Nicotine, Cotinine, and Tobacco-Specific Nitrosamines Measured in Children's Silicone Wristbands in Relation to Secondhand Smoke and E-cigarette Vapor Exposure

Chemical uptake into silicone wristbands over a five day period

Silicone wristbands are a noninvasive personal exposure assessment tool. However, despite their utility, questions remain about the rate at which chemicals accumulate on wristbands when worn, as validation studies utilizing wristbands worn by human participants are limited. This study evaluated the chemical uptake rates of 113 organic pollutants from several chemical classes (i.e., polychlorinated biphenyls (PCB), organophosphate esters (OPEs), alkyl OPEs, polybrominated diphenyl ethers (PBDEs), brominated flame retardants (BFR), phthalates, pesticides, and polycyclic aromatic hydrocarbons (PAHs) over a five-day period. Adult participants (n = 10) were asked to wear five silicone wristbands and then remove one wristband each day. Several compounds were detected in all participants' wristbands after only one day. The number of chemicals detected frequently (i.e. in at least seven participants wristbands) increased from 20% of target compounds to 26% after three days and more substantially increased to 34% of target compounds after four days of wear. Chemicals detected in at least seven participants' day five wristbands (n = 24 chemicals) underwent further statistical analysis, including estimating the chemical uptake rates over time. Some chemicals, including pesticides and phthalates, had postive and significant correlations between concentrations on wristbands worn five days and concentrations of wristbands worn fewer days suggesting chronic exposure. For 23 of the 24 compounds evaluated there was a statistically significant and positive linear association between the length of time wristbands were worn and chemical concentrations in wristbands. Despite the differences that exist between laboratory studies using polydimethylsiloxane (PDMS) environmental samplers and worn wristbands, these results indicate that worn wristbands are primarily acting as first-order kinetic samplers. These results suggest that studies using different deployment lengths should be comparable when results are normalized to the length of the deployment period. In addition, a shorter deployment period could be utilized for compounds that were commonly detected in as little as one day.

Nicotine exposure from packaged cigarettes in tobacco retail settings

BACKGROUND

Although many studies on exposure to environmental tobacco smoke from passive smoking have been conducted, most of such studies have only focused on the chemicals produced by active combustion. The current study examined the extent to which uncombusted and packaged cigarettes in cigarette racks at retail stores diffuse airborne nicotine.

METHODS

Airborne nicotine samples were collected for 15 days on passive monitors mounted near the indoor cigarette racks (Point 1) and farthest point from the cigarette racks (Point 2) in tobacco retailer stores (N=95) in South Korea (5 months, data collection from January to May in 2022.

RESULTS

The average airborne nicotine level was 0.0908 ug/m3 at Point 1 and 0.0345 ug/m3 at Point 2. We found a positive correlation (r=0.647, p <0.001) in nicotine concentration between the two measurement points. The interior size of the target stores was positively correlated (r=0.334, p <0.001) with the within-store difference in nicotine concentration between the two measurement points. The airborne nicotine concentration at Point 1 was statistically significantly higher than at Point 2 (z=-2.326, p=0.020, effect size: 0.2215), especially at larger stores.

CONCLUSIONS

Our findings indicate that packaged, unopened, and uncombusted cigarettes in cigarette racks at tobacco retailers emits airborne nicotine, which is a previously unrecognized source of nicotine exposure. This result has implications for policy considerations, such as the potential installation of ventilation systems on cigarette racks or the exploration of alternative packaging methods.

Advanced Materials Design for Adsorption of Toxic Substances in Cigarette Smoke

Cigarettes, despite being economically important legal consumer products, are highly addictive and harmful, particularly to the respiratory system. Tobacco smoke is a complex mixture containing over 7000 chemical compounds, 86 of which are identified to have "sufficient evidence of carcinogenicity" in either animal or human tests. Thus, tobacco smoke poses a significant health risk to humans. This article focuses on materials that help reduce the levels of major carcinogens in cigarette smoke; these include nicotine, polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines, hydrogen cyanide, carbon monoxide, and formaldehyde. Specifically, the research progress on adsorption effects and mechanisms of advanced materials such as cellulose, zeolite, activated carbon, graphene, and molecularly imprinted polymers are highlighted. The future trends and prospects in this field are also discussed. Notably, with advancements in supramolecular chemistry and materials engineering, the design of functionally oriented materials has become increasingly multidisciplinary. Certainly, several advanced materials can play a critical role in reducing the harmful effects of cigarette smoke. This review aims to serve as an insightful reference for the design of hybrid and functionally oriented advanced materials.

