Electronic cigarettes: isolated and combined use among Brazilian adolescents in PeNSE 2019

Corrêa, Paulo César Rodrigues Pinto; Souza, Juliana Bottoni de; Malta, Déborah Carvalho

doi:10.1590/1980-549720260024

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Original Article • Rev. bras. Epidemiol. 29 • 2026 • https://doi.org/10.1590/1980-549720260024 linkcopy

Electronic cigarettes: isolated and combined use among Brazilian adolescents in PeNSE 2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To analyze the prevalence and factors associated with e-cigarette (EC) use among adolescents aged 13-17 in Brazil, and to describe the pattern of polytobacco/nicotine product use.

Methods: This is a cross-sectional study using data from 159,245 students from the 2019 National School Health Survey (PeNSE). The prevalence of EC use and combined use with other products (conventional cigarettes, hookah, and others) was estimated. The association with sociodemographic variables, mental health, and other substance use was analyzed through multivariate logistic regression, calculating adjusted Odds Ratios (aOR) and their 95% confidence intervals (95% CI).

Results: The prevalence of EC use in the last 30 days was 2.82% (95%CI 2.62–3.04). Polytobacco use was significant, with dual use (EC + conventional cigarette) found in 8.56%. The combined use of all smoked products was 14.83%, and quadruple use (EC + conventional + hookah + straw) reached 14.04%. After adjustment, the factors associated with higher odds of EC use were: alcohol consumption (aOR=3.94), having friends who smoke in their presence (aOR=2.53), regular tobacco use (aOR=2.22), other drug use (aOR=2.04), feeling lonely (aOR=1.25), feeling sad (aOR=1.24), and having parents who smoke (aOR=1.17).

Conclusions: E-cigarette use among Brazilian adolescents is associated with mental health factors, social influences, and the concomitant use of alcohol and other drugs. The polytobacco use is a worrying reality among these adolescents. The findings highlight the need for public policies that articulate tobacco control with mental health initiatives and strategies for preventing alcohol/other drug use.

Keywords:
Adolescent; Tobacco use disorder; Nicotiana; Electronic nicotine delivery systems

Characteristic		%			Bivariate model
			95%CI		OR	95%CI		p-value
			Lower	Upper	OR	Lower	Upper	p-value
Total		2.82	2.62	3.04
Age (years)
	13 to 15	2.32	2.09	2.58	1.00
	16 and 17	3.74	3.34	4.18	1.63	1.39	1.91	0.00
Gender
	Male	3.33	3.03	3.66	1.00
	Female	2.33	2.09	2.59	0.69	0.60	0.79	0.00
Race/ethnicity
	White	3.34	3.00	3.72	1.00
	Black	2.79	2.33	3.35	0.83	0.66	1.04	0.11
	Yellow	3.10	2.19	4.37	0.93	0.64	1.35	0.69
	Brown	2.40	2.14	2.69	0.71	0.62	0.82	0.00
	Indigenous	2.44	1.71	3.49	0.73	0.49	1.07	0.10
Lives with mother and/or father
	No	3.29	2.60	4.16	1.00
	Yes	2.78	2.58	2.99	0.84	0.66	1.06	0.14
Parental supervision
	No	4.03	3.60	4.51	1.00
	Yes	2.31	2.11	2.53	0.56	0.49	0.65	0.00
Missed classes without authorization
	No	2.33	2.13	2.55
	Yes	4.83	4.32	5.39	2.12	1.86	2.42	0.00
Feels lonely
	No	2.07	1.81	2.36	1.00
	Yes	3.45	3.18	3.74	1.69	1.46	1.96	0.00
Sadness
	No	2.09	1.81	2.42
	Yes	3.20	2.95	3.47	1.55	1.31	1.82	0.00
Friends
	1 or more	2.81	2.60	3.03	1.00
	None	2.93	2.09	4.09	1.05	0.75	1.47	0.80
Regular tobacco use
	No	1.89	1.74	2.06
	Yes	15.68	14.30	17.16	9.65	8.53	10.92	0.00
Alcohol consumption
	No	0.96	0.84	1.11	1.00
	Yes	7.53	6.95	8.15	8.37	7.16	9.79	0.00
Regular drug use
	No	2.04	1.87	2.22	1.00
	Yes	17.08	15.26	19.06	9.90	8.54	11.48	0.00
Friends smoked in your presence
	No	1.12	0.98	1.28	1.00
	Yes	6.95	6.44	7.50	6.61	5.70	7.66	0.00
People smoked in your presence
	No	2.35	2.14	2.59	1.00
	Yes	4.06	3.60	4.58	1.76	1.50	2.06	0.00
Parents or guardians who smoke
	No	2.42	2.21	2.66	1.00
	Yes	4.08	3.65	4.56	1.71	1.49	1.98	0.00

Characteristic		Fina Multivariate Model
		OR*	95%CI		p-value
		OR*	Lower	Upper	p-value
Gender
	Male	1.00
	Female	0.59	0.52	0.68	0.00
Feels lonely
	No	1.00
	Yes	1.25	1.05	1.49	0.01
Sadness
	No	1.00
	Yes	1.24	1.04	1.48	0.02
Regular tobacco use
	No	1.00
	Yes	2.21	1.87	2.63	0.00
Alcohol consumption
	No	1.00
	Yes	3.94	3.29	4.73	0.00
Regular drug use
	No	1.00
	Yes	2.04	1.67	2.50	0.00
Friends smoked in your presence
	No	1.00
	Yes	2.53	2.09	3.07	0.00
Parents or guardians who smoke
	No	1.00
	Yes	1.17	1.01	1.36	0.04

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