For the past three decades, cardiologist Jaqueline Scholz has read about the negative impacts of smoking on human health on a daily basis. Director of the smoking treatment program at the Heart Institute (INCOR) of the University of São Paulo School of Medicine (FM-USP), she has already treated thousands of individuals seeking help to overcome cigarette addiction.
In recent years, however, a new profile of patient has become increasingly common: young people and adults who are trying to free themselves from addiction caused by the continuous use of electronic smoking devices (ESDs), or electronic cigarettes, also known as vapes. “Symptoms that take years to appear in traditional smokers, like waking up in the middle of the night with the urge to smoke, appear in vape users just a few months after starting,” says a concerned Scholz.
The situation is worrying because the use of vapes has spread, especially among young people. According to the 2019 National Survey of Health (PNS), around 1 million Brazilians were current electronic cigarette users, with greater prevalence among young people from 15 to 24 years of age, who represented 70% of all consumers of the product.
The third edition of the Brazilian National Alcohol and Drugs Survey (LENAD), published in June, found that more than one in ten adolescents (11.4%) have already tried electronic cigarettes, a higher proportion than among adults (8.8%). Prevalence is even greater among 18- to 24-year-olds: 25% confirmed having used an electronic device at least once and 16.7% reported having used one within the past year. Furthermore, 76.3% of the adolescents who had tried them continue to use the devices, revealing high rates of continued use. The survey included data about the use of ESDs based on a representative sample (16,608 people) of the Brazilian population aged 14 and older.
Of all the individuals who had used electronic cigarettes (vapes), 26% reported using them in the month prior to the survey—31.8% among adolescents—considered by experts as the most reliable indicator for identifying continuous or recurring use of these devices. This number is similar to that recorded by the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL), which has been monitoring vape use in the Brazilian population since 2019. According to VIGITEL, 2.1% of adults in the country’s state capitals use electronic cigarettes on either a daily or occasional basis.
Although vapes have spread globally, they have not yet become widely popular in Brazil. According to LENAD, 91.2% of Brazilians have never tried the devices, and 17.6% do not even know what vapes are. One of the reasons for their limited use is that their sale is prohibited in Brazil, a ban imposed by the Brazilian Health Regulatory Agency (ANVISA). Proportionally, 15% of the country’s population, equivalent to 26.8 million people, smoke nicotine in some form—with two vape users for every 8 regular smokers.
“Many people downplay the legality issue, but the data show that keeping these devices off the legal market has been fundamental for protecting the Brazilian population, especially younger people,” says psychologist Clarice Madruga, of the Federal University of São Paulo (UNIFESP), responsible for the LENAD study.
Epidemiologist André Szklo, of Brazil’s National Cancer Institute (INCA), who did not participate in this study, has noticed a change in the profile of smokers. “The tobacco epidemic in Brazil has always been concentrated among low-income and low-education populations, but vapes have introduced young people from higher social classes and with higher levels of education to this scenario, individuals who would have been unlikely to start smoking regular cigarettes,” the researcher explains.
New vape users include segments of the population that previously had lower rates of tobacco use, such as pregnant women. In a study published in June 2024 in the journal Nicotine & Tobacco Research, based on the PNS, Szklo, and researchers from Johns Hopkins University, in the USA, found that tobacco use among pregnant women increased from 4.7% in 2013 to 8.5% in 2019, practically the same rate recorded among nonpregnant women in 2019.
“Some women smokers began using electronic cigarettes during their pregnancy because they believe them to be less harmful to their health, but later end up returning to regular cigarettes, which are cheaper,” he says. According to him, the situation is concerning, because women who have always been a minority among smokers, are now the majority among younger vape users.
According to LENAD, this is the only drug with a higher proportion of female users in the adolescent group. The prevalence of use in the month prior to the survey was 4.6% among girls and 2.6% among boys. Among girls, 12.3% had already used a vape at some point in their lives, compared to 10.6% of boys.
Price differences favor vapes. A pod (refillable or disposable capsule) costs an average of R$150 and lasts for 15,000 puffs (inhalations), while a packet of 20 regular cigarettes costs between R$6.50 and R$15.00. However, prices for complete electronic devices vary greatly, depending on features, power, and personalization. Simpler or disposable models cost between R$50 and R$200, while more advanced ones can reach R$700.
