Electronic smoking device use in Brazil: nationally representative comparative analysis of adolescents and adults

Background Electronic Smoking Devices (ESDs) have emerged as a novel cardiovascular risk factor, particularly among young populations. Experimental and clinical studies suggest that ESD exposure may induce mechanisms directly implicated in atherosclerosis and premature vascular aging. In Brazil, despite a national ban, evidence suggests widespread accessibility among users. Robust data from middle-income countries, especially focusing on adolescents, remain scarce. Objective To evaluate national prevalence and patterns of ESD use in the Brazilian population aged ≥14 years, with emphasis on adolescents (14–17 years). Methods This study analyzed secondary data from the Third National Survey on Alcohol and Drug Use (LENAD III), a nationally representative survey conducted between 2022 and 2024 using complex probabilistic sampling (n=16,608). Standardized face-to-face household interviews and confidential self-administered questionnaires assessed electronic smoking device (ESD) use. Weighted prevalence estimates and 95% confidence intervals (CIs) were calculated accounting for the complex survey design. In addition to descriptive analyses of the LENAD, we conducted comparative analyses between adolescents and adults, estimating prevalence ratios (PRs) and risk ratios (RRs) with corresponding 95% CIs to assess differences in ESD use and associated variables between age groups. Results Lifetime use of ESDs was reported by 8.8% (95% CI: 7.8–9.9) of the general population. Past-year prevalence was 5.6% (95% CI: 4.9–6.5), and past-month prevalence was 2.2% (95% CI: 1.8–2.8), with daily use reported by 6.9% of users. Among adolescents aged 14–17 years, lifetime prevalence reached 11.4% (95% CI: 10.0–13.0), significantly higher than that observed in adults (PR 1.33; 95% CI: 1.19–1.49; p<0.001). Current use was also more frequent among adolescents (PR 1.61; 95% CI: 1.41–1.84; p<0.001). In this group, frequent use was reported by 6.9% (4.7% almost always and 2.2% always), and 28.6% reported concomitant use with cannabis, alcohol, or other psychoactive substances. While 14.1% of adolescents had never heard of ESDs, 71.6% perceived access as easy or very easy (53.3% easy and 18.3% very easy). Among adolescent non-users, 8.9% expressed potential intention to use (7.4% unsure, 1.4% probably will use, and 0.1% definitely will use), significantly higher than that observed in other age groups (PR 2.14; 95% CI: 1.51–3.04; p<0.001). Conversion from experimentation to current use reached 76.3%. Conclusion Despite a nationwide ban, ESD use is highly prevalent among Brazilian adolescents, characterized by easy access, frequent use, concomitant consumption of other psychoactive substances, and a high progression rate to current use. Early exposure may increase cardiovascular risk. These findings reinforce the need for targeted preventive strategies focused on young populations within the context of cardiovascular health and ESD use.Use, access and transition to regular use.Comparative ESD behavior.