Tobacco product use patterns, and nicotine and tobacco-specific nitrosamine exposure: NHANES 1999–2012

Kelvin Choi, Melanie Sabado, Sherine El-Toukhy, Emily Vogtmann, Neal D. Freedman, Dorothy Hatsukami

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: Few studies have examined differences in product consumption patterns and nicotine and tobacco-specific nitrosamines (TSNA) exposure between single versus dual- and poly-tobacco users. We applied the Tobacco Product Use Patterns (T-PUPs) model to fill this gap in the literature. Methods: Data from adults (age ≥18 years) who used any tobacco products during the 5 days prior to participating in the 1999–2012 National Health and Nutrition Examination Survey (NHANES) were analyzed. Participants were classified into seven T-PUPs: (1) cigarettes only, (2) noncigarette combustibles only, (3) noncombustibles only, (4) dual noncigarette combustibles and noncombustibles, (5) dual cigarettes and noncombustibles, (6) dual cigarettes and noncigarette combustibles, and (7) poly-tobacco use. Weighted regression models were used to compare product consumption, serum cotinine, and urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (i.e., NNAL) levels between single-, dual-, and poly-tobacco T-PUPs. Results: Dual- and poly-tobacco T-PUPs were associated with lower product consumption compared with single-product T-PUPs only in some cases (e.g., dual cigarette and noncombustible users smoked cigarettes on 0.6 fewer days in the past 5 days compared with cigarette-only users; P < 0.05). Dual- and poly-tobacco T-PUPs had either nondistinguishable or higher levels of serum cotinine and urinary total NNAL than corresponding single-product T-PUPs. Conclusions: Product consumption, and nicotine and TSNAs exposure of dual- and poly-tobacco product category users somewhat differ from those of single-product category users as defined by the T-TUPs model. Impact: Higher levels of cotinine and NNAL among dual- and poly-tobacco T-TUPs users compared with the single-product T-TUPs users may indicate health concerns.

Original languageEnglish (US)
Pages (from-to)1525-1530
Number of pages6
JournalCancer Epidemiology Biomarkers and Prevention
Issue number10
StatePublished - Oct 1 2017

Bibliographical note

Funding Information:
K. Choi, M. Sabado, and S. El-Toukhy's efforts were supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities. E. Vogtmann's and N.D. Freedman's efforts were supported by the Intramural Research Program of the National Cancer Institute. D. Hatsukami's effort was supported by a research grant funded by the National Cancer Institute (U19CA157345; PI: D. Hatsukami).

Publisher Copyright:
©2017 AACR.


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