Biomarkers of Exposure in ENDS Users, Smokers, and Dual Users of American Indian Descent
Dana Mowls Carroll1, Theodore L Wagener1, Jennifer D Peck1
1Dana Mowls Carroll, Postdoctoral Fellow, Tobacco Research Programs, University of Minnesota, Minneapolis, MN. Theodore L. Wagener, Associate Director for Training, Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Jennifer D. Peck, Associate Professor, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Lacy S. Brame, Medical Student, College of Osteopathic Medicine, Oklahoma State University Center for Health Sciences, Oklahoma City, OK. David M. Thompson, Professor Emeritus, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Lancer D. Stephens, Assistant Professor of Research, Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma Shared Clinical and Translational Resources, Oklahoma City, OK. Janis E. Campbell, Associate Professor of Research, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Laura A. Beebe, Professor of Epidemiology, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Objectives:
We measured biomarkers of exposure among American Indian (AI) ENDS users, smokers, and dual users.
Methods:
Urine was analyzed for total nicotine equivalents (TNE) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol(NNAL). Expired-air carbon monoxide (CO) was collected. Two analyses were performed. "CO analysis" included smokers and dual users whose CO was ≥ 6 ppm and ENDS users whose CO was < 6 ppm. "NNAL analysis" included smokers and dual users whose NNAL was ≥ 47.3 pg/mg, and ENDS users whose NNAL was < 47.3 pg/mg. Biomarkers were summarized by geometric means (GM) and compared with nonparametric tests.
Results:
In both analyses, TNE was no different across the groups, and NNAL and CO were lower in ENDS users. In the NNAL analysis the GM of NNAL was 261.4, 6.1, and 228.0 pg/mg among smokers, ENDS users, and dual users (p < .001). Also in the NNAL analysis, the GM of CO was 14.7, 2.4, and 16.8 ppm among smokers, ENDS users, and dual users (p < .001).
Conclusions:
ENDS users did not differ in nicotine and had lower exposure to a lung carcinogen and a cardiovascular toxicant than smokers or dual users. Dual users and smokers did not differ in biomarker levels. Results should be used to inform tribal regulations and to educate the AI community on ENDS.