An Exploratory Study on Strategies Adopted by Parents Who Use E-Cigarettes to Negotiate Risk Perceptions of Their Children's Secondhand Exposure and Parental Role Modeling

Existing health messages mainly targeted youth susceptible to vaping or parents who do not have much knowledge about e-cigarettes. This study makes a unique contribution by conducting the first in-depth investigation of e-cigarette-using parents' risk perceptions and parental role modeling and how these two factors affect their vaping behaviors at home or implementation of any strategies to reduce their children's risk. Fifteen parents who used e-cigarettes participated in a semi-structured interview. Interview transcripts were coded and analyzed through a deductive approach of thematic analysis. This study demonstrates the need to develop and disseminate future health messages for e-cigarette-using parents who may have low-risk perceptions of secondhand exposure or who have adopted ineffective strategies to reduce their children's exposure. This study also identifies some possible targets for future intervention efforts through these parents including increasing their knowledge about the health risk of secondhand exposure to e-cigarettes, emphasizing the caregiver role, and effective communications with children about the consequences of vaping.

Wearable Passive Samplers for Assessing Environmental Exposure to Organic Chemicals: Current Approaches and Future Directions

PURPOSE OF REVIEW

We are continuously exposed to dynamic mixtures of airborne contaminants that vary by location. Understanding the compositional diversity of these complex mixtures and the levels to which we are each exposed requires comprehensive exposure assessment. This comprehensive analysis is often lacking in population-based studies due to logistic and analytical challenges associated with traditional measurement approaches involving active air sampling and chemical-by-chemical analysis. The objective of this review is to provide an overview of wearable passive samplers as alternative tools to active samplers in environmental health research. The review highlights the advances and challenges in using wearable passive samplers for assessing personal exposure to organic chemicals and further presents a framework to enable quantitative measurements of exposure and expanded use of this monitoring approach to the population scale.

RECENT FINDINGS

Overall, wearable passive samplers are promising tools for assessing personal exposure to environmental contaminants, evident by the increased adoption and use of silicone-based devices in recent years. When combined with high throughput chemical analysis, these exposure assessment tools present opportunities for advancing our ability to assess personal exposures to complex mixtures. Most designs of wearable passive samplers used for assessing exposure to semi-volatile organic chemicals are currently uncalibrated, thus, are mostly used for qualitative research. The challenge with using wearable samplers for quantitative exposure assessment mostly lies with the inherent complexity in calibrating these wearable devices. Questions remain regarding how they perform under various conditions and the uncertainty of exposure estimates. As popularity of these samplers grows, it is critical to understand the uptake kinetics of chemicals and the different environmental and meteorological conditions that can introduce variability. Wearable passive samplers enable evaluation of exposure to hundreds of chemicals. The review presents the state-of-the-art of technology for assessing personal exposure to environmental chemicals. As more studies calibrate wearable samplers, these tools present promise for quantitatively assessing exposure at both the individual and population levels.

Exposure to secondhand aerosol from electronic cigarettes at homes: A real-life study in four European countries

Electronic cigarette (e-cigarette) use emits potentially hazardous compounds and deteriorates indoor air quality. Home is a place where e-cigarettes may frequently be used amid its increasing prohibition in public places. This study assessed the real-life scenario of bystanders' exposure to secondhand e-cigarette aerosol (SHA) at home. A one-week observational study was conducted within the TackSHS project in four countries (Greece, Italy, Spain, and the United Kingdom) in 2019 including: 1) homes of e-cigarette users living together with a non-user/non-smoker; and 2) control homes with no smokers nor e-cigarette users. Indoor airborne nicotine, PM2.5, and PM1.0 concentrations were measured as environmental markers of SHA. Biomarkers, including nicotine and its metabolites, tobacco-specific nitrosamines, propanediol, glycerol, and metals were measured in participants' saliva and urine samples. E-cigarette use characteristics, such as e-cigarette refill liquid's nicotine concentration, e-cigarette type, place of e-cigarette use at home, and frequency of ventilation, were also collected. A total of 29 e-cigarette users' homes and 21 control homes were included. The results showed that the seven-day concentrations of airborne nicotine were quantifiable in 21 (72.4 %) out of 29 e-cigarette users' homes; overall, they were quite low (geometric mean: 0.01 μg/m3; 95 % CI: 0.01-0.02 μg/m3) and were all below the limit of quantification in control homes. Seven-day concentrations of PM2.5 and PM1.0 in e-cigarette and control homes were similar. Airborne nicotine and PM concentrations did not differ according to different e-cigarette use characteristics. Non-users residing with e-cigarette users had low but significantly higher levels of cotinine, 3'-OH-cotinine and 1,2-propanediol in saliva, and cobalt in urine than non-users living in control homes. In conclusion, e-cigarette use at home created bystanders' exposure to SHA regardless of the e-cigarette use characteristics. Further studies are warranted to assess the implications of SHA exposure for smoke-free policy.

