Search

The rate of nicotine absorption from tobacco products is a determinant of addiction potential and other detrimental health effects. Oral nicotine bioavailability from moist snuff smokeless tobacco (ST) is influenced by nicotine content, pH, flavors, and tobacco cut. For use in a clinical study testing the effect of pH on nicotine pharmacokinetics, four investigational ST products that differed only in pH were produced. A commercial ST product (Copenhagen Long Cut Original, pH 7.7) was modified with citric acid monohydrate (23 mg/g tobacco) or sodium carbonate (4.6 and 11 mg/g) to create products with pH 5.0, 8.2, and 8.6, respectively. All products - including the original product with pH 7.7 - were individually packaged (approximately 2 g) in aluminum foil pouches and stored frozen (-20 °C); pH, nicotine, tobacco-specific nitrosamines, moisture content, and mold and yeast counts were tested for up to 19 months to verify stability. Remarkable stability was demonstrated in this packaging/storage combination. For example, pH from all products were within 0.1 pH units and never exceeded 0.2 units. Nicotine concentration averaged 9.07 mg/g at baseline, maximal deviations from baseline in the four products averaged 0.30 mg/g. Similarly, TSNA, moisture content, yeast, and mold did not materially change. This study illustrates a method of investigational tobacco products formulation by manipulating a single design feature (or component) with the purpose of independently and systematically assessing its influence on nicotine bioavailability in a clinical study.

Introduction Studies have evaluated the role of menthol cigarettes on various addiction-related outcomes; however, the effect of varying menthol content on these outcomes has not been evaluated. We developed a method to amend non-menthol SPECTRUM Research Cigarettes to contain menthol at four different levels. Aims and Methods SPECTRUM Research Cigarettes, NRC 600 (0.8 mg nicotine; 10 mg tar), were modified to contain target menthol amounts at 3, 6, and 12 mg/cigarette by injecting 25 µL ethanol/triacetin/menthol solutions of varying concentrations (120 mg menthol/mL, 240 mg/mL, and 480 mg/mL) into four distinct locations in the filter and tobacco rod. Menthol content was tested in triplicate in the whole cigarette and in the tobacco rod and filter at 1, 24, 48, and 72 hours for each target menthol level using an extraction solution of quinoline in methyl-tert-butyl ether and measured using gas chromatography with flame ionization detection. Results Injections into the filter and tobacco rod (12.5 µL each) yielded equal menthol distribution up to 72 hours. However, total menthol content decreased from an average of 90.3% of the target menthol concentration at 1 hour to 80.7% at 72 hours in cigarettes stored individually in glass tubes at room temperature. Analysis of urinary menthol glucuronide confirmed that amended cigarettes used within 24 hours of injection delivered dose-related menthol levels to participants in a clinical laboratory setting. Conclusion This method can be used to modify cigarettes with a range of reliable menthol levels in both filter and tobacco rod for use in laboratory and clinical research. Implications This study presents a technique for modifying cigarettes with different levels of menthol that can reliably deliver dose-related menthol levels to participants when smoked in a clinical study. The technique can be used to quickly amend cigarettes to examine the independent effects of varying flavor and additive levels on smoking behavior, nicotine pharmacokinetics, mainstream smoke emissions, and other laboratory or clinical research outcomes.

Co-users of cannabis and tobacco frequently use cannabis, then tobacco cigarettes, in a sequential pattern within an occasion, that is, they "chase" smoked cannabis with a tobacco cigarette. The objective of this placebo-controlled, double-blind, within-subjects human laboratory study was to gather preliminary data on how smoking active versus placebo cannabis impacts tobacco cigarette smoking behavior, craving, and subjective effects. Adult daily cannabis and tobacco co-users (N = 9) were randomly assigned to two experimental visit orders (i.e., active cannabis (5.2% THC) first visit and placebo cannabis second visit, or vice versa). Participants smoked one cannabis cigarette, and approximately 30 min later were given a 5-min ad libitum period to smoke one of their own brand of tobacco cigarette. As expected, boost in plasma THC levels and cannabis-related subjective effects differed between active and placebo cannabis conditions. Tobacco cigarette puff topography measures and tobacco craving did not differ between cannabis conditions, but there appeared to be between-participants heterogeneity in cumulative total puff volume. After smoking active versus placebo cannabis, the changes in subjective effects of tobacco smoking after adjusting for pretobacco smoking levels were not significant. Results do not support the notion that immediate effects of smoked cannabis change the behavior of tobacco smoking. The strong overlap between cannabis and tobacco smoking may not be explained by primarily pharmacological factors, but may be driven by more nuanced and complex mechanisms involving pharmacological processes as well as learning factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Understanding the potential inhalation toxicity of poorly characterized aerosols is challenging both because aerosols may contain numerous chemicals and because it is difficult to predict which chemicals may present significant inhalation toxicity concerns at the observed levels. We have developed a novel systematic procedure to address these challenges through non-targeted chemical analysis by two-dimensional gas chromatography–time-of-flight mass spectrometry (GC × GC-TOFMS) and assessment of the results using publicly available toxicity data to prioritize the tentatively identified detected chemicals according to potential inhalation toxicity. The procedure involves non-targeted chemical analysis of aerosol samples utilizing GC × GC-TOFMS, which is selected because it is an effective technique for detecting chemicals in complex samples and assigning tentative identities according to the mass spectra. For data evaluation, existing toxicity data (e.g. from the U.S. Environmental Protection Agency CompTox Chemicals Dashboard) are used to calculate multiple toxicity metrics that can be compared among the tentatively identified chemicals. These metrics include hazard quotient, incremental lifetime cancer risk, and metrics analogous to hazard quotient that we designated as exposure–(toxicology endpoint) ratios. We demonstrated the utility of our procedure by detecting, identifying, and prioritizing specific chemicals of potential inhalation toxicity concern in the mainstream smoke generated from the machine-smoking of marijuana blunts. By designing a systematic approach for detecting and identifying numerous chemicals in complex aerosol samples and prioritizing the chemicals in relation to different inhalation toxicology endpoints, we have developed an effective approach to elucidate the potential inhalation toxicity of aerosols.

Introduction Moist snuff smokeless tobacco (ST) products are available in the United States in both “loose” and “portioned” (ie, pouched) formats, but no published study to date has clinically evaluated the associations between ST format, use behavior, and nicotine exposure. Aims and Methods Participants used their usual brand of ST (loose ST [n = 30] or portioned ST [n = 20]) during an experimental visit wherein use behavior and plasma nicotine pharmacokinetic parameters were measured following single use (first hour of the session) and ad libitum use (remaining 7 h of the session). Participants’ ST products were chemically characterized prior to use for pH and nicotine content. Results The average amount per use (2.99 vs. 1.52 g; p = .005) and total amount used (11.45 vs. 5.4 g; p = .002) were significantly higher among the loose ST group. Maximum plasma nicotine concentration (Cmax; 33.4 vs. 19.1 ng/ml) and area under the nicotine concentration versus time curve (AUC) were significantly higher for the loose ST group for the first hour (1474.8 vs. 807.2 min* ng/ml; p = .003) and throughout the 8-hour session (15827.9 vs. 8155.3 min* ng/ml; p < .001). Significant associations were observed between free nicotine content and first use Cmax (rs = .488, loose ST group) and AUC0–1 h (rs = 0.448, loose ST group; rs = .441, portioned ST group). Conclusions The loose ST group used more product and had a greater average deposition time per use than the portioned ST group. Nicotine exposure was more strongly associated with free nicotine content than total nicotine content. Implications To our knowledge, the current investigation was the first study to date to clinically evaluate the associations between usual-brand smokeless format, use behavior, and nicotine exposure. We observed meaningful differences in use behavior and subsequent nicotine exposure between loose and portioned ST users. Further, we observed that nicotine exposure was more strongly associated with free nicotine content than total nicotine content.

