O impacto do cigarro eletrônico na saúde bucal de pacientes adultos jovens / The impact of electronic cigarettes on oral health of young adult patients

O cigarro eletrônico (CE) surgiu como uma alternativa ao uso do cigarro convencional (CC) atuando como um meio de combate ao tabagismo. Apesar de ser considerado menos prejudicial à saúde do que o cigarro convencional, por muitos autores, seu uso não é isento de riscos. O presente estudo visa discutir e elucidar os impactos do uso de cigarros eletrônicos na saúde oral de pacientes adultos jovens. Esta revisão de literatura foi elaborada através da seleção de artigos científicos nos idiomas português e inglês, que abordam os temas de cigarro eletrônico e saúde oral. Utilizaram-se os bancos de dados Biblioteca Virtual em Saúde (BVS), PubMed e Google acadêmico, a busca foi baseada nos seguintes descritores de saúde: cigarro eletrônico, vaping e saúde bucal, e os respectivos em inglês, com limite temporal de 2019 a 2023. Diversas pesquisas relatam os efeitos dos cigarros eletrônicos na saúde bucal, como a xerostomia, halitose, cárie dental, perda e avulsão de elementos dentários, doença periodontal e diversas patologias orais. Além disso, os componentes químicos presentes nos líquidos dos cigarros eletrônicos também podem afetar a saúde bucal, podendo levar a danos no esmalte dentário e riscos desconhecidos as células e tecidos da cavidade oral. Logo, é necessário abordar o impacto que os cigarros eletrônicos causam e seus riscos à saúde bucal, além dos riscos já conhecidos para saúde geral dos usuários. Os profissionais de saúde devem estar atentos a essa questão e incluir informações sobre o uso de cigarros eletrônicos em suas avaliações e orientações aos pacientes.

The electronic cigarette (EC) emerged as an alternative to conventional cigarette (CC) use, acting as a means to combat smoking. Despite being considered less harmful to health than conventional cigarettes by many authors, its use is not without risks. The present study aims to discuss and elucidate the impacts of electronic cigarette use on the oral health of young adult patients. This literature review was conducted through the selection of scientific articles in Portuguese and English languages, addressing the topics of electronic cigarettes and oral health. The databases used included the Virtual Health Library (BVS), PubMed, and Google Scholar. The search was based on the following health descriptors: electronic cigarette, vaping, and oral health, and their English equivalents, with a time limit from 2019 to 2023. Several studies report the effects of electronic cigarettes on oral health, such as xerostomia, halitosis, dental caries, tooth loss and avulsion, periodontal disease, and various oral pathologies. Furthermore, the chemical components present in electronic cigarette liquids can also impact oral health, potentially leading to dental enamel damage and unknown risks to oral cavity cells and tissues. Therefore, it is necessary to address the impact and risks of electronic cigarettes on oral health, in addition to the known risks to users' overall health. Health professionals should be attentive to this issue and include information about electronic cigarette use in their assessments and patient guidance.

Cuantificación de cannabinoides y acetato de vitamina E en cartuchos para vaporizar incautados en Chile / Quantification of cannabinoids and vitamin E acetate in vape cartridges seized in Chile

Resumen La marihuana es la droga de abuso de mayor consumo en Chile y el mundo. La forma de consumo más utilizada es fumada como cigarrillos, sin embargo, en el último tiempo se ha masificado el uso de vaporizadores. Estos dispositivos utilizan calor para evaporar la resina que se encuentra al interior de los cartuchos, la cual está compuesta principalmente por delta-9-tetrahidrocannabinol en altas concentraciones y otros aditivos como propilenglicol y acetato de vitamina E. En Estados Unidos se ha descrito toxicidad letal asociado al uso de estos dispositivos. En Chile no se conocen intoxicaciones asociadas a estos productos, sin embargo, su uso ha aumentado en los últimos años por lo que es importante conocer cuál es su composición química. El objetivo de este trabajo fue determinar la concentración de los principales compuestos presentes en los cartuchos para vaporizar que son incautados en nuestro país y para esto se im-plementó una metodología analítica para cuantificar los cannabinoides delta-9-tetrahidrocannabinol (THC), cannabidiol (CBD), canna-binol (CBN), y acetato de vitamina E mediante la técnica cromatografía gaseosa con detector de espectrometría de masas (GC/MSD). Se analizaron 51 muestras de cartuchos con una concentración promedio de THC de 60,2% (p/p). Las concentraciones de CBD y CBN no superaron el 2% (p/p) y en el caso de acetato de vitamina E fue detectado en 9 muestras con una concentración promedio de 51,4% (p/p).