Home e-cigarette rules and youth's vulnerability to initiate and sustain e-cigarette use

Existing studies of the impact of home rules on youth's vulnerability to e-cigarette use were based on cross-sectional data, youth or parent reports alone, as well as youth's perceptions and susceptibility. This study capitalizes on the restricted-use data of the Population Assessment of Tobacco and Health (PATH) Study to examine the longitudinal association between home rules for e-cigarette use and youth's vulnerability including initiation of use and regular use two years later. Secondary analysis was conducted on 1203 parent-youth pairs who participated in both Wave 4 (2016-2018) and Wave 5 (2018-2019) assessment of the PATH Study and while the youth were age 12-16 at Wave 4. Linear and logistic regressions were performed to examine the associations between having a strict home rule for e-cigarette use at Wave 4 and the youth's outcomes including perceived social norms, expectancies, susceptibility, initiation of use, and regular use of e-cigarettes at Wave 5, controlling for parent and youth factors. The results show that having a strict home rule for e-cigarette use was associated with youth's heightened level of perceived injunctive norms (β = 0.22, p < 0.01), higher expectancy of harmfulness (β = 0.28, p < 0.01) and lower odds for regular e-cigarette use (OR = 0.36, p < 0.05). In conclusion, the findings of this study support the potential protective effects of implementing a strict home rule for e-cigarette use. Future intervention efforts may promote parents' awareness of the potential protective effects of a strict home e-cigarette rule on youth's normative belief, harm expectancy, and behavior of e-cigarette use.

Silicone wristbands as personal passive sampling devices: Current knowledge, recommendations for use, and future directions

Personal chemical exposure assessment is necessary to determine the frequency and magnitude of individual chemical exposures, especially since chemicals present in everyday environments may lead to adverse health outcomes. In the last decade, silicone wristbands have emerged as a new chemical exposure assessment tool and have since been utilized for assessing personal exposure to a wide range of chemicals in a variety of populations. Silicone wristbands can be powerful tools for quantifying personal exposure to chemical mixtures in a single sample, associating exposure with health outcomes, and potentially overcoming some of the challenges associated with quantifying the chemical exposome. However, as their popularity grows, it is crucial that they are used in the appropriate context and within the limits of the technology. This review serves as a guide for researchers interested in utilizing silicone wristbands as a personal exposure assessment tool. Along with briefly discussing the passive sampling theory behind silicone wristbands, this review performs an in-depth comparison of wristbands to other common exposure assessment tools, including biomarkers of exposure measured in biospecimens, and evaluates their utility in exposure assessments and epidemiological studies. Finally, this review includes recommendations for utilizing silicone wristbands to evaluate personal chemical exposure and provides suggestions on what research is needed to recognize silicone wristbands as a premier chemical exposure assessment tool.

Inter-method reliability of silicone exposome wristbands and urinary biomarker assays in a pregnancy cohort

Silicone wristbands act as passive environmental samplers capable of detecting and measuring concentrations of a variety of chemicals. They offer a noninvasive method to collect complex exposure data in large-scale epidemiological studies. We evaluated the inter-method reliability of silicone wristbands and urinary biomarkers in the New Hampshire Birth Cohort Study. A subset of study participants (n = 96) provided a urine sample and wore a silicone wristband for 7 days at approximately 12 gestational weeks. Women were instructed to wear the wristbands during all their normal activities. Concentrations of urinary compounds and metabolites in the urine and parent compounds in wristbands were compared. High detection rates were observed for triphenyl phosphate (76.0%) and benzophenone (78.1%) in wristbands, although the distribution of corresponding urinary concentrations of chemicals did not differ according to whether chemicals were detected or not detected in wristbands. While detected among only 8.3% of wristbands, median urinary triclosan concentrations were higher among those with triclosan detected in wristbands (9.04 ng/mL) than without (0.16 ng/mL). For most chemicals slight to fair agreement was observed across exposure assessment methods, potentially due to low rates of detection in the wristbands for chemicals where observed urinary concentrations were relatively low as compared to background concentrations in the general population. Our findings support the growing body of research in support of deploying silicone wristbands as an important exposure assessment tool.