Objectives: Due to rapidly emerging electronic nicotine delivery system (ENDS) technologies, increasing use in the US, and the unclear impact on users' health, investigating behavior associated with ad libitum ENDS use is an important research topic. ENDS use behavior is typically assessed either by direct observation or through smoking topography recording units; however, systematic comparisons between these methods are lacking. Therefore, we sought to compare 2 common methods to quantify ENDS topography. Methods: Current ENDS users (N = 18) used their own brand ENDS ad libitum in a clinical laboratory. We compared smoking topographybased recording units (desktop Clinical Research Support System; CReSS) and observational video-recordings with frame-by-frame (FxF) analysis methods to quantify ENDS topography. Results: Although CReSS analyses tended to estimate higher puff count and shorter average puff duration than FxF analyses, estimates of total puff duration were not different. Furthermore, both topography analysis methods showed significant associations with estimated nicotine intake. Conclusions: Neither the CReSS nor the FxF method is suited perfectly for analyzing ENDS topography. However, because FxF analysis is time-consuming and cumbersome, smoking topography-based recording unit methods may offer a more practical approach to measure ENDS topography; however, researchers must consider its limitations.

After comparing results of three prenatal substance use screening tools with biochemical verification, two were found to have satisfactorily high sensitivity and the third had greater specificity., OBJECTIVE: To compare and evaluate the accuracy of three screening tools in identifying illicit drug use and prescription drug misuse among a diverse sample of pregnant women. METHODS: This prospective cross-sectional study enrolled a consecutive sample of 500 pregnant women, stratified by trimester, receiving care in two prenatal clinical settings in Baltimore, Maryland, from January 2017 to January 2018. All participants were administered three index tests: 4P's Plus, NIDA Quick Screen-ASSIST (Modified Alcohol, Smoking and Substance Involvement Screening Test), and the SURP-P (Substance Use Risk Profile-Pregnancy) scale, and administered reference tests (urine and hair drug testing) at the in-person baseline visit. To assess test–retest reliability of the index tests, screening tool administrations were repeated 1 week later by telephone. For each screening tool, sensitivity, specificity, positive predictive value, negative predictive value and test–retest reliability were computed. Results were stratified by age, race, and trimester of pregnancy. RESULTS: Of the 500 enrolled pregnant women, 494 completed the index screening tools, 497 completed reference testing, and 453 underwent test–retest analysis. For the 4P's Plus, sensitivity=90.2% (84.5, 93.8), and specificity=29.6% (24.4, 35.2). For the NIDA Quick Screen-ASSIST, sensitivity=79.7% (71.2, 84.2), and specificity=82.8% (78.1, 87.1). For the SURP-P, sensitivity=92.4% (87.6, 95.8) and specificity=21.8% (17.4, 27.2). Test–retest reliability (phi correlation coefficients) was 0.84, 0.77, and 0.79 for the 4P's Plus, NIDA Quick Screen-ASSIST and the SURP-P, respectively. For all screening tools, there were differences in validity indices by age and race, but no differences by trimester. CONCLUSION: The SURP-P and 4P's Plus had high sensitivity and negative predictive values, making them more ideal screening tests than the NIDA Quick Screen-ASSIST. A clear recommendation for a clinically useful screening tool for prenatal substance use is crucial to allow for prompt and appropriate follow-up and intervention.

Worldwide, cigarette smoking is the major cause of premature mortality and diseases that can be prevented. Given that people continue smoking despite associated health risks, delivering nicotine without combustion should be considered a valuable and much less harmful way to reduce the public health burden caused by smoking. E‑cigarettes could play such a role if they were proven to be less harmful than combustible cigarettes. Although the number of clinical trials and human studies assessing the safety of e‑cigarettes is limited, numerous in vitro and in vivo studies reported on the potential harmful effects of the aerosol generated from e‑cigarettes. This article reviews the results of major clinical trials and laboratory studies with regard to cancer as well as cardiovascular and respiratory risk associated with the use of e‑cigarettes. Additionally, it also discusses the potential application of e‑cigarettes as smoking cessation tools. Most studies have indicated so far that e‑cigarettes are less harmful, but this applies only to smokers who completely switched to e‑cigarettes. In the opinion of the authors, good-quality research is crucial to establish the tolerance, safety, efficacy, and harm reduction potential of new technologies. Considering a significant role that physicians and other health providers play in helping smokers, there is an urgent need for evidence‑based guidelines and recommendations for clinical practitioners on potential benefits and risks of e‑cigarette use.

Background A non-invasive phenotypic indicator of the rate of nicotine metabolism is nicotine metabolite ratio (NMR) defined as a ratio of two major metabolites of nicotine – trans-3′-hydroxycotinine/cotinine. The rate of nicotine metabolism has important clinical implications for the likelihood of successful quitting with nicotine replacement therapy (NRT). We conducted a study to measure NMR among Polish smokers. Methods In a cross-sectional study of 180 daily cigarette smokers (42% men; average age 34.6 ± 13.0), we collected spot urine samples and measured trans-3′-hydroxycotinine (3-HC) and cotinine levels with LC–MS/MS method. We calculated NMR (molar ratio) and analyzed variations in NMR among groups of smokers. Results In the whole study group, an average NMR was 4.8 (IQR 3.4–7.3). The group of women below 51 years had significantly greater NMR compared to the rest of the population (6.4; IQR 4.1–8.8 vs. 4.3; IQR 2.8–6.4). No differences were found among group ages of male smokers. Conclusions This is a first study to describe variations in nicotine metabolism among Polish smokers. Our findings indicate that young women metabolize nicotine faster than the rest of population. This finding is consistent with the known effects of estrogen to induce CYP2A6 activity. Young women may require higher doses of NRT or non-nicotine medications for most effective smoking cessation treatment.

Evidence suggests exposure of nicotine-containing e-cigarette aerosol to nonusers leads to systemic absorption of nicotine. However, no studies have examined acute secondhand exposures that occur in public settings. Here, we measured the serum, saliva and urine of nonusers pre- and post-exposure to nicotine via e-cigarette aerosol. Secondarily, we recorded factors affecting the exposure. Six nonusers of nicotine-containing products were exposed to secondhand aerosol from ad libitum e-cigarette use by three e-cigarette users for 2 h during two separate sessions (disposables, tank-style). Pre-exposure (baseline) and post-exposure peak levels (Cmax) of cotinine were measured in nonusers’ serum, saliva, and urine over a 6-hour follow-up, plus a saliva sample the following morning. We also measured solution consumption, nicotine concentration, and pH, along with use behavior. Baseline cotinine levels were higher than typical for the US population (median serum session one = 0.089 ng/ml; session two = 0.052 ng/ml). Systemic absorption of nicotine occurred in nonusers with baselines indicative of no/low tobacco exposure, but not in nonusers with elevated baselines. Median changes in cotinine for disposable exposure were 0.007 ng/ml serum, 0.033 ng/ml saliva, and 0.316 ng/mg creatinine in urine. For tank-style exposure they were 0.041 ng/ml serum, 0.060 ng/ml saliva, and 0.948 ng/mg creatinine in urine. Finally, we measured substantial differences in solution nicotine concentrations, pH, use behavior and consumption. Our data show that although exposures may vary considerably, nonusers can systemically absorb nicotine following acute exposure to secondhand e-cigarette aerosol. This can particularly affect sensitive subpopulations, such as children and women of reproductive age.