Abstract Marijuana is the most widely used drug of abuse in Chile and the world. The most common form of consumption is smoking cigarettes, but more recently the use of vaporizers has become widespread. These devices use heat to vaporize the resin in the cartridges, which consists mainly of THC in high concentrations and other additives such as propylene glycol and vitamin E ace-tate. Lethal toxicity associated with the use of these devices has been described in the United States. In Chile, there are no known poisonings associated with these products; however, their use has increased in recent years, so it is important to know their chem-ical composition. The aim of this study was to determine the concentration of the main compounds present in the vaporizer car-tridges seized in our country. To this end, an analytical methodology was implemented to quantify the cannabinoids delta-9-tetra-hydrocannabinol (THC), cannabidiol (CBD) and cannabinol (CBN), and vitamin E acetate using the GC/MSD technique. Fifty-one cartridge samples were analyzed with an average THC concentration of 60.2% (w/w). The concentrations of CBD and CBN did not exceed 2% (w/w) and in the case of vitamin E acetate it was detected in 9 samples with an average concentration of 51.4% (w/w).

Electronic cigarettes: a new social practice and the challenge of tobacco control policies / Cigarros eletrônicos: uma nova prática social e o desafio das Políticas de controle do tabagismo

O tabagismo é uma doença crônica e é considerado um grave problema de saúde pública e tem sido alvo ao longo do tempo de muitas ações preventivas e de promoção à saúde. O produto do tabaco mais consumido entre adultos e jovens é o cigarro convencional, entretanto, o consumo de tabaco sem fumaça ou outros produtos do tabaco fumado, como os cigarros eletrônicos, tem sido observado de forma crescente no mundo. Os dispositivos eletrônicos para fumar (DEF), que têm despertado cada vez mais a atenção de consumidores jovens, envolvem diferentes equipamentos e tecnologias. Fundamentado no princípio da precaução, desde 2009, o Brasil proibiu a comercialização, importação e propaganda de todos os tipos de DEF que oferecessem a substituição de cigarro, cigarrilha, charuto, cachimbo e similares ou que objetivem alternativa ao tratamento do tabagismo, por meio da RDC n 46, de 28 de agosto de 2009. Mesmo proibido no Brasil, evidencia-se o uso dos cigarros eletrônicos como uma alternativa, revelando um novo desafio a ser enfrentado pelas políticas de controle do tabagismo. As lacunas de conhecimento inerentes a uma prática social nova, bem como da necessidade de construção de referenciais que contribuam para a melhor tomada de decisões, seja no âmbito da intervenção profissional ou da gestão das políticas públicas, com vistas a proteger a saúde da população, por si só já torna relevante a ampliação de conhecimentos acerca desta temática. Contudo, é necessário a compreensão de que as ações de prevenção, promoção e controle devem ser compreendidas de forma transversal e interdisciplinar, a fim de que se possa refletir sobre os processos que envolvem aspectos políticos, socioeconômicos e culturais que interagem diretamente com o processo saúde-doença. Deste modo, com base na problemática apresentada e considerando a relevância da temática em questão, como campo pouco enfrentado deste âmbito, destaca-se que a ampliação de investigações e o aprofundamento de discussões sobre ela, possibilitarão uma melhor compreensão e visibilidade do problema

Smoking is a chronic disease and is considered a serious public health problem and has been the target of many preventive and health promotion actions over time. The most consumed tobacco product among adults and young people is the conventional cigarette, however, the consumption of smokeless tobacco or other smoked tobacco products, such as electronic cigarettes, has been observed on an increasing basis in the world. Electronic smoking devices (EFD), which have increasingly attracted the attention of young consumers, involve different equipment and technologies. Based on the precautionary principle, since 2009, Brazil has prohibited the sale, importation and advertising of all types of DEF that offer the replacement of cigarettes, cigarillos, cigars, pipes and the like or that aim at an alternative to the treatment of smoking, through RDC n 46, of August 28, 2009. Even though it is prohibited in Brazil, the use of electronic cigarettes as an alternative is evident, revealing a new challenge to be faced by tobacco control policies. The knowledge gaps inherent to a new social practice, as well as the need to build references that contribute to better decision-making, whether in the scope of professional intervention or the management of public policies, with a view to protecting the health of the population, for itself already makes the expansion of knowledge about this theme relevant. However, it is necessary to understand that prevention, promotion and control actions must be understood in a transversal and interdisciplinary way, so that one can reflect on the processes that involve political, socioeconomic and cultural aspects that interact directly with the health process -illness. Thus, based on the problem presented and considering the relevance of the issue in question, as a field little faced in this area, it is emphasized that the expansion of investigations and the deepening of discussions about it, will allow a better understanding and visibility of the problem.

Long-term e-cigarette aerosol exposure causes pulmonary emphysema in adult female and male mice.

