At a small tobacco shop in the Central District of São Paulo, Brazil, a variety of e-cigarettes are for sale alongside rolling papers and bongs.
A shop clerk behind the counter assures that e-cigarettes aren’t dangerous: “Nicotine is addictive, but it doesn’t kill you,” he said.
Since some e-cigarettes don’t use tobacco — only a fluid with nicotine and other substances — it wouldn’t cause harm, he argued, incorrectly.
Actually, nicotine is itself associated with cardiovascular problems, and the other chemical compounds could cause cancer, lung injuries and other diseases. Still, e-cigarettes may be less harmful than regular ones, although independent studies are inconclusive on that matter so far.
The Central District shop is among a number of places in the area that blatantly peddles e-cigarettes despite the fact that they’ve been prohibited in Brazil since 2009, when ANVISA, the federal health sanitary agency, issued a ruling against the commercialization of electronic devices used for smoking.
That ruling, however, may soon change as tobacco companies are pressuring the agency for a more flexible regulation that would allow sales. ANVISA is expected to revisit the issue this year, but it has remained silent on it so far.
Some people argue that if people can find e-cigarettes on the streets and on the internet, why prohibit them? They say that, without the ban, at least the country could tax the sales.
But Stella Bialous, a Brazilian expert on tobacco issues and a professor from the University of California, San Francisco, disagrees with that move.
“Once the product is legally allowed to be commercialized, it gets into the distribution network of the tobacco companies, which have one of the best distribution systems around.”
“Once the product is legally allowed to be commercialized, it gets into the distribution network of the tobacco companies, which have one of the best distribution systems around,” Bialous said.
In 2019, fewer than 1% of Brazilians used e-cigarettes, mostly in large, urban areas. Legalization, however, could boost these rates rapidly, since it would make access easier in other parts of the country, according to Bialous.
Bialous also said that e-cigarettes aren’t necessarily safe: “Being less harmful than cigarettes might mean very little. There’s barely any other consumer product that kills half of its users when used as intended.”
But if there’s a possibility of harm reduction, why not grab it? That’s another argument used by the tobacco companies that manufacture e-cigarettes.
Fernando Landucci is a 34-year-old entrepreneur in São Paulo who switched from regular cigarettes to an electronic device in 2017.
“I felt a huge difference one month after I stopped smoking the conventional cigarette. I became someone else,” he said.
Landucci said he was once more able to taste and smell and climb stairs without losing his breath.
But the flip side is that some smokers don’t quit the conventional cigarette, and the dual use might cause special harm.
Besides that, studies show that most e-cigarette consumers are not adults trying to quit smoking — they are teenagers and young adults. In the US, data from the Centers for Disease Control and Prevention shows that 11% of high school students smoked e-cigarettes in 2021, versus 4% of adults in 2020. In Canada, 15% of people older than 15 tried a vaping product in 2017, versus 34% of students from grades 7 to 12.
In Brazil, a national survey showed that 70% of the users of the electronic devices are between 15 and 24 years old, and most of them have never used conventional cigarettes before.
Raquel De Bonis is a 13-year-old from São Paulo and doesn’t smoke. But she said that in her classroom of 30 students, she knows at least a handful who are using e-cigarettes. Her social media, and especially her TikTok, she said, is flooded with influencers and teenagers smoking electronic devices.
“I’ve seen several videos with people playing with smoke or showing vapes,” Raquel said.
She even decided to make a promise with her best friend — they won’t let the other one smoke.
Monica Andreis, the executive director from ACT Promoção da Saúde, a nongovernmental organization that focuses on tobacco control policies, is against the legalization of e-cigarettes in Brazil.
“Considering that these products are attractive to youth and that we can’t affirm that they really work for tobacco cessation, we believe that we must prioritize the public policies to prevent smoke initiation and also to promote health for the Brazilian population.”
“Considering that these products are attractive to youth and that we can’t affirm that they really work for tobacco cessation, we believe that we must prioritize the public policies to prevent smoke initiation and also to promote health for the Brazilian population,” Andreis said.
In 2019, a study did show benefits of e-cigarettes for smoking cessation, but the participants were accompanied in a strict medical setting. And two recent studies (here and here) didn’t associate e-cigarettes with a higher chance of quitting tobacco products.
Andreis argued that Brazil already has a smoking cessation program with scientifically effective treatments. So, there wouldn’t be a need for devices that haven’t shown their potential yet.
“Brazil has a leadership role in Latin America and also around the world related to tobacco control policies. I believe that the decision from ANVISA has the potential to influence other countries in Latin America,” Andreis said.
The federal health agency said it preferred not to comment because it is still analyzing the data. In a statement published in February for the website G1, however, the agency said: “Up to this point, there are still uncertainties and controversies related to the risks attributed to these devices.”
Disclosure: Rachel De Bonis is the reporter's niece.