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We do not currently have a biomarker that reliably reflects tobacco exposure. Both self-reported cigarettes smoked per day and urine cotinine concentration have important limitations. Efforts to identify a better biomarker of tobacco exposure should be intensified.

An important consideration in developing biomarkers of exposure is understanding which components of tobacco smoke are detrimental. Our search for better biomarkers should be driven by our knowledge of which components are important. This is difficult in tobacco research as tobacco smoke contains so many potentially harmful ingredients.