Por que os cigarros eletrônicos são uma ameaça à saúde pública?

Abstract

In October 2018, the U.S. Food and Drug Administration (FDA) held a surprise inspection of the headquarters of the Juul company, manufacturers of electronic cigarettes, where thousands of documents were seized on grounds that the company was engaged in practices aimed at inducing young people to consume these tobacco products 1. The raid was part of the response by the FDA to what can be considered an e-cigarette epidemic use among elementary and High School students in the United States. Among High School students, e-cigarette vaping increased from 1.5% in 2011 to 20.8% in 2018, and 2017 saw the most significant increase 2. Among elementary school students, e-cigarette use increased from 0.6% in 2011 to 4.9% in 2018 2. In short, practically 1 in 5 American High School students use e-cigarettes, mostly products with diverse flavors and mainsly of the brand Juul 2. The significant increase in 2017 is purportedly associated with this brand's popularity on the American market 2. The reasons for the great popularity of these products among students are their format, the possibility of low-profile use, the high nicotine content, and attractive flavors 3. The small and rectangular shape of the product, presenting several colors, resembling a pen drive, and charged via USB port is attractive and discreet. The nicotine is loaded via "pods", which contain the amount of nicotine equivalent to 20 conventional cigarettes (one pack) 4,5. Compared to other e-cigarettes, the "pods" used by Juul have far higher addictive potential, causing a physiological sensation similar to that experienced by smokers of conventional cigarettes. The product uses nicotine treated with benzoic acid (resulting in the nicotine salts, its natural form in tobacco leaves) to deliver concentrations 10 times higher than in other e-cigarettes, which use freebase nicotine in their formulations 5. Other manufacturers, possibly inspired by Juul's commercial success, have also begun to adopt nicotine salts in their products 4. Interestingly, the tobacco industry has a history of manipulating nicotine levels in cigarettes, with techniques ranging from the addition of ammonia to cigarettes to increase the freebase nicotine to using modified tobacco strains that produce higher nicotine concentrations (Y-1 tobacco) 6,7 , but the use of these salts in e-cigarettes is unprecedented. One study suggests that Juul pods have greater addictive potential for young people than other e-cigarettes or even ordinary cigarettes 8. Like other electronic smoking devices, Juul comes in various flavors such as creme brûlée, mango, and menthol, making these products even more attractive to young people, just as flavors are used in Why electronic cigarettes are a public health threat? Por que os cigarros eletrônicos são uma ameaça à saúde pública? ¿Por qué los cigarrillos electrónicos son una amenaza para la salud pública?

Sais de Nicotina e Nicotina Sintética: Novos Desafios para um Velho Problema

“…Porém, estudos apontam que esses dispositivos, além de potencialmente causarem danos significativos à saúde, podem levar a uma dependência sustentada de nicotina 22,23 . E, pelo fato de as suas versões mais modernas possuírem formas otimizadas para a entrega de nicotina, design atrativo, com mais de 8 mil sabores e 250 marcas somente nos Estados Unidos 24 , entre outros fatores, potencializam a capacidade de cativarem o público, especialmente os mais jovens e os não fumantes 6,10,19 .…”

“…Dessa forma, é preocupante a restrição das opções terapêuticas pare esse grupo 4 . Tal público é justamente o mais susceptível a se tornar tabagista e a sofrer as consequências da exposição à nicotina 5 , além de ser alvo de uma série de estratégias utilizadas para atrai-lo, por exemplo, propagandas, novos produtos atraentes 6 e o uso de aditivos que conferem sabores de balas e doces a produtos de tabaco 7 .…”

A dialogue with Janus: thoughts on the regulation of tobacco products in Brazil

“…In Brazil, prevalence rates for conventional cigarettes have been estimated at 15.35%, while for shisha and electronic cigarettes the rates are 1.65 % and 0.43% respectively (BERTONI et al, 2019). Although the rates for the latter two are significantly lower than for conventional cigarettes, both have the potential to grow in their consumption, especially among younger people (MARTINS et al, 2019;SILVA et al, 2019a) and thus reverse tobacco control policies if effective measures are no longer taken.…”