Impact of e-cigarettes use on the oral health-related quality of life among young people in metropolitan Lima / Impacto en la calidad de vida relacionada a la salud oral del uso de cigarrillos electrónicos en los jóvenes de Lima metropolitana

Aim: To determine the effects of e-cigarette use on oral health-related quality of life (OHRQOL) in young people in Metropolitan Lima. Materials and Methods: This observational, analytical and cross-sectional study was performed with 189 individuals (age, 18­29 years) who used electronic cigarettes. The OHIP-Sp5 instrument was used to assess OHRQOL. Results: The use of e-cigarettes was higher among male participants (47.79%) than that among the female participants (26.32%). The mean OHRQOL scores of individuals who did and did not use e-cigarettes were 3.17 (2.26) and 3.12 (2.47), respectively These scores for people who did and did not use mouthwash were 2.92 (2.34) and 3.57 (2.43), respectively. Regarding orofacial pain 2.65% participants frequently re-ported "painful discomfort" and 7.41% of the young people presented such discomfort of orofacial aspect "frequently." Conclusions: Recording e-cigarette uses and frequency in patients' medical records is important, as well as incorporating educational strategies to reduce e-cigarette consumption and avoiding harmful effects on general health.

Objetivo: Evaluar el impacto en la calidad de vida relacionada a la salud oral del uso de cigarrillos electrónicos en los jóvenes de Lima Metropolitana. Materiales y Métodos: Se realizó un estudio observacional, analítico y transversal en un total de 189 jóvenes con edades comprendidas de 18 a 29 años que son usuarios de cigarrillos electrónicos. Para evaluar la calidad de vida relacionada a la salud oral se utilizó el instrumento "OHIP-Sp5". Resultados: Se determinó que los participantes del sexo masculino (47.79%) son los que más utilizan el cigarrillo electrónico en comparación a las participantes del sexo femenino (26.32%). Se observó una calidad de vida relacionada a la salud oral media de 3,17 (2,26) para los usuarios de cigarrillos electrónicos, mientras que para los no usuarios de cigarrillos electrónicos la media fue de 3,12 (2,47). Asimismo, para los que usan enjuagues bucales se encontró una media de 2.92(2.34), a diferencia de los que no hacían uso del mismo que presentaban peor calidad de vida relacionada con la salud oral con una media de 3.57(2.43). En cuanto a dolor orofacial el 2.65% de los participantes referían "molestias dolorosas" a menudo y el 7.41% de los jóvenes presentaban dicho disconfort de la apariencia orofacial "a menudo". Conclusión: El registro del uso y frecuencia del cigarrillo electrónico en la historia clínica de los pacientes es de suma importancia, así como incorporar estrategias educativas para reducir el consumo de los vapeadores y evitar efectos nocivos en la salud general.

Cigarros eletrônicos: uma abordagem acerca do conhecimento de jovens adultos e os riscos para o sistema respiratório / Electronic cigarettes: an approach about the knowledge of young adults and the risks to the respiratory system / Cigarrillos electrónicos: una aproximación sobre el conocimiento de los adultos jóvenes y los riesgos para el sistema respiratorio

A presente pesquisa teve o objetivo de avaliar o conhecimento dos jovens adultos sobre os cigarros eletrônicos e os seus efeitos no sistema respiratório. Tratou-se de uma pesquisa transversal, descritiva, com abordagem quantitativa, que foi desenvolvida através da plataforma Google Forms com aplicação de um questionário, contendo dados sociodemográficos e informações acerca do nível de conhecimento sobre os cigarros eletrônicos, divulgado nos grupos de Whatsapp e redes sociais, durante o período de julho a outubro de 2022. A amostra foi composta por adultos jovens, com idade entre 18 e 24 anos, com histórico de tabagismo ou não. Foram respeitadas as normas da Resolução 466/12 do Conselho Nacional de Saúde e a análise foi feita através da estatística descritiva simples. O estudo contou com a participação de 80 indivíduos, com participação homogênea entre os gêneros , sendo 40 do sexo feminino e 40 do masculino, com média de idade dos participantes de 21 anos ± 2,16, no qual, 35% (n=28) utilizam cigarros eletrônicos, 48% (n=38) afirmam ter alto nível de conhecimento sobre os mesmos, 41% (n=33) acreditavam que os dispositivos eletrônicos possuíam o mesmo risco que os cigarros convencionais, com isso, 76% (n=61) afirmam que os cigarros eletrônicos podem causar malefícios, mas não especificaram, além disso, observou-se que 25% (n=20) relatam sentir sensação de relaxamento, prazer ao consumir cigarro eletrônico. Dessa forma, pode-se observar que a amostra da pesquisa possui conhecimento sobre os cigarros eletrônicos, assim como os riscos, embora não saibam quais especificamente, bem como sua proporção no sistema respiratório.

This research aimed to evaluate the knowledge of young adults about electronic cigarettes and their effects on the respiratory system. This was a cross- sectional, descriptive research, with quantitative approach, which was developed through the Google Forms platform with application of a questionnaire, containing sociodemographic data and information about the level of knowledge about electronic cigarettes, disclosed in Whatsapp groups and social networks, during the period from July to October 2022. The sample was composed of young adults, aged between 18 and 24 years, with a history of smoking or not. The norms of Resolution 466/12 of the National Health Council were respected and the analysis was done through simple descriptive statistics. The study had the participation of 80 individuals, with homogeneous participation between genders, 40 females and 40 males, with a mean age of 21 years ± 2.16, in which, 35% (n=28) use electronic cigarettes, 48% (n=38) claim to have a high level of knowledge about them, 41% (n=33) believed that electronic devices have the same risk as conventional cigarettes, with this, 76% (n=61) stated that electronic cigarettes can cause harm, but did not specify, in addition, it was observed that 25% (n=20) report feeling a sense of relaxation, pleasure when consuming electronic cigarette. Thus, it can be observed that the research sample has knowledge about electronic cigarettes, as well as the risks, although they do not know which ones specifically, as well as their proportion on the respiratory system.

