{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:57:49Z","timestamp":1791233869032,"version":"4.1.0"},"reference-count":64,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T00:00:00Z","timestamp":1692835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100018336","name":"National Institute for Health Research Health Protection Research Unit","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018336","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Health Security Agency"},{"DOI":"10.13039\/501100000761","name":"Imperial College London","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000761","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UK Society"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Smoking exposes people to high levels of Tobacco-Specific Nitrosamines (TSNAs), which include potent carcinogens. We systematically reviewed TSNA exposure between people smoking, vaping, and doing neither.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims and Methods<\/jats:title>\n                  <jats:p>Databases were searched between August 2017\u2013March 2022, using vaping-related terms. Peer-reviewed articles reporting TSNA metabolites (NNAL, NNN, NAB, and NAT) levels in bio-samples among adults exclusively vaping, exclusively smoking, or doing neither were included. Where possible, meta-analyses were conducted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 12 781 identified studies, 22 were included. TSNA levels fell substantially when people who smoke switched to vaping in longitudinal studies and were lower among people who vaped compared to smoked in cross-sectional studies. Levels of TSNAs were similar when comparing people who switched from smoking to vaping, to those who switched to no use of nicotine products, in longitudinal studies. Levels were higher among people who vaped compared to people who neither vaped nor smoked in cross-sectional studies.<\/jats:p>\n                  <jats:p>When comparing people who vaped to smoked: pooled urinary NNAL was 79% lower across three randomized controlled trials and 96% lower across three cross-sectional studies; pooled NAB was 87% lower and NAT 94% lower in two cross-sectional studies. When comparing people who neither vaped nor smoked to people who vaped, pooled urinary NNAL was 80%, NAB 26%, and NAT 27% lower in two cross-sectional studies. Other longitudinal data, and NNN levels could not be pooled.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Exposure to all TSNAs was lower among people who vaped compared to people who smoked. Levels were higher among people who vaped compared to people who neither vaped nor smoked.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>As well as TSNAs, there are many other toxicant exposures from smoking and vaping that can increase the risk of disease. However, it is likely that the reduced exposure to TSNAs from vaping relative to smoking reduces the risk to health of those who use vaping products to quit smoking. Future high-quality research, with robust definitions of exclusive vaping and smoking, and accounting for TSNAs half-lives, is needed to fully assess exposure to TSNAs among people who vape.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntad156","type":"journal-article","created":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T14:57:01Z","timestamp":1692716221000},"page":"257-269","source":"Crossref","is-referenced-by-count":37,"title":["Exposure to Tobacco-Specific Nitrosamines Among People Who Vape, Smoke, or do Neither: A Systematic Review and Meta-Analysis"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3987-4760","authenticated-orcid":false,"given":"Eve","family":"Taylor","sequence":"first","affiliation":[{"name":"Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King\u2019s College , London ,","place":["UK"]},{"name":"NIHR HPRU Environmental Exposures and Health , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6323-3659","authenticated-orcid":false,"given":"Erikas","family":"Simonavi\u010dius","sequence":"additional","affiliation":[{"name":"Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King\u2019s College , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"McNeill","sequence":"additional","affiliation":[{"name":"Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King\u2019s College , London ,","place":["UK"]},{"name":"NIHR HPRU Environmental Exposures and Health , London ,","place":["UK"]},{"name":"SPECTRUM Consortium , London ,","place":["UK"]},{"name":"NIHR ARC South \u00a0 London, Oxford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6503-6854","authenticated-orcid":false,"given":"Leonie S","family":"Brose","sequence":"additional","affiliation":[{"name":"Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King\u2019s College , London ,","place":["UK"]},{"name":"SPECTRUM Consortium , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9083-2131","authenticated-orcid":false,"given":"Katherine","family":"East","sequence":"additional","affiliation":[{"name":"Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King\u2019s College , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Marczylo","sequence":"additional","affiliation":[{"name":"NIHR HPRU Environmental Exposures and Health , London ,","place":["UK"]},{"name":"Radiation, Chemical and Environmental Hazards, UK Health Security Agency (UKHSA)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie","family":"Robson","sequence":"additional","affiliation":[{"name":"Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King\u2019s College , London ,","place":["UK"]},{"name":"NIHR HPRU Environmental Exposures and Health , London ,","place":["UK"]},{"name":"SPECTRUM Consortium , London ,","place":["UK"]},{"name":"NIHR ARC South \u00a0 London, Oxford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,8,24]]},"reference":[{"issue":"10292","key":"2024121116412107200_CIT0001","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"397","author":"Reitsma","year":"2021","journal-title":"Lancet"},{"key":"2024121116412107200_CIT0002","volume-title":"Statistics on Smoking, England 2020 - NHS Digital. 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