Cluster Analysis of Urinary Tobacco Biomarkers among U.S. Adults: Population Assessment of Tobacco and Health (PATH) Biomarker Study (2013-2014).”

Presentation given at 7th Annual Conference. Complementary Contributions of Tobacco Control and Regulatory Science Research to Protecting the Public Health. Abstracts Background: Urinary biomarkers of exposures (BOE) to nicotine, Tobacco-Specific Nitrosamines (TSNA), Volatile Organic Compounds (VOC), and Polycyclic Aromatic Hydrocarbons (PAH) offer objective measurement of toxicant exposure. We used cluster analysis to identify and describe data-driven groups (clusters) of tobacco users, based on concentrations of urinary tobacco biomarkers. Methods: Data are from Wave 1 of the PATH Study (2013-2014). The study included established current tobacco users, who had complete data on biomarkers of nicotine (TNE2), TSNA (NNN and NNAL), VOC (CYMA, CEMA, and MHB3), and PAH (1-NAP and 3-FLUO) (N=6,724). Adults were classified into smokers/users of: combustible cigarettes only; ecigarettes only; other combustible tobacco (OCT; cigars, pipe, and hookah) only; smokeless tobacco (SLT) only; dual users; and poly users. Cluster analysis and multivariable multinomial logistic regression were used. Results: Half the sample were exclusive cigarette smokers; 32.3% were poly users; 5.2% were SLT users; and 4.2% were dual users. Based on concentrations of BOE, nine clusters were identified and cluster membership varied by pattern of use. Of adults who smoked cigarettes only, 37.6% were in cluster I (slightly high TNE2 and TSNA and somewhat high PAH and VOC) and 24% belonged to II (somewhat low TNE2, TSNA, PAH, and VOC). Third of exclusive e-cigarette users belonged to cluster VI (high TNE2 and very high TSNA, and low/very low PAH and VOC). Conclusions: Findings suggest that level of exposure to tobacco toxicants among users vary by type and number of product used, and provide some evidence for nicotine product continuum of risk