Factors affecting exposure to nicotine and carbon monoxide in adult cigarette smokers

https://doi.org/10.1016/j.yrtph.2011.07.003Get rights and content

Abstract

Exposure to cigarette smoke among smokers is highly variable. This variability has been attributed to differences in smoking behavior as measured by smoking topography, as well as other behavioral and subjective aspects of smoking. The objective of this study was to determine the factors affecting smoke exposure as estimated by biomarkers of exposure to nicotine and carbon monoxide (CO). In a multi-center cross-sectional study of 3585 adult smokers and 1077 adult nonsmokers, exposure to nicotine and CO was estimated by 24 h urinary excretion of nicotine and five of its metabolites and by blood carboxyhemoglobin, respectively. Number of cigarettes smoked per day (CPD) was determined from cigarette butts returned. Puffing parameters were determined through a CreSS® micro device and a 182-item adult smoker questionnaire (ASQ) was administered. The relationship between exposure and demographic factors, smoking machine measured tar yield and CPD was examined in a statistical model (Model A). Topography parameters were added to this model (Model B) which was further expanded (Model C) by adding selected questions from the ASQ identified by a data reduction process. In all the models, CPD was the most important and highest ranking factor determining daily exposure. Other statistically significant factors were number of years smoked, questions related to morning smoking, topography and tar yield categories. In conclusion, the models investigated in this analysis, explain about 30–40% of variability in exposure to nicotine and CO.

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.

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