ArticleChemical research in toxicology2018
Presence of the Carcinogen N'-Nitrosonornicotine in Saliva of E-cigarette Users.
Article in Chemical research in toxicology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
38 citing papers in PubMed, 5 syntheses or guidelines pooled it, 69 citations in OpenAlex.
- Inflammatory and Carcinogenic Biomarker Signatures in E-Cigarette Users: A Comprehensive Meta-Analysis of ∼24,000 Adults.International journal of public health · 2025Pooled it
- Exposure to Tobacco-Specific Nitrosamines Among People Who Vape, Smoke, or do Neither: A Systematic Review and Meta-Analysis.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2024Pooled it
- The use of E-cigarettes as a risk factor for oral potentially malignant disorders and oral cancer: a rapid review of clinical evidence.Medicina oral, patologia oral y cirugia bucal · 2024Pooled it
- The impact of electronic and conventional cigarettes on periodontal health-a systematic review and meta-analysis.Clinical oral investigations · 2023Pooled it
- Genotoxic and Carcinogenic Potential of Compounds Associated with Electronic Cigarettes: A Systematic Review.BioMed research international · 2019Pooled it
- Exposure to electronic cigarette aerosols triggers alterations in genomic DNA methylation that impacts cancer pathways in mice.Inhalation toxicology · 2026Article
- Characterization of a thermotolerant strain inhibiting tobacco-specific nitrosamines in cigar fermentation.World journal of microbiology & biotechnology · 2026Article
- E-Cigarette effects on oral health: A molecular perspective.Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association · 2025Review
- Oral health risks in adults who use electronic nicotine delivery systems and oral nicotine pouches: a critical review of the literature and qualitative synthesis of the available evidence.Harm reduction journal · 2024Review
- Effects of E-Cigarette (e-cig) Aerosols on Mutagenesis in Selected Organs in a C57International journal of environmental research and public health · 2024Article
- Oral Health of the Electronic Cigarette Smokers: A Systematic Review.Journal of pharmacy & bioallied sciences · 2024Article
- Consideration of vaping products as an alternative to adult smoking: a narrative review.Substance abuse treatment, prevention, and policy · 2023Review
- Review
- DNA damage in human oral cells induced by use of e-cigarettes.Drug testing and analysis · 2023Review
- Saliva and Exhaled Breath Condensate Correlate With Serum in 4-12-Year-Olds Exposed to Secondhand Electronic Cigarette Vapors: A Pilot Study.Biological research for nursing · 2023Article
- Mass Spectrometric Quantitation ofChemical research in toxicology · 2022Article
- Risk and safety profile of electronic nicotine delivery systems (ENDS): an umbrella review to inform ENDS health communication strategies.Tobacco control · 2022Article
- Metabolism and DNA Adduct Formation of Tobacco-SpecificInternational journal of molecular sciences · 2022Review
- E-Cigarette Aerosol Exposure Favors the Growth and Colonization of Oral Streptococcus mutans Compared to Commensal Streptococci.Microbiology spectrum · 2022Article
- Assessment of the Exposure to NNN in the Plasma of Smokeless Tobacco Users.Chemical research in toxicology · 2022Article
Corrections and comments
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Authors and funding
8 authors at 1 institution in 2 countries.
Funding
Abstract
Many harmful constituents are present in e-cigarettes at much lower levels than in cigarette smoke, and the results of analysis of urinary biomarkers in e-cigarette users are consistent with these findings. However, understanding the health effects of chronic exposures to e-cigarette aerosols may require thinking beyond these comparisons. In this study, we investigated the endogenous formation of the tobacco-specific oral and esophageal carcinogen N'-nitrosonornicotine (NNN) in e-cigarette users. Salivary NNN, nornicotine, and nicotine as well as urinary tobacco biomarkers, including total NNN, were analyzed in 20 e-cigarette users, 20 smokers, and 19 nonsmokers. Nornicotine and NNN levels in e-cigarettes used by the study participants were also analyzed. The mean of NNN in saliva of e-cigarette users was 14.6 (±23.1) pg/mL, ranging from nonquantifiable (below the limit of quantitation, LOQ) to 76.0 pg/mL. In smokers, salivary NNN ranged from below LOQ to 739 pg/mL, with 80% of smokers having salivary NNN in the range of levels found in e-cigarette users. Consistent with a previous report, very low levels of urinary total NNN were present in only 5 out of 20 e-cigarette users (ranging from 0.001 to 0.01 pmol/mL urine). Only trace levels of NNN were found in e-cigarette liquids. Together, our findings demonstrate that NNN is formed endogenously in e-cigarette users. While the overall exposure to NNN in e-cigarette users is dramatically lower than in smokers, the known carcinogenic potency of NNN warrants further investigations into the potential consequences of its endogenous formation. Salivary NNN, rather than urinary total NNN, which accounts for only 1-3% of the NNN dose, should be used to monitor e-cigarette users' exposure to this carcinogen.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.