Concentrations of selected metals in blood,serum, and urine among US adult exclusive users of cigarettes,cigars, and electronic cigarettes

Data from National Health and Nutrition Examination Survey for 2013–2014 were used to compare observed levels of selected metals in blood, serum, and urine among US adults aged ≥20 years for exclusive cigar, cigarettes, and e-cigarette users. Adjusted geometric means for e-cigarette users were found to be higher than for cigar users for blood manganese (10.3 vs. 7.9 µg/L, p = 0.02). Cigar users were found to have lower adjusted geometric means than cigarette users for urine cobalt (0.22 vs. 0.4 µg/L, p = 0.04) and urine antimony (0.03 vs. 0.06 µg/L, p = 0.03). Adjusted levels of blood selenium, serum copper, selenium, and zinc, and urine arsenic, barium, molybdenum, tin, strontium, thallium, tungsten, and uranium were found to be comparable among cigarettes only, cigar only, and electronic cigarettes only users. However, irrespective of the comparative levels of these metals among cigar, cigarette, and e-cigarette users, focus must be to assess the short- and long-term health effects of the exposure to these metals particularly nanoparticles via inhalation from e-cigarette aerosols.