OBJECTIVES: To pilot-test a Phone-based Postpartum Continuing Care (PPCC) protocol developed from existing evidence-based approaches to address both postpartum smoking relapse among low-income women who quit smoking during pregnancy and postpartum smoking increase among those who had cut down. METHODS: One hundred thirty low-income pregnant women who were current or recently quit tobacco smokers were recruited at their first prenatal appointment and randomized to either a Control (standard care) or Experimental (standard care + PPCC) group. An intent-to-treat analysis was conducted on biochemically-verified data from 6 in-person interviews during pregnancy and postpartum. Feasibility with regard to recruitment, randomization, assessment, and implementation of PPCC were assessed, along with acceptability among the target population. RESULTS: PPCC was found to be feasible and acceptable to some participants but not all. There were no significant differences in tobacco products per day at 6 months postpartum between groups; however, effect sizes differed at 6 weeks compared with 6 months postpartum. Similarly, there were no significant differences between groups in cessation rate (24% in each group) and past 90-day tobacco use (59 days vs 55 days, for Control and Experimental groups respectively). CONCLUSIONS: The PPCC intervention did not differentially reduce tobacco use postpartum compared with a controlled comparison group, though it was found to be acceptable among a subpopulation of low-income pregnant women and feasible with regard to recruitment, randomization, assessment procedures, and implementation. Further research is needed to identify an intervention that significantly improves smoking relapse rates postpartum.

OBJECTIVE Although most cigarillos and little cigars smokers also smoke cigarettes (dual use), there are few studies comparing toxicant exposure and smoking behavior in cigars and cigarettes. METHODS Two groups of dual users smoked their usual brand of cigarette and either a Winchester unflavored little cigar (N = 21) or a Black & Mild cigarillo (N = 23). Acute exposure of nicotine and exhaled carbon monoxide (CO) and puffing topography parameters were collected. Individual cigar puffing data were used to machine-replicate smoking for analysis of volatile organic compounds (VOC) and semi-volatile organic compounds (SVOC) in mainstream smoke. RESULTS There were significant differences in puff topography, plasma nicotine and exhaled CO after cigarettes, little cigars, and cigarillos. Puff topography differences between cigarillos and cigarettes were due to the difference in the size of the article. Mainstream cigar and cigarette smoke was qualitatively similar; the yield was dependent on the smoking behavior. When smoke yield was adjusted for weight of tobacco burned or puff volume, exposure differences decreased. CONCLUSIONS There is a wide range of delivery of both SVOC and VOC components of cigar and cigarillo smoke. The difference in exposure is largely dependent on the article size and the amount consumed.

Background Few studies have examined the extent of inhalation or dermal contact among bystanders following short-term, secondhand e-cigarette exposure. Objective Measure PM2.5 (particles < 2.5 microns), UF (ultrafine particles < 100 nm), and nicotine in air and deposited on surfaces and clothing pre-/during/post- a short-term (2-hour) e-cigarette exposure. Methods E-cigarettes were used ad libitum by three experienced users for 2 hours during two separate sessions (disposable e-cigarettes, then tank-style e-cigarettes, or "tanks") in a 1858 ft3 room. We recorded: uncorrected PM2.5 (using SidePak); UF (using P-Trak); air nicotine concentrations (using air samplers; SKC XAD-4 canisters); ambient air exchange rate (using an air capture hood). Wipe samples were taken by wiping 100 cm2 room surfaces pre- and post- both sessions, and clean cloth wipes were worn during the exposure and collected at the end. Results Uncorrected PM2.5 and UF were higher (p < .0001) during sessions than before or after. Median PM2.5 during exposure was higher using tanks (0.515 mg/m3) than disposables (0.035 mg/m3) (p < .0001). Median UF during exposure was higher using disposables (31 200 particles/cm3) than tanks (25 200 particles/cm3)(p < .0001). Median air nicotine levels were higher (p < .05) during both sessions (disposables = 0.697 ng/L, tanks = 1.833 ng/L) than before (disposables = 0.004 ng/L, tanks = 0.010 ng/L) or after (disposables = 0.115 ng/L, tanks = 0.147 ng/L). Median accumulation rates of nicotine on surface samples were 2.1 ng/100 cm2/h using disposables and 4.0 ng/100 cm2/h using tanks; for cloth samples, it was 44.4 ng/100 cm2/h using disposables and 69.6 ng/100 cm2/h using tanks (p < .01). Mean room ventilation rate was ~5 air changes per hour during both sessions. Conclusions Short-term e-cigarette use can produce: elevated PM2.5; elevated UF; nicotine in the air; and accumulation of nicotine on surfaces and clothing. Implications Short-term indoor e-cigarette use produced accumulation of nicotine on surfaces and clothing, which could lead to dermal exposure to nicotine. Short-term e-cigarette use produced elevated PM2.5 and ultrafine particles, which could lead to secondhand inhalation of these particles and any chemicals associated with them by bystanders. We measured significant differences in PM2.5 and ultrafine particles between disposable e-cigarettes and tank-style e-cigarettes, suggesting a difference in the exposure profiles of e-cigarette products.

Nicotine is the primary addictive constituent of tobacco products. The purpose of the chapter is to review the findings of clinical smokeless tobacco (ST) laboratory studies of use characteristics, user preferences, and additive content. Assessment tools such as the Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST), the Hooked on Nicotine Checklist (HONC), and the Product Evaluation Scale (PES) are discussed and their strengths and limitations noted. The absorption of nicotine from ST products is contingent upon both user behaviors and product characteristics. Particular emphasis is placed on characteristics that affect nicotine bioavailability and thus addiction liability. Some other factors that affect use, such as format, are mentioned. Projections and suggestions are offered for the future of clinical laboratory studies.

Background Although numerous studies have documented the prevalence and increasing use of little cigars and other cigar products, the present study is the first direct, head-to-head laboratory comparison of little cigar and cigarette smoking. The study addressed a fundamental objective to compare exposure and use characteristics of little cigar and cigarette smoking. Methods Smoking patterns, toxicant exposure and subjective measures were collected and analysed in 21 adults after smoking a little cigar (Winchester) and a cigarette (own brand). Participants were dual users of little cigars and cigarettes. Results Similar to cigarettes, little cigars delivered substantial nicotine and relatively more carbon monoxide. Puff volume, puff duration and time to smoke were significantly greater after cigarettes, but the temporal pattern of smoking more intensively at the beginning was similar in little cigars and cigarettes. Both little cigars and cigarettes reduced urge to smoke. Participants consistently mentioned that the lower cost of little cigars was a reason for initiation and continuation of their use. Conclusions The results support the notion that regulation of little cigars is appropriate in light of public health considerations.

The legalization of medical and recreational cannabis use has occurred ahead of science. The current evidence base has poor utility for determining if cannabis products can meet the standards of safety, efficacy, and quality intrinsic to modern medicine, and for informing regulation of cannabis as a legal intoxicant. Individual jurisdictions that pass cannabis reforms may not have adequate resources to support the level of new scientific research needed to inform regulatory actions; this could make it difficult to keep a rapidly growing multi-billion-dollar cannabis industry in check. Further, the present lack of evidence-based regulatory oversight for cannabis parallels the climates that gave rise to the tobacco and prescription opioid epidemics, suggesting that continued omission may result in negative public health consequences. However, translating a methodological framework developed through research on these compounds may promote rapid advances in cannabis science germane to regulatory knowledge gaps. The present review highlights specific advancements in these areas, as well as in alcohol regulation, that are prime for informing policy-relevant cannabis science, and also offers some recommendations for evidence-based regulatory policy. Resulting progress may directly inform both regulation of cannabis in both medical and licit recreational drug frameworks, and new cannabis-related public health initiatives.

