Have a personal or library account? Click to login
Wastewater-Based Epidemiology (WBE): Potential Application for Assessing the Use of Conventional and New Generation Tobacco and Nicotine Products Cover

Wastewater-Based Epidemiology (WBE): Potential Application for Assessing the Use of Conventional and New Generation Tobacco and Nicotine Products

Contributions to Tobacco & Nicotine Research
Volume 34 (2025): Issue 2 (May 2025)
By: Gerhard Scherer,  Nikola Pluym and  Max Scherer  
Open Access
|May 2025

Figures & Tables

Figure 1.

Flow chart on identification, exclusion and inclusion of studies considered in this systematic review on WBE studies of tobacco/nicotine product use according to the PRISMA guidelines (136).
Flow chart on identification, exclusion and inclusion of studies considered in this systematic review on WBE studies of tobacco/nicotine product use according to the PRISMA guidelines (136).

Figure 2.

Mean WBE-derived nicotine consumption in 4 continents. Error bars represent the variation between 5% and 95% quantiles.
Mean WBE-derived nicotine consumption in 4 continents. Error bars represent the variation between 5% and 95% quantiles.

Figure 3.

Monte Carlo simulations (MCSs) of Scenario 1 and 2 over 10 years for WW concentrations of cotinine (top), AB (middle) and 2CyEMA (bottom).
Monte Carlo simulations (MCSs) of Scenario 1 and 2 over 10 years for WW concentrations of cotinine (top), AB (middle) and 2CyEMA (bottom).

Figure 4.

Monte Carlo simulations of Scenario 1 and 2 over 10 years for the WW concentration ratios AB/cotinine (top) and 2CyEMA/cotinine (bottom).
Monte Carlo simulations of Scenario 1 and 2 over 10 years for the WW concentration ratios AB/cotinine (top) and 2CyEMA/cotinine (bottom).

Studies investigating long-term time trends for WBE-assessed tobacco/nicotine consumption_

StudyCountryPeriod (years)Time trends in nicotine consumption observedComparison to sales/surveysInterpretation by authors
Mackie et al. 2019 (53)Australia2010–2017 (7 years)
  • -

    Decrease by 25%

  • -

    ~3% decrease per year

  • -

    Similar decrease in sales, but at lower level (reasons, see right cell)

  • -

    Self-reports too low

  • -

    Illicit tobacco use incompletely assessed

  • -

    Other Nic sources (NRT, EC) unimportant

Bade et al. 2020 (102)Australia2015–2019 (4 years)
  • -

    Cot decreased by 3.3%

  • -

    AB decreased by 30%

  • -

    None reported
  • -

    Reason for difference between change in Cot and AB: Increased use of NRT

  • -

    EC played no role in Australia at that time

Garcia-Lor et al. 2020 (18)Italy2013–2015 (2 years)
  • -

    Decrease in North and South Italy

  • -

    Unchanged in Central Italy

  • -

    In fair agreement with survey data on cigarette consumption
  • -

    Success of tobacco control policies

  • -

    Other Nic sources (NRT, EC, snus) considered to be insignificant

Zheng et al. 2020 (63)China2012–2017 (5 years)
  • -

    Decrease of Cot in WW by 2.1 % per year

  • -

    AB decreased by 3.0 % per year

  • -

    Tobacco tax and survey data: decreased by ~4%
  • -

    Faster decrease in tobacco than in nicotine consumption: other Nic sources play a role

  • -

    Market share of Nic patches increased from 0.47 to 0.95%

Gao et al. 2020 (31)China2014–2016 (2 years)
  • -

    Cotinine relatively consistent over time

  • -

    In agreement with WHO statistics, surveys and sales data for CC

  • -

    NRT and EC market shares were negligible in China at that time

Boogaerts et al. 2021 (25)Lithuania2018–2019 (1 year)
  • -

    Stable in Lithuania (whole country)

  • -

    Unexplained decrease of 25% in the city of Kaunas
  • -

    Cig sales over time also stable but by 35% lower (various reasons, see right cell)
  • -

    Outdated sales data (from 2016)

  • -

    Other Nic sources play a role (NRT, EC, pipes)

  • -

    Illegal tobacco products in circulation

  • -

    Disposed cig butts (chemical conversion to Cot and OH-Cot)

Campo et al. 2023 (137)Spain2018–2020 (2 years)*
  • -

    Decrease by 65% (!) during the study period

* Contradictory statements for study period: 2014–2017 in the text
  • -

    Unfortunately, the authors gave no explanation or interpretation of their results

Thai et al. 2023 (138)Australia2017–2020 (3 years)
  • -

    Decrease 2017-2019: 5%/a (slope: −0.035)

  • -

    Increase 2019-2020

  • -

    Stronger decrease in sales (slope: −0.12)
  • -

    Increase in NRT use 2017–2020 (estimated contribution to Nic consumption: < 10%)

  • -

    EC use of less importance (prohibited in Australia)

Wang et al. 2024 (59)Australia2013–2021 (8 years)
  • -

    First (until 2018) decrease (−18%), then increase (+40%)