La presente investigación tuvo como objetivo evaluar el conocimiento de los jóvenes adultos sobre los cigarrillos electrónicos y sus efectos sobre el sistema respiratorio. Se trató de una investigación transversal, descriptiva, con abordaje cuantitativo, que se desarrolló a través de la plataforma Google Forms con aplicación de un cuestionario, conteniendo datos sociodemográficos e informaciones sobre el nivel de conocimiento sobre cigarrillos electrónicos, divulgados en grupos de Whatsapp y redes sociales, durante el período de julio a octubre de 2022. La muestra fue compuesta por jóvenes adultos, con edad entre 18 y 24 años, con historia de fumador o no. Fueron respetadas las normas de la Resolución 466/12 del Consejo Nacional de Salud y el análisis fue hecho a través de estadística descriptiva simple. El estudio contó con la participación de 80 individuos, con participación homogénea entre géneros, siendo 40 mujeres y 40 hombres, con edad media de los participantes de 21 años ± 2,16, en los cuales, 35% (n=28) utilizan cigarrillos electrónicos, 48% (n=38) afirman tener alto nivel de conocimiento sobre los mismos, 41% (n=33) creen que los dispositivos electrónicos tienen el mismo riesgo que los cigarrillos convencionales, con esto, 76% (n=61) afirman que los cigarrillos electrónicos pueden causar daño, pero no especificaron, además, se observó que 25% (n=20) dicen sentir sensación de relajación, placer al consumir cigarrillo electrónico. Por lo tanto, se puede observar que la muestra de la investigación tiene conocimiento sobre los cigarrillos electrónicos, así como los riesgos, aunque no saben cuáles específicamente, así como su proporción en el sistema respiratorio.

Consumo actual de cigarrillos electrónicos entre estudiantes de secundaria que nunca han fumado / Current use of electronic cigarettes among never smoker high school students

Objetivo: Examinar si en España el uso de los cigarrillos electrónicos está asociado a la iniciación del consumo de nicotina entre los estudiantes de secundaria. Método: Análisis secundario de datos de la encuesta ESTUDES 2019, estudio transversal realizado a una muestra representativa de estudiantes entre 14 y 18 años. Seleccionamos los alumnos que nunca habían fumado (n = 16.705). Calculamos la prevalencia y estimamos los factores asociados al consumo de cigarrillos electrónicos al menos una vez en el mes anterior a la entrevista, con y sin nicotina. Resultados: La prevalencia de consumo actual de cigarrillos electrónicos entre estudiantes que nunca han fumado es del 2,5% (intervalo de confianza del 95% [IC 95%]: 2,2-2,9). El 0,1% (IC 95%: 0,08-0,2) reportó haber utilizado alguna vez líquidos con nicotina y el 2,4% (IC 95%: 2,1-2,8) siempre sin nicotina. Ser varón, menor de 17 años, hacer botellón y tener amigos habituales que consumen cannabis aumenta la probabilidad de consumo actual de cigarrillos electrónicos. Estas dos últimas variables parecen actuar como variables contextuales asociadas al consumo de cigarrillos electrónicos. Conclusiones: El porcentaje de estudiantes españoles que nunca han fumado, pero que consumen cigarrillos electrónicos actualmente, es menor que en los países de nuestro entorno, a excepción del Reino Unido. Solo uno de cada 1000 estudiantes españoles de secundaria que nunca han fumado se inicia en el consumo actual de nicotina con un cigarrillo electrónico. No obstante, debemos vigilar cómo evoluciona este indicador. (AU)

Objective: To test whether electronic cigarettes use among secondary school students in Spain is associated with initiating nicotine use. Method: Secondary analysis of the ESTUDES 2019 survey, a cross-sectional study conducted on a representative sample of students aged 14–18 years and selected students who had never smoked (n = 16,705). We computed the prevalence and estimated the factors associated with current electronic cigarettes use (at least once in the month before the interview), with and without nicotine. Results: The prevalence of current electronic cigarettes use among students who have never smoked is 2.5% (95% confidence interval [95%CI]: 2.2–2.9). 0.1% (95%CI: 0.08–0.2) declared using liquids with nicotine at least sometimes and 2.4% (95%CI: 2.1–2.8) using liquids always without nicotine. Being male and under 17 years of age, reporting binge drinking behavior, and having regular friends who use cannabis, increases the probability of current use of electronic cigarettes. The latter two variables seem to act as contextual variables associated with electronic cigarettes use. Conclusions: The percentage of Spanish never smoker students who currently use electronic cigarettes is lower than in neighboring countries, except for the United Kingdom. Only one in every 1000 Spanish students between 14 and 18 years old who have never smoked initiates the current use of nicotine with an electronic cigarette. However, we must monitor the evolution of this indicator. (AU)

[Current use of electronic cigarettes among never smoker high school students]. / Consumo actual de cigarrillos electrónicos entre estudiantes de secundaria que nunca han fumado.

OBJECTIVE: To test whether electronic cigarettes use among secondary school students in Spain is associated with initiating nicotine use. METHOD: Secondary analysis of the ESTUDES 2019 survey, a cross-sectional study conducted on a representative sample of students aged 14-18 years and selected students who had never smoked (n=16,705). We computed the prevalence and estimated the factors associated with current electronic cigarettes use (at least once in the month before the interview), with and without nicotine. RESULTS: The prevalence of current electronic cigarettes use among students who have never smoked is 2.5% (95% confidence interval [95%CI]: 2.2-2.9). 0.1% (95%CI: 0.08-0.2) declared using liquids with nicotine at least sometimes and 2.4% (95%CI: 2.1-2.8) using liquids always without nicotine. Being male and under 17 years of age, reporting binge drinking behavior, and having regular friends who use cannabis, increases the probability of current use of electronic cigarettes. The latter two variables seem to act as contextual variables associated with electronic cigarettes use. CONCLUSIONS: The percentage of Spanish never smoker students who currently use electronic cigarettes is lower than in neighboring countries, except for the United Kingdom. Only one in every 1000 Spanish students between 14 and 18 years old who have never smoked initiates the current use of nicotine with an electronic cigarette. However, we must monitor the evolution of this indicator.

