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After adjustment for age, sex, race and ethnicity, education, and body mass index, primary cigar users (those who smoked less than 100 cigarettes in their lives) had 138 times higher serum cotinine concentrations (6.2 ng/mL versus 0.045 ng/mL) and 18.9 times higher urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) concentrations (19.1 picogram [pg]/mg creatinine versus 1.01 pg/mg creatinine) than nontobacco users