Biomarkers of oxidative stress and inflammation in users of little cigars and other tobacco use categories from the Population Assessment of Tobacco and Health (PATH) Study

Introduction: The health effects of little cigars are not well-documented, especially at population level. We compared the levels of oxidative and inflammatory biomarkers in users of little cigars (LC) to current, never and other tobacco use categories using adult samples from the Population Assessment of Tobacco and Health (PATH) study. Methods: This is a cross-sectional study of adult samples (≥18 y) from selected waves of the nationally representative, longitudinal cohort PATH study. Levels of biomarkers of potential harm (BOPH) were analyzed using weighted general linear regression models, adjusted for covariates. The study periods include Wave 1 (2013-2014), Wave 4 (2016-2017), and Wave 5 (2018-2019). Exposures included tobacco use categories: exclusive little cigar users, exclusive cigarette users, little cigar and cigarette dual-users, ever other tobacco users, former tobacco users, and never smokers (reference). Outcomes and Measures were natural log-transformed mean levels of BOPH from Wave 1, including the oxidative stress marker urinary 8-isoprostane (F2PG2A), and the blood inflammation markers high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), fibrinogen, and soluble intercellular adhesion molecule-1 (sICAM-1). PATH Waves 4 and 5 included the urinary marker. Results: The majority of LC users were dual-users with cigarettes. Compared with never smokers and other tobacco use categories, dual LC users had the highest levels of biomarker concentrations (except for hs-CRP). The levels for dual LC users were higher than for exclusive cigarette smokers, although these differences were not significant. Conclusion and relevance: These findings indicate that LC do not lower tobacco harm potential compared to cigarettes.