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Nicotine Tob Res. 2019 Nov 5. pii: ntz206. doi: 10.1093/ntr/ntz206. [Epub ahead of print]

5-Day Changes in Biomarkers of Exposure among Adult Smokers after Completely Switching from Combustible Cigarettes to a Nicotine-Salt Pod System.

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JUUL Labs, Inc. (San Francisco, CA).
Celerion, Inc. (Lincoln, NE).



This study examined changes in biomarkers of exposure (BoE) after five days of nicotine-salt pod system (NSPS) use, compared to continuation of usual cigarette smoking and cigarette abstinence, among adult combustible cigarette smokers.


A randomized, open‑label, parallel‑cohort, confinement study of healthy adult smokers, naive to NSPS use was conducted. Participants (N=90) were randomized to 6 cohorts (n=15 each): exclusive ad libitum use of NSPS (4 flavors: Virginia Tobacco, Mint, Mango, Creme), continuation of usual brand cigarette smoking, or cigarette abstinence. Total nicotine equivalents and biomarkers of exposure (NNN, NNAL, 3-HPMA, MHBMA, S-PMA, HMPMA, CEMA, 1-OHP, and COHb) were measured.


Eight non-nicotine BoEs, measured in urine, were reduced by an aggregate of 85.0% in the pooled NSPS cohort; increased by 14.4% in the cigarette cohort (P<0.001 for pooled NSPS vs. cigarette); and reduced by 85.3% in the abstinence cohort (P>0.05; 99.6% relative reduction between pooled NSPS vs. abstinence). Similar changes in individual BoEs were also observed (P<0.001 for each BoE between pooled NSPS vs. cigarettes; and abstinence vs. pooled NSPS; P>0.05 for each BoE between pooled NSPS vs. abstinence). Blood COHb decreased by 71.8% in the pooled NSPS cohort and 69.1% in the abstinence cohort (P>0.05) and increased by 13.3% in the cigarette cohort (P<0.001). Mean total urine nicotine equivalents increased in the pooled NSPS and cigarette cohorts by 9% and 26%, respectively, and did not significantly differ (P>0.05).


Complete switching from cigarettes to NSPS produced significant reductions in key non-nicotine BoEs associated with cigarette smoking.


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