Association of electronic cigarette use with lead, cadmium, barium, and antimony body burden: NHANES 2015-2016

J Trace Elem Med Biol. 2020 Dec;62:126602. doi: 10.1016/j.jtemb.2020.126602. Epub 2020 Jun 26.


Background: Exposure of toxic metals from e-cigarette use is a cause for public health concern because youth, young adults, and non-smokers are the target population rapidly adopting e-cigarette use. The purpose of this research is to determine the association of the body burden of heavy metals with e-cigarette use using NHANES (U.S.) 2015-2016 data.

Methods: Blood lead (N = 1899) and urinary cadmium, barium, and antimony (N = 1302) data were extracted from NHANES, 2015-2016; geometric means were calculated and bivariate and multivariable linear regression analyses were conducted. Participants were categorized as having neither e-cigarette nor cigarette use; smoking history (including dual use with e-cigarettes); and only e-cigarette (current or former).

Results: In multivariable analyses adjusted for sex, race/ethnicity, age, and poverty levels, current or former e-cigarette use failed to reach a statistical significance in the association with metals. However, participants with a smoking history were more likely to have higher blood lead and urinary cadmium than participants who neither used e-cigarettes nor cigarettes.

Conclusion: Blood lead levels, and urinary cadmium, barium, and antimony levels were similar between participants who used e-cigarettes and participants who did not.

Keywords: Antimony; Barium; Cadmium; Lead; Metals; e-Cigarettes.

MeSH terms

  • Adult
  • Antimony / blood*
  • Barium / blood*
  • Cadmium / blood*
  • Electronic Nicotine Delivery Systems*
  • Female
  • Humans
  • Lead / blood*
  • Male
  • Multivariate Analysis


  • Cadmium
  • Barium
  • Lead
  • Antimony