ArticleNicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco2021
Tobacco-Specific Nitrosamines (NNAL, NNN, NAT, and NAB) Exposures in the US Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014).
Article in Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.
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Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 56 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
- Biomarkers of Nicotine and Tobacco Carcinogen Exposure in Socioeconomically Disadvantaged Black Adults Receiving a Brief Smoking Reduction Intervention.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025Trial
- Impact of four tobacco tax policies on tobacco product purchasing patterns across socioeconomic groups.Tobacco control · 2026Article
- Association between urinary NNAL concentrations and osteoarthritis: Evidence from NHANES 2007-2012.Tobacco induced diseases · 2026Article
- Electronic Nicotine Delivery Systems Use and Nicotine Exposure Among Adults Who Use ENDS Alone or With Cigarettes: The Population Assessment of Tobacco and Health Study 2013-2019.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2025Article
- Nicotine and Toxicant Exposure among Individuals using both Combustible Cigarettes and E-cigarettes Based on Level of Product Use.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2025Article
- Effects of oral nicotine pouches on cigarette smoking behaviour and tobacco harm exposure: a randomised pilot trial in adults.Tobacco control · 2025Article
- Estimating lung cancer risk from e-cigarettes and heated tobacco products: applications of a tool based on biomarkers of exposure and of potential harm.Harm reduction journal · 2025Article
- Nicotine pouches: a narrative review of the existing literature.Frontiers in public health · 2025Review
- Urinary anatalline and nicotelline cut-points to distinguish between exclusive and dual use of tobacco products.Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals · 2024Article
- CYP2A6 Activity and Cigarette Consumption Interact in Smoking-Related Lung Cancer Susceptibility.Cancer research · 2024Article
- Biomarkers of Electronic Nicotine Delivery Systems (ENDS) use.Addiction neuroscience · 2023Article
- Associations between biomarkers of nicotine/tobacco exposure and respiratory symptoms among adults who exclusively smoke cigarettes in the U.S.: Findings from the PATH Study Waves 1-4 (2013-2017).Addictive behaviors reports · 2023Article
- Relationship between urinary tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and lung function: Evidence from NHANES 2007-2012.Tobacco induced diseases · 2023Article
- Hand nicotine as an independent marker of thirdhand smoke pollution in children's environments.The Science of the total environment · 2022Article
- [Influence of smoking on the gastrointestinal tract : Range of findings].Radiologie (Heidelberg, Germany) · 2022Review
- Understanding heterogeneity among individuals who smoke cigarettes and vape: assessment of biomarkers of exposure and potential harm among subpopulations from the PATH Wave 1 Data.Harm reduction journal · 2022Article
- Metabolism and DNA Adduct Formation of Tobacco-SpecificInternational journal of molecular sciences · 2022Review
- Optimal Cutoff Concentration of Urinary Cyanoethyl Mercapturic Acid for Differentiating Cigarette Smokers From Nonsmokers.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2022Article
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Authors and funding
30 authors at 6 institutions in 1 country.
Funding
Abstract
introductionThe tobacco-specific nitrosamines (TSNAs) are an important group of carcinogens found in tobacco and tobacco smoke. To describe and characterize the levels of TSNAs in the Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014), we present four biomarkers of TSNA exposure: N'-nitrosonornicotine, N'-nitrosoanabasine, N'-nitrosoanatabine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) which is the primary urinary metabolite of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone.
methodsWe measured total TSNAs in 11 522 adults who provided urine using automated solid-phase extraction coupled to isotope dilution liquid chromatography-tandem mass spectrometry. After exclusions in this current analysis, we selected 11 004 NNAL results, 10 753 N'-nitrosonornicotine results, 10 919 N'-nitrosoanatabine results, and 10 996 N'-nitrosoanabasine results for data analysis. Geometric means and correlations were calculated using SAS and SUDAAN.
resultsTSNA concentrations were associated with choice of tobacco product and frequency of use. Among established, every day, exclusive tobacco product users, the geometric mean urinary NNAL concentration was highest for smokeless tobacco users (993.3; 95% confidence interval [CI: 839.2, 1147.3] ng/g creatinine), followed by all types of combustible tobacco product users (285.4; 95% CI: [267.9, 303.0] ng/g creatinine), poly tobacco users (278.6; 95% CI: [254.9, 302.2] ng/g creatinine), and e-cigarette product users (6.3; 95% CI: [4.7, 7.9] ng/g creatinine). TSNA concentrations were higher in every day users than in intermittent users for all the tobacco product groups. Among single product users, exposure to TSNAs differed by sex, age, race/ethnicity, and education. Urinary TSNAs and nicotine metabolite biomarkers were also highly correlated.
conclusionsWe have provided PATH Study estimates of TSNA exposure among US adult users of a variety of tobacco products. These data can inform future tobacco product and human exposure evaluations and related regulatory activities.
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