Nicotine metabolism, tobacco consumption, and carcinogen exposure among American Indian smokers, electronic nicotine delivery system users, and dual users

Publication date: Available online 28 October 2018

Source: Addictive Behaviors

Author(s): Dana Mowls Carroll, Theodore L. Wagener, Lancer D. Stephens, Lacy S. Brame, David M. Thompson, Laura A. Beebe

Abstract

Background

We tested the hypothesis that in AI tobacco users from the southern plains region of the US tobacco consumption and carcinogen exposure is related to nicotine metabolism whereby a higher nicotine metabolism is associated with higher nicotine and carcinogen exposure.

Methods

Smokers (n = 27), electronic nicotine delivery system (ENDS) users (n = 21), and dual users (n = 25) of AI descent were recruited from a southern plains state. Urinary biomarkers of nicotine metabolism (nicotine metabolite ratio[NMR]), nicotine dose (total nicotine equivalents[TNE]), and a tobacco-specific lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides[total NNAL] were measured.

Results

Geometric mean of NMR was 4.47 (95% Confidence Interval(CI):3.19, 5.75), 5.91 (CI:3.91, 7.90), and 4.12 (CI:2.87, 5.37) among smokers, ENDS users, and dual users. Each of the three user groups had relatively low levels of TNE, indicative of light tobacco use. Among smokers, there were inverse relationships between NMR and TNE (r = −0.45) and between NMR and NNAL(r = −0.50). Among dual users, NMR and TNE, and NNAL were unassociated. Among ENDS users, NMR and TNE were unassociated.

Conclusions

AI tobacco users with higher rates of nicotine metabolism did not have higher nicotine and carcinogen exposure. This supports prior work among light smokers who do not adjust their tobacco consumption by nicotine metabolism.

Impact

The high smoking prevalence and cancer risks among AI in the southern plains may not be related to nicotine metabolism. Environmental cues may play a more important role in light smokers and this may be particularly true among AI who have strong cultural ties to tobacco.

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