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Biomarkers of metal exposure in adolescent e-cigarette users: correlations with vaping frequency and flavouring
  1. Andrew Kochvar1,2,
  2. Gary Hao3,
  3. Hongying Daisy Dai1
  1. 1 University of Nebraska Medical Center, Omaha, Nebraska, USA
  2. 2 Kansas City University, Kansas City, Missouri, USA
  3. 3 Millard West High School, Omaha, Nebraska, USA
  1. Correspondence to Dr Hongying Daisy Dai, University of Nebraska Medical Center, Omaha, NE 68198-4375, USA; daisy.dai{at}


Background Youth vaping poses a significant public health concern as metals have been detected in e-cigarette aerosols and liquids. This study investigated factors associated with biomarkers of metal exposure.

Methods Data were drawn from Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study Youth Panel, a nationally representative sample of US adolescents aged 13–17 years. Urinary biomarkers of exposure to cadmium, lead, and uranium were assessed by vaping frequency (occasional (1–5 days), intermittent (6–19 days), and frequent (20+ days)) in the past 30 days and flavour type (menthol/mint, fruit, and sweet).

Results Among 200 exclusive e-cigarette users (median age 15.9 years, 62.9% female), 65 reported occasional use, 45 reported intermittent use, and 81 reported frequent use. The average number of recent puffs per day increased exponentially by vaping frequency (occasional: 0.9 puffs, intermittent: 7.9 puffs, frequent: 27.0 puffs; p=0.001). Both intermittent (0.21 ng/mg creatinine) and frequent users (0.20 ng/mg creatinine) had higher urine lead levels than occasional users (0.16 ng/mg creatinine). Frequent users also had higher urine uranium levels compared with occasional users (0.009 vs 0.005 ng/mg creatinine, p=0.0004). Overall, 33.0% of users preferred using menthol/mint flavours, 49.8% fruit flavours, and 15.3% sweet flavours. Sweet flavour users had higher uranium levels compared with menthol/mint users (0.009 vs 0.005 ng/mg creatinine, p=0.02).

Conclusions Vaping in early life could increase the risk of exposure to metals, potentially harming brain and organ development. Regulations on vaping should safeguard the youth population against addiction and exposure to metals.

  • Electronic nicotine delivery devices
  • Heavy Metals
  • Priority/special populations

Data availability statement

Data are available upon reasonable request. Data can be accessed at

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  • Contributors AK contributed to the interpretation of the findings and the draft of the initial manuscript and critically revised the manuscript. GH contributed to the interpretation of the findings and critically revised the manuscript. HD conceptualised and designed the study, performed data analyses and interpretation of the findings, drafted the initial manuscript, and critically revised the manuscript. The corresponding author, HD, is responsible for the overall content as the guarantor, who accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding Research of HD reported was partially supported by the National Institute on Drug Abuse under Award Number R21DA058328 (PI: HD). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • Competing interests None declared.

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