Chemical and biological assessments of environmental mixtures: A review of current trends, advances, and future perspectives

Considering the chemical complexity and toxicity data gaps of environmental mixtures, most studies evaluate the chemical risk individually. However, humans are usually exposed to a cocktail of chemicals in real life. Mixture health assessment remains to be a research area having significant knowledge gaps. Characterization of chemical composition and bioactivity/toxicity are the two critical aspects of mixture health assessments. This review seeks to introduce the recent progress and tools for the chemical and biological characterization of environmental mixtures. The state-of-the-art techniques include the sampling, extraction, rapid detection methods, and the in vitro, in vivo, and in silico approaches to generate the toxicity data of an environmental mixture. Application of these novel methods, or new approach methodologies (NAMs), has increased the throughput of generating chemical and toxicity data for mixtures and thus refined the mixture health assessment. Combined with computational methods, the chemical and biological information would shed light on identifying the bioactive/toxic components in an environmental mixture.

A systematic review of the use of silicone wristbands for environmental exposure assessment, with a focus on polycyclic aromatic hydrocarbons (PAHs)

BACKGROUND

Exposure assessment is critical for connecting environmental pollutants to health outcomes and evaluating impacts of interventions or environmental policies. Silicone wristbands (SWBs) show promise for multi-pollutant exposure assessment, including polycyclic aromatic hydrocarbons (PAHs), a ubiquitous class of toxic environmental pollutants.

OBJECTIVE

To review published studies where SWBs were worn on the wrist for human environmental exposure assessments and evaluate the ability of SWBs to capture personal exposures, identify gaps which need to be addressed to implement this tool, and make recommendations for future studies to advance the field of exposure science through utilization of SWBs.

METHODS

We performed a systematic search and a cited reference search in Scopus and extracted key study descriptions.

RESULTS

Thirty-nine unique studies were identified, with analytes including PAHs, pesticides, flame retardants, and tobacco products. SWBs were shipped under ambient conditions without apparent analyte loss, indicating utility for global exposure and health studies. Nineteen articles detected a total of 60 PAHs in at least one SWB. Correlations with other concurrent biological and air measurements indicate the SWB captures exposure to flame retardants, tobacco products, and PAHs.

SIGNIFICANCE

SWBs show promise as a simple-to-deploy tool to estimate environmental and occupational exposures to chemical mixtures, including PAHs.

Silicone Wristbands in Exposure Assessment: Analytical Considerations and Comparison with Other Approaches

Humans are exposed to numerous potentially harmful chemicals throughout their lifetime. Although many studies have addressed this issue, the data on chronic exposure is still lacking. Hence, there is a growing interest in methods and tools allowing to longitudinally track personal exposure to multiple chemicals via different routes. Since the seminal work, silicone wristbands (WBs) have been increasingly used to facilitate human exposure assessment, as using WBs as a wearable sampler offers new insights into measuring chemical risks involved in many ambient and occupational scenarios. However, the literature lacks a detailed overview regarding methodologies being used; a comprehensive comparison with other approaches of personal exposure assessment is needed as well. Therefore, the aim of this review is fourfold. First, we summarize hitherto conducted research that employed silicone WBs as personal passive samplers. Second, all pre-analytical and analytical steps used to obtain exposure data are discussed. Third, we compare main characteristics of WBs with key features of selected matrices used in exposure assessment, namely urine, blood, hand wipes, active air sampling, and settled dust. Finally, we discuss future needs of research employing silicone WBs. Our work shows a variety of possibilities, advantages, and caveats associated with employment of silicone WBs as personal passive samplers. Although further research is necessary, silicone WBs have already been proven valuable as a tool for longitudinal assessment of personal exposure.

