title: Chinese "herbal" cigarettes are as carcinogenic and addictive as regular cigarettes.
abstract: OBJECTIVE
  To examine the Chinese tobacco industry's claim that herbal cigarettes are less harmful than regular cigarettes.
  
  
  METHODS
  The study design was a cross-sectional survey. One hundred thirty-five herbal cigarette smokers and 143 regular smokers from one city in China completed a questionnaire on smoking behavior and provided a urine sample. The main outcome measures were cotinine and trans-3'-hydroxycotinine in all samples, and polycyclic aromatic hydrocarbon metabolites (PAH; 1-hydroxypyrene, naphthols, hydroxyfluorenes, and hydroxyphnanthrenes) and the tobacco specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-butanol (NNAL) and NNAL-glucuronide in randomly selected 98 samples (47 from the herbal smokers' group and 51 from the regular smokers' group). Values were normalized by creatinine to correct for possible variability introduced by dilution or concentration of the urine.
  
  
  RESULTS
  Health concern was among the main reasons that smokers switched to herbal cigarettes from regular cigarettes. Smokers reported increased consumption after switching to herbal cigarettes from regular cigarettes. For all the four markers analyzed (cotinine, trans-3'-hydroxycotinine, total NNAL, and total PAHs), we observed no significant difference in the levels (P = 0.169, P = 0.146, P = 0.171, and P = 0.554, respectively) between smokers of herbal cigarettes and smokers of regular cigarettes. Both total NNAL and total PAHs were significantly correlated with cotinine and trans-3'-hydroxycotinine (P < 0.001 for all four correlations).
  
  
  CONCLUSIONS
  Our findings showed that herbal cigarettes did not deliver less carcinogens than regular cigarettes. The public needs to be aware of this fact, and the Chinese tobacco industry should avoid misleading the public when promoting herbal cigarettes as safer products.
authors: Center for Tobacco Control Research and Education, University of California, San Francisco, 94143-1390, USA.
authors: Quan
authors: Q
authors: Gan
authors: Jie
authors: J
authors: Yang
authors: Gonghuan
authors: G
authors: Yang
authors: Maciej
authors: M
authors: Goniewicz
authors: Neal L
authors: NL
authors: Benowitz
authors: Stanton A
authors: SA
authors: Glantz
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000209:etiology*; D015415:Biomarkers / Q000652:urine; D002273:Carcinogens; D003367:Cotinine / Q000652:urine; D003430:Cross-Sectional Studies; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009602:Nitrosamines / Q000652:urine; D010946:Plants, Medicinal; D011084:Polycyclic Aromatic Hydrocarbons / Q000652:urine; D012907:Smoking / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D002273:Carcinogens; D004365:Drugs, Chinese Herbal; D009602:Nitrosamines; D011084:Polycyclic Aromatic Hydrocarbons; D003367:Cotinine