Background Non-cigarette other tobacco products (OTP; e.g., cigarillos, little cigars) are typically used in combination with cigarettes, but limited data exists on the tobacco toxicant exposure profiles of dual cigarette-OTP (Cig-OTP) users. This study examined biomarkers of nicotine and carcinogen exposure in cigarette smokers who used or did not use OTP. Methods 111 Cig-OTP and 111 cigarette only (Cig Only) users who smoked equivalent cigarettes per day were matched on age (< 40, > = 40), race (African American, White), and gender. Participants reported past 7-day daily use of cigarettes and OTP and provided urine for nicotine, cotinine, total nicotine equivalents (TNE) and total NNAL concentrations. Results Cig-OTP users reported greater past 7-day tobacco use (15.9 versus 13.0 products/day, p < 0.01) but had significantly lower creatinine-normalized nicotine (606 versus 1301 ng/mg), cotinine (1063 versus 2125 ng/mg), TNE (28 versus 57 nmol/mg) and NNAL (251 versus 343 pg/mg) than Cig Only users (p < 0.001). Conclusions Cig-OTP users had lower levels of nicotine and metabolites of a lung carcinogen relative to Cig-Only users, but concentrations of toxicants among Cig-OTP users were still at levels that place smokers at great risk from the detrimental health effects of smoking. Impact Our study finds that nicotine and carcinogen exposure in Cig-OTP users are lower compared to cigarette only users, but still likely to be associated with substantial harm. A better understanding of why toxicant levels may be lower in Cig-OTP is an important area for future study.
Bibliographical noteFunding Information:
This work was supported by NIDA R01 DA031815 (NN) , NCATS UL1 TR 000001 (NN) , NCI P30 CA168524 (NN) , NIDCR K23 DE023572 (SK) , NCI and FDA Center for Tobacco Products P50 CA 180890 (NB) and NIDA P30 DA 012393 (NB). The funding sources had no role in the study design; collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. Appendix A
- Non-cigarette tobacco products
- Tobacco toxicants