Urinary Tobacco and Nicotine Exposure Biomarkers as Predictors of Transitions between Cigarette and e-Cigarette Use in the Exhale Longitudinal Cohort Study
Abstract
Introduction: Urinary tobacco and nicotine exposure biomarkers may be predictive of subsequent transitions in product use.
Methods: We used data from an observational study of 371 adults who smoked cigarettes daily, some of whom also used e-cigarettes, and who were followed every 2 months for up to 2 years (Wisconsin, United States, 2015-2019). Using a multistate transition model, we assessed continuous associations between transition propensities and urinary tobacco biomarker concentrations, namely 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) (NNAL) and NE-2 (cotinine + trans-3'-hydroxycotinine), the nicotine metabolite ratio (NMR; trans-3'-hydroxycotinine:cotinine), and NNAL:NE-2, measured every 4 months.
Results: The biomarkers were generally more predictive of transitions from dual use, but not from cigarette-only use, than self-reported product use was. Propensity to stop smoking cigarettes decreased with increasing concentrations of NNAL and NE-2, for both participants who smoked only cigarettes and those who used both cigarettes and e-cigarettes. For example, we estimated that, at 20 pg NNAL per mg creatinine, 30.2% (95% CI = 14.6%, 47.0%) of those who only smoke cigarettes and 26.6% (95% CI = 11.3%, 42.5%) who dual use would transition to non-current cigarette use and e-cigarette use in 1 year, while at the 200 pg/ng, we estimate these probabilities to be 3.2% (95% CI = 1.7%, 5.8%) and 3.9% (95% CI = 1.9%, 8.5%), respectively. The ratio NNAL:NE-2 was predictive of…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 371 participants or records.
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