This study aimed to evaluate long-term exposure to conventional cigarette smoke (CC) and electronic cigarette (EC) aerosol in adult male and female C57BL/6 mice. Forty-eight C57BL/6 mice were used, male (n = 24) and female (n = 24), both were divided into three groups: control, CC and EC. The CC and EC groups were exposed to cigarette smoke or electronic cigarette aerosol, respectively, 3 times a day for 60 consecutive days. Afterwards, they were maintained for 60 days without exposure to cigarettes or electronic cigarette aerosol. Both cigarettes promoted an influx of inflammatory cells to the lung in males and females. All animals exposed to CC and EC showed an increase in lipid peroxidation and protein oxidation. There was an increase of IL-6 in males and females exposed to EC. The IL-13 levels were higher in the females exposed to EC and CC. Both sexes exposed to EC and CC presented tissue damage characterized by septal destruction and increased alveolar spaces compared to control. Our results demonstrated that exposure to CC and EC induced pulmonary emphysema in both sexes, and females seem to be more susceptible to EC.

Estudio cualitativo del uso de los cigarrillos electrónicos en los estudiantes universitarios / Qualitative Study of E-Cigarette Use in College Students

Objetivos: El propósito de esta investigación fue determinar el nivel de conocimiento, creencias, percepción y practicas asociadas al consumo de cigarrillos electrónicos en los estudiantes universitarios (UASD), recinto Santiago, República Dominicana. Cada estudiante firmó un consentimiento informado certificando que éste respondió cada pregunta realizada por el entrevistador de manera voluntaria. El método de recolección de los datos fue mediante entrevistas, las cuales fueron grabadas por los entrevistadores. La muestra fue de 53 entrevistas, 48 individuales y 5 grupos focales, la misma se tomó hasta alcanzar el punto de saturación de cada pregunta, es decir cuando todas las respuestas se tornaron repetitivas. Materiales y métodos: Se realizó un estudio cualitativo de tipo fenomenológico y de fuentes primarias en el período mayo-agosto del año 2019 en la universidad privada Pontificia Universidad Católica Madre y Maestra (PUCMM) y la universidad pública Universidad Autónoma de Santo Domingo. (UASD), campus Santiago, República Dominicana. El método de recolección de datos se realizó a través de entrevistas, las cuales fueron grabadas por los entrevistadores. Cada estudiante entrevistado firmó un consentimiento informado certificando que respondió voluntariamente a cada pregunta formulada por el entrevistador. La muestra estuvo compuesta por 53 entrevistas, 48 personas y cinco grupos focales. Las entrevistas se realizaron hasta llegar al punto de saturación de cada pregunta, que es cuando todas las respuestas se volvieron repetitivas. Resultados: El conocimiento que tiene los estudiantes universitarios sobre cigarrillo electrónico (CE), es pobre, desde su funcionamiento, partes, sustancias e incluso las posibles complicaciones que puede traer a la salud, tanto en la Pontificia Universidad Católica Madre y Maestra (PUCMM) como en la Universidad Autónoma de Santo Domingo (UASD), pero es más notable en la universidad pública. Por otro lado, muchos perciben el CE, como una alternativa del uso de tabaco, que posee diversidad de sabores, olor agradable, atractivo, práctico y capaz de ofrecer relajación. En cuanto a la actitud hacia el dispositivo, en PUCMM exhibe un mayor nivel de rechazo con respecto al uso. Es importante mencionar, que mayoría de los entrevistados son o alguna vez fueron usuarios de este, no obstante, no lo recomiendan en gran medida, ya que asumen que puede causar daño y ser adictivo, aunque en menor medida al cigarrillo convencional. La población más susceptible a su uso, son los jóvenes y el sexo masculino, aunque las féminas se han ido sumando de manera significativa. De igual modo, se logró apreciar las grandes influencias que mueven a los jóvenes a su consumo, incluyendo, las redes sociales, familia, amigos, en general el entorno en que se rodean. Conclusión: Concluimos que los estudiantes universitarios carecen de conocimiento con respecto al cigarrillo electrónico, tanto en el funcionamiento, sustancias y complicaciones para la salud. Muchos observan al cigarrillo electrónico como un dispositivo para fumar con un olor agradable, por lo cual puede ser muy atractivo para los usuarios. Se logró apreciar el importante papel que juegan las influencias sociales para el uso del dispositivo, promovido por las redes sociales y relaciones cercanas. Otro problema en la sociedad actual es el uso de CE en menores de edad. Según los resultados existe una gran necesidad de intervención y educación, principalmente en los jóvenes.

