Two decades of temporal trends in cigarette smoking and electronic smoking device use in brazil.

Background Tobacco use remains a leading modifiable risk factor for cardiovascular disease (CVD) and premature mortality. Although Brazil has achieved substantial reductions in cigarette smoking over the past two decades, recent changes in nicotine consumption patterns — particularly the emergence of electronic smoking devices (ESD) — warrant continued surveillance. Evaluating temporal trends by sex and age group is essential to identify demographic shifts with potential implications for future CVD burden. Purpose To evaluate temporal trends in cigarette smoking and electronic smoking device use among Brazilian adults from 2006 to 2024, stratified by sex and age group. Methods Data were obtained from Vigitel (2006–2024), an annual telephone survey representative of adults ≥18 years (n=833,217) residing in the 26 Brazilian state capitals and the Federal District. Current smoking was defined as self-reported cigarette use at the time of the interview. Electronic smoking device (ESD) use (daily or occasional) and experimentation were assessed from 2019 onward. Annual prevalence and average annual variation estimates were obtained from official Vigitel reports, and trends were assessed using 95% confidence intervals. Analyses were stratified by sex and age group (18–24, 25–34, 35–44, 45–54, 55–64, ≥65 years). Results From 2006 to 2024, the prevalence of current cigarette smoking declined from 15.7% to 11.5%, reflecting a sustained long-term reduction. However, trend analyses indicated stabilization during the 2019–2024 period. In 2024, smoking prevalence remained higher among men than women (13.9% vs. 9.5%), although the absolute sex gap narrowed compared to 2006 (19.5% vs. 12.4%). Smoking was consistently more prevalent among adults aged 35–54 years than among those aged ≥65 years. Between 2019 and 2024, overall adult ESD use remained statistically stable. However, age-stratified analyses identified statistically significant annual increases in ESD use among adults aged 35–54 years. For ESD experimentation, significant increases were observed among adults aged 25–34 years. In 2024, the highest prevalence of ESD use was observed among adults aged 18–24 years (10.1%), and 24.8% in this age group reported prior experimentation. Conclusion Brazil faces a dual challenge: the plateauing of cigarette smoking decline and age-specific increases in electronic smoking device use and experimentation. These evolving nicotine exposure patterns may influence future cardiovascular risk and highlight the importance of continued surveillance and targeted prevention strategiesShifting nicotine consumption in Brazil.