are E-Cigarette Flavors associated with Exposure to Nicotine and Toxicants? Findings from Wave 2 of the Population assessment of Tobacco and health (PaTh) Study.

Introduction:
This text is a letter published in the International Journal of Environmental Research and Public health, presenting the results of a study examining the association between e-cigarette flavors and exposure to nicotine and toxicants. The study utilizes data from Wave 2 of the Population assessment of Tobacco and health (PaTh) Study Biomarker Restricted Use Files.

Key Points:

* The study analyzed urinary biomarkers of exposure to nicotine and three select tobacco-related toxicants among exclusive e-cigarette users who reported using their product within the last 24 hours.
* Exclusive e-cigarette users reported their use of flavored e-cigarettes within the past 30 days, which were classified into use of fruit-only, tobacco-only, single other flavor, and fruit + use of additional flavors.
* Users of fruit-only flavored e-cigarettes exhibited significantly higher concentrations of the biomarker for acrylonitrile compared to users of a single other flavor.
* Concentrations of biomarkers of exposure to nicotine, benzene, and acrolein did not significantly differ across flavors.
* The study did not confirm findings from laboratory studies suggesting that fruit-flavored e-cigarettes contribute to significantly elevated concentrations of nicotine among exclusive e-cigarette users.
* Differences in user behavior, devices, and e-liquids used likely play a role in the discrepancy between laboratory findings and the study results.
* The main message of the text is that while e-cigarette flavors may not contribute to elevated concentrations of nicotine, they may still affect user-health outcomes through exposure to other toxicants, such as acrylonitrile. Further investigation is necessary to fully understand the role of e-cigarette flavors in user-health outcomes.

Main Message:
The study highlights the importance of considering the potential health impacts of e-cigarette flavors beyond their contribution to nicotine exposure. The significantly higher concentrations of the biomarker for acrylonitrile among users of fruit-only flavored e-cigarettes suggest that e-cigarette flavors may still pose health risks to users. Further investigation is necessary to understand the full extent of these risks and to inform regulatory measures aimed at protecting public health.

Smith DM, Schneller LM, O’Connor RJ, Goniewicz ML. are E-Cigarette Flavors associated with Exposure to Nicotine and Toxicants? Findings from Wave 2 of the Population assessment of Tobacco and health (PaTh) Study. International journal of environmental research and public health. 2019;16(24). doi:10.3390/ijerph16245055