Biomedical scientist Patrícia de Oliveira, 28, remembers the month and year well: October 2017. That was when she first tried a fruit-flavored cigarette, at a club with friends. At first, I only smoked on weekends, but soon the habit spread to other days as well.
At the time, she was introduced to electronic cigarettes by friends who brought the devices from Miami (USA). “Since it didn’t leave a smell and they said it would help with the addiction, I thought it was perfect”, he recalls.
During the Covid-19 pandemic, however, it began to combine electronic cigarettes with hand-rolled tobacco. A month ago, realizing her dependence and lack of breath for exercise, she sought medical help to stop smoking, with the help of medication and psychotherapy.
Among friends, however, use of the devices has been increasingly frequent. “I went with five of them to a Japanese rotation last weekend. On the way out, the five had electronic cigarettes. They are very easily found in tobacconists, newsstands and even delivered by delivery apps for R$90”, he says.
Datafolha research commissioned by ACT Health Promotion shows that most users of so-called DEFs (electronic smoking devices) bought these products in places such as tobacconists, convenience stores, newsstands, supermarkets and websites, even though the sale is prohibited in the country since 2009.
The survey reveals that 3% of the population over 18 years uses these devices daily or occasionally, also called electronic cigarettes, e-cigarette, e-ciggy, e-pipe and heated tobacco.
The subject has worried public health specialists and became the subject of a hearing last Thursday (26), in the Chamber of Deputies. Their perception is that the use of these devices among young people is increasing and many are starting to smoke from them.
This situation, associated with the fact that there was a 34% increase in cigarette consumption in the country during the pandemic, may slow down the fall in the number of smokers in Brazil, according to experts.
A world reference, the national program to combat smoking managed to reduce the percentage of smokers in the country from 30% to 12.8% of the population between 1986 and 2019. Data for 2020 have not yet been released by the Ministry of Health
Press officer Clarissa Perillo, 37, is part of the team who saw the increase in cigarette consumption during the pandemic due to anxiety. “Before I smoked about 14 cigarettes a day, now there are 20, a pack”, says she, who has smoked since her teens.
On two occasions she tried to quit smoking, one of them for almost a year, but ended up relapse. “My husband and I decided together. We stopped going out with friends, drinking, so we wouldn’t have the trigger.”
A transition to e-cigarettes didn’t work either. “I inhaled and gave me a coughing fit, in addition to feeling unwell. The Le [o marido] smoked electronics for a while, but went back to conventional.”
According to doctors, users of electronic devices, who had never smoked before, have migrated at some point to conventional cigarettes. “If for some reason they don’t have electronics, they go for the conventional one,” says cardiologist Jaqueline Scholz, director of the Tobacco Treatment Program at InCor (Institute of the Heart).
A study by Inca (National Cancer Institute) found that half of the people who use or have used these products, being a quarter of them young, never used conventional cigarettes.
A systematic review, also by Inca, concluded that the use of electronic cigarettes increases by three times the risk of trying conventional cigarettes and by more than four times the risk of becoming a smoker. The article, published in the journal Ciência & Saúde Coletiva, analyzed 29 studies from different countries, with a total of more than 130 thousand people.
There are also studies that link the use of these devices to an increased risk of lung and cardiovascular diseases. “Cardiovascular mortality in California [Estados Unidos] it is the same for those who use electronic or conventional cigarettes. Electronic cigarettes are the biggest shot in the foot,” says Jaqueline Scholz.
According to her, these devices have released a greater amount of nicotine, which becomes addictive even more quickly. “The effect can be even worse than conventional cigarettes, because the person is not inhibited from using it. The more you use nicotine, the more you want to use it. The conventional, due to a series of limitations, such as the smell, the individual ends up consuming less.”
The warning about the dangers of electronic cigarettes was also made by the AMB (Brazilian Medical Association). “DEFs, in their vapor, contain severely toxic and carcinogenic substances, including nicotine, whose exposure during adolescence can harm the developing brain because they expose the body to toxic substances in the process of heating or vaporization,” says the text.
For Mônica Andreis, executive director of ACT Health Promotion, the concern becomes even greater when looking at the increased consumption of these devices among young people in countries where the sale was released. In the United States, in just one year, the jump was 78%, according to her.
“This industry discourse that they would be less harmful products aimed at adult audiences who cannot stop smoking is not confirmed. Electronic smoking devices, in the form of pens, pen drives, are very attractive among young people.”
Diogo Alves, national consultant at Opas (Pan American Health Organization), recalls that there are over 16,000 different flavors of these products, including caramel, cookies and apple pie.
“These are not flavors for smokers, they are clearly aimed at initiation [do jovem], to mask the harshness of nicotine. The industry talks about harm reduction for adults, but those who use these products are children, teenagers.”
Anvisa is preparing a review of the legislation on the subject. On the one hand, public health advocates that the sale remain prohibited. The tobacco industry is pushing for the release.
In note to sheet, the agency says that several studies have been carried out with the aim of evaluating the contents of the emissions, measuring the health impacts and describing the risks associated with these products.
“So far, there are still uncertainties and controversies regarding the use and risks attributed to these devices”, says Anvisa. According to the agency, a preliminary regulatory impact analysis report on this matter is currently being concluded.
In the Datafolha survey, 67.7% of the population defends that these devices are not released, as they understand that the country does not need more tobacco products on the market.
Manufacturer defends regulation of electronic smoking devices
In a statement, BAT Brasil (formerly Souza Cruz) says it defends the regulation of vaporizers and heated tobacco products in Brazil, ensuring the quality, safety and proper distribution of these products to adult cigarette consumers.
The company says it hopes that the review of the regulation taken up by Anvisa will be made in light of the best evidence, as this debate needs to include the concept of harm reduction, adopted and accepted in developed countries such as the United States, Canada, Australia, UK and European Union.
“Evidence that these products have a lower potential health risk than conventional cigarettes is that the NHS [National Health Service], England’s public health service, recommends vaporizers for smokers who do not choose to quit smoking and want alternatives with a potential lower health risk.”
For BAT, there are many myths and misinformation about vaporizers and heated tobacco products. “The evidence, however, shows that they offer less exposure to substances considered to be hazardous to health. We can compare the issue with those who defend foods with less sodium, sugar or fat. Ultimately, it is a harm reduction policy. , without resorting to banning or banning any product.”
According to the company, there is a growing consumer market for vaporizers in Brazil. “Today, 100% of this market is illegal, and consumers are looking for these products not only clandestinely, they can be easily found for sale in both traditional retailers and the internet and delivery applications.”