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

Abstract

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 1,301 ng/mg), cotinine (1,063 versus 2,125 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.

Cluster analysis of urinary tobacco biomarkers among U.S. adults: Population Assessment of Tobacco and Health (PATH) biomarker study (2013–2014)

“…Tobacco toxicant exposure varies depending on type and number of products used (Goniewicz et al, 2017, Nollen et al, 2017. For example, in some studies, exclusive use of electronic nicotine delivery systems (electronic cigarettes, ECIGs) was associated with lower levels of exposure to toxicants including TSNAs, VOCs, and PAHs, relative to exclusive combustible cigarette smoking (Shahab et al, 2017, Goniewicz et al, 2018.…”

“…Previous studies evaluating the impact of tobacco product use on biomarkers of exposure used conventional techniques (Nollen et al, 2017, such as pairwise t-tests and analysis of variance, to examine group differences in geometric means of individual tobacco biomarkers. These conventional techniques are useful in describing how a particular biomarker may vary across groups.…”

Patterns and Correlates of Multiple Tobacco Product Use in the United States

“… 11 Another study reported that cigarette plus other tobacco product users had lower nicotine and carcinogen levels relative to exclusive cigarette smokers. 12 These conflicting results suggest that additional research is needed to better understand how the frequency of use and type of products that are being dual and poly used may impact associations with levels of biomarkers of nicotine and exposure to carcinogens.…”

Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review

“…Smoking topography determines the exposure to toxicants, which has disease implications. Individuals who use non-cigarette tobacco products (including individuals who use LCC) had lower urinary nicotine, cotinine, total nicotine equivalents, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) levels compared to individuals who smoke only cigarettes, despite reporting similar past 7-day tobacco product use [ 50 ]. The differences in smoking topography between the products could account for the differences in exposure, but smoking topography was not evaluated in this study.…”