Factors affecting exposure to nicotine and carbon monoxide in adult cigarette smokers
Highlights
► The factors affecting cigarette smoke exposure were assessed using statistical models. ► Cigarette smoke exposure was estimated using biomarkers of exposure to nicotine and CO. ► CPD was the most important factor determining daily exposure. ► Years smoked and questions related to morning smoking were also significant factors. ► Models explain about 30–40% of variability in exposure to Nicotine and CO.
Introduction
Smoking is a complex, multi-faceted highly variable behavior believed to be motivated or reinforced by psychosocial, sensory and/or pharmacological factors (Russell, 1974, Russell, 1989, Russell et al., 1980). There is currently no generally accepted scientific definition of “smoking behavior”. Smoking behavior has been related to the demographic characteristics unique to the smoker (Moody, 1980) and to factors such as smoking duration (number of years smoked), number of cigarettes smoked per day, choice of brand, cigarette design (Thielen et al., 2008, Schuman, 1977) and smoking topography (e.g. number of puffs per cigarette, duration of puff, time interval between puffs). All these factors contribute to the large variability in the smoke exposure observed in cigarette smokers (Hammond et al., 2005, Lee et al., 2003, Strasser et al., 2004) when measuring levels of various cigarette smoke constituents (e.g. nicotine and its metabolites) in the body. In addition, several questionnaires have been developed and applied to understand the reasons for smoking that could possibly explain part of the variability in exposure among individual smokers. The assessments of these questionnaires have revealed that the behavioral and subjective aspects of smoking can be divided into broad categories that identify unique characteristics (Jarvis et al., 1991, Russell, 1974, West and Russell, 1985). There may be several factors that influence smoking behavior that contribute to the large variability in exposure. However the relationship between objective measures of smoke exposure and smoking behavior has not been systematically investigated.
The purpose of this analysis was to determine whether smoking history, demographic factors, topography variables and questions from the adult smoker survey could explain the variability in exposure to nicotine and carbon monoxide.
Daily urinary excretion of nicotine is considered to be a reasonable surrogate for overall short-term smoke exposure since several of the smoke constituents (tobacco specific as well as non-tobacco specific) appear to exhibit a close relationship with nicotine (Mendes et al., 2009, Roethig et al., 2005, Scherer et al., 2007, Sutton et al., 1982). Carboxyhemoglobin measured as percent of hemoglobin saturation (COHb % sat.) is considered a surrogate for CO exposure.
Section snippets
Study design, subjects and study conduct
The data for this paper was collected as part of the total exposure study (TES) which was a cross-sectional, observational, multi-center, ambulatory study (Mendes et al., 2009, Roethig et al., 2005). Adult males and females, 21 years of age and older, who were in generally good health were enrolled from 31 states (39 investigative sites across the United States) into one of five parallel groups: four tar yield categories (i.e.,T1 ⩽ 2.9 mg tar; T2 = 3.0–6.9 mg tar; T3 = 7.0–12.9 mg tar; and T4 ⩾ 13 mg tar,
Topography – CreSS® micro device
Some measurement errors were observed in the topography parameters derived from the CReSS micro device, e.g. puff volumes of >1000 ml or puff duration of >30 s, which did not appear to be biologically plausible. Therefore, some of the observations were excluded from analysis, based on previous observations with this device on individual smokers and plausibility considerations. This process eventually led to n = 3156 evaluable subjects with complete puffing profile measurements. Cigarettes with puff
Demographics
A total of 4706 subjects were enrolled between August 2002 and October 2003. 4662 subjects were evaluable, 3585 adult smokers and 1077 adult nonsmokers. Of the adult smokers in the TES, 57.4% of them were female. The mean age was 41.7 years and average BMI was 27.8 kg/m2. Seventy-six percent of the smokers were White and 17% were Black. On average, adult smokers had smoked for 22 years. Fewer than 6% of all smokers had smoked for 1–4 years, and 11% had smoked for 40 or more years. Daily cigarette
Discussion
This is the first study in a large representative sample of adult smokers in the US in which the puffing parameters in smokers of more than 300 commercial brands were measured along with responses from an extensive survey and measures of biomarkers of exposure to tobacco smoke constituents. Nicotine equivalents were considered a reasonable surrogate of overall smoke exposure since it accounts for ∼85% of nicotine exposure (Benowitz and Jacob, 1994, Feng et al., 2007) and is specific for tobacco
Conflict of interest
All authors are current or former employees of Philip Morris USA Inc./Altria Client Services Inc.
Funding source
The study was funded by Philip Morris USA Inc.
References (36)
- et al.
Puffing topography as a determinant of smoke exposure
Pharmacol. Biochem. Behav.
(1990) - et al.
Smoking topography and carbon monoxide levels in smokers
Addict. Behav.
(1985) - et al.
Relationships among measures of smoking topography
Addict. Behav.
(1982) - et al.
Respiratory retention of nicotine and urinary excretion of nicotine and its five major metabolites in adult male smokers
Toxicol. Lett.
(2007) - et al.
Smoking topography and nicotine blood levels
Addict. Behav.
(1988) - et al.
The relationship between smoking machine derived tar yields and biomarkers of exposure in adult cigarette smokers in the US
Regul. Toxicol. Pharmacol.
(2009) The relationships of quantified human smoking behavior and demographic variables
Soc. Sci. Med.
(1980)- et al.
Validation of self-reported smoking status by simultaneous measurement of carbon monoxide and salivary thiocyanate
Prev. Med.
(2001) - et al.
The relationship between nicotine dependence scores and biomarkers of exposure in adult cigarette smokers
Regul. Toxicol. Pharmacol.
(2011) Subjective and behavioural effects of nicotine in humans: some sources of individual variation
Prog. Brain Res.
(1989)
Relationship between machine-derived smoke yields and biomarkers in cigarette smokers in Germany
Regul. Toxicol. Pharmacol.
Tobacco smoke: unraveling a controversial subject
Exp. Toxicol. Pathol.
Metabolism of nicotine to cotinine studied by a dual stable isotope method
Clin. Pharmacol. Ther.
The validation of self-reported smoking status by analysing cotinine levels in stimulated and unstimulated saliva, serum and urine
Oral Dis.
Smokers’ sex and the effects of tobacco cigarettes: subject-rated and physiological measures
Nicotine Tob. Res.
Measuring nicotine dependence: a review of the Fagerström Tolerance Questionnaire
J. Behav. Med.
Smoking topography, brand switching, and nicotine delivery: results from an in vivo study
Cancer Epidemiol. Biomarkers Prev.
Cigarette yields and human exposure: a comparison of alternative testing regimens
Cancer Epidemiol. Biomarkers Prev.
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