ArticleNicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco2025
Nicotine and Toxicant Exposure among Individuals using both Combustible Cigarettes and E-cigarettes Based on Level of Product Use.
Article in Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Sustained effects of reduced nicotine cigarettes and co-use of non-combusted alternative nicotine delivery systems: A one-month follow-up to a randomized clinical trial.Drug and alcohol dependence · 2026Trial
- Electronic cigarettes, smoking and lung cancer risk: some evidence about the continuum of harm.Nature reviews. Clinical oncology · 2026Article
- Examining current E-cigarette use among U.S. adults by groups stratified by demographic characteristics, 2014-2023.Preventive medicine reports · 2026Article
- Perception of e-cigarette as a harmful product delays initiation by two years among Mexican students aged 14-29 years.BMC pulmonary medicine · 2026Observational
- The association of parental use of new tobacco products and combustible cigarettes with nausea and vomiting in pregnancy: a cross-sectional study.Environmental health and preventive medicine · 2026Article
- Tobacco use trends in South Korea, 2013-2023: Persistent disparities and emerging challenges in a repeated cross-sectional study.Tobacco induced diseases · 2026Article
- Assessment of nicotine pharmacokinetics and abuse liability in randomized, crossover studies of Vuse Alto electronic nicotine delivery systems.Frontiers in pharmacology · 2026Article
- Estimating the likelihood of cigarette maintenance and dual use among people using e-cigarettes for cigarette cessation: Analysis of the Population Assessment of Tobacco and Health Study Waves 5 and 6.Addictive behaviors · 2025Article
- "Dual Use" of E-Cigarettes Alongside Cigarettes Encompasses Varied Behavior Patterns and Motives That Have Different Implications for Health and Smoking Cessation.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2025Article
- Cigarette Smoking-Induced Glucose Metabolic Reprogramming in Chronic Obstructive Pulmonary Disease: Mechanisms and Therapeutic Implications.International journal of chronic obstructive pulmonary disease · 2025Review
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
introductionDual use of combustible cigarettes and e-cigarettes is the most common multiple tobacco-use behavior in the United States, but its long-term health impact remains unclear. Biomarkers of exposure (BOE) can help identify potential health risks of dual use.
methodsWe analyzed data from 2,679 adult participants from Wave 5 of the Population Assessment on Tobacco and Health Study, a U.S. nationally representative study, including individuals reporting current exclusive cigarette use (n = 1,913), exclusive e-cigarette use (n = 316), and dual use (n = 450). Eight subgroups were created based on self-reported high/low (above/below mean) cigarettes per day (CPD) and days of e-cigarette use in past the 30 days (ECIG). Adjusted geometric mean concentrations were compared for total nicotine equivalents, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), three volatile organic compounds (VOCs), and heavy metals (lead and cadmium).
resultsIndividuals reporting dual use did not differ from those reporting exclusive cigarette use on CPD (13.1 vs. 11.8, respectively). Dual-use groups with high CPD had higher levels of NNAL and VOCs compared to those with low CPD (eg, NNAL for high CPD/high ECIG: 257.07 ng/mg creatinine vs. low CPD/high ECIG: 64.57 ng/mg creatinine, p < .001; high CPD/low ECIG: 312.02 ng/mg creatinine vs. low CPD/low ECIG: 144.11 ng/mg creatinine, p < .001). Cigarette use (dual or exclusive use) was generally associated with higher BOE than exclusive e-cigarette use, though metal exposure did not differ between groups.
conclusionsDual use and exclusive cigarette use are associated with higher toxicant exposure compared to exclusive e-cigarette use. IMPLICATIONS: In this population-based cross-sectional study, individuals reporting dual use appear to have nicotine and toxicant exposure at least at the same level as those using cigarettes alone and higher than exclusive e-cigarette use (except for metals). Given the adverse health consequences of dual use, including potential cancer risk, our findings highlight the need for clinicians and public health practitioners to increase awareness of the potential risks associated with dual use.
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