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Teens with more frequent vaping had increased urine lead and uranium levels, researchers found.

Among 200 individuals ages 13 to 17, those who vaped intermittently had 40% higher urine lead levels than occasional users (mean 0.21 vs 0.16 ng/mg creatinine, adjusted geometric mean ratio [GMR] 1.4, P=0.03), reported Hongying Daisy Dai, PhD, of the University of Nebraska Medical Center in Omaha, and colleagues.

Frequent vapers also had 30% higher urine lead levels than occasional users (0.20 vs 0.16, adjusted GMR 1.3, P=0.01), they noted in .

And frequent users had about twice the urine uranium levels of occasional users (0.009 vs 0.005, adjusted GMR 2.3, P=0.0004).

"E-cigarettes have been the most commonly used tobacco products among U.S. adolescents since 2014, and youth e-cigarette use continues to be a public health concern," Dai told MedPage Today in an email. "In 2022, an estimated 2.5 million U.S. middle and high school students reported current (past 30-day) e-cigarette use (or vaping). E-cigarette aerosol contains various potentially harmful compounds, such as metals, and e-cigarette products are currently marketed with a variety of flavors (e.g., mint, fruit, and sweet) appealing to youth."

In their study, a comparison of flavor types indicated higher uranium levels in users of sweet-flavored vape liquids compared with menthol or mint vape liquid users (0.009 vs 0.005, adjusted GMR 1.9, P=0.02).

However, no statistically significant differences were found between urine cadmium levels across e-cigarette use frequency and flavor types.

Chronic exposure to metals like lead and uranium, even at low levels, have been linked to cognitive impairment, behavioral disturbances, respiratory complications, cancer, and cardiovascular diseases in children. "Vaping in early life could increase the risk of exposure to metals, potentially harming brain and organ development," Dai and colleagues concluded.

"It's imperative for clinicians to counsel adolescent patients to quit vaping, as no form of tobacco consumption is safe for young individuals," Dai added.

The group used data from the Population Assessment of Tobacco and Health (PATH) Study Youth Panel, a nationally representative sample of U.S. adolescents ages 13 to 17 (mean 15.9).

Urine biomarkers of exposure to cadmium, lead, and uranium were assessed by vaping frequency in the past 30 days (occasional, defined as use on 1 to 5 days; intermittent, 6 to 19 days; and frequent, 20 or more days) and by flavor type (menthol/mint, fruit, or sweet).

Of the 200 exclusive e-cigarette users (62.9% female) included in the study, 65 reported occasional use, 45 reported intermittent use, and 81 reported frequent use. Nine had missing data on vaping frequency.

The average number of recent puffs per day "increased exponentially" by vaping frequency (occasional, 0.9 puffs; intermittent, 7.9 puffs; and frequent, 27 puffs), Dai and colleagues noted.

The most common flavor preference was fruity (49.8%), while 33% of the teens reported preferring menthol/mint flavors, 15.3% sweet flavors, and 1.9% other flavors.

There was no variation in flavor selection based on vaping frequency.

Limitations included that the cross-sectional nature of the study restricted causal inference, Dai and colleagues noted.

Urine uranium and lead signal chronic exposure, but a single time point is inadequate for assessment, they added. And the presence of uranium in urine may be attributed to various sources such as environmental exposure from natural deposits, industrial activities, and dietary intake.

Limitations further included that small sample sizes might have hampered statistical power and limited the inclusion of participants reporting other flavors, they noted.

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