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

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.