Léo Ramos Chaves / Pesquisa FAPESPOnline sales now predominate, since enforcement focuses on newsstands and storesLéo Ramos Chaves / Pesquisa FAPESP
First sold in 2004, initially in China, vapes gained attention for their small, colorful, and high-tech designs that resembled toys. They offered fruity flavors and pleasant aromas, and provided a supposedly healthier alternative to regular cigarettes. The promise of being less harmful did not last, as research began to reveal previously little-known risks and more and more people began experiencing the adverse effects of prolonged use firsthand.
In addition to addiction—the treatment of which combines psychological support, behavioral changes, and medication—cardiovascular and respiratory diseases are appearing early among vape users. An example is Evali (E-cigarette or Vaping Product Use-associated Lung Injury), acute lung damage linked to the use of electronic cigarettes, which emerged in the USA in 2019 and primarily affected young adults around 20 years of age with no prior history of respiratory issues (see Pesquisa FAPESP issue n° 319).
High nicotine concentration
The high nicotine concentration of vapes is one of the main causes of health damage. The absorption of nicotine, the substance that causes addiction to tobacco, is quick: it reaches the brain in 6 to 10 seconds, where it stimulates the release of neurotransmitters responsible for the feeling of pleasure associated with smoking.
Scholz, from INCOR, took part in a study published in June 2025 in the International Journal of Environmental Research and Public Health that detected elevated concentrations of nicotine in the saliva of those who exclusively used vapes, regardless of the duration of use, smoking history, or age. Among the 417 participants of this study who exclusively smoked vapes, 49 presented levels above 400 nanograms per milliliter (ng/ml), the equivalent to that of someone who smokes around 20 cigarettes per day. Another 15 reached average concentrations of 2,400 ng/ml, levels which experts found alarming.
Vapes soften the throat burn, a common undesired effect of traditional cigarettes. The reduced discomfort of electronic cigarettes is due to nicotine salt, obtained by combining nicotine with one or more acids. The formulation used in electronic cigarettes allows manufacturers to produce liquids with much higher nicotine concentrations without causing the typical irritation associated with cigarette smoke. Scholz and Szklo highlight that this characteristic facilitates repeated use and may accelerate the development of addiction, as high doses are inhaled without irritating the throat.
According to Scholz, the addictiveness of vapes results precisely from the higher nicotine levels, added to the possibility of smoking discreetly in public places where traditional cigarettes are not allowed. “Vapes allow people to smoke without leaving evidence, like smell, which becomes an invitation to continuous use,” he says. “It takes a person around two to three years to go from smoking traditional cigarettes occasionally to smoking a pack per day. With vape users, this progression is much faster.”
For Madruga, coordinator of LENAD, it is essential to adopt specific strategies to reach the different user profiles and levels of addiction risk. This includes restricting access by adolescents, combating the mistaken perception that vapes pose fewer health risks, and, above all, intensifying and modernizing the enforcement of laws against their illicit sale, whether online or in physical stores. “Channels heavily used by adolescents, such as Instagram and TikTok, require stricter monitoring, as they are now the main gateways for the exposure and promotion of electronic smoking devices,” she recommends. “The sale of these devices is illegal and should be reported.”
The story above was published with the title “Youth trap” in issue 354 of August/2025.
Scientific articles
Caderno Temático LENAD III: Tabagismo e uso de Dispositivos Eletrônicos de Fumar. 2025.
PATEL D. et al. Headspace analysis of E-cigarette fluids using comprehensive two dimensional GC×GC-TOF-MS reveals the presence of volatile and toxic compounds. Journal of Pharmaceutical and Biomedical Analysis. Vol. 196, 113939. Mar. 2021, 113930.
SCHOLZ, J. R. et al. Nicotine dependence in a banned market: Biomarker evidence from e-cigarette users in São Paulo, Brazil. Environmental Research and Public Health. Vol. 22, no. 6. June 19 2025.
VALENZUELA, E. F. et al. Analysis of volatile organic compounds (VOCs) in e-cigarettes: A thermal desorption coupled with gas chromatography-mass spectrometry (TD-GC-MS) approach. Talanta. Vol. 294, 128255. Nov. 1, 2025.
ZSKLO, A. et al. Maternal smoking prevalence in Brazil in 2013 and 2019: Not what we expected when they were expecting! Nicotine & Tobacco Research. Vol. 26, no. 12. Dec. 2024.
Vigitel Brasil 2006–2023: Tabagismo e consumo abusivo de álcool. Brasília: Ministry of Health, 2023.
World Health Organization (WHO). Prevalence of tobacco and e-cigarette use by young people in the WHO European Region. World Health Organization Regional Office for Europe. 2024.
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