Compared to cigarette smokers, users of smokeless tobacco are exposed to equal or higher levels of nicotine and NNK, a cancer-causing chemical in tobacco products, according to a study from the US government.

The study found the level of cotinine, which is a marker for nicotine exposure, was 0.043 nanograms/milliliter (ng/ml) in nonsmokers, compared to about 180 ng/ml among smokeless tobacco users, about 131 ng/ml among cigarette users and about 184 ng/ml among people who used both smokeless tobacco and cigarettes.

“There really is no safe form of tobacco,” said Dr Frank Leone, who is director of the University of Pennsylvania’s Comprehensive Smoking Treatment Program in Philadelphia. “Even types of tobacco that may be theoretically safer because of their mode of delivery really depend on user specific details,” such as how much and how long people use tobacco products.