Tobacco Biomarkers by Latino Heritage and Race, U.S., 2007-2014 National Health and Nutrition Examination Survey

Background: Tobacco biomarkers reflect smoking intensity and are used to assess cessation status. No study has evaluated variation by Latino heritage. Methods: Data from the 2007-2014 National Health and Nutrition Examination Survey were used to evaluate geometric mean concentrations of serum cotinine and urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), stratified by smoking status and race and ethnicity, and receiver operating characteristic curves estimated values to distinguish smokers from non-smokers by race and ethnicity and Latino heritage. Results: The sample (n=18,597) was 50.1% female, 16.6% Latino (58.6% Mexican, 10.4% Central American, 9.1% South American, 7.3% Puerto Rican, 3.5% Dominican, 2.7% Cuban, 8.4% Other Latinos, overall), 12.7% Black, and 70.7% White. Black non-smokers and smokers had the highest cotinine concentrations (0.1 ng/mL and 177.1 ng/mL) and among non-smokers, Black individuals had the highest NNAL concentrations (1.4 pg/mL). Latino smokers had the lowest cotinine (32.7 ng/mL) and NNAL (63.9 pg/mL) concentrations. Among Latino smokers, Puerto Rican individuals had higher concentrations of cotinine (100.0 ng/mL) and NNAL (136.4 pg/mL). Cotinine levels defining smoking (Black: 9.1 ng/mL, Latino: 0.9 ng/mL, White: 3.8 ng/mL) and NNAL (Black: 24.1 pg/mL, Latino: 5.7 pg/mL, White: 15.5 pg/mL) varied. Puerto Rican adults (cotinine: 8.5 ng/mL, NNAL: 17.2 pg/mL) had higher levels than Central American (cotinine: 1.0 ng/mL, NNAL: 5.5 pg/mL) and Mexican (cotinine: 0.9 ng/mL, NNAL: 6.0 pg/mL) adults. Conclusions: Cotinine and NNAL concentrations that define smoking differed by race and ethnicity and by heritage among Latinos, showing meaningful differences. Impact: Cessation interventions with biomarker validation need to consider Latino heritage.