Do brand characteristics contribute significantly to variability in toxicant exposure in smokers? Data from NHANES 2007-2012

INTRODUCTION: This study sought to quantify the difference in serum cotinine and other biomarkers indicative of cigarette smoking in current US cigarette smokers attributable to brand level versus individual level factors. METHODS: A total of 2,558 daily exclusive smokers, 20 years and older in the United States participated in the National Health and Nutrition Examination Surveys 2007-2012 and provided biospecimens and cigarette brand information. Biomakers of interest were serum cotinine, and urinary NNAL, PAHs, and heavy metals. Adjustments were made for person-level factors (e.g., sex, age, race, education), smoking behavior (cigarettes per day), brand, tar group (≤ 6mg, >6-15mg, >15mg), and menthol status. RESULTS: The most commonly reported brands of US cigarettes were Marlboro, Newport, Camel, and Pall Mall. Cotinine levels differed by age (p=0.0065), race (p<0.0001), and cigarettes smoked per day (p<0.0001) but not brand, tar or menthol. Brand family was significantly associated with urinary levels of NNAL, 1HP, HFs, and HPHs. For NNAL. Person-level factors accounted for some of these differences. No consistent differences in metal exposure by brand were noted. Overall, brand information accounted for 2-8% of variance depending on the marker. Together, age, sex, race, education, and cigarettes smoked per day accounted for 20% in variance in cotinine levels, and adding the brand information (brand family, tar group, menthol) to the model accounted for an additional 0.5% (p<0.0948). In the full multivariate model, no significant difference in cotinine was seen by brand (p=0.2205), tar (p=0.2987) or menthol (p=0.1583). CONCLUSIONS: Brand to brand differences seen in serum cotinine levels and other biomarkers indicative of cigarette smoking between the top US cigarette brands from 2007-2012 are primarily driven by individual differences among smokers, and to a lesser extent by differences among products.