Abstract
To describe the prevalence of use of electronic nicotine delivery systems (ENDS) and waterpipe in Brazil, by population subgroups, and to evaluate the trend between 2013 and 2019. We used data from the 2019 National Health Survey to estimate the prevalence of lifetime and current use of ENDS and current use of waterpipes by socio-behavioral characteristics. Differences in prevalence over time were calculated using data from the III Brazilian Household Survey on Substance Use-2015 and the National Health Survey-2013. For 2019, the prevalence of current use of ENDS was estimated at 0.64% (∼1 million people), of which ∼70% were in the age group of 15-24 years old. The highest prevalence was observed in the Midwest region, but the Southeast region concentrates half of these users. Almost 90% are non-smokers, with high prevalence among those who also use waterpipe and abuse alcohol. There was an increase in ENDS use between 2015 and 2019, particularly among younger people. The prevalence of current waterpipe use in 2019 was estimated at 0.47% (∼800,000 individuals), of which ∼80% were 15-24 years old. There was an increase in the prevalence of current waterpipe use between 2013 and 2019, and among young people the increase was ∼300%. In Brazil, ENDS have been used mostly by young people, and by never smokers of manufactured cigarettes. The use of ENDS and waterpipe has been increasing even with the country's regulatory restrictions, which may compromise the successful history of the tobacco control policy.
Highlights
IntroductionWith the reduction in the number of industrialized cigarette users worldwide[1], the tobacco industry has invested in the marketing of new products such as electronic nicotine delivery systems (ENDS) — which include electronic cigarettes, heated tobacco cigarettes and electronic waterpipes —, and in giving greater visibility to more traditional products, such as the waterpipe
With the reduction in the number of industrialized cigarette users worldwide[1], the tobacco industry has invested in the marketing of new products such as electronic nicotine delivery systems (ENDS) — which include electronic cigarettes, heated tobacco cigarettes and electronic waterpipes, and in giving greater visibility to more traditional products, such as the waterpipe.Unlike conventional cigarettes, the release of nicotine in ENDSs does not depend on combustion to produce smoke, but on an electronic mechanism that produces steam, heating a liquid that contains nicotine and additives or solid tobacco sheets
The subpopulation of adolescents and young people aged 15–24 years had the highest prevalence of ENDS use (5.41% for lifetime use and 2.38% for current use), accounting for about 70% of ENDS users both in lifetime and currently
Summary
With the reduction in the number of industrialized cigarette users worldwide[1], the tobacco industry has invested in the marketing of new products such as electronic nicotine delivery systems (ENDS) — which include electronic cigarettes, heated tobacco cigarettes and electronic waterpipes —, and in giving greater visibility to more traditional products, such as the waterpipe. The release of nicotine in ENDSs does not depend on combustion to produce smoke, but on an electronic mechanism that produces steam, heating a liquid that contains nicotine and additives (electronic cigarettes) or solid tobacco sheets (heated tobacco cigarette). There was an explosion ENDS use among young people, and in the United States, where until 2016 these new products were not regulated, the prevalence of use of PREVALENCE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS AND WATERPIPE IN BRAZIL electronic cigarettes has surpassed that of manufactured cigarettes among high school students (27.5 versus 5.8% in 2019)[6]
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