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As you correctly point out, chemical levels in dual users may be similar to normal smokers, but you have to look at actual changes in health

Qualitative analysis was performed using the Human Metabolome Database 12 , lipid maps 2.3 13 , Metabolite Link (METLIN) 14 , and self-built databases

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Investigations for a very short time period in canine models and long-term cannulated mice exposed to concentrated air particles showed that hypertension was produced and that there was an indication of central sympathetic activation of the neuron system, presumably induced by neuro-inflammation in relation to the disclosure of PM 2.5 (190, 191)