Comparative Assessment of Pesticide Exposures in Domestic Dogs and Their Owners Using Silicone Passive Samplers and Biomonitoring

Pesticides are used extensively in residential settings for lawn maintenance and in homes to control household pests including application directly on pets to deter fleas and ticks. Pesticides are commonly detected in the home environment where people and pets can be subject to chronic exposure. Due to increased interest in using companion animals as sentinels for human environmental health studies, we conducted a comparative pesticide exposure assessment in 30 people and their pet dogs to determine how well silicone wristbands and silicone dog tags can predict urinary pesticide biomarkers of exposure. Using targeted gas chromatography-mass spectrometry analyses, we quantified eight pesticides in silicone samplers and used a suspect screening approach for additional pesticides. Urine samples were analyzed for 15 pesticide metabolite biomarkers. Several pesticides were detected in >70% of silicone samplers including permethrin, N,N-diethyl-meta-toluamide (DEET), and chlorpyrifos. Significant and positive correlations were observed between silicone sampler levels of permethrin and DEET with their corresponding urinary metabolites (r_s = 0.50-0.96, p < 0.05) in both species. Significantly higher levels of fipronil were observed in silicone samplers from participants who reported using flea and tick products containing fipronil on their dog. This study suggests that people and their dogs have similar pesticide exposures in a home environment.

Operationalizing the Exposome Using Passive Silicone Samplers

The exposome, which is defined as the cumulative effect of environmental exposures and corresponding biological responses, aims to provide a comprehensive measure for evaluating non-genetic causes of disease. Operationalization of the exposome for environmental health and precision medicine has been limited by the lack of a universal approach for characterizing complex exposures, particularly as they vary temporally and geographically. To overcome these challenges, passive sampling devices (PSDs) provide a key measurement strategy for deep exposome phenotyping, which aims to provide comprehensive chemical assessment using untargeted high-resolution mass spectrometry for exposome-wide association studies. To highlight the advantages of silicone PSDs, we review their use in population studies and evaluate the broad range of applications and chemical classes characterized using these samplers. We assess key aspects of incorporating PSDs within observational studies, including the need to preclean samplers prior to use to remove impurities that interfere with compound detection, analytical considerations, and cost. We close with strategies on how to incorporate measures of the external exposome using PSDs, and their advantages for reducing variability in exposure measures and providing a more thorough accounting of the exposome. Continued development and application of silicone PSDs will facilitate greater understanding of how environmental exposures drive disease risk, while providing a feasible strategy for incorporating untargeted, high-resolution characterization of the external exposome in human studies.

Smoking habit in parents and exposure to environmental tobacco smoke in elementary school children of Milan

INTRODUCTION

Children with smoking parents are potentially exposed to Environmental Tobacco Smoke (ETS). The aims of this study were: 1) to assess ETS exposure in Milan schoolchildren, by measuring urinary cotinine (COT-U), 2) to compare the parents' perception of children ETS exposure, with the actual ETS exposure measured by COT-U, 3) to explore the factors influencing COT-U, including smoking bans at home, the season, and children characteristics.

METHODS

One-hundred school children (7-11 years) and their parents were recruited for the study in Spring 2018 (n = 81) and in Winter 2019 (n = 94), 75 children participated to both campaigns, for a sum of 175 observations. A questionnaire was submitted to parents to collect information about smoking habits in the house. COT-U was measured by LC-MS/MS in spot urine sample collected in the morning from children.

RESULTS

Detectable COT-U levels were found in 42% and 57% of children, in spring and winter, in contrast with 17% and 13% of parents acknowledging ETS exposure. Children living with smokers or e-cigarette users (vapers) (30% of the participants) had higher COT-U levels than children not living with smokers or vapers (median 0.67, 0.46, and <0.1 μg/L in spring, and 0.98, 0.85, and 0.11 μg/L in winter, respectively). Increasingly higher COT-U levels were observed in children living in homes where smoking was completely banned, allowed in the external parts of the home, or allowed in some rooms. The multiple regression analysis confirmed the positive significant effect of living with smokers, a partial smoking ban and absence of smoking ban at home, the winter season, and BMI as determinants of COT-U.

CONCLUSION

ETS exposure resulted in measurable urinary cotinine in children. Smoking parents underestimate exposure to ETS of their children. Living with smokers is a determinant of COT-U, only slightly mitigated by adopting partial smoking ban.

