Exposure to metals among Electronic Nicotine Delivery System (ENDS) users in the PATH study: A longitudinal analysis

Area of Science:

• Environmental Health
• Toxicology
• Public Health

Background:

• Electronic Nicotine Delivery Systems (ENDS) are increasingly prevalent, yet their long-term health effects, particularly metal exposure, remain understudied.
• Metals found in ENDS aerosols may pose carcinogenic, neurotoxic, and cardiotoxic risks.

Purpose of the Study:

• To evaluate metal body burden in relation to ENDS use status using longitudinal population-based data.
• To compare urinary metal concentrations between exclusive ENDS users (never and former tobacco users) and never tobacco users.

Main Methods:

• Utilized data from the Population Assessment of Tobacco and Health (PATH) Study (waves 1-3, 2013-2016).
• Assessed urinary concentrations of seven metals in adult participants categorized by tobacco use: ENDS-only (never tobacco users), ENDS-only (former tobacco users), and never tobacco users.
• Adjusted for various demographic, behavioral, and environmental factors.

Main Results:

• ENDS-only users who never used other tobacco products showed higher urinary cadmium (GMR=1.25) and lead (GMR=1.19) compared to never users.
• ENDS-only users who were former tobacco users exhibited significantly higher urinary cadmium (GMR=1.48) and lead (GMR=1.43) than never users.
• No significant differences were found for other assessed metals.

Conclusions:

• ENDS use is associated with increased urinary levels of cadmium and lead, even among individuals who exclusively use ENDS.
• Limitations include small sample sizes for ENDS-only groups and potential underreporting of past tobacco use.
• Further research with larger sample sizes is needed to investigate long-term metal exposure from exclusive ENDS use (≥5 years).