Objective: The purpose of this research was to determine the level of knowledge, beliefs, perception, and practices associated with consuming electronic cigarettes among university students. Materials and methods: A qualitative study of phenome-nological type and from primary sources was carried out in the period of May-August of the year 2019 at the private university Pontificia Universidad Católica Madre y Mae-stra (PUCMM) and the public university Universidad Autónoma de Santo Domingo (UASD), Santiago campus, Dominican Republic. The data collection method was done through interviews, which the interviewers recorded. Each student interviewed signed an informed consent cer-tifying that they answered voluntarily each question asked by the interviewer. The sample consisted of 53 interviews, 48 individuals, and five focus groups. Interviews were done until reaching the saturation point of each question, which is when all the answers became repetitive. Results: University students' knowledge regarding elec-tronic cigarettes (EC) is poor. Knowledge regarding its mechanism, parts, substances, and possible complications to one's health, is scarce both in PUCMM and the UASD, but this is more notable at the public university. Addition-ally, many perceive EC as an alternative to tobacco use, the former, as per our study population, having a variety of fla-vors, a pleasant smell, being attractive, practical, and capa-ble of offering relaxation. Regarding the attitude towards the device, PUCMM exhibits a higher level of rejection regarding its use. It is essential to mention that most inter-viewees were once users of EC. However, they do not rec-ommend it to a great extent since they assume that it can cause harm and be addictive, although to a lesser extent than conventional cigarettes. The population most suscep-tible to its use are young people, including minors and the male gender, although females have been significantly increasing its use. Similarly, it was possible to appreciate the influences that greatly evoke the younger population's consumption, including social networks, family, friends, and the surrounding environment. Conclusion: We concluded that university students have insufficient knowledge regarding electronic cigarettes, both in their mechanism, substances, and health compli-cations. Most see electronic cigarettes as smoking devices with a pleasant smell, which can be very attractive to users. It was possible to observe the critical role played by social influences on the use of the device, promoted by social networks and close relationships. Another problem in cur-rent society is the use of CE in minors. According to the results, there is a great need for intervention and educa-tion, mainly among the younger generation.

E-Cigarettes: A New Threat to Cardiovascular Health - A World Heart Federation Policy Brief.

Tobacco is widely recognized as a leading cause of cardiovascular morbidity and mortality, accounting for approximately seventeen percent of all cardiovascular disease deaths globally. Electronic nicotine delivery systems such as e-cigarettes have been developed and advertised as safer alternatives to traditional tobacco cigarettes. Aggressive marketing strategies, as well as misleading claims by manufacturers, have largely contributed to the belief that e-cigarettes are harmless. In reality, e-cigarettes are far from innocuous. E-cigarette solutions and aerosols generally contain harmful substances that are commonly found in tobacco cigarette emissions. A growing body of literature suggests that e-cigarettes are associated with an increased risk of cardiovascular morbidity and mortality. In addition, the effectiveness of e-cigarettes as smoking cessation tools has yet to be determined. Concerningly, most smokers do not give up on tobacco cigarettes and eventually become dual users. Unregulated, e-cigarettes constitute a serious threat to established tobacco control policies. Fortunately, many countries have demonstrated that strong regulations were effective in protecting their populations from the dangers of e-cigarettes. The World Heart Federation recommends applying the precautionary principle and a set of measures to protect vulnerable populations, prevent exposure to second-hand smoking, and address misleading claims. In this regard, we recommend that governments, policymakers, and other relevant stakeholders enact or support the following measures, among others: Prohibit the sale and distribution of e-cigarettes to minors, as well as the use of flavouring agents.Prohibit the use of e-cigarettes anywhere tobacco cigarettes have been banned.Prohibit marketing, advertising, and misleading claims regarding e-cigarettes.Apply excise taxes on e-cigarettes.Conduct more research regarding the long-term effects of e-cigarettes on cardiovascular health. Lastly, countries that have banned the commercialization of e-cigarettes should maintain these measures.

Lung Damage Caused by Heated Tobacco Products and Electronic Nicotine Delivery Systems: A Systematic Review.

The tobacco industry promotes electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) as a safer alternative to conventional cigarettes with misleading marketing sustained by studies with conflict of interest. As a result, these devices sell without regulations and warnings about their adverse effects on health, with a growing user base targeting young people. This systematic review aimed to describe the adverse effects on the respiratory system in consumers of these devices. We conducted a systematic review and bibliometric analysis of 79 studies without conflict of interest evaluating ENDS and HTP effects in the respiratory system in experimental models, retrieved from the PubMed database. We found that the damage produced by using these devices is involved in pathways related to pulmonary diseases, involving mechanisms previously reported in conventional cigarettes as well as new mechanisms particular to these devices, which challenges that the tobacco industry's claims. The present study provides significant evidence to suggest that these devices are an emerging public health problem and that they should be regulated or avoided.