E-Cigarette Toxicology

Since the spread of tobacco from the Americas hundreds of years ago, tobacco cigarettes and, more recently, alternative tobacco products have become global products of nicotine addiction. Within the evolving alternative tobacco product space, electronic cigarette (e-cigarette) vaping has surpassed conventional cigarette smoking among adolescents and young adults in the United States and beyond. This review describes the experimental and clinical evidence of e-cigarette toxicity and deleterious health effects. Adverse health effects related to e-cigarette aerosols are influenced by several factors, including e-liquid components, physical device factors, chemical changes related to heating, and health of the e-cigarette user (e.g., asthmatic). Federal, state, and local regulations have attempted to govern e-cigarette flavors, manufacturing, distribution, and availability, particularly to underaged youths. However, the evolving e-cigarette landscape continues to impede timely toxicological studies and hinder progress made toward our understanding of the long-term health consequence of e-cigarettes. Expected final online publication date for the Annual Review of Pharmacology and Toxicology, Volume 62 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Use of E-Cigarettes and Associated Factors among Youth in Thailand

OBJECTIVE

The study explored e-cigarette use among youth and associated factors in Thailand.

METHODS

This was a cross sectional study of 6,045 seventh grade students selected using a multistage design. Self-administered questionnaires relating to the socio-demographic characteristics, history of cigarette and e-cigarette uses, friends' and family's use of e-cigarettes, knowledge and perception of e-cigarette use, history of alcohol uses, and life assets were gathered. Multivariate logistic regression models were used to examine the variables and their association with e-cigarette use.

RESULTS

Prevalence of ever e-cigarette use was 7.2% and current e-cigarette use was 3.7%. We found that current cigarette smoking (AOR 4.28, 95% CI: 2.05-8.94), parental e-cigarette use (AOR 6.08, 95% CI: 2.81-13.17), peer e-cigarette use (AOR 3.82, 95% CI: 2.19-6.65), peer approval of smoking (AOR 1.95, 95% CI: 1.11-3.41), and unaware of e-cigarettes' risk (AOR 5.25, 95% CI: 2.67-10.34). were significantly associated with current use of e-cigarettes. Male sex, poor academic achievement, and poor life assets (power of wisdom) were only significantly associated with ever e-cigarette use.

CONCLUSION

Prevalence of current e-cigarette use among Thai middle school students did not change significantly since the government banned importation and sales of e-cigarettes in 2015, suggesting that the Thai ban has been a success. Factors associated with e-cigarette use among Thai youth were consistent with other countries. Ever e-cigarette use, increased, but less than in countries without a ban. To strengthen efforts to prevent youth from e-cigarette use and addiction, the government should improve law enforcement, especially against online marketing and strengthen school-based anti-smoking programs to include e-cigarette lessons, educating parents and the public about the harm of e-cigarettes, including secondhand effects on non-users.
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Identification of newly formed toxic chemicals in E-cigarette aerosols with Orbitrap mass spectrometry and implications on E-cigarette control

The increasing use of electronic nicotine delivery systems (ENDS) is of concern due to multiple emerging adverse health effects. Most analyses of the harmful chemicals of ENDS have targeted metals or carbonyls generated by thermal decomposition of carrier liquids such as propylene glycol. However, new complex compounds not routinely identified and with unknown health consequences could be formed. ENDS aerosol samples were collected by the direct aerosol droplet deposition method. Untargeted analysis was performed using Orbitrap mass spectrometry with high mass accuracy. We identified more than 30 "features" in the aerosol characterized by pairs of the mass-to-charge ratio "m/z" of the compound and the retention time. We identified several compounds containing nicotine and propylene glycol (NIC-PG), whose abundance relative to nicotine increased along with vaping power used. On the basis of the prediction by the Environmental Protection Agency Toxicity Estimation Software Tool, these compounds exert developmental toxicity. In addition, a nitrogen-containing compound, likely tributylamine (a known lung irritant), was identified based on the molecular weight. This compound has not been previously identified in ENDS e-liquids and aerosols. ENDS produce not only small toxic compounds such as aldehydes, but also large complex toxic compounds such as NIC-PG. Predicted development toxicity for NIC-PG is concerning for fetal development in pregnant women who use ENDS, children exposed to secondhand or thirdhand ENDS aerosols, and teenage ENDS users whose brains are still developing. The strong positive association between NIC-PG levels and ENDS power output supports regulating high-powered ENDS.