TY - JOUR
T1 - Exposure to Tobacco-Specific Nitrosamines Among People Who Vape, Smoke, or do Neither
T2 - A Systematic Review and Meta-Analysis
AU - Taylor, Eve
AU - Simonavičius, Erikas
AU - McNeill, Ann
AU - Brose, Leonie S.
AU - East, Katherine
AU - Marczylo, Tim
AU - Robson, Debbie
N1 - Funding Information:
ET is funded by the National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures and Health, a partnership between the UK Health Security Agency and Imperial College London. AM and DR are supported by the NIHR HPRU and the Applied Research Collaboration South London at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR, UK Health Security Agency or the Department of Health and Social Care. KE is the recipient of Fellowship funding from the UK Society for the Study of Addiction. This research updates and enhances research commissioned by the Office for Health Improvement and Disparities. AM, DR, and LB are members of SPECTRUM which is supported by the UK Prevention Research Partnership (MR/S037519/1), which is funded by the British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division (Welsh Government), Medical Research Council, National Institute for Health Research, Natural Environment Research Council, Public Health Agency (Northern Ireland), The Health Foundation and Welcome.
Funding Information:
ET is funded by the National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures and Health, a partnership between the UK Health Security Agency and Imperial College London. AM and DR are supported by the NIHR HPRU and the Applied Research Collaboration South London at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR, UK Health Security Agency or the Department of Health and Social Care. KE is the recipient of Fellowship funding from the UK Society for the Study of Addiction. This research updates and enhances research commissioned by the Office for Health Improvement and Disparities. AM, DR, and LB are members of SPECTRUM which is supported by the UK Prevention Research Partnership (MR/S037519/1), which is funded by the British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division (Welsh Government), Medical Research Council, National Institute for Health Research, Natural Environment Research Council, Public Health Agency (Northern Ireland), The Health Foundation and Welcome.
Publisher Copyright:
© The Author(s) 2023.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - Introduction: Smoking exposes people to high levels of Tobacco-Specific Nitrosamines (TSNAs), which include potent carcinogens. We systematically reviewed TSNA exposure between people smoking, vaping, and doing neither. Aims and Methods: Databases were searched between August 2017–March 2022, using vaping-related terms. Peer-reviewed articles reporting TSNA metabolites (NNAL, NNN, NAB, and NAT) levels in bio-samples among adults exclusively vaping, exclusively smoking, or doing neither were included. Where possible, meta-analyses were conducted. Results: Of 12 781 identified studies, 22 were included. TSNA levels fell substantially when people who smoke switched to vaping in longitudinal studies and were lower among people who vaped compared to smoked in cross-sectional studies. Levels of TSNAs were similar when comparing people who switched from smoking to vaping, to those who switched to no use of nicotine products, in longitudinal studies. Levels were higher among people who vaped compared to people who neither vaped nor smoked in cross-sectional studies. When comparing people who vaped to smoked: pooled urinary NNAL was 79% lower across three randomized controlled trials and 96% lower across three cross-sectional studies; pooled NAB was 87% lower and NAT 94% lower in two cross-sectional studies. When comparing people who neither vaped nor smoked to people who vaped, pooled urinary NNAL was 80%, NAB 26%, and NAT 27% lower in two cross-sectional studies. Other longitudinal data, and NNN levels could not be pooled. Conclusions: Exposure to all TSNAs was lower among people who vaped compared to people who smoked. Levels were higher among people who vaped compared to people who neither vaped nor smoked. Implications: As well as TSNAs, there are many other toxicant exposures from smoking and vaping that can increase the risk of disease. However, it is likely that the reduced exposure to TSNAs from vaping relative to smoking reduces the risk to health of those who use vaping products to quit smoking. Future high-quality research, with robust definitions of exclusive vaping and smoking, and accounting for TSNAs half-lives, is needed to fully assess exposure to TSNAs among people who vape.
AB - Introduction: Smoking exposes people to high levels of Tobacco-Specific Nitrosamines (TSNAs), which include potent carcinogens. We systematically reviewed TSNA exposure between people smoking, vaping, and doing neither. Aims and Methods: Databases were searched between August 2017–March 2022, using vaping-related terms. Peer-reviewed articles reporting TSNA metabolites (NNAL, NNN, NAB, and NAT) levels in bio-samples among adults exclusively vaping, exclusively smoking, or doing neither were included. Where possible, meta-analyses were conducted. Results: Of 12 781 identified studies, 22 were included. TSNA levels fell substantially when people who smoke switched to vaping in longitudinal studies and were lower among people who vaped compared to smoked in cross-sectional studies. Levels of TSNAs were similar when comparing people who switched from smoking to vaping, to those who switched to no use of nicotine products, in longitudinal studies. Levels were higher among people who vaped compared to people who neither vaped nor smoked in cross-sectional studies. When comparing people who vaped to smoked: pooled urinary NNAL was 79% lower across three randomized controlled trials and 96% lower across three cross-sectional studies; pooled NAB was 87% lower and NAT 94% lower in two cross-sectional studies. When comparing people who neither vaped nor smoked to people who vaped, pooled urinary NNAL was 80%, NAB 26%, and NAT 27% lower in two cross-sectional studies. Other longitudinal data, and NNN levels could not be pooled. Conclusions: Exposure to all TSNAs was lower among people who vaped compared to people who smoked. Levels were higher among people who vaped compared to people who neither vaped nor smoked. Implications: As well as TSNAs, there are many other toxicant exposures from smoking and vaping that can increase the risk of disease. However, it is likely that the reduced exposure to TSNAs from vaping relative to smoking reduces the risk to health of those who use vaping products to quit smoking. Future high-quality research, with robust definitions of exclusive vaping and smoking, and accounting for TSNAs half-lives, is needed to fully assess exposure to TSNAs among people who vape.
UR - http://www.scopus.com/inward/record.url?scp=85182365252&partnerID=8YFLogxK
U2 - 10.1093/ntr/ntad156
DO - 10.1093/ntr/ntad156
M3 - Review article
C2 - 37619211
AN - SCOPUS:85182365252
SN - 1462-2203
VL - 26
SP - 257
EP - 269
JO - Nicotine and Tobacco Research
JF - Nicotine and Tobacco Research
IS - 3
ER -