Little cigar and cigarillo smoking is increasing in popularity in the U.S., but little is known about the topography and mainstream smoke (MSS) constituents of these types of cigar products. This report describes the quantity of selected MSS toxicants generated from puff-by-puff replication of human laboratory smoking. Participants were dual users of cigarettes and either little cigars ( n = 21) or cigarillos ( n = 23). In the laboratory smoking session, participants of the little cigar group smoked a filtered unflavored Winchester Little Cigar; those in the cigarillo group smoked an unfiltered, unflavored BlackMild cigarillo. MSS components included both volatiles and semivolatile compounds. The MSS of five representative U.S. domestic cigarettes was generated using smoking topography profiles of the participants smoking their own brand of cigarettes. Machine smoking accurately replicated individual puff profiles as indicated by a high correlation between lab and machine smoked: time to smoke, number of puffs, and total puff volume. There was wide variability in smoking patterns across subjects of both little cigars and cigarillos. For example, total puff volume ranged from 84 to 732 mL after the little cigar and from 270 to 2089 mL after the cigarillo. Qualitatively, cigar smoke from little cigars and cigarillos were similar and resembles cigarette smoke. All analytes (VOC and SVOCs) were greater in cigarillo smoke compared to that of little cigars and cigarettes. However, when the toxicants were adjusted for grams of tobacco burned, little cigar smoke contained more nicotine, tobacco-specific nitrosamines, acetonitrile, and acrylonitrile compared with cigarillo smoke. When the constituents were adjusted for nicotine content, cigarillo MSS contained more of all toxicants compared with little cigar. Cigarillos and little cigars, like cigarettes, deliver nicotine and other toxicants known to be harmful to health; their regulation by the FDA is appropriate for their public health risk.

There has been an increase in the use of cigarillos in the US. People who smoke cigarillos typically also regularly smoke cigarettes (dual users).We compared puffing topography, biomarkers of acute exposure [exhaled carbon monoxide (COex) and plasma nicotine] and physiologic effects from usual brand cigarette and BlackMild cigarillo smoking in dual users (N=23) in two laboratory sessions.Participants (21 men) smoked an average of 17.5cigarettes/day. Cigarillo consumption varied widely from as few as 1/week to daily. Participants were highly nicotine dependent (average FTND score: 6.3). There were statistically significant differences in smoking behavior between cigarette and cigarillo smoking in time to smoke, number of puffs, and total puff volume (all P0.001). Average puff duration, interpuff interval average puff volume, and puff velocity did not differ between cigarettes and cigarillos. Nicotine boost was similar after both cigarettes and cigarillos. COex boost was significantly greater after cigarillo smoking compared to cigarette smoking (P0.001).The smoking pattern and exposure profile indicate that dual users inhale cigarillo smoke just as they inhale cigarette smoke thereby exposing themselves to considerable amounts of nicotine and other components of tobacco smoke. COex exposure results imply that cigarillo smoking may be associated with higher exposure to smoke-delivered volatile components of mainstream cigarillo smoke including carcinogens when compared to cigarettes.The findings that cigarillos and cigarettes are smoked similarly in dual users are relevant to health and regulatory considerations on cigar products.

Objective Smoking topography variables and toxicant exposure (plasma nicotine and exhaled CO) were examined in 3 groups of study participants that smoked both cigarettes and either filtered little cigars (Winchester), cigarillos (Black & Mild), or large cigars (Phillies Blunt). Methods Laboratory ad lib smoking of the cigar products was collected with a smoking puff analyzer; plasma levels of nicotine and exhaled CO were collected before and after smoking. Results Although there were no statistically significant differences in demographic and cigarette smoking topography among the groups, there were significant differences in how the different cigar products were smoked. Plasma nicotine boost was similar after all products but exhaled CO was greater after the cigarillo and large cigar than the little cigar. Some of the differences were due to the differences in article size but other differences were apparent even after adjustment for the amount of tobacco burned or the mouth intake (puff volume). Conclusions The topography findings of differences among products challenge the practice of grouping cigars as a single entity in surveys, regulatory decisions, and discussions of toxicant exposure. The results add to the discussion of distinctions among products in the scientific assessment of public health risk and regulatory decisions.

Background: Despite considerable use of make your own (MYO) cigarettes worldwide and increasing use in the United States, relatively little is known about how these cigarettes are smoked and the resultant toxicant exposure. Methods: In a laboratory study, we compared two types of MYO cigarettes—roll your own (RYO) and personal machine made (PMM)—with factory-made (FM) cigarettes in three groups of smokers who exclusively used RYO (n = 34), PMM (n = 23), or FM (n = 20). Within each group, cigarettes were smoked in three conditions: (i) after confirmed overnight tobacco abstinence; (ii) in an intense smoking paradigm; and (iii) without restrictions. All cigarettes were smoked ad lib through a smoking topography unit. Results: Plasma nicotine significantly increased after cigarettes in all conditions except PMM in the intense smoking paradigm. Puff volume, puff duration, total puff volume, and puff velocity did not differ between cigarette types but the puffs per cigarette and time to smoke were significantly smaller for RYO compared with PMM and FM. Regardless of the cigarette, participants consumed the first three puffs more vigorously than the last three puffs. Conclusions: Despite the belief of many of their consumers, smoking MYO cigarettes is not a safe alternative to FM cigarettes. Like FM, MYO cigarettes expose their users to harmful constituents of tobacco smoke. Despite differences in size and design their puffing profiles are remarkably similar. Impact: These data are relevant to health and regulatory considerations on the MYO cigarettes. Cancer Epidemiol Biomarkers Prev; 23(9); 1793–803. ©2014 AACR.

Introduction Cigars are combusted tobacco products consisting of filler, binder, and wrapper, which are derived from tobacco. Despite the abundance of literature on the composition of traditional combusted cigarettes, research is limited on the physical and chemical properties of cigars. Therefore, research on cigar properties may be useful to better understand their health impact. Methods In this study, twenty large cigar and cigarillo products were characterized for physical properties (ie, weight, length, and diameter), filler nicotine content, and tobacco pH. Tobacco pH was used to calculate free nicotine content, free nicotine concentration, and percent free nicotine for all cigars using the Henderson-Hasselbach equation. An additional analysis was performed on a second batch of two large cigar and two cigarillo brands to determine within-brand consistency. All analyses were performed in triplicate. Results The initial analysis of the twenty cigars showed that cigars exhibited wide variation in product size and nicotine content, although tobacco pH was similar across cigars. Furthermore, in the two large cigar and cigarillo brands analyzed a second time, there was considerable within-brand variance in nicotine content and concentration between the first and second analyses. Conclusions While only a small sample of commercially-available cigars was analyzed, our data suggest there is wide variability in nicotine content and some physical properties in the domestic cigar market. The data may help to inform potential future regulatory decisions related to these products. Implications This study reveals some of the challenges to experimental cigar research and illustrates the need to characterize cigar products (eg, nicotine and tobacco content) before use in clinical studies. Additional studies and characterization of the physical and chemical properties of cigars may be useful to further understand these products' toxicity, abuse potential, and public health impact.

Background Cigar smoking in the United States continues despite decreases in cigarette smoking and increased tobacco control efforts. We compared large cigar and cigarette smoking for use patterns, smoking topography, and toxicant exposure. Methods Dual users (n = 17, 94% men, 77% African American) smoked ad libitum either their usual cigarette brand or a study large cigar (Phillies Blunt) in two laboratory sessions. Plasma nicotine and exhaled carbon monoxide were collected before and after smoking. Smoking topography measures of puff volume, puff duration, puff velocity, and interpuff interval were also collected. Results Both cigarettes and large cigars significantly increased plasma nicotine and carbon monoxide and significantly decreased the urge to smoke. Cigarettes delivered more nicotine per gram of tobacco smoked and per 1000 mL of puff volume. Number of puffs, time to smoke, puff volume, and puff velocity were significantly larger and interpuff interval was significantly shorter in large cigar smoking. The temporal pattern of puffing more intensely at the beginning of smoking was similar for both large cigars and cigarettes. Conclusions People who regularly use both large cigars and cigarettes adapt their smoking pattern such that they are exposed to similar levels of nicotine from each product. The immediate increase in plasma nicotine and carbon monoxide suggest significant inhalation of large cigar smoke. These data call to question the assumption that cigar smoking is less toxic than cigarette smoking. By smoking large cigars, dual users expose themselves to toxic components that have been linked with the addiction risk, morbidity, and mortality of cigarette smoking. Implications This study found that dual users of large cigars and cigarettes inhale significant quantities of carbon monoxide, nicotine, and presumably other components of mainstream smoke. Large cigar smoke exposure may lead to or sustain nicotine addiction as wells as subject large cigar consumers to similar risks associated with cigarette smoking such as lung cancer and cardiovascular disease.

