Health risks of dual use of electronic and combustible cigarettes: exposure to acrylamide and glycidamide.

ABSTRACT

INTRODUCTION: A combustible cigarette is a significant source of acrylamide, which is associated with numerous adverse effects. Electronic cigarette (e­cigarette) is an emerging smoking device with uncertain health effects. OBJECTIVES The aim of the study was to explore the exposure risks of acrylamide (AA) by measuring biomarkers, hemoglobinadducts of AA (HbAA) and of glycidamide (HbGA), in serum samples of the general adult population with regard to different smoking status (smoking vs nonsmoking). PATIENTS AND METHODS: This was a cross­sectional study of 1657 participants aged 18 years or older from the United States National Health and Nutrition Examination Survey (2015-2016) with recorded patient smoking status and concentrations of HbAA and HbGA. Multivariable linear regression models were used to analyze HbAA and HbGA in different smoking groups (nonsmokers, cigarettes smoking only, e­cigarettes smoking only, and dual users). RESULTS: Dual users had the highest HbAA and HbGA concentrations (median [interquartile range], 83.75 [53.28-128.25] pmol/gHb and 61.20 [40.73-89.78] pmol/gHb, respectively). There was a positive association between the use of e­cigarettes and the HbAA concentration. The standardized ß coefficients of HbAA and HbGA between the combustible cigarette smokers and nonsmokers in the fully adjusted model were 0.312 and 0.255 (both P <0.001) and those between the dualusers and nonsmokers in the fully adjusted model were 0.396 and 0.342, respectively (both P <0.001). CONCLUSIONS: E­cigarette users are exposed to AA, and users of both combustible and e­cigarettes have highest measures of HbAA and HbGA. Aside from the adverse effects caused by e­cigarette smoking, coexposure risks of combustible cigarettes and e­cigarettes need to be communicated to the public. Further studies are warranted to aid in health promotion.