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Toxicant Exposure in Users of E-Cigarettes and Combustible Cigarettes
Study Questions:
What are the concentrations of tobacco-related toxicants among e-cigarette users compared to concentrations seen in those who smoke combustible cigarettes or never users?
Methods:
Data from a population-based cohort study (the Population Assessment of Tobacco and Health Study) conducted between 2013-2014 were used for the present analysis. A cross-sectional study design was used to collect data on tobacco use and biomarkers of exposure to tobacco-related toxicants (via urine samples). A total of 247 reported using e-cigarettes exclusively, while 2,411 reported smoking cigarettes exclusively and 792 reported use of both cigarettes and e-cigarettes. A total of 1,655 participants were never users of tobacco products. The primary outcomes were mean concentrations of 50 separate biomarkers from five major classes of tobacco product constituents including nicotine, tobacco-specific nitrosamines (TSNAs), metals, polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs).
Results:
The majority of the 5,105 participants were young (ages 35-54 years), female (60%), and non-Hispanic white (61%). Compared with exclusive e-cigarette users, never users had 19-81% significantly lower concentrations (19-81%) of biomarkers of exposure to nicotine, TSNAs, some metals (e.g., cadmium and lead), and some VOCs (including acrylonitrile). Exclusive e-cigarette users showed 10-98% significantly lower concentrations of biomarkers of exposure, including TSNAs, PAHs, most VOCs, and nicotine, compared with exclusive cigarette smokers. Concentrations of metals and three VOCs were comparable for e-cigarette users and cigarette smokers. Participants who use both e-cigarettes and combustible cigarettes have higher concentrations of several biomarkers compared to those who use combustible cigarettes exclusively.
Conclusions:
The authors concluded that exclusive use of e-cigarettes appears to result in measurable exposure to known tobacco-related toxicants, generally at lower levels than cigarette smoking.
Perspective:
Currently little is known about the long-term health effects of e-cigarette use. These data provide some evidence of exposure to toxins, which is concerning. Among cigarette smokers looking to transition from combustible cigarettes to complete smoking cessation, e-cigarettes may play a role; however, in this study, those who used both had higher levels of some toxins. In those who use e-cigarettes exclusively, providers are advised to counsel such users on the potential health effects related to toxin exposure.
Clinical Topics: Cardiovascular Care Team, Prevention, Smoking
Keywords: Acrylonitrile, Biomarkers, Electronic Nicotine Delivery Systems, Hazardous Substances, Nicotine, Nitrosamines, Polycyclic Aromatic Hydrocarbons, Primary Prevention, Smoke, Smoking, Smoking Cessation, Tobacco Products
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