Encuesta sobre conocimiento en cigarrillo electrónico y nuevos productos de consumo de nicotina en el personal sanitario / Survey on knowledge of electronic cigarettes and new nicotine consumer products among health personnel

Introducción.La irrupción de los cigarrillos electrónicos (e-cig) y nuevos productos de consumo de tabaco ha supuesto un desfase en el conocimiento del tabaquismo entre el personal sanitario. Los escasos estudios sobre su eficacia y la intromisión de la industria tabaquera no ayudan a dirimir la controversiaexistente entre su uso como ayuda para la cesación/reducción de daños frente a su asimilación al resto de labores del tabaco. Sujetos y métodos: Se realiza una encuesta dirigida a personal sanitario a nivel de toda España tratando de constatar el conocimiento sobre los e-cig, sus potenciales daños, empleo en la clínica, papel de la industria y legislación actual en España. Para ello, a través de un entorno online, se distribuye un cuestionario a responder entre los días 12 y 26 de agosto de 2019. Resultados: Se reciben 266 encuestas, la mayoría de mujeres (3:1), médicas (73,3 %) y con 11 años o más de experiencia (54,5%). Un 30,5% no conoce ningún tipo de e-cig y el 78,6 % no se siente capacitado ni para informar ni para tratar a los consumidores. Ven riesgos de cronificar la cesación (77,8%) y normalizarel consumo de nicotina en lugares ya libres de humo (62,8%), aunque hasta el 44% cree que pueden tenerun papel como herramienta de cesación en determinados pacientes, siendo asumida la ausencia de estudios que los avalen (38,3%). El 62% ve una actitud engañosa de las tabaqueras y el 51,9% en su regulación como productos de consumo sin existir una legislaciónespecífica. Comparadas las respuestas entre profesionales médicos y no médicos, por años de experiencia ygrupos de edad, destacan diferencias estadísticamente significativas (p < 0,05) en la percepción de daños,el papel de las tabaqueras y en el conocimiento más específico de los dispositivos entre el personal másjoven y/o con menos años de experiencia. (AU)

Introduction: The appearance of electronic cigarettes (E-cig) and new products of use of tobacco have entailed a lag in the knowledge of smoking habit among health care personnel. The scarce studies on its efficacy and the meddling of the tobacco industry have not helped to solve the controversy existing between its use as an aid for smoking cessation/reduction of harm against its assimilation to the remaining tobacco products.Subjects and methods: A survey addressed to the health care personnel in Spain was carried out. It aimed to determine the knowledge on the E-cig, their potential harm, use in the clinical practice, role of the industry and current legislation in Spain. To do so, a questionnaire to be answered was distributed onlinebetween 12 and 26 of August 2019. Results: A total of 266 surveys were received, most of which were from women (3:1), doctors (73.3%) and with 11 years of more of experience (54.5%). Of these, 30.5 % did not know any type of E-cig and 78.6 % did not feel qualified to inform or to treat the users. They see risks of the smoking cessation becoming chronic (77.8%) and making the use of nicotine normal in sites that are already smoke free (62.8%), although up to 44% believe that they canhave a role as a tool to quit smoking in some patients, the absence of studies that support being assumed (38.3%). 62% consider that the tobacco companies have a misleading attitude and 51.9% in their regulation as products of use without the existence of specific legislation. When comparing the answersbetween the medical and non-medical professionals, there are statistically significant differences by years of experience and age groups (p < 0.05) in the perception of harm, the role of the tobacco companies and in the most specific knowledge of the devices among the younger personnel and/or those with fewer years of experience. (AU)

Características de consumo de tabaco en jóvenes estudiantes en Paraguay / Characteristics of tobacco use in young students in Paraguay

Introducción: Actualmente el tabaquismo es una de las mayores amenazas para la salud pública a nivel mundial. La muerte atribuida al tabaco en Paraguay representa el 12,2% de todas las muertes y el costo de la enfermedad asociada al consumo de tabaco en el sistema de salud es elevado. Objetivos: El objetivo de este estudio es describir las características del consumo de tabaco en jóvenes en Paraguay. Materiales y métodos: Se realizó un estudio descriptivo transversal no probabilístico de muestreo estandarizado con representatividad nacional en estudiantes matriculados del 7° al 9° grado de la educación escolar básica, de 13 a 15 años de ambos sexos que incluyo a 6.518 estudiantes, correspondiente a 25 escuelas de la capital y 25 escuelas en el resto del país. Resultados: La prevalencia actual de consumo de productos de tabaco fue del 7%, fumadores actuales de 3,9% y fumadores de cigarrillos electrónicos de 3,7%. La prevalencia de fumadores de segunda mano fue más del 20% en todos los escenarios estudiados. Alto porcentaje de adolescentes con acceso fácil a la compra de cigarrillos sin verificación de la edad. Más del 50% con acceso a mensajes publicitarios sobre tabaco. Casi un 30% tenían conocimiento del efecto dañino del tabaco y más del 80% se manifiestan favorables a la prohibición de fumar en espacios cerrados y abiertos. Conclusión: Aunque la prevalencia de fumadores en adolescentes no es muy elevada, es un problema de salud pública creciente. Se requiere fortalecer las medidas de prevención y control.

