Alcohol and nicotine consumption trends in three U.S. communities determined by wastewater-based epidemiology

Wastewater-based epidemiology (WBE), an emerging tool for monitoring public health in near real-time, is used extensively in Europe but applications to U.S. populations are still scarce. In this longitudinal study, raw wastewater was collected monthly from three U.S. cities as 24-h weekday composites and analyzed for evidence of alcohol and tobacco consumption. Over the 11-month sampling period, biomarkers of stimulant use were detected in wastewater by isotope dilution liquid chromatography tandem mass spectrometry in units of μg/L (ethyl sulfate, 1.6-25.1; nicotine, 0.6-26.7; cotinine, 0.2-3.8; and 3‑hydroxycotinine, 0.3-3.8). Average consumption rates in the three communities were calculated using detected biomarker levels in conjunction with wastewater flow rates, metabolic excretion factors, and population size data. Computed average per-capita consumption rates estimated for the sub-population aged 15 and above for alcohol (13.4 ± 5.6 L/y/person) and daily consumption of nicotine by smokers (14.2 ± 3.6 cigarettes/d/person) were in good agreement with U.S. survey data (9.0 L/y/person; 14.2 cigarettes/d/smoker). The WBE approach also captured impacts of temporal population influx on substance consumption patterns. This first U.S. WBE study to track recreational use of stimulants longitudinally and concurrently in multiple American cities highlights opportunities for collecting robust public health information from wastewater anonymously, economically and in near real-time.