Biomarker evidence of toxicant exposure among blunt and nonblunt cigar smokers

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Abstract
Introduction: Blunts, combining tobacco and cannabis, fall into a regulatory gray area under United States federal and state laws. Blunt use is increasing among adults, yet limited evidence exists on how toxicant exposure among blunt users differ from that of non-blunt cigar users. Methods: We analyzed biospecimen data from 8332 adults in Wave 4 of the Population Assessment of Tobacco and Health Study. Weighted multivariable linear regression models compared urine biomarkers of exposure across five classes of harmful and potentially harmful constituents, along with a biomarker of oxidative stress between exclusive blunt users and exclusive non-blunt cigar users. Analyses were stratified by cigar type (traditional cigar, cigarillos, filtered cigar) and use frequency (some-day vs. daily). Results: Compared with non-blunt cigar users, blunt users exhibited higher geometric mean concentrations of volatile organic compounds (VOCs), including metabolites of acrylamide (AAMA: 129 vs. 64 ng/mg, P < 0.001) and acrylonitrile (CYMA: 31.7 vs. 7.8, P = 0.018), but lower lead (0.23 vs. 0.38 ng/mg, P < 0.029). Blunt use was associated with distinct toxicant exposure profiles that varied by frequency of use. Among some-day users, blunt use showed higher VOCs compared with non-blunt cigar use. Conversely, daily blunt users exhibited lower urinary nicotine metabolites, tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons, and VOCs than daily non-blunt cigar users. Conclusions: These findings highlight the complexity of toxicant exposure associated with blunt use and underscore the need for future studies on health implications and regulatory approaches addressing concurrent tobacco and cannabis use. Implications: Blunt use is persistently rising among adults. This study provides important public health and regulatory implications. Blunt use represents a distinct and underregulated form of tobacco–cannabis co-use that exposes users to a unique toxicant profile, including elevated volatile organic compounds. The frequency-dependent exposure patterns observed suggest that blunt smoking behaviors, together with plausible variations in blunt product construction, substantially influence toxicant intake and associated disease risk. Targeted surveillance, consumer education, and evidence-based regulations are needed to address misconceptions about blunt safety and to mitigate long-term risks for cancer, cardiovascular disease, and respiratory illness.
Funding Information
  • National Institute on Drug Abuse (R21DA058328)

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