title: Tobacco Consumption and Toxicant Exposure of Cigarette Smokers Using Electronic Cigarettes.
abstract: There is considerable debate about the benefits and risks of electronic cigarettes (ECs). To better understand the risk-benefit ratio of ECs, more information is needed about net nicotine consumption and toxicant exposure of cigarette smokers switching to ECs.
  
  
  
  Forty cigarette smokers (≥1 year of smoking) interested in switching to ECs but not necessarily quitting smoking were enrolled in a 4-week observational study and provided an e-Go C non-variable battery and refillable atomizers and choice of eight flavors in 12 or 24 mg nicotine dosage. Measurement of urinary cotinine (metabolite of nicotine), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL; a pulmonary carcinogen), and eight volatile organic compounds (VOCs) that are toxic tobacco smoke constituents was conducted at baseline and week 4.
  
  
  
  All participants with follow-up data (92.5%) reported using the study EC. Of the 40 smokers, 16 reported no cigarettes at week 2 (40%) and six continued to report no cigarettes at week 4 (15%). Change in nicotine intake over the 4 weeks was non-significant (p = .90). Carbon monoxide (p < .001), NNAL (p < .01) and metabolites of benzene (p < .01) and acrylonitrile (p = .001) were significantly decreased in the study sample. Smokers switching exclusively to ECs for at least half of the study period demonstrated significant reductions in metabolites of ethylene oxide (p = .03) and acrylamide (p < .01).
  
  
  
  Smokers using ECs over 4 weeks maintained cotinine levels and experienced significant reductions in carbon monoxide, NNAL, and two out of eight measured VOC metabolites. Those who switched exclusively to ECs for at least half of the study period significantly reduced two additional VOCs.
  
  
  
  This study extends current literature by measuring change in smoking dependence and disease-associated biomarkers, NNAL and a panel of eight common VOCs that are toxic tobacco smoke constituents in smokers who switch to ECs. The findings support the idea of harm reduction, however some levels of toxicant exposure are still of clinical concern, particularly for dual users. Extrapolation of these results must be careful to separate the different toxic exposure results for exclusive switchers versus dual cigarette + EC users, and not to equate harm reduction with the idea that using ECs is harmless.
authors.affiliation: Department of Psychology, California State University San Marcos, San Marcos, CA.
authors.forename: Kim
authors.initials: K
authors.lastname: Pulvers
authors.affiliation: Department of Psychology, California State University San Marcos, San Marcos, CA.
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Emami
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Nollen
authors.affiliation: Department of Kinesiology, California State University San Marcos, San Marcos, CA.
authors.forename: Devan R
authors.initials: DR
authors.lastname: Romero
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego, CA.
authors.forename: David R
authors.initials: DR
authors.lastname: Strong
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA.|Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA.
authors.forename: Neal L
authors.initials: NL
authors.lastname: Benowitz
authors.affiliation: School of Public Health, Rutgers University, Piscataway, NJ.
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Ahluwalia
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D002248:Carbon Monoxide / Q000032:analysis; D002273:Carcinogens / Q000032:analysis; D003367:Cotinine / Q000652:urine*; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009538:Nicotine / Q000008:administration & dosage / Q000652:urine*; D000074285:Smokers; D064424:Tobacco Use / Q000009:adverse effects*; D055549:Volatile Organic Compounds / Q000032:analysis*
chemical_list: D015415:Biomarkers; D002273:Carcinogens; D055549:Volatile Organic Compounds; D009538:Nicotine; D002248:Carbon Monoxide; D003367:Cotinine