Electronic nicotine delivery systems in Brazilian state capitals: prevalence, profile of use, and implications for the National Tobacco Control Policy

The objectives of this study were to estimate the prevalence of use of electronic nicotine delivery systems (ENDS) and to explore the potential impact of ENDS use on smoking initiation with conventional cigarettes. We used data from the Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel), 2019 edition, which interviewed 52,443 individuals 18 years or older in Brazil's 26 state capitals and the Federal District. Point prevalence rates and confidence intervals (95%CI) were calculated for current and ever use of ENDS in each state capital, and the profile of ENDS users were described. Prevalence of lifetime use was estimated at 6.7% (95%CI: 6.13-7.27) and current use at 2.32% (95%CI: 1.97-2.68). A total of 2.4 million individuals had used ENDS any time in life, and 835,000 were currently using them. Approximately 80% of persons who had used ENDS were 18 to 34 years-old. Prevalence rates for daily use and dual use in individuals aged 18 to 24 years were nearly 10 times than prevalence in the older age groups. More than half of individuals who had ever used ENDS were never smokers. The proportion of women and individuals with high educational level were higher in the group of young people who only used ENDS than among those who only smoked conventional cigarettes. ENDS users also presented a higher proportion of binge drinking. Our findings are opposite to the tobacco industry's argument that the target public for ENDS is adult smokers. Considering that groups purportedly less prone to using conventional cigarettes are experiencing initiation with ENDS, our findings call attention to the possible negative impact of the dissemination of ENDS on Brazil's successful experience in the fight against tobacco.