Introduction: Currently, smoking is one of the greatest threats to public health worldwide. Death attributed to tobacco in Paraguay represents 12.2% of all deaths and the cost of the disease associated with tobacco consumption in the health system is high. Objectives: The objective of this study is to describe the characteristics of tobacco consumption in young people in Paraguay. Materials and methods: A non-probabilistic descriptive cross-sectional study of standardized sampling was carried out with national representativeness in students enrolled from 7th to 9th grade of basic school education, from 13 to 15 years old of both sexes that included 6,518 students, corresponding to 25 schools in the capital and 25 schools in the rest of the country. Results: The current prevalence of tobacco product use was 7%, current smokers 3.9%, and electronic cigarette smokers 3.7%. The prevalence of second-hand smokers was more than 20% in all the scenarios studied. High percentage of adolescents with easy access to the purchase of cigarettes without age verification. More than 50% with access to advertising messages about tobacco. Almost 30% were aware of the harmful effect of tobacco and more than 80% are in favor of the prohibition of smoking in closed and open spaces. Conclusion: Although the prevalence of smoking in adolescents is not very high, it is a growing public health problem. It is necessary to strengthen prevention and control measures.

Efectos en la salud de los sistemas electrónicos de administración de nicotina (SEAN) / Health Effects of Electronic Nicotine Delivery Systems (SEAN)

Resumen Sin lugar a dudas, el tabaquismo continúa siendo la principal causa de enfermedad, discapacidad y muerte prematura a nivel mundial. Sin embargo, el advenimiento de los nuevos sistemas electrónicos de administración de nicotina (SEAN), entre los que destaca el cigarrillo electrónico, ha tenido un crecimiento explosivo y en algunos países ha desplazado a los cigarrillos de tabaco, especialmente entre los jóvenes que se sienten atraídos por sus llamativos sabores y por el despliegue de tecnología que se utiliza en su diseño y funcionamiento. Los SEAN surgieron inicialmente en 2003 como una supuesta ayuda para dejar de fumar, a 16 años de esta fecha no hay estudios clínicos que confirmen su superioridad sobre los medicamentos existentes para tal fin: terapias de reemplazo de nicotina, bupropión y vareniclina, ni sobre las terapias psicológicas como la racional emotiva y la cognitivo conductual. Por el contrario, se han acumulado gran cantidad de evidencias sobre el efecto deletéreo que tienen sobre la salud de los consumidores, el riesgo que representan es indudable y esto se confirma por reportes recientes de Centros de Control de Enfermedades de los Estados Unidos (CDC) que señalan 2,172 casos hospitalizados con enfermedad pulmonar aguda y 42 muertes por esta causa, siendo el 79% personas menores de 35 años. Este brote de enfermedad pulmonar ha determinado que se plantee la prohibición de los SEAN en Estados Unidos. Asimismo, la Food and Drug Administration (FDA) aprobó la venta de los cigarrillos híbridos o heets que utilizan tabaco calentado, los cuales ya están disponibles en nuestro país. No cabe duda de que como profesionales del área de la salud nuestra obligación es informar con evidencias científicas sobre los riesgos que representan los SEAN para sus consumidores, asimismo debemos aprender de la historia del tabaquismo para poder prevenir la morbimortalidad asociada con estos nuevos productos del tabaco.

Abstract Without a doubt, smoking continues to be the leading cause of disease, disability, and premature death worldwide. However, the advent of the new Electronic Administration Systems of Nicotine (SEAN), among which the electronic cigarette stands out, has had explosive growth and in some countries has depleted tobacco cigarettes, especially among young people who feel attracted by its striking flavors and the deployment of technology that is used in its design and operation. The SEANs initially emerged in 2003 as a supposed help to quit smoking, at 16 years from this date no clinical studies are confirming their superiority over existing medications for this purpose: nicotine, bupropion and varenicline replacement therapies, or over psychological therapies such as emotional and cognitive-behavioral rational. On the other side, a large amount of evidence has been accumulated on the deleterious effect they have on the health of consumers, the risk they represent is unquestionable and this is confirmed by recent reports from the Centers for Disease Control of the United States (CDC) that indicate 2142 hospitalized cases with acute lung disease and 42 deaths from this cause, 79% being people under 35 years. This outbreak of lung disease has determined that the ban on SEAN in the United States will be planted. Also, the Food and Drug Administration (FDA) approved the sale of hybrid cigarettes or "Heets" (Heat-not-burn tobacco products), which uses heated tobacco, and are now available in our country. There is no doubt that as health professionals, we must inform with scientific evidence about the risks that SEANs pose to their consumers, we must also learn from the history of smoking to prevent the morbidity and mortality associated with these new tobacco products.

Frecuencia y perfil del uso de cigarrillos electrónicos en estudiantes de una Universidad Pública / Frequency and profile of the electronic cigarettes use in students of a Public University

Introducción: El consumo de Cigarrillos electrónicos (CE) ha aumentado considerablemente en los últimos años. Estos productos son ahora los más comúnmente utilizados por la juventud en diversos países del mundo y nuestro país no está exento de su utilización. En este contexto se ha realizado el presente estudio; cuyo objetivo fue conocer la frecuencia de uso de cigarrillo electrónico y otras características del consumo de CE en universitarios. Materiales y Métodos: Estudio observacional, descriptivo. Se procesaron datos de 1500 estudiantes de diferentes Unidades Académicas de la UNA que respondieron a la encuesta electrónica. Se determinaron variables demográficas como sexo y edad, particularidades sobre los CE relacionadas a la preferencia por determinado dispositivo, motivaciones para el consumo, simultaneidad de consumo de cigarrillo común, así como la percepción de riesgo con respecto al mismo y las molestias ocasionadas por vapear. La encuesta fue anónima y realizada entre los meses de junio y julio del año 2019 mediante la plataforma libre Google Form. Para el procesamiento de datos se utilizó la planilla Excel. Los estudiantes recibieron vía aplicación de mensajería instantánea un link para responder el cuestionario, el mismo fue distribuido por grupos de docentes y delegados de los cursos de cada unidad académica. Resultados: Respondieron a la encuesta un total de 1500 alumnos, 502 hombres (33,5%) y 998 mujeres (66,5%). El promedio de edad fue de 24 años (DE: ± 3.2), con edades comprendidas entre los 17 y 62 años. Al preguntar sobre el hábito de fumar o vapear los estudiantes respondieron: No fuma ninguno 1222 (81 %), consume cigarrillos electrónicos: 74(5 %), 146 (10%) consumen cigarrillo común y un total de 58(4%) consumen ambos productos. Considerando el total de consumidores de CE y aquellos que utilizan ambos (CE y Cigarrillo común), tenemos una frecuencia de 132 consumidores de CE (9%). Percepción de riesgo con respecto a cigarrillos comunes: Ningún riesgo 32 (24%), pequeño riesgo: 54 (41%), riesgo moderado: 34 (26%), alto riesgo: 9 (7%) e igual riesgo: 3 (2%). Entre las molestias más frecuentes: tos 27 (20%), irritación de garganta 20 (15%), dolor de cabeza 6 (5 %) y malestar general 4 (3%). Conclusión: El uso de CE se aproxima al consumo de cigarrillo común y los universitarios no son conscientes sobre los daños potenciales que confiere el uso de estos dispositivos. Para prevenir y reducir el uso de cigarrillos electrónicos por los jóvenes y los adultos jóvenes debemos poner en práctica estrategias de prevención efectivas.

