ArticleEnvironmental research2023
Exposure to metals among Electronic Nicotine Delivery System (ENDS) users in the PATH study: A longitudinal analysis.
Article in Environmental research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.
- Metal in biological samples from electronic cigarette users and those exposed to their second-hand aerosol: a narrative review.Frontiers in medicine · 2024Pooled it
- Influence of e-Liquid pH on Heavy Metal Emissions in Open-System Electronic Cigarette Aerosols and Associated Health Risks.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2026Article
- Molecular Health Effects of Electronic Cigarettes.Biomolecules · 2026Review
- Sociodemographic determinants, knowledge, and patterns of e-cigarette use among adults in Riyadh, Saudi Arabia: A cross-sectional study.Tobacco induced diseases · 2026Article
- Biomarkers of metal exposure in adolescent e-cigarette users: correlations with vaping frequency and flavouring.Tobacco control · 2025Article
- Elevated Toxic Element Emissions from Popular Disposable E‑Cigarettes: Sources, Life Cycle, and Health Risks.ACS central science · 2025Article
- Electronic Cigarette-Derived Metals: Exposure and Health Risks in Vapers.Chemical research in toxicology · 2025Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundFew studies have evaluated Electronic Nicotine Delivery Systems (ENDS) in longitudinal studies, as a potential source of metals which may have carcinogenic, neurotoxic, and cardiotoxic effects. We evaluated metal body burden by ENDS use status in a longitudinal population-based national survey.
methodsWe used the Population Assessment of Tobacco and Health (PATH) Study wave 1 (2013-2014), wave 2 (2014-2015), and wave 3 (2015-2016) adult data to assess urinary concentrations of seven metals among (1) ENDS only users who never used any nonelectronic tobacco products (n = 50), (2) ENDS only users who were former users of any nonelectronic tobacco products (n = 123) and (3) Never users (n = 1501) of any tobacco product.
resultsAmong ENDS only users who never used any nonelectronic tobacco products (n = 50), the geometric mean ratios (GMRs) of Cd and Pb were 1.25 (95%CI: 1.09-1.42) and 1.19 (95%CI: 1.05-1.34), respectively, compared to never users after adjustment for PATH Study wave, age, sex, race/ethnicity, education, region, secondhand smoke at home and work, and cannabis and other substance use. After the same adjustment, the corresponding GMRs were 1.48 (95%CI: 1.32-1.67) and 1.43 (95%CI: 1.28-1.60) for ENDS only users who were former users of any nonelectronic tobacco products (n = 123). No difference was observed in urinary concentrations of other metals comparing ENDS users to never users of any tobacco product. DISCUSSION: ENDS users show higher urinary levels of Cd and Pb, including lifetime exclusive ENDS users compared to never users of any tobacco product. These findings are limited by the small sample size and could be related to underreporting of past combustible tobacco use or other factors. Metals typical of ENDS such as nickel and chromium unfortunately are not available in PATH. Studies assessing metal exposure associated with long term lifetime exclusive ENDS use (≥5 years) with larger sample size are needed.
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