Yonsei Med J.  2024 Dec;65(12):752-760. 10.3349/ymj.2023.0488.

Polycyclic Aromatic Hydrocarbons Mediate the Association between Tobacco Smoking and Alcohol Use Disorder

• Lee D
• Bae MJ
• Kim MJ
• Oh SS
• Park KS
• Lee CJ
• Park S
• Lee SK
• Koh SB
• Jung SJ
• Kim C
• Cho J

• KMID: 2561695
• DOI: http://doi.org/10.3349/ymj.2023.0488

Abstract

Purpose
Smoking is causally related to alcohol use disorder. Although polycyclic aromatic hydrocarbons (PAHs) are major neurotoxic pollutants in tobacco smoke, evidence is lacking on the role of PAHs in the relationship between smoking and alcohol use disorder. This study investigated the types of PAHs associated with smoking and whether exposure to those PAHs mediated the effect of smoking on alcohol use disorder.
Materials and Methods
A total of 968 male firefighters were analyzed. Smoking history and cumulative pack-years were obtained using self-reported questionnaires. Alcohol use disorder was defined using the Alcohol Use Disorder Identification Test. PAH exposure was assessed by urinary metabolites. Regression analyses were performed between exposure (smoking), outcome (alcohol use disorder), and mediator (PAH metabolites) variables. A mediation analysis was performed to test the indirect effect of PAH metabolites on the association between smoking and alcohol use disorder. All analyses were repeated for 770 participants who were followed up after 2 years, while alcohol use disorder was redefined from follow-up data ensuring the temporal sequence of the variables.
Results
Both 2-naphthol [β=0.78, 95% confidence interval (CI): 0.59–0.98] and 2-hydroxyfluorene (β=0.69, 95% CI: 0.56–0.82) were associated with smoking history. Furthermore, 2-naphthol and 2-hydroxyfluorene mediated the associations of smoking history (proportion mediated: 14.2%, 23.6% respectively) or cumulative pack-years (proportion mediated: 14.4%, 25.4% respectively) with alcohol use disorder. The results were consistent in longitudinal settings.
Conclusion
Exposure to PAHs mediated the association between tobacco smoking and alcohol use disorder. PAH exposure from tobacco may increase the risk of addictive disorders.

Keyword

Polycyclic aromatic hydrocarbons; tobacco; smoking; alcohol; alcoholism