Exposure to nicotine and tobacco-related chemicals among individuals reporting exclusive combustible cigarette use, exclusive e-cigarette use, and dual use of combustible cigarettes and e-cigarettes, 2018-2019
People who use both e-cigarettes and cigarettes were exposed to about the same amount of nicotine (measured by TNE-2) and tobacco-related chemicals (measured by NNAL, a known carcinogen) as those who smoke only cigarettes at similar smoking intensity. However, their exposure was significantly higher than that of people who use only e-cigarettes.
Footnote
Nicotine exposure is measured by nicotine equivalent-2 (TNE-2). Tobacco-related chemicals exposure is measured by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). CPD = Number of cigarettes smoked per day and ECIGS = Frequency of e-cigarette use per day. The bars represent adjusted geometric means and boxes represent the 95% confidence intervals of biomarkers of exposure based on weighted multivariate regression analysis. Shared letters indicate no statistically significant difference between groups (e.g., groups sharing “a” denotes no significant difference between groups; groups with different letters, “a” and “b,” denotes a significant difference between groups). nmol/mL = nanomole per milliliter, normalized for creatinine. pg/mg creatinine = picograms per milligram, normalized for creatinine.
Source
- Zheng Xue, Eva Orr-Souza, Nigar Nargis, Minal Patel, Tyler Nighbor, Nicotine and Toxicant Exposure among Individuals using both Combustible Cigarettes and E-cigarettes Based on Level of Product Use, Nicotine & Tobacco Research, Volume 27, Issue 9, September 2025, Pages 1591–1599, https://doi.org/10.1093/ntr/ntaf053