Use of electronic cigarettes and hookah in Brazil: a new and emerging landscape. The Covitel study, 2022.

OBJECTIVE: To estimate the prevalence of current commercial cigarette smoking, as well as those of e-cigarette and hookah experimentation and current use among adults (≥ 18 years of age) in Brazil. METHODS: This study was based on a countrywide cross-sectional telephone-based survey conducted in 2022. The sample was designed to be representative of the five macroregions in Brazil and included 1,800 individuals from each of the regions. Telephone numbers, using a random digit dialing procedure, were proportionally selected for each direct distance dialing code in each region and then electronically validated (i.e., 900 cell and 900 landline phone numbers per region). Information on current commercial cigarette smoking (regardless of frequency/amount), as well as lifetime history of or current e-cigarette and hookah use (regardless of amount), were collected. RESULTS: The prevalence of lifetime history of e-cigarette and hookah use was identical (7.3%; 95% CI: 6.0-8.9), whereas the prevalence of current commercial cigarette smoking was 12.2% (95% CI: 10.4-14.1). Young adults (18-24 years) had the highest prevalence of e-cigarette experimentation (19.7%; 95% CI: 15.1-17.0) and hookah experimentation (17%; 95% CI: 12.2-23.2). E-cigarette and hookah use was more common in the Central-West region and among those with a high level of education, whereas current commercial cigarette smoking was more common among those with a lower level of education. Individuals who used the three forms of nicotine delivery corresponded to 1.5% of the sample (nearly 2 million individuals based on the estimated size of the Brazilian adult population). CONCLUSIONS: Surveillance is essential for the monitoring and prevention of these new forms of nicotine consumption.

Os jovens seguem usando narguilé apesar do conhecimento dos possíveis riscos à saúde / Young people continue to use hookah despite knowledge of possible health risks

É preocupante notar que os usuários sigam usando o narguilé, embora a literatura aponte que o seu uso cause danos irreversíveis à saúde. Esse estudo avaliou a percepção dos usuários de narguilé e a interferência do seu consumo sobre a saúde. Método Esse é um estudo qualitativo. Uma amostra intencional de usuários foi recrutada. Os participantes responderam a uma entrevista semiestruturada. Todas as entrevistas foram avaliadas pelo método de análise de conteúdo. Resultados A maioria dos discursos apontou que os entrevistados conhecem os malefícios à saúde advindos do uso de narguilé. Entretanto, os efeitos sobre a saúde mental raramente foram lembrados pelos entrevistados, embora muitos deles já estivessem em uso problemático de tabaco, álcool e ou de outras drogas. A percepção de controle sobre o uso, o poder reforçador dos efeitos e a ausência de experiências pessoais negativas com o narguilé são importantes motivadores para seguir o uso. Conclusão Campanhas educativas e medidas para a redução e o controle do uso devem ser encorajadas.

Although the scientific literature show that waterpipe tobacco smoking causes irreversible damage to health, users continue to use it. Method This study evaluates the users' perceptions about the effect of this consumption on health. This is a qualitative study. A purposeful sample of current users was recruited. Participants were invited to undertake an in-depth semi-structured interview. The interviews were evaluated by content analysis method. Results Most speeches pointed out that the interviewees are aware of the harm to health from using waterpipe tobacco smoking. Although most interviewees were already developing a problematic use of tobacco, alcohol or other drugs, they rarely related waterpipe tobacco smoking with mental health consequences. The essential motivators for its continued use were the perception of control over waterpipe tobacco smoking use, the reinforcing tobacco effects, and the absence of negative health experiences in life. Conclusion Understand that educational campaigns and control measures should be encouraged.

The use of cigarettes, hookahs, electronic cigarettes, and other tobacco indicators among Brazilian schoolchildren: data from National School Health Survey 2019. / O uso de cigarro, narguilé, cigarro eletrônico e outros indicadores do tabaco entre escolares brasileiros: dados da Pesquisa Nacional de Saúde do Escolar 2019.

OBJECTIVE: To describe the prevalence of smoking indicators among Brazilian students according to sociodemographic characteristics in 2019, and compare the prevalence between 2015 and 2019. METHODS: Data from the National Survey of School Health 2015 and 2019 were used. Indicators related to tobacco use were analyzed. Indicators were compared between the 2015 and 2019 editions. Prevalence and respective 95% Confidence Interval (95%IC) were calculated for the total population and according to sex, age group and type of school. RESULTS: 22.6% (95%CI 21.7-23.4) of the students had tried any cigarette and it was higher between 16 and 17 years of age (32.6%; 95% CI 31.4-33, 8) and in males (35.0%; 95%CI 33.6-36.4). The experimentation of hookah, electronic cigarette and other tobacco products are also high, with 26.9% (95%CI 26.0-27.8), 16.8% (95%CI 16.2-17.4) and 9.3% (95%CI 8.8-9.8), respectively, being higher among boys aged 16 to 17 years. It is noteworthy that there were no changes in the indicators of cigarette experimentation, smoking for the first time before the age of 13, smoking in the 30 days prior to the survey, and at least one of the smoking parents. CONCLUSION: Although smoked tobacco indicators are stable between 2015 and 2019, the high prevalence of experimentation with products such as hookah and electronic cigarettes is highlighted, drawing attention to the need for new regulatory measures.

