Nicotine Dependence in a Banned Market: Biomarker Evidence from E-Cigarette Users in São Paulo, Brazil

Jaqueline Ribeiro Scholz (), Elaine Cristine D’Amico, Juliana Takitane, Daniele Mayumi Sinagawa, João Mauricio Castaldelli-Maia, Marcelo Filonzi dos Santos, Rodrigo Alves de Oliveira, Guilherme Vinicius Marques, Eric Nagamine Lima, Diana Fernanda Lasso Rodriguez, Sara Ziotti, Vilma Leyton and Maria Cristina Megid
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Jaqueline Ribeiro Scholz: Serviço de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil
Elaine Cristine D’Amico: Secretaria de Estado da Saúde, Vigilância Sanitária Estadual, Sao Paulo 01246-901, Brazil
Juliana Takitane: Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao—LIM40, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil
Daniele Mayumi Sinagawa: Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao—LIM40, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil
João Mauricio Castaldelli-Maia: Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil
Marcelo Filonzi dos Santos: Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao—LIM40, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil
Rodrigo Alves de Oliveira: Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao—LIM40, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil
Guilherme Vinicius Marques: Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo 05508-090, Brazil
Eric Nagamine Lima: Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo 05508-090, Brazil
Diana Fernanda Lasso Rodriguez: Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo 05508-090, Brazil
Sara Ziotti: Serviço de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil
Vilma Leyton: Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao—LIM40, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil
Maria Cristina Megid: Secretaria de Estado da Saúde, Vigilância Sanitária Estadual, Sao Paulo 01246-901, Brazil

IJERPH, 2025, vol. 22, issue 6, 1-18

Abstract: Although electronic cigarettes have been banned in Brazil since 2009, their use is increasing, particularly among youth. We conducted a biomarker-based study to profile exclusive e-cigarette users in São Paulo and to examine the associations of e-cigarette use with salivary nicotine and cotinine levels. A population-based, cross-sectional study was conducted between April and September 2024 in six municipalities in São Paulo, Brazil. Randomly selected participants who reported exclusive use of electronic cigarettes completed a questionnaire and provided oral fluid samples for the determination of their nicotine and cotinine concentrations using LC-MS/MS. The cohort consisted of N = 417 participants. Significant associations were found between nicotine and cotinine concentrations and variables such as knowledge of nicotine content and product type. Addiction status significantly influenced the nicotine and cotinine concentrations, as well as smoking history, last consumption, recharge/purchase frequency, and consumption duration (all p < 0.001). Participants who perceived themselves to have a moderate or severe addiction exhibited higher nicotine and cotinine concentrations compared with those who did not perceive that they had an addiction ( p < 0.001). Most participants were young, predominantly White, and highly educated and earned higher incomes. The findings reveal a correlation between perceived nicotine dependence and salivary nicotine and cotinine concentrations, underscoring the physiological and behavioral markers of electronic cigarette addiction. High salivary concentrations of nicotine appear to be independent of duration of e-cigarette use, smoking history, and age. These findings underscore the urgent need for surveillance and public health interventions, even in jurisdictions where these products remain illegal. The study limitations include its cross-sectional design and potential selection bias due to convenience sampling.

Keywords: electronic cigarettes; nicotine or derivatives; toxicology (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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