almentioning

confidence: 99%

Daily and Nondaily Smoking Varies by Acculturation among English-Speaking, US Latino Men and Women

et al. 2018

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Background: Higher smoking prevalence and quantity (cigarettes per day) has been linked to acculturation in the United States among Latinas, but not Latino men. Our study examines variation between a different and increasingly important target behavior, smoking level (nondaily vs daily) and acculturation by sex.Methods: An online English-language survey was administered to 786 Latino smokers during July through August 2012. The Brief Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) and other acculturation markers were used. Multinomial logistic regression models were implemented to assess the association between smoking levels (nondaily, light daily, and moderate/ heavy daily) with acculturation markers.Results: Greater ARMSA-II scores (relative risk ratio, RRR=.81, 95% CI: .72-.91) and being born inside the United States (RRR=.42, 95% CI: .24-.74) were associated with lower relative risk of nondaily smoking. Greater Latino orientation (RRR=1.29, 95% CI: 1.11-1.48) and preference for Spanish language (RRR=1.06, 95% CI: 1.02-1.10) and media (RRR=1.12, 95% CI: 1.05-1.20) were associated with higher relative risk of nondaily smoking. The relationship between acculturation and smoking level did not differ by sex. Conclusion:This study found that among both male and female, English-speaking Latino smokers, nondaily smoking was associated with lower acculturation, while daily smoking was linked with higher acculturation.

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Cotinine and Tobacco-Specific Carcinogen Exposure Among Nondaily Smokers in a Multiethnic Sample

Cited by 20 publications

References 22 publications

Tobacco toxicant exposure in cigarette smokers who use or do not use other tobacco products

Tobacco toxicant exposure in cigarette smokers who use or do not use other tobacco products

A randomized clinical trial of counseling and nicotine replacement therapy for treatment of African American non-daily smokers: Design, accrual, and baseline characteristics

Daily and Nondaily Smoking Varies by Acculturation among English-Speaking, US Latino Men and Women

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