OBJETIVO: Descrever a prevalência de indicadores do tabagismo entre escolares brasileiros segundo características sociodemográficas em 2019 e comparar as prevalências entre 2015 e 2019. MÉTODOS: Utilizaram-se dados da Pesquisa Nacional de Saúde do Escolar de 2015 e 2019. Foram analisados os indicadores referentes ao uso do tabaco, que foram comparados entre as edições de 2015 e 2019. Foram calculadas as prevalências e os respectivos intervalos de confiança de 95% (IC95%) para a população total e segundo sexo, faixa etária e tipo de escola. RESULTADOS: Dos escolares, 22,6% (IC95% 21,7-23,4) já experimentaram cigarro alguma vez, porcentagem mais elevada entre os de 16 a 17 anos de idade (32,6%; IC95% 31,4-33,8) e no sexo masculino (35,0%; IC95% 33,6-36,4). A experimentação de narguilé, cigarro eletrônico e outros produtos do tabaco também se mostra elevada, com 26,9% (IC95% 26,0-27,8), 16,8% (IC95% 16,2-17,4) e 9,3% (IC95% 8,8-9,8), respectivamente, sendo mais alta entre os escolares do sexo masculino de 16 a 17 anos. Destaca-se que não houve mudanças nos indicadores "experimentação do cigarro", "fumar pela primeira vez antes dos 13 anos", "fumar nos 30 dias anteriores à pesquisa" e "ter ao menos um dos pais fumantes" entre os anos indicados. CONCLUSÃO: Embora os indicadores de tabaco fumado estejam estáveis entre 2015 e 2019, destacam-se as elevadas prevalências de experimentação de produtos como narguilé e cigarro eletrônico, que chamam a atenção para a necessidade de novas medidas regulatórias.

Intoxicación aguda con monóxido de carbono (ICO) secundaria a pipa de agua (Narguile). Reporte de un caso / Carbon monoxide poisoning caused by water pipe smoking (Narghile). A case report

Resumen Dentro de las formas alternativas de consumo de tabaco, se describe el uso de pipas de agua (también llamadas hookah, shisha o narguile) como implementos de uso. Esta forma de uso es una forma emergente en nuestro medio, con uso en estudiantes universitarios y secundarios. Debido a que utiliza carbón para quemar el tabaco, junto a largos períodos de uso, presenta riesgo de intoxicación por monóxido de carbono, especialmente si se utiliza en ambientes cerrados. En este artículo presentamos el caso de una paciente femenina de 19 años, quién fue traída al hospital con una intoxicación grave por monóxi do de carbono secundaria a uso de pipa de agua, requiriendo tratamiento con oxígeno en cámara hiperbárica. Realizamos una revisión de la bibliografía.

Abstract Amongst the alternative ways of tobacco use, water pipes (also called hookah, shisha or narghile) have been used as implements. This type of use is an emergent one in our environment, being used by high school and college students. Due to the use of charcoal as a way to burn the tobacco, and the long using times it presents, the users are at risk of being poisoned by carbon monoxide, especially if they smoke in enclosed spaces. In this paper, we present the case of a 19-year-old female patient, who was brought to the hospital with a severe case of carbon monoxide poisoning, requiring treatment with oxygen in a hyperbaric chamber. We make a review of the literature.

A Qualitative Study of Chronic Hookah Use in São Paulo, Brazil.

Background: Hookah is a device commonly employed for the use of tobacco, which is becoming popular in Western countries, especially among young people. In fact, its use has become a public health problem worldwide. Few Brazilian studies have researched its use, in this way, hookah culture has not been adequately examined in the country. Objective: This study aimed to investigate in depth the culture of hookah use in the city of São Paulo, Brazil. Methods: To do so, a cross-sectional, observational qualitative study was conducted. An intentional sample made by 29 subjects was selected through key informants and the snowball sampling technique. Participants were asked to engage in a semi-structured individual interview, which was recorded with the participant's prior consent. The interviews were analyzed according to Bardin's content analysis method. Results: Most of the participants were young, single men. The use of hookah is predominantly done in groups and during festive situations. Public places such as lounges, snack bars, and on the street were most often reported locations for hookah use. Interviewees have reported using hookah for long periods of time, for instance, from 1 to 10 hours continuously. Physical and psychological effects were reported, especially unpleasant ones. Engagement in polydrug use was reported for coping with the hookah effects. Participating in games was the main reason to use hookah. Conclusions: It is worrisome that a health risk behavior such as hookah use is conducted as an entertainment activity among young people, and thus it deserves a different approach and evaluation from the appropriate authorities.

