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Exposure to Tobacco Specific Nitrosamines among people who vape, smoke or do neither. A Systematic Review and Meta Analysis Abstract Background: 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. Methods: Databases were searched between August 2017-March 2022, using vaping related terms. Peer-reviewed articles reporting TSNA metabolites (NNAL,NNN,NAB,NAT) levels in bio-samples among adults exclusively vaping, exclusively smoking, or doing neither were included. Where possible, meta-analyses were conducted. Results: 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.When comparing people who vaped to smoked: pooled urinary NNAL was 79% lower across three randomised 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. Conclusions: 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. Time:2023 Nov 11

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Urgent action is needed to control e-cigarettes to protect children, as well as non-smokers and minimize 

health harms to the population. E-cigarettes as consumer products are not shown to be effective for 

quitting tobacco use at the population level. Instead, alarming evidence has emerged on adverse 

population health effects.

E-cigarettes have been allowed on the open market and aggressively marketed to young people. 

Thirty-four countries ban the sale of e-cigarettes, 88 countries have no minimum age at which 

e-cigarettes can be bought and 74 countries have no regulations in place for these harmful 

products.

“Kids are being recruited and trapped at an early age to use e-cigarettes and may get hooked 

to nicotine," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "I urge countries to

 implement strict measures to prevent uptake to protect their citizens, especially their children

and young people.”

 

01/01/2024

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