El cigarrillo electrónico: un problema de salud pública emergente / The electronic cigarette: an emerging public health problem

RESUMEN Desde el 2004 se dispone del cigarrillo electrónico (CE), dispositivo que calienta nicotina y la administra formando parte de un vapor. Presentamos una revisión narrativa del CE y su efecto en la salud. Su uso es para dejar de fumar, en lo que la evidencia es baja, terminando usándolo a la vez que el cigarrillo que no pudieron dejar. Además, los que nunca fumaron, principalmente adolescentes y jóvenes, se inician en su consumo. Su uso eleva en el aire los niveles de nicotina, partículas, compuestos orgánicos volátiles, hidrocarburos aromáticos policíclicos, carbonilos y metales como aluminio. In vitro el CE causa infla mación, estrés oxidativo y es tóxico para múltiples tipos de células, incluyendo células pulmonares, en doteliales y células madre. Produce incremento de la susceptibilidad a infecciones virales y bacterianas. Comparado con cigarrillos, el CE produce un número mayor y más intenso de genes suprimidos. A la broncoscopia las vías aéreas están friables y eritematosas, y el epitelio bronquial con expresión diferen ciada de proteínas. Se le ha asociado con tos, síntomas de bronquitis y con la epidemia de insuficiencia respiratoria por neumonitis que ha llevado a varias decenas de personas a la muerte. Por sus efectos dañinos el CE debería solo usarse por prescripción médica, como una medida para ayudar a dejar el tabaco, y estar prohibido su uso en interiores y ambientes públicos. Como no se han determinado los componentes del CE responsables de las muertes asociadas, su uso debería ser proscrito hasta que se conozcan cuáles son estos factores.

ABSTRACT Since 2004, the electronic cigarette (EC) is available, a device that heats nicotine and administers it as part of a vapor. We present a narrative review of the EC and its effect on health. Its use is to stop smoking, in which the evidence is low, and ends up being used at the same time as the cigarette they could not quit. In addition, those who never smoked, mainly teenagers and young people, begin consumption. Its use rais es the levels of nicotine, particles, volatile organic compounds, polycyclic aromatic hydrocarbons, carbo nyls and metals such as aluminum. In vitro, the EC causes inflammation, oxidative stress and is toxic to multiple cell types, including lung, endothelial and stem cells. Produces increased susceptibility to viral and bacterial infections. Compared to cigarettes, the EC produces a larger and more intense number of deleted genes. At bronchoscopy the airways are friable and erythematous, and the bronchial epithelium with a differentiated protein expression. It has been associated with cough, bronchitis symptoms and the respiratory failure by pneumonitis epidemic that has led several dozen people to death. Because of its harmful effects, the EC should only be used by medical prescription, as a measure to help quit tobacco, and its use in indoor and public environments be prohibited. As the EC components responsible for the associated deaths have not been determined, their use should be banned until these factors are known.

Cigarrillo electrónico y otros sistemas electrónicos de liberación de nicotina: revisión de evidencias sobre un tema controversial / Electronic cigarette and other electronic nicotine delivery systems: a review of evidence on a controversial topic / Cigarro eletrônico e outros sistemas eletrônicos de liberação de nicotina: revisão de evidências sobre um tema controverso

Resumen: Introducción: los cigarrillos electrónicos (CE) son sistemas que liberan aerosol conteniendo nicotina y otras sustancias. Desde su aparición han generado una gran controversia en la comunidad científica dedicada al control de tabaco, existiendo evidencias que los posicionan como una alternativa de tratamiento para la cesación tabáquica y otros estudios que muestran sus daños a la salud, así como convertirlos en la puerta de entrada a los jóvenes a la adicción a nicotina. Objetivo: recopilar evidencia disponible sobre CE con referencia a componentes, riesgos para la salud, cesación de tabaquismo, impacto poblacional y aspectos normativos y regulatorios. Método: revisión narrativa. Se realizó búsqueda bibliográfica en bases PubMed, MEDLINE, SCOPUS, Redalyc, SciELO, LiLACS, Dialnet, ScienceDirect, así como en documentos de la Organización Mundial de la Salud, sociedades científicas, sitios web dedicados a consumidores y legislación nacional e internacional. Resultados: se revisaron 130 documentos, de los cuales se toman los 63 más relevantes. Existen evidencias científicas sobre contenidos tóxicos y carcinógenos en líquidos y aerosoles de los CE, así como de daño a la salud cardiovascular y respiratoria. Se presentan estudios controversiales sobre su eficacia para dejar de fumar. Se presenta evidencia acerca de cómo los CE impactan negativamente en la iniciación de jóvenes al consumo y en la recaída de exfumadores. Se analiza la normativa nacional e internacional para regular los CE. Conclusiones: los profesionales de la salud no deben aconsejar el uso de CE, dado que no son seguros y exponen a los consumidores y a la población en general de los efectos deletéreos directos e indirectos de los CE.

