Compared with adults who smoke cigarettes, adults who vape nicotine are exposed to similar levels of nicotine and significantly lower levels of tobacco-specific nitrosamines (TSNAs). Little research outside the USA has included youth who vape, particularly those using newer disposable vapes. We investigated exposure to nicotine and the TSNA NNK (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) among youth in England who vape, smoke, do both (dual) or do neither.
In 2023, youth aged 16–19 years from England completed a survey and provided a urine sample (n=201). Linear regressions examined associations of creatinine-normalised urinary concentrations of total nicotine equivalents (TNE-2) and NNAL (a metabolite of NNK) with past 7-day smoking/vaping status and self-reported recency of vaping. All analyses were adjusted for age, sex at birth, ethnicity and any past 7-day cannabis use.
Over three-quarters (77%) of those vaping were using the newer disposable vapes. Urinary TNE-2 concentrations among those who exclusively vaped in the past 7 days (n=83, geometric mean (GM)=5.09 nmol/mg creatinine (95% CI 3.19 to 8.12)) did not differ significantly from those who smoked (n=9, GM=1.74 nmol/mg creatinine (95% CI 0.64 to 4.72), p=0.426) or those who dual used (n=55, GM=5.60 nmol/mg creatinine (95% CI 3.32 to 9.43), p=0.953). Levels of NNAL among those who exclusively vaped (GM=1.87 pg/mg creatinine (95% CI 1.62 to 2.17)) were significantly lower than those who smoked (GM=4.87 pg/mg creatinine (95% CI 2.45 to 9.68), p=0.001) or those who dual used (GM=3.67 pg/mg creatinine (95% CI 2.76 to 4.86), p<0.001) and not significantly different from youth who neither vaped nor smoked (GM=1.84 pg/mg creatinine (95% CI 1.52 to 2.24), p=0.887).
Youth who vape are exposed to similar levels of nicotine as those who smoke or who dual use. NNAL exposure among youth who vape is much lower than among those who smoke and indistinguishable from youth who do not vape or smoke.