The association between cigarette rod length, slim design, and blood cadmium levels among U.S. smokers: NHANES 1999–2010

•Long and/or slim cigarette rod design mitigates perception of harmfulness.•Cadmium is a toxicant contained in cigarettes.•The effect of cigarette rod design on blood cadmium is assessed.•Longer cigarette has higher cadmium levels regardless of circumference.•Slim cigarette design does not reduce blood cadmium levels.

BackgroundPrevious research has shown that long or slim cigarette design can mitigate perception of harmfulness. Cadmium (Cd) is a toxicant in cigarettes and is associated with adverse outcomes. We assessed the relationship between cigarette rod length/circumference and blood Cd levels among U.S. smokers using data from the 1999–2010 National Health and Nutrition Examination Survey.MethodsThe analyses were performed on 4486 current cigarette smokers aged ≥ 20 years old. Cigarette rod length included regular (68–72 mm), king (79–88 mm), long (94–101 mm), and ultra-long (110–121 mm) cigarettes currently smoked. Overall and gender stratified multivariate linear regression analyses were performed, adjusting for other influential covariates.ResultsGender stratified analysis indicated that female smokers of long and ultra-long cigarette had 20% and 27% higher mean Cd levels compared to smokers of regular sized cigarettes respectively, despite the fact that all the ultra-long cigarettes were slim cigarettes. Furthermore, among females, slim cigarette users did not reduce blood cadmium levels compared to non-slim users.ConclusionsFemale smokers of long or ultra-long cigarettes had higher mean blood Cd levels compared to smokers of regular cigarettes independent of slim design. Further research into this association is warranted.