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. 2012 Jun;21(6):934-42.
doi: 10.1158/1055-9965.EPI-11-1178. Epub 2012 Apr 6.

Exposure to nicotine and carcinogens among Southwestern Alaskan Native cigarette smokers and smokeless tobacco users

Neal L Benowitz  1 , Caroline C Renner, Anne P Lanier, Rachel F Tyndale, Dorothy K Hatsukami, Bruce Lindgren, Irina Stepanov, Clifford H Watson, Connie S Sosnoff, Peyton Jacob 3rd
Affiliations

Exposure to nicotine and carcinogens among Southwestern Alaskan Native cigarette smokers and smokeless tobacco users

Neal L Benowitz et al. Cancer Epidemiol Biomarkers Prev. 2012 Jun.

Abstract

Background: The prevalence of tobacco use, both cigarette smoking and smokeless, including iqmik (homemade smokeless tobacco prepared with dried tobacco leaves mixed with alkaline ash), and of tobacco-related cancer is high in Alaskan Native people (AN). To investigate possible mechanisms of increased cancer risk we studied levels of nicotine and tobacco-specific nitrosamines (TSNA) in tobacco products and biomarkers of tobacco toxicant exposure in Southwestern AN people.

Methods: Participants included 163 cigarette smokers, 76 commercial smokeless tobacco, 20 iqmik, 31 dual cigarette smokers and smokeless tobacco, and 110 nontobacco users. Tobacco use history, samples of tobacco products used, and blood and urine samples were collected.

Results: Nicotine concentrations were highest in cigarette tobacco and TSNAs highest in commercial smokeless tobacco products. The AN participants smoked on average 7.8 cigarettes per day. Nicotine exposure, assessed by several biomarker measures, was highest in iqmik users, and similar in smokeless tobacco and cigarette smokers. TSNA exposure was highest in smokeless tobacco users, and polycyclic aromatic hydrocarbon exposure was highest in cigarette smokers.

Conclusions: Despite smoking fewer cigarettes per day, AN cigarette smokers had similar daily intake of nicotine compared to the general U.S. population. Nicotine exposure was greatest from iqmik, likely related to its high pH due to preparation with ash, suggesting high addiction potential compared to other smokeless tobacco products. TSNA exposure was much higher with smokeless tobacco than other product use, possibly contributing to the high rates of oral cancer.

Impact: Our data contribute to an understanding of the high addiction risk of iqmik use and of the cancer-causing potential of various forms of tobacco use among AN people.

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Conflict of interest statement

Disclosure of Potential Conflicts of Interest

R.F. Tyndale has honoraria from speakers’ bureau for CPT associate editor, has ownership interest (including patents) for Nicogen research, and is the consultant/advisory board member for Novartis and McNeil. The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. No potential conflicts of interest were disclosed by other authors.

Figures

Figure 1
Figure 1
Box and whisker plots of biomarkers of nicotine exposure in different tobacco use groups. A, plasma cotinine. B, urine nicotine equivalents. The solid line inside the box is the median, the diamond is the mean, the top and bottom of the box represent the 25% to 75% interquartile range, and the vertical line indicates minimum and maximum values.
Figure 2
Figure 2
Box and whisker plot of urine total NNAL in different tobacco use groups.
Figure 3
Figure 3
Box and whisker plots of urine PAH metabolites in different tobacco use groups. 2-Naphthol (A) and 1-hydroxypyrene (B).
See this image and copyright information in PMC

References

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