Summary: Introduction: e-cigarettes are systems that produce and release aerosol that contains nicotine and other substances. They have been controversial in the scientific community that works on tobacco control ever since they were created. There is evidence suggesting they are an alternative therapy for tobacco cessation and other studies prove they are harmful to health, and they end up being the door that welcomes young people to the world of nicotine addiction. Objective: to collect evidence on e-cigarette in connection with: components, risks to the health, tobacco cessation, impact on the population and normative and regulatory aspects. Method: Review of the literature. Bibliographic search on PubMed, MEDLINE, SCOPUS, Redalyc, Scielo, LiLACS, Dialnet, ScienceDirect, as well as in other documents of the World Health Organization, scientific societies, websites dedicated to consumers and the national and international laws. Results: 130 documents were reviewed, and the 63 most relevant ones served as the grounds for the study. There is scientific evidence on the toxic and carcinogenic content of liquids and aerosols of e-cigarettes, as well as on their negative effect on cardiovascular and respiratory health. We present controversial studies on its effectiveness to give up smoking, evidence on how e-cigarettes have a negative influence on the initiation of consumption by the young and on ex-smokers relapse. The study also analyses the national and international norms regulating e-cigarettes. Conclusions: health professionals must not recommend the use of e-cigarettes, since they are not safe and expose consumers and the general population to its direct and indirect harmful effects.

Resumo: Introdução: os cigarros eletrônicos (CE) são sistemas que liberam aerossol contendo nicotina e outras substâncias. Desde seu surgimento geraram uma grande controvérsia na comunidade científica dedicada ao controle do tabaco, existindo evidências que os colocam como uma alternativa de tratamento para a cessação do tabagismo e outros estudos que mostram seus danos à saúde, e como se transformam na porta de entrada dos jovens a adição a nicotina. Objetivo: recuperar a evidência disponível sobre CE com referência a: componentes, riscos para a saúde, cessação de tabagismo, impacto populacional e aspectos normativos e regulamentares. Método: revisão narrativa. Fez-se uma pesquisa bibliográfica nas bases PubMed, MEDLINE, SCOPUS, Redalyc, Scielo, LiLACS, Dialnet, ScienceDirect, e também em publicações da Organização Mundial da Saúde, sociedades científicas, sites web dedicados a consumidores e legislação nacional e internacional. Resultados: foram selecionados os 63 documentos mais relevantes dos 130 recuperados. Existem evidências científicas sobre conteúdos tóxicos e carcinogênicos em líquidos e aerossóis dos CE e também dos danos à saúde cardiovascular e respiratória. Apresentam-se estudos controversos sobre sua eficácia para apoiar o abandono do hábito de fumar e evidência de como os CE têm um impacto negativo na iniciação de jovens ao consumo e na recaída de ex- fumantes. Faz-se uma análise das normas nacionais e internacionais para regular os CE. Conclusões: os profissionais de saúde não devem aconselhar o uso de CE por não ser seguros e por que expõem os consumidores e a população em geral aos efeitos deletérios diretos e indiretos de seu uso.

Investigación del grado de interés sobre el término "cigarrillo electrónico" en la Web / Investigation about the degree of interest of the term "electronic cigarette" on the Web

El cigarrillo electrónico introduce un fuerte debate en el mercado con respecto a su intencionalidad de uso. El objetivo del presente trabajo es describir el grado de interés del término "cigarrillo electrónico" y la intencionalidad de su búsqueda en la Web en la Argentina. La herramienta que utilizamos fue el software libre de Google Trends. Las búsquedas en internet por parte de los usuarios estarían relacionadas con el consumo y no con la cesación. La vigilancia de consultas en la Web puede ser una herramienta innovadora en el control del tabaco, especialmente respecto de los dispositivos electrónicos administradores de nicotina.

The electronic cigarette introduces a strong debate in the market regarding its intentionality of use. The objective of the present work is to describe the degree of interest of the term "electronic cigarette" and the intentionality of its search in the Web in Argentina. The tool that we used was the free software of Google Trends. Internet searches by users would be related to the consumption and not with the cessation. The monitoring of web queries can be an innovative tool in tobacco control, especially in respect to the nicotine delivery system.

Electronic cigarettes and narghile users in Brazil: Do they differ from cigarettes smokers?

