Nicole L Nollen1, Matthew S Mayo2, Lauren Clark3, Lisa Sanderson Cox4, Samir S Khariwala5, Kim Pulvers6, Neal L Benowitz7, Jasjit S Ahluwalia8. 1. Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, United States. Electronic address: nnollen@kumc.edu. 2. Department of Biostatistics, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, United States. Electronic address: mmayo@kumc.edu. 3. Department of Biostatistics, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, United States. Electronic address: lclark5@kumc.edu. 4. Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, United States. Electronic address: lcox@kumc.edu. 5. Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, United States. Electronic address: khari001@umn.edu. 6. Department of Psychology, California State University San Marcos, 333 S. Twin Oaks Valley Road, San Marcos, CA, 92096, United States. Electronic address: kpulvers@csusm.edu. 7. Division of Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California, San Francisco School of Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, United States. Electronic address: neal.benowitz@ucsf.edu. 8. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, United States. Electronic address: jsahluwal@gmail.com.
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 1301ng/mg), cotinine (1063 versus 2125ng/mg), TNE (28 versus 57 nmol/mg) and NNAL (251 versus 343pg/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.
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 1301ng/mg), cotinine (1063 versus 2125ng/mg), TNE (28 versus 57 nmol/mg) and NNAL (251 versus 343pg/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.
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