Objectives To compare pregnant women who are current smokers at their first prenatal visit with those who recently quit smoking in the 90 days prior to their first prenatal visit (i.e., spontaneous quitters) to identify differences between them and factors that predict their intake smoking status. Methods One hundred and thirty participants were enrolled in this cross-sectional research study. The sample was drawn from a population of pregnant women attending their first prenatal visit at a low-income obstetrics clinic in Baltimore, Maryland; the large majority of which have characteristics that previous research has identified as putting them at high-risk of continued smoking during pregnancy. Participants were recruited through referrals from clinical staff. Intake data collection occurred between March and December, 2013. Results Of the 130 pregnant women enrolled in the study, 126 had complete intake data. The sample included 86 current smokers and 40 recent quitters. The large majority of participants were African American with an average age of 26. Current smokers were significantly more likely than recent quitters to have: more depression symptoms; self-perceived stress; internalizing and externalizing disorder symptoms; substance use disorders; and tobacco dependence. The most significant predictors of smoking status at first prenatal visit were depressive symptoms, readiness to quit, and number of children. Conclusions for Practice Differences were identified at intake among this sample of pregnant women already considered to be at high-risk for continued smoking throughout their pregnancy. This study identified relevant factors associated with whether or not a woman had recently quit smoking in early pregnancy or was continuing to smoke at her first prenatal visit. Knowledge of these factors may benefit physicians in understanding and promoting smoking cessation throughout the perinatal period and specifically intervening to decrease depressive symptoms and increasing readiness to quit may improve outcomes.

Global use of electronic nicotine delivery systems (ENDS; also called electronic cigarettes, e-cigarettes) has increased dramatically in recent years. However, due to the limited safety studies and growing concerns on the potential toxicity from long term use of ENDS, many national and international governments have employed regulatory measures to curtail its use. One of the most significant challenges regulators of ENDS encounter is the lack of quality standards to assess ENDS, e-liquid (solution used with ENDS which contain nicotine--a highly toxic and addictive substance), and amount of nicotine delivery to aerosol during ENDS use.Aims of the study were to (1) measure and compare nicotine concentration in e-liquids to values reported by manufacturers on packaging labels; (2) assess the precision of nicotine delivery from tank during aerosol formation. Methods: Nine popular Polish e-liquids (based on the market share data from October 2014) were purchased for the study. The labelled nicotine concentration for the selected e-liquids ranged between 11-25 mg/mL. All e-liquids were aerosolized in the laboratory using a smoking simulation machine (Palaczbot). Each e-liquid was aerosolized in a series of 6 consecutive bouts. A single bout consisted of 15 puffs with the following puff topography: 65 mL puff volume, 2.8 sec. puff duration, and 19 sec. interpuff interval. A total of 90 puffs were generated from each e-liquid. Nicotine content in the e-liquids and the aerosol generated were determined by gas chromatography with thermionic sensitive detection (GC-TSD).For seven of nine analyzed e-liquids, the difference between measured and manufacturer labeled nicotine concentration was less than 10%. Nicotine dose in aerosol per bout ranged between 0.77-1.49 mg (equivalent to one-half the nicotine a smoker inhales from a single combustible cigarette).Our analysis showed the high consistency between the labeled and measured nicotine concentration for popular on the Polish market ENDS e-liquids. Also, our analysis demonstrates that the risk for nicotine overdose is likely minimal when ENDS are used in a similar manner as a combustible cigarette. However, due to the toxicity risk nicotine poses regulatory measures focused on safety and quality of e-liquids should continually be exercised.

In Poland, 38.0% of men and 25.6% of women smoke daily. One method for expanding access to smoking cessation services is through community-based pharmacists. Surveys were administered in 2007—2008 to (a) current smokers, (b) members of a pharmacy association, and (c) pharmacy students in their final year of training. Pharmacists were the highest ranked health professionals to whom Polish smokers reported they would turn for information about pharmacological support for smoking cessation. Most pharmacists (79%) reported their knowledge allowed them to provide basic smoking cessation information to their patients. Pharmacy students reported being more able to provide information about the health consequences of tobacco smoking than to help patients quit smoking (85% vs. 61%). In Poland, community-based pharmacists are positioned to provide smoking cessation interventions to all segments of the population. To extend and promote smoking cessation efforts, comprehensive tobacco cessation training should be a required component of the pharmacy school curriculum.

4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) is tobacco specific and has a longer half-life than other tobacco biomarkers studied thus far. An accurate measurement of the NNAL half-life is important for optimal use to assess exposure to tobacco smoke. We determined the half-life of NNAL in urine in eight daily smokers on a clinical research ward and in five occasional smokers in a real-life environment. Total NNAL in urine was monitored for 14 days in daily smokers after stopping smoking and for up to 60 days in occasional smokers. The average half-life for the terminal phase in the daily smoker group using a two-compartmental body model was 10.3 days (beta phase), and using a noncompartmental model, it was 9.1 days. In the occasional group, these values were 17.6 and 16.0 days, respectively. The alpha-phase half-lives were 14.3 and 27.8 hours for the two groups, respectively. The inter-subject coefficient of variation of the NNAL terminal half-life ranged from 14% to 30%, and the intra-subject coefficient of variation ranged from 3% to 18%. There was very good agreement between the plasma and urinary half-lives in two subjects with plasma analyses: 7.4 versus 7.9 days and 9.2 versus 10.7 days. Mean renal clearance of NNAL was 13 ± 2.3 mL/min. The terminal half-life of NNAL of 10 to 18 days indicates that this biomarker can be used to detect tobacco smoke exposure for 6 to 12 weeks after cessation of exposure and requires a similar time to assess the steady levels of NNAL after switching from one tobacco product to another. (Cancer Epidemiol Biomarkers Prev 2009;18(12):3421–5)

The aim of the present study was to develop a new analytical method of chromatographic determination of two important markers of ETS exposure: nicotine and 3-vinylpyridine (3-ethenylpyridine, 3-EP) in mainstream (MS) and sidestream (SS) smoke of one single cigarette and in indoor air using direct solid phase extraction combined with gas chromatography. The method can be utilised for both nicotine and 3-EP determination in SS and MS of one single cigarette as well as it allows for a precise determination of compound distribution in indoor air. The application of the same analytical method for both kinds of samples allows anticipating indoor air distribution of both analysed compounds in a very precise way. The precision of the method (calculated as a relative standard deviation) was 9.78% for nicotine and 2.67% for 3-EP; whereas the accuracy (evaluated by a recovery study conducted at three different levels) was 70.1 and 87.3%, respectively. The limit of detection was 0.06 µg per cigarette for both nicotine and 3-EP. The method was evaluated by determining the compounds of interest in two commercially available brands of cigarettes as well as in the reference cigarettes 3R4F and also in indoor air polluted with tobacco smoke. Determined levels of compounds of interest in MS varied from 586 to 772 (nicotine) µg per cigarette and from 3.5 to 10.7 (3-EP) µg per cigarette. In SS smoke the level varied from 14,370 to 22,590 (nicotine) µg per cigarette and from 185 to 550 (3-EP) µg per cigarette, whereas levels in indoor air polluted with tobacco smoke varied from 50.1 to 157.3 (nicotine) µg m(-3) and from 7.7 to 20.8 (3-EP) µg m(-3).

