Nicotine pouches can increase plasma cotinine levels more than cigarettes

Background The tobacco and nicotine product market has expanded. Cotinine levels of people who use different products has not been studied in Finland.

Methods We used samples from two population-based surveys that included plasma cotinine measurements (FinHealth Study 2017: n=1543 samples; Healthy Finland Survey 2022–2023: n=1599 samples). Using regression analyses, we compared average cotinine levels among persons who used only cigarettes, snus, nicotine pouches, or electronic cigarettes daily (n=1150) and among those who used two or more products (n=31).Self-reported smoking status was compared with plasma cotinine levels.

Results Cotinine levels were elevated (≥10 ng/mL) for participants who used tobacco and nicotine products daily. Respondents using snus (difference 71–147 ng/ml) and 35- and 45-year-old respondents who used nicotine pouches (difference 87–199 ng/mL) had higher cotinine levels than those who smoked cigarettes. A substantial proportion of persons who reported having smoked their last cigarette days to weeks earlier had elevated cotinine values.

Conclusions Persons who use snus or nicotine pouches are exposed to higher nicotine levels than those who smoke cigarettes. Stopping the use of all tobacco and nicotine products should be promoted in health care services.

Otto Ruokolainen, Tommi Härkänen, Hanna Ollila, Jaakko Kaprio