Introduction: The consumption of Electronic Cigarettes (EC) has increased considerably in recent years. These products are now the most commonly used by youth in various countries of the world and our country is not exempt from their use. In this context, the present study has been carried out; whose objective was to know the frequency of use of electronic cigarettes and other characteristics of CE consumption in university students. Materials and methods: Observational, descriptive study. Data from 1500 students from different UNA Academic Units that responded to the electronic survey were processed. Demographic variables such as sex and age, peculiarities on EC related to the preference for a certain device, motivations for consumption, simultaneity of consumption of common cigarettes, as well as the perception of risk with respect to it and the discomfort caused by vaping were determined. The survey was anonymous and carried out between the months of June and July of the year 2019 through the free platform Google Forms. The Excel spreadsheet was used for data processing. The students received a link via instant messaging application to answer the questionnaire, it was distributed by groups of teachers and delegates of the courses of each academic unit. Results: A total of 1500 students answered the survey, 502 men (33.5%) and 998 women (66.5%). The average age was 24 years (SD: ±16), with ages between 17 and 62 years. When asked about the habit of smoking or vaping, the students answered: 1222 (81%) do not smoke, use electronic cigarettes: 74 (5%), 146 (10%) use a regular cigarette and a total of 58 (4%) use both products. Considering the total of EC consumers and those who use both (EC and Common Cigarette), we have a frequency of 132 EC consumers (9%). Perception of risk with respect to common cigarettes: No risk 32 (24%), small risk: 54 (41%), moderate risk: 34 (26%), high risk: 9 (7%) and equal risk: 3 (2 %). Among the most frequent complaints: cough 27 (20%), throat irritation 20 (15%), headache 6 (5%) and general discomfort 4 (3%). Conclusion: The use of EC is close to the consumption of common cigarettes and the university students are not aware of the potential damage that the use of these devices confers. To prevent and reduce the use of electronic cigarettes by youth and young adults, we must implement effective prevention strategies.

Tackling second-hand exposure to tobacco smoke and aerosols of electronic cigarettes: the TackSHS project protocol.

OBJECTIVE: The TackSHS project aims to comprehensively elucidate the impact that exposure to second-hand smoke (SHS) from cigarettes and second-hand aerosols (SHA) from electronic cigarettes have on the respiratory health of the European population according to socioeconomic characteristics and other determinants. METHOD: The TackSHS project involves a series of coordinated studies carried out by 11 academic and public health organisations from six European countries. The project will investigate: a) the determinants of SHS and SHA exposure assessed at the individual level (surveys on representative general population samples) and in common environments (environmental sampling in specific settings); b) the overall disease burden, mortality and morbidity attributable to such exposure; and c) its economic impact in terms of direct health care costs. The project will also examine specific acute respiratory health changes in healthy individuals and patients with respiratory diseases exposed to SHS and SHA. In addition, the project will examine the effectiveness of a novel intervention to reduce SHS exposure in households where smoking is permitted. All these studies are inter-related and involve collaborative coordination among the participant organisations. CONCLUSION: The comprehensive, integrated approach of the TackSHS project will enable a significant step forward from the current status quo in the understanding of the impact of SHS and SHA exposure on health and provide the basis for health policy recommendations to help European countries to further reduce the harm caused by SHS and SHA exposure.

Estado actual y desafíos emergentes en la prevención y el control del tabaco / Current and emerging issues in tobacco prevention and control

Resumen: Objetivos: Revisar la aplicación del Convenio Marco de la OMS para el Control del Tabaco en las Américas, describir dos estudios de caso nacionales y analizar la evidencia sobre los cigarrillos electrónicos desde la perspectiva de salud pública. Material y métodos: Revisión de la legislación de control de tabaco y la evidencia científica sobre los cigarrillos electrónicos. Resultados: La aplicación de políticas no es homogénea, con avances importantes en ambientes libres de humo, advertencias sanitarias gráficas y vigilancia epidemiológica, pero desafíos pendientes en la prohibición total de la publicidad, incremento de impuestos y cesación tabáquica. La interferencia de la industria tabacalera es uno de los principales obstáculos para avanzar y los nuevos productos crean incertidumbre sobre su regulación. Conclusiones: Se necesita revitalizar la voluntad política para aplicar integralmente el Convenio, tomando decisiones basadas en evidencia ante los nuevos desafíos y defendiendo los logros de la interferencia de la industria.

