Table 3.

Geometric mean ratios for biomarkers of exposure by tobacco use status, NHANES 1999 to 2012

BiomarkerTobacco use categoryUnadjusted geometric mean ratio (95% CI)Adjusted geometric mean ratio (95% CI)
Serum cotinineExclusive smokeless tobacco users4,160 (3,406–5,081)3,194 (2,623–3,888)
Exclusive cigarette smokers3,027 (2,801–3,270)2,439 (2,240–2,655)
Dual cigarette/smokeless tobacco users4,265 (3,064–5,936)3,009 (2,174–4,164)
Nontobacco users (Ref)11
Urinary NNALExclusive smokeless tobacco users760 (574–1006)587 (451–764)
Exclusive cigarette smokers229 (205–255)190 (171–210)
Dual cigarette/smokeless tobacco users541 (313–935)393 (252–614)
Nontobacco users (Ref)11
Blood cadmiumExclusive smokeless tobacco users0.82 (0.75–0.90)1.00 (0.93–1.08)
Exclusive cigarette smokers3.52 (3.41–3.63)3.69 (3.57–3.81)
Dual cigarette/smokeless tobacco users2.41 (1.93–3.00)3.10 (2.50–3.85)
Nontobacco users (Ref)11
Blood leadExclusive smokeless tobacco users1.49 (1.37–1.61)1.30 (1.21–1.38)
Exclusive cigarette smokers1.48 (1.44–1.53)1.46 (1.42–1.49)
Dual cigarette/smokeless tobacco users1.49 (1.31–1.70)1.50 (1.34–1.67)
Nontobacco users (Ref)11
Blood mercuryExclusive smokeless tobacco users0.81 (0.71–0.92)0.86 (0.75–0.98)
Exclusive cigarette smokers0.76 (0.72–0.80)0.83 (0.79–0.87)
Dual cigarette/smokeless tobacco users0.62 (0.48–0.79)0.70 (0.55–0.89)
Nontobacco users (Ref)11
Urinary arsenicExclusive smokeless tobacco users0.91 (0.75–1.09)0.86 (0.73–1.02)
Exclusive cigarette only smokers0.83 (0.76–0.92)0.87 (0.80–0.94)
Dual cigarette/smokeless tobacco users0.83 (0.45–1.55)0.81 (0.59–1.10)
Nontobacco users (Ref)11
Urinary CYMAExclusive smokeless tobacco users2.04 (1.04–4.01)1.62 (0.83–3.18)
Exclusive cigarette only smokers84.9 (72.5–99.3)75.3 (65.2–87.1)
Dual cigarette/smokeless tobacco users33.5 (0.8–1398.5)18.4 (0.7–463.5)
Nontobacco users (Ref)11

NOTE: NNAL data were available for 2007 to 2012 NHANES participants, arsenic data were available for 2003 to 2012 NHANES participants, and CYMA data were available for 2005 to 2006 and 2011 to 2012 NHANES participants. The adjusted geometric mean ratios control for age, sex, race/ethnicity, educational attainment, and body mass index. For urinary arsenic, CYMA, and NNAL, the adjusted ratios further control for urinary creatinine.