BACKGROUND: Cigarette smoking prevalence is declining, however, other tobacco products have emerged recently, such as electronic cigarettes (e-cigarettes) and narghile (hookah/shisha/waterpipe). Narghile sales are not prohibited in Brazil, but e-cigarettes are. Accurate estimates of such products are key for proper monitoring and control. OBJECTIVE: To describe the prevalence of e-cigarettes and narghile use and to investigate whether sociodemographic characteristics of individuals who are using these products differ from those who are using manufactured cigarettes. METHODS: Using a nationally representative sample survey of Brazilians aged 12-65 years in 2015, we estimated the prevalence rates of each tobacco products within the last 12-months, stratified by macro-region, municipality size, sex-at-birth, sexual orientation, color/race, age-group, and monthly income. Multivariable logistic models were fitted to understand determinants of each tobacco product use, considering the complex sample design. RESULTS: E-cigarette, narghile, and cigarette prevalence rates were estimated at 0.43%, 1.65% and 15.35%, respectively, corresponding to around 0.6million e-cigarette users, 2.5 million narghile users and 23.5 million cigarette users. Non-heterosexual individuals were a most-at-risk group for both e-cigarette/narghile and cigarette use. Despite similarities, e-cigarette/narghile users were younger and had higher socioeconomic status than cigarette users. Additional analyses showed that recent cigarette use seems to be more associated with e-cigarette/narghile use among youth than among adults. CONCLUSIONS: Our findings may provide valuable information about e-cigarette/narghile use in Brazil. Prevention strategies targeted to youth to both narghile and e-cigarettes use should be implemented together, which might be one strategy to prevent the emergency of a new generation of smokers in Brazil.

Grado de conocimiento y uso del cigarrillo electrónico en pacientes fumadores / Degree of knowledge and use of the electronic cigarette in smokers

El cigarrillo electrónico (CE) es un dispositivo electrónico de entrega de nicotina, cuyo uso ­a pesar de la prohibición oficial por parte de ANMAT­ ha ido en aumento. Para saber el grado de conocimiento y de uso del cigarrillo electrónico ­por parte de la población fumadora ­ realizamos una encuesta a los pacientes que asistieron a los Consultorios de Cesación Tabáquica del Hospital General de Agudos "José M. Ramos Mejía" y del Hospital de Oncología "Marie Curie". La casi totalidad de los encuestados conocía su existencia. Menos de la mitad lo ha utilizado como método para dejar de fumar, pero solo un reducido porcentaje lo ha logrado.

The electronic cigarette is an electronic nicotine delivery device, whose use ­despite the prohibition­ by ANMAT has been increasing. In order to know the degree of knowledge and the use of electronic cigarettes by the smoking population, we conducted an inquest of patients who attended the Smoking Cessation Clinics of the General Acute Hospital "José M. Ramos Mejía" and the Oncology Hospital "Marie Curie". Almost all of the respondents knew of its existence. Less than half have used it as a method to stop smoking, but only a small percentage has achieved it.

"Technophilia": A new risk factor for electronic cigarette use among early adolescents?

PURPOSE: Develop and validate a scale that measures Technophilia (positive orientation toward new technology) and use it to address orientation toward new technologies to explain e-cigarette trial and adoption, especially in relatively low risk adolescents. METHODS: Survey data were obtained from students of the three largest cities in Mexico (n = 8123). We developed eight questions involving access, use and pleasure from different electronic media to measure technophilia. Exploratory factor analysis (EFA) was conducted. Linear GEE models were used when regressing technophilia on covariates. When regressing e-cigarette and conventional cigarette trial and use, logistic GEE models were used. Finally, we used multinomial logistic regression to evaluate the associations between technophilia and e-cigarettes as the first tobacco product. RESULTS: Technophilia were correlated with theoretically-related variables. Unadjusted and adjusted models regressing e-cigarette trial and use indicated that students in the highest quartile for technophilia were more likely to have tried e-cigarettes compared with the lowest quartile (AORQ4 vs Q1 = 1.36, 95% CI 1.14-1.62). Technophilia was not independently associated with current e-cigarette use in adjusted models. Students with higher technophilia were more likely to have first tried e-cigarettes in both crude and adjusted models (AORQ4vQ1 = 1.66, 95% CI 1.20-2.31; AORQ3vQ1 = 1.43, 95% CI 1.02-2.01). Technophilia did not have a statistically significant, independent association with first use of other tobacco products. CONCLUSION: This study suggests that technophilia is associated with trial of e-cigarettes among youth. The measure we developed appears useful for understanding why some youth are open to trying novel, technologically oriented ways to consume nicotine.

Knowledge and Perceptions of E-cigarettes and the Motivations for their Use: Talking to Smokers (E-cigarettes and/or Conventional Cigarettes) and Non-smokers in Puerto Rico.

