Chinese “Herbal” Cigarettes Are as Carcinogenic and Addictive as Regular Cigarettes

Quan Gan; Jie Yang; Gonghuan Yang; Maciej Goniewicz; Neal L. Benowitz; Stanton A. Glantz

doi:10.1158/1055-9965.EPI-09-0620

DOI: 10.1158/1055-9965.EPI-09-0620 Published December 2009

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Figure 1.
There is no significant difference in the levels of cotinine and trans-3′-hydroxycotinine (normalized by creatinine to account for differences in urine concentration) between herbal smokers and regular smokers.
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Figure 2.
There is no significant difference in PAHs between herbal smokers and regular smokers.
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Figure 3.
There is no significant difference in NNAL between herbal smokers and regular smokers.
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Figure 4.
Scatter plots of cotinine versus total NNAL (r_s = 0.535, P < 0.001) and total PAHs (r_s = 0.668, P < 0.001) show that higher levels of cotinine are associated with higher levels of carcinogens.

Tables

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Table 1.

Demographic characteristics of the subjects

	Smokers of herbal cigarettes	Smokers of regular cigarettes	P
Sample size, n	135	143
Age (y), median (IQR)	48 (38-56)	48 (39-54)	0.567*
Cigarettes per day on average
Median (IQR)	20 (15-20)	20 (15-20)	0.962*
Education, n (%)
Junior high school and below	70 (52)	77 (54)
Secondary technical school	41 (30)	42 (29)
Junior college	20 (15)	18 (12)
College and above	4 (3)	6 (4)	0.621^†
Employment status, n (%)
Employed	81 (60)	94 (66)
Unemployed	54 (40)	49 (34)	0.979^†
Monthly income (yuan), n (%)
<500	19 (14)	30 (21)
500-999	40 (30)	41 (29)
1,000-1,999	58 (43)	52 (36)
2,000-4,999	17 (12)	18 (12)
≥5,000	1 (1)	2 (1)	0.567^†
Change in daily consumption after switching from regular cigarettes (14-15 mg) to herbal cigarettes, %
Increased daily consumption	47	—
Decreased daily consumption	30	—
No change in daily consumption	23	—
Cotinine and trans-3′-hydroxycotinine, median (IQR)
Sample size	134	142
Cotinine (μg/mg creatinine)	12.8 (5.57-22.2)	14.3 (8.00-23.7)	0.169*
Cotinine (ng/mL)	1,142 (476-2,175)	1,538 (666-2,463)	0.047*
trans-3′-Hydroxycotinine (μg/mg creatinine)	33.0 (9.88-61.4)	41.1 (15.6-65.7)	0.146*
trans-3′-Hydroxycotinine (ng/mL)	2,799 (732-6,346)	3,732 (1,518-7,230)	0.058*
Total PAHs and total NNAL, median (IQR)
Sample size	44	49
Total PAHs (pmol/mg creatinine)	172 (87.1-245)	159 (126-225)	0.554*
Total NNAL (pmol/mg creatinine)	0.454 (0.256-0.862)	0.410 (0.291-0.649)	0.171*

↵*Based on Mann-Whitney signed rank test.
↵^†Based on χ² test.

Table 2.

Reasons for herbal cigarette smokers to switch from regular cigarettes (14-15 mg tar) to current herbal brands

Ranking of reasons	Specific reasons	Response, n (%)
1	Better taste	50 (47)
2	Health concerns	26 (24)
3	Convenience of purchase	22 (21)
4	Support for local product and business	15 (15)
5	Price	10 (9)
6	No fake cigarettes of current brand	4 (4)

NOTE: Of 135 subjects who smoked herbal cigarettes, 106 answered this multiple-choice question. Percentages do not add up to 100% because respondents were allowed to report more than one reason.