Factors related to the use of hookah among medical students. / Fatores relacionados ao consumo do narguilé entre estudantes de medicina.

OBJECTIVE: This study evaluated the factors related to the use of hookah among medical students, the level of knowledge about the involved harms, and their relationship with the use and intention to stop using it. METHODS: Students of the 1st and 6th year of medical school were evaluated. A multivariate logistic regression model was used to evaluate the association between the outcome (use of hookah in the last 30 days) and demographic, subjective psychosocial data and level of knowledge about the harms of hookah use. RESULTS: The experimentation rate of hookah and current use was high (59.6% and 27.7%, respectively), with no difference between the 1st and 6th year groups (p=0.70). The 6th grade students were more knowledgeable about the harm of using hookah when compared to the 1st year students (p <0.0001), and there was no association between the use of hookah in the last 30 days and the knowledge about its harms. Cigarette smoking and the use of alcoholic beverages were associated with the use of hookah in the last 30 days, with unadjusted Odds Ratio (OR) of 11.3; 95% CI 4.62-27.7; p <0.0001 and OR 8.74; 95% CI 3.78-20.2; p <0.0001; respectively. CONCLUSION: There is a high experimentation, current use of hookah and cigarettes among medical students. Sixth year students are more knowledgeable about the harms involved. There was no association between the use of hookah in the last 30 days and the knowledge about its harms. Smoking and the use of alcoholic beverages are independent predictors of use of hookah.

OBJETIVO: Avaliar o nível de conhecimento sobre os malefícios do narguilé, a frequência e os fatores psicossociais envolvidos na sua utilização entre os estudantes de Medicina de dois diferentes períodos e sua relação com a intenção de parar de utilizar. MÉTODOS: Foram avaliados alunos do 1o e do 6o ano do curso de Medicina. Regressão logística multivariada foi utilizada para avaliar a associação entre o uso de narguilé nos últimos 30 dias com os dados demográficos, psicossociais e com o nível de conhecimento sobre seus malefícios. RESULTADOS: A taxa de experimentação e do uso atual de narguilé foi elevada (59,6% e 27,7% respectivamente), sem diferença entre os grupos. O nível de conhecimento dos alunos do 6o ano acerca dos malefícios do uso de narguilé foi maior em relação aos alunos do 1o ano (p<0,0001), e não houve relação do consumo de narguilé nos últimos 30 dias com o nível de conhecimento. O tabagismo de cigarros e o uso de bebida alcoólica estavam associados ao uso de narguilé nos últimos 30 dias. Odds Ratio não ajustada de 11,3; IC95% 4,62-27,7; p<0,0001 e OR 8,74; IC95% 3,78-20,2; p<0,0001; respectivamente. CONCLUSÕES: Há uma elevada experimentação, uso atual de narguilé e de cigarros entre os estudantes de Medicina, que possuem maior conhecimento sobre o malefício do uso no 6° ano do curso. Não foi observada relação entre o conhecimento sobre o malefício do uso e o consumo. O tabagismo e o uso de bebidas alcoólicas são preditores independentes de uso de narguilé.

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.

Fatores relacionados ao consumo do narguilé entre estudantes de medicina / Factors related to the use of hookah among medical students

RESUMO Objetivo Avaliar o nível de conhecimento sobre os malefícios do narguilé, a frequência e os fatores psicossociais envolvidos na sua utilização entre os estudantes de Medicina de dois diferentes períodos e sua relação com a intenção de parar de utilizar. Métodos Foram avaliados alunos do 1o e do 6o ano do curso de Medicina. Regressão logística multivariada foi utilizada para avaliar a associação entre o uso de narguilé nos últimos 30 dias com os dados demográficos, psicossociais e com o nível de conhecimento sobre seus malefícios. Resultados A taxa de experimentação e do uso atual de narguilé foi elevada (59,6% e 27,7% respectivamente), sem diferença entre os grupos. O nível de conhecimento dos alunos do 6o ano acerca dos malefícios do uso de narguilé foi maior em relação aos alunos do 1o ano (p<0,0001), e não houve relação do consumo de narguilé nos últimos 30 dias com o nível de conhecimento. O tabagismo de cigarros e o uso de bebida alcoólica estavam associados ao uso de narguilé nos últimos 30 dias. Odds Ratio não ajustada de 11,3; IC95% 4,62-27,7; p<0,0001 e OR 8,74; IC95% 3,78-20,2; p<0,0001; respectivamente. Conclusões Há uma elevada experimentação, uso atual de narguilé e de cigarros entre os estudantes de Medicina, que possuem maior conhecimento sobre o malefício do uso no 6° ano do curso. Não foi observada relação entre o conhecimento sobre o malefício do uso e o consumo. O tabagismo e o uso de bebidas alcoólicas são preditores independentes de uso de narguilé.