  • -

    AB: First strong (−21%), then slight (−10%) decrease

  • -

    Tobacco sales show similar pattern to AB, but at lower consumption levels
  • -

    Illicit tobacco use suggested

  • -

    Non-tobacco nicotine use (NRT, ECs, etc.) suggested to increase after 2018

Conditions and assumptions applied in two scenarios of Monte Carlo Simulations (MCSs) for WW concentrations of cotinine (Cot), anabasine (AB) and 2-cyanoethyl mercapturic acid (2CyEMA) of a hypothetical WWTP serving a large city_

Input variablesMean value (unit)UncertaintyDistributionAssumptions and Rationale
Pop: Catchment population size of the WWTP150000015%Normal
  • -

    Stable over the study period of 10 years

  • -

    In other studies normal distribution of Pop with uncertainties of 10 (20), 15 (36) and 20% (40) were assumed

F: Flow rate of WWTP350,000,000 (L/d)15%Normal
  • -

    In other studies normal distribution of F with uncertainties of 10 (20, 166) and 20% (40) were assumed

  • -

    Reported F values for comparable Pops were in the same range (166)

UERBM: Daily urinary excretion rates of the BMsIn the rows below, the group- and BM-specific UER values are listed. These are derived from a controlled study with 10 subjects per group (159, 160, 169). As uncertainty, the relative standard errors (RSE) are provided. Specifics are indicated in the last column. Most distributions are between normal and lognormal. As a first approach, normal distributions are assumed. It is assumed that UERs are valid for steady-state conditions.
UERCotCC5.736 (mg/d)18%Normal
UERCotEC2.309 (mg/d)23%NormalUECot values were obtained from reported nicotine equivalents (Nic+10) (160) assuming that Nic+10 represents 95% of the absorbed nicotine dose and that 32.3% are excreted as Cot (free + conjugated) (50)
UERCotHTP4.240 (mg/d)17%Normal
UERCotONP6.625 (mg/d)18%NormalNo values for UERCotONP are available. It is assumed that the UER for ONP users is between those of CC and OT users.
UERCotNRT2.220 (mg/d)31%NormalThere were mainly nicotine gum users in the controlled study (160)
UERCotOT7.174 (mg/d)19%NormalThere were mainly snus users in the controlled study (160)
UERCotNU0.020 (mg/d)47%Normal
UERABCC14.6 (µg/d)21%NormalUERAB values were obtained from the published controlled study (169)
UERABEC0.50 (µg/d)25%NormalOutliers were excluded
UERABHTP2.51 (µg/d)22%Normal
UERABONP0.38 (µg/d)32%NormalNo data for ONP were available, the UERAB values for NRT users were applied
UERABNRT0.38 (µg/d)32%Normal
UERABOT22.2 (µg/d)50%NormalThere were mainly snus users in the controlled study (160)
UERABNU0.21 (mg/d)12%Normal
UER2CyEMACC186.4 (µg/d)18%NormalUER2CyEMA values were obtained from the published controlled study (159)
UER2CyEMAEC2.52 (µg/d)39%Normal
UER2CyEMAHTP14.00 (µg/d)28%Normal
UER2CyEMAONP0.58 (µg/d)6%Normal
UER2CyEMANRT0.58 (µg/d)6%NormalDue to obvious outliers, UER2CyEMA values of NU were used
UER2CyEMAOT0.58 (µg/d)6%Normal
UER2CyEMANU0.58 (µg/d)6%Normal
UER for DU (only in Scenario 2)It is assumed that DUs (simultaneous use of CCs and ECs) exhibit the same daily nicotine uptake as CCs do and would have the same UERCot. For a 20 CPD (cigarettes per day) smoker this could be achieved by reducing the consumption to 10 CPD (= 50% reduction) and simultaneously carry out 25 EC sessions per day. UERABDU and UER2CyEMADU were therefore reduced by 50% compared to the corresponding UER levels for CC-only users.

Population-normalized consumption of nicotine (PNC, mg/d/1000 persons) based on Cot or Cot + OH-Cot levels in WW reported in 170 data sets from 60 publications_

AllEuropeAmericaAsiaAustralia/New Zealand
N (data sets)170107182025
Mean27692947254320282763
SD18661428111215433480
Median23942650267314421800
5% Percentile8071227189564571
95% Percentile56335673394042628588
Min8666916244086
Max1700070564433703417000
DOI: https://doi.org/10.2478/cttr-2025-0007 | Journal eISSN: 2719-9509
Journal RSS Feed
Language: English
Page range: 59 - 83
Submitted on: Dec 18, 2024
Accepted on: Apr 7, 2025
Published on: May 16, 2025
Published by: Institut für Tabakforschung GmbH
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
Wastewater-based epidemiology,
new generation tobacco products,
new generation nicotine products,
combustible cigarettes,
tobacco harm reduction,
Monte Carlo simulation
Related subjects:
General interest,
Life sciences,
Life sciences, other,
Physics,
Physics, other

© 2025 Gerhard Scherer, Nikola Pluym, Max Scherer, published by Institut für Tabakforschung GmbH
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License.

Previous articleVolume 34 (2025): Issue 2 (May 2025)Next article