Electronic cigarette awareness and use among students at the Federal University of Mato Grosso, Brazil

ORIGINAL ARTICLE Electronic cigarette awareness and use among students at the Federal University of Mato Grosso, Brazil Wemerson José Corrêa de Oliveira1  http://orcid.org/0000-0003-1945-1592 Alexandre Figueiredo Zobiole1  http://orcid.org/0000-0002-9527-6055 Claudia Bonadiman de Lima1  http://orcid.org/0000-0002-5935-516X Rebeca Melo Zurita1  http://orcid.org/0000-0002-5709-5202 Pedro Eduardo Muniz Flores1  http://orcid.org/0000-0003-2779-4675 Luís Guilherme Val Rodrigues1  http://orcid.org/0000-0002-5503-9223 Raissa Carolina de Assis Pinheiro1  http://orcid.org/0000-0003-3010-7610 Victor Francisco Figueiredo Rocha Soares e Silva1  http://orcid.org/0000-0002-3678-9475 1. Faculdade de Medicina, Universidade Federal de Mato Grosso, Cuiabá (MT) Brasil. ABSTRACT Objective: To analyze the prevalence of electronic cigarette (e-cigarette) awareness and experimentation among university students, as well as the characteristics associated with that awareness. Methods: This was a cross-sectional study, conducted in 2015, in which 489 university students at the Federal University of Mato Grosso (Cuiabá campus), Brazil, were interviewed with the use of a specific questionnaire. We estimated the prevalence of e-cigarette awareness and use, as well as analyzing the major characteristics associated with that awareness and use. Results: The prevalence of e-cigarette awareness was 37%, and the rate of e-cigarette experimentation was 2.7%. Awareness of e-cigarettes was found to be associated with marital status, work status, the level of parental education, and the presence or absence of smokers in the family. Conclusions: A high proportion of university students were aware of e-cigarettes. Although the prevalence of those who had experimented with e-cigarettes was low, there is concern that there could be an increase in the use of these types of device. There is a need for measures targeting university students, in order to build awareness of and prevent e-cigarette use. Keywords: Electronic Nicotine Delivery Systems; Young adult; Smoking INTRODUCTION Invented in 2003, electronic cigarettes (e-cigarettes), also known as electronic nicotine delivery systems, are devices that produce an aerosol by heating a liquid that contains a solvent (vegetable glycerin, propylene glycol, or a mixture of these), flavorings, and nicotine.1 Some e-cigarettes have a light-emitting diode at the tip that is activated during use to simulate traditional smoking.2 The lack of regulation and quality control policies for e-cigarettes makes it difficult to determine the safety of these devices, and their potential health risks remain unclear.3 In Brazil, according to Article 1 of Brazilian National Health Oversight Agency Collegiate Board Resolution no. 46/2009,4 “it is forbidden to market, import, or advertise electronic smoking devices, known as electronic cigarettes, e-cigarettes, e-cigs, e-cigars, vaporizers, etc., especially those claiming to be a substitute for cigarettes, cigarillos, cigars, pipes, and similar products in the smoking habit or aimed at being an aid in smoking cessation treatment.” The use of e-cigarettes has increased exponentially since their invention in 2003. In 2010, 1.8% of U.S. adults reported having used an e-cigarette at some time, a rate that rose to 13% by 2013. The rate of those who reported being current e-cigarette users increased from 0.3% to 6.8% during the same period, and one third of these reported never having used tobacco.1 To determine the profile of e-cigarette users in the United States., a study based on data from the U.S. National Center for Health Statistics, published in 2016 by the American Journal of Preventive Medicine, showed that, unlike traditional cigarette smokers (African-Americans and individuals with a low level of education), e-cigarette users tended to be young, White, and single, as well as having a college education level.5 Few studies in Brazil have examined e-cigarette awareness and use. A study on awareness, experimentation, and current use of e-cigarettes in 10 countries, which is a result of the International Tobacco Control Project and was published in 2014 in the International Journal of Environmental Research and Public Health, showed that, in Brazil, the prevalence of e-cigarette awareness was 35% and the self-reported rate of e-cigarette experimentation was 3%. Those are comparable to the values reported for Canada and China, but are lower than those found in the United States and Australia, where the prevalence of e-cigarette awareness was 73% and 66%, respectively, and the self-reported rate of e-cigarette experimentation was 15% and 20%, respectively.6 Recent studies have suggested that e-cigarette use might be associated with an increased risk of using tobacco products. Enjoyment of the sensations and pharmacological effects of inhaling nicotine via an e-cigarette may increase propensity to use other products that also deliver inhaled nicotine, including tobacco products.7 If e-cigarettes prove to be a means of “transition”, leading to an increase in smoking, that will represent a serious public health problem in the fight against tobacco use.8 Since that e-cigarette awareness and experimentation have progressively increased, especially among young people, and considering the uncertainties regarding the safety and health risks of e-cigarettes, we designed this study. The objective of this study was to identify the prevalence of e-cigarette awareness and use, as well as to analyze the characteristics associated with that awareness, among students at the Federal University of Mato Grosso (Cuiabá campus), Brazil, in 2015. In addition, we aimed to lay the groundwork future public health initiatives focusing on measures to prevent and build awareness of e-cigarette use. METHODS This was an observational cross-sectional study involving undergraduate students at the Federal University of Mato Grosso (Cuiabá campus), Brazil, conducted in 2015. The sample size was calculated on the basis of the prevalence of smoking among undergraduate health sciences students in the city of Cuiabá, Brazil, in 2009,9 which was 9%, and the sampling error was set at 0.05. The random sampling was based on data from the 2012 Mandate of the Unified Selection System for the Federal University of Mato Grosso. The courses were grouped by area of knowledge (as defined by the Brazilian National Council for Scientific and Technological Development),10 and the sample size was calculated proportionally to the number of students in each area. The sample size was increased by 20% to account for losses and refusals. Data were collected with a standardized, pre-codified, multiple-choice self-administered, anonymous questionnaire that was developed by the authors based on the Special Smoking Survey questionnaire (2008 Brazil Report).11 The questionna (...truncated)