Abstract: Objectives: To review the implementation of the WHO Framework Convention on Tobacco Control in the Americas, describe two national case studies and analyze the evidence on electronic cigarettes from a public health perspective. Materials and methods: Revision of the tobacco control legislation and the scientific evidence regarding electronic cigarettes. Results: Implementation of tobacco control policies is not homogeneous, with important advances in smoke-free environments, pictorial health warnings, and epidemiological surveillance, but challenges that remain for the implementation of a total ban of tobacco advertising, increases in tobacco taxes, and tobacco cessation programs. Tobacco industry interference is one of the main obstacles for advancing and novel products create uncertainty about their regulation. Conclusion: There is a need for political will for a comprehensive implementation of the Convention, with evidence-based decisions to confront challenges and to defend the achievements from tobacco industry interference.

Nuevos productos de tabaco, una amenaza para el control de tabaco y la salud pública de México / New tobacco products, a threat for tobacco control and public health of Mexico

Resumen Los nuevos productos de tabaco, entre los que se incluyen los cigarros electrónicos (denominados "E Cigs", "e-hookahs", "mods", "vape-pens"), los sistemas electrónicos de administración de nicotina (SEAN), los sistemas similares sin nicotina (SSSN) y los sistemas alternativos de consumo de nicotina (SACN), incursionan en el mercado global con un discurso de reducción del daño y minimización del riesgo. Este manuscrito resume la evidencia científica y una propuesta regulatoria sobre esta innovación tecnológica, con el fin de orientar la toma de decisiones de legisladores, instituciones gubernamentales y la sociedad civil organizada. La evidencia científica concluye que no existe un producto de tabaco seguro para la salud; la naturaleza adictiva de la nicotina y los daños a la salud causados en niños, adolescentes y mujeres embarazadas constituyen el argumento fundamental. Estos nuevos productos promueven la transición al consumo de cigarros combustibles y no han demostrado eficacia para la cesación tabáquica; por el contrario, promueven el uso dual. Toda regulación debe formularse sin la intervención de los fabricantes o instituciones con conflicto de interés y en el marco de la implementación completa e integral del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco.

Abstract: The new tobacco products that include electronic cigarettes (called "E Cig", "e-hookahs", "mods", "vape-pens"), electronic nicotine delivery systems (SEAN, Spanish acronym), similar systems without nicotine (SSSN, Spanish acronym) and alternative nicotine consumption systems (SACN, Spanish acronym), are positioned in the global market with a discourse of harm reduction and risk minimization. This manuscript summarizes the scientific evidence and presents a regulatory proposal for this technological innovation, oriented to guide the decision making of legislators, government institutions and organized civil society. The scientific evidence concludes that there is no safe tobacco product for health. The addictive nature of nicotine and the health damages for children, adolescents and pregnant women is the fundamental argument. These new products promote the transition to conventional cigarettes and have not shown efficacy for smoking cessation, on the contrary, they promote dual use. High-level regulation must be formulated without the intervention of the manufacturers or institutions with a conflict of interest in the context of the complete and integral World Health Organization Framework Convention on Tobacco Control implementation.

[Using consumer panels in public health observational studies]. / Uso de paneles de consumidores en estudios observacionales de salud pública.

Consumer panels are a market research method useful for gathering information about low-frequency or difficult-access customers. The objective of this field-note is to explain our experience using this method in a cross-sectional public health study on the use of electronic cigarettes. After taking into account other non-probabilistic sampling techniques to obtain a huge sample of electronic-cigarette users (n=600), in the end we decided to use consumer panels (recruiters) because of the relative short duration of the field work and the high representativeness of the sample.

[Changes in tobacco consumption: boom of roll-your-own cigarettes and emergence of e-cigarettes]. / Cambios en el consumo de tabaco: auge del tabaco de liar e introducción de los cigarrillos electrónicos.

OBJECTIVE: To assess changes in smoking prevalence and study roll-your-own (RYO) tobacco and e-cigarette use in the Galician population between 2007 and 2015. METHODS: Data were obtained from five independent, cross-sectional studies carried out in Galicia (Spain) between 2007-2015 in the population aged 16 and over (n=8,000/year). Prevalence of use was estimated, with 95% confidence intervals, overall, according to sex and by age group, area of residence and level of education. RESULTS: Smoking prevalence decreased from 25.4% in 2007 to 21.8% in 2015. In 2007, 1.8% of current smokers declared that they had smoked RYO tobacco, compared to 18.6% in 2015. Among smokers, RYO tobacco consumption increased across all demographic groups. In both 2014 and 2015, ever use of e-cigarettes was 0.7%. E-cigarette use was more frequent in urban settings. CONCLUSION: Smoking prevalence decreased in Galicia between 2007 and 2015, and there has been rapid growth in the prevalence of RYO tobacco use. Although smokers are more likely to use e-cigarettes, both former and never smokers declared their use. The boom of RYO cigarettes and the emergence of e-cigarettes highlight the importance of having continuous surveillance systems to identify smoking behavioural changes.

Névoas, vapores e outras volatilidades ilusórias dos cigarros eletrônicos / Nieblas, vapores y otras volatilidades ilusorias de los cigarrillos electrónicos / Mists, vapors and other illusory volatilities of electronic cigarettes

Resumo: Neste artigo, analisa-se o discurso de fornecedores de cigarros eletrônicos para convencer potenciais usuários (fumantes, ex-fumantes ou nunca fumantes de cigarros) a adquirir e usar o novo produto. É um estudo qualitativo, descritivo e exploratório acerca do discurso de vendedores em oito sites de venda on-line que, entre 2011 e 2013, tiveram maior frequência de buscas na Internet. Os sites foram identificados pela ferramenta Google Trends, com base no número de acessos e frequência de buscas ao tema cigarro eletrônico. Tendo como referencial metodológico a hermenêutica-dialética, a categorização do material empírico sob o esquema "compreensão/interpretação" apontou quatro abrangentes sentidos: apropriação do discurso antitabagista; comparação entre cigarros convencional e eletrônico; apelo à crença na fidedignidade da ciência; e projeção da imagem do cigarro eletrônico. A análise desses sentidos configurou os elementos argumentativos do discurso de posicionamento de marketing utilizado por fabricantes e fornecedores de cigarros eletrônicos.

