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Review
Systemic biomarkers of exposure associated with ENDS use: a scoping review
  1. Marzena Hiler,
  2. Anna-Sophie Weidner,
  3. Lynn C Hull,
  4. Allison N Kurti,
  5. Elena V Mishina
  1. Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
  1. Correspondence to Dr Marzena Hiler, Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA; Marzena.Hiler{at}fda.hhs.gov

Abstract

Objective This scoping review provides an overview of the existing literature on biomarkers of exposure from electronic nicotine delivery systems (ENDS) use and identifies gaps in existing knowledge.

Data sources We searched two international databases (PubMed and Web of Science) to identify relevant studies published from August 2013 to February 2021.

Data selection Studies were included if they assessed and compared biomarkers of exposure between exclusive ENDS users, non-users, exclusive cigarette smokers, dual users of ENDS and cigarettes or cigarette smokers who switch to ENDS.

Data extraction and synthesis Of the 5074 studies identified, 188 studies met criteria and were selected for full-text screening. Of these, 27 studies were selected for inclusion and data extraction.

Conclusions Consistent, although limited, evidence shows that exclusive ENDS users have elevated levels of biomarkers of certain volatile organic compounds (VOCs; eg, acrylamide and acrylonitrile), metals (eg, cadmium and selenium) and propylene glycol compared with non-users; however, evidence for biomarkers of other toxicants (eg, acrolein, benzene and chromium) is mixed. Biomarkers of most VOCs are lower in ENDS users compared with cigarette smokers, and cigarette smokers who switch to ENDS consistently show reductions in VOC biomarkers. Evidence comparing metal exposures from exclusive ENDS use, cigarette smoking and dual use is mixed and depends on the metal. ENDS and e-liquid characteristics as well as use patterns may be associated with elevated exposure to VOCs and metals. Additional rigorous, controlled studies can assess biomarker exposures from ENDS use and inform the overall risk–benefit of ENDS use for different user populations.

  • electronic nicotine delivery devices
  • public policy
  • addiction

https://doi.org/10.1136/tobaccocontrol-2021-056896

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    Footnotes

    • Contributors MH conducted the review, wrote the initial draft, provided critical feedback and approved the final manuscript. A-SW contributed to writing the initial draft, provided critical feedback and approved the final manuscript. LCH provided critical feedback and approved the final manuscript. ANK conducted concurrence review, provided critical feedback and approved the final manuscript. EM conceived the study idea, conducted concurrence review, contributed to writing the initial draft, provided critical feedback and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.