NNAL exposure by race and menthol cigarette use among U.S. smokers

Nicotine Tob Res. 2013 May;15(5):950-6. doi: 10.1093/ntr/nts223. Epub 2012 Oct 22.


Introduction: Researchers have recently suggested that nicotine and carcinogen exposure as measured by biomarkers such as cotinine and NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) does not vary with cigarettes smoked per day (CPD) among Black smokers. Researchers have also suggested that nicotine exposure does not differ between menthol and nonmenthol smokers. In this study, we examine NNAL exposure for U.S. smokers by race, CPD, and menthol cigarette use.

Methods: We analyzed urinary NNAL concentrations for more than 1500 everyday smokers participating in the National Health and Nutrition Examination Survey from 2007-2010. For purposes of comparison, we also analyzed serum cotinine concentrations for these smokers. We used linear regression analysis to estimate mean biomarker concentrations by CPD and race/ethnicity group and to examine the association between biomarker concentrations and menthol cigarette use by race/ethnicity group, controlling for other demographic and smoking characteristics.

Results: Biomarker concentrations increased with CPD for White, Black, and Hispanic smokers although NNAL concentrations leveled off for Black smokers at lower CPD levels compared with other smokers. Mean NNAL concentrations were lower among menthol smokers compared with nonmenthol smokers among smokers overall (β = -0.165, p = .032) and White smokers (β = -0.207, p = .048).

Conclusions: We find evidence in national health survey data that nicotine and carcinogen exposure generally increases with CPD across race/ethnicity groups although the pattern of NNAL exposure differs by race/ethnicity group at high CPD levels. We also find evidence of differences in NNAL exposure for menthol smokers compared with nonmenthol smokers among smokers overall and White smokers.

MeSH terms

  • Adult
  • African Continental Ancestry Group / statistics & numerical data
  • Biomarkers / analysis
  • Carcinogens / metabolism*
  • Cotinine / blood*
  • Demography
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Male
  • Menthol
  • Middle Aged
  • Nicotine / metabolism*
  • Nitrosamines / metabolism*
  • Nitrosamines / urine
  • Nutrition Surveys
  • Pyridines / metabolism*
  • Pyridines / urine
  • Smoking / epidemiology*
  • Smoking / ethnology
  • Tobacco Products
  • United States / epidemiology


  • Biomarkers
  • Carcinogens
  • Nitrosamines
  • Pyridines
  • Menthol
  • Nicotine
  • 4-(methylnitrosamino)-1-(3-pyridyl)-1-butan-1-ol
  • Cotinine