OBJECTIVE: The awareness and use of e-cigarettes have been increasing in recent years. The World Health Organization recently reported that regulations are needed to impede the promotion of e-cigarettes to young people, prohibit unproven health claims about them (including those regarding smoking-cessation efficacy), minimize potential health risks to e-cigarette users and non-users, and protect existing tobacco controls. The study described herein explored e-cigarette knowledge, perceptions, and usage motivations among a group of adults in Puerto Rico. METHODS: This research study used a validated questionnaire with closed-ended questions to gather data. Non-inferential and inferential statistics were used to characterize smokers (of e-cigarettes, of conventional cigarettes, and of both) and non-smokers. RESULTS: A total of 415 respondents took part; they were evenly distributed by gender, age, and socioeconomic status; all were residents of Puerto Rico at the time of the survey. The overall awareness of e-cigarettes was high, but knowledge of nicotine content and regulations was limited. Asked whether e-cigarettes contain nicotine (they do not), approximately two thirds stated either that they do or that they didn't know; asked whether e-cigarettes are regulated as a tobacco product (they are in Puerto Rico), 84% stated either that they are not or that they didn't know. Common perceptions of e-cigarettes are that they are harmful to health and that they are no less harmful than cigarettes are. However, a significant portion of the respondents perceived e-cigarettes to be less addictive than conventional cigarettes are. Overall, the respondents were divided on the efficacy of e-cigarettes for smoking cessation. Nonetheless, the most common motivation for their use, according to both current users and potential future users, is to aid in smoking cessation or reduction. CONCLUSION: The majority of individuals surveyed were aware of e-cigarettes but had limited knowledge of their contents or regulation. As an aid in smoking cessation was the most commonly mentioned motivation for e-cigarette use.

Cigarrillo electrónico y pipas de agua: conocimientos y uso entre estudiantes de Medicina, Uruguay, 2015 / Electronic cigarette and waterpipe: knowledge and use among medical students, Uruguay, 2015

RESUMEN Introducción. El uso de cigarrillo electrónico (CE) y la pipa de agua (PA) se ha difundido ampliamente como alternativa al consumo del tabaco, y el primero se ha invocado como herramienta para la cesación. Objetivo. Determinar conocimientos, actitudes y prácticas sobre el CE y PA en los estudiantes de 5º de la Facultad de Medicina, Universidad de la República, Uruguay, año 2015. Métodos. Estudio de corte transversal, descriptivo. Se aplicó cuestionario de conocimientos, actitudes y prácticas sobre CE y PA, en estudiantes de medicina, en Julio y Agosto 2015. Los resultados se analizaron en frecuencias absolutas y relativas; se utilizó test de Chi². Resultados. 241 estudiantes respondieron el cuestionario; 54,6% de la población objetivo. El 21,1% de los estudiantes eran tabaquistas. 72,2% de los encuestados conoce el CE y 69,7% la PA. Un 7,5% han utilizado CE y 31,5% PA. El 41,5% cree que los CE son dañinos mientras que 44,4% no sabe. Hubo diferencias significativas entre fumadores y no fumadores con respecto conocimientos y prácticas. Conclusiones. La mayoría de los estudiantes afirma conocer el CE y PA; es poco frecuente la experimentación de CE, la de PA asciende a un tercio de los encuestados. Menos de la mitad conocen que el CE provoca daños a la salud. Los estudiantes tienen escasa información sobre los riesgos del uso de estos dispositivos. Existe necesidad de abordar este tema en la formación médica.

ABSTRACT Introduction. The use of electronic cigarette (CE) and hookah (PA) has spread widely as an alternative to the consumption of snuff, and the first has been invoked as a tool for cessation. Objective. Determine knowledge, attitudes and practices on CE and PA in 5th students of the Faculty of Medicine, University of the Republic, Uruguay, 2015. Methods. Cross-sectional study, descriptive court. survey of knowledge, attitudes and practices EC and PA, medical students in July and August 2015. The results were analyzed in absolute and relative frequencies were applied; Chi2 test was used. Results. 241 students answered the questionnaire; 54.6% of the target population. 21.1% of students were smokers. 72.2% of respondents know the EC and 69.7% BP. 7.5% have used EC and 31.5% PA. 41.5% believe that the EC are harmful while 44.4% do not know. There were significant differences between smokers and non-smokers with respect knowledge and practices. Conclusions. Most students say they know the EC and PA; is rare experimentation EC, the PA amounts to a third of respondents. Less than half know that the EC causes damage to health. Students have little information about the risks of using these devices. There is need to address this issue in medical training.

Tobacco smoking: From 'glamour' to 'stigma'. A comprehensive review.

In this narrative review, we explore the history of tobacco smoking, its associations and portrayal of its use with luxury and glamour in the past, and intriguingly, its subsequent transformation into a mass consumption industrialized product encouraged by advertising and film. Then, we describe the next phase where tobacco in parts of the world has become an unwanted product. However, the number of smokers is still increasing, especially in new markets, and increasingly younger individuals are being attracted to it, despite the well-known health consequences of tobacco use. We also explore current smoking behaviors, looking at trends in the prevalence of consumption throughout the world, discrimination against smokers, light and/or intermittent smokers, and the electronic cigarette (e-cigarette). We place these changes in the context of neuroscience, which may help explain why the cognitive effects of smoking can be important reinforcers for its consumption despite strong anti-smoking pressure in Western countries.