Tobacco toxicant exposure in cigarette smokers who use or do not use other tobacco products

Nicole L. Nollen, Matthew S. Mayo, Lauren Clark, Lisa Sanderson Cox, Samir S. Khariwala, Kim Pulvers, Neal L. Benowitz, Jasjit S. Ahluwalia

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)330-336
Number of pages7
JournalDrug and alcohol dependence
StatePublished - Oct 1 2017

Bibliographical note

Funding 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

Publisher Copyright:
© 2017 Elsevier B.V.


  • Biomarkers
  • Cigarettes
  • Non-cigarette tobacco products
  • Tobacco toxicants


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