title: Exposure to nicotine and carcinogens among Southwestern Alaskan Native cigarette smokers and smokeless tobacco users.
abstract: BACKGROUND
  The prevalence of tobacco use, both cigarette smoking and smokeless, including iqmik (homemade smokeless tobacco prepared with dried tobacco leaves mixed with alkaline ash), and of tobacco-related cancer is high in Alaskan Native people (AN). To investigate possible mechanisms of increased cancer risk we studied levels of nicotine and tobacco-specific nitrosamines (TSNA) in tobacco products and biomarkers of tobacco toxicant exposure in Southwestern AN people.
  
  
  METHODS
  Participants included 163 cigarette smokers, 76 commercial smokeless tobacco, 20 iqmik, 31 dual cigarette smokers and smokeless tobacco, and 110 nontobacco users. Tobacco use history, samples of tobacco products used, and blood and urine samples were collected.
  
  
  RESULTS
  Nicotine concentrations were highest in cigarette tobacco and TSNAs highest in commercial smokeless tobacco products. The AN participants smoked on average 7.8 cigarettes per day. Nicotine exposure, assessed by several biomarker measures, was highest in iqmik users, and similar in smokeless tobacco and cigarette smokers. TSNA exposure was highest in smokeless tobacco users, and polycyclic aromatic hydrocarbon exposure was highest in cigarette smokers.
  
  
  CONCLUSIONS
  Despite smoking fewer cigarettes per day, AN cigarette smokers had similar daily intake of nicotine compared to the general U.S. population. Nicotine exposure was greatest from iqmik, likely related to its high pH due to preparation with ash, suggesting high addiction potential compared to other smokeless tobacco products. TSNA exposure was much higher with smokeless tobacco than other product use, possibly contributing to the high rates of oral cancer.
  
  
  CONCLUSIONS
  Our data contribute to an understanding of the high addiction risk of iqmik use and of the cancer-causing potential of various forms of tobacco use among AN people.
authors.affiliation: University of California, San Francisco, CA, USA. NBenowitz@MedSFGH.ucsf.edu
authors.forename: Neal L
authors.initials: NL
authors.lastname: Benowitz
authors.forename: Caroline C
authors.initials: CC
authors.lastname: Renner
authors.forename: Anne P
authors.initials: AP
authors.lastname: Lanier
authors.forename: Rachel F
authors.initials: RF
authors.lastname: Tyndale
authors.forename: Dorothy K
authors.initials: DK
authors.lastname: Hatsukami
authors.forename: Bruce
authors.initials: B
authors.lastname: Lindgren
authors.forename: Irina
authors.initials: I
authors.lastname: Stepanov
authors.forename: Clifford H
authors.initials: CH
authors.lastname: Watson
authors.forename: Connie S
authors.initials: CS
authors.lastname: Sosnoff
authors.forename: Peyton
authors.initials: P
authors.lastname: Jacob
mesh_terms: D000328:Adult; D000413:Alaska; D002273:Carcinogens / Q000378:metabolism*; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D009538:Nicotine / Q000378:metabolism*; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology* / Q000378:metabolism*; D014030:Tobacco, Smokeless / Q000009:adverse effects / Q000378:metabolism*
chemical_list: D002273:Carcinogens; D009538:Nicotine