Hidden nicotine: Cotinine levels among young adult Black men who smoke cannabis blunts.

Abstract

Young adult Black men who smoke cannabis blunts face increased risk for nicotine exposure and addiction. We assessed salivary cotinine levels (a nicotine derivative) associated with blunt use, explored blunt construction characteristics, and established congruence between self-reported tobacco exposures and salivary cotinine levels. Data were collected between July 2023 and March 2024 from young adult Black men (ages 18-30) who reported 30-day blunt use but reported no tobacco/nicotine use. Data included a baseline survey, timeline follow-back, and saliva sample, followed 10h later by an additional survey and sample. Pearson correlations and independent t-tests assessed relationships between blunt use frequency, cravings, affect, risk perception, and cotinine levels. Of the 111 participants, 46 provided saliva sample; over half (54.3%) of the 46 had at least one saliva sample containing more than 10ng/mL cotinine. Higher cotinine concentrations were significantly associated with more blunts smoked (r(44) = .35, p = .017), self-constructed blunts (t(16.5) = 2.58, p = .02), quantity of cannabis (T1: r(43) = 0.33, p =  0.03, T2: r(43) = .426, p = .004), cannabis and blunt cravings (T1: r(44) = 0.36, p =  0.014) (T1: r(43) = 0.33, p =  0.03), cannabis dependence (r(43) = 0.31, p = 0.046), and affect (T1: r(44) = - 0.33, p =  0.023). Participants had considerable nicotine exposure exceeding that which is typical of secondhand smoke, despite not reporting other tobacco use. Thus, nicotine exposure may be unintentional and unaccounted for, highlighting the need for tobacco harm reduction interventions focused on blunt smoking.