Resumen: En este artículo, se analiza el discurso de provedores de cigarrillos electrónicos para convencer a potenciales usuarios (fumadores, ex-fumadores o no fumadores) a adquirir y usar el nuevo producto. Es un estudio cualitativo, descriptivo y exploratorio acerca del discurso de vendedores en ocho sitios de venta on-line que, entre 2011 y 2013, tuvieron una mayor frecuencia de búsquedas en Internet. Los sitios fueron identificados por la herramienta Google Trends, en base al número de accesos y frecuencia de búsquedas sobre el asunto cigarrillo electrónico. Teniendo como referencia metodológica la hermenéutica-dialéctica, la categorización del material empírico bajo el esquema "comprensión/interpretación" apuntó a cuatro sentidos más amplios: apropiación del discurso antitabaquista; comparación entre cigarrillos convencionales y electrónicos; apelo a la creencia en las cualidades fidedignas de la ciencia; y proyección de la imagen del cigarrillo electrónico. El análisis de esos sentidos configuró los elementos argumentativos del discurso de posicionamiento de marketing, utilizado por fabricantes y proveedores de cigarrillos electrónicos.

Abstract: In this article, we analyze the discourse of electronic cigarette suppliers directed at convincing potential users (smokers, former smokers or never smokers) to acquire and use the new product. This is a qualitative, descriptive and exploratory study on sellers' discourse found in eight on-line sales websites which, between 2011 and 2013, had the highest search frequencies. The websites were identified through Google Trends based on the number of accesses and search frequencies related to electronic cigarettes. Our methodological reference was dialectical-hermeneutics. We categorized the empirical material within the "understanding/interpretation" scheme within four broad meanings: appropriation of the anti-smoking discourse; comparison between conventional and electronic cigarettes; appeal to the trustworthiness of science and projection of e-cigarettes' image. The analysis of these meanings configured the argumentative elements of the marketing discourse used by electronic cigarette makers and suppliers.

Conhecimento e uso de cigarros eletrônicos e percepção de risco no Brasil: resultados de um país com requisitos regulatórios rígidos / Concienciación sobre el cigarrillo electrónico, uso, y percepción de sus efectos dañinos en Brasil: resultados de un país que cuenta con estrictos requisitos normativos / Electronic cigarette awareness, use, and perception of harmfulness in Brazil: findings from a country that has strict regulatory requirements

Resumo: Devido às incertezas sobre o impacto dos cigarros eletrônicos na saúde, o Brasil adotou, em 2009, regulamentação que proibiu venda, importação e propaganda desses produtos até que fabricantes possam demonstrar que são seguros e/ou efetivos na cessação de fumar. O objetivo do estudo foi analisar entre fumantes brasileiros: (1) conhecimento sobre existência de cigarros eletrônicos, uso na vida, e uso recente; (2) percepção de risco sobre cigarros eletrônicos comparados a cigarros convencionais; e (3) fatores correlacionados ao conhecimento e percepção de risco. Este é um estudo transversal entre fumantes brasileiros (≥ 18 anos) usando amostra de reposição da Onda 2 do Inquérito Internacional sobre Controle do Tabaco. Os participantes foram recrutados em três cidades por meio de um protocolo de discagem randomizada entre outubro de 2012 e fevereiro de 2013. Entre os 721 respondentes, 37,4% (n = 249) dos fumantes atuais conheciam cigarros eletrônicos, 9,3% (n = 48) relataram ter experimentado ou usado alguma vez na vida e 4,6% (n = 24) ter usado nos últimos 6 meses. Entre os que conheciam cigarros eletrônicos, 44,4% (n = 103) acreditavam que eles eram menos nocivos que os cigarros regulares (baixa percepção de risco). A "baixa percepção de risco" foi associada com ter maior nível educacional e com ter experimentado/usado cigarro eletrônico recentemente. Apesar das restrições aos cigarros eletrônicos no Brasil, 4,6% dos fumantes da amostra relataram uso recente. Programas de vigilância em saúde do Brasil e demais países deveriam incluir questões sobre uso e percepções sobre cigarros eletrônicos considerando os respectivos ambientes regulatórios.

Resumen: Debido a las incertezas sobre el impacto de los cigarrillos electrónicos en la salud, en 2009 Brasil adoptó una regulación que prohibió su venta, importación y propaganda de esos productos hasta que los fabricantes pudiesen demonstrar que son seguros y/o efectivos en el abandono del tabaco. El objetivo fue analizar entre fumadores brasileños: (1) conocimiento sobre la existencia de cigarrillos electrónicos, uso en vida, y uso reciente; (2) percepción de riesgo sobre cigarrillos electrónicos, comparados con cigarrillos convencionales; y (3) factores correlacionados con el conocimiento y percepciones de riesgo. Este es un estudio transversal entre fumadores brasileños (≥ 18 años), usando una muestra de reposición de la Oleada 2 de la Encuesta Internacional sobre Control del Tabaco. Los participantes fueron reclutados en tres ciudades, a través de un protocolo de llamadas telefónicas randomizadas entre octubre de 2012 y febrero de 2013. Entre los 721 encuestados que respondieron, un 37,4% (n = 249) de los fumadores actuales conocían el cigarrillo electrónico, un 9,3% (n = 48) relataron haberlo probado o consumido alguna vez en la vida y un 4,6% (n = 24) haberlo usado en los últimos 6 meses. Entre los que conocían los cigarrillos electrónicos, un 44,4% (n = 103) creían que ellos eran menos nocivos que los cigarrillos regulares (baja percepción de riesgo). La "baja percepción de riesgo" se asoció con tener un mayor nivel educacional y con haber probado/consumido cigarrillos electrónicos recientemente. A pesar de las restricciones a los cigarrillos electrónicos en Brasil, un 4,6% de los fumadores de la muestra relataron un uso reciente. Los programas de vigilancia en salud de Brasil y demás países deberían incluir cuestiones sobre el uso y percepciones sobre los cigarrillos electrónicos, considerando los respectivos ambientes regulatorios.

