Research has shown that regular cigarette use is decreasing among young people, while electronic cigarettes are becoming increasingly popular among this group in recent years (1).

Also known as vape, pod, e-cigarette, e-ciggy, e-pipe, e-cigar, heated tobacco, among other names, the electronic cigarette was created in 2003 and, since then, took on different forms until becoming what it is today. Initially, they were disposable products, then they became refillable with liquid refills that contain ingredients such as propylene glycol, glycerin, nicotine and flavoring agents, some may even contain a refill to put tobacco on and there are also pod systems, similar to a flash drive, which contain nicotine salts and other substances that dissolve in liquids (2).

Despite the high levels of nicotine and other additives, these devices have gained enormous popularity among the population, especially among young adults, with an estimated 35 million users worldwide. The vape is considered the latest technology on the market and its use has become popular among university students due to factors such as novelty, variety of flavors, the possibility of using the device indoors or because it puts the young smoker “in fashion".

During 2019, there was an outbreak of lung injury due to the use of electronic cigarettes, leading to a significant number of deaths, which generated an alert about the effects that this device can cause to health.

Health impacts

 Currently, there are few clinical data on the pathologies resulting from the use of electronic cigarettes. It is known, however, that lung diseases such as pneumonia, bronchiolitis, interstitial lung diseases, asthma and diffuse alveolar hemorrhages are among the most common.

The impacts of vaping devices, however, are not just related to lung health. Because they are advertised as less harmful, they end up being used as an alternative to the traditional cigar.

As a result, vaping has gained popularity among cancer patients: according to an American survey, the prevalence of vaping has increased from 8.5% in 2014 to 10.7% in 2017. Exposure to this type of cigarette, with or without nicotine, showed significant evidence of cell death and necrosis compared to people not using the device. In addition, potent carcinogens were found in these devices. It has also been observed that the nicotine supply is substantially higher in e-cigarettes than in traditional cigarettes, which has led to the conclusion that electronics are not safer than tobacco.

Cardiovascular disease is one of the leading causes of smoking-related deaths. According to the American Heart Association, smoking causes more than 20% of deaths due to heart disease in the US. And when it comes to electronic cigarettes, the effects are as harmful as those of regular cigarettes. E-cigarette use can be a contributing factor to stroke as well, in addition to increasing its damage.

Users of these devices are still subject to damage to the oral cavity caused by inhaling many toxic components present in vapes, such as benzene, lead, ultrafine particles, diacetyl, nicotine, nickel and tin.

There are also effects on the central nervous system, which include the development of dependence, seizures, syncope or tremors. Neurological symptoms such as headache, malaise, nausea, tiredness, dizziness, fatigue, dizziness, migraine and stroke have also been reported.

 Alcohol and electronic cigarette

The relationship between alcohol consumption and common cigarettes has already been documented in the medical literature. Studies report that individuals who drink alcohol are more likely to smoke regular cigarettes compared to individuals who do not drink, and individuals who smoke are more likely to report alcohol consumption compared to those who do not smoke. In addition, heavy drinkers tend to be heavy smokers and vice versa, that is, alcohol use disorders are comorbid with tobacco dependence (3).

A survey carried out with 631 students (4) showed that compulsive drinkers (12.1%) smoke more (regular) cigarettes than moderate drinkers (5.1%). In addition, almost a quarter of the sample reported having tried electronic cigarettes (21.7%), with the majority (26.5%) being drinkers. Overall, 8.4% of the sample reported current use of electronic cigarettes, mostly people who use alcoholic beverages (10.1%).

Among the motivations for vaping, the most popular (29.5%) is the belief that vaping is less harmful to others than tobacco smoke. Other popular reasons given by students are: saving money (18.9%), e-cigarettes are better for your health (17.0%), being able to smoke in non-smoking areas (15.1%), and tasting better than tobacco/variety of flavors (14.9%). Compared to people who do not drink, these motivations are more commonly endorsed by those who consume alcohol, particularly the possibility of using the device in non-smoking areas.

A relationship was also observed between the amount of alcohol typically consumed and having already tried electronic cigarettes. In this sense, drinking less per occasion would be associated with never having tried electronic cigarettes; on the other hand, higher consumption of beverages per episode would be associated with an increase in e-cigarette experimentation rates.

CISA warns about the risks of harmful use of alcohol and, mainly, of its association with tobacco and electronic cigarettes. In addition, we reinforce that the commercialization, import and advertising of these smoking devices are prohibited in Brazil through the Resolution of the Collegiate Board of Directors of Anvisa, based on the precautionary principle, due to the limited amount of data and scientific evidence that proves that this product it is not harmful.