Overview of Analysis of Chemicals Found in Cigarette Smoke in a Special Sample of U.S. Adults, NHANES 2011-2016
Background
The Family Smoking Prevention and Tobacco Control Act of 2009 gave the Food and Drug Administration regulatory authority over tobacco products. In Section 907(a)[1], the Act states that the Secretary of Health and Human Services will establish tobacco product standards. These product standards will include provisions for the testing of tobacco products. To determine the effectiveness of these product standards, surveillance systems need to be in place before the standards are enacted to determine their impact on exposure among people who continue to use tobacco products. NHANES is an ideal source of samples of clinical specimens from humans for assessing smokers in multiple locations around the country. NHANES will provide a robust dataset for identifying changes in exposure of smokers that follow enactment of tobacco product standards.
Special Sample in NHANES
Beginning with NHANES 2011-2012, a Special Sample was selected for measurement of certain groups of chemicals associated with tobacco smoke exposure. The Special Sample consists of: 1) a nationally representative sample of adults; and 2) all adults who reported being current cigarette smokers. For this sample, adults were defined as ages 20 years and older in 2011-2012 and 18 years and older beginning in 2013.
Cigarette smokers were defined by their responses to the Smoking-Cigarette Use (SMQ_G) questionnaire: “Have you smoked at least 100 cigarettes in your life?” (SMQ020=1), and then, confirmed that they smoke every day (SMQ040=1) or some days (SMQ040=2). The nonsmoker category was comprised of the remaining adults in the Special Sample who were not categorized as smokers of any tobacco products. Excluded from the nonsmoker category was any adult who reported that they used any of the following non-cigarette tobacco products: cigars; pipes; chewing tobacco; snuff; or nicotine patch, gum or other replacement product. This resulted in exclusion of 3.54% (weighted) from the total sample for NHANES 2011-2012, 4.85% (weighted) in NHANES 2013-2014, and 4.18% (weighted) in NHANES 2015-2016.
Too few adults reported use of non-cigarette tobacco products to allow separate categories for these products. We did not use serum cotinine concentrations to distinguish between smokers and nonsmokers because not all adults in the sample had results: for example, 4.17% (weighted) and 3.68% (weighted) of the 2011-2012 and 2013-2014 samples, respectively, were missing serum cotinine results. In 2013-2014 and 2015-2016 four additional non-cigarette tobacco products were included in the NHANES questionnaire, but in order to maintain consistency across surveys, users of these products were not included in the nonsmoker category in the later surveys. If these products had been included in the later surveys, the weighted percentages of subjects in the non-smoker category would have changed by only 1.3% and 2.0%, respectively, for the 2013-2014 and 2015-2016 surveys; and the smoker category would have changed by only 0.04% and 0.24%, respectively.
Results are displayed separately for adult cigarette smokers and nonsmokers. Each data table shows geometric mean and selected percentiles by three categories: total, age group (20-49 or 18-49 years, 50 years and older), and sex (male, female). Racial/ethnic categories are not presented because the sample sizes were too small to yield reliable estimates in one or more of the categories.
[1] https://www.fda.gov/tobacco-products/rules-regulations-and-guidance/section-907-federal-food-drug-and-cosmetic-act-tobacco-product-standards