Racial disparities in biomarkers, tobacco cessation, and smoking relapse in association with electronic cigarette use

项目摘要 尽管美国在减少吸烟方面取得了巨大进展，但 少数族裔等亚群体之间的差距依然存在。戒烟可以极大地降低患病风险 疾病和早逝。然而，非洲裔美国人(AA)成功戒烟的可能性低于 是非西班牙裔白人，他们抽薄荷醇香烟的可能性也是白人的三倍。 吸烟导致肺癌的发病率在不同种族/民族之间有显著差异。 美国的群体和非裔美国人比水平较低的白人有更大的风险 吸烟的人。美国成年人的烟草使用情况正在发生变化，据估计，18岁的成年人中有4.5% 年及以上报告目前电子烟(EC)的使用情况。有证据表明，电子烟气雾剂 与易燃香烟相比，电子烟的毒性要小得多，但使用电子烟也可能会增加风险 对于曾经吸烟的人来说，重新吸食易燃香烟是必要的。生物标记物可以在 评估烟草产品对健康的潜在影响和研究发现，AA具有更高的 每吸一支香烟的血清可替宁，尿中TNE和NNAL的量高于白人。然而， 关于EC使用生物标志物结果的种族差异的证据很少，特别是是否使用以及使用什么 在很大程度上，它们与EC↔香烟中使用的各种EC设备、风味和过渡不同。这个 这项研究的首要目标是检查接触和毒物生物标志物的种族差异。 通过分析受限人群烟草与健康评估(PATH)与EC使用的关系 波1-4生物标志物数据。我们将把生物标记物数据与成人调查的路径联系起来，以确定- 通过使用不同的蒸发产品、口味和过渡，生物标志物的人和人之间的差异 在EC和可燃香烟中跨越不同浪潮(目标1)。我们将进一步利用机器学习 开发复合生物(生物标志物)-社会(社会-人口学)-心理(心理-社会因素)的算法 每个种族/民族的风险指数得分预测随后的戒烟和 重新吸烟，因为这两个结果代表着从公众到 从健康角度来看。这项研究在关注生物标志物的种族差异方面具有创新性， 全国纵向数据，并使用机器学习算法来预测未来的戒烟和 EC↔卷烟转型中的复发行为。这些目标的实现将为 最大化现有生物标本收藏的价值。这项R21研究的结果有望为 减少与烟草有关的发病率和死亡率并为未来的R01奠定基础的监管战略 将开发个性化干预策略的应用程序，其中包含生物标记物措施以 减少烟草使用方面的种族差异，改善健康状况。 1

Project Summary Although enormous progress has been made in reducing cigarette smoking in the United States, large disparities remain across subpopulations such as racial minorities. Quitting smoking can greatly reduce the risk of disease and early death. However, African Americans (AA) are less likely to quit smoking successfully than are non-Hispanic Whites, and they are also three times more likely to smoke menthol cigarettes than Whites. There is a remarkable variation in the incidence of lung cancer due to cigarette smoking among racial/ethnic groups in the United States, and African Americans have significantly greater risks than Whites at lower levels of smoking. Tobacco use landscape is changing among U.S. adults with an estimated 4.5% of adults aged 18 years and older reporting current use of electronic cigarettes (EC). Evidence suggests that e-cigarette aerosol is substantially less toxic than combustible cigarette smoking, but e-cigarette use may also post elevated risk for former smokers to relapse back to combustible cigarette smoking. Biomarker can play an important role in assessing the potential health effects of tobacco products and studies have found that AA have higher levels of serum cotinine per cigarette smoked, higher urinary amount of TNE and NNAL than Whites. However, evidence on the racial disparities of biomarker outcomes of EC use is scarce, especially whether and to what extent they are different from use of various EC devices, flavors, and transitions in EC ↔ cigarettes. The overarching goal of this study is to examine the racial disparities in biomarkers of exposure and toxicants in association with EC use by analyzing the restricted Population Assessment of Tobacco and Health (PATH) Wave 1-4 biomarker data. We will link the biomarker data with the PATH adult surveys to identify the between- person and within-person differences in biomarkers by use of different vaping products, flavors, and transition in EC and combustible cigarettes across different waves (Aim 1). We will further leverage machine learning algorithms to develop a composite bio (biomarker)-socio (socio-demographics) -psycho (psychosocial factors) risk index score for each racial/ethnic group to predict subsequent abstinence from cigarette smoking and relapse to cigarette smoking since these 2 outcomes represent the most meaningful transitions from a public health perspective. This study is innovative in its focus on racial disparities of biomarkers by leveraging the nationally longitudinal data, and on using machine learning algorithms to predict future smoking cessation and relapse behaviors in EC ↔ cigarette transition. Fulfillment of these aims will build a scientific base for maximizing the value of existing biospecimen collections. Findings from this R21 study are expected to inform regulatory strategies to reduce tobacco-related morbidity and mortality and set the stage for a future R01 application that will develop personalized intervention strategies that incorporate biomarker measures to reduce racial disparities in tobacco use and improve health outcomes. 1