Comparing cotinine levels between men and women who smoke heavily

Abstract Background Heavy smoking, for example 16 or more cigarettes per day (CPD), reflects generally greater nicotine dependence. Heavy smoking is more common among men than among women. We compared cotinine levels between men and women who smoke heavily. Methods Two population-based surveys in 2017 and 2023 including plasma cotinine measurements (ng/mL) of subsample of 3142 persons (52 % men) aged 20 year or older were used. Cotinine levels of people who smoke heavily (16 + CPD) among persons who smoke daily were compared between men and women with age-adjusted regression analyses including the interaction term between sex and heavy smoking as the independent variable. Results Heavy smoking among persons who smoked daily was more common among men than among women (40% vs 21%, p < 0.0001). Age-adjusted mean level of cotinine for heavy smoking men (n = 210) was 283 ng/mL (95% confidence interval (CI): 265-301) and for women (n = 107) 290 ng/mL (95% CI 267-313). The cotinine levels did not differ from each other (difference 7.5 ng/mL; 95% CI: -21.51, 36.43). Conclusions The plasma cotinine levels of men and women who smoke heavily do not differ in a population-based sample. Policy measures to support the cessation of smoking and to reduce the number of cigarettes smoked per day should be strengthened while health care professionals should provide tailored smoking cessation support for persons who smoke heavily. Key messages • The levels of a proxy measure of physical nicotine dependence does not differ between men and women who smoke heavily. • Cessation support should address different consumption patterns among men and women should be enacted.