Verve, an oral nicotine delivery product (ONDP), was introduced by Nu Mark (Altria Client Group, Richmond VA) for smokers to use in places where smoking is prohibited. This study assessed the effect of this ONDP on plasma nicotine levels, heart rate, product satisfaction, and ability to suppress smoking urge and cigarette cravings. Thirteen daily cigarette smokers [8 men and 5 women; average age 33.4 years] attended two laboratory sessions, one occurred after overnight tobacco abstinence. Plasma samples were collected before and after ONDP use and measured for nicotine. In non-abstinent smokers, mean plasma nicotine levels increased from 18.3 to 21.0 ng/mL. In abstinent smokers, average nicotine levels increased from 3.1 to 4.5 ng/mL. After overnight tobacco abstinence, ONDP use significantly (p < 0.01) increased heart rate from 69 beats per minute (bpm) to 75 bpm; while urge to smoke decreased significantly (p < 0.01) from a score of 8.6 to 4.9. Participants indicated moderate product satisfaction that was not changed by tobacco abstinence. Analysis of unused ONDP revealed total nicotine levels of 1.68 ± 0.09 mg/disc. Spent ONDP discs were also analyzed to determine % nicotine liberated during chewing; results were 80% in the non-abstinent and 82% in the abstinent conditions (ns). Our study results indicate that ONDP use can increase plasma nicotine levels and heart rate and reduce cigarette cravings in abstinent smokers.

Tobacco smoking leads to changes in hemodynamic parameters such as heart rate and systolic or diastolic blood pressure. It has a direct influence on the elasticity of blood vessels and increases arterial stiffness, which can result in development of atherosclerosis. Data show that the nicotine in tobacco smoke probably is responsible for these changes. Electronic cigarettes (e-cigarettes) were supposedly a healthier alternative to combustible cigarettes because they imitate a process of cigarettes smoking but generate nicotine aerosol without the toxic substances from tobacco combustion. However, the use of e-cigarettes is still controversial because their toxicity, safety and long term use health impact have not been sufficiently studied.The aim of this study was to evaluate changes in arterial stiffness parameters after smoking a cigarette or e-cigarette use.Fifteen healthy women, aged 19-25 years old, smoking ≥5 cigarettes per day for at least two years participated in the study. A non-invasive measurement of arterial stiffness parameters - Stiffness Index (SI) and Reflection Index (RI) - was conducted and systolic and diastolic blood pressure and heart rate were measured before and after smoking a conventional cigarette as well as use of an e-cigarette.Statistically significant changes in the SI and RI were observed before and after smoking of a conventional cigarette [SI: 6.75m/s (6.66 - 6.85, 95% CI) vs 6.56m/s (6.46 - 6.65. 95% CI), p=0.0056; RI: 54.0% (51.5 - 56.7, 95% CI) vs 49.6% (47.5 - 51.8, 95% CI), p=0.010]. The use of e-cigarettes resulted in no statistically significant changes in the SI and RI. After both product use systolic and diastolic blood pressure and heart rate increased but the changes were not statistically significant.In contrast to conventional cigarette use, the use of electronic cigarettes causes no changes in arterial stiffness. This may indicate lower bioavailability of nicotine from the e-cigarette or an additional effect of other substances present in cigarette smoke but absent in an e-cigarette aerosol.

IntroductionPrescription-drug use in the USA has increased by more than 60% in the last three decades. Prevalence of prescription-drug use among pregnant women is currently estimated around 50%. Prevalence of illicit drug use in the USA is 14.6% among pregnant adolescents, 8.6% among pregnant young adults and 3.2% among pregnant adults. The first step in identifying problematic drug use during pregnancy is screening; however, no specific substance-use screener has been universally recommended for use with pregnant women to identify illicit or prescription-drug use. This study compares and validates three existing substance-use screeners for pregnancy—4 P’s Plus, National Institute on Drug Abuse (NIDA) Quick Screen/Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and the Substance Use Risk Profile-Pregnancy (SURP-P) scale.Methods and analysisThis is a cross-sectional study designed to evaluate the sensitivity, specificity and usability of existing substance-use screeners. Recruitment occurs at two obstetrics clinics in Baltimore, Maryland, USA. We are recruiting 500 participants to complete a demographic questionnaire, NIDA Quick Screen/ASSIST, 4 P’s Plus and SURP-P (ordered randomly) during their regularly scheduled prenatal appointment, then again 1 week later by telephone. Participants consent to multidrug urine testing, hair drug testing and allowing access to prescription drug and birth outcome data from electronic medical records. For each screener, reliability and validity will be assessed. Test–retest reliability analysis will be conducted by examining the results of repeated screener administrations within 1 week of original screener administrations for consistency via correlation analysis. Furthermore, we will assess if there are differences in the validity of each screener by age, race and trimester.Ethics and disseminationThis study is approved by the Institutional Review Board of the University of Maryland (HP-00072042), Baltimore, and Battelle Memorial Institute (0619–100106433). All participants are required to give their informed consent prior to any study procedure.

Introduction: There is currently the potential for a great deal of transition and product switching among cigarette smokers. Studies on the transition when cigarette smokers switch from one type of nicotine delivery product to another are needed to understand subsequent toxicant exposure. Methods: A preliminary study was performed to determine the feasibility of experimentally replicating the transition from factory made (FM) to personal machine made (PMM) cigarette smoking. The adaptability and perceptions of the consumer and the consequent exposure to cigarette-delivered toxins were assessed. Six adults (4 men) were recruited for four laboratory visits (V1-V4) on study days 1, 5, 10 and 15, respectively. All of the participants agreed to switch from exclusive FM smoking to exclusive PMM cigarette smoking for the duration of the study. Results: Compliance was very high among these participants. Participants progressively accepted the PMM cigarettes and became efficient producers of PMMs as evidenced in the reduced time to make 5 PMMs in the laboratory. Participants reported a preference for FM at visit 2 (V2), but had stated no preference by the fourth visit. Compared to the FMs, the PMMs at V3 (p

Introduction: Nicotine delivery from smokeless tobacco (ST) products leads to addiction and the use of ST causes pathology that is associated with increased initiation of cigarette smoking. The rapid delivery of nicotine from ST seems to be associated with the pH of the aqueous suspension of the products - high pH is associated with high nicotine absorption. However, early studies compared nicotine absorption from different commercial products that not only differed in pH but in flavoring, nicotine content, and in format-pouches and loose tobacco. Methods: The present study compared nicotine absorption from a single unflavored referent ST product (pH 7.7) that was flavored with a low level of wintergreen (2 mg/g) and the pH was amended to either high (8.3) or low (5.4) pH with sodium carbonate or citric acid, respectively. Results: In a within-subject clinical study, the higher pH products delivered more nicotine. No significant differences were seen between perceived product strengths and product experience in all conditions. Heart rate increased by 4 to 6 beats per minute after the high pH flavored and the un-amended product but did not change after the low pH flavored product. Conclusions: These results indicate that pH is a primary determinant of buccal nicotine absorption. The role of flavoring and other components of ST products in nicotine absorption remain to be determined.

SUMMARY Introduction and Aims: It is beyond any doubt that nicotine yield in cigarettes as determined using standard ISO method bears almost no rela- tion to smokers' actual intake. However, the ISO method is still in use in many countries where the government is responsible for controlling and monitoring cigarette quality. The aim of the study was to measure the nicotine yield in single cigarettes and to evaluate their statistical distribution among the same brand. Materials and methods: Nicotine yields were measured according to the ISO method in single cigarettes of the twenty most popular Polish brands of cigarettes. Results: Relative standard deviation of nicotine yields in single cigarettes of the same brands varied from 16% to 34%. Relative differences between nicotine yields in a single cigarette of a particular brand and the mean value varied from −65% to +76%. Discussion and Conclusions: The results indicate high variation in nicotine yields between cigarettes of the same brand. Such variation might affect compensatory smoking. This provides another reason why yields estimated using the standard ISO method are potentially misleading to smokers. Further studies are needed to better understand the implications of within-brand variability in yields for tobacco product regulation.

