{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T07:13:28Z","timestamp":1792826008431,"version":"4.5.0"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Limited data are available for how biomarkers of tobacco exposure (BOE) change when cigarette smokers transition to using electronic nicotine delivery systems (ENDS). Using biomarker data from Waves 1 (2013\u20132014) and 2 (2014\u20132015) of the PATH Study, we examined how mean BOE concentrations, including metabolites of nicotine, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOC) and metals, changed when 2475 adult smokers transitioned to using ENDS or quit tobacco products. Exclusive smokers who transitioned to dual use had a significant decrease in NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), but not nicotine metabolites, most PAHs, metals, or VOCs. Exclusive smokers who became dual users had significant reductions in total nicotine equivalents, NNAL, and 2CyEMA (acrylonitrile metabolite), but only in those who reduced cigarettes per day (CPD) by &gt;=50%. Smokers who transitioned to exclusive ENDS use had significant reductions in most TSNAs, PAHs, and VOCs; however, nicotine metabolites did not decrease in dual users who became exclusive ENDS users. Smokers who quit tobacco use had significant decreases in nicotine metabolites, all TSNAs, most PAHs, and most VOCs. Cigarette smokers who became dual users did not experience significant reductions in most BOEs. Reductions were impacted by changes in CPD. However, transitioning from smoking to no tobacco or exclusive ENDS use was associated with reduced exposure to most BOEs measured. Future analyses could incorporate additional waves of PATH data and examine changes in biomarker exposure by ENDS device type and CPD.<\/jats:p>","DOI":"10.3390\/ijerph19031462","type":"journal-article","created":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T21:59:55Z","timestamp":1643320795000},"page":"1462","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Changes in Biomarkers of Tobacco Exposure among Cigarette Smokers Transitioning to ENDS Use: The Population Assessment of Tobacco and Health Study, 2013\u20132015"],"prefix":"10.3390","volume":"19","author":[{"given":"Gabriella M.","family":"Anic","sequence":"first","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian L.","family":"Rostron","sequence":"additional","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoda T.","family":"Hammad","sequence":"additional","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana M.","family":"van Bemmel","sequence":"additional","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arseima Y.","family":"Del Valle-Pinero","sequence":"additional","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol H.","family":"Christensen","sequence":"additional","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gladys","family":"Erives","sequence":"additional","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2889-0039","authenticated-orcid":false,"given":"Lisa M.","family":"Faulcon","sequence":"additional","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4788-8169","authenticated-orcid":false,"given":"Benjamin C.","family":"Blount","sequence":"additional","affiliation":[{"name":"Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5089-0855","authenticated-orcid":false,"given":"Yuesong","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia M.","family":"Calafat","sequence":"additional","affiliation":[{"name":"Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8278-0095","authenticated-orcid":false,"given":"Heather L.","family":"Kimmel","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colm D.","family":"Everard","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3108-5118","authenticated-orcid":false,"given":"Wilson M.","family":"Compton","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn C.","family":"Edwards","sequence":"additional","affiliation":[{"name":"Behavioral Health and Health Policy, Westat, Rockville, MD 20850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6748-3068","authenticated-orcid":false,"given":"Maciej L.","family":"Goniewicz","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binnian","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hyland","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy K.","family":"Hatsukami","sequence":"additional","affiliation":[{"name":"Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen S.","family":"Hecht","sequence":"additional","affiliation":[{"name":"Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond S.","family":"Niaura","sequence":"additional","affiliation":[{"name":"College of Global Public Health, New York University, New York, NY 10003, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolette","family":"Borek","sequence":"additional","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget K.","family":"Ambrose","sequence":"additional","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy M.","family":"Chang","sequence":"additional","affiliation":[{"name":"Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1158\/1055-9965.EPI-16-0675","article-title":"Biomarkers of tobacco exposure: Summary of an FDA-sponsored public workshop","volume":"26","author":"Chang","year":"2017","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1136\/tobaccocontrol-2012-050859","article-title":"Levels of selected carcinogens and toxicants in vapour from electronic cigarettes","volume":"23","author":"Goniewicz","year":"2014","journal-title":"Tob. Control"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"De Jes\u00fas, V.R., Bhandari, D., Zhang, L., Reese, C., Capella, K., Tevis, D., Zhu, W., Del Valle-Pinero, A.Y., Lagaud, G., and Chang, J.T. (2020). Urinary biomarkers of exposure to volatile organic compounds from the Population Assessment of Tobacco and Health Study wave 1 (2013-2014). Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155408"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1093\/ntr\/ntz021","article-title":"Characterization of volatile organic compound metabolites in cigarette smokers, electronic nicotine device users, dual users, and nonusers of tobacco","volume":"22","author":"Keith","year":"2020","journal-title":"Nicotine Tob. Res."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Smith, D.M., Shahab, L., Blount, B.C., Gawron, M., Kosminder, L., Sobczak, A., Xia, B., Sosnoff, C.S., and Goniewicz, M.L. (2020). Differences in exposure to nicotine, tobacco-specific nitrosamines, and volatile organic compounds among electronic cigarette users, tobacco smokers, and dual users from three countries. Toxics, 8.","DOI":"10.3390\/toxics8040088"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e185937","DOI":"10.1001\/jamanetworkopen.2018.5937","article-title":"Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes","volume":"1","author":"Goniewicz","year":"2018","journal-title":"JAMA Netw. Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1093\/ntr\/nty089","article-title":"Comparison of urinary biomarkers of exposure in humans using electronic cigarettes, combustible cigarettes, and smokeless tobacco","volume":"21","author":"Lorkiewicz","year":"2019","journal-title":"Nicotine Tob. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1093\/ntr\/nty231","article-title":"Dual users compared to smokers: Demographics, dependence, and biomarkers","volume":"21","author":"Piper","year":"2019","journal-title":"Nicotine Tob. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e20173557","DOI":"10.1542\/peds.2017-3557","article-title":"Adolescent exposure to toxic volatile organic chemicals from e-cigarettes","volume":"141","author":"Rubinstein","year":"2018","journal-title":"Pediatrics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1093\/ntr\/ntu218","article-title":"Evaluation of toxicant and carcinogen metabolites in the urine of e-cigarette users versus cigarette smokers","volume":"17","author":"Hecht","year":"2015","journal-title":"Nicotine Tob. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"390","DOI":"10.7326\/M16-1107","article-title":"Nicotine, carcinogen, and toxin exposure in long-term e-cigarette and nicotine replacement therapy users: A cross-sectional study","volume":"166","author":"Shahab","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1093\/ntr\/nty174","article-title":"Biomarkers of exposure among \u201cdual users\u201d of tobacco cigarettes and electronic cigarettes in Canada","volume":"21","author":"Czoli","year":"2019","journal-title":"Nicotine Tob. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1093\/ntr\/ntw160","article-title":"Exposure to nicotine and selected toxicants in cigarette smokers who switched to electronic cigarettes: A longitudinal within-subjects observational study","volume":"19","author":"Goniewicz","year":"2017","journal-title":"Nicotine Tob. Res."},{"key":"ref_14","first-page":"206","article-title":"Tobacco consumption and toxicant exposure of cigarette smokers using electronic cigarettes","volume":"20","author":"Pulvers","year":"2018","journal-title":"Nicotine Tob. Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"D\u2019Ruiz, C.D., Graff, D.W., and Robinson, E. (2016). Reductions in biomarkers of exposure, impacts on smoking urge and assessment of product use and tolerability in adult smokers following partial or complete substitution of cigarettes with electronic cigarettes. BMC Public Health, 16.","DOI":"10.1186\/s12889-016-3236-1"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1158\/1940-6207.CAPR-15-0058","article-title":"Effects of switching to electronic cigarettes with and without concurrent smoking on exposure to nicotine, carbon monoxide, and acrolein","volume":"8","author":"McRobbie","year":"2015","journal-title":"Cancer Prev. Res."},{"key":"ref_17","first-page":"443","article-title":"Reductions in biomarkers of exposure (BoE) to harmful or potentially harmful constituents (HPHCs) following partial or complete substitution of cigarettes with electronic cigarettes in adult smokers","volume":"26","author":"Graff","year":"2016","journal-title":"Toxicol. Mech. Methods"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1136\/tobaccocontrol-2016-052934","article-title":"Design and methods of the Population Assessment of Tobacco and Health (PATH) Study","volume":"26","author":"Hyland","year":"2017","journal-title":"Tob. Control"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4094","DOI":"10.1002\/sim.3222","article-title":"Multi-rule quality control for the age-related eye disease study","volume":"27","author":"Caudill","year":"2008","journal-title":"Stat. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1093\/ntr\/ntaa156","article-title":"Cigarette Smoking Reduction and Health Risks: A Systematic Review and Meta-analysis","volume":"23","author":"Chang","year":"2021","journal-title":"Nicotine Tob. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1093\/ntr\/ntaa038","article-title":"Changes in cigarettes per day and biomarkers of exposure among US adult smokers in the Population Assessment of Tobacco and Health Study waves 1 and 2 (2013-2015)","volume":"22","author":"Rostron","year":"2020","journal-title":"Nicotine Tob. Res."},{"key":"ref_22","unstructured":"International Agency for Research on Cancer (2004). Tobacco Smoke and Involuntary Smoking, IARC."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1080\/1047322X.1990.10389587","article-title":"Estimation of average concentration in the presence of nondetectable values","volume":"5","author":"Hornung","year":"1990","journal-title":"Appl. Occup. Environ. Hyg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1111\/add.14931","article-title":"Twenty-four-hour subjective and pharmacological effects of ad-libitum electronic and combustible cigarette use among dual users","volume":"115","author":"Harvanko","year":"2020","journal-title":"Addiction"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1111\/add.14884","article-title":"Differences in nicotine intake and effects from electronic and combustible cigarettes among dual users","volume":"115","author":"Nardone","year":"2020","journal-title":"Addiction"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1136\/tobaccocontrol-2018-054382","article-title":"Vaping versus JUULing: How the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market","volume":"28","author":"Huang","year":"2019","journal-title":"Tob. Control"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1001\/jama.2018.10488","article-title":"Electronic cigarette sales in the United States, 2013\u20132017","volume":"320","author":"King","year":"2018","journal-title":"JAMA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e20183531","DOI":"10.1542\/peds.2018-3531","article-title":"Self-reported use of tobacco, e-cigarettes, and marijuana versus urinary biomarkers","volume":"143","author":"Boykan","year":"2019","journal-title":"Pediatrics"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1462\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:09:28Z","timestamp":1760134168000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1462"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,27]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["ijerph19031462"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19031462","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,27]]}}}