Understanding heterogeneity among individuals who smoke cigarettes and vape: assessment of biomarkers of exposure and potential harm among subpopulations from the PATH Wave 1 Data

Abstract

Introduction People who both smoke cigarettes and vape are often considered as a homogenous group even though multiple subgroups may exist. We examined biomarkers of exposure (BOE) and biomarkers of potential harm (BOPH) to differentiate between subgroups of people who smoke and vape based on PATH Study Wave 1 (2013–2014) data. Methods We compared people who only smoke cigarettes everyday (Group A, n = 2442) and people who only vape everyday (Group C, n = 169) against people who smoke and vape segmented into subgroups of people who frequently smoke and vape (Group B1, n = 169), frequently smoke and infrequently vape (Group B2, n = 678), frequently vape and infrequently smoke (Group B3, n = 57), and infrequently smoke and vape (Group B4, n = 66). Eighteen BOEs (representing exposure to TSNAs, nicotine, heavy metals, PAHs, and volatile organic compounds) and four BOPHs (representing inflammation and oxidative stress) were compared within the subgroups. Results Levels of many BOEs/BOPHs were higher among Group B2 relative to Groups B1, B3, and B4. Compared to Group A, many BOEs were significantly lower in Groups B3 (15/18) and B4 (17/18), and some BOEs were higher among B2 (4/18). Compared to Group C, significantly lower BOEs were observed for Group B4 (2/18). Conclusions Overall, the levels of BOEs and BOPHs in people who smoke and vape are associated with frequency of cigarette smoking. Our findings indicate that not all people who smoke and vape are the same, and tobacco product use frequency should be considered when categorizing people who smoke and vape.

Comparison of biomarkers of exposure among US adult smokers, users of electronic nicotine delivery systems, dual users and nonusers, 2018–2019

“…The results of this analysis concord with previous observational studies using data from the PATH Study 24 – 26 and other studies 39 that were conducted when earlier-generation ENDS products were predominant, and extend these findings to the more recent tobacco product marketplace, specifically recent-generation ENDS products. The levels of BOEs observed among ENDS users relative to cigarette smokers are also consistent with controlled confinement studies, randomized trials and longitudinal observational studies in which smokers who switch to ENDS experience substantial reductions in BOEs 10 , 40 , 41 , and suggest that smokers who switch to exclusive ENDS use can reduce exposure to many HPHCs for which biomarker data are available to a similar extent as abstinence from tobacco products or smoking cessation.…”

“…Several recent analyses have utilized BOE data from the Population Assessment of Tobacco and Health (PATH) Study, a longitudinal cohort study of tobacco use among a nationally representative sample of US adults, to assess variation in HPHC exposure. Cross-sectional analyses of PATH Wave 1 (2013–2014) demonstrated that exclusive ENDS users have lower levels of many of the measured BOEs compared to cigarette smokers and dual users 22 , 23 , and that among dual users, it is cigarette smoking, and not ENDS use, that is the primary driver of HPHC exposures 24 – 26 . Consistent with these findings, two longitudinal studies using data from PATH Wave 1 (2013–2014) to Wave 2 (2014–2015) found that smokers who switch from cigarette smoking to exclusive ENDS use experienced substantial decreases in BOEs, and smokers who transition to dual use and reduce their cigarette consumption by at least 50% also experience significant reductions in BOEs 27 , 28 .…”

“…The primary aim of the current study was to assess differences in levels of BOEs to TSNAs, VOCs, metals and nicotine, comparing: (i) exclusive ENDS users; (ii) exclusive smokers; (iii) dual users; and (iv) past 30-day tobacco non-users using data from Wave 5 (2018–2019) of the PATH Study. Further, given heterogeneity in cigarette smoking behaviors among dual users 26 , 35 , exposures among dual users were also evaluated by their level of cigarette consumption.…”

Metal in biological samples from electronic cigarette users and those exposed to their second-hand aerosol: a narrative review

“…In addition, from PATH Study Wave 1, Lizhnyak et al ( 12 ) compared people who smoke against vape users and dual users split according to the frequency of cigarette and/or vape use. Urinary Cd levels were significantly different between people who frequently smoke and vape and people who frequently vape (0.33 vs. 0.28); between the group who infrequently smoke and vape (0.16) and people who smoke every day (0.31); and people who vape more than smoke (0.29) and people who frequently vape (0.28).…”

Switching Behavior and Changes in Smoking Behavior by Menthol Cigarette Preference and Menthol Heated Tobacco Product Use Among Adults Who Smoke Cigarettes: An Actual Use Study

“…Reducing cigarette consumption consequentially reduces HPHC exposure and has been associated with reductions in tobacco-related negative health outcomes, but not at the same magnitude as stopping use of all tobacco products (40)(41)(42)(43). Additionally, dual use incorporates a wide range of use behaviors, with varying proportions of use across the two or more tobacco products used by an individual (44). Dual use behavior has often been shown to be a transitional period when switching from combusted cigarettes to ENDS and HTP (25,(45)(46)(47)(48).…”