The way smoker smokes his cigarette (smoking topography) depends on many factors, like his age and sex, or the type of cigarettes he smokes. Smoking topography includes a puff volume, a number of puffs taken during smoking one cigarette, a frequency and time of puffing, and the intervals between puffs.The aim of the study was to verify if the level of nicotine dependence affects smoking topography.We investigated 59 regular smokers (33 females and 26 males), in the age of 34 +/- 12. The level of nicotine dependence was determined with Fagerström Test (FTND) and Nicotine Dependence Syndrome Scale (NDSS). Smoking topography was measured five times during a single day. Smokers smoked their regular brands of cigarettes.We showed, that the puff volume and intervals between puff strongly correlated with the level of nicotine dependence. When using NDSS test, we found that the total puff volume and the number of puffs taken from a single cigarette correlated with a drive to smoke. Negative correlation was found between the total puff volume and the number of puffs taken from a single cigarette and a tolerance. Continuity of smoking affected a number of puffs and the intervals between puffs.Nicotine dependence affects smoking topography.

Tobacco smoking is common among various social groups. There is still high prevalence of smoking among health care professionals.The aim of the study was to assess knowledge about smoke-free law in public places in Poland among smoking and nonsmoking students of selected medical university. We surveyed 50 students of one medical university aged 23 +/- 2 years. Control group consisted with 61 students of other universities located in the same region aged 23 +/- 3 years. We developed a new survey to assess students knowledge about smoke-free regulations and their implementations in various public places. Smoking status was verified with exhaled carbon monoxide levels (COex).57% off all surveyed students declared being familiar with smoke-free law. However, we detected a significant difference between the knowledge of medical vs. nonmedical students (76% vs. 41%, p0.05). The knowledge about smoke-free law in Poland among students is not sufficient, especially among nonmedical students.

Waterpipe has been used for many centuries in Asia and Africa regions to smoke tobacco leaves. In recent years it has been gaining popularity also among adolescents and youths in Poland.The aim of the study was to examine waterpipe smoking prevalence among adolescents living in Silesia region of Poland. We investigated if waterpipe is used as alternative way to smoke tobacco and awareness among adolescents about heath risk of waterpipe smoking.We surveyed 769 students of high schools located in Silesia region of Poland.Mean age of surveyed students was 16.5 years, and 52.5% were females. Our results showed that prevalence of waterpipe was higher than cigarette smoking (46.7% vs. 34.6%). Prevalence of waterpipe smoking among girls was almost the same as among boys. Most of the surveyed students used waterpipe as an alternative tool to smoke tobacco.The prevalence of waterpipe smoking among Polish adolescents is very high. There is an urgent need for education about health risks of waterpipe use in Poland.

The aim of the study was: 1) to assess RSPs concentration in MS and SS of the cigarettes smoked in a wide variety of topography parameters (various: puff volumes [V], puff flows [W] and breaks between puffs [T]); 2) to assess smokers' exposure to tobacco-smoke-derived respirabile suspended particles.Tobacco smoke was generated using a self-constructed automatic smoking machine. The device is highly accurate and precise (SD +/- 1%), which was confirmed by checking smoking topography parameters with CressMicro portable monitor (Plowshare, USA). One full-flavored cigarette brand, available commercially in Poland was used for RSPs determination. The topography parameters were changed as follows: V (25-60 ml); W (27-52 ml/s) and T (20-60s). The MS and SS were collected in containers of 51 and 201, respectively. Additionally, the SS was sampled according to ISO 3308. Finally, RSP2.5 were measured using DustTrak 8520 (TSI, USA).MS RSP2.5 concentration varied from 0.14 +/- 0.01 (V = 25 ml, W = 52 ml/s, T = 60s) to 2.215 +/- 0.17 mg/cig. (V = 60 ml, W = 52 ml/ s, T =20s), whereas the SS RSP2.5 concentration varied from 2.79 +/- 0.03 (V = 25 ml, W = 41 m/s, T = 60 s) to 18.3 +/- 1.0 mg/cig (V = 35 ml, W = 35 ml/s, T = 20s). The MS and SS RSP2.5 concentration in ISO 3308 conditions (V = 35 ml, W = 17.5 ml/s, T = 60 s) were 0.39 +/- 0.02 and 3.71 +/- 0.24 mg/cig., respectively. RSP2.5 levels determined with topography conditions which corresponded to the way Polish smokers smoke cigarettes (V = 60 mL, F = 3 8 mL/sec, T = 20 sec) were as follows: 0.74 +/- 0.08 for MS and 3.31 +/- 0.17 mg/cig for SS. There was a positive correlation between both V and F and RSP2.5 levels in MS. It was noticed that by increasing V and W parameters, the RSP2.5 in MS rises, while by decreasing T gives an opposite effect. As far as the RSP2.5 in SS is concerned, it is positively correlated with V value.Smoking topography strongly affects smokers' exposure to RSP2.5. It confirms that using ISO standards for determination RPS2.5 derived from tobacco smoke might reflect inadequately active and passive smokers' exposure do RSP2.5.

Cotinine is the most widely used biomarker to distinguish active versus passive smoking. However, there is an overlap in cotinine levels when comparing light or occasional smokers versus heavily exposed passive smokers. 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) is a tobacco-specific nitrosamine measurable in urine with a much longer half-life than cotinine. The aim of the study was to determine optimal cutoff points to discriminate active versus passive smokers and to compare sensitivity and specificity for the use of cotinine, NNAL, and the ratio of the NNAL/cotinine in urine.Cotinine and NNAL were measured in urine of 373 active smokers and 228 passive smokers.Geometric mean cotinine levels were 2.03 ng/ml (interquartile interval: 0.43-8.60) and 1,043 ng/ml (658-2,251) and NNAL levels were 5.80 pg/ml (2.28-15.4) and 165 pg/ml (90.8-360) pg/ml in passive and active smokers, respectively. NNAL/cotinine ratio in urine was significantly higher for passive smokers when compared with active smokers (2.85 vs. 0.16, p.01). The receiver operating characteristics analysis determined optimal cutoff points to discriminate passive versus active smokers: 31.5 ng/ml for cotinine (sensitivity: 97.1% and specificity: 93.9%), 47.3 pg/ml for NNAL (87.4% and 96.5%), and 0.74 x 10⁻³ for NNAL/cotinine ratio (97.3% and 87.3%).Both urine cotinine and NNAL are sensitive and specific biomarkers for discriminating the source of tobacco smoke exposure. Cotinine is the best overall discriminator when biomarkers are measured while a person has ongoing exposure to tobacco smoke. NNAL because of its long half-life would be particularly useful when there is a delay between exposure and biomarker measurement. The NNAL/cotinine ratio provides similar sensitivity but poorer specificity at discriminating passive versus active smokers when compared with NNAL alone.

Objectives: Cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) are widely used biomarkers for tobacco-derived nicotine and the lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), respectively. The discrepancy between cotinine levels in relation to disease risk comparing active versus passive smoking suggests a nonlinear tobacco smoke dose-response and/or that cotinine is not providing an accurate measure of exposure to the toxic constituents of secondhand tobacco smoke. Methods: Cotinine and NNAL were measured in the urine of 373 active smokers and 228 passive smokers. Results: Average cotinine levels were 1,155 (interquartile range, 703-2,715) for active smokers and 1.82 (0.45-7.33) ng/mg creatinine for passive smokers. Average NNAL levels were 183 (103-393) and 5.19 (2.04-11.6) pg/mg creatinine, respectively. NNAL/cotinine ratio in urine was significantly higher for passive smokers when compared with active smokers (2.85 × 103 versus 0.16 × 103, P < 0.0001). Conclusions: Passive smoking is associated with a much higher ratio of NNAL/cotinine in the urine compared with active smoking. Impact: Cotinine measurement leads to an underestimation of exposure to the carcinogen NNK from secondhand smoke when compared with active smoking. Cancer Epidemiol Biomarkers Prev; 19(11); 2795–800. ©2010 AACR.

