TUESDAY, April 22, 2025 (HealthDay News) — Both dual use of traditional and electronic cigarettes and exclusive cigarette use are associated with higher toxicant exposure than exclusive e-cigarette use, according to a study published online April 15 in Nicotine & Tobacco Research.

Zheng Xue, M.S.P.H., from the American Cancer Society in Atlanta, and colleagues analyzed data from 2,679 adult participants in wave 5 of the Population Assessment on Tobacco and Health Study to better understand the health impact of dual use.

The researchers found that the dual-use groups with high numbers of cigarettes per day had higher levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and volatile organic compounds versus those with low numbers of cigarettes per day (e.g., NNAL for high cigarettes per day/high e-cigarette: 257.07 ng/mg creatinine versus low cigarette/high e-cigarette: 64.57 ng/mg creatinine; high cigarette/low e-cigarette: 312.02 ng/mg creatinine versus low cigarette/low e-cigarette: 144.11 ng/mg creatinine). Compared with exclusive e-cigarette use, cigarette use (dual or exclusive use) was generally associated with higher biomarkers of exposure, though metal exposure was similar between the groups.

“Clinicians and public health practitioners should increase awareness that dual use of cigarettes and e-cigarettes is not safe and may present similar risks as continuing to smoke cigarettes, especially if one does not reduce the number of cigarettes smoked,” Xue said in a statement.

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