Nicotine and heavy metal exposure in recent exclusive cigar users: Insights from the U.S. population assessment of tobacco and health study wave 7 (2022−2023)

Objective Population-level biomarker data among recent exclusive cigar users remain limited. We examined nicotine exposure (urinary TNE-2) and heavy metal biomarkers among recent exclusive cigar users, cigarette users and never tobacco users using PATH Wave 7 (2022–2023) data. Methods We compared geometric mean urinary cadmium, lead, uranium, cotinine, and TNE-2 among exclusive cigar users ( n = 79), exclusive cigarette users ( n = 1192), and never tobacco users ( n = 691). Users were classified by last use as Today (same-day biospecimen collection), or Yesterday/Day Before (1–2 days earlier). Survey-weighted regression assessed unadjusted and covariate-adjusted group differences. Results Cigar users were predominantly male, older (≥55 years), non-Hispanic Black, and had higher prevalence of cardiovascular conditions/risk factors than cigarette users ( p < 0.05). Compared with never users, same-day cigar users had higher cadmium, uranium, cotinine and TNE-2 (all p < 0.01). Cadmium and lead levels were comparable between same-day cigar and cigarette users (p = ns), whereas uranium was higher among cigar users ( p < 0.05). Adjusted models showed higher cadmium, uranium, and nicotine biomarkers in same-day cigar users, and lead and nicotine biomarkers in yesterday/day-before cigar users, versus never users. Conclusions Despite lower nicotine biomarkers, same-day cigar users had cadmium and lead concentrations similar to same-day cigarette smoking, while uranium was higher unadjusted. These findings support cigar regulation and cessation efforts.