Many epidemiological studies on health consequences of tobacco smoke exposure require classification of examined subjects either as active or passive smokers. Receiver operating characteristics (ROC) curves are useful for organizing cut-off values of tobacco biomarkers and visualizing their performance. The cut-off values might be applied to distinguish cigarette smokers and persons involuntary exposed to second-hand tobacco smoke (SHS). Aim of the study was estimation of optimal levels of three biomarkers (cotinine, 1-hydroxypyren, and carboxyhemoglobin) to distinguish active and passive smokers using ROC curves. 98 subjects (62% females) were qualified to the study. Mean age was 40 +/- 12 years. Active smokers (n = 38) had an average smoking history of 9 +/- 8 years and declared smoking at least 5 cigarettes per day (mean 17 +/- 7). Passive smokers (n = 60) declared being exposed to environmental tobacco smoke either at home or work (n = 18) or other indoor microenvironments, where they spent some time during their daily activity (n = 42). Cut-off values were determined for each biomarker using ROC curves. Optimal cut-off values were: 327 microg/g creatinine for cotinine, 47 ng/g creatinine for hydroxypyren, and 1.27% HbCO for carboxyhemoglobin. Among three studied biomarkers, cotinine showed the best sensitivity of 97.4% and specificity of 90.0%. Carboxyhemoglobin showed sensitivity of 89.5% and specificity of 93.3%, whereas 1-hydroxypyren 76.3% and 78.3%, respectively. Analysis of ROC curves appears to be a way to distinguish active and passive smokers using various tobacco biomarkers.

Particulate matter (PM), including fine particulate matter (PM2.5), is one of the main pollutant which it damages of human health seriously. Tobacco smoke is significant source of PM2.5 in indoor microenvironments. New bill of complete smoking ban in all public places in Poland is currently under consideration in polish parliament. Proposed maximum allowed concentration of PM2.5 for all non-smoking sections is 0.03 mg/m3. Concentrations of tobacco-specific fine particulate matter (PM2.5) were monitored in thirteen pubs located in southern part of Poland during winter season. All examined pubs had two types of sections: smoking and non-smoking. PM2.5 concentrations were monitored during one hour in each section using DustTrak monitor (TSI Inc., USA). The Wilcoxon matched pair test was used to compare pollutant concentrations in smoking vs. non-smoking sections. Average 1-hour PM2.5 concentration in smoking sections was 1.25 +/- 1.85 mg/ m3 and varied from 0.18 do 7.21 mg/ m3. Average 1-hour PM2.5 concentration in non-smoking sections was 0.35 +/- 0.29 mg/m3 and varied from 0.056 to 1.01 mg/m3. The highest temporary PM2.5 concentration of 25.5 mg/m3 was found in a pub located in cellar storey were with volume of 60 m3, 13 smokers and no air-condition. There was little difference in PM2.5 levels between smoking and non-smoking section.

Pierwsza praca dotycząca oznaczania nikotyny we włosach została opublikowana w 1983 roku przez Ishiyama i wsp. Od czasu tych pionierskich badań minęło już ponad 25 lat, a badanie zawartości nikotyny we włosach stało się cennym narzędziem służącym ocenie narażenia na liczne ksenobiotyki, w tym na dym tytoniowy. Niniejszy artykuł jest próbą zwięzłego przeglądu najważniejszych badań ostatnich lat, które wykorzystywały nikotynę we włosach jako biomarker. W artykule opisano także stosowane do oznaczeń nikotyny we włosach techniki laboratoryjne oraz przedstawiono wady i zalety włosów jako biomarkera narażenia na dym tytoniowy.

Tobacco smoking, counted as one of the alternating external cardiovascular risk factors, can cause disadvantageous changes of concentration of compounds considered to be the new internal risk factors. The aim of the study was to determine the influence of tobacco smoke on concentration levels of homocysteine, dimethylarginine (ADMA), fibrinogen and C-reactive protein (CRP) in healthy smoking male's blood plasma. 71 healthy male volunteers, aged 30-59, were chosen for the study. Based on a questionnaire they were divided into non-smoking group (37 individuals) and active smokers group (34 individuals). The results obtained indicate the most significant increasing effect of tobacco smoke on blood plasma homocysteine levels (by 11.9%) and then, successively, on fibrinogen (by 10.1%) and ADMA (by 9.1%). Changes of CRP concentration, although differentiated similarly to other factors, were insignificant. Since the coexistence of elevated risk factors shows a synergistic effect on cardiovascular risk level in general, it is advisable to perform tests of new risk factors among people exposed to tobacco smoke. The tests will appoint the ones at risk of disease and help to cover them with a medical care.

Cigarette smokers believe that quitting smoking is the hardest thing in their life. Modern pharmacology offers a wide range of various drugs and therapies that might support smoking cessation. One of the most effective drug is varenicline. Varenicline has been introduced this year to Polish pharmaceutical market by Pfizer company under the trade name Champix. The aim of the study was to critically review all new information about Champix pharmacology and pharmacokinetics but also evaluate safety and economical aspects of using this new drug. From the presented data it might be concluded that nowadays varenicline is the most effective drug used in smoking cessation (about 40%). The unique properties of varenicline, which is a partial agonist and antagonist to alpha4beta2 nicotinic receptor, are the reasons of dual mechanism of the drug action. The agonist effect is caused by binding to nicotinic receptors and stimulating receptor-mediated activity. The antagonist effect occurs when varenicline blocks the ability of nicotine to activate nicotinic receptors. The most frequently adverse effects of varenicline are: nausea, headache, insomnia, and abnormal dreams. Although the price of complete therapy with Champix seems to be quite high, but potential benefits (in case of therapy finished successfully) are much higher than these costs. Pharmacological properties of varenicline described in the article, along with its high relative effectiveness and safeness, make the drug very attractive and promising for the smokers who want to quit.

Tobacco (Nicotiana sp.) is of the most often used model plants for research in the field of physiology, biochemistry, molecular biology and genetic engineering. Tobacco was also the first plant subject to genetic transformation--in 1983 the plant was introduced with the kanamycin resistance gene. The internet database PubMed includes roughly 3,500 records concerning transgenic tobacco, out of which nearly 200 works were published this year. Advancement of state-of-the-art techniques of genetic engineering offers new, as yet unprecedented opportunities to take advantage of tobacco. Apparently tobacco is not only a source of carcinogenic tobacco smoke, but also a plant which due to genetic modifications may be used in a positive way in medicine and biological sciences. The aim of the article is to summarize the role of genetically modified Nicotiana genus plants in modern medicine and environmental protection. The publication describes the usage of transgenic plants in the tobacco industry and evaluates possible effects of such applications. Moreover, potential possibilities of deployment of genetically modified tobacco for production of anti-virus and antibacterial vaccinations, interferon, antibodies, etc. have been characterized.

Smoking addiction consists in co-existence of pharmacological nicotine dependence and behavioral dependence. The most commonly used nicotine dependence pharmacotherapy is the Nicotine Replacement Therapy (NRT). At first, NRT preparations in many countries have been available on prescription only. Gradual introduction of NRT into over-the-counter sale involved the possibility of abuse. As a consequence, patients could become dependent on nicotine contained in the preparations, which are meant to be therapeutic. The analysis of results of current studies indicates that a small fraction of NRT patients (0.4-17%) uses it for a time longer than recommended. Thorough research assessing particular dependence symptoms do not, however, reveal such symptoms as: pleasure or satisfaction connected with taking the NRT preparations, subjective sense of dependence, difficulty in ceasing using NRT or occurrence of withdrawal symptoms. Thus, it has been suggested that NRT dependence occurs extremely rare is often times confused with chronic use. On the other hand, numerous studies show increased effectiveness of prolonged Nicotine Replacement Therapy, especially in heavy smokers. It is believed that a prolonged therapy using one NRT preparation does not pose any threat of severe side effects, just like simultaneous using of two NRT preparations or using NRT while continuing smoking. Conclusions drawn from current studies are reflected in the state-of-the-art guidelines concerning NRT use.