Cluster analysis of urinary tobacco biomarkers among U.S. adults: Population assessment of Tobacco and health (PaTh) biomarker study (2013-2014).

Introduction:
This text provides an analysis of the Population assessment of Tobacco and health (PaTh) Biomarker Wave 1 data to determine and describe groups (clusters) with distinct exposure profiles based on levels of urinary biomarkers of exposure to nicotine, tobacco-specific nitrosamines (TSNas), volatile organic compounds (VOCs), and polycyclic aromatic hydrocarbons (Pahs) among a national sample of current, established, adult tobacco users. The study also examines the association of product use behavior and cluster membership.

Key Points:

* The study used a nationally representative longitudinal cohort study launched to assess tobacco use and health outcomes among the non-institutionalized adult civilian population.
* Participants were categorized into mutually exclusive groups: exclusive combustible cigarette smokers, exclusive electronic cigarette (ECIG) users, exclusive smokeless tobacco (SLT) users, dual (cigarette and ECIG) users, and poly tobacco users.
* Cluster analysis, pairwise comparisons, and multinomial logistic regression were conducted to determine and describe groups with distinct exposure profiles based on levels of urinary biomarkers of exposure to nicotine, TSNas, VOCs, and Pahs.
* The study found that cigarette smokers were primarily in clusters with high biomarker concentrations across all groups, but actual concentrations were associated with smoking quantity.
* a cluster with high TSNas but low levels of Pahs and VOCs was heavily populated by SLT users.
* Exclusive ECIG users, depending on use frequency, were predominantly in clusters with low biomarker concentrations, except for one cluster that had relatively high TSNas.
* Clusters heavily populated by dual and poly tobacco users were the same as those heavily populated by cigarette smokers.

Main Message:
The study's findings suggest that there are distinct exposure profiles based on levels of urinary biomarkers of exposure to nicotine, TSNas, VOCs, and Pahs among a national sample of current, established, adult tobacco users. These profiles are associated with type and frequency of tobacco product used, indicating differential toxicant exposure profile as a function of use behavior. The results can inform future research and policy initiatives regarding tobacco regulation and harm reduction strategies.

Majeed B, Linder D, Eissenberg T, Tarasenko Y, Smith D, ashley D. Cluster analysis of urinary tobacco biomarkers among U.S. adults: Population assessment of Tobacco and health (PaTh) biomarker study (2013-2014). Preventive medicine. 2020;140:106218. doi:10.1016/j.ypmed.2020.106218