ABSTRACT Objective This study evaluated the factors related to the use of hookah among medical students, the level of knowledge about the involved harms, and their relationship with the use and intention to stop using it. Methods Students of the 1st and 6th year of medical school were evaluated. A multivariate logistic regression model was used to evaluate the association between the outcome (use of hookah in the last 30 days) and demographic, subjective psychosocial data and level of knowledge about the harms of hookah use. Results The experimentation rate of hookah and current use was high (59.6% and 27.7%, respectively), with no difference between the 1st and 6th year groups (p=0.70). The 6th grade students were more knowledgeable about the harm of using hookah when compared to the 1st year students (p <0.0001), and there was no association between the use of hookah in the last 30 days and the knowledge about its harms. Cigarette smoking and the use of alcoholic beverages were associated with the use of hookah in the last 30 days, with unadjusted Odds Ratio (OR) of 11.3; 95% CI 4.62-27.7; p <0.0001 and OR 8.74; 95% CI 3.78-20.2; p <0.0001; respectively. Conclusion There is a high experimentation, current use of hookah and cigarettes among medical students. Sixth year students are more knowledgeable about the harms involved. There was no association between the use of hookah in the last 30 days and the knowledge about its harms. Smoking and the use of alcoholic beverages are independent predictors of use of hookah.

Características do uso de produtos derivados do tabaco entre universitários do curso de Odontologia em uma Universidade de Curitiba / Factors associated with tobacco use among dental students at a University in Curitiba

Introdução: Profissionais da saúde, incluindo dentistas, são referências de comportamento e exercem grande influência sobre a população que assistem. Objetivo: Este estudo teve como objetivos investigar a prevalência do uso de produtos derivados do tabaco entre universitários de Odontologia, analisar fatores associados à ocorrência do uso e quais são os produtos mais utilizados. Material e método: Realizou-se um estudo transversal descritivo por meio de um questionário online no ano de 2012. A estatística descritiva gerou um perfil da amostra e aplicou-se o teste Qui-quadrado para análise de associação entre variáveis, seguido da análise multivariada de regressão logística com as variáveis que se mostraram significativas. Resultado: A prevalência de uso de produtos derivados de tabaco foi de 24,92%. O narguilé mostrou-se o produto de maior uso (66,23%), seguido do cigarro industrializado (54,55%). Os fatores associados ao uso de produtos de tabaco foram morar sozinho (p=0,012; OR=2,13; IC=1,17-3,85), conviver com alguém que fuma(p=0,000; OR=3,22; IC=1,75-5,91) e permanecer próximo às pessoas enquanto elas fumam(p=0,000; OR=6,96; IC=2,37-20,45). Conclusão: Este estudo provê informação importante para desenvolvimento de programas de sensibilização e capacitação dos profissionais de saúde por instituições de ensino superior em relação ao uso de produtos derivados de tabaco.

Introduction: Health care professionals, including dentists, are role models and have great influence on the population they serve. Objective: This purpose of this study was two-fold: (1) to examine the prevalence of tobacco use among dental students, and (2) to examine factors associated with use as well as which products were being used by this population. Material and method: This was a cross-sectional descriptive study in which the data was collected through an online questionnaire in 2012. Descriptive statistics were used to characterize the sample, chi-square to examine association among variables of interest, and multivariate logistic regression to examine factors associated with tobacco use. Result: The prevalence of tobacco use was 24.92%. Waterpipe was the most frequent tobacco product used by participants who endorsed using tobacco products (66.23%) followed by industrialized cigarettes (54.55%). Factors associated with tobacco use included: living alone (p=0.012; OR=2.13; CI=1.17-3.85), socializing with other smokers (p=0.000; OR=3.22; CI=1.75-5.91), and being close to these smokers when they were smoking (p=0.000; OR=6.96; IC=2.37-20.45). Conclusion: This study provides relevant information to the development of awareness and capacity building programs tailored to health care professional in higher education with regard to tobacco use.