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Pediatrics. 2018 Apr;141(4). pii: e20173557. doi: 10.1542/peds.2017-3557. Epub 2018 Mar 5.

Adolescent Exposure to Toxic Volatile Organic Chemicals From E-Cigarettes.

Author information

Division of Adolescent Medicine,
Department of Psychiatry, and.
Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California.
Division of Clinical Pharmacology and Experimental Therapeutics, Departments of Medicine and Bioengineering and Therapeutic Sciences.



There is an urgent need to understand the safety of e-cigarettes with adolescents. We sought to identify the presence of chemical toxicants associated with e-cigarette use among adolescents.


Adolescent e-cigarette users (≥1 use within the past 30 days, ≥10 lifetime e-cigarette use episodes) were divided into e-cigarette-only users (no cigarettes in the past 30 days, urine 4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol [NNAL] level <1 pg/mL of creatinine; n = 67), dual users (use of cigarettes in the past 30 days in addition to e-cigarettes, NNAL level >30 pg/mL; n = 16), and never-using controls (N = 20). Saliva was collected within 24 hours of the last e-cigarette use for analysis of cotinine and urine for analysis of NNAL and levels of 8 volatile organic chemical compounds. Bivariate analyses compared e-cigarette-only users with dual users, and regression analyses compared e-cigarette-only users with dual users and controls on levels of toxicants.


The participants were 16.4 years old on average. Urine excretion of metabolites of benzene, ethylene oxide, acrylonitrile, acrolein, and acrylamide was significantly higher in dual users versus e-cigarette-only users (all P < .05). Excretion of metabolites of acrylonitrile, acrolein, propylene oxide, acrylamide, and crotonaldehyde were significantly higher in e-cigarette-only users compared with controls (all P < .05).


Although e-cigarette vapor may be less hazardous than tobacco smoke, our findings can be used to challenge the idea that e-cigarette vapor is safe, because many of the volatile organic compounds we identified are carcinogenic. Messaging to teenagers should include warnings about the potential risk from toxic exposure to carcinogenic compounds generated by these products.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Benowitz is a consultant to several pharmaceutical companies that market medications to aid smoking cessation and has served as a paid expert witness in litigation against tobacco companies. Drs Ramo and Rubinstein have consulted for Carrot Inc, which makes a tobacco cessation device; and Dr Delucchi has indicated he has no potential conflicts of interest to disclose.

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