Changes in Biomarkers of Tobacco Exposure among Cigarette Smokers Transitioning to ENDS Use: The Population Assessment of Tobacco and Health Study, 2013–2015

Gabriella M. Anic, Brian L. Rostron, Hoda T. Hammad, Dana M. van Bemmel, Arseima Y.Del Valle-Pinero, Carol H. Christensen, Gladys Erives, Lisa M. Faulcon, Benjamin C. Blount, Yuesong Wang, Lanqing Wang, Deepak Bhandari, Antonia M. Calafat, Heather L. Kimmel, Colm D. Everard, Wilson M. Compton, Kathryn C. Edwards, Maciej L. Goniewicz, Binnian Wei, Andrew HylandDorothy K. Hatsukami, Stephen S. Hecht, Raymond S. Niaura, Nicolette Borek, Bridget K. Ambrose, Cindy M. Chang

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Limited data are available for how biomarkers of tobacco exposure (BOE) change when cigarette smokers transition to using electronic nicotine delivery systems (ENDS). Using biomarker data from Waves 1 (2013–2014) and 2 (2014–2015) of the PATH Study, we examined how mean BOE concentrations, including metabolites of nicotine, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOCM) and metals, changed when 2475 adult smokers transitioned to using ENDS or quit tobacco products. Exclusive smokers who transitioned to dual use had a significant decrease in NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), but not nicotine metabolites, most PAHs, metals, or VOCMs. Exclusive smokers who became dual users had significant reductions in total nicotine equivalents, NNAL, and 2CyEMA (acrylonitrile metabolite), but only in those who reduced cigarettes per day (CPD) by >=50%. Smokers who transitioned to exclusive ENDS use had significant reductions in most TSNAs, PAHs, and VOCMs; however, nicotine metabolites did not decrease in dual users who became exclusive ENDS users. Smokers who quit tobacco use had significant decreases in nicotine metabolites, all TSNAs, most PAHs, and most VOCMs. Cigarette smokers who became dual users did not experience significant reductions in most BOEs. Reductions were impacted by changes in CPD. However, transitioning from smoking to no tobacco or exclusive ENDS use was associated with reduced exposure to most BOEs measured. Future analyses could incorporate additional waves of PATH data and examine changes in biomarker exposure by ENDS device type and CPD.

Original languageEnglish (US)
Article number1462
JournalInternational journal of environmental research and public health
Issue number3
StatePublished - Feb 1 2022

Bibliographical note

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • Biomarkers
  • Cigarettes
  • E-cigarettes
  • Electronic nicotine delivery systems (ENDS)
  • Tobacco
  • Smokers
  • Tobacco Products
  • Biomarkers/analysis
  • Electronic Nicotine Delivery Systems
  • Humans
  • Tobacco Use
  • Adult

PubMed: MeSH publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Journal Article


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