Abstract: Given the uncertainties regarding electronic cigarettes' (e-cigs) impact on health, in 2009 Brazil prohibited sales, importation or advertisements of these products until manufacturers are able to show they are safe and/or effective in smoking cessation. This study sought to analyze: (1) awareness of electronic cigarettes, ever-use and recent use; (2) perception of harmfulness of electronic cigarettes when compared with conventional cigarettes; and (3) correlates of awareness and perception of harmfulness. This is a cross-sectional study among Brazilian smokers (≥ 18 years) using the Wave 2 replenishment sample of the Brazilian International Tobacco Control Policy Evaluation Survey. Participants were recruited in three cities through a random-digit dialing sampling frame between October 2012 and February 2012. Among the 721 respondents, 37.4% (n = 249) of current smokers were aware of e-cigs, 9.3% (n = 48) reported having ever tried or used e-cigs and 4.6% (n = 24) reported having used them in the previous six months. Among those who were aware of e-cigs, 44.4% (n = 103) believed they were less harmful than regular cigarettes (low perception of harmfulness). "Low perception of harmfulness" was associated with a higher educational level and with having recently tried/used e-cigs. Despite restrictions to e-cigs in Brazil, 4.6% of sample smokers reported having recently used them. Health surveillance programs in Brazil and other countries should include questions on use and perceptions of e-cigs considering their respective regulatory environments.

Cigarrillos eléctrónicos: ¿Podemos recomendar su uso? / Electronic cigarettes: can we recommend its use?

Los cigarrillos electrónicos (Cig-e) son dispositivos que contienen un líquido compuesto por un solvente, saborizantes y, en la mayoría de los casos, nicotina. Este liquido, al ser calentado en el dispositivo, se vaporiza, siendo aspirado por el usuario. En los últimos años, el uso de los Cig-e ha aumentado rápidamente, especialmente entre escolares y gente joven, sin existir hasta el día de hoy evidencias ciertas sobre su seguridad y efectos a largo plazo. En este artículo revisamos la evidencia existente en cuanto a los efectos y seguridad de cada uno de los componentes de los Cig-e y analizamos sus potenciales indicaciones en distintos escenarios clínicos.

Electronic cigarettes (Cig-e) are devices that contain a liquid composed of a solvent, flavors and, in most cases, nicotine. This liquid, when heated in the device, vaporizes, being aspirated by the user. In recent years, the use of Cig-e has increased rapidly, especially among schoolchildren and young people, with no clear evidence of safety and long-term effects to date. In this article we review the existing evidence regarding the effects and safety of each of the components of Cig-e and analyze their potential indications in different clinical scenarios.

Opinions and practices regarding electronic cigarette use among Romanian high school students.

OBJECTIVE: The study assessed awareness, opinions, practices regarding electronic cigarettes (e-cigarettes) and factors associated with their use among Romanian high school students. METHODS: A cross-sectional study was conducted in 2013 in two major Romanian cities, distributing anonymous questionnaires to 342 high school students aged 16-18. RESULTS: 52.3% of the smokers, 29.2% of the ex-smokers and 7% of the never-smokers had tried e-cigarettes at least once in their life; 7.8% of the smokers and 4.6% of the ex-smokers had used e-cigarettes in the last month. Among smokers, e-cigarette use was associated with lower participation in school health education regarding e-cigarettes and with having parents using e-cigarettes.. Among ex-smokers and never-smokers, e-cigarette use was associated with intention to use e-cigarettes in the next year and with having friends who use e-cigarettes. CONCLUSION: Health education programmes and regulatory interventions addressing e-cigarettes are needed in Romania. More research is necessary on how to develop effective public health messages.

The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes.

The electronic cigarette (EC) is a device formed by three basic elements: battery, atomizer and cartridge. When assembled, it looks like a cigarette. The cartridge contains different substances: propylene glycol, glycerine and, sometimes, nicotine. When the user "vapes", the battery is activated, the atomizer is heated and the liquid is drawn in and vaporized. The smoker inhales the mist produced. Various substances have been detected in this mist: formaldehyde, acetaldehyde and acrolein and some heavy metals. Although these are found in lower concentrations than in cigarettes, they may still be harmful for the human body. Several surveys show that 3-10% of smokers regularly use e-cigarettes. A randomized study has shown that the efficacy of e-cigarettes for helping smokers to quit is similar to nicotine patches. Nevertheless, the study has relevant methodological limitations and reliable conclusions cannot be deduced. This report sets down the Position Statement of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) on the efficacy and safety of e-cigarettes. This statement declares that e-cigarettes should be regulated as medicinal products.

[The challenge of electronic cigarettes]. / El desafío de los cigarrillos electrónicos.

The electronic cigarette (e-cig) is a device with a conventional cigarette shape that releases a determined dose of nicotine vapour through an electronic heating process. The nicotine cartridges vary significantly in the amount of nicotine released, even within the same brand. Not all brands admit that they contain nicotine, but this is detected in the majority of units analysed. The e-cig usually contains a propellant, such as propylene glycol, which is a lung irritant. The short-term respiratory effect of the vapour of an e-cig is similar to that caused by the smoke of a cigarette, and is a cause of broncho-restriction. The majority of brands contain glycerine and at least one case of lipoid pneumonia has been detected due to this substance. Many brands contain traces of N-nitrosamines, heavy metals, and other products that are found in conventional cigarette smoke, but in a much higher proportion. There is currently no scientific evidence available that shows it is an effective device for quitting smoking, thus it should not be pro-actively recommended for this purpose, and may interfere with the use of demonstrated scientific evidence-based treatments for quitting smoking. It may have an undesirable effect on promoting the starting of smoking in adolescents or keeping adult smokers consuming nicotine and on gestural dependency. The toxicity of the vapour is not well known, but it is known that they are not innocuous, thus they should not be used in closed public spaces.