The association of e-cigarette use with exposure to nickel and chromium: A preliminary study of non-invasive biomarkers.

Abstract Background Nickel (Ni) and chromium (Cr) are components of e-cigarette heating coils. Whether e-cigarettes increase metal internal dose, however, is unknown. We assessed the association of e-cigarette use patterns and of e-liquid and aerosol metal concentrations with Ni and Cr biomarker levels in e-cigarette users from Maryland. Methods We recruited 64 e-cigarette users from December 2015 to March 2016. We collected urine, saliva, and exhaled breath condensate (EBC), data on e-cigarette use, and samples from their e-cigarette device (dispenser e-liquid, aerosol, and tank e-liquid). Results Median Ni and Cr levels were 0.73 and 0.39 μg/g creatinine in urine, 2.25 and 1.53 μg/L in saliva, and 1.25 and 0.29 μg/L in EBC. In adjusted models, tertiles 2 and 3 of aerosol Ni concentrations were associated with 16% and 72% higher urine Ni and 202% and 321% higher saliva Ni compared to the lowest tertile. Tertile 3 of aerosol Cr levels were associated with 193% higher saliva Cr. An earlier time to first vape in the morning and more frequent coil change were associated with higher urine Ni. Tertile 2 of e-liquid consumption per week and voltage were associated with higher saliva Ni levels than tertile 1. Conclusion Positive associations of Ni and Cr aerosol concentrations with corresponding Ni and Cr biomarker levels indicate e-cigarette emissions increase metal internal dose. Increased e-cigarette use and consumption were also associated with higher Ni biomarker levels. Metal level standards are